Running head: COMMUNITY HEALTH ASSESSMENT PROJECT
Community Health Assessment Project
Layal Mansour
Walden University
1
COMMUNITY HEALTH ASSESSMENT PROJECT
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Community Health Assessment Project
Demographics and Health Status
Sarnia city is situated to the Southwestern side of Ontario in Canada. It is the largest city
in Lambton County with a population density of about 434 per square kilometers (Weichenthal,
2016). As at 2016, Sarnia had a population of 71,594. The city’s population is predominantly
white, with only about 5% minorities. The median age for the city is 46 years. This age is
slightly higher than the national figure, which stands at 41. The population of Sarnia city is
relatively aged compared to the rest of Canada. In 2015, the median income for individuals aged
15 years and above stood at about $35,000. On the other hand, the median family income was
about $87,000. These figures were fairly comparable with state figures which stood at about
$35,000 an $90,000 respectively. The cost of living in the city is low in comparison to that of
Ontario. In Sarnia, the median value of dwelling is about $200,000 compared to Ontario’s
$400,000. Older adults, aged 65 years and above, constitute about 17% of Sarnia’s population.
The dependency ratio for this age bracket is about 29 percent. The youth constitute about 8% of
the population.
Sarnia has been christened Canada’s toxic town. The presence of huge petrochemical
complexes has exposed the population of this city to serious lung and respiratory health risks. In
addition to lung and respiratory conditions, the other chronic disease troubling the city is cancer.
The two are the major contributors to Sarnia’s mortality. Notable diseases that are prevalent in
Sarnia and that relate to exposure to toxic fumes include COPD, asthma, and ischemic heart
conditions. Osteoarthritis is also prevalent, especially given that the population is relatively aged.
COMMUNITY HEALTH ASSESSMENT PROJECT
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The prevalence of diabetes in the city is significant as is cerebrovascular disease. In recent years,
the city has also had to give significant focus to the prevalence of mental health issues.
Health Access
Sarnia is served by Bluewater Health. The hospital has about 190 acute care beds and 70
complex continuing beds. Additionally, it has 27 rehabilitation beds. It is an umbrella healthcare
provider which brought together multiple facilities in 2010 and boasts of its commitment to care
quality and patient safety. The 7% of the population classified as having low-income status
cannot access affordable healthy foods. This prevents the achievement of holistic health
coverage. Whereas diabetes remains a significant health concern, there is little attention directed
to its early diagnosis and proper management. This is evidenced by the limited access to
recreational and physical facilities. Bluewater health is marked as having registered nurse
shortage, with a low patient-nurse ratio, especially for chronic diseases. Of Bluewater Health’s
close to 2,000 staff, only about 200 constitute the professional staff with the rest being
volunteers. Most of the hospitals are in need of modernization and facelift, limiting their
capacities to provide premium care.
Primary Health Issue
Sarnia suffers two primary health issues that affect the population which is constantly
exposed to the risk of lung and respiratory diseases and cancer. The first primary health issue
affecting Sarnia is the constant exposure to pollutants. Sarnia is an international industrial city
which hosts one of the world’s largest petrochemical industries. Gaseous industrial wastes
pollute the environment, exposing the population to respiratory diseases and cancer. Secondly,
there is a shortage of registered nurses to attend to the patients suffering from chronic diseases,
and who need constant monitoring.
COMMUNITY HEALTH ASSESSMENT PROJECT
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Barriers to Access to Health Care
There are both system and individual barriers to health care access in Sarnia. Foremost,
the allocation of health care resources on the basis of individual needs rather than community
need limits the scope of treatment of chronic diseases that are caused by a polluted environment
(Bergstra, Brunekreef, & Burdorf, 2018). The challenge here is that health care providers are
unable to identify those who do not present themselves as patients, making it impossible to make
early diagnosis. Secondly, the low numbers of registered nurses make it difficult for patients to
have regular care. This especially arises since it is difficult to acquire a family doctor, especially
among the aged and those with chronic diseases. Consequently, home-based care also becomes
inadequate.
Behavioral Risk Factors
There are high youth smoking rates. Besides the active smokers being at risk, passive
smokers are at a higher risk of developing respiratory diseases. Alcohol and substance misuse is
equally high among the youth. Young people are also less likely to adopt healthy eating which
results to the poor management of chronic diseases at individual level.
Local Health Care Environment and Capacity
Low income earners in this region are slightly more compare to the state number. There
is a permanent exposure to industrial fumes given that Sarnia has its foundation on industry. The
shortage of registered nurses and resource allocation which targets the individual rather than the
community means that respiratory complications remain a going concern.
Unmet Need for Health Care Services
A review of Sarnia’s performance compare to that of Ontario indicates that, as one of the
largest areas in terms of population, there is need for proper planning to comprehensively
COMMUNITY HEALTH ASSESSMENT PROJECT
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address the risk that exposure to industrial fumes leads the population. Sarnia’s population is at a
constant risk of respiratory diseases and cancer which has not been appropriately addressed.
References
Bergstra, A. D., Brunekreef, B., & Burdorf, A. (2018). The mediating role of risk perception in
COMMUNITY HEALTH ASSESSMENT PROJECT
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the association between industry-related air pollution and health. PloS one, 13(5),
e0196783.
Crouse, D. L., Peters, P. A., Villeneuve, P. J., Proux, M. O., Shin, H. H., Goldberg, M. S., ... &
Jerrett, M. (2015). Within-and between-city contrasts in nitrogen dioxide and mortality in
10 Canadian cities; a subset of the Canadian Census Health and Environment Cohort
(CanCHEC). Journal of Exposure Science and Environmental Epidemiology, 25(5), 482.
Weichenthal, S. A., Lavigne, E., Evans, G. J., Godri Pollitt, K. J., & Burnett, R. T. (2016). Fine
particulate matter and emergency room visits for respiratory illness. Effect modification
by oxidative potential. American journal of respiratory and critical care
medicine, 194(5), 577-586.
Andersen et al. BMC Psychology (2015) 3:35
DOI 10.1186/s40359-015-0092-1
RESEARCH ARTICLE
Open Access
Bullied at school, bullied at work: a
prospective study
Lars Peter Andersen1*, Merete Labriola2,3, Johan Hviid Andersen1, Thomas Lund1,3 and Claus D. Hansen4
Abstract
Background: The consequences of childhood bullying victimisation are serious. Much previous research on risk factors
for being bullied has used a cross-sectional design, impeding the possibility to draw conclusions on causality, and has
not considered simultaneous effects of multiple risk factors. Paying closer attention to multiple risk factors for being
bullying can provide a basis for designing intervention programmes to prevent or reduce bullying among children
and adolescents.
Methods: Risk factors for bullying were examined by using questionnaire data collected in 2004 and 2007. In 2004,
the participants were aged 14–15 years and 17–18 years in 2007. The baseline questionnaire was answered by 3054
individuals in 2004, and 2181 individuals participated in both rounds. We analysed risk factors for being bullied at the
individual and societal level. Information on the social background of the participants was derived from a national
register at Statistics Denmark.
