Factors associated with verbal bullying in adolescents in the Amazon, according to the PeNSE, Brazil, 2015

Abstract

School violence can affect all people present in the institution environment and generate fear in students who suffer aggression. Verbal bullying has an impact on who experiences it and can be one of the doors to reach physical violence. The sample consisted of 23,977 adolescents from seven Amazônia states in Brazil. Multinomial regression was performed to verify the association of variables with categories of verbal bullying. The level of statistical significance of 5% was adopted. The prevalence among adolescents in the Amazon in Brazil who were victims of verbal bullying at school was 4.3% (95%CI 3.86-4.72); among those who practiced bullying, denominated as perpetrators, 15.9% (95%CI 15.02-16.87); and among those who were victims and perpetrators of bullying, 2.0% (95%CI 1.70-2.23). The school context of adolescents in the Brazilian Amazon continues to be a space for the reproduction of violence and that the school is not solely responsible for the production of violence, because it is a complex, dynamic, multifaceted and multicausal phenomenon, with roots also in macrosocial, economic and sociocultural issues.

Key words:
Adolescent; Violence; Academic institutions; Health risk behavior; Bullying

Resumo

A violência escolar pode afetar todos os que estão inseridos na instituição e gerar medo nos estudantes que sofrem agressões. O bullying verbal tem um impacto sobre quem o vivencia e pode ser umas das portas para se chegar à violência física. A amostra contou com 23.977 adolescentes de sete estados da Amazônia no Brasil. Realizou-se a regressão multinomial para verificar a associação das variáveis com as categorias de bullying verbal. Adotou-se o nível de significância estatística de 5%. A prevalência entre os adolescentes da Amazônia no Brasil vitimados pelo bullying verbal na escola foi de 4,3% (IC95% 3,86-4,72); entre aqueles que praticaram o bullying, denominados como perpetradores, de 15,9% (IC95% 15,02-16,87); e entre aqueles que foram vítimas e perpetradores do bullying, 2,0% (IC95% 1,70-2,23). O contexto escolar dos adolescentes na Amazônia brasileira continua sendo um espaço de reprodução da violência e a escola não é a única responsável pela produção da violência. Trata-se de um fenômeno complexo, dinâmico, multifacetado e multicausal, com raízes também em questões macrossociais, econômicas e socioculturais.

Palavras-chave:
Adolescente; Violência; Instituições acadêmicas; Comportamento de risco à saúde; Bullying

Resumen

La violencia escolar puede afectar a todos en la institución y generar miedo en los alumnos que sufren agresiones. El acoso escolar verbal tiene impacto en quien lo sufre y puede ser una de las puertas de entrada a la violencia física. La muestra incluyó 23.977 adolescentes de siete estados amazónicos de Brasil. Se realizó una regresión multinomial para comprobar la asociación entre las variables y las categorías de acoso verbal. Se adoptó un nivel de significación estadística del 5%. La prevalencia entre los adolescentes de la Amazonia brasileña que fueron víctimas de acoso verbal en la escuela fue del 4,3% (IC95% 3,86-4,72); entre los que practicaron el acoso, denominados agresores, del 15,9% (IC95% 15,02-16,87); y entre los que fueron tanto víctimas como agresores de acoso del 2,0% (IC95% 1,70-2,23). El contexto escolar de los adolescentes de la Amazonía brasileña continúa siendo un espacio de reproducción de la violencia y la escuela no es la única responsable por la producción de violencia, ya que se trata de un fenómeno complejo, dinámico, multifacético y multicausal, enraizado también en cuestiones macrosociales, económicas y socioculturales.

Palabras clave:
Adolescente; Violencia; Instituciones académicas; Comportamientos de riesgo para la salud; Acoso escolar

Introduction

Violence among adolescents is a public health issue that manifests in various social spaces, notably the school. The school-violence relationship encompasses both explicit aggression and symbolic forms, rooted in cultural norms and social inequality¹.

