Abstract

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Bullying creates stress from conflict in interpersonal relationships, and has a negative impact on the mental and physiological health of victims, including depression and anxiety. However, little attention has been focused on the impact of bullying on the physical health of victims. The purpose of this study was to examine whether bullying had a negative impact on victims’ quality of sleep, since lack of sleep can cause diseases, depression, and even suicidal tendency. Participants of this study included 418 undergraduate students at a southeastern university in the United States. Confirmatory Factor Analysis (CFA) was conducted in order to evaluate how types of traditional bullying associated with sleep disturbance. The results indicated that interpersonal conflict associated with traditional bullying in the form of verbal and social victimization correlated with the sleep quality of victims. Implications of this study are discussed, along with limitations and suggestions for future research.

Keywords: traditional bullying, physical health, sleep disturbance

Introduction

Adolescents often experience bullying at schools. The rates of bullying in the United States have increased with the number of students that report being victimized doubling from 2001 to 2011 (Davis, Stafford, & Pullig, 2014). According to the U.S. National Center for Education Statistics (2013), 5,386,000 students (22%) ages 12 through 18 reported being bullied at school, and 1,713,000 students (7%) indicated being bullied online (as cited in Robers, Zhang, Morgan, & Musu-Gillette, 2015). Bullying can harm youths to an extent where they see death as the only way to escape their pain, and some victims commit suicide or demonstrate an intention towards suicide (Hazelden Foundation, 2007; Mueller, James, Abrutyn, & Levin, 2015): “Eight out of every 100,000 teenagers committed suicide in 2000 as a result of bullying” (U.S. National Institute of Mental Health, 2000, as cited in Hashem, 2015, p. 117).
Bullying is a serious problem at an individual, social, and organizational level (Craig & Pepler, 2007; Koo, 2007; Roscigno et al., 2009). This antisocial behavior is usually an issue associated with K-12 grade levels, which is considered not to exist once students enter college (Krasselt, 2014). However, this is a misconception since bullying can occur in almost any environmental setting, including elementary and high schools, post-secondary schools, and professional organizations (Lutgen-Sandvik & McDermott, 2011; Misawa, 2015; Olweus, 1995). According to a 2010 U.S. Workplace Bullying Survey, 35% of the U.S. workforce (estimated 53.5 million Americans) reported being bullied at work (Workplace Bullying Institute, 2010). Bullying generates harmful organizational outcomes by creating a hostile environment in the workplace, where frequent interpersonal conflicts and violence cause decreased productivity, as well as increase staff turnover and job stress (Lutgen-Sandvik, 2003; Misawa, 2015).

Consequences of bullying can have a negative impact not only on victims and their families, but also on organizations and communities causing significant financial and social costs to the general public (Kemp-Graham & Hendricks, 2015). The nature of bullying is rooted in anti-social and rule-breaking behaviors, and there is a strong correlation between bullying in early adolescence and later criminality (Olweus, 2011). On the individual level, bullying has a negative impact on psychological health of the victims, and can cause stress, depression, and anxiety. Although, there are many studies addressing the correlation between bullying and victims’ psychology, little attention has focused on the influence of bullying on physical health. A few studies demonstrate that bullying can weaken the victims’ physical health, causing an increased risk of infectious disease, asthma, ulcers, and strokes (Schat et al., 2005). As a result, poor health conditions cause increased absences and poor academic performance in schools, and decreased productivity in the workplace.

Scholars in areas such as sociology, psychology, and business also examined this phenomenon to understand various tools that could be utilized to eliminate bullying and prevent its negative consequences (e.g., Jamal et al. 2015; Pilch & Turska, 2015; Samnani, Boekhorst, & Harrison, 2016). Bullying is recognized as a communication phenomenon through interaction between the parties involved in bullying (Tracy et al., 2005), including verbal and nonverbal bullying. Therefore, exploring the process of bullying and its mechanism is important from a communication research lens to find ways to prevent its potential destructive consequences on interpersonal relationships. Previous communication research focused primarily on negative interactions in bullying, including conflict experiences in families and organizations (e.g. Clair, 1993; Matsunaga, 2009; Tracy et al., 2005). The overall goal of this current study is examining the impact of bullying as a communication phenomenon on physical health of the victims.
The effects of bullying are damaging to individuals in various contexts, including academic settings. Keashly (2015) noted, “25-35 percent of faculty have been targets of workplace bullying with 40-50 percent reporting they have witnessed someone else being bullied” (p. 24). In the past, scholars paid little attention to this issue and its consequences in university settings. The present student is a step towards filling this gap by examining the prevalence of bullying in universities. In addition, this study aims to evaluate the impact of bullying on victims’ physical health. Although there are many studies indicating that bullying has a negative correlation with the psychological and mental health of victims (Trépanier, Fernet, & Austin, 2013; Verkuil, Atasayi, & Molendijk, 2015), insufficient research addresses the influence of bullying on physical health. One of the important elements of physical health is sleep (Hongyun et al., 2017; Yilmaz, Tanrikulu, & Dikmen, 2017). Lack of sleep can have a negative impact on social interactions and cause diseases, including memory loss, slow response, and irritability, which can influence development of depression and suicidal tendency. Sleep problems are also associated with poor academic performance and work related accidents. Since few studies address bullying as a stressor causing sleep disturbance, this research will examine the impact that bullying has on the victim’s physical health and quality of sleep.