Results: Several risk factors were identified. Being obese, low self-assessed position in school class, overprotective
parents, low self-esteem, low sense of coherence and low socioeconomic status were risk factors for being bullied at
school. Being overweight, smoking, low self-assessed position in class, low sense of coherence and low socioeconomic
status were risk factors for being bullied at work. However, most associations between risk factors in 2004 and being
bullied in 2007 disappeared after adjustment for being bullied in 2004.
Conclusions: The strongest risk factor for being bullied was being previously bullied. Our results stress the importance
of early prevention of bullying at schools. In addition, attention should be drawn to the role of overprotective parents.
Keywords: Adolescents, Bullying at school, Bullying at work, Risk factors, Prospective study
Background
Bullying has been conceptualised as a distinct type of
aggression characterised by a multifaceted form of
mistreatment seen mostly at schools and at work. The
most widely employed definition of bullying emphasises
persistent and repeated negative actions intended to intimidate or hurt a weaker person. Bullying includes acts
of deliberate physical aggression (e.g. knocks, punches
and kicks), verbal aggression (e.g. name calling and
threats), relational aggression (e.g. social isolation and
rumour spreading) and cyber aggression (e.g. text messaging and e-mailing hurtful messages or pictures) [1].
The negative interaction must occur relatively often
* Correspondence: laande@rm.dk
1
Danish Ramazzini Centre, Department of Occupational Medicine, University
Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400
Herning, Denmark
Full list of author information is available at the end of the article
(roughly on a weekly basis) and over a prolonged period
of time (often 6 months) [2]. Given the seriousness of
bullying, prevention of childhood and adolescent bullying has long been considered an important social and
clinical problem.
The prevalence of bullying
The prevalence of bullying among adolescents varies
across countries. In two large cross-national studies –
The Health Behavior in School-aged Children Survey
and the Global School-based Students Health Survey –
totalling 218,104 students in 66 countries aged between
11 and 15 years, the average prevalence of bullying
victimisation at least once during the past month was
32.1 % in the first study, and in second study, 37.4 % of
participants reported that they had been bullied at least
once within the past 2 months. However, in both studies,
© 2015 Andersen et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Andersen et al. BMC Psychology (2015) 3:35
a large variation in prevalence was found across countries, from 6 to 41 % in the first study and from 9 to 54
% in the second [3]. In spite of large differences in the
prevalence of bullying, the results indicate that too many
pupils suffer from being victims of aggressive acts
intended to hurt them.
The consequences of being bullied
The consequences of childhood bullying victimization
are serious. Both cross-sectional and longitudinal studies
have found that being a victim of bullying is associated
with long-term psychological problems, including loneliness, general and social anxiety, diminished self-esteem,
increased depressive symptoms and more frequent use
of pain medication [4–6]. Finally, being a victim of bullying is an important risk factor for suicidal behaviour in
adolescence and early adulthood [7, 8]. A review based
on 37 studies found that any kind of participation in
bullying increased the risk of suicidal ideation and/or behaviour. The strongest risk was for victim-perpetrators
[7]. However, bullies also suffer because severe suicidal
ideation has been found among both those who were
bullied and among those who were bullies [9].
Not surprisingly, many antibullying programmes and
interventions have been implemented in an attempt to
reduce the prevalence of being bullied. Unfortunately, the
success of intervention programmes to prevent or mitigate
bullying in childhood and adolescence has been limited. A
synthesis of the existing research on antibullying programmes concluded that the majority of programmes
yielded no significant reductions in self-reported bullying,
and therefore only cautious recommendations could be
made [9].
Theoretical frame of reference
Given the limited efficacy of bullying intervention programmes, the purpose of the present study was to more
closely investigate multiple risk factors for bullying.
Identifying risk factors can provide a basis for designing
intervention programmes to prevent or reduce bullying
among children and adolescents.
Studies on bullying at schools have identified several
risk factors such as gender, age and deviate appearance
of the victim; personal characteristics such as low selfesteem and lack of adequate coping skills; social status
among peers and socioeconomic status in society. However, bullying is a complex phenomenon, and there is no
single explanation for why some children are bullied by
others [10]. Furthermore, bullying is conceptualised as a
distinct type of aggressive behaviour, and psychological
theories of aggression assert that the occurrence of aggression can seldom be reduced to one single factor but
is more likely to be influenced by several factors simultaneously [11]. Aggressions, like other forms of complex
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behaviour, stem from the interplay of a wide range of
personal, situational and social factors. Therefore, aggressive behaviour such as bullying occurs as a result of
interactions between the persons involved and factors in
the social context that may either facilitate or mitigate
the risk of such behaviour [12, 13]. Although a detailed
discussion of the causes of aggression is beyond the
scope of this paper, it is important to underline the
complexity of the task of identifying risk factors that
are relevant in understanding bullying at schools and
workplaces.
Several risk factors for being bullying at schools have
been identified (for a review see [1]), but most studies
identifying risk factors for bullying have included only a
limited number of risk factors in their statistical models.
All the risk variables may be correlated with each other,
but some may be more important than others in predicting bullying. Therefore, the present study will simultaneously examine several different risk factors in young
people related to their individual and personal levels, social levels and socioeconomic levels in order to identify
the most important risk factors for bullying at schools
and workplaces. This knowledge may be important in
order to prevent bullying.
Preventing bullying may be good for the bullied as well
as for the bullies in term of the negative psychological
outcomes for both parties.
Risk factors for bullying
Potential risk factors for bullying at the individual level
include gender, age, physical appearance and health behaviour. Regarding gender, the results are inconsistent,
and no substantial gender differences have been observed among adolescents in terms of the frequency of
being bullied either at school or at work [14]. With respect to age, results from both cross-sectional and longitudinal studies on bullying at schools show that the
prevalence of bullying tends to fall with age during adolescence [15–17].
When teens are asked why some adolescents are
bullied, a common response is the deviant appearance
of the victim [18]. Overweight and obesity have been
found to be associated with an increased risk of being
bullied in both cross-sectional studies and cohort
studies [19–22]. Also, bullying has been found to be
related to underweight in adolescents [23], and even
short pupils are at greater risk of being bullied [24].
Apparently, any deviance from the physical norm may
increase the risk of being bullied. Being a smoker also
has been found to increase the risk of being bullied, but
the results of studies on the relation between smoking and
bullying are inconsistent [25–27].
At the personal level, self-esteem has been found to be
associated with bullying [28]. Self-esteem refers to the
Andersen et al. BMC Psychology (2015) 3:35
global and evaluative view of oneself, and low selfesteem is associated with a variety of psychological dysfunctions, whereas high self-esteem is associated with
social adeptness, leadership, higher levels of adjustment
and good social skills. Therefore, because of poor social
skills and low levels of adjustment, it seems plausible
that low self-esteem may be a risk factor for being bullying. It is, however, unclear whether low self-esteem is a
risk factor for bullying or a consequence of being bullied
[29–31]. For instance, among 2326 Italian adolescents,
Brighi et al. [30] found that low global self-esteem was a
risk factor for victimisation, but on the other hand, another study found that victimisation was the most consistent predictor of low self-esteem [31]. Thus, it is unclear
whether low self-esteem is a risk factor for or a consequence of being bullied. Furthermore, most studies are
cross-sectional in design, making causal interpretations
difficult. In this study, self-esteem was conceptualised as a
risk factor, because it is considered to be a general internal
presentation of social acceptance and rejection and a
measure of social functioning. Thus, low self-esteem could
be a risk factor for being a target of bullying.
