Victimization in traditional and cyberbullying as risk factors for substance use, self-harm and suicide attempts in high school students
Published Online: Sep 03, 2020
Page range: 101 - 109
DOI: https://doi.org/10.21307/sjcapp-2020-010
Keywords
© 2020 Mohammad Saeed Azami et al., published by sciendo.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Traditional bullying (or peer bullying) is defined as a repetitive and damaging act that contains a power imbalance (1). Research has shown that many students have experienced traditional bullying victimization. A study indicated that the prevalence rates of being a victim of traditional bullying in the last month were 16.2% (2). The results of other studies demonstrated that about 30 to 50% of students were bullied at school (3-5). Also, a study was accomplished in Iran and its results revealed that the percentages of students who were victims and perpetrators of traditional bullying were 22.6% and 15.7%, respectively (6). Unfortunately, it seems that bullying is not an uncommon phenomenon.
In recent years, we have been faced with another type of bullying, which occurs through electronic devices. This kind of bullying is known as cyberbullying. Patchin and Hinduja (7) introduced cyberbullying as intentional and repeated damage, which occurs through the medium of electronic text. Research indicates that many students experience cyberbullying victimization (cyber victimization). For example, a study reports that 17.3% of students are victims of cyberbullying (3). Also, prevalence of cyber victimization was reported to be 10.2% in Canada (8). A study was developed in Iran, and its results revealed that 11.4 and 1.1% of boys and girls were cyberbullying victims, respectively. Whereas, 7.5 and 1.1% of boys and girls were social network victims, respectively (9). Aboujaoude et al. (10) developed a review article, and their results demonstrated that between 20 and 40% of children and adolescents have been victims of cyberbullying.
Research shows that there is a significant association between involvement in bullying and low academic achievement (11-13). Some studies investigated the influences of traditional bullying on physiological health, and their results showed that students who have experienced traditional bullying at least 2 or 3 times a month, were more likely to report stomachache, headache, back pain and neck/shoulder pain in comparison with non-bullied students. In addition, bullying victimization increases the likelihood of weekly pain (14). Another study revealed that school victims were more likely to develop many difficulties such as sleep problems, tension, bedwetting, and fatigue (15). Also, traditional bullying victimization can have serious psychological consequences as well. A literature survey showed that overt victimization in school was positively associated with fear of negative evaluation, loneliness, social avoidance and depressive symptoms for both girls and boys (16). Other studies found that traditional victimization increases the likelihood of smoking and drinking (17, 18), self-harm (19, 20), and suicide (21, 22). In a review article, Smokowski and Kopasz (23) declared that traditional bullying victimization has many short-term and long-term effects. The short-term consequences were comprised of reduced school performance, absenteeism, headache, loneliness, suicidal ideation, and even suicide. The long-term effects included depression, low self-esteem, and interpersonal difficulties.
Like traditional bullying, cyberbullying can cause serious problems for its victims as well. It is reported that cyber victims are faced with the higher rates of leaving school early, being absent from school, and getting lower grades than a non-involved group (24). Cyber-victimization was associated with headaches, recurrent abdominal pain, and sleeping problems (25). Furthermore, a systematic review and meta-analysis showed that there is a significant relationship between cyber victimization, lower school attendance, and lower academic achievement (26). In addition, cyber victims are at greater risk for many problems such as substance use, panic symptoms, self-harm, depression, suicidal ideation, suicide attempts, as well as skipping school and suspension from school (27). A study of adolescents indicated that cyber victimization was positively related to depression, anxiety, self-harm, suicidal thoughts, and suicide attempts (odds ratios ranging from 1.55 to 3.49). In addition, the higher rates of victimization coincided with higher odds ratios (28). A systematic review was developed to compare cyber victims with non-victims. The results revealed that cyber victims were 2.35 times more likely to harm themselves and they were 2.57 times more likely to attempt suicide (29). A review of the impacts of cyber victimization on adolescent health showed that cyber victims reported increased depressive affect, anxiety, loneliness, as well as suicidal behavior and somatic symptoms (30). In summary, cyber victimization--like traditional victimization--can generate important issues.