History of Bullying

Bullying has always been a part of social life (Koo, 2007; Olweus, 1995; Roscigno, Lopez, & Hodson, 2009). Bullying attracted public attention when The Times published a story about a soldier’s death as a result of bullying in 1862. The Times was the first to address the critical issues of bullying and the serious consequences that can follow such behavior (Koo, 2007). This story may have shocked many people since society did not consider the behaviors that caused this death to be harmful, therefore, accepted bullying as a normal behavior. As bullying became more prevalent, this problem began to draw attention, and the public wanted to know more about this phenomenon. Another tragic incident was the death of a twelve-year old boy in King’s School in the U.K. in 1885. This schoolboy died from bullying behaviors by an older group (Koo, 2007). At that time, no punishment was given to the boys involved since bullying was considered a misadventure, and acceptable among young males as a normal part of school life (Koo, 2007).

The next wave of interest regarding peer bullying was in Scandinavia during the 1960s and 1970s (Olweus, 2013). These studies included diverse populations, although they mostly focused on bullying in schools (Koo, 2007; Olweus, 1995, 2011). Anti-bullying research in Scandinavian countries lead to the development of national campaigns to prevent bullying, which were successfully implemented in Norway and Sweden. Later Finland, United Kingdom, Ireland and Japan developed similar interventions (Smith & Brain, 2000). In the late 1990s, anti-bullying initiatives and campaigns were implemented in other European countries (i.e., Ireland, Germany, Netherlands, Belgium, Italy, Spain, Portugal, France, Switzerland), as well as in Australia and New Zealand (Smith & Brain, 2000). In the United States, the bullying problem attracted increased interest of scholars and policy makers after several school shootings, e.g., Amish Schoolhouse in 2006, Columbine High School in 1999. Victimization of students being bullied was connected to these shocking events (Duplechain & Morris, 2014; Olweus & Limber, 2010). Tragic situations such as these also contributed to the development of state laws addressing bullying in schools (Smith & Brain, 2000).
Bulling: Demonstration of Social Agression

Process of Bullying

Definitions of bullying typically identify the following criteria: (1) Aggressive behavior with intention to do harm; (2) imbalance of power; and (3) process carried out repeatedly over time (Houbre, Tarquinio, Thuillier, & Hergott, 2006; Olweus, 1995; Pörhölä, Karhunen, & Rainivaara, 2006). Researchers identified main parties and roles involved in the bullying process, including the “bully or perpetrator,” “target or victim,” “bully-victim,” and “bystander” (Houbre et al., 2006; Liepe-Levinson & Levinson, 2005; Olweus, 1995).

Bullies or perpetrators. Bullies use a higher level of power compared to their victims, which is intended to insult or attack the victims (Liepe-Levinson & Levinson, 2005). Bullies engage in a conscious hostility toward the victims, and communicate behavior through verbal and non-verbal aggression (i.e., physical and relational) (Liepe-Levinson & Levinson, 2005). Typical bullies often demonstrate an aggressive reaction pattern combined with physical strength (Olweus, 1995). Bullies are often highly emotional, hot tempered, and hyperactive (Yang & Salmivalli, 2015).

Targets or victims.

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Victims are individuals who are attacked or insulted by bullies (Olweus, 1995). Victims usually experience fear and a feeling of helplessness (Liepe-Levinson & Levinson, 2005; Olweus (1995), as well as being cautious, sensitive, and quiet (Liepe-Levinson & Levinson, 2005). Victims are often more anxious, depressed and insecure than others in general, and tend to have a negative view of themselves and low self-esteem (Yang & Salmivalli, 2015). Victim-boys are often physically weaker than other boys at school, and are usually viewed as insecure individuals unwilling to resist aggression by bullies (Olweus, 1995). Bullying during childhood could have long term dangerous consequences for victims, “leave scars on their minds” (Olweus, 1995, p. 197), and are more likely to experience higher levels of depression and lower levels of self-esteem when older than non-victimized peers.

Bully-victims.

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Bully-victims assume the roles of both bully and victim during different bullying situations (Craig et. al, 2009). Previous research indicated that bully-victims usually bully others more often than pure bullies (e.g., only a bully) and were victimized more frequently than pure victims (e.g., only a victim) (Yang & Salmivalli, 2013). When victimized by more powerful peers, bully-victims may turn to others whom they perceive to be weaker victims for bullying perpetration. It is possible that deficits in self-regulation and aggressive impulsive behaviors of bully-victims allow their peers and teachers to think that peer rejection and maltreatment is “deserved,” thereby reducing the empathy felt towards them (Yang & Salmivalli, 2015).