Studies have demonstrated associations between an increased risk of being bullied and conflicts with parents
and being from a family characterised by a punitive,
conflicting and nonsupportive parenting style [10, 32].
Additionally, victims’ homes have been found to be characterised by a higher level of criticism and fewer rules
[33] and having authoritative parents who rarely value
their children and tend not to give them the opportunity
to speak up for themselves [34]. Overly protective
parenting style could be a risk factor for bullying as well
because parents who are overly protective of their
children and do not let them handle conflicts with peers
by themselves may contribute to the causation of bullying [35, 36]. However, the causal direction is unclear
because of the cross-sectional design of these studies,
and protective parenting could also be an outcome of
bullying.
One consequence of inadequate parenting style or
poor family functioning may be children’s insufficient
coping strategies. For instance, a study found a clear relation between perceived parenting practices and coping
in offspring [37]. These researchers found that parenting
characterised by warmth and acceptance involved both a
high degree of parental monitoring but also parental
demands for age-appropriate behaviour. Thus, the child
may learn that events are to some degree controllable.
The result of the study was that the children of parents
using an accepting and warm parenting style more often
used problem-focused coping strategies than did children
who reported that their parents used other rearing styles.
Therefore, one of the consequences of inadequate parenting style or poor family functioning may be inadequate
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coping skills and lack of social skills needed in order
to resolve conflicts in the peer group or with work
colleagues due to lack of experience with conflict
resolution in the family. Based on this background,
we sought to examine whether poor family functioning and overprotective parents predict bullying later
at school or work.
The associations between bullying and coping have
been examined in several studies, and the results show
that victims of bullying lack adaptive coping strategies
and more often use avoidant coping or similar strategies
that might be considered similar [10, 38, 39]. For instance, one study found that victims of bullying rarely
asked for help or talked about what happened, but
instead remained passive [40]. Another study found a
positive association between emotionally oriented coping
strategies and victimisation [10]. Thus, it seems relevant
to study the association between coping and bullying.
Regarding coping strategies, it is important to include
the victims’ appraisal of the bullying situation because
appraisals, according to the transactional theory of
stress, determine the coping response, and thus victims’
perceptions of control become important for the implementation of coping strategies [41].
The concept of sense of coherence brings the perception of control and manageability into consideration.
The concept refers to the individual’s perception of comprehensibility, meaningfulness and manageability, the
last referring to expectations about the availability of
adequate resources to cope with stressors. Sense of
coherence affects how individuals perceive the events
that happen to them, as well as the extent to which they
perceive these events as controllable. Persons with a
strong sense of coherence are described as more resistant to stress and able to cope adaptively [42], and studies
have found a direct effect of sense of coherence on stress
[43]. One study found that strong sense of coherence
offered protective benefits to targets exposed to bullying
[44], and another study found that employees with a low
sense of coherence more often were subjected to
violence [45]. In the present study, we analysed whether
a low sense of coherence is a risk factor for bullying.
In regard to the social context, bullying is related to
social status in the group. Indicators of status are social
preference, popularity, school performance and socioeconomic status. Research has found that low levels of
social preference and low levels of perceived popularity
are associated with an increased risk of being bullied
[46, 47]. However, the cross-sectional nature of the studies
cannot exclude the possibility that low social status may be
an outcome and not a precursor of bullying, and therefore
more longitudinal studies are needed. Furthermore, a
meta-analysis concluded that bullied pupils were more
likely to achieve lower grades than nonbullied pupils. Low
Andersen et al. BMC Psychology (2015) 3:35
grades may reflect interpersonal and social difficulties
that may increase the risk of bullying. However, the
cross-sectional nature of the studies cannot exclude
that bullying may lead to mental distress, which could
affect school performance [48]. Although the negative
relation between victimisation and academic performance is significant, there are few longitudinal studies
on this topic. Thus, it is unclear whether victimisation can be conceptualised as a risk factor or an outcome of poor academic performance. In the present
study, low social status and low school performance
were conceptualised as risk factors for bullying; even
though some longitudinal studies have shown that being a victim of bullying predicts later academic difficulties, there are only limited results supporting this
notion [49].
Finally, the socioeconomic status in society is also related to bullying, and research has revealed that exposure to bullying is patterned by socioeconomic status
because adolescents from lower socioeconomic status
families are at higher risk of being bullied [50–53]
One explanation could be that inequalities in society
may lead to more widespread approval of behaviours associated with social status differences such as bullying
[54]. Furthermore, growing up in a low social status
family might be associated with more stress in the form
of unemployment, divorce, illness and moving, which
might affect children’s adaptive skills [55], again possibly
increasing the risk of being bullied.
Stability of victimisation from bullying at school and
at work
Given the negative consequences of bullying, it is important to examine the continuance continued risk of
being bullied. In other words, is being bullied once a risk
factor in itself for later victimisation?
Relatively little attention has been given to the effect of being bullied once on later victimisation, and
the few studies that have examined the stability of
victimisation from bullying during adolescence have
found the risk of being bullied to be relatively stable.
For instance, it was found that being a victim of
bullying at age 8 was associated with victimisation 8
years later [8, 16]. So far only a few studies have
differentiated between victimisation that continues
from primary school to secondary school and from
primary school to the workplace. Both at school and
at work, environmental and organisational factors can
be sources of bullying, so the stability of victimisation
from primary school to the workplace would not
necessarily be expected because environmental and
organisational factors change. In spite of this, researchers have found that the highest risk factor for
being bullied in the workplace was being a bully
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victim at school [56]. This relationship was seen for
both males and females. Furthermore, another study
found that victims who are bullied at school report
being bullied at work somewhat more often than do
others [57]. These results indicate that factors of
continuity in the risk of victimisation could be more
related to individual attributes such as low selfesteem, personality, lack of sufficient coping strategies and poor ability to establish protective social
relationships than to environmental and organisational factors. While both studies were retrospective
in design, which could have resulted in recall bias,
the results indicate that being bullied once may be
an important risk factor for being bullied later. In
spite of the expansion of research on bullying victimisation, few studies have investigated possible
links between individuals’ experience of previous victimisation at school and later victimisation at work
or secondary school [58].
Present study
Research has revealed several different risk factors for
being bullied at school.
Using data from a prospective cohort study of young
people from the western part of Denmark, this study
examines several risk factors for being bullied at 17–18
years of age, making it possible to test the independent
contribution of each risk factor after adjustment for
covariates in the same domain.
The purpose of the present study was to identify risk
factors measured at age 14–15 for being bullied at age
17–18 at either work or school. Additionally, the study
examines the associations between victimisation at the
age of 14–15 years and victimisation later at the age of
17–18 years at a site of higher education or at work.
