Bulletin of the World Health Organization Past issues Volume 88: 2010 Volume 88, Number , !

une 2010, "01#"80

Bulletin of the World Health Organization

Bulletin Past issues $nformation for %ontributors &ditorial members Ho' to order (bout the Bulletin )is%laimer

Prevention of bullying-related morbidity and mortality: a call for public health policies
Jorge C rabstein a ! Bennett " "eventhal b
a* +hildren,s National -edi%al +enter, )e.artment of Ps/%hiatr/ and Beha0ioral 1%ien%es, 111 -i%higan (0enue, Washington, )+, 20010, 2nited 1tates of (meri%a* b* Nathan 1 3line $nstitute for Ps/%hiatri% 4esear%h, Orangeburg, 21(* +orres.onden%e to !orge + 1rabstein 56srabste7%nm%*org8* Bulletin of the World Health Organization 2010988:"0:#"0:* doi: 10*2";1<B=>*10*0;;12: Bull/ing is a ma6or .ubli% health .roblem that demands the %on%erted and %oordinated time and attention of health#%are .ro0iders, .oli%/#ma?ers and families* &0ol0ing a'areness about the morbidit/ and mortalit/ asso%iated 'ith bull/ing has hel.ed gi0e this .s/%hoso%ial hazard a modest le0el of 'orld'ide .ubli% health attention*1@A Ho'e0er, it is not enough* Bull/ing is a multifa%eted form of mistreatment, mostl/ seen in s%hools and the 'or?.la%e* $t is %hara%terized b/ the re.eated eB.osure of one .erson to .h/si%al and<or emotional aggression in%luding teasing, name %alling, mo%?er/, threats, harassment, taunting, hazing, so%ial eB%lusion or rumours* ,; ( 'ide range of bull/ing .re0alen%e has been do%umented among students and in labour for%es 'orld'ide*A,8 ( gro'ing bod/ of resear%h is highlighting the range of signifi%ant morbidities affe%ting indi0iduals in0ol0ed in bull/ing 'hether as b/standers, bullies and<or 0i%tims* 1tudents

in0ol0ed in bull/ing are at a signifi%ant ris? of eB.erien%ing a 'ide s.e%trum of .s/%hosomati% s/m.toms, running a'a/ from home, al%ohol and drug abuse, absenteeism and, abo0e all, self#infli%ted, a%%idental or .er.etrated in6uries*1,2 >he %onseCuen%es of bull/ing eBtend into adulthood, as there is e0iden%e of a signifi%ant asso%iation bet'een %hildhood bull/ing beha0iour and later .s/%hiatri% morbidit/* : -oreo0er, adults bullied in the 'or?.la%e are .rone to suffer from a 0ariet/ of health ris?s, in%luding de.ression and %ardio0as%ular .roblems*" -ulti.le re.orted %ases of death asso%iated 'ith bull/ing ha0e led to legislati0e initiati0es around the 'orld*D &na%ted legislation has .la%ed the res.onsibilit/ of .re0ention on the shoulders of organizational 5edu%ational or 'or?.la%e8 management 'ith no a..arent in.ut eB.e%ted from the .ubli% health se%tor*10 (s 'e re%ognize the health and safet/ hazards lin?ed to bull/ing a%ross the lifes.an, 'e are %hallenged 'ith the need to de0elo. health .oli%ies for bull/ing .re0ention* >he s%hool milieu is fun%tionall/ an o%%u.ational en0ironment, 'here future em.lo/ees and em.lo/ers de0elo. their .h/si%al, %ogniti0e, so%ial, moral and ethi%al s?ills* -oreo0er, students and 'or?ers are eB.osed to similar .h/si%al and .s/%hologi%al hazards* >his notion is refle%ted in the 1'edish Wor? &n0ironment (uthorit/ (%t 'hi%h is fo%used on .re0enting ill#health and a%%idents in the 'or?.la%e* >his statute %onsiders students, .rison inmates and members of the armed for%es as em.lo/ees*11 1ome ma/ argue that the a..roa%hes for eradi%ating s%hool bull/ing should be different from those addressing bull/ing at the adult 'or?.la%e* (lthough there are differen%es in the de0elo.mental and legal status of students and adult 'or?ers, as 'ell as in the so%io#e%ologi%al as.e%ts of s%hools and industr/, both en0ironments ma/ benefit from the same a..roa%h to .re0ent bull/ing and its asso%iated health ris?s* >he s%ientifi% literature suggests that .re0entati0e inter0entions should in%lude 'hole %ommunit/ a'areness %am.aigns about the nature of bull/ing and its dangers*12 &fforts should also be made to enhan%e the emotional and organizational en0ironments in s%hool and 'or? settings b/ .romoting sensiti0it/, mutual res.e%t and toleran%e to di0ersit/ 'hile .rohibiting bull/ing* Bull/ing in%idents should be re.orted to organizational leadershi. 'hi%h should ensure a %onsistent and organized res.onse, in%luding su..ort of the 0i%tim and %ounselling for the .er.etrator b/ sensitizing him or her to the harm the/ ha0e infli%ted* 4eferral to a..ro.riate health ser0i%es 'ill be reCuired to alle0iate the .h/si%al and emotional %onseCuen%es of bull/ing, as 'ell as to hel. those 'ho %ontinue bull/ing beha0iour in s.ite of organizational %ounselling* >he effi%a%/ of this .ubli% health a..roa%h should be monitored b/ a .eriodi% assessment of the .re0alen%e of bull/ing#related morbidit/ and mortalit/* Poli%/#ma?ers %ould %reate ad0isor/ grou.s to .ro0ide re%ommendations and de0elo. guidelines for a 'hole#%ommunit/ strateg/ for the .re0ention, inter0ention and treatment of bull/ing#related .ubli% health ris?s* Bull/ing .re0ention strategies %an hel. go0ernments to ensure safe and health/ learning and 'or?ing %onditions, 'hile redu%ing eB.enditure on bull/ing#related in6uries and ill health* Eurthermore, the/ %an redu%e disru.ted student a%hie0ement and 'or?er ineffe%ti0eness, due to absenteeism9 eB.enses in so%ial 'elfare<benefits and other %osts related to loss of .rodu%ti0e 'or?ers at a .remature stage* Ee'er Fdro.outsG lin?ed to bull/ing mean a healthier, ha..ier and more .rodu%ti0e .o.ulation*

