Bullying victimization and child sexual abuse among left-behind and non-left-behind children in China

Prevalence and associated factors of school bullying among adolescents in Inner Mongolia, China

Background

Although studies in China have found that school bullying is prevalent among adolescents, most relevant research has focused on southern China, while research in northern China is limited. This study aimed to explore ethnic disparities in the socio-demographic determinants of school bullying in Inner Mongolia, a northern region of China.

Methods

A cross-sectional study was conducted among 2891 adolescents in Inner Mongolia, China, from September to December 2022. Data on participants' sociodemographic characteristics and school bullying experiences were collected through questionnaires. Multivariate logistic regression analyses, stratified by ethnicity, were employed to examine factors associated with school bullying. Furthermore, subgroup analyses and interaction tests were conducted to explore potential effect modifiers of the relationship between ethnicity and bullying.

Results

The prevalence of school bullying was 18.99 % (549/2891) overall, with 17.96 % (420/2339) among Han and 23.37 % (129/552) among ethnic minorities. Minority adolescents faced a higher risk of bullying compared to Han (OR = 1.35, 95 % CI: 1.08-1.69, P < 0.05). Middle school students were more vulnerable to bullying than high school students (OR = 1.25, 95%CI:1.03-1.52, P < 0.05). Among Han adolescents, having a mother with high school education was protective against bullying (OR = 0.71, 95 % CI: 0.54-0.93, P < 0.05), while it was an associated factor for minorities (OR = 2.06, 95%CI:1.23-3.46, P < 0.05). Good family economic status was an associated factor for bullying among Han (OR = 1.62, 95%CI: 1.11-2.36, P < 0.05), but not among minorities. Belonging to other family structures (remarriage/foster family, intergenerational families, live with relatives and elders) was an associated factor for minorities (OR = 2.60, 95 % CI: 1.37-4.92, P < 0.05), but not for Han. Subgroup analyses revealed significant ethnic disparities in bullying experiences among middle school students, those from nuclear family, other family, and fair economic backgrounds (all P < 0.05). Interaction effects between ethnicity and these variables were not significant (all P > 0.05).

Limitations

This cross-sectional study has limitations in establishing causal relationships between identified associated factors and school bullying.

Conclusions

Ethnic minority adolescents in Inner Mongolia, China, especially middle school students, face a higher risk of school bullying than their Han peers. The differential impact of maternal education, family economic status, and family structure on bullying risk between Han and minority adolescents underscores the need for culturally sensitive, targeted interventions that consider the unique challenges faced by ethnic minority students.

Parent-child attachment mediates the association between parental conflict perceptions and suicide intention: a cross-sectional survey among middle school students in China

Introduction

Adolescent suicide is a prevalent issue globally, with various factors contributing to this phenomenon. This study aimed to investigate these factors and their interrelationships to better understand the causes of adolescent suicide and provide evidence for its prevention.

Methods

This study conducted among middle school students in Liaoning Province, China, from April to May 2016, A cross-sectional survey was administered to 1,028 students aged 10-19, using instruments such as the Behavior Questionnaire-Revised (SBQ-R), Children's Perception of Interparental Conflict Scale (CPIC), and revised version of Inventory of Parent Attachment (IPPA-R).

Result

Binary logistic regression analysis revealed that adolescents aged 15-19, adolescents with strong perceptions of parental conflict were at high risk of suicide intention. Adolescents living in rural areas, adolescents with high mother-child attachment, adolescents with high father-child attachment were at low risk of suicide intention. Furthermore, parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention.

Discussion

The study concludes that adolescents living in urban areas, older adolescents, adolescents with a high level of parental conflict intensity, and those with low levels of parent-child attachment are at high risk of suicide intention. parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention. Interventions aimed at reducing family conflicts and improving parent-child relationships are recommended to decrease the incidence of adolescent suicide.

