RESEARCH ARTICLE

Who Suffers Most From Being Involved in

Bullying—Bully, Victim, or Bully-Victim?
LAURALIISA MARK, PhDa AIRI VÄRNIK, MD, PhDb MERIKE SISASK, PhDc

ABSTRACT
BACKGROUND: Bullying has been associated with many mental health problems. The effect of bullying has been found to be
affected by the way students are involved in bullying. The purpose of the study was to explore the association between mental
well-being, hopelessness, and being involved in bullying (as a bully, victim, or bully-victim), and to detect more harmful bullying
types to students’ mental well-being.
METHODS: The study was conducted among Estonian students from grades 5 to 9 (N = 2048). The survey was nationwide,
cross-sectional, anonymous, and web-based by nature. Mental well-being was assessed by using WHO-5 well-being index
and hopelessness by 1-item Beck Hopelessness Scale.
RESULTS: The odds for being severely distressed (ie, students expressing both poor mental well-being and hopelessness) were
greater for both sexes bullying others and being victims of bullying. For bully-victims the odds were greater for girls only. The
victims of extensive cyber bullying expressed the lowest level of mental well-being for both sexes.
CONCLUSIONS: Boys might be the most vulnerable if being pure victims, while girls if being bully-victims. More attention
should be paid to cyber bullying, as victims of extensive cyber bullying had the lowest level of mental well-being.

Keywords: bullying; types of bullying; mental well-being; hopelessness; sex difference.

Citation: Mark L, Värnik A, Sisask M. Who suffers most from being involved in bullying—bully, victim, or bully-victim? J Sch
Health. 2019; 89: 136-144. DOI: 10.1111/josh.12720

Received on December 2, 2016

Accepted on March 25, 2018

A student can be involved in bullying as a victim,

as a bully or as a bully-victim. Previous studies
have tried to find out who suffers most from bullying.
Several studies have shown greater risk for mental
health problems among victims of bullying,1,2 whereby
the worst effects of bullying involvement have been
imputed to bully-victims.3-5 The effects of bullying on
pure bullies has been disputable as there is evidence
suggesting that bullies may be even healthier than
their peers,6 while some have found that bullies
and victims are equally disturbed,7 and others have
communicated that the well-being of bullies can be
severely compromised.5,8
It has also been found that internalized symp-
toms (such as depression, anxiety, fear, withdrawal
from social contacts) are more prevalent among
victims of bullying,9 while externalized symptoms
(such as anger, aggression, conduct problems, ten-
dency to engage in risky, impulsive, and crimi-
nal behaviors) are displayed more frequently by
bullies.10 For example, it has been found that
bullies have heightened risk of developing antiso-
cial personality disorders in young adulthood, even
when controlling for preexisting psychiatric prob-
lems, family hardships, and child maltreatment.11
Thus, involvement in bullying reduces mental

a Adviser at Riigikogu, (lauraliisa.mark@gmail.com), Parliament of Estonia, Research Department of the Riigikogu, Lossi plats 1a Tallinn 15165 Estonia; PhD candidate at Tallinn
University, School of Governance, Law and Society, Narva mnt 25 Tallinn 10120 Estonia.
bManagement Board Member and Principal Investigator, (varnik.airi@gmail.com), Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Õie 39 Tallinn 11615 Estonia;

Professor of Mental Health at Tallinn University, School of Governance, Law and Society, Narva mnt 25 Tallinn 10120 Estonia.
c Executive Director and Senior Researcher, (sisask.merike@gmail.com), Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Õie 39 Tallinn 11615 Estonia; Professor of

Social Health Care at Tallinn University, School of Natural Sciences and Health, Narva mnt 25 Tallinn 10120 Estonia.
Address correspondence to: Lauraliisa Mark, Adviser at Riigikogu, (lauraliisa.mark@gmail.com), Parliament of Estonia, Research Department of the Riigikogu, Lossi plats 1a Tallinn
15165 Estonia; PhD Candidate at Tallinn University, School of Governance, Law and Society, Narva mnt 25, Tallinn 10120, Estonia.
This work was supported by the EU employment and social solidarity program PROGRESS (2007-2013) via the Law School of the Tallinn University of Technology under public
procurement number 156437 (Uuring kiusamine koolis; Bullying at school study). We thank participants and school personnel who were helpful in conducting the survey in the
classroom.

