Public Health 199 (2021) 46e50

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journal homepage: www.elsevier.com/locate/puhe

Original Research

Cyberbullying and problematic social media use: an insight into the

positive role of social support in adolescentsddata from the Health
Behaviour in School-aged Children study in Italy
N. Marengo a, A. Borraccino a, *, L. Charrier a, P. Berchialla a, P. Dalmasso a, M. Caputo b,
P. Lemma a
a
Department of Public Health and Paediatrics, University of Torino, Torino, Italy
b
SSD Health Promotion, ASLCN1, Via Torino 143, Savigliano, 12038, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: The global spread of electronic devices has made cyberbullying and problematic social media
Received 31 March 2021 use (PSMU) emerging public health concerns. This study aimed to investigate the prevalence of cyber-
Received in revised form bullying and PMSU among adolescents in northwestern Italy. We also explored the association between
13 August 2021
cyberbullying and PSMU and whether this association was moderated by social support.
Accepted 16 August 2021
Study design: Data were collected as part of the Italian 2018 Health Behaviour in School-aged Children
Available online 17 September 2021
(HBSC) study in the Piedmont region; 186 school classes participated, comprising 3022 children aged 11,
13 and 15 years. The prevalence of cyberbullying and PSMU were estimated in subgroups of age and
Keywords:
Adolescent
gender. Multivariate logistic regression was used to investigate the association between cyberbullying
Cyberbullying and PSMU, before and after taking into account social support.
Social media use Results: Girls reported higher cyber-victimisation and PSMU than boys (9.1% vs 6.0% and 10.2% vs 6.1%,
Social support respectively), and the risk of cyber-victimisation was higher in the presence of PSMU. This risk was
HBSC attenuated in the presence of social support.
Conclusions: PSMU is an important driver of cyberbullying, although social support can mediate these
behaviours. Public health interventions are needed to guide adolescents how to use social media
appropriately and to prevent cyberbullying and the mental health problems they can provoke.
© 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Introduction future mental health.8e11 In particular, girls aged between 12 and

Cyberbullying that encompasses victimisation and perpetration
and problematic social media use (PSMU) are emerging public
health issues among adolescents worldwide. The occurrence of
cyberbullying victimisation was reported to range between 10% and
40%;1 as for bullying, it was as well associated to negative out-
comes2 as the loss of self-esteem and self-confidence,3 depression,
anxiety or suicidal behaviour4,5 and, owing to the increased use of
social media among adolescents, this phenomenon is alarmingly
rising.6,7 Moreover, recent literature has posed the hypothesis that
in the presence of PSMU, adolescents may increase their risk of
being exposed to cyberbullying victimisation and perpetration,
with potential significant damage, especially to their present and
* Corresponding author. Via Santena 5bis, Torino, 10126, Italy. Tel.: þ0116705836.
E-mail address: alberto.borraccino@unito.it (A. Borraccino).
15 years are reported both to be more frequently victims of
cyberbullying and to show higher proportions of PSMU than coe-
taneous males.7,12 As cyberbullying perpetration can happen at any
time, and at any place, and especially when the victim seems alone
and without protection,3,13,14 it appears that the presence of social
support could represent a protective factor, particularly during
developmental ages.15 Perceiving the presence of a solid social
support was shown to have a positive role on subjective well-being
and to reduce vulnerability in the occurrence of stressful life events
as for bullying.16e18 High Hih-school support and positive family
relationships, indeed, have been shown to reduce cyberbullying
victimisation and perpetration,19 whereas school detachment,
weaker familial emotional bonds and less parental involvement in
setting rules for online activities were shown to increase both as-
pects of cyberbullying.15 Additionally, school and family can act
synergistically in supporting young people, and the school has the
potential to intervene in situations where family support is

