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Impacts social media has on mental health 

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Impacts social media has on mental health 

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The article talks about the pros and cons that social media has on one’s mental well being. Comprehensive research on the positive and negative effects of social media use are provided in the article.

Quantitative: people spemdam average of 2.3 hours on social media everyday, including youtube, tiktok instagram etc. One third of social media users believe they spend too much time engaging in social media. Research suggests that excessive consumption of social media is associated with people who have a low psychological well being.

Qualitative: Social media impacts mental health significantly. From enhancing connections with others, improving self esteem, to peer pressure, sadness isolation etc. Resarch suggest that quality over quantity use of social media can determine whether one’s experience will enhance or diminish the social media users mental health.

-Itzenith Sanchez

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Pros & cons: impacts of social media on mental health | BMC Psychology

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Topic 1: What the average American diet looks like, in quality the diet of a average American may not be as good as people perceive them to be, studies have described that "People feel good, for the most part, about their dietary choices". But studies has shown as little as 10% of respondents felt ambivalent or poorly about their diets. When in truth the average American may eat 15.3% less grains and 10.6% more protein Than what is recommended for daily consumption.

Topic 2: How much does the average American spend per year, the spending of the average American consumer in 2022 hit $72,967 or around 6,080.58 per month. Studies has also shown that the average spending of a U.S citizen from the past two years has increased "faster than the rate of increase in income (before taxes)". Which can create a great amount of concern for what the future holds in the American economy for U.S citizens.

Chris P. Jeantinord

https://www.shopify.com/blog/how-much-does-the-average-person-spend-per-year

https://www.innerbody.com/what-average-american-diet-looks-like

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Does a teacher's effort influence her student's behavior and test scores? 

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Does a teacher's effort influence her student's behavior and test scores? 

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Qualitative-

When teachers are better at raising test scores, their students are less happy, study finds - Chalkbeat.

“A large body of past research has found that teachers have a meaningful impact on student test scores, and a number of more recent studies have found that teachers also impact other measures — sometimes called non-cognitive outcomes — such as behavior and attendance.  “

The study concludes there was only a weak relationship between test score performance and student behavior and feeling of efficacy in math. But when it came to student happiness, there was a moderate negative association — on average, greater test score gains meant less happy students.

What explains this potentially surprising inverse relationship?

It could be that teachers who were less demanding were more popular because their instruction was less likely to promote learning — but more enjoyable for students. Maybe those teachers just popped in a video on many days; perhaps they never gave homework.

there were certainly teachers who succeeded in improving both test scores and happiness.

Past research has generally shown that test-based measures capture some, but not all, of the components of effective teaching. Test score results tend to be only modestly related to other measures of performance, like classroom observations or effects on student attendance.

On the other hand, teachers’ impacts on tests have rarely been negatively related to other measures. In fact, there is usually a small positive association, including with regards to student surveys. Moreover, a number of studies have linked teachers’ and schools’ test score impacts to longer-term results, including adult income and college success.

Quantitative-

Problems with the use of student test scores to evaluate teachers | Economic Policy Institute (epi.org)

One study found that across five large urban districts, among teachers who were ranked in the top 20% of effectiveness in the first year, fewer than a third were in that top group the next year, and another third moved all the way down to the bottom 40%. Another found that teachers’ effectiveness ratings in one year could only predict from 4% to 16% of the variation in such ratings in the following year. Thus, a teacher who appears to be very ineffective in one year might have a dramatically different result the following year. The same dramatic fluctuations were found for teachers ranked at the bottom in the first year of analysis. This runs counter to most people’s notions that the true quality of a teacher is likely to change very little over time and raises questions about whether what is measured is largely a “teacher effect” or the effect of a wide variety of other factors.

-Alexis T

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In this article researchers created studies to examine what the best way would be to deal with childhood abuse. The subjects of these studies had different experiences and have dealt with it in different ways. The

experiences these people have had are being used to determine what can be done about it.

-Sendly Fleurinord

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What Haunts Child Abuse Victims? The Memory, Study Finds

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A study of adults who were mistreated in childhood found that those who did not recall it showed fewer psychological aftereffects.

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Does social media affect students mental health? (Qualitative Data)

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Does social media affect students mental health? (Qualitative Data)

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The website offers mental health and wellness resources. It covers topics like ADHD, addiction, anxiety, relationships, aging well and meditation.

-Donella Brown

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Social Media and Mental Health: Social Media Addiction

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Excessive use of social media can fuel anxiety, depression, and other mental health issues. Here’s how to change your habits and improve your mood.

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Does social media affect students mental health? (quantitative Data)

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Does social media affect students mental health? (quantitative Data)

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The article discusses the negative effects of social media usage on students' mental health, revealing a link between increased time spent on social media and higher rates of anxiety and depression among teenagers.

-Donella Brown

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According to a recent report from the Pew Research Center, 95% of teens use a smartphone, and 45% say they are online almost constantly. About 70% of teens are on Snapchat and Instagram, while 85% are on Youtube.

One would think all this near constant "socializing" would make teens feel more connected than ever before.

In her classroom, says teacher Cori McAbee, the opposite is true.

"Social media has crippled my students when it comes to interacting with one another in person. Their very ability to communicate is deteriorating," says McAbee, who teaches 11th grade English in Rutherford County, North Carolina.

The very definition of "social" media may be misleading, according to experts who are finding that the more time teens spend on social media, the lonelier and more anxious they are.

There's a correlation between smartphone usage and lower satisfaction with life, according to Jacob Barkley, professor of health sciences at Kent State University.

"Interaction on social media is not beneficial. It's electronic," explains Barkley, who has been studying smartphone use and students since 2013. "The higher the cellphone use, the more time spent on social media, and the higher the anxiety. Peer relationships actually get worse the more you use your phone."

Jean Twenge, a psychology professor at San Diego State University, reached similar conclusions in 2017. In her study, Twenge discovered that students who spend more time using smartphones and other electronic devices are less satisfied with their lives than students who frequently engage in face-to-face interaction.

"We found that teens who spent five or more hours a day online were 71 percent more likely than those who spent less than an hour a day to have at least one suicide risk factor (depression, thinking about suicide, making a suicide plan or attempting suicide). Overall, suicide risk factors rose significantly after two or more hours a day of time online," Twenge wrote in 2017.

If teens were to follow up high social media usage with lots of time spent socializing in person, the effects perhaps wouldn't be so adverse. But in most cases, they aren't. It turns out, liking a post, commenting "Cute," or keeping up with a "snapchat streak" isn't the same as catching up. It's not even close. Yet too many teens, according to these experts, are substituting real life interactions for instagram posts, and paying the price.

Because research into social media and education is still generally in its infancy, many educators are still trying to fully understand the effects of these technologies. Social media can be an effective teaching tool, but many educators are alarmed at the role it plays in heightening student anxiety and stress.

Social Media and Anxiety

In 2018, the Centers for Disease Control issued some sobering statistics about student anxiety and depression. Teens are more lonely, anxious and depressed than ever. About a third of teens surveyed by the CDC said they'd felt persistent sadness or hopelessness. Social media, says John Richter, director of Public Policy at the Mental Health Association, believes social media is exacerbating this trend.

"Researchers are finding that when someone develops depression and withdraws from peers, they see other people on social media smiling and at parties with friends. It magnifies their sense of isolation," says Richter.

The Child Mind Institute's 2018 Children's Mental Health Report f ocuses on anxiety in teenagers, spotlighting the prevalent role of social media has in their lives. The report points out that existing research does conclude that social media can be constructive,"youth with a stronger emotional investment in social media are likely to have higher levels of anxiety."

And yet, students have trouble putting their phone down for too long, says Crystal Huset, counselor at Pardeeville High School in Wisconsin.

"It seems like many students struggle to detach from their electronic devices," says Huset. "Many students do see social media as an issue, but it is also the only thing that they know."

Anne Braun, 5th/6th grade teacher at Woodland Elementary in Kansas, noticed the increase of mental health issues in her students. "I never had kids diagnosed with anxiety and depression 10 years ago," says Braun. "They compare themselves, and it brings on bad feelings."

Katrina Smith, a 5th grade teacher in North Carolina, agrees. "They base their love of themselves on how people respond to their pictures," says Smith. "

The lack of real life communication, the comparison, and the bullying are too much for some students to bear, Smith adds.

Recently, she noticed a student acting out in her classroom. "She was especially agitated and disrupted the class. After working with her, I found that she had a lot more going on, and it had to do with Instagram. Her so-called friends had called her names the evening before."

Anne Braun, says students will talk about feeling left out when they see their friends communicating on social media. "They have FOMO- fear of missing out. They don't have the tools to deal with these negative emotions."

Discussing Social Media in the Classroom

Ideally, every school district in the nation would be equipped with a comprehensive, systemic program to address students' mental health challenges. Despite renewed attention to the problem in recent years, t's clear schools have a long way to go.

In 2018, New York and Virginia became be the first states to require mental health education as part of the public school curriculum. It's a start, says John Richter, because the curriculum will help teach kids how to deal with some of the pressures in their lives.

"How do we help kids who experience anxiety because of social media? The first step is teaching kids to recognize what anxiety actually is and feels like, and how to seek help," Richter said.

While many districts are taking significant steps in designing new evience-based programs, helping students navigate social media is a challenge that many educators are taking on at the classroom level.

Larissa May, CEO of #HALFTHESTORY, a company dedicated to healthy social media use, believes that educators, first and foremost, should simply be aware of their student's experiences on social media.

"Every adult has experienced scrolling through Facebook for too long or comparing themselves on social media. Let your students know you understand these issues," she says.

Showing students other ways to use social media in the classroom can also help prepare them for healthy use in adult life, says teacher Anne Braun.

"I had a student create a website after her friend got diagnosed with cancer, and the website allowed visitors to donate to the American Cancer Foundation," Braun recalls. Her students also respond favorably to positive feedback online via the classroom Twitter account. "They get comments from the online community, as well as parents and grandparents."

Larz suggests integrating a social media component into every project. "Social media is an extremely useful and powerful tool, and we can't run away from that," she says.

Awareness of the issue is the first step for educators, parents and students alike, says Jacob Barkley of Kent State. "Encourage students to step back and examine their usage more critically," he advises. "Smartphones weren't a thing...now we're using them a lot. How is that affecting our lives?"

It's not about educators controlling their students' social media usage, adds Larz, it's about holding a conversation that many students want to have.

"It's important to present the impact of social media talk as facts. There is research showing the effect on our mental health, and it's something to be discussed in the classroom."

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Social Media's Impact on Students' Mental Health Comes Into Focus | NEA

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Research suggests social media is increasing student anxiety and depression, eclipsing any positive role it could potentially play.

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The article mentions ways to detect and how the disfunction of a family can look like and the negative impact it can have specially in kids and teenagers.

Quantitative Data

https://www.pewresearch.org/social-trends/2015/12/17/1-the-american-family-today/

The article shows statistics of how throughout the tears the diversity of the diversity of families like the increase of single parents and the decrease of married parents can also impact the stability of the family.

By Barbara Perez

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Many issues that arise later in life may originate from childhood experiences in a dysfunctional family. One in seven children faces trauma, such as emotional abuse or abnormal sexual behavior, which can impact their emotional well-being into adulthood. Dysfunctional family members and common dysfunctional parental behavior contribute to creating an unhealthy environment. Begin by examining the characteristics of a family's dysfunction and the long-term effects of growing up in such families.

What Is A Dysfunctional Family?

Dysfunctional families may appear diverse, as family dynamics can be intricate. The McGraw-Hill Concise Dictionary of Modern Medicine defines a dysfunctional family as "a family with multiple internal or external conflicts that affect the basic needs of the family unit." For instance, this may involve:

Sibling rivalries

Parent-child conflicts

Domestic violence or sexual abuse

Physical or mental illness

Single parenthood or one parent households

Alcohol, drug use, or an addicted parent

Extramarital affairs

Gambling addiction

Unemployment influences

Financial concerns

Other traumatic family occurrences, such as unfair treatment

Some families have minor dysfunction, while others have deeply rooted issues leading to serious problems. Numerous factors can contribute to dysfunctional family life, with each occurring to varying degrees.
*If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. The Hotline provides essential tools and support to help survivors of relationship abuse and domestic violence so they can live their lives free of abuse.
What Are The Factors Of A Dysfunctional Family?

If you grew up in a dysfunctional family, you might have faced concerns since childhood, affecting you even as an adult. Dysfunctional families, involving other family members, tend to be unstable or conflict-ridden. The caregiver/s might be so preoccupied with their worries and needs that they fail to meet those of the children, leading to neglect, abuse, or conflict.

Such children may feel lonely, developing low self-esteem and self-worth. They might experience physical or mental health problems and adopt survival mechanisms or unhealthy coping mechanisms as a result. Kids raised in these toxic environments often carry survival mechanisms with them for years.

The following factors may indicate family dysfunction. You might also take the ACES test, as providers often use it to determine if someone experienced trauma as a child.

Family History Of Dysfunction

Dysfunctional family patterns may repeat themselves within such families. For example, people may learn their parenting styles from their own parents or caregivers. If one or both caregivers abused them, they might abuse their children or struggle to model healthy relationships.

In some cases, parents may try to avoid abusing their children as they were abused, by being lenient or neglectful. Spouses might partake in conflict if their parents did, not understanding how to exhibit healthy behaviors.

Those who grew up in dysfunctional households can learn healthier techniques for parenting. They may address the negative emotions they carry as adults and learn how to love, appreciate, respect, and treat others healthily.

A willingness to work on overcoming these issues can help end a dysfunctional family environment. For example, trauma therapy can be effective in treating adults who were sexually abused. Additionally, your attachment style can change over time.

Medical Problems

Physical illness alone may not cause family dysfunction. However, it may have impacts on the family unit, involving other family members. Parents might rely on their children, including younger siblings, to care for their health, which can cause anxiety and depression. Additionally, if one family member is ill and is not cared for, this may cause the children to grow up invalidating their illnesses.

You may not have had any control over the illness that strained your family, but you can control your actions, learn to use the resources available, such as a support group, and meet your children's needs.

Mental Illness

Biology may play a role in many mental illnesses. However, behavioral issues that can accompany them may make family life much more challenging, especially without treatment.

People with untreated mental illnesses like trauma disorders, anxiety, or depression may act unhealthily toward their families. With treatment, people with mental illness may start to contribute positively.

Life Circumstances

Stress is often an unavoidable part of life. While low levels of stress can positively impact people and push them to achieve their goals, excessive stress may jeopardize a family's safety and well-being, even in a two parent household.

High levels of stress could lead to hostility within a family, affecting both the other parent and other members. Learning to manage life's stressors healthily can be essential to the happiness and well-being of the individual and the family. When you model healthy coping strategies to your children, including a rebellious child, they may learn how to regulate their emotions.

Addiction

Substance addiction, gambling, or psychological addictions may lead to codependency, with caretakers spending excessive amounts of time, energy, and other resources on the individual who's addicted. Certain family roles in addiction are adopted by the family members to cope with the situation. At times, children fill the role of caretaker. When an addiction is severe, it may drain a family's financial and emotional resources, including the emotional resources of children living with a parent who's addicted. A parent living with an untreated substance use disorder or other addiction may be emotionally unavailable to their children.

While addiction can cause problems within a family, addictive behaviors may also develop due to dysfunctional family dynamics. Those living in a family that doesn't meet their needs may turn to substances, food, or gambling for temporary relief.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 or visit the website to receive support and resources.
Perfectionism

Parents who are perfectionistic may put pressure on their partners and children not just to do their best but to accomplish the impossible. Perfectionism may lead to unrealistic expectations and be detrimental to family life.

Loved ones of perfectionistic individuals might feel they're walking on eggshells. Children with perfectionist parents may lose their innate lighthearted spirit and find learning difficult. These children may lack self-esteem or feel at fault for their parent's behavior.

Ineffective Communication

Poor communication may be a characteristic of a dysfunctional family. Problems might be managed with open, honest, and healthy communication.

Dysfunctional families may struggle to listen to each other, and indirect communication could cause bitterness or passive-aggressive behavior. Teaching children active listening skills and learning them yourself may avoid this.

Lack Of Empathy

When caregivers lack empathy, their children may feel that a parent's love is conditional. When a parent shows empathy, they model this trait to the child, which may help children become compassionate, empathetic adults. Empathy is a skill that can be learned.

In healthy families, caregivers are often intent on helping their children make good decisions and learn from their mistakes rather than belittling them or instilling shame.

Excessive Attempts To Control

Dysfunctional families are often characterized by a caregiver's excessive need to control their children or partner. When parents fail to help children develop a healthy sense of autonomy, children may not feel self-confident and struggle to form relationships with their own friends.

Taking a more relaxed, accepting approach encourages kids to do their best in every situation rather than living to appease the controlling parent. Regarding parenting styles, studies show that authoritative parenting is often the most beneficial.

Lack Of Seclusion And Independence

Parents in dysfunctional families may lack trust in their children and invade their comfort and seclusion. While there are times when parents may need to know what's going on with their children, parents in a functional family may utilize honest communication and questions instead of forcing their child to open up.

Constant Criticism

Criticism may run rampant in a dysfunctional family. At times, the criticism could be blatant, with parents chastising everything the child says or does. Other times, parents take a more subtle approach by using sarcasm, insults, or teasing. When criticism involves attempts to frighten, control, or isolate, it may signify emotional abuse.

Dysfunctional Family Roles

There are five to six common roles in a dysfunctional family:

Enabler or caretaker: The individual may attempt to keep the family going despite the presence of addiction or other dysfunctions in the family.

Scapegoat or troublemaker: Scapegoating exists in a dysfunctional family. The scapegoat or troublemaker may become sick, weak, angry, or rebellious in response to their treatment. They may receive the majority of abuse or maltreatment.

Lost child: The lost child may spend most of their time alone, avoiding the family and its dysfunctional ways.

Mascot: This individual may try to alleviate tension within the family by utilizing humor or mischief in everyday life. The mascot may be labeled the family clown.

The hero or golden child: This person may be idolized or pressured by their caregiver. They may receive less abuse or neglect but may feel pressure to excel, to please their parents, and to be "perfect."

Immediate Effects Of Living In A Dysfunctional Family

When you live in a dysfunctional family as a child, your brain may respond to stressors in unhealthy ways. Your fight or flight response in your nervous system could remain activated long after you have left your family dynamic.

What Is It Like To Grow Up In A Healthy Family?

If you grew up in a dysfunctional family, you might get the impression that there is no such thing as a healthy, functional family life. It may feel hard to believe that functional families can be a reality.

However, healthy families do exist. So, what does a healthy family look like? There are a few characteristics of a healthy family environment:

People communicate freely and openly but compassionately

Everyone's basic physical and emotional needs are met, including water, food, shelter, social belonging, and bladder/digestive needs

Caregivers show unconditional love for each child, even when they disapprove of specific behaviors

Through their words and actions, parents may support children's emotional growth

Children feel open to bringing up concerns or questions to their caregivers

Counseling For Support

Adult children of caregivers who displayed dysfunctional behavior may benefit from working with a therapist. To overcome a childhood affected by a dysfunctional family, healing internal wounds can be a decisive step.

Studies show that many adults feel most comfortable at home, which can make in-person therapy feel daunting. If you relate, you may enjoy trying therapy from home in the form of online counseling.

Online therapy can effectively treat various mental health conditions and heal certain kinds of trauma. While many problems often arise from adverse childhood experiences, your mental health can be affected at any life stage.

One study showed how internet-delivered therapy successfully reduced the severity of PTSD symptoms in participants. The same group also saw a reduction in co-morbid depression and anxiety, proving the efficacy of online therapy for these concerns.

Talking with family about your experience could worsen existing issues. Speaking with a therapist allows you to express your feelings about what happened in a safe environment. If you're ready to try counseling, consider signing up through an online platform such as BetterHelp for individuals or Regain for couples.

What are some examples of a dysfunctional family?

Dysfunctional families are families that have some form of unhealthy dynamic, such as frequent conflict, emotional, physical, or sexual abuse, poor communication, and other challenges.

A dysfunctional family can be one in which one parent has a substance use disorder and is unable to care for the child or children, or offers them alcohol or other substances.

It may also be a family in which parents rely on their child for financial or emotional support.

Another example is when a parent is physically, emotionally, or sexually abusive toward a child or children, while the other parent defends and protects the abuser.

Finally, a dysfunctional family may be one in which a parent or parent neglects the wellbeing and development of their children to focus on their own life and problems. This can include things like forgetting to feed their kids, not offering emotional support to them, or even leaving them alone in dangerous situations.

What causes a dysfunctional family?

There can be a number of causes for dysfunction in a family. Some of the most common are things like:

Untreated mental health conditions

Childhood trauma for a parent or parents

Substance use

Socioeconomic status

A lack of boundaries

Conditional love

Perfectionism

Lack of intimacy

A dominant parent

Abusive behavior

How does a dysfunctional family affect a child?

There can be a number of effects on a child from a dysfunctional family. They may become depressed or anxious, have anger issues, demonstrate behavioral problems, mimic the problematic behavior (including substance abuse or physical abuse), and have ongoing identity issues. Often growing up in a dysfunctional family leads to a perpetuation of dysfunction in their own family.

How do you overcome a dysfunctional family?

If you grew up in a dysfunctional family, you may experience feelings of worthlessness, guilt, or shame. One of the first steps in overcoming your past is to recognize patterns of abuse, and decide to take responsibility for your own life and actions. You may not be able to change your family or your upbringing, but you can work on yourself.

You may have to set boundaries with your family, some may even do this to the point of cutting them out of their life completely. In addition, it can be a good idea to meet with a therapist to identify any negative patterns of thought or behavior, and to learn positive coping skills and stress management techniques.

What are the side effects of a dysfunctional family?

Having a dysfunctional family can be harmful in a number of ways, and have a negative impact on the lives of the children. Some side effects of family dysfunction include:

Low self-esteem

Loneliness

Substance use

Post traumatic stress disorder (PTSD)

Anger issues

Depression

Difficulty establishing and maintaining relationships

Personality disorders

A belief that they do not deserve good things in life

How do you deal with a dysfunctional family?

Breaking dysfunctional patterns is possible. Family therapy can help to navigate some of the issues that underlie family dysfunction. In cases of substance use, substance abuse treatment can be helpful in addressing the underlying issues that dysfunctional households may experience. In cases of physical violence or other forms of abuse, the best option is to get away from the abuser. In all of these cases, however, there needs to be both a recognition of dysfunction, and a willingness for change in someone with power. In some cases, children are unable to get away until they are older.

How do dysfunctional families start?

Dysfunction patterns can be self-perpetuating. Dysfunctional families very often grow out of other dysfunctional families. When a child grows up without the opportunity to become well-equipped with healthy coping mechanisms and has experienced unpredictability and fear during developmental years, they often contribute to dysfunction in their own children. Or in cases of physical, emotional, or sexual abuse, in some cases (especially in those where they have never received help) a victim can go on to develop the tendency to visit this type of abuse on others.

Other factors may contribute, including substance use, poverty, medical need, mental health conditions, and any other number of challenges.

What happens when you grow up in a dysfunctional family?

Growing up in a dysfunctional household can be difficult, but there is no common answer to this question. It can depend on the individual, and on the types of emotional support they receive from others. There are a number of family roles that are filled by people who grow up in these situations, and these roles can have different effects. Most dysfunctional families experience at least one of the following:

The black sheep or scapegoat. This is often a child who identifies problems within the family and speaks out. The other children or family members may distance themselves and play the blame game with this person, especially if they are in denial of any problems in their own family.

The parentified child. They take on a caretaker role, or a spousal role in the family. They will often struggle with unhealthy relationship dynamics in adulthood, and often base their self-worth on the approval of others.

The golden child. This is often the older child or the youngest child, and is considered to be the one who can do no wrong. They often grow up with attachment issues.

The lost child. This child spends their life trying to go undetected, staying under the radar. This can lead to low self-esteem and feelings of invisibility as an adult.