To explain how bullying victimization can cause adverse consequences,
Previous research has demonstrated that traditional and cyber victimization have almost the same consequences, but what will happen if a student experiences both of them? Which kind of bullying can cause more problems for its victims? In one study, there was an association between both kinds of bullying and psychosomatic problems. From a statistical point of view, there were no significant differences between traditional and cyber victims in psychosomatic problems (35). A study of students in 9th to 12th grade showed that 6.4% were victims of cyberbullying, 16.5% were victims of traditional bullying, and 9.4% were victims of both kinds of bullying. Controlled analyses indicated that the distress rate was higher among victims of both cyber and traditional bullying. Victims of only one form of bullying also reported elevated levels of distress. In this regard, the victims of cyberbullying only were more likely to report depressive symptoms, self-injury, suicidal ideation and suicide attempts than the victims of traditional bullying only (36). In other research, it was reported that traditional victims felt their bullying was harsher and meaner than cyber victims reported In addition, it had more effects on their lives, but the correlates of their mental health showed that cyber victims reported significantly more social problems and higher levels of depression and anxiety than the other group (37). This inconsistency in the results of the research studies motivated us to examine which kind of victimization is a stronger risk factor for self-harm and suicide attempts. Also, some studies show that victims of traditional and cyberbullying were more likely to use drugs (17, 18, 27), but there is not enough evidence to determine the effects of experiencing both kinds of victimization on substance use, which drugs these adolescents are more likely to use, or which kind of victimization is a stronger risk factor for substance use in adolescents. Therefore, we decided to examine substance use as a possible consequence of victimization in traditional and cyberbullying. In summary, we examine the possible role of traditional and cyberbullying victimization as risk factors for substance use, self-harm, and suicide.
This is a cross-sectional study conducted in 2019. The sample was comprised of 425 students from six high schools in the city of Kermanshah, Iran. This study has been configured with respect to the following procedure. The city of Kermanshah has three urban areas. In addition, there is a gender separation in Iran’s schools. To provide a representative sample for our study, we randomly selected two high schools in each urban area (one for girls and one for boys) and three classes in each school. Finally, we chose 18 classes in six different high schools; a multi-stage randomized cluster sampling procedure was developed for solving the problem. In this sample, 226 students (53.2%) are girls and 199 of them are boys (46.8%). The average age of participants is 16.61 and the standard deviation is 0.95.
The research ethics committee at the University of Social Welfare and Rehabilitation Sciences approved the permission to conduct this study. In addition, the Education and Training administration in Kermanshah province permitted us to conduct this study in Kermanshah’s high schools.
Prior to beginning the survey, we informed the students that they were free to refuse or discontinue participation with no penalty. In addition, we received informed consent from the school and all students involved in the survey. We also noted that the provided information by the students would not be revealed to anyone. Students completed the paper-pencil questionnaire and it was written during a one-hour class in Persian language.
Students completed a Persian version of the E-Victimization Scale (38). This questionnaire contains five items. As an example, a question was developed as follows: “How many times did someone tease you using emails, texting, or social networks?” Students were asked to present the number of times they had been cyber victims during the past two months. The answer was configured by a five-point scale (1 = never, 2 = 1 to 5 times, 3 = 6 to 10 times, 4 = 11 to 20 times and 5 = more than 20 times). We changed the original time range (last week) to the last two months to synchronize with the time range in traditional victimization questions. We also changed the original two-point scale (0 to 6 times and more than 6 times) to a five-point scale. Then, we dichotomized the responses in 0 = did not experience cyber victimization and 1 = experienced cyber victimization. Hajlo et al. (39) validated this questionnaire in Iran and reported that the Cronbach’s alpha was 0.87. In this study, Cronbach’s alpha was 0.85 for this questionnaire.
