
==== Front
J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-239
10.4103/jehp.jehp_92_24
Original Article
Prevalence and patterns of workplace cyberbullying among dental and medical undergraduate students. A cross-sectional study
Kumari Roopam
Prasad Raj Kishore
Davis Dilu 1
Patil Pankaj Bajirao 2
Choudhury Basant K. 3
Mulla Munaz 4
Rajguru Jagadish Prasad 5
Department of Psychiatry, Nalanda Medical College and Hospital, Patna, Bihar, India
1 Department of Conservative Dentistry and Endodontics, P.S.M Dental College, Akkikavu, Thrissur, Kerala, India
2 Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Deemed to be University, Karad, Maharashtara, India
3 Department of Oral Medicine and Radiology, Institute of Dental Science, Soa Deemed to be University, Bhubaneswar, Odisha, India
4 Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
5 Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, Bhubaneswar, India
Address for correspondence: Dr. Roopam Kumari, Department of Psychiatry, Nalanda Medical College and Hospital, Patna, Bihar, India. E-mail: r42835952@gmail.com
2024
11 7 2024
13 23915 1 2024
26 2 2024
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
BACKGROUND:

Cyberbullying is an act of bullying that is conducted through the use of technology in an online mode such as over social media platforms or via text-based messages. It is an intentionally repeated aggressive activity in which harm is inflicted on a person using electronic media. This study aimed to evaluate the prevalence and pattern of workplace cyberbullying in undergraduate students inmedical and dental streams.

MATERIALS AND METHODS:

This study used a mixed explanatory cross-sectional study design by making use of a structured questionnaire for the survey. This “two-phase” mixed design utilized qualitative data for the explanation of quantitative observations. The selected study subjects were three hundred undergraduate medical and dental students. To obtain data, an electronically fabricated questionnaire (i.e. Google Form) consisting of open- and closed-ended questions was distributed. All questions were designed for studying prevalence and patterns of cyberbullying that had been experienced by the victims. Obtained data were analyzed using Statistical Package for Social Science software version 20.0 (SPSS v20.0) based on a Likert-based questionnaire scale in which responses were recorded in “yes” or “no” format. The statistical tool employed was the “Chi-square” test.

RESULTS:

On analysis of the level of knowledge, 92% of the study sample was aware of cyberbullying as different from the physical form of bullying. The most commonly employed tools for handling cyberbullying were conferencing (0.66% of cases) and disciplinary tools (5% of cases). 14.33% of cases involved the use of investigations, and 2.66% made use of victim counseling. Most of the students, along with their parents (89%), were of the opinion that teachers must have active participation in cyberbullying cases. On statistical comparison, the P-value was found to be less than 0.05.

CONCLUSION:

In the present study, cases of cyberbullying were found to be less prevalent in medical and dental undergraduate students although there was knowledge regarding this form of bullying in studied participants.

Cyberbullying
dental
knowledge
prevalence
undergraduate
==== Body
pmcIntroduction

The terminology “bully” may be dated as late as the 1930s. This involves any person mistreating a chosen victim to experience superiority along with being powerful. Usually, bullying can be defined as an aggressive type of behavior directed toward any victim who is unable to defend one against the perpetrators. Bullying is repetitive, causes harm intentionally, and takes place with no provocation.[12]

Due to the increased accessibility and use of electronic-based communication-related tools, young individuals are increasingly getting exposed to a newer type of aggression, which is termed as “cyberbullying.” Cyberbullying is an intentional and repeated act of harm using technology toward any victim who is unable to defend himself or herself.[3]

Cyberbullying includes mailing offensive types of emails and/or textual messages, creating insulting or deleterious websites on a particular victim, and posting unsettling images, pictures, or content online.[4] As per traditional bullying, cyberbullying has been established to be a pervasive and harmful type of abuse that has rapidly expanded, has become vague, and is hard to underline. Cyberbullied individuals have shown feelings related to sadness, fearfulness, difficulty in concentration, depression, and substance usage.[56] Cyberbullying is increasingly becoming a serious matter of global importance.[1]