Bystanders.

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Bystanders are those who witness or are aware of the bullying behavior, but do nothing to prevent violence against the victim as most bystanders are afraid of becoming the next victim (Hutchinson, 2012). Bystanders simply stand-by and witness how a bully mistreats or insults the victim, which communicates approval for inappropriate behavior of the bully. This silent approval empowers the bully and undermines the victim’s power (Liepe-Levinson & Levinson, 2005). In most cases, bystanders do not like to be involved in a bullying situation as they dislike the bully’s behavior (Liepe-Levinson & Levinson, 2005), which causes bystanders to experience symptoms of psychological distress (Nielsen & Einarsen, 2013).

Traditional Bullying

Bullies use verbal and nonverbal behaviors during the bullying process (Tracy et al., 2005), and communicate their aggressiveness to the victims directly and indirectly. Researchers recognize traditional bullying, which occur through personal interactions, and cyberbullying, or misbehavior through technology (e.g., email, instant messaging, and websites). Traditional bullying includes verbal, physical, and social misbehavior.

Verbal bullying.

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Verbal bullying is found in “70 percent of all reported incidents of bullying” (Liepe-Levinson & Levinson, 2005, p. 6), which includes withholding information, humiliating, ridiculing, starting rumors, gossiping, insulting, offensive remarks, shouting at, teasing, sarcasm, persisting criticism, and threating violence (Ockerman et al., 2014). Other strategies used by bullies are name calling, taunting, belittling, and teasing, as well as using racist, sexist, and ageist slurs (Liepe-Levinson & Levinson, 2005).

Physical bullying.

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Although physical bullying is the most visible form, it is less common, representing approximately 30% of bullying interactions (Liepe-Levinson & Levinson, 2005). This type of bullying includes biting, choking, scratching, spitting, tickling, and destroying property of the victim (Heeman, 2007). Other strategies are “crashing into a student on purpose as she/he walked by,” “getting into a physical fight with a student because a bully does not like him/her,” “slapping or punching a student,” and “throwing something at a student to hit him/her” (Hamburger, Basile, & Vivolo, 2011, p. 44).

Social bullying.

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Social or relational bullying is also referred to as relational aggression (Liepe-Levinson & Levinson, 2005). Relational bullying diminishes the target’s self-esteem and includes ignoring, isolating, excluding, taunting, gossiping, writing negative notes, and spreading rumors. Social bullying includes stares, rolling eyes, sighs, frowns, and sneers (Heeman, 2007). Strategies used by bullies during the process of relational bullying are “letting students out of activities or games on purpose,” “getting other students to ignore the victim,” and “getting other students to start rumors about the victim” (Hamburger et al., 2011, p. 44).

Bullying in Different Contexts
Bullying in Primary and Secondary Schools

Bullying is one of the most serious issues in primary and secondary schools (Allen, 2010; Annerbäck, Sahlqvist, & Wingren, 2014; Cemaloglu, 2011; Cowan, 2012; Shetgiri et al., 2015). Educators, psychiatrists, and mental health professionals address this issue worldwide due to its negative consequences on social life and well-being of the victims. In the U.S., approximately three million students were bullied each year resulting in as many as 160,000 students skipping school for fear of being victimized (American Public Health Association, n.d., as cited in Yu-Ying & Jiun-Hau, 2015). The occurrence of different types of bullying among 6th to 12th grade students in 2005-2006 was estimated as follows: 21% physical bullying, 53% verbal bullying, 51% social bullying, and 14% cyber bullying (Shetgiri, 2013). Given the increase of social media, it would be expected that cyber bullying has also increased among students. In addition to widely spread victimization among peers at schools, bullying could be expressed as top-down (teacher-student) and bottom-up processes (student-teacher). Twemlow and Fonagy (2005) define a bullying teacher as “one who uses his or her power to punish, manipulate, or disparage a student beyond what would be a reasonable disciplinary procedure” (p. 2387). Researchers previously stated about half of the students were bullied by teachers in schools (Allen, 2010; Twemlow, Fonagy, Sacco, & Brethour, 2006). On the other hand, Terry (1998) reported high school teachers often become victims of students’ misbehavior as well.

