As the most populous state in the New England region, Massachusetts’ culture is strongly influenced by human interactions. Unfortunately, not all of these interactions are pleasant or fruitful. From kindergarten to college to the workplace to online media and even at home, bullying is a serious problem. In fact, CNN believes it is now a public health concern all across America.

Suicide is one of the most heartbreaking results from bullying, but it is not the only effect. In fact, there are many other mental health problems that may or may not result in this final act. These include depression, anxiety and substance abuse. For people who are bullied as kids or teens, this may even follow them into adulthood.

Ironically, bullies themselves also tend to suffer emotionally and may engage in self-destructive behavior not unlike those sometimes triggered in their victims. High-risk behavior is also prevalent among bullies, including theft and vandalism. Other potential high-risk behaviors not identified by CNN include assault and domestic abuse.

NBC News notes that because of this, several states have either considered or enacted laws requiring automatic notification when children are bullied at school. However, this become tricky when bullying is related to suspected or confirmed sexual orientation, as this may result in further turmoil in a young person’s life at home. Even when the student is not LGBTQ, potential homophobia at home may result in further abuse in the one place they should feel safe.

Adults often face their fair share of bullying, as well. Domestic abuse, sexual assault, racial discrimination, misogyny and other forms of hostile behavior in some people’s everyday lives are arguably as a result of bullies who never quite grew out of their favorite childhood past time. Thus, the best time to address bullying is in childhood. However, how to do so without putting some children at risk for further abuse is a minefield that concerned parties are forced to navigate with extreme caution.