Also, the distance created by technology has led to more severe negative behavioral patterns toward any victim when compared to conventional face-to-face type of bullying.[7] Cyberbullying involves events such as a wide distribution of any embarrassing photograph to a large community and hence is more distressful when compared with on-face physical bullying though cases of cyberbullying are still less prevalent than physical or traditional bullying methods.[89] Cyberbullying is an emerging issue associated with public health-related concerns leading to mental and behavioral issues. This has led to an increase in the risk of committing suicide events. Cyberbullying is linked with face-to-face confrontational energiesand phobias involving attending college or school and physical fights.[10] In the United States, the majority of school students who were aged between 12 years and 18 years have reported being cyberbullied the minimum of two times in a year.[11] Children subjected to bullying experience varied symptoms related to mental health-related disorders, for example, depression, anxiety, alterations in sleeping and feeding habits, and increase in feelings related to loneliness coupled with losing interest in earlier enjoyable activities.[12] Traditional physically and cyberbullied victims have demonstrated self-injury-afflicting behavior and suicidal addiction alongside exhibiting suicidal tendencies at equal frequency.[11]

The most commonly observed characteristics of cyberbullied individuals include frequent use of Internet facilities, lower self-esteem, depression, anxiety, and stress.[13]

Bullying among children is commonly studied, but studies assessing cyberbullying, especially among medical and dental undergraduates, are very less. Such studies must be conducted to aware these students. A careful analysis of previous data has found few studies conducted on dental and medical undergraduate students in India. Thus, based on existing literature, this study was designed with the aim of analyzing the prevalence and patterns of workplace cyberbullying among dental and medical undergraduate students.

Materials and Methods

Study design and setting

The present study was conducted by making use of a mixed-methods explanatory cross-sectional study design using a structured survey questionnaire. The explanatory study design is a “two-phase” mixed tool design that utilizes qualitative type of data for explaining the quantitative result. The first phase of the two-phase study design comprised the collection of quantitative study data, while the second phase included the collection and analysis of qualitative data.

Study participants and sampling

The study participants comprised 300 undergraduate students studying in Medical and Dental Colleges in Bihar, India, between June 2021 and June 2023. For obtaining the required information from study participants, an electronically designed questionnaire (Google Form), which consisted of both open- and closed-ended questions, was circulated. These questions were designed for understanding the prevalence of cyberbullying and patterns of cyberbullying experienced by affected subjects.

Responsiveness toward the present study was enhanced by circulating a signed letter by a researcher thatexplained the study’s aim and its significance.

Dependent variables in the study werea) knowledge and prevalence of cyberbullying, b) students’ academic year of study, c) communication with parents, d) teacher involvement in tackling cyberbullying, and e) any reporting through anonymous systems. The inclusion criteria of the study included a) students who were willing to divulge information regarding any episode of cyberbullying, b) students who actively engage in Internet-based communications, and c) students who have knowledge regarding cyberbullying. The exclusion criteria for study subjects are as follows: a) students not willing to participate in the study and b) students against whom any disciplinary activity has been initiated in the past.

Data collection tool and technique

Information gathered by the current survey was then entered into Statistical Package for Social Science software version 20.0 (SPSS v20.0). Information was derived from a Likert-based questionnaire scale in which responses were registered as“yes” or “no” answers. The recorded data were then analyzed by employing descriptive statistics such as numbers, frequencies, and measures of central tendency. The statistical tool employed was the “Chi-square” test using responses received.

Ethical consideration

The ethical approval for conducting the study was obtained from the institutional ethical committee (NM/IEC68/22).

Results

The following results were obtained after analyzing the study data:

Demographic characteristics: Of the studied population, the student sample belonged within the age range of 18 to 25 years. The male-to-female ratio was 35% (male students) and 65% (female students). Students belonged to pan-Indian states such as Maharashtra, Uttar Pradesh, Andhra Pradesh, Telangana, Jammu, Himachal Pradesh, Haryana, Mizoram, Punjab, and West Bengal.