https://doi.org/10.1016/j.puhe.2021.08.010
0033-3506/© 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
N. Marengo, A. Borraccino, L. Charrier et al.
lacking.7,16,20 Given these premises, it is urgent to better under-
stand the role of PSMU in the occurrence of cyberbullying victim-
isation and perpetration, exploring whether this association could
be moderated by the presence of positive social support. The aim of
our study was to evaluate the role of social support on the associ-
ation between cyberbullying and PSMU and to guide possible
public health policies7 that working on social support protects the
mental health of adolescents from cyberbullying and PSMU.
Methods
Study population
The 2018 Health Behaviour in School-aged Children (HBSC)
study was conducted in 47 countries worldwide during the
2017e2018 school year.21 The sampling procedure followed the
international guidelines,22,23 and as the study represents one of
the official ministerial epidemiological surveillances for the Ital-
ian country, the same approach was applied to each region to
guarantee representatively.24 Schools in the region were identi-
fied by systematic sampling from the complete list of public and
private schools provided by the Ministry of Education, University
and Research, and participants were selected through a cluster
sampling approach, using school class as the primary sampling
unit.25
This analysis is based on 2018 HBSC data from the Piedmont
region, a northwestern territory of approximately 4.4 million in-
habitants, nearly 550k of whom are of school age. The analytical
sample included 186 classes comprising 3022 children aged 11, 13
and 15 years.26
Measures
Cyberbullying victimisation and perpetration
Two questions on cyberbullying were introduced in the 2014
HBSC study.27 One asked how often in the past 2 months students
had perpetrated cyberbullying, and the other asked how often in
the past 2 months students had been the victim of cyberbullying.
Response options were: “I have not cyberbullied/been cyberbullied”,
“once or twice”, “2 or 3 times a month”, “about once a week”, “several
times a week”. Responses were dichotomised into never and once or
more.5
Problematic social media use
PSMU was investigated using the Social Media Disorder Scale,28
a validated nine-item, binary-answer (0/1) scale. The nine items
investigate the respondent's behaviours and feelings during the
past year: preoccupation (“… have you regularly found that you can't
think of anything else but the moment that you will be able to use
social media again?”), tolerance (“… have you regularly felt dissat-
isfied because you wanted to spend more time on social media?”),
withdrawal (“… have you often felt bad when you could not use social
media?”), persistence (“… have you tried to spend less time on social
media, but failed?”), displacement (“… have you regularly neglected
other activities e.g. hobbies, sport because you wanted to use social
media?“), problem (“… have you regularly had arguments with others
because of your social media use?“), deception (“… have you regu-
larly lied to your parents or friends about the amount of time you
spend on social media?“), escape (“… have you often used social
media to escape from negative feelings?) and conflict (“… have you
had serious conflict with your parents, brothers(s) or sister(s) because
of your social media use?“).21,28 For the present analysis, responses
were summed, and PSMU was defined as a score 6. Participants
with three or more missing items were excluded.
47
Public Health 199 (2021) 46e50
School support
School support was measured using three-item teacher and
classmate support scales.29,30 Items regarding teacher support
where about acceptance (“I feel that my teachers accept me as I am”),
teacher care (“I feel that my teachers care about me as a person”) and
trust (“I feel a lot of trust in my teachers”). Cronbach's alpha for
teacher support was 0.75. Items regarding classmate support were
about cohesion (“The students in my class enjoy being together”),
kindness (“Most of the students in my class are kind and helpful”) and
acceptance (“Other students accept me as I am”). Cronbach's alpha
for classmate support was 0.73. All responses were given on a 5-
point Likert scale (from 0 meaning ‘strongly disagree’ to 4 mean-
ing ‘strongly agree’). Scores for teacher and classmate support were
summed individually, and each sum was divided by three, and then
these two results were summed and divided by two to get the
school support score. High school support was defined as a score
2.5, and low school support as a score <2.5.16 Cronbach's alpha for
school support was 0.72. Participants with one or more missing
items were excluded.
Family support and peer support
Family support and peer support were calculated using a
foureitem scale.31,32 Items regarding family support were about
supportiveness (“My family really try to help me”), emotional aid (“I
get the emotional help and support I need from my family”), confi-
dence (“I can talk about my problems to my family”) and encour-
agement (“My family is willing to help me make decisions”). Items
regarding peer support were about receiving help (“My friends
really try to help me”), support (“I can count on my friends when
things go wrong”), affinity (“I have friends with whom I can share my
joys and sorrows”) and confidence (“I can talk about my problems
with my friends”). All responses were given on a 7-point Likert scale
(from 0 meaning ‘very strongly disagree’ to 6 meaning ‘very strongly
agree’). Scores for family and peer support were summed individ-
ually; high family and peer support was defined as a score 5.5, and
low family and peer support as a score <5.5.33,34 Cronbach's alpha
for family and peer support was 0.90 in both scales. Participants
with one or more missing item were excluded.17
Family Affluence Scale
The Family Affluence Scale (FAS) is a validated, sixeitem scale
that estimates an adolescent's socio-economic status based on that
of their family.32 The items collect information on family ownership
of a car and a dishwasher; whether the adolescent has their own
bedroom and the number of computers owned by the family,
bathrooms in the house and holidays taken in the past year.35 The
FAS score was categorised as low (<6), medium (7e9) and high
(10).16
Statistical analysis
Descriptive analyses, stratified by gender and age, were used to
depict the prevalence of cyberbullying victimisation, cyberbullying
perpetration, PSMU, high school support, high family support, high
peer support and low, medium and high FAS scores. Several
multivariable logistic regression analyses were then used to study
the association between cyberbullying victimisation or cyberbul-
lying perpetration (dependent variables) and PSMU (independent
variable). The effect of each type of support was further tested
individually (model 2 to model 4) and altogether (model 5). All
models were adjusted for age and the FAS score, whereas model 5
was mutually adjusted for all independent variables. No students
had missing data on age, gender or family support. All analyses
were performed using IBM SPSS Statistics 26.0 version for
Windows.36
N. Marengo, A. Borraccino, L. Charrier et al. Public Health 199 (2021) 46e50

