Cyber Bullying and Physical Bullying in Adolescent Suicide: The Role of Violent Behavior and Substance Use

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Cyber Bullying and Physical Bullying in Adolescent Suicide: The Role of
Violent Behavior and Substance Use
Article
in Journal of Youth and Adolescence · February 2013
DOI: 10.1007/s10964-013-9925-5 · Source: PubMed
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E M P I R I C A L R E S E A R C H
Cyber Bullying and Physical Bullying in Adolescent Suicide:
The Role of Violent Behavior and Substance Use
Brett J. Litwiller • Amy M. Brausch
Received: 6 November 2012 / Accepted: 29 January 2013 / Published online: 5 February 2013
Ó Springer Science+Business Media New York 2013
Abstract The impact of bullying in all forms on the
mental health and safety of adolescents is of particular
interest, especially in the wake of new methods of bullying
that victimize youths through technology. The current
study examined the relationship between victimization
from both physical and cyber bullying and adolescent
suicidal behavior. Violent behavior, substance use, and
unsafe sexual behavior were tested as mediators between
two forms of bullying, cyber and physical, and suicidal
behavior. Data were taken from a large risk-behavior
screening study with a sample of 4,693 public high school
students (mean age = 16.11, 47 % female). The study’s
findings showed that both physical bullying and cyber
bullying associated with substance use, violent behavior,
unsafe sexual behavior, and suicidal behavior. Substance
use, violent behavior, and unsafe sexual behavior also all
associated with suicidal behavior. Substance use and vio-
lent behavior partially mediated the relationship between
both forms of bullying and suicidal behavior. The com-
parable amount of variance in suicidal behavior accounted
for by both cyber bullying and physical bullying under-
scores the important of further cyber bullying research. The
direct association of each risk behavior with suicidal
behavior also underscores the importance of reducing risk
behaviors. Moreover, the role of violence and substance
use as mediating behaviors offers an explanation of how
risk behaviors can increase an adolescent’s likelihood of
suicidal behavior through habituation to physical pain and
psychological anxiety.
Keywords Adolescence  Suicide  Bullying  Cyber
bullying  Substance abuse  Violence
Introduction
For American youth between the ages of 10 and 24, suicide
ranks as the third leading cause of death (Murphy et al.
2012). Recent increases in adolescent suicide rates have
motivated attempts to identify and understand the causes of
adolescent suicide (Cash and Bridge 2009). Research
findings (e.g., Klomek et al. 2010) and media reports of
adolescent suicides (e.g., Cloud 2010) have identified
bullying as an environmental stress that substantially
increases an adolescent’s suicide risk. A large amount of
theoretical and empirical evidence supports this relation-
ship between bullying and adolescent suicide. Bullying
consists of intentional and repeated aggression that
involves a disparity of power between the victim and the
perpetrator (Olweus 1993). Recent studies of bullying
prevalence show that approximately 20–35 % of adoles-
cents report involvement in bullying as a bully, victim, or
both (Levy et al. 2012). Given the high prevalence of
bullying in adolescence and its association with suicide
risk, it is crucial to further study this relationship.
Bullying in adolescence has been identified as occurring
in different forms, with different prevalence rates for the
various forms. Bullying behavior generally takes one of
four forms: physical (i.e., assault), verbal (i.e., threats or
insults), relational (exclusion or rumor spreading), and
cyber (i.e., aggressive texts or social network posts) (Wang
et al. 2009). Previous findings from longitudinal and cross-
B. J. Litwiller
Industrial/Organizational Psychology, University of Oklahoma,
455 West Lindsey Street, Norman, OK 73019, USA
A. M. Brausch (&)
Department of Psychology, Western Kentucky University,
1906 College Heights Blvd., Bowling Green, KY 42101, USA
e-mail: [e-mail]
123
J Youth Adolescence (2013) 42:675–684
DOI 10.1007/s10964-013-9925-5

sectional research have shown that each of these types of
bullying can increase the risk of a victimized adolescent
experiencing suicidal thoughts and behaviors (Klomek
et al. 2010). Several differences between cyber bullying
and more traditional forms of bullying have been identified.
Specifically, cyber bullying is perceived as different from
other types of bullying by victims (Slonje and Smith 2008)
more likely to occur outside of school (Smith et al. 2008).
Unlike victims of the other three types of bullying, victims
of cyber bullying are more likely to report depressive
symptoms than cyber bullies or bully-victims (Wang et al.
