Trends in Psychology

https://doi.org/10.1007/s43076-021-00101-2

ORIGINAL ARTICLE

Association Between School Bullying, Suicidal Ideation,

and Eating Disorders Among School‑Aged Children
from Antioquia, Colombia

Jessica Quintero‑Jurado1 · Nadia Moratto‑Vásquez1 ·

Beatriz Caicedo‑Velasquez1,2 · Natalia Cárdenas‑Zuluaga1 ·
Dorothy L. Espelage3

Accepted: 10 August 2021

© Associação Brasileira de Psicologia 2021

Abstract
Evidence has suggested that various mental health problems are associated
with school bullying. The present study investigated the associations between
bullying and suicidal ideation and eating disorders in school-aged children. A
cross-sectional study was conducted with 3222 adolescents from grades 5 to
9 enrolled in public schools in the urban area of the Department of Antioquia
(Colombia), selected through multi-stage sampling. The prevalence of suicidal
ideation was 38% (95% CI: 35.8–39.4), and the prevalence of eating disorders
was 18% (95% CI: 16.2–18.9). Adolescents exposed to medium–high levels of
school bullying had a significantly higher risk of suicidal ideation (PR = 1.38).
Also, the greater the family dysfunction, the significantly higher risk of sui-
cidal ideation. Regarding eating disorders, adolescents with medium–high
exposure to bullying showed a greater risk of eating disorders (PR = 3.86).
Neither suicidal ideation nor eating disorders were associated with sex and
age of the adolescents. This study concludes that school bullying could poten-
tially affect mental health outcomes in school-aged children while describing
the relevance of family functionality.

Keywords Bullying · Eating disorders · Suicide · Family functionality

* Jessica Quintero‑Jurado
quinteroj.jessica@uces.edu.co
1
Grupo de Investigación en Psicología, Salud y Sociedad, Universidad CES, Medellín, Colombia
2
Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
3
University of North Carolina At Chapel Hill, Chapel Hill, NC, USA

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Introduction

Bullying is currently considered a pervasive problem and an emerging public

health issue due to the growing knowledge and awareness of the morbidity and
mortality associated with this phenomenon (Ansary et al., 2015). Consequently, a
new UNESCO report confirms that school violence and bullying are major prob-
lems worldwide. However, despite the gravity of the problem, some countries
have made significant progress towards reducing or containing school violence
and bullying (UNESCO, 2019).
Furthermore, bullying is highly prevalent. Latin America is estimated to have a
mean global prevalence of 29.3% from a systematic review of 216 studies includ-
ing elementary, middle, high school, and university students (Herrera-López et al.,
2018), similar to the global prevalence estimated at 32%. This indicates that one
out of three adolescents reports being bullied or intimidated (UNESCO, 2018).
Being a victim of school bullying is associated with numerous long-term del-
eterious psychological and health outcomes. In this regard, various mental health
problems associated with school bullying have been found, such as depression,
anxiety, low self-esteem, suicidal ideation and suicidal behavior, psychotic symp-
toms, consumption of psychoactive substances (Zych et al., 2015), and eating dis-
orders (Lie et al., 2019). Approximately 90% of those targeted through bullying
present one or more of the psychological adversities mentioned above (Ballesteros
et al., 2018). Bullying victimization has also been significantly associated with
somatic symptoms such as headache, stomach and back pain, sleep problems, diz-
ziness, and an increased risk of being overweight or obese (Moore et al., 2017),
in addition to other consequences such as poor academic performance (Nakamoto
& Schwartz, 2010), poor social functioning, feeling of loneliness (Moore et al.,
2017), and, in general, lower satisfaction with life as an indicator of subjective
well-being and worse quality of life (Bilic et al., 2014; Navarro et al., 2015).
Adverse consequences of bullying victimization are not limited to school-age
youth as victims often report compromised psychosocial functioning into adult-
hood. Those who were victims of bullying in childhood or adolescence report
greater rates of suicidal ideation and suicidal behavior, diagnoses of depression,
and anxiety as adults (Wolke & Lereya, 2015). These consequences are similar to
those reported after having suffered other adverse childhood experiences (ACEs),
such as having been placed in a foster home or transit home (Takizawa et al.,
2014). Research to date points to the severity and impact of the phenomenon on
the physical and mental health of children and adolescents and their life-course
and development. Furthermore, the physical, psychological, social, and academic
consequences and associated morbidity and mortality have a high social cost and
to the health system (Wolke et al., 2013).
Of the mental health outcomes associated with bullying victimization, two
of them are particularly striking: suicidal behavior and eating disorders, given
their impact and prevalence in Latin America. In recent years, suicidal ideation
and suicide attempts have increased among children and adolescents. It has been
suggested that bullying, especially cyberbullying, might be one of the potential