The enabler. This child will often attempt to maintain an appearance of normalcy within the family (although sometimes this person is the spouse). They support and affirm unhealthy behaviors. As an adult they may feel a strong responsibility to "fix" or help others.

What makes a dysfunctional family different from a healthy family?

A dysfunctional family is defined by a lack of healthy patterns and dynamics, while other families demonstrate more positive behaviors. Some general indicators of dysfunctional vs healthy families:

Dysfunctional:

Poor communication

Neglect or over-involvement

Favoritism

Fear and uncertainty

Exploitation

Healthy family:

Open and appropriate communication

A balanced sense of involvement

Equality

A safe, stable environment

Unconditional love

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Dysfunctional Family: What It Is And What It's Like To Grow Up In One | BetterHelp

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Families all look different and can contain both healthy and unhealthy characteristics. Growing up in a dysfunctional family can have harmful mental health effects and cause issues even as one reaches adulthood. It's important to recognize dysfunction so that you can confront any problems that arise from it.

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qualitative data:Social media facilitates increased communication and connection, helping people stay connected with loved ones regardless of distance.It may promote unrealistic expectations, fostering jealousy and insecurity as individuals compare their relationships to idealized versions online.

quantitative data: This article mainly focused on qualitative data and didnt really show any stats.

-Tyler Morrison

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Qualitative data: The articles talks about why not only women get paid less but people as a whole because as technology advances it gives business owners less reason to pay people and have ai do it for them because it saves time money and stress.

quantitative data:Over the past four decades, there has been a broad trend of rising income inequality across countries.ncome inequality has risen in most advanced economies and major emerging economies, which together account for about two-thirds of the world’s population and 85 percent of global GDP

-Tyler Morrison

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This article gives percentages and facts about childhood obesity. It shows the rates of how obesity effects different ethnic groups.

By: Juliana B

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Prevalence of Childhood Obesity in the United States

Childhood obesity is a serious problem in the United States, putting children and adolescents at risk for poor health. Obesity prevalence among children and adolescents is still too high.

For children and adolescents aged 2-19 years in 2017-2020 ¹:

The prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents.

Obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.

Obesity prevalence was 26.2% among Hispanic children, 24.8% among non-Hispanic Black children, 16.6% among non-Hispanic White children, and 9.0% among non-Hispanic Asian children.

Obesity-related conditions include high blood pressure, high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems.

¹Read CDC National Center for Health Statistics (NCHS) data brief

Note: Obesity is defined as a body mass index (BMI) at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts.

Obesity and Socioeconomic Status

[ Read the Morbidity and Mortality Weekly Report (MMWR)]

In 2011-2014, among children and adolescents aged 2-19 years, the prevalence of obesity decreased as the head of household's level of education increased.

Obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle-income group, and 10.9% among those in the highest income group.

Obesity prevalence was lower in the highest income group among non-Hispanic Asian boys and Hispanic boys.

Obesity prevalence was lower in the highest income group among non-Hispanic White girls, non-Hispanic Asian girls, and Hispanic girls. Obesity prevalence did not differ by income among non-Hispanic Black girls.

Women, Infant, Children (WIC) Data

Data and Statistics
Interactive database, surveillance systems, state reports, and maps related to obesity.

Connect with Nutrition, Physical Activity, and Obesity

Page last reviewed:

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Childhood obesity is a serious problem in the United States. Learn more...

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It gives victims of those who have been cyber bullied the ability to tell their stories. This could make others who have been cyber bullied not feel alone. The article gives others mouth on what the effects of cyber bullying does.

By: Juliana

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We have many resources on this site to help you deal with cyberbullying. If you are a teen, check out: Responding to Cyberbullying: Top Ten Tips for Teens. If you are an adult who is being harassed online, see our recommendations here. If you are a parent of a child who is being cyberbullied, please see: Responding to Cyberbullying: Top Ten Tips for Parents and educators should review: Responding to Cyberbullying: Top Ten Tips for Educators.

If you feel comfortable sharing your story, we would like to hear from you. You can anonymize your experiences if you'd like, and we promise to maintain your individual confidentiality to the maximum extent of the law. The more detail you can provide the better. We use these stories to educate the public about the serious nature of cyberbullying with the goal of preventing others from doing it. We read every one of these stories and please know that you are not alone. Even though it may seem like there is nothing that can be done to stop the cyberbullying, don't give up.

SOME STORIES SHARED WITH US

The following is a small sample of the thousands of anecdotal stories and comments we've received from children and adolescents who have experienced cyberbullying. If you would like to anonymously submit a description of your cyberbullying experience to us, please do so in the form below. Please provide as many specific details of your experience as you can.

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Cyberbullying Stories - Cyberbullying Research Center

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We have many resources on this site to help you deal with cyberbullying. If you are a teen, check out: Responding to Cyberbullying: Top Ten Tips for Teens. If you are an adult who is being harassed online, see our recommendations here.

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Qualitative: This article talks about different cyberbullying cases using different analysis methods. It uses age ranges between 13-17 that would report cyberbullying cases on the online survey.

-Daniella Maldonado

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What Counts?: A Qualitative Study of Adolescents’ Lived Experience with Online Victimization and Cyberbullying

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To inform development of cyberbullying interventions that are both accurate and meaningful to all adolescents, this qualitative analysis examines experiences of online peer victimization among a sample of predominately minority and low-income youth.Adolescents…

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Quantitative: This article shows different surveys done to estimate how much cyberbullying is done between middle school and high school students, whether they are the victims of it or do the actual bullying themselves.

-Daniella Maldonado

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Cyberbullying Data 2019 - Cyberbullying Research Center

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Presents data on cyberbullying from a 2019 national survey of middle and high school students in the United States.

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In this article it discusses the quantitative data on different people from different backgrounds working long hours causes different mental depression. It also shows qualitative data on certain variables that take place in workers having depression due to long hours.

Posted by- Tiana I. Martinez

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Abstract

Our aim is to examine the associations between long working hours and depression and mental well-being among the working population in Shanghai, as well as to identify the impact of having hobbies on these relationships. A cross-sectional study was conducted in Shanghai, with depression assessed by the Patient Health Questionnaire-9 (PHQ-9) scale and mental well-being assessed by the World Health Organization five-item Well-Being Index (WHO-5) scale. The phenomenon of long working hours (69.3%) was quite common among employees in Shanghai, and the rate of working over 60 h was 19.3%. Those who worked over 60 h had the highest prevalence of poorer mental health compared with individuals working ≤40 h per week. After adjustment in the logistic regression model, those who reported weekly working time over 60 h were 1.40 (95%CI: 1.03-1.90) and 1.66 (95%CI: 1.26-2.18) times more likely to have depression and poor mental well-being (PMWB), respectively. Adjusted ORs for having hobbies were 0.78 (95%CI: 0.62-0.97) and 0.62 (95%CI: 0.51-0.75), respectively. Meanwhile, having hobbies could significantly lower the mean score on the PHQ-9 and elevate the mean score on the WHO-5 in each working time group, with no interaction effect. Long working hours could have a significantly negative impact on workers' psychological health. Importantly, having hobbies in their daily lives might help to mitigate the adverse effects of long working hours on workers' depression and mental well-being.

Keywords: long working hours, having hobbies, depression, mental well-being

1. Introduction

Individual overall health during working life can be determined by working conditions, and long working hours have caught the eye of public health professionals and labor policymakers. According to recent statistics from the Organization for Economic Cooperation and Development (OECD), the countries with the highest annual working hours per worker were Mexico, Costa Rica, and South Korea [ 1]. However, statistics about working hours in mainland China are limited. Nevertheless, the Chinese phenomenon called "guolaosi" (death by overwork) has happened in several enterprises and received vast media attention. As Chinese are educated to complete tasks with absolute dedication based on Confucian belief since their childhood, domestic workers are prone to overburdening or burning themselves out during career life. One earlier study using data from the China Health and Nutrition Survey (CHNS) from 1991-2009 found that the average weekly working hours of Chinese employees were around 47 h, with approximately 62% of respondents working more than the national standard of 40 h per week [ 2].

Considering the severity of long working hours' prevalence, empirical studies have shown that long working hours can elevate the risk of several physical diseases, such as coronary heart disease, stroke, and diabetes [ 3, 4, 5]. Moreover, poor mental health among employees, such as depressive symptoms and suicidal thoughts, has also brought about tremendous disease burden in developed countries, leading to work disability and reduced quality of life [ 6, 7, 8].

Clarifying the relationship between long working hours and psychological outcomes has gained significant research interest, and there is a growing body of evidence suggesting that long working hours are detrimental to workers' mental health and psychological well-being. Studies have shown that long working hours are implicated in anxiety, depression, suicidal thoughts, and worsened emotional well-being [ 9, 10, 11, 12, 13, 14, 15, 16]. A prospective cohort designed in Australia over the period of 2001-2012, using the Mental Component Summary of the Short Form 36 (SF-36) survey to measure outcome, found that respondents had worse mental health when they were working 49-59 h or 60 h or more compared to those who were working 35-40 h/week [ 10]. A longitudinal study based on the Korea Welfare Panel Study (KOWEPS) conducted from 2010-2013, using the Center for Epidemiological Studies Depression (CES-D) scale to measure depressive symptoms, found that employees working over 68 h had higher odds of depressive symptoms after full adjustments compared with individuals working 35-40 h/week [ 12].

However, some other studies showed that the adverse effect of long working hours on mental health only occurred among either male or female participants [ 8, 17, 18]. Beyond this, the results of a nationwide prospective follow-up study conducted among Danish senior medical consultants did not support the hypothesis that long working hours may increase the risk of depression [ 19]. Furthermore, a systematic review and meta-analysis with an inclusion standard of prospective or cohort study design, confining the outcome as depressive disorders clinically diagnosed or assessed by a structured interview, showed that overtime work was associated with a small, non-significant, elevated risk of depressive disorder and concluded that the effect of long working hours on depressive disorder remained inconclusive [ 20].

Inconsistencies between past findings might be attributed to several factors, including the disparity in study design, different assessment tools of exposure, outcome, and potential confounding factors, various kinds of participant occupations, heterogeneity in sample size, insufficient controlling for bias, and even cultural discrepancy among regions. For example, the cut-off point chosen for long working hours had differential values, ranging from 40 h/week to as high as 70 h/week, and mental health status was measured with SF-36, CES-D, and WHO-5 scales.

Although long working hours may have adverse effects on the mental health status of the working population, positive life events could help employees cope better with the impact of adverse events. Noticeably, growing evidence has shown that leisure activities (e.g., hobbies, cultural activities, exercise, and sports) have salutary effects for individuals. Scholars in the leisure science field have long insisted that leisure plays a crucial role in promoting overall well-being and buffering stress [ 21]. These benefits may be consequences of leisure encouraging positive feelings and augmenting ways of utilizing social and physical resources, which ultimately help individuals to feel refreshed and better deal with various stressors [ 22, 23]. For example, an online study in Australia reported that satisfying leisure activities were beneficial to dementia caregivers aged 18-82 years, and particularly engaging in social activities buffered the negative impact of caregiving [ 24].

In sum, research on the associations between long working hours and mental health status has remained very limited in China, and no research has demonstrated whether having hobbies could play a beneficial role in this relationship. Hence, the present study aimed to firstly explore the distribution of working hours among employees and examine how long working hours affect their depression and mental well-being using representative data from a large cross-sectional survey conducted in Shanghai, and secondly investigate the impact of having hobbies on this relationship.

2. Materials and Methods

2.1. Sampling and Participants

This survey was conducted using a cross-sectional methodology between July and August 2018. Shanghai is one of the boom cities in eastern China, and employees live a fast-paced life with a great of hustle and bustle. Excessive dedication to work could make them vulnerable to mental health problems due to a work-life imbalance and lack of recovery after busy routines.

To make up as representative a sample as possible, we used a multistage random sampling scheme containing a variety of work types in Shanghai, including white-collar workers, blue-collar workers, service personnel, and self-employed industrialists. In the first step, our sampling was done by geographical location, covering one downtown area of Xuhui District, and the other five districts (Pudong, Minhang, Songjiang, Qingpu, and Jiading Districts) which are located around the urban district. In the second step, sampling was done by the workplace or organization, including participants from seven companies or workplaces (staff number ≥300) based on our previous recruitment. Lastly, in the third step, sampling was done by the unit or department, taking employees from a specific work unit within the company or workplace as our study subjects. For this study, an initial number of 3310 employees were recruited. We designed a questionnaire to collect demographic and work characteristics data and used the PHQ-9 scale and WHO-5 scale to assess depression and mental well-being, respectively. Previously designed questionnaires were distributed to various departments by investigators and company administration managers contacted. Trained investigators were allocated to instruct participants when they had any questions and to ensure good quality control during our survey. All the participants completed the questionnaires independently with informed consent. Finally, 2985 valid questionnaires were collected with a response rate of 90.2%.

2.2. Exposure and Other Variables

The exposure variable was the average number of working hours employees worked per week. Participants answered the question "How many hours do you currently work on average per week?" Long working hours (defined as overtime per week beyond normal or regular working hours) was operationally defined as more than 40 h/week in this study, which was in line with the definition adopted by many countries, according to a recent International Labor Office survey and previous studies [ 2, 12, 19, 25]. Then weekly working hours (WWH) were split into four groups (≤40 h, 40 h < WWH ≤ 50 h, 50 h < WWH ≤ 60 h, and >60 h), with ≤40 h used as the reference category.

We also collected other information for our analysis. The questionnaire included basic sociodemographic characteristics, questions about living and working conditions, self-perceived health (SPH), and health-related behaviors. For having or not having hobbies, participants answered the question "Do you have any regular hobbies or leisure activities?" For SPH, respondents responded to the question "In general, how would you rate your overall health?" on a scale ranging from 1 to 5, indicating "very poor," "poor," "fair," "good," and "very good," respectively. Work-related psychosocial factors (job demand, job control, and social support) were obtained with the Job Content Questionnaire based on Karasek's job demand-control model, and job stress was calculated via job demand divided by job control. Moreover, gender, age, education level, household registration (HR), marital status, monthly income, living with family, sleeping status, drinking, smoking status, and moderate physical activity (MPA) per week were addressed as categorized variables.

2.3. Outcome Variables

Depression and mental well-being were measured using the PHQ-9 (Cronbach's alpha = 0.869) and WHO-5 (Cronbach's alpha = 0.926), respectively. The PHQ-9 scale has been proved valid and reliable in Chinese populations [ 26]; in this scale, participants are asked to rate the frequency of specific depression symptoms over the last two weeks from not at all (score 0) to nearly every day (score 3), for a total score ranging from 0 to 27. At a cutoff score of 9 (PHQ-9 score ≥ 10), the PHQ-9 scale was found to have a sensitivity of 88% and a specificity of 88% for detecting major depression compared with a structured psychiatric interview [ 27]. The WHO-5 scale has also been shown to be a well-being scale with good reliability and validity, serving as a sensitive screening test for mental well-being, and has been used in Chinese populations [ 28]. Participants were asked to rate their status from never (score 0) to all the time (score 5) over the last four weeks, and the sum score could range from 0-25, with a total score below 13 defined as poor mental well-being (PMWB).

2.4. Statistics

The WHO-5 scores were calculated according to the established scoring algorithms, with higher scores indicating better mental well-being, contrary to the depression scores of the PHQ-9. Sociodemographic variables were categorized for analysis purposes as shown in Table 1 . We first investigated the prevalence of depression and PMWB across different characteristics among participants by using Pearson's χ ² test. Then the associations between long working hours and psychological outcomes (depression and PMWB) were assessed via multivariate logistic regression. The logistic regression models were fitted using the categories of scale scores as the dependent variables and weekly working hours as the independent variable. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Finally, we assessed the impact of having hobbies on the mean score changes of the PHQ-9 and WHO-5 scales in the four WWH groups using a general linear model and simultaneously explored whether there was an interaction effect between working hours and having hobbies. A two-tailed alpha with p value < 0.05 was considered statistically significant. All the data analyses were performed using SPSS software for Windows, version 22.0 (IBM, Armonk, NY, USA).

Table 1

Variables

Depression n (%)

PMWB n (%)

χ ²

df

p

2.5. Ethics Approval

Informed consent was obtained from the participants after detailed explanation of this study. The study was approved by the Institutional Review Board (IRB) of the School of Public Health of Fudan University with an IRB approval number of IRB #2015-12-0574.

3. Results

3.1. Basic Findings

In this study, a valid sample size of 2985 was confirmed, and there were more female participants (54.6%) than male participants (45.4%). The mean age was 30.98 years (SD = 9.48), with a range of 18-60. Among all the employees, the prevalence of long working hours was 69.3%. In detail, the proportions of those who worked 41-50 h, 51-60 h, and more than 60 h per week were 20.6%, 29.4%, and 19.3%, respectively. The mean scores on the PHQ-9 and WHO-5 were 6.09 (SD = 4.47) and 16.09 (SD = 5.66), respectively. According to our cut-offs, the prevalence of depression and PMWB was 19.0% and 25.3%, respectively.

The associations between general characteristics and depression and PMWB are shown in Table 1 . As expected, workers who had hobbies had significantly better mental health status than those who did not in terms of both prevalence of depression (16.4% vs. 21.6%) and PMWB (20.4% vs. 30.7%). In terms of weekly working hours, the prevalence of PMWB gradually increased with workers working from ≤40 h to >60 h per week, but this was not the case for depression except that working over 60 h per week significantly predisposed workers to the highest prevalence of depression (25.9%). As for work-related psychosocial factors, workers who had low job control, low social support, and job stress had a significantly higher prevalence of depression and PMWB.

3.2. Factors Related to Depression and PMWB

Table 2 represents the multivariate logistic regression results. Under the crude model (Model I), there were significant associations between long working hours, having hobbies, and poor mental health status, with increased ORs of 1.62 (95%CI: 1.26-2.09) and 1.81 (95%CI: 1.44-2.29) for working over 60 h per week on depression and PMWB, respectively. Similarly, decreased ORs of 0.72 (95%CI: 0.59-0.86) and 0.58 (95%CI: 0.49-0.68) were found for having hobbies. However, when the adjusted model (Model II) was run after adjustment for basic characteristics, health-related behaviors, and work-related psychosocial factors, the ORs for working over 60 h per week declined to 1.40 (95%CI: 1.03-1.90) and 1.66 (95%CI: 1.26-2.18), respectively, and the ORs for having hobbies climbed to 0.78 (95%CI: 0.62-0.97) and 0.62 (95%CI: 0.51-0.75).

Table 2

Factors

ORs of Depression

ORs of PMWB

Model I

WWH

Model II

WWH

3.3. The Role of Having Hobbies

Table 3 shows the mean scores of two measurements stratified by having hobbies or not in the general linear model. In all four WWH groups, the mean scores on the PHQ-9 for having hobbies were significantly lower than those for having no hobbies. Accordingly, the mean score on the WHO-5 in each WWH group was significantly higher among workers who had hobbies. Moreover, the mean score on the WHO-5 decreased with increasing weekly working hours for both those who had hobbies and those who did not. However, this was not the case for the PHQ-9, for which the mean scores of the 41-50 h group were lower than those of the ≤40 h group. P values for the interaction effects between weekly working hours and having hobbies on the PHQ-9 and WHO-5 demonstrated statistically insignificant results ( Figure 1 ).

Table 3

WWH

Mean Score on PHQ-9

Mean Score on WHO-5

F (F1; F2)

p (p1; p2)

Having Hobbies

No Hobbies

Having Hobbies

No Hobbies

4. Discussion

The main findings of our study were that long working hours, specifically working over 60 h per week, were significantly associated with depression and PMWB among the working population in Shanghai and having hobbies in their lives played a beneficial role in these relationships without an interaction effect.

In this study, the prevalence of long working hours among participants was 69.3%, which was slightly higher than that (62.0%) of one previous study using Chinese national data from 1991 and 2009 [ 2], indicating that employees in Shanghai are more prone to working overtime due to the fast-pace life of this megacity. We also found that nearly one-fifth of respondents had depression, and approximately one-fourth showed PMWB. We found that working over 60 h in one week was an independent risk factor for both depression and PMWB, which was similar to one study using the WHO-5 in Korea [ 14] and others using different measurements [ 11, 12, 16]. However, we did not detect a dose-response relationship between weekly working hours and risks of depression or PMWB, as some previous studies did [ 13, 16].

Long working hours can affect the overall health of workers from different perspectives. Regarding the relationship between long working hours and mental health status, there could be complicated pathways through which the effect of long working hours may give rise to deterioration in psychological health or mental well-being. Furthermore, long working hours may partially exert an impact on mental health via measured or unmeasured factors in our study. Some studies with robust evidence have shown that the existence of long working hours could lead to a shortage of sleep and time to "recover or repair" from the demands of a job, making workers more vulnerable to worsening mental health [ 29, 30]. In addition to the loss of time for sleep, long working hours may cut down the time available for other leisure-related activities or personal hobbies that help to relieve pressure and provide refreshment, further causing a decline in mental health [ 9]. It is also possible that workers with long working hours cannot maintain a balance between work and family life, often leading to time poverty and exclusion from family events. Consequently, work-family conflicts come into being, which in turn results in higher stress and depression [ 31]. Previous studies have revealed that longer working hours are associated with work-family conflict, which contributes to less family interaction, more conflict in marriage, and less participation in housework [ 32]. Besides, long working hours could probably result in worse health behaviors and have been associated with increased risk of alcohol use and suicide [ 11, 33]. Noticeably, leisure hobbies are indeed about employees' private lives. When employers or managers are considering about conducting any workplace wellness (or well-being) programs, they should take care to avoid the tendency to shift blame from institutions/employers to individuals/employees, to create and sustain hierarchy, and to cede employers control over employees' private lives [ 34].

The present study is one of the first to clarify how long working hours affect mental health status among the occupational population in China and the first to provide evidence of the beneficial role of having hobbies in this relationship. This study also provides a better understanding of the current situation of long working hours and the prevalence of poor mental health status in Shanghai, China. However, there are also several limitations to this study. First, it was a cross-sectional study, unable to reliably establish a temporal relationship between long working hours and mental health outcomes. A longitudinal study would be necessary to verify whether long-term exposure to long working hours could have effects on the causal change of mental health status or psychological well-being. Second, a lack of validity from self-reported surveys may exist. The use of self-reports to assess and categorize the number of working hours may give rise to subjective errors. Third, when touching on sensitive issues, such as depression in a domestic context, respondents tend to answer questions more in line with social norms than with their actual situations-A phenomenon known as social desirability [ 35], in which depressive individuals may be reluctant to admit their psychological problems even under conditions of anonymity and confidentiality. In addition, there may have been a healthy survivor effect, as individuals with severe depression or the worst state of psychological well-being are considerably unlikely to be present at work and have certain difficulties in maintaining full-time occupations. Finally, this study was conducted in Shanghai, a coastal megacity where employees may be more likely to face a fast-paced work life and enormous pressure to get promoted, and we excluded some job categories, such as part-time jobs and shift work. Hence, the current findings may not be highly generalizable to the whole working population in China.

5. Conclusions

Using two types of outcome measurements, we found that long working hours (over 60 h/week) were uniformly associated with a decline in mental health status compared to standard working hours. Having hobbies played a beneficial role in this relationship for working-age people. These findings have important implications for workplace policy and the prevention of mental illness among workers. Strengthening regulation of long working hours and improving time management skills among working-age people in workplaces, while encouraging employees to cultivate certain kinds of hobbies or leisure activities in their spare time, may be conducive to their mental health status. Workplace health promotion programs or interventions should also pay close attention to these factors to achieve the goal of total worker health. Future studies should adopt a longitudinal methodology to identify the causal relationships between long working hours and psychological outcomes, include a more representative sample with higher generalizability, and take examine hobbies in more detail to determine which one can best enhance workers' mental health.

Acknowledgments

The authors thank all the research staff for their efforts, communication and collaboration, and all the participants and relevant unit managers involved in this study for their cooperation, dedication and support.

