Jorge Srabstein, M.D., medical director of the Clinic for Health Problems Related to Bullying at Children's National Medical Center in Washington, D.C., along with his co-author studied data from a 1996 survey of 9,574 students in grades 6 through 10.
The students not only took into account their involvement in bullying in the last year, but also identified whether they had participated in a variety of risky behaviors.
"We see that the [obvious] victims are not the only victims. The bullies are also victims of their own emotional problems," said Srabstein.
They found that more than one-third (39 percent) of students reported some involvement in bullying within the preceding 12 months, either as bullies, victims or both.
"Both the bullies and the victims have a very significant, high probability of suffering from injuries - self-inflicted, accidental and injuries that are perpetrated by others - as compared to those who are not involved in bullying incidents. Because of this, they are at a considerable danger of dying from suicide, homicide and accidents," said Srabstein.
In this study, victims proved more likely to inflict self-injury or experience accidental injuries, abuse over-the-counter medications, hurt animals and people on purpose, use weapons and be absent from school, compared to uninvolved students.
But, it also came out that bullies and bully/victims - students who have both bullied and been bullied - experienced an even greater risk of these problems than victims. Bullies and bully/victims were more likely - with up to a 14-fold increased risk - to abuse alcohol, drugs and tobacco; experience injuries requiring hospitalization; set fires; carry weapons to school; skip classes; and receive poor grades, compared to victims alone.
"Bullying occurs among children in every part of the world where it has been studied. The amount of bullying has not changed in recent years. Instead, more people identify bullying as a problem among children, look for bullying and look for ways to prevent it," said Rachel Vreeman, M.D., a fellow in children's health services research at Indiana University School of Medicine.
"While being involved in bullying is associated or tied with some scary things like hurting others, using weapons and abusing medicines, this does not mean that one causes the other. They go together in these groups of kids, but this type of study cannot tell us that being bullied or being a bully means that you will do these types of things," she said.
Srabstein said that finally the research would declare bullying as a public health issue for both educators and health care practitioners.
Both "bullies and victims need to be referred for health care if their participation is accompanied by problems like this," he said.
The study is published in the International Journal of Adolescent Medicine and Health.