http://e-journal.unair.ac.id/JNERS | 557 Jurnal Ners Vol. 15, No. 2, Special Issue 2020 http://dx.doi.org/10.20473/jn.v15i2.20479 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License Systematic Review The Bullying Phenomenon and Handling Efforts in Reducing Cases of Bullying: A Systematic Review Devis Yulia Rohmana, Kartini Estelina and Iskandar Iskandar Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia ABSTRACT Introduction: Bullying is behavior that deliberately wants to dominate, hurt, or get rid of its victims, both directly (physical) or indirectly (verbal). The impact of bullying can cause psychological distress and if left untreated will worsen the victim to the point of committing suicide. This study aims to find out the most appropriate types of interventions that can be implemented to reduce intimidation and prevent the risk of suicide by using systematic reviews based on PRISMA guidelines. Methods: The studies were searched in five databases: Scopus, ScienceDirect, Proquest, Pubmed and CINHL and had to be published from 2014-2019. The articles were identified using the keywords “bullying” AND “intervention”, “anti-bullying program”. Results: 14 articles found were used using this systematic review. The article reviewed mentions that an antibullying program that involves several parties has the benefit of reducing bullying. Conclusion: Several intervention efforts can be used in preventing recurring breaches and can also be used as promotive and preventive efforts in cases of bullying in schools and communities. ARTICLE HISTORY Received: Feb 27, 2020 Accepted: April 1, 2020 KEYWORDS bullying; intimidation; intervention; prevention CONTACT Devis Yulia Rohamana  devis.yulia.rohmana- 2019@fkp.unair.ac.id  Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Cite this as: Rohmana, D. Y., Estelina, K & Iskandar, I. (2020). The Bullying Phenomenon and Handling Efforts in Reducing Cases of Bullying: A Systematic Review. Jurnal Ners, Special Issues, 557-562. doi:http://dx.doi.org/10.20473/jn.v15i2.20479 INTRODUCTION Bullying is a behavior that is carried out directly (physical bullying) and indirectly (verbal bullying). Risk factors for cyberbullying and traditional bullying might be similar. For instance, lack of empathy has been shown among cyberbullies (Chaux, Velásquez, Schultze-Krumbholz, & Scheithauer, 2016). Direct bullying includes pushing, hitting, kicking. Indirect bullying (verbal bullying) includes teasing, mocking, threatening, spreading false rumors or news that seeks either to cause fear, discomfort, or injury to others (Vassallo, Edwards, Renda, & Olsson, 2014). Three-quarters of students in the USA reported being bullied at school or bullied online at some point in their lives (Hinduja & Patchin, 2017). Bullying is a type of proactive aggressive behavior, which contains the intentional aspect to dominate, hurt, or get rid of someone. Imbalance of strength whether physical, age, cognitive abilities, skills, and social status, which is done repeatedly by one or several children against other children is a characteristic of bullying behavior (Garmy, Vilhjálmsson, & Kristjánsdóttir, 2018). According to Plan International and the International Center for Research on Women, one of the cases of bullying experienced by teens at school in 2013 reached 84%. This figure is higher compared to the Asian region, where it is 70%. The research was carried out in five Asian countries including Vietnam, Nepal, Pakistan, and Indonesia, involving 9000 students aged 12-17, teachers, principals, parents, and representatives. Adolescence can be interpreted as a period of looking for one’s self-identity, as during this period there is rapid development and growth both physically, mentally or psychologically, and socially. Adolescence is divided into three parts, namely early adolescence (11-14), middle adolescence (15-17) and late adolescence (18-20). In this period the problems often faced by adolescents. If adolescents fail to carry out their developmental tasks, then it will have an impact on the crisis of self- identity, self-esteem, and belief, that can lead to juvenile delinquency and violent behavior and one of https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ http://dx.doi.org/10.20473/jn.v15i2.1355 D. Y. ROHMANA ET AL. 558 | pISSN: 1858-3598  eISSN: 2502-5791 them is to be a bullying perpetrator (Fisher et al., 2012). Bullying behavior needs to be dealt with early on because it will turn into juvenile delinquency which is difficult to handle so there needs to be an action to reduce intimidation and prevent the risk of suicide (Damayanti, 2019). MATERIALS AND METHODS This Systematic review uses guidelines based on Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) (Liberati et al., 2009). The studies were searched in five databases: Scopus, ScienceDirect, Proquest, Pubmed and