136 • Journal of School Health • February 2019, Vol. 89, No. 2 • © 2019, American School Health Association
well-being and may hinder from evolving to healthy
adulthood.
There are no simple and universal explanation of
why do some adolescents bully others. For example,
bullying has been attributed to low self-control,12
poor impulsivity,13 psychological disturbances,7 psy-
chiatric disorders,14,15 unfavorable family factors,16
and to attaining a social status goals.17 Thus, bul-
lying others can be viewed as an attempt to man-
age one’s social problems. However, there is no
adequate reason for being a target of bully.18 Usu-
ally these children are simply different in some
ways (shorter/taller, thinner/fatter, wears ‘‘funny’’
clothes/glasses, talks or walks ‘‘funny’’), as if it would
justify violent acts.
According to theory of psychosocial development,19
young person’s peer group is a major source of his/her
self-esteem. Thus, bullying may severely impair
young person’s self-esteem. Furthermore, when tra-
ditional bullying stops after crossing the doorsill of
one’s home, an era of technology has granted the
possibility to bully even behind the closed home
doors.
The present study investigates sex-specific bullying
experience among Estonian students from grades 5 to
9 in association with mental well-being and hopeless-
ness. The association between mental well-being and
hopelessness and being involved in bullying is analyzed
separately for bullies, victims, and bully-victims. The
means of bullying reported by victims are under special
attention with an intent to detect bullying types that
are more harmful to students’ mental well-being and
hopelessness.
METHODS
Procedure
This study analyzes the data from the Bullying
at School (Kiusamine koolis) study, which was con-
ducted in Estonia in spring 2015. The survey was
nationwide, cross-sectional, anonymous, and web-
based (using Limesurvey online) by nature. Fill-
ing in the online questionnaires took approximately
10 minutes and were administered by school person-
nel during school lessons. Each student had a unique
ID code for Limesurvey, the names of the students
filling in the questionnaire are not identifiable.
Sampling was conducted by focusing on attaining
a representative sample in terms of sex, different
classes (grades 5-9), regions of Estonia, school type
(urban or rural), and teaching language (Estonian or
Russian). Relevant data for sampling procedure were
derived from the Estonian Statistics.20 The general list
of schools was created using the Estonian Education
Information System (EHIS),21 which was then a
subject to random sampling procedure, where a class
was handled as a sampling unit.
Journal of School Health • February 2019, Vol. 89, No. 2
Ethics and Consent Issues
Participation in the study was voluntary. The con-
sent for participation was obtained from schools,
parents, and students. The primary consent for par-
ticipation was obtained from school managements.
After obtaining the agreement from 58 schools, each
school appointed the administrator for the survey.
Before the survey, an information letter with the pos-
sibility to refuse from filling in the questionnaire was
sent to parents and students. Those who refused, did
not participate in the survey (the respective data was
collected and stored by the administrator). In addi-
tion, the confirmation of agreement to participate was
obtained directly before filling in the questionnaire (it
was impossible to access the questionnaire without
the confirmation).
Instruments
In addition to sex of the students, the following
variables were selected for analysis.
Bullying. The meaning of bullying and bullying
others was provided in the questionnaire along
with the respective questions. It was emphasized
that bullying is an intended and repeated behavior,
which is (probably) hurtful for the victim. It was also
emphasized that bullying is not friendly or playful
behavior, as far as the friendliness or playfulness of the
behavior was understood by the other party as well.
Students were asked if they have:
1) Been bullied during the last 12 months? (If yes,
the experienced means of bullying were ticked):
I was:
1. laughed at/ridiculed
2. mocked by homophobic words or movements
(somebody called you a ‘‘gay,’’ imitated same-sex
sexual intercourse etc)
3. mocked for my look
4. mocked for not being enough masculine/feminine
5. mocked for my academic achievements/capacity
6. mocked for socioeconomic reasons (rich, poor)
7. mocked for my family (ethnicity, looks, profession
etc)
8. mocked for some other reason
9. left out/ostracized from the peer group
10. hit
11. pushed
12. threatened
13. forced to do things I did not want to do
Others:
1. spread rumors about me
2. took away my money or my personal belongings
3. sent me mean or hurtful messages/e-mails
4. posted mean or hurtful messages about me in social
network
5. made mean or hurtful phone calls to me
• © 2019, American School Health Association • 137
 2) Bullied (alone or with others) other student
during the last 12 months?
Based on ‘‘yes’’ and ‘‘no’’ answers to being bullied
or bullied others, a new variable ‘‘Involvement in
