[The health of children in the Netherlands: relatively healthy, but lifestyle raises some concerns]. / De gezondheid van de Nederlandse jeugd: relatief gezond, maar leefstijl vraagt aandacht.

Dutch young people are generally healthy, and more than 80% of them feel healthy and happy. This percentage is high compared with other European countries. Infant mortality rates are low, and the prevalence of most health problems among children is less than 10%. However, children from risk groups more often engage in unhealthy behaviours or have psychosocial problems. Adolescents smoke and drink less than they did 10 years ago, but extreme alcohol use has increased. The number of overweight children has stabilised in the past few years, but remains at a high level. These trends are expected to follow the same line in the future. Attention to the increasing use of social media is important, and the increasing number of high-risk children will also require attention. Due to these changes, along with policy changes in the provision of healthcare services for young people, intensive communication and cooperation between general practitioners, healthcare physicians, and care workers responsible for young people is increasingly important.

Effects of antibullying school program on bullying and health complaints.

OBJECTIVE: To evaluate the effects of an antibullying school intervention in elementary schools. DESIGN: Two-year follow-up randomized intervention group-control group. SETTING: Forty-seven elementary schools in the Netherlands. PARTICIPANTS: Three thousand eight hundred sixteen children aged 9 to 12 years. INTERVENTION: During the first study year, an antibullying school program was implemented in the schools in the intervention group. MAIN OUTCOME MEASURES: A questionnaire measuring bullying behavior, depression, psychosomatic complaints, delinquent behavior, and satisfaction with school life and peer relationships was filled out by the students at 3 times to obtain the following data: a baseline measurement, a first-effect measurement at the end of the first year, and a second-effect measurement at the end of the second year. RESULTS: The number of bullied children decreased by 25% in the intervention group compared with the control group (relative risk, 0.75; 95% confidence interval, 0.57-0.98). The intervention group also showed a decline in the scale scores of victimization (-1.06 vs 0.28; P< .01) and active bullying behaviors (-0.47 vs 0.12, P< .05). Self-reported peer relationships also improved in the intervention schools (0.48 vs 0.11; P< .05), and there was a trend for a decrease in reported depression in the intervention schools (-0.33 vs -0.10; P< .10). At follow-up, there were no differences between the intervention and control groups for the outcome measures. Schools had also lowered their antibullying activities during the second study year. CONCLUSIONS: An antibullying school policy can reduce bullying behavior. To keep bullying at a consistently low level, schools must continue antibullying measures every year. Continued counseling may help schools in their efforts to establish a lasting antibullying policy.

Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the relationship between bullying and health-related symptoms.

OBJECTIVES: A number of studies have shown that victimization from bullying behavior is associated with substantial adverse effects on physical and psychological health, but it is unclear which comes first, the victimization or the health-related symptoms. In our present study, we investigated whether victimization precedes psychosomatic and psychosocial symptoms or whether these symptoms precede victimization. DESIGN: Six-month cohort study with baseline measurements taken in the fall of 1999 and follow-up measurements in the spring of 2000. SETTING: Eighteen elementary schools in the Netherlands. PARTICIPANTS: The study included 1118 children aged 9 to 11 years, who participated by filling out a questionnaire on both occasions of data collection. OUTCOME MEASURES: A self-administered questionnaire measured victimization from bullying, as well as a wide variety of psychosocial and psychosomatic symptoms, including depression, anxiety, bedwetting, headaches, sleeping problems, abdominal pain, poor appetite, and feelings of tension or tiredness. RESULTS: Victims of bullying had significantly higher chances of developing new psychosomatic and psychosocial problems compared with children who were not bullied. In contrast, some psychosocial, but not physical, health symptoms preceded bullying victimization. Children with depressive symptoms had a significantly higher chance of being newly victimized, as did children with anxiety. CONCLUSIONS: Many psychosomatic and psychosocial health problems follow an episode of bullying victimization. These findings stress the importance for doctors and health practitioners to establish whether bullying plays a contributing role in the etiology of such symptoms. Furthermore, our results indicate that children with depressive symptoms and anxiety are at increased risk of being victimized. Because victimization could have an adverse effect on children's attempts to cope with depression or anxiety, it is important to consider teaching these children skills that could make them less vulnerable to bullying behavior.

Bullying behavior and associations with psychosomatic complaints and depression in victims.

OBJECTIVES: To assess the association between bullying behavior and a wide variety of psychosomatic health complaints and depression. Study design In a cross-sectional study, 2766 elementary school children age 9 to 12 years filled out a questionnaire on bullying behavior and health complaints. Three groups-bullied children, active bullies, and children who both bully and are bullied-were compared with the group of children not involved in bullying behavior. Subsequently, risks for psychosomatic symptoms and depression were calculated by means of odds ratios. RESULTS: Bully victims had significantly higher chances for depression and psychosomatic symptoms compared with children not involved in bullying behavior. Odds ratios were as follows: headache, 3.0; sleeping problems, 2.4; abdominal pain, 3.2; bed-wetting, 2.9; feeling tired, 3.4; and depression, 7.7. Children who actively bullied did not have a higher chance for most of the investigated health symptoms. CONCLUSIONS: Being bullied is strongly associated with a wide range of psychosomatic symptoms and depression. These associations are similar to the complaints known to be associated with child abuse. Therefore, when such health complaints are presented, pediatricians and other health care workers should also be aware of the possibility that a child is being bullied to take preventive measures.