CINHL and had to be published from 2014-2019. The articles were identified using the keywords “bullying” AND “intervention”, “anti-bullying program”; the criteria of inclusion was the use of interventions in preventing bullying. Focusing on bullying and case- control studies, the data were assessed and compared before and after the intervention to ensure that changes verified in the experimental group were associated with the intervention rather than with any other conditions or variables not included in the investigation. No restrictions were imposed on the year of publication and only the language (English). RESULTS Bullying has been defined as unwanted aggressive behavior that involves a real or perceived power imbalance (Olweus & Limber, 2010). Bullying includes physical, verbal, relational and cyberbullying. According to the international research network Health Behaviour in School-aged Children (HBSC), 11% of children aged 11–15 claimed to have been bullied at least two or three times per month within the last couple of months(Cosma, Whitehead, Neville, Currie, & Inchley, 2017). The total respondents in this review were 16,847 participants. Bullying is a type of proactive aggressive behavior, which contains the intentional aspect to dominate, hurt, or get rid of someone. This research area belongs to the community. In total, the review consisted of 14 articles. In this review, adolescence can be interpreted as a period of looking for one’s self-identity, as during this period there is rapid development and growth both physically, mentally or psychologically, and socially. Several studies have been carried out by providing different interventions according to the criteria of researchers to adolescents who experienced bullying, for example, interventions carried out in stressed patients were measured using The Strengths and Difficulties Questionnaire (SDQ) for psychological distress (Bhui, Silva, Harding, & Stansfeld, 2017), which is used to assess emotional symptoms, attention in dealing with and seeing problems experienced in both relationships; prosocial behavior. Other measures “Bullying Tendency Scale”, “Coping with Bullying Scale,” and “Personal Information Form” were used in this section too (Yuksel-sahin, 2015). Also used, according to the journal discussion, to see depression in adolescents, were the Mood and Feel Questionnaire (MFQ) and Youth Self-Report (YSR) carried out in schools with the effectiveness of approaches to reduce bullying. Many implementations of anti-bullying, which is effective classroom management in a small class setting with a well-trained teacher(Chan & Wong, 2015), in line with research, that the program significantly stimulated can decrease bullying and cyberbullying (Garaigordobil & Martínez-valderrey, 2015), the functions of peer support and active coping (Yin et al., 2017). Furthermore, the interventions reported by the studies can be assigned into four categories: multi-component (whole-school), social skills training, bullying prevention integrated into the curriculum, and computer-based interventions (Silva et al., 2017). Bullying is quite prevalent and when considering its detrimental effects, it may well be said that there is a need for anti-bullying programs that will reduce this type of behavior (Albayrak, Yildiz, & Erol, 2016). The effectiveness of policy interventions for school bullying gets policy results that can be done to guide organizational practices, such as establishing anti- bullying procedures and reporting incidents that occur in schools. But bullying policies can be Table 1. Type of bullying Article Physical Bullying Verbal Bullying Cyberbullying Hinduja et al. (2017)    Garaigordobil & Martinez- Valderrey (2015)    Gaffney et al. (2019)    Vassallo et al. (2014)   Yin et al. (2017)   Chan et al. (2015)    Chaux et al. (2016)  Albayrak et al. (2016)  Bhui et al. (2017)   Hall et al. (2017)   Silva et al. (2017)   Zhou et al. (2017)   Garmy et al. (2017)    Yuksel-Sahin (2015)   JURNAL NERS http://e-journal.unair.ac.id/JNERS | 559 influenced by individual or organizational behavior (Hall, 2017). Another advantage of bullying policies is that they are upstream interventions that provide the basis for downstream interventions, in other words, more targeted intervention programs, practices, and services at the organization, group, and individual Table 2. Handling bullying Article Handling Bullying Chaux et al. (2016) Schools randomly assigned classrooms to one of three conditions: control; long version; or short-version. Self-report measures of bullying perpetration and bullying victimization were administered before and after the intervention. Vassallo et al. (2014) interpersonal skills and parent and peer relationships Garaigordobil & Martinez- Valderrey (2015) Cyber program 2.0; Cyberbullying intervention program, traditional bullying also included; 