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predictors for these increases (Plemmons et al., 2018). In Colombia, where this
study was conducted, there is an estimated prevalence of suicidal ideation of
6.6% and suicide attempts of 2.5% in the adolescent population (Ministerio de
Salud & Colciencias, 2015). However, suicide attempts have increased continu-
ously in recent years, with an increase of 10.9% for 2018 compared to 2017. The
Department of Antioquia in Colombia, a department with a population of over 6
million (13.3% of Colombia’s population), reports a higher rate than the national
mean, and the most affected age group are adolescents between 15 and 19 years
(Instituto Nacional de Salud, 2019).
Regarding eating disorders, Latin America presents a prevalence of 0.1% for
anorexia nervosa, 1.16% for bulimia nervosa, and 3.53% for binge eating disor-
der (Kolar et al., 2016). In relation to other western countries, anorexia nervosa
appears to be significantly lower in Latin America. In contrast, the prevalence
of bulimia nervosa and binge eating disorder appears to be higher than in other
western countries. It has been suggested that this increase may be due to cul-
tural factors such as the affective and social significance that food has in Latin
America (Kolar et al., 2016). Given the cultural specificity in eating disorders, it
is important to explore the relationship with bullying in the Colombian context,
considering that longitudinal data has established that victims of bullying are at
higher risk for symptoms of anorexia nervosa and bulimia nervosa (Copeland
et al., 2015). Furthermore, appearance and weight-related bullying are associated
with body dissatisfaction and disordered eating (Thompson et al., 2020).
As well as bullying, family dysfunction has also been identified as an impor-
tant risk factor for both mental health problems: suicidal ideation (Lipschitz et al.,
2012) and eating disorders (Le Grange et al., 2010). That is why in this study, the
relationship between bullying and mental health outcomes is controlled by family
functioning, as it is considered a potential confounder, taking into account that fam-
ily functioning could influence the relationship between the variables mentioned.
Despite a few recent studies in Latin America on the relationship between bully-
ing and mental health outcomes, in general, the scientific production on bullying and
associated factors in the region is limited and has emerged mainly in the last dec-
ade. This is a disadvantage compared to scientific production worldwide, with more
than 40 years of theoretical development and empirical examination (Herrera-López
et al., 2018). Therefore, there is a need to understand the associations between bul-
lying and suicidal outcomes and eating disorders such that prevention programming
can be tailor to the Colombian context.
To explain more of the context concerning the prevention strategies, in Colombia,
through the law 1620 of 2013, the national system of school coexistence and train-
ing for the exercise of human rights, education for sexuality, and the prevention and
mitigation of school violence was created. The objective of this system is to ensure
compliance with the care path that consists of the promotion, prevention, care, and
monitoring of strategies for the improvement of school coexistence and human, sex-
ual, and reproductive rights in the school context.
The 1620 law raises situations that affect school coexistence and the exercise
of human, sexual, and reproductive rights. The situations are classified into three
types. Type l situations correspond to conflicts handled inappropriately and

