Introduction
Cyber victimization has emerged as a new public mental health issue affecting youth today, as expanding use of the Internet and cell phones has provided a new arena for both social interaction and opportunities for abuse [
1‐
4]. In Sweden practically all adolescents have their own cell phones (most often smart phones) and have access to the Internet, where they spend an increasing amount of time [
5]. Girls use more social networking sites, chats, and blogs, and more sites where you can upload pictures for public display (e.g., Instagram), while boys play more games and watch more video clips [
5].
Cyber victimization can be broadly defined as bullying or harassment performed via electronic means, such as using cell phones or the Internet [
4]. However, research has yet to reach consensus on a more precise definition. Extending the concept of traditional bullying into the cyberworld would seem logical [
6], but is somewhat problematic [
7], as the criteria of traditional bullying—intent to harm, repetition over time, and an imbalance of power between the perpetrator and the victim [
6]—are relatively clear-cut in traditional bullying, while the aspects of repetition and power imbalance are more difficult to define in a cyber context [
7,
8]. A single online act, such as posting a malevolent picture, may be seen, commented on, and forwarded by many others, which constitutes a repetition, but not necessarily one that involves the original perpetrator [
7]. The anonymity of the perpetrator can be viewed as a form of power imbalance, as can the size of the potential audience, the longevity of the message, and the difficulty of escaping from it—there is no safe haven, even at home [
1,
3,
7,
8]. It has been argued that the very nature of the Internet implies that all three elements of traditional bullying may be present in a single online interaction [
9]. However, it has also been proposed that victimization in cyberspace is less harmful than victimization by traditional bullying as the victim cannot be hurt physically [
8].
Estimates of cyber victimization vary widely due to different definitions as well as differences in age group, sampling, methodology, and time frame [
1,
10]. Studies with narrow definitions and shorter time frames (past few months) have reported prevalence as low as around 2 % [
11,
12], while studies with wider definitions and longer time frames (past year) have reported cyber victimization of more than every fourth adolescent [
13]. The Swedish Media Council reported a prevalence of 6 % among boys and 20 % among girls 13–16 years, using the definition of cyber victimization as “Someone having been mean to or bullied you using the Internet or a cell phone during the past year” [
14]. Cyber victimization (defined as having been treated in a nasty or hurtful way online during the past 12 months) increased among European children 9–16 years old from 7 % (boys 6 %; girls 8 %) to 12 % (boys 8 %; girls 15 %) between 2010 and 2014 [
15]. Traditional bullying victimization (TBV) on the other hand consistently decreased in most countries including Sweden between 1993/94 and 2005/06 [
16]. The prevalence of TBV is low in Sweden by international comparison [
16‐
18] however, the associations between TBV and subjective health complaints (SHC) are stronger in Sweden than in many other countries [
17]. Cyber victimization has been shown to have negative outcomes similar to those of TBV, for example, psychosomatic complaints [
19,
20], depressive symptoms [
4,
10,
20‐
23], anxiety [
20], loneliness [
24], lower self-rated health (cyber victimization included in written–verbal bullying victimization) [
12], lower self-esteem [
4,
6,
20], lower academic performance [
20], substance use [
21], delinquency [
21], self-injury [
10], suicidal ideation [
10,
20,
23], and suicide attempts [
10]. The highest psychological distress has been seen among children who are victimized in both contexts [
10].
Social support is a protective factor for health [
25], associated with a lower prevalence of both cyber victimization [
2,
26] and TBV [
2,
27‐
30]. Parents are the first significant source of support for children, and parental support continues to be valuable [
29,
31], even though peer support becomes increasingly important as children grow older [
18,
28]. A meta-analysis of studies on parenting behavior and peer victimization concluded that positive parenting behavior including good communication of parents with the child, a warm and affectionate relationship, parental involvement and support, and parental supervision were protective against peer victimization [
30]. Results from a longitudinal study showed that family support protected adolescents living in single-parent families from cyber victimization when their friends were not supportive, and furthermore that low family support coupled with low friend support predicted the highest levels of cyber victimization [
26].
Social support is furthermore associated with a lower prevalence of mental health problems in adolescents [
27‐
29,
31‐
33]. Communication with parents is fundamental in establishing the family as a protective factor [
18], and young people who easily communicate with their parents have fewer SHC [
33]. Although relationships to parents have been shown to be a stronger predictor of good health than relationships to siblings or friends in adolescence [
33,
34], positive peer relationships are crucial for adolescents regarding developmental tasks such as forming identity, developing social skills, and establishing autonomy [
18].
The way social support influences health can be described by two alternative (but not mutually exclusive) theoretical models: the main effect model and the stress-buffering model [
25]. According to the main effect model, support has an overall beneficial effect on psychological outcomes, regardless of the level of adversity experienced. In the context of the present study, social support would reduce SHC among students irrespective of exposure to cyber harassment. According to the stress-buffering (or interaction) model, the protective effect of social support differs according to the level of stress experienced. In this context, the beneficial effect of social support on SHC would vary among students differently exposed to cyber harassment (CH) (statistically there would be a significant interaction effect of social support and CH on SHC) [
25,
35].
Earlier research on TBV among children has investigated these two models for different sources of social support on a variety of mental health outcomes. Solid evidence for the main effect model has been provided [
27‐
29,
32,
36‐
38], but evidence regarding the stress-buffering model is inconclusive. While several studies have reported support for stress-buffering effects on different combinations of social support and gender [
28,
29,
32,
37], others have found no support for the stress-buffering model [
36,
38]. The effect of social support on cyber victimization and mental health outcomes has been less extensively researched. To the best of our knowledge there is no earlier study on adolescent cyber victimization that has explored the theories of main and stress-buffering effects of support from parents and friends with respect to SHC. We found one population-based study (in which cyber victimization was included in written-verbal bullying) that reported that the opportunity to speak to an adult about things that worried the child modified the associations between cyber victimization and self-reported general health [
12]. The present study will primarily contribute to the existing body of knowledge by adding information on the effect of support from parents/friends on the association between cyber victimization (measured as harassment) and SHC. In this study cyber victimization is defined as “cyber harassment” instead of “cyberbullying” in order to include even single incidents of cyber violation during the past year.
We hypothesize that there will be significant associations between CH and SHC among 9th grade students in Scania, with stronger associations for having been cyber harassed several times than for only once (H1). We also hypothesize that there will be a generally beneficial effect of parental/friend support (a main effect) on the association between CH and SHC (H2). Furthermore, we hypothesize that there will be indications of a stress-buffering effect of social support on the association between CH and SHC (H3), however, we make no assumptions regarding differences between parental/friend support or gender differences, due to inconsistent findings in earlier research. Finally, we hypothesize that further adjustment for TBV in the multiple adjusted regression models will weaken the association between CH and SHC slightly, but will not affect the significance of the association. This result would indicate that CH has an effect of its own on SHC (H4).