Bullying and Suicidality in Urban Chinese Youth: The Role of Teacher

Abstract

The aim of this study is to examine the link between bullying and the tendency toward suicide (suicidality). In particular, we tested the interaction effect of teacher–student relationships on the association between bullying and suicidality among urban youth in China. A total of 3,675 participants were recruited from 7 provinces in urban China. Three questions were used to capture suicidality-related measures: suicide ideation, suicide planning, and attempting suicide. Traditional bullying and cyberbullying were used to measure the effect of being bullied. The results show that being bullied, traditionally or online, is significantly associated with suicidality. The interaction effect between traditional bullying and the teacher–student relationship for suicidal ideation is significant (odds ratio 1.34, 95% confidence interval 1.03–1.74). However, no significant interaction effects in teacher–student relationships have been found in the association between cyberbullying and suicidality. The results indicate that teacher–student relationships have a significant protective, but limited, effect on the relationship between bullying and suicidality. Future development of suicidality intervention strategies adapted to the development of society will be beneficial.

Introduction

Suicide is a significant public health problem that has aroused great concern worldwide over the last few decades.¹ According to the World Health Organization, >800,000 people die, worldwide, from suicide annually.² In China, suicide is ranked the fifth most common cause of death and, with increasing pressure in society, it is becoming more and more serious, especially among adolescents who are sensitive to peer pressure and trauma.³ Suicide is the most common killer among Chinese people aged 15–34 years, which accounts for 19% of all deaths in the age category.⁴ Identifying influencing factors of suicidality has great significance both theoretically and practically in guiding the suicide prevention policy in China, particularly since suicide not only leads to loss of life but also negatively impacts on family members.

Previous studies have established various factors associated with youth suicidality, such as school adaptation, traditional as well as cyberbullying,^5,6 an unsupportive home climate,⁷ and even unemployment rates.⁸ Among these factors, the experience of victimization through bullying is one of the most probable determinants of suicide-related behavior in youth, especially traditional bullying that occurs in schools. According to the strain theory of suicide postulates, conflicting and competing pressures (or stresses) in an individual's life accelerate the condition of strain and usually precede suicidal behavior.⁹ Although many efforts have been made to prevent or to stop bullying entirely, it remains highly prevalent worldwide, ranging from about 12% in Sweden to around 55% in Lithuania,^10,11 and contributes increasingly to the strain that individuals face.^12,13

In addition, with fast development of the Internet and social media, a new form of bullying behavior, namely cyberbullying, is becoming more and more prevalent among adolescents.¹⁴ Cyberbullying, which is generally considered as bullying behavior conducted by others using information tools such as the Internet, social media, and mobile phones,¹⁵ has different characteristics and impacts differently than traditional forms of bullying. Thus, establishing the association between varied forms of bullying (traditional and cyber) and suicidality, in the context of fast-developing information societies, contributes to the knowledge field of suicidality studies and the prevention of suicide in adolescents.

In the existing literature, several studies have shown that interpersonal relationships are related to suicide.^16,17 Kim et al.¹⁶ found that suicide probability showed a significantly negative correlation with interpersonal relationships with parents, friends, and teachers among Korean adolescents and, within these social relationships, the teacher–student relationship had the greatest significance. Possible reasons are as follows: first, as an internalized problem, suicide ideations are not easily noticed or observed until occurrence. A positive relationship with teachers means closer contact and a relatively superior position in the distribution of attention by teachers. Thus, suicidality is more likely to be noticed.¹⁸ Second, as a combination of emotive, cognitive, and behavioral interactions, the teacher–student relationship is constructed to meet students' particular social contact demands, reflecting the ability for interpersonal communication and adaptability held by individuals.¹⁹ Students who remain in a positive relationship with their teachers are more likely to have positive associations with peers and society more broadly and are thus less likely to be involved in school bullying and suicidality. Last, but not least, previous studies have proved that higher levels of attachment between students and teachers improve the student's sense of belonging toward teachers and the school, which could decrease the possibility of mental illness and deviant behaviors in the future.²⁰

With the development of society in China, there is an increasing number of boarding students in society, and nowadays, adolescents spend the majority of their time on campus. For these reasons, it is necessary to take teacher–student relationships into consideration as an interaction factor for suicide reduction among youth who are being bullied.