Table 1
Prevalence of cyberbullying victimisation, cyberbullying perpetration, problematic social media use (PSMU), high social support and low, medium, and high Family Affluence
Scale (FAS) scores by age and gender. 2018 HBSC study, Piedmont Region, Italy.

Study variables 11 years old, n ¼ 1000 [% (N)] 13 years old, n ¼ 1065 [% (N)] 15 years old, n ¼ 957 [% (N)] Total, n ¼ 3022 [% (N)]

Boys Girls Boys Girls Boys Girls Boys Girls

Cybervictimisation 6.4 (33) 10.3 (49) 5.2 (29) 10.3 (52) 6.4 (33) 6.2 (27) 6.0 (95) 9.1 (128)*
Cyberbullying perpetration 6.4 (33) 5.7 (27) 5.6 (31) 8.0 (40) 7.9 (41) 4.8 (21) 6.6 (105) 6.2 (88)
PSMU 8.2 (38) 8.1 (36) 6.4 (34) 13 (64) 4.0 (20) 9.2 (39) 6.1 (92)* 10.2 (139)*
High school support 82.2 (417) 85.7 (400) 76.9 (423) 70.3 (348) 62.2 (317) 55.4 (241) 73.8 (1157)* 70.8 (989)*
High family support 80.5 (420) 81.6 (390) 72.7 (407) 70.1 (354) 69.4 (360) 59.6 (261) 74.1 (1187)* 70.7 (1005)*
High peer support 61.1 (311) 74.7 (355) 63.8 (350) 72.6 (366) 60.2 (310) 66.7 (291) 61.7 (971) 71.5 (1012)*
Low FAS 21.4 (110) 28.7 (135) 23.9 (131) 24.2 (121) 25.0 (126) 27.0 (117) 23.4 (367) 26.6 (373)
Medium FAS 50.7 (260) 47.7 (224) 46.3 (332) 48.3 (241) 49.7 (251) 47.3 (205) 48.8 (765) 47.8 (670)
High FAS 27.9 (143) 23.6 (111) 29.9 (164) 27.5 (137) 25.3 (128) 25.6 (111) 27.8 (435) 25.6 (359)

Boys n ¼ 1601; girls n ¼ 1421; missing data: 0.7% (21) for cyberbullying victimisation; 0.9% (27) for cyberbullying perpetration; 5.3 (161) for PSMU; 1.8% for school support
(58); 1.1% (34) for in peer support and 1.8% (53) for FAS.
*
chi-squared test significance for a value of P < 0.05.

