The Relationship between Shame and Mental Health Problems in Nursing Students Experiencing Bullying at a University in Central Java
DOI:
https://doi.org/10.31674/mjn.2025.v17i01.021Abstract
Background: Bullying is a major factor contributing to mental health problems in Indonesia, including depression, anxiety, and stress. Preliminary research found a high rate of bullying among nursing students at a university in Central Java, with verbal bullying being the most common (33.33%). This study explored the relationship between shame and mental health problems in nursing students who have experienced bullying at a university in Central Java. Methods: The research employed a cross-sectional design, targeting a population of 607 students, with a total sample of 265 participants selected through random sampling. The data collection utilised two main instruments: the External and Internal Shame Scale (EISS), which included four valid items measuring internal shame (α=0.850), and the Depression Anxiety Stress Scale (DASS-21), comprising 21 valid items to assess mental health problems (α=0.85, 0.84, 0.84). Pearson’s Product Moment correlation test was applied for data analysis. Results: Results showed a significant correlation between shame and mental health problems (P=0.000, r=0.733), with stress being the most common mental health issue. Conclusion: The study revealed that nursing students who experienced bullying reported high levels of shame, with stress identified as the most prevalent mental health issue. A significant relationship was found between shame and mental health problems, underscoring the urgent need for targeted interventions.
Keywords:
Bullying, Mental Health Problems, Nursing Student, ShameDownloads
References
Ambarwati, P. D., Pinilih, S. S., & Astuti, R. T. (2019). Gambaran tingkat stres mahasiswa [Overview of student stress levels]. Jurnal Keperawatan Jiwa, 5(1), 40-47. Retrieved from: https://jurnal.unimus.ac.id/index.php/JKJ/article/view/4466/4081. Accessed on 18th January 2023.
Arjanto, P. (2022). Uji Reliabilitas dan Validitas Depression Anxiety Stress Scales 21 (DASS-21) pada Mahasiswa [Reliability and validity test of depression anxiety stress scales 21 (DASS-21) in college students]. Journal of Perceptual Psychology, 7(1). https://doi.org/10.24176/perseptual.v7i1.6196
Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., Kessler, R. C., & WHO WMH-ICS Collaborators. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362
Badillo-Sánchez, N., Gómez-Salgado, J., Allande-Cussó, R., Yildirim, M., López-López, D., Goniewicz, K., Prieto-Callejero, B., & Fagundo-Rivera, J. (2025). Impact of the COVID-19 pandemic on the mental health of nursing students: A systematic review and meta-analysis. Medicine, 104(2). https://doi.org/10.1097/MD.0000000000040797
Barta, T., & Kiropoulos, L. (2022). The mediating role of stigma, internalized shame, and autonomous motivation in the relationship between depression, anxiety, and psychological help-seeking attitudes in multiple sclerosis. International Journal of Behavioral Medicine, 30(1), 133–145. https://doi.org/10.1007/s12529-022-10078-6
Cao, H., Wang, S., Zhou, N., & Liang, Y. (2025). From childhood real-life peer victimization to subsequent cyberbullying victimization during adolescence: A process model involving social anxiety symptoms, problematic smartphone use, and internet gaming disorder. Psychology of Violence, 15(1), 106–120. https://doi.org/10.1037/vio0000548
Dolezal, L. (2022). Shame anxiety, stigma and clinical encounters. Journal of Evaluation in Clinical Practice, 28(5), 854–860. https://doi.org/10.1111/jep.13744
Farr, J., Ononaiye, M., & Irons, C. (2021). Early shaming experiences and psychological distress: The role of experiential avoidance and self‐compassion. Psychology and Psychotherapy Theory Research and Practice, 94(4), 952–972. https://doi.org/10.1111/papt.12353
Feng, Y., Zhang, S., Liao, X., Jia, Y., Yang, Y., & Zhang, W. (2024). Association between bullying victimization and mental health problems among Chinese left-behind children: A cross-sectional study from the adolescence mental health promotion cohort. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1440821
Ferreira, C., Moura-Ramos, M., Matos, M., & Galhardo, A. (2022). A new measure to assess external and internal shame: development, factor structure and psychometric properties of the External and Internal Shame Scale. Current Psychology, 41(4), 1892–1901. https://doi.org/10.1007/s12144-020-00709-0
Foster, K., Withers, E., Blanco, T., Lupson, C., Steele, M., Giandinoto, J.-A., & Furness, T. (2019). Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study. International Journal of Mental Health Nursing, 28(5), 1068–1080. https://doi.org/10.1111/inm.12634
Gallagher, A. (2025). 30 years of nursing ethics: Reflections on progress in the field. Nursing Ethics, 32(1), 7–14. https://doi.org/10.1177/09697330241312536
Ghafara, R. A., Fandi Achmad, B., Harjanto, T., & Setiyarini, S. (2022). Bullying on nursing students. Jurnal Berita Ilmu Keperawatan, 15(2), 229–237. https://doi.org/10.23917/bik.v15i2.17859
Gilbert, P. (2020). Compassion: from its evolution to a psychotherapy. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.586161
Health Development Policy Agency. (2023, December 2). Indonesian health survey 2023. Retrieved from: https://drive.google.com/file/d/1NMZwTtFMamkmMe-H8OpZwan105kiSQtq/view. Accessed on 15th April 2023.
