Cyberbullying and adolescent mental health: systematic review

Bottino, Sara Mota Borges; Bottino, Cássio M. C.; Regina, Caroline Gomez; Correia, Aline Villa Lobo; Ribeiro, Wagner Silva

doi:10.1590/0102-311X00036114

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Review • Cad. Saúde Pública 31 (3) • Mar 2015 • https://doi.org/10.1590/0102-311X00036114 copy

Cyberbullying and adolescent mental health: systematic review

Cyberbullying e saúde mental dos adolescentes: revisão sistemática

Acoso cibernético y la salud mental de los adolescentes: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.

Bullying; Adolescent; Mental Health

Reference	Country	Study design	Sample characteristics	Participants	Participation rate	Cyberbullying measurements	Quality of studies
Ybarra ¹³	USA	Cross-sectional populational-based. Randomly selected phone numbers. Telephone survey	Regular Internet urban users (i.e., at least six times in the previous six months). One young person and one caregiver	N = 1,501. Age: 10-17 years. 47% girls and 53% boys.	82%	(1) Whether the respondent felt worried or threatened because of someone else bothering or harassing him or her while online (yes/no) and (2) whether the respondent felt threatened or embarrassed because someone had posted or sent a message about the young person for other people to see (yes/no)	Strong
Ybarra et al. ¹⁶	USA	Cross-sectional populational-based. Randomly selected phone numbers. Telephone survey	Regular Internet urban users (i.e., at least six times in the previous six months). One youth and one caregiver	N = 1,500. Age: 10-17 years. 51% girls and 49% boys	45%	(1) In the past year did you ever feel worried or threatened because someone was bothering or harassing you on-line? (2) In the past year did anyone ever use the Internet to threaten or embarrass you by posting or sending messages about you for other people to see?	Strong
Juvonen & Gross ¹⁵	USA	Cross-sectional. Anonymous web-based survey	Participants from 55 states recruited through a popular teen web site	N = 1,454. Age: 12-17 years. 75% girls and 25% boys	NI	9 questions about aggressive behavior on the Internet	Weak
Hinduja & Patchin ²¹	USA	Cross-sectional, randomized. Self-reported questionnaire	36 middle schools from the largest school district of USA. Representative sample	N = 1,963. 6^th-8^th grades. 48% girls and 52% boys	96%	14 questions: 9 questions about cybervictimization and 5 question about cyberbullying offending	Moderate
Sourander et al. ¹⁷	Finland	Cross-sectional populational-based. Self-reported questionnaire	Two cities in north and south of Finland. All children attending the seventh and ninth grade, except for children attending classes for the physically or mentally disabled	N = 2,215. 7^th-9^th grades. 50% girls and 50% boys	90.9%	Two general questions about cyberbullying, defined as: “cyberbullying is when someone repeatedly makes fun of another person online or repeatedly picks on another person through e-mail or text messages or when someone posts something online about another person that they don’t like”: (1) During the past 6 months, how often have you been cyberbullied? (2) During the past 6 months, how often have you cyberbullied others	Strong
Wang et al. ¹⁹	USA	Cross-sectional populational-based. Self reported questionnaire	A U.S. nationally-representative sample of adolescents	N = 7,313. 6^th-10^th grades. 42.3% girls and 56.7% boys	NI	Two questions about: (1) having suffered bullying through computer: messages or photos; (2) having suffered bullying through cellular	Strong
Ortega et al. ²²	Italy, Spain, England	Cross-sectional, multicentric. Self-reported questionnaire	Urban students.Representative sample	N = 5,862. Age: 12-16 years. 8^th-, 10^th and 12^th grades. 48.8% girls and 52.2% boys	NI	12 questions to cellular phone; 12 questions to internet; DAPHNE questionnaire (Genta et al. ³³)	Moderate
Schneider et al. ¹⁸	USA	Census: (86%) of Boston metropolitan area. Self-reported questionnaire	22 high school urban students, middle and upper-middle class families	N = 20,406. 9^th to 12^th grades. 50.4% girls and 49.6% boys	88.1%	One question: “How many times someone used the internet, cellular or other means of electronic communication to intimidate, provoke or threaten you?”	Strong
Litwiller & Brausch ²⁰	USA	Cross-sectional, randomized.Self-reported questionnaire	27 high schools public students, from seven-county region. Representative sample. Rural Midwest region	N = 4,693. 9^th-12^th grades. 47% girls and 53% boys	65%	Three questions about cyberbullying: (1) someone spread rumors about you online in chats, website, by emails or text messages?; (2) someone posted compromising or inappropriate photos of you online?; (3) someone sent you aggressive messages or messages with threats by e-mail or text	Strong
Chang et al. ¹⁴	Taiwan	Cross-sectional, randomized. Self-reported questionnaire	26 urban high schools, two cities. Representative sample	N = 2,992. 10^th grade. 48% girls and 52% boys	80%	12 questions: six cybervictimization (how often has someone: posted rude comments; embarrassing photos; spread rumours; threatening comments; talked about sex online) and six cyberbullying (how often have you ever: posted rude comments; sent embarrassing photos; spread rumours; made threatening comments; talked about sex online)	Strong