Using nationally representative data collected in 2016, the purpose of this study is to (1) examine the association between bullying and suicidality of youth in urban China and (2) test the interaction effect of teacher–student relationships on the association of bullying and suicidality to guide suicide prevention strategies in China.

Methods

Participants

This study is based on a national survey conducted in 2016 by the School Safety Research Committee within the China Association of Emergency Management. Seven provinces, including Liaoning, Beijing, Hunan, Jiangsu, Guangdong, Guizhou, and Gansu, were selected according to their particular geographical characteristics. For each selected province, a convenience sampling method was used to select schools (one primary school, one middle school, one high school, and one vocational school) within each of the targeted provinces' capital cities. Then, one class was randomly selected from each grade and every student in these classes joined the survey. In primary schools, only students over grade 3 answered the questionnaire. In total, 3,777 questionnaires were collected and 3,675 students answered all the related questions.

The study protocol was approved by the Institutional Review Board of Central South University of China, where the School Safety Research Committee is located. All participants gave consent after being informed about the aim of the survey as well as their right to refuse to participate. An active informed consent for students from their class master teachers and parents was also obtained.

Measurements

Suicidality

Adopted from the Centers for Disease Control and Prevention Youth Risk Behavior Survey, three questions were used to capture suicidality-related measures: suicide ideation, suicide planning, and suicide attempt.²¹ Suicide ideation was assessed through the question: “In the last year, have you thought about ending your life through any method?” Suicide planning was established by the question: “In the last year, have you thought about how you would kill yourself?” Finally, an attempt at suicide was established by the question: “In the last year, have you tried to end your life?” The possible answers to all three questions were either yes (1) or no (0).

Being bullied

The questions about being bullied were drawn and modified from the National Center for Education Statistics' School Survey on Crime and Safety.²² We did not use any direct questions using the term bullying or being bullied because the construction of these terms has several expressions in Chinese that may have been confusing or unfamiliar to students. Instead, we asked, “In the last year, have any of your classmates or peers done any of the following actions to you?” Ten kinds of bullying activities were proposed; six of them traditional bullying behaviors and four of them cyberbullying actions. The six traditional bullying actions consisted of three verbal actions (being made fun of in a hurtful way, having rumors spread about oneself, and/or threatened with harm), one physical behavior (being pushed, shoved, tripped, or spit on), one relational behavior (being excluded from activities on purpose), and one property-related behavior (having one's property destroyed on purpose). The four cyberbullying experiences included being made fun of in a hurtful way online, being threatened or insulted online, being hurt through an intentional leak of private information, or being purposively excluded in cyberspace.

The answers to each of these questions ranged from never, rarely, sometimes to frequently. Considering the three generally accepted criteria of bullying (intentionality, a degree of repetitiveness, and an imbalance of power), we coded the never and rarely choices as not being bullied (0), and the sometimes or frequently choice as being bullied (1). If any of the six traditional bullying methods were selected, the respondent was classified as being traditionally bullied. If any of the four cyberbullying methods were selected, the respondent was classified as being cyberbullied. Cronbach's alpha test result of the six traditional bullying variables was 0.807, while the result of the four cyberbullying variables was 0.809, indicating good internal reliability.

