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Connecting Adolescent Suicide to the Severity of Bullying and Cyberbullying

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Connecting Adolescent Suicide to the Severity of

Bullying and Cyberbullying

Sameer Hinduja & Justin W. Patchin

To cite this article: Sameer Hinduja & Justin W. Patchin (2018): Connecting Adolescent
Suicide to the Severity of Bullying and Cyberbullying, Journal of School Violence, DOI:
10.1080/15388220.2018.1492417

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JOURNAL OF SCHOOL VIOLENCE
https://doi.org/10.1080/15388220.2018.1492417

Connecting Adolescent Suicide to the Severity of Bullying and

Cyberbullying
Sameer Hindujaa and Justin W. Patchinb
a
School of Criminology and Criminal Justice, Florida Atlantic University, Jupiter, Florida, USA; bDepartment of
Political Science, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA

ABSTRACT ARTICLE HISTORY

While previous studies have identified that school bullying and cyberbully- Received 13 October 2017
ing victimization among adolescents is associated with suicidal thoughts Accepted 14 May 2018
and attempts, no work has measured the severity of bullying incidents and
KEYWORDS
their impact on the youth at school within that context. As such, a survey
Suicide; suicidal ideation;
was distributed to a representative sample of U.S. youth between the ages bullying; cyberbullying;
of 12 and 17, and students who experienced either school-based or online adolescence
bullying were significantly more likely to report suicidal thoughts. Students
who reported being bullied at school and online were even more likely to
report not just suicidal thoughts, but also attempts. Those who were bullied
or cyberbullied in a way that affected them at school were also at a higher
risk for suicidal thoughts and attempts. We discuss how school commu-
nities can provide substantive instructional and emotional support to all
teens, particularly with the increased prominence of these issues over the
last decade.

According to the Centers for Disease Control and Prevention (CDC; 2015), suicide was the
second leading cause of death in the United States among 10- to 17-year-olds in 2015. What is
more concerning is that from 2000 through 2015, there was a marked rise (21%) of the age-
adjusted suicide rate (2015) of this same grouping of adolescents. These figures underscore the
significance of suicide as a top public health concern and call for a redoubling of our efforts to
understand why it occurs—as well as what schools, families, and communities can do to
prevent it.
Apart from these facts, numerous high-profile tragedies over the last 15 years have ostensibly
linked experience with school bullying and/or cyberbullying to teen suicide—even though the
weight of research has not identified a direct, causal link (Hinduja & Patchin, 2010, 2015). At the
same time, there has been an increase in the exploration of this link by researchers who seek to
determine how and why peer victimization can be a persistent risk factor for youth suicidal
ideation, attempts, and completions (Bauman, Toomey, & Walker, 2013; Hinduja & Patchin,
2010; Kim & Leventhal, 2008; Klomek, Sourander, & Gould, 2010; LeBlanc, 2012; Van Geel,
Vedder, & Tanilon, 2014).
In the current study, we analyze recent data from a national sample of middle and high
schoolers in the United States to measure the association between school bullying, cyberbully-
ing, and suicidal thoughts and attempts. We move beyond previous inquiries into these
relationships by then focusing specifically on the school bullying and cyberbullying incidents
that respondents deemed to be of a serious nature, or that significantly impacted their ability to
learn at school. Implications stemming from the findings are discussed in conclusion with a

CONTACT Sameer Hinduja hinduja@fau.edu School of Criminology and Criminal Justice, Florida Atlantic University,
Jupiter, FL, USA
© 2018 Taylor & Francis Group, LLC
2 S. HINDUJA AND J. W. PATCHIN

focus on mitigating the impact of school bullying and cyberbullying as a possible way to
prevent teen suicide.