Author Contributions

H.F. and J.D. developed the concept and design; H.F., J.D. and Y.J. acquired the funding; J.D., N.W. and Z.L. did the survey; H.F., J.D. and J.G. provided project administration and resources; H.F. and J.D. supervised and validated the item; Z.L. and J.D. wrote and revised the manuscript. All authors read and approved the final manuscript.

Funding

This work was partly funded by the National Natural Science Foundation of China (NSFC) (grant number: 71561137001), and partly supported by the Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System (The Fourth Round-V): The Demonstration Project for Strengthening the Construction of Public Mental Health System (grant number: GWIV-5).

Conflicts of Interest

The authors declare no conflict of interest.

References

23. Iwasaki Y., Mannell R.C. Hierarchical Dimensions of Leisure Stress Coping. Leis. Sci. 2010;22:163-181. [ Google Scholar]

26. Hu X.C., Zhang Y.L., Liang W., Zhang H.M., Yang S.C. Reliability and validity of the patient health questinnaire-9 in Chinese adolescents. Sichuan Ment. Health. 2014;27:357-360. [ Google Scholar]

28. Wang Z., Bian Q. Reliability and validity of the World Health Organization Five-item Well-being Index for detecting depressive disorders in senior middle school students. Chin. Ment. Health J. 2011;25:279-283. [ Google Scholar]

Articles from International Journal of Environmental Research and Public Health are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Effect of Long Working Hours on Depression and Mental Well-Being among Employees in Shanghai: The Role of Having Leisure Hobbies

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Our aim is to examine the associations between long working hours and depression and mental well-being among the working population in Shanghai, as well as to identify the impact of having hobbies on these relationships. A cross-sectional study was conducted ...

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In this article they give quantitive data discussing what trauma and how much physical abuse one takes to show signs of a diagnosis of a serial killer. It also show qualitative data describing the time of physiological abuse one goes through in childhood to develop serial killer traits.

Posted by-Tiana I. Martinez

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Abstract

The aim of the current research was to provide a new method for mapping the developmental sequences of serial killers' life histories. The role of early childhood abuse, leading to types of serial murder and behaviours involved in the murders, was analysed using Behaviour Sequence Analysis. A large database ( n  = 233) of male serial killers with known childhood abuse (physical, sexual, or psychological) was analysed according to typologies and crime scene behaviours. Behaviour Sequence Analysis was used to show significant links between behaviours and events across their lifetime. Sexual, physical, and psychological abuse often led to distinct crime scene behaviours. The results provide individual accounts of abuse types and behaviours. The present research highlights the importance of childhood abuse as a risk factor for serial killers' behaviours, and provides a novel and important advance in profiling serial killers and understanding the sequential progression of their life histories.

Key words: behaviour sequence analysis, crime, homicide, profiling, serial killer

Homicide is legally defined as the killing of another person. Homicide is an all-inclusive term, and there are different subcategories of homicide, such as murder, multicide, and manslaughter. Serial homicide, as defined by the Federal Bureau of Investigation, is "the unlawful killing of two or more victims in separate events." Serial homicide is an intentional, premeditated act, not a crime carried out on impulse or in response to a perceived provocation or threat (Reid, 2016). Athrough it is form of multicide, serial homicide is not to be confused with mass murder, which is defined as four or more murders that occur in one event, with no distinctive time lapse between them, or spree-killing, which is any murder that occurs at two or more locations with no emotional cooling-off period between (Douglas et al., 1992).

Advances in computational intelligence and the establishment of large datasets have meant that researchers in serial homicide are moving towards predictive models and understanding. In particular, researchers are now beginning to develop models to help to predict who is likely to commit serial homicide, and how to interpret offending patterns as a way to predict later offending behaviour (Hewitt, Beauregard, & Martineau, 2016; Ioana, 2013; Miller, 2014). Regardless of the type of prediction, to develop any such model, it is important that researchers understand the chain of events that preceded the homicides. One way in which researchers do this is by grouping related behaviours together, using a "thematic" or offending style typology approach (Grubin et al. 1997).

Typologies

Since the 1970s, investigative profilers at the FBI's Behavioural Science Unit (BSU) have been analysing crime scenes in the attempt to generate 'profiles' of violent offenders. Profiles consist of aggregated data collected from several sources, which combine to indicate specific characteristics relevant to the offender (Douglas, Ressler, Burgess, & Hartman, 1986). These profiles, in turn, are meant to aid law enforcement officers in the detection and apprehension of violent offenders, including serial killers. Originally, the analysis of crime scenes revealed a dichotomized classification of a crime that was considered to be either organized or disorganized (Hazelwood & Douglas, 1980), the organized typology being a form of murder carried out by an individual who appeared to plan the crime, target the victims specifically, and displayed control (Douglas et al., 1986). Disorganized scenes, in contrast, exhibited a form of murder carried out by an offender who was less apt to plan the offence, who obtained victims by chance, and who behaved haphazardly during the crime (Douglas et al., 1986).

This original typology, that of the organized or the disorganized offender, was deemed overly simplistic and has since broadly expanded (Canter, 1994; Holmes & Rossmo, 1996; Turco, 1990). Recently, researchers have developed more sophisticated typologies including (1) visionary, mission-oriented, hedonistic, and power-control oriented killers (Holmes, De Burger, & Holmes, 1988); (2) thrill-motivated killers, murders for profit, and family slayings (Levin & Fox, 1985); and (4) travelling serial killers, local serial killers, and place-specific serial killers. Despite the development of refined typologies, research has found that there is no such thing as a prototypical serial killer, consequently limiting the usefulness of the typologies developed so far (Walters, Drislane, Patrick, & Hickey, 2015).

Profiles are created retrospectively - that is, after a crime had been committed. They are developed viay a thorough observation of the crime scene, interviews with surviving victims, and even wiretappings of taunts made by the subject to the victims' families (Douglas et al., 1986). However, one limitation to this is that the profiles generated rely, to a large extent, on the use of educated guesses developed on the basis of data that may be unreliable. While profiles are undoubtedly a useful investigative tool that should not be overlooked, the accuracy of profiling could still be developed.

Studies have suggested that it is important to include personal histories and personality factors when proposing an 'offender profile' (Hazelwood & Warren, 2000). The FBI's BSU also noted the value of this when they conducted a series of extensive interviews with several violent sexual offenders, including 25 serial killers, in the 1980s (Ressler, Burgess, & Douglas, 1988). The results from those interviews have helped to inform the development of criminal profiles today. The present study uses a broader categorization, such as those designed by Holmes and Holmes ( 1998). The present study includes influencing factors before the kill, such as personal histories and serial killers' experiences of abuse.

Abuse

The World Health Organization (WHO) defines child abuse as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child" (World Health Organization, 1999, p. 80). Although this definition covers a spectrum of abuse, the three main types defined in the present study are physical, sexual, and psychological abuse. Physical child abuse relates to acts that cause actual physical harm or have the potential for harm. Sexual abuse is defined as those acts in which a child is used for sexual gratification. Psychological abuse includes the lack of an appropriate and supportive environment or acts that have an adverse effect on the emotional health and development of a child.

Research has suggested that the 'profile' of a serial murderer typically includes abuse during childhood (Ressler, Burgess, Douglas, & Depue, 1985). It is possible that this is due to habituation and tolerance of pain, depending on the extent to which the abuse had been experienced as violent or painful (Joiner, 2007). Childhood abuse has also been associated with later cognitive processing problems, which may lead to an aggressive thought pattern - for example, encoding errors, hostile attributional biases, accessing of aggressive responses, and positive evaluations of aggression (Dodge, Pettit, Bates, & Valente, 1995).

Furthermore, research has shown that there is a very strong link between early childhood abuse and individuals who kill for sexual gratification (Lust/rape typology), as previous research has found that all types of abuse, excluding neglect, were significantly higher in the lust typology serial killer population than in a controlled sample (Mitchell & Aamodt, 2005). On average, 50% of serial killers suggest that they have experienced psychological abuse, 36% have experienced physical abuse, and 26% have experienced sexual abuse (Mitchell & Aamodt, 2005). Therefore, abuse in childhood is linked to serial killers' later behaviours; however, what is not known is the sequential pathway between childhood abuse and different types of serial killer. A method is needed that can systematically link and sequence childhood abuse with typology of the criminal and crime scene behaviours. The present study provides this novel methodological approach to understanding the link between childhood abuse and later serial killer behaviour.

Behaviour Sequence Analysis (BSA)

A useful method for understanding the dynamic relationship between progressions of behaviours and social interactions occurring over time is Behaviour Sequence Analysis (BSA; Beune, Giebels, & Taylor, 2010; Marono, Clarke, Navarro, & Keatley, 2018; Taylor, Keatley, & Clarke, 2017; Keatley, Barsky, & Clarke, 2016; Keatley, 2018). BSA, also referred to as lag sequence analysis, is a method for investigating how chains of behaviours and events are linked over time.

Behaviour Sequence Analysis involves the study of transitions between behaviour pairs (Marono et al., 2017). Sequences can be on large (lifetime, e.g., Keatley, Golightly, Shephard, Yaksic, & Reid, 2018) or small (millisecond, e.g., Marono et al., 2017) scales. In lag-one BSA, which the present study uses, the antecedent behaviour (e.g., type of abuse) is the first event in a pairing, and the sequitur (e.g., first murder behaviour) is the second behaviour in the pair. Obviously, there are intervening behaviours and events through the lifetime; however, the purpose of the present study is to highlight BSA as a method for understanding homicide and connecting established risk factors and behaviours. This provides a simplified model of types of abuse linked to type of murders. Put simply, a BSA will determine how likely it is, compared to chance, that a sequitur occurs following an antecedent. The analysis indicates which pairings of behaviours occur above the expected level of chance - for instance, if an individual suffers 'abuse type A', how likely is 'Behaviour B' or 'Behaviour C' to follow. Sequence Analysis is not limited to only two behaviours; it is possible to analyse the pattern between potentially unlimited numbers of behaviours (from the start to end of a sequence). This technique has been applied to a variety of behaviours and social interactions and is commonly applied to forensic contexts, such as rape cases (Ellis, Clarke, & Keatley, 2017; Fossi, Clarke, & Lawrence, 2005; Lawrence, Fossi, & Clarke, 2010), violent episodes between people (Beale, Cox, Clarke, Lawrence, & Leather, 1998; Taylor et al., 2017), and marital conflict (Gottman, 1979).

Present study

The present study uses a BSA approach to investigate the effects of different types of early childhood abuse (physical, psychological, and sexual abuse) on later serial killings. The pattern of actions explored begins with this early abuse, leading on to the typology of the serial killer. This is included in the analysis to indicate links between abuse and typology, rather than direct sequential effects. 1 The effect of experiencing multiple types of abuse at the same time was also investigated. Typologies were classified into four groups, dependent on the serial killer's motivation: lust, anger, power, and financial gain. The next behaviour explored was the crime scene behaviour - such as how the victim was killed and what was done with the body. Thus, the sequence from early childhood abuse, typology of the killer, and crime scene behaviours was analysed. While formal hypotheses are not made, owing to the novel nature of the research, several expected links can be outlined. First, it is likely that childhood sexual abuse will lead predominantly to sexual typologies, taking into account previous literature highlighting that violent upbringings influence later delinquency, adult criminality, and violence (Maxfield & Widom, 1996). It is also likely that individuals who have experienced early physical abuse will show a greater amount of violence - for example, signs of torture and overkill (infliction of excessive and unnecessary violence).

Methods

Sample

An all-male sample of 233 serial killers with a documented history of childhood abuse was collected. Numbers experiencing each type of abuse were as follows: psychological abuse ( n = 35), physical abuse ( n = 36), sexual abuse ( n = 21), psychological and physical abuse ( n = 88), physical and sexual abuse ( n = 7), and physical, sexual, and psychological abuse ( n = 46). The dates of first kill ranged from 1850 to 2014. The date of last kill ranged from 1893 to 2014. In calendar years of the sample at the time of their first kill ranged from 6 to 60 ( M = 28, SD = 8.96), and their last kill ranged from 16 to 68 ( M = 34, SD = 10), although the exact age in childhood when abuse occurred is unknown. The number of kills ranged from 3 to 138 within several countries: Brazil ( n = 3), Canada ( n = 6), Australia ( n = 6), USA ( n = 176), Argentina ( n = 1), Columbia ( n = 4), Ecuador ( n = 1), England ( n = 8), France ( n = 4), Germany ( n = 4), Italy ( n = 1), Mexico ( n = 2) Ireland ( n = 1), Scotland ( n = 1), Pakistan ( n = 1), Russia ( n = 5), South Africa ( n = 7), and Spain ( n  = 2). As the sample had been obtained from secondary sources and so does not contain any studies with human participants, ethics approval was not needed.

Coding procedure

The sample was split according to the type of abuse experienced in childhood. The typology of the serial killer in each group was then coded (Lust/rape, power, financial gain, or anger) into the BSA. Lust/rape killers were those whose murders involved sexual elements, including rape, sexual assault without penetration, or symbolic sexual assault such as the insertion of a foreign object into body orifices (Douglas et al., 1992). Power killers were those who derived pleasure from having complete control over their victims. Financial gain killers were those who killed for motivations based on the accumulation of goods or finances. Anger killers were those who killed for motivations that stemmed from feelings of anger, frustration, or betrayal, whether real or imagined. The overall methods used across kills was also recorded for all killers. 2 The final factor considered for each individual was what they had done with their victim's body(s) after the murder (e.g., moved the body to a different location and buried it, hid the body at the crime scene, etc.). Percentages of participants for each individual were calculated at each stage.

A coding scheme was developed based on every recorded outcome/behaviour reported in the dataset. Given the straightforward nature of the task, there was no ambiguity over responses or coding. The typology of serial killers was assessed by forensic psychologists.

Statistical analysis

After data were coded into chains of discrete behaviours and categories, data were entered into the statistical software R (R Core Team, 2013) and analysed using a behaviour sequence analysis program developed by the researchers. The program calculated frequencies of individual behaviours, transitional frequencies, chi-square (χ ²) statistics, and standardised residuals.

Results

The main stage of BSA is to focus on the transitions between pairs of behaviours. Transition frequencies between antecedents and sequiturs are calculated, and chi-square analyses are indicated if these transitions occur above the level of chance. State transition diagrams can then be drawn, which indicate pairs of behaviours with high standardised residuals ( SR). It is important to note that while pairs of behaviours can be connected to form longer chains, the analyses are only on pairs of behaviours. Longer chains, though intuitively appealing, are actually limited in terms of generalizability, owing to over-fitting of data. All of the transition lines in the diagram are significant ( p < .05) (see Figure 1 ).

Importantly, Figure 1 shows that there is a clear distinction between type of abuse experienced and later typology of the serial killer. For example, experiences of sexual abuse most likely to lead to the power typology ( n = 6, SR = 9.21), compared to other typologies. Rape/lust typology was the most common typology in the current dataset ( n = 152). However, it had followed more frequently from psychological abuse ( n = 10, SR = 7.06) and a combination of all three types of abuse ( n = 12; SR = 7.04). There did not seem to be a strong connection between financial gain and any type of abuse or combination of abuse, as it was infrequent in all cases, particularly the experience of all three combined. There was no strong pattern between any single type of abuse and anger typology, and only 23 subjects classified as this typology. There was a clear pattern between rape/lust typology and torture of the victim ( n = 16, SR = 9.59). There was a clear pattern between financial gain and the murder being carried out quickly ( n = 12, SR  = 8.33). An additional benefit of the BSA approach is that particular cases can be highlighted and analysed individually. For instance, the following analyses focused on each type of abuse sequence by itself. This allows researchers and investigators to refine their search parameters and to begin narrowing in on particular sequences based on evidence or interests.

Physical abuse

For physical abuse ( Figure 2 ), there was a distinct sequence between the experience of physical abuse and rape/lust typology ( n = 6, SR = 4.80) and anger typology ( n = 2, SR = 2.77). Those with rape/lust typologies were more likely to carry out the murder quickly ( n = 5, SR = 5.75), and crime scenes exhibited signs of the victim having been bound ( n = 3, SR  = 4.64). There was also evidence of overkill, and in all cases where overkill occurred, the body had been left at the crime scene.

Psychological abuse

For psychological abuse ( Figure 3 ), there was a distinct sequence between the experience of psychological abuse and rape/lust typology ( n = 10, SR = 6.50) and financial gain ( n = 5, SR = 4.60). Murders were carried out quickly in all cases where the motivation was financial gain; however, if the typology was rape/lust, then fewer were carried out quickly ( n = 5, SR = 3.63). There was also a strong link between torture and evidence of overkill ( n = 5, SR = 6.25), and evidence of overkill and mutilation of the body ( n = 6, SR  = 6.84).

Sexualabuse

Unlike the other types of abuse, sexual abuse was linked to all four typologies (see Figure 4 ). The rape/lust typology was slightly more likely to the torture of victims ( n = 4, SR = 5.92) compared to showing signs of overkill ( n = 4, SR = 4.27). The power typology was more strongly related to carrying out the murder quickly ( n = 4, SR = 5.23) than to mutilating the victim ( n = 2, SR = 3.16). The anger typology showed a link to carrying out the murder quickly ( n = 2, SR = 2.16), and financial gain was also linked to carrying out the murder quickly ( n = 4, SR = 5.85). Finally, there were strong links between torturing and binding the victim ( n = 4, SR = 9.39), and the victim being bound and mutilation ( n = 4, SR  = 8.63).

All types of abuse

When a combination of sexual, physical and psychological abuse was experienced ( Figure 5 ), the rape/lust typology for killing was most likely to follow ( n = 12, SR = 6.76). Rape/lust was more likely to lead to the victims being bound ( n = 6, SR = 7.11) than to killers carrying out their murders quickly ( n = 4, SR = 2.63). Subjects who killed for anger were more likely to carry out the murder quickly ( n = 4, SR = 4.49) than show evidence of overkill ( n = 2, SR = 1.61).Those who killed for financial gain carried out the murder quickly ( n = 3, SR  = 5.03).

Discussion

The main aim of the present study was to examine whether there were distinguishable sequences that occur after experiencing different types of abuse in childhood, leading to different typologies/motivations for killing victims, and how murders were carried out. The outcome is an insight into the sequential chains that different types of abuse result in for an individual. Within the current dataset, results indicate that different types of abuse affect later typologies and murder behaviours.

Previous literature suggests that early physical abuse leads to later aggression and violence (Widom, 1989). Current results partially supported this. Although those who were physically abused were more likely to demonstrate 'overkill' of their victim, the most specifically violent methods of kill were practised by those who had been sexually or psychologically abused in early life. For example, mutilation, torture, and binding the victim were more typical of serial killers who had experienced sexual abuse. Furthermore, those who had been sexually abused rarely showed evidence of overkill, and the murders tended to be carried out quickly. This was not the case for both physical and psychological abuse, as both showed evidence of overkill. The exact reason for this cannot be clarified from this sequence chain, although based on previous research (Briere & Elliott, 1994; Wyatt & Newcomb, 1990), it may be that these patterns emerge because those who have experienced sexual abuse suffer from deep-seated anger and self-blame, leading them to lash out and kill their victims quickly, and they are more likely to feel guilt or remorse afterwards and thus are unlikely to show evidence of overkill.

Furthermore, all recorded murders were carried out quickly by those who were classified as motivated by power. There was also no evidence of any torture, mutilation, or overkill. Although again, the sequence chain cannot direct determine the reason as to why this is, based on previous research (Canter & Wentink, 2004; Holmes & Holmes, 1998), a reason could be that this stems from a need to control the victim and assert dominance. Therefore, killers see the act of killing as a necessity, rather than obtaining any enjoyment out of the kill, per se. In these killings, there is, therefore, no unnecessary means of killing, infliction of unnecessary pain, or evidence of enjoyment.

Those who were classified as exhibiting rape/lust typology commonly engaged in post-mortem sex, regardless of the type of abuse experienced as a child. There was also no evidence of overkill in any of the cases, although torture was commonly used. A possible explanation for this is the presence of abnormal paraphilias or sexual sadism, which supports Dietz, Hazelwood, and Warren's ( 1990) argument that psychopathic sexual sadists kill for the sheer pleasure of torturing and murdering their victims in a sexual way. Importantly, the experience of sexual abuse, whether isolated or experienced alongside physical and/or psychological abuse, led to the mutilation or torture of the victim. Similarly, individuals who classified as lust/rape typology where more likely to torture or mutilate their victims. This suggests a correlation with sexual behaviour and a need to inflict pain.

Additionally, results are incongruent with previous literature on typologies, as there was no consistent pattern for method of killing and disposal of the body within each typology. This supports the suggestion by Canter and Wentink ( 2004) that features of power/control typologies were consistent for serial killers rather than forming a distinct type. Thus, the reliability of isolated typologies is less mutually exclusive than previously believed, and more attention should be paid to what factors influence specific methods of killing than to the motivations of individual offenders. Indeed, it may be that the cross-sectional approach to typology defining could be developed to include temporal dimensions. The current analytical method can be used to show linkages between behaviours and events, over time, which may provide investigators with a clearer understand and method for developing typologies.

A limitation of the current research is the potential influence of additional life events that may intervene in the current diagrams, as these were not available to be analysed. These other variables and events may have effects on later behaviours; however, the present research outlines a new approach to understanding serial killers' life histories, rather than a complete timeline. Given the nature of the coding and behaviour sequence analysis, future research can be added directly to the current data to extend the sequence pattern, and other influential factors can be added. Indeed, this research marks the beginning of a new framework for understanding life histories and behaviours of serial killers, which can be developed and expanded. This research underlines the important impact of childhood abuse on serial killers' motivations and behaviours. Future research should aim to fill in the gaps between childhood abuse and other life events leading up to the first murder, and then further murders.

Notes

¹ It is possible that other, unmeasured variables play an important role in the sequence; however, the current research is presented as a framework foundation on which more complex sequences can be built in the future. The methods and statistics are open to additions being imputed into the sequences at later times, to develop more complex sequential chains.

² Owing to limitations of the dataset, behaviours for each sequential murder are not known. Therefore, overall behaviours across murders are presented in the current dataset. While we acknowledge this is a limitation of the study, it still indicates typical crime scene behaviours for each individual killer.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Ethical standards

Declaration of conflicts of interest

Abbie Marono has declared no conflicts of interest. Sasha Reid has declared no conflicts of interest. Enzo Yaksic has declared no conflicts of interest. David Keatley has declared no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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A Behaviour Sequence Analysis of Serial Killers' Lives: From Childhood Abuse to Methods of Murder

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The aim of the current research was to provide a new method for mapping the developmental sequences of serial killers' life histories. The role of early childhood abuse, leading to types of serial murder and behaviours involved in the murders, ...

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This source gives data taken from teens, young adults, and parents on how they feel about social media. 52% of students feel as if social media makes them less confident and also creates loneliness, depression, and anxiety.

-Posted by Jayda

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Social Media's Impact on Mental Health

The rise of social media at the turn of the 21 st century, has given us easy access to friends, family and people we admire - allowing us all to stay connected online. As social creatures, we crave contact with others, and social media allows us to do just that, any time, any place.

As social media sites have increased their influence on our lives, more attention has been drawn to the connection it has with our mental health. If social media is used to excessively, it can lead to mental health challenges including anxiety, depression, eating disorders and addictions.

This guide takes a deep dive into the subject of social media and mental health. We explore:

Cyberbullying

Sometimes, people use social media networks to victimise and abuse others online. Harmful or offensive comments are commonplace in some areas of social media, making it a cruel place for those on the receiving end.

Whilst this can happen to anyone, it's especially a problem for children and adolescents. Hurtful comments, rumours and lies can have a big impact on the mental health of a child. It can be even more damaging if that child is also being bullied at school, as digital spaces give the perpetrator a chance to continue to bully out of school hours.

Fear of missing out (FOMO)

Whether on social media or not, when we see friends or family having fun, we get a sense that everyone is enjoying a more eventful life than our own. In many ways, this is just a natural human reaction.