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those sporadic situations that negatively affect the school climate and that in no
case cause damage to the body or health. Type II situations correspond to situ-
ations of school aggression, bullying, and cyberbullying, which do not have the
characteristics of the commission of a crime. These situations meet any of the
following characteristics: (a) That they occur repeatedly or systematically and
(b) that they cause damage to the body or health without generating any incapac-
ity for any of those involved. Finally, type III situations are situations of school
aggression that are constitutive of alleged crimes against freedom, integrity, and
sexual formation, referred to in Law 599 of 2000, or when they constitute any
other crime established in current Colombian criminal law.
In summary, school bullying constitutes a significant risk factor for both
suicidal ideation and suicidal behavior (Geel et al., 2014) and eating disorders
(Lie et al., 2019). However, this matter requires further studies to establish the
relationship between these variables in Colombia. Therefore, the present study
aimed to investigate the association among school bullying, suicidal idea-
tion, and eating disorders among a large sample of school-aged children from
the Department of Antioquia, Colombia. Based on the existing literature, we
hypothesized that there would be a higher prevalence of suicidal ideation, as
well as a higher prevalence of eating disorders, among those participants who
reported high-medium risk of bullying at school than among those participants
who did not, even after accounting for family dysfunction.

Method

Participants and Sources of Information

A cross-sectional study was conducted. The study population corresponds to

students from grades 5 to 9 enrolled in public schools in the urban area of the
Department of Antioquia (Colombia). Data for the present study was obtained
from a population-based research study in which the objective was to determine
the prevalence of school bullying and associated factors in the student popu-
lation of the Department of Antioquia (Moratto et al., 2015). For the present
study, students were selected through a multi-stage sampling in three stages.
In the first place, 40 municipalities were chosen through systematic sampling,
using a random starting number (2) and a constant of (3). In the second stage,
schools were selected according to a proportional probability. Finally, the groups
were selected by simple random sampling. In these groups, the instrument was
applied to all students who signed the informed consent.

Data Collection and Ethical Procedures

This research was approved by the ethics committee for research on human beings
of CES University (Medellin, Colombia), act number 54 of 2012. The committee

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was in charge of reviewing and approving the ethical protocol. The protocol con-
templated the requirements of Resolution 8430 of 1993, in which access to the ado-
lescent population requires the authorization of the educational institution and the
consent of the minor and parents. In the consent form, it was specified that participa-
tion was voluntary, and no economic incentive was received. On the other hand, the
school received training in the prevention of aggressive behavior and the return of
the general results of the research. Different sensitizations were carried out, includ-
ing virtual training on bullying for directors and teachers of all the institutions of
the Department, with the support of the Secretary of Education of Antioquia. After
choosing the municipalities and institutions, a second sensitization campaign was
carried out explaining the research process, the benefits for the institution in terms
of return, and support from CES University on conflict management in the class-
room and a third moment of sensitization with teachers belonging to the institutions
that signed the consent of participation.
The research protocol consisted of seven tests with a total of 180 questions, which
took a maximum of 1 h to complete and was applied during school hours in person
and on paper. The protocol was printed, and the TeleForm format was used for its
scoring. Those that had problems in filling out due to crossing out, double answers
in a question, among others, were discarded. The personnel chosen for the fieldwork
was selected based on their training and experience in the information gathering
tasks, and the research team permanently supervised the process. It is important to
clarify that this application was carried out in the educational institution during the
school day. There was no type of economic or in-kind retribution for the participat-
ing institutions or students. It was clear that the process had an academic intention
and that, at the moment that a student, or even an institution, decided to withdraw
from the study, they could do it. It is estimated that there was a loss of 5% of surveys,
corresponding to all those that were not filled out entirely, were scratched outside
the scoring fields, and those that the TeleForm system could not read. Thus, 3,222
surveys were finally processed for analysis. Therefore, the data used in the present
study included 3,222 adolescents (100% of the original study) who had complete
information on the outcomes of interest (i.e., suicidal ideation and eating disorders).

Instruments

Suicidal Ideation

Suicidal ideation was measured using the Positive and Negative Suicide Idea-
tion (PANSI) questionnaire (Osman et al., 1998) in the Colombian validation.
The PANSI questionnaire has 14 items related to the clinical expressions of posi-
tive suicidal ideation (protective factors) (e.g., “Felt Hopeful”; “Felt life worth liv-
ing”) and negative suicidal ideation (risk factors) (e.g., “Considered killing your-
self”; “You felt like a failure”). In addition, the questionnaire assesses how often the
youth respondents have presented each of the 14 thoughts within the past 2 weeks.
Response options range from 0 (Never) through 4 (Always) on a 5-point Likert-type

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scale. The results of this questionnaire allow assessing the risk of suicidal behav-
ior related to suicidal ideation. Participants who score 14 or higher are categorized
as “present or at risk of suicidal ideation.” The Colombian validation questionnaire
that was used reported a total internal consistency of α = 0.899 and a bi-factor struc-
ture. The first factor corresponded to negative suicidal thoughts (α = 0.931), while
the second one included protective thoughts against suicide (α = 0.836) (Villalobos-
Galvis, 2010).

