Skip to main content
SpringerLink
Log in

The cost incurred by victims of bullying from a societal perspective: estimates based on a German online survey of adolescents

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Being a victim of bullying is linked to various social, emotional and behavioral problems potentially leading to a reduced quality of life. Furthermore, victims of bullying may cause extensive costs for society, for example by an above-average need for healthcare services. The present study was designed to quantify the costs and the loss of quality of life attributable to bullying by comparing victims with a control group of non-bullied students. A cross-sectional sample of 1293 adolescents (mean age 14.07, SD = 1.36) and their parents reported on bullying victimization, quality of life (adolescents’ self-report), and annual direct (medical and non-medical) as well as indirect costs (parents’ self-report) from a societal perspective (all expressed in €, year 2014 and 2015). For frequent (20.6% of our sample; costs: €8461.80 p.a.) but not occasional (13.3%; costs: €2850.06) bullying, victimization was associated with significantly higher costs compared to non-bullied adolescents (costs: €3138.00; annual difference between frequently bullied students and controls: €5323.01 p.a.; p = 0.008). Cost drivers included increased direct medical costs, but mostly indirect costs caused by productivity losses of the parents. Self-reported quality of life of frequent victims was considerably reduced (T = − 10.96; p < 0.001); also occasional bullying showed significantly reduced values in global quality of life (T = − 5.73; p < 0.001). The present findings demonstrate that frequent bullying is associated with substantial cost to society and reduced quality of life of victims. This observation underscores the need for effective school-based bullying prevention and suggests a high potential of effective programs to be cost effective as well.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Olweus D (1994) Annotation: bullying at school: Basic facts and effects of a school based intervention program. Child Psychol Psychiatry Allied Discip 35:1171–1190. https://doi.org/10.1111/j.1469-7610.1994.tb01229.x

    Article  CAS  Google Scholar 

  2. Olweus D (2012) Cyberbullying: an overrated phenomenon? Eur J Dev Psychol 9:520–538. https://doi.org/10.1080/17405629.2012.682358

    Article  Google Scholar 

  3. Craig W, Harel-Fisch Y, Fogel-Grinvald H et al (2009) A cross-national profile of bullying and victimization among adolescents in 40 countries. Int J Public Health 54(Suppl 2):216–224. https://doi.org/10.1007/s00038-009-5413-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gini G, Pozzoli T (2009) Association between bullying and psychosomatic problems: a meta-analysis. Pediatrics 123:1059–1065. https://doi.org/10.1542/peds.2008-1215

    Article  PubMed  Google Scholar 

  5. Nakamoto J, Schwartz D (2010) Is peer victimization associated with academic achievement? A meta-analytic review. Soc Dev 19:221–242. https://doi.org/10.1111/j.1467-9507.2009.00539.x

    Article  Google Scholar 

  6. Bond L, Carlin JB, Thomas L et al (2001) Does bullying cause emotional problems? A prospective study of young teenagers. BMJ 323:480–484. https://doi.org/10.1136/bmj.323.7311.480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Barker ED, Arseneault L, Brendgen M et al (2008) Joint development of bullying and victimization in adolescence: relations to delinquency and self-harm. J Am Acad Child Adolesc Psychiatry 47:1030–1038. https://doi.org/10.1097/CHI.0b013e31817eec98

    Article  PubMed  Google Scholar 

  8. Jantzer V, Haffner J, Parzer P et al (2015) Does parental monitoring moderate the relationship between bullying and adolescent nonsuicidal self-injury and suicidal behavior? A community-based self-report study of adolescents in Germany. BMC Public Health 15:583. https://doi.org/10.1186/s12889-015-1940-x

    Article  PubMed  PubMed Central  Google Scholar 

  9. Klomek AB, Sourander A, Gould M (2010) The association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings. Can J Psychiatry Rev Can Psychiatr 55:282–288

    Article  Google Scholar 

  10. Copeland WE, Wolke D, Angold A, Costello EJ (2013) Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry 70:419–426. https://doi.org/10.1001/jamapsychiatry.2013.504

