Addressing Cyberbullying, Suicidality, Suicide, and Psychological Distress in Youth Populations: Clinical Implications for Mental Health Counselors

Professional Resource Article

Abstract

Understanding the impact of social media and technology on child and adolescent mental health is paramount in improving clinical approaches and overall behavioral outcomes. The increase in electronic communication modalities such as Facebook, WhatsApp, TikTok, and Snapchat by youth in America has led to a revision of therapeutic practices to address the current patient's needs. A poll by the United Nations International Children's Emergency Fund (UNICEF) found that in 30 countries, one-third of students reported that being cyberbullied was associated with higher-income families than lower-income families (UNICEF, 2019). According to the 2019 Youth Risk Behavior System Surveillance (YRBSS), 15.7% of students have been victims of cyberbullying in the previous year in the United States (Stopbullying.gov, 2021). International communities have explored the impact of cyberbullying on child and adolescent populations; however, limited research on clinical practice in the United States has been conducted (Byers, Mishna, and Solo, 2019). Cyberbullied students have higher rates of selfharm, suicidality, suicide, substance abuse, and gender differences than in-person bullying. The access and increase of usage of electronic devices by youth have led to higher exposure rates and susceptibility/development of mental health illnesses. By mental health counselors implementing a holistic, systemic approach, mindfulness-based therapies, updating clinical intake questionnaires, and identifying at-risk populations through school belonging programs, youth can process their phenomenological experiences. This article discusses the challenges and implications of cyberbullying on adolescent and youth populations and the future of counseling research and clinical practices.

Keywords: Clinical practice, cyberbullying, suicide, suicidality, social media

Introduction

Cyberbullying is using electronic devices where content can be shared online, SMS, forums, chatrooms, or social media and viewed by others to communicate mean-spirited messages to intimidate, harass, shame, or spread false information about another person (Stopbullying.gov, 2021). Pew research center reported that 81% of adolescents use social media (Memon, Shive, Mohite, Jain, 2018). During the Covid-19 Pandemic of 2020, there was a notable increase in suicide attempts by 50% in female populations and a 4% increase in male populations for ages 12-17 compared to the 2019 statistics (Smith-Schoenwalder, 2021). Based on currently limited data collected from the Covid-19 pandemic, researchers found that the number of students who experienced online bullying decreased due to online learning; the rates have returned to pre-pandemic levels as children and adolescents return to in-person learning (Martinez and Temkin, 2021)—as such, addressing the challenges currently impacting this vulnerable population is imperative. Cyberbullying victims reported higher risk-taking behaviors of self-harm, substance use, and sexting (Long and Dowdell, 2021). Victims are more likely to seek out online relationships to validate and accept their behaviors through watching videos online and chatting online with others to gain acceptance. At the same time, they may find acceptance for self-destructive behaviors or become subjected to online abuse (Long and Dowdell, 2021, Memon et al., 2018). For these reasons, it is essential to understand the underlying issues to clinical challenges when counseling cyber victims and perpetrators of cyberbullying. The higher use of online and social networking accounted for higher psychological distress, suicidality, and lower self-esteem (Memon et al., 2018). Many studies have examined traditional bullying, and fewer have focused on the escalating cyberbullying crisis. Much research has conclusively indicated that internet usage alters human psychological behavior. Cyberbullying is the new frontier that clinicians and communities must contend with and implement a systematic, holistic treatment and pragmatic program development approach.

Self-harm and suicidality in adolescents experiencing cyberbullying.

The prevalence of self-harm and suicidality in children and teenagers has been identified as increasing risk factors for cyberbullying. However, research on the influence of cyberbullying on suicidality and self-injury is limited. Although self-injurious behavior in adolescents is not always associated with suicide intent, self-injury typically starts around 13 or 14 years of age. (Fridh, Lindstrom, and Rosvall, 2019). A study in Sweden involving many 9th and 12th grade students identified a strong correlation between self-injury and cyberbullying. A significant contribution from the student found that adolescents who experienced mental distress for at least two weeks consecutively are often socioeconomically disadvantaged, involved in cyberbullying, and reported higher levels of risky lifestyles such as tobacco, alcohol, and narcotics. This association between self-injury and peer victimization in cyberspace, especially among victims and bully-victims, is a significant public health concern that needs to be addressed since 20-30% of these cases of self-harm among children and adolescents, according to the study, could be prevented if cyberbullying was addressed (Fridh, Lindstrom and Rosvall, 2019). This previous study design is limited by not establishing causal relationships on whether cyberbullying encourages adolescents to self-injure or whether adolescents who engage in this behavior have a higher risk of experiencing cyberbullying.