Bullying in Universities

Although there are many studies focusing on bullying in primary and secondary schools, this issue also occurs in universities among faculty-to-student, student-to-faculty, student-to-student, and faculty-to-faculty (Luparell, 2007; Marchiondo, Marchiondo, & Lasiter, 2010; Mott, 2014; Raineri, Frear, & Edmonds, 2011). In a 2011 study conducted at the University of Indiana, 22% of college students reported being victims of cyberbullying, and 15% reported traditional bullying (Krasselt, 2014). Mott (2014) examined victimization of undergraduate nursing students in the United States, who often reported cases of bullying by faculty members in nursing education (e.g., belittling, targeting, and being unresponsive or unreceptive to students’ needs, questions, and unprofessionalism). Clarke, Kane, Rajacich, and Lafreniere (2012) studied bullying in clinical nursing education among Canadian undergraduate nursing students. Their findings indicated that nursing students experienced and witnessed different frequencies of bullying behaviors most notably by clinical instructors and staff nurses.

Bullying in the Workplace

Workplace bullying is sometimes called “mobbing” (e.g. Ertureten, Cemalcilar, & Aycan, 2013; Ozturk, Sokmen, Yilmaz, & Cilingir, 2008) that builds upon a combination of behaviors by workers occurring in various forms, such as harassment, emotional abuse, and incivility (Einarsen, 1999). Workplace bullying could be executed by supervisors towards subordinates, among subordinates, and subordinates toward supervisors (Salin, 2003; Vandekerckhove & Commers, 2003). The mostly widespread form of workplace bullying in the U.S. and Europe is bullying by a supervisor against a subordinate, or top-down bullying (Vandekerckhove & Commers, 2003). Workplace bullying can be a result of various social and individual factors, including strong interpersonal conflict (e.g., conflict-related bullying), authoritative abuse (Pilch & Turska, 2015), low salaries, stressful work environment, and professional jealousy (Wright & Hill, 2015). The level of bullying in a workplace depends on the kind of organization, and can range from 30% to 50% (Cox, 1991; Lutgen-Sandvik, 2003, 2007; Lutgen-Sandvik & Tracy, 2012; Spratlen, 1995; Van Fleet & Van Fleet, 2012). Workplace bullying presents significant costs for employers, including employees refocusing energy from productivity to self-protection, replacing absent victims, processing formal complaints, and damage a company’s image (Bartlett & Bartlett, 2011; Moayed, Daraiseh, Shell, & Salem, 2006; Namie, 2007; Lutgen-Sandvik, 2003; Rogers & Kelloway, 1997). Workplace bullying also contributes to financial damages in various countries. In the United States, “the annual approximate total organizational monetary loss due to bullying of the LGBT sector is $35 trillion” (Hollis & McCalla, 2013, p.10). Australia workplace bullying cost between $6 billion and $36 billion every year (Productivity Commission, 2010, as cited in Skinner et al., 2015).

Bullying and Victims’ Health

Impact of Bullying on Psychological Health

Many researchers agree that bullying can lead to significant psychological, physical, and emotional consequences in victims, which results in anger, frustration, depression, and decreased confidence (Hase, Goldberg, Smith, Stuck, & Campain, 2015; Liu & Graves, 2011; Mott, 2014; Owusu et al., 2011; Rodwell & Demir, 2012; Trépanier et al., 2013; Zou, Andersen, & Blosnich, 2013). Owusu et al. (2011) examined the impact of bullying on the physiological health of senior high school students in Ghana, West Africa, and analyzed data from a 2008 Ghana Global School-based Student Health Survey. The study revealed that about 40% of the total 7,137 participants were victimized by bullying and were more likely to experience psychological health issues compared with those who has not been bullied. The reported health issues included signs of depression, suicide ideation, and sleep disorder. Menesini, Modena, and Tani (2009) conducted research among 1,278 students enrolled in 13 secondary schools in Italy. Almost half of the participants reported being involved in the bullying process, including 140 victims and 81 bully/victims. The results of this study indicated that victims and bully/victims experienced higher degrees of anxiety, depression, and withdrawal in comparison with the other groups. In the U.S., Greenleaf, Petrie, and Martin (2014) examined the impact of weight-based teasing on adolescents’ psychological well-being among middle school students from the six middle schools in a central southern state. Out of 1,419 participants, approximately 17% reported being teased because they were overweight. The findings demonstrated that victims experienced higher levels of depression and lower degrees of self-esteem, physical self-concept, and physical activity self-efficacy.
Bullying has a negative impact on psychological health among adults as well, and can cause depression, loneliness, insomnia, nervous symptoms, melancholy, apathy, lack of concentration and sociophobia (Ekici & Beder, 2014; Einarsen, 1999; Iyer-Eimerbrink, Scielzo, & Jensen-Campbell, 2015; Verkuil, Atasayi, & Molendijk 2015; Wang, Iannotti, & Luk, 2012). Negative health outcomes are associated with increased absenteeism, staff turnover, burnout, lower job satisfaction and decreased morale. Because of high levels of stress and decreased levels of self-confidence, victims often use sick leave and worker’s compensation to deal with stress, or quit jobs, and in some extreme cases commit suicide (Cemaloglu, 2011). Trépanier et al. (2013) conducted research investigating how exposure to workplace bullying undermines psychological health among 1,179 nurses, and found that being a victim of bullying had a negative impact reporting higher burnout and lower work engagement. Dehue, Bolman, Völlink, and Pouwelse (2012) examined the mental and physical health consequences of bullying in the workplace among 361 employees, and confirmed victimization was negatively associated with participants’ well-being and health, especially depressive symptoms. Similarly, Ekici and Beder (2014) examined workplace bullying and its effects on performance and depression at a university hospital in Turkey. Researchers found that psychological violence at work was associated with depression of physicians and nurses. In Norway, Einarsen and Nielsen (2015) analyzed the impact of bullying on a sample of 1,613 employees over a five-year time lag. The findings indicated that bullying can cause long-term symptoms of anxiety and depression.

