CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING

Volume 16, Number 3, 2013 ORIGINAL ARTICLES

ª Mary Ann Liebert, Inc.
DOI: 10.1089/cyber.2012.0087

Violent Online Games Exposure

and Cyberbullying/Victimization Among Adolescents

Lawrence T. Lam, PhD,1,2 ZaoHuo Cheng, PhD,3 and XinMin Liu, PhD 4

Abstract

This population-based cross-sectional survey examined the association between exposure to violent online
games and cyberbullying and victimization in adolescents recruited from two large cities utilizing a stratified
two-stage random cluster sampling technique. Cyberbullying and victimization were assessed by the E-victimization
and E-bullying scales validated in a previous study. Exposure to violent online games was measured by self-
nomination of the degree of violent content in the games played. Results indicated that the majority (74.3
percent) of respondents did not experience any cyberbullying or victimization in the last 7 days before the
survey, 14.4 percent reported to be victimized via cyberspace, 2.9 percent admitted that they had bullied others,
and 8.4 percent reported to be both perpetrators- and- victims. One hundred and eighty seven (15.3 percent)
considered games they were playing were of moderate to severe violence. Students who had been involved in
cyberbullying as well as being victimized were two times as likely to have been exposed to violent online games,
and nearly four times as likely for those involved in bullying others. Exposure to violent online games was
associated with being a perpetrator as well as a perpetrator-and-victim of cyberbullying. Parents and clinicians
need to be aware of the potential harm of these exposures. The policy implications of results were also discussed.

Introduction Among adolescents, bullying, harassment, and victimiza-

tion are terms used to describe aggressive behavior that can

T he relationship between exposure to violence and

aggression has long been noted since the 60s.1 In recent
years, due to the rapid development of media technologies,
particularly video games, the association between violent
video games and aggression became a focus of research in
areas of personality and social psychology as well as health.
Theories and models about the relationship between violent
video games and aggression have been put forward and
studied.2–4 In the last decade, many studies, including
systematic reviews and meta-analytical studies, have been
conducted to investigate the possible link between violent
video games and aggression and were reported in the
literature.5–9 Of these, two reviews have found insufficient
evidence for the association between violent video games
playing and aggressive behavior in children and adults with
one only focused on children with behavioral and emotional
difficulties.7,8 On the other hand, other reviews have con-
cluded that there is sufficient evidence to support the notion
of an association between playing violent video games and
aggressive behavior.5,6,9
be characterized by an intention to harm, repetitiveness, and
occur in an imbalanced power relationship.10 With the recent
rapid development of cybertechnologies, aggressive behavior
can also be expressed and manifested online resulting in the
term ‘‘cyberbullying and victimization’’ being suggested as
an equivalent phenomenon of that observed offline.11 Since
then, there has been a growing volume of work in the area of
cyberbullying and victimization among adolescents. Unlike
the well-established traditional bullying and victimization,
information on the population-based prevalence of cyber-
bullying and victimization has not been forthcoming.
Adopting the concept and definition of tradition bullying and
translating online, the recent national population Health
Behavior in School-Age Children survey conducted in the
United States, suggested that 13.6 percent of young people
were involved in or affected by cyberbullying. Of these, 3.8
percent were perpetrators only, 5.3 percent victims only, and
4.5 percent were both perpetrators as well as victims.12 In
another U.S. study on cyberharassment, it was reported that
about 9 percent of youth were harassed online in the year

1
The School of Medicine Sydney, The University of Notre Dame Australia, Darlinghurst NSW, Australia.
2
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
3
Wuxi Mental Health Institute, Jiangsu Academy of Psychological Sciences, Wuxi, Jiangsu, P.R. China.
4
Departmen of Psychology, Wannan Medical College, Wuhu, Anhui, P.R. China.

