Abstract
BACKGROUND: Bullying is a rising social concern and public health challenge, threatening the mental health of the youth. Existing evidence lacks comprehensive insight into the gender disparities in such association. This cross-sectional study aimed to elucidate the gender differences in the association between bullying victimization and depressive symptoms among children and adolescents. METHODS: A total of 21,654 fourth-grade and above students were recruited from the annual school-based survey "China Common Disease and Risk Factor Surveillance among Students" in Zhejiang Province, China, conducted in 2021. Six forms of bullying victimization were assessed with a self-administered questionnaire and further categorized into three subtypes, including physical, verbal, and relational bullying victimization. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. A multilevel generalized linear model was employed to analyze the gender-specific association of bullying victimization (in specific forms, subtypes, and cumulative measures) with depressive symptoms. Gender differences were tested by the girls-to-boys ratios of odds ratios (RORs) and the 95% confidential intervals (CIs). RESULTS: The median age of recruited children and adolescents was 15.07 years. All specific forms of bullying victimization were significantly associated with increased odds of depressive symptoms. Girls who were mocked or teased (ROR = 1.27, 95% CI = 1.05-1.56), body-shamed (ROR = 1.39, 95% CI = 1.05-1.85) and experienced the subtype of verbal bullying (ROR = 1.22, 95% CI = 1.01-1.46) exhibited greater depressive symptoms than boys. Concerning cumulative effects, girls who experienced two or more forms of bullying victimization (ROR = 1.42, 95% CI = 1.09-1.84), all three subtypes of bullying victimization (ROR = 1.89, 95% CI = 1.10-3.24) had more prominently increased odds of depressive symptoms than boys. CONCLUSIONS: Bullied girls exhibited a higher susceptibility to depressive symptoms than boys with the same experience, especially when exposed to multiple bullying incidents. These findings underscore the need for developing gender-specific strategies to protect children from bullying, with an emphasis on safeguarding girls.