Within the school environment, adolescents form affective bonds outside the family context, and interpersonal relationships -between teachers and students, and among peers-are pivotal for learning and value development^2,3. These dynamics can foster positive experiences or lead to conflict, including bullying³. Bullying refers to repeated intentional aggression rooted in power imbalance, manifesting verbally, physically, relationally, or online^4,5. Its consequences span short to long-term impacts and can trigger health-risk behaviors^4,6.

The school mirrors broader societal relationships and plays a crucial role in shaping adolescent experiences, citizenship, and social integration^5,7,8. In Brazil, school violence gained attention from the 1980s, initially linked to vandalism and theft. From the 1990s onwards, the focus shifted to interpersonal conflicts and behavioral issues, including bullying^9,10. Such violence can affect the entire school community, compromising students’ well-being and academic performance^11-15.

Verbal violence, though frequent, remains underestimated despite its potential to escalate into physical aggression¹². Fights among students are common, as shown in international studies, with significant prevalence among adolescents¹¹^,¹⁶^,¹⁷. Brazilian surveys corroborate these findings, highlighting disparities linked to race, socioeconomic status, and type of school^18-20.

Understanding the specificities of school violence is essential for developing effective strategies. Awareness of risk factors supports the creation of healthier educational environments^7,21,22.

This study analyzes factors associated with verbal bullying among adolescents in the Amazon, based on data from the 2015 National School Health Survey (PeNSE).

Methods

This is a cross-sectional study using data from the 2015 edition of the National School Health Survey (PeNSE), conducted by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Ministry of Health and Ministry of Education. Only data from students in the 9th grade of elementary school from the Northern region of Brazil (Amazon states) were analyzed.

PeNSE uses a complex, multi-stage, stratified sampling design to represent Brazilian students enrolled in public and private schools. For this study, 23,977 adolescents from 714 schools in the Northern region were included. Students attending evening classes and those from other regions of Brazil were excluded.

Instrumentation

Data were collected through self-administered structured questionnaires on smartphones. The instrument covered thematic modules, including socioeconomic factors, family context, bullying, eating habits, physical activity, violence, and safety. The 2015 database is publicly available²³.

Study variables

The outcome variable was verbal bullying, categorized as follows:

Neither suffers nor practices: students who responded “no” to both victim and perpetrator questions;

Victim: those who reported having been verbally offended or humiliated by classmates;

Perpetrator: those who reported offending or humiliating classmates;

Victim/perpetrator: those who reported both suffering and practicing verbal bullying.

Independent variables included sociodemographic data (sex, age, skin color/race, type of school, mother’s education), mental health indicators (loneliness, insomnia, presence of friends), body image (perception and satisfaction) and family context (supervision, emotional understanding, intrusion).

Data Processing and Analysis

Data were cleaned and processed in Stata version 14.0, using the svyset command to account for sample weights and complex design. Pearson’s chi-square test was applied to assess associations (significance level: 5%). Multinomial logistic regression was used to examine associations between bullying categories and the independent variables, with “neither suffers nor practices” as the reference. Models were adjusted for sociodemographic factors, including sex, age, skin color/race, and type of school.

Results

The final sample included 23,977 adolescents from seven states in the Brazilian Amazon region, selected through a complex sampling process as described in the Methods section. The sample selection process is detailed in Figure 1.

Figure 1
Flowchart of the sample selection process - PeNSE 2015, Northern Brazil.

Among the participants, 51.4% were female, and 64.7% were aged between 11 and 14 years. Most adolescents (89.2%) attended public schools and self-identified as having brown skin color/race (56.4%).

Table 1 presents the distribution of adolescents by sociodemographic and mental health characteristics. All sociodemographic variables showed statistically significant associations with bullying categories. A higher prevalence of perpetrators was observed among males (19.2%) compared to females (12.9%). Victimization was more prevalent among adolescents who identified as having yellow skin color/race (7.4%), while brown, white, and Indigenous students had rates close to 4%.

Table 1
Characterization of the sociodemographic and mental health aspects of adolescents in the Northern region of Brazil, according to the categories of bullying, 2015.