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Impact of Bullying on Physical Health

Although several studies revealed that bullying has a negative impact on mental and psychological well-being of victims, some evidence indicated that bullying positively correlates with physical health. This can be explained by the fact that stressful life experiences have a negative impact on psychological functioning resulting in a wide range of physical diseases and symptoms (Schat, Kelloway, & Desmarais, 2005). Stressful situations can negatively influence psychological welfare of victims and weaken their immune system, causing an increase of susceptibility to various diseases (Schat et al., 2005). For example, work-related stress is associated with increased risk of infectious disease, asthma, ulcers, and strokes as a result of the suppressed immune functioning (Schat et al., 2005).

Studies providing evidence of bullying associated with negative physical health outcomes mostly concentrate on victims at school and in the workplace. Baldry (2004) conducted research among 661 adolescents from ten different middle schools in Rome. Findings indicated that bullying was associated with mental and physical health of these students resulting in long lasting negative effects. Dehue et al. (2012) examined influence of bullying on the mental and physical health among 361 employees in the Netherlands. Researchers found that victims of frequent bullying reported more health issues (e.g., depressive symptoms, headaches, palpitations, and back pain), than non- or rarely victimized employees. Overall, negative health outcomes are associated with increased absenteeism, burnout, lower job satisfaction and lower morale, as well as organization-related effects damaging productivity and reputation (Verkuil, Atasayi, & Molendijk, 2015).

Little attention has been paid to the impact of bullying as one of the main reasons of stress on physical health of victims among undergraduate students. A study by Politis and colleagues (2014) provided a sample of 2,427 adolescents aged 16 to 18 years old in Greece to investigate the association between bullying and subjective health complaints. Researchers found that victims of bullying were more likely to report backache, dizziness, and fatigue. In the U.S., Woodford, Kulick, and Atteberry (2015) conducted research among undergraduates and graduate students in a Midwest university. The results revealed that interpersonal heterosexist discrimination can cause negative health outcomes among minority students associated with symptoms of depression and anxiety, and negative outcomes for physical health, such as headaches and sleeping problems.

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Sleep Disturbance

Sleep is an essential element of our life and one of the basic human needs that is directly related to health and quality of life, as well as influences our social and cultural interactions (Hongyun et al., 2017; Yilmaz et al., 2017). High quality of sleep is an important element in clinics and related research, associated with feeling energetic and fit. Low quality of sleep is an indicator of a wide range of medical diseases. Nowadays, difficulties with sleep is a prevalent complaint among the general population in Western countries, with rates of self-reported insomnia ranging between 10 and 48% (Hongyun et al., 2017).There is strong relationship between physical and psychological wellness and sleep (Hongyun et al., 2017; Lee, Wuertz, Rogers, & Chen, 2013; Takeuchi, Nakao, & Yano, 2007; Yilmaz et al., 2017). Long-term sleep problems could cause thought retardation, memory loss, slow response, low spirit, and irritability. It can influence development of depression and suicidal tendency. In the workplace, chronic sleep issues are associated with greater work absenteeism and work related accidents or injuries (Hongyun et al., 2017). An important factor found to cause sleep disturbance was occupational stress. Lee, Wuertz, Rogers, and Chen (2013) conducted research among 676 professionals in South Africa, including architects, engineers, surveyors, and project and construction managers. They found physiological effects of workplace stress include disturbances of sleep patterns, difficulty in concentrating and relaxing after hours (Lee et al., 2013). Takeuchi et al. (2007) conducted a 20-year study among workers, and reported that sleep disturbance and fatigue were important factors causing a long-term depressive state. Sleep disturbances were also common among college students, which could be associated with stress derived from academic challenges and daily life (Lee et al., 2013). Magee et al. (2015) examined the relationship between workplace bullying and sleep quality among Australian employees. The findings revealed association of bullying with the poor sleep quality. Hansen et al. (2016) conducted a study among public and private sector employees, and found support that workplace bullying is related to development of some sleep problems (i.e., problems staying awake and lack of restful sleep). Zhou et al. (2015) conducted research among high school students in six cities in China and found being involved in bullying behaviors was related to increased risks of poor sleep quality. However, there are not many studies addressing influence of bullying on the quality of sleep for students in U.S. universities.