159
160
before the survey.13 On the other hand, a Canadian study,
utilizing the same definition of cyberbullying and a large and
diverse sample of middle- and high-school students, found
that nearly half (49.5 percent) indicated that they had been
bullied online and about 34 percent had bullied others on-
line.14 Such a discrepancy could be explained by differences
in the methods of cyberbullying assessment. Nevertheless,
these results indicated that cyberbullying and victimization is
a common and growing problem among young people.
In terms of risk factors of cyberbullying and victimization
among adolescents, information provided from the literature
is scarce. There seemed to be a gender differential dependent
on categories of bullying.12 Young males were more likely to
be involved in bullying only (odds ratio [OR] = 1.73, 95%
confidence interval [CI] = 1.21–2.45) and less likely to be a
victim only (OR = 0.71, 95% CI = 0.54–0.93) in comparison to
the those who had never been involved in cyberbullying or
been a victim.12 Unlike traditional bullying, being overweight
or underweight were not associated with cyberbullying and
victimization.15 However, smoking and drinking were found
to be associated with cyberbullying and victimization.16
Several psychosocial characteristics, such as hostility, anger,
and being diagnosed with attention deficit and hyperactivity
disorder (ADHD) or Asperger syndrome, were also sug-
gested to be related to cyberbullying and victimization.17–19
For the consequences of cyberbullying, the literature sug-
gests that there are similarities with traditional bullying. In a
large-scale Australian study among school children, it was
demonstrated that cybervictimization is associated with
symptoms of stress.20 Other studies have also shown that
being a victim of cyberbullying is associated with negative
emotions, fear, and a greater sense of helplessness. 21,22 For
health outcomes, cyberbullying and victimization have been
shown to be related to depression, anxiety, and self-harm.23–25
In recent years, we have seen a proliferation of online
games. Moreover, it has been suggested that the gaming ex-
perience of online games, particularly, the Massively Multi-
player Online Role-Playing Games, is different to that of the
traditional offline video games.26 This experience maybe the
reason of attracting people to these games.26 This has pro-
vided a reason for concern in terms of the effect of violent
game exposure and online aggressive behaviors, particularly
among young people. As aforementioned, there are sufficient
evidence for the relationship between playing violent video
games and aggressive behavior. It would be logical to deduce
that violent online games may have a similar effect as offline
violent video games on aggressive behavior and manifest as
cyberbullying and victimization. A search in the related lit-
erature has revealed little information on the relationship
between exposure to violent online games and cyberbullying
and victimization among adolescents. Hence, the aim of this
exploratory study is to bridge the gap in knowledge on the
relationship between exposure to violent online games and
cyberbullying and victimization among adolescents. It is
hypothesized that exposure to violent online games is asso-
ciated with cyberbullying and victimization.
Materials and Methods
This cross-sectional health survey was conducted in two
main cities, Wuxi and Wuhu cities of the Jiangsu and Anhui
Provinces in Northeast China in October 2011. Both are cap-
LAM ET AL.
ital cities of their Provinces and are highly populated. There
were about 90 and 25 high schools in these two cities, re-
spectively. Institute ethics approval for the study was granted
by the Wuxi Mental Health Institute, Jiangsu Academy of
Psychological Sciences.
The sample consisted of high-school students aged be-
tween 13–18 years with the total student population attend-
ing high schools in the two cities as the sample frame. The
entire list of high schools was obtained from local education
departments of the two cities. The sample was generated
using a two-stage random cluster sampling technique with
stratification according to the population size of high-school
students in these two cities. First, using individual schools as
primary sampling unit, a number of schools were randomly
selected with a probability, which is proportional to the size
of the target population in each school. Second, using the
class as the secondary sampling unit, different clusters of
students were randomly selected from each of the selected
schools. A sample size estimation was accordance to the
study design.27
The health survey was conducted within 2 weeks on
campus at different schools. Students and their parents of the
