The Relationship between Cyberbullying and Mental Health among University Students

: Background: The term ‘cyberbullying’ is linked to traditional bullying, and both refer to oppression. This study aimed to determine the overall effects of cyberbullying on mental health among university students of various ages, and to investigate the extent to which victims (students) directed less attention and focus towards their academic achievement. Methods: The participants in this study were 326 male and female students from King Faisal University in the Al-Ahsa Governorate. The researchers in this study employed the descriptive correlative approach. Results: The study’s ﬁndings revealed that there were substantial variations in the categories of sex, academic specialty (medical and non-medical students), and family economic status, in relation to cyberbullying surveys. In addition, there was a signiﬁcant negative relationship between cyberbullying and mental health. Conclusions: It is highly recommended that, in order to prevent cyberbullying, people of all generations need to be made aware of it via speciﬁc programs in different public areas, for example, in schools, colleges, and malls, and on social media.


Introduction
Bullying is an aggressive behavior that is intentionally and repeatedly directed at individuals who have less power than the attacker does. Bullying may take many forms, including physical, verbal, and social bullying [1]. In its physical form, bullying includes hitting, pushing, spitting, and other physical acts. Bullying in the oral form includes mocking, name-calling, and threatening. In its social form, it consists of spreading rumors (slander), exclusion from peer groups, and other forms. When dealing with perpetrators, these three forms of bullying most commonly occur face to face [2].
Both cyberbullying and cyber victimization research have grown in popularity in recent years in various countries. Traditional forms of bullying, such as school bullying and school victimization, are still prevalent among children. The phenomenon of cyberbullying has gained scientists' attention because it is a new form of bullying in the digital era. Individuals can now use new media to intimidate others [3]. Bullying has also grown as information and communications technology has advanced [3,4]. This situation makes sense, because indirect intimidation is considered the safest and most convenient approach, compared to traditional bullying. Bullying victims can be easily intimidated without their names being revealed [5]. Even the perpetrators can use digital media to quickly publicize intimidation acts to the general public. Cyberbullying has a more dangerous effect than traditional bullying; it can even encourage victims to respond reactively to accidents and deaths. This type of cyberbullying often happens in the educational setting, particularly among students [3]. online harassment, online dating, cyberstalking, and phishing scams, with a focus on raising awareness and encouraging assertive initiatives to solve these societal problems as the digital era evolves [17].
After reading many literature reviews on cyberbullying in the age groups of 8-13 and 9-17, we decided to focus our study on college students, namely those aged 18 and above. This is a focus that differentiates our study from other, similar research. The goal of the current study was to determine the overall impact of cyberbullying on mental health. We also wished to investigate whether there was a substantial difference in mental health between males and females at King Faisal University, Saudi Arabia.
However, every generation has its view of cyberbullying, including teachers, some of whom are judged on their appearance, or due to racism and prejudice, among other things. Even when the bullying has ceased, cyberbullying can have long-term emotional consequences. Cyberbullying may also cause mental health problems, including tension and worry, sadness, aggressive behavior, and low levels of self-esteem.
The current research aimed to investigate the overall impact of cyberbullying on the mental health of college students of different age groups. Moreover, we also aimed to study the extent to which victimized persons (students) direct less concentration/less focus towards their academic performance. Objectives:

1.
To explore whether there is a relationship between cyberbullying and emotional mental health, i.e., depression, anxiety, and stress.

2.
To evaluate the differences between males and females, as well as students at medical and non-medical colleges, with regard to the impact of cyberbullying on psychological disorders.

3.
To explore whether there is a significant relationship between academic performance and mental health in relation to cyberbullying.

