Interventions on bullying and cyberbullying in schools: a systematic review

Nursing faculty members' response to bullying in the eyes of their students: A pilot study in Pangasinan

BACKGROUND

Bullying is a pervasive issue that can occur in any setting, including among nursing students and within the nursing profession. Faculty members have a vital role in resolving bullying.

OBJECTIVES

To examine the nursing faculty members' responses to incidents of bullying within two nursing institutions in Pangasinan.

DESIGN

Descriptive- comparative design.

SETTINGS

Two Colleges of Nursing in a city in Pangasinan, Philippines.

PARTICIPANTS

Nursing students from first to fourth year BS Nursing students.

METHODS

An online survey was the main tool in this study, Lynch formula was utilized to calculate the sample size. There are 458 nursing students who participated in this study. Frequency, percentage, mean, standard deviation, one-way ANOVA, and t-test were used to analyze the data.

RESULTS

It was revealed that faculty members sometimes address bullying by group discussion (M = 3.26, SD = 1.27), and they almost never utilized non-intervention in bullying (M = 2.33, SD = 0.85). There is a variation in terms of group discussion with a one-way ANOVA score of F (2, 455) = 3.22, p = 0.04, when faculty members are grouped according to their degrees. Regarding the difference between the faculty members' responses to bullying when grouped according to gender, there is a significant difference between male and female for mediation (t(457) = 2.10, p = 0.04), group discussion (t(457) = 2.79, p = 0.01), victim support (t(457) = 2.54, p = 0.01), and disciplinary methods (t(457) = 2.66, p = 0.01).

CONCLUSION

The study emphasizes the complex nature of tackling bullying among nursing students. It highlights the efficacy of several solutions used by faculty members, such as group discussions, mediation, victim assistance, and disciplinary measures. The findings indicate that a comprehensive understanding of the dynamics involved in addressing bullying is necessary. This understanding highlights the significance of a cooperative and compassionate strategy that includes all individuals involved in the educational setting. It is clear that a standardized approach may not be enough, and customized techniques that take into account the particular circumstances and requirements of the persons involved are essential.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Peer Victimization and Adolescent Mental Health: School-level Victimization as a Moderator

As a global issue, peer victimization is closely associated with adolescent mental health. Although previous research has explored the relationship between peer victimization and mental health in some contexts, the school context, particularly within the Chinese cultural context, has not received sufficient attention. Based on the Healthy Context Paradox, this study aimed to explore the moderating role of school-level victimization in the relationship between individual-level peer victimization and mental health. This study tested two hypotheses by using a multilevel design: higher individual-level and school-level peer victimization are associated with higher depressive symptoms and lower life satisfaction (Hypothesis 1); school-level victimization moderates the association between individual-level peer victimization and mental health (Hypothesis 2). Participants were 39,720 adolescents (50.41% females; Mage = 13.68, SD = 2.39) across 292 Chinese schools. They completed a set of questionnaires, including the Center for Epidemiologic Studies Depression Scale, the single-item Life Satisfaction Questionnaire, the Peer Victimization Scale, and demographics. The multilevel model indicated that both individual-level and school-level peer victimization were positively correlated with depressive symptoms and negatively correlated with life satisfaction. In schools with lower levels of victimization, there was a stronger association between individual peer victimization and adolescent mental health. A potential explanation for these results might be the victimization visibility and perceived severity in different contexts. These findings extended the discussion of the Healthy Context Paradox within the Chinese school context and provided valuable insights for developing school support strategies for victimized adolescents. School management might play a significant role in affecting the mental health of victimized adolescents.

Left-Behind Experiences and Cyberbullying Behavior in Chinese College Students: The Mediation of Sense of Security and the Moderation of Gender

Left-behind children seem to be more sensitive in interpersonal communication, find it more difficult to establish a stable, safe relationship with surrounding people, and have fewer positive coping styles when encountering problems, thus the aim of the present study was to explore the association between left-behind experiences and cyberbullying behavior among Chinese college students through the mediation of sense of security and the moderation of gender. A questionnaire survey comprised 553 college students with left-behind experiences and 526 college students without such experiences. The results showed that, firstly, cyberbullying behavior was significantly higher in college students with left-behind experiences than those without such experiences; secondly, left-behind experiences and cyberbullying behavior in college students was partially mediated by a sense of security; and finally, that gender moderated the mediation of the sense of security between left-behind experiences and cyberbullying behavior. This study suggests the family environment is important for individual growth and illustrates how the influence of childhood left-behind experience persists in individuals.

Effectiveness of Parent-Related Interventions on Cyberbullying Among Adolescents: A Systematic Review and Meta-Analysis

Given the high prevalence of cyberbullying and its negative physical and psychological effects on the development of adolescents, numerous studies have attempted its reduction by developing anti-cyberbullying interventions. In the present study, we investigated the effectiveness of parent-related programs in reducing the frequency of cyberbullying perpetration and victimization among adolescents. A thorough search was carried out on seven electronic databases: EBSCO, ERIC, PubMed, PsycINFO, Scopus, Web of Science, and ProQuest Dissertations and Theses. Only quantitative studies that reported the effectiveness of parent-related programs in reducing the frequency of cyberbullying perpetration or victimization were included in the review. Eleven studies were finalized, and meta-analyses were performed using a random effect model on RevMan v5.4 software developed by Cochrane. Findings reveal that existing parent-related programs have very small effect sizes on cyberbullying perpetration (standardized mean differences [SMDs] = -0.17, 95% confidence interval [CI] [-0.26, -0.09]) and victimization (SMD = -0.17, 95% CI [-0.24, -0.10]). The modes of parental involvement and intervention do not moderate the program effectiveness, but those with shorter durations are more effective than longer ones in reducing the frequency of cyberbullying victimization. Furthermore, findings indicate that interventions with a theoretical foundation are more effective than those without one. This review provides evidence to improve anti-cyberbullying interventions by effectively enabling parent involvement, as well as increasing parenting skills, parent-child interactions, and communication. Given the limited effectiveness of parent-related interventions, future research is needed to identify key moderators to improve such programs or to develop school-family patterns to reduce cyberbullying.

Influence of cyber-victimization and other factors on depression and anxiety among university students in Bangladesh

BACKGROUND AND OBJECTIVES

Cyber-victimization is closely linked with mental health problems such as anxiety, depression, etc., and has become a growing concern among university students in Bangladesh. In the era of globalization, smart gadgets, the internet, and other online resources are readily available, and these tools and devices have now become the primary method for cyberbullying. The authors aim to explore the impacts of cyber-victimization and other factors on anxiety and depression among university students in Bangladesh.

METHODS

The primary data for this cross-sectional study were collected using a well-structured questionnaire. This study employs three widely used scales such as cyberbullying inventory, general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). Descriptive statistics and multivariable logistic regression analyses are carried out to identify the factors associated with depression and anxiety among university students in Bangladesh.