Results 95% CI ¼ 1.23e3.40). In models 2e4, high school support (OR ¼

Of the 3022 adolescents who participated in the HBSC study in
the Piedmont region, 53% (N ¼ 1601) were boys and 47% (N ¼ 1421)
were girls; 33% (N ¼ 1000) were 11 years old, 35.2% (N ¼ 1065)
were 13 years old and 31.7% (N ¼ 957) were 15 years old. More girls
than boys reported cyberbullying victimisation (9.1% vs 6.0%),
especially in the 11- and 13-year-old groups (10.3%). Cyberbullying
perpetration was reported by 6.6% of boys and 6.2% of girls, with the
highest percentage observed in 13-year-old girls and 15-year-old
boys (8.0% and 7.9%, respectively). PSMU was more common in girls
than in boys (10.2% vs 6.1%), with the highest prevalence among 13-
year-old girls (13.0%) (Table 1). The proportion of boys who re-
ported cyberbullying victimisation and PSMU was slightly higher
than that of girls in all three age categories, although it never
exceeded 3% in either gender (data not shown). More boys than
girls reported high school support (73.8% vs 70.8%) and high family
support (74.1% vs 70.7%), whereas more girls than boys reported
high peer support (71.5% vs 61.7%). The prevalence of high school
support decreased with age in both genders, although the decrease
was sharper for girls. Similar results were observed for family
support, with a marked decrease observed with age in girls. The
prevalence of high peer support was similar across age categories.
Nearly half of the participants had a medium FAS score (48.8% of
boys and 47.8% of girls) (Table 1).
PSMU was positively associated with cyberbullying victim-
isation in all five models, with the strongest association observed in
girls (odds ratio [OR] ¼ 2.61; 95% confidence interval [CI] ¼
1.61e4.22). High social support showed a protective effect in both
genders, although this effect was more evident in girls (OR ¼ 2.04;
0.53; 95% CI ¼ 0.35e0.80), high family support (OR ¼ 0.33; 95% CI ¼
0.22e0.49) and high peer support (OR ¼ 0.52; 95% CI ¼ 0.35e0.77)
were all significant, protective factors against cyberbullying vic-
timisation in girls. In model 5, only family support was significant in
girls (OR ¼ 0.38; 95% CI ¼ 0.25e0.58). Similar results were observed
in boys, although the protective effect of high social support was
not as strong (from OR ¼ 2.47; 95% CI ¼ 1.28e4.75 to OR ¼ 2.34;
95% CI ¼ 1.20e4.57) (Table 2). The risk of cyberbullying perpetra-
tion with PSMU was significantly higher in girls (OR ¼ 3.0; 95% CI ¼
1.17e5.23) than in boys (OR ¼ 1.39; 95% CI ¼ 0.65e2.98) (Table 3).
Discussion
In this digital era, adolescents start to use electronic devices a
very young age; some start to use social media as early as 11 years
old, shaping their personal social image to better express their
identity among peers.37 Cyberbullying can occur as a consequence
of this intense, premature exposure, destroying adolescents' self-
esteem and provoking other mental health problems.2e4 In young
people of all ages from almost all regions of Italy, the prevalence of
cyberbullying victimisation, cyberbullying perpetration and PSMU
is higher among girls than among boys, which is in line with in-
ternational HBSC reports.25 Our study showed that the prevalence
of cyberbullying victimisation, cyberbullying perpetration and
PMSU was the highest in 13-year-old girls in the Piedmont region.26
Emotional instability has been observed in victims of cyberbully-
ing.12 For this reason, social support is essential in preventing dis-
orders that may be prejudicial to adolescents for the rest of their
lives. Social support can come from school, family and peers.

Table 2
Association between cyberbullying victimisation and PSMU by social support and gender. 2018 HBSC study, Piedmont Region, Italy.

Gender Study variables Model 1 Model 2 Model 3 Model 4 Model 5

OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI

Girls PSMU 2.61 1.61e4.22 2.34 1.42e3.84 2.11 1.28e3.46 2.55 1.57e4.14 2.04 1.23e3.40
High school support \ \ 0.53 0.35e0.80 \ \ \ \ 0.74 0.48e1.14
High family support \ \ \ \ 0.33 0.22e0.49 \ \ 0.38 0.25e0.58
High peer support \ \ \ \ \ \ 0.52 0.35e0.77 0.68 0.45e1.03
Boys PSMU 2.47 1.28e4.75 2.41 1.24e4.67 2.23 1.15e4.33 2.53 1.31e4.88 2.34 1.20e4.57
High school support \ \ 0.42 0.26e0.65 \ \ \ \ 0.54 0.33e0.87
High family support \ \ \ \ 0.5 0.32e0.79 \ \ 0.6 0.37e0.98
High peer support \ \ \ \ \ \ 0.52 0.33e0.80 0.65 0.41e1.04

PSMU: problematic social media use; OR: odds ratio; CI: confidence interval.
Models 1e5 were adjusted for age and the Family Affluence Scale score; model 5 was mutually adjusted. Dichotomous variables reference value considered was ‘not have’ for
PSMU and ‘low’ for all social support.

48
N. Marengo, A. Borraccino, L. Charrier et al. Public Health 199 (2021) 46e50

Table 3
Association between cyberbullying perpetration and PSMU by social support and gender. 2018 HBSC study, Piedmont Region, Italy.