Students completed three questions about traditional victimization from the
A composite variable was created from these two victimization variables, with the following four groups: cyber only; traditional only; cyber and traditional; and has not experienced victimization.
To measure substance use, we just asked one question about each substance, for example, “How many times did you smoke cigarettes in the last couple of months?” Students were asked to indicate the frequency of smoking cigarettes on a five-point scale (1 = never to 5 = so many times). Then, we dichotomized the responses as 0 = did not smoke cigarettes and 1 = smoked cigarettes. We performed this procedure for alcohol, hashish/marijuana, opium, and cigarettes/hookah (a single- or multi-stemmed instrument for vaporizing and smoking flavored cannabis, tobacco sometimes opium, whose vapor or smoke is passed through a water basin—often glass-based—before inhalation- in Iran mostly used for tobacco).
To measure self-harm, we just asked one question: “Have you intentionally harmed yourself without trying to suicide?” The student responded with ”Yes” or ”No”.
To measure suicide attempts, we just asked one question: “Have you intentionally harmed yourself by trying to suicide?” The student responded with ”Yes” or ”No”.
To analyze data, we used SPSS statistical software (version 23). We used a binary logistic regression method in which an Odds Ratio can be calculated for a nominal dependent variable (for example, smoking cigarette: 1-Yes, 0-No) through combination of several independent variables. In this study, we used traditional and cyber victimization and gender as predictors for substance use, self-harm, and suicide. The statistical significance level was considered as
As some of the students did not properly answer the questions, 25 cases were excluded from the analyses. (This is called social desirability and defined as the tendency of survey respondents to answer questions in a manner that will be viewed favorably by others (42). It can take the form of over-reporting “good behavior” or under-reporting “bad”, or undesirable behavior). Thus, a total of 400 students responded to the survey and they provided usable information for the research. This procedure represented a response rate of 94%.
Table 1 shows demographic characteristics for the sample, and the results demonstrated that 45.8 and 54.2% of the sample were boys and girls, respectively. The analysis results showed that about 61% of students had an average socioeconomic status. Also, the sample analysis revealed that 76% of students had smartphones. In addition, more than 90% of them were living with their mother or father at home. Furthermore, it was revealed that about 57% of them spent 2-7 hours on the Internet per day.
Demographic characteristic of the sample
| Frequency | Percentage | |
|---|---|---|
| Gender | ||
| Male | 183 | 45.8 |
| Female | 217 | 54.2 |
| Socio-Economic status | ||
| Below-average | 63 | 15.8 |
| Average | 242 | 60.8 |
| Above-average | 93 | 23.4 |
| Do you have a smartphone? | ||
| Yes | 303 | 76.3 |
| No | 30 | 7.6 |
| I don’t have cellphone at all | 64 | 16.1 |
| Is your father living with you at home? | ||
| Yes | 368 | 92.5 |
| No | 12 | 3.0 |
| He passed away | 18 | 4.5 |
| Is your mother living with you at home? | ||
| Yes | 384 | 96.7 |
| No | 9 | 2.3 |
| She passed away | 4 | 1.0 |
| Daily internet use | ||
| Less than 1 hour | 129 | 32.4 |
| 2-4 hours | 153 | 38.4 |
| 5-7 hours | 72 | 18.1 |
| 7-10 hours | 18 | 4.5 |
| More than 10 hours | 26 | 6.5 |
Table 2 presents the prevalence of traditional and cyber victimization. The results demonstrate that 45.8% of students did not experience any kind of bullying victimization (n = 183). However, the results showed that 29.3% of students were victims of cyberbullying only (n = 117), 11% were victims of traditional bullying only (n = 44) and 14% were victims of both types of bullying (n = 56).
