Introduction: The aim of this study was to examine whether (a) cyberbullying has unique associations with mental health problems, risk-taking, and self-harm behavior in victims and perpetrators when compared to school bullying and (b) if cyberbullying is associated with an additional burden for students already involved in school bullying. Methods: Data were collected from 6,561 students across 23 schools in Germany (grades 5–13). The sample was divided into the following four groups: cyber-only involvement (victims = 1.9%, perpetrators = 0.6%), school-only involvement (victims = 17.2%, perpetrators = 11.9%), dual involvement (victims = 5.7%, perpetrators = 2.9%), and noninvolvement (victims = 75.3%, perpetrators = 84.6%). Multilevel mixed-effects regression analysis was conducted to examine group differences in mental health (Strengths and Difficulties Questionnaire, KIDSCREEN-10), risk-taking, and self-harm behavior (e.g., substance use, suicide attempts). Results: Cyber-only bullying had unique associations with mental health problems and risk-taking behavior in victims (lower levels of peer relationship problems: p < 0.001, greater substance use: p < 0.05) and perpetrators (higher levels of peer relationship problems: p < 0.05) when compared to school-only bullying. Dual victims and perpetrators reported significantly more mental health problems (victims: χ2(5) = 221.58, p < 0.001; perpetrators: χ2(5) = 116.40, p < 0.001) and were more likely to report risk-taking and self-harm behavior (victims: χ2(7) = 115.15, p < 0.001; perpetrators: χ2(7) = 38.79, p < 0.001) than students involved in school-only bullying. Conclusion: Cyber-only bullying appears to be related to specific mental health issues beyond those associated with school-only bullying. Cyberbullying and school bullying go along with additive mental health problems, risk-taking, and self-harm behavior in both victims and perpetrators. Thus, bullying prevention and intervention programs should also target cyberbullying.

1.
Olweus
D
.
Bullying at school: basic facts and effects of a school based intervention program
.
J Child Psychol Psychiatry
.
1994 Oct
;
35
(
7
):
1171
90
.
2.
Gaffney
H
,
Farrington
DP
,
Espelage
DL
,
Ttofi
MM
.
Are cyberbullying intervention and prevention programs effective? A systematic and meta-analytical review
.
Aggress Violent Behav
.
2019 Mar
;
45
:
134
53
.
3.
Smith
PK
,
del Barrio
C
,
Tokunaga
RS
.
Definitions of bullying and cyberbullying: how useful are the terms?
In:
Bauman
S
,
Cross
D
,
Walker
J
, editors.
Principles of cyberbullying research: definitions, measures, and methodology [Internet]
.
New York (NY)
:
Routledge
;
2012
. p.
26
40
. Available from: https://www.taylorfrancis.com/chapters/defi-nitions-bullying-cyberbullying-useful-terms-peter-smith-cristina-del-barrio-robert-tokunaga/e/10.4324/9780203084601-14.
4.
Fischer
SM
,
John
N
,
Melzer
W
,
Kaman
A
,
Winter
K
,
Bilz
L
.
Traditional bullying and cyberbullying among children and adolescents in Germany – cross-sectional results of the 2017/18 HBSC study and trends
.
J Health Monit
.
2020 Sep 16
;
5
(
3
):
53
68
. Available from: https://edoc.rki.de/handle/176904/6980.
5.
Chudal
R
,
Tiiri
E
,
Brunstein Klomek
A
,
Ong
SH
,
Fossum
S
,
Kaneko
H
,
.
Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries
.
Eur Child Adolesc Psychiatry
.
2021 Apr 21
. [cited 2021 May 16]. Available from: https://link.springer.com/10.1007/s00787-021-01779-6.
6.
Cosma
A
,
Walsh
SD
,
Chester
KL
,
Callaghan
M
,
Molcho
M
,
Craig
W
,
.
Bullying victimization: time trends and the overlap between traditional and cyberbullying across countries in Europe and North America
.
Int J Public Health
.
2020 Jan
;
65
(
1
):
75
85
.
7.
Kowalski
RM
,
Limber
SP
.
Psychological, physical, and academic correlates of cyberbullying and traditional bullying
.
J Adolesc Health
.
2013 Jul
;
53
(
1
):
S13
20
.
8.
Waasdorp
TE
,
Bradshaw
CP
.
The overlap between cyberbullying and traditional bullying
.
J Adolesc Health
.
2015 May
;
56
(
5
):
483
8
.
9.
Barzilay
S
,
Brunstein Klomek
A
,
Apter
A
,
Carli
V
,
Wasserman
C
,
Hadlaczky
G
,
.
Bullying victimization and suicide ideation and behavior among adolescents in Europe: a 10-country study
.
J Adolesc Health
.
2017 Aug
;
61
(
2
):
179
86
.
10.
Jantzer
V
,
Haffner
J
,
Parzer
P
,
Resch
F
,
Kaess
M
.