Symptoms of Eating Disorders

Screening of symptoms related to eating disorders in adolescents was assessed

with the SCOFF Colombian validation (Campo-Arias et al., 2006). This ques-
tionnaire focuses on assessing the predominant characteristics of anorexia ner-
vosa and bulimia nervosa. Items assess the following symptoms (the name of the
questionnaire derives from the initials of each one): induce vomiting (sick), con-
trol over intake (control), weight loss (out weight), feel fat (fat), and food domi-
nates life (food) (Morgan, Reid, & Lacey, 1999). Respondents are asked to indicate,
for example, if they have recently lost more than one stone (14 lb.) in a 3-month
period. Response options were 0 (No) and 1 (Yes). People who answer affirmatively
to two or more questions are identified with symptoms related to eating disorders.
The internal consistency of the questionnaire was α = 0.521, and the factor analysis
showed that a one-factor structure best fits the data.

Bullying

Bullying was measured using the abbreviated CIE-A Bullying Questionnaire (in Span-
ish, Cuestionario de Intimidación Escolar) (Moratto et al., 2012). The instrument con-
sists of three subscales with 12 items each: (1) bullying victimization (e.g., “They break
my things on purpose”, “They tell others not to be with me or not to talk to me”); (2)
symptomatology, which groups variables on symptoms of anxiety, depression, post-
traumatic stress and effects on self-esteem (e.g., “I have horrible dreams and night-
mares”, “Sometimes I hate myself”); and (3) bully perpetration, which collects infor-
mation about forms of violence used by people who carry out actions of bullying to
peers (e.g., “I force him/her to give me his/her things”, “I send messages to threaten”).
Cronbach alpha for the subscales were α = 0.87, α = 0.89, and α = 0.83, respectively.
Response options for 24 of the 36 items range from 0 (Never) through 2 (Always)
on a 3-point Likert-type scale. Response options for the remaining 12 items are 0
(No) and 1 (Yes). Both subscales and the final scale result in the following classifica-
tion: low risk for those who score 14 or less and medium/high risk for scores of 15
or greater.

Control Variables

Individual and family risk factors were included in the analysis as potential
control variables for the relationship between bullying and the two dependent

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variables. These variables were sex (male–female), age (9–13 years, 14, and
over), and family functioning (severe, moderate, mild dysfunction, and func-
tional). Family functioning was measured using the 5-item APGAR scale (Forero
et al., 2006; Smilkstein, 1978). The name of the scale is an acronym correspond-
ing to its five components: adaptability (“I am satisfied that I can turn to my
family for help when something is troubling me”), partnership (“I am satisfied
with the way my family talks about things with me and shares problems with
me”), growth ( “I am satisfied that my family accepts and supports my wishes
to take on new activities or directions”), affection (“I am satisfied with the way
my family expresses affection and responds to my emotions such as anger, sor-
row and love”), and resolve (“I am satisfied with the way my family and I share
time together”). Response options range from 0 (Never) through 4 (Always) on a
5-point Likert-type scale. The higher the score, the better the family functioning.
Based on the total score, family functioning can be classified as functional, mild,
moderate, and severe dysfunction. The internal consistency of the questionnaire
was α = 0.793, and the factor analysis showed that a one-factor structure best fits
the data.

Data Analysis Procedure

The Stata 14 program (Stata Corp., College Station, USA) was used for data
analysis. The prevalence of suicidal ideation and eating disorders was calculated,
as well as the respective confidence intervals. Associations were identified using
the chi-squared test for univariate analysis, adopting a significance level of 20%
(P < 0.20) to identify potential confounders. This pre-specified cutoff value has
proven to identify better the presence of confounding effects that using a cutoff
of 0.05 (Maldonado & Greenland, 1993; Mickey & Greenland, 1989). To analyze
the associations of suicidal ideation and eating disorder with bullying at school,
Poisson regression was used crude and adjusted for age, sex, and family dys-
function. For the analysis of nominal variables, the chi-squared test was used for
heterogeneity, which estimated prevalence ratios and their respective 95% confi-
dence intervals (95% CI).

