BackgroundThe risk factors and effects of bullying are well recognised in many countries, but evidence from China is scarce. This study aimed to investigate the prevalence and risk factors of traditional bullying and cyberbullying in Chinese middle school children (aged 12–15 years) and the psychosomatic symptoms associated with bullying. MethodsA cross-sectional survey using a self-completion questionnaire was done in middle schools in urban and rural Zhejiang, Henan, and Chongqing provinces. In the schools, research assistants introduced the purpose and content of the survey, distributed the questionnaire and stayed in the classroom to respond to any queries. Ethical approval was obtained from the Medical Ethics Committee of Zhejiang University, School of Public Health, Hangzhou, China. FindingsFrom May 20 to Sept 25, 2018, 12 schools in total participated. 3774 questionnaires were completed: the mean age of respondents was 13·58 years (SD 0·87 years). For traditional bullying, 1332 (35·3 % identified as victims, and 341 (9·0% as perpetrators. For cyberbullying, 1170 (31·0%) identified as victims, and 622 (16·5%) as perpetrators. After adjusting for confounders, risk factors for traditional victimisation or perpetration were male sex, rural residence, low academic performance, and a poor relationship with parents. Risk factors for being a victim or perpetrator of cyberbullying were male sex, boarding at school, and a poor relationship with parents. In terms of psychosomatic symptoms, 491 (13·0%) reported they often had headache, 607 (16·1%) abdominal pain, and 597 (15·8%) sleep problems. Traditional victims and cyber victims were more likely to have frequent headaches (adjusted odds ratio 1·3, 95% CI 1·2–1·5 for traditional victims; 1·5, 1·3–1·8 for cyber victims) and frequent abdominal pain (1·2, 1·1–1·4 for traditional victims; 1·3, 1·1–1·5 for cyber victims). Traditional victims (1·3, 1·1–1·5), traditional bullies (1·3, 1·0–1·6), and cyber victims (1·6, 1·4–1·9) were more likely to have frequent sleep problems. InterpretationThe prevalence of bullying among Chinese adolescents is high and it is associated with psychosomatic conditions. Schools must take measures to raise awareness of bullying and to protect the most vulnerable adolescents. FundingGlobal Health Center of Zhejiang University.
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