Nature and extent of school bullying, cyberbullying, and youth suicide

Due to its presence at the forefront of scholarly research agendas in disciplines that work with
adolescents, the CDC recently convened a number of experts to develop the following uniform
definition of bullying: “any unwanted aggressive behavior(s) by another youth or group of youths
who are not siblings or current dating partners that involves an observed or perceived power
imbalance and is repeated multiple times or is highly likely to be repeated” (Gladden, Vivolo-
Kantor, Hamburger, & Lumpkin, 2014, p. 7). This largely mirrors definitions historically posited by
other researchers (Espelage & Swearer, 2003; Manning, Heron, & Marshal, 1978; Nansel et al., 2001;
Olweus, 1995). What is more, these definitions have informed conceptualizations of cyberbullying
(arguably a subset of the general term “bullying”), which has been defined as “willful and repeated
harm inflicted through the use of computers, cell phones, and other electronic devices” (Hinduja &
Patchin, 2015, p. 11). Essentially, cyberbullying is bullying perpetrated online or otherwise carried
out using technology.
According to the 2015 Youth Risk Behavior Surveillance System data (the most recent year
available), slightly more than one fifth (20.2%) of students in Grades 9–12 reported that they were
bullied at school, while 15.5% were bullied online during the previous year (Kann, 2016). Similarly,
the National Crime Victimization Survey’s School Crime Supplement report that 20.8% of students
had been bullied at school (also in 2015), and 11.5% of those said it happened online or by text
(National Center for Education Statistics, 2016). Often, targets have no escape from mistreatment as
studies have indicated an overlap where those who are bullied at school are also bullied online
(Erdur-Baker, 2010; Juvonen & Gross, 2008; Raskauskas & Stoltz, 2007; Wang, Iannotti, & Nansel,
2009), and that in some of those cases, it is the very same aggressor who seeks to inflict harm
(Ybarra, Diener-West, & Leaf, 2007). What is more, a compounding effect of victimization may
result, as youth targets experience multiple forms of bullying (physical, relational, verbal, and cyber)
at or around the same time (e.g., in one recent study, 50.3% of those who had been bullied reported
experiencing all four forms in the past month; Waasdorp & Bradshaw, 2015).
With regard to demographics, research generally shows that boys are more heavily involved in
school bullying (as a victim and offender), while girls are just as likely if not more likely to be
involved in online bullying (Hinduja & Patchin, 2015). Findings do vary, though, depending on how
school bullying and cyberbullying are defined and measured—with girls often partaking in more
indirect and relational forms of aggression while boys are more likely to physically bully their peers
(Archer, 2004; Carbone-Lopez, Esbensen, & Brick, 2010; Li, 2006). Finally, studies that have
examined school bullying and cyberbullying by race have been largely inconclusive (Peskin,
Tortolero, & Markham, 2006; Wang et al., 2009). Students from all racial backgrounds experience
and participate in bullying, with no clear group consistently shown to be significantly more involved
than the others.
In terms of consequences, research has regularly found that experience with both school bullying
and cyberbullying contribute to a host of maladaptive emotional, psychological, behavioral, and even
physical problems. These include, but are not limited to: anger, self-pity, depression, anxiety, eating
disorders, and chronic illness (Bauman et al., 2013; Cowie & Berdondini, 2002; Gámez-Guadix,
Orue, Smith, & Calvete, 2013; Klomek, Marracco, Kleinman, Schonfeld, & Gould, 2007; Kowalski &
Limber, 2013; Natvig, Albrektsen, & Quarnstrom, 2001; Patchin & Hinduja, 2010, 2012; Seals &
Young, 2003; Takizawa, Maughan, & Arseneault, 2014). Minor and moderate forms of school
misbehaviors and violence have also been associated with cyberbullying in recent years (Ericson,
2001; Hay & Meldrum, 2010; Hinduja & Patchin, 2007; Nixon, 2014).
Suicide among school-aged youth is also an issue of great concern. The aforementioned Youth
Risk Behavior Surveillance System sheds light on the proportion of U.S. high school students who
 JOURNAL OF SCHOOL VIOLENCE 3

report suicidal ideation and attempts. In 2015, 17.7% seriously considered attempting suicide, 14.6%
made a plan, 8.6% attempted suicide, and 2.8% attempted suicide in a way that had to be treated by a
medical professional during the 12 months before the survey (Kann, 2016). For these attempts, girls
were involved more than boys—consonant with findings in other research (Lewinsohn, Rohde,
Seeley, & Baldwin, 2001). With respect to race and ethnicity, research has found that White students
are more likely than African-American and Hispanic students to attempt suicide, although the rate
among African-American adolescents has significantly grown since the turn of the century (Mueller,
James, Abrutyn, & Levin, 2015).