bullying’’ was created. Each student was categorized
into one of the following categories: (1) pure victim,
(2) bully-victim, (3) pure bully, (4) uninvolved.
Mental well-being. Mental well-being was assessed
by WHO-5 well-being index, which is a short,
simple, positively loaded, and well-known instrument
for assessing mental well-being and symptoms relevant
to depression among population.22-25 The raw score
ranges from 0 to 25, where ‘‘0’’ is representing the
worst possible and ‘‘25’’ the best possible subjective
mental well-being.26 Score 13 is a critical cutoff point,
meaning that a score below that value indicates
poor mental well-being. The WHO-5 well-being index
consists of 5 statements (‘‘I have felt cheerful and in
good spirits,’’ ‘‘I have felt calm and relaxed,’’ ‘‘I have
felt active and vigorous,’’ ‘‘I have felt fresh and rested,’’
‘‘My daily life has been filled with things that interest
me’’) and these statements are being assessed on a
5-point scale from never to always.
Hopelessness. Hopelessness was measured by a one-
item Beck Hopelessness Scale (‘‘My future seems dark
to me’’). Previous studies have found that both, the
1-item and the full scale yield to reliable result.25,27
Mental well-being and hopelessness index. Based
on ‘‘yes’’ and ‘‘no’’ answers to hopelessness toward
future and calculated WHO-5 score (below 13 versus
equal to or above 13), the mental well-being
and hopelessness index was created with categories:
(1) good (WHO-5 score equal to or above 13 and no
hopelessness); (2) distressed (WHO-5 score below 13
or hopelessness); (3) severely distressed (WHO-5 score
below 13 and hopelessness).
Data Analysis
The data analysis was performed with SPSS 17. In
addition to descriptive statistics, χ 2 tests were used
to compare and investigate the sex-specific differences
in mental well-being and hopelessness, experience
of bullying, and the association between experience of
bullying and mental well-being. T-test and analysis of
variance (ANOVA) was used to verify the differences
in the mean WHO-5 scores.
Multinomial logistic regression analysis was
performed to investigate the association between
involvement in bullying and mental well-being and
hopelessness index. The odds ratios (ORs) were
calculated with a confidence interval (CI) at 95%.
The mental well-being and hopelessness index was
treated as a dependent variable using the category of
‘‘good mental well-being’’ (including hopefulness) as
a reference category. The role in bullying was treated
138 • Journal of School Health • February 2019, Vol. 89, No. 2
as independent variable with being uninvolved in
bullying as a reference category.
To examine the relationship between the means
of bullying and to regroup them based on shared
variance, an exploratory factor analysis (EFA) was
conducted. The data was subjected to principal
components analysis using oblique Promax rota-
tion, which does not assume lack of correlation
between variables and which is often seen as pro-
ducing more accurate results for research involv-
ing human behaviors, or when the data does not
meet priori assumption.28 Variables with communal-
ities <0.3 (N = 4) and close to that value (N = 1),
and factors with overlapping variance (N = 1) were
discarded. Using an eigenvalue cut-off at 1.0 and find-
ings from the scree plot, 4 factors that explained
54.41% of the cumulative variance were retained.
Kaiser-Meyer-Olkin measure (KMO = 0.73) indicated
sufficient data for EFA and Bartlett’s Test of Sphericity
(χ 2 = 587.70; p < .001) showed patterned relation-
ships between the items. Each factor contained 3
variables, which is the least recommended number
of variables in the factor.29 EFA was used to assem-
ble variables into descriptive categories only. There
was no analyze conducted with computed factor
scores.
RESULTS
Self-Reported Mental Well-Being and Hopelessness
Toward the Future
From 2048 students studied, the overall mean score
of WHO-5 was 16.7 (±4.75) with boys (17.1 ± 4.46)
having higher mean score than girls (16.4 ± 4.97)
(t = 3.54; p < .001). The proportion of students
with poor mental well-being (WHO-5 score below
13) was 18.1% (N = 367). Poor mental well-being
was more common among girls (21.5%; N = 224)
compared to boys (14.4%; N = 143) (χ 2 = 16.98;
p < .001).
The proportion of students reporting hopelessness
was 9.8% (N = 191) and there were no statistically
significant differences between boys (10.1%; N = 93)
and girls (9.6%; N = 98) (p > .05).
Based on ‘‘yes’’ and ‘‘no’’ answers to hopeless-
ness scale and calculated WHO-5 score (below 13
versus equal to or above 13), 4.5% (N = 87) of
students reported poor mental well-being with con-
current hopelessness (severely distressed); 18.7%
(N = 360) reported poor mental well-being or
hopelessness (distressed), and 76.8% (N = 1480)
expressed good mental well-being without hopeless-
ness (Table 1). Being severely distressed was twice
as common among girls (5.9%) compared to boys
(3.0%), while there was no significant difference
between boys (19.1%) and girls (18.2%) being
distressed.
• © 2019, American School Health Association
Table 1. Mental Well-Being and Hopelessness, and Involvement in Bullying by Sex