    Article  PubMed  PubMed Central  Google Scholar 

  11. Arseneault L, Milne BJ, Taylor A et al (2008) Being bullied as an environmentally mediated contributing factor to children’s internalizing problems: a study of twins discordant for victimization. Arch Pediatr Adolesc Med 162:145–150

    Article  PubMed  Google Scholar 

  12. Silberg JL, Copeland W, Linker J et al (2016) Psychiatric outcomes of bullying victimization: a study of discordant monozygotic twins. Psychol Med 46:1875–1883. https://doi.org/10.1017/S0033291716000362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Takizawa R, Maughan B, Arseneault L (2014) Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. Am J Psychiatry 171:777–784. https://doi.org/10.1176/appi.ajp.2014.13101401

    Article  PubMed  Google Scholar 

  14. Rupp A, Gause EM, Regier DA (1998) Research policy implications of cost-of-illness studies for mental disorders. Br J Psychiatry 173(Suppl 36):19–25

    Article  Google Scholar 

  15. Pelham WE, Foster EM, Robb JA (2007) The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. J Pediatr Psychol 32:711–727. https://doi.org/10.1093/jpepsy/jsm022

    Article  PubMed  Google Scholar 

  16. Gold MR, Siegel JE, Russell LB (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York

    Google Scholar 

  17. Kumpulainen K, Räsänen E, Puura K (2001) Psychiatric disorders and the use of mental health services among children involved in bullying. Aggress Behav 27:102–110

    Article  Google Scholar 

  18. Fosse GK (2006) Mental health of psychiatric outpatients bullied in childhood. Dissertation, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim

  19. Dyer K, Teggart T (2007) Bullying experiences of child and adolescent mental health service-users: a pilot survey. Child Care Pract 13:351–365. https://doi.org/10.1080/13575270701488733

    Article  Google Scholar 

  20. Evans-Lacko S, Takizawa R, Brimblecombe N et al (2017) Childhood bullying victimization is associated with use of mental health services over five decades: a longitudinal nationally representative cohort study. Psychol Med 47:127–135. https://doi.org/10.1017/S0033291716001719

    Article  CAS  PubMed  Google Scholar 

  21. Sourander A, Gyllenberg D, Brunstein Klomek A et al (2016) Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age. JAMA Psychiatry 73:159–165. https://doi.org/10.1001/jamapsychiatry.2015.2419

    Article  PubMed  Google Scholar 

  22. Espelage DL, De La Rue L (2013) School bullying: its nature and ecology. In: Srabstein JC, Merrick J, Srabstein JC, Merrick J (eds) Bullying: a public health concern. Nova Science Publishers, Hauppauge, pp 23–37

    Google Scholar 

  23. Vreeman RC, Carroll AE (2007) A systematic review of school-based interventions to prevent bullying. Arch Pediatr Adolesc Med 161:78–88. https://doi.org/10.1001/archpedi.161.1.78

    Article  PubMed  Google Scholar 

  24. Ttofi MM, Farrington DP (2011) Effectiveness of school-based programs to reduce bullying: a systematic and meta-analytic review. J Exp Criminol 7:27–56. https://doi.org/10.1007/s11292-010-9109-1

    Article  Google Scholar 

  25. Beckman L, Svensson M (2015) The cost-effectiveness of the Olweus bullying prevention program: results from a modelling study. J Adolesc 45:127–137. https://doi.org/10.1016/j.adolescence.2015.07.020

    Article  PubMed  Google Scholar 

  26. Hummel S, Naylor P, Chilcott J et al (2008) Cost-effectiveness of universal interventions which aim to promote emotional and social wellbeing in secondary schools. Report, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield

  27. Center for Health Promotion and Disease Prevention (2011) The cost benefit of bullying prevention. A first-time analysis of savings. Highmark Foundation, Pittsburgh

    Google Scholar 

  28. McDaid D, Hopkin G, Knapp M (2017) The economic case for prevention in young people’s mental health: bullying. Report to be published by MQ: Transforming Mental Health, London, England

  29. Shaw T, Dooley JJ, Cross D et al (2013) The Forms of Bullying Scale (FBS): validity and reliability estimates for a measure of bullying victimization and perpetration in adolescence. Psychol Assess 25:1045–1057. https://doi.org/10.1037/a0032955