Bullying and suicidal ideation

Many studies have been conducted over the last two decades to measure the relationship between
face-to-face bullying and suicidal ideation (see e.g., Kaltiala-Heino, Rimpelä, Marttunen, Rimpelä, &
Rantanen, 1999; Kim, Koh, & Leventhal, 2005; Klomek et al., 2007; Mills, Guerin, Lynch, Daly, &
Fitzpatrick, 2004; Roland, 2002), and statistically significant associations have been found in ele-
mentary (van der Wal, De Wit, & Hirasing, 2003), middle (Seals & Young, 2003), and high school
(Klomek et al., 2007). A recent meta-analysis involving 34 studies and 66 independent effect sizes,
found that peer victimization was significantly related to suicidal ideation (OR = 2.23; 95% CI [2.10–
2.37]), while an examination of nine studies and 13 independent effect sizes showed that peer
victimization was significantly related to suicide attempts (OR = 2.55; 95% CI [1.95, −3.34]) among
adolescents (Van Geel et al., 2014).
The body of research exploring the relationship between cyberbullying and suicide has continued
to grow in recent years (Bauman, 2014). Hinduja and Patchin (2010) surveyed approximately 2,000
middle-school youth and found that school bullying victims were 1.7 times more likely and offenders
were 2.1 times more likely to have attempted suicide than those not involved in bullying. Similarly,
cyberbullying victims were 1.9 times more likely and offenders were 1.5 times more likely to have
attempted suicide than those not involved in cyberbullying (Hinduja & Patchin, 2010). Finally,
cyberbullying victimization was more strongly related to suicidal thoughts and behaviors than school
bullying victimization (Hinduja & Patchin, 2010).
These findings have been duplicated in more recent work (Hay & Meldrum, 2010; Van Geel et al.,
2014) and in general, cyberbullying victimization tends to be a consistent covariate of suicidal
ideation (Bauman, 2014; Jasso Medrano, Lopez Rosales, & Gámez-Guadix, 2017), although possibly
mediated by depressive symptomatology (Bauman et al., 2013). Indeed, the weight of empirical
evidence consistently points out that students who are involved in bullying offending and victimiza-
tion (Kindrick, Castro, & Messias, 2013; Messias, Kindrick, & Castro, 2014; Mills et al., 2004;
Sampasa-Kanyinga, Roumeliotis, & Xu, 2014; van der Wal et al., 2003) and/or cyberbullying
offending and victimization (Hay & Meldrum, 2010; Schneider, O’Donnell, Stueve, & Coulter,
2012; Van Geel et al., 2014) have an increased likelihood of suicidal thoughts, attempts, and
completed suicides.
The present work further examines the nature of the connection between suicide and bullying
(face-to-face and cyber) among a youthful population. It is clear that not all who experience bullying
consider suicide; however, those who are bullied appear to be at a higher risk. The present work
explores the self-reported seriousness and impact of the bullying victimization as a way to distin-
guish among bullying incidents. It is hypothesized that students who report that their experience
with school bullying or cyberbullying was relatively serious (based on their own subjective assess-
ment), or that the school bullying or cyberbullying significantly affected them at school, will be more
likely to report suicidal ideation and attempts.
4 S. HINDUJA AND J. W. PATCHIN

Participants and method

Data for the current study came from a survey administered to a nationally representative sample of
English-speaking 12- to 17-year-old middle and high school students residing in the United States
(M age = 14.5). A survey was distributed via e-mail between August and October of 2016 that
examined perceptions of, and experiences with, school bullying, cyberbullying, and related teen
behaviors, and took 23 minutes on average to complete. Nested age, sex, and region quotas were
used to ensure a diverse sample of respondents that was representative of students across the nation.
Parental consent and child assent was obtained for all participants, leading to a final response rate of
15%. Admittedly, this is lower than other methods of data collection and not ideal (Baruch &
Holtom, 2008; Kaplowitz, Hadlock, & Levine, 2004), and should be kept in mind when interpreting
the results (Fricker & Schonlau, 2002; Manfreda et al., 2008). However, as Cook, Heath, and
Thompson (2000, p. 821) persuasively argued, “response representativeness is more important
than response rate in survey research” (see also Johnson & Wislar, 2012). And our final sample of
2,670 was evenly divided by sex (49.9% female, 49.6% male) and comparable to the population of
middle and high school students in the U.S. (Office of Adolescent Health, 2016) by race (66% of the
sample is White/Caucasian, 12% is Black/African American, 11.9% is Hispanic/Latin American, and
10% were another race).

Measures
Suicidal ideation and suicide attempt
Two dependent variables were utilized in this study. The first, suicidal ideation, included four items
adapted from the American School Health Association (1989) National Adolescent Student Health
Survey. They included: In the past year, have you (a) felt so sad or hopeless almost every day for two
weeks or more in a row that you stopped doing some usual activities; (b) seriously thought about
attempting suicide; (c) made a specific plan about how you would attempt suicide; and (d) seriously
attempted suicide. Respondents indicated either “yes” or “no” to each of these questions, and so our
resultant summary scale ranges from 0–4 (M = 0.26; SD = 0.72) with higher values representing
more suicidal thoughts (Cronbach’s α = .73). We also used factor analysis (PCR) to establish
construct validity and found that all items loaded on a single factor (loadings ranged from .634 to
.872; eigenvalue = 2.60). To account for a negatively skewed distribution, responses were ultimately
dichotomized where respondents who scored 0 on the summary scale were coded 0 and those who
scored 1–4 were coded 1. In addition to suicidal ideation, we also wanted to focus on the subset of
students who have attempted suicide. Suicide attempt is a single-item indicator where students who
said they had actually attempted suicide in the previous year were coded 1 while those who did not
were coded 0.