selected classes from different schools were informed of the
survey with a written information letter. They were invited to
participate in the study with a consent form signed by their
parents or carers before the survey. During the survey, stu-
dents were to fill in a self-reported questionnaire designed
specifically for the study.
Cyberbullying and victimization were assessed using the
E-victimization (E-VS) and E-bullying (E-BS) scales that were
designed based on the conceptual model of the Aggression
and Victimization Scale by Orpinas and Horne, but translat-
ing it to the online environment.28 These two scales were
designed as a self-reported instrument with 6 items each
using a response set with a rating from 0 to 6 corresponding
to a range of 0 times to 6 times or more was used. An example
question asked the respondent to indicate: ‘‘In the past 7 days,
how many times did someone threaten you using emails,
texting, short messages, on a Web site such as Facebook, etc.?’’
Results obtained from a validation study suggested good in-
ternal reliability with Cronbach’s alpha ranging from 0.55 to
0.96 that were largely not affected by sex. Correlations be-
tween E-VS and Centre for Epidemiological Studies-
Depression for Children (CES-DC)29 as well as the Zung’s
Anxiety Scales (SAS)30 showed positive and significant
relationships. Both CES-DC and SAS were validated and
commonly used instruments with good internal reliability of
0.84 and 0.85, respectively. The test–retest reliability of CES-
DC was moderate with an intra-class correlation of 0.54, and
the split half reliability of SAS was estimated to be 0.71. Each
scale was dichotomized into two categories as Involved in
cyberbullying and Never for the E-BS and Being victimized
and Never for the E-VS. There were two main reasons for
dichotomized measure into categories. First, the literature
clearly indicated that there are different categories of indi-
viduals involved in cyberbullying; namely, victims only,
perpetrators only, and perpetrator-victims. Since each scale
was designed to measure one specific construct, either
victimization or bullying, it would be difficult to identify
different cyberbullying types, particularly, the perpetrator-
victims without dichotomizing the scales. Second, using a
dichotomized scale for assessing cyberbullying was in
ONLINE GAME VIOLENCE AND CYBERBULLYING/VICTIMIZATION
consistent with the practice of previous studies in the area.12–16
For the ease of comparisons of results with other studies, it
would be prudent to use the same methodology for mea-
suring the outcome variable. To satisfy the repetitive char-
acteristic of bullying, the Never category contained those
responded 0 or 1 time only to all items in the scales. A com-
posite variable was also created from these two exposure
variables with four groups; namely, Bully-Victim; Victim;
Bully; and Nonbully-victim.
In terms of exposure to violent online games, a series of
questions were included in the questionnaire to elicit infor-
mation on students’ cyberbehavior, including Internet access,
involvement with online games, duration of playing online
games, playing violent online games, and the most frequent
games played online. Exposure to violent online games was
assessed by the response to a specific question asking stu-
dents to self-nominate the degree of violent content in the
games they were playing. The degree of violence exposure
was measured using a 5-point Likert scale ranging from 0 as
Not violent at all to 5 as Extremely violent. For ease of anal-
ysis, the exposure measure was again dichotomized into No
and little and Moderate and Severe exposures. To assess the
validity of the exposure variable using a single question,
the following procedures were implemented. The content of
the reported games played online were examined by a panel
of mental health experts using a 5-point rating scale ranging
from nonviolent to extreme violent. The ratings of experts
and the self-nominated degree of violent content were subject
to being examined using Pearson correlation analysis. Results
indicated a moderate and significant correlation between two
scores (r = 0.521, p < 0.001). Due to the fact that the online
gaming variables were highly correlated, only exposure to
violent online games was included in the final analysis to
avoid problems of colinearity.
Other information collected in the survey included demo-
graphics, whether the respondent was a single child, parental
education levels, health behaviors, including body weight
and height, alcohol drinking, parental drinking, and gam-
bling. Other potential confounding factors of bullying and
victimization, such as anger, hostility, ADHD status, and
