A new study confirms the emotional harm caused by cyberbullying in adolescents, particularly the most vulnerable youth.

The study showed significant increases in depression and anxiety among adolescent psychiatric inpatients and outpatients who were recent victims of cyberbullying.

“We found what some of the other literature has shown, with higher levels of depression and anxiety in victims of cyberbullying. This was shown in two different settings, inpatient and outpatient, and in two different states, New York and Florida,” co–first author Samantha Saltz, MD, from University of Miami Miller School of Medicine in Florida, told Medscape Medical News.

“When we do a psychiatric interview, we ask all of our patients about physical abuse, we ask about sexual abuse, we ask about neglect, but we don’t specifically ask about bullying and cyberbullying, and nowadays, those kinds of victimizations actually may be more prevalent than other kinds of abuse. We just might not be identifying it,” said Saltz.

The study was presented here May 5 at the American Psychiatric Association (APA) 2018 annual meeting.

High Anxiety, Depression

With co–first author, Nils Westfall, MD, also from University of Miami Miller School of Medicine, the investigators examined associations of recent cyberbullying with depression and anxiety among 51 adolescent psychiatric inpatients (mean age, 15 years) and 50 adolescent psychiatric outpatients (mean age, 14 years).

The vast majority of adolescent inpatients (94%) and outpatients (100%) had ready access to electronic social media via a phone or computer and reported recent use of online social media, “making them very vulnerable to cyberbullying,” Westfall told Medscape Medical News. Inpatients used a wider variety of online social media than outpatients. Such media included Facebook, instant messaging, and online chat rooms.

The prevalence of recent cyberbullying was higher in inpatients than outpatients (23% vs 10%) and among girls (29% female inpatients and 15% female outpatients). Female inpatients were 4.6 times more likely to be a victim of cyberbullying than their male peers, and female outpatients were 3.4 times more likely to be a victim than their male peers.

The most common mode of cyberbullying was phone texting.

“It’s important to look not just at social media use but specific types of social media, because the risk of being cyberbullied may differ a lot by the type of social media teenagers are using,” Westfall said. “For prevention purposes and trying to address this problem, it would be good to know where people are actually being cyberbullied.”

Among both inpatients and outpatients, being cyberbullied was associated with about a 1.5 standard deviation (SD) increase in depressive symptoms and about a 1 SD increase in anxiety on standard scales.

Among outpatients, levels of total anxiety, panic, generalized anxiety, and school-related anxiety were significantly greater by roughly two to three times, and there was a strong trend toward greater levels of separation anxiety among cyberbullying victims compared to nonvictims.

Given how common cyberbullying is and its associations with worsening mental health, simple age-appropriate screening instruments for cyberbullying are needed. Such screening may facilitate prevention efforts and improve care, the researchers say.

“We would encourage all psychiatrists, especially child psychiatrists, to incorporate cyberbullying into their general interview. Social media is now a big part of adolescents’ social life. It absolutely should be asked in primary care as well,” said Saltz.

Major Problem

Reached for comment, Shannon Bennett, PhD, clinical site director of the Youth Anxiety Center at New York–Presbyterian Hospital and clinical psychologist at New York–Presbyterian Hospital and Weill Cornell Medicine, said this study “adds useful statistics” about the frequency of reported recent cyberbullying in both inpatient and outpatient youth and the association with depression and anxiety.

Bennett cautioned that these data do not explain causal relationships between cyberbullying and reported anxiety and depression symptoms. “More research is needed to understand the role of cyberbullying in youth reports of anxiety, depression, and traumatic stress in both inpatient and outpatient contexts,” she noted.

“Cyberbullying is a significant problem,” said Bennett, “particularly for youth who are already vulnerable because of mental health symptoms, prior trauma experience, or history of inpatient and/or outpatient treatment. Clinicians should ask their patients about experiences of cyberbullying.”

To address the problem, schools and youth agencies “must continue to make youth aware of the negative consequences of bullying, whether in person or online, through awareness campaigns and activism, and also denote safe spaces for youth to disclose and discuss their experiences of bullying,” said Bennett. “Clinicians can partner with parents and schools when bullying is reported by a patient in order to protect the child and assess the personal and psychological consequences of the bullying experience,” she added.

Earlier this week, First Lady Melania Trump launched an awareness campaign called Be Best, which is aimed at combating cyberbullying and teaching children the importance of social awareness, self-awareness, positive relationship skills, and responsible decision making.

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