Bullying victimization
The current analysis utilized two measures of bullying: one for school bullying and another for
cyberbullying. School bullying represents the respondent’s experience in the previous 30 days as a
victim of 10 different forms of school bullying. As noted in Table 1, the measure included a
variety of behaviors representing relatively minor and common forms of bullying (“I was called
mean names”) to more serious and less common forms (“I was threatened with a weapon”). The
response set for these questions was never, once, a few times, and many times. As such, our 10-
item summary scale ranges from 0 to 30 (M = 4.93; SD = 6.42) with higher values representing
more experience as a victim of bullying at school (Cronbach’s α = .91). Factor analysis results
indicated that all items loaded on a single factor (loadings ranged from .734 to .806;
eigenvalue = 6.00).
Cyberbullying represents the respondent’s experience in the previous 30 days as a victim of eleven
different forms of cyberbullying. As noted in Table 1, this measure also included a variety of
 JOURNAL OF SCHOOL VIOLENCE 5

Table 1. Descriptive statistics: Experience with bullying and suicide (N = 2,670).

Variable M SD Range % Cronbach’s α
School bullying victimization 6.60 6.93 0–30 .906
I was called mean names, was made fun of, or teased in a hurtful way 50.9
Other students left me out of things on purpose, excluding me from their group of 46.9
friends, or completely ignored me
Other students told lies or spread false rumors about me and tried to make others 43.3
dislike me
I was bullied at school 38.6
I was bullied with mean names, comments, or gestures with a sexual meaning 30.1
I was threatened or forced to do things I didn’t want to do 22.6
I was bullied with mean names or comments about my race or color 21.4
I was hit, kicked, pushed, shoved around, or locked indoors 20.5
I had money or other things taken away from me or damaged 19.2
I was threatened with a weapon such as a knife or gun while at school 8.3
I was bullied in a way that really affected my ability to learn and feel safe at school 40.5
On a scale of 0–10, bullied at school 6 or higher 24.5
Cyberbullying victimization 2.27 5.26 0–33 .945
Someone posted mean or hurtful comments about me online. 22.1
Someone spread rumors about me online, through text messages, or emails. 19.6
I was cyberbullied 16.5
Someone posted mean names, comments, or gestures about me with a sexual 12.3
meaning.
Someone threatened to hurt me while online. 11.7
Someone threatened to hurt me through a cell phone text message. 11.5
Someone posted a mean or hurtful picture online of me. 10.7
Someone pretended to be me online and acted in a way that was mean or hurtful 9.9
to me.
Someone posted mean names or comments online about my race or color. 9.7
Someone posted a mean or hurtful video online of me. 6.9
Someone created a mean or hurtful web page about me. 6.7
I was cyberbullied in a way that really affected my ability to learn and feel safe at 15.7
school
On a scale of 0–10, cyberbullied 6 or higher 20.7
Suicide
Suicidal ideation 0.26 0.72 0–4 0.730
Students who experienced suicidal ideation 16.1
Suicide attempts 2.1

behaviors (“Someone posted mean or hurtful comments about me online”; “Someone threatened to
hurt me while online.”). The response set for these questions was also never, once, a few times, and
many times. As such, our 11-item summary scale ranges from 0 to 33 (M = 2.70; SD = 5.98) with
higher values representing more experience as a victim of cyberbullying (Cronbach’s α = .95). Factor
analysis results indicated that all items loaded on one factor (loadings ranged from .751 to .875;
eigenvalue = 7.83).
Finally, to explore the importance of the magnitude (or relative seriousness) of the bullying
experience, we included four single-item indicators (two each for school bullying and cyberbullying)
that assess the respondent’s view of how serious the bullying incident was. We first asked students
who reported that they had been bullied (at school or online) to rate on a scale of 0 to 10 their overall
experience with school bullying and cyberbullying during the last 30 days, with 0 meaning they were
not bothered at all and 10 meaning they were really hurt and bothered (school bullying M = 3.76;
school bullying SD = 3.14; cyberbullying M = 4.64; cyberbullying SD = 3.31). Each measure was
dichotomized where those who rated their experiences as a 5 or lower were coded 0 while those who
rated their experiences as a 6 or higher were coded 1. Next, we asked respondents whether they had
been bullied or cyberbullied in a way that “really affected their ability to learn and feel safe at
school.” Students who responded that they had were coded 1 and those who had not were coded 0.
In addition to these primary variables of interest, we also included age, sex, and race in all models
to control for any effect these demographic features may have on suicidal ideation or attempts. Age
6 S. HINDUJA AND J. W. PATCHIN

was a continuous variable ranging from 12–17 (M = 14.4; SD = 1.66); Sex was dichotomized into
male respondents and female respondents (1 = male, 0 = female), while Race was dichotomized into
White and non-White (1 = White; 0 = African American, Asian, Hispanic, or another race). The
sample is evenly distributed when it comes to gender (49.6% were male) but less so when it comes to
race (68% were White).