Social relationship

The student's relationship with classmates was obtained through the question, “In general, how do you get along with your classmates at school?” The student's relationship with teachers was obtained through the question, “In general, how do you get along with your teachers at school?” The answers to these two questions were measured by a five-point Likert scale from one to five, indicating very poor (1) to very good (5). We proposed nine statements to describe the relationship between the respondent and his/her parents and asked the respondent to evaluate their degree of agreement with the statements. The agreement to each of the statements was measured in four categories, from one to four, representing strongly disagree (1) to strongly agree (4). The principal factor analysis result indicated that these nine statements could be clustered into two factors; one describing a positive relationship with parents (six items, 1, 2, 3, 4, 7, and 8) and the others (three items, 5, 6, and 9) encompassing negative descriptions. Cronbach's alpha test result of the six positive items was 0.851, indicating good internal measurements. Cronbach's alpha test result of the three negative items was 0.614, also indicating that treating the three items as one factor was acceptable. The sum of agreements of the six positive statements was used as the positive parent–child relationship score, while the sum of agreements to the three negative statements was used as the negative parent–child relationship score.

Potentially confounding variables

The following variables were controlled in the analysis: characteristics of the school (primary/middle/high/vocational, whether it was a leading school in the region and or whether it had boarding students), students' demographic variables (minority, gender), students' family attributes (the primary caregiver, the father's and mother's education status, respectively, and the family's perceived socioeconomic status), student's self-reported health status, and the geographical location (province).

The family's perceived socioeconomic status was established through the question: “In general, how do you think your family's socioeconomic status compares within your region?” The answers were ranked from one to five, indicating an increased degree of perceived socioeconomic status. The self-reported health status was measured on three scales through the question: “In general, how do you evaluate your overall health status?” The answers were poor (1), average (2), and good (3).

Data analyses

We began by reporting the means and standard deviations of continuous variables as well as the distribution of categorical variables. Considering the fact that suicide ideation, planning, and attempt are dummy variables, three binary logistic regression models were employed to estimate the effects of being bullied, respectively. We then generated two interactive variables using the relation between teacher–student relationships and being traditionally and/or cyberbullied and, again, estimated the interaction effects of the student's relationship with teachers between being bullied and the suicidality of youth. The odds ratios and 95% confidence interval were reported. The data analysis was implemented by the statistical software Stata 13.1 MP version.

Results

Descriptive analyses

Descriptive analyses for the participants are presented in Table 1. Among all 3,675 adolescents, 12.30% of students indicated suicide ideation, while the rates for suicidal plans and attempts were 8.46% and 5.09%, respectively. In addition, 25.39% of respondents reported that they were being bullied traditionally, while the prevalence of cyberbullying was 8.30%. Within social demographics, 48.22% of the surveyed students were male, 8.24% of which belonged to minority groups. In addition, about 18.18% of participants were boarders (living on campus during weekdays). The distribution of the sample was 37.77% primary school students, 27.76% middle school students, 26.91% high school students, and 7.56% vocational school students.

Table 1.

Descriptive Analysis of the Characteristics of Youth in Urban China (N = 3,675)

Variable	Mean	SD	Min	Max
Relationship with classmates	4.27	0.88	1	5
Relationship with teacher	4.08	0.95	1	5
Relationship with parent (+)	19.0	3.92	6	24
Relationship with parent (−)	6.14	2.12	3	12
Self-reported health	2.81	0.47	1	3
Family's social status	2.83	0.83	1	5

	Frequency (N)	Percent (%)
Suicide (ideation)	452	12.30
Suicide (plan)	311	8.46
Suicide (attempt)	187	5.09
Bullied (traditional)	933	25.39
Bullied (cyber)	305	8.30
Leading school	1,266	34.45
Minority	303	8.24
Male	1,772	48.22
Boarding school	668	18.18
Grade
Primary school	1,388	37.77
Middle school	1,020	27.76
High school	989	26.91
Vocational-technical school	278	7.56
Living with
Parents	2,693	73.28
Single parent	364	9.90
Grandparents	618	16.82
Father's education
Illiteracy or primary	370	10.07
Middle	1,152	31.35
High	891	24.24
College	935	25.44
Graduate school	327	8.90
Mother's education
Illiteracy or primary	527	14.34
Middle	1,103	30.01
High	819	22.29
College	919	25.01
Graduate school	307	8.35
Total	3,675	100

SD, standard deviation.