Literature Review
Today's teenagers are completely connected in their everyday lives. Aboujaoude (2015) refers to today's teenagers as completely wired, since they are constantly switching from one type of media to another [1]. Ongoing technological growth has brought about the continuous development of the concept of relationships. Non-mandatory entry to social networks and online communities suggests instant presence broadcasting over the network [18].
Cyberbullying, also known as electronic bullying, is a well-known risk of technological evolution; it involves purposed and repeated actions toward at least one individual, using electronic devices [19]. Cyberbullying, like traditional bullying, is dependent on an asymmetrical relationship between the person who make the cyberbullying and the targeted person [20]. The main feature of cyberbullying is the anonymity guaranteed by the internet, which makes victims feel weak and lonely. [21].
The rates of cyberbullying vary significantly across studies conducted in European and non-European countries, with values ranging from 6.5% to 72% for cyber victimization [22]. For instance, according to a 2017 Brazilian survey conducted in the United States, between 33.8% and 39% of adolescents have reported being victims of cyberbullying at some point in their lives. Rates of cyber victimization in China span from 14% to 57%, and cyber violence from 3% to 35%, according to research published between 2013 and 2018 [23].

Cyberbullying and Mental Health
Victims of cyberbullying use alcohol and narcotics more often than other students in schools, and are more likely to be absent from school (United Nations Children's Fund) [24]. In addition, they are more likely to perform poorly and have problems with self-esteem and health [25]. When it comes to cyberbullying, adolescents usually hesitate to confide in adults. Cyberbullying presents with the same symptoms as a post-traumatic stress disorder, and suicide can result from these symptoms [26]. Harassment and cyberbullying are frequently linked to anxiety and depression. [27].

The Psychological Effects of Cyberbullying
Cyberbullying has the potential to harm the victim's mental health. Victims experience increased levels of anger, helplessness, unhappiness, and fright [28]. The most significant emotional and non-physical results of cyberbullying include anger, helplessness, grief, and anxiety. Students who experience cyber victimization can develop symptoms of depression [29]. However, traditional bullying has a stronger link to depressive symptoms, as compared to cyberbullying [30]. Other research has revealed that victims of cyberbullying suffer from increased levels of depression than victims of traditional bullying [31]. In addition, cyberbullying has a stronger link to anxiety symptoms than traditional bullying [32].
When students do not know who is intimidating them, the negative impacts intensify, leaving victims feeling helpless and afraid. This is highly understandable, given that cyberbullying is often carried out anonymously by perpetrators [33]. In comparison to those instances when the victim knows who is committing the cyberbullying, anonymity generates heightened feelings of disordered anxiety: that is, in instances when the victim is unaware of the perpetrator's identity. The anonymity factor can make the victim feel less secure, resulting in a more pronounced power imbalance in cyber victimization than in traditional victimization [32].

Reactive Behavior
Cyberbullying victims may exhibit reactive behaviors, such as suicide attempts. This condition occurs due to ongoing depression, which eventually leads to the formation of suicidal ideation and attempts [34]. Several studies have found that cyberbullying has more severe consequences than traditional bullying. Cyberbullying has a greater incidence of depression, drug use, self-injury, suicidal ideation, and suicide attempts, compared to traditional bullying [35]. The researcher states that involvement in cyberbullying, whether as a bully or a victim, functions as a predictor for symptoms of depression and thoughts of suicide, in a way that traditional forms of intimidation (physical, verbal, relational) do not [35]. Victims attempt suicide, and cyberbullying has been shown to have a direct influence on suicide attempts [35]. Young individuals who experience traditional bullying or cyberbullying, either as perpetrators or victims, have greater rates of suicidal thoughts and are more likely to attempt suicide than those who have not experienced any form of aggression from their peers [36].

Difficulties in Social and Academic Development
Another problem caused by cyberbullying is the inability to make friends [37]. Cyberbullying enables victims and attackers to avoid facing social communications and building connections, which can have harmful emotional implications. [37]. Furthermore, perpetrators of cyberbullying have lower levels of conscience [37]. Additionally, cyberbullying can also obstruct students' academic development [37]. Feelings of pressure and shame discourage students from focusing on educational activities. Victims find it challenging to develop their academic, social, and emotional capacities [37].

