Interpretation of the findings
Research on the psychological and mental health impacts of cyberbullying victimization and traditional bullying in general, especially among adolescents, continues to receive attention and interest significantly in recent times [
10,
16,
19,
28]. Using the most recent data from the GSHS from three countries, namely Argentina, Panama, St. Vincent and the Grenadines, the results showed that 20% and 21% prevalence of cyberbullying victimization and suicidal ideation, respectively. The prevalence of cyberbullying victimization is higher than those reported in individual country studies in Vietnam (9%) [
16], the US (4.8.–18.3%) [
19,
33] and Hong Kong (11.9%) [
28] but consistent with rates reported in another multi-country study in seven European countries (13.3–37.3%) [
34]. The current study’s relatively higher cyberbullying victimization rate may reflect an increasing temporal trend among adolescents globally [
10]. Importantly, in our analysis, suicidal ideation was somewhat higher, and the prevalence of suicidal ideation among victims of cyberbullying was higher than among non-victims. This finding is in line with a study conducted in Hong Kong, which reported that suicidal ideation was high among adolescents who were cyberbullying victims [
28]. Studies and reports indicate that suicidal behaviors among adolescents globally have become a serious concern [
10,
13]. Data from the 2017 Youth Risk Behavior Survey in the US suggest that 17.2% of adolescents seriously contemplated suicide, 13.6% planned how to attempt suicide, and 7.4% attempted suicide [
14]. Elia et al. [
15] reported suicidal thoughts and planning of 7.5% and 17.5%, respectively in 21 Latin American and Caribbean countries. Thus, it is essential to emphasize that the relatively high prevalence of cyberbullying victimization coupled with the significantly high likelihood of suicidality in cyberbullying victimization implies that more efforts toward prevention and intervention programs are needed.
Cyberbullying victimization has been demonstrated to be associated with adverse psychological and mental health, especially among adolescents [
10,
16,
19,
28,
33,
34]. Our findings have shown that cyberbullying victimization has a significant association with suicidal ideation among adolescents after adjusting for potential confounders. Victims of cyberbullying in our sample were more likely to have suicidal ideation than non-victims. Our findings resonate with extant studies demonstrating that cyberbullying victimization is independently associated with suicidal ideation among adolescents. For example, using data from 1,963 students in 30 middle schools in the US, Hinduja and Patchin [
19] found that cyberbullying victims were 1.9 times more likely to have attempted suicide. In another study among 4,886 Grades 7–12 Canadian students, cyberbullying victims were six times more likely to experience suicidal ideation [
35]. Again, in representative cross-sectional data from a school-based sample of 3,522 Hong Kong adolescents, Chang et al. [
28] found that cyberbullying victims were likelier to consider suicide seriously.
Though unsurprising, several plausible mechanisms may underline the association between cyberbullying victimization and suicidal ideation. Despite the positive correlation between cyberbullying victimization and suicidal behaviors, cyberbullying victimization does not directly cause suicide [
19]. Some authors have argued that the incidence of health risk behaviors such as drug use, smoking, alcohol use, and lack of physical activity, among others, in adolescents needs to be closely examined in the association between cyberbullying victimization and suicidal ideation over time at the country level to make intervention policies more fitting and progressive [
23]. Moreover, studies have demonstrated that many adolescents who experience suicidal ideation after experiencing cyberbullying victimization have other emotional, psychological, and social issues, such as academic struggle, low self-esteem, and depression [
19]. Also, cyberbullying victimization tends to exacerbate instability and hopelessness in the minds of adolescents already struggling with stressful life circumstances [
36]. Supportively, Bauman et al. [
37], in their mediation analysis, found that depression partially or partly acts as a mechanism by which bullying affects suicidal ideation among students. All these explanations indicate the impact of additional factors that interact with cyberbullying victimization to cause suicidal ideation, and there are still more gaps that require further studies to identify and examine the contribution of factors such as stress, depression, and healthy lifestyles in the association of cyberbullying victimization with suicidal ideation. Future longitudinal studies should also seek to determine the role of conditioning factors that mitigate the association between cyberbullying victimization and suicidal risks. Though Chang et al. [
28] performed a moderation and reported that life satisfaction partially mitigates the relationship between cyberbullying victimization and suicide ideation, their study was cross-sectional. In-depth qualitative studies are also needed to offer some lived experiences, explanations, and clarifications on the association between cyberbullying victimization with suicidal ideation.
