A substantial body of research supports specific deleterious correlates of bullying [6]. In terms of cognitive functioning, victims of bullying report lower school attachment and lower academic achievement compared to children not involved in bullying [7,8].

Researchers have also documented psychological and health factors related to bullying. Findings from a national study that examined 123,227 children 11, 13, and 15 years of age residing in 28 countries found bullying was strongly related to psychological symptoms, including nervousness, sleep difficulty, and feelings of rejection, loneliness, and helplessness [9]. Other studies have found that frequent exposure to bullying is significantly related to internalizing disorders, with signs and symptoms of anxiety, depression, social withdrawal, diminished self-esteem or diminished sense of self-worth, and suicide ideation [1,10,11]. Fekkes [10] extended previous research inquiries into the relationship between mental health symptoms and bullying using longitudinal data. Findings suggest that children who were regularly bullied at the beginning of the school year were more likely to develop new mental health and health-related symptoms throughout the year, including depression, anxiety, bed-wetting, abdominal pain, and tension [10]. Similar to findings related to traditional bullying, children who are bullied online are significantly more likely to experience psychological symptoms than children not involved in bullying [12].

In addition to these cognitive and psychological symptoms, many researchers have demonstrated a number of behavioral problems related to bullying. Similar to victims of traditional bullying, victims of cyberbullying are likely to display externalizing behaviors, such as drug and alcohol use [12]. In addition, they are more likely to report carrying a weapon to school compared to children who have not experienced online bullying [12]. Other studies have found that frequent exposure to bullying experiences is linked with higher reports of eating disorders, such as bulimia nervosa, among female youth [13].

Although they may be disliked by the peers they target, aggressive children experience average levels of popularity [5]. Additionally, they do not necessarily exhibit low levels of self-esteem [14], are not highly anxious [5,14], nor are they highly depressed [14]. Nevertheless, the negative effects of bullying are not restricted to victimized children. Research has also documented negative health experiences for children who perpetrate the bullying. For example, they tend to have cognitive difficulties such as poor academic achievement [15,16]. They also tend to require mental health services [17]. They may exhibit conduct problems, such as vandalism [18], smoking [16], and drinking [16,18]. In addition, Holmes and Brandenburg-Ayres [19] reported that early bullying experiences significantly predicted later gang membership and incarceration.

In addition to children who bully and those who are victimized, there exists a group of children who both bully and are victimized (bully/victims). Hanish and Guerra [20] described these children as having the most disturbed functioning and note that they “are more likely to have emotional, behavioral, social, academic, and family problems.” Children who both bully others and are bullied are considered the most vulnerable to negative developmental outcomes [21].

Despite years of research, measures typically assess one or two of the cognitive, psychological, or behavioral dimensions discussed. The purpose of our research, therefore, is to create and test a multidimensional measure of the health experiences associated with bullying.

The Internet is an expedient means of transferring information and is recognized as a valid method of collecting qualitative and quantitative data [22,23]. It is also becoming an effective means of delivering general and personal information about health [24,25]. It is superior to traditional paper-based survey methods because it allows greater access to respondents through mass distribution and eliminates data entry errors arising from transcribing responses, which are entered into a database [26]. In addition, online data collection yields higher rates of completion than mail-out surveys [27]. Although it is not possible to verify the identity of the respondent, the validity of data from any method of data collection is always in question. Recall bias, misinterpretation of questions, fabrication of information, and so on are inherent to all data collection methods. It may be advantageous to use electronic methods with certain populations about certain topics of study. Given that youths ages 12-17 years use the Internet more than any other age group [28], they are likely to have access to and skill in using it for a variety of purposes. Therefore, it seems appropriate to use the Internet to ask youths questions about their behaviors while on the Internet. Using the Internet as a means of data collection is likely to provide valid and generalizable results about youths’ Internet experiences [29].

Power and dominance exerted through aggression are endemic in human societies. Although researchers have investigated this phenomenon for decades, multidimensional measures of children’s functioning related to bullying have not yet been developed. The purpose of our study was to comprehensively examine the health experiences of all forms of bullying using a web-based survey, and to determine whether it yields reliable and valid information when compared across groups of children who are bullied, bully others, neither, or both. We predict that children who are bullied and/or bully others are more likely to experience problems across cognitive, psychological, and behavioral domains of functioning than children who are not bullied.

We planned to recruit a convenience sample of 200 children with an open online survey.  We selected the Kids Help Phone website for recruitment because of its widespread use among youth [30]. Based on the average of 15,000 unique visits to the Kids Help Phone home page per week, and a response rate of 1%, we estimated it would take two weeks to recruit our sample. We actually recruited 377 subjects in two weeks. The completion rate was 100%. The sample included 377 children (n = 277 girls, n = 100 boys) from age 10 to 17 years (M = 13.90, SD = 1.84). Most children lived in urban (n = 307) compared to rural areas (n = 70); were born in Canada (n = 319) compared to outside of Canada (n = 58, all children were living in Canada at the time of the survey); and spoke English at home (n = 280) compared to another language (n = 97).