Boy Girl Total

N % N % N %
Mental well-being and hopelessness index
Severely distressed (poor well-being and hopelessness) 27 3.0 60 5.9 87 4.5
Distressed (poor well-being or hopelessness) 166 18.2 194 19.1 360 18.7
Good mental well-being without hopelessness 718 78.8 762 75.0 1480 76.8
Total 911 100.0 1016 100.0 1927 100.0
Missing 90 31 121
Involvement in bullying
Pure bully 75 7.7 30 2.9 105 5.2
Pure victim 119 12.1 160 15.3 279 13.8
Bully-victim 53 5.4 34 3.3 87 4.3
Uninvolved 733 74.8 818 78.5 1551 76.7
Total 980 100.0 1042 100.0 2022 100.0
Missing 21 5 26

Table 2. Mental Well-Being and Hopelessness Index in Association With Involvement in Bullying by Sex: Multinomial Logistic
Regression Analysis

Boy Girl
OR 95% CI OR 95% CI
Severely distressed (poor well-being and hopelessness) Pure bully 3.57 1.09-11.74 3.35 1.09-10.26
Pure victim 6.14 2.35-16.07 3.44 1.85-6.41
Bully-victim 3.63 0.76-17.33 4.85 1.71-13.76
Uninvolved
Distressed (poor well-being or hopelessness) Pure bully 0.69 0.34-1.44 0.84 0.29-2.49
Pure victim 1.59 0.96-2.63 2.40 1.61-3.57
Bully-victim 2.19 1.13-4.27 1.71 0.70-4.14
Uninvolved
The bold values indicate that independent variables (involvement in bullying) predict the outcome of dependent variable (poor well-being and/or hopelessness) at a statistically
significant level (*p < .05, **p < .01). The OR represents a relative measure of effect of being involved in bullying one one’s mental well-being and hopelessness (compared to
those who have not been involved in bulling).

