Psychiatry and Psychological Disorders

Abstract

Introduction: Bullying in schools is a global phenomenon associated with multiple physical and mental health problems that last into adulthood. Analysis by UNICEF in 2022 showed that 89% of Gambian children experienced violence such as bullying, sexual abuse and psychological aggression. There is however dearth of studies on bullying and mental health problems amongst Gambian students. This study was conducted to determine the prevalence of bullying and its effects on mental health of students in a senior secondary school in Banjul, The Gambia

Methodology: This was a cross-sectional study conducted among 167 senior secondary students in Banjul who met the inclusion criteria. A simple random sampling technique was used for the selection of participants. The tools used for the study were the socio-demographic questionnaire, the Adolescent Peer Relations Instrument (APRI), the Strengths and Difficulties Questionnaire (SDQ) and Socio-demographic Questionnaire. The socio-demographic characteristics of the participants were summarized using descriptive statistics, including means and standard deviations for continuous variables. Categorical variables were presented using bar charts, frequencies and percentage distributions. For the bivariate analysis, Fisher’s exact test was employed to examine the association between bullying and mental health.  A significance level of P<0.05 was considered statistically significant.

RESULT: In all, 167 students participated in the study with mean age (SD) of 17.0(2.31) years with majorly (77.8%) in the age range of 17-19 years. The participants were predominantly females (76.6%). Overall, the prevalence of bullying among the participants was 89.8%.

Among the 167 students recruited for the study, only 9(5.3%) did not report bully or victim behaviors. There were 17(10.2%) bullies, 8(4.8%) victims and 133(79.6%) of students who were bully-victims. Verbal bullying was the most common form of bullying perpetrated by 86.8% of the participants with 20.3% being purely verbal bullying while 66.5% were in combination with other subtypes. Similarly, verbal bullying was the commonest form reported by 81.4% of the victims.

The most common combination was of all 3 subtypes (verbal+social+physical) which were reported by 40.5% of bully perpetuators and 58.2% among the victims of bullying. Among the participants, 64.7% reported having difficulties affecting their activities at classroom, home, friendship and leisure activities with 6.6% reporting the difficulties to be severe while 22.8% stated that they had experienced these difficulties for over one year. Also, 52.1% had substantial clinical risk of developing mental health problems. Among the participants, all (100%) the victims of bullying had mental health problems compared to those who were not victims (P<0.05).

Conclusion: The experience and manifestation of bullying behaviors was highly prevalent among the senior secondary school students in Banjul. Mental health problems were experienced by many of the victims of bullying. A firm anti-bullying policy and the development of school mental health programs will help to reduce the incidence of bullying and aid early identification and intervention for students with mental health challenges.

Introduction

Bullying was described by American society of psychology as a form of aggressive behavior in which an individual intentionally and repeatedly causes another person injury or discomfort. It can take the form of physical contact, words or more subtle actions.1 School bullying consists of harassing behaviors and is characterized by violent acts such as mockery or even humiliation between students. More recently, with the development of new technologies, our society have seen the emerging of cyberbullying.1

Globally, more than half of students aged 13 -15years experience bullying and roughly 3 in 10 students in 39 industrialized countries admit to bullying peers according to UNICEF report in 2018.2 While girls and boys are at an equal risk of being bullied, girls are more likely to become victims of psychological forms of bullying such as body shaming, and emotional abuse to name a few. Boys on the other hand are more likely to experience physical violence and threats.2

In the past, bullying was looked upon almost as a rite of passage for school students.3 This however changed in the 1990s when researchers began to make efforts to study bullying systematically. The study started in Scandinavia and spread quickly to Africa countries including Nigeria in the 1980s to 1990s.4,5 A study examining the rates of bullying victimization across 66 countries in 5 continents including Africa recorded prevalence rates ranging from 7-70% and in 2016 a poll carried out by the United Nations (UN) showed 100,000 young people between ages 13-30 from 10 countries including The Gambia, had two-thirds of participants reporting being victims of bullying .6

Previously, bullying was misconstrued to be harmless, though an unpleasant means of interacting among youths 7,8. Research has however shown that bullying is associated with adverse physical, emotional and mental health outcomes. Some of which persist into adulthood 9,10. The mental health problems associated with bullying include depression11,12 anxiety13, suicidal ideation and intent14, increased rate of psychopathic complaints15,16, and victims exposed to frequent bullying have also been shown to be more likely to receive psychiatric treatment and be prescribed psychiatric medications. Bullying has been found to have higher rates of antisocial behaviors, alcohol abuse, and depression later in life.

