The research was conducted by Jingqi Guan, Yik Wa Law and Tingyu Luo of the Department of Social Work and Social Administration at the University of Hong Kong. Drawing on a larger sample of 1,515 primary school students, the team identified 241 children as bully-victims and randomly selected an additional 241 pure victims for comparison, creating two groups matched in size. All participants reported repeated bullying-related peer victimization, meaning they had been on the receiving end of aggressive peer behavior more than once — the defining feature of bullying as understood in the classic Olweus framework of repeated aggression involving an imbalance of power.

Rather than asking whether one group is simply “more depressed” or “more anxious” than the other, the researchers adopted a network analysis approach, a method that has gained traction in psychology over the past decade. In the network perspective, mental disorders are not assumed to reflect a single latent disease entity. Instead, symptoms are treated as components that interact with and reinforce one another, forming a network of causal relationships. A symptom such as unhappiness may feed into sleeplessness, which in turn makes it harder to cope with daily activities, and so on. Within such networks, some symptoms occupy more “central” positions than others, meaning they are more strongly connected to the rest of the network and may act as triggers that activate other symptoms. Identifying these central symptoms has become an important goal in clinical research, because highly central symptoms are considered promising targets for intervention: disrupt a central node, the logic goes, and the whole network may be less likely to activate.

To build the symptom networks, the researchers used items from the 12-item General Health Questionnaire, a widely used screening instrument for mental distress that has been validated in Chinese-speaking adolescent populations. Items included experiences such as not enjoying day-to-day activities, feeling unhappy and depressed, feeling constantly under stress, losing confidence in oneself, being unable to overcome difficulties, and losing sleep over worry. Network estimation techniques, including regularized partial correlation methods such as the graphical lasso, were used to derive the connections between symptoms while guarding against spurious associations. The team then compared the resulting network structures between pure victims and bully-victims using statistical procedures designed to test whether the global strength of the networks, and the specific connections within them, differed between groups.

The results were striking in their similarities and suggestive in their differences. Both groups shared the same core symptoms: not enjoying day-to-day activities, feeling unhappy and depressed, and feeling unable to overcome difficulties sat at the center of the distress networks in both cases. Overall, the architecture of the two networks was broadly similar, suggesting that the fundamental structure of psychological distress among repeatedly victimized children does not depend dramatically on whether the child also bullies others. This finding challenges the simple assumption that bully-victims — often described in the literature as the most troubled group, at elevated risk for everything from depression to nonsuicidal self-injury — experience an entirely different kind of psychological pain from pure victims.

Yet the differences, though descriptive rather than definitive, were far from trivial. The item “constantly under stress” appeared to be more central in the networks of pure victims, painting a picture of children who are chronically pressed by their circumstances — perhaps because, without any aggressive counter-response, they endure victimization in a more sustained and one-sided way. By contrast, “losing confidence in oneself” showed higher centrality among bully-victims. This is consistent with a long line of research suggesting that low or unstable self-esteem plays a key role in the making of a bully-victim. The compensation model of aggression holds that some children who are bullied strike back as a way of defending a fragile sense of self-worth, and longitudinal studies have linked low self-esteem both to becoming a perpetrator after victimization and to the persistence of the bully-victim role over time. In a network framework, the centrality of lost confidence in this group suggests that damaged self-esteem may be a hinge around which other distress symptoms organize.

The second half of the study examined how coping strategies were woven into these distress networks, and this is where the picture became more complicated. Coping research, rooted in the classic stress-and-coping theory of Lazarus and Folkman, distinguishes broadly between approach coping — strategies that directly engage the stressor or its emotional consequences, such as seeking social support, solving the problem, or expressing feelings — and avoidance coping, which involves distancing oneself from the problem, denying it, or wishing it away. In the combined coping-and-distress networks, approach coping items were negatively associated with distress symptoms in both groups. In other words, children who leaned on approach strategies tended to show weaker connections to the core of the distress network, hinting that these strategies may act as protective buffers regardless of whether a child is a pure victim or a bully-victim.

Avoidance coping told a different and more troubling story. Among pure victims, avoidance items showed few links with distress at all — the networks were largely silent on the matter. Among bully-victims, however, avoidance coping items showed more heterogeneous connections, some of which were partly adverse. This heterogeneity matters because it suggests that avoidance is not a uniform category with uniform effects. “Doing nothing” in the face of peer victimization has been found in earlier work to be associated with worse depression and even suicidal ideation, yet avoidance can also serve short-term emotional regulation functions in some contexts. The Hong Kong findings add a new layer to this debate by suggesting that the same coping strategy may function differently depending on the child’s position in the bullying dynamic. For bully-victims — children already navigating both victimization and their own aggression — certain forms of avoidance may intertwine with distress in ways that approach coping does not.

The authors are careful to frame their conclusions as preliminary and evidence-informed rather than definitive. Network analysis of cross-sectional data cannot establish causal direction, and centrality measures are known to be influenced by the specific items included and the structure of the instrument used. The random matching of pure victims to bully-victims strengthens the comparison, but the study cannot capture how these networks evolve over time, which is a critical question given that longitudinal research has shown bullying roles can be surprisingly stable and that early aggressive-victim status predicts later mental health problems and functional impairment. Still, the study is notable for focusing on primary school students — a younger population than most bullying research, which tends to concentrate on adolescents — and for doing so in a Chinese cultural context, where whole-day schooling means children spend extended hours in the same peer environment and bullying dynamics may unfold differently than in Western settings.

The practical implications are nonetheless concrete. If approach coping is consistently negatively linked to distress across both roles, then interventions that strengthen problem-solving, help-seeking and emotional expression — hallmarks of social and emotional learning programs, which meta-analyses have shown to produce meaningful improvements in wellbeing — may benefit bullied children broadly. At the same time, the findings caution against one-size-fits-all coping guidance. The observation that avoidance coping behaves differently in bully-victims suggests that school counselors and mental health professionals should assess and coach coping strategies in a role-sensitive, strategy-specific way, rather than simply telling children to “not avoid” the problem. Targeting shared core symptoms — anhedonia in daily activities, depressed mood, and the feeling of being unable to overcome difficulties — could offer another entry point for support, since these symptoms anchor the distress networks in both groups.

In a broader sense, the study contributes to a growing movement in psychology that treats mental distress as a dynamic system rather than a checklist of disorders, and it applies that lens to a population and a problem — young bullied children in East Asia — where such fine-grained analysis has been rare. As schools worldwide grapple with how to support the most entangled participants in bullying, the message from Hong Kong is that victims and bully-victims may suffer in recognizably similar ways, but they may need to be helped in recognizably different ones.