Research Questions

Numerous studies indicated that bullying has a negative correlation with physiological and mental health of the victims (Trépanier et al., 2013; Verkuil et al., 2015), specifically in a university environment. When studies were conducted, it was seldom clear what specific type of bullying had a negative impact on the victim’s health. The current research examined how different forms of bullying influenced the physical health of victims in an academic setting using a communication lens, and examined the influence of traditional bullying on quality of sleep among undergraduate students.

Rather than advancing a scientific theory of bullying, this project should be viewed as an initial exploration to an applied problem, namely the linkage between various types of bullying and victims’ health outcomes. Except for physical, violent manifestation of traditional bullying types such as verbal and social bullying have relied on subjective reactions to socially inappropriate behavior. This study seeks to determine whether the non-physical forms of bullying have quantifiable physical effects on victims. Based on the previous review of literature, the following research questions were proposed:
RQ1: What type of traditional bullying occurs among undergraduate students?
RQ2: Do non-physical forms of traditional bullying have a negative impact on sleep
quality of the victims of bullying?

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Methods

This study measured the impact of traditional bullying on a victim’s health. Specific examination included forms of traditional bullying (verbal and social) to determine the influence of bullying on quality of sleep for victims.

Participants

Participants included 418 undergraduate students, including females (n=284, 68%) and males (n=134, 32%) at a southeastern university in the U.S. Student ages ranged from 18 to 29 (M =20.50, SD = 1.84). Participants were Caucasian 51.8%, Hispanic 23, 4%, Asian 9.3%, African American 8.4%, and Other 7.2% that represented seniors 29.1%, juniors 28.4%, sophomores 22.4% and freshman 8.1%. Participants responded during class to a questionnaire containing demographics and self-report items, which focused on two instruments addressing the following areas: Traditional bullying victimization and physical health outcomes (sleep disturbance).
Measurements

The following instruments were utilized for this study: (1) Adolescent Peer Relations Instrument-Target measuring victimization by traditional bullying; and (2) Sleep Disturbance subscale from Physical Health Questionnaire measuring physical health outcomes (sleep) of bulling victims (see below for details on instruments).

Adolescent Peer Relations Instrument-Target (APRI-T).Adolescent Peer Relations Instrument-Target (APRI-T) is a part of Adolescent Peer Relations Instrument Bully/Target developed by Parada (2000) and utilized by Hamburger et al. (2011). APRI-T consists of 18 items to measure victimization by traditional bullying (e.g., verbal, physical, and social). Target factor items were preceded by the sentence “In the past year at this school …” The second part of the sentence in the items reflects victimization by three types of bullying: Verbal, physical and social victimization. Verbal victimization is presented by six items: #1, #4, #7, #11, #13, and #18. Examples of items “I was teased by students saying things to me,” and “A student made rude remarks at me.” Social victimization is presented by six items, including items #3, #6, #9, #12, #14, and #17. Examples of items included: “A student wouldn’t be friends with me because other people didn’t like me” and “A student ignored me when they were with their friends.” Physical victimization is presented by six items: #2, #5, #8, #10, #15, and #16. Examples of questions included: “I was pushed or shoved” and “I was hit or kicked hard.” Students were asked to indicate how often they experienced a series of bullying behaviors on a 7-point bipolar scale anchored from “never” at one end and “every day” at the other. The scale was tested by Parada (2000) with reliabilities for the total victimization instrument .95; and subscale scores (verbal, physical, and social victimization) ranging from .83 to 92 (as cited in Hamburger et al., 2011). The reliability subscale scores in this study were as follows: verbal victimization .86, social victimization .82, and physical victimization .81.

Sleep Disturbance. In order to assess student’s physical health, the Spence, Helmreich, and Fred’s (1987) scale revised by Schat, Kelloway, and Desmarais (2005), Physical Health Questionnaire (PHQ), was used in this study. The modified PHQ consists of 14 items and four subscales measuring: sleep disturbance, headaches, gastrointestinal problems, and respiratory infections. For the purpose of this study, sleep disturbance subscale was used to examine impact of bullying on the victims’ quality of sleep. Sleep disturbance subscale items are (1) “How often have you had difficulty getting to sleep at night?” (2) “How often have you woken up during the night?” (3) “How often have you had nightmares or disturbing dreams?” and (4) “How often has your sleep been peaceful and undisturbed?” (Reverse score Item #4.) Reliabilities of the PHQ subscale items were above .70 (Schat et al., 2005). In the present study, students were asked to indicate how often they experienced health issues on a 7-point bipolar scale anchored from “never” at one end and “every day” at the other. The reliability score for sleep disturbance subscale in this study was .67.
Results

This research examined bullying at universities and its effect on physical health of the victims. The study specifically focused on evaluating the impact of traditional bullying on quality of the victims’ sleep utilizing a quantitative approach based on a questionnaire designed for this project.
RQ1: What type of traditional bullying occurs among undergraduate students?

