Prevalence of bullying and deliberated self-harm behaviors among high school students

Document Type : Research Paper



Introduction: The aim of this study was to assess the prevalence of bullying, deliberate self-harm (DSH) and related factors among the localized sample of Iranian adolescents.
 Materials and Methods: This is a cross-sectional study and was conducted in 2011, A stratified, random sample of adolescents (n=1064) was recruited from high school students in Zanjan city, northwest of Iran. Data on pertaining to deliberate self-harm and bullying as well as socio-economic status, smoking and psychosocial variables was obtained from a validated questionnaire. Binary logistic regression models for the association factors as independent variables and DSH and bullying behaviors were used as the dependent variable. Both univariate and multivariate models were constructed.
 Results: Overall, 285 (26.8%) and 280 (26.3%) students, acknowledged having DSH behavior and bullying respectively. Results of multivariate logistic regression analysis indicated that smoking students were 5.92 times more than nonsmoking students to be in the DSH group. (OR=5.92, 95% CI=3.57-9.79) but for bullying, socio economic status have the most odds ratio (OR= 2.92, 95 % CI=1.80-4.74). Among supportive factor, high self-esteem on DSH behavior (OR=0.32, 95% CI=0.12-0.84) and parental controls on bullying (OR=0.53, 95% CI=0.37-0.57) had the greatest impact.
 Conclusion: Prevalence of violent behavior such as DSH and bullying among adolescents is of concern. Smoking and socioeconomic status had the most association with DSH behavior and bullying respectively. High self-esteem and Parental controls had the greatest supportive impact on DSH behavior and bullying respectively. 


