Bullying: An Unexamined Cause of Assault-related Emergency Department Visits for Urban Adolescents



This study aims to understand the prevalence of bullying in as well as the attributes and characteristics of injuries resulting from bullying treated in the emergency department (ED).


Data come from 188 adolescents (ages 10–15) who were treated for a peer-related assault-injury in two United States urban EDs. Descriptive statistics were used to understand differences between bullied and non-bullied adolescents. A receiver operating curve (ROC) analysis was used to evaluate a possible risk index.


Forty percent of adolescents identified that the incident was a result of bullying. Bullied youth reported significantly more previous bullying victimization and post-traumatic stress symptoms, but less aggression and rule breaking. A group fight, the fight involving a discordant gender, perceiving oneself as a victim, feeling that the person(s) meant to hurt them, and reporting that the fight was not resolved were significantly associated with an injury as the result of bullying. Situational characteristics such as the fight occurring in school and not arriving to the ED in an ambulance also were associated with an increased likelihood of a bullying situation. Having greater than three of these risk factors correctly identified 88% of youth who attributed the situation to bullying.


Taking into account the characteristics of the assault and asking about the adolescent’s attributions of the incident can help identify patients and facilitate tailoring of appropriate intervention by social workers and other ED providers.

ClinicalTrials.gov ID: NCT01770873.

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  1. Achenbach, T. M. (2001). Child behavior checklist for ages 6 to 18. Burlington: University of Vermont, Research Center for Children, Youth, and Families.

    Google Scholar 

  2. Amanullah, S., Heneghan, J., Steele, D., Mello, M., & Linakis, J. (2014). Emergency Department visits resulting from intentional injury in and out of school. Journal of Pediatrics, 133, 254–261. https://doi.org/10.1542/peds.2013-2155.

    Article  Google Scholar 

  3. Bradshaw, C. P., Waasdrop, T. E., Goldweber, A., & Lindstrom Johnson, S. (2013). Bullies, gangs, drugs, and school: Understanding the overlap and the role of ethnicity and urbanicity. Journal of Youth and Adolescence, 42, 220–234. https://doi.org/10.1007/s10964-012-9863-7.

    Article  PubMed  Google Scholar 

  4. Briere, J. (1996). Trauma symptom checklist for children: Professional manual. Lutz, FL: Psychological Assessment Resources Inc.

    Google Scholar 

  5. Centers for Disease Control and Prevention. (2015). Web-based injury statistics query and reporting system. Retrieved from https://www.cdc.gov/injury/wisqars/index.html

  6. Centers for Disease Control and Prevention. (2017). Youth risk behavior survey. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/results.htm

  7. Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York: Routledge.

    Book  Google Scholar 

  8. Coie, J. D., & Dodge, K. A. (1998). Aggression and antisocial behavior. In W. Damon & N. Eisenberg (Eds.), Handbook of child psychology (5th ed.). Social emotional and personality development, 3 (pp. 779–862). Hoboken, NJ: Wiley.

    Google Scholar 

  9. Copeland-Linder, N., Johnson, S., Haynie, D., Chung, S., & Cheng, T. (2012). Retaliatory attitudes and violent behaviors among assault injured youth. Journal of Adolescent Health, 50, 215–220. https://doi.org/10.1016/j.jadohealth.2011.04.005.

    Article  PubMed  Google Scholar 

  10. IBM Corp. (2014). IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY.

  11. Cunningham, R., Knox, L., Fein, J., Harrison, S., Frisch, K., Walton, M., et al. (2009). Before and after the trauma bay: The prevention of violent injury among youth. Annals of Emergency Medicine, 53, 490–500. https://doi.org/10.1016/j.annemergmed.2008.11.014.

    Article  PubMed  Google Scholar 

  12. Cunningham, R. M., Ranney, M., Newton, M., Woodhull, W., Zimmerman, M., & Walton, M. A. (2014). Characteristics of youth seeking emergency care for assault injuries. Pediatrics, 133, 96–105. https://doi.org/10.1542/peds.2013-1864.

    Article  Google Scholar 

  13. Cunningham, R. M., Carter, P. M., Ranney, M., Zimmerman, M. A., Blow, F. C., Booth, B. M., et al. (2015). Violent reinjury and mortality among youth seeking emergency Department care for assault-related injury. JAMA Pediatrics, 169, 63–70. https://doi.org/10.1001/jamapediatrics.2014.1900.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Djerboua, M., Chen, B. E., & Davison, C. (2016). Trends and demographic characteristics of physical fighting and fighting-related injuries among Canadian youth, 1993–2010. Canadian Journal of Public Health, 107, e231–e238. https://doi.org/10.17269/CJPH.107.5274.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dukes, R. L., Stein, J. A., & Zane, J. I. (2010). Gender differences in the relative impact of physical and relational bullying on adolescent injury and weapon carrying. Journal of School Psychology, 48, 511–532. https://doi.org/10.1016/j.jsp.2010.08.001.

    Article  PubMed  Google Scholar 

  16. Fein, J. A., Ginsburg, K. R., McGrath, M. E., Shofer, F. S., Flamma, J. C., & Datner, E. M. (2000). Violence prevention in the emergency department: Clinician attitudes and limitations. JAMA Pediatrics, 154, 495–498. https://doi.org/10.1001/archpedi.154.5.495.

    Article  Google Scholar 

  17. Fein, J., Mollen, C., & Greene, M. (2013). The assault-injured youth and the emergency medical system: What can we do? Clinical Pediatric Emergency Medicine, 14, 47–55. https://doi.org/10.1016/j.cpem.2013.01.004.

    Article  Google Scholar 

  18. Gini, G., & Pozzoli, T. (2013). Bullied children and psychosomatic problems: A meta-analysis. Pediatrics, 132, 720–729. https://doi.org/10.1542/peds.2013-0614.