Social media can intensify these feelings. If we see pictures of other people out enjoying themselves while we sit at home, this can make us feel like we're missing out and worry that our social life isn't an exciting as other people's. Over time, these feelings can escalate into real mental health problems such as anxiety and depression.

Feelings of Inadequacy

Social media has long been criticised for the ease with which people can manipulate images using filters and other tools. These doctored images often promote an unrealistic body image, which can cause us to feel insecure about how we look. This can lead to conditions like eating disorders and body dysmorphic disorder (BDD), particularly among younger people.

It's not just other people's appearances on social media that can make us feel insecure. The system of 'likes' and 'shares' used by most social platforms, mean that we can be constantly comparing ourselves to other people. If we find that our posts receive fewer likes than a friend, it can make us feel less popular or generally inadequate. Also, it can mean that our sense of self-esteem and self-worth becomes dependent on the amount of engagement we get on social media, as opposed to more important things such as what we're like as people.

Read more here.

Loneliness and Isolation

Social media can also make us feel more lonely and isolated. Evidence shows that physical, face-to-face interaction with other people acts as a boost to our mental health, whereas a 2015 study in the Journal of the American Geriatrics Society found that limiting face-to-face contact almost doubles the risk of someone developing depression.

If we start to reduce our face-to-face interactions with people, and only interact with them through social media, this can put us at a higher risk of:

Developing mood disorders like depression

Being less able to deal with stress

Feeling more isolated and lonely

Social Media's Connection to Other Conditions

Eating Disorders

Idealised body images and photo editing tools used on social media, mean that these platforms may contribute to people developing eating disorders. A recent 2019 study said the more often young teens use social media, the more prone they are to developing an eating disorder.

There are also trends such as 'fitspiration' on social media, where healthy eating and fitness become an unhealthy obsession. Research from International Journal of Eating Disorders found that women who post 'fitspiration' images on Instagram are more likely to engage in eating and exercise behaviours that are potentially harmful to their physical and mental health.

Addiction

Opening up your phone releases dopamine in our brains - a neurotransmitter known as the 'happy chemical'. Over time, we can develop an association between using our phones and gaining a rewarding, pleasurable experience. While social media can be a welcome distraction at first, this dopamine hit can mean that you want to log on over and over again, which can soon spiral into an addiction.

In the US, it's now estimated that as many as 5-10% of Americans could meet the criteria for being at risk of social media addiction.

Social Media's Influence on Families

Influence on Children and Teens

Social media can impact us all negatively, but when the damage is inflicted on children and young people, it's natural to feel even more worried.

Social media can seem like the centre of a young person's world. They probably don't have the maturity or life experiences that an older person has to 'cushion' them from any negativity they might experience online.. This means that the impact of social media on their mental health can be much greater than someone who is older and potentially more mentally robust, or with other things to focus on.

The impact of social media on young people is wide reaching, to the extent that Facebook (which also owns Instagram) has recently been criticised for keeping their own research on the topic hidden. Research suggests that these social media channels have a negative impact on young people's body images (affecting young girls in particular) and that teenagers blame these channels for rising levels of depression and anxiety.

Cyberbullying is more keenly felt by younger generations too. The Office of National Statistics say nearly 1 in 5 10-15 year olds have experienced cyberbullying, but a 2018 Pew Research study suggested this could be as high as 59%.

Calls for social media channels to do more to limit the negative impact they have on younger people are growing stronger, as are suggestions the government should get involved. In a Priory poll, we found that 67% of parents want legislation on smartphone use in 10-17 year olds. 44% go as far to say they would support an outright ban on smartphones for under 16s.

Influence on Parents

For parents, worrying about the safety of your children online is bad enough, but adults are not immune from the impact of excessive social media use.

A survey by Priory found that social media is partially responsible for triggering symptoms of anxiety and depression in parents - fuelled by the same feelings of 'FOMO' and feeling 'less than' that affect our children.

22% said that happy family pictures posted on Instagram or Facebook made them feel inadequate

23% said it made them feel depressed

36% said they thought that baby bloggers and 'Instamums"' were contributing to rising rates of depression amongst parents

Read more here.

Influence on Relationships

Social media can also lead to tension or strain in relationships. It can cause feelings of jealousy or envy, especially if one member of the relationship becomes secretive with their smartphone use. As a response, over a third (34%) of partnered adults say they have checked their partner's phone at some point.

These areas of conflict can lead to ongoing relationship problems. A study from 2017 said that people engage more in "infidelity-related behaviours on social media" are less satisfied in their relationship.

Signs Your Social Media Use Is Affecting Your Mental Health

There are signs you can look out for that might suggest your social media use is having a detrimental impact on your mental health. These include:

You're spending more time socialising on social media than face-to-face

You feel sad or low on self-esteem when you see other people's posts

You find you're comparing yourself to others in an unhealthy way

You're distracted by social media when at work or school

You find you're doing things/behaving in a certain way, just to attract likes on social media

You feel sad or disappointed if your posts don't get as many likes as others

Checking social media is the first thing you do in the morning and the last thing you do at night

You start to neglect your other hobbies or interests in favour of going on social media more

How to Modify your Social Media use for Positive Mental Health

Become More Aware of How Much You Use Social Media

Making yourself aware of how much social media consumes your life is the first step towards starting to cut back. Try this exercise, as recommended by a specialist in addictions.

Read more here.

Doing the above will increase self-awareness of how much technology is adversely affecting your life - and how you could replace your 'addiction' with things that might improve your happiness levels and mental health.

Reduce Use Wherever You Can

Alongside becoming more aware of how much you use social media, you can introduce a series of small changes to your digital habits, making them instantly more sustainable and healthy:

Turn your screen to greyscale to reduce the lure and addictiveness of colours, sounds and app styles

Remove apps which 'hook' you in

Turn off all notifications

Use an app to track your usage of different apps and set a goal that aims to reduce it

Look for usage patterns. Are you logging in or switching on during times of stress, boredom, anger or sadness?

Don't take your devices to bed with you

Prioritise Other Activities

Social media is an enticing distraction. If you can shift your focus and engage your brain in something else that captures your attention, you'll be less inclined to pick up your phone. There are loads of ways you can do this, like finding a new hobby, volunteering or practising mindfulness. Meeting someone face-to-face is proven to have a more positive effect on your mental health when compared to other forms of communication. Therefore, you could also take the time to reach out to family and friends and organise physical meet-ups with them.

Fundamentally, it's a good idea to try and replace the dopamine hits that come from social media with something more fulfilling in the long-term.

Helping a Child Develop a Healthier Relationship with Social Media

Signs That a Child Isn't Having a Positive Experience Online

Studies show that social media can affect young people more severely than any other age group. It's bound to be a concern for parents who want their children to develop positive mental health, to the point of them questions whether children should have a smartphone at all. Here are some warning signs that may suggest a child might not be having a positive experience with social media:

They seem nervous when they get a notification or go on their phone

They're secretive about their online activity

They seem angry, sad or frustrated following phone use

They turns off their screen when you enter the room

They seem to be socially withdrawing from family and friends

Tips for Keeping a Child Safe Online
Get to grips with privacy settings
It's important that you put some time aside to understand the apps your child uses. Try to get a feel for how these apps work and discover the ways they try to 'hook' users. It's also a good idea to get your head around any privacy settings or parental controls you could make use of. This means you can step in if you feel you need to.
Encourage them to talk about their life online
Without being intrusive, try to regularly discuss with your child the latest 'goings on' on social media. What apps are new and trendy for kids their age? What viral videos have made them laugh recently?

Social media small talk like this encourages your child to open up about life online and helps you to gauge their general safety and how they're feeling when using social media.
Introduce some basic boundaries
You can also nudge your child in the right direction by setting a few boundaries that encourage a healthy relationship with social media. You could introduce tech-free zones or times, like the dinner table or at bedtime. Lead by example and make sure you also follow these boundaries.

Instead, you can replace this time with other fun, engaging activities or family time to reduce your child's temptation to break these rules.
Discuss social media with other parents
It can be really useful to start a dialogue with fellow parents to see how they also deal with the issue of social media. You could discuss setting up the same boundaries so that none of your children feels 'left out' or claims that every other child is allowed to do something they're not.

Plus, it's another good way to keep tabs on your child's activity. Parents can look out for one another, keeping their 'ear to the ground' and alerting everyone else if something concerning arises.

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The impact that social media can have on our mental health and expert tips on how you can reach a healthy balance online for you and your children.

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Qualitative Data:

This source collected its qualitative data in Singapore and focuses on the negative effects associated with social media such as cyber bullying, low self esteem and eating disorders.

-Posted by Jayda

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PLoS One. 2022; 17(11): e0277928.

Ellaisha Samari, Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing - original draft, 1 ,* Sherilyn Chang, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - review & editing, 1 Esmond Seow, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - review & editing, 1 Yi Chian Chua, Data curation, Formal analysis, Investigation, Methodology, Writing - review & editing, 2 Mythily Subramaniam, Funding acquisition, Writing - review & editing, 1 , 3 Rob M. van Dam, Writing - review & editing, 3 , 4 Nan Luo, Writing - review & editing, 3 Swapna Verma, Writing - review & editing, 2 and Janhavi Ajit Vaingankar, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing - review & editing 1

Abstract

Purpose

This study aimed to expand and inform the emerging body of research on the negative experiences of social media use among youths and how youths deal with them, in an Asian setting, using a qualitative approach.

Methods

Data were collected using 11 focus group discussions (FGDs) and 25 semi-structured interviews (SIs) among youths aged 15 to 24 years residing in Singapore who were recruited via purposive sampling. Data were analysed using thematic analysis.

Results

The salient negative effects mentioned by participants include the development of negative reactions and feelings from upward comparisons with others (e.g., others' achievements and lifestyle), receiving hurtful comments, exposure to controversial content (e.g., political events and social movements), as well as the perpetuation of negative feelings, behaviours, and sentiments (e.g., rumination, unhealthy eating behaviour, and self-harm). Participants also described strategies which they have employed or deemed to be useful in mitigating the negative effects of social media use. These include filtering content and users, taking breaks from social media, cognitive reframing, and self-affirmation, where they identify and change stress-inducing patterns of thinking by setting realistic social, physical, and lifestyle expectations for themselves, and focusing on self-development.

Conclusion

The current results highlight that while youths experience negative effects of social media use, they have high media literacy and have employed strategies that appear to mitigate the negative effects of social media use. The findings can inform various stakeholders involved in helping youths navigate the harms of social media use or provide directions for intervention studies aimed at reducing the harms of social media use.

Introduction

The marked rise in social media use today exemplifies the evolution of the digital landscape. Social media platforms such as Facebook and YouTube continue to dominate the online scene with an estimated 2.9 and 2.1 billion monthly active users respectively [ 1, 2]. Other platforms such as Instagram and TikTok, developed later, have since gained traction, especially among younger audiences with 120 and 100 million active users respectively [ 3- 5]. Using social media sites can arguably be a norm of growing up in the digital age, especially among youths [ 6]. This is reflected in research conducted in 2019 among the younger population of the US where 85% of teenagers were reported using YouTube, while 72% used Instagram and 69% used Snapchat [ 7].

Social media platforms have drastically changed the way people socialize, share information, present themselves, perceive others, and work [ 8]. It is an influential and integral element in today's interaction and communication which is readily available and easily accessible through multiple devices such as smartphones, computers, and tablets. Furthermore, persistent cues through notifications and variable reward mechanism (e.g., social validation for social media post through likes and comments, infinite scroll etc.) encourage greater social media use. Naturally, this phenomenon has sparked interest among researchers to examine the experiences of social media use, particularly among youths given new social dynamics [ 9] and the intricate period of transition to adulthood where young people are experiencing significant developmental and psychosocial shifts including identity exploration [ 10, 11]. It is also a period where youths are experiencing intensified peer relationships, seeking romantic relationships, and engaging with potential or current partners [ 10] and may be motivated to gain attention from their peers or to observe peers' self-presentations.

Arguably, the harms or benefits of social media use depends on how and why people use them, and who uses them. Social media sites provide opportunities for youths to develop and maintain social relationships [ 12], cultivate a sense of belongingness, present themselves to others [ 13], keep up to date [ 14] and even learn about sexual health and identity [ 15]. Some studies have reported associations between social media use and psychological well-being, which is a state of wellness where an individual is feeling good and functioning well based on having positive relationships with others, environmental mastery, self-acceptance, personal growth, autonomy, sense of purpose in life and experiencing positive emotions such as happiness and contentment [ 16, 17]. Specifically, judicious use of social media has been found to be associated with several positive psychosocial outcomes such as increased quality of friendship [ 16] and social support [ 17]. On the other hand, social media use has also been associated with negative experiences such as stress, social isolation, cyberbullying, and mental health issues including depression, anxiety, poor body image and disordered eating [ 18], or found to have no substantive links to mental health issues [ 19- 22]. For example, a longitudinal study by Heffer et al. [ 20] found that social media use did not predict future depressive symptoms and adolescent girls who experience depressive symptoms tend to use more social media across time, and not vice versa. In another longitudinal study by Coyne et al. [ 19], increased time spent on social media was not associated with increased depression or anxiety across adolescents' developmental period at an individual level.

The literature on social media use has been primarily focused on the association between social media use and its impact on users' well-being, while factors associated with harm reduction or how young people manage or reduce the harms of its use have received less attention. Notwithstanding, spending less time on social media sites or using social media mindfully was perceived by youths to help mitigate the negative experiences from social media use [ 23, 24]. In addition, high levels of confidence, high level of media literacy and appreciation of individual differences appeared to mitigate the potential negative effects of social media exposure on body image among adolescent girls [ 25]. Findings from these studies highlight some perceived effective means of mitigating the negative experiences of social media use. Nonetheless, given the dearth of research on harm reduction strategies for negative experiences of social media use, the current study aimed to contribute to the emerging evidence base on negative experiences of social media use among youths and ways youths reduce the harms of social media use in Asia. Identifying harm reduction strategies is critical as it offers insights into how young people mitigate these negative effects which can inform the development and implementation of interventions aimed at improving health outcomes. A qualitative approach will allow a deeper understanding of the psychological mechanisms and processes (i.e., how and under what circumstances) behind youths' negative experiences and the ways they deal with them. Thus, we used a qualitative approach to explore the broad experiences of young people in Singapore with social media use to answer the following questions- 1) What are the negative experiences of social media use? 2) What are the strategies youths employ to reduce these harms?

Methods

Sample

A purposive sampling design was used to obtain the study sample of young people aged 15-24 years, with an approximately equivalent proportion of men and women as well as those belonging to age groups 15-19 and 20-24 years, and three main ethnic groups in Singapore (Chinese, Malay and Indian). Initially, referrals for these participants were sought from colleagues and acquaintances who were provided with the study brochures. Subsequently, participants who had participated were also given the study brochures to disseminate to others and initiate snowball recruitment. Efforts were also made to include young people who had experiences of psychological distress, school drop-out or risky behaviours (e.g., substance use, gang involvement, and incarceration) to ensure greater diversity of the study sample. Referrals for these participants were sought from community-based youth welfare organisations which are providing services to clients with these experiences. Written informed consent was obtained from all participants before they participated in the study. For participants aged below 21 years, parental consent was also obtained. Ethical approval was obtained from the National Healthcare Group's Domain Specific Review Board (DSRB No. 2020/0228).

Data collection

Data were collected through a combination of semi-structured interviews (SIs) and focused group discussions (FGDs) conducted in English and via online videoconferencing using the Zoom platform (11 FGDs, 21 SIs) or in person (4 SIs) between May 2020 and November 2020. Almost all SIs and FGDs were conducted by the lead female researcher [JAV] who has extensive experience in conducting qualitative studies, while some were conducted by the other trained study team members [ES1, SC, ES2, and YCC] who have also received training in qualitative research and had prior experience conducting qualitative interviews. Data from this study originates from a larger study which examined youths' interpretation of positive mental health and its associated pathways. As part of that study, participants were asked questions relating to social media use (as seen in Table 1 ) and their mental health including their or their peers' experience of any pleasant or unpleasant experiences/incidents on social media, their feelings arising from those experiences/incidents and how it influenced their or their peers' mental health. Interviews ceased once data saturation was reached, where no new information was observed and collected. The present study explored data gathered on the harms of social media use and the strategies youths employ or perceive to be useful against these harms.

Table 1

* Tell me about your experience of using social media.

* What are some of the social media platforms that you often use?

* What do you or your friends usually do on these platforms? How does it make you/your friends feel?

* What about your friends? Any pleasant or unpleasant experiences/ incidents that you can recall in relation to social media? How does it make them feel?

* What are some of the strategies you use when engaging with social media?

* You mentioned that social media can affect [experience]. How can you or one overcome this? What are some of the strategies you can use to maintain positive mental health? Activity (only for FGDs): "When I use social media, I feel..."

* When did you/your friends feel [experience/emotion]? Can you/someone describe any such incident or experience? How did it influence your/their mental health?

Data analysis

All FGDs and SIs were audio-recorded and transcribed verbatim. Data management and coding were conducted on NVivo 11 software. Data were analysed using thematic analysis as informed by Braun and Clark [ 26]. Following the inductive approach, five study team members [ES1, SC, ES2, YCC, JAV] identified preliminary codes on the harms of social media use and strategies to avoid those harms from the first six transcripts using the open coding method [ 27]. Through thorough and iterative discussions within the study team, codes were generated into higher-order concepts (themes and sub-themes) based on their common properties and formed an initial codebook. Regular discussions were carried out to review, refine and build consensus on the final codebook, which served as a framework for coding of remaining transcripts [ 28]. A high level of consensus was reached during the framework development process.

Results

Data from the present study comprise 36 data units- 11 FGDs and 25 SIs. A total of 95 young people (51 women and 44 men; mean age = 20.1 years) participated in the study. Participants belonged to Chinese (n = 32), Malay (n = 27), Indian (n = 28) and other ethnicities (n = 8) such as Filipino or Burmese. Among them, eight participants had a history of psychological distress, school drop-out or risky behaviour (e.g., substance use, gang involvement and incarceration). Table 2 displays information on participants' sociodemographic backgrounds.

Table 2

Focus group discussions (n = 11; 70 participants)

Semi-structured interviews (n = 25)

Total

Age, years (mean±SD)

19.8 ± 2.5

21.0 ± 2.6

20.1 ± 2.5

n

%

n

%

n

%

ITE 1

6

8.6

2

8.0

8

8.4

Social media use

All participants reported having experience with social media use. The primary purposes of using social media included sharing information, gathering information, connecting with others, maintaining relationships, and entertainment which occurred on various platforms including Instagram, Facebook, TikTok, Reddit, Twitter, and YouTube. The following results are presented as themes encapsulating the various negative experiences and impact of social media use as experienced and perceived by participants or their peers, as well as practised and perceived mitigations against these harms.

Negative experiences of social media use

Theme 1: Experience of negative emotions and behaviour from upward comparisons with others. A common theme in the interview was the development of negative reactions from upward comparisons with others. Comparisons with others' achievements (e.g., school-related, work-related), material possessions, and experiences (e.g., travels), were more saliently discussed during the interviews as opposed to physical appearance, which was noticeably mentioned more by female participants than male participants. Participants noted that comparisons were usually made with peers, social media influencers, and celebrities with narratives on comparisons to peers and social media influencers being more pronounced. The resulting negative reactions to these comparisons included the development of negative feelings (e.g., feelings of inferiority, insecurity, self-consciousness, hurt, and loneliness), negative behaviours (e.g., self-loathing, starving, engaging in unhealthy competitions and overly intense workouts), and negative body image (e.g., idealizing skinny body types).

" Social media is a platform where there are many many different beauty standards, and I can't help but tend to compare myself with them. I think over the past one year or so, I tried many, many, many ways to lose weight because I felt that I wasn't good enough to the point that like I lost too much weight which wasn't good for myself. "-FGD03

" When you're looking at like, maybe the Instastory of like, some influencer or like, and stuff like that, or people who are like, on holidays and whatnot, then kind of make you feel as though like, you are inadequate or you are missing out or you're not doing something right, that kind of puts on unnecessary trigger or stress on you. "-SI10

Furthermore, comparisons with others can result in the erosion of individuality when users feel compelled to follow the trend or be like other users just to fit in. This desire to belong can inadvertently fuel feelings of insecurity.

" ... it's very natural to then feel, "Okay. We must do this as well because that's what a lot of our generation people are trying to do." We're trying to follow other people. We're trying to follow to be like someone else. And along that process, we either worsen the insecurities we already have or we don't feel confident about ourselves. We don't feel good about ourselves. We don't want to be ourselves"-FGD10

Theme 2: Experience of negative emotions from receiving hurtful remarks. Some participants recounted being emotionally affected by hurtful remarks directed towards them or having witnessed their friends suffer from such insults. These hurtful remarks stem from varying sources, including disagreement with or disapproval towards the content (e.g., activities, opinions, or comments) they had shared, and come from both known and unknown contacts. Furthermore, the anonymity afforded by fake social media accounts allows unbounded and harsh criticisms without consequences towards the perpetrator. Following that experience, some removed the content shared or deactivated their accounts.

" One of my friends, she posted her point of view about this situation and other things. Then there's this another person who just created another fake account and went on to talk shit about her and attack her saying that "Oh, you shouldn't have this point of view. Why are you acting this way," all that stuff. Then it sort of affected her mental health... she was really affected by it that she had to deactivate her account for a couple of weeks until she got back online again-SI14

A participant also recounted how easy it was to have been a bully on social media:

" ...talking to people online through the screen is so much easier. So, it also increases cyberbullying. Yeah, it's so easy to cyberbully someone because it's just like... and then just send. Yeah, I'm sorry to say this, but I was a bully also. Yeah, it felt very bad, but I'm not that person anymore. "-SI07

Theme 3: Experience of negative emotions from exposure to controversial content. Some participants described experiencing or seeing their peers experience negative feelings from exposure to controversial content. While a broad range of content was discussed, the prominent ones leaned towards global political events (e.g., repression of Uyghurs), natural or man-made disasters (e.g., Beirut explosion), social issues (e.g., misogynistic content and animal cruelty), and social movements (e.g., Black Lives Matter). Consumption of this controversial content had left them feeling disturbed, drained, helpless, overwhelmed, and pessimistic.

" ...I feel like certain situations are full of injustice, for example, the Uyghur situation or how people criticize Muslims a lot in this world. And it just frustrates me because a lot of, yeah, misunderstandings are due to them not wanting to educate themselves. Like the comments are so ignorant and it's just so frustrating. "-FGD07

Theme 4: Perpetuation of negative emotions, behaviours, and sentiments. The perpetuation of negativity through social media use was commonly mentioned by participants. First, social media platforms enable rumination through posts or stories. Second, negative sentiments are sometimes echoed by like-minded communities and exacerbated. Third, social media can encourage the perpetuation of negative behaviours such as self-harm, unhealthy eating behaviour and unhealthy coping styles when users follow self-harm content/accounts and emulate them.

" If they're feeling down right, instead of looking at something positive, they end up going on Reddit, and they look at-they enter those communities that are all the same people, and it becomes an echo chamber of negative things, and it gets worse because it's just the same kind of people. " FGD08

" It's very, very sad because you see that their (friends with eating disorders) whole lives are just engrossed and obsessed with numbers, calories, food, exercise, all these things. And it's really very, very, very sad and disheartening to see that social media has such a huge role in worsening these things. "-SI16

" I work mostly with youths at risk, and the kind of content that you follow online is always more towards the emo genre. Sometimes, it does have the elements of suicide or taking a life, or like self-harm, and all those various aspects, and that became their way of dealing with stress, either they learn to take the action from there, or it just comes ingrained, and they do something similar towards the destructive and that's maladaptive. "-FGD08

Mitigation of negative effects of social media use

Theme 5: Filtering content and users. Most participants described curating content or being selective of users they follow as means to reduce any negative effect social media use can have on their mental health. These include choosing only positive content to follow from the start, filtering out accounts followed (e.g., unfollowing accounts which trigger negative feelings), muting selected users' posts/stories on social media, and scrolling past negative content.