sense of belonging were also assessed by Anger and Hostility
subscales of the Aggression Questionnaire and the DSM-IV
Symptom subscale of the Conners Rating Scale-Revised
(CRS-R).31,32 These scales were also validated with good
psychometric properties of a Cronbach’s alpha of 0.82 and
0.94, respectively. The sense of belonging was assessed using
the Sense of Belonging scale designed for the Program of
International Student Assessment in 2000 (PISA).33 Depres-
sion, anxiety, and intentional self-harm of students were as-
sessed using the CES-DC and the Zung Self-Rating Anxiety
Scale.29,30
Data were analyzed using the Stata V10.0 statistical soft-
ware program.34 Since the study was of a cluster sampling
design, data were set up with the survey design function
utilizing the svy commands for handling the cluster sampling
effect. The svy algorithm assigned appropriate weight to each
data point in the dataset according to the study design using
the sizes of the primary and secondary samples as weighting
factors. Bivariate analyses were conducted to examine the
unadjusted relationships between exposure to violent online
games, other variables of interest, and cyberbullying and
victimization. The majority of potential risk factors were
161
categorical or ordinal by nature; thus, comparisons across
groups were conducted. Equality of means among groups
was examined using F-tests with adjustments for the cluster
sampling design. As cyberbullying and victimization was a
categorical variable with four subgroups, multinomial logis-
tic regression modeling was then applied to investigate as-
sociations between violent online games exposure, selected
potential risk factors, and cyberbullying and victimization
with adjustment for the cluster sampling effect. For the
inclusion of any variable in the initial regression model, the
criteria of a bivariate association with p < 0.20 was used. This
was to ensure that all potential risk factors were included in
the multiple regression models for model reduction. Multi-
nomial logistic regression models were constructed with a
backward elimination process aiming to derive a parsimo-
nious model that contained significant variables only. A sig-
nificance level of 5 percent was used for hypothesis testing.
The interaction terms of significant variables retained in the
model were then tested for their significance. A significance
level of 1 percent was used for hypothesis testing of all in-
teraction terms. This was to prevent possible type I error with
the inclusion of the interaction terms as well as variables from
which the interaction terms were derived.
Results
A total of 1,278 students responded to the survey provid-
ing usable information. This represented a response rate of 94
percent. The demographics of the sample were presented in
Table 1 with a mean age of 14.7 (SD = 0.9) and 619 (48.4
percent) males. Other characteristics, including cyberbullying
and victimization of the respondents were also summarized
in Table 1. In terms of cyberbullying and victimization, the
majority of respondents did not experience any cyberbullying
or victimization in the last 7 days (n = 933, 74.3 percent), 184
(14.4 percent) respondents reported to be victimized via cy-
berspace, 31 (2.9 percent) admitted that they had bullied
others, and 117 (8.4 percent) reported to be both bullies and
victims. For exposure to online games, 486 (41.2 percent) in-
dicated that they had spent less than 1 hour playing online
games each day, 342 (29.2 percent) 1–2 hours, and 250 (21.5
percent) 3 hours or more. Of those who did play online
games, 222 (26.0 percent) reported that they had mostly
played combat and war games, 100 (10.7 percent) gambling
games, and the majority played other games (n = 562, 63.4
percent). In terms of the extent of violence of these online
games, 187 (15.3 percent) considered the games they were
playing to be of moderate to severe violence.
The bivariate relationships between cyberbullying and
victimization, students’ demographics, health conditions and
behaviors, Internet access, online game playing, and exposure
to violent online games, as well as health outcomes were
examined. The results were also summarized in Table 1. As
shown, without adjustment for other variables, cyberbullying
and victimization were significantly associated with a num-
ber of variables. These included exposure to violent online
games, duration of playing online games, alcohol consump-
tion in the last 3 months, parents drunk in the last 3 months,
anger, hostility, ADHD, and a sense of belonging. In terms
of detrimental health effects, there were also unadjusted
significant associations between cyberbullying/victimization
and depression (v23 = 34.51, p < 0.001) and intentional self-harm
162 LAM ET AL.

