Lithuanian University of Health Sciences MEDICAL ACADEMY FACULTY OF MEDICINE Gabriela Ilionsky Association between cyberbullying and school bullying and suicidality among schoolchildren in Israel, Lithuania and Luxembourg In the Department of Preventive Medicine Submitted in partial fulfillment of the requirements for the degree of Master of Medicine Scientific supervisor: Apolinaras Zaborskis, PhD, professor June 2017 Kaunas 1 TABLE OF CONTENTS Summary ................................................................................................................................................... 3 Acknowledgements ................................................................................................................................... 4 Conflicts of interest ................................................................................................................................... 5 Abbreviations list ...................................................................................................................................... 6 Introduction ...............................................................................................................................................7 Aim and objectives of the thesis ............................................................................................................... 8 1. Literature review ................................................................................................................................... 9 2. Subjects and methods ........................................................................................................................... 13 3. Results .................................................................................................................................................. 18 4. Discussion ............................................................................................................................................ 30 5. Conclusions .......................................................................................................................................... 33 References ................................................................................................................................................ 34 Annex ....................................................................................................................................................... 37 2 SUMMARY ASSOCIATION BETWEEN CYBERBULLYING AND SCHOOL BULLYING AND SUICIDALITY AMONG SCHOOLCHILDREN IN ISRAEL, LITHUANIA AND LUXEMBOURG. Gabriela Ilionsky Scientific supervisor: Apolinaras Zaborskis, PhD, professor Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health sciences, Kaunas; 2017, 39 pages. Aim of the study. To analyse the prevalence of bullying and cyberbullying and their correlation with suicidal behaviour among school aged children, by performing a comparison between children in three countries: Israel, Lithuania and Luxembourg. Objectives. 1. To analyse and compare the prevalence of traditional bullying and cyberbullying among 15-years old children, according to their gender in the countries Israel, Lithuania and Luxembourg. 2. To analyse and compare the prevalence of suicidal ideation and behaviour among 15- years old children in Lithuania, Israel and Luxembourg. 3. To determine the correlation between traditional bullying, cyberbullying and suicidal behaviour among 15- years old children in Israel, Lithuania and Luxembourg, comparing their effects on the studied samples. Methods. Study subjects (N= 3,814) were 15-years old adolescents from schools in Israel, Lithuania and Luxembourg who were surveyed in the Health Behaviour in School-aged Children (HBSC) cross-national survey carried out in 2013/2014 with the support of the World Health Organization (WHO). The survey was conducted by means of self-report standardized questionnaires that were administrated in school classrooms ensuring confidentiality and anonymity of the participants. Results. 6.5% of adolescents reported being cyberbullied, 15.6% reported being bullied at school (also called traditional bullying), and 16.7% bullied others at school. 38.6% of adolescents reported experiencing emotions that stopped them from doing activities during the last 12 months, 17.8% seriously considered attempting suicide, 12.0% made a suicide plan and 9.5% attempted suicide, among them 40.1% needed medical attention for their attempt. Victims of cyberbullying and school bullying were found to have a significantly higher risk of suicidal ideations, plans and attempts. Conclusions. Being a victim of any kind of bullying increases the risk for adolescent suicidality. The impact of cyberbullying on adolescents suidality is as severe and important as the impact of school bullying, making cyberbullying a very strong predictor for adolescent suicidality. Key words. Cyberbullying, School (traditional) Bullying, Suicidal ideation, Suicidal behaviour, Health Behaviour in School Aged Children (HBSC), Israel, Lithuania, Luxembourg. 3 ACKNOWLEDGEMENTS We would like to express our gratitude to professor Riki Tesler (Ariel University, Israel) who helped with the interpretation of the study results and editing of the manuscript. 4 CONFLICTS OF INTEREST The author reports no conflicts of interest. 5 ABBREVIATIONS LIST HBSC - Health Behaviour in School-aged Children WHO - World Health Organization FAS - Family affluence scale YRBS - Youth Risk Behaviour Survey p- statistical significance OR – odds ratio CI – confidence interval SEM - Structural Equation Modeling CFI - Comparative Fit Index TLI - Tucker–Lewis Index RMSEA - Root Mean Square Error of Approximation df - degree of freedom 6 INTRODUCTION Bullying during the adolescence period is a worldwide public health problem that has been on a rising trend for years. Nowadays, due to the ever growing and expanding developments in communicational technologies, i.e. more sophisticated computers and phones, a new form of bullying, called cyberbullying, has risen. Cyberbullying is a relatively new tool for bullies that enable them to carry out their aggression using technology, and its continuous progression and growth is mainly due to the ever growing fast developments in technology [1]. Suicide is another worldwide public health problem that may be closely related to bullying. Nowadays suicide is one of the leading causes of death among young people worldwide, and adolescence is the period of time in which there is the highest risk in developing suicidal behaviours and ideations and even committing suicide [2]. Repeated exposure to bullying, especially during adolescence is a factor that may greatly contribute to the development of suicidal tendencies [3]. Bullying, cyberbullying and suicidality are serious and progressive problems around the world with varying negative effects on the world's adolescence and youth population. Therefore, a significant amount of attention must be given to them in further researches, in order to achieve a deeper and more extended understanding of these problems in all of their aspects. This current thesis inspires to analyze the prevalence and correlations between this three serious public health problems (bullying, cyberbullying and suicidality) among school-aged children by using data that was obtained from the Health Behaviour in School-aged Children (HBSC) survey which was carried out in 2013/2014 . The study focuses on 15-years old adolescents in three selected countries; Israel, Lithuania and Luxembourg. The hypothesis was that bullying, traditional and cyber, increases the risk of suicide ideations and behaviour in school-aged children, with cyberbullying being as much as a strong predictor of adolescent suicidality as traditional bullying. As the author of the present thesis I formulated the aim and objectives of the study, also I was responsible for literature review and data analysis design, presentation and discussion of the data analysis results. The thesis was drafted individually by the author. 7 AIM AND OBJECTIVES The aim of the thesis is to analyse the prevalence of bullying and cyberbullying and their correlation with suicidal behaviour among school aged children, by performing a comparison between children in three countries: Israel, Lithuania and Luxembourg. Objectives of the study: 1. To analyse and compare the prevalence of traditional bullying and cyberbullying among 15-years old children, according to their gender in the countries Israel, Lithuania and Luxembourg. 2. To analyse and compare the prevalence of suicidal ideation and behaviour among children 15- years old children in Lithuania, Israel and Luxembourg. 3. To determine the correlation between traditional bullying, cyberbullying and suicidal behaviour among 15- years old children in Israel, Lithuania and Luxembourg, comparing their effects on the studied sample. 8 1. LITERATURE REVIEW 1.1 Traditional bullying and cyberbullying Bullying is an intentional and repeated form of aggression, with a component of power imbalance between the victim and the bully [4]. Traditional bullying, also called school based bullying, has three main features: first is an aggressive behaviour of one or several people, that is directed toward a victim, purposely wanting to cause them harm. Secondly, this behaviour should occur repeatedly, and the third feature is presence of a power imbalance, physical and/or social, between the bully and the victim [5]. Bullying