Bullying is listed as one of the items in the criteria for diagnosis of conduct disorders in the tenth edition of the International Classification of Diseases (ICD-10) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).17,18

The country office annual report in 2022 for the Gambia by UNICEF19 showed that 89% of Gambian children experienced violence such as bullying, sexual abuse and psychological aggression.

Bullying has been associated with mental health problems among adolescent students with reported prevalence of mental health problems of 1.2% and 4.6% among male and female students respectively.20The study further stated that reports of mental health problems were four times higher among boys who had been bullied compared to those not bullied with corresponding figure for girls which was 2.4 times higher.20

Despite the high prevalence of bullying among school adolescents at the global scene, there is scarcity of research on bullying among secondary school students in the Gambia. This study was therefore undertaken to determine the prevalence of bullying among senior secondary students in Banjul, Gambia and to explore the relationship between bullying behavior and mental health problems among the students.

Methods

The study was conducted among students of one of the secondary schools in Banjul, Gambia. The student population of the school was more than 1200 comprising male and female students.

A descriptive cross-sectional design was utilized in the study. A simple random sampling technique was used for the selection of participants. In the first stage, all students who did not give their assent for the study were excluded. In the second stage, students who met the inclusion criteria were selected at random to participate in the study.

Sample Size Calculation

Using the Leslie-Kish formula for calculating sample size, for a known prevalence rate:22

n= sample size required

Z = 1.96 from a z-table at a 95% confidence interval

p = Prevalence rate of violence among Gambian children, which was reported to be 89%19

q = 1-p (1-0.89)

d = Sampling error = 5%

Sample size n = (1.96) ² (0.89(1-0.89) / (0.05) ²)

n=150

Accounting for non-response with 11% non-response rate reported in previous study19,

Sample size is approximately 170.

Study Instruments:

The Socio-demographic Questionnaire

This consists of variables related to age, gender, family structure, information regarding students' attitudes to their schools and their relationship with classmates and teachers. It also consists of the measured weight and height of the participating students. It was modeled after the school health questionnaire designed by Omigbodun et al., in 2008.23

The Adolescent Peer Relations Instrument (APRI)

This is a multiple-item and multiple-scale measure of bullying that was developed by Parada in 2000.24 The APRI has two sections containing items for bullies and for victims, each of which has 18 questions, bringing the total number of questions to 36. It measures three categories of bullying (physical, verbal and social), with 6 items per category.

Scoring is based on a 6-point Linkert scale with scores ranging from 1=Never, 2=Sometimes, 3=Once or twice a month, 4=Once a week, 5=Several times a week,6= every day.

Scoring is achieved by adding the items up for each total score (bullying and victimization) or each subscale score (verbal, social, and physical). Any student who scores 18 for either the bullying or victimization total score has never been bullied or has never bullied others. There are no cutoff scores for this instrument. For the subscales, a score of 6 means the respondent has never been bullied or has never bullied others in that particular way.

The Strengths and Difficulties Questionnaire (SDQ).

The Strengths and Difficulties Questionnaire (SDQ) was developed by Goodman in 1997 as a brief screening tool for mental health and behavioral problems in children and young people.25 The self-administered version, which has 25 items in 5 domains of emotional symptoms, conduct problems, hyperactivity/inattention, peer problems and a pro-social scale was used for this study.

The total difficulties score is generated by summing scores from all the scales except the prosocial scale (which is a measure of strength) and ranges from 0 to 40. The externalizing score ranges from 0 to 20 and is the sum of the conduct and hyperactivity scales. The internalizing score ranges from 0 to 20 and is the sum of the emotional and peer problems scales. The established cut-offs for the self-report version based on the total difficulties score are: normal (0–15), borderline (16–19) and abnormal (20–40).