Logistic analysis results

Logistic analyses were used to assess the relationship between suicidality with being bullied while taking other factors into consideration. Generally, being bullied was significantly associated with suicidality, whether traditionally or cyber. Specifically, those who suffered from traditional bullying were at 1.79 (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.37–2.34) times risk of developing suicidal ideation and 1.81 (OR 1.81, 95% CI 1.22–2.70) times risk of suicidal attempts. In comparison, those who experienced cyberbullying were 1.49 (OR 1.49, 95% CI 1.05–2.11) times more likely to have suicidal ideation, 2.80 (OR 2.80, 95% CI 1.91–4.09) times more likely to plan suicide, and 2.70 (OR 2.70, 95% CI 1.74–4.20) times more likely to attempt suicide. Taking suicidal ideation as an independent variable, victimization through traditional bullying was more closely related to suicidality than cyberbullying; however, this is completely different when it comes to planning and or attempting suicide. The pseudo R² for the model was 0.115, 0.111, and 0.125, respectively, with a higher value indicating better model fit (Table 2).

Table 2.

Binary Logistic Regressions for Suicidality Among Urban Youth in China (N = 3,675)

	Univariate regressions			Multivariate regressions
	Ideation OR [95% CI]	Plan OR [95% CI]	Attempt OR [95% CI]	Ideation OR [95% CI]	Plan OR [95% CI]	Attempt OR [95% CI]
Bullied (traditional)	2.29^*** [1.87–2.81]	2.22^*** [1.75–2.82]	3.34^*** [2.48–4.50]	1.79^*** [1.37–2.34]	1.21 [0.87–1.67]	1.81^** [1.22–2.70]
Bullied (cyber)	2.98^*** [2.26–3.93]	4.33^*** [3.23–5.80]	5.73^*** [4.09–8.02]	1.49^* [1.05–2.11]	2.80^*** [1.91–4.09]	2.70^*** [1.74–4.20]
Middle (primary school as reference)	1.59^*** [1.23–2.06]	1.38^* [1.03–1.85]	1.41 [0.97–2.04]	1.57^** [1.17–2.11]	1.33 [0.95–1.86]	1.39 [0.91–2.12]
High	1.85^*** [1.44–2.37]	1.32 [0.98–1.78]	1.32 [0.91–1.94]	1.79^*** [1.32–2.42]	1.16 [0.81–1.65]	1.21 [0.77–1.90]