Analysis
Statistical analyses were conducted using SPSS (version 20.0). Descriptive statistics were initially
computed to obtain baseline data on suicidal ideation and attempts, as well as with bullying and
cyberbullying experiences among the sample (see Table 1). Next, a series of logistic regression
models were computed to assess the effect of bullying and cyberbullying on suicidal ideation and
attempts. We first examined the relationship between bullying and suicide by focusing on subgroups
of targets who experienced (a) only school bullying, (b) only cyberbullying, and (c) both forms of
bullying. We computed models for these three indicators for suicidal ideation (Table 2, Models 1–3)
and suicide attempt (Table 3, Models 4–6). Then, we estimated odds ratios for the relationship

Table 2. Logistic regression analysis: The effect of bullying and cyberbullying victimization on suicidal ideation (N = 2,670).
Model 1 Model 2 Model 3
Variable b (SE) Exp(B) (95% CI) b (SE) Exp(B) (95% CI) b (SE) Exp(B) (95% CI)
Constant −3.14 0.04*** −2.98 0.05*** −3.58 0.03***
(0.50) (0.49) (0.52)
Male 0.04 (0.10) 1.04 [0.85, 1.27] 0.04 (0.10) 1.04 [0.86, 0.04 (0.11) 1.04 [0.85, 1.28]
1.27]
White 0.09 (0.12) 1.09 [0.86, 1.37] 0.11 (0.12) 1.12 [0.89, 0.04 (0.12) 1.04 [0.82, 1.32]
1.41]
Age 0.09 (0.03) 1.10** [1.03, 0.08 (0.03) 1.09* [1.02, 0.11 (0.03) 1.11** [1.04,
1.17] 1.16] 1.19]
School bullying (victimization only) 0.49 (0.14) 1.63*** [1.25,
2.12]
Cyberbullying (victimization only) 0.47 (0.21) 1.59* [1.06,
2.40]
Both school bullying and 1.69 (0.13) 5.41*** [4.20,
cyberbullying 6.98]
Nagelkerke R2 0.013 0.008 0.108
*p < .05; **p < .01; ***p < .001 (two-tailed).

Table 3. Logistic regression analysis: The effect of bullying and cyberbullying victimization on suicide attempts (N = 2,670).
Model 4 Model 5 Model 6
Variable b (SE) Exp(B) (95% CI) b (SE) Exp(B) (95% CI) b (SE) Exp(B) (95% CI)
Constant −6.88 0.00*** −6.98 0.00*** −8.29 0.00***
(1.31) (1.31) (1.37)
Male 0.20 (0.25) 1.22 [0.75, 0.20 (0.25) 1.22 [0.75, 0.21 (0.26) 1.24 [0.75, 2.05]
1.97] 1.97]
White 0.77 (0.35) 2.16* [1.07, 0.76 (0.35) 2.13* [1.07, 0.63 (0.36) 1.87 [0.93, 3.79]
4.31] 4.26]
Age 0.16 (0.09) 1.18 [0.99, 0.17 (0.09) 1.18* [1.00, 0.21 (0.09) 1.23* [1.04, 1.46]
1.39] 1.40]
School bullying (victimization −0.27 0.76 [0.34,
only) (0.41) 1.71]
Cyberbullying (victimization only) 0.23 (0.60) 1.02 [0.32,
3.33]
Both school bullying and 2.44 (0.29) 11.42*** [6.49,
cyberbullying 20.09]
Nagelkerke R2 0.022 0.021 0.165
*p < .05; **p < .01; ***p < .001 (two-tailed).
 JOURNAL OF SCHOOL VIOLENCE 7

between serious school bullying and cyberbullying (Table 4) among a subsample of only those
respondents who had been bullied or cyberbullied (while controlling for age, sex, and race).