    Article  PubMed  Google Scholar 

  30. Grupp H, König H-H, Konnopka A (2017) Calculation of standardised unit costs for the economic evaluation of mental disorders. Gesundheitswesen Bundesverb Arzte Offentlichen Gesundheitsdienstes Ger 79:48–57. https://doi.org/10.1055/s-0035-1555950

    Article  Google Scholar 

  31. Bock J-O, Brettschneider C, Seidl H et al (2015) Calculation of standardised unit costs from a societal perspective for health economic evaluation. Gesundheitswesen Bundesverb Arzte Offentlichen Gesundheitsdienstes Ger 77:53–61. https://doi.org/10.1055/s-0034-1374621

    Article  Google Scholar 

  32. Bock J-O, Brettschneider C, Seidl H et al (2015) Standardisierte bewertungssätze aus gesellschaftlicher perspektive für die gesundheitsökonomische evaluation, 1st edn. Nomos, Baden-Baden

    Google Scholar 

  33. Drummond MF, Sculpher MJ, Claxton K et al (2015) Methods for the economic evaluation of health care programmes, 4th edn. Oxford University Press, Oxford

    Google Scholar 

  34. Neumann PJ, Sanders GD, Russell LB et al (2017) Cost-effectiveness in health and medicine, 2nd edn. Oxford University Press, New York

    Google Scholar 

  35. Statistisches Jahrbuch-Statistisches Jahrbuch (2014) Statistisches bundesamt (Destatis). https://www.destatis.de/DE/Publikationen/StatistischesJahrbuch/StatistischesJahrbuch2014.html. Accessed 9 May 2018

  36. Online GL (2018) Gelbe Liste Online|Gelbe Liste. https://www.gelbe-liste.de. Accessed 16 May 2018

  37. van den Berg B, Brouwer WBF, Koopmanschap MA (2004) Economic valuation of informal care. An overview of methods and applications. Eur J Health Econ HEPAC Health Econ Prev Care 5:36–45. https://doi.org/10.1007/s10198-003-0189-y

    Article  Google Scholar 

  38. The-KIDSCREEN-Group-Europe (2006) Health-related quality of life screening instrument for children and adolescents—deutsche fassung

  39. Analitis F, Velderman MK, Ravens-Sieberer U et al (2009) Being bullied: associated factors in children and adolescents 8 to 18 years old in 11 European countries. Pediatrics 123:569–577. https://doi.org/10.1542/peds.2008-0323

    Article  PubMed  Google Scholar 

  40. Scott S, Knapp M, Henderson J, Maughan B (2001) Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 323:191. https://doi.org/10.1136/bmj.323.7306.191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Kaltiala-Heino R, Rimpelä M, Marttunen M et al (1999) Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ 319:348–351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Brunstein Klomek A, Marrocco F, Kleinman M et al (2007) Bullying, depression, and suicidality in adolescents. J Am Acad Child Adolesc Psychiatry 46:40–49. https://doi.org/10.1097/01.chi.0000242237.84925.18

    Article  PubMed  Google Scholar 

  43. Lynch FL, Clarke GN (2006) Estimating the economic burden of depression in children and adolescents. Am J Prev Med 31:S143–S151. https://doi.org/10.1016/j.amepre.2006.07.001

    Article  PubMed  Google Scholar 

  44. Glied S, Neufeld A (2001) Service system finance: implications for children with depression and manic depression. Biol Psychiatry 49:1128–1135. https://doi.org/10.1016/S0006-3223(01)01131-3

    Article  CAS  PubMed  Google Scholar 

  45. Mandell DS, Guevara JP, Rostain AL, Hadley TR (2003) Economic grand rounds: medical expenditures among children with psychiatric disorders in a Medicaid population. Psychiatr Serv 54:465–467. https://doi.org/10.1176/appi.ps.54.4.465

    Article  PubMed  Google Scholar 

  46. Smith JP, Smith GC (2010) Long-term economic costs of psychological problems during childhood. Soc Sci Med 1982 71:110–115. https://doi.org/10.1016/j.socscimed.2010.02.046