Authors	Prevalence of cyberbullying	Risk factors related to cyberbullying	Measures of mental health problems	Mental health problems related to cyberbullying
Ybarra ¹³	6.5%	Male gender: Depressive sintomatology (OR = 3.38; CI: 1.78-6.45); Daily use of the internet for three or more hours (OR = 4.34; CI: 2.12-8.89); Harasser of others online (OR = 4.19; CI: 2.06-8.50); Interpersonal victimization (OR = 3.07; CI: 0.57-6.00). Female gender: Daily use of the internet for three or more hours (OR = 3.67; CI: 1.53-8.8); Daily use of internet for two hours a day (OR = 2.34; CI: 1.16-4.73); Using the Internet most frequently for instant messaging (OR = 2.92; CI: 1.19-7.79) or e-mail (OR = 2.75; CI: 1.20-6.26); Harasser of others online (OR = 2.82; CI: 1.43-5.50)	Depressive symptoms of DSM-IV ³⁴	Symptoms of major depression (OR = 3.38; CI: 1.78-6.45)
Ybarra et al. ¹⁶	9%	Harassing others online (OR = 3.6; CI: 2.3-5.7); Using internet for instant messaging, blogging, and chat room (OR = 3.4; CI: 0.9-6.3); Borderline/clinically significant social problems (OR = 2.4; CI: 1.2-4.4); Interpersonal victimization (OR = 1.5; CI: 1.0-2.2)	Youth Self-Report of Child Behavior Checklist (Achenbach ³⁵)	Emotional distress: 38% of the harassed youth reported distress associated; Characteristics associated with emotional distress among targets of harassment incident: preadolescence (OR = 0.5.5; CI: 1.5-19.3), adult harasser (OR = 4.1; CI: 1.4-11.6); Being asked to send a picture of oneself (OR = 3.2; CI: 1.2-8.4); Aggressive offline contact (OR = 3.9; CI: 1.5-10.1)
Juvonen & Gross ¹⁵	72%	School bullying (OR = 6.87; CI: 4.90-9.62); Daily use of the internet for three hours or more (OR = 1.45; CI: 1.04-2.02); Instant messaging (OR = 2.84; CI: 1.08-7.49); Webcam (OR = 1.50; CI: 1.04-2.14)	Social anxiety scale with 5 items (La Greca & Lopez ³⁶)	Social anxiety (β = 0.31; p < 0.01)
Hinduja & Patchin ²¹	Cy-v: 5.7-18.3%. Cy-b: 9-23.1%	Not found	Four items about suicide attempt and suicide adapted from American School Health Associations ³⁷	Suicidal ideation: Cybervictim (OR = 1.94; p < 0.001); Cyberbully (OR = 1.49; p < 0.05)
Sourander et al. ¹⁷	17.6%. Cy-v: 4.8%. Cy-b: 7.4%. Cy-v/b: 5.4%	Cybervictimization: not living with both biological parents; perceived difficulties; emotional problems and peer problems; headache, abdominal pain, sleeping problems, not feeling safe at school and uncared about by teachers. Traditional victimization and school bullying. Cyberbullies: high level of perceived difficulties, hyperactivity, conduct problems, and lowprosocial behavior. Traditional bullying. Cybervictim and cyberbully were associated with all these risk factors above	Strengths and Difficulties Questionnaire – SDQ (Goodman ³⁸)	Cyberbully: Hyperactivity problems (OR = 2.4; 95%CI: 1.4-3.9); Behavior problems (OR = 2.6; 95%CI: 1.5-4.5); Low prosocial behavior (OR = 2.3; 95%CI: 1.5-3.4); Emotional problems (OR = 2.1; 95%CI: 1.1-3.6); Peer problems (OR = 4.8; 95%CI: 2.9-7.7); Cybervictim: Behavior problem (OR = 2.6; 95%CI: 1.5-4.5); Hyperactivity problems (OR = 2.4; 95%CI: 1.4-3.9); Emotional problems (OR = 2.2; 95%CI: 1.2-3.9); Peer problems (OR = 4.8; 95%CI: 2.9-7.7)