One limitation of this past research is its focus on participants in a clinical setting, failing to provide insight into the generalizability of the other populations, which could have many unreported cases of self-harm due to cyberbullying. Although an association has been identified, examining the impacts and risk factors associated with self-injurious behaviors and suicidality experienced by adolescents involved in cyberbullying is crucial. A systematic review of 66 studies identified repetitive factors that influence the impact of cyberbullying on suicidal behavior and self-harm. The review reported that mental health problems, loneliness, sexual orientation/gender identity, and substance abuse were all associated with a high risk of suicide and selfharm, such as self-cutting and self-burning. (Dorol-Beauroy- Eustache and Mishara, 2021). An even higher risk for suicidality and self-harm could arise from adolescents experiencing disabilities or specific medical conditions since these children have a higher incidence of cyberbullying. Another cross-sectional study on 14–17-year-old adolescents in Australia found that a history of sexual activity and eating disorders among bullying victims had a higher risk of involvement in suicidality and selfinjury. The study further examines the percentages of self-harm with a 32.8% prevalence in cyberbullying victims compared to a 22.3% prevalence in traditional bullying; Suicidality, in contrast, suicidality had a 34.4% in cyberbullying victims, while traditional bullying had a prevalence of 21.6%. This finding implies a higher prevalence of self-harm and suicidality in cyberbullying victims than in traditional bullying victims, with girls at a higher risk of experiencing suicide attempts and self-harm than boys. (Islam, Yunus, Kabir, and Khanam, 2022).

Further investigation of cyberbullying and self-injurious behavior could provide insight into policy efforts to reduce the prevalence of cyberbullying and strategies for additional appropriate coping mechanisms among adolescent populations. Children and adolescents with these risk factors may have an increased association with cyber discrimination or stigmatization, which may exacerbate depression symptoms and lead to youth selfharming, suicidality, and suicide if no social support is available.

Research by Wang et al. (2019) found that one-third of its adolescents were involved in bullying. However, the author's findings outline the overlap of traditional bullying and cyberbullying links with several studies that demonstrate an association between the role of cyberbullying nonsuicidal selfinjury (NSSI) in adolescents and dispositional mindfulness. Mindfulness refers to the self-awareness that emerges when one is conscious of their actions and thoughts in the present moment and nonjudgmentally to the unfolding experience moment by moment (Kabat-Zinn, 2003). The authors found that dispositional mindfulness is associated with higher levels of psychological well-being and lower psychological distress (Hanley et al., 2015, Tomlinson et al., 2018). Patients' selfawareness and efficacy are essential in developing self-esteem and a greater sense of self-efficacy.

In the two separate studies conducted on dispositional mindfulness, one conducted in China by Zhao et al. (2022) and the other conducted in Spain by Faura-Garcia, Orue, and Calvete (2021), adolescents found that dispositional mindfulness provides a deeper understanding of the relationship between cyberbullying victimization and NSSI among adolescents and its underlying mechanisms. However, researchers suggested that intervention and prevention strategies reduce emotional reactivity in youth to help stop cyberbullying victimization leading to the NSSI cycle (Zhao et al., 2022). Emotional reactivity is crucial as a mediator and is defined as a low threshold for negative emotional experiences, high emotional intensity, with a slow return to baseline (Nock et al., 2008). These findings show a relationship between emotional reactivity and cyberbullying victimization leading to the likelihood of engaging NSSI. Emotional reactivity is associated with dispositional mindfulness. Researchers indicated a higher association level with conditional mechanisms and the link between cyberbullying victimization and NSSI. Expanding upon these results in the United States for future studies would aid behavioral institutions and mental health practitioners in enhancing treatment for patients experiencing the sensation of NSSI. The clinical outcomes regarding the use of dispositional mindfulness interventions from Taiwan, China, and Spain are unique in cultural differences and are not directly comparable, given the variances in populations and demographics. Based on these factors, it is crucial to consider cultural settings as a limitation and to focus on adjusting the caveats when working with diverse populations. Culture is an important variable when developing standard questionnaires for those participating in a study or working with patients to connect the context of the bullying phenomenon to their phenomenological experience. Cultural competence is imperative for mental health counselors when utilizing these methods. The findings correlated with cyberbullying and NSSI demonstrate the effectiveness of dispositional mindfulness.