More specifically, the purposes of the study were as
follows:
1. To examine the prevalence of being bullied at age 15
and at age 18 at work and at school
2. To identity the most important risk factors for being
bullied at age 18, including the following:
a. Individual risk factors: gender, body mass index,
smoking, previously being bullied at age 15
b. Personal risk factors: self-esteem and sense of
coherence at age 15
c. Social risk factors: parental relations and family
function at age 15
d. Coping strategies: avoidance strategies and
support seeking at age 15
e. Indicators of social status: social position in peer
group and social position in society at age 15
3. To examine the continuity of being bullied from
age 15 to age 18
Andersen et al. BMC Psychology (2015) 3:35
Methods
The data used in this study stem from the ongoing West
Jutland Cohort Study (Vestliv), a birth cohort study
following a complete regional cohort of adolescents born
in 1989 in the county of Ringkoebing in the western part
of Denmark. The cohort comprised 3681 individuals
born in 1989, of which 3054 (83 %) answered the baseline questionnaire in 2004. Those who had not opted
out of the study (N = 3293) were sent the second-round
questionnaire in 2007, and 2400 (73 %) answered the
questionnaire. In all, 2181 individuals participated in
both rounds (59 % of the original cohort). These 2181
individuals constitute the primary study base, although
some of the analyses were carried out on data collected
in only one of the two rounds due to differences in the
available variables.
The study gathered comprehensive information on the
occurrence, severity and impact of manifold symptoms
of physical and mental health problems, both selfreported and register-based [55]. In addition, information on exposures at school and at home was gathered.
Finally, information on parental socioeconomic status
was derived from national registers and linked to the
questionnaire data.
Information on the social background of the participants (e.g. household income, parents’ highest education
etc.) was derived from a national register at Statistics
Denmark by using information from the Central Office
of Civil Registration, in which the respondents are linked
to their legal parents or guardians via a personal identification number given to everyone in Denmark at birth
(or upon entry for immigrants). The study and the linking
of information using the Central Office of Civil Registration were approved by the Danish Data Protection Agency
(Study No. 2009-41-3761). The study was approved by the
Danish Data Protection Agency and followed the regulations for data storage and protection
Page 5 of 15
and had a job, 348 were trainees and 125 had an ordinary
job. Both questions on bullying in 2007 were recorded in
the same way as the 2004 variable.
Health-related lifestyle
Two indicators of health-related lifestyle, smoking and
Body Mass Index were included as possible risk factors
for being bullied. Daily smoking and overweight/obesity
(defined according to the Body Mass Index-for-age
values defined by World Health Organisation at age 15)
were included in the analyses as indicators of unhealthy
lifestyle that may be stigmatising and thus lead to a
higher risk of being bullied.
Indicators of status
Two traditional measures of parental socioeconomic
status were derived from information about the participants’ parents from national registers on income and
education in 2003 (i.e. the year before baseline data was
collected). Household income and highest attained educational level in the household were used as measures of
socioeconomic status. If the participants’ parents were
divorced, information on the household in which the
participants had their place of residence according to
the Central Personal Register was used. Information on
income was taken from the tax register (recoded into
tertiles for some of the analyses), and information on
educational attainment was taken from the Danish
Educational Register and recoded into three categories:
compulsory school (12 years).
Another mechanism hypothesised to be responsible
for bullying is differences in the social position of adolescents in their peer groups foremost in their school
class. In this study, The MacArthur Scale of Subjective
Social Status – Youth Version was used [59].
Outcome measures
Parental relations
Bullying was measured using three single items. In 2004,
the respondents were asked “How much have you been
bullied at school during the last 6 months?” with the
response categories “Never”, “Once or twice”, “A few
times”, “Once a week” and “Several times a week”. For
use in the analyses, this variable was recorded as “has
ever been bullied” and “has not been bullied at all”. In
2007, two single measures were used with slightly different wording. The respondents were asked: “How much
have you been bullied in an unpleasant way at school
during the last 6 months?” with the same response
categories as in 2004. In addition, the question was
asked about bullying at work for the respondents who
had a job at the time of the baseline questionnaire. 478
of those studied did not have a job, 1305 were at school
Parent overprotection was measured using four items
from the short version of the Parental Bonding Instrument [60] (Cronbach’s alpha = 0.69). Another aspect of
parental relations is summed up in the Family Functioning Index, which taps into how well conflicts are resolved in the family. Family functioning was measured
using 12 items from the Family Assessment Device –
General Functioning scale (FAD-GF) [61]. (Cronbach’s
alpha = 0.86). Both indicators of parental relations were
dichotomised for the multivariate analyses using the
median as cut-off point.
Personal psychological characteristics
Two different aspects of the adolescents’ personal
characteristics were included in the analyses. First of all,
Andersen et al. BMC Psychology (2015) 3:35
Page 6 of 15
self-esteem – measured by the 6-item version of Rosenberg’s global self-esteem scale [62] – was included
(Cronbach’s alpha = 0.82). Secondly, the four items tapping into the meaningfulness dimension of Antonovsky’s
construct SOS were also included [42] (Cronbach’s
alpha = 0.62). One could argue that the measure of internal consistency was a little low. However, comparing our results with those of other translations, the
consistency actually appeared to be somewhat higher
in our sample [63]. Coping was measured using two
scales based on the Brief COPE Scale used in a previous paper based on data from this cohort [55]. The original subscales were divided into two coping dimensions
that emphasised either an “active” approach to problem
solving, generally considered to be more adaptive, or
“avoidance”-based approach, considered to be less adaptive. The six items from the subscales “active coping”,
“planning” and “positive reframing” were combined to
form the “active” coping scale (Cronbach’s alpha = 0.75),
and the four items from the subscales “self-distraction”
and “behavioural disengagement” were used to form the
“avoidance” coping scale (Cronbach’s alpha = 0.53). Once
again, one could argue that the measure of internal
consistency was a little low, but our sample’s consistency
appeared to be higher than that of other translations.
Cronbach’s alphas for the coping subscales were similar to
the alpha values reported by Carver, supporting the reliability of our measures despite the somewhat low alpha
coefficients. Both scales were created using the mean of
the items, thus yielding two scales with scores between 1
and 4, with higher scores indicating higher levels of that
type of coping. All four measures of psychological characteristics were dichotomised for use in the multivariate analyses using the median as cut-off value.
Statistical analyses
Table 1 shows all the characteristics of the study sample.
Multiple logistic regression models were used to study
the association between bullying and the two dependent
variables. For use in the logistic regression models, all of
the scales were dichotomised using the median score as
the cut-off point, e.g. creating a variable coded 1 if the
respondent had levels of self-esteem below the median.