2011). Current research suggests that cyber bullying occurs
with less prevalence than the other types of bullying, but
still affects around 10–20 % percent of adolescents who
report being bullied or bullying others electronically
(Ybarra, Boyd, et al. 2012; Ybarra, Mitchell, et al. 2012).
The experience of bullying in childhood and adolescence is
important to study as research has shown that childhood
bullying predicts adult suicide attempts (Meltzer et al.
2011) as well as suicide deaths by the age of 25 (Klomek
et al. 2009).
Although each form of bullying has been shown to relate
to adolescent suicide, significant uncertainty exists
regarding the relationship between victimization from
bullying and suicidal behavior. Currently, there are no
empirically supported answers to questions of why vic-
timization increases the risk for suicidal behavior or how
the effects of cyber bullying compare to the effects of
specific traditional forms of bullying (e.g., physical, verbal,
and relational). A widely supported theory of suicide eti-
ology, called the interpersonal theory of suicide, appears to
have tremendous value for explaining the effects of bul-
lying on suicidal behavior (Joiner 2005). The interpersonal
theory of suicide posits that thwarted belongingness and
perceived burdensomeness cause suicidal desire. The the-
ory further states that individuals with high amounts of
suicidal desire only become capable of engaging in suicidal
behavior through habituation to the physically painful and
anxiety provoking nature of self-harming behaviors (Van
Orden et al. 2010).
Bullying and Suicidal Behavior
In the context of the interpersonal theory of suicide, vic-
timization from bullying would represent an environmental
cause of thwarted belongingness, perceived burdensome-
ness, and ultimately suicidal desire. Victimization from
bullying has been shown to associate with low self-esteem
(Juvonen et al. 2000), anxiety (Kumpulainen et al. 1998),
and depression (Fekkes et al. 2004; Klomek et al. 2007).
Low self-esteem, anxiety, and depression also have all
been identified as correlates of thwarted belongingness and
perceived burdensomeness (Van Orden et al. 2008; Van
Orden et al. 2012). To result in suicidal behavior, victim-
ized adolescents who are habituated to the physical and
psychological pain associated with suicidal behavior may
then develop suicidal desire and capability. Consequently,
one attempt to explain how bullying results in suicidal
behavior is to examine risk behaviors that co-vary with
both bullying and suicidal behavior and may habituate
adolescents to physical pain and psychological anxiety.
Joiner (2005) proposed that painful and provocative
behaviors, such as drug use, prostitution, and violent
behavior may provide pathways to an acquired capability
for suicidal behavior. In adults, these painful and provoc-
ative behaviors have been shown to increase an individ-
ual’s capability for self-harm (Van Orden et al. 2008). The
current study attempted to examine some behaviors that
may result in habituation to physical pain and emotional
distress that also relate to bullying in an adolescent sample.
Risk Behaviors
Several painful and provocative behaviors have been iden-
tified consistently as behaviors that relate to both bullying
and adolescent suicidal behavior. Of all such risk behaviors,
alcohol and/or illicit drug use has most frequently been
shown to relate to bullying and suicidal behavior. Victim-
ization from bullying generally has been shown to associate
with or predict adolescent alcohol/drug use (Mitchell et al.
2007; Windle 1994). Findings from these studies of bullying
victimization and alcohol use suggest that experiences of
bullying produce negative psychological states that increase
the probability than an adolescent will engage in substance
use. This view of alcohol use as a means to cope with neg-
ative affect is consistent with past research related to the
etiology of adolescent substance use (Sher, Grekin, and
Williams 2005). Findings from other studies also have
shown substance use to increase an adolescent’s risk of
performing suicidal behaviors (Bolognini et al. 2003; Dey-
kin and Buka 1994; Fombonne 1998; Spirito et al. 2003).
These findings suggest that substance use may contribute to
habituation of physical pain and psychological anxiety
associated with self-harm. Specifically, substance use may
enable adolescents already experiencing suicidal desire
to perform suicidal behaviors by decreasing inhibition,
encouraging self-harming behaviors, and exacerbating pre-
existing negative moods (Gould et al. 1998).