Results

The mean age of adolescents was 13 years (SD ± 1.9), and the age range was
9–17 years old. Table 1 shows that 51% of the participants were female and 62%
came from families with some type of dysfunction, including severe, moderate, or
mild dysfunction. Regarding the experience of bullying at school, 32.29% of stu-
dents were classified as medium to high risk.
The prevalence of suicidal ideation was 38% (95% CI: 35.8–39.4), being more
frequent in children 9–13 years (40%), in adolescents from families with severe fam-
ily dysfunction (72%), and among those with a medium–high risk of bullying (51%).

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Table 1  Sample description for Variable Sample distribution

sex, age, family functioning, and
bullying (Antioquia, Colombia, N %
2013)
Age
9–13 years 1803 56.29
14–17 years 1400 43.71
Sex
Male 1562 48.48
Female 1660 51.52
Family functioning
Severe dysfunction 486 19.07
Moderate dysfunction 408 16.01
Mild dysfunction 687 26.95
Functional 968 37.98
Bullying
Low risk 1917 67.71
Medium–high risk 914 32.29

As the level of family dysfunction increased, the prevalence of suicidal ideation

increased (Table 2). Regarding eating disorders, the prevalence was 18% (95% CI:
16.2–18.9), being more frequent in minors from families with moderate or severe
family dysfunction (21%) and with a medium–high risk of school bullying (33%)
(Table 2).
Table 2 shows the results of the analysis examining the relationship between
suicidal ideation and eating disorders with bullying at school, before and after
adjustment for potential confounding variables. According to the crude regression
analysis, adolescents exposed to medium–high levels of school bullying had a sig-
nificantly higher risk of suicidal ideation than adolescents with low levels of school
bullying. After adjustment for all the variables, this effect continued to be signifi-
cant. Adolescents with medium–high exposure to bullying at school showed a 38%
higher risk of suicidal ideation than adolescents with low exposure. The crude and
adjusted analysis also showed the significant effect of the family environment on
suicidal ideation, where the greater the family dysfunction, the significantly higher
risk of suicidal ideation. Age and sex of the adolescents were not associated with
suicidal ideation.
Regarding eating disorders, the crude analysis shows a significantly higher risk in
adolescents with dysfunctional families and those exposed to bullying. According to
the adjusted analysis, adolescents with medium–high exposure to bullying showed
approximately four times greater risk of eating disorders than adolescents with low
exposures. The family dysfunction variable, which was significantly associated with
eating disorders in the crude analysis, lost its statistical significance after adjusting
for bullying. Similarly, age and sex remained as non-significant effects. Additional
analyses showed that family dysfunction and age did not modify the relationship
between bullying and suicidal ideation.

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 Table 2  Crude and adjusted analysis of the association between school bullying with suicide ideation and eating disorders, Antioquia, Colombia, 2013
Trends in Psychology

Suicidal ideation Eating disorders

Prevalence Crude PR (95% CI) Adjusted PR (95% CI) Prevalence Crude PR (95% CI) Adjusted PR (95% CI)