Knowledge level of study participants regarding cyberbullying: On analyzing the level of knowledge, it was found that 92% of the studied sample was aware of the existence of cyberbullying apart from the physical form of bullying. Of the most commonly used tools for handling episodes of cyberbullying, 0.66% of the studied sample believed in conferencing and 5% made use of disciplinary tools. 14.33% made use of proper investigations in such reported episodes. 2.66% used counseling for victims and individuals who had been reported for cyberbullying [Table 1 and Graph 1].

Table 1 Most commonly utilized interventional tools

Category	Numbers	Percentages	
Conferencing	02	0.66%	
By using disciplinary tools	15	5%	
Investigations	43	14.33%	
Counseling methods	68	2.66%	

Graph 1 Graph demonstrating the most common methods against cyberbullying

The least effective methods in cyberbullying were trying to reach peaceful results (2.3%) and communication with parents to help in psychological counseling of the bullied subject or the perpetrator (4%) [Table 2 and Graph 2].

Table 2 Interventions that are less effective in tackling cyberbullying

Category	Numbers	Percentages	
Arriving on peace by signing contracts	07	2.3%	
Communicating with parents	12	04%	

Acceptance and precipitation: The majority of students and their parents (89%) believed that teachers should be actively involved in providing solutions to incidents of cyberbullying among students.

Graph 2 Graph showing less effective methods against cyberbullying

Table 3 Shows questionnaire regarding the pattern and prevalence of cyberbullying. However, the actual number of incidents of cyberbullying that were reported was less than 0.2%, which is less compared to the physical acts of bullying reported (10%). This difference was found to have a statistical significance of less than 0.05.

Table 3 Questionnaire regarding the pattern and prevalence of cyberbullying

Question	Yes/no	
Is cyberbullying a problem in your college		
Are there any protocols available for addressing cyberbullying?		
Are there proactive strategies against cyberbullying?		
Are anti-cyberbullying policies along with procedures focusing more over prevention or punishment?		
Which is the most efficient way for addressing cyberbullying?		
Which is the most effective method for tackling cyberbullying?		
Which is the least efficient method against cyberbullying?		
Is disciplinary action effective against cyberbullying?		
Are parents involved in cases of cyberbullying?		
Is teacher involvement present in cases of cyberbullying in your college?		

Discussion

Cyberbullying has been defined as “aggressive and intentional act carried by any group or a particular individual, for utilizing electronic media for repeated contact for a long period of time against any particular victim who is unable to defend for self.”[13]

Different types of cyberbullying include anonymous identification, fraudulent messaging, aggressive language, unwanted type of messages, spreading false rumors, hacking into email accounts, issuing threats, mental and emotional harassment, verbal attacks, unwanted telephonic calls, and use of malicious and abusive language.[14]

Cyberbullying is often repeated hurtful activity. It may be of intense nature and involves a show of power by making the victim feel helpless.[15]

Three basic criteria have been identified for cyberbullying practice: a) intention to harm, b) imbalance in power, and c) repetition of the same act.[15] Cyberbullying may be of intentional or accidental nature. The concept of cyberbullying involves different meanings and content, which may encompass impersonal type of textual messages, instant messaging, comments, and use of social media to spread hate messages or propaganda against a person or by using abusive language in chat rooms and electronic mailing services. These sometimes do not allow one to make a clear distinction in one’s tone or joke that may culminate as an insult. However, such a pattern when repeated is hardly accidental or a chance occurrence.

Zhu et al. in 2021 in their systematic review of cyberbullying cases found that there were eleven nationwide studies conducted in the United States (four studies), South Korea (three studies), and one study each conducted in Singapore, Malaysia, Israel, and Canada that indicated the prevalence of cases of cyberbullying ranging between 14.6% to 52.2% (in victimization) and 6.3% to 32% (penetrability of cyberbullying), respectively.[1617181920212223242526]

This is in contrast to our study findings where only 0.2% of cases of cyberbullying were reported. Hence, physical bullying is more prevalent than cyberbullying in the present study.