Prevalence of traditional and cyber victimization
| Frequency | Percentage | |
|---|---|---|
| Non-victim | 183 | 45.8 |
| Cyber only | 117 | 29.3 |
| Traditional only | 44 | 11.0 |
| Both | 56 | 14.0 |
As presented in Table 3, boys were more likely to be cyber victims, but the girls were more likely to be traditional victims and traditional-cyber victims. Table 3 presents substance use, self-harm and suicide rates. As shown in the Table 3, 26.7% (n = 104) of students smoked cigarettes/hookah, 13.7% (n = 53) drank alcohol, 6.2% (n = 24) smoked hashish/marijuana, and 4.4% (n = 17) smoked opium. In addition, 23.2% (n = 86) of students had self-harm and 17.7% (n = 66) of them tried to commit suicide. The cyber victim-only group had a higher frequency of all substances, self-harm, and suicide. Cigarettes/hookah and alcohol were more prevalent than other drugs. Substance use, self-harm and suicide is more prevalent in victims of any kind of bullying.
Descriptive statistics (frequency and percentages) of victim’s substance use, self-harm and suicide
| Traditional and cyber victimization status | |||||
|---|---|---|---|---|---|
| Total N = 400 | Non-victim n = 183 | Cyber Only n = 117 | Traditional Only n = 44 | Both n = 56 | |
| Male | 183 (45.8) | 83 (45.4) | 60 (51.3) | 16 (36.4) | 24 (42.9) |
| Female | 217 (54.2) | 100 (54.6) | 57 (48.7) | 28 (63.6) | 32 (57.1) |
| Cigarette/hookah | |||||
| Yes | 104 (26.7) | 33 (18.3) | 42 (37.2) | 12 (28.6) | 17 (30.9) |
| No | 286 (73.3) | 147 (81.7) | 71 (62.8) | 30 (71.4) | 38 (69.1) |
| Alcohol | |||||
| Yes | 53 (13.7) | 17 (9.6) | 23 (20.4) | 3 (7.1) | 10 (18.2) |
| No | 335 (86.3) | 161 (90.4) | 90 (79.6) | 39 (92.9) | 45 (81.8) |
| Hashish/marijuana | |||||
| Yes | 24 (6.2) | 5 (2.8) | 11 (9.9) | 2 (4.8) | 6 (10.9) |
| No | 362 (93.8) | 173 (97.2) | 100 (90.1) | 40 (95.2) | 49 (89.1) |
| Opium | |||||
| Yes | 17 (4.4) | 4 (2.2) | 6 (5.3) | 3 (7.1) | 4 (7.3) |
| No | 373 (95.6) | 176 (97.8) | 107 (94.7) | 39 (92.7) | 51 (92.7) |
| Self-Harm | |||||
| Yes | 86 (23.2) | 21 (12.3) | 33 (31.4) | 12 (29.3) | 20 (37.0) |
| No | 285 (76.8) | 150 (87.7) | 72 (68.6) | 29 (70.7) | 34 (63.0) |
| Suicide | |||||
| Yes | 66 (17.7) | 16 (9.4) | 23 (21.3) | 8 (20.0) | 19 (35.2) |
| No | 307 (82.3) | 155 (90.6) | 85 (78.7) | 32 (80.0) | 35 (64.8) |
Table 4 presents substance use, self-harm and suicide rates according to gender. As shown in Table 4 smoking cigarette/hookah is almost equal among boys and girls. Boys more than girls drink alcohol. Boys more than girls smoked hashish/marijuana and opium. Also, girls more than boys harmed themselves and committed suicide. Table 5 presents Cramer’s V correlation between variables. The results demonstrated that victimization had a significant correlation with cigarette/hookah, hashish/marijuana smoking, alcohol drinking, self-harm and suicide, the last two had stronger correlation with victimization than any substance uses. In addition, gender exhibited a significant correlation with hashish/marijuana and opium smoking, alcohol drinking and suicide. Gender had stronger correlation with alcohol drinking than other substances.