RESULTS

Findings depict that the prevalence of depression and anxiety among university students was 52.5% and 44.0%, respectively. Depressed respondents were considerably more likely to have difficulty sleeping (p < 0.001), spend more time on social media (p = 0.002), have suicidal thoughts (p < 0.001), and have a high cyber-victimization score (p < 0.001) compared to non-depressed respondents. In comparison with non-anxious respondents, anxious respondents were significantly more likely to: have sleeping difficulties (p < 0.001); spend more time on social media (p = 0.031); have suicidal thinking (p < 0.001); and have a comparatively high cyber-victimization score (p < 0.001). Multivariable logistic regression analysis identified that a one-unit increase in the cyber-victimization score results in a 1.24 times higher chance of experiencing depression (AOR: 1.24, 95% CI 1.17-1.31, p < 0.001), and a one-unit increase in the cyber-victimization score results in a 1.23 times higher chance of experiencing anxiety (AOR: 1.23, 95% CI 1.17-1.30, p < 0.001).

CONCLUSION

University students are struggling with cyberbullying, which can lead to depression and anxiety levels. Promoting more cyberbullying awareness is necessary since failing to do so could result in a sustained or increased prevalence of anxiety and depression levels among students, which could have disastrous repercussions.

Characteristics and effectiveness of interventions to reduce cyberbullying: a systematic review

Background

This paper presents the results from a systematic review on the effectiveness of interventions to reduce Cyberbullying (CB) as a function of their outcomes and main characteristics; and an analysis of the level of completeness to which the characteristics of these interventions are described.

Methods

Systematic searches were conducted in PubMed, Scopus, ERIC and Psycinfo databases on February 14, 2022. In addition, relevant publications were hand searched for relevant studies. We considered interventions that provided data on CB prevalence changes in populations between primary school and college age.

Results

In total, 111 studies were retained for further screening from 3,477 results. Following rigorous screening, 43 reports including 46 studies and information from 36 different interventions were included in our systematic review. Results shows that most of the interventions measuring reductions in global CB, cyberperpetration/victimization, cybervictimization and cyberperpetration were effective or partially effective. While the interventions measuring reductions in cyber-bystanding were not effective. Multicomponent interventions showed higher effectiveness than single-component interventions. After completion of the TIDieR check-list, included interventions were considered to offer an insufficient level of detail for a number of the analyzed items in relation to "how well planned," "intervention modifications" and "tailoring."

Conclusion

Given the aforementioned, it is critical to increase the number of studies and the quality of interventions targeting CB and the level of detail of its description in order to obtain more robust outcomes about how to reduce its prevalence and facilitate the replication of the effective interventions.

Systematic review registration

https://archive.org/details/osf-registrations-wn5u4-v1, Identifer DOI: 10.17605/OSF.IO/WN5U4.

Effectiveness of Digital Health Interventions in Reducing Bullying and Cyberbullying: A Meta-Analysis

Bullying and cyberbullying bring adverse physical and psychological impacts on individuals and an economic burden for society. Scholars have developed anti-bullying intervention programs to combat these problems. This meta-analysis aims to examine and compare the effectiveness of digital health interventions (DHIs) in reducing bullying and cyberbullying. A comprehensive search was conducted using databases (PsycINFO, Social Service Abstracts, Sociological Abstracts, MEDLINE, ERIC, and EMBASE). Quasi-experimental and randomized controlled trials (RCTs) published before 31 January 2021 that reported the effects of DHIs in reducing bullying or cyberbullying were included. The 16 studies included in the synthesis reported overall random effect sizes (Cohen's d) for bullying and cyberbullying reduction were 0.41 and 0.19, respectively. The results provide evidence on the effectiveness of DHIs, comparable to that of face-to-face interventions. The subgroup analysis revealed that the critical components of effective DHIs include training on bystander and bully-victim dual roles, coping skills, and interactive serious games. It highlights the promising effects of digital health approaches in bullying and cyberbullying interventions. Our review identifies avenues for future research on the development of more effective DHIs to reduce bullying and cyberbullying.

The Long-Term Efficacy and Sustainability of the Tabby Improved Prevention and Intervention Program in Reducing Cyberbullying and Cybervictimization

Although cyberbullying and cybervictimization prevention programs have proved effective in the short term, their effectiveness remains unclear in the long run. Thus, the present study evaluated the long-term effects of the Tabby Improved Prevention and Intervention Program (TIPIP). Participants were 475 middle and high school students (Mage = 12.38; SD = 1.45; F = 241, 51%), of whom, 167 were in the Experimental Group (EG; Mage = 13.15; SD = 1.52; M = 51.5%), and 308 were in the Control Group (CG; Mage = 13.47; SD = 1.35; M = 47.7%). Students completed measures assessing cyberbullying and cybervictimization at three time points: baseline (T1), immediately after the intervention (6 months, T2), and at 1 year (T3). The results showed no significant effects of the TIPIP in reducing both cyberbullying and cybervictimization over time. Overall, our results confirm the lack of effectiveness of long-term preventive programs and emphasize that different curricula should be implemented in future programs to prevent and manage cyberbullying and cybervictimization, also taking into account psychological mechanisms and processes involved in such behaviors.

Effects of interpretation bias modification on hostile attribution bias and reactive cyber-aggression in Chinese adolescents: a randomized controlled trial

Highly aggressive individuals tend to interpret others' motives and intentions as hostile in both offline and online social situations. The current study examined whether hostile interpretation bias can be modified to influence cyber-aggression in Chinese middle school students using an interpretation bias modification program. Gender differences and the heterogeneity of cyber-aggression were also investigated since previous studies suggest that they play important roles in determining the intervention effect. One hundred and twenty-one middle school students were randomized to receive either an eight-session interpretation bias modification task (CBM-I; n = 61) or an eight-session placebo control task (PCT; n = 60) over four weeks. Measures of hostile attribution bias and cyber-aggression were administered at baseline, post-training, and at one week follow-up. Results showed that compared to PCT, participants in CBM-I showed a significant reduction in reactive cyber-aggression. However, contrary to our expectation, there was no significant difference between the two groups in the reduction of hostile attribution bias after training. The moderated mediation analysis revealed that the effect of CBM-I on hostile attribution bias and the mediating role of hostile attribution bias in the relationship between CBM-I condition and reactive cyber-aggression was only observed among females, but not among males. These findings provide initial evidence for the potential of CBM-I in reducing hostile attribution bias and cyber-aggression. However, for male students, CBM-I might not be effective enough as expected.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04433-3.

Middle School Students' Experiences with Cyberbullying and Perspectives Toward Prevention and Bystander Intervention in Schools

Cyberbullying is a growing problem for middle school students. Bystander interventions that train witnesses to positively intervene can prevent cyberbullying. Through six focus groups, we explored forty-six middle school students' experiences with cyberbullying and opportunities for school-based prevention programs to encourage positive bystander behavior. Focus groups were recorded, transcribed, and analyzed using content analysis. Students viewed cyberbullying as an important problem with significant consequences. They noted hesitancy in reporting to parents and school personnel and felt more comfortable discussing cyberbullying with a near-peer (e.g., older sibling or friend). Students desired combining school-based and online programming with near-peer mentorship. This study suggests need for targeted prevention programs that center middle school students' lived experiences with cyberbullying and their preferences for learning and utilizing positive bystander strategies.