Does parental monitoring moderate the relationship between bullying and adolescent nonsuicidal self-injury and suicidal behavior? A community-based self-report study of adolescents in Germany
.
BMC Public Health
.
2015 Dec
;
15
(
1
):
583
8
.
11.
Ossa
FC
,
Pietrowsky
R
,
Bering
R
,
Kaess
M
.
Symptoms of posttraumatic stress disorder among targets of school bullying
.
Child Adolesc Psychiatry Ment Health
.
2019 Dec
;
13
(
1
):
43
11
.
12.
Moore
SE
,
Norman
RE
,
Suetani
S
,
Thomas
HJ
,
Sly
PD
,
Scott
JG
.
Consequences of bullying victimization in childhood and adolescence: a systematic review and meta-analysis
.
World J Psychiatry
.
2017
;
7
(
1
):
60
.
13.
Wolke
D
,
Lereya
ST
.
Long-term effects of bullying
.
Arch Dis Child
.
2015 Sep
;
100
(
9
):
879
85
.
14.
Jantzer
V
,
Ossa
FC
,
Eppelmann
L
,
Parzer
P
,
Resch
F
,
Kaess
M
.
Under the skin: does psychiatric outcome of bullying victimization in school persist over time? A prospective intervention study
.
J Child Psychol Psychiatry
.
2021 Aug 16
.
15.
Reed
KP
,
Cooper
RL
,
Nugent
WR
,
Russell
K
.
Cyberbullying: a literature review of its relationship to adolescent depression and current intervention strategies
.
J Hum Behav Soc Environ
.
2016 Jan 2
;
26
(
1
):
37
45
.
16.
Ybarra
ML
,
Diener-West
M
,
Leaf
PJ
.
Examining the overlap in internet harassment and school bullying: implications for school intervention
.
J Adolesc Health
.
2007 Dec
;
41
(
6
):
S42
50
.
17.
Bauman
S
,
Toomey
RB
,
Walker
JL
.
Associations among bullying, cyberbullying, and suicide in high school students
.
J Adolesc
.
2013 Apr
;
36
(
2
):
341
50
.
18.
van Geel
M
,
Vedder
P
,
Tanilon
J
.
Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis
.
JAMA Pediatr
.
2014 May 1
;
168
(
5
):
435
42
.
19.
Hase
CN
,
Goldberg
SB
,
Smith
D
,
Stuck
A
,
Campain
J
.
Impacts of traditional bullying and cyberbullying on the mental health of middle school and high school students
.
Psychol Sch
.
2015 Jul
;
52
(
6
):
607
17
.
20.
Bonanno
RA
,
Hymel
S
.
Cyber bullying and internalizing difficulties: above and beyond the impact of traditional forms of bullying
.
J Youth Adolesc
.
2013 May
;
42
(
5
):
685
97
.
21.
Gini
G
,
Card
NA
,
Pozzoli
T
.
A meta-analysis of the differential relations of traditional and cyber-victimization with internalizing problems
.
Aggress Behav
.
2018 Mar
;
44
(
2
):
185
98
.
22.
Vieno
A
,
Gini
G
,
Lenzi
M
,
Pozzoli
T
,
Canale
N
,
Santinello
M
.
Cybervictimization and somatic and psychological symptoms among Italian middle school students
.
Eur J Public Health
.
2015 Jun 1
;
25
(
3
):
433
7
.
23.
Sticca
F
,
Perren
S
.
Is cyberbullying worse than traditional bullying? Examining the differential roles of medium, publicity, and anonymity for the perceived severity of bullying
.
J Youth Adolesc
.
2013 May
;
42
(
5
):
739
50
.
24.
Fletcher
A
,
Fitzgerald-Yau
N
,
Jones
R
,
Allen
E
,
Viner
RM
,
Bonell
C
.
Brief report: cyberbullying perpetration and its associations with socio-demographics, aggressive behaviour at school, and mental health outcomes
.
J Adolesc
.
2014 Dec
;
37
(
8
):
1393
8
.
25.
Cañas
E
,
Estévez
E
,
Martínez-Monteagudo
MC
,
Delgado
B
.
Emotional adjustment in victims and perpetrators of cyberbullying and traditional bullying
.
Soc Psychol Educ
.
2020 Sep
;
23
(
4
):
917
42
.
26.
Beckman
L
,
Hagquist
C
,
Hellström
L
.
Does the association with psychosomatic health problems differ between cyberbullying and traditional bullying
.
Emot Behav Diffic
.
2012 Sep
;
17
(
3–4
):
421
34
.
27.
Gradinger
P
,
Strohmeier
D
,
Spiel
C
.
Traditional bullying and cyberbullying: identification of risk groups for adjustment problems
.
J Psychol
.
2009 Jan
;
217
(
4
):
205
13
.
28.
Juvonen
J
,
Graham
S
,
Schuster
MA
.
Bullying among young adolescents: the strong, the weak, and the troubled
.
Pediatrics
.