Hikmat, R., Yosep, I., Hernawaty, T., & Mardhiyah, A. (2024). A scoping review of anti-bullying interventions: reducing traumatic effect of bullying among adolescents. Journal of Multidisciplinary Healthcare, 2024(17), 289-304. https://doi.org/10.2147/JMDH.S443841
Huang, Q.-L., Ho, W.-S., & Cheung, H.-N. (2024). Exploring the mediating role of self-regulation in bullying victimization and depressive symptoms among adolescents: a cross-regional and gender analysis. Healthcare, 12(15), 1486. https://doi.org/10.3390/healthcare12151486
Jones, T., Garzon, F. L., & Ford, K. (2023). Christian accommodative mindfulness in the clinical treatment of shame, depression, and anxiety: Results of an N-of-1 time-series study. Spirituality in Clinical Practice, 10(2), 118–130. https://doi.org/10.1037/scp0000221
Jungert, T., Sarıca, S., & Bäckström, M. (2025). The impact of witnessing school bullying in the classroom: exploring perceptions and responses among turkish students. International Journal of Bullying Prevention, 1-12. https://doi.org/10.1007/s42380-025-00292-7
Kotera, Y., Conway, E., & Van Gordon, W. (2019). Mental health of UK university business students: Relationship with shame, motivation and self-compassion. Journal of Education for Business, 94(1), 11–20. https://doi.org/10.1080/08832323.2018.1496898
Kotera, Y., Jackson, J. E., Kirkman, A., Edwards, A.-M., Colman, R., Underhill, A., Jackson, J. G., Baker, D., & Ozaki, A. (2023). Comparing the mental health of healthcare students: mental health shame and self-compassion in counselling, occupational therapy, nursing and social work students. International Journal of Mental Health and Addiction, 22. https://doi.org/10.1007/s11469-023-01018-w
Kotera, Y., Van Laethem, M., & Ohshima, R. (2020). Cross-cultural comparison of mental health between Japanese and Dutch workers: relationships with mental health shame, self-compassion, work engagement and motivation. Cross Cultural & Strategic Management, 27(3), 511–530. https://doi.org/10.1108/CCSM-02-2020-0055
Li, H., Mu, M., He, Y., Wang, J., Cai, Z., Tang, H., Zhang, B., Luo, H., & Zeng, W. (2025). Prevalence of workplace bullying among medical students: A meta-analysis and systematic review protocol. PLOS One, 20(2). https://doi.org/10.1371/journal.pone.0310076
Li, H., Zheng, L., Le, H., Zhuo, L., Wu, Q., Ma, G., & Tao, H. (2020). The mediating role of internalized stigma and shame on the relationship between COVID-19 related discrimination and mental health outcomes among back-to-school students in Wuhan. International Journal of Environmental Research and Public Health, 17(24). https://doi.org/10.3390/ijerph17249237
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
MacGinley, M., Breckenridge, J., & Mowll, J. (2019). A scoping review of adult survivors’ experiences of shame following sexual abuse in childhood. Health & Social Care in the Community, 27(5), 1135-1146. https://doi.org/10.1111/hsc.12771
Malfasari, E., Devita, Y., Erlin, F., & Ramadania, I. (2018). Lingkungan Rumah Sakit dan Tingkat Kecemasan Mahaiswa Saat Melakukan Praktek Klinik [Hospital environment and students anxiety levels when doing clinical practice]. Journal of the Indonesian National Nurses Association, 2(2), 117–125. https://doi.org/10.32419/jppni.v2i2.89