Prevalence 37.59 35.8–39.4 17.58 16.2–18.9

Age p = 0.006 p = 0.016 p = 0.07 p = 0.554
9–13 years 39.86 1.15 (1.04–1.26) 1.14 (1.02–1.26) 18.64 1.15 (0.98–1.35) 1.06 (0.87–1.27)
14–17 years 34.76 1 1 16.16 1 1
Sex p = 0.334 p = 0.523 p = 0.937 p = 0.653
Male 38.5 1.05 (0.95–1.15) 1.03 (0.93–1.14) 17.52 0.99 (0.85–1.16) 0.96 (0.80–1.15)
Female 36.74 1 1 17.63 1 1
Family functioning p < 0.001 p =  < 0.001 p = 0.001 p = 0.4803
Severe 72.24 4.13 (3.54–4.82) 4.12 (3.47–4.87) 21.06 1.52 (1.20–1.93) 1.22 (0.95–1.55)
Moderate 54.82 3.13 (2.64–3.72) 3.12 (2.58–3.75) 21.19 1.53 (1.19–1.96) 1.11 (0.85–1.45)
Mild 30.19 1.72 (1.43–2.08) 1.77 (1.45–2.17) 17.54 1.27 (1.01–1.59) 1.12 (0.88–1.41)
Functional 17.47 1 1 13.86 1 1
Bullying p < 0.001 p < 0.001 p < 0.001 p < 0.001
Low risk 30.73 1 1 8.62 1 1
Medium–high risk 50.94 1.66 (1.50–1.83) 1.38 (1.24–1.52) 33.48 3.89 (3.27–4.62) 3.86 (3.16–4.72)

PR prevalence ratio, CI confidence interval

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Discussion

For the United Nations Educational, Scientific, and Cultural Organization (UNE-
SCO, 2018), bullying is an international phenomenon that has become increasingly
evident in schools worldwide. Bullying is a public health concern given the lack
of safety in schools and the increase in this phenomenon’s effects on mental health
(Zych et al., 2015). The present study, based on the existing literature, hypothesized
that there would be a higher prevalence of suicidal ideation, as well as a higher
prevalence of eating disorders in school-aged children from Antioquia, Colombia,
among those participants who reported high-medium risk of bullying at school than
among those participants who did not. The association of these variables can have
implications for the immediate and long-term well-being of adolescents.
Following the above, an important finding in this study was that adolescents exposed
to medium–high levels of school bullying have a significantly higher risk of suicidal
ideation than adolescents with low levels of school bullying. This finding is consistent
with the extant literature. More specifically, Geel et al. (2014) show a positive relation-
ship between peer victimization and suicidal ideation among young people and between
peer victimization and suicide attempts. In that regard, it has been found in a longitudi-
nal study that victims and perpetrators of bullying have higher scores in suicidal idea-
tion assessments in time 1, in comparison with those who are noninvolved in bullying.
However, those scores remain high in Time 2 only in victims (Undheim, 2013).
Similarly, international studies such as the one conducted by Messias et al.
(2014) suggest that victims of school bullying are between one and five times more
likely to present suicidal ideation compared to those not involved in this phenom-
enon. Likewise, in cases where cyberbullying was involved, it was found that those
who are bullied are five times more likely to present suicidal ideation compared to
noninvolved participants. Furthermore, the Colombian National Institute of Health
(2018), in its bulletin no. 2 of the year 2017, establishes that the most frequent
causes for which young people commit suicide in Colombia are related to depres-
sive and affective disorders and school problems are identified as one of the three
first trigger factors, along with financial and couple problems. Furthermore, in the
systematic review carried out by Villalobos-Galvis et al. (2019), it was concluded
that “the majority of research links ‘bullying’ as a relevant risk factor for victimized
children and adolescents to present self-injurious and/or suicidal behavior” (p. 63).
The researchers warn that these types of situations can lead children and adolescents
to attempt suicide as the only solution to the difficulties that they are encountering.
This leads us to conclude that suicidal ideation in adolescents who have been
exposed to a situation of bullying at school is related to a series of emotions like
frustration and sadness, as well as negative cognitions about themselves and others
(i.e., series of interpretations regarding the adolescent’s place in interpersonal rela-
tionships where the target is at a disadvantage). Skapinakis and colleagues (2011)
affirm that suicidal ideation when being a victim of bullying appears in a context
where the feeling of the power of the aggressor increases, and the self-concept of the
targeted person revolves around helplessness and self-blaming where they attribute
the victimization to their personality or behavior.