    Article  PubMed  Google Scholar 

  19. Hamby, S., Taylor, E., Jones, L., Mitchell, K. J., Turner, H. A., & Newlin, C. (2018). From poly-victimization to poly-strengths: Understanding the web of violence can transform research on youth violence and illuminate the path to prevention and resilience. Journal of Interpersonal Violence, 33, 719–739. https://doi.org/10.1177/0886260517744847.

    Article  PubMed  Google Scholar 

  20. Hawley, P. H., & Williford, A. (2015). Articulating the theory of bullying intervention programs: Views from social psychology, social work, and organizational science. Journal of Applied Developmental Psychology, 37, 3–15. https://doi.org/10.1016/j.appdev.2014.11.006.

    Article  Google Scholar 

  21. Johnson, S., Bradshaw, C., Wright, J., Haynie, D., Simons-Morton, B., & Cheng, T. (2007). Characterizing the teachable moment: Is an emergency department visit a teachable moment for intervention among assault-injured youth and their parents? Journal of Pediatric Emergency Care, 23, 553–559. https://doi.org/10.1097/pec.0b013e31812c6687.

    Article  PubMed  Google Scholar 

  22. Limber, S. (2013). Best practices in the prevention of bullying: An example of the Olweus Bullying Prevention Program. In M. G. Masiello & D. Schroader (Eds.), A public health approach to bullying prevention (pp. 127–148). Washington, D.C.: American Public Health Association.

    Google Scholar 

  23. Mikhail, J. N., & Nemeth, L. S. (2016). Trauma center based youth violence prevention programs: An integrative review. Trauma, Violence, and Abuse, 17, 500–519. https://doi.org/10.1177/1524838015584373.

    Article  PubMed  Google Scholar 

  24. Mishna, F. (2004). A qualitative study of bullying from multiple perspectives. Children & Schools, 26, 234–247.

    Article  Google Scholar 

  25. National Academies of Sciences, E., and Medicine. (2016). Preventing bullying through science, policy, and practice. Washington, DC: The National Academies Press.

    Google Scholar 

  26. Park, S. H., Goo, J. M., & Jo, C.-H. (2004). Receiver operating characteristic (ROC) curve: Practical review for radiologists. Korean Journal of Radiology, 5(1), 11–18. https://doi.org/10.3348/kjr.2004.5.1.11.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Perlus, J. G., Brooks-Russell, A., Wang, J., & Iannotti, R. J. (2014). Trends in bullying, physical fighting, and weapon carrying among 6th-through 10th-grade students from 1998 to 2010: Findings from a national study. American Journal of Public Health, 104, 1100–1106. https://doi.org/10.2105/AJPH.2013.301761.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Roberts, N., Axas, N., Nesdole, R., & Repetti, L. (2016). Pediatric emergency department visits for mental health crisis: Prevalence of cyber-bullying in suicidal youth. Child and Adolescent Social Work Journal, 33(5), 469–472. https://doi.org/10.1007/s10560-016-0442-8.

    Article  Google Scholar 

  29. Scherr, T. G., & Larson, J. (2010). Bullying dynamics associated with race, ethnicity, and immigration status. In S. R. Jimerson, S. M. Swearer, & D. L. Espelage (Eds.), Handbook of bullying in schools: An international perspective (pp. 223–224). New York: Routledge.

    Google Scholar 

  30. Snider, C., & Lee, J. (2009). Youth violence secondary prevention initiatives in emergency departments: A systematic review. Canadian Journal of Emergency Medicine, 11, 161–168. https://doi.org/10.1017/S1481803500011131.

    Article  PubMed  Google Scholar 

  31. Waasdorp, T. E., & Bradshaw, C. P. (2015). The overlap between cyberbullying and traditional bullying. Journal of Adolescent Health, 56, 483–488. https://doi.org/10.1016/j.jadohealth.2014.12.002.

    Article  PubMed  Google Scholar 

  32. Waseem, M., Arshad, A., Leber, M., & Perales, O. (2013). Victims of bullying in the emergency department with behavioral issues. Journal of Emergency Medicine, 44, 605–610. https://doi.org/10.1016/j.jemermed.2012.07.053.

    Article  PubMed  Google Scholar 

  33. Waseem, M., Paul, A., Schwartz, G., Pauze, D., Eakin, P., Barata, I., et al. (2017). Role of pediatric emergency physicians in identifying bullying. Journal of Emergency Medicine, 52, 246–252. https://doi.org/10.1016/j.jemermed.2016.07.107.

    Article  PubMed  Google Scholar 

  34. Williams, J. L., & Hussain, S. B. (2017). Bullying and cultural considerations. In C. B. Bradshaw (Ed.), Handbook on bullying prevention: A lifecourse perspective (pp. 101–111). Washington, D.C: NASW Press.

    Google Scholar 

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This research was supported by the National Institute on Minority Health And Health Disparities (Grant P20MD000198). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information




SLJ conceived of the study, ran analyses, and drafted the manuscript; LR, VJ, and JF facilitated data collection, TC and JF conceptualized the project and received funding; LR, VJ, JF, and TC provided feedback on drafts and approved final manuscript.

Corresponding author

Correspondence to Sarah Lindstrom Johnson.

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A procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration an and its later amendments or comparable ethical standards.

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Lindstrom Johnson, S., Ryan, L.M., Jones, V. et al. Bullying: An Unexamined Cause of Assault-related Emergency Department Visits for Urban Adolescents. Child Adolesc Soc Work J 37, 153–161 (2020). https://doi.org/10.1007/s10560-020-00653-9

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  • Violence
  • Peer-assault
  • Screening
  • Intervention