#eferences

Hini H, Pozzoli >* (sso%iation bet'een bull/ing and .s/%hosomati% .roblems: a meta# anal/sis* Pediatrics 200D9 12:: 10AD# A doi: 10*1A"2<.eds*2008#121A* 1rabstein !, Piazza >* Publi% health, safet/ and edu%ational ris?s asso%iated 'ith bull/ing beha0iors in (meri%an adoles%ents* Int J Adolesc Med Health 20089 20: 22:# ::* 1ourander (, 3lome? (B, NiemelI 1, Haa0isto (, H/llenberg ), Helenius H, et al*, et al* +hildhood .redi%tors of %om.leted and se0ere sui%ide attem.ts: findings from the Einnish 1D81 Birth +ohort 1tud/* Arch Gen Psychiatry 200D9 : :D8#"0 doi: 10*1001<ar%hgen.s/%hiatr/*200D*21* 3i0imI?i -, Virtanen -, Vartia -, &lo0ainio -, Vahtera !, 3elti?angas#!Ir0inen =* Wor?.la%e bull/ing and the ris? of %ardio0as%ular disease and de.ression* Occup Environ Med 200:9 0: ;;D#8: doi: 10*11: <oem* 0*10*;;D* European or!ing conditions survey" violence# harass$ent and discri$ination in the or!place% )ublin: &uro.ean Eoundation for the $m.ro0ement of =i0ing and Wor?ing +onditions9 200A* (0ailable from: htt.:<<'''*eurofound*euro.a*eu<do%s<e'%o<"&W+1<ef0 D8<%ha.ter"*.df Ja%%essed A -a/ 2010K* Ol'eus )* Nor'a/% $n: 1mith P3, -orita L, !unger#>as !, Ol'eus ), +atalano 4, 1lee Pl, editors* &he nature of school 'ullying" a cross(national perspective, 1st edition* =ondon: 4outledge9 1DDD* .* :1* &inarsen 1, Hoel H, Ma.f ), +oo.er +=* >he %on%e.t of bull/ing at 'or?* $n: &inarsen 1, Hoel H, Ma.f ), +oo.er +=, editors* Bullying and e$otional a'use in the or!place" international perspectives in research and practice, 1st edition* =ondon: >a/lor and Eran%is9 200:* .* * )ue P, Holstein B&, 1o% -1* Bull/ing 0i%timization among 1: to 1A#/ear#old s%hool %hildren: results from t'o %om.arati0e studies in %ountries and regions* Int J Adolesc Med Health 20089 20: 20D#21* Bernas%oni +* +hile s%hools to get state hel. to fight bull/ing, &he )antiago &i$es# 1: O%tober 2008* (0ailable from: htt.:<<'''*santiagotimes*%l<indeB*.h.N o.tionO%omP%ontentQ0ie'Oarti%leQidO1"8AD:+H$=&#1+HOO=1#>O#H&>#1>(>&# H&=P#>O#E$HH>#B2==L$NHQ%atidO:1:editorial#and#o.inionsQ$temidO1": Ja%%essed -a/ 2010K* 1rabstein !+, Ber?man B&, P/nti?o0a &* (ntibull/ing legislation: a .ubli% health .ers.e%ti0e* J Adolesc Health 20089 "2: 11#20 doi: 10*101 <6*6adohealth*200;*10*00;* >he Wor? &n0ironment (%t, +ha.ter 1, Pur.ose and 1%o.e of the (%t, 1e%tion :* 1to%?holm: 1'edish Wor? &n0ironment (uthorit/9 200D* (0ailable from: htt.:<<'''*a0*se<inenglish<la'and6usti%e<'or?a%t<%ha.ter01*as.B Ja%%essed A -a/ 2010K* 1rabstein !, !oshi P, )ue P, Wright !, =e0enthal B, -erri%? !, et al*, et al* Pre0ention of .ubli% health ris?s lin?ed to bull/ing: a need for a 'hole %ommunit/ a..roa%h* Int J Adolesc Med Health 20089 20: 18A#DD*