Bullying Can Hurt Much More Than Children’s Feelings

Chalanda Jones, MD

Bullying, especially cyberbullying, is an important risk factor for suicidal ideation and suicide attempts in children and adolescents.

Bullying, particularly among school-aged children, has been cited as a major public health problem.1 Its prevalence in society in undeniable, with the media inundated with stories about bullying among peers as a source of violence, low self-esteem, and poor social situations. Worldwide, between 5% and 20% of children are estimated to be targets of bullying.2 

Bullying has been associated with suicidal ideation and suicide attempts in children. In the United States, approximately 20% of adolescents seriously consider suicide, with between 5% and 8% attempting it in a given year.

In a recent meta-analysis published in JAMA Pediatrics, van Geel and colleagues examined the relationship between peer victimization and suicide in children and adolescents.2 They reviewed 43 studies spanning more than 100 years of publications: 34 of them, with a total of 284,375 participants, focused on the relationship between suicidal ideation and bullying victimization; 9 other studies, with a total of 70,102 participants, focused on the relationship between suicide attempts and bullying victimization. Participants in the 43 studies ranged in age from 9 to 21 years. All but 4 of the studies relied strictly on children’s self-reports of bullying.

The researchers examined whether the effects of bullying on suicidal ideation are more severe in girls than in boys, and whether young children suffer more from bullying than do older children. They also analyzed the comparative effects of cyberbullying and traditional bullying on suicidal ideation.

The analysis demonstrated a significant relationship between peer victimization and suicidal ideation. A significant relationship also was found between peer victimization and suicide attempts in children and adolescents. No significant differences in the effects of bullying were observed between boys and girls or between older and younger children. Likewise, peer victimization and suicidal ideation were positively related whether or not the victims once were bullies themselves.

Cyberbullying was more strongly related to suicidal ideation than was traditional bullying, although the reasons for this relationship were not explored in the analysis. The authors hypothesized that because cyberbullying reaches a wider audience than physical bullying does, and because bullying material can be stored online, it results in young victims reliving their denigrating experiences more often.

The authors noted that their meta-analysis has limitations, including that it did not analyze the effects of various types of bullying individually (since most studies focused on combinations), and that its broad construct of suicidal ideation (wishing to commit suicide versus actually planning a suicidal action) made it impossible for them to determine the severity of children’s suicidal ideation.

Despite these limiting factors, the analysis highlights an important health risk among children and adolescents: Bullying, particularly cyberbullying, is an important area on which to focus as we discuss life and life stressors with our young patients. Because even the youngest of school-aged patients can be victims of bullying, it is an important topic to discuss as a part of the American Academy of Pediatrics’ Medical Home for Children and Adolescents Exposed to Violence project.3 n

Chalanda Jones, MD, is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Charles A. Pohl, MD—Series Editor, is professor of pediatrics and senior associate dean of student affairs and career counseling at Jefferson College in Philadelphia, Pennsylvania.


1. Measuring bullying victimization, perpetration, and bystander experiences: a compendium of assessment tools. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/violenceprevention/pub/measuring_bullying.html. Updated January 13, 2014. Accessed April 7, 2014.

2. van Geel M, Vedder P, Tanilon J. Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis [published online ahead of print March 10, 2014]. JAMA Pediatr. doi:10.1001/jamapediatrics.2013.4143.

3. Bullying and cyberbullying. Medical Home for Children and Adolescents Exposed to Violence. American Academy of Pediatrics Web site. http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Medical-Home-for-Children-and-Adolescents-Exposed-to-Violence/Pages/Bullying-and-Cyberbullying.aspx. Accessed April 7, 2014.