Bullying victimization had been recognized as the universal public health concern which instigated a huge number of adolescents. Present nationwide study revealed the prevalence of peer victimization among Malaysian school-going adolescents was about one in five (17.9%). Our figure was tiny compared to other low middle-income countries like Thailand (27.8%) (32), Tanzania (25%), Zambia (63%) (33), Arab Countries including Lebanon (33.6%) and Moroco (31.9%) (34); somehow higher than developed Western region such as Sweden (10.6%)(35) and Australia (12%)(36). On the other hand, Malaysian Prevalence of victimization was comparable to some neighboring South East Asia Countries including Indonesia (20.6%), Myanmar (19.4%) and Brunei (21.1%). The discrepancy in the prevalence reported in different countries reflected the socioeconomic and cultural variation. The cultural divergence in the understanding, definition and conceptualization of bullying during the cross-national data collection had been reported (37). Individuals from different socio-cultural background perceived and interpret bullying dissimilarly. Besides, differences in the methodological scale assessing school bullying might also contributed to the large difference in the cross-national prevalence. Moreover, the rate of bullying victimization in fact mirrors the attainment in the implementation of national initiatives such as health policy and preventive program. For example, in Scandinavian the victimization prevalence was low principally due to the national programs in place in addressing the issue whereas in Eastern Europe where the victimization rate was high secondary to lack of country-wide national campaign (38). In addition, the fairly low prevalence of being victimized among Malaysian adolescents might be secondary to some diverse factors such as the tiny size country with culture tolerance and acceptance within the community which yield a long standing social stability and balanced community.
The present study reported made fun of gender and body image as the most prevalent type of bullying, consistent with the report released by the National Human Right Society Malaysia (HAKAM ) on bullying issue in Malaysian schools in 2018 (39). Although the most extravagant cases of physical bullying were reported in the media which obtained the greatest public attention, instead the verbal and social bullying is most common among Malaysian schools, including teasing, made fun, name-calling and gossiping. On the other hand, the concern about cyber bullying as another type of social bullying rather than direct physical bullying has been raised by the Cyber Security Malaysia. The cyber bullying among Malaysian students has been reported growing almost daily, with 338 cases reported in 2016 compared to only 291 cases in year 2014 (40). The present study shared homogenous findings with that of reported among Korean adolescents in term of categorization of victimization subtypes, that social and verbal bullying were the more common subtypes of victimization. On the other hand, physical abuse only documented the least frequent type of victimization (16% in Korean study while 12% in present study)(24). In line with our study, similar study conducted in Chile, Croatia, New Zealand and US similarly reported the predominant types of bullying was made fun of body image or face appearance (41–45). Nevertheless, the types of bullying either direct or indirect bullying was predicted by the socio-cultural environment, although multiple studies consistently reported that the boys were more likely to be involved in physical bullying while the girls were more involved in verbal or indirect bullying (46). The stereotypical participation in bullying victimization among the boys and girls related to the social roots. A more aggressive and violent behavior traditionally reinforced within boys, while the girls were more prone to indirect involvement in homogeneous with the classical stereotypes of femininity. These stereotypes affirm the approach used by different genders to ensure a prominent and outstanding place in peer relations.
The boys were significantly more likely to have been victimized compared to the girls, which conforms to other studies (33, 35, 47, 48). This was supported by the ideology that of the differences exist in between male gender construction form the female gender construction. Boys have higher threshold on the acceptance of power practices (49) as well as they were more willing to report their victimization experience compared to girls (18). Literatures had identified strong evidence that bullying victimization correlates with sexuality and gender, especially in the context of feelings of belonging to a social group and school (50). The cultivation theory proposed that gender construct is influenced by the socialization composed from multiple factors in a child’s life, such as play between peers, teacher–child relationships, and media influences (51). Through social learning, boys were portrayed to be aggressive, direct, ingenious and closely linked to power relationships. As a result, the gender considerations and the involvement in victimization situations will allow the formation and conceptions of intervention practices in schools applying the inter-sectorial focus.
The age trend displayed an obvious pattern with bullying victimization. The younger children tend to report higher levels of victimization compared the elder age group, reflecting the power imbalance between students at different age. Multiple School-based surveys worldwide consistently documented reports of being bullied revealed a steady downward trend through ages from eight to sixteen years (48, 52). In addition, victimization was found consistently declined across 11 to 15 years across international comparative cross-sectional study in 28 countries (53). We hypothesized this age‐related decline plausibly due to the younger children have more students older than them in school who are in a position to bully them. On the other hand, the younger age group has not acquired the assertiveness skills to handle bullying incidents effectively in order to discourage further bullying. As adolescents grow up, the development changes in term of physical, social and psychological provide the protective factor against victimization, as well as the equalization of physical size which further inhibiting victimization. Besides, young adolescents might report bullying victimization more compared to elder age group in view of the social climate (54). Therefore, systematic assessment of bullying in schools is imperative and should reflect the age group of the adolescents involved. The younger age groups require more intensive prevention efforts and intervention program. They need to be educated on the appropriate handling techniques and social skills while facing victimization.