Sadness, hopelessness and suicide attempts in bullying: Data from the 2018 Iowa youth survey

BACKGROUND

Bullying in schools is a common problem that can have significant consequences on the mental health of both bullies and victims of bullying. Some estimates suggest that 30% of American youth are bullied. Self-reported incidence of depression, anxiety, and suicide attempts has been correlated with bullying. Victims may also suffer from a variety of somatic complaints such as headache, sleep disorders, and others. Youth surveys undertaken by Education or Public Health Departments in most US states are an underutilized resource in evaluating the problem and any consequences.

OBJECTIVE

The objective of this study was to explore the association of being involved in bullying either as a victim and/or a bully on mental health and suicide ideation by analyzing data from the 2018 Iowa Youth Survey. The results will then be applied to the published anti-bullying literature to make suggestions for how anti-bullying programs may be designed.

METHODS

Data were obtained from the 2018 Iowa Youth Survey (IYS), which is a cross-sectional survey of 6th, 8th and 11th grade students. We chose two mental health questions as dependent variables and used a multivariable logistic regression analysis to evaluate the correlation between the two dependent variables and ten types of bullying included in the IYS. Since some respondents in the IYS were prescribed psychotropic medications to help with feeling angry, anxious, nervous, or sad, we adjusted for the use of psychotropic medication in our analysis. Similarly, the literature suggests that some students are both bullies and victims (bully-victims). Accordingly, we also adjusted for bully-victims.

RESULTS

Unadjusted Odds Ratios (ORs) showed that not all forms of bullying were correlated with a significant risk of mental distress. Physical bullying had comparatively little association (ORs < 1 or overlapped 1), while identity bullying on sexual orientation or gender identity or sexual joking was consistently correlated with significant ORs for feeling sad or hopeless and attempting suicide (ORs 1.40-2.84). Cyberbullying (ORs 1.32-1.70) and social bullying (ORs < 1-2.21) were correlated with mental distress with ORs generally between physical and identity bullying. When adjusting for medication use or bully-victim status, adjusted ORs (aORs) were generally lower than unadjusted ORs.

CONCLUSIONS

Not all types of bullying were significantly correlated with feeling sad or hopeless or attempting suicide. Being able to evaluate the specific associations of different types of bullying may have implications for teachers or policy makers hoping to implement bullying mitigation strategies in their schools.

"If it's really excessive, it can enter your heart": A Mixed Methods Investigation of Bullying Among Early Adolescents in Semarang, Indonesia

Bullying is a major public health concern for Indonesian adolescents, with well-documented links to a range of emotional and behavioral problems. Despite such evidence, few investigations have employed qualitative methods to illuminate youth's own perceptions of bullying and its psychosocial correlates in this context. The current study aimed to address this gap through an exploration of Indonesian adolescents' motivations, perceptions, and beliefs regarding bullying. Building on prior quantitative findings, an explanatory sequential mixed methods approach was used to better understand the myriad ways in which bullying ties into other psychosocial challenges. Qualitative interviews were conducted with a total of 45 adolescents ages 13 to 14 (25 girls and 20 boys) in two junior high schools in Semarang between October and December 2019. Interviews were audio-recorded, transcribed verbatim, and translated into English for analysis. Qualitative data were then coded using an inductive thematic analysis approach. Interviews yielded contextual insights into adolescents' definitions of bullying including the distinction between "normal" and "serious" bullying; related risk behaviors; key drivers; social and emotional consequences; and coping strategies. Across these thematic categories, a number of noteworthy gender differences emerged, highlighting the role that underlying gender norms can play in driving bullying involvement. Further, findings emphasize the need to develop a locally valid definition of bullying which takes into account the ways in which emotional distress may be both a criterion and a consequence of bullying. Findings can be used to inform bullying prevention programs targeting Indonesian youth.

Nursing Intervention for Preventing Cyberbullying and Reducing Its Negative Impact on Students: A Scoping Review

Cyberbullying Prevalence of cyberbullying has increased every year on students as the most internet users. The negative impact of cyberbullying are anxiety, depression, and risk of suicide. Nurses have role to reduce the negative impact of cyberbullying on students. The aim of the study to describe the method of nursing interventions to prevent and reduce the negative impact of cyberbullying on students. This study used Scoping Review method. Articles from CINAHL, PubMed, and ProQuest databases. The keywords used in English are cyberbullying OR cyber-victimizations, nursing intervention, and students. The inclusion criteria were full text, randomized control trial or quasi-experimental design, sample was students, and articles publication period last 10 years (2013-2022). Based on the initial research, 11 articles were found that were relevant with the research objectives from 678 studies. The range of samples is 35-2771 respondents from elementary school to college students. Most of the samples in this study are from developed countries, there are USA, Spain, and Italy. There are three methods of nursing interventions, namely online programs, school-based programs and Social Competence Programs. Nursing interventions are focused on increasing resilience to build students' awareness of cyberbullying, and increasing resilience and adaptive coping in reducing the negative effects of cyberbullying. Then, the school-based program method is the most effective method in preventing and reducing the negative effects of cyberbullying because it comprehensively involves teachers, students, nurses, and parents to collaborate in carrying out nursing interventions.

Variation in the prevalence of different forms of bullying victimisation among adolescents and their associations with family, peer and school connectedness: a population-based study in 40 lower and middle income to high-income countries (LMIC-HICs)

This study aimed to estimate the prevalence of different forms of bullying victimization experiences and their association with family functioning, peer relationships and school connectedness among adolescents across 40 lower and middle income to high-income countries (LMIC-HICs). Data were drawn from the Health Behaviour in School-Aged Children (HBSC) school-based survey of adolescents aged 11-15 years, between 2013 and 2014. We estimated the weighted prevalence by categorising experiences into traditional bullying victimization only, cyberbullying victimization only, and combined traditional and cyberbullying victimization, at country and country income classification. We used multinominal logistic regression models to estimate the adjusted association with the form of bullying victimization by demographic characteristics, family functioning, peer relationships and school connectedness. Overall, 8.0% reported traditional bullying victimization only (8.8% males, 7.4% females), 2.3% of adolescents reported cyberbullying victimization only (2.1% males, 2.2% females), and 1.7% reported combined traditional and cyber bullying victimization (1.7% males, 1.8% females). All three forms of bullying victimization during adolescence were significantly associated with poor family functioning, poor peer relations and poor school connectedness. A consistent finding is that traditional bullying victimization is considerably more common among adolescents across both LMICs and HICs than cyberbullying victimization. This study also demonstrated that a significant proportion of adolescent's experience victimization in both forms. Positive family functioning, strong peer relationships and greater school connectedness are associated with a lower risk of both forms of bullying victimization.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-022-00451-8.

