Bullying can be defined by many things. It's teasing, name-calling, stereotyping, fighting, exclusion, spreading rumors, public shaming and aggressive intimidation. It can be in person and online. But it can no longer be considered a rite of passage that strengthens character, new research suggests. Adolescents who are bullied by their peers actually suffer from worse long-term mental health effects than children who are maltreated by adults, based on a study published last week in The Lancet Psychiatry. The findings were a surprise to Dr. Dieter Wolke and his team that led the study, who expected the two groups to be similarly affected. However, because children tend to spend more time with their peers, it stands to reason that if they have negative relationships with one another, the effects could be severe and long-lasting, he said. They also found that children maltreated by adults were more likely to be bullied. The researchers discovered that children who were bullied are more likely to suffer anxiety, depression and consider self-harm and suicide later in life. While all children face conflict, disagreements between friends can usually be resolved in some way. But the repetitive nature of bullying is what can cause such harm, Wolke said. "Bullying is comparable to a scenario for a caged animal," he said. "The classroom is a place where you're with people you didn't choose to be with, and you can't escape them if something negative happens." Children can internalize the harmful effects of bullying, which creates stress-related issues such as anxiety and depression, or they can externalize it by turning from a victim to a bully themselves. Either way, the result has a painful impact. The study also concluded with a call to action, suggesting that while the government has justifiably focused on addressing maltreatment and abuse in the home, they should also consider bullying as a serious problem that requires schools, health services and communities to prevent, respond to or stop this abusive culture from forming. "It's a community problem," Wolke said. "Physicians don't ask about bullying. Health professionals, educators and legislation could provide parents with medical and social resources. We all need to be trained to ask about peer relationships."