Verbal bullying categories
Variables	Neither victim nor perpetrator n = 18.187 (77.8%)		Victim n = 1.085 (4.3%)		Perpetrator n = 3.968 (15.9%)		Victim/Perpetrator n = 537 (2.0%)		p - value*
	n	%	n	%	n	%	n	%
Gender Male Female	8,439 9.748	74.4 81.1	504 581	4.1 4.4	2,321 1,647	19.2 12.9	345 192	2.3 1.6	< 0.001
Age ≤ 14 years 15 years or more	11,828 6,359	78.1 77.5	750 335	4.7 3.7	2,515 1,453	15.4 16.7	334 203	1.8 2.1	0.042
School type Public Private	16,257 1,930	78.2 78.2	972 113	4.3 3.9	3,504 464	15.6 18.9	463 74	1.9 3.0	0.014
Color skin/race§ White Black Yellow Brown Indigenous	4,4557 2,077 688 10,264 686	77.6 75.5 74.8 78.7 75.4	240 133 54 616 42	4.2 5.4 7.4 3.9 4.5	902 478 189 2,253 145	16.1 17.2 15.9 15.6 17.3	126 85 21 272 30	2.1 1.8 1.8 1.9 2.7	0.040
Loneliness Yes No	2,687 15,483	68.1 79.8	437 646	10.6 3.0	775 3,190	17.9 15.6	159 377	3.4 1.7	< 0.001
Insomnia Yes No	1,777 16,387	65.3 79.4	275 810	10.4 3.5	551 3,409	20.4 15.3	128 407	3.8 1.7	< 0.001
Friendship Yes No	745 1,741	74.0 78.0	89 996	6.7 4.2	161 3,802	16.7 15.9	32 504	2.6 1.9	< 0.031

• * Pearson chi-square test. ^§ Self-declared information.
• Source: Authors.

Regarding verbal bullying, the prevalence of victims was 4.3% (IC95%: 3.86-4.72), perpetrators 15.9% (IC95%: 15.02-16.87), and victims/perpetrators 2.0% (IC95%: 1.70-2.23).

Mental health aspects such as feeling alone, insomnia, and lack of friendships were more frequently reported among perpetrators (Table 1).

Table 2 shows that adolescents who considered their body image unimportant, or reported feeling indifferent or dissatisfied with their body, had higher prevalence of victimization. Those who considered themselves “too fat” also showed higher rates among victims and victims/perpetrators. Among perpetrators, the distribution remained more stable across categories.

Table 2
Characterization of aspects related to body image, family context and verbal bullying categories - PeNSE 2015, Northern Brazil, 2015.

Variables	Verbal bullying categories
	Neither victim nor perpetrator		Victim		Perpetrator		Victim/perpetrator		p- value*
	n	%	n	%	n	%	n	%
Body perception									<0.001
Skinny/very skinny	4,535	75.3	311	4.7	1,066	17.6	166	2.4
Normal weight	10,869	80.5	479	3.2	2,198	14.8	236	1.5
Fat	2,393	73.1	215	6.7	599	17.6	100	2.6
Very fat	250	61.7	74	16.4	76	15.1	25	6.8
Body image evaluation									<0.001
Important	15,324	78.9	822	3.8	3,278	15.6	400	1.8
Somewhat important	1,977	73.1	147	6.5	463	17.8	82	2.7
Not important	739	69.4	113	8.8	200	18.4	46	3.4
Body satisfaction									<0.001
Satisfied	13,891	80.3	601	3.1	2,837	15.1	324	1.6
Indifferent	1,618	68.8	166	8.2	432	20.0	77	3.0
Dissatisfied	2,516	71.0	313	8.1	669	17.8	127	3.1
School attendance									<0.001
3 or more times	971	62.5	74	6.3	402	26.0	81	5.2
1 or 2 times	2,527	72.7	165	4.2	744	20.5	112	2.6
Never	14,676	80.0	846	4.1	2,820	14.3	343	1.6
Parental supervision
Free time supervision									<0.001
Yes	11,591	81.6	655	43.3	1,924	12.5	249	1.7
No	6,550	72.1	427	4.3	2,038	21.2	286	2.3
Homework supervision									<0.001
Yes	6,298	81.2	389	4.9	976	12.3	137	1.7
No	11,856	76.2	696	4.0	2,981	17.8	395	2.1
Family support
Understands adolescent's issues									<0.001
Yes	7,910	81.8	380	3.7	1,299	13.0	163	1.6
No	10,236	75.1	702	4.7	2,659	18.0	373	2.2
Parental intrusion
Parents interfere with belongings									<0.001
Yes	1,863	69.9	225	10.6	586	17.9	123	3.4
No	16,286	79.8	859	3.0	3,374	15.6	413	1.7
Sexual violence history									<0.001
Yes	723	61.1	104	7.4	343	24.6	93	6.9
No	17,379	78.8	978	4.1	3,605	15.4	438	1.7