Technical school	1.30 [0.86–1.97]	1.36 [0.86–2.14]	1.40 [0.79–2.47]	1.24 [0.74–2.09]	1.33 [0.74–2.36]	1.33 [0.64–2.77]
Leading school	1.51^*** [1.24–1.84]	1.35^* [1.06–1.71]	1.35^* [1.00–1.83]	1.41^* [1.07–1.84]	1.49^* [1.09–2.03]	1.77^** [1.21–2.59]
Relationship with classmates	0.68^*** [0.61–0.75]	0.75^*** [0.67–0.84]	0.65^*** [0.56–0.75]	0.93 [0.81–1.06]	1.17 [0.99–1.37]	0.96 [0.79–1.15]
Relationship with teacher	0.66^*** [0.60–0.73]	0.63^*** [0.56–0.70]	0.61^*** [0.53–0.69]	0.84^** [0.73–0.96]	0.72^*** [0.62–0.84]	0.80^* [0.67–0.97]
Relationship with parent (+)	0.88^*** [0.86–0.91]	0.89^*** [0.87–0.92]	0.88^*** [0.85–0.91]	0.91^*** [0.89–0.94]	0.93^*** [0.90–0.96]	0.92^*** [0.89–0.96]
Relationship with parent (−)	1.09^*** [1.04–1.14]	1.11^*** [1.05–1.17]	1.09^* [1.02–1.16]	1.07^* [1.01–1.13]	1.09^** [1.03–1.16]	1.05 [0.98–1.14]
Self-reported health	0.42^*** [0.36–0.50]	0.42^*** [0.35–0.50]	0.45^*** [0.36–0.57]	0.56^*** [0.46–0.68]	0.56^*** [0.45–0.69]	0.68^** [0.53–0.89]
Minority	0.89 [0.62–1.29]	0.88 [0.57–1.37]	1.36 [0.84–2.19]	0.93 [0.61–1.41]	0.73 [0.45–1.20]	1.19 [0.69–2.05]
Male	1.02 [0.84–1.24]	1.17 [0.93–1.47]	1.28 [0.95–1.72]	0.86 [0.69–1.06]	0.98 [0.77–1.26]	1.06 [0.77–1.45]
Boarding school	0.95 [0.73–1.23]	0.96 [0.71–1.31]	1.20 [0.83–1.72]	0.76 [0.56–1.04]	0.82 [0.57–1.18]	0.97 [0.63–1.50]
Single parent (parents as reference)	1.50^** [1.11–2.04]	1.53^* [1.08–2.18]	1.33 [0.84–2.10]	1.51^* [1.09–2.11]	1.47^* [1.01–2.15]	1.22 [0.75–1.98]
Grandparents	1.26 [0.97–1.62]	1.22 [0.90–1.65]	1.15 [0.78–1.69]	1.26 [0.94–1.68]	1.08 [0.77–1.52]	0.88 [0.57–1.36]
Father's education	0.97 [0.89–1.06]	0.93 [0.84–1.03]	0.92 [0.81–1.05]	0.93 [0.80–1.07]	0.95 [0.80–1.13]	1.05 [0.85–1.30]
Mother's education	0.99 [0.91–1.07]	0.96 [0.87–1.06]	0.93 [0.82–1.05]	1.03 [0.90–1.19]	1.08 [0.91–1.27]	1.00 [0.81–1.23]
Family's social status	1.18^** [1.04–1.32]	1.22^** [1.06–1.40]	1.22^* [1.02–1.45]	0.97 [0.84–1.11]	1.02 [0.87–1.19]	1.00 [0.82–1.21]
Pseudo R²	—	—	—	0.115	0.111	0.125