Four models were tested. The bivariate association was
calculated between each of the independent variables
and bullying (Model 1). After this procedure, the
Table 1 Characteristics of study population of children at age 15 years. N = 2,278
Variable name
Categories
N
Pct/mean (SD)
Gender
Female
1,237
54.3
Male
1,041
45.7
Severe thinness
57
2.9
Lifestyle factors
Body Mass Index for age
Smoking habits
Normal weight
1,640
83.0
Overweight
216
10.9
Obese
62
3.1
Not smoker smoke
1,857
89.3
Daily smoker
222
10.7
Indicators of status
School performance
Mean (SD). scale; 0-13
8.99
1.17
Self-assessed position in school class
Mean (SD). scale;1-10
7.08
1.72
Parental educational level
13
852
37.4
Mean (SD)
2,276
573,574 (250,511)
Overprotective parents
Mean (SD) scale; 4-16
8.10
2.63
Family functioning
Mean (SD), scale;1-4
1.72
0.50
Self-esteem
Mean (SD) scale: 6-24
19.08
2.90
Sense of Coherence (Meaningfulness)
Mean (SD) scale: 5-20
14.37
2.14
Active coping
Mean (SD) scale: 1-4
2.65
0.52
Avoidance coping
Mean (SD) scale: 1–3.5
1.94
0.47
Household income, DKR
Social relations with parents
Personal psychological characteristics
Andersen et al. BMC Psychology (2015) 3:35
Page 7 of 15
Table 2 Prevalence of bullying at school and at work at ages 15 and 18
Variable
Level
N
Pct
Bullied at school during last 6 months (age 14–15)
Not bullied
2,255
74.6
Bullied
766
25.4
Frequently bullieda
76
9.9
Bullied in an unpleasant way at school during last 6 months (age 17–18)
Bullied in an unpleasant way at work during last 6 months (age 17–18)
Not bullied
1,843
87.8
Bullied
256
12.2
Frequently bullieda
12
Not bullied
1,535
4.7
91.4
Bullied
144
8.6
Frequently bullieda
8
5.5
a
Frequently bullied = Bullied at least once a week/Ever bullied
independent variables were entered into models by the
abovementioned themes to test the independent contribution of each of the variables after taking into account
other aspects of the same processes (Model 2). Bullying
experience in 2004 was entered into the domain-specific
models (Model 3). Last, a final model in which stepwise forward selection was used to reduce the number of independent variables was created (Model 4).
The Hosmer-Lemeshow goodness-of-fit was used to
evaluate the quality of the models [64]. All in all, the
sample used for the multivariate analyses consisted of
1853 and 1376 respondents being bullied at school
and at work, respectively; participants were excluded
on a model-based basis, so the number of participants in
each model varied according to the number of missing
data elements on any of the variables. The analyses were
performed using STATA 13 (Stata Statistical Software:
Release 13. College Station, TX, USA: StataCorp LP).
Results
Table 2 shows the prevalence of being bullied at age
14–15 at school and age 17–18 at school and at work.
Due to changes in the wording of the question, it was not
possible to compare the prevalence across years. At age
17–18, it appeared that bullying was more prevalent in the
school context than at the adolescents’ workplaces. A very
low number of individuals were exposed to weekly
bullying behaviour; less than 10 % of those reporting
any bullying were bullied weekly or more often.
In Table 3, the association between bullying at age
14–15 and bullying in either setting at age 17–18 is
shown. The risk of experiencing bullying at school at
age 17–18 was approximately twice as high for those
who were bullied at school at age 14–15. The association was somewhat stronger for bullying at work.
Nearly 45 % of those who experienced bullying at
school at age 14–15 also experienced bullying in their
higher educational track at age 17–18 or at work 3
years later.
Table 4 displays risk factors for bullying experiences at
school at age 17–18. Only three variables remained statistically significantly associated with bullying after mutually adjusting for each other and for being bullied at
age 14–15. First of all, having been bullied at school at
age 14–15 raises the risk of experiencing being bullying
3 years later by factor of 3 even when after taking other
possible factors into account. Secondly, having a parent
with a parenting style more overprotective than the
median also raised the risk of being bullied. For those
scoring in the highest decile on the scale, the risk of being bullied was more than twice as high as it is for those
having the least overprotective parents. Many of the
included variables were bivariately associated with bullying, e.g. Body Mass Index and measures of social position in the school class attended at age 14–15. These
associations were diluted and largely disappeared after
mutually adjusting for all the variables used, as well as
after entering the variable indicating whether the respondents had experienced bullying at age 14–15.
Finally, Table 5 shows the associations between the
independent variables and experiencing bullying at the
workplace at age 17–18. The strongest association
Table 3 Association between bullying at age 15 and bullying at age 18. Percentages and prevalence proportion ratios (PPRs) with
95 % confidence intervals
Proportion bullied at school (age 18)
Proportion bullied at work (age 18)
N (Pct)
PPR (95 % CI)
N/Pct
PPR
Not bullied at school age 15
69 (6.0 %)
1 (ref)
123 (8.5 %)
1 (ref)
Bullied at school at age 15
56 (15.1 %)
1.99 (1.56-2.54)
107 (23.4 %)
2.23 (1.86-2.67)
Andersen et al. BMC Psychology (2015) 3:35
Page 8 of 15
Table 4 Associations between and lifestyle, personal characteristics, peer group and parental relations at age 15 and being bullied
at school age 18. Odds ratios (OR) obtained by logistic regression with 95 % confidence intervals
Model 1
Bivariate
Model 2a Adjusted
for covariates in
same domain
Model 3a Adjusted for
covariates in same
domain and bullying
Model 4** Forward
stepwise selection
OR (95% CI)
OR (95 % CI)
OR (95 % CI)
OR (95 % CI)
1.00
1.00
1.00
1.36 (1.04-1.76)
1.37 (1.04-1.82)
1.40 (1.04-1.89)
1.18 (0.53-2.65)
1.17 (0.51-2.68)
removed
Gender
Girls
Ref
Boys
Lifestyle factors
Body Mass Index
Underweight
Normal weight
1.18 (0.53-2.66)
1.00
1.00
1.00
Overweight
Ref
1.35 (0.88-2.06)
1.35 (0.89-2.07)
1.22 (0.79-1.89)
Obesity
2.27 (1.17-4.41)
2.37 (1.17-4.40)
1.68 (0.85-3.33)
Smoking
Does not smoke
Ref
Smoke
1.00
1.00
1.00
1.14 (0.73-1.77)
0.98 (0.46-2.08)
0.95 (0.44-2.06)
removed
Social position in peer group
School performance
School performance above median
Ref.
School performance below median
1.00
1.00
1.00
1.26 (0.95-1.67)
1.06 (0.78-1.43)
1.04 (0.76-1.42)
1.00
1.00
1.00
1.49 (1.12-1.99)
1.46 (1.08-1.98)
1.18 (0.86-1.62)
removed
Self-assessed position in schoolat school class
Self-assessed position in school at school
class above median
removed
Ref.
Self-assessed position in school at school
class below median
Parental relations
Over-protection
Parents less over-protective than median
Ref.
Parents more over-protective than median
1.00
1.00
1.00
1.00
1.70 (1.29-2.25)
1.52 (1.12-2.06)
1.41 (1.03-1.92)
1.46 (1.08-1.95)
1.00
1.00
1.00
removed
1.51 (1.13-2.01)
1.25 (0.92-1.70)
1.14 (0.83-1.56)
1.00
1.00
1.00
1.00
1.66 (1.23-2.22)
1.51 (1.10-2.06)
1.33 (0.97-1.84)
1.41 (1.03-1.94)
removed
Family Functioning
Family functioning above median
Ref.
Family Functioning below median
Personal psychological characteristics
Self-esteem
Self-esteem above median
Ref.