The Role of the School Environment
Cyberbullying must receive serious attention from school stakeholders and must be addressed by teachers, parents, and peers [38]. Various protective strategies may be implemented to avoid cyberbullying, and education is an important component of cyberbullying prevention and response. Educators must devise innovative techniques to engage young people in meaningful discussions regarding the use of accessible technology. In this context, they can create lessons that teach students to express their opinions appropriately on social media [39]. An encouraging school environment plays a vital role in reducing the occurrence of cyberbullying [40]. Previous studies have revealed that a positive school climate [3,37] and school safety [3] can protect children from the victimization and oppression of cyberbullying [41].

The Role of the Family
Cyberbullying victims frequently have the lowest level of family support [42]. Parents can assist in anti-cyberbullying interventions by providing: (a) emotional and practical support for students, (b) knowledge of ICT safety, and (c) a structured environment, characterized by warm involvement and control of behavior, combined with discussions of and participation in children's online lives, to promote critical thinking, respect, and finally autonomy [5]. Some types of social support can protect against cyberbullying. Specifically, perceived social support from the family and teacher reduces the likelihood of depression and anxiety symptoms, and a higher level of social support from the family increases the probability of a greater level of subjective well-being among children who are victims of cyberbullying [43].

The Role of Peers
A positive community can protect children from cyberbullying. Information and communications technology may be used as a medium for communication between users [6]. However, students who have offline relationship problems are more likely to become victims of cyberbullying [9]. Therefore, the role of positive interaction and peer support is vital to reducing the incidence of cyberbullying [43]. Previous studies revealed that positive peer influence and peer support are linked to decreased cyber victimization [3]. Furthermore, choosing a positive community is a significant factor in reducing the occurrence of cyberbullying.

Individual Role
Protective measures against cyberbullying not only rely on situational factors but also on personal factors [6]. Students are thought to play a vital role in protecting themselves against cyberbullying. Prosociality is expected to prevent cyber victimization and cyberbullying by lowering the frequency of technology usage, among other individual factors [3]. Additionally, social competence, intelligence, and problem-solving can protect against victimization [3,6].
Furthermore, the ViSC Social Competence Program is also proposed as a cyberbullying prevention program [44]. ViSC is a primary prevention program, with secondary prevention features to minimize violent behavior and intimidation in schools, as well as to promote social and intercultural competency [45]. Given that cyberbullying harms students, the findings of this study provide further evidence that teenage peer aggression must be addressed seriously both at school and at home. In addition, in programs that respond to cyber victimization and cyberbullying in the school setting, both the prevention of and intervention in cyberbullying are critical components [46].
All technological developments provide various benefits and unexpected losses. This includes impacts on the school environment and the way students learn. The downside of technological development is that it might have a bad influence: for example, when technology is used as a tool for cyberbullying [47]. The development of technology has had a significant influence on this new form of bullying. The ease with which people can use the internet, and other technical gadgets such as cell phones, has also contributed to the emergence of new forms of bullying. Individual relationships have been altered by the increased use of technology. Rapid changes in communication and social interaction have significant effects, both positive and negative, including encouraging the emergence of cyberbullying [3].
Cyberbullying refers to humiliation, threats, sexual harassment, or social exclusion using information and communications technology [6]. Perpetrators attack victims by sending demeaning or threatening messages and images using websites, instant messages, blogs, chat rooms, cell phones, e-mails, and personal online profiles [7,8,48]. As a result, it is clear that cyberbullying is different from traditional bullying. This situation creates new challenges for educators in the school/college learning process. In the digital era, teachers must be aware of changes in student behavior. Furthermore, they face the challenge of keeping students safe at school, both physically and virtually, which has become a hazardous environment. Until now, there has been no regulation or supervision of virtual room security [12].

Materials and Methods
Study type: IT Cross-sectional design. The sample size consisted of 326 students from different colleges of King Faisal University. All the respondents (males and females) were aged 18 and above, and came from different socio-economic backgrounds.

Hypothesis 1 (H1).
There is a significant difference in mental health between males and females, with regard to cyberbullying.

Hypothesis 2 (H2).
There is a significant difference in mental health between students at medical and non-medical colleges, with regard to cyberbullying.