Table 1. Frequency (Percent)a or Mean (SE) of Students’ Demographics, Personal

and Familial Risk Factors, Psychosocial Measures, Internet Access, Violence Online Game Exposure,
and Health Outcomes by Cyberbullying and Victimization Status and Results
on Comparisons Across Bullying and Victimization Status (n = 1278)

Cyberbullying and victimization status

Bully and Victim Bully Non-bully-

Students’ characteristics victim (n = 117) (n = 184) (n = 31) victim (n = 933) Results

Demographics
City
Wuxi 51 (73.3) 95 (79.2) 21 (88.2) 495 (80.1) v23 = 4.37, p = 0.143
Wuhu 66 (26.7) 89 (20.8) 10 (11.8) 438 (19.9)
Age group
< 14 years 37 (29.4) 67 (35.5) 7 (20.3) 333 (31.7) v26 = 10.26, p = 0.280
14–15 years 49 (45.7) 79 (41.9) 10 (32.9) 370 (41.1)
16 years or older 31 (24.9) 38 (22.7) 14 (46.7) 226 (27.3)
Sex
Male 62 (50.9) 84 (42.4) 16 (46.1) 457 (50.2) v23 = 3.98, p = 0.408
Female 55 (49.1) 100 (57.6) 15 (53.9) 476 (49.8)
Single child
Yes 73 (75.1) 121 (69.6) 21 (76.5) 662 (75.9) v23 = 3.19, p = 0.393
No 42 (24.9) 61 (30.4) 8 (23.5) 261 (24.1)
Father’s education level
Primary or lower 14 (12.9) 32 (14.7) 3 (9.6) 116 (9.2)
Middle school 56 (38.1) 81 (42.3) 14 (40.7) 383 (35.7) v29 = 14.23, p = 0.433
High school/college 39 (40.6) 54 (31.2) 10 (39.0) 321 (40.0)
University or higher 8 (8.4) 17 (11.8) 4 (10.8) 112 (15.0)
Mother’s education level
Primary or lower 36 (20.8) 60 (27.2) 7 (23.4) 232 (18.1)
Middle school 49 (40.5) 76 (41.8) 15 (44.9) 376 (39.4) v29 = 17.23, p = 0.170
High school/college 26 (32.2) 37 (24.2) 4 (16.8) 262 (33.9)
University or higher 6 (6.7) 11 (6.8) 5 (15.0) 61 (8.6)
Risk factors
BMI
Under weight 47 (42.5) 82 (45.3) 9 (31.8) 406 (40.2) v26 = 5.48, p = 0.528
Normal 64 (54.8) 88 (50.5) 20 (59.8) 459 (53.7)
Over weight/obese 4 (2.7) 7 (4.2) 2 (8.4) 45 (6.1)
Alcohol consumption
in the last 3 months
Yes 29 (29.3) 21 (13.4) 11 (31.1) 109 (13.1) v23 = 27.25, p < 0.001
No 88 (70.7) 162 (86.6) 20 (68.9) 822 (86.9)
Parents binge drank
in the last 3 months
Yes 33 (23.7) 30 (17.8) 2 (2.4) 126 (10.2) v23 = 25.40, p < 0.001
No 84 (76.3) 154 (82.2) 29 (97.6) 807 (89.9)
Parents gambled in the last 3 months
Yes 29 (20.0) 306(17.4) 5 (8.9) 157 (12.6) v23 = 7.26, p = 0.059
No 88 (80.0) 148 (82.6) 26 (91.1) 776 (87.4)
Psychosocial measures
Anger 15.7 (0.50) 14.8 (0.39) 14.4 (1.15) 13.1 (0.19) F(3,26) = 21.89, p < 0.001
Hostility 16.9 (0.67) 14.5 (0.50) 13.4 (0.57) 13.2 (0.19) F(3,26) = 16.90, p < 0.001
ADHD score 13.4 (1.08) 9.6 (0.56) 9.9 (1.17) 8.5 (0.41) F(3,26) = 8.16, p < 0.001
Sense of belonging 18.5 (0.42) 18.6 (0.29) 19.1 (0.79) 19.2 (0.15) F(3,26) = 4.74, p = 0.009
Internet access, online gaming,
and violence exposure
Owing a computer at home
Yes, use by myself 39 (38.6) 54 (37.2) 15 (50.9) 215 (27.5)
Yes, used by family members 54 (49.1) 98 (51.4) 12 (38.3) 489 (56.0) v26 = 19.39, p = 0.025
No 22 (12.3) 30 (11.4) 4 (10.8) 217 (16.5)
Hours of playing online game/day
> 3 hours 37 (34.3) 41 (24.4) 10 (26.9) 158 (19.1)
1–2 hours 39 (34.1) 53 (27.9) 11 (37.1) 238 (28.9) v29 = 32.66, p = 0.029
< 1 hour 33 (29.5) 79 (43.8) 10 (36.0) 358 (41.9)
No access 5 (2.1) 6 (3.9) 0 (0.0) 120 (10.0)

(continued)
ONLINE GAME VIOLENCE AND CYBERBULLYING/VICTIMIZATION 163

Table 1. (Continued)
Cyberbullying and victimization status

Bully and Victim Bully Non-bully-

Students’ characteristics victim (n = 117) (n = 184) (n = 31) victim (n = 933) Results

Types of online game played

Combat/war games 23 (21.6) 25 (13.8) 10 (33.3) 161 (21.2)
Gambling games 13 (13.1) 14 (7.9) 3 (6.6) 69 (8.0) v29 = 18.02, p = 0.165
Other games 59 (50.8) 102 (58.8) 15 (51.5) 380 (48.3)
Did not play games 14 (14.6) 33 (19.6) 2 (8.5) 173 (22.5)
Exposure to violent online games
Moderate/severe 37 (33.0) 30 (13.6) 11 (33.3) 108 (12.8) v23 = 35.59, p < 0.001
No/little 74 (67.0) 142 (86.4) 17 (66.7) 659 (87.2)
Health outcomes
Ever committed self harm
in the last 3 months
Yes 36 (33.3) 38 (22.7) 8 (24.5) 111 (11.5) v23 = 47.35, p < 0.001
No 80 (66.7) 145 (77.3) 23 (75.5) 821 (88.5)
Depression
Yes 74 (60.9) 101 (58.8) 10 (29.9) 368 (40.7) v23 = 34.51, p < 0.001
No 39 (39.1) 78 (41.2) 21 (70.1) 542 (59.3)
Anxiety
Yes 17 (15.2) 20 (12.7) 3 (9.6) 50 (5.5) v23 = 21.57, p = 0.049
No 99 (84.8) 159 (87.3) 28 (90.4) 867 (94.5)
a
Due to rounding, not all total percentages were added to 100 percent; percentages were adjusted for cluster sampling effect.
ADHD, attention deficit and hyperactivity disorder.