Like substance use, the amount of violent or physically
aggressive behavior exhibited by adolescents also relates
positively to victimization from bullying and suicidal
behavior. In particular, adolescents who experience phys-
ically violent victimization have been shown to be more
likely to act violently towards others (Cleary 2000; Ma
2001; Nickerson and Slater 2009). Klomek et al. (2007)
found that adolescents who reported being both a bully and
676 J Youth Adolescence (2013) 42:675–684
123

a victim of bullying were most at risk. Taken together,
these findings related to bullying and the performance of
violent behavior suggest a possible cyclical relationship
between being a victim of violent bullying and violently
bullying others. Additional studies also have shown that
engaging in violent behavior increases the probability that
an adolescent will perform suicidal behavior (Borowsky
et al. 2001; Evans et al. 2001). The findings regarding
bullying, violent behavior, and suicidal behavior support
theoretical views that physical pain and psychological
anxiety provoked by violent behavior may habituate ado-
lescents to the physical and psychological pain associated
with suicidal behavior (Joiner 2005).
Unsafe sexual behavior, such as unprotected sex,
anonymous sex, or coerced sex, constitutes a third painful
and provocative behavior that co-varies with both bullying
and adolescent suicidal behavior. Specifically, adolescents
who reported being victims of relational or verbal bullying
have been found to be more likely to engage in unsafe
sexual behavior (Zweig et al. 2002). These findings suggest
that sexual behavior may represent a means of coping with
negative psychological consequences of victimization.
Investigations of these behaviors demonstrate that unsafe
sexual behavior may have consequences comparable to
victimization. Several studies have shown that unsafe
sexual behavior increased the likelihood that an adolescent
would engage in suicidal behavior (Houck et al. 2008;
Silverman et al. 2001). Like violent behavior and substance
use, repeated experiences of unsafe sexual behavior may
habituate adolescents to the physical pain and psycholog-
ical anxieties associated with suicidal behavior and exac-
erbate any suicidal desire caused by being a victim of
bullying.
Rationale and Hypotheses
The present study attempted to examine the role of
painful and provocative risk behaviors as potential
explanations for how adolescents who are bullied acquire
the ability to perform suicidal behaviors. This study also
attempted to determine if a novel form of bullying, cyber
bullying, had a similar relationship with suicidal behavior
as a physical bullying. To examine these research ques-
tions, the study tested two different models that predicted
adolescent suicidal behavior. Each model used a different
form of bullying, cyber or physical, to predict suicidal
behavior. Both models hypothesized that the amount of
bullying experienced by an adolescent would positively
predict substance use, violent behavior, unsafe sexual
behavior, and ultimately suicidal behavior. Additionally,
hypotheses presented by the models posited that sub-
stance use, violent behavior, and unsafe sexual behavior
would each uniquely predict suicidal behavior and
mediate the relationship between both forms of bullying
and suicidal behavior. If supported as mediators, sub-
stance use, violent behavior, and unsafe sexual behavior
would provide three related explanations for how ado-
lescents who experienced bullying acquired the capability
to perform suicidal behavior.
Method
Participants and Procedure
Data for the current study were accessed from an existing
database of a large-scale community mental health
screening in a rural area of a Midwestern state in the US
The data collection occurred in the spring of 2008 and was
collected from 27 high schools in a seven-county region.
All high schools in the region received the opportunity
to participate in the survey. Regional enrollment for all
high schools for the academic year was 7,232 and 4,693
students completed the survey, for a participation rate of
65 %. A local coalition, sponsored by the community hos-
pital, conducts biennial screenings of area high schools for
prevalence and prevention purposes, and received approval
from the hospital’s Human Subjects Review Board. Simi-
larly, the authors consulted with the university Institutional
Review Board with whom both authors were previously
affiliated, and received approval for analyzing an archival
data set. The coalition utilized passive parental consent,
and students were not asked to sign assent documents to
protect confidentiality of students at schools with low
enrollment (e.g., total student body \100).
Adolescents were between the ages of 14 and 19 years
old (M = 16.11, SD = 1.20) and were all high school
students. The ethnic distribution of the sample was 89 %
White, 1.5 % Black, 1.5 % Hispanic, 1.0 % Asian, 2.0 %
American Indian, 1.0 % Native Hawaiian or other Pacific
Islander, and 3.6 % multi-racial. The sample had a near
equal distribution of participants in the freshmen, sopho-
more, junior, and senior grade levels. Participant sex was
equally distributed with 47 % percent of the sample male,
47 % female, and 6 % of participants not identifying a sex.
Data collection took place at schools attended by the
adolescents during school days. Generally, data was col-
lected from large groups of students who sat at individual
desks in classrooms. Before beginning the survey, research
assistants and staff from the coalition instructed adoles-
cents that their participation was completely voluntary and
that they could stop at any time for any reason. Students
were told to mark their responses on a bubble sheet and
avoid marking any identifying information on the response
sheet or survey packet. Throughout the survey, project staff
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