Gender Study variables Model 1 Model 2 Model 3 Model 4 Model 5

OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI

Girls PSMU 3 1.72e5.23 2.68 1.51e4.78 2.42 1.37e4.28 3.02 1.73e5.28 2.31 1.28e4.17
High school support \ \ 0.52 0.32e0.85 \ \ \ \ 0.62 0.37e1.06
High family support \ \ \ \ 0.34 0.21e0.55 \ \ 0.33 0.20e0.55
High peer support \ \ \ \ \ \ 0.99 0.59e1.65 1.49 0.86e2.58
Boys PSMU 1.39 0.65e2.98 1.39 0.65e2.98 1.28 0.59e2.75 1.43 0.67e3.07 1.33 0.62e2.87
High school support \ \ 0.8 0.51e1.26 \ \ \ \ 0.91 0.56e1.47
High family support \ \ \ \ 0.58 0.38e0.90 \ \ 0.65 0.41e1.04
High peer support \ \ \ \ \ \ 0.77 0.50e1.16 0.84 0.54e1.31

PSMU: problematic social media use; OR: odds ratio, CI: confidence interval.
Models 1e5 were adjusted for age and the Family Affluence Scale score; model 5 was mutually adjusted. Dichotomous variables reference value considered was ‘not have’ for
PSMU and ‘low’ for all social support.

Recently, Del Rey et al.38 described the effectiveness of a Spanish
anticyberbullying school programme, which involved teachers
directly. They showed that teacher support reduced cyberbullying
victimisation, cyberbullying perpetration and PSMU, indepen-
dently of teachers’ experience with or knowledge of social media,
which is in accordance with our results. Moreover, in line with the
results of the study by Del Rey et al.,38 our study showed that
perception of a high school support, both from the teacher and
classmate, was associated with a reduced occurrence of cyberbul-
lying victimisation and cyberbullying perpetration in both genders,
especially in those who with PSMU. Our results also showed that
the association between cyberbullying victimisation and cyber-
bullying perpetration and PSMU could be further reduced in the
presence of high family support. Indeed, a recent study discussed
how family problems can increase the likelihood of cyberbullying
victimisation, cyberbullying perpetration and PSMU, mostly in
girls, owing to their sensitivity and frequent communication
problems, especially with their mothers.39 The same study showed
that absence of empathy in parents, negative communications with
family and poor family relationships can increase psychological
distress in adolescents, provoking a need to counteract social
norms,39 thereby increasing the occurrence of cyberbullying vic-
timisation and perpetration.20
As for peer support, our results showed different behavioural
patterns, especially in 13-year-old girls, for whom peer support
seemed to act as an incentive to cyberbullying perpetration. The
perception of high peer support can boost involvement in cyber-
bullying perpetration, as peers are likely to support bulling be-
haviours.18 Unfortunately, few studies have researched peer
relationships in comparison with other sources of support. Our
results confirm that more studies are needed, at least extending to
other Italian regions, to better investigate the effect of peers and
peer support on cyberbullying victimisation, cyberbullying perpe-
tration and PSMU, especially among girls. Our results suggest that
efforts to prevent cyberbullying victimisation, cyberbullying
perpetration and their health consequences should place a stronger
focus on girls.7,12
Limitations and strengths have to be considered. The HBSC
study is cross-sectional, so we could not draw conclusions about
causation, but only about association;17 we assume that a reduction
in PSMU would lead to a reduction in cyberbullying victimisation
and perpetration. Furthermore, our study is limited to 11, 13 and 15
year olds in the Piedmont region. On the other hand, the use of
HBSC data is an advantage because these data can be compared
across other regions of Italy, and other countries participating in the
HBSC study.21,22
PSMU is an important driver of cyberbullying victimisation and
perpetration, although social support, especially school and family
support, can mediate these behaviours. Therefore, achieving a
perception of high social support among adolescents is one of the
keys to preventing cyberbullying victimisation and perpetration.
Public health interventions are also urgently needed to teach ad-
olescents how to use social media appropriately and to prevent
cyberbullying victimisation and perpetration, as well as the mental
health problems they can provoke. Further investigations from
other countries participating in the HBSC study should further
explore the connections between cyberbullying victimisation/
perpetration and PSMU and could support the promotion of public
health education policies that favour healthy development in ad-
olescents, in particular addressing the reduction of PSMU.
Author statements
Ethical approval
The Ethics Committee of the National Institute of Health
formally approved the 2018 Italian HBSC survey questionnaire and
protocol on 20 November 2017 (PROT-PRE876/17, 20 November
2017).
Funding
Italian HBSC survey was supported by the Ministry of Health and
by the Italian National Institute of Health.
Competing interests
All authors declare no conflict of interest.
Acknowledgements
The authors thank the 2018 HBSC Piedmont Group, the co-
ordinators of the Local Health Units, the health workers and the
school head teachers. The authors would like to specially thank the
teachers for actively implementing the HBSC survey and to the
students for filling the questionnaires.
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