Self-esteem below median
Sense of coherence (meaningfulness)
Sense of coherence above median
Ref.
1.00
1.00
1.00
1.55 (1.17-2.05)
1.38 (1.02-1.87)
1.25 (0.92-1.70)
Active coping above median
1.00
1.00
1.00
Active coping below median
1.17 (0.88-1.55)
0.95 (0.70-1.29)
0.94 (0.69-1.28)
1.00
1.00
1.00
1.39 (1.04-1.84)
1.27 (0.95-1.71)
1.20 (0.89-1.63)
Sense of coherence below median
Active coping
removed
Avoidance coping
Avoidance coping below median
Avoidance coping above median
Socioeconomic status
Ref.
removed
Andersen et al. BMC Psychology (2015) 3:35
Page 9 of 15
Table 4 Associations between and lifestyle, personal characteristics, peer group and parental relations at age 15 and being bullied
at school age 18. Odds ratios (OR) obtained by logistic regression with 95 % confidence intervals (Continued)
Household income 2003
removed
Lowest tertile
1.45 (1.03-2.03)
1.32 (0.92-1.89)
1.18 (0.80-1.74)
Middle tertile
1.40 (1.03-1.90)
1.38 (1.01-1.90)
1.25 (0.90-1.76)
1.00
1.00
1.00
Highest tertile
Ref
Household highest attained
education 2003
removed
13 years
Ref
1.47 (0.94-2.29)
1.50 (0.92-2.43)
1.03 (0.77-1.37)
0.95 (0.71-1.28)
0.93 (0.68-1.27)
1.00
1.00
1.00
Being bullied at age 14–15
Not being bullied at age 14–15
Ref
1.00
1.00
Being bullied at age 14–15
3.14 (2.34-4.23)
Hosmer-Lemeshow Goodness-of-fit
Chi-square 23.44 = 0.02)
2
Nagelkerke Pseudo R
0.06
a
Adjusted for other factors in the same domain
**Adjusted for all variables with a p-value < 0.20
observed for bullying at work was gender; boys had a
more than twofold higher risk of experiencing bullying
in the adjusted analysis. Having experienced bullying at
school at age 14–15 raised the risk of being bullied at
work, and this was also seen for bullying at secondary
school. The association, however, was somewhat lower
than the association between bullying at primary and
secondary school. Parental relations also predict experiencing bullying: having more troublesome relationships
with parents characterised by conflict and lack of communication raised the risk of bullying at work. And finally, scoring below the median on the meaningfulness
dimension of the sense of coherence scale increased
the risk of being bullied at work even after taking
into account the experience of bullying at age 14–15.
As was the case with the risk factors for bullying in
school, several variables were bivariately associated
with experiencing bullying at work at age 17–18. The
effects of Body Mass Index, daily smoking and
measures of social position in the peer group were all
diluted after mutually adjusted for each other and for
the experience of bullying at age 14–15. There was
still, however, a slightly elevated risk for obese adolescents to experience bullying at work, even if the
estimate was somewhat fragile.
Discussion
The first purpose of the present study was to examine the
prevalence of being bullied at age 14–15 and age 17–18 at
work and school. We found that that nearly 10 % of the
participants reported being frequently bullied at age
14–15 during the last 6 months. This is in line with
other studies. At age 17–18, the prevalence had decreased,
with 4.7 % being frequently bullied at school and 5.5 %
being bullied at work. This is also in accordance with previous studies, which have documented a decrease in the
frequency of bullying during school life [15, 17]. Furthermore, at age 17–18 bullying was more frequent at work
than at school.
The wording of the questions in 2007 was somewhat
stricter, which meant that it was not possible to directly
compare the prevalence of bullying at school between
the two rounds.
The second purpose of the study was to identify the
most important risk factors for being bullied at age 18,
including risk factors at several levels. As mentioned
earlier, aggressive behaviour such as bullying stems
from the interplay of a wide range of personal, situational and social factors. In model 2, in which we
mutually adjusted for other risk factors, we found
that obesity, low self-assessed position in school class,
overprotective parents, low self-esteem, low sense of
coherence and middle socioeconomic status were all
significant risk factors for being bullied 3 years later
at school. In this same model (model 2), nearly identical risk factors (plus being a smoker) were identified
at work. The results underline that bullying acts
occur as a result of complex interactions between the
persons involved and factors in the social context [12,
13], and furthermore, the results indicate somewhat
similar risk factors for bullying across organisational
settings (i.e. school and workplace).
In the next section, we will discuss the most important
risk factors.
We found that physical appearance was a risk factor
for being bullied both in school and at work. Obesity
Andersen et al. BMC Psychology (2015) 3:35
Page 10 of 15
Table 5 Associations between and lifestyle, personal characteristics, peer group and parental relations at age 15 and being bullied
at work age 18. Odds ratios (OR) obtained by logistic regression with 95 % confidence intervals
Model 1 Bivariate
Model 2aAdjusted
for covariates in
same domain
Model 3aAdjusted
for covariates in same
domain and bullying
Model 4** Forward
stepwise selection
OR (95 % CI)
OR (95 % CI)
OR (95 % CI)
OR (95 % CI)
1.00
1.00
1.00
2.39 (1.68-3.41)
2.11 (1.44-3.09)
2.23 (1.48-3.35)
0.95 (0.28-3.23)
0.84 (0.24-2.95)
Gender
Girls
Ref
Boys
Lifestyle factors
Body Mass Index
Underweight
Normal weight
1.05 (0.32-3.47)
Ref
1.07 (0.32-3.55)
1.00
1.00
1.00
1.00
Overweight
1.95 (1.17-3.23)
1.94 (1.17-3.23)
1.84 (1.10-3.09)
1.77 (1.04-3.02)
Obesity
2.04 (0.84-4.96)
2.14 (0.88-5.22)
1.76 (0.71-4.35)
1.43 (0.56-3.64)
Smoking
Does not smoke
Ref
Smoke
1.00
1.00
1.00
1.00
1.98 (1.02-3.85)
2.16 (1.10-4.24)
2.23 (1.12-4.43)
1.97 (0.94-4.11)
removed
Social position in peer group
School performance
School performance above median
Ref.
School performance below median
1.00
1.00
1.00
1.33 (0.91-1.94)
1.11 (0.74-1.68)
1.08 (0.71-1.64)
1.00
1.00
1.00
1.84 (1.24-2.73)
1.78 (1.18-2.68)
1.49 (0.98-2.26)
1.00
1.00
1.00
1.40 (0.97-2.02)
1.11 (0.75-1.64)
1.03 (0.69-1.54)
1.00
1.00
1.00
removed
2.03 (1.37-3.01)
1.95 (1.29-2.95)
1.87 (1.23-2.85)
1.69 (1.10-2.59)
1.00
1.00
1.00
1.00
1.65 (1.11-2.45)
1.37 (0.90-2.10)
1.29 (0.84-2.00)
1.60 (1.03-2.49)
1.00
1.00
1.00
removed
1.99 (1.36-2.91)
1.70 (1.13-2.57)
1.56 (1.03-2.37)
1.00
1.00
1.00
1.40 (0.96-2.05)
1.13 (0.75-1.71)
1.09 (0.72-1.64)
1.00
1.00
1.00
1.32 (0.90-1.92)
1.17 (0.79-1.74)
1.14 (0.76-1.69)
Self-assessed position in school class
Self-assessed position in school class
above median
removed
Ref.