Ethical Considerations

Written approval to conduct the study was obtained from the Edward Francis small Teaching Hospital Ethics committee. Permission for participation of the students was sought from the parents or guardians, who were given consent forms to sign and return via the students. Permission was also sought from the principal of the school. The aims and objectives were discussed with the students who were told that their participation was voluntary and there would be no foreseeable risk in participation. Only students with parental consent who also assented to the study were recruited. Questionnaire administration was anonymous and strict confidentiality was observed. Questionnaires were identified by a code rather than by names. No names or any other forms of identification would be used in subsequent publications arising from this study.

Procedure

An arrangement was made with the principal of the school to dedicate a hall where the students were assembled. They were informed that balloting would be done to select those who would participate in the study and that those who did not participate would not be penalized. Simple random sampling via yes or no balloting was done to select the required number of students from each class. They were then given consent forms to take home to their parents. The consent forms were returned to the researcher on the day of the study. A suitable break period was agreed on with the principal and teachers of the school, during which the researcher and research assistants visited the school. The pilot study suggested that the required time for filling the instruments was likely to take the entire break period. The principal was informed about this and graciously made the academic schedule for the day of the study flexible, thus ensuring that the students had time to participate without missing their school work. On the day of the study, the definition of bullying was explained to the students, with mention being made of how bullying differed from arguments or fights among friends. The Socio-demographic questionnaire, Adolescent Peer Relations Instrument (APRI) and the Strengths and Difficulties Questionnaire (SDQ) were given to the students to fill at the same time. This was done confidentiality with the help of two research assistants. The study questionnaires were administered to study participants with duly filled consent forms. They were also informed that the exercise was not a test and that they should answer the questions honestly. This procedure was repeated for all classes of the selected school until the required proportion of students from each of the selected classes was recruited.

The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. The socio-demographic characteristics of the participants were summarized using descriptive statistics, including means and standard deviations for continuous variables. Categorical variables were presented using bar charts, frequencies and percentage distributions. For the bivariate analysis, Fisher’s exact test was employed to examine the association between bullying and mental health.  A significance level of P<0.05 was considered statistically significant.

Results

The results in table 1.1 present the demographic information of the participants. A total of 170 students were recruited for the study. However, 3 students had incomplete participation resulting to a total of 167 participants. Thus, the response rate was 98.2%. The mean age of the participants was 17±2.31 SD. Most (76.0%) of the participant’ age ranged from 17 -19 years, 18.0% of the participants were aged 14 – 16 years, and 6.0% of the participants were between the age of 20 to 22 years. Also, majority of the respondents were female (76.6).

Table 1.1: Demographic distribution of the study participants

Figure 1.1 presents the prevalence of bullying among the participants, 89.8% (150/167) reported that they were bullies, 84.4% (141/167) reported that they have been a victim of bully.

Table 1.2presents the pattern of bullying among those who bullied people and the victims of bullying as well as their bullying behaviour. Of the 167 students who participated in this study, 17 (10.2%) reported they were bullies only, 8(4.8%) were victims of bullying only, and 133 (79.6%) reported they were both victims and have perpetuated bullying and 9 (5.4%) said they were neither bullies nor victims of bully. The pattern among those who perpetuated bullying showed that 32 (20.3%) participants carried out purely verbal bullying while, 21 (13.3%) perpetuated a combination of verbal and social bullying, and 28 (17.7%) were involved in a combination of verbal and physical bullying. Also, 64 (40.5%) were engaged in a combination of verbal bullying, social bullying and physical bullying. Similarly, the pattern among the victims of bullying showed that 13 (8.2%) participants face purely verbal bullying, 3 (1.9%) faced social bullying and 2(1.3%) faced physical bullying. We also found that 92(58.2%) participants faced all forms of bullying, 24 (15.2%) faced a combination of verbal and social bullying and 7 (4.4%) faced a combination of verbal and physical bullying.