19 lessons aimed to raise awareness, outline the consequences of, and develop coping strategies relating to bullying and cyberbullying. Participants are also taught to develop positive social and emotional skills. Yin et al. (2017) Enhancement of active control and peer support as a prevention strategy to reduce adverse mental health outcomes in adolescents due to bullying victims Hinduja et al. (2017) Resilience is a good protective factor in preventing bullying and reducing its effects. Implications for school and community-based interventions. Albayrak et al. (2016) The post-test results showed that the PVS and PBBS bullying scale were significantly lower than in the control group Gaffney et al. (2019) Confident Kids Program and Whole-school program Chan et al. (2015) The effectiveness of the whole school approach was proven in terms of preventing and reducing school bullying among Chinese children and adolescents. Bhui et al. (2017) Family social support is independently associated with less psychological pressure Hall et al. (2017) Anti-bullying policies might be effective at reducing bullying if their content is based on evidence and sound theory and if they are implemented with a high level of fidelity. More research is needed to improve on limitations among extant studies Silva et al. (2017) Intervention models for the prevention and reduction of bullying cases have practical implications for reducing bullying and a positive impact on students' psychosocial well- being Zhou et al. (2017) Symptoms that can be mediated by the effects of endurance and mindfulness are stronger for children with low attention Garmy et al. (2017) Victims of bullying are at least 2-3 times each month at 5.5%, covering a younger age, not living with their parents, and living in rural areas. Related parties and school health administrators must first consider sociodemographics when planning interventions to reduce bullying in schools Yuksel-Sahin (2015) Bullying scores, bullying tendencies, and handling of bullying have differences with gender, participation in social activities, being submissive, and the presence of school counselors about bullying prevention Table 3 Review Article Sample Measures Findings Chaux et al. (2016) 1,075 students aged 11 – 17 (mean = 13.36) from five schools in Germany. Self-report measures of bullying perpetration and bullying victimization Schools randomly assigned classrooms to one of three conditions: control; long version; or short-version. Self-report measures of bullying perpetration and bullying victimization were administered before and after the intervention. Vassallo et al. (2014) n=1359 young adults A broader measure of oppositional behavior, Self-Report Delinquency scale plus a single item asserting illicit substance Preventive interventions that target interpersonal skills and parent and peer relationships are effective in reducing the adverse effects of bullying Garaigordobil & Martinez-Valderrey (2015) n=352 Classrooms from 3 different schools were randomly assigned to either the control or intervention condition and participants from both conditions completed self-report bullying measures pre- and postimplementation. Cyber program 2.0; Cyberbullying intervention program, traditional bullying also included; 19 lessons aim to raise awareness, outline the consequences of, and develop coping strategies relating to bullying and cyberbullying. Participants are also taught to develop positive social and emotional skills. Yin et al. (2017) Sample: n=755 adolescents Social supports scale Enhancement of active control and peer support as a prevention strategy to reduce adverse mental health outcomes in adolescents due to bullying victims Chan et al. (2015) Sample: n=545 high school students The Olweus Bullying Prevention Program (OBPP) The effectiveness of the whole school approach was proven in terms of preventing and reducing school bullying among Chinese children and adolescents. D. Y. ROHMANA ET AL. 560 | pISSN: 1858-3598  eISSN: 2502-5791 level. For example, bullying policies can be adopted in the state or district; the policy then applies to all schools in the country or district. DISCUSSION Physical bullying is the first discussion of bullying in the journals we have analyzed, then there is verbal bullying, and also cyberbullying. The handling of bullying that was discussed throughout the journals that we analyzed said that it could not only provide intervention to the perpetrators or victims of bullying but also needed to involve many related parties who supported the implementation of a comprehensive bullying intervention. The greater impact of the risk of bullying on psychological pressure s in adolescents shows a greater increase in boys compared to girls in adolescents. Overall this increase was influenced by difficulties, such as poverty and unemployment. Also, most studies