Wang et al. ¹⁹	10.1%	Male-gender. 6-8 grade	Depression: Six items: sadness; irritation, bad mood; hopelessness; changes in appetite; sleep; concentration problems in the past 30 days (Dahlberg et al. ³⁹)	Depression, medically attended injuries, medicine use for sleeping problems and nervousness *
Ortega et al. ²²	England: 2.0% mobile phone, 2.6% Internet; Italy: 2.2% mobile phone; 1.9% Internet; Spain: 0.5% mobile phone 1.3% Internet	NI	DAPHNE questionnaire (Genta et al. ³³)	Mobile phone cyberbullying: angry – 35.8%; not bothered – 25.4%;worried – 19.5%; upset – 18.3%; stressed – 13.3%; afraid – 13.3%; depressed – 10.7% Internet cyberbullying: not bothered – 35.7%; angry – 33.7%; upset – 19.5%; worried – 15.5%; afraid – 12.8%; depressed – 10.3%
Schneider et al. ¹⁸	15.8%	Female gender; non-white/mixed race; non heterosexuality identified; lower school performance; lower school attachment	Centers for Disease Control and Prevention ⁴⁰; Health and Risk Behaviors of Massachusetts Youth ⁴¹	Distress: Depressive symptoms (OR= 4.38; 99%CI: 3.76-5.10); Self-injury (OR = 4.79; 99%CI: 4.06-5.65); Suicidal ideation (OR = 3.35; 99%CI: 2.71-4.13); Suicide attempt (OR = 5.04; 99%CI: 3.88-6.55); Suicide attempt that required medical treatment (OR = 5.42; 99%CI: 3.56-8.26)
Litwiller & Brausch ²⁰	23%	Not founded	Suicidal behavior: Center for Disease and Control ⁴⁰; Substance use: 17 items from Monitoring the Future Survey (Johnston ⁴²); Violent behavior: 4 items from Center for Disease and Control, 2008 ⁴⁰; Sexual behavior: 5 items from Center for Disease and Control ⁴⁰	Substance use (estimate = 0.33; 95%CI: 0.28-0.35); Violent behavior (estimate = 0.16; 95%CI: 0.14-0.19); Non safe sex behavior (estimate = 0.005; 95%CI: 0.00-0.15); Suicidal behavior R²adj = 0.67
Chang et al. ¹⁴	35.4%. Cy-v: 18.4%; Cy-b: 5.4%; Cy-v/Cy-b: 11.2%	Male (OR = 1.57; 95%CI: 1.15-2.16); Lower academic performance (OR = 1.69; 95%CI: 1.34-2.15). Internet risks behaviors: Posting personal information photos and using a webcam to chat with strangers: Cy-b (OR = 1.87; 95%CI: 1.28-2.73); Cy-v (OR = 1.58; 95%CI: 1.28-1.96); Cy-v/Cy-b (OR = 4.28; 95%CI: 3.00-6.10)	Rosenberg Self-esteem Scale (Rosenberg ⁴³); Depression CES-D (Radloff ⁴⁴)	Low self-esteem scores and high depression scores *: Cy-v: low self-esteem scores and high depression scores; Cy-b: high depression scores; Cy-b/Cy-v: low self-esteem and high depression scores

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[1] Correspondence S. M. B. Bottino Universidade Federal de São Paulo. Rua Cônego Eugênio Leite 933, cj. 93, São Paulo, SP 05414-012, Brasil. sarabottino@uol.com.br