Clinical implications

Depression, anxiety, self-harm, suicidality, and suicide have been indicative of those with increased usage of online and social media access. Individual or group counseling has been utilized extensively in treating cyberbullying, victims, and perpetrators of bullying. Cognitive-behavioral therapy (CBT), Mindfulness-based interventions, and psychodynamic therapeutic approaches have been successful for individuals in gaining self-awareness and increasing self-esteem by building upon self-efficacy, addressing relational challenges, and reducing NSSI. However, with cyberbullying, a complex system of dynamics, users cannot overcome viewing negative comments or images that may be shared virally through telecommunications and cannot be removed from the internet, which increases the risk of mental distress, self-harm, suicidality, and suicide. The victims return to the cycle of NSSI behavior, cutting, and high-risk behaviors of substance abuse, suicide attempts, and sexting. Based on these assertations, it is evident that the future of program development and interventions should shift towards integrated approaches involving early detection, decreased screen time online, and increased cyber usage screenings and community involvement, with access to reporting abuse and supportive services for all parties involved (Byers, Mishna, and Solo, 2019).

Other clinical approaches, using trauma-focused approaches for victims and engaging the bully with counseling instead of the punitive approaches utilized by the educational systems, have elicited evidence-based outcomes (Martinez and Temkin, 2021). The use of peer leaders and school nurses in educational settings has been successful in locating victims and bullies within the educational system (Long and Dowdell, 2021). School nurses as frontline workers are the first step in cyberbullying intervention step due to being able to ask questions related to cyberbullying. Upon building rapport with youth patients, pediatric nurses can include screening, educating, and using questionnaires regarding excessive online behaviors, which can assist in working with atrisk youth (Long and Dowdell, 2021). These methods are adaptable for counselors; showing empathy, validating, and mirroring the patient's phenomenological experience of pain, shame, anger, and humiliation from the incidents allows for the expression of feelings of students who desire to extract retribution on bullies in a safe environment which can be then be explored and allows for the patient's ability to regain control over the incident and learn other means of coping with the trauma (Byers, Mishna, and Solo, 2019). In-person group counseling highlights bullying as not an isolated individual experience but a social phenomenon by bringing other victims together in shared suffering and recognizing social pain (Byers, Mishna, and Solo, 2019).

Protective factors associated with decreased suicidality and suicide were noted in public health interventions on behalf of the school and the student's home. The more a student felt they belonged within the school environment and the school climate was safe, the student was less likely to commit or attempt suicide after bullying (Hertz, Donato, and Wright, 2013). Schools should ensure a safe environment for students, which helps decrease bullying incidents and apply a systematic approach by involving a multi-layer approach that includes parents, teachers, and administrators, with an increased focus on the involvement of mental health counselors in the school's community.

Limitations

The limitations of this article are the variation in cultural differences and limited data on addressing cyberbullying and social media in the United States. The article did not cover the intensification of mass violence in schools based on bullying incidents. Gender identity was not explored due to limited data on the issues associated with the LGBTQA+ community and and cyberbullying. While interventions were suggested, the recommendations were not exhaustive.

Conclusion

The evolving generations of technology and social media usage by youth and adolescents need guidance and interventions conducive to the modern world. A complex, multi-faceted approach is necessary to address cyberbullying in youth populations, suicidality, suicide, and psychological distress, including substance abuse and NSSI. Future research should consider the implications of increasing screenings in assessments for clinical practitioners to include the questions related to hours of usage of electronic communications and questions regarding cyberbullying and in-person bullying. Gender identity and gender differences in approaches should be considered when assessing and developing treatment plans to address the needs of patients. Additional considerations are the social investments by practitioners to work with families, educational systems, and community organizations, to facilitate improved clinical and cultural outcomes from a phenomenological approach for children and youth.

Written By: Dr. Kimberly M. McCreary, Andrea V. Carcamo, & Rebekah Belkin

Dr. Kimberly McCreary, Andrea V. Carcamo, and Rebekah Belkin work for Orlando Health South Seminole Hospital. Dr. McCreary earned a bachelor’s in criminology from the University of South Florida, a Master’s in Counseling and Psychology from Troy University, and a Doctorate in Public Health Leadership from Georgia Southern University. Andrae V. Carcamo earned a Bachelor of Science in pre-clinical Health Science from University of South Florida. Rebehak Belkin completed a bachelor’s degree in Health Sciences. The team shares an interest in pediatric and adolescent research and medicine, volunteering in the community and working with vulnerable populations.

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