Descriptive statistics demonstrate all types of examined bullying existing among the participants. To address the question “Please indicate how often a student (students) at this school has done the following things [types of bullying] to you since you have been at this school this year,” the answers were measured on the scale from 1 (“Never”) to 7 (“Every day”). The maximum scores (Max) indicate that at least some students experience all types of bullying, with some reporting verbal victimization, physical victimization, social victimization, almost every day. Verbal victimization (Max = 6.33, M=1.45, SD = .77), physical victimization (Max = 5.33, M=1.11, SD =.38), and social victimization (Max = 6.17, M=1.41, SD = .69). Approximately 68.5% experienced traditional bullying. The widely used types of bullying reported by the victims were verbal bullying (56.6%) and social bullying (53.7%); approximately 23% of the participants experienced physical bullying. Due to the fact that the majority of the participants experienced verbal and social bullying, further step was to examine whether these types of bullying influence the victims’ physical health, in particular, the quality of sleep.

RQ2: Do non-physical forms of traditional bullying have a negative impact on sleep quality of the victims of bullying?
In the literature, verbal bullying and social bullying are treated as separate components of bullying. However, to date, evidence supporting the treatment of the measures as separate factors has not been produced. As a starting point, we submitted data from the measures to confirmatory factor analysis (CFA), specifying the six verbal bullying items as indicators of one latent factor and the six social bullying items as indicators of a second latent factor. Although the fit indices indicated reasonable overall fit for a two factor model, RMSEA = .02, CI = .00-.04, SRMR = .04, CFI=.99, TLI = .98, and the factor loadings were acceptable ranging from .80 to .60 (standardized), the interactor correlation, r = .85, exceeded the generally acceptable parameter value, indicating that the distinction between the two factors was artificial. A follow-up model specifying all twelve bullying items as one factor resulted in equally good fit, RMSEA = .03, SRMR = .04, CFI = .95, TLI = .94, factor loading ranging from .59 to . 73, as well as a more parsimonious model of the data.

Upon determination that the twelve bullying items measured one factor, a structural equation model specifying the twelve bullying items as indicators of the bullying latent factors, and the four sleep items as indicators of the sleep disturbance latent factor indicated good overall fit, RMSEA = .04, SRMR = .04, CFI = .95, TLI = .94; with factor loadings for sleep disturbance items ranging from .78 to .38, and a significant correlation, r =.30, p<.05 between bullying and sleep disturbance it indicates a positive answer to research question two. An inspection of modification indices for the unique variances for bullying and sleep disturbance indicated that the error terms for both variables were not significantly correlated. Therefore, the correlation between bullying and sleep disturbance is not likely due to an outside latent variable. Consequently, it is likely that the relationship between bullying and sleep disturbance is a causal one.

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Discussion

Bullying is an intentional act of harm expressed in various ways and often repeated over a certain period of time. It occurs in multiple contexts, including primary and secondary schools, universities, and organizations. This is a serious problem that has attracted public attention for over a century because of its negative affect on both victims and bystanders, as well as an impact on workplace environment, productivity, and profit (Craig & Pepler, 2007; Koo, 2007; Misawa, 2015; Roscigno et al., 2009). Bullying continues to be an issue since it demonstrates anti-social and inappropriate behaviors where victims of bullying have been exposed to experiencing physical and psychological harm.

Results of the present study indicated that a majority of undergraduate participants (68.5%) experienced various types of traditional bullying (verbal, social, and physical), with prevailing rates of verbal (56.6%), and social (53.7%) as indicated by the victims. Students who experienced verbal bullying reported being teased or ridiculed by other students, and bullies making rude remarks to them. Bullies also targeted victims by making jokes about them, negative comments about their looks, and calling them nasty names. As a part of social bullying, victims experienced situations where students would not be friends since they were not liked by others. Some students reported being ignored when bullies were with other friends, or friends turned against victims. Social bullying also included bullies starting rumors about victims, or victims being excluded from invitations to social activities when other students did not like the victims.

While previous research indicates negative effects of bullying, little attention has been given to the relationship of bullying and physical health of the victims, especially its impact on sleep among undergraduate students. Findings of the present study revealed that verbal and social bullying as a communication phenomenon in interpersonal interactions have a negative impact on victims’ physical health such as quality of sleep. Victims reported having difficulty sleeping at night, and experiencing disturbed sleep by waking up multiple times during the night. Sleep is an essential requirement of a person’s health and well-being, and the results of being bullied indicated a negative influence on the quality of sleep. Consequently, prevention of bullying should be considered a priority for universities in order to provide a healthier and less stressful environment.