In the Internet era with increased gadget use, the ease of virtual communication and networking has led to various physical and psychological morbidities.[27] Cybervictimization or cyberbullying can be associated with academics associated and emotional issues, lowering of self-esteem, low psychological health, and reduced perceptions regarding safety in college or school. Cyberbullying is currently the newer type of violent behavioral conduct in electronic communications due to variety in communication; specially, progression in the field of mass electronic communication has enabled, especially in young adolescents.

Various effects of cyberbullying are described as follows:

Physical effects: These include headaches, stomachaches, disorders of sleep, continuous tiredness, back pain, loss of appetite, and digestion-associated problems;

Psychological and emotional effects: These include feeling of fear, terror, anxiousness, anguish, pity or sadness, stressfulness, depression, and suicidal thoughts. Sourander et al.(2010) observed that individuals who have been subjected to cyberbullying have twice more prevalence of suicidal thoughts. Also, they are 2.5 times more prone to committing suicide than victims of traditional forms of bullying.[28] Van Geel et al. in 2014 concluded that suicidal thoughts had a greater prevalence in subjects who had some experience in traditional bullying and cyberbullying and then decreased prevalence was seen in individuals who were subjected to cyberbullying alone and the least tendency for such thoughts was seen in individuals who were subjected to the traditional type of bullying.[29]

Institution related: Cyberbullying leads to one having low motivation regarding attending classes, which leads to a downfall in academic performance.[29]

Psychosocial effects of cyberbullying: Cyberbullied subjects develop emotions that lead to one’s life in isolation or solitude. They feel ostracized and sometimes feel socially rejected.[3031]

Altogether, these negative effects cause one harm as they influence the social behavior of an individual primarily psychosocial well-being such as feeling of belonging, positiveness regarding their identity, and lowered self-esteem.

Limitation and recommendation

The major limitation of the study included a cross-sectional study design as longitudinal follow-up was not performed to assess the delayed effects of cyberbullying on subjects. A few more questionnaires on the related subject must be included to assess the knowledge, attitude, and perception of undergraduates toward cyberbullying.

Conclusion

Cyberbullying is a rapidly increasing social menace that negatively influences a subject’s psychological and social well-being. Hence, it is important to raise awareness and identify cyberbullying, especially among college and school-going subjects. Reporting mechanisms should be present along with effective methods to deal with such issues as they cause mental, emotional, and psychological harm to victims.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The authors would like to thank all the study participants who agreed to participate in the study.
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References