Efficacy of an anti-bullying video literacy program in Pakistani primary school children

With a scarcity of research looking at violent and extremist tendencies in primary school children in Pakistan, this study aimed to look at the effects of emotional resilience education through the means of cartoon-based learning. Children have a limited attention span and research on video/cartoon-based literacy projects has indicated greater efficacy with more retention and engagement. The cartoon based on the theme of anti-bullying was used in a 6-week intervention program in an experimental design setup with 120 experimental and 40 control group students recruited from the Islamabad/Rawalpindi area (ages 9-11). The behaviours and awareness about the concepts of physical and verbal bullying, coercion and damaging others' property, as well as qualitative information about the cartoon themes were assessed before and after the program for pre- and post-test comparison. The cartoon was accompanied with teaching aids, worksheets and activity-based learning. The results indicated that only 3.3% students were aware about bullying and its various types to begin with and after intervention 98.7% understood the concept clearly. Before the intervention, 65.8% students didn't understand that they were bullies - after the intervention it reduced to 22.5% who thought they were not bullies. Effectiveness of the results from this video literacy program will enable development of more emotional resilience education courses in the curriculum to create a more resilient society in the long run and curb bullying in schools.

The Effects of a Cyberbullying Intervention Programme Among Primary School Students

Background

With the increase of cyberbullying, several intervention programmes have been created that aim at reducing cyber-victimisation and perpetration.

Objective

Our study presents the effects of the STAnD anti-cyberbullying programme with peer-education both on the short and the long run among lower and upper primary school students, with a focus on the participants' cyberbullying roles.

Method

The sample comprised of 536 students who participated in the intervention programme, involving 36% lower and 64% upper primary school students. Participants were measured by a self-reported questionnaire before and right after the programme, then six months later.

Results

The main effect of the STAnD programme was a positive change in the participants' willingness to engage in help-seeking and their active-defending reaction, although this effect decreased after six months. The changes were larger among lower primary school students compared to upper primary school participants.

Conclusion

Our results imply that long-lasting and intensive health promotion programmes are necessary to reach a long-term intervention effect. Anti-cyberbullying programmes should take into consideration participants' involvement and roles in cyberbullying. As our study was a non-randomised uncontrolled study design, thus interpretation of the effectiveness of the programme is limited.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09714-9.

What Works to Address Violence Against Children (VAC) in and Around Schools

Violence against children (VAC) is a pervasive, global issue with both short- and long-term health, social, and economic consequences. This systematic review sought to identify best practices for designing and implementing social and behavior change communication (SBCC) programs targeting VAC in and around schools. Combinations of key search terms within five domains were entered into four databases: PubMed Central, Google Scholar, Sociological Abstracts, and EBSCOhost. Results were screened according to the inclusion and exclusion criteria. Namely, articles had to be published in English, be published after March 2014, focus on VAC in and around schools, focus on children, and use SBCC approaches. The searches produced 892,271 results. Of these, 63,183 were screened and 54 articles were selected. These articles were combined with 16 articles, gathered from a previous systematic review using the same databases and search domains conducted by the same research team, for a total of 70 articles. Articles were quantitatively analyzed using a coding guide in STATA and qualitatively analyzed using Nvivo. Results showed that most programs addressed bullying, were implemented in high-income countries, and included children aged 10 and older. Best practices in program design were using theory, conducting formative research, and involving program beneficiaries. Best practices in implementation were combining whole-school and targeted approaches, including special and hidden populations, involving secondary and tertiary audiences, using nonclassroom settings, using peer leader/mentor and cascade training models, and conducting process monitoring. Implications and avenues for future planning and implementation of SBCC interventions to address VAC in and around schools are discussed.

School-Based Diversity Education Activities and Bias-Based Bullying Among Secondary School Students

Bias-based bullying (e.g., bullying related to race, weight, sexual orientation) is a common experience among youth, yet few school-based prevention programs explicitly address this type of bullying. This study explores whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey (N = 216 schools) and the 2019 Minnesota Student Survey (N = 64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students, with attention to effect modification by relevant demographic characteristics. Students attending schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color (OR = 0.89, CI: 0.80, 1.00), about sexual orientation for gay, bisexual, and questioning boys (OR = 0.81, CI: 0.67, 0.97), and about disability for boys with a physical health problem (OR = 0.86, CI: 0.76, 0.99). Attending a school with more types of diversity education activities may protect vulnerable students against specific types of bias-based bullying and advance health equity. A diversity education is recommended as a key component of antibullying efforts and policy.

Analysis of Attempted Suicide in a Pediatric Setting: Extracted Notes for Clinical Practice and Complexity of Help

Background and Objectives: Suicidality among adolescents is a global mental health issue. However, the post-suicidal care of minors is insufficient and lacks complexity, as repeated attempts occur. Further, little is known about the social (i.e., family setting) and psychological (for example, exposure to bullying, suicidality, or addiction within a close environment) backgrounds of minors who engage in suicidal behavior in Lithuania. Thus, the aim of our study was to evaluate and compare psychosocial factors that may influence minors’ decisions to attempt suicide for the first time and then repeatedly and to extract notes for future clinical practice. Materials and Methods: Data from 187 cases of suicide attempts by minors treated at the Children’s Hospital of Vilnius University Santara Clinics from January 2011 to January 2018 was obtained and analyzed. Results: The data showed that 48.7% of minors hospitalized because of a suicide attempt had a history of previous suicide attempts. Minors who attempted suicide repeatedly were more often engaged in non-suicidal self-injurious behavior (p = 0.033). Further, a small number had experienced suicide within their close surroundings (p = 0.045). The comparative analysis did not reveal any significant differences in psychosocial backgrounds between first-time attempters and those who attempted suicide for at least a second time. Conclusions: Social and psychological support after a suicide attempt in a pediatric setting is lacking efficiency, as minors who repeatedly attempt suicide suffer from similar psychosocial burdens. Complex and targeted follow-up care is needed.

Delivery Strategies Supporting School-Age Child Health: A Systematic Review

CONTEXT

School-aged children (SAC; 5-9 years) remain understudied in global efforts to examine intervention effectiveness and scale up evidence-based interventions.

OBJECTIVE

This review summarizes the available evidence describing the effectiveness of key strategies to deliver school-age interventions.

DATA SOURCES

We searched Medline, PsycINFO, Campbell Collaboration, and The Cochrane Library during November 2020.

STUDY SELECTION

Systematic reviews and meta-analyses that: target SAC, examine effective delivery of well-established interventions, focus on low- and middle-income countries (LMICs), were published after 2010, and focus on generalizable, rather than special, populations.

DATA EXTRACTION

Two reviewers conducted title and abstract screening, full-text screening, data extraction, and quality assessments.

RESULTS

Sixty reviews met the selection criteria, with 35 containing evidence from LMICs. The outcomes assessed and the reported effectiveness of interventions varied within and across delivery strategies. Overall, community, school, and financial strategies improved several child health outcomes. The greatest evidence was found for the use of community-based interventions to improve infectious disease outcomes, such as malaria control and prevention. School-based interventions improved child development and infectious disease-related outcomes. Financial strategies improved school enrollment, food security, and dietary diversity.

LIMITATIONS

Relatively few LMIC studies examined facility, digital, and self-management strategies. Additionally, we found considerable heterogeneity within and across delivery strategies and review authors reported methodological limitations within the studies.