Descriptive statistics (frequency and percentages) of student’s substance use, self-harm and suicide
| Total N = 400 | boys n = 183 | girls n = 217 | |
|---|---|---|---|
| Cigarette/Hookah | |||
| Yes | 110 (26.6) | 56 (29.5) | 54 (24.1) |
| No | 304 (73.4) | 134 (70.5) | 170 (75.9) |
| Alcohol | |||
| Yes | 58 (14.1) | 39 (20.6) | 19 (8.5) |
| No | 354 (85.9) | 150 (79.4) | 204 (91.5) |
| Hashish/marijuana | |||
| Yes | 25 (6.1) | 19 (10.2) | 6 (2.7) |
| No | 384 (96.9) | 168 (89.8) | 216 (97.3) |
| Opium | |||
| Yes | 19 (4.6) | 16 (8.4) | 3 (1.3) |
| No | 395 (95.4) | 174 (91.6) | 221 (98.7) |
| Self-harm | |||
| Yes | 92 (23.4) | 37 (20.4) | 55 (25.8) |
| No | 302 (76.6) | 144 (79.6) | 158 (74.2) |
| Suicide | |||
| Yes | 69 (17.5) | 22 (12.6) | 47 (21.4) |
| No | 326 (82.5) | 153 (87.4) | 173 (78.6) |
Cramer’s V correlations between variables
| Cigarette/hookah | Alcohol | Hashish/marijuana | Opium | Self-harm | Suicide | Gender | Victimization | |
|---|---|---|---|---|---|---|---|---|
| Cigarette/hookah | ||||||||
| Alcohol | 0.576** | |||||||
| Hashish/marijuana | 0.317** | 0.394** | ||||||
| Opium | 0.312** | 0.361** | 0.633** | |||||
| Self-harm | 0.226** | 0.089 | 0.089 | 0.094 | ||||
| Suicide | 0.244** | 0.043 | 0.038 | 0.061 | 0.566** | |||
| Gender | 0.061 | 0.174** | 0.155** | 0.169** | .063 | 0.115* | ||
| Victimization | 0.185** | 0.155* | 0.147* | 0.103 | 0.244** | 0.235** | 0.090 | |
Logistic regression assumptions were tested, and there was no evidence of multicollinearity or outliers. Results of the binary logistic regression analyses are presented in Tables 6 and 7.
Odds Ratios (95% Confidence Interval) and significance obtained from the binary logistic regression of risk factors on substance use
| Substance | ||||||
|---|---|---|---|---|---|---|
| Cigarette/hookah | Alcohol | |||||
| ORa | B | CI | ORa | B | CI | |
| Male | 1.372 | .316 | (0.866, 2.174) | |||
| Cyber only | ||||||
| Traditional only | 1.851 | .616 | (0.855, 4.009) | 0.819 | -0.199 | (0.225, 2.979) |
| Cyber & traditional | 2.174 | 0.777 | (0.916, 5.159) | |||
| Hashish/marijuana | Opium | |||||
|---|---|---|---|---|---|---|
| ORa | B | CI | ORa | B | CI | |
| Male | ||||||
| Cyber only | 2.286 | 0.827 | (0.622, 8.396) | |||
| Traditional only | 2.039 | 0.712 | (0.374, 11.109) | 4.324 | 1.464 | (0.895, 20.896) |
| Cyber & traditional | 3.623 | 1.287 | (0.855, 15.346) | |||
Odds Ratios (95% Confidence Interval) and significance obtained from the binary logistic regression of risk factors on self-harm and suicide
| Self-harm | |||
|---|---|---|---|
| ORa | B | CI | |
| Male | 0.771 | -0.260 | (0.464, 1.281) |
| Cyber only | |||
| Traditional only | |||
| Cyber & traditional | |||
| Suicide | |||
|---|---|---|---|
| ORa | B | CI | |
| Male | -0.663 | ||
| Cyber only | |||
| Traditional only | 2.295 | 0.831 | (0.900, 5.853) |
| Cyber & traditional | |||
According to the results, males were 3 times (OR = 2.91, 95% CI: 1.563-5.443) more likely to drink alcohol, almost 4 times (OR = 3.95, 95% CI: 1.512-10.304) more likely to smoke hashish/marijuana, and almost 6.6 times (OR = 6.57, 95% CI: 1.832-23.632) more likely to smoke opium than girls. Also boys were less likely to attempt suicide than girls.
