Initiating change locally in bullying and aggression through the school environment (INCLUSIVE): a pilot randomised controlled trial

Abstract

The prevalence, harms and costs of aggressive behaviours, such as bullying and violence, among young people make addressing them a public health priority.(1-4) The World Health Organization considers bullying to be a major adolescent health problem, defining it as the intentional and repetitive use of physical or psychological force against another individual or group.(5) This includes verbal and relational aggression that aims to harm the victim or their social relations, such as through spreading rumours or purposely excluding them.(6,7) The prevalence of bullying among British youth is above the European average,(8) with approximately 25% of young people stating that they have been subjected to serious peer bullying.(9) Being a victim of peer bullying is associated with an increased risk of physical health problems;(10) engaging in health risk behaviours such as substance use;(11-13) long-term emotional, behavioural and mental health problems;(14-16) self-harm and suicide;(17) and poorer educational attainment.(18,19) Students who experience physical, verbal and relational bullying on a regular basis tend to experience the most adverse health outcomes.(20) There is also emerging evidence suggesting that childhood exposure to bullying and aggression may also influence lifelong health through biological mechanisms, for example through reduced telomere length.(21) The perpetrators of peer bullying are also at a greater risk of a range of adverse emotional and mental health outcomes, including depression and anxiety.(8,22) Although bullying is different from youth violence, which involves the intention of physical force, bullying is often a precursor to more serious violent behaviours commonly reported by British youth. For example, one UK study of 14,000 students found that 1 in 10 young people aged 11-12 years reported carrying a weapon and 8% of this age group admitted they had attacked another with the intention to hurt them seriously.(23) By age 15-16 years, 24% of students report that they have carried a weapon and 19% report attacking someone with the intention of hurting them seriously.(23) Interpersonal violence can cause physical injury and disability, and is also associated with long-term emotional and mental health problems. There are also links between aggression and antisocial behaviours in youth and violent crime in adulthood.(24,25) Although all bullying does not necessarily involve or lead to violence, and youth violence may emerge in isolation from bullying or victimisation, these different aggressive behaviours share common determinants which make common universal approaches to address aggressive behaviours appropriate.(14,22,23,25) Although a universal problem, the prevalence of aggressive behaviours varies significantly between schools, both in the UK22,26 and internationally.(27,28) For example, among 11- to 14-year-olds in London, the frequency of reporting being bullied at school has been found to vary from 21% to 47% across different schools, and the frequency of reporting being recently involved in physical violence from 22% to 52%.(26) There are also marked social gradients in bullying and violence among young people, with both family deprivation and school-level deprivation increasing the risk of experiencing bullying.(29) As well as leading to further health inequalities, the economic costs to society as a whole of youth aggression, bullying and violence are extremely high. For example, the total cost of crime attributable to conduct problems in childhood has been estimated at about 60B pound a year in England and Wales.(30)