Self-Reported Involvement in Bullying and Its Association
With Mental Well-Being and Hopelessness
Based on ‘‘yes’’ and ‘‘no’’ answers to being a
victim of bullying and bullying others, 5.2% (N = 105)
of students reported being a pure bully, 13.8%
(N = 279) reported being a pure victim, and 4.3%
(N = 87) reported being a bully-victim (Table 1). Being
a pure bully (7.7%) or bully-victim (5.4%) was more
common among boys compared to girls (2.9% and
3.3%, respectively). Girls (15.3%) compared to boys
(12.1%) reported more frequently being a pure victim.
Multinomial logistic regression analysis indicated
that the odds for being severely distressed was statisti-
cally significantly greater for boys and girls purely bul-
lying others (for boys OR = 3.57; for girls OR = 3.35)
and purely being victims of bullying (for boys
OR = 6.14; for girls OR = 3.44). Only for girls the odds
for being severely distressed were greater (OR = 4.85)
if being bully-victims (Table 2). Odds for being dis-
tressed were greater for boys (OR = 2.19) being bully-
victims and for girls (OR = 2.40) being pure victims.
Victimized boys and girls reported somewhat
different experience in terms of the means of bullying
(Table 3). Being laughed at (12.2%), being pushed
(9.4%) and being hit (7.1%) were the most frequently
experienced means of bullying among boys. Being
laughed at (11.2%), being a subject for rumors (9.2%),
and being mocked for the look (8.8%) were the most
frequently reported by girls.
Most of the experienced means of bullying were
associated with poorer mental well-being and/or hope-
lessness for boys and girls (exact results in Table 3).
Girls compared to boys had more statistically signifi-
cant associations between a certain mean of bullying
and poor mental well-being and/or hopelessness.
EFA modeled 4 factors (Table 4)—cyber bullying,
physical bullying, verbal bullying, and relational
bullying—which were the basis for creating respective
variables with 4 categories (experienced 2-3 different
means of bullying, experienced one mean of bullying,
did not experience that bullying type; did not
experience bullying at all). Then the mean WHO-5
score was calculated for each category to investigate
the cumulative effect on mental well-being within a
specific bullying type (Table 5). Boys being victims of
cyber bullying in 2-3 different ways and verbal bullying
had the lowest mean WHO-5 score. Being a victim
of extensive (2-3 different ways) cyber bullying and

Journal of School Health • February 2019, Vol. 89, No. 2 • © 2019, American School Health Association • 139
Table 3. Frequency of Experienced Means of Bullying by Sex

Male Female
Means of Bullying N % N %
I was laughed at/ridiculed 122 12.2 117* 11.2
I was pushed 94 9.4 42 4.0
I was hit 71 7.1 29* 2.8
I was left out/ostracized from the peer group 68 6.8 66* 6.3
I was mocked for my look 65 6.5 92 8.8
I was mocked for some other reason 59** 5.9 70 6.7
Others spread rumors about me 58 5.8 96** 9.2
I was mocked by homophobic words or movements 47** 4.7 36** 3.4
I was threatened 41 4.1 38 3.6
I was mocked for my academic achievements/capacity 40** 4.0 40 3.8
I was mocked for not being enough masculine/feminine 32* 3.2 18 1.7
I was mocked for socioeconomic reasons (rich, poor) 25 2.5 13* 1.2
I was forced to do things that I did not want to do 23 2.3 15* 1.4
Others took away my money or my personal belongings 18 1.8 18 1.7
Others sent me mean or hurtful messages/e-mails 17* 1.7 28 2.7
I was mocked for my family (ethnicity, looks, profession etc.) 16 1.6 15** 1.4
Others made mean or hurtful phone calls to me 9 0.9 12*,** 1.1
Others posted mean or hurtful messages about me in social network 8 0.8 14* 1.3
∗ The bold values indicate to means of bullying where there are statistically significant differences (p < .05) between those who have experienced the specified means of
bullying and those who have not experienced the specified means of bullying; the differences are assessed by WHO-5 well-being index (poor vs good).
∗∗ The bold values indicate to means of bullying where there are statistically significant differences (p < .05) between those who have experienced the specified means of
bullying and those who have not experienced the specified means of bullying; the differences are assessed by hopelessness (yes vs no).