Results
Across our sample, 16.1% of respondents experienced suicidal ideation (16.7% of females; 15.3% of
males) while 2.1% reported they had attempted suicide (2.2% of females; 2.0% of males). Even
though females have a markedly higher incidence rate of suicidal ideation than males during
adolescence (Lewinsohn et al., 2001), major gender disparities were not found in the current
study. With regard to school bullying, prevalence rates for individual behaviors ranged from 8.3%
to 50.9%. The most frequently cited form of school bullying was: “I was called mean names, was
made fun of, or teased in a hurtful way.” In terms of cyberbullying, prevalence rates for individual
behaviors ranged from 6.7% to 22.1% with the most commonly reported form being: “Someone
posted mean or hurtful comments about me online.” It is worth noting that the mean for the
summary scores for both school bullying (6.60) and cyberbullying (2.27) are on the lower end of
their range, indicating relatively infrequent experiences with bullying overall among this population.
Recall that the primary purpose of the current study was to establish if experience with school
bullying and cyberbullying was correlated with suicidal ideation and attempts. Before presenting
those results, it is necessary to account for the effect of age, race, and gender on suicidal ideation and
attempts. As noted in Tables 2 and 3, older students were generally more likely to report suicidal
ideation and to have attempted suicide, while White students were more likely to have attempted
suicide in two out of the six models (Table 3, Models 4 and 5).
Table 2 presents results of the logistic regression analysis examining the relationship between school
bullying and cyberbullying on suicidal ideation. Students who experienced only school bullying and
only cyberbullying were significantly more likely to report suicidal ideation (OR = 1.63 and 1.59,
respectively). Students who experienced both forms of bullying, however, were more than 5 times as
likely to report suicidal ideation compared to those who had not been bullied or cyberbullied (OR =
5.41). The explained variance of the model as a whole also demonstrates the disproportionate impact
of experiencing bullying in multiple environments. Only about 1% of the variation in suicidal ideation
can be explained by experience with school bullying or cyberbullying alone, but experiencing both
forms of bullying accounted for over 10% of the variation in suicidal ideation. Comparable results were
also identified when examining the relationship between experience with bullying and suicide attempts
(Table 3). Those who experienced only school bullying or only cyberbullying were at no greater risk for
attempted suicide, while those who experienced both forms of bullying were more than 11 times as
likely to attempt suicide compared to those who had not been bullied (OR = 11.42).
Finally, Table 4 presents the impact of serious bullying on suicidal thoughts and attempts among
subsamples of only those who had been bullied at school or online. As expected, even among those
who had been bullied, the more serious incidents all had a significant and positive association with
suicidal ideation and suicide attempts. Specifically, respondents who ranked their experience with

Table 4. Logistic regression analysis: The effect of serious bullying and cyberbullying victimization on suicide.
Suicidal ideation Suicide attempt
Variable OR 95% CI OR 95% CI
Among those bullieda
Bullying affected me at school 3.38*** [2.26, 5.07] 10.88*** [1.42, 83.63]
Bullying score of 6 or higher on seriousness scale (0–10) 3.31*** [2.61, 4.21] 4.21*** [2.37, 7.47]
Among those cyberbulliedb
Cyberbullying affected me at school 3.21*** [2.38, 4.34] 7.17*** [3.30, 15.62]
Cyberbullying score of 6 or higher on seriousness scale (0–10) 3.07*** [2.29, 4.10] 2.25** [1.24, 4.08]
Note. Odds ratios adjusted for age, sex, and race.
a
n = 1,786. bn = 943.
**p < .01; ***p < .001 (two-tailed).
8 S. HINDUJA AND J. W. PATCHIN

school bullying or cyberbullying as 6 or higher on a scale that ranged from 0 to 10, or indicated that
the experience seriously affected them at school, were more than three times as likely to report
suicidal ideation compared to those who had relatively less serious experiences with school bullying
and cyberbullying. Odds ratios were even higher in three out of four of the models examining the
effect of serious school bullying and cyberbullying on attempted suicide. In all cases, though,
students who reported that their experience with school bullying or cyberbullying affected them at
school were at the highest risk for suicidal ideation and attempted suicide.