The results demonstrated that cyber victims were 3 times (OR = 2.59, 95% CI: 1.516-4.450) more likely to smoke cigarettes/hookah, 2.3 times (OR = 2.33, 95% CI: 1.173-4.654) more likely to drink alcohol, 3.6 times (OR = 3.62, 95% CI: 1.211-10.834) more likely to smoke hashish/marijuana, 3.3 times (OR = 3.34, 95% CI: 1.803-6.203) more likely to harm themselves and 2.7 times (OR = 2.74, 95% CI: 1.369-5.516) more likely to attempt suicide than non-victim group.
The results demonstrated that traditional victims were 2.9 times (OR = 2.88, 95% CI: 1.277-6.522) more likely to harm themselves than non-victim group.
The results demonstrated that cyber and traditional victims group were 2 times (OR = 2.00, 95% CI: 1.008-3.984) more likely to smoke cigarettes/hookah, 4.4 times (OR = 4.43, 95% CI: 1.275-15.399) more likely to smoke hashish/marijuana, 4.2 times (OR = 4.19, 95% CI: 2.048-8.606) more likely to harm themselves and 5.4 times (OR = 5.46, 95% CI: 2.534-11.765) more likely to attempt suicide than non-victim group.
Results showed that cyber victimization was significantly associated with smoking cigarettes/hookah and hashish/marijuana, drinking alcohol, self-harm, and suicide. This finding is associated with other works (27). Patchin and Hinduja (43) said that cyber victimization is associated with low self-esteem. With respect to low self-esteem and suicide relationship (44), we can say that bullying victimization can cause low self-esteem, and thus this can lead to suicide or substance use. As mentioned earlier, bullying victims may feel social isolation, their frequent need for help from family and friends could lead them to feel they have become a burden on other people, and according to
Results showed that traditional victimization was significantly associated with self-harm. This finding is associated with other work (45). Concerning
Results showed that being bullied in both ways was significantly associated with cigarette/hookah and hashish/marijuana smoking, and especially self-harm and suicide attempts. These results were in line with previous studies that found those who experienced both traditional and cyberbullying were at great risk for suicide (45) and self-harm (36). This group feels more pressure and frustration because of their victimization experience, and according to
Another goal of this study was focused on comparison of the consequences of traditional bullying to those of cyberbullying. It seems that cyber victimization is more dangerous than traditional victimization. This outcome is consistent with other research (24). This may be because cyberbullying can happen anywhere and anytime, so its victims think that they cannot stop their bullies and that they have no control over what might happen. This could lead them to develop learned helplessness. Research shows that learned helplessness can cause mental health problems (47), and this issue may be able to explain why cyber victimization has more consequences.
This study has some limitations including (a) using self-report questionnaires, students may make the more socially acceptable answer rather than being truthful; (b) this survey was developed for high school students, and thus the achieved results may not be generalized to other social groups; (c) because of the cross-sectional design of the study, the attained results can’t be interpreted as cause and effect relationships and (d) we did not consider other potential confounders, such as personality or family factors, which may have had an impact on the association between victimization and substance use, self-harm and suicide attempts.
This study shows that there is a difference between traditional and cyberbullying consequences and it is concluded that cyber victimization is more serious. Research findings indicated that those who experienced both kinds of bullying require more attention, especially for self-harm and suicide attempts. The present study suggests that any kind of bullying needs immediate intervention to reduce the negative effects of the victimization experience. In addition, prevention programs should consider the possible effects of traditional and cyber victimization on substance use, self-harm, and suicide attempts in students.