CONCLUSIONS

Despite limited research, available information suggests community-based strategies can be effective for the introduction of a range of interventions to support healthy growth and development in SAC. These also have the potential to reduce disparities and reach at-risk and marginalized populations.

Mental Health and Positive Development Prevention Interventions: Overview of Systematic Reviews

CONTEXT

Previous reviews of mental health interventions have focused on adolescents (10-19 years), with a paucity of comprehensive evidence syntheses on preventive interventions for school-aged children (5-10 years).

OBJECTIVE

To summarize and synthesize the available evidence from systematic reviews of mental health and positive development interventions for children aged 5-14.9 years in both high-income (HIC) and low- and middle-income countries (LMIC), with a focus on preventive and promotive strategies.

DATA SOURCES

This overview includes all relevant reviews from OVID Medline, The Cochrane Library, and Campbell Systematic Reviews through December 2020.

STUDY SELECTION

We included systematic reviews that synthesized empirical studies using experimental or quasi-experimental designs to evaluate the effectiveness of interventions in children aged 5-14.9 years.

DATA EXTRACTION

Data extraction and quality assessment were completed independently and in duplicate by two review authors. The AMSTAR2 tool was used to assess methodological quality.

RESULTS

We included 162 reviews. The greatest evidence was found in support of school-based universal and anti-bullying interventions in predominantly HIC. Moderate evidence was found for the use of substance abuse prevention, and early learning and positive development interventions in mixed settings. In LMIC-only contexts, the most promising evidence was found for positive youth development programs.

LIMITATIONS

The review was primarily limited by paucity of high-quality research due to methodological issues and high heterogeneity.

CONCLUSIONS

This overview of reviews highlights the need for further research to consolidate findings and understand the specific criteria involved in creating positive mental health and development outcomes from the various interventions considered.

Conceptual Application of Trauma-Focused Cognitive Behavioral Therapy to Treat Victims of Bullying

Bullying is a critical pediatric public health problem; estimates across diverse methodologies generally indicate that roughly 36% of youth are bullied. Although policy initiatives aim to address the universal prevention of bullying, and school-level secondary prevention programs aim to reduce the occurrence of bullying, tertiary prevention and intervention programs that mitigate the negative consequences experienced by victims of bullying remain an understudied need. The nature of bullying (that it occurs as events, leaves children feeling unsafe, and engenders emotional distress) and the association of bullying with posttraumatic stress symptoms among youth suggests that trauma treatment for bullying is promising. This manuscript presents the rationale for treating victims of bullying with trauma-focused cognitive behavioral therapy (TF-CBT), describes the components of TF-CBT, and discusses how to use TF-CBT specifically for bullying. Conducting research on treatment outcomes when using TF-CBT for bullying is critical to evaluate its efficacy and effectiveness in this group. Behavioral clinical trials would provide evidence for whether TF-CBT reduces the mental health harm experienced by youth victims of bullying. This evidence is an essential step to address the public health problem of bullying because the scientific literature currently does not have a well-established individual-level treatment for victims of bullying that mental health providers in diverse settings can deliver, despite individuals' beliefs that health care providers are important sources of help for youth who have been bullied.

Predicting the severity of peer victimization and bullying perpetration among youth with interpersonal problems: A 6-month prospective study

INTRODUCTION

Peer victimization is prevalent and associated with adverse outcomes. In this prospective study of youth who self-reported interpersonal problems, we examined school connectedness, school behavioral difficulties, academic difficulties, and internalizing problems (social anxiety, self-esteem, depression) as predictors of peer victimization and bullying perpetration severity. We also examined the moderating effects of gender.

METHODS

Participants were 218 youth (66.5% female), ages 12-15 years (M = 13.5, SD = 1.1), who screened positive for peer victimization, bullying perpetration, and/or low social connectedness using self-report measures. Youth were recruited from an emergency department in the United States as part of an intervention trial. Youth identified primarily as African American (53.7%) and Caucasian (31.7%). Youth completed a 6-month follow-up assessment (75% retention). Separate Bayesian regression models were used to examine the effects of baseline school connectedness, school behavioral difficulties, academic difficulties, and internalizing problems on the severity of 6-month peer victimization and bullying perpetration.

RESULTS

Baseline depression was positively related to both peer victimization and bullying perpetration severity. Baseline behavioral problems were positively related to bullying perpetration severity. Interactions indicated that gender moderated the relationship between school connectedness and peer victimization.

CONCLUSIONS

Given the adverse outcomes linked with peer victimization and bullying perpetration, an improved understanding of factors that predict victimization and perpetration severity may be helpful in defining intervention targets.

The Effectiveness of Educational Interventions on Traditional Bullying and Cyberbullying Among Adolescents: A Systematic Review and Meta-Analysis

In consideration of the adverse societal, physical, and psychological impacts of bullying on a child's development and future, many studies have developed anti-bullying programs and educational interventions to curb bullying occurrences. Therefore, this systematic review aimed to examine the effectiveness of such educational interventions at reducing the frequencies of traditional bullying or cyberbullying and cybervictimization among adolescents. A comprehensive search was conducted using PubMed, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and ProQuest Dissertations and Theses. Only quantitative studies that reported the effects of educational interventions on reducing the frequencies of traditional bullying or cyberbullying victimization and perpetration were included. Seventeen studies (N_total = 35,694 adolescents, Range_{child age} = 10-18 years) were finalized, and meta-analyses were conducted using a random effect model. Overall, the existing educational interventions had very small to small effect sizes on traditional bullying and cyberbullying perpetration (traditional: standardized mean differences [SMD] = -.30 and cyber: SMD = -.16) and victimization (traditional: SMD = -18 and cyber: SMD = -.13) among adolescents. Type of intervention (i.e., whole school-based or classroom-based), program duration, and presence of parental involvement did not moderate program effectiveness, but cyberbullying programs were more effective when delivered by technology-savvy content experts compared to teachers. Since existing educational interventions were marginally effective in reducing bullying frequencies, further research is needed to identify key moderators that enhance educational programs or develop alternative forms of anti-bullying interventions.

School Interventions for Bullying-Cyberbullying Prevention in Adolescents: Insights from the UPRIGHT and CREEP Projects

Background: Several challenges and emotional demands characterize adolescence, affecting the mental well-being of youths. Among these, bullying and cyberbullying are recognized nowadays as a major social problem, affecting more than one-third of adolescents, with extensive negative consequences for the victims involved, such as lower self-esteem, increased loneliness, depression, and anxiety. School programs and interventions that foster resilience, coping, and well-being are particularly important during adolescence as protective and preventive factors against the consequences of (cyber)bullying. The paper presents two recent co-designed interventions for (cyber)bullying prevention deployed in Europe, targeting early adolescents and their school communities. Methods: The UPRIGHT project developed an evidence-based, whole-school intervention to train resilience as a protective factor to promote mental well-being in adolescents, in a cross-national perspective. The CREEP project designed and implemented digital interventions to support schools in (i) early detection of cyberbullying events on social media and (ii) coaching adolescents (victims, bullies, bystanders) on how to cope with (cyber)bullying behaviors. Results: The main challenges and insights collected during the design and implementation of both interventions are discussed to inform future research and practice. Conclusion: The feasibility and acceptance of prevention programs are key to the reducing risk of (cyber)bullying and improving the psychological well-being of early adolescents.