• * Pearson chi-square test.
• Source: Authors.

Regarding family context, 21.4% of adolescents reported skipping school without their parents’ knowledge, and only 32.9% reported parental supervision of homework. In contrast, 60.7% had supervision during free time. While 41.1% felt understood by their families, 11.8% reported that their parents intruded on their personal belongings.

Victims of bullying were the ones who most reported experiencing parental intrusion and sexual violence. Among perpetrators and victim/perpetrators, the prevalence of sexual violence was also notably high. Adolescents who missed school three or more times per week showed higher prevalence of bullying behavior compared to those who never missed school (26.0% vs. 14.3% among perpetrators; 5.2% vs. 1.6% among victims/perpetrators).

Among the 12 variables analyzed, only “having family members who understand their problems” acted as a protective factor for all bullying categories. Other variables, such as skipping school, parental intrusion, and negative body feelings, were consistently associated with all categories (Table 3).

Table 3
Association between mental health, body image and family context among adolescents in the North of Brazil according to the categories of bullying, 2015.

Study variables	Verbal bullying categories
	Victim		Perpetrator		Victim/perpetrator
	OR	95%CI	OR	95%CI	OR	95%CI
Loneliness
Yes	1.00	-	1.00	-	1.00	-
No	4.37	(3.30-5.80)	1.44	(1.17-1.77)	2.72	(1.92-3.85)
Insomnia
Yes	1.00	-	1.00	-	1.00	-
No	4.03	(3. 00-5.45)	1.70	(1.43-2.03)	2.81	(1.96-4.03)
Friendship	1.00	-	1.00	-	1.00	-
Yes
No	0.63	(0.42-0.94)	0.89	(0.66-1.19)	0.75	(0.36-1.53)
Body perception
Normal weight	1.00	-	1.00	-	1.00	-
Skinny/ very skinny	1.55	(1.20-2.02)	1.21	(1.01-1.46)	1.94	(1.27-2.95)
Fat	2.17	(1.60 - 2.97)	1.29	(1.04-161)	2.03	(1.37-3.02)
Very fat	6.08	(3.79-9.77)	1.21	(0.79-1.87)	6.26	(3.05-12.85)
Body image evaluation
Important	1.00	-	1.00	-	1.00	-
Somewhat important	1.79	(1.31-2.45)	1.17	(0.96-1.43)	1.36	(0.88-2.11)
Not important	2.87	(2.00-4.11)	1.08	(0.81-1.44)	2.58	(1.49-4.49)
Body satisfaction
Satisfied	1.00	-	1.00	-	1.00	-
Indifferent	3.29	(2.46-4.40)	1.66	(1.34-2.05)	1.63	(1.09-246)
Dissatisfied	2.83	(2.22-3.60)	1.55	(1.32-1.81)	2.28	(1.56-3.32)
School attendance
No	1.00	-	1.00	-	1.00	-
Yes	1.42	(1.13-1.78)	1.42	(1.30-1.81)	2.08	(1.62-267)
Parental supervision
Homework supervision
Yes	1.00	-	1.00	-	1.00	-
No	1.24	(1.00-1.53)	0.62	(0.53-0.72)	0.78	(0.54-1.14)
Free time supervision
Yes	1.00	-	1.00	-	1.00	-
No	0,82	(0.66-1.03)	0.52	(0.46-0.60)	0.72	(0.52-1.00)
Family support
Understands adolescent's issues
Yes	1.00	-	1.00	-	1.00	-
No	0.67	(0.53-0.83)	0.60	(0.51-0.70)	0.62	(0.44-0.87)
Parental intrusion
Parents interfere with belongings
Yes	1.00	-	1.00	-	1.00	-
No	0.82	(0.66-1.03)	0.52	(0.46-0.60)	0.72	(0.52-1.00)
Sexual violence history
Yes	1.00	-	1.00	-	1.00	-
No	2.22	(1.43-3.42)	2.34	(1.79-3.06)	6.18	(3.66-10.44)