    Article  Google Scholar 

  47. Schöffski O, Sohn S, Happich M (2008) Overall burden to society caused by hyperkinetic syndrome (HKS) and attention deficit hyperactivity disorder (ADHD). Gesundheitswesen Bundesverb Arzte Offentlichen Gesundheitsdienstes Ger 70:398–403. https://doi.org/10.1055/s-0028-1082049

    Article  Google Scholar 

  48. Schlander M, Trott G-E, Schwarz O (2010) The health economics of attention deficit hyperactivity disorder in Germany. Part 1: health care utilization and cost of illness. Nervenarzt 81:289–300

    Article  CAS  PubMed  Google Scholar 

  49. Swensen AR, Birnbaum HG, Secnik K et al (2003) Attention-deficit/hyperactivity disorder: increased costs for patients and their families. J Am Acad Child Adolesc Psychiatry 42:1415–1423. https://doi.org/10.1097/00004583-200312000-00008

    Article  PubMed  Google Scholar 

  50. Olweus D (2013) School bullying: development and some important challenges. Annu Rev Clin Psychol 9:751–780. https://doi.org/10.1146/annurev-clinpsy-050212-185516

    Article  PubMed  Google Scholar 

  51. Tippett N, Wolke D (2014) Socioeconomic status and bullying: a meta-analysis. Am J Public Health 104:e48–e59. https://doi.org/10.2105/AJPH.2014.301960

    Article  PubMed  PubMed Central  Google Scholar 

  52. Chamberlain T, George N, Golden S et al (2010) Tellus4 national report. https://www.nfer.ac.uk/publications/TEL01. Accessed 11 May 2018

  53. Radford L, Corral S, Bradley C, Fisher HL (2013) The prevalence and impact of child maltreatment and other types of victimization in the UK: findings from a population survey of caregivers, children and young people and young adults. Child Abuse Negl 37:801–813. https://doi.org/10.1016/j.chiabu.2013.02.004

    Article  PubMed  Google Scholar 

  54. Dale J, Russell R, Wolke D (2014) Intervening in primary care against childhood bullying: an increasingly pressing public health need. J R Soc Med 107:219–223. https://doi.org/10.1177/0141076814525071

    Article  PubMed  PubMed Central  Google Scholar 

  55. Scott E, Dale J, Russell R, Wolke D (2016) Young people who are being bullied—do they want general practice support? BMC Fam Pract 17:116. https://doi.org/10.1186/s12875-016-0517-9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all families who took part in the study. Special thanks also go to the Marga und Walter Boll—Stiftung, who financially supported this project. Finally we thank Ramon Schaefer of InnoValHC who assisted in the aggregation of medication resource use and unit cost data.

Funding

The study was financially supported by the Marga und Walter Boll—Stiftung.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany

    Vanessa Jantzer, Johann Haffner, Peter Parzer, Sarah Trick, Franz Resch & Michael Kaess

  2. German Cancer Research Center (Deutsches Krebsforschungszentrum DKFZ, Division of Health Economics) and University of Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Michael Schlander

  3. Institute for Innovation and Evaluation in Health Care (InnoValHC), An der Ringkirche 4, 65197, Wiesbaden, Germany

    Michael Schlander

  4. University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Stöckli, Bolligenstrasse 141c, 3000, Bern 60, Switzerland

    Michael Kaess

Authors
  1. Vanessa Jantzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Schlander
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johann Haffner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Parzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah Trick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franz Resch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Kaess
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Vanessa Jantzer or Michael Schlander.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

The study has been approved by ethics committee of the Medical Faculty of the University of Heidelberg and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

At the beginning of the online questionnaire, parents were informed about protection of data privacy and the anonymity of their answers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jantzer, V., Schlander, M., Haffner, J. et al. The cost incurred by victims of bullying from a societal perspective: estimates based on a German online survey of adolescents. Eur Child Adolesc Psychiatry 28, 585–594 (2019). https://doi.org/10.1007/s00787-018-1224-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-018-1224-y

Keywords

Search

Navigation