Matthiesen, S. B., & Einarsen, S. (2004). Psychiatric distress and symptoms of PTSD among victims of bullying at work. British Journal of Guidance & Counselling, 32(3), 335–356. https://doi.org/10.1080/03069880410001723558
Mendy, C. B., Umukoro Onofa, L. E., Olujobi, A. O., Jallow, M. S., Agboola, Afis A., Nano, K., Eniade, O., Jarju, A., Olubodun, Y., & Ogun, G. (2025). Bullying and its effects on mental health among students of a Senior Secondary School in Banjul, The Gambia. Psychiatry and Psychological Disorders, 4(1). https://doi.org/10.58489/2836-3558/029
Pörhölä, M., Cvancara, K., Kaal, E., Kunttu, K., Tampere, K., & Torres, M. B. (2020). Bullying in university between peers and by personnel: Cultural variation in prevalence, forms, and gender differences in four countries. Social Psychology of Education, 23(1), 143–169. https://doi.org/10.1007/s11218-019-09523-4
Ramiro, B. M. F., Domínguez, S. G., & González-Sanguino, C. (2024). Stigma towards child and adolescent mental health problems among fathers and mothers. A cross-sectional study. Clinical and Health, 35(1), 27-33. https://doi.org/10.5093/clysa2024a8
Ricker, B. T. (2024). Interactive effects of parental support and psychological control on children’s emotion regulation. Journal of Family Psychology, 38(6), 956–965. https://doi.org/10.1037/fam0001235
Rutherford, D., Gillespie, G. L., Bresler, S., Johnson, K., & Smith, C. R. (2025). Bullying behaviors in clinical settings. Nursing Education Perspectives, 46(4), 246-248. https://doi.org/10.1097/01.NEP.0000000000001380
Sam, D. L., Bruce, D., Agyemang, C. B., Amponsah, B., & Arkorful, H. (2019). Cyberbullying victimization among high school and university students in Ghana. Deviant Behavior, 40(11), 1305–1321. https://doi.org/10.1080/01639625.2018.1493369
Stone-Sabali, S., Uanhoro, J. O., McClain, S., & Devese, K. (2025). Disentangling the discrimination and mental health relationship among diverse college students: Moderation analyses of shame-proneness across race, gender, and race-by-gender interactions. Cultural Diversity & Ethnic Minority Psychology, 31(1), 151–163. https://doi.org/10.1037/cdp0000620
Woller, S. J., Boffa, J. W., Viana, A. G., Albanese, B. J., & Vujanovic, A. A. (2025). PTSD symptoms, suicidal ideation, and suicidal risk among university students: The role of shame. Psychological Trauma: Theory, Research, Practice, and Policy, 17(1), 145–153. https://doi.org/10.1037/tra0001829
World Health Organisation. (2022, June 8). Mental disorders. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/mental-disorders. Accessed on 19th January 2023.
Zhang, D., Fu, M., Zhang, J., Li, Y., Chen, L., Chen, Y.-J., Zhong, Z., & Zhang, Y.-P. (2025). Evaluating whether nonimmersion virtual reality simulation training improves nursing competency in isolation wards: randomized controlled trial. Journal of Medical Internet Research, 27. https://doi.org/10.2196/63131
Zhang, G.-B., Wang, G.-F., Han, A.-Z., Xu, N., Xie, G.-D., Chen, L.-R., & Su, P.-Y. (2019). Association between different stages of precollege school bullying and murder-related psychological behaviors among college students in Anhui Province, China. Psychiatry Research, 282. https://doi.org/10.1016/j.psychres.2019.112593
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