1. Campbell MA Cyber bullying: An old problem in a new guise? Aust J Guid Couns 2005 15 68 76
2. Olweus D Limber SP Bullying in school: Evaluation and dissemination of the Olweus bullying prevention program American J Orthopsychiatr 2010 80 124 34
3. Hinduja S Patchin JW Personal information of adolescents on the Internet: A quantitative content analysis of My Space J Adolescence 2008 31 125 46
4. Wensley K Campbell M Heterosexual and Non heterosexual Young University students’ involvement in traditional and cyber forms of bullying Cyberpsychol Behav Soc Netw 2012 15 649 51 23078337
5. Beran T Li Q Cyber-harassment: A study of a new method for an old behavior J Educ Comput Res 2005 32 265 77
6. Mitchell KJ Ybarra M Finkelhor D The relative importance of online victimization in understanding depression, delinquency, and substance use Child Maltreat 2007 12 314 24 17954938
7. Donegan R Bullying and cyberbullying: History, statistics, law, prevention and analysis Elon J Undergrad Res Commun 2012 3 33 42
8. Wang J Iannotti RJ Nansel TR School bullying among adolescents in the United States: Physical, verbal, relational, and cyber J Adolescent Health 2009 45 368 75
9. Kaplan AM Haenlein M Users of the world, unite! The challenges and opportunities of social media Bus Horiz 2010 53 59 68
10. Elgar FJ Napoletano A Saul G Cyberbullying victimization and mental health in adolescents and the moderating role of family dinners JAMA Pediatr 2014 168 1015 22 25178884
11. Reed KP Cooper RL Nugent WR Russell K Cyberbullying: A literature review of its relationship to adolescent depression and current intervention strategies J Hum Behav Soc Environ 2016 26 37 45
12. Garett R Lord LR Yond SD Associations between social media and cyberbullying: A review of the literature mHealth 2016 2 46 53 28293616
13. Smith PK Del Barrio C Tokunaga RS How useful are the terms? Principles of CB Research: Definitions, Measures, and Methodology American Psychological Association 2013 26 40 NYork/Londres: Routledge
14. Lawrence FJ Prevalence and Consequences of Negative Workplace Cyber Communications in the Australian Public Sector Australia Queensland University of Technology 2015
15. Geel M Vedder P Tanilon J Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: A meta-analysis JAMA Pediatr 2014 168 435 42 24615300
16. Zhu C Huang S Evans R and Zhang W 2021 Cyberbullying Among Adolescents and Children: A Comprehensive Review of the Global Situation, Risk Factors, and Preventive Measures Front. Public Health 2021 9 1 12
17. Alhajji M Bass S Dai T Cyberbullying, mental health, and violence in adolescents and associations with sex and race: Data from the 2015 youth risk behavior survey Global Pediatr Health 2019 6 2333794X19868887 doi: 10.1177/2333794X19868887
18. Mesch GS Parent-child connections on social networking sites and cyberbullying Youth Soc 2018 50 1145 62
19. Sam J Wisniewski P Xu H Rosson MB Carroll JM How are social capital and parental mediation associated with cyberbullying and cybervictimization among youth in the United States? Stephanidis C HCI International 2017 – Posters’ Extended Abstracts Communications in Computer Information Science Cham Springer International Publishing 638 44 2017
20. Hong JS Kim DH Thornberg R Kang JH Morgan JT Correlates of direct and indirect forms of cyberbullying victimization involving South Korean adolescents: An ecological perspective Comput Hum Behav 2018 87 327 30
21. Lee C Shin N Prevalence of cyberbullying and predictors of cyberbullying perpetration among Korean adolescents Comp Hum Behav 2017 68 352 8
22. You S Lim SA Longitudinal predictors of cyberbullying perpetration evidence from Korean middle school students Person Ind Differ 2016 89 172 6
23. Holt TJ Fitzgerald S Bossler AM Chee G Ng E Assessing the risk factors of cyber and mobile phone bullying victimization in a nationally representative sample of Singapore Youth Int J Offend Ther Comp Criminol 2016 60 598 615
24. Marret MJ Choo WY Factors associated with online victimisation among Malaysian adolescents who use social networking sites: A cross-sectional study BMJ Open 2017 7 e014959 doi: 10.1136/bmjopen-2016-014959
25. Tesler R Nissanholtz-Gannot R Zigdon A Harel-Fisch Y The association of cyber-bullying and adolescents in religious and secular schools in Israel J Relig Health 2019 58 2095 109 31646424
26. Beran T Mishna F McInroy LB Shariff S Children’s experiences of cyberbullying: A Canadian national study Child School 2015 37 207 14
27. Rao R Verma M Singh CM Nirala SK Naik BN Internet addiction and nomophobia among medical undergraduates of a tertiary care teaching institute in Patna, Eastern India J Educ Health Promot 2023 12 286 37849868
28. Sourander A Brunstein KA Ikonen M Psychosocial risk factors associated with cyberbullying among adolescents: A population-based study Arch Gen Psychiatry 2010 67 720 8 20603453
29. VanGeel M Vedder P Tanilon J Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: A meta-analysis JAMA Pediatr 2014 168 435 42 24615300
30. Bargh JA McKenna KYA The internet and social life Annu Rev Psychol 2004 55 573 90 14744227
31. Wright MF Li Y The association between cyber victimization and cyber aggression: The moderating effect of peer rejection J Youth Adolesc 2013 42 662 74 23299177