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Our findings also contribute to the association between bullying, age, gender,
and adolescent mental health outcomes. Our study did not find a significant associa-
tion between bullying at school and suicidal behavior with age and sex. This finding
is also evidenced in the meta-analysis carried out by Geel and colleagues (2014),
where it was found that the relationship between victimization and suicidal ideation
was not moderated by age or sex.
On the other hand, the results of this study provide evidence of the relationship
between exposure to bullying at school and an increased risk for eating disorders.
In the systematic review by Lie and colleagues (2019), the authors found that indi-
viduals with eating disorders were significantly more likely to have been bullied and
teased than participants in healthy control groups. The authors found that the associa-
tion was particularly strong for bulimia nervosa and binge eating disorder. The main
finding of this review was that a history of being bullied and teased was significantly
more common among people with eating disorders compared to healthy controls.
In line with the above, Copeland and colleagues (2015) found that all study
groups related to school bullying had a higher risk of presenting eating disorders
symptoms or associated characteristics compared to adolescents who were not
involved in bullying situations. In particular, victims of bullying were at an increased
risk of reporting symptoms of anorexia, bulimia, or an associated characteristic.
In this regard, it has been found that patients with depression, especially those
who have been bullied and teased, tend to show more unfavorable social compari-
sons than those who are healthy (McCarthy & Morina, 2020). Likewise, Menzel
et al. (2010) and Stice (2016) find that adolescents teasing tends to focus on physical
appearance, generating an effect of greater body dissatisfaction and therefore dietary
restriction, which is another risk factor for the onset of depressive symptoms.
Finally, this study reports a marked tendency of an increased prevalence of sui-
cidal ideation as the level of family dysfunction increases. This finding is consist-
ent with the extant literature that more family conflicts predict higher suicidality in
adolescence (Law & Shek, 2016). In this regard, previous research suggests that in
families with conflicts, communication problems, and low parental support, the ado-
lescent’s resources are reduced (Cordero, 2015; Graza, 2013). Consequently, per-
sonal variables such as self-esteem and coping strategies are affected, leading to an
increase in abuse of these adolescents by their peers. Similarly, Ortega (2010) states
that the aggressors expect signs of suffering and submission in their victims.
Further to this, Romero-Abrio et al. (2018) describe the importance of the
family as a mediating variable in the development of violent behaviors, including
factors such as the quality of family communication. In this regard, family func-
tioning has been stated as a protective factor that makes individuals adapt well in
the face of adversity (Davies et al., 2016), such as bullying victimization. Moreo-
ver, family functioning, specifically warmth and supportiveness, can be improved
after intervention (Pineda & Dadds, 2013). Therefore, prevention and interven-
tion programs addressing family functioning should be implemented to reduce
the risk of adolescent suicide.
Consequently, this study concludes that school bullying has significant asso-
ciations with mental health outcomes in school-aged children while describing
the relevance of family functionality as a protective factor for the participant

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positioning in interpersonal relationships. These findings are consistent with what

has been reported in international literature. Therefore, this study contributes to
exploring the phenomenon in another context, in this case, Colombia.

Study Limitations

These findings highlight a need for further research on associations among bully-
ing involvement, suicidal ideation, and eating disorders among Colombian adoles-
cents. However, it is also important to recognize several limitations of the current
study. First and foremost, this study was cross-sectional in nature, which does not
allow us to understand the temporal timing of the associations between bullying
experience, suicidal ideation, and the onset of eating disorder symptoms. Second,
data presented here are self-reports from youth and do not involve teacher or peer
reports. Therefore, it would be important to replicate these findings with bully-
ing assessments that involve multiple informants. Third, this study did not con-
trol other variables such as anxiety, depression, and conduct problems, which have
been shown to have a significant association between bullying and suicidal behav-
ior (Baiden & Tadeo, 2020). Other variables such as delinquency, reported by
Espelage and Holt (2013) in their studies, were not controlled either. Finally, con-
cerning eating disorders, this research did not control other associated variables
such as body dissatisfaction and depressive symptoms, which have been reported
in the literature as predictors of this psychopathology (Stice et al., 2011).

Funding This study was financially supported by Universidad CES, Medellín, Colombia, and Corpo-
ración Universitaria Lasallista.

Data Availability The data that support the findings of this study are available from the corresponding
author, upon reasonable request.

Declarations
Ethics Approval This research was approved by the Ethics Committee of the CES University (Medellin,
Colombia), act number 54 of 2012.

Consent to Participate School principals, parents, and all the adolescents that were chosen were asked to
sign the informed consent.

Conflict of Interest The authors declare no competing interests..

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