Hypothesis 3 (H3).
There is a significant difference in mental health between victimized students and non-victimized students with regard to cyberbullying.

Hypothesis 4 (H4).
There is a significant relationship between poor academic performances/diminished concentration/poor mental health, and cyberbullying.
Tools: Two main questionnaires were used. The first of these was the Cyberbullying Scale, which was developed by the Cyberbullying Assessment Instrument [36]. This questionnaire focuses on assessing cyberbullying among college students, and consists of 20 items. The second questionnaire, "Mental Health Questionnaire", was developed by DASS 21, and consists of 21 items that focus on depression, anxiety, and stress.
Procedure: The study was carried out among university students at King Faisal University, Saudi Arabia. The sample size was 326 students, aged 18 and above, and the study was conducted using valid questionnaires through online surveys. The target was focused on students with different levels of socio-economic status, male and female students, and students from both medical colleges and non-medical colleges, at King Faisal University. Two questionnaires were used: DASS-21 and the Cyberbullying Assessment Instrument. The collection of questionnaires was carried out between January and March 2022, during the academic year.
Analysis of data: The data was entered and analyzed using the SPSS program, version 26, with the help of different statistical techniques such as Chi-square, Pearson correlation, and frequency. Chi-square was used to assess the significance level of various factors such as sex, age group, academic level, academic specialty (medical and non-medical students), and the economic level of the family, with regard to the cyberbullying questionnaire. The Pearson correlation was used to determine the existence of a significant relationship between cyberbullying and mental health. Likewise, the frequency technique was used to determine the significance of sex, socio-economic status, and academic level and specialty (non-medical colleges) for mental health.
Ethical Approval: The ethics committee of the university granted and informed IT, giving the researchers consent to carry out the research. The ethical principles were considered with respect to research with human beings. Table 1 shows the demographic percentages: 311 students (95%) were aged 18-25, the highest percentage of the age groups; 2.1% of students were 26-30 years of age; and 2.5% were above 30 years of age. With regard to sex, males comprised 42.6% of respondents and females 57.4%. In terms of different academic levels, 23.6% were in first year; 48.5% second year; 16% third year; 3.7% fourth year; 2.8% fifth year; and 5.5% sixth year. The percentage of students at medical colleges was 78.2%, and the percentage of students at non-medical colleges was 21.8%. In terms of family socio-economic level: SAR 5000-1000, 23.6%; less than SAR 5000, 17.2%; greater than SAR 1000, 59.2%. Table 2 shows that there is a significant difference level in sex, academic specialty (medical and non-medical students), and economic level of the family, among respondents to the cyberbullying questionnaires. Table 3 shows that there is a significant negative (−0.687) relationship between cyberbullying and mental health. Table 4 shows that 15% of the participants mentioned that cyberbullying is a significant/big problem at their college. The majority (84%) of the participants agreed that cyberbullying is on the rise. About one-half (49.1%) of the participants have been cyberbullied in the past three years. I felt that I was using a lot of nervous energy 0.005 Males who never felt that they were using a lot of nervous energy.

Results
I felt that I was rather touchy 0.000 Males who sometimes felt that they were rather touchy. Sixth-year students who mentioned that we should not leave the student on the internet without watching him, directing, or guiding him. If the student took a photo of someone else, should he have the right to publish it with permission?

0.006
Third-year student who mentioned that we should take permission to publish the photos.
I could not seem to experience any positive feeling at all 0.036 Fourth-year students who sometimes could not seem to experience any positive feeling at all.
I felt I was close to panic 0.031 Fourth-year students who sometimes felt they were close to panic.

Specialty
Bullying always occurs when you are in 0.005 Non-medical students who mentioned that bullying always occurs when they are in college.
Bullying occurs through 0.000 Medical students who mentioned that it is occurs through personal profile pages.
Should we leave the student on the internet without watching him, directing, or guiding him?