(v23 = 47.35, p < 0.001). Anxiety was marginally associated with

cyberbullying/victimization (v23 = 21.57, p = 0.049). These vari-
ables, except for the health outcomes, were included in further Table 2. Odds Ratios (95% Confidence Interval)
analyses. Cities, maternal education levels, and parental gam- and Significance Obtained from the Multinomial
bling were also selected due to the reason that associations Logistic Regression of Violence Exposure,
between these variables and cyberbullying and victimization Other Potential Confounding Factors
attained a significance level p0.20. Other Internet-related var- on Cyberbullying and Victimization
iables were not included in further analyses due to the afore-
mentioned reasons. Variables in the
final model OR (95% CI)a Significance
The results obtained from the multinomial logistic regres-
sion analyses were presented in Table 2. Five variables re- Cyberbullying and
mained significant in the final model after adjusting for each victimization
other. The results suggested that, after adjusting for other Violence exposure 2.20 (1.36–3.55) t = 3.36, p = 0.002
potential confounding factors, including time spent online, Parental binge 2.16 (1.20–3.88) t = 2.69, p = 0.012
moderate to severe exposure to violent online games was drinking
significantly associated with bullying–victimization (t = 2.93, Anger 1.04 (0.97–1.12) t = 1.20, p = 0.239
p = 0.007) and bullying only (t = 2.64, p = 0.014), but not with Hostility 1.07 (1.01–1.14) t = 2.36, p = 0.026
victimization only. Students who had been involved in ADHD 1.04 (0.99–1.09) t = 1.69, p = 0.102
Cyberbullying
cyberbullying as well as being victimized were two times as
Violence exposure 3.75 (1.50–9.35) t = 2.96, p = 0.006
likely to have been moderately to severely exposed to violent Parental binge 0.22 (0.05–1.00) t = - 2.09, p = 0.050
online games (OR = 2.04, 95% CI = 1.24–3.35). For those who drinking
had been involved in bullying others via cyberspace, it was Anger 1.11 (0.95–1.29) t = 1.42, p = 0.166
nearly 4 times as likely that they had been exposed to violent Hostility 0.94 (0.88–1.00) t = - 2.04, p = 0.051
online games moderately or severely (OR = 3.60, 95% ADHD 1.02 (0.95–1.08) t = 0.46, p = 0.651
CI = 1.33–9.72). An examination of the interaction terms of the Cybervictimization
exposure variable and other potential confounding variables Violence exposure 0.99 (0.45–2.19) t = - 0.02, p = 0.986
indicated that none were significant. Parental binge 1.69 (1.05–2.74) t = 2.25, p = 0.033
drinking
Anger 1.09 (1.05–1.13) t = 5.23, p < 0.001
Discussion
Hostility 1.02 (0.95–1.09) t = 0.57, p = 0.577
This study aims to examine the relationship between ADHD 0.99 (0.96–1.03) t = - 0.28, p = 0.782
exposure to violent online games and cyberbullying and
Bold indicates significant results.
victimization among a population of young people in a
Non-bully-victim group as the referent group; ORs were
Northeast China. The results suggested that moderate to calculated with adjustment to cluster sampling effect.
severe exposure to violent online games was significantly OR, odds ratio; CI, confidence interval.
164
associated with being a perpetrator and victim as well as a
perpetrator only of cyberbullying. The results indicated there
were no significant associations between exposure to online
game violence and being a victim of cyberbullying.
Due to the lack of a similar study, a comparison of results is
difficult. However, the point estimate of cyberbullying and
victimization obtained from this study could be compared to
that reported in the literature, particularly from studies con-
ducted in the United States.12,13 For each subtype of bullying
and victimization, the pattern of distribution remains similar
with a larger proportion of victims of bullying at 14.4 percent,
followed by perpetrators-victims of 8.4 percent, with only 2.9
percent of perpetrators only. Also, in consistent with the
literature are the associations between cyberbullying and
victimization and depression and intentional self-harm. The
results of this study provided further evidence of the detri-
mental effects of cyberbullying and victimization on the
mental health among young people.
There could be many explanations for the associations
between exposure to violent online games and cyberbullying
and victimization. The most intuitive one is that exposure to
violence online games, as to other violence through media,
will enhance the aggressive tendency of an individual.9 An-
derson and Bushman have put forth the General Aggression
Model (GAM) for the formation of the long-term effects of
exposure to video game violence.5 The model stipulates that
repeated violent game playing will lead to an increase in