Our study documented obese children had higher odds of being bullied, which correlated with making fun of body image as the most prevalent type of victimization reported. This finding was identical to multiple worldwide studies that having abnormally high body mass index had been shown to be associated with greater risk of being victimized (55–60). The victims’ physical appearance and body image has become one of the commonly targeted aspects in cases of bullying; and high body mass index generally associated with physical inactivity. It had been postulated that physically inactive children were less fit compared to those physically active children, therefore were unable to protect or prevent them from being bullied (61). Furthermore, physically activities are helpful in maintaining psychosocial wellbeing as well as improving social skills (62). On the other hand, obese children are more likely to perceive negative self-image which might further weaken self-esteem and self-confident hence making themselves more vulnerable towards peer bullying. Recognizing the basis of body weight as one of the risk factors of victimization, specific and focused intervention must consider physical activity in order to improve overall health and against obesity. In addition, recommendation of cultural and psychosocial intervention is another important measure to reduce victimization secondary to basis of body image or negative self-image. The school authority and teachers have greatest responsibility in counteracting school bullying by providing adequate concern and support besides developing positive classroom climate to inhibit bullying culture towards students with imperfections.
The present study observed suicidal tendencies among more than one in twenty of the victims (6%-8%). The victimized children are highly distressed and traumatized individuals due to the aversive experience in peer abuse. Therefore they might reinforce negative self-concept, display internalizing problems, exhibit social withdrawal and even suffered from depression. Those lack of peer and parental support were reported more prone to develop psychological distress including truancy as well as suicidal behaviors (7). Sustained victimization will mark significant and persistent health impacts especially on the socioemotional functioning (23). This is because the adolescence is the transitional period from childhood into adulthood hence the developmental phase will be marked by overall changes in physical, mental and social. Peer victimization had been reported to have association with several adjustment difficulties including depression and self-harm (63), school-related fear, anxiety and avoidance (64), low self-esteem and negative self-evaluations (65). In addition, the poor self-esteem was reported to mediate the relationship between victimization and suicidality. Numerous longitudinal studies in past two decades evidently documented the psychosocial maladjustment which significantly increased over time and even poor mental health outcomes which extended into the later adulthood, have been linked with the experience of being involved in interpersonal violent (66–68). The experience of being bullied may cause poor emotional adjustment secondary to the negative self-concept among the youth, reflecting that stress of being victimized repeatedly. The victims of school bullying may intentionally skip class or miss school to avoid peer victimization in conjunction with studies reported in Zambia and China (33, 69). This vulnerable group would be absent from school as they were likely to feel lonely, nervous, anxious and fear of attending school as a result of previous experience. As a result, bullying victimization may post severe impacts on students’ academic achievements.
The connectedness and bonding arise from peer support and parental supervision has been recognized as the protective factors against victimization (70). Excellent parental practice as well as acquiring more close friends was found to be less socially isolated therefore were negatively associated with victimization (71). The positive parent-child bonding, including parental emotional support and family warmth enabled both behavioral and emotional pliancy in response to victimization (72). The developmental and attachment theory proposed that the early caregivers’ experiences were essential in which they deeply influenced children’s behaviors in peer interactions or relationship in later life (73). Children who were dissatisfied with their family function and parental care were found more likely to involve in bullying or even be a victim of bullying. On the other hand, the “friendship protection hypothesis” suggested the quality of support in friendships helps protect against bullying. In other words, acquiring more close friends, adolescents will be less socially isolated hence negatively related to peer victimization. The effective socialization among peers results in an effective response to victimization therefore less vulnerable to aggressive peers. Study reported that when adolescents encountered peer abuse, they mostly seek for help from their parents or peers rather than school teachers, which strongly suggested that emotional support from both social influencers, the parents and peers was of paramount importance (74). In contrast, students with lack of family support and aberrant peer relationship were consistently correlated with the exposure of victimization and even significantly related to suicidal behaviors (75). As the step forward to strengthen these two protective factors in bullying victimization among the youth, the school-based intervention program must be designed involving parents or guardians for better engagements among students in school. It is worth nothing that the “Check and connect” model can be one of the highly recommended measures to be employed. The “Check” model is monitor risk factors of bullying victimization while the “Connect” model includes the effective communication between students, school and parent, so that students may seek better ways in handling victimization issue. In addition, a one-to-one mentor-mentee system is needed to establish a long-term relationship among school staffs, students and parents. On the other hand, the peer group based intervention is necessary to educate adolescents about negative peer pressures. Children will be able to engage in the interactive group sessions which are useful in addressing useful topics of moral values and peer communication.
This study had a few limitations. Firstly, the data was collected in a cross-sectional survey hence unable to generate causality to those associated factors revealed in the study. Secondly, the self-administered questionnaire might allow misreported from some participants either intentionally or unintentionally. Recall bias may limit its validity. The respondents might have different interpretation of the abusive interactions and variation in the willingness to report such a humiliating yet painful experience. This current GSHS only recruited adolescents who attended school and may not represent all adolescents nationwide as the bullying behavior may varies between the two groups. Nevertheless, the sample size included in this study represented Malaysian adult population, therefore allowed for nationally representative estimates. Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up is therefore highly recommended to identify specific causal pathways between bullying and suicidality.