Addressing Depression, Anxiety, and Stress Among Bullied Victim: A Quasi-Experimental Time-Series Study
Abstract
Bullying has been a persistent threat to mental health among university students in Malaysian higher learning institutions, defiling the university as an effective learning institution. This study examined how effective the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was in reducing symptoms of depression, anxiety, and stress among bullied university students. In a quasi-experimental time-series design, 32 students aged 23–30 were purposively recruited from three universities in Kedah based on DASS-42 scores of moderate to severe psychological distress. The participants had nine TF-CBT group sessions over four months. Depression, anxiety, and stress were assessed at four time points using the validated Malay version of DASS-42. Repeated measures ANOVA showed significant differences on all measures, with depression scores decreasing from M=17.34 (pre-test) to M=3.69 (post-test), anxiety from M=12.44 to M=2.88, and stress from M=22.28 to M=4.91. Significant pairwise differences at each level were reported using Bonferroni post-hoc analysis (p < .001). The intervention had a large effect size (η² = .996), attesting to the efficacy of TF-CBT in preventing psychological harm caused by bullying. Findings highlight the importance of institutional mental health treatment, timely intervention, and trauma-informed care on campus. Larger, diverse samples and longitudinal designs are necessary for future research to enhance generalizability and assess long-term outcomes.
Downloads
References
Abdul Malek Abdul Rahman. (2004). Kesan kaunseling kelompok tingkah laku kognitif dalam merawat tingkah laku langsang buli dalam kalangan pelajar sekolah menengah (Tesiss Ph.D, Universiti Kebangsaan Malaysia, Bangi).
Bai, H., Sun, J., & Xu, W. (2023). The mental health consequences of bullying among college students: Depression and academic performance. Journal of Adolescent Health, 72(2), 239–246. https://doi.org/10.1016/j.jadohealth.2022.09.021
Cohen, J. A., & Mannarino, A. P. (2008). Trauma‐focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158-162.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents (1st ed.). New York, NY: The Guilfrod Press.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
Dake, J. A., Price, J. H., & Telljohann, S. K. (2020). Bullying and suicide: A review of the literature. Journal of School Health, 90(1), 27–35.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11
Field, A.P. (2018) Discovering Statistics Using IBM SPSS Statistics. 5th Edition, Sage, Newbury Park.
Huang, H., Ding, Y., Wan, X., Liang, Y., Zhang, Y., Lu, G., & Chen, C. (2022). A meta-analysis of the relationship between bullying and non-suicidal self-injury among children and adolescents. Scientific Reports, 12, 17285. https://doi.org/10.1038/s41598-022-22122-2
Humphrey, N., & Bliuc, A.-M. (2022). Self-stigma and psychological help-seeking attitudes among international university students in Malaysia. International Journal of Academic Research in Business and Social Sciences, 12(4), 861–880. https://doi.org/10.6007/IJARBSS/v12-i4/12345
Ishak, N. H. (2022). Kesan kaunseling kelompok terapi kognitif tingkah laku berfokuskan trauma terhadap kemurungan, kebimbangan dan stres dalam kalangan murid mangsa buli. Universiti Pendidikan Sultan Idris.
Ishak, N. H., Mubarak Ali, N., & Ishak, N. A. (2025). Pendekatan Trauma-Focused CBT (TF-CBT) terhadap kemurungan mangsa buli: Satu kajian kes. Malaysian Journal of Social Sciences and Humanities (MJSSH), 10(7), e003470. https://doi.org/10.47405/mjssh.v10i7.3470
Israel, G. D. (1992). Determining sample size (Fact Sheet PEOD-6). Gainesville, FL: University of Florida, Institute of Food and Agricultural Sciences, Extension Service.
Kennedy, R. S. (2020). A meta-analysis of the outcomes of bullying prevention programs on subtypes of traditional bullying victimization: Verbal, relational, and physical. Aggression and Violent Behavior, 55(May), 101485. https://doi.org/10.1016/j.avb.2020.101485
Kline, R. B. (1998). Principles and practice of structural equation modeling. Guilford Press.
Lambe, L. J., Cioppa, V. D., Hong, I. K., & Craig, W. M. (2019). Standing up to bullying: A social ecological review of peer defending in offline and online contexts. Aggression and Violent Behavior, 45, 51–74. https://doi.org/10.1016/j.avb.2018.05.007.
Liu, Y., Wu, S., & Li, X. (2021). The relationship between bullying victimization and stress in university students: A longitudinal study. Journal of Behavioral Health, 50(4), 420–429.
Lim, W. Y., Hisham, I. N., & Tan, S. Y. (2023). Cyberbullying, social media addiction, and associations with depression, anxiety, and stress among medical students in Malaysia. International Journal of Environmental Research and Public Health, 20(3), 2278. https://doi.org/10.3390/ijerph20032278
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation.
Marshall, C., & Rossman, G. B. (2016). Designing qualitative research (6th ed.). SAGE Publications
Malecki, C. K., Demaray, M. K., Coyle, S., Geosling, R., Rueger, S. Y., & Becker, M. (2015). Frequency, power differential, and intentionality and their association with feelings of sadness and safety in bullied children. Children and Youth Services Review, 58, 1–9. https://doi.org/10.1016/j.childyouth.2015.08.003
Martin, B. D. (2018). The effect of bullying prevention curriculum on prosocial behaviors, empathy, and cyberbullying. Humanities and social sciences, 79(11-A(E)). Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference& D=psyc15&NEWS=N&AN=2018-40525-244
Ministry of Higher Education Malaysia. (2023). Statistik pendidikan tinggi 2023 [Laporan tahunan]. Putrajaya, Malaysia: Kementerian Pendidikan Tinggi Malaysia.
Mokhtar, D., Halim, M. F. A., & Nor, N. I. Z. (2021). The Influence of Job Demands on Workplace Bullying Experience among Healthcare Employees. International Journal of Academic Research in Accounting, Finance and Management Sciences, 11(3), 223–234.
Musa, R., Fadzil, M. A., & Zain, Z. (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry, 8(2), 82-89.
Musu-Gillette, L., Zhang, A., Wang, K., Zhang, J., and Oudekerk, B.A. (2017). Indicators of school crime and safety: 2016 (NCES 2017-064/NCJ 250650). National Center for Education Statistics, U.S. Department of Education, and Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice. Washington, DC. https://nces.ed.gov/pubs2017/2017064.pdf.
Nelson, H. J., Burns, S. K., Kendall, G. E., & Schonert-Reichl, K. A. (2019). Preadolescent children’s perception of power imbalance in bullying: A thematic analysis. PLoS ONE, 14(3), 1–15. https://doi.org/10.1371/journal.pone.0211124
Nielsen, M. B., Tangen, T., Idsoe, T., Matthiesen, S. B., & Magerøy, N. (2015). Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and meta-analysis. Aggression and Violent Behavior, 21, 17–24. http://doi.org/10.1016/j.avb.2015.01.001.
Olweus, D. (2013). School bullying: Development and some important challenges. Annual Review of Clinical Psychology, 9, 751-780. https://www.annualreviews.org/ doi/10.1146/annurev-clinpsy-050212-185516
Olweus, D. (1994). Bullying at school: Long-term outcomes for the victims and an effective school-based intervention program. DalamHuesmann, L.R. (Ed.). Plenum series in social/clinical psychology. Aggressive behavior: Current perspectives. New York: Plenum Press. 97-130. http://dx.doi.org/10.1007/978-14757- 9116-7_5
Rajput, R., Sharma, A., & Singh, S. (2024). Mental health impacts of bullying among students in higher education: A comprehensive review. Psychology, Health & Medicine, 29(1), 12–21. https://doi.org/10.1080/13548506.2024.1840287
Rigby, K. (2010). Bullying interventions in schools: Six basic approaches. Aust Council for Ed Research.
Samsiah Mohd Jais, Mohammad Nasir Bistamam & Muhammad Bazlan Mustafa (2017). Pembinaan dan pengesahan itf-cbt (internet trauma focused – cognitive behavior therapy) sebagai inovasi pencegahan dan rawatan trauma serta gangguan mental geran penyelidikan universiti (GPU khas). Universiti Pendidikan Sultan Idris, Tg. Malim Perak.
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Houghton Mifflin.
Slee, P. T., Ma, L., & Taki, M. (2003). Bullying in schools. InJ. P. Keeves, &R. Watanabe (Eds.), International handbook of educational research in the Asia-Pacific region, 425-439. Dordrecht: Kluwer Academic Publisher. https://www.researchgate.net/publication/307974388_School_Bullying
Undheim, A. M., Wallander, J., & Sund, A. M. (2016). Coping Strategies and Associations With Depression Among 12- to 15-Year-Old Norwegian Adolescents Involved in Bullying. The Journal of Nervous and Mental Disease, 204(4), 274–279. https://doi.org/10.1097/NMD.0000000000000474
UNICEF Malaysia. (2018, June 21). Standing together to curb bullying. UNICEF Malaysia. https://www.unicef.org/malaysia/stories/standing-together-curb-bullying
Vidourek, R. A., King, K. A., Merianos, A. L., Vidourek, R. A., King, K. A., & Merianos, A. L. (2016). School bullying and student trauma: Fear and avoidance associated with victimization. Journal of Prevention & Intervention in the Community, 44(2) https://doi.org/10.1080/10852352.2016.1132869
Walters, G. D., & Espelage, D. L. (2018). From victim to victimizer: Hostility, anger, and depression as mediators of the bullying victimization–bullying perpetration association. Journal of School Psychology, 68(December 2017), 73–83. https://doi.org/10.1016/j.jsp.2017.12.003
Wan Hassan Wan Embong, Zulaihi Yaacob, Zetty Heriza Rohani, Mardhiyana Abidin, & Farisah Ibrahim. (2015). Kajian tinjauan: Buli Siber di Kalangan Mahasiswa Universiti Teknologi Malaysia. Universiti Teknologi Malaysia Institutional Repositor
Woods, S. et al. (2021). The impact of bullying on the mental health of university students: A systematic review. Journal of Health Psychology, 26(1), 98–111.
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Zhang, L., Zhang, Y., & Zhao, W. (2022). The role of social support in alleviating anxiety and depression among bullying victims in college. Journal of Mental Health Counseling, 44(1), 55–68. https://doi.org/10.17744/jmhc.2022.44.1.55
Zhou, Y., Guo, L., & Wang, X. (2023). The impact of cyberbullying on mental health: A comparison with traditional bullying. Frontiers in Public Health, 11, 1100069. https://doi.org/10.3389/fpubh.2023.1100069.