The Dosage, Context, and Modality of Interventions to Prevent Cyberbullying Perpetration and Victimization: a Systematic Review

Past reviews of cyberbullying preventative interventions have critiqued the field regarding scientific rigor, and a meta-analysis found that randomized controlled trials (RCTs) of such interventions were more effective than non-RCTs. However, no review has examined the risk of bias, dosage, modality, and delivery context of such programs to date. The current study addresses this gap through a systematic review of the literature. Potential articles (N = 4,737) from 4 databases were identified and screened (Academic Search Premier including ERIC, PsychINFO, and the Psychology and Behavioral Collection; PubMed; Web of Science; Compendex); 72 articles were reviewed for eligibility. Final articles included (N = 30) were based on a rigorous search process guided by inclusion and exclusion criteria. The majority of studies were conducted in Europe; two were conducted in the USA, three in Australia, and two in the Middle East. Efforts to reduce risk of bias were evaluated using the Cochrane's Risk of Bias tool. Harvest plots were constructed to qualitatively illustrate the rigor, dosage, modality, and context of the interventions, and meta-analytic random effects models were conducted to examine effect sizes of the interventions on cyberbullying perpetration and victimization. Results suggest that cyberbullying interventions delivered through schools are effective, though expanded follow-up time is suggested, and additional evidence is needed for home settings and digital delivery.

Development and Validation of the Assessment of Bullying Experiences Questionnaire for Neurodivergent Youth

Bullying victimization is a prevalent concern for neurodivergent (e.g., autistic, ADHD) youth. Bullying assessment methods vary widely and there is currently no questionnaire specific to neurodivergent youth. The Assessment of Bullying Experiences (ABE) was created to fill this gap. The ABE questionnaire was completed by 335 parents of school-age youth characterized as autistic, having ADHD, or community comparison. Exploratory and Confirmatory Factor Analysis identified a four-factor solution, aligning with verbal, physical, relational, and cyber victimization. Construct validity analyses indicate the ABE converges with an existing bullying questionnaire and diverges from disruptive behavior or internalizing symptoms. The ABE questionnaire is a valid measure of bullying that furthers understanding of nuance in peer victimization for neurodivergent youth and informs group-specific intervention.

Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design

BACKGROUND

Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking.

OBJECTIVE

This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization.

METHODS

Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability.

RESULTS

A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3.

CONCLUSIONS

This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.

The Relation of Callous-Unemotional Traits and Bullying in Early Adolescence Is Independent from Sex and Age and Moderated by Conduct Problems

In youths, callous–unemotional (CU) traits and conduct problems (CP) are independently associated with bullying perpetration and these effects are also observed when controlling for sex. Moreover, research indicates that the co-existence of high levels of both CU and CP further increase the risk. Although several studies have examined the relationship between CU traits and traditional bullying, few have also included a measure of cyberbullying and very few of them have focused the early adolescence. The aim of this study was to replicate and extend these findings in a large sample of Italian early adolescents considering both traditional and cyberbullying behaviors. Data were extracted from the Bullying and Youth Mental Health Naples study (BYMHNS) which included 2959 students of 10–15 years of age. CP, CU traits, traditional bullying behaviors, and cyberbullying behaviors were assessed by multi-item self-report scales. As expected, we replicated the significant and specific association between CU traits and traditional bullying, extending the findings to cyberbullying. In addition, in the latter case the effect was moderated by CP. The theoretical and clinical implications of these results were discussed.

Bullying experiences, body esteem, body dissatisfaction, and the moderating role of weight status among adolescents

INTRODUCTION

The present study examined the relationships between bullying victimization experiences, body esteem (BE), and body dissatisfaction (BD) by obesity status.

METHODS

Using a cross-sectional design, adolescents (10-16y) from the U.S. completed surveys. Weight and height were objectively assessed. Bullying was assessed using the Personal Experiences Checklist, with a total score that included three subscales (cyber, verbal-relational, and physical). BE was assessed using total score on the BE Scale, and BD was assessed using the Body Image Assessment for Pre-Adolescents, operationalized as the discrepancy between current and ideal body figure. Linear regression models, controlling for sociodemographics, were used to examine obesity status (with vs. without obesity) and sex as moderators of the relationships between bullying, BE, and BD.

RESULTS

On average, adolescents (n = 328) were 12.6 ± 1.9 y, 45.4% male, 58.2% White, 35.7% Black, and 36.0% had obesity. Obesity status moderated the relationship between bullying experiences and BE, such that these relationships were only significant (B = -0.38, p<.05) among adolescents with obesity compared to adolescents without obesity. In both groups, greater verbal-relational bullying experiences were associated with lower BE, while greater physical bullying experiences were related to higher BE only among adolescents with obesity. In adolescent girls without obesity, greater cyberbullying experiences were associated with lower BD.

CONCLUSIONS

The findings suggest different associations between sub-types of bullying victimization experiences and BE and BD, highlighting the importance of examining these associations separately by obesity status.

Early childhood parenting and adolescent bullying behavior: Evidence from a randomized intervention at ten-year follow-up

RATIONALE

Bullying in education is a significant public health problem with long-run life cycle consequences, but efforts to reduce bullying were met with mixed results. We ask whether improving early childhood parenting can reduce subsequent bullying behavior by the children.

METHOD

We analyze ten-year follow-up of a randomized intervention where the parents of preschool children received a training aimed at improving parenting techniques, such as disciplinary strategies. 280 parents in 17 preschools were cluster-randomized at the preschool level (intervention group, cluster = 11, n = 186 vs. control group, cluster = 6, n = 94). Their children were followed ten years later, at ages between 12 and 16, with overall attrition rate of 12.5%. Ordinary least squares is used to estimate the intent-to-treat effects, controlling for the baseline characteristics of the child and the mother. Multiple imputation and inverse probability weighting are used to account for attrition and wild-cluster bootstrap test is used for statistical inference with few clusters. We estimate treatment-on-the-treated effects using two-stage least squares to account for noncompliance in the intervention group. Finally, we examine the associations between bullying and externalizing behavior.

RESULTS

Adolescent children are significantly less likely to bully their peers if their parents received the parenting training when their children were in preschools. The effects are stronger for boys and for aggressive forms of bullying such as 'beating' and 'threatening'. Treatment-on-the-treated effects are greater in magnitude and more significant than intent-to-treat effects, suggesting that the effects are driven by program participants. No effect is found for cyberbullying and for victimization. The results were robust to using multiple imputation and inverse probability weighting. We also find suggestive evidence that the effects on bullying are not explained by changes in externalizing behavior.

CONCLUSION

We show that improving early childhood parenting can have important public health benefits through reduction in adolescent bullying behavior.

Interventions that address institutional child maltreatment: An evidence and gap map

Background

Child maltreatment has serious short and long-term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment.