A Scoping Review of Programs to Prevent Child Sexual Abuse in Mainland China

Child sexual abuse (CSA) is a worldwide public health concern. With the widespread dissemination of prevention approaches to end CSA, numerous CSA prevention programs exist in developed countries, but there is little evidence on how these programs are performing in Mainland China. The aim of this study was to review the existing research focusing on CSA prevention programs in Mainland China. Studies of CSA prevention programs were identified by conducting a comprehensive search of major academic databases for Chinese and English research. Articles were retained if they were original empirical studies that conducted programs to prevent CSA in Mainland China and measured related outcomes. Twelve studies met the inclusion criteria. A child-targeted, universally focused, and school-based educational program was the most common (n = 7), followed by specifically focused programs that covered migrant and left-behind children using group-based intervention strategies (n = 2) and ordinary parents with self-learning strategies (n = 2); one study delivered agency-based face-to-face education to parents with disabled children. However, the shortcomings in research design limited its replication to the broader population. CSA prevention program research in Mainland China is in an early stage due to the limited target populations, lack of large-scale government-led initiatives, and low involvement of multicomponent collaboration. We provide suggestions for conducting future research involving more inclusive programs for other populations, comprehensive programs with multiple targets and stakeholders, large-scale evidence-based research, culturally tailored and contextual adaptation programs.

Parental Migration and Children's Exposure to Polyvictimization in Rural China

The present study aims to investigate (1) the difference in polyvictimization rate between children left behind and those living with non-migrant parents in rural China, and (2) the social processes through which the effects of parental migration are conveyed through children's behaviors and interaction with the immediate external environment (e.g., family, school, and peers). The research hypotheses were tested by using a probability sample consisting of 1,681 middle school students in rural areas in Guizhou province (Mean age = 13.55, SD = 1.01; 50% of the participants were boys). Findings from multivariate logistic regression models and indirect effect analyses suggest that (1) overall, left-behind children are exposed to a higher level of polyvictimization than children living with both non-migrant parents in rural China and (2) whereas all left-behind children face similar challenges in school and family settings, each type of parental migration and caretaking arrangement entails unique protective or risk factors of polyvictimization. As one of the first studies to systematically investigate the rate and etiology of polyvictimization among children left behind in rural China, this study highlights the prominent role of parental migration in reproducing and reinforcing children's differential exposure to polyvictimization among China's rural families.

Sex and Urban–Rural Differences in the Relationship between Childhood Sexual Abuse and Mental Health among Chinese College Students

This study aimed to reveal sex and urban–rural differences in the association between childhood sexual abuse (CSA) and mental health among Chinese college students. The study used data from the “National College Student Survey on Sexual and Reproductive Health 2019”, a cross-sectional study conducted in all 31 provinces of mainland China. Weighted logistic regression analysis was conducted to determine the association between CSA (noncontact CSA, contact CSA, and penetrative CSA) and mental health (suicide attempts and mental disorders). Among 49,728 students, 39.42% of the male participants and 43.55% of the female participants had ever experienced CSA. According to the OR results of logistic regression analysis, compared to females, males in the contact CSA group (AOR: 3.49, 95% CI: 1.95–6.23) and the penetrative CSA group (AOR: 8.79, 95% CI: 3.15–24.52) had higher odds of suicide attempts. Participants from rural and suburban areas that were categorized in the penetrative CSA group were more likely to report suicide attempts (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban AOR: 4.86, 95% CI: 2.52–9.36) and mental disorders (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban: AOR: 4.86, 95% CI: 2.52–9.36). In conclusion, the findings revealed a high prevalence of CSA in both sexes and reported that males are more vulnerable to the adverse effects of CSA. In addition, we also found that undergraduates growing up in rural and suburban areas are more vulnerable to the adverse psychological effects of CSA. Policymakers should pay more attention to this vulnerable population and implement effective measures to alleviate mental trauma.

Parental divorce and nicotine addiction in Lebanese adolescents: the mediating role of child abuse and bullying victimization

BACKGROUND

Lebanon ranks first amongst Middle-Eastern countries in terms of cigarette and waterpipe smoking. Understanding the mediating factors for nicotine addiction in adolescents who have experienced parental divorce is vital to take effective measures that will help in lowering its prevalence in our community. The objective of this study was to investigate the association between the increasingly concerning parental divorce and nicotine addiction in Lebanese adolescents while taking into consideration the plausible mediating effect of abuse and bullying victimization.

METHODS

This was a cross-sectional survey-based study that was conducted between January and May 2019. A total of 1810 adolescents aged between 14 and 17 years was enrolled from 16 Lebanese schools. Linear regressions taking the cigarette and waterpipe dependence scores as dependent variables were conducted respectively, using the SPSS software. PROCESS v3.4 model 4 was used for mediation analysis.