The Kids Help Phone website has been in existence since 1996 and provides professional counseling and referrals to people aged 5 to 20 years on any problem or concern. Through word-of-mouth and advertising, many children in Canada have become aware of this resource. Participants were recruited by placing a click-through badge with a message about the survey on the webpage. Visitors were shown a distorted password that they typed in. This password served as a security check to prevent automated programs from accessing the questionnaire. In cases where someone responded twice, we included only the first response.

Respondents first read the following definition:

Then respondents were provided with examples of forms of bullying, as shown in Table 1.

Children indicated whether and how often they experienced any of the listed forms of bullying within the last month using a Likert scale with anchors from “no” to “several times a week.” A similar question was administered about bullying others.

Children were then administered 37 items asking about their cognitive, psychological, and behavioral experiences. These items were obtained from a review of the research and various measures of children’s functioning. These were rated on a Likert scale according to their frequency using the following anchors: “never,” “only once or twice,” “two or three times a month,” “about once a week,” and “several times a week.” All items included a “no” response option. The questions constituted 8 subscales, as shown in Table 2.

Significant differences in health experiences emerged among groups according to the type of involvement in bullying. Specifically, children who reported victimization also reported engaging in risk behaviors, such as weapons possession. This is consistent with findings published by Ybarra [12]. Children may be exposed to these risk behaviors through acts of bullying, or they may participate in these risk behaviors as a coping reaction to being bullied. Participation in these risky behaviors probably increases the likelihood of physical injury, as was found in our study. Children who participated in risky behaviors also reported fewer positive relationships with peers, which is consistent with research showing that children who are bullied may experience interpersonal victimization and social skills difficulties [12]. Several studies have substantiated that children who are bullied experience high levels of anger and anxiety [1,9,10,11]. Other health problems, such as eating problems involving vomiting or limiting food intake, were more often reported by children who were bullied compared to children not involved in bullying. This finding is also substantiated by previous research [13].

Similar to children who were bullied, children who perpetrated bullying reported elevated levels of anger, as shown in previous research [35]. They did not report high levels of anxiety, which is also consistent with other studies [14]. In addition, they reported experiencing positive relationships, which supports research suggesting that bullies perceive themselves as liked by their peer group [5]. Indeed, bullying attracts attention from the peer group, which bullies may interpret as positive attention. Bullies are, moreover, likely to report similar levels of self-esteem as non-bully/victims [14], which is consistent with our findings. Contrary to our expectations, children who reported bullying others did not report high levels of risk behaviors. The absence of reported risky behaviors in this group could be related to the relatively young age of our sample. For example, a multinational study of the prevalence of substance use indicates that peak onset of alcohol and cannabis use is in mid- to late adolescence, and at age 18 for all other drugs [36].

We also included children who were both victims and perpetrators of bullying. Several health concerns were higher for these children than those not involved in bullying. That is, the bully/victim was likely to experience poor peer relationships, anger, anxiety, and eating problems, as suggested by previous research [37]. We found, however, that these children did not report the most negative outcomes, as expected. Rather, victims did. This could be due to the relatively strong self-esteem and positive relationships that the bully/victim reported, which may buffer negative outcomes. Moreover, children who are bullied and victimized typically receive the lowest levels of social support [38], which may explain the negative outcomes documented in most research. In our study, however, they may have been receiving support from the Kids Help Phone website. This support may have lessened the detrimental correlates of bullying, resulting in lower reporting of these negative behaviors.

We chose not to use items about academic achievement and educational experiences because they did not appear to reliably or accurately measure the constructs of our scale. In addition, we did not include questions about depression. We recommend further research in item development on questions pertaining to academic achievement and depression. Moreover, considering that no single source could feasibly assess all aspects of functioning, we recommend that additional instruments be administered to provide a more comprehensive profile, particularly when designing or providing interventions or support. In addition, identifying children as bullies or victims based on experiencing any or all types of bullying created heterogeneous groups. However, given the large number of groups that would have been formed for each type and combinations of types of bullying, it was not possible to compare functioning across all groups. Generalizability of the results may be limited because participants were recruited from the Kids Help Phone website, which they may have been visiting because they were already troubled or seeking support. Although the prevalence of bullying we report is similar to other research, our participants may be unique on other unknown dimensions. Participants filled out a questionnaire via a computer using the Internet. Accordingly, this study was restricted to children who have access to a computer and the Internet. Because the survey was administered online, participants could not ask for clarification or help from the individual administering the questionnaire, which could have affected the accuracy of some responses. Finally, in common with all anonymous online research, it was not possible to verify the information provided by participants.

Despite these limitations, this study provides strong evidence for the usefulness of this multidimensional web-based survey on health experiences related to bullying. It further adds to the growing evidence of the detrimental impact of bullying among multiple profiles of children and youth, whether in the role of bully, victim, or bully/victim.