Table 4. Factor Analysis of Means of Bullying (Significant Factor Criterion of 0.3)

Pattern Matrix Structure Matrix

(N = 385) 1 2 3 4 1 2 3 4
I Cyber bullying (Cronbach α = 0.63)
Others sent me mean or hurtful messages/e-mails 0.778 0.765
Others posted mean or hurtful messages in social network 0.698 0.700
Others made mean or hurtful phone calls 0.683 0.725 0.334
II Physical bullying (and threats) (Cronbach α =0.66)
I was pushed 0.832 0.821
I was hit 0.827 0.839
I was threatened 0.361 0.585 0.404 0.610
III Verbal bullying (Cronbach α =0.43)
I was mocked for my academic achievements/capacity 0.712 0.693
I was mocked for not being enough masculine/feminine 0.664 0.676
I was mocked for my origin family (ethnicity, looks, profession, etc) 0.621 −0.316 0.396 0.656
IV Relational bullying (Cronbach α =0.39)
I was mocked for my look 0.655 0.662
I was laughed at/ridiculed 0.640 0.652
Others spread rumors about me 0.548 0.325 0.572
Extraction Method: Principal Component Analysis. Rotation method: Promax with Kaiser Normalization. Rotation converged in 5 iterations. Coefficients with absolute value
below 0.30 are suppressed. The bold values represent variables assembled into factors with communalities > 0.5.

physical bullying yielded to the lowest mean WHO-5
score among girls.
DISCUSSION
The present study examined mental well-being,
hopelessness, and bullying experiences among Esto-
nian students from grades 5 to 9. Mental well-
being was assessed by the WHO-5 well-being index
and hopelessness by the 1-item Beck Hopelessness
Scale, which has proven to yield a reliable result in pre-
vious studies.25,27 The study aimed to assess, whether
these mental well-being parameters are associated
with bullying experiences. The association between
mental well-being parameters and involvement in bul-
lying was assessed from different perspectives (role
in bullying, sex, bullying type). In addition, the
authors attempted to answer a question, which bul-
lying types are more harmful on individual’s mental
well-being.
The study supports previous outcome that females
in general report several disadvantages of men-
tal health more frequently than males.30,31 The

140 • Journal of School Health • February 2019, Vol. 89, No. 2 • © 2019, American School Health Association
Table 5. Being a Victim of Bullying and Mean WHO-5 Score by Type of Bullying

Boy Girl
Mean WHO-5 score N % Mean WHO-5 score N %
Cyber bullying
2-3 different ways 14.43 (±5.71) 7 0.7 13.08 (±7.73) 12 1.2
1 way 15.78 (±5.01) 18 1.8 14.33 (±4.93) 24 2.3
No cyber bullying 15.84 (±4.85) 160 16.2 14.62 (±5.25) 160 15.3
No bullying experience 17.42 (±4.30) 805 81.3 16.80 (±4.78) 847 81.2
F= 7.09; p< .001 F= 12.22; p< .001
Physical bullying
2-3 different ways 16.00 (±4.94) 68 6.9 13.30 (±5.69) 27 2.6
1 way 15.07 (±4.61) 41 4.1 14.98 (±5.68) 44 4.2
No physical bullying 15.97 (±5.00) 76 7.7 14.58 (±5.19) 125 12.0
No bullying experience 17.42 (±4.30) 805 81.3 16.80 (±4.78) 847 81.2
F= 7.32; p< .001 F= 12.55; p< .001
Verbal bullying
2-3 different ways 14.80 (±5.65) 35 3.6 13.94 (±4.79) 47 4.5
1 way 14.17 (±6.66) 18 1.8 9.20 (±10.18) 5 0.5
No verbal bullying 16.27 (±4.31) 132 13.3 14.85 (±5.27) 144 13.8
No bullying experience 17.42 (±4.30) 805 81.3 16.80 (±4.78) 847 81.2
F= 8.81; p< .001 F= 14.34; p< .001
Relational bullying
2-3 different ways 15.03 (±5.25) 80 8.1 13.60 (±5.74) 105 10.1
1 way 15.90 (±4.72) 59 6.0 15.79 (±5.03) 58 5.6
No relational bullying 16.96 (±4.22) 46 4.6 15.03 (±4.18) 33 3.1
No bullying experience 17.42 (±4.30) 805 81.3 16.80 (±4.78) 847 81.2
F= 8.78; p< .001 F= 14.60; p< .001