Objectives

The objectives of this EGM were twofold: (a) To provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of interventions addressing institutional child maltreatment-for those who work to fund, develop, implement and evaluate interventions aimed at ensuring children's safety in institutional settings; (b) to identify gaps in the available evidence on interventions addressing institutional child maltreatment-thereby helping to inform the research agendas of funders and other organisations.

Search Methods

A comprehensive search strategy identified relevant studies from published and grey literature, comprising: (1) 10 electronic academic databases; (2) five trial and systematic review registries; (3) nine organisational websites; (4) websites and reference lists of inquiry reports associated with seven international inquiries into child abuse and (4) the lists of included studies within systematic reviews identified by the search strategy. Members of this EGM's Subject Matter Experts group were also invited to forward relevant unpublished studies or grey literature.

Selection Criteria

The selection criteria were developed to identify finalised and ongoing overviews of reviews, systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment (including sexual abuse, physical abuse, neglect and emotional abuse) within institutional settings. Eligible effectiveness study designs included: randomised controlled trials (RCTs), nonrandomised trials, controlled before-and-after studies and quasi-experimental studies. Reviews were eligible if they reported a systematic literature search strategy.

Data Collection and Analysis

All screening, data extraction, coding and critical appraisals were undertaken by two or more reviewers working independently, with discrepancies resolved via consensus or by a third reviewer. The titles and abstracts of studies identified by the search strategy were screened, and each full text of potentially relevant studies was further assessed for inclusion. Key data were extracted from all included studies and reviews. This included information about: publication details (e.g., year, author, country), inclusion/exclusion criteria (for reviews), study design, institutional setting, target population, type of maltreatment, intervention type and outcomes. Critical appraisal of included systematic reviews was achieved using the AMSTAR 2 tool, and completed RCTs were assessed using the updated Cochrane Risk of Bias 2.0 tool.

Main Results

Number of studies The electronic database search yielded 6318 citations, and a further 2375 records were identified from additional sources. Following deduplication and title/abstract screening, 256 studies remained for full text review. A total of 73 eligible studies (reported across 84 publications) met the inclusion criteria, including: 11 systematic reviews (plus, one update); 62 primary studies (including, three protocols for primary studies). Study characteristics The studies were conducted across 18 countries, however more than half (52%) were undertaken in the United States. Overall, most studies evaluated curriculum-based interventions delivered in educational settings, primarily aimed at the prevention of sexual abuse. Institutional setting: Most studies evaluated interventions in school or early learning environments (n = 8 systematic reviews; n = 58 primary studies). Far fewer studies examined other organisational settings. Out of home care (including foster care, residential care and orphanages), and social service organisations servicing children were minimally represented. No studies were identified where the primary setting was sports clubs, churches/religious organisations, summer/vacation camps, detention centres/juvenile justice settings, or primary/secondary health care facilities. Target population: Most interventions targeted children rather than adults (n = 7 systematic reviews; n = 47 primary studies) from the general population. Fewer studies included populations known to be at an increased risk, or those already exposed to maltreatment. Just over a third of the primary studies conducted an analysis to ascertain differences in the effect of an intervention between the genders. Intervention type: Prevention interventions were the most studied (n = 5 systematic reviews; n = 57 primary studies), with additional studies including prevention approaches alongside other intervention types. Fewer studies evaluated interventions targeting disclosure, institutional responses, or treatment interventions. Type of maltreatment: The vast majority of the studies assessed interventions solely addressing the sexual abuse of children (n = 8 systematic reviews; n = 45 primary studies). The remaining studies addressed other forms of maltreatment, including physical and emotional abuse, or neglect, either in combination or as a sole focus. Outcomes: Primary reported outcomes reflected the bias toward child targeted interventions. Outcome measures captured child wellbeing and knowledge outcomes, including measures of mental health, children's knowledge retention and/or self-protective skills. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally or not reported. A third of studies reported on some measure of implementation. Study quality The overall quality of the studies was low to moderate. Most systematic reviews were low-quality (n = 10), with only one high quality review (and update) identified. Most completed RCTs had some concerns relating to the risk of bias (n = 30), and the remainder were considered to be at a high risk of bias (n = 19).

Authors' Conclusions

This EGM has highlighted a substantial need for more high quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The current evidence base does not represent countries with large populations and the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. Further evidence gaps were identified for interventions relating to disclosure, organisational responses and treatment, and few studies assessed interventions targeting perpetrators' maltreatment behaviours, recidivism or desistence. Future studies should also include measure of programme implementation.

Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study

Background

Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia.

Methods

This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics.

Results

WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018.

Conclusion

WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.

Cyberbullying and Adolescents

Purpose of Review

Cyberbullying is an aggressive behavior involving a type of electronic communication intending to harm a victim that can have profound effects on adolescents. This review examines the epidemiology, issues from cyberbullying, presentation to care of its victims and proposed interventions to this behavior.

Recent Findings

There are a variety of physical and psychological effects on victims of cyberbullying that can include recurrent abdominal pain, headaches and difficulty with sleep. In addition, victims have higher rates of anxiety, depression, suicidal ideation and a lower level of well-being. Unfortunately, victims may remain silent, so screening for cyberbullying is encouraged in a variety of settings. Interventions can be designed at the level of the victim (and perpetrator), family, school and other support networks. Prevention of cyberbullying can be a focus for providers of healthcare.

Summary

Cyberbullying can have profound biopsychosocial effects on its victims. There are strategies currently in use and under development to identify and intervene on behalf of those affected by these behaviors.

Loneliness in young adults with a visual impairment: Links with perceived social support in a twenty-year longitudinal study

BACKGROUND

Young people with disabilities are more at risk of experiencing loneliness in later life than their typically developing peers.

AIM

To identify those who become lonely in later life, trajectories of perceived parent and peer support from adolescence to adulthood of young people with a visual impairment were studied.

METHODS

A total of 316 adolescents (M = 18 years; SD = 6.5) enrolled in a cohort study in 1996; 205 of them participated in 2005, 178 in 2010, and 161 in 2016. Latent growth curve models were fitted to the data.

RESULTS

Perceived parent support followed a linear decreasing course. No association was found between perceived parent support and loneliness in later life. For perceived peer support a quadratic growth pattern was found, with an increase in peer support up to age 27, and thereafter a decrease. Both the initial level and the rate of change in perceived peer support significantly predicted loneliness in adulthood.

CONCLUSIONS

The course of peer support is a better indicator for the risk of loneliness in later life than support from parents. Normative life transitions may affect the already vulnerable social support for young people with a visual impairment. This study highlights the importance of establishing and maintaining peer relationships throughout life.

Effectiveness of school-based mental well-being interventions among adolescents: A systematic review

AIMS

This systematic review aimed to identify school-based interventions for ensuring mental health and well-being of adolescents, synthesize existing interventions, and summarize the quality of identified studies.

DESIGN

A systematic review, analysis, and synthesis were performed.

DATA SOURCES

Search was performed in Cochrane Library, PsychARTICLES, Web of Science, CINAHL, and Medline.