0.042
Sixth-year students who mentioned that we should not leave the student on the internet without watching him, directing, or guiding him.   Table 5 shows the assessment of the mental health of the participants related to different issues, such as anxiety, stress, and depression. The results show that (58.6%) of participants found it hard to calm down after any kind of stress; (20%) reported that this was never an issue; and the remaining (9%) answered 'almost always' in relation to mental health issues. The results show that it is difficult for the participants (university students) to return to a normal mood after experiencing stress. Moreover, regarding the questions related to overreactions and difficulties calming down quickly in situations such as cyberbullying, (9.5%) of the participants showed overreactions; (31.6%) of respondents reported that tended to overreact to situations was 'never' an issue; (16.6%) of participants responded that it was 'often' the case; and (42.3%) responded 'sometimes' regarding mental health issues.

Discussion
The present research aimed to assess the overall impact of cyberbullying on mental health, and the extent to which victims (students) paid less attention to their academic performance.
In terms of cyberbullying, the results of the present study revealed that there was significant differences according to the following variables: sex (p = 0.0001), academic specialty (p = 0.039), medical (p = 0.0001) and non-medical (p = 0.005) students, and family economic status (p = 0.038). In relation to mental health, surveys demonstrate that females (p = 0.009) are more stressed than males (p = 0.007) when it comes to cyberbullying. When we analyzed the data at different academic levels, we found that third-year students (p = 0.006), fourth-year students (p = 0.036), and sixth-year students (p = 0.039) were more fearful of cyberbullying than first-year and second-year students. This might be due to students gaining experience and maturity as they progress through their academic years. However, aside from demonstrating a major difference between students at medical and non-medical colleges, one unexpected finding from this study is that students are not willing to discuss any problems with their family members. The students imply that no matter what transpired in their social lives, they would never tell their parents about their problems. As a result of the bullying they endure, students are constantly stressed, anxious, and depressed [37].
According to the results of the present study, about one-half of university students (49.1%) say they have been victims of cyberbullying, with the percentage being greater in the case of aggressors. Prior empirical investigations have indicated that prevalence rates for both victims and aggressors are similar [24]. Data have demonstrated that various emotional issues are predictors of being a victim of cyberbullying. Higher percentages of anxiety and stress, in particular, indicate a higher likelihood of being a victim of cyberbullying, although higher depression rates among students predict a greater likelihood of becoming a cyberbully [12,24,37], proving hypotheses 2 and 3 of this research.
Unfortunately, few studies have investigated whether these high levels are the outcome of predictors of cyberbullying in the college environment, making comparisons of the findings of this research very difficult indeed. Even so, the distinctive features of this transition phase may predict psychological issues in the college population as a whole [49]. Moreover, it has been demonstrated that these issues increase the chances of being a victim.
Results of the recent study revealed that there was an overall significant negative relationship between mental health and cyberbullying. These results clarified that cyberbullying has a negative impact on students' well-being, academic performance, and mental health. The results clearly show that victims of cyberbullying experience emotional problems, such as worry, tension, and sadness. Bullies' violent and domineering behavior [12] is associated with sad emotions, dissatisfaction with life, depression, and high levels of irritation. [44,48] Results of the recent study show that (58.6%) of participants found it hard to calm down after any kind of stress; (20%) responded that this was 'never' an issue; and the remaining (9%) answered 'almost always' in relation to mental health issues. From these results, it is shown to be difficult for participants (college students) to return to a normal mood after experiencing stress. Moreover, with regard to questions related to overreactions and difficulties calming down quickly in situations such as cyberbullying: (9.5%) of the participants overreacted; (31.6%) of participants responded that this was 'never' an issue; (16.6%) of participants responded 'often'; and (42.3%) responded 'sometimes' regarding mental health issues. Here, the results show that there is an anxiety among college students who are victimized.
However, we can also identify from the results based on mental health questions that respondents who are victimized suffered from depression. Questions related to "I am not a deserving/a worthy person" received affirmative responses from (30.1%) of respondents; question based on "meaningless life" from (12%); and questions related to not being able to cope for trivial reasons from (8.9%). These results show that the participants thought that it was useless or of no value to live, felt discouraged by society, experienced discrimination, and felt desperate and lonely. Similar studies also support these results [28,45].
Similar studies were also supported [46], which concluded that there was relationship between victimization and the internalization of problems, whereby being a victim of bullying predicted future emotional problems. At the same time, depression, anxiety, anguish, insecurity, and low self-esteem all predisposed the student to become a victim.
Students who experience cyber-victimization are at greater risk of depressive symptoms [29]. Additionally, traditional bullying has a stronger relationship with depressive symptoms, as compared to cyberbullying [30]. This finding does not follow other studies, which found that victims of cyberbullying have higher rates of depression than victims of traditional bullying [10].
In addition, the present study shows how some university adjustment factors are predictors of becoming a victim. Specifically, personal-emotional adjustment and social adaption were discovered to be predictive factors of becoming a target of bullying, with higher levels of individual and interpersonal adaption reducing the likelihood of becoming a target. Previous research has indicated that students who are victims of cyberbullying experience internalized issues such as stress, discomfort, fear, aloofness, depression, shame, indifference, and low academic performance due to mental health problems [12]. This has a negative impact on university students' academic performance, which supports hypothesis 4 of our study. According to Egeberg (2016), bullies have poor academic performance and a lack of integration in academic and scholastic dynamics [50]. As a result, making positive academic adjustments (the desire to fulfil educational obligations, educational hard work, and educational satisfaction) protects against participating in violent behavior toward peers.
Several types of research have found that victims have poorer social adaptation than non-victims, experiencing challenges interacting with peers, and social difficulties [51]. As a result of the findings of this research, excellent psychological and community adaptation appears to be a preventative measure against being a target of mockery, insults, or bullying via online technology [43,52].
Emotional skills can help students to feel a greater level of understanding for their schoolmates. However, one of the characteristics that cyberbullies frequently mention is a lack of understanding for victims, as they do not seem to feel distressed or guilty as a result of their aggression, and thus are unable to empathize with the victim's emotions or feelings [12]. Bullying is also associated with poor scholarly performance and a lack of collaboration in scholarly interactions [53].
We believe that future studies should focus on determining which factors might aid in a better understanding of cyberbullying. Other variables include social support [54], impulsivity or other features of self-regulation [5], aggressiveness [55], sexual orientation [31], and coping style [56]. As a result, experimental strategies in cyberbullying should be aimed at increasing the levels of these protecting factors [54].