Figure 1.1 Prevalence of Bullying

Table 1.2:  Pattern of bullying and pattern of bullying behaviour among respondents

Effects of bullying on participants activities

As presented in table 1.3, the mental health of participants who were bullies, victims and bully-victims were assessed using the strength and difficulty questionnaire variables.  Assessing their mental health status was based on five variables: emotional, conduct, hyperactivity, peer problems and prosocial domains.

The most common mental health problem encountered by majority were related to four difficulties which was reported by 70.1% of the participants. This was in the hyperactivity disorders domain which comprised (aggressiveness, being impulsive, inability to concentrate, being easily distracted), peer problems (trouble making friends and maintaining relationships.), and conduct disorders (steal, violating rights of others, manipulative behavior, alcoholism, drug abuse, etc.) in combination with emotional disorder.

Also, the impact of the mental health difficulties of the participants was assessed and 59 (35.3%) of the participants stated the difficulties they had has not in any way affected their lives, while 82 (49.1%) admitted having minor difficulties affecting their life, 15 (9.0%) admitted having definite difficulties and 11 (6.6%) stated having severe difficulties.

The duration of the presence of mental difficulties in students who admitted to having difficulties (n=108) was also looked at, 50 (29.9%) students had difficulties lasting less than a month, 14 (8.4%) had difficulties lasting about 1 and 5 months, 6 (3.6%) had difficulties lasting 6 months to a year and 38 (22.8%) had difficulties lasting for over a year.

Participants also reported that the difficulties they had have impacted on their lives at home: 58 (34.7%) admitted the difficulties they had affected them in a little way in their homes, 16 (9.6%) were affected moderately and 16 (9.6%) were affected in a great deal. The study participants also reported that the difficulties they had affected their classroom learning as 42 (25.1%) participants were affected a little, 19 (11.4%) experience a medium amount of effect, and 21 (12.6%) reported a great deal of effect of difficulties on classroom activities. Regarding the participants friendship, 53 (31.7%) reported that the bullying affected their friendship in a little way, 20 (12%) reported medium effect, and 17 (10.2%) reported a great deal.

In addition, 146 (87.4%) participants had prosocial behavior, 15 (9%) reported that they sometimes acted prosocial, while 6 (3.6%) were not prosocial. Similarly, the total score of strength and difficulty questionnaire was used to assess the clinical relevance of the difficulties present in the participants. About 21% (35) participants reported a slightly raised risk of developing mental health difficulties that are of clinical relevance, 87 (52.1%) reported a substantial clinical risk while 45 (26.9%) were unlikely to have clinical risk difficulties.

Table 1.3: Effects of bullying on participants activities

Bivatiate analysis of mental health disorder and bullying

The bivariate result shown in table 1.4 shows that almost all (99.3%) the participants who perpetuated bullying had mental health problems compared to the 0.7% of the bullies who had no mental health problems. Although the result was not statistically significant. All (100.0%) the victims of bully had mental health problems as compared to those who were not victims (P<0.05).

Table 1.4 Bivatiate analysis of mental health disorder and bullying

Discussion

This was monocenter study on the prevalence of bullying among senior secondary school students in Banjul, Gambia. It sought to determine the prevalence among of different bullying roles (uninvolved, bullies, victims and bully victims) in the selected secondary school and, in addition, investigate the association between these bullying roles and various variables, including mental health problems, home life, peer relationships, learning, leisure and scores on the Strengths and Difficulties Questionnaire. The response rate in this study was 98.2%, which suggests that the response rate was comparable to that of other studies carried out in secondary schools in Nigeria, which ranged from 96%-100%26-29 and this is a pointer to good strategies for survey administration by the researchers, and responsiveness by the participating school and study participants

The respondents were within the age bracket of 14– 22 years, with a mean age of 17(2.31) and majority being in the 17- 19 years category. These figures are similar to those reported among secondary school populations in Calabar, Nigeria with a slight female preponderance30,31  