• Adjusted for sociodemographic variables (gender, age, color skin/ race and type of school).
• Source: Authors.

Feeling alone was strongly associated with victimization (OR: 4.37; IC95%: 3.30-5.80) and both roles (OR: 2.72; IC95%: 1.92-3.85), compared to perpetration (OR: 1.44; IC95%: 1.17-1.77). Insomnia showed a similar pattern, with stronger associations for victims (OR: 4.03; IC95%: 3.00-5.45) and victims/perpetrators (OR: 2.81; IC95%: 1.96-4.03) than for perpetrators (OR: 1.70; IC95%: 1.43-2.03). Having friends was inversely associated only with victimization.

Regarding body perception, categories such as “very skinny” and “fat” were associated with all bullying groups, while “very fat” was not linked to perpetration but showed strong associations with victimization (OR: 6.08; IC95%: 3.79-9.77) and victim/perpetration (OR: 6.26; IC95%: 3.05-12.85).

Considering body image as “unimportant” was associated with victimization (OR: 2.87; IC95%: 2.00-4.11) and both roles (OR: 2.58; IC95%: 1.49-4.49), but not with perpetration.

Parental supervision of homework appeared as a protective factor among perpetrators and was positively associated with victimization. Supervision during free time was associated only with perpetration. Experiencing sexual violence was most strongly associated with the victim/perpetrator group (OR: 6.18; IC95%: 3.66-10.44), compared to victimization (OR: 2.22; IC95%: 1.43-3.42) and perpetration (OR: 2.34; IC95%: 1.79-3.06).

Discussion

This study revealed that among adolescent students from the Brazilian Amazon, verbal bullying is a relevant issue, with higher prevalence of perpetration among male adolescents. Additionally, factors related to mental health (such as loneliness and insomnia), body image dissatisfaction, family context (lack of understanding, weak supervision, and intrusion), and experiences of sexual violence were significantly associated with bullying - either as victim, perpetrator, or both.

Consistent with prior literature, male adolescents showed greater prevalence of bullying perpetration^24-27. Boys often display more physically aggressive or explosive behaviors, which may account for the gender difference. Among mental health indicators, feeling alone and having insomnia were strongly associated with victimization, while having friends was protective against being a victim of bullying^28-31. These results reinforce the psychosocial vulnerabilities experienced by bullied adolescents, often leading to emotional suffering, impaired learning, and potential long-term consequences like antisocial behavior^29,30.

Other studies corroborate the association between bullying and sleep disorders, depressive symptoms, and suicidal ideation^16,32-36. Regarding body image, self-perception of being “very fat” was strongly associated with victimization and dual-role bullying. Dissatisfaction and perceived deviance from body ideals - often influenced by media - contribute to stigma and social exclusion among adolescents^37-40.

School absenteeism without parental awareness has also been linked to bullying, particularly among those are victims or occupy dual roles as both perpetrators and targets^41-45. For perpetrators, school absence may reflect engagement in risky behaviors such as alcohol use^24,46-49. While this variable was statistically significant, its directionality remains uncertain.