proportion of boys and girls with poor mental well-
being (WHO-5 score below 13) was 14% and 22%,
respectively. However, there were no statistically
significant sex differences for hopelessness (10% for
both sexes).
Hopelessness and poor mental well-being have been
consistently associated with depressive disorders.24,32
It has also been found that hopelessness maybe
even stronger predictor of adolescent suicidal ideation
than depression.33,34 Thus, hopelessness and poor
subjective mental well-being are health risk factors,
which may refer to a suicide potential, and therefore
should be taken seriously.
In the present study, it was assumed that co-
occurrence of hopelessness and poor mental well-
being indicates severely impaired mental state, and
was therefore treated as the status of being severely
distressed (3% of boys and 6% of girls). The presence
of either hopelessness or poor mental well-being was
treated as the status of being distressed (18% of boys
and 19% of girls).
The study results showed that being involved in
bullying was primarily associated with being severely
distressed. Being a pure bully increased the odds for
being severely distressed more than 3-fold for both
sexes (in comparison with uninvolved group). Being a
pure victim increased the respective odds more than 6
times for boys and more than 3 times for girls. Being
a bully-victim increased the odds for being severely
distressed almost 5 times for girls, while for boys the
result was statistically insignificant. Being distressed
(but not severely) had less clear associations with
bullying.
The devastating impact of bullying can be at least
partly be explained by the need to feel accepted by
others, which is especially true during adolescence,35
when individuals rely in developing self-esteem more
on social comparison and feedback from peers.19
Furthermore, boys might be especially vulnerable to
being pure victims, as Western role for men expresses
characteristics such as strength and endurance.36 Thus,
being a pure victim may impair boys’ perception of
themselves as a male. Likewise, as the traditional
role for female embodies tolerance, mildness, and
solicitude,36 being a victim and bully at the same
time may add extra stress for girls, as in addition to
impaired feeling of acceptance, girls may experience
role confusion due to their anti-feminine partake in
relations with peers.
Most of the experienced means of bullying associ-
ated with poor mental well-being and/or hopelessness
for both sexes. Girls compared to boys had more sta-
tistically significant associations between means of
bullying and mental well-being/hopelessness, which
might be explained by their greater interpersonal
sensitivity and concern about peer evaluation.37,38
Furthermore, all types of bullying (cyber bullying,
physical bullying, verbal bullying, and relational bully-
ing) associated significantly with mean WHO-5 score:
the more extensive the experienced bullying type,