RESULTS

A total of 11.9% of the enrolled participants had divorced parents. Higher cigarette and waterpipe dependence were found in adolescents whose parents were divorced compared to those living together. More child psychological abuse, having divorced parents vs living together, and more child physical abuse were significantly associated with higher cigarette dependence. More child psychological and physical, and having divorced parents vs living together were significantly associated with more waterpipe dependence. In addition, all forms of abuse (except neglect) and bullying victimization had a partially mediating effect in the associations between parental divorce and nicotine dependence (cigarette and waterpipe) in adolescents.

CONCLUSION

This study results may serve as a first step towards enrolling separated parents and their children in special prevention programs to help them create a protective and supportive environment.

Association of child maltreatment and bullying victimization among Chinese adolescents: The mediating role of family function, resilience, and anxiety

BACKGROUND

Among adolescents, child maltreatment is linked to being bullied at school. Nevertheless, little is known about the mediating mechanisms underlying this association. Therefore, our research aimed to explore and evaluate the potential mediators of the relationship between child maltreatment and bullying victimization among Chinese adolescents.

METHODS

From October to December 2020, a population-based cross-sectional survey was conducted among 6247 adolescents (3401 males, 2846 females) in Anhui Province, China. The subjects of the survey were elementary and middle school students from grades 4 to 9. The data were collected through self-report questionnaires. Pearson correlation and linear regression were used to examine the relationships among child maltreatment, bullying victimization, family function, resilience, and anxiety. Structural equation modeling (SEM) was employed to conduct mediation analyses.

RESULTS

The results indicated that child maltreatment positively predicted the later bullying victimization of adolescents. Resilience and anxiety were each shown to separately mediate this relationship. Moreover, the sequential mediating effects of family function, resilience, and anxiety also mediated the predictive effect of child maltreatment on bullying victimization.

CONCLUSIONS

Resilience and anxiety were both shown to be important independent mediators for the relationship between child maltreatment and bullying victimization. Furthermore, the combined mediating effects of family function, resilience, and anxiety were also of great significance. These findings provide additional evidence that family and individual factors are critical to understanding bullying victimization. Effective prevention and intervention strategies for school bullying should target family and individual vulnerabilities in adolescents.

Boys should not be overlooked: Sexual violence victimization and associated factors among school-going adolescents in urban Ghana

BACKGROUND

Adolescent sexual violence victimization is still less researched in countries within sub-Saharan Africa, including Ghana.

OBJECTIVES

To estimate the 12-month prevalence of sexual violence victimization and describe the differences and commonalities in the associated factors between school-going boys and girls in urban Ghana.

PARTICIPANTS AND SETTING

Students (n = 1692) aged 13-19 years attending Second Cycle Schools in the Greater Accra Region of Ghana participated in this study.

METHODS

This is a cross-sectional survey involving the use of a self-report anonymous questionnaire. Items measuring sexual violence victimization and correlates were adopted from the 2012 WHO-Global School-based Student Health Survey. Data analysis involved bivariable and multivariable approaches.

RESULTS

Overall, 17.6% (95% confidence interval [CI] 15.7, 19.4) adolescents (males = 10.4% [95% CI 8.3, 13.6]; females = 24.3% [95% CI 21.5, 27.3]) reported sexual violence victimization during the previous 12 months. Girls (compared to boys) were nearly three times more likely to report sexual violence victimization (aOR = 2.74, 95% CI 2.01, 3.74, p < 0.001). Breakup, sexual minority status, and conflict with parents were uniquely associated with sexual violence victimization among females. Regardless of gender, adolescents who were in a romantic relationship (aOR = 1.63, 95% CI 1.19, 2.24, p = 0.002) and reported physical abuse victimization (aOR = 1.84, 95% CI 1.36, 2.49, p < 0.001) were more likely to report sexual violence victimization.

CONCLUSIONS

The prevalence of sexual violence victimization among school-going adolescents in urban Ghana compares with estimates from sub-Saharan Africa, but also warrants the need for universal and targeted prevention regimes against the offence in both boys and girls.

Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China

BACKGROUND

This cross-sectional study aimed to identify adverse childhood experience (ACE) subtypes using variable- and person-centered approaches and examine the possible sex-differentiated associations with violence involvement as victim, perpetrator, and victim-perpetrator.

METHODS

Adolescents aged 10-14 years in three junior high schools in Shanghai, China, were selected using a cluster sampling method in November and December 2017. Participants were surveyed anonymously using a computer-assisted self-interview approach via tablets. Thirteen items modified from the CDC-Kaiser ACE study were used to measure the ACEs. Results show subtypes as neglect, abuse, and household dysfunction by developing cumulative index score from the variable perspective and subgroups identified through the latent class analysis (LCA) from the person perspective. Logistic regression analyses were used to test the association between each ACE subtype and violence victimization and perpetration after adjusting for some demographic characteristics.

RESULTS

A total of 1,700 participants were included in the final analysis. Approximately 1,322 (77.76 %) participants reported experiencing at least one ACE. The prevalence of neglect, abuse, and household dysfunction was 64.12 % (n = 1090), 61.29 % (n = 1042), and 18.24 % (n = 310), respectively. Three classes were identified through the LCA: low exposure to all ACEs (n = 854, 50.23 %), high exposure to emotional and physical abuse and neglect (n = 715, 42.06 %), and high exposure to all ACEs (n = 131,7.71 %). After controlling the covariates, experiencing abuse, neglect, and household dysfunction was significantly related to violence victimization (adjusted odds ratio [aOR] = 3.19, 3.29, 2.37, P < 0.001) and victim-perpetrator (aOR = 3.48, 4.41, 5.16, P < 0.001). Adolescent violence perpetration was only found to be associated with being neglected (aOR = 2.37, P = 0.003) and suffering household dysfunction (aOR = 3.25, P < 0.001). LCA revealed the cumulative effects of ACEs on adolescent violence victimization and perpetration. Sex-stratified analysis indicate that girls were more vulnerable to the negative effects of ACEs, with a higher risk of perpetration among girls exposed to distinctive subtypes or multiple ACEs.

CONCLUSIONS

ACEs were ubiquitous and significantly associated with an elevated risk of violence victimization and perpetration during early adolescence. Future research should examine whether these associations persist over time and the intermediating mechanism from the perspectives of individual neurodevelopment, cognition and resilience ability, and social support.

The association between sibling bullying and psychotic-like experiences among children age 11-16 years in China

BACKGROUND

Few studies exist on sibling bullying or even sibling aggression more generally in the past 30 years. Studies of sibling bullying have shown that sibling bullying may associate with depression, anxiety, self-harm, suicide ideation in early adulthood. Nevertheless, few studies have explored the relationship between sibling victimization types and the occurrence of psychosis, not to mention that psychotic-like experiences (PLEs) always occur before psychotic disorders. Therefore, the current study aims to examine the association between sibling bullying and PLEs among children age 11-16 years in China.

METHOD

This is a cross-sectional study which included 3231 students from eight junior middle schools in three cities of Hunan Province, China. Frequency and types of sibling bullying was assessed with Sibling Bullying Questionnaire and PLEs was assessed with Community Assessment Psychic Experiences-42.

RESULTS

The percentage of sibling bullying were 12.9% for victimization and 10.8% for perpetration. Sibling bullying plays as an independent influence factor for all subtypes of PLEs, and verbal victimization was the most important risk factor in developing different subtypes of PLEs followed by physical victimization and verbal perpetration.

CONCLUSION

The current study found that sibling bullying is associated with PLEs. Intervention programs should be conducted to focus on those children and adolescents who are involved in multiple types of sibling victimization or perpetration.

Childhood maltreatment with school bullying behaviors in Chinese adolescents: A cross-sectional study

OBJECTIVE

Although childhood maltreatment and school bullying are common among Chinese adolescents, their possible connection remains severely under-discussed in this population. This study primarily aims to explore the association between childhood maltreatment experience and school bullying behaviors in a large sample of Chinese teenagers.

METHOD

A school-based sampling survey was implemented with 2579 adolescents in southwest China. Self-administered questionnaire was used to collect relevant information form the participants. Binary Logistic regression models were adopted to estimate the crude and adjusted associations between childhood maltreatment experience and school bullying involvement in general, as well as between different types of child maltreatment and school bullying.