Discussion
The current work explored the nature of the association between experience with school bullying
and cyberbullying, and suicidal ideation and attempts. In line with findings from previous studies
(Bauman, 2014; Hinduja & Patchin, 2010; Van Geel et al., 2014), middle and high school students
who experienced either school-based or online bullying were significantly more likely to report
suicidal ideation. Contrary to the relatively consistent finding in the limited research base that
cyberbullying victimization is more strongly tied to suicidal ideation and attempts than school
bullying (Hay & Meldrum, 2010; Hinduja & Patchin, 2010; Van Geel et al., 2014), we found a
stronger relationship with the latter. That said, experiencing both forms of bullying compounds the
negative effects and greatly increases the likelihood of suicidal ideation among adolescents.
When it comes to suicidal attempts, the present research did not find a significant association
with school-based or online bullying by themselves—contrary to findings from previous studies (see
e.g., Van Geel et al., 2014). However, experiencing both together was linked to an exponentially
higher likelihood of trying to take one’s own life. Perhaps some students can manage the emotional
and psychological harm associated with a limited amount of victimization in one environment or the
other, but are seemingly much less so able when the impact is amplified through its occurrence and
persistence both at school and online.
This point is supported by the relationship between the severity of incidents and suicidal ideation
and attempts. Those adolescents who rated their victimization as more severe (in terms of a general
evaluation of how much they were hurt and bothered, as well as its specific impact on their feelings
of safety at school and their ability to learn) were much more likely to report suicidal thoughts (more
than three times as likely) and attempts (from twice as likely for serious cyberbullying to more than
ten times as likely for school-based bullying), compared to those who experienced milder forms of
bullying. Collectively, these findings bear out the very tangible impact that bullying can have on the
mental health of youth today, especially if multiple forms combine and are magnified to plague a
student in pointedly negative ways.
As mentioned earlier, no research has shown a direct link between experience with school
bullying or cyberbullying and suicide (Hinduja & Patchin, 2010, 2015). That remains true when
considering the findings at hand. While there have been several tragic examples where teens have
taken their lives after being bullied, most youth who are bullied do not. To be sure, the factors that
lead to suicide are varied and complex, and at the mercy of many situational and contextual factors
(see Rodway et al., 2016 for a review of these across 145 studied suicides). The point is that there
exists a number of critical elements that can increase one’s suicide risk, particularly when they co-
occur with peer-based victimization. As such, an amalgamation of various painful internal and
external experiences—which may also consist of harm from school bullying or cyberbullying—seems
to most commonly lead to the ultimate tragic decision to end one’s life.

Limitations
As with any social science study, the current analysis suffers from methodological limitations that
merit acknowledgement. The primary shortcoming stems from the cross-sectional nature of the data.
Since the data were collected at one point in time, it is impossible to conclude that experience with
 JOURNAL OF SCHOOL VIOLENCE 9

school bullying or cyberbullying caused one to have suicidal thoughts or to attempt suicide (Bauman,
2014). The common concerns associated with asking students to self-report deviant behaviors also
need to be kept in mind when evaluating the current work. Even though the survey was conducted
online and respondents were reassured that their results would remain confidential to the maximum
extent allowable by law, experience with bullying or cyberbullying, along with suicidal thoughts and
attempts, may have been underreported or overreported for a variety of reasons. Relatedly, recall bias
may also have occurred. Some have argued that data which stem from individuals’ recollection about
the past is inherently unreliable because of the tendency for individuals to misrepresent, distort, or
forget facts from a previous time period (Himmelweit, Biberian, & Stockdale, 1978; Horvath, 1982;
Morgenstern & Barrett, 1974). However, we sought to minimize the influence of these concerns
through careful wording and revision of survey items, and feel reasonably confident that they do not
compromise the intentions and implications of the research.
Additionally, though we sought to obtain a nationally representative sample of middle and high
school students across the United States, we can never be certain of the generalizability of the sample
of youth who ultimately completed the surveys. Even though the demographic characteristics of the
sample are relatively consistent with those of U.S. youth as a whole, there could be uncontrolled for
differences between those who ultimately agreed to complete our survey and those who did not. This
is of particular concern given the relatively low response rate.