ORs are reported; 95% CIs in brackets; ^*p < 0.05, ^**p < 0.01, and ^***p < 0.001; the provincial variations were controlled using a series of dummy variables, but not reported.

CI, confidence interval; OR, odds ratio.

In Table 3, we show the interaction effect of the teacher–student relationship with bullying. This study reveals that a student's effective relationship with teachers in the school was beneficial for those suffering from traditional bullying and the interaction effect between traditional bullying and teacher–student relationships in relation to suicidal ideation was significant (OR 1.34, 95% CI 1.03–1.74). However, we found no significant interaction effects between the teacher–student relationship, cyberbullying, and suicidality. The pseudo R² for the model was 0.118, 0.114, and 0.125, respectively, with higher value indicating a better model fit.

Table 3.

Binary Logistic Regressions for the Interaction Effect of Teacher–Student Relationship and Bullying on Suicidality Among the Youth in Urban China (N = 3,675)

	Ideation OR [95% CI]	Plan OR [95% CI]	Attempt OR [95% CI]
Teacher–student relationship^* traditionally bullied	1.34^* [1.03–1.74]	1.33 [0.97–1.83]	1.02 [0.69–1.49]
Teacher–student relationship^* cyberbullied	1.03 [0.76–1.41]	1.06 [0.75–1.50]	0.98 [0.66–1.46]
Bullied (traditional)	0.59 [0.21–1.68]	0.42 [0.12–1.40]	1.71 [0.39–7.45]
Bullied (cyber)	1.39 [0.43–4.51]	2.38 [0.65–8.72]	2.87 [0.68–12.14]
Middle (primary school as reference)	1.56^** [1.16–2.10]	1.33 [0.95–1.86]	1.39 [0.91–2.12]
High	1.77^*** [1.31–2.39]	1.14 [0.80–1.63]	1.21 [0.77–1.90]
Professional	1.23 [0.73–2.07]	1.33 [0.75–2.37]	1.33 [0.64–2.77]
Leading school	1.41^* [1.07–1.84]	1.49^* [1.09–2.02]	1.77^** [1.21–2.59]
Relationship with classmates	0.94 [0.82–1.07]	1.17^* [1.00–1.37]	0.96 [0.79–1.15]
Relationship with teacher	0.72^*** [0.61–0.86]	0.62^*** [0.51–0.75]	0.80 [0.62–1.03]
Relationship with parent (+)	0.91^*** [0.89–0.94]	0.93^*** [0.90–0.96]	0.92^*** [0.89–0.96]
Relationship with parent (−)	1.07^* [1.01–1.12]	1.09^** [1.02–1.15]	1.05 [0.98–1.14]
Self-reported health	0.55^*** [0.46–0.67]	0.55^*** [0.45–0.68]	0.68^** [0.53–0.89]
Minority	0.92 [0.61–1.40]	0.73 [0.44–1.19]	1.19 [0.69–2.05]
Male	0.86 [0.70–1.07]	0.99 [0.77–1.27]	1.06 [0.77–1.45]
Boarding school	0.75 [0.55–1.02]	0.81 [0.56–1.15]	0.97 [0.63–1.50]
Single parent (parents as reference)	1.48^* [1.06–2.06]	1.44 [0.98–2.10]	1.22 [0.75–1.99]
Grandparents	1.26 [0.94–1.68]	1.09 [0.77–1.53]	0.88 [0.57–1.36]
Father's education	0.93 [0.80–1.08]	0.95 [0.80–1.13]	1.05 [0.85–1.30]
Mother's education	1.04 [0.90–1.20]	1.09 [0.92–1.28]	1.00 [0.81–1.23]
Status	0.97 [0.85–1.12]	1.03 [0.88–1.20]	1.00 [0.82–1.21]
Pseudo R²	0.118	0.114	0.125

ORs are reported; 95% CIs in brackets; ^*p < 0.05, ^**p < 0.01, and ^***p < 0.001; the provincial variation was controlled using a series of dummy variables, but not reported.

Discussion

This study estimated the prevalence of suicidality among school adolescents in urban China and further examined the associations of being bullied while taking the interaction effects of teacher–student relationship into consideration. Results in this study provide evidence that victimization through cyberbullying and traditional bullying is partially related to suicidality. In addition, corresponding to the idea that the teacher–student relationship is highly significant to issues of adolescents' mental health and behavior, this study empirically supports that effective relationships between teachers and students could be developed as protective factors for preventing suicidality among adolescents, which could be beneficial in strengthening ongoing bullying prevention to make school environments safe and happy places in future.

Generally, about 12% of participants reported that they developed suicide ideation(s) within the last year, while suicide plans and attempts were 8% and 5%, respectively. It is reasonable to say that nowadays adolescents in urban China are suffering from a relatively high risk of committing suicide. As one of the highest rates of adolescent suicidality in Europe, one study reported that 26% of students have, or have had, suicidal thoughts, while the rates for suicidal plans and attempts were about 15% and 3%, respectively.²³ Furthermore, the prevalence of suicidal attempts among Chinese adolescents has increased over time. A meta-analysis conducted in 2015 revealed that the prevalence of suicidal attempts by adolescents varied from 0.94% to 7.99% during 2002–2014 and averaged at 2.94%,²⁴ which was only about half of the prevalence demonstrated by this study. This could be explained because adolescents have more frequent contact with diverse, but complex, external environments, along with the fast development of the Internet, mass media, and social media, and that potentially damaging experiences may be largely social and emotional in nature, which are exacerbated by the intensity of threats inflicted.²⁵ Thus, this study supports the need for further action and attention to protect adolescents from suicide.