Importantly, our findings show some significant associations between adolescents’ demographics, certain health-related factors, and suicidal ideation. Demographics such as age and gender and health behaviors, including cigarette smoking, drug use, tobacco use, loneliness, food insecurity, physical activity, peer support, and parental support, were significantly associated with suicidal ideation. Unsurprisingly, demographics such as gender and health behaviors such as loneliness, alcohol intake, tobacco use, drug use, cigarette smoking, and food insecurity associated with suicidal ideation. For instance, adolescents who were mostly lonely were seven times more likely to have suicidal ideation, which is consistent with earlier research [
24]. Cyberbullying victimization is a serious experience that can lead to various psychopathologies, including feelings of loneliness [
38]. Loneliness symptoms can impair one’s capacity to manage emotions and cause one to focus nearly entirely on negative parts of life [
39]. The finding suggests that an approach to effective suicidal ideation prevention programs and policy should consider loneliness and other social isolations.
The fact that female adolescents are more likely to have suicidal ideation backs up previous research that revealed similar results that females have high rates rates of suicidal ideation [
12]. It has been argued that females are more likely to use less dependable ways of suicide [
40]. It has also been explained that though males may feel depressed and hopeless, they are less likely to admit and seriously consider suicide than females due to the perception that suicidal ideation is a sign of weakness and inadequacy in managing one’s affairs [
41]. Several studies have also indicated that impulsivity, aggressiveness, anger, and hostility are crucial in explaining the gender differences in adolescents’ suicidal ideation because males are more likely to respond to frustration and stress with anger and hatred than females [
42]. Our finding, therefore, implies that this relationship between gender and suicidal ideation cannot be overlooked. School-based suicidal ideation prevention programs and interventions should be developed and implemented through a gender lens.
A strong relationship between adolescents’ substance use and suicidal ideation was found in this study, which needs to be commented on. Adolescents who reported substance use such as cigarette, alcohol, and tobacco use were more likely to have suicidal ideation, which resonates with the growing evidence of substance use and suicide behaviors [
43]. Empirical evidence suggests one main reason underlying the association between substance use and suicidal ideation. Substance use is likely to increase suicidal ideation risk because substance use may cause depressed feelings, decrease cognitive processing and problem-solving abilities, and influence adolescents’ essential associations and school/work performance [
44]. The implication is that adolescents’ substance use is a severe public health issue and a significant predictive factor for suicidal ideation that needs to be addressed with evidence-based policies and interventions.
In line with other studies [
45,
46], food insecurity is strongly associated with adolescent suicidal ideation. The mechanisms that connect food insecurity and suicidal ideation have been explained by a few hypotheses and theories [
47]. Stuff et al. [
46] have suggested that the potential stress and biological pathways can be responsible for the association between food insecurity and suicidal ideation. Feeling and experiencing food insecurity can be a source of embarrassment, anxiety, and stress [
48], which may exacerbate mental disorders. In line with this argument, mental disorders among food inscured groups and individuals have been found [
47]. Literature on dieting and starvation has hypothesized that malnutrition and micronutrient deficiency among food-insecured populations could explain the link between suicide ideation and food insecurity [
49]. More research is needed to further explore the mechanism linking food insecurity and suicidal behaviors besides the commonly known risk factors, psychological factors, especially among adolescents.
Our findings also suggest the importance of physical activity on suicidal ideation among adolescents. Adolescents engaged in physical activity were significantly less likely to have suicidal ideation than those involved in physical activity. This finding is in line with other adolescent studies [
50,
51]. A systematic review and meta-analysis of studies examining the relation between physical activity and suicidal ideation observed that being physically active is associated with lower suicidal ideation [
52]. The association could be explained by the evidence that physical activity may protect suicidal-related risk behaviors by promoting positive emotional and psychological wellbeing [
53], such as improvement in depressed mood, anxiety and stress, and self-esteem [
54].
It has also been found that engaging in physical activity, especially among adolescents, promotes a positive self-image and protects against suicidality via its effect on psychological wellbeing [
51]. Based on our findings and their consistency with previous results, we suggest that encouraging and promoting physical activity among adolescents may protect against their suicide-related risks. Interventions or studies for addressing suicidal ideation among adolescents should therefore consider physical activity.
Adolescents with parental and peer support and two or more friends had significantly lower odds of having suicidal ideation in our study, suggesting the importance of social networks and support regarding suicidal ideation among adolescents. Modern trends emphasize adolescents’ competence and need for independence. However, parental consent is critical in leading children to the next level of social functioning and promoting their mental health [
16]. Previous research has found a link between peer support, parent-child relationships, and adolescent suicidal ideation, consistent with our findings [
55]. Simultaneously, cross-sectional and longitudinal studies have found that increased peer support reduces suicide ideation with time [
55]. The impact of parental and peer interactions on adolescent suicidal ideation should be factored into national programs to improve population mental health in this era of rapid technological development and changes. Similarly, organizing community activities that will enhance peer connectedness can assist in minimizing loneliness, anxiety, and suicidal ideation.