Limitations of the Study
Two notable limitations affected the recent study:

1.
There was a time limitation.

2.
The results would have been better if we had assessed a larger sample size for both males and females.

Conclusions
The present research aimed to study the connection between online bullying and psychological health in college students. There was a significant negative relationship between mental health and cyberbullying with regard to gender, age, economic level, specialty, and academic level. Furthermore, this study showed that the higher the educational level, the more likely students were to deal positively with cyberbullying issues. It is highly recommended that, in order to protect them from cyberbullying, people of all generations need to be made aware of it via specific programs in different public areas, for example, in schools, colleges, and malls, and on social media. Moreover, this study gives us a foundation to conduct more studies on cyberbullying, which is understudied in many Arab countries owing to cultural and societal factors.

Recommendations
The researchers recommend the following:

1.
Providing awareness programs about cyberbullying in order to prevent this behavior in younger generations.

2.
Giving counseling to people who have been exposed to cyberbullying.

3.
Constructing special units in educational institutions to provide support for people who have been exposed to cyberbullying.

4.
Conducting further studies about the relationship between cyberbullying and mental health among different populations, such as high school students. 5.
Conducting the same research but using a bigger sample size.

6.
Conducting similar studies over longer periods of time.
Author Contributions: All authors contributed to the paper. S.I.A. collected data, analyzed data, wrote the methods and results sections, and supervised the manuscript writing; N.B.S. wrote the manuscript (introduction, literature review, discussion, and references). All authors have read and agreed to the published version of the manuscript. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement:
The data presented in this study are available within the paper.