Self-assessed position in school class
below median
Parental relations
Over-protection
Parents less over-protective than median
Ref.
Parents more over-protective than median
removed
Family Functioning
Family functioning above median
Ref.
Family Functioning below median
Personal psychological characteristics
Self-esteem
Self-esteem above median
Ref.
Self-esteem below median
Sense of coherence (meaningfulness)
Sense of coherence above median
Ref.
Sense of coherence below median
Active coping
Active coping above median
Ref.
Active coping below median
removed
Avoidance coping
Avoidance coping below median
Avoidance coping above median
Socioeconomic status
Ref.
removed
Andersen et al. BMC Psychology (2015) 3:35
Page 11 of 15
Table 5 Associations between and lifestyle, personal characteristics, peer group and parental relations at age 15 and being bullied
at work age 18. Odds ratios (OR) obtained by logistic regression with 95 % confidence intervals (Continued)
Household income 2003
Lowest tertile
2.06 (1.29-3.28)
1.89 (1.15-3.11)
1.64 (0.96-2.80)
1.54 (0.89-2.67)
Middle tertile
2.17 (1.41-3.33)
2.16 (1.39-3.36)
1.95 (1.22-3.10)
2.10 (1.30-3.39)
1.00
1.00
1.00
Highest tertile
Ref.
Household highest attained
education 2003
13 years
1.00
removed
Ref.
1.83 (1.07-3.11)
1.44 (0.81-2.55)
1.39 (0.73-2.65)
1.13 (0.77-1.66)
0.94 (0.63-1.40)
1.01 (0.66-1.55)
1.00
1.00
1.00
Being bullied at age 14–15
Not being bullied at age 14–15
1.00
Being bullied at age 14–15
2.09 (1.39-3.14)
Hosmer-Lemeshow Goodness-of-fit
Chi-square 166.26 = 0.48)
2
Nagelkerke Pseudo R
0.09
a
Adjusted for other factors in the same domain
** Adjusted for all variables with a p-value < 0.20
was a risk factor for being bullied at school, and overweight was a risk factor for being bullied at work.
After controlling for previously being bullied, the
association between obesity and bullying at school
disappeared, but overweight remained a risk factor for
being bullied at work. Several studies have found that
overweight is a risk factor for being bullied [20–22].
The possible link between overweight and bullying
could be that overweight adolescents have poorer psychological well-being and more depressive feelings,
which would put them at increased risk of being
bullied and furthermore affect their perceptions of
other people’s teasing [65, 66]. Thus, it could be that
it is the psychological consequences of being overweight, not simply being overweight, that increase the
risk of being bullied.
At work, overweight remained a risk factor for being
bullied even after adjusting for covariates such as selfesteem and sense of coherence. At work at least, it is
more likely to be the physical appearance of overweight
that is the determining factor behind the observed association. One mechanism might be that overweight
workers may have difficulties keeping up with the rapid
tempo of unskilled piecework jobs and thus be at risk of
being bullied. For instance, in unskilled piecework in the
construction sector, if a crew member has difficulties
keeping up the tempo, he or she is at risk of informal
sanctions [67].
The results show that being a smoker at age 15 is a
significant risk factor for being bullied at age 18, but
only at work. This association remains significant
even after controlling for being bullied at age 14–15.
One explanation might be that being a smoker is associated with lower social and economic status [68], which is
often found to be a risk factor for being bullied [47, 69].
Another plausible interpretation is that smoking is increasingly being frowned upon because legislation regulating smoking at workplaces was tightened in 2007 when
the adolescents were 17–18 years old. This would lead to
smoking behaviour being more and more at odds with the
prevailing norms in society.
Social position in the peer group was found to be a
risk factor for being bullied both at work and at school.
Previous studies have demonstrated that there is an association between low social status and increased risk of
bullying [47, 69], and the present study adds to the
current knowledge that low social position is a significant risk factor for being bullied irrespective of whether
the adolescents at age 17–18 are at school or at work.
One explanation could be that perceived popularity reflects dominance, and therefore it may be easy for a
popular child or adolescent to bully others who are low
in popularity without fear of being sanctioned by peers
[46]. Consequently, bullying could be one way to maintain high status. Most studies examining the importance
of social position in peer groups in relation to bullying
have used cross-sectional designs [46, 47], but this study
adds to the existing literature by using a longitudinal design, making the results more robust. However, after adjustment for previously being bullied, the associations
were weaker. Furthermore, low school performance was
not shown to be a risk factor for bullying in our study.
Social position in society, measured as socioeconomic status, was also found to be a risk factor both
Andersen et al. BMC Psychology (2015) 3:35
at work and at school. The negative association was
seen for both low income and low education among
parents, but it was diluted after adjusting for previously being bullied.
Having parents with a parenting style classified as
overprotective was found to be a risk factor for being
bullied at school, and low family function was a risk
factor for being bullied at work even after adjusting
for being bullied at age 14–15. In other words, parenting style at age 14–15 increases the risk of being
bullied 3 years later. Other studies have also demonstrated an association between parenting style and
being bullied [10, 32], and parental overcontrol has
been found to be a risk factor for bullying among
adolescent girls. The mechanism could be that parental overcontrol and protection limits adolescents’ opportunities to interact with certain kinds of peers and
prevents adolescents from developing a diverse set of
social skills [70]. Another mechanism could be that
children, through their experiences at home (e.g. observational learning [71]), learn and reproduce insufficient ways of solving conflicts, which they reproduce
at school or at work with their peers. Thus, parenting
style may either increase the risk of being bullied or
protect children from being bullied.
Low self-esteem was found to be a risk factor for being
bullied both at school and at work. This is in line with
previous findings [29, 30]. In the present study, the association was weakened after adjusting for previously being
bullied. The mechanism could be that being bullied
damages self-esteem, which would make it harder to
manage teasing and bullying from peers.
Low levels of a sense of coherence were also a risk
factor for being bullied both at school and at work.
People with a strong sense of coherence are more resistant to stress and may be more insensitive to stressors
like bullying [42]. We found that a weak sense of coherence increased the risk of being bullied. This result is in
accordance with a Danish study that found that
employees subjected to violence had a weaker sense of
coherence [45].
Based on the size of the odds ratio, the increased
risk for being bullied seems to be embedded first and
foremost in individual and personal characteristics
(obesity, low self-esteem, overprotective parents, low
sense of coherence) and to a lesser degree in social
contexts (low self-assessed position, low/middle socioeconomic status). Most likely the risk factors for being bullied reinforce each other, and future research
may address the interaction between risk factors.
After adjusting for being bullied at baseline, most of
the aforementioned associations became insignificant,
but irrespective of statistical significance, the size of
the associations (odd ratio) between risk factors and
Page 12 of 15
bullying remained moderately strong or strong in
most cases.