" I don't really feel that way [negative feelings] when I use social media because, yeah, why would I want to make myself feel so bad? Yeah, I tend to go for the more positive kind of posts instead of those that kind of puts you down"-FGD01

" Let's say you have a favourite YouTuber who is so pretty. She's a beauty vlogger. And you love watching her videos. But every time you watch her videos, you feel so self-conscious about your own face. I think it's important to make that hard sacrifice to cut it out, to stop watching that YouTuber. "- SI13

Theme 6: Taking breaks from social media. Participants also highlighted the importance of being aware of the negative impacts of social media consumption on themselves, such as from social comparisons or absorbing overwhelming content and managing time spent on social media to reduce these impacts. They also mentioned different ways and benefits of taking breaks from social media use. For some, breaks can either be temporary or permanent (e.g., deactivating social media accounts for good), and the benefits include being able to focus on other tasks at hand (e.g., studying/schoolwork) and experiencing boosted mental health.

" ...I think what we don't realize is that these (social media) are outlets that feed on your energy every single day. So, if it gets to a point where you can't function or perform well because of it, then you need to give yourself a break from it. "-FGD7

" So, for one period, I deleted all my social media like kind of a social media cleanse, and I think a lot of youth do that as well, as they are growing a little bit older, because social media is very superficial, in a sense. "-FGD2

Theme 7: Cognitive reframing and self-affirmation. This theme explicates the conscious effort by users to identify and change stress-inducing patterns of thinking by setting realistic social, physical, and lifestyle expectations for themselves and not being swayed by unrealistic social media portrayals. Participants also showed awareness of the superficial nature of the content on social media which does not necessarily mirror complete real-life situations or experiences. In addition, focusing on self-development and self-affirmation were other ways participants noted as safeguards against the pitfalls of social comparisons on social media.

" So, you see these people's successes... but then I just try to remind myself that, "Okay. I'll be happy for them. Yours will come in time," instead of feeling like, "Oh, why isn't mine here? "-SI03

Discussion

Findings from this study expand and inform the emerging body of research on the negative experiences of social media use among a sample of youths in Asian society and how they deal with them. While youths reported experiencing or witnessing their peers experience significant negative effects of social media use, it is promising to note youths' awareness of these negative effects and their attempts to avoid or reduce them.

Youths' narratives suggest a predisposition towards upward social comparisons, particularly with peers and influencers on social media sites. This tends to result in negative effects; most of which are reflected in prior studies including the development of negative feelings (e.g., feelings of inadequacy, lowered self-esteem [ 29]), as well as an unhealthy mindset (e.g., negative body image [ 30]) and behaviours (e.g., disordered eating behaviours [ 31]). [ 32, 33]. Scholars suggest that the fundamental and universal desire for comparisons with others serves a variety of functions such as evaluating the self [ 34], fulfilling affiliation needs [ 35], and being inspired [ 36]. Given the social functions of social media sites and the detailed information about others, it may be natural for people to engage in social comparisons either consciously or unconsciously [ 37]. Furthermore, unlike real-life situations, social media sites allow people to present an optimized or idealized version of themselves and their experiences [ 38, 39]. It is therefore possible that further exposure to 'enhanced' profiles can create more discrepancy between their perceived self and others and perhaps amplify feelings of inadequacy. This could be supported by the finding of Chou and Edge [ 40] who examined the impact of using Facebook on people's perception of others' lives and found that people who have spent more time on Facebook tend to perceive other social media users as having better lives than they do.

Qualitative studies examining comparisons on social media among young people in Western populations have mostly focused on examining the relationship between social media use and physical or bodily appearance [ 25, 41, 42] or found the appearance-related social comparison to be discussed by participants when examining the role of social media on mental health [ 43]. In such studies, negative impacts from such comparisons were often highlighted. For example, in a study based in the UK by Easton et al. [ 42], the authors examined young adults' (aged 18-25) experience with 'fitspiration' (blend of "fitness" and "inspiration") on social media. They found that comparisons with another's perceived fitness (content on healthy lifestyle habits, relating to exercise and diet), can give rise to negative effects on their psychological health. In particular, minor negative effects include being frustrated about the deceptive nature of posts and jealousy towards unattainable body appearance while more perturbing effects include negative feelings towards their bodies and unhealthy eating habits. These findings are reflected in the narratives of a few participants in this study, particularly female participants, who had mentioned engaging in upward physical appearance comparisons and resonated with such experiences. On the other hand, a unique finding which emerged from this study is the upward comparison with others' achievements (e.g., academics, employment) or material possessions and lifestyles. Research exploring cultural differences in social comparisons suggests that people living in countries whose cultures tend to be more collectivistic, rather than individualistic, are more likely to engage in social comparisons [ 44] and that Eastern cultures are suggested to be more concerned about one's relative social standing [ 45]. Therefore, it seems unsurprising that youths in Asian society are inclined to seek upward social comparisons with peers' achievements, such as having a good social network, occupation, and education, which are contributors to a person's social standing.

Participants highlighted cognitive reframing as a strategy to reduce the harms of social comparisons on social media. Cognitive reframing among participants entails identifying negative patterns of self-evaluations and reinterpreting how they view content on social media, such as reminding themselves of the superficial nature of social media portrayals as well as creating more realistic self-expectations. Research indicates that low self-esteem has been linked to unrealistic standards for self-evaluation [ 46] and that negative self-evaluations can occur when discrepancy increases between ideal and real self-image [ 47]. In the context of social media, for example, exposure to 'fitspiration' content, which tends to involve images and messages praising thinness and high fitness levels [ 48, 49], can lead to increased body dissatisfaction if these ideals are internalized and unattained [ 39] Cognitive reframing mentioned by youths, such as setting realistic body image or achievement expectations, can therefore act as a buffer against the development of negative self-evaluations when comparing with unrealistic and unattainable body images or others' achievements on these platforms.

Narratives of negative feelings from exposure to controversial content are worth paying attention to. Specifically, youths mentioned feeling drained and helpless from bearing witness to cruelty or disasters to which they are unable to contribute to improving the situation. Social media has emerged as a source of news content over the years [ 50] and provides many opportunities to be exposed to news incidentally or deliberately through content shared by others within their social networks [ 51], or when they follow official accounts of news broadcasters. Media writers have argued that news in the digital age has become increasingly visual, with images taken from various sources, and written to convey excitement and danger, and be fear-laden [ 52]. Importantly, user-generated images of important world events are frequently captured on smartphones by witnesses in these events, allowing the audience to view such events in real-time [ 53]. Such user-generated images allow news broadcasters to display more intense and shocking visuals that may not have been available or approved in earlier times. It is therefore unsurprising that there is an observed negative effect on mental well-being with exposure to such raw and intense visuals and commentaries.

However, it is arguably reassuring to note that participants are aware of the control they have over social media's influence on their lives and have exercised proactive self-control strategies to regulate their social media use, such as limiting content seen on social media or keeping off social media. Participants recognize the feeling of relief and benefit to their mental well-being when they step away from stress-inducing content or when they disabled their social media accounts, incidentally, highlighting the pervasiveness of social media in their lives. Indeed, some studies have shown that taking a break from social media positively affects subjective well-being [ 54- 56]. It is also worth noting that keeping off social media among participants appears to involve internal negotiation and contention, alluding to resisting compulsions towards using it.

The negative experiences and harm minimisation strategies reported in this study align well with some emerging initiatives to protect young people from the harms of social media use. An example of such an initiative is #Chatsafe. #Chatsafe was developed to guide and educate young people about communicating safely about suicide on social media [ 57, 58]. The social media campaign was found to be effective in improving young people's capacity to intervene against suicide online, perceived internet self-efficacy and safety when communicating about suicide on social media [ 58]. A similar initiative based on the #Chatsafe guideline was also implemented in Singapore [ 59]. Specifically, the #Chatsafe guideline was adapted to the local context of Singapore into a #PauseBeforeYouPost campaign which educates young people on how to conduct safe conversations around mental health issues and engage safely with those who are at risk of suicide. In addition, a #Chatsafe training curriculum is also being developed for youths and caregivers to provide them with the relevant skills and knowledge to engage positively with suicide-related online content and support those around them who are in distress. The effectiveness of this campaign can inspire the implementation of future interventions targeting different needs of youths, as exemplified by the narratives among this sample population, to mitigate negative experiences and outcomes of social media use. For example, users could be taught and reminded of proper etiquette when communicating with others on social media to avoid making hurtful remarks. In addition, self-esteem, which can mediate the effects of upward comparisons on well-being, could also be addressed in these campaigns.

Efforts could also be extended beyond the social media realm as programs in schools. Educators could teach youths how to manage content and conversations on social media and encourage the diversification of content by suggesting accounts that nurture intellectual passions or interests, resilience, and increase self-esteem in them. As exemplified by narrations of adolescents from Burnette et al.'s [ 25] study, a supportive school environment and its effective communication of social media-related messages and programmes on accepting differences in body image can contribute to the development of high media literacy and confidence among them.

Strengths and limitations

This study has several strengths. Data were gathered from both FGDs and SIs, and deviant samples, allowing for the generation of broad and rich qualitative data. FGDs are generally more dynamic and allow participants to discuss and expand on their pre-existing ideas in light of points mentioned by other participants, which may not have been uncovered in in-depth interviews [ 60]. On the other hand, SIs allows for the gathering of greater insight into the individuals through the discussion of topics in detail [ 60]. However, study findings must be considered in the context of several limitations. The nature of the topic-the negative impact of social media use-may be sensitive or controversial to some participants; therefore, participants may limit sharing due to social desirability bias [ 61]. In addition, we did not examine whether experiences of social media use differ across individuals with different patterns of social media use, or those from different sociodemographic and sociocultural backgrounds, which may account for differences in experiences of negative effects and subsequently adoption and success of different coping mechanisms. It is recommended that future research delve into this topic further and explore the interaction between an individual's socioecological environment and their experiences with social media use. Future research could also investigate differences in terms of strategies adopted by Asian and Western youth populations.

Conclusion

Results from the present study indicate that social media can influence youths' lives today. While social media can enhance learning, connection and communication [ 62], the salience of its negative effects on users' mental well-being drives the need to actively monitor these harms and explore effective ways to steer users away from them. The current results offer a preliminary portrait of the salient negative effects of social media use in a multi-ethnic Asian youth population. It also indicates that while youths experience the negative effect of social media use, they have high media literacy and have employed strategies that appear to mitigate the negative effects of social media.

Acknowledgments

The authors are immensely grateful to all the participants and CHAT Hub, Human Hearts, The Green House Community, and Touch Community for kindly circulating information on our study to their clients.

Funding Statement

This study was supported by the Singapore Ministry of Health's National Medical Research Council under the Centre Grant Programme (NMRC/CG/004/2013) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

Our data contain potentially sensitive information and restriction to sharing of data has been imposed by our ethics committee. However, data for this study are available upon reasonable request. The data request can be sent to The Institutional Research Review Committee, Institute of Mental Health, Singapore; Email address: gs.moc.hmi@hcraeserhmi.

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Articles from PLOS ONE are provided here courtesy of PLOS

# data[].attributes.attachment_link.title
A qualitative study on negative experiences of social media use and harm reduction strategies among youths in a multi-ethnic Asian society

# data[].attributes.attachment_link.description
This study aimed to expand and inform the emerging body of research on the negative experiences of social media use among youths and how youths deal with them, in an Asian setting, using a qualitative approach.Data were collected using 11 focus group ...

# data[].attributes.headline
How Much Does Stress Negatively Impact People?

# data[].attributes.subject
How Much Does Stress Negatively Impact People?

# data[].attributes.body
In this article, research is being done on how stress affects the nervous system. In this article, things like the effects stress may have on memory or learning are talked about more in detail, and the reason why stress can affect those things.

Isabella Paez

# data[].attributes.attachment_link.readable_text
Abstract

Any intrinsic or extrinsic stimulus that evokes a biological response is known as stress. The compensatory responses to these stresses are known as stress responses. Based on the type, timing and severity of the applied stimulus, stress can exert various actions on the body ranging from alterations in homeostasis to life-threatening effects and death. In many cases, the pathophysiological complications of disease arise from stress and the subjects exposed to stress, e.g. those that work or live in stressful environments, have a higher likelihood of many disorders. Stress can be either a triggering or aggravating factor for many diseases and pathological conditions. In this study, we have reviewed some of the major effects of stress on the primary physiological systems of humans.

Keywords: stress, physiology, homeostasis

Abbreviations

ACTH: Adrenocorticotropic hormone

CNS: Central nervous system

CRH: Corticotropin releasing hormone

GI: Gastrointestinal

LTP: Long-term potentiation

NMDA : N-methyl-D-aspartate

VTA: Ventral tegmental area

Stress and the Brain Function Complications

The effects of stress on the nervous system have been investigated for 50 years (Thierry et al., 1968[ 115]). Some studies have shown that stress has many effects on the human nervous system and can cause structural changes in different parts of the brain (Lupien et al., 2009[ 65]). Chronic stress can lead to atrophy of the brain mass and decrease its weight (Sarahian et al., 2014[ 100]). These structural changes bring about differences in the response to stress, cognition and memory (Lupien et al., 2009[ 65]). Of course, the amount and intensity of the changes are different according to the stress level and the duration of stress (Lupien et al., 2009[ 65]). However, it is now obvious that stress can cause structural changes in the brain with long-term effects on the nervous system (Reznikov et al., 2007[ 89]). Thus, it is highly essential to investigate the effects of stress on different aspects of the nervous system (Table 1(Tab. 1) ; References in Table 1: Lupien et al., 2001[ 63]; Woolley et al., 1990[ 122]; Sapolsky et al., 1990[ 99]; Gould et al., 1998[ 35]; Bremner, 1999[ 10]; Seeman et al., 1997[ 108]; Luine et al., 1994[ 62]; Li et al., 2008[ 60]; Scholey et al., 2014[ 101]; Borcel et al., 2008[ 9]; Lupien et al., 2002[ 66]).

Stress and Memory

Memory is one of the important functional aspects of the CNS and it is categorized as sensory, short term, and long-term. Short term memory is dependent on the function of the frontal and parietal lobes, while long-term memory depends on the function of large areas of the brain (Wood et al., 2000[ 121]). However, total function of memory and the conversion of short term memory to long-term memory are dependent on the hippocampus; an area of the brain that has the highest density of glucocorticosteroid receptors and also represents the highest level of response to stress (Scoville and Milner, 1957[ 107]; Asalgoo et al., 2015[ 1]). Therefore, during the past several decades, the relationship between the hippocampus and stress have been hotly debated (Asalgoo et al., 2015[ 1]; Lupien and Lepage, 2001[ 63]). In 1968, it was proven that there were cortisol receptors in the hippocampus of rats (McEwen et al., 1968[ 74]). Later, in 1982, by using specific agonists of glucocorticosteroid and mineralocorticoid receptors, the existence of these two receptors in the brain and hippocampus area of rats was proven (Veldhuis et al., 1982[ 119]). It should also be noted that the amygdala is very important to assessing the emotional experiences of memory (Roozendaal et al., 2009[ 91]).

Stress also has negative effects on learning. Results from hippocampus-dependent loading data demonstrate that subjects are not as familiar with a new environment after having been exposed to a new environment (Bremner, 1999[ 10]). Moreover, adrenal steroids lead to alteration in long-term potentiation (LTP), which is an important process in memory formation (Bliss and Lømo, 1973[ 7]).

Two factors are involved in the memory process during stress. The first is noradrenaline, which creates emotional aspects of memories in the basolateral amygdala area (Joëls et al., 2011[ 47]). Secondly, this process is facilitated by corticosteroids. However, if the release of corticosteroids occurs a few hours earlier, it causes inhibition of the amygdala and corresponding behaviors (Joëls et al., 2011[ 47]). Thus, there is a mutual balance between these two hormones for creating a response in the memory process (Joëls et al., 2011[ 47]).

The process of strengthening memory is usually reinforced after stress (Schwabe et al., 2012[ 103]). Various studies on animal and human models have shown that administration of either glucocorticosteroids, or stress shortly after learning has occurred facilitates memory (Schwabe et al., 2012[ 103]). Also, it has been shown that glucocorticosteroids (not mineralocorticoids) are necessary to improve learning and memory (Lupien et al., 2002[ 66]). However, the retrieval of events in memory after exposure to stress will be decreased (Schwabe et al., 2012[ 103]), which may result from the competition of updated data for storage in memory in a stressful state (de Kloet et al., 1999[ 23]). Some investigations have shown that either exposure to stress, or injection of glucocorticosteroids before a test to assess retention, decreases the power of memory in humans and rodents (Schwabe and Wolf, 2009[ 104]).

In summary, it has been concluded that the effect of stress on memory is highly dependent on the time of exposure to the stressful stimulus and, in terms of the timing of the imposed stress, memory can be either better or worse (Schwabe et al., 2012[ 103]). Moreover, recent studies have shown that using a specific-timed schedule of exposure to stress not only affects hippocampus-dependent memory, but also striatum-dependent memory, which highlights the role of timing of the imposed stressful stimulus (Schwabe et al., 2010[ 105]).

Stress, Cognition and Learning

Cognition is another important feature of brain function. Cognition means reception and perception of perceived stimuli and its interpretation, which includes learning, decision making, attention, and judgment (Sandi, 2013[ 95]). Stress has many effects on cognition that depend on its intensity, duration, origin, and magnitude (Sandi, 2013[ 95]). Similar to memory, cognition is mainly formed in the hippocampus, amygdala, and temporal lobe (McEwen and Sapolsky, 1995[ 73]). The net effect of stress on cognition is a reduction in cognition and thus, it is said that any behavioral steps undertaken to reduce stress leads to increase in cognition (Scholey et al., 2014[ 101]). In fact, stress activates some physiological systems, such as the autonomic nervous system, central neurotransmitter and neuropeptide system, and the hypothalamus-pituitary-adrenal axis, which have direct effects on neural circuits in the brain involved with data processing (Sandi, 2013[ 95]). Activation of stress results in the production and release of glucocorticosteroids. Because of the lipophilic properties of glucocorticosteroids, they can diffuse through the blood-brain barrier and exert long-term effects on processing and cognition (Sandi, 2013[ 95]).

Cognitive disorders following exposure to stress have been reported in past studies (Lupien and McEwen, 1997[ 64]). Stress has effects on cognition both acutely (through catecholamines) and chronically (through glucocorticosteroids) (McEwen and Sapolsky, 1995[ 73]). Acute effects are mainly caused by beta-adrenergic effects, while chronic effects are induced in a long-term manner by changes in gene expression mediated by steroids (McEwen and Sapolsky, 1995[ 73]). In general, many mechanisms modulate the effects of stress on cognition (McEwen and Sapolsky, 1995[ 73]; Mendl, 1999[ 75]). For instance, adrenal steroids affect the function of the hippocampus during cognition and memory retrieval in a biphasic manner (McEwen and Sapolsky, 1995[ 73]). In chronic stress, these steroids can destroy neurons with other stimulatory neurotransmitters (Sandi, 2013[ 95]). Exposure to stress can also cause disorders in hippocampus-related cognition; specifically, spatial memory (Borcel et al., 2008[ 9]; Sandi et al., 2003[ 96]). Additionally, stress can halt or decrease the genesis of neurons in the dentate gyrus area of the hippocampus (this area is one of the limited brain areas in which neurogenesis occurs in adults) (Gould and Tanapat, 1999[ 34]; Köhler et al., 2010[ 54]). Although age is a factor known to affect cognition, studies on animals have demonstrated that young rats exposed to high doses of adrenal steroids show the same level of decline in their cognition as older adult animals with normal plasma concentrations of glucocorticoids (Landfield et al., 1978[ 57]). Also, a decrease in the secretion of glucocorticosteroids causes preservation of spatial memory in adults and has also been shown to have neuroprotective effects (Montaron et al., 2006[ 78]). Other studies have shown that stress (or the injection of adrenal steroids) results in varied effects on cognition. For instance, injection of hydrocortisone at the time of its maximum plasma concentration (in the afternoon) leads to a decrease in reaction time and improves cognition and memory (Lupien et al., 2002[ 66]).

In summary, the adverse effects of stress on cognition are diverse and depend on the type, timing, intensity, and duration (Sandi, 2013[ 95]). Generally, it is believed that mild stress facilitates an improvement in cognitive function, especially in the case of virtual or verbal memory. However, if the intensity of stress passes beyond a predetermined threshold (which is different in each individual), it causes cognitive disorders, especially in memory and judgment. The disruption to memory and judgment is due to the effects of stress on the hippocampus and prefrontal cortex (Sandi, 2013[ 95]). Of course, it must be realized that factors like age and gender may also play a role in some cognitive disorders (Sandi, 2013[ 95]). Importantly, it should be emphasized that different people may exhibit varied responses in cognition when exposed to the very same stressful stimulus (Hatef et al., 2015[ 39]).

Stress and Immune System Functions

The relationship between stress and the immune system has been considered for decades (Khansari et al., 1990[ 50]; Dantzer and Kelley, 1989[ 21]). The prevailing attitude between the association of stress and immune system response has been that people under stress are more likely to have an impaired immune system and, as a result, suffer from more frequent illness (Khansari et al., 1990[ 50]). Also, old anecdotes describing resistance of some people to severe disease using the power of the mind and their thought processes, has promoted this attitude (Khansari et al., 1990[ 50]). In about 200 AC, Aelius Galenus (Galen of Pergamon) declared that melancholic women (who have high levels of stress and, thus, impaired immune function) are more likely to have cancer than women who were more positive and exposed to less stress (Reiche et al., 2004[ 88]). This may be the first recorded case about the relationship between the immune system and stress. In an old study in the early 1920's, researchers found that the activity of phagocytes in tuberculosis decreased when emotional stress was induced. In fact, it was also suggested that living with stress increases the risk of tuberculosis by suppressing the immune system (Ishigami, 1919[ 44]). Following this study, other researchers suggested that the probability of disease appearance increases following a sudden, major, and extremely stressful life style change (Holmes and Rahe, 1967[ 41]; Calabrese et al., 1987[ 12]).

Over the past several decades, there have been many studies investigating the role of stress on immune system function (Dantzer and Kelley, 1989[ 21]; Segerstrom and Miller, 2004[ 109]). These studies have shown that stress mediators can pass through the blood-brain barrier and exert their effects on the immune system (Khansari et al., 1990[ 50]). Thus, the effect of stress on the immune system is now an accepted relationship or association.

Severe stress can lead to malignancy by suppressing the immune system (Reiche et al., 2004[ 88]). In fact, stress can decrease the activity of cytotoxic T lymphocytes and natural killer cells and lead to growth of malignant cells, genetic instability, and tumor expansion (Reiche et al., 2004[ 88]). Studies have shown that the plasma concentration of norepinephrine, which increases after the induction stress, has an inverse relationship with the immune function of phagocytes and lymphocytes (Reiche et al., 2004[ 88]). Lastly, catecholamines and opioids that are released following stress have immune-suppressing properties (Reiche et al., 2004[ 88]).

Stress and the Function of the Cardiovascular System

The existence of a positive association between stress and cardiovascular disease has been verified (Rozanski et al., 1999[ 93]). Stress, whether acute or chronic, has a deleterious effect on the function of the cardiovascular system (Rozanski et al., 1999[ 93]; Kario et al., 2003[ 48]; Herd, 1991[ 40]). The effects of stress on the cardiovascular system are not only stimulatory, but also inhibitory in nature (Engler and Engler, 1995[ 29]). It can be postulated that stress causes autonomic nervous system activation and indirectly affects the function of the cardiovascular system (Lazarus et al., 1963[ 59]; Vrijkotte et al., 2000[ 120]). If these effects occur upon activation of the sympathetic nervous system, then it mainly results in an increase in heart rate, strength of contraction, vasodilation in the arteries of skeletal muscles, a narrowing of the veins, contraction of the arteries in the spleen and kidneys, and decreased sodium excretion by the kidneys (Herd, 1991[ 40]). Sometimes, stress activates the parasympathetic nervous system (Pagani et al., 1991[ 82]). Specifically, if it leads to stimulation of the limbic system, it results in a decrease, or even a total stopping of the heart-beat, decreased contractility, reduction in the guidance of impulses by the heart stimulus-transmission network, peripheral vasodilatation, and a decline in blood pressure (Cohen et al., 2000[ 17]). Finally, stress can modulate vascular endothelial cell function and increase the risk of thrombosis and ischemia, as well as increase platelet aggregation (Rozanski et al., 1999[ 93]).