1. Crockett LJ, Petersen A. Adolescent development: Health risks and opportunities for health promotion. New York: Oxford University; 1993: 13-37.
2. Fergusson DM, Horwood LJ. Transitions to cigarette smoking during adolescence. Addict Behav 1995; 20(5): 627-42.
3. Wan YH, Hu CL, Hao JH, Sun Y. Deliberate self-harm behaviors in Chinese adolescents and young adults. Eur Child Adolesc Psychiatry 2011; 20(10): 517-25.
4. Fisher HL, Moffitt TE, Houts RM, Belsky DW, Arseneault L, Caspi A. Bullying victimisation and risk of self harm in early adolescence: Longitudinal cohort study. BMJ 2012; 26: 344.
5. Shetgiri R, Lin H, Flores G. Trends in risk and protective factors for child bullying perpetration in the United States. Child Psychiatry Hum Dev 2013; 44(1): 89-104.
6. Moran P, Coffey C, Romaniuk H, Olsson C, Borschmann R, Carlin JB, et al. The natural history of self-harm from adolescence to young adulthood: A population-based cohort study. Lancet 2012; 379(9812): 236-43.
7. Brunstein Klomek A, Sourander A, Gould M. The association of suicide and bullying in childhood to young adulthood: A review of cross-sectional and longitudinal research findings. Can J Psychiatry 2010; 55(5): 282-8.
8. Andover MS, Gibb BE. Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Res 2007; 178(1): 101-5.
9. Mortimer JT. The benefits and risks of adolescent employment. Prev Res 2001; 17(2): 8-11.
10. Nock MK, Joiner TE Jr, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res 2008; 144(1): 65-72.
11. Jacobson CM, Muehlenkamp JJ, Miller AL, Turner JB. Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol 2008; 37(2): 363-75.
12. Gratz KL, Latzman RD, Young J, Heiden LJ, Damon J, Hight T, et al. Deliberate self-harm among underserved adolescents: The moderating roles of gender, race, and school-level and association with borderline personality features. Personal Disord 2004; 3(1): 39-54.
13. Veenstra R, Lindenberg S, Munniksma A, Dijkstra JK. The complex relation between bullying, victimization, acceptance, and rejection: Giving special attention to status, affection, and sex differences. Child Dev 2010; 81(2): 480-6.
14. Lee HY, Kim YK. Gender effect of catechol-o-methyltransferase Val158Met polymorphism on suicidal behavior. Neuropsychobiology 2011; 63(3): 177-82.
15. Vieno A, Gini G, Santinello M. Different forms of bullying and their association to smoking and drinking behavior in Italian adolescents. J Sch Health 2011; 81(7): 393-9.
16. Tuisku V, Pelkonen M, Karlsson L. Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year follow-up. Nord J Psychiatry 2011; 23(4): 265-75.
17. Bowes L, Arseneault L, Maughan B, Taylor A, Caspi A, Moffitt TE. School, neighborhood, and family factors are associated with children’s bullying involvement: A nationally representative longitudinal study. J Am Acad Child Adolesc Psychiatry 2005; 48(5): 545-53.
18. Idsoe T, Solli E, Cosmovici EM. Social psychological processes in family and school: More evidence on their relative etiological significance for bullying behavior. Aggress Behav 2006; 34(5): 460-74.
19. You J, Leung F. The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: A 2-year follow-up study. J Adolesc 2009; 35(2): 389-95.
20. Tsai MH, Chen YH, Chen CD, Hsiao CY, Chien CH. Deliberate self-harm by Taiwanese adolescents. Acta Paediatr 2011; 100(11): 117-28.
21. Scoliers G, Portzky G, Madge N, Hewitt A, Hawton K, de Wilde EJ, et al. Reasons for adolescent deliberate self-harm: A cry of pain and/or a cry for help? Findings from the child and adolescent self-harm in Europe (CASE) study. Soc Psychiatry Psychiatr Epidemiol 2009; 44(8): 601-7.
22. Blood GW, Blood IM, Tramontana GM, Sylvia AJ, Boyle MP, Motzko GR. Self-reported experience of bullying of students who stutter: Relations with life satisfaction, life orientation, and self-esteem. Percept Mot Skills 2011; 113(2): 353-64.
23. Seeds PM, Harkness KL, Quilty LC. Parental maltreatment, bullying, and adolescent depression: Evidence for the mediating role of perceived social support. J Clin Child Adolesc Psychol 2010; 39(5): 681-92.
24. Wahl RA, Cotton S, Harrison-Monroe P. Spirituality, adolescent suicide, and the juvenile justice system. South Med J 2008; 101(7): 711-5.
25. Mohammad Poorasl A, Vahidi R, Fakhari A, Rostami F, Dastghiri S. Substance abuse in Iranian high school students. Addict Behav 2007; 32(3): 622-7.
26. Momtazi S, Rawson R. Substance abuse among Iranian high school students. Curr Opin Psychiatry 2010; 23(3): 221-6.
27. Alireza Ayatollahi S, Mohammadpoorasl A, Rajaeifard A. Predicting the stages of smoking acquisition in the male students of Shiraz’s high schools, 2003. Nicotine Tob Res 2005; 7(6): 845-51.
28. Prinstein MJ, Heilbron N, Guerry JD, Franklin JC, Rancourt D, Simon V, et al. Peer influence and nonsuicidal self injury: Longitudinal results in community and clinically-referred adolescent samples. J Abnorm Child Psychol 2010; 38(5): 669-82.
29. Brunner R, Parzer P, Haffner J, Steen R, Roos J, Klett M, et al. Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolesc Med 2007; 161(7): 641-9.
30. You J, Leung F, Fu K. Exploring the reciprocal relations between nonsuicidal self-injury, negative emotions and relationship problems in Chinese adolescents: A longitudinal cross-lag study. J Abnorm Child Psychol 2011; doi: 10.1007/s10802-011-9597-0
31. Shek DT, Yu L. Self-harm and suicidal behaviors in Hong Kong adolescents: Prevalence and psychosocial correlates. Scientific world journal 2011; 20(10): 517-25.
32. Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 2012; 6: 10.
33. Ramya SG, Kulkarni ML. Bullying among school children: Prevalence and association with common symptoms in childhood. Indian J Pediatr 2011; 78(3): 307-10.
34. Lemstra M, Rogers M, Redgate L, Garner M, Moraros J. Prevalence, risk indicators and outcomes of bullying among on-reserve First Nations youth. Can J Public Health 2011; 102(6): 462-6.
35. Ortega A, Hogh A, Pejtersen JH, Feveile H, Olsen O. Prevalence of workplace bullying and risk groups: a representative population study. Int Arch Occup Environ Health 2009; 82(3): 417-26.
36. Hughes JR. Smoking and suicide: A brief overview. Drug Alcohol Depend 2008; 98(3): 169-78.
37. Schneider B, Wetterling T, Georgi K, Bartusch B, Schnabel A, Blettner M. Smoking differently modifies suicide risk of affective disorders, substance use disorders, and social factors. J Affect Disord 2009; 112(1-3): 165-73.
38. Chen K, Sheth AJ, Elliott DK, Yeager A. Prevalence and correlates of past-year substance use, abuse, and dependence in a suburban community sample of high-school students. Addict Behav 2004; 29(2): 413-23.
39. O'Connor RC, Rasmussen S, Miles J, Hawton K. Self-harm in adolescents: Self-report survey in schools in Scotland. Br J Psychiatry 2009; 194(1): 68-72.
40. Mohammadpoorasl A, Fakhari A, Rostami F, Vahidi R. Predicting the initiation of substance abuse in Iranian adolescents. Addict Behav 2007; 32(12): 3153-9.
41. Wolke D, Woods S, Stanford K, Schulz H. Bullying and victimization of primary school children in England and Germany: Prevalence and school factors. Br J Psychol 2001; 92(Pt 4): 673-96.
42. Kumpulainen K, Räsänen E, Henttonen I. Children involved in bullying: Psychological disturbance and the persistence of the involvement. Child Abuse Negl 1999; 23(12): 1253-62.
43. Scheithauer H, Hess M, Schultze-Krumbholz A, Bull HD. School-based prevention of bullying and relational aggression in adolescence: the fairplayer.manual. New Dir Youth Dev 2012; 133: 55-70.