Implications of Study

The results of this study have significant implications at universities. Providing information about negative health consequences is an important tool to extend awareness of this destructive phenomenon. Traditional bullying typically creates interpersonal problems, as well as negatively influencing a victim’s health. These problems could lead to repeated absences at school, and be negatively associated with academic performance. However, it is possible school counselors are not aware of how serious bullying issues are in their schools, or the availability of bullying prevention and intervention programs (Richardson, 2015).

The university administration should consider development of specific bullying prevention programs (Hertz et al., 2015; Squires st al., 2013) that would be more proactive in deterring bullying on campus (Wajngurt, 2018). It would be beneficial for these programs to include information about various types of bullying, and its negative consequences on the well-being of victims. Students should be informed regarding support systems and resources on campus (e.g., counseling centers and health treatments) to address this problem in order to find an effective solution. Reasons for bullying should be thoroughly evaluated in order to establish a healthier and productive school environment. Bullying prevention programs could be developed based on earlier implemented campaigns. One intervention campaign against bullying was developed in 1983 in Norway using the Olweus Self-Report Questionnaire, and resulted in a decrease of an estimated 50% of bullying (Smith & Brain, 2000). Another effective monitored intervention was conducted in Sheffield, England, from 1991 to 1994. The participating schools observed a decrease in bullying, especially those that developed anti-bullying policies, and programs working with individuals and groups. Other intervention campaigns included anti-bullying programs in Toronto, Canada; Flanders region of Belgium; and Schleswig-Holstein in Germany. All of these campaigns utilized the anti-bullying program developed in 1983 by Olweus (as cited in Smith & Brain, 2000). According to Jones and Augustine (2015), effectiveness of anti-bullying programs in schools depends on involvement of the community to address this problem (i.e., faculty, staff, students, parents, and administrators). Programs should focus on teaching children and adults to be empathetic towards others. Another way to increase effectiveness of anti-bullying programs is “to prepare and promote the professional skills of teachers and school counselors to deal effectively with behavioral problems of students” (Vahedi, Fathi Azar, & Golparvar, 2016, p. 68). Wajngurt (2018) recommends educating faculty and staff about the existence of different forms of bullying through conferences and/or special events. Another way to prevent negative consequences of bullying is to create a help desk or anonymous email address for students who have been bullied. Counseling departments should periodically review anti-bullying interventions and promote awareness of health risks associated with bullying and offer professional help and support to the victims (Wajngurt, 2018). It is also important that anti-bullying policies and procedures are adopted in organizations (Francis, 2015). In order to prevent bullying and harassment, employers, managers and employees should be trained to recognize assertiveness and aggression, as well as implementing conflict resolution strategies (Etienne, 2014). Spreading awareness of bullying, as well as development of prevention programs, is important for maintaining a healthy atmosphere in any environment.

Limitations and Suggestions for Future Research

One limitation of the present study was the impact of bullying on victims’ physical health evaluated based on self-report surveys. Self-report tools reflect victims’ perception and may not provide an accurate assessment of their situation. Students may report being bullied because of low self-esteem, therefore, assuming that any negative communication or situation is bullying. Some individuals who perceive themselves as victims or become targets of bullying might be predisposed to psychological or emotional orientations towards bullying. Other students may not accept the fact that they were targets of bullying and may not report victimization because of embarrassment. Some students may not trust that their identity will be protected, and choose not to reveal information about being victimized for fear of being punished or bullied. Future research should utilize qualitative methods (e.g., interviews or focus groups) that would provide greater depth regarding our understanding of bullying issues. In addition, analyzing the bullying and victimization process from a cross-cultural perspective would highlight issues in diverse schools, communities, and organizations that could be addressed in anti-bullying programs. Moreover, due to rapidly developing technology, bullies now target victims using cell phones and social media (e.g., Facebook, Twitter). This new area of bullying was recognized in the literature as “cyberbullying,” and included text bullying (e.g., text messages, e-mails) and visual bullying (e.g., sending offensive videos or images). Wajngurt (2018) reports cyberbullying is becoming an increasing issue in higher education, and recommends college and university administrators develop policies and guidelines to address this situation on campus and at home. Consequently, future research should focus on analyzing cyberbullying and its effects on the physical health of the victims.

Bullying is an extremely serious issue in our world today. Accordingly, it has become an important area to study in the field of communication in order to better understand this destructive phenomenon. The National Communication Association (NCA, 2018) has given special attention to this social problem by initiating the NCA Anti-Bullying Project to develop an overall greater awareness and sensitivity to bullying that occurs on a daily basis (National Communication Association, 2018). This campaign highlights issues related to school and workplace bullying, social aggression, harassment, stalking, and role of bystanders in the bullying process. Multiple resources are provided in an attempt to ensure easy access of data and current research, as well as exchanging ideas about the prevention of bullying. The NCA Anti-bullying Resource Bank includes pedagogical resources, conference papers, and workshops addressing topics such as: Integrating Classroom Bullying into Instructional Practice, Awareness of Cyberbullying, and Strategies for Empowering Bystanders.

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