2003 Dec 1
;
112
(
6
):
1231
7
.
29.
Copeland
WE
,
Wolke
D
,
Lereya
ST
,
Shanahan
L
,
Worthman
C
,
Costello
EJ
.
Childhood bullying involvement predicts low-grade systemic inflammation into adulthood
.
Proc Natl Acad Sci U S A
.
2014 May 27
;
111
(
21
):
7570
5
.
30.
Ossa
FC
,
Jantzer
V
,
Eppelmann
L
,
Parzer
P
,
Resch
F
,
Kaess
M
.
Effects and moderators of the Olweus bullying prevention program (OBPP) in Germany
.
Eur Child Adolesc Psychiatry
.
2021 Nov
;
30
(
11
):
1745
54
.
31.
Breivik
K
,
Olweus
D
.
An item response theory analysis of the Olweus bullying scale
.
Aggress Behav
.
2015 Jan
;
41
(
1
):
1
13
.
32.
Olweus
D
.
The revised Olweus bully/victim questionnaire
.
University of Bergen, Research Center for Health Promotion
;
1996
.
33.
Goodman
R
.
Psychometric properties of the strengths and difficulties questionnaire
.
J Am Acad Child Adolesc Psychiatry
.
2001 Nov
;
40
(
11
):
1337
45
.
34.
The KIDSCREEN Group Europe
.
Health-related quality of life screening instrument for children and adolescents – Deutsche Fassung [Internet]
.
2006
[cited 2021 Jan 23]. Available from: http://www.redi-bw.de/db/ebsco.php/search.ebscohost.com/login.aspx%3fdirect%3dtrue%26db%3dpdx%26AN%3dPT9004990%26site%3dehost-live.
35.
Nock
MK
,
Holmberg
EB
,
Photos
VI
,
Michel
BD
.
Self-Injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample
.
Psychol Assess
.
2007
;
19
(
3
):
309
17
.
36.
World Health Organisation & Centers for Disease Control and Prevention
.
Global school-based student health survey (GSHS) 2013 core questionnaire modules [Internet]
.
2013
[cited 2021 Jan 23]. Available from: https://www.who.int/ncds/surveillance/gshs/GSHS_Core_Modules_2013_English.pdf.
37.
StataCorp
.
Stata statistical software: release 16
.
College Station (TX)
:
StataCorp LLC
;
2019
.
38.
Craig
W
,
Harel-Fisch
Y
,
Fogel-Grinvald
H
,
Dostaler
S
,
Hetland
J
,
Simons-Morton
B
,
.
A cross-national profile of bullying and victimization among adolescents in 40 countries
.
Int J Public Health
.
2009 Sep
;
54
(
S2
):
216
24
.
39.
Wang
J
,
Iannotti
RJ
,
Nansel
TR
.
School bullying among adolescents in the United States: physical, verbal, relational, and cyber
.
J Adolesc Health
.
2009 Oct
;
45
(
4
):
368
75
.
40.
Scheithauer
H
,
Hayer
T
,
Petermann
F
,
Jugert
G
.
Physical, verbal, and relational forms of bullying among German students: age trends, gender differences, and correlates
.
Aggress Behav
.
2006 Jun
;
32
(
3
):
261
75
.
41.
Gámez-Guadix
M
,
Orue
I
,
Smith
PK
,
Calvete
E
.
Longitudinal and reciprocal relations of cyberbullying with depression, substance use, and problematic internet use among adolescents
.
J Adolesc Health
.
2013 Oct
;
53
(
4
):
446
52
.
42.
Hinduja
S
,
Patchin
JW
.
Bullying, cyberbullying, and suicide
.
Arch Suicide Res
.
2010 Jul 28
;
14
(
3
):
206
21
.
43.
König
A
,
Gollwitzer
M
,
Steffgen
G
.
Cyberbullying as an act of revenge
.
J Psychol Couns Sch
.
2010 Dec 1
;
20
(
2
):
210
24
.
44.
Wolke
D
,
Samara
MM
.
Bullied by siblings: association with peer victimisation and behaviour problems in Israeli lower secondary school children
.
J Child Psychol Psychiatry
.
2004 Jul
;
45
(
5
):
1015
29
.
45.
Campbell
MA
,
Whiteford
C
,
Duncanson
K
,
Spears
B
,
Butler
D
,
Slee
PT
.
Cyberbullying bystanders: gender, grade, and actions among primary and secondary school students in Australia
.
Int J Technoethics
.
2017 Jan
;
8
(
1
):
44
55
.
46.
Olweus
D
.
Cyberbullying: an overrated phenomenon
.
Eur J Dev Psychol
.
2012 Sep
;
9
(
5
):
520
38
.
47.
Wolke
D
,
Lee
K
,
Guy
A
.
Cyberbullying: a storm in a teacup
.
Eur Child Adolesc Psychiatry
.
2017 Aug
;
26
(
8
):
899
908
.
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