Journal of School Health • February 2019, Vol. 89, No. 2 • © 2019, American School Health Association • 141
the lower the mental well-being score. Being a vic-
tim of extensive (2-3 different ways) cyber bullying
and physical bullying yielded to the lowest mean
WHO-5 score among girls; being a victim of cyber
bullying or verbal bullying among boys. Cyber bul-
lying turned out to be the most devastating form of
bullying. The reason presumably lies in the character
of cyber bullying—it can get you any time and in any
place; the perpetrators are often meaner than they
would be in face-to-face communication; the higher
level of perceived anonymity encourages more people
to post hurtful messages; hurtful messages often reach
many people, but at the same time it is unknown who
exactly has seen the writing, photo, or video, which
in turn can make the victim more embarrassed and
anxious.
Limitations
The study has several limitations. First, the estimates
were obtained by self-reports, which might cause
some under- or overestimations as well as recall
and interpretation problems. Second, the causal
relationship is unclear, as the study was cross-sectional
by nature. Third, only being victimized was analyzed
more in details, as bullying others was beyond
the volume of this paper. Further research is needed
to explore the means used to bully others in association
with mental well-being.
Conclusions
Although the authors recognize that mental well-
being of schoolchildren is mediated by numerous
factors, not solely by bullying experience, it is
obvious that bullying is associated with poorer
mental well-being and including hopelessness (with
being severely distressed). However, the damage
associated with bullying is affected by the role being
involved in bullying. Elevated vulnerability of victims
among boys and bully-victims among girls should
be considered when providing assistance and care
to students involved in bullying. As assumed, the more
extensive was the bullying, the lower was the reported
mean WHO-5 score. Furthermore, being a victim
of extensive cyber bullying associated with the lowest
mean WHO-5 score for both, boys and girls. It is crucial
that schools would invest in consistent anti-bullying
programs with proven effectiveness. Likewise, it is
important to talk about the dangers of social media,
online safety and about the opportunities to help
oneself or others in case of becoming a victim of cyber
bullying.
IMPLICATIONS FOR SCHOOL HEALTH
We feel it is important to stress that it is not just
the victims who suffer, just the opposite, the bullies
142 • Journal of School Health • February 2019, Vol. 89, No. 2 •
struggle with poor mental health as well. Moreover,
as found in present study, the vulnerability to bullying
depends on the role being involved in bullying
and varies between the sexes—boys had the highest
odds for being severely distressed if being pure victims,
while girls had the highest odds if being bully-
victims. This should be considered when monitoring
the school climate, addressing within-school relations,
and providing support services for the distressed
students. Thus, boys being a victim of bullying and girls
being bully-victims need special attention, although,
they might be one of the most difficult target groups
to approach (due to withdrawing into oneself, distrust,
fear of reactions from others, etc). When possible,
these students should be interviewed by psychologist
or other specialist with appropriate training.
We recognize that schools are not solely respon-
sible for solving bullying. However, schools have
considerable potential to reduce persecution in
school environment—especially when implement-
ing a whole-school approach, introducing partnership
with homes,39 shaping attitudes against violence, and
contributing to raising students’ self-esteem and self-
efficacy.
It is crucial that bullying behaviors are not
overlooked or ignored, but unequivocally condemned.
Peers especially are able to discourage bullying
behaviors (when condemning it), while at the same
time, to encourage it (when, eg, laughing with the
perpetrator). It is worth bearing in mind that at the
time school personnel becomes aware of the bullying,
it might have been lasted for a relatively long time
already. The more systematic the bullying has been,
the more detrimental are its’ effect.40 Therefore, it
is important to develop a nonviolent attitude—so
that the bystanders would not encourage bullying
unsuspectingly by tolerating bully’s attempts to raise
his or her social status. It is worth to implement
some existing anti-bullying program that have showed
its efficacy in the area concerned already—the
concrete programs with promising results may vary
by country/region, on account of which, the authors
do not point out any specific program.
According to findings of present study, girls had
more statistically significant associations between
mental health variables (hopelessness and poor mental
well-being) and experience of bullying. However, the
number of statistically significant associations between
means of bullying and hopelessness was similar among
boys and girls. Thus, although girls seemed to be more
vulnerable to bullying, the harm of bullying should
not be underestimated for boys. It is possible, that
(depending on an experienced means and frequency
of bullying) boys and girls suffering from bullying
simply experience somewhat different mental health
complaints. Furthermore, not all means of bullying
have the same effect—some are more harmful than
© 2019, American School Health Association
others, especially if these impair students´ perception
of themselves as a male/female or knocks down their
self-worth. Schools should provide necessary support
services to ensure counseling (or referral) to those in
need in order to avoid further damage.
Bullying does not only relate to decreased school
engagement, academic achievement, or low mood.
Bullying may have tremendous impact on young
people lives—starting with serious mental health
disorders, self-esteem problems, and finishing with
self-harming, school shooting and suicide. It is vital
to invest in proven methodologies aimed to reduce
bullying.
Human Subjects Approval Statement
Approval to conduct the survey was obtained from
national research ethic committee (Decision No 969,
12.03.2015).
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