While school bullying has been shown to be associated with depression and suicidality among teens, the relationship between these outcomes and cyberbullying has not been studied in nationally representative samples. Data came from the 2011 CDC Youth Risk Behavior Survey (YRBS), a nationally representative sample of high-school students (N = 15,425). We calculated weighted estimates representative of all students in grades 9–12 attending school in the US. Logistic regression was used to calculate adjusted odds ratios. Overall, girls are more likely to be report being bullied (31.3% vs. 22.9%), in particularly to be cyberbullied (22.0% vs. 10.8%), while boys are only more likely to report exclusive school bullying (12.2% vs. 9.2%). Reports of 2-week sadness and all suicidality items were highest among teens reporting both forms of bullying, followed by those reporting cyberbullying only, followed by those reporting school bullying only. For example, among those reporting not being bullied 4.6% reported having made a suicide attempt, compared to 9.5% of those reporting school bullying only (adjusted odd ratio (AOR) 2.3, 95% C.I. 1.8-2.9), 14.7% of those reporting cyberbullying only (AOR 3.5 (2.6-4.7)), and 21.1% of those reporting victimization of both types of bullying (AOR 5.6 (4.4-7)). Bullying victimization, in school, cyber, or both, is associated with higher risk of sadness and suicidality among teens. Interventions to prevent school bullying as well as cyberbullying are needed. When caring for teens reporting being bullied, either at school or in cyberbullying, it’s important to screen for depression and suicidality.
In a large, nationally representative sample of US high school students, we found that bullying, both school bullying and cyberbullying, is prevalent (27.4%) and that those reporting either form of bullying are at higher risk for also reporting 2-week sadness, suicidal ideation, plans, attempts, and attempts requiring treatment. We also found that while school bullying decreases with age, as previously reported in other studies [26], this decreasing trend was not observed with cyberbullying. In fact, we see a slight increase in the prevalence of cyberbullying taking place in the 17-year-old age bracket. We also found that, while boys are more exposed to school bullying, girls are almost twice as likely to be cyberbullied, as previously reported among middle school students [27].
The limitations of our study should be considered. First, survey data depends on self-reports which can be biased, being especially prone to recall bias. Second, a cross-sectional analysis such as ours cannot show the sequence of events leading to the association noticed. In other words, it’s possible that being bullied leads to depression and suicidal ideation, but it’s also conceivable that students who were showing signs of depression and suicidal thoughts were picked on as vulnerable.
The first limitation on self-report surveys can be partially addressed by looking at the validity of the suicidality items of the YRBS. A study examining those items’ relationships to criterion variables, such as anxiety, depression, and substance abuse, found that these YRBS items assessing suicidal thoughts and behaviors have good convergent and discriminant validity [24]. The second limitation on the cross-sectional data has to be viewed in the context of cyberbullying being a recent exposure – the term cyberbullying was first used according to Webster’s in 2000, the term bullying itself was added to the MeSH in 2011, and the 2011 YRBS used in this study was the first one to have a specific question on cyberbullying.
Prospective studies are best suited to answer the question about which came first. A recent longitudinal study conducted in North Carolina documented long term adverse mental health outcome among those being school bullied as teens, with the worst effects affecting both bullying victims and the bullies themselves [28]. Given the novelty of the cyberbullying exposure in the population, any such longitudinal study on the topic starting today will take at least ten years to be completed.
We hope this study serves to inform health care professionals, students, parents, and teachers, about the prevalence of bullying in our schools, as well as in cyberspace, and that those behaviors are associated with high levels of reported sadness and suicidality. The advantage of recognizing such association is that interventions to mitigate school bullying have been shown to be effective and should be made available [29], [30] and [31] while effective measures against cyberbullying can, and should, be developed [32].