Parental supervision has demonstrated a protective effect, especially concerning bullying perpetration. Adolescents who received support, guidance, and feel understood by family members are less likely do engage in bullying behaviors^16,24,50-52. Conversely, limited parental involvement and family instability are recognized as significant risk factors for bullying^32,53,54.

Experiencing sexual violence was most strongly associated with dual-role adolescents. Literature supports the link between early sexual trauma and involvement in bullying - both as victim and perpetrator^32,47,55-63. The findings reinforce the notion that adolescents who experience sexual violence may internalize or reproduce this trauma through bullying, sometimes fueled by substance use or emotional distress^64,65.

This study has limitations, such as the reliance on self-reported data, which may be subject to recall bias or social desirability. Additionally, skin color/race was self-declared, a variable influenced by sociocultural context and perception, which may affect classification and interpretation of findings. Also, the cross-sectional nature of the study precludes causal inference between associated variables.

On the other hand, the study’s strengths include the use of a large, representative sample of adolescents from the Amazon region, and the analysis of a wide range of variables - sociodemographic, mental health, body image, and family context. Moreover, distinguishing between victims, perpetrators, and dual-role adolescents enabled a more nuanced understanding of the complexity of bullying.

Limitations

This study has limitations inherent to its cross-sectional design, which precludes the establishment of causal relationships between the variables analyzed. Although associations were observed, it is not possible to determine the temporality or direction of the effects. Additionally, because the data were collected through self-administered questionnaires, there may have been memory bias or social desirability bias, especially in sensitive topics such as violence and family context.

Another important limitation concerns the use of self-reported skin color/race, which is a subjective and context-dependent classification. In Brazil, the perception and declaration of race or skin color can be influenced by regional, socioeconomic, and cultural factors, potentially introducing classification bias and affecting the interpretation of differences among population subgroups.

Conclusion

The school context of adolescents in the Brazilian Amazon continues to be a space for the reproduction of violence and that the school is not solely responsible for the production of violence, because it is a complex, dynamic, multifaceted and multicausal phenomenon, with roots also in macrosocial, economic and sociocultural issues.

Implications for school health

The indicators of violence evidenced in this study can guide and sustain the need for intervention projects and public policies at school, with a view to strengthening respect for differences. It is estimated that violence is one of the leading causes of death of adolescents worldwide, and this is one of the factors that sustains it as a public health problem.

In Brazil, violence and its effects have not been seen as effective public policies in the school field. In the last ten years, school education has been an arena between more conservative versus progressive institutions, and in the last five years, there has been policies with more contentious perspectives. These disputes and perspectives make education that promotes citizenship, inclusion and prevention of violence impossible.

In the Brazilian Amazon, cultural aspects intertwined with native and colonialist practices may favor even more disputes between victims and perpetrators. Adolescence is a stage of the life cycle in which the experiences of violence are present, social relations extend beyond the family axis and training begins for the autonomy of their choices. In the face of these aspects, several contributions are proposed:

• Initial and continued training of teachers about adolescence as a life project, and not as a problematic stage. This formation can be conducted under the socioconstructivist perspective of human development, which considers the social and cultural dimensions of adolescents, in addition to a reductionist, biological and psychological view.

• Projects involving the school community and the integration of sectors of society: family, school, health network and social assistance. Improve the monitoring mechanisms of adolescents, expanding alternatives for the construction of a new life project based on values such as citizenship, ethics, respect for differences and solidarity.

• Activities at school, such as cultural events, conversation wheels and contextualized articulation of the contents of the disciplines, such as mobilizers of dialogues and protagonism, which aim to mobilize adolescents to build exits from the reality of violence in which they are involved. With this, the school can become more attractive, and establish itself as a potential space for welcoming and promoting the mental health of adolescents.

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Data availability statement

The data sources adopted in the research are indicated in the article’s body.

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva, Vania de Matos Fonseca

Publication Dates

• Publication in this collection
  09 Oct 2026
• Date of issue
  2026

History

• Received
  18 Oct 2024
• Accepted
  21 June 2025
• Published
  23 June 2025