do not present the effectiveness of different interventions to prevent or fight bullying according to the type of intervention, age, and socio- culture in the context of students. In terms of age, interventions are more efficient among older students. Most studies include a sample consisting of participants older than 10 years, which limits the interpretation of the results. That means the results may be biased because of the large number of studies addressing older children. Despite these limitations, one possible explanation for this result is that older student colleagues have further developed cognitive skills. They better understand the nature of bullying or the possibility of making more rational decisions, thus making themselves skilled in handling aggression in defending themselves. CONCLUSION Bullying behavior is one of the many problems of behavior and discipline among school students today. Gaffney et al. (2019) n=474 prevention programs Anti-bullying programs (The Confident Kids Program and Whole-school program to reduce bullying) were proven to reduce bullying in schools by more than 20%. Hinduja et al. (2017) Sample: 1204 adolescents between age 12- 17 years old The Connor-Davidson Resilience 25-item self-report scale (CD- RISC) Resilience is a good protective factor in preventing bullying and reducing its effect. Implications for school and community-based interventions. Albayrak et al. (2016) n=367 adolescents Peer Bullying Behaviour Scale (PBBS) PEER Victimization scale (PVS) The post-test results showed that the PVS and PBBS bullying scale were significantly lower than the control group Bhui et al. (2017) n=3322 students The strengths and difficulties questionnaire (SDQ) Total difficulties score (TDS) for psychological distress Family social support is independently associated with less psychological pressure Hall et al. (2017) n= 489 Anti-bullying policies Anti-bullying policies might be effective at reducing bullying if their content is based on evidence and sound theory and if they are implemented with a high level of fidelity. More research is needed to improve on limitations among extant studies Silva et al. (2017) n= 449 Anti-bullying intervention Intervention models for the prevention and reduction of bullying cases have practical implications for reducing bullying and a positive impact on students' psychosocial well-being Zhou et al. (2017) n= 448 children in China The children and adolescent mindfulness measure, Center of Epidemiologic Studies Depression scale (CES-DC) Symptoms that can be mediated by the effects of endurance and mindfulness and are stronger for children with low attention Garmy et al. (2017) n=5.018 students Family Affluence Scale (FAS), The Icelandic version of the survey included 12 questions regarding bullying Victims of bullying are at least 2-3 times each month at 5.5%, covering a younger age, not living with their parents, and living in rural areas. Related parties and school health administrators must first consider sociodemographics when planning interventions to reduce bullying in schools Yuksel-Sahin (2015) 402 Senior High School Students Bullying Tendency scale, Coping with Bullying scale Bullying scores, bullying tendencies, and handling of bullying have differences with gender, participation in social activities, being submissive, and the presence of school counselors about bullying prevention JURNAL NERS http://e-journal.unair.ac.id/JNERS | 561 Direct or indirect bullying behavior is part of the behavior of aggression. Several factors encourage bullying behavior among school students, namely individual, family, peer group, school, media. Bullying behavior needs to be prevented at school. Therefore schools need to have a Good Intervention Prevention Program, a Recovery Program which involves all the Components in the Teaching and Learning process in schools. This research shows, on the one hand, that by reducing bullying the effects of emotional coping are reduced at the level of depressive symptoms. On the other hand, by reducing emotional-oriented coping, it is better to replace it with more adaptive coping, the impact of risk factors such as being bullied in the development of depressive symptoms can be reduced. Therefore it is important to prevent maladaptive coping strategies. More adaptive handling strategies must be incorporated as early as possible. Interventions with elements of cognitive- behavioral therapy for distressed adolescents, including recognition, challenging negative thoughts, stopping self-blame, and increasing self-esteem, can help. CONFLICT OF INTEREST No Conflicts of interest have been declared. ACKNOWLEDGEMENT The authors of this study would like to thank the Faculty of Nursing and also Masters in Nursing Study Program, for providing the opportunity to present this study. 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