RESULTS

Multivariate Logistic regression models revealed that, for adolescents who had experienced any type of childhood maltreatment, their risk of implicating into school bullying significantly increased (OR=1.75, 95% CI: 1.41-2.16). Further analysis revealed that, for all types of childhood maltreatment and school bullying, only child abuse showed prominent association with bullying victimization: adolescents who reported a history of sexual abuse and emotional abuse were found 4.31 (95% CI: 2.79-6.68) and 2.11 (95% CI: 1.32-3.39) folds of odds for bullying victimization. However, the dose-response association was not apparent between the severity of child abuse and bullying victimization based on subgroup analysis of abused participants.

CONCLUSIONS

Childhood maltreatment, especially sexual abuse and emotional abuse, were significantly associated with increased risk of school bullying victimization among Chinese adolescents. Targeted intervention measures should be designed and implemented to protect the abused adolescents from being bullied at school.

Bullying Victimization and Life Satisfaction Among Rural Left-Behind Children in China: A Cross-Sectional Study

Objectives: This study aimed to evaluate the associations between bullying victimization and life satisfaction in primary school children and also investigate the interactive effects of left-behind status and bullying victimization on life satisfaction. Materials and Methods: Bullying victimization was measured using the Chinese version of the revised Olweus Bully/Victim Questionnaire. Life satisfaction was assessed using the Multidimensional Students' Life Satisfaction Scale (MSLSS). Life satisfaction is composed of five domains, namely, family, school, friends, environment, and self-satisfaction. Left-behind status of rural children was defined as one or both their parents migrating to working in cities. The data were analyzed using Mann-Whitney U tests, Chi-square tests, and multivariate linear and logistic regression analyses. Results: A total of 810 primary school children were involved, of which 8.5% reported bullying victimization, and 44.3% were left-behind children (LBC). We found that bullying victimization was negatively associated with all domains of life satisfaction (all p < 0.05). With further left-behind status-stratified analysis, we found that negative association between bullying victimization and friend satisfaction was more profound in the LBC group than in the non-LBC group [b(SE)= -0.133 (0.03) vs. -0.061 (0.026) for LBC and non-LBC, respectively, p < 0.05]. When further interaction analysis was conducted, we identified interaction effects between left-behind status and bullying victimization on friend satisfaction (p _interaction = 0.048). Similar interaction effect between bullying victimization and left-behind status on school satisfaction was also found (p _interaction = 0.004). Conclusions: Bullying victimization was associated with low life satisfaction (including lower family, friends, school, self, and environment satisfaction). There were significant interactions between left-behind status and bullying victimization on friend satisfaction, as well as school satisfaction. Left-behind status of children may exaggerate the impact of bullying victimization on friends/school satisfaction rating.

Bullying victimization among Lebanese adolescents: The role of child abuse, Internet addiction, social phobia and depression and validation of the Illinois Bully Scale

Background

Both bullying victimization and perpetration were associated with depression, social phobia, physical and psychological child abuse and Internet addiction in Lebanon. The prevalence of bullying in Lebanon is alarming, with 50% of school-aged children and adolescents reporting being bullied at some point. The high rate of both bullying victimization can be reflective of the inefficacy of current prevention and intervention policies in targeting associated problematic individual and contextual factors. The objective of the present study was to analyze factors associated with bullying victimization and validate the Illinois Bully Scale among Lebanese adolescents.

Methods

This is cross-sectional study that took place between January and May 2019. We enrolled 1810 adolescents between 14 and 17 years of age. The Illinois Bully scale was used to measure bullying victimization. In order to ensure the adequacy of the sample with values greater than 0.8 - an indicator that component or factor analysis was useful for these variables - we used Kaiser-Meyer-Olkin (KMO) measurement. Statistical significance considered if the p-value < 0.05.

