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Original Investigation
November 2, 2020

Assessment of School Anti-Bullying Interventions: A Meta-analysis of Randomized Clinical Trials

Author Affiliations
  • 1Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
  • 2Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
  • 3Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
  • 4Department of Psychiatry, Hospital del Mar, Institut de Neuropsiquiatria i Addiccions, Barcelona, Catalonia, Spain
  • 5Department of Developmental Psychology and Education, Universidad Complutense, Madrid, Spain
JAMA Pediatr. 2021;175(1):44-55. doi:10.1001/jamapediatrics.2020.3541
Key Points

Question  What is the effectiveness of anti-bullying interventions, their population impact, and is there an association between moderator variables and the effectiveness of these interventions?

Findings  Across 77 samples from 69 randomized clinical trials (111 659 participants), meta-analyses showed that interventions were statistically significantly effective in reducing bullying and improving mental health problems at study end point. Meta-regression analyses showed that duration of intervention was not statistically significantly associated with effectiveness and that the impact of the anti-bullying programs did not diminish over time during follow-up.

Meaning  Findings of this meta-analysis support the concept that school anti-bullying interventions may have a valuable population impact.


Importance  Bullying is a prevalent and modifiable risk factor for mental health disorders. Although previous studies have supported the effectiveness of anti-bullying programs; their population impact and the association of specific moderators with outcomes are still unclear.

Objective  To assess the effectiveness of school anti-bullying interventions, their population impact, and the association between moderator variables and outcomes.

Data Sources  A search of Ovid MEDLINE, ERIC, and PsycInfo databases was conducted using 3 sets of search terms to identify randomized clinical trials (RCTs) assessing anti-bullying interventions published from database inception through February 2020. A manual search of reference lists of articles included in previous systematic reviews and meta-analyses was also performed.

Study Selection  The initial literature search yielded 34 798 studies. Included in the study were articles that (1) assessed bullying at school; (2) assessed the effectiveness of an anti-bullying program; (3) had an RCT design; (4) reported results; and (5) were published in English. Of 16 707 studies identified, 371 met the criteria for review of full-text articles; 77 RCTs were identified that reported data allowing calculation of effect sizes (ESs). Of these, 69 independent trials were included in the final meta-analysis database.

Data Extraction and Synthesis  Random-effects and meta-regression models were used to derive Cohen d values with pooled 95% CIs as estimates of ES and to test associations between moderator variables and ES estimates. Population impact number (PIN), defined as the number of children in the total population for whom 1 event may be prevented by an intervention, was used as an estimate of the population impact of universal interventions targeting all students, regardless of individual risk.

Main Outcomes and Measures  The main outcomes are the effectiveness (measured by ES) and the population impact (measured by the PIN) of anti-bullying interventions on the following 8 variable categories: overall bullying, bullying perpetration, bullying exposure, cyberbullying, attitudes that discourage bullying, attitudes that encourage bullying, mental health problems (eg, anxiety and depression), and school climate as well as the assessment of potential assocations between trial or intervention characteristics and outcomes.

Results  This study included 77 samples from 69 RCTs (111 659 participants [56 511 in the intervention group and 55 148 in the control group]). The weighted mean (range) age of participants in the intervention group was 11.1 (4-17) years and 10.8 (4-17) years in the control group. The weighted mean (range) proportion of female participants in the intervention group was 49.9% (0%-100%) and 50.5% (0%-100%) in the control group. Anti-bullying interventions were efficacious in reducing bullying (ES, −0.150; 95% CI, −0.191 to −0.109) and improving mental health problems (ES, −0.205; 95% CI, −0.277 to −0.133) at study end point, with PINs for universal interventions that target the total student population of 147 (95% CI, 113-213) and 107 (95% CI, 73-173), respectively. Duration of intervention was not statistically significantly associated with intervention effectiveness (mean [range] duration of interventions, 29.4 [1 to 144] weeks). The effectiveness of anti-bullying programs did not diminish over time during follow-up (mean [range] follow-up, 30.9 [2-104] weeks).

Conclusions and Relevance  Despite the small ESs and some regional differences in effectiveness, the population impact of school anti-bullying interventions appeared to be substantial. Better designed trials that assess optimal intervention timing and duration are warranted.

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