aggressive belief and attitude; enhancement of aggressive
perceptual schemata; deepening of aggression desensitiza-
tion; and thus, an increase in aggressive personality. This, in
turn, will manifest as aggressive behavior when the envi-
ronmental trigger is available.5 The results obtained from this
study renders some support to the GAM for the following
two reasons. First, exposure to violent online games is sig-
nificantly associated with anger and hostility, and both are
measures of an aggressive personality. Second, exposure to
violent online games has increased the odds of being a per-
petrator as well as a perpetrator-victim of cyberbullying, but
not for victims of cyberbullying. One remaining issue in this
explanation is the interaction terms between exposure and
anger, as well as exposure and hostility as are both insignif-
icant in the model. These results seem to suggest a direct
effect of violent online game exposure on cyberbullying
behavior after adjusting for anger and hostility, but not
mediated by aggressive personality. This is worthy of further
investigation.
The results obtained from this study have a direct impli-
cation for the detection as well as the prevention of mental
problems among young people. The results of this study
suggest that cyberbullying is common among Chinese high-
school students as those in the United States. Parents, carers,
teachers, and school principals should be aware of the po-
tential harmful effects of the exposure to violent online games
on the psychosocial aspects of children’s cognitive and emo-
tional development. This can be achieved through greater
information sharing via the media and the school system.
Psychological distress and depressive symptoms might be a
signal of possible involvement of cyberbullying and victimi-
zation. The results also have implications on policy devel-
opment. It has been noted by the Australian government that
censorship laws and regulations on Internet materials, par-
ticularly relating to violence, vary across many developed
LAM ET AL.
countries that render them ineffective in protecting children
and young people on the Internet.35 Should the potential
causal link between exposure to online violent games and
cyberbullying and victimization be demonstrated, this infor-
mation could possibly be utilized to facilitate evidence-based
policy making. It could be used to support the argument for
international regulations on violent online game censorship.
As in all studies, there are strengths and weaknesses in this
study. This is a population-based study that includes a
random sample of students from two large cities utilizing a
two-stage cluster random sampling technique. An appropri-
ate statistical analytical approach has been used to adjust for
the effect of cluster sampling. The use of a standardized and
validated assessment instrument for cyberbullying mini-
mized some measurement biases. Some potential limitations
have also been identified in this study. First, information on
violence exposure is collected using a single question via self-
reporting. It is an assessment of self-perception of violence
exposure, not a quantitative measure of real life exposure.
Hence, this will constitute an assessment bias in the exposure
variable although it would most likely be a nondifferential
bias. Second, a cross-sectional study could be considered as
an appropriate design for exploring potential risk factors for a
condition or disease. However, the evidence provided from
such a study can only be considered as associative and it is
insufficient to draw any causal inference.36 This study can be
considered as an exploratory study to identify the potential
risk factors for cyberbullying and victimization among
adolescents. Future studies could be conducted with a better
design, such as a longitudinal cohort study, to elucidate
whether the association is of a causal nature. To improve the
assessment of exposure to violent online games, it would be
prudent to employ a more objective method, such as utilizing
content descriptor ratings of games provided by the U.S.
Entertainment Software rating Board (ESRB).
Author Disclosure Statement
All authors ensure that there is no conflict of interest of any
kind involved in the production of this manuscript nor is the
study associated with any commercial bodies. No competing
financial interests exist.
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Address correspondence to:
Prof. Lawrence T. Lam
School of Medicine Sydney
The University of Notre Dame Australia
Darlinghurst Campus
160 Oxford St.
Darlinghurst NSW 2010
Australia
E-mail: lawrence.lam@nd.edu.au
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