Results

The results showed that 841 (46.5%, CI: 44.1% – 48.7%) participants were classified as having been previously bullied. None of the bullying scale items was removed. Items on the bullying scale converged on a two-factor solution with Eigenvalues greater than 1, accounting for a total of 73.63% of the variance (Factor 1: bullying victimization; Factor 2: bullying perpetration; KMO = 0.899, Bartlett’s sphericity test p < 0.001; αCronbach = 0.955). Having a separate parents (ORa = 3.08), Mild (ORa-4.71) to moderate (ORa = 3.84) internet addiction test, higher social fear (ORa = 1.50), higher psychological abuse (ORa = 3.59), higher child neglect (ORa = 2.21) and physical (ORa = 4.55) abuse were significantly associated with higher odds of being bullied. However, higher social avoidance (ORa = 0.49), poor (ORa = 0.20), fair (ORa = 0.94) and very good (ORa = 0.04) physical activity as compared to sedentary were significantly associated with lower odds of being bullied.

Conclusions

Our findings attest that bullying victimization is likely to be associated with certain factors such as child abuse of all forms, Internet addiction, social fear and avoidance. In addition, the Illinois Bully Scale was validated in Lebanon. More attention should be paid to students vulnerable to bullying victimization, such as those with environmental or domestic problems, and adolescents with psychological disorders such as behavioral addictions.

Being bullied and depressive symptoms in Chinese high school students: The role of social support

The aims of this study were to: 1) examine the relationship between being bullied and depressive symptoms; 2) explore whether the three mentioned sources of social support moderated this association; and 3) examine gender differences in the moderating effects of social support on bullying-associated depressive symptoms among Chinese high school students. A total of 1252 students were selected from three high schools in Zhenping County of Henan Province in China. The results suggest that bullying victimization is significantly associated with depressive symptoms among high school students. In addition, we found that only school-type social support had a moderating effect on depressive symptoms. Those who had been bullied but who had high levels of school support had lower levels of depressive symptoms than those with less school support. However, moderating effects of this support were only found for girls, not for boys. This study empirically supports that programs aimed at boosting social support for students from teachers and classmates, could help protect high school students from depressive symptoms.

Patterns of Bullying Victimization and Associations with Mental Health Problems in Chinese Adolescents: A Latent Class Analysis

Bullying victimization in school students is a serious public health concern and has been linked to a wide range of mental health problems. The current study aims to examine patterns of involvement in different types of bullying victimization among Chinese adolescents and evaluate the associations between bullying victimization and mental health problems. Cross-sectional data from 20,722 middle school students from Guangdong Province were sampled using a multistage, stratified cluster-randomized sampling method. Latent class analysis (LCA) was performed on seven items representing bullying victimization. Levels of mental health outcomes were compared across each latent class. Four latent classes were identified for boys: the high victimization class (0.6%), the moderate victimization class (2.8%), the verbal victimization class (12.4%), and the low victimization class (84.2%). For girls, three latent classes were identified: the high victimization class (0.7%), the moderate victimization class (5.6%), and the low victimization class (93.7%). Characteristics of the item probabilities were different between boys and girls. For both genders, a graded relationship was found between bullying victimization class membership and mental health outcomes. These findings underline the complexity of bullying victimization patterns among Chinese adolescents. Students with higher involvement in bullying victimization have more severe mental health problems.

School Bullying Among Left-Behind Children: The Efficacy of Art Therapy on Reducing Bullying Victimization

Background: Left-behind children (LBC) are becoming a widespread phenomenon and face higher risks of psychological and educational problems. Our study aimed to explore school bullying in LBC and examine the effectiveness of art therapy intervention for reducing bullying victimization affecting LBC in rural areas. Methods: A total of 603 children, including 272 LBC and 331 non-LBC, were sampled from 6 rural schools. Questionnaires regarding school life satisfaction, children's social anxiety, self-esteem, and school bullying were used to assess the psychological and school behavior status of these children. One Hundred and Eighty LBC who were victims of school bullying were then selected and randomly assigned to 3 groups to evaluate the effects of art therapy intervention. The interventions of art therapy and general counseling were conducted in 6 sessions over 3 months. Results: Our results demonstrated LBC experienced more bullying victimization than non-LBC. Left-behind boys were more likely to be bullied than left-behind girls. LBC > 12 years old, LBC whose parents are divorced, separated, or widowed, were more vulnerable to being bullied. School bullying of LBC was affected by social anxiety scores and school life satisfaction. The bullying victimization of LBC in the art therapy group was significantly improved. Conclusions: LBC suffered more school bullying than did non-LBC. Art therapy can effectively help LBC in rural primary schools to reduce their vulnerability to bullying.