The prevalence of being a victim of bullying found in the present study was similar to the average prevalence found in another paper. The paper was an analysis of two comparative studies on bullying spanning 5 continents and 66 countries.32The proportion of victims however varied widely in the preceding study. African countries generally had higher rates of victims than other countries. Rates in Africa varied from 27.8% in Tanzania to 40.7% in Benin Republic and 65% in Zambia. Within individual regions, however, there was marked disparity between the rates found in different countries. It is thought that the civil unrests and communal clashes common in Africa may have an adverse effect on adolescents, making them more likely to perpetuate violent behaviour.33 Indeed, studies have shown a positive relationship between living in a community with a high crime rate and being victimized at school. 33

While some Nigerian studies reported victim prevalence as high as 62%, this is lower than the 84% obtained in this study. International victim prevalence rates were 35% in Canada, 33% in Wuhan, China, 21.6% in Finland and 33.3% in the United States of America.31 The rate of victimization found in this study is more than the rate found in countries with little or no civil unrests. The other difference could be due to instruments used, subtypes of victimization measured and retrospective period under survey might also have played a role in the wide differences found. 

 Bully prevalence in this study resembled that of other studies carried out in Nigeria.34,35 A review of extant literature from international studies also showed that at least 1 in every 5 students was involved in bullying behavior as a bully, which is lower than the findings from this study.36

When categorized into bullying involvement roles however, bullies represented 8.9%of the total population while victims and bully-victims were 4.8% and 84.4% respectively. Those uninvolved in bullying constituted 5.3%. This is in contrast to the prevalence found in a sample of secondary school students in Kwara state, Nigeria and in studies among adolescents in other countries.37,12, 38-39

Some other studies found a much smaller prevalence of bully-victims, with the individual numbers of bullies and victims far exceeding that of bully-victims.40-42 There are very few Nigerian and African studies on bully-victims. Most studies on bullying in this region tend to focus on bullies and to a lesser extent on victims. Some of the papers that reported a low prevalence of bully-victims interviewed the child and parent at the same time43,44 and this might have led to the participants under-reporting their role in bullying so as not to upset their parents. Also, in a bid to present their children as socially desirable, parents may inaccurately report the presence and/or frequency of bullying behavior in their children.

The finding of a high number of bully-victims in this study may be related to the large number of students who took part in bullying behavior, particularly as bullies. It may also be due to lack of social skills to deal with being bullied and a resort to violence as a means of settling scores with bullies. In addition, it is an eye-opener to an alarming cycle of victimized students bullying others when they get the chance.  As noted in literature, being a victim of bullying in schools is a significant contributor to later self-reports of violent behaviour.45,46 This is a source for concern as bully-victims had the worst mental health outcomes when compared to other bullying involvement roles.11,42

Verbal bullying such as insulting, mocking and threatening, was the most common form of bullying behavior in this study and this was similar to what was found in other studies.10,28,36 Verbal bullying does not leave any physical marks and is therefore less easily noticeable by teachers, leading to its high frequency. Previous studies alluded to physical bullying being the most prevalent type of bullying, but most of those studies did not meticulously inquire about scenarios depicting social and verbal bullying.

Our study was conducted just in one of the several secondary schools in Banjul, and this makes generalization of our findings difficult. However, the findings in this study are pointers to the enormity of the problem in the community. Future research on bullying in the Gambia should be done in multi-centers cutting across various ethnics and religious backgrounds.

Conclusion

Bullying behaviors is not an exception among senior secondary school students in The Gambia. The experience and manifestation of bullying behaviors was highly prevalent in the study site. Mental health problems were experienced by many of the victims of bullying. A firm anti-bullying policy and the development of school mental health programs will help to reduce the incidence of bullying and aid early identification and intervention for students with mental health challenges.

Conflicts of Interest

None

Supports to Students with Difficulties

The Results of this work has been submitted to the Principal and Management of the secondary school where the study was conducted.

Students who have difficulties and require counseling could do so via the contact mobile number of the First Author which had been made available to the school Authority and Students

Appreciations

Special appreciations to the Principal, Teachers and Students of the Senior Secondary School for their supports throughout the conduct of this Research.  The Research Assistants that were involved in this study are highly appreciated

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