Health-related quality of life associated with bullying and aggression: a cross-sectional study in English secondary schools

  • Catherine Fantaguzzi
  • Elizabeth Allen
  • Alec Miners
  • Deborah Christie
  • Charles Opondo
  • Zia Sadique
  • Adam Fletcher
  • Richard Grieve
  • Chris Bonell
  • Russell M. Viner
  • Rosa Legood
Original Paper



Associations between adolescent health-related quality of life (HRQoL), bullying, and aggression are not well understood. We used baseline data from a large-cluster randomized school trial to study the relationship between HRQoL, bullying experience, and other demographic factors.


Cross-sectional self-reported questionnaires collected pre-randomization from the on-going INCLUSIVE trial. The questionnaires were completed in the classroom. The Gatehouse Bullying Scale measured bullying victimization and the Edinburgh Study of Youth Transitions and Crime school misbehavior subscale (ESYTC) measured aggressive behaviors. HRQoL was assessed using the Child Health Utility 9 Dimensions (CHU-9D) and general quality of life using the Pediatric Quality of Life Inventory (PedsQL). Participants were a cohort of year 7 students (age 11–12 years) from 40 state secondary schools in England. Descriptive statistics for the CHU-9D and PedsQL were calculated using standard methods with tests for differences in median scores by sex assessed using quantile regression. Correlation between HRQoL measures was conducted using Spearman’s rank correlation coefficients. Predictors of HRQoL were identified using univariate and multiple regressions.


A total of 6667 students filled out the questionnaire. The CHU-9D was correlated with the PedsQL (0.63, p < 0.001). The multivariable regression results suggest that if students were bullied frequently and upset it resulted in a decrement in CHU-9D scores of (−0.108) and fall in PedsQL score of (−16.2). The impact of the antisocial/aggressive behavior on the ESYTC scale resulted in a utility decrement of −0.004 and fall of −.5 on the PedsQL.


Adolescents’ involvement in bullying and aggression is a strong correlate of HRQoL. These data have important implications for the potential cost-effectiveness of reducing bullying and aggression in schools.


Utility CHU-9D Health-related quality of life Bullying Aggression 


95% CI

95% Confidence interval


Child Health Utility 9 Dimensions


Edinburgh Study of Youth Transitions and Crime school antisocial/aggressive behavior subscale


Gatehouse Bullying Scale


Health-related quality of life


Initiating change locally in bullying and aggression through the school environment


Institute of Education


Interquartile range


London School of Hygiene and Tropical Medicine


National Institute for Health and Clinical Excellence


Pediatric Quality of Life Inventory


Quality-adjusted life year


Standard deviation


Standard error


University College London


United Kingdom


World Health Organization



The trial was funded by the National Institute for Health Research (NIHR). Thanks to all the students that completed the questionnaire and staff and parents that supported this. Dr. Nichola Shackleton assisted cleaning the dataset and scoring composite measures.

Author contributions

RL, RG, DC, AF, EA, CB, and RV designed the trial and data collection. CF, EA, ZS, CO, AM, advised on the design of the statistical analysis. CF and ZS undertook all analyses under the supervision of RL. All authors were responsible for drafting the manuscript. CF undertook the initial analysis of this project as part of her MSc project dissertation.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Supplementary material

10198_2017_908_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Catherine Fantaguzzi
    • 1
  • Elizabeth Allen
    • 1
  • Alec Miners
    • 1
  • Deborah Christie
    • 2
  • Charles Opondo
    • 1
  • Zia Sadique
    • 1
  • Adam Fletcher
    • 3
  • Richard Grieve
    • 1
  • Chris Bonell
    • 1
  • Russell M. Viner
    • 4
  • Rosa Legood
    • 1
  1. 1.London School of Hygiene and Tropical MedicineLondonUK
  2. 2.University College London Hospitals NHS Foundation TrustLondonUK
  3. 3.School of Social SciencesCardiff UniversityCardiffUK
  4. 4.UCL Institute of Child HealthLondonUK

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