Prevention and future considerations

Even though most bullied youth do not commit suicide, the grave possibility that a small number
will necessitates that more be done at school and in the community to safeguard vulnerable youth
(Messias et al., 2014). The breadth and depth of bullying prevention programming is many times still
left to the discretion of individual schools, who are at the mercy of time, personnel, and resource
constraints (Ttofi & Farrington, 2011). These findings should motivate them to redouble their efforts
and make sure they are intentional about addressing peer harassment in order to forestall any serious
consequences. The blurring of boundaries and distinctions between online and offline interactions
among kids accentuates a deep need to pay attention to bullying wherever it is occurring, and best
practices are evolving to guide administrators in the proper direction (Bauman, 2011; Davis &
Nixon, 2012; Hinduja & Patchin, 2012; Kärnä et al., 2011; Patchin & Hinduja, 2016; Pearce, Cross,
Monks, Waters, & Falconer, 2011; Ttofi & Farrington, 2011).
A few research-based suicide prevention initiatives have also demonstrated success at preventing
bullying, including: Sources of Strength (Katz et al., 2013; Wyman et al., 2010), Signs of Suicide
(SOS; Aseltine Jr & DeMartino, 2004; Aseltine, James, Schilling, & Glanovsky, 2007), and the Good
Behavior Game (Greenberg, Domitrovich, & Bumbarger, 1999; Katz et al., 2013; Wilcox et al., 2008).
Generally speaking, these programs seek to accomplish a variety of risk-reduction goals such as:
increasing positive ties to adults and the school in general; teaching positive coping techniques;
imparting life skills; shaping attitudes and perspectives about bullying, suicide, and other behaviors;
promoting the acceptability of seeking help; encouraging stepping up on behalf of others; and
developing connectedness and belongingness. While these programs do not vary their content (or
their delivery method) based on each student’s individual background and learning style, they cover
a spectrum of possible antecedents that include personal, social, and familial issues. If a school’s goal
is to prevent suicidal ideation resulting from bullying, it may be beneficial to intentionally combine
specifically applicable portions from these evidence-based programs after carefully considering and
evaluating the needs of their student population (Katz et al., 2013).
Furthermore, it is critical that every school—at all levels—have formal suicide prevention pro-
grams in place (Kalafat, 2003), as health care providers often fail to screen for suicidal ideation
markers in adolescents and thereby miss an opportunity to meaningfully assist (Borowsky,
Taliaferro, & McMorris, 2013). School programming should provide life skills training, health and
wellness content, positive coping mechanisms, tie-ins to mental health services and helplines, and
10 S. HINDUJA AND J. W. PATCHIN

provide some sort of screening functionality to identify those students most at-risk (Haas et al., 2010;
Joshi, Hartley, Kessler, & Barstead, 2015; Zenere & Lazarus, 2009). Indeed, a whole school approach
that views bullying as systemic and involves all stakeholders can successfully reduce bullying, which
can—perhaps—prevent suicidal attitudes and actions (Borowsky et al., 2013).
Results from the present research clarified that students who experienced particularly serious
forms of school bullying and cyberbullying were most at risk for suicidal thoughts and attempts.
School professionals must earnestly and consistently convey that they are available to assist targeted
students, and will do so in a mutually-agreeable manner since many teens are hesitant to report for
fear of retaliation, overreaction, or ineffectiveness (Eliot, Cornell, Gregory, & Fan, 2010; Hinduja &
Patchin, 2012; Mishna & Alaggia, 2005). Also, the provision of mechanisms to report bullying
privately and even anonymously are useful through a drop box on campus, a form on the school’s
webpage, or a phone or text line they can use (Patchin & Hinduja, 2016; Whitted & Dupper, 2005).
All reports—regardless of perceived severity—should then be properly investigated by an adminis-
trator to make sure bullying is addressed or prevented, and that all students feel safe. Perhaps
supporting a child through a mild or minor victimization incident may keep certain ill effects of
bullying from iteratively building upon themselves and causing significant harm that largely was
avoidable (Hinduja & Patchin, 2015; Rigby, 2007).
As a final point, suicide prevention programming is incomplete if only championed and led by
school personnel. While it is not known (or easily measurable) how many bystanders are present in
cyberbullying incidents, research has found that bystanders are present in most bullying incidents
(Holfeld, 2014; Lynn Hawkins, Pepler, & Craig, 2001; Salmivalli, 2014). Youth observe and assess
how others are treated as they witness various forms of bullying taking place, and based on their own
experiences or reference points likely have an accurate idea of what might be classified as mild or
severe mistreatment. Even if they do not intervene, what they witness does typically prompt an
emotional and even physiological response and bothers them on some level (Barhight, Hubbard, &
Hyde, 2013).
Students must realize that their individual and collective voice is powerful, and that they should
press past their hesitations and fears and use it to: raise awareness; set (or reset) appropriate social
norms and considerations around bullying and suicide; promote vulnerability, acceptance, tolerance,
and kindness; and collectively stand against hate and harassment of all forms (Mitra, 2008; Patchin &
Hinduja, 2014; Smith et al., 2011). Toward this end, educators would do well to supplement their
formal schoolwide programming by repeatedly reminding the student body that they need to come
through for their classmates with intentionality by encouraging, defending, supporting, and rallying
to their aid as necessary (Davis & Nixon, 2012, 2014; DeSmet et al., 2012). If this messaging is part of
the culture on campus, targeted youth may more readily seek support from their peer group, and
nontargeted youth may look for opportunities to come through for those struggling because doing so
has been institutionalized as normative in that environment (Eliot et al., 2010; Hinduja & Patchin,
2012; Orpinas & Horne, 2009).

Funding
This work was supported by the Digital Trust Foundation [31-3].

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