Furthermore, this study reveals that being bullied, whether traditionally or via cyberbullying, is of great significance in relation to the risk factors associated with suicidal ideation as well as suicide plans and attempts among adolescents. It confirms prior studies using the strain theory that conflicting pressure in an individual's life would lead to suicidal behavior⁹; particularly, being bullied traditionally had a higher correlation with suicidal ideation, while cyberbullying was more closely associated with suicide attempts, although both were more extensively correlated with suicide attempts than suicide ideation. Similar conclusions were drawn by previous studies,¹ which suggest that a significant lack of knowledge regarding Internet safety among youth might increase their vulnerability toward suicidality and attempt at suicide, especially because traditional bullying has a significant impact on suicidal ideations.²⁶ However, another study postulates the opposite conclusion concerning the aforementioned relationship,²⁷ but admits the close association between being bullied and suicidality.

In addition, teacher–student relationships present an effect of interaction because they can significantly lower the odds ratio existing between traditional bullying and suicidal ideation. As a potential mechanism, this could be explained insofar as adolescents who establish a positive relationship with their teachers are more likely to be under their care. Similarly, social control theory proposes, “delinquent acts occur when an individual's bind to society is weak and broken.”²⁸ Those students who are loved by their teachers are less likely to develop deviant behaviors (suicidality included) because they have secure bonds and positive relationships with important others, while those who are ignored by teachers are at a higher risk of committing suicide because of weakness in their social support. Furthermore, adequate existing empirical studies support that positive teacher–student relationships work as a protective factor in reducing internalized problems, which contribute to an integrated school bonding and school climate, and are found to be associated with fewer bullying behaviors.^29–31 However, the protective effect of the student–teacher relationship against suicidality among adolescents becomes nonsignificant in relation to newly developed cyberbullying. As Stauffer's study suggests, almost one-fourth of teachers indicated that cyberbullying did not have long-lasting negative effects on students' lives and many even contended the opinion that cyberbullying prepares students for life.³² Teachers' perceptions regarding the effects of cyberbullying on students lead to a lack of intervention when cyberbullying occurs. Since teachers mean a lot for students on campus and a positive school climate is critical to reduce the probability of bullying,³³ we need to improve the intervention fidelity toward cyberbullying among teachers and create a unified effort focused on decreasing student suicidality in relation to cyberbullying.

This study provides some interesting findings on the topic of adolescent suicidality from the perspective of bullying and teacher–student relationships. However, several limitations should be addressed. First, the questionnaires administrated in this survey were self-reported data rather than face-to-face interviews. Thus, potential bias issues may exist. Second, we evaluated the concurrence of being bullied and suicidality in a relatively crude way; only one question was used to assess and judge instead of more scientific measurements. In addition, we only tested the occurrence of being bullied or not, nothing was established about the frequency and intensity of bullying, which may be influential as well. More detailed studies should be conducted. Third, due to limited resources, some potential confounding factors have not been considered and controlled, which may cause bias or something significant may get ignored. Finally, the cross-sectional nature of data precludes evaluation of temporality and causality of the observed relationship between bullying and suicidality, as well as the association of the teacher–student relationship. Further research with longitudinal data would be beneficial for establishing temporal sequence.

Conclusion

This study indicates that suicidality among adolescents is in need of more attention as a significant public health issue. Cyberbullying and traditional bullying victimization is partially related with suicidality. Teacher–student relationships have a significant protective, but limited, effect on the relationship between bullying and suicidality, and more applicable suicidality intervention strategies that can be adapted to the development of society should be proposed further.

Footnotes

Acknowledgments

This study was supported by the National Natural Science Foundation of China (Grant No. 31500912) and the National Social Science Foundation of China under the grant, Emerging Risk and Adaptation of Public Safety System (Grant No. 13AGL009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Author Disclosure Statement

No competing financial interests exist.

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Bullying and Suicidality in Urban Chinese Youth: The Role of Teacher–Student Relationships

Abstract

Abstract

Introduction

Methods

Participants

Measurements

Suicidality

Being bullied

Social relationship

Potentially confounding variables

Data analyses

Results

Descriptive analyses

Logistic analysis results

Discussion

Conclusion

Footnotes

Acknowledgments

Author Disclosure Statement

References