REVIEW METHODS

Literature search was performed in March 2019 using inclusion and exclusion criteria. PRISMA guidelines were followed. Identified records were reviewed by title, abstract, and by the full text by two independent researchers. Three authors independently made a quality assessment of the included studies. Included studies were extracted and synthesized. A systematic review was registered in PROSPERO (CRD42019128919).

RESULTS

The initial search yielded 1,199 articles. Of them, 57 articles were included in the final analysis and synthesis. Only four studies were assessed as high quality. Identified themes were mental health and well-being, positive psychology, problem-solving and stress reduction, mindfulness, and physical activity. More than half (N = 32, 56.14%) interventions showed a positive outcome after implementation. Most of those interventions focused on positive psychology and mindfulness.

CONCLUSION

Mental well-being is important for the healthy development of adolescents. Countries are aware that healthy adolescents will become healthy adults who will contribute to his/her community and will lower costs of the absence of work and treatments. Thus, they support and invest in interventions that prevent mental disorders. There is a need for developing multidimensional mental well-being interventions that are effective in low- and secondary-income countries.

IMPACT

This study ensured rigorous methodology, followed PRISMA recommendations and evaluated quality of identified literature using the GRADE guidelines. A critical synthesis was performed to produce an integrated conceptualization of the evidence. The synthesis represents a list of effective school interventions for the promotion of adolescents' mental well-being.

Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a South African cohort

INTRODUCTION

Efficacious antiretroviral treatment (ART) enables people to live long and healthy lives with HIV but young people are dying from AIDS-related causes more than ever before. Qualitative evidence suggest that various forms of HIV-related discrimination and resulting shame act as profound barriers to young people's engagement with HIV services. However, the impact of these risks on adolescent retention in HIV care has not been quantified. This study has two aims: (1) to examine whether and how different types of discrimination compromise retention in care among adolescents living with HIV in South Africa; and (2) to test whether internalized stigma mediates these relationships.

METHODS

Between 2014 and 2017, adolescents living with HIV (aged 10 to 19) from 53 health facilities in the Eastern Cape, South Africa, were interviewed at baseline (n = 1059) and 18-month follow-up (n = 979, 92.4%), with responses linked to medical records. Data were analysed through multiple regression and mediation models.

RESULTS

About 37.9% of adolescents reported full retention in care over the 2-year period, which was associated with reduced odds of viral failure (OR: 0.371; 95% CI: .224, .614). At baseline, 6.9% of adolescents reported discrimination due to their HIV status; 14.9% reported discrimination due to HIV in their families and 19.1% reported discrimination in healthcare settings. Healthcare discrimination was associated with reduced retention in care both directly (effect: -0.120; CI: -0.190, -0.049) and indirectly through heightened internalized stigma (effect: 0.329; 95% CI: 0.129, 0.531). Discrimination due to family HIV was associated with reduced retention in care both directly (effect: -0.074, CI: -0.146, -0.002) and indirectly through heightened internalized stigma (effect: 0.816, CI: 0.494, 1.140). Discrimination due to adolescent HIV was associated with reduced retention in care only indirectly, through increased internalized stigma (effect: 0.408; CI: 0.102, 0.715).

CONCLUSIONS

Less than half of adolescents reported 2-year retention in HIV care. Multiple forms of discrimination and the resultant internalized stigma contributed to this problem. More intervention research is urgently needed to design and test adolescent-centred interventions so that young people living with HIV can live long and healthy lives in the era of efficacious anti-retroviral treatment.

Associations among Adolescents' Relationships with Parents, Peers, and Teachers, Self-Efficacy, and Willingness to Intervene in Bullying: A Social Cognitive Approach

We applied the Social Cognitive Theory to investigate whether parent–child relationships, bullying victimization, and teacher–student relationships are directly as well as indirectly via self-efficacy in social conflicts associated with adolescents’ willingness to intervene in a bullying incident. There were 2071 (51.3% male) adolescents between the ages of 12 and 17 from 24 schools in Germany who participated in this study. A mediation test using structural equation modeling revealed that parent–child relationships, bullying victimization, and teacher–student relationships were directly related to adolescents’ self-efficacy in social conflicts. Further, teacher–student relationships and bullying victimization were directly associated with adolescents’ willingness to intervene in bullying. Finally, relationships with parents, peers and teachers were indirectly related to higher levels of students’ willingness to intervene in bullying situations due to self-efficacy in social conflicts. Thus, our analysis confirms the general assumptions of Social Cognitive Theory and the usefulness of applying its approach to social conflicts such as bullying situations.

Racial and Ethnic Differences in Bullying: Review and Implications for Intervention

Despite increased research on bullying over the past few decades, researchers still have little understanding of how bullying differentially affects racial and ethnic minority and immigrant youth. To facilitate efforts to better evaluate the impact of bullying among racial and ethnic minority youth and improve interventions, we integrated research from multiple disciplines and conducted a systematic search to review relevant cross-cultural research on the prevalence of bullying, risk and protective factors, and differences in behaviors and outcomes associated with bullying in these populations. Studies measuring differences in bullying prevalence by racial and ethnic groups are inconclusive, and discrepancies in findings may be explained by differences in how bullying is measured and the impact of school and social environments. Racial and ethnic minorities and immigrants are disproportionately affected by contextual-level risk factors associated with bullying (e.g., adverse community, home, and school environments), which may moderate the effects of individual-level predictors of bullying victimization or perpetration (e.g., depressive symptoms, empathy, hostility, etc.) on involvement and outcomes. Minority youth may be more likely to perpetrate bullying, and are at much higher risk for poor health and behavioral outcomes as a result of bias-based bullying. At the same time, racial and ethnic minorities and immigrants may be protected against bullying involvement and its negative consequences as a result of strong ethnic identity, positive cultural and family values, and other resilience factors. Considering these findings, we evaluate existing bullying interventions and prevention programs and propose directions for future research.

Cyberbullying, cyber aggression, and cyber victimization in relation to adolescents' dating and sexual behavior: An evolutionary perspective

This study examined adolescents' cyberbullying, cyber aggression, and cyber victimization from an evolutionary perspective, extending previous research showing that traditional forms of bullying, aggression, and victimization are associated with reproductively relevant outcomes. Consistent with hypotheses based on theory and research linking bullying and aggression to intrasexual competition for mates, results indicated that cyber victimization was positively associated with a number of dating and sexual partners. Findings for cyber aggression were more complex, depending on the degree of cyber victimization experienced by the perpetrator, and the balance of power between the perpetrator and victim. Specifically, nonbullying cyber aggression by perpetrators with equal or less power than the victim had stronger positive relations with the number of dating or sexual partners when perpetrators experienced a high level of cyber victimhood. In contrast, cyberbullying by perpetrators with more power than the victim was negatively associated with the number of dating partners when the perpetrators' exposure to cyber victimization was low. Although cyber aggression and cyber victimization are new forms of aggression that involve the use of modern electronic devices, the results of this study demonstrate the usefulness of viewing this behavior from an evolutionary perspective and show that adolescents are likely to use cyber aggression against rivals in the context of intrasexual competition for mates.