The third purpose of the study was to examine the
continuity of being bullied from age 15 to age 18. The
results showed that the highest risk (besides gender) for
being bullied at age 17–18 at secondary school or at
work was associated with being bullied at age 15. Apparently, being bullied once significantly increased the risk
for future exposure to bullying. This is similar to previous findings demonstrating that being a victim of bullying increases the risk of later victimisation [8, 16, 56],
which suggests a continuity of being bullied. In this
study, the highest risk factor for being bullied was previously being bullied, and the results remained stable after
adjustment for other risk factors. This degree of individual
consistency of being bullied in different environments and
at different ages points to factors of continuity in the
risk of victimisation. One explanation may be that
early bullying affects the perception of the self and
relations to others, or the answer may be in individual attributes such as temperament, self-esteem, the
ability to form protective relationships and coping.
Temperament is a stable characteristic of the individual [72], but coping and self-esteem also seem to be
rather stable over time. The stability of the coping
response in adolescence was studied by Kirchner et
al. [73], who found that coping responses were quite
stable over time, especially avoidance coping, which
may explain the continuing risk of bullying. Similar
results have been found by other researchers [74, 75].
Furthermore, Alsaker and Olweus [76] found that adolescents’ negative self-evaluation (self-esteem) is
likely to become relatively more crystallised with increasing age. These findings suggest the importance
of certain individual characteristics as risk factors for
later bullying at school and at the workplace.
However, there is also a substantial degree of discontinuity in being bullied. Many victims of early school
bullying do not become workplace victims or victims of
bullying at secondary school. This suggests that although
stable individual factors may have some importance in
explaining victimisation risk, contextual factors such as
immediate environment and social support are also important. This is supported by research that has shown
that the most important risk factors for the development
of bullying in the workplace on the team and organisational level were leadership style, norms and values, and
communication and social climate [77]. Furthermore,
employees that experienced bullying had lower perceptions of their work environment in general, especially in
relation to trust, cooperation, conflict resolution and
justice in the organisation [78]. Thus, a great deal of the
variance in workplace bullying may be due to environmental factors.
Andersen et al. BMC Psychology (2015) 3:35
Limitations
Although the study reveals significant associations between risk factors and bullying, caution about causal
inference is warranted. Firstly, it can be argued that a
3-year gap between exposure to bullying and the measurement of bullying is too long. However, a certain amount
of time between baseline and follow-up data is necessary
as one main criterion of the definition of being bullied is
the prolonged nature of the negative experience [2], and
negative acts often develop over a long time span [79]. In
addition, it is unknown to what extent the associations reported in this paper are weakened due to dropouts among
those being bullied at age 14–15 from the first to the
second questionnaires, but the response rate was still 59 %
of the original cohort.
Furthermore, the results should be interpreted with
some caution because the study is based only on selfreported measures, which increases the risk of common
methods bias [80]. Furthermore, it is also worth noting
that the measurement of bullying consisted of a single
item, leaving it up the individual participant to define
the concept of bullying. However, self-reported measures
are common in this area of research and seem to yield
reliable and valid results [81].
Finally, the data did not contain information on personality traits such as neuroticism that could affect the
reporting of bullying and the predictor variable.
Future research
The results stress the importance of more prospective
cohort studies. The underlying and longitudinal psychosocial mechanisms of being bullied are unclear
and may be mediated through a decreased ability to
adapt sufficiently. More prospective studies with several time lags are needed to determine the moderating and mediating psychological processes between
risk factors and bullying and to determine whether
the increased risk of early victimisation from being
bullied remains a risk factor into adulthood. Furthermore, future research must focus on factors related to
the individual or family context that can moderate
negative factors and make the individual more resilient. Finally, future research must examine the importance of personality. So far the results concerning
personality as a risk factor are inconsistent, and there is a
need for more prospective studies to determine whether
neuroticism predisposes children to victimisation in
school or whether victimisation affects the development of a vulnerable personality [82]. In addition,
there is a need for qualitative studies exploring in
detail the psychological processes leading from being
bullied once to an increased vulnerability to later
victimisation.
Page 13 of 15
Finally, the discontinuity in being bullied may be a
focus for future research because many victims of early
school bullying do not become workplace victims or
victims of bullying at secondary school. It is importance
to identify protective factors at both the personal and
organisational levels.
Another important addition to our paper would have
been the implementation of more sophisticated statistical modelling, such as structural equation modelling,
e.g. using cross-lagged models. This would have made it
possible to gain more knowledge about the associations
between the risk factors examined in this paper and the
two outcomes: bullying at work and bullying at school.
This type of analysis has the potential to better illuminate the possible causal associations between the risk
factors for bullying identified in this study. However, we
were not able to use cross-lagged modelling of bullying
for two reasons. First of all, in the first round of the
questionnaire there was only one question on bullying
(because the adolescents were too young (14–15) to
have a job in which they spent enough time to allow for
an exposure to bullying). Secondly, the wording of the
questions was slightly different, which also prohibit a
proper cross-lagged analysis. Finally, if the aim was to
cross-lag socioeconomic status and bullying, this would
also be difficult because the measure of socioeconomic
status is of the educational level and income in the
household in which the adolescents are living. This
means that those adolescents that have moved out of
their parent’s homes would no longer have a comparable
socioeconomic status measure, which again makes the
cross-lagged approach very difficult because of the
transitional phase the adolescents were in at the time
of participation in the study.
Conclusion
The results show that the most important risk factors for
being bullied at age 17–18, whether at work or in school,
were being a boy and previously being bullied. This result
stresses the importance of early prevention of bullying at
schools. In addition, having overprotective parents was a
risk factor for being bullied at school. Being overweight,
smoking, experiencing low family function and having low
socioeconomic status were additional risk factors for being
bullied at work.
In summary, the increased risk for being bullied seems
to be embedded first and foremost in individual and personal characteristics, to a lesser degree in the social context, but most importantly, in the experience of previously
being bullied.
Competing interests
No competing interests or financial competing interests are declared.
Andersen et al. BMC Psychology (2015) 3:35
Authors’ contributions
LPA interpreted data, drafted the manuscript and made the final version
ready for publication. JHA participated in the conception and design of the
study, interpreted the data, revised the draft for important content and
made the final version for publication. CDH participated in the conception
and design of the study, performed the statistical analyses, interpreted the
data, drafted the section on methods and results, revised the draft for
important content and made the final version for publication. TL and ML
interpreted data, revised the draft for important content and made the final
version for publication. All agree to be accountable for all aspects of the
work. All authors read and approved the final manuscript.
Acknowledgements
This research was supported by The Danish Working Environment Research
Fund. Grant number 5253.
Author details
1
Danish Ramazzini Centre, Department of Occupational Medicine, University
Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400
Herning, Denmark. 2Aarhus University, Department of Public Health,
Universitets Parken, Aarhus 8000, Denmark. 3CFK Public Health and Quality
Improvement Central Denmark Region, P. P. Orumsgade 11, Aarhus 8000,
Denmark. 4Department of Sociology & Social Work, Kroghstrædet 5, Aalborg
University, Aalborg 9220, Denmark.
Received: 16 November 2014 Accepted: 30 September 2015
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