Stress and Gastrointestinal Complications

The effects of stress on nutrition and the gastrointestinal (GI) system can be summarized with two aspects of GI function.

First, stress can affect appetite (Bagheri Nikoo et al., 2014[ 2]; Halataei et al., 2011[ 37]; Ranjbaran et al., 2013[ 86]). This effect is related to involvement of either the ventral tegmental area (VTA), or the amygdala via N-methyl-D-aspartate (NMDA) glutamate receptors (Nasihatkon et al., 2014[ 80]; Sadeghi et al., 2015[ 94]). However, it should also be noted that nutrition patterns have effects on the response to stress (Ghanbari et al., 2015[ 31]), and this suggests a bilateral interaction between nutrition and stress.

Second, stress adversely affects the normal function of GI tract. There are many studies concerning the effect of stress on the function of the GI system (Söderholm and Perdue, 2001[ 112]; Collins, 2001[ 18]). For instance, studies have shown that stress affects the absorption process, intestinal permeability, mucus and stomach acid secretion, function of ion channels, and GI inflammation (Collins, 2001[ 18]; Nabavizadeh et al., 2011[ 79]). Stress also increases the response of the GI system to inflammation and may reactivate previous inflammation and accelerate the inflammation process by secretion of mediators such as substance P (Collins, 2001[ 18]). As a result, there is an increase in the permeability of cells and recruitment of T lymphocytes. Lymphocyte aggregation leads to the production of inflammatory markers, activates key pathways in the hypothalamus, and results in negative feedback due to CRH secretion, which ultimately results in the appearance of GI inflammatory diseases (Collins, 2001[ 18]). This process can reactivate previous silent colitis (Million et al., 1999[ 76]; Qiu et al., 1999[ 85]). Mast cells play a crucial role in stress-induced effects on the GI system, because they cause neurotransmitters and other chemical factors to be released that affect the function of the GI system (Konturek et al., 2011[ 55]).

Altering the permeability of the mucosal membrane by perturbing the functions of mucosal mast cells may be another way that stress causes its effects on the GI system, since this is a normal process by which harmful and toxic substances are removed from the intestinal lumen (Söderholm and Perdue, 2001[ 112]). Also, stress can both decrease the removal of water from the lumen, as well as induce sodium and chloride secretion into the lumen. This most likely occurs by increasing the activity of the parasympathetic nervous system (Barclay and Turnberg, 1987[ 3]). Moreover, physical stress, such as trauma or surgery, can increase luminal permeability (Söderholm and Perdue, 2001[ 112]) (Table 2(Tab. 2) ; References in Table 2: Halataei et al., 2011[ 37]; Ranjbaran et al., 2013[ 86]; Mönnikes et al., 2001[ 77]; Collins, 2001[ 18]; Nabavizadeh et al., 2011[ 79]; Barclay and Turnberg, 1987[ 3]; Million et al., 1999[ 76]; Gonsalkorale et al., 2003[ 33]).

Stress also affects movement of the GI tract. In this way, it prevents stomach emptying and accelerates colonic motility (Mönnikes et al., 2001[ 77]). In the case of irritable bowel syndrome, stress increases the movement (contractility and motility) of the large intestine (Mönnikes et al., 2001[ 77]). Previous studies have revealed that CRH increases movement in the terminal sections of the GI tract and decreases the movements in the proximal sections of the GI tract (Mönnikes et al., 2001[ 77]). A delay in stomach emptying is likely accomplished through CRH-2 receptors, while type 1 receptors affect the colon (Mönnikes et al., 2001[ 77]). The effects produced by CRH are so prominent that CRH is now considered an ideal candidate for the treatment of irritable bowel syndrome (Martinez and Taché, 2006[ 69]). When serotonin is released in response to stress (Chaouloff, 2000[ 14]), it leads to an increase in the motility of the colon by stimulating 5HT-3 receptors (Mönnikes et al., 2001[ 77]). Moreover, it has also been suggested that stress, especially mental and emotional types of stress, increase visceral sensitivity and activate mucosal mast cells (Mönnikes et al., 2001[ 77]). Stimulation of the CNS by stress has a direct effect on GI-specific nervous system ( i.e., the myenteric system or plexus) and causes the above mentioned changes in the movements of the GI tract (Bhatia and Tandon, 2005[ 5]). In fact, stress has a direct effect on the brain-bowel axis (Konturek et al., 2011[ 55]). Various clinical studies have suggested a direct effect of stress on irritable bowel syndrome, intestinal inflammation, and peptic ulcers (Konturek et al., 2011[ 55]).

In conclusion, the effects of stress on the GI system can be classified into six different actions: GI tract movement disorders, increased visceral irritability, altered rate and extent of various GI secretions, modified permeability of the intestinal barrier, negative effects on blood flow to the GI tract, and increased intestinal bacteria counts (Konturek et al., 2011[ 55]).

Stress and the Endocrine System

There is a broad and mutual relationship between stress and the endocrine system. On one hand, stress has many subtle and complex effects on the activity of the endocrine system (Sapolsky, 2002[ 97]; Charmandari et al., 2005[ 15]), while on the other hand, the endocrine system has many effects on the response to stress (Ulrich-Lai and Herman, 2009[ 117]; Selye, 1956[ 110]). Stress can either activate, or change the activity of, many endocrine processes associated with the hypothalamus, pituitary and adrenal glands, the adrenergic system, gonads, thyroid, and the pancreas (Tilbrook et al., 2000[ 116]; Brown-Grant et al., 1954[ 11]; Thierry et al., 1968[ 115]; Lupien and McEwen, 1997[ 64]). In fact, it has been suggested that it is impossible to separate the response to stress from the functions of the endocrine system. This premise has been advanced due to the fact that even a minimal amount of stress can activate the hypothalamic-pituitary-adrenal axis, which itself is intricately involved with the activation of several different hormone secreting systems (Sapolsky, 2002[ 97]). In different locations throughout this article, we have already discussed the effects of stress on hormones and various endocrine factors and, thus, they will not be further addressed.

Conclusion

Altogether, stress may induce both beneficial and harmful effects. The beneficial effects of stress involve preserving homeostasis of cells/species, which leads to continued survival. However, in many cases, the harmful effects of stress may receive more attention or recognition by an individual due to their role in various pathological conditions and diseases. As has been discussed in this review, various factors, for example, hormones, neuroendocrine mediators, peptides, and neurotransmitters are involved in the body's response to stress. Many disorders originate from stress, especially if the stress is severe and prolonged. The medical community needs to have a greater appreciation for the significant role that stress may play in various diseases and then treat the patient accordingly using both pharmacological (medications and/or nutraceuticals) and non-pharmacological (change in lifestyle, daily exercise, healthy nutrition, and stress reduction programs) therapeutic interventions. Important for the physician providing treatment for stress is the fact that all individuals vary in their response to stress, so a particular treatment strategy or intervention appropriate for one patient may not be suitable or optimal for a different patient.

Notes

Yunes Panahi and Amirhossein Sahebkar (Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, P.O. Box: 91779-48564, Iran; Tel: 985118002288, Fax: 985118002287, E-mail: sahebkara@mums.ac.ir, amir_saheb2000@yahoo.com) contributed equally as corresponding authors.

Conflict of interest

The authors declare that have no conflict of interest in this study.

Acknowledgement

The authors would like to thank the "Neurosciences Research Center of Baqiyatallah University of Medical Sciences" and the "Clinical Research Development Center of Baqiyatallah (a.s.) Hospital" for providing technical supports.

References

51. Kiecolt-Glaser JK, Glaser R. Stress and immune function in humans. In: Ader R, editor. Psychoneuroimmunology. 2nd. London: Academic Press; 1991. p. 849-867. [ Google Scholar]

71. McEwen B, Lupien S. Stress: hormonal and neural aspects. In: Ramachandran VS, editor. Encyclopedia of the human brain. Amsterdam: Elsevier; 2002. pp. 463-474. [ Google Scholar]

97. Sapolsky RM. Endocrinology of the stress-response. In: Becker JB, Breedlove SM, Crews D, McCarthy MM, editors. Behavioral endocrinology. 2nd. Cambridge, MA: MIT Press; 2002. pp. 409-450. [ Google Scholar]

Articles from EXCLI Journal are provided here courtesy of Leibniz Research Centre for Working Environment and Human Factors

# data[].attributes.attachment_link.title
The impact of stress on body function: A review

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Any intrinsic or extrinsic stimulus that evokes a biological response is known as stress. The compensatory responses to these stresses are known as stress responses. Based on the type, timing and severity of the applied stimulus, stress can exert various ...

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How Much Does Stress Negatively Impact People?

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How Much Does Stress Negatively Impact People?

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In this article , a bar graph is shown with different types of ways people may feel when stressed. This bar gives insight on how many people can react differently to stress, and may have more negative impacts than others.

Isabella Paez

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Reported stress levels for Americans overall are continuing to drop and have reached their lowest point since 2007, when the Stress in America™ survey first began tracking stress levels. While stress levels appear to be balancing out, they remain high and exceed what Americans consider to be healthy. Year after year, many Americans report extreme stress (22 percent in 2011; 24 percent in 2010 and 2009; 30 percent in 2008; and 32 percent in 2007) - an 8, 9 or 10 on a 10-point scale where 1 is little or no stress and 10 is a great deal of stress. These findings are indicative of a serious trend that could have long-term consequences on people's health.

Overall, people seem to recognize that stress can have an impact on health and well-being, but they do not necessarily take action to prevent stress or manage it well. Survey findings also suggest that time management may be a significant barrier preventing people from taking the necessary steps to improve their health. The good news: there appears to be a growing understanding about the impact of stress in general and an increased value placed on effectively managing it.

Stress Continues to Be a Burden

On a scale of 1 to 10, the mean rating for stress this year fell to 5.2, the lowest level in 5 years (5.4 for 2009 and 2010; 5.9 for 2008; and 6.2 for 2007).

The gap between what Americans see as a healthy level of stress and their perception of their own stress level continues to exceed one point, reaching a 1.6-point differential this year (compared to 1.7 for 2008 - 2010 and 1.8 for 2007) on a scale of 1 to 10.

More adults report that their stress is increasing than decreasing. 39 percent said their stress had increased over the past year and even more said that their stress had increased over the past five years (44 percent). Only 27 percent of adults report that their stress has decreased in the past five years and fewer than a quarter of adults report that their stress has decreased in the past year (17 percent).

While adults continue to fall short of their ideal when it comes to how well they are achieving key goals related to specific aspects of well-being, there does appear to be some improvement related to stress management. The gap between the importance that respondents placed on stress management and their success at managing stress shrank from 32 percent in 2010 to 26 percent in 2011.

While people's perceptions of their own personal stress may be improving, the impact of stress on their physical health and their inability to prevent stress is cause for continued concern. At the same time, while there is an awareness that stress can have a health impact, there is a disconnect when it comes to the awareness of the impact stress may have on an individual's personal health.

More than half of Americans reported personal health problems (53 percent) as a source of stress, roughly the same level (52 percent) as last year but up from 2009 (47 percent).

More than half (56 percent) of adults say they are doing an excellent or very good job of knowing when they are feeling stressed, but only about half as many (26 percent) report doing an excellent or very good job at preventing themselves from becoming stressed.

When stress occurs, only 29 percent say they are doing an excellent or very good job at managing or reducing it.

The majority of adults (83 percent) report that they think stress can have a strong or very strong impact on a person's health.

More than 9 in 10 (94 percent) adults believe that stress can contribute to the development of major illnesses, such as heart disease, depression and obesity, and that some types of stress can trigger heart attacks, arrhythmias and even sudden death, particularly in people who already have cardiovascular disease (92 percent).

Although the majority of adults understand that stress has a strong impact on a person's health, a sizeable minority still think that stress has only a slight or no impact on their own physical health (31 percent) and mental health (36 percent).

What's Causing Stress in America

Money, work and the economy continue to be the most frequently cited causes of stress for Americans, as they have every year for the past 5 years. In addition, a growing number of Americans are citing personal health and their family's health as a source of stress.

Significant sources of stress include money (75 percent), work (70 percent), the economy (67 percent), relationships (58 percent), family responsibilities (57 percent), family health problems (53 percent), personal health concerns (53 percent), job stability (49 percent), housing costs (49 percent) and personal safety (32 percent).

The percentage of adults reporting that family health problems are causing them stress (53 percent) increased in 2011 compared to the last 2 years (47 percent for both 2009 and 2010).

Stress Management Strategies Rooted in Sedentary Activities

Though exercise does rank among one of the top choices for managing stress, a great many Americans continue to choose more sedentary activities to wind down.

Adults manage their stress in a variety of ways. Some of the most common techniques include listening to music (48 percent), exercising or walking (47 percent), reading (42 percent), spending time with friends or family (39 percent) and napping (34 percent).

Spending time with friends or family, while ranked as important by many (76 percent reported that having good relationships with family and 60 percent reported that having good relationships with friends was extremely/very important), has declined as a stress management strategy since last year: Only 38 percent reported spending time with friends or family as a stress management technique, compared with 46 percent in 2010.

Strategies for dealing with stress that are believed to be effective among those who use them are focusing on the positive (62 percent), managing time better (56 percent), being flexible and willing to compromise (53 percent), avoiding people or situations that are stressful (53 percent), expressing feelings instead of bottling them up (51 percent), saying "no" (50 percent) and adjusting expectations (41 percent).

The Emotional and Physical Toll of Stress

While awareness about the impact stress can have on emotional and physical health seems to be present, many Americans continue to report symptoms of stress.

Similar proportions of adults engage in unhealthy behaviors due to stress as did last year.

29 percent skipped a meal due to stress (31 percent in 2010).

39 percent reported overeating or eating unhealthy foods (40 percent in 2010).

44 percent reported lying awake at night, the same number as in 2010.

There's some indication that Americans are beginning to exercise more. The number reporting that they exercise "a few times a week" rose from 36 percent in 2010 to 41 percent in 2011; however, many continue to report barriers to being more physically active, particularly a lack of time.

Lack of motivation seems to be a key part of why people are not exercising more frequently (41 percent), but both work and personal obligations might also be at play, with one-third (33 percent) of respondents exercising once a week or less saying they are too busy to exercise more often.

Half (51 percent) of adults with families report that it takes a great amount or some effort to get their families to exercise.

Finding Time for a Healthy Lifestyle

Clearly, there's still room for improvement when it comes to making changes to improve one's health. Americans continue to rank key behaviors such as exercise and eating a healthy diet as less important than other activities.

Eating well and exercising (54 percent each) are ranked at the bottom in terms of importance when compared with other aspects of well-being, including good family relationships (76 percent), managing stress (61 percent), getting enough sleep (60 percent), good friendships (60 percent) and doing well in career or studies (59 percent). These actions are also rated lowest for achievement; only 27 percent of Americans believe they are doing a very good/excellent job at performing them. However, eating a healthier diet (77 percent), exercising more (75 percent) and losing weight (66 percent) are the most common behavior changes adults reported they have attempted in the past 5 years.

Second only to willpower (27 percent), lack of time was mentioned by 26 percent of adults as a barrier preventing them from creating lifestyle and behavior changes. In fact, lack of time has been mentioned as a barrier by more adults year after year (20 percent in 2009 and 22 percent in 2010).

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2011 Stress in America: The Impact of Stress

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Survey findings report that stress can have an impact on health and well-being, but they do not necessarily take action to prevent stress or manage it well.

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In this article, research is done to see how children were affected when their parents remarried, and how their relationships with their parents may have changed. A survey was done on thirteen former stepchildren to see how their experiences were like court arrangments or custody arrangements.

Isabella Paez

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Maintaining Intergenerational Stepkin Relations in Divorced Families

Presented by: Caroline Sanner, Ashton Chapman, Luke Russell, Lawrence Ganong, Marilyn Coleman

Remarriages have higher divorce rates than first marriages, suggesting that children may experience multiple stepfamily transitions. Little is known about how families navigate ex-stepkin relationships resulting from these transitions. Given the demonstrated importance of stepgrandparent/stepgrandchild relationships in remarried families, our grounded theory study seeks to explore relationship maintenance strategies with ex-stepgrandparents employed by stepgrandchildren following parental divorce. 13 former stepchildren were interviewed and common themes were identified. Preliminary results indicate that stepgrandchild's age, steprelationship length, relationship quality, and presence of biological grandparents impacted young adults' decisions to maintain contact with ex-stepgrandparents post-divorce.

Negotiating Nonresidential Parent-child Relationships in Emerging Adulthood

Presented by: Richard Feistman, Marilyn Coleman, Lawrence Ganong

The well-being of emerging adults' (ages 18 to 25) often relies on the emotional and financial support provided by their parents. However, relationships between emerging adults and their divorced parents, particularly their nonresidential parents, are fragile. Our grounded theory study will result in a model of the processes involved in forming or maintaining relationships between emerging adults and their nonresidential parents. Preliminary results from 32 participants indicate that emerging adults' often control levels of contact. Several factors, such as attitudes on family ties, influence the degree of contact emerging adults have with nonresidential parents.

Custody Arrangement Decisions Among Divorcing or Separating Parents

Presented by: Jaimee Hartenstein, Melinda Stafford Markham

A secondary qualitative data analysis of a database of interviews from a previous grounded theory study of 30 participants was conducted. This study investigated how divorced or separated parents determine the custody arrangements for their children. Four categories emerged from the data including no court involvement, agreement decided by couple to be included in divorce decree, court ordered arrangement, and custody changed over time. The findings suggest that there is a great deal of variation in the custody arrangements among divorcing or separating parents. There is not a universal arrangement that will be suitable for all divorcing or separating parents.

Young Adults' Socialization Narratives After Parental Divorce

Presented by: Mick Cunningham, Kelly Skillingstead

Despite the enormous body of evidence investigating parental influences on children, we know remarkably little about how people think and talk about socialization processes. The current study focuses on young adults' narrative explanations of how they perceive they were affected by their parents' divorce. Results show that many young adults 1) believe that their parents have modeled behavior that the offspring hope to avoid in their own marriages, 2) lament the absence of effective relationship modeling, and 3) suggest they will themselves act in ways that are opposite of the behaviors they observed in their parents' marriages.

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Qualitative Insights Into Divorce’s Impact on Children

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Presented by: Caroline Sanner, Ashton Chapman, Luke Russell, Lawrence Ganong, Marilyn Coleman

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In this article, a bar graph is used to show through percentages how after a divorce the bonds between a child and a parent tend to fall apart. This is shown in the bar graph through two different groups "litigation " and "mediation"

Isabella Paez

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In psychology, we were learning about marriage and divorce. A fact from our textbook stated "Divorce is a fact of life within 20 years of marriage for at least 40% of current marriages." (Positive Psychology and Wellbeing: Applications for Enhanced Living) This struck me as a crazy number and got me thinking of how much divorce can impact people, especially children.

Robert. E. Emery, Ph.D., conducted a study to see what effect divorce has on children. His study was to see if mediation, intervention in a dispute in order to resolve it, could positively impact the long term effects of divorce for children. In his study, he used random assignment like we had talked about in class. He flipped a coin to see if the families being studies would go to mediation or adversary settlement. The sample was young families with a low income. The study was set up that the mediation was around 5 years and focused mostly toward the grief aspect of divorce.

The first part of the study showed that most of the families who went through mediation stayed out of court. It also stated that when the mediation failed, parents tried to work things out with the help of
lawyers.

Another graph that I found to be interesting was the involvement of the parents in litigation vs. mediation. The graph clearly shows that when couples going through a divorce went through mediation instead of litigation, the child had much more involvement with both parents than just the one we live with.

In an article written by divorce.usu.edu, "Children of divorce are 2-3 times more likely to experience a divorce compared to children who did not experience a divorce growing up". Contrary to what the above article stated, this article says that divorce really impacts children BEFORE the divorce actually occurs, instead of year after. However, it still agrees that it will has effects throughout their lives, just not as significant. "Children are developing physically, socially, emotionally, educationally, morally, and spiritually; research shows that divorce can affect children in each of these developmental areas".

I discovered another article from the MDRC. Their mission is to build knowle
dge to improve social policy. This article is titled "The Effects of Marriage and Divorce on Families and Children". Author Gordon Berlin writes, children who grow up in an intact, two-parent family with both biological parents present do better on a wide range of outcomes than children who grow up in a single-parent family. Single parenthood is not the only, nor even the most important, cause of the higher rates of school dropout, teenage pregnancy, juvenile delinquency, or other negative outcomes we see; but it does contribute independently to these problems".

This means that children whose parents are still in a successful marriage performed better on certain tasks and had less of a risk of teenage pregnancy and juvenile delinquency. By no means does this suggest that divorce will cause any of these problems or deem that someone is less intelligent to complete tasks. It just shows the correlation between divorce an
d these factors. Correlation is not causation.

Overall, I have found that divorce does have some impacts on children, but the way parents handle their divorce can GREATLY impact how their child lives the rest of their life.

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SiOWfa15: Science in Our World: Certainty and Controversy

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In psychology, we were learning about marriage and divorce. A fact from our textbook stated "Divorce is a fact of life within 20 years of marriage for at least 40% of current marriages." (Positive Psychology and Wellbeing: Applications for Enhanced Living) This struck me as a crazy number and got me thinking of how much divorce can impact people, especially children.

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Description: Our peers and who we hang with is a secondary socialization agent that can have a big impact on us. So the real question is how powerful Peer-Pressure has one people?

Qualitative data: Teen who was put on life-support for vaping says 'I didn't think of myself as a smoker' - ABC News (go.com)

Vapes are one big consumer item that many people (mostly male highschoolers) tend to stock up on. Due to this teen seeing other student vaping without any problems, she thought it was safe until she was hospitalized.

Quantitative data

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873718/

A girl influenced by her friends/peers  to drink and drive at the same time.

Yves

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Clothing making the person

Description: As humans most of us are judgmental and tend to define a person based on their outside features. How we dress is a feature that people tend to be exposed to the most thus bringing up the question of “does clothing reflect how others treat you.”

Qualitative data: Does Appearance Matter? Social Experiment (youtube.com)

Quantitative data: 50 Shocking Bullying Statistics Based on Clothing: 2024 Guide (atonce.com)

Bullying is a reoccurring event that parents. It is said that 70% of Bullying are based on Clothing and having outdated appearances make you prone to Bullying.

Yves Watkins

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This sources gives multiple statics of single parent households based on race, gender and the challenges single parent face.

-Posted by Jayda

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Since the 1960s, there has been an increase in the share of American households led by single parents. The rise in single parenthood can be attributed to many factors, including changing perceptions about marriage and divorce. The attitude of society towards single parenthood is also a factor. Single parent statistics show there is growing acceptance of single parents not seen in previous decades.

In this article, we have put together this compilation of data to shed light on the patterns and trends of this phenomenon. This is especially relevant at a time when single parents face greater economic pressure than other parents due to the pandemic. From the demographics of single parents to the effects of the pandemic on single parents, these statistics will paint a picture of who the modern-day single parent is.

1. General Single Parent Households Statistics

According to a Pew Research study, the United States has the highest number of children living in single parent households. In contrast, countries like Mali, Afghanistan, Turkey, Vietnam, and Japan recorded only single-digit percentages in single parent households. Out of all states, Mississippi stands out as the one with the highest percentage of single parent households. It also has the highest percentage of single-mom households while Alaska holds the highest percentage of single-dad households.

Global single parent statistics

On average, 6.8% of children around the world under the age of 18 live in a single parent household. (Pew Research, 2019)

The second highest country with the most children in single parent households is the UK (21%), followed by Russia (18%), and Sao Tome and Principe (19%). (Pew Research, 2019)

Conversely, the lowest percentages of single parent households are recorded in Mali (1%), Afghanistan (1%), and Turkey (2%). (Pew Research, 2019)

Among OECD countries, Latvia has the highest proportion of children living with a single parent. (OECD Soical Policy Division, 2020)

In EU countries, 11% of households with a single adult and dependent children are headed by women compared to only 3% of households that are headed by men. (European Parliament, 2020)

The United Nations estimates that there are over 100 million single mothers all over the world. (UN Women, 2020)

Single parent statistics in the U.S.

Over 18.5 million children in the U.S. lived with a single mother or father. (U.S. Census Bureau, 2020)

Approximately five million children in the US aged five and under live in a single parent household. (Center for Translational Neuroscience at the University of Oregon, 2020)

Almost one-fourth (23%) of children in the US under the age of 18 live with one parent and no other adult, which is the highest in the world. US figures of children in single parent households are more than three times the number of children around the world under similar living arrangements. (Pew Research, 2019)

Half of all children in the US live with a single parent. (The Harvard Gazette, 2020)

On the other hand, one in three children spends time living with an extended relative. (The Harvard Gazette, 2020)

Single parent households in Mississippi comprise 11% of the total households, the highest among all states. The Hospitality State has the highest percentage of single-mom households in the US at 9.2%. (Stacker, 2021)

On the other hand, Montana has the least number of single-mom households in the US, comprising only 4.5% of households. (Stacker, 2021)

Washington, D.C. has the lowest percentage of single-dad households at 1.4%. (Stacker, 2021)

Meanwhile, Alaska holds the record of the state with the highest percentage of single-dad homes. (Stacker, 2021)

2. Single Parent Statistics by Gender

The decline in two-married-parent households has led to the prevalence of single-mom and single-dad households. However, single parent statistics by gender show that there are more women than men who are single parents. Consequently, more children stay with their mothers than their fathers in the US. Meanwhile, unpartnered fathers showed higher percentages of presence in the workplace than unpartnered mothers. Unpartnered fathers were less impacted by the pandemic compared to unpartnered women in the workplace.

Some 19 million children below the age of 18 live with a single parent, while 15 million children live with two parents. (U.S. Census Bureau, 2020)

There are about 15.3 million children in the United States who lived with a single mother while there are only 3.2 million children who live with a single father. (U.S. Census Bureau, 2020)

There are 14.84 million families with a single mother in the US. On the other hand, there are 6.5 million families with a single father in the US. (U.S. Census Bureau, 2020)

Women aged 35 to 39 in the US have a 9% likelihood of living as single parents. In contrast, men in the US only have a 2% likelihood to live as single parents. (Pew Research, 2019).

During the pandemic, the share of unpartnered mothers who are working in the US dropped to 67.4% in September 2020 compared to 76.1% in September 2019. Unpartnered parents include those who have never been married, are not cohabiting, are not widowed or separated, or are married but have an absent spouse. (Pew Research, 2020)

On the other hand, the share of unpartnered fathers who are working in the US dropped by 86.1% in September 2020 compared to 91.1% in September 2019. (Pew Research, 2020)

3. Single Parent Statistics by Race

When it comes to single parent statistics by race, US census data shows that the predominant ethnicity of single parent mothers and fathers is white non-Hispanic. This is followed by African American single mothers then Hispanic single mothers. The ethnicity with the least number of single parents are Asians. In terms of the poverty levels of single-mom households by ethnicity, white non-Hispanic and Asian women fare better than Native American, African American, and Latina single mothers.

There were 6.6 million white, non-Hispanic families with a single mother in the US. (Statista, 2019)

There are 3.29 million Hispanic families with single mothers in the US. (US Census Bureau, 2019).

There are 4.14 million African American families with a single mother in the US. (US Census Bureau, 2019)

There are 543,000 Asian families with a single mother in the US. (US Census Bureau, 2019)

There are 3.3 million white, non-Hispanic families with single fathers in the US. (U.S. Census Bureau, 2019)

There are 1.5 million Hispanic families with a single father in the US. (US Census Bureau, 2019)

There are 1.05 million African American families with a single father in the US. (US Census Bureau, 2019)

There are 375,000 Asian families with a single father in the US. (US Census Bureau, 2019)

The share of white unpartnered mothers working in the US fell from 78.8% in September 2019 to 73% in September 2020. On the other hand, the share of African American unpartnered mothers at work dropped from 72.5% to 62% while the share of Hispanic unpartnered mothers at work fell from 76.5% to 65.8%. (Pew Research, 2020)

64% of children in single parent households are Black or African-American. On the other hand, 52% are American Indian and 42% are Hispanic or Latino. (The Annie E. Casey Foundation, 2019)

Source: U.S. Census Bureau, 2019

4. Challenges that Single Parents Face

Being a single parent poses challenges to a parent's resources to provide for a child. The costs of childcare and household expenses are borne alone by the parent, which can put a strain on a single parent's finances. Single parent statistics census shows that single parent families struggle with poverty, with single mothers being in a worse position than single fathers. It also certainly does not help that childcare costs are expensive. What is more, college trends also show that tuition fees are ballooning over the past few years.

Three in five poor children in the US. (60%) lived in families headed by unwed mothers. (National Women's Law Center, 2020)

There were 440,000 families headed by unwed mothers that are classified as poor. They comprise 10% of families with a householder who worked full-time. (National Women's Law Center, 2020)

Families with children headed by unwed mothers have a poverty rate of 31% while those headed by an unwed father had a poverty rate of 15%. The lowest poverty rate is 5% for families headed by a married couple. (National Women's Law Center, 2020)

Over 3.3 million single mothers in the US living below the federal poverty level have never married. On the other hand, 1.09 million single mothers are divorced; 853,000 are separated; 333,000 have absent spouses, and 137,000 are widowed. (U.S. Census Bureau, 2019)

Income inequality is seen to be a huge factor in raising kids. In fact, there are 78,000 Asian families with a single mothers in the US who live below the poverty level. (US Census Bureau, 2019)

The poverty rate for families of unmarried mothers who are of color is highest among Native Americans at 43%. This is followed by unmarried mothers who are African American (35%), Latino (34%), non-Hispanic White (26%), and Asian (22%). (National Women's Law Center, 2020)

There are 746,000 poor families with a single father in the US who live below the poverty level. (US Census Bureau, 2019)

On average, single parent households spend 34% of their household income on child care. On the other hand, families usually spend over 10% of their household income on child-care costs for a single child. (CNBC, 2020)

In the US, families spend an average of $9,200 to $9,600 per child. Childcare is most expensive in the Northeast ($26,155), followed by the West ($21, 483). Meanwhile, families spend the least on childcare in the South ($19,069) followed by the Midwest ($19,306). (CNBC, 2020)

5. Effect of the COVID-19 Pandemic on Single Parent Households

Single parenthood is not an easy road to take. The onset of the pandemic has even made it more difficult for single parents to look after themselves and their children. According to a study, single parents in the US reported higher levels of stress and anxiety compared to other households. These stressors can come from the effects of being new to the remote work setup or being unemployed, which are experienced more by single parents, as well as a decline in income and loss of employment benefits. It appears that there are also many effects of single parent households on children that are further affected by the pandemic such as behavioral problems.

Effect on Parents and Children

Single parents reported higher levels of stress (59.1%) during the pandemic compared to parents from other households (53.4%). They also reported higher levels of anxiety (43.2%), depression (35.1%), and loneliness 54.9% compared to parents from other households. (Center for Translational Neuroscience at the University of Oregon, 2020)

During the pandemic, children of single-parent households reported more behavioral problems (55.6%) than children from other households (50.5%). These children also report experiencing more anxiety (32.2%) than other households (25.4%). (Center for Translational Neuroscience at the University of Oregon, 2020)

More single parents (32%) have become unemployed during the pandemic than other households (25%). (Center for Translational Neuroscience at the University of Oregon, 2020)

Hiring statistics show that the number of single mothers with jobs was 22% lower in April 2020 compared to April 2019. Single-mom employment rates were also 9% lower than other parents with children. (Nonprofit Quarterly, 2020)

Source: Center for Translational Neuroscience at the University of Oregon

Effect on Household Expenses

The costs of childcare have increased by 47% in the US, making it hard for single parents to work during the early months of the pandemic. (Center for Translational Neuroscience at the University of Oregon, 2020)

The percentage of single parents who struggle to pay for food and housing utilities (33%) has nearly doubled during the pandemic. (Center for Translational Neuroscience at the University of Oregon, 2020)

On the other hand, the percentage of single parents who are experiencing difficulty in paying for childcare (11%) has nearly tripled during the pandemic. (Center for Translational Neuroscience at the University of Oregon, 2020)

Out of all household expenses, single-parent households had the most difficulty in paying for utilities (56.5%), followed by housing (50.6%), then food (46.7%). (Center for Translational Neuroscience at the University of Oregon, 2020)

One in five mothers who don't live with a spouse or partner found housework and childcare more challenging during the pandemic. This is because they are more likely than other parents to do all the housework and childcare by themselves. Single mothers are also more likely than other mothers to cite financial insecurity as their top concern. (McKinsey & Company, 2020)

Single parent households reported a higher percentage of temporary or permanent layoff of the household head (23.2%) compared to other households. They were also more likely to report a decline in household income (42.1%) and loss of health insurance, sick leave, and other employee benefits (13.2%). (Liberty Street Economics, 2020)

Single parent households were more likely to cut back spending overall (73.5%), postpone in-person healthcare visits to doctors and hospitals (62.1%), and cancel summer trips or camps (50.3%). (Liberty Street Economics, 2020)

The Pros and Cons of Single Parenthood

They say it takes a village to take a child, but single parents upend this adage by taking on the task of child-rearing alone. The reality is that with no one to share the effort and resources for rearing a child, being a single parent poses a challenge to a single parent's finances and well-being. The current pandemic has only magnified the difficulties of being the sole financial provider in the household.

The good news is that there is less stigma about being a single parent nowadays. And even with the burgeoning costs of childcare and other household expenses, the rewards of being a parent and the joy that children bring cannot be quantified in monetary terms. As such, being a single parent can be thought of as an accomplishment in itself, regardless of the occasional bumps along the way.
References:

1. Aggarwal-Schifellite, M. (2020). Two-parent homes aren't the key for all. Retrieved from The Harvard Gazette

2. Armantier, O., Koşar, G., Pomerantz, R., & Van Der Klaauw, W. (2020). The Disproportionate Effects of COVID-19 on Households with Children. Retrieved from Liberty Street Economics

3. Barroso, A. & Kochhar, R. (2020). In the pandemic, the share of unpartnered moms at work fell more sharply than among other parents. Retrieved from Pew Research Center

4. Bhatt, A. (2020). Expert's take: By undercounting single mothers, we underserve families. Retrieved from UN Women

5. Fins, A. (2020). National Snapshot: Poverty among Women & Families, 2020. Retrieved from National Women's Law Center

6. Kramer, S. (2019). U.S. has world's highest rate of children living in single-parent households. Retrieved from Pew Research Center

7. Leonhardt, M. (2020). Without federal support, experts say child care is likely to get more expensive for parents. Retrieved from CNBC

8. Levine, C. (2020). Single Moms Hit Hard by Economic Impact of COVID-19. Retrieved from Nonprofit Quarterly

9. McKinsey & Company (2020). Women in the Workplace. Retrieved from McKinsey &Company

10. Nieuwenhuis, R. (2020). The situation of single parents in the EU. Retrieved from the European Parliament

11. OECD (2020). OECD Database: Children in Families. Retrieved from oecd.org

12. Statista (2020). Single Parents in the U.S. Retrieved from Statista

13. The Annie E. Casey Foundation (2019). Children in single-parent families by race in the United States. Retrieved from Kids Count Data Center

14. Underwood, A. (2021). States with the most single-parent households. Retrieved from Stacker

15. UOregon CTN (2020). Home Alone: The Pandemic is Overloading Single-Parent Families. Retrieved from Medium

16. US Census Bureau (2020). Historical Living Arrangements of Children. Retrieved from census.gov

17. US Census Bureau (2019). Number of families with a single mother in the United States from 1990 to 2019. Retrieved from Statista

18. US Census Bureau (2019). Number of Hispanic families with a single mother in the US from 1990 to 2019. Retrieved from Statista

19. US Census Bureau (2019). Number of Black families with a single mother in the United States from 1990 to 2019. Retrieved from Statista

20. US Census Bureau (2019). Number of Asian families with a single mother U.S. 2002-2019. Retrieved from Statista

21. US Census Bureau (2019). Number of white, non-Hispanic families with a male householder and no spouse present in the U.S. from 1990 to 2019. Retrieved from Statista

22. US Census Bureau (2019). Number of Hispanic families with a single father U.S. 1990-2019. Retrieved from Statista

23. US Census Bureau (2019). Number of Black families with a single father U.S. 1990-2019. Retrieved from Statista

24. US Census Bureau (2019). Number of Asian families with a single father U.S. 2002-2019. Retrieved from Statista

25. US Census Bureau (2019). Number of poor Asian families with a single mother U.S. 2002-2019. Retrieved from Statista

26. US Census Bureau (2019). Poverty status of children living with single mothers, by marital status in U.S. 2019. Retrieved from Statista

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45 Single Parent Statistics You Can't Ignore: 2024 Gender, Race & Challenges - Financesonline.com

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In this article, we have put together this compilation of data to shed light on the patterns and trends of this phenomenon. This is especially relevant at a time when single parents face greater economic pressure than other parents due to the pandemic.

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Qualitative Data:

This source includes how children living in a single parent household shows example of poor academic performances, low social interactions, and emotional and behavioural problems. It also talks about the relationship between the parent and child.

-Posted by Jayda

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(Quantitative) This article makes an estimation on the amount of people that live with people who have addiction issues and what those people have to deal with.

-Eric Stephenson

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Addiction In the Family

Family can be one of our greatest sources of physical security and emotional support. But family environments can also foster destructive emotions and behaviors, including substance abuse and addiction. The genetic ties that make blood relatives so close can also hold the seeds of compulsive or addictive behaviors, and the self-harming actions that children observe in their parents can become habits that affect their own lives as they grow. Partners or spouses may feel deeply betrayed or abandoned if the person they love turns to alcohol or drugs. Understanding the nature of addiction and the options for treatment can help family members avoid the cycle of addiction or remain close if substance abuse affects their lives.

No matter how much an individual knows about addiction, it can still come as a shock to find out that a relative has a substance abuse problem. While facing the reality that a loved one is addicted can be heart-wrenching, it is easier to confront that reality with the support of professionals and experts who understand the disease of addiction. Substance abuse counselors, family therapists, marriage counselors, spiritual leaders, school counselors, and intervention specialists are a few of the guides who can help families cope with the effects of addiction and mend broken bonds. Learning about the experiences shared by families struggling with substance abuse, and the resources available to cope with those experiences, can make it easier to overcome this all-too-common disease.

Substance Abuse: How Big Is the Problem?

In popular cultural stereotypes of the American family, drugs and alcohol are not part of a happy household. Yet statistics indicate that the problem of substance abuse affects people from all walks of life, including parents, children, spouses, and partners living in otherwise "normal" homes. According to the National Survey on Drug Use and Health (NSDUH) of 2014, one out of 10 Americans age 12 and older used an illicit drug in the past 30 days - a number higher than any year since 2002. The primary reasons for this increase include the rise in abuse of marijuana and nonmedical use of prescription drugs, especially narcotic pain relievers like OxyContin, Percocet, Vicodin, and fentanyl.

Alcohol abuse is also prevalent among American households. Out of the 139.7 million Americans age 12 and older who reported drinking alcohol in 2014, 16.3 million defined themselves as "heavy drinkers," and 60.9 reported that they were "binge drinkers," according to the NSDUH.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the consumption of 4-5 drinks in a two-hour period, while heavy drinking is defined as the consumption of five or more alcoholic beverages on five or more days within the past month.

These numbers become even more significant when the families and partners of these individuals are taken into consideration. Each individual who abuses alcohol or drugs touches the lives of a child, parent, sibling, spouse, or partner. Estimates from the Child Welfare Information Gateway indicate that 12 percent of American children live with at least one parent who abuses alcohol or drugs or who has a substance use disorder. Children of substance-abusing parents are at an increased risk of neglect, poverty, and mistreatment, as well as a higher risk of developing a substance use disorder themselves. Up to two-thirds of cases of child abuse involve chemical dependence in some form, and over 30 percent of children removed from their homes by Child Protective Services in 2012 were removed because of parental drug or alcohol abuse.

There is no doubt that parental substance abuse interferes with the physical and emotional development of children, yet addiction also affects the health of the family as a whole. In order for all members of a household to have rewarding relationships and healthy lives, substance abuse treatment must address everyone in the family, not just the individual who uses drugs or alcohol, notes Social Work in Public Health. When researching the resources available for families affected by addiction, it is important to consider the emotional, psychological, and physical needs of all individuals who occupy the home.

Signs and Symptoms of Substance Abuse

No matter how well we think we know the people we share our homes and hearts with, every individual is capable of keeping secrets. Addiction, by its nature, drives the individual to suppress painful emotions and harmful behaviors in order to fuel episodes of drinking or using drugs. The signs of addiction can range from obvious to subtle, revealing themselves in an individual's appearance, behavior, moods, mental function, occupational status, or finances.

Perhaps most importantly for families, addiction can affect the quality of interpersonal relationships. Addiction can undermine formerly strong relationships, creating an atmosphere of distrust and provoking feelings of betrayal. The following checklist can help family members identify the potential signs of addiction in the early stages of the disease.

When looking for the potential signs of addiction, remember that substance abuse affects many areas of an individual's life, and one or two changes in habits or appearance do not necessarily prove that a loved one is abusing drugs. These changes may also be caused by conditions such as depression, personal loss, job stress, or a difficult life transition. A mental health professional or addiction counselor can help to determine whether the changes in the person's life can be attributed to chemical dependence or abuse.

Signs of Addiction In the Family

If you've checked off at least one of these characteristics from two or more categories, and your loved one has displayed a habit of using alcohol or drugs, it is likely that they have a problem with substance abuse. It can be tempting to mask the problem by attributing it to outside circumstances ("She's going through a rough time since she got divorced," or "He'll stop drinking once he's done with this stressful project."). However, a pattern of destructive use of drugs or alcohol indicates that the person involved, as well as the entire household, needs help and support in order to recover from this disease.

How Addiction Affects the Family

Substance abuse affects a family on every level: emotional, psychological, financial, and social. A parent's preoccupation with getting drunk or high can lead to neglect or abuse. The use of alcohol and drugs can lead to financial hardship, poverty, or bankruptcy. Shame and embarrassment over a family member's intoxicated behavior can lead to social isolation and the avoidance of friends or relatives outside the home. These factors can create a destructive cycle in which substance abuse leads to emotional pain or mental instability, which triggers an even greater craving for alcohol or drugs.

Worst of all, addiction undermines the loving, trusting relationships that sustain a healthy family. Children may be forced into a parental role for parents who can no longer function independently. Spouses may hide their addictions from their partners, lying about their actions or expenditures. Parents of addicted children may go to great lengths to rescue a son or daughter from a destructive lifestyle, only to experience the heartbreak of seeing their child return to that lifestyle again and again. Restoring those relationships, which were often damaged long before the substance abuse began, requires time, patience, and the support of knowledgeable addiction professionals.

How to Approach Addiction In the Family

It's never easy to bring up the subject of substance abuse with a family member, but in most cases, the person with the problem will not be the one to initiate this conversation. Whether your loved one is your child, parent, or partner, there are certain techniques you can use that will help to make this difficult discussion a little easier and less painful. By the same token, there are approaches and attitudes that should be avoided in order to reach your goal of getting help for your loved one.

Approaches to Talking to Loved Ones about Addiction

For many families, the prospect of approaching substance abuse is so daunting that they would rather hide the problem than confront their loved one. It's important to remember that while it may be uncomfortable, facing the problem actually provides a path to healing and reconciliation. Denial only sets up further barriers to recovery.

Seeking Outside Intervention

Even when families approach the subject of addiction with a compassionate, nonjudgmental attitude, there are times when the best attempts to help a loved one fail. Addiction is a chronic disease of the brain that can distort reality, making the individual feel that change is impossible. When a person is caught in the cycle of addiction, the brain's overwhelming need for chemical gratification can overpower their sense of reason. If confronted by family, the loved one may lash out in anger, turn inward, or even become violent. Communication may seem impossible, and parents or partners may be left feeling helpless.

When communication breaks down among family members, it could be a good time to seek help from a professional who understands the effects of substance abuse. Some of the best sources of professional guidance in an addiction crisis include:

An experienced professional can help a family break through the resistance that blocks the way to treatment. This process often occurs through a formally structured intervention. An intervention is a prearranged meeting with the loved one who is using drugs or alcohol, in which concerned family members, friends, or coworkers of the individual gather to discuss the problem and attempt to persuade the individual to seek treatment.

During the meeting - which may or may not be arranged with the individual's knowledge of the reason for the discussion - the specialist gathers with the concerned family members to talk about the problem and present a solution. The two primary goals of an intervention are (1) to help the person with the problem see the relationship between substance abuse and the problems in their life, such as job loss, failure in school, relationship conflicts, or financial problems, and (2) to persuade the person to get into treatment. Many interventionists recommend presenting the person with a contract that clarifies the family's expectations and clearly states the consequences that will occur if the individual does not meet these expectations or refuses treatment. Expectations might include making changes in behavior or stopping certain activities, as well as agreeing to go to detox and rehab. Sample expectations and consequences are listed below:

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Family Addiction: How Does Addiction Affect Families?

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Read on to learn more about family addiction, including the common signs of substance abuse and how to approach addiction in the family.

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(Qualitative) On this website it is stated that families that have people with addiction problems are constantly left with feelings of worry, resentment, and shame.

-Eric Stephenson

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How Drug Addiction Affects the Entire Family

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It's easy to think of the ways drug addiction affects the person using substances. As addiction progresses, the impact only gets worse with time. The short- and long-term health effects, loss of jobs, increasing financial troubles, run-ins with the law. Living in active addiction is not a simple way to live.

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(Quantitative) This article contains statistics showing the amount of people affected by cyberbullying and which age groups are most affected.

-Eric Stephenson

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Abstract

Background: Cyberbullying is well-recognized as a severe public health issue which affects both adolescents and children. Most extant studies have focused on national and regional effects of cyberbullying, with few examining the global perspective of cyberbullying. This systematic review comprehensively examines the global situation, risk factors, and preventive measures taken worldwide to fight cyberbullying among adolescents and children.

Methods: A systematic review of available literature was completed following PRISMA guidelines using the search themes "cyberbullying" and "adolescent or children"; the time frame was from January 1st, 2015 to December 31st, 2019. Eight academic databases pertaining to public health, and communication and psychology were consulted, namely: Web of Science, Science Direct, PubMed, Google Scholar, ProQuest, Communication & Mass Media Complete, CINAHL, and PsycArticles. Additional records identified through other sources included the references of reviews and two websites, Cyberbullying Research Center and United Nations Children's Fund. A total of 63 studies out of 2070 were included in our final review focusing on cyberbullying prevalence and risk factors.

Results: The prevalence rates of cyberbullying preparation ranged from 6.0 to 46.3%, while the rates of cyberbullying victimization ranged from 13.99 to 57.5%, based on 63 references. Verbal violence was the most common type of cyberbullying. Fourteen risk factors and three protective factors were revealed in this study. At the personal level, variables associated with cyberbullying including age, gender, online behavior, race, health condition, past experience of victimization, and impulsiveness were reviewed as risk factors. Likewise, at the situational level, parent-child relationship, interpersonal relationships, and geographical location were also reviewed in relation to cyberbullying. As for protective factors, empathy and emotional intelligence, parent-child relationship, and school climate were frequently mentioned.

Conclusion: The prevalence rate of cyberbullying has increased significantly in the observed 5-year period, and it is imperative that researchers from low and middle income countries focus sufficient attention on cyberbullying of children and adolescents. Despite a lack of scientific intervention research on cyberbullying, the review also identified several promising strategies for its prevention from the perspectives of youths, parents and schools. More research on cyberbullying is needed, especially on the issue of cross-national cyberbullying. International cooperation, multi-pronged and systematic approaches are highly encouraged to deal with cyberbullying.

Keywords: cyberbullying, children, adolescents, globalization, risk factors, preventive measures

Introduction

Childhood and adolescence are not only periods of growth, but also of emerging risk taking. Young people during these periods are particularly vulnerable and cannot fully understand the connection between behaviors and consequences ( 1). With peer pressures, the heat of passion, children and adolescents usually perform worse than adults when people are required to maintain self-discipline to achieve good results in unfamiliar situations. Impulsiveness, sensation seeking, thrill seeking, and other individual differences cause adolescents to risk rejecting standardized risk interventions ( 2).

About one-third of Internet users in the world are children and adolescents under the age of 18 ( 3). Digital technology provide a new form of interpersonal communication ( 4). However, surveys and news reports also show another picture in the Internet Age. The dark side of young people's internet usage is that they may bully or suffer from others' bullying in cyberspace. This behavior is also acknowledged as cyberbullying ( 5). Based on Olweus's definition, cyberbullying is usually regarded as bullying implemented through electronic media ( 6, 7). Specifically, cyberbullying among children and adolescents can be summarized as the intentional and repeated harm from one or more peers that occurs in cyberspace caused by the use of computers, smartphones and other devices ( 4, 8- 12). In recent years, new forms of cyberbullying behaviors have emerged, such as cyberstalking and online dating abuse ( 13- 15).

Although cyberbullying is still a relatively new field of research, cyberbullying among adolescents is considered to be a serious public health issue that is closely related to adolescents' behavior, mental health and development ( 16, 17). The increasing rate of Internet adoption worldwide and the popularity of social media platforms among the young people have worsened this situation with most children and adolescents experiencing cyberbullying or online victimization during their lives. The confines of space and time are alleviated for bullies in virtual environments, creating new venues for cyberbullying with no geographical boundaries ( 6). Cyberbullying exerts negative effects on many aspects of young people's lives, including personal privacy invasion and psychological disorders. The influence of cyberbullying may be worse than traditional bullying as perpetrators can act anonymously and connect easily with children and adolescents at any time ( 18). In comparison with traditional victims, those bullied online show greater levels of depression, anxiety and loneliness ( 19). Self-esteem problems and school absenteeism have also proven to be related to cyberbullying ( 20).

Due to changes in use and behavioral patterns among the youth on social media, the manifestations and risk factors of cyberbullying have faced significant transformation. Further, as the boundaries of cyberbullying are not limited by geography, cyberbullying may not be a problem contained within a single country. In this sense, cyberbullying is a global problem and tackling it requires greater international collaboration. The adverse effects caused by cyberbullying, including reduced safety, lower educational attainment, poorer mental health and greater unhappiness, led UNICEF to state that "no child is absolutely safe in the digital world" ( 3).

Extant research has examined the prevalence and risk factors of cyberbullying to unravel the complexity of cyberbullying across different countries and their corresponding causes. However, due to variations in cyberbullying measurement and methodologies, no consistent conclusions have been drawn ( 21). Studies into inconsistencies in prevalence rates of cyberbullying, measured in the same country during the same time period, occur frequently. Selkie et al. systematically reviewed cyberbullying among American middle and high school students aged 10-19 years old in 2015, and revealed that the prevalence of cyberbullying victimization ranged from 3 to 72%, while perpetration ranged from 1 to 41% ( 22). Risk and protective factors have also been broadly studied, but confirmation is still needed of those factors which have more significant effects on cyberbullying among young people. Clarification of these issues would be useful to allow further research to recognize cyberbullying more accurately.

This review aims to extend prior contributions and provide a comprehensive review of cyberbullying of children and adolescents from a global perspective, with the focus being on prevalence, associated risk factors and protective factors across countries. It is necessary to provide a global panorama based on research syntheses to fill the gaps in knowledge on this topic.

Methods

Search Strategies

This study strictly employed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We consulted eight academic databases pertaining to public health, and communication and psychology, namely: Web of Science, Science Direct, PubMed, Google Scholar, ProQuest, Communication & Mass Media Complete, CINAHL, and PsycArticles. Additional records identified through other sources included the references of reviews and two websites, Cyberbullying Research Center and United Nations Children's Fund. With regard to the duration of our review, since most studies on cyberbullying arose around 2015 ( 9, 21), this study highlights the complementary aspects of the available information about cyberbullying during the recent 5 year period from January 1st, 2015 to December 31st, 2019.

One researcher extracted keywords and two researchers proposed modifications. We used two sets of subject terms to review articles, "cyberbullying" and "child OR adolescent." Some keywords that refer to cyberbullying behaviors and young people are also included, such as threat, harass, intimidate, abuse, insult, humiliate, condemn, isolate, embarrass, forgery, slander, flame, stalk, manhunt, as well as teen, youth, young people and student. The search formula is (cyberbullying OR cyber-bullying OR cyber-aggression OR ((cyber OR online OR electronic OR Internet) AND (bully* OR aggres* OR violence OR perpetrat* OR victim* OR threat* OR harass* OR intimidat* OR * OR insult* OR humiliate* OR condemn* OR isolate* OR embarrass* OR forgery OR slander* OR flame OR stalk* OR manhunt))) AND (adolescen* OR child OR children OR teen? OR teenager? OR youth? OR "young people" OR "elementary school student*" OR "middle school student*" OR "high school student* "). The main search approach is title search. Search strategies varied according to the database consulted, and we did not limit the type of literature for inclusion. Journals, conference papers and dissertations are all available.

Specifically, the inclusion criteria for our study were as follows: (a). reported or evaluated the prevalence and possible risk factors associated with cyberbullying, (b). respondents were students under the age of 18 or in primary, junior or senior high schools, and (c). studies were written in English. Exclusion criteria were: (a). respondents came from specific groups, such as clinical samples, children with disabilities, sexual minorities, specific ethnic groups, specific faith groups or samples with cross-national background, (b). review studies, qualitative studies, conceptual studies, book reviews, news reports or abstracts of meetings, and (c). studies focused solely on preventive measures that were usually meta-analytic and qualitative in nature. Figure 1 presents the details of the employed screening process, showing that a total of 63 studies out of 2070 were included in our final review.

Meta-analysis was not conducted as the limited research published within the 5 years revealed little research which reported odds ratio. On the other hand, due to the inconsistency of concepts, measuring instruments and recall periods, considerable variation could be found in research quality ( 23). Meta-analysis is not a preferred method.

Coding Scheme

For coding, we created a comprehensive code scheme to include the characteristics. For cyberbullying, we coded five types proposed by Willard ( 24- 26), which included verbal violence, group violence, visual violence, impersonating and account forgery, and other behaviors. Among them, verbal violence is considered one of the most common types of cyberbullying and refers to the behavior of offensive responses, insults, mocking, threats, slander, and harassment. Group violence is associated with preventing others from joining certain groups or isolating others, forcing others to leave the group. Visual violence relates to the release and sharing of embarrassing photos and information without the owners' consent. Impersonating and account forgery refers to identity theft, stealing passwords, violating accounts and the creation of fake accounts to fraudulently present the behavior of others. Other behaviors include disclosure of privacy, sexual harassment, and cyberstalking. To comprehensively examine cyberbullying, we coded cyberbullying behaviors from both the perspectives of cyberbullying perpetrators and victims, if mentioned in the studies.

In relation to risk factors, we drew insights from the general aggression model, which contributes to the understanding of personal and situational factors in the cyberbullying of children and adolescents. We chose the general aggression model because (a) it contains more situational factors than other models (e.g., social ecological models) - such as school climate ( 9), and (b) we believe that the general aggression model is more suitable for helping researchers conduct a systematic review of cyberbullying risk and protective factors. This model provides a comprehensive framework that integrates domain specific theories of aggression, and has been widely applied in cyberbullying research ( 27). For instance, Kowalski and colleagues proposed a cyberbullying encounter through the general aggression model to understand the formation and development process of youth cyberbullying related to both victimization and perpetration ( 9). Victims and perpetrators enter the cyberbullying encounter with various individual characteristics, experiences, attitudes, desires, personalities, and motives that intersect to determine the course of the interaction. Correspondingly, the antecedents pertaining to cyberbullying are divided into two broad categories, personal factors and situational factors. Personal factors refer to individual characteristics, such as gender, age, motivation, personality, psychological states, socioeconomic status and technology use, values and perceptions, and other maladaptive behaviors. Situational factors focus on the provocation/support, parental involvement, school climate, and perceived anonymity. Consequently, our coders related to risk factors consisting of personal factors and situational factors from the perspectives of both cyberbullying perpetrators and victims.

We extracted information relating to individual papers and sample characteristics, including authors, year of publication, country, article type, sampling procedures, sample characteristics, measures of cyberbullying, and prevalence and risk factors from both cyberbullying perpetration and victimization perspectives. The key words extraction and coding work were performed twice by two trained research assistants in health informatics. The consistency test results are as follows: the Kappa value with "personal factors" was 0.932, and the Kappa value with "situational factors" was 0.807. The result shows that the coding consistency was high enough and acceptable. Disagreements were resolved through discussion with other authors.

Quality Assessment of Studies

The quality assessment of the studies is based on the recommended tool for assessing risk of bias, Cochrane Collaboration. This quality assessment tool focused on seven items: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias ( 28). We assessed each item as "low risk," "high risk," and "unclear" for included studies. A study is considered of "high quality" when it meets three or more "low risk" requirements. When one or more main flaw of a study may affect the research results, the study is considered as "low quality." When a lack of information leads to a difficult judgement, the quality is considered to be "unclear." Please refer to Appendix 1 for more details.

Results

This comprehensive systematic review comprised a total of 63 studies. Appendices 2, 3 show the descriptive information of the studies included. Among them, 58 (92%) studies measured two or more cyberbullying behavior types. The sample sizes of the youths range from several hundred to tens of thousands, with one thousand to five thousand being the most common. As for study distribution, the United States of America, Spain and China were most frequently mentioned. Table 1 presents the detail.

Table 1

Study location

Number of studies

Proportion(%)

Prevalence of Global Cyberbullying

Prevalence Across Countries

Among the 63 studies included, 22 studies reported on cyberbullying prevalence and 20 studies reported on prevalence from victimization and perpetration perspectives, respectively. Among the 20 studies, 11 national studies indicated that the prevalence of cyberbullying victimization and cyberbullying perpetration ranged from 14.6 to 52.2% and 6.3 to 32%, respectively. These studies were conducted in the United States of America ( N = 4) ( 29- 32), South Korea ( N = 3) ( 33- 35), Singapore ( N = 1) ( 36), Malaysia ( N = 1) ( 37), Israel ( N = 1) ( 38), and Canada ( N = 1) ( 39). Only one of these 11 national studies is from an upper middle income country, and the rest are from highincome countries identified by the World Bank ( 40). By combining regional and community-level studies, the prevalence of cyberbullying victimization and cyberbullying perpetration ranged from 13.99 to 57.5% and 6.0 to 46.3%, respectively. Spain reported the highest prevalence of cyberbullying victimization (57.5%) ( 41), followed by Malaysia (52.2%) ( 37), Israel (45%) ( 42), and China (44.5%) ( 43). The lowest reported victim rates were observed in Canada (13.99%) and South Korea (14.6%) ( 34, 39). The reported prevalence of cyberbullying victimization in the United States of America ranged from 15.5 to 31.4% ( 29, 44), while in Israel, rates ranged from 30 to 45% ( 26, 42). In China, rates ranged from 6 to 46.3% with the country showing the highest prevalence of cyberbullying perpetration (46.30%) ( 15, 43, 45, 46). Canadian and South Korean studies reported the lowest prevalence of cyberbullying perpetration at 7.99 and 6.3%, respectively ( 34, 39).

A total of 10 studies were assessed as high quality studies. Among them, six studies came from high income countries, including Canada, Germany, Italy, Portugal, and South Korea ( 13, 34, 39, 46- 48). Three studies were from upper middle income countries, including Malaysia and China ( 37, 43) and one from a lower middle income country, Nigeria ( 49). Figures 2 , ​,3 3 describe the prevalence of cyberbullying victimization and perpetration respectively among high quality studies.

Prevalence of Various Cyberbullying Behaviors

For the prevalence of cyberbullying victimization and perpetration, the data were reported in 18 and 14 studies, respectively. Figure 4 shows the distribution characteristics of the estimated value of prevalence of different cyberbullying behaviors with box plots. The longer the box, the greater the degree of variation of the numerical data and vice versa. The rate of victimization and crime of verbal violence, as well as the rate of victimization of other behaviors, such as cyberstalking and digital dating abuse, has a large degree of variation. Among the four specified types of cyberbullying behaviors, verbal violence was regarded as the most commonly reported behaviors in both perpetration and victimization rates, with a wide range of prevalence, ranging from 5 to 18%. Fewer studies reported the prevalence data for visual violence and group violence. Studies also showed that the prevalence of impersonation and account forgery were within a comparatively small scale. Specific results were as follows.

Group Violence

The prevalence of group violence victimization was explored within 4 studies and ranged from 5 to 17.8% ( 26, 34, 42, 43), while perpetration prevalence was reported in three studies, ranging from 10.1 to 19.07% ( 34, 43, 47). An Israeli study suggested that 9.8% of respondents had been excluded from the Internet, while 8.9% had been refused entry to a group or team ( 26). A study in South Korea argued that the perpetration prevalence of group violence was 10.1% ( 34), while a study in Italy reported that the rate of online group violence against others was 19.07% ( 47).

Risk and Protective Factors of Cyberbullying

In terms of the risk factors associated with cyberbullying among children and adolescents, this comprehensive review highlighted both personal and situational factors. Personal factors referred to age, gender, online behavior, race, health conditions, past experiences of victimization, and impulsiveness, while situational factors consisted of parent-child relationship, interpersonal relationships, and geographical location. In addition, protective factors against cyberbullying included: empathy and emotional intelligence, parent-child relationship, and school climate. Table 2 shows the risk and protective factors for child and adolescent cyberbullying.

Table 2

Level

Risk factors

Protective factors

Personal factors (victimization)

Age ( 15, 26, 33, 38, 52, 53)

Empathy and emotional intelligence ( 34, 45, 48, 54- 57)

Gender ( 13, 26, 29, 38, 43, 46, 52, 54, 55, 58, 59)

Online behavior ( 32, 36, 43, 48, 49, 60)

Health condition ( 29, 33, 41, 52, 61- 66)

Gender ( 34, 39, 42, 55, 56, 61, 68- 71)

Past experience of victimization ( 35, 42, 49, 51, 55)

Situational factors

Parent-child relationship ( 19, 33, 43, 64, 68, 73- 77)

Parent-child relationship ( 31, 45, 46, 50, 55, 68, 71, 73, 74)

Interpersonal relationship ( 33, 52, 61, 78)

School climate ( 33, 44, 61, 79)

In terms of the risk factors associated with cyberbullying victimization at the personal level, many studies evidenced that females were more likely to be cyberbullied than males ( 13, 26, 29, 38, 43, 52, 54, 55, 58). Meanwhile, adolescents with mental health problems ( 61), such as depression ( 33, 62), borderline personality disorder ( 63), eating disorders ( 41), sleep deprivation ( 56), and suicidal thoughts and suicide plans ( 64), were more likely to be associated with cyberbullying victimization. As for Internet usage, researchers agreed that youth victims were probably those that spent more time online than their counterparts ( 32, 36, 43, 45, 48, 49, 60). For situational risk factors, some studies have proven the relationship between cyberbullying victims and parental abuse, parental neglect, family dysfunction, inadequate monitoring, and parents' inconsistency in mediation, as well as communication issues ( 33, 64, 68, 73). In terms of geographical location, some studies have reported that youths residing in city locations are more likely to be victims of cyberbullying than their peers from suburban areas ( 61).

Regarding the risk factors of cyberbullying perpetration at the personal level, it is generally believed that older teenagers, especially those aged over 15 years, are at greater risk of becoming cyberbullying perpetrators ( 55, 67). When considering prior cyberbullying experiences, evidence showed that individuals who had experienced cyberbullying or face-to-face bullying tended to be aggressors in cyberbullying ( 35, 42, 49, 51, 55); in addition, the relationship between impulsiveness and cyberbullying perpetration was also explored by several pioneering scholars ( 55, 72, 80). The situational factors highlight the role of parents and teachers in cyberbullying experiences. For example, over-control and authoritarian parenting styles, as well as inharmonious teacher-student relationships ( 61) are perceived to lead to cyberbullying behaviors ( 74, 75). In terms of differences in geographical locations, students residing in cities have a higher rate of online harassment than students living in more rural locations ( 49).

In terms of the protective factors in child and adolescent cyberbullying, scholars have focused on youths who have limited experiences of cyberbullying. At the personal level, high emotional intelligence, an ability for emotional self-control and empathy, such as cognitive empathy ability ( 44, 55), were associated with lower rates of cyberbullying ( 57). At the situational level, a parent's role is seen as critical. For example, intimate parent-child relationships ( 46) and open active communication ( 19) were demonstrated to be related to lower experiences of cyberbullying and perpetration. Some scholars argued that parental supervision and monitoring of children's online activities can reduce their tendency to participate in some negative activities associated with cyberbullying ( 31, 46, 73). They further claimed that an authoritative parental style protects youths against cyberbullying ( 43). Conversely, another string of studies evidenced that parents' supervision of Internet usage was meaningless ( 45). In addition to conflicting roles of parental supervision, researchers have also looked into the role of schools, and posited that positive school climates contribute to less cyberbullying experiences ( 61, 79).

Some risk factors may be protective factors under another condition. Some studies suggest that parental aggressive communication is related to severe cyberbullying victims, while open communication is a potential protective factor ( 19). Parental neglect, parental abuse, parental inconsistency in supervision of adolescents' online behavior, and family dysfunction are related to the direct or indirect harm of cyberbullying ( 33, 68). Parental participation, a good parental-children relationship, communication and dialogue can enhance children's school adaptability and prevent cyberbullying behaviors ( 31, 74). When parental monitoring reaches a balance between control and openness, it could become a protective factor against cyberbullying, and it could be a risk factor, if parental monitoring is too low or over-controlled ( 47).

Despite frequent discussion about the risk factors associated with cyberbullying among children and adolescents, some are still deemed controversial factors, such as age, race, gender, and the frequency of suffering on the internet. For cyberbullying victims, some studies claim that older teenagers are more vulnerable to cyberbullying ( 15, 38, 52, 53), while other studies found conflicting results ( 26, 33). As for student race, Alhajji et al. argued that non-white students were less likely to report cyberbullying ( 29), while Morin et al. observed no significant correlation between race and cyberbullying ( 52). For cyberbullying perpetration, Alvarez-Garcia found that gender differences may have indirect effects on cyberbullying perpetration ( 55), while others disagreed ( 42, 61, 68- 70). Specifically, some studies revealed that males were more likely to become cyberbullying perpetrators ( 34, 39, 56), while Khurana et al. presented an opposite point of view, proposing that females were more likely to attack others ( 71). In terms of time spent on the Internet, some claimed that students who frequently surf the Internet had a higher chance of becoming perpetrators ( 49), while others stated that there was no clear and direct association between Internet usage and cyberbullying perpetration ( 55).

In addition to personal and situational factors, scholars have also explored other specific factors pertaining to cyberbullying risk and protection. For instance, mindfulness and depression were found to be significantly related to cyber perpetration ( 76), while eating disorder psychopathology in adolescents was associated with cyber victimization ( 41). For males who were familiar with their victims, such as family members, friends and acquaintances, they were more likely to be cyberstalking perpetrators than females or strangers, while pursuing desired closer relationships ( 13). In the school context, a lower social likability in class was identified as an indirect factor for cyberbullying ( 48).

Discussion

This comprehensive review has established that the prevalence of global childhood and adolescent victimization from cyberbullying ranges from 13.99 to 57.5%, and that the perpetration prevalence ranges from 6.0 to 46.3%. Across the studies included in our research, verbal violence is observed as one of the most common acts of cyberbullying, including verbal offensive responses, insults, mocking, threats, slander, and harassment. The victimization prevalence of verbal violence is reported to be between 5 and 47.5%, and the perpetration prevalence is between 3.2 and 26.1%. Personal factors, such as gender, frequent use of social media platforms, depression, borderline personality disorder, eating disorders, sleep deprivation, and suicidal tendencies, were generally considered to be related to becoming a cyberbullying victim. Personal factors, such as high school students, past experiences, impulse, improperly controlled family education, poor teacher-student relationships, and the urban environment, were considered risk factors for cyberbullying perpetration. Situational factors, including parental abuse and neglect, improper monitoring, communication barriers between parents and children, as well as the urban environment, were also seen to potentially contribute to higher risks of both cyberbullying victimization and perpetration.

Increasing Prevalence of Global Cyberbullying With Changing Social Media Landscape and Measurement Alterations

This comprehensive review suggests that global cyberbullying rates, in terms of victimization and perpetration, were on the rise during the 5 year period, from 2015 to 2019. For example, in an earlier study conducted by Modecki et al. the average cyberbullying involvement rate was 15% ( 81). Similar observations were made by Hamm et al. who found that the median rates of youth having experienced bullying or who had bullied others online, was 23 and 15.2%, respectively ( 82). However, our systematic review summarized global children and adolescents cyberbullying in the last 5 years and revealed an average cyberbullying perpetration rate of 25.03%, ranging from 6.0 to 46.3%, while the average victimization was 33.08%, ranging from 13.99 to 57.5%. The underlying reason for increases may be attributed to the rapid changing landscape of social media and, in recent years, the drastic increase in Internet penetration rates. With the rise in Internet access, youths have greater opportunities to participate in online activities, provided by emerging social media platforms.

Although our review aims to provide a broader picture of cyberbullying, it is well-noted in extant research that difficulties exist in accurately estimating variations in prevalence in different countries ( 23, 83). Many reasons exist to explain this. The first largely relates poor or unclear definition of the term cyberbullying; this hinders the determination of cyberbullying victimization and perpetration ( 84). Although traditional bullying behavior is well-defined, the definition cannot directly be applied to the virtual environment due to the complexity in changing online interactions. Without consensus on definitions, measurement and cyberbullying types may vary noticeably ( 83, 85). Secondly, the estimation of prevalence of cyberbullying is heavily affected by research methods, such as recall period (lifetime, last year, last 6 months, last month, or last week etc.), demographic characteristics of the survey sample (age, gender, race, etc.), perspectives of cyberbullying experiences (victims, perpetrators, or both victim and perpetrator), and instruments (scales, study-specific questions) ( 23, 84, 86). The variety in research tools and instruments used to assess the prevalence of cyberbullying can cause confusion on this issue ( 84). Thirdly, variations in economic development, cultural backgrounds, human values, internet penetration rates, and frequency of using social media may lead to different conclusions across countries ( 87).

Acknowledging the Conflicting Role of the Identified Risk Factors With More Research Needed to Establish the Causality

Although this review has identified many personal and situational factors associated with cyberbullying, the majority of studies adopted a cross-sectional design and failed to reveal the causality ( 21). Nevertheless, knowledge on these correlational relationships provide valuable insights for understanding and preventing cyberbullying incidents. In terms of gender differences, females are believed to be at a higher risk of cyberbullying victimization compared to males. Two reasons may help to explain this. First, the preferred violence behaviors between two genders. females prefer indirect harassment, such as the spreading of rumors, while males tend toward direct bullying (e.g., assault) ( 29) and second, the cultural factors. From the traditional gender perspective, