Associations between school bullying and anxiety in children and adolescents from an ethnic autonomous county in China

School bullying is a widespread public health issue that negatively impacts the mental health of children and adolescents. This study aimed to investigate associations between school bullying involvement and anxiety of children and adolescents. A survey covering all types of pre-college schools (primary, middle, high, and vocational school) was conducted in an ethnic autonomous county in China. 1,943 students participated in this study. Being a victim of verbal (OR=3.08, 95%CI = [2.43,3.91]), physical (OR=3.24, 95%CI = [2.46,4.27]), relational (OR=3.72, 95%CI = [2.90,4.76]), or cyberbullying (OR=3.47, 95%CI = [2.61,4.61]) were associated with increased symptoms of generalized anxiety. Similarly, being a perpetrator of verbal (OR=2.12, 95%CI = [1.45,3.10]), physical (OR=1.85, 95%CI = [1.22,2.79]), relational (OR=1.78, 95%CI = [1.15,2.74]), or cyber-bullying (OR=1.59, 95%CI = [1.08,2.33]) were related to a higher degree of anxiety. Moreover, in both victims and perpetrators higher levels of anxiety were associated with a greater number of types of bullying they were involved in, suggesting a dose-response relation between school bullying involvement and anxiety. Therefore, both bullying victims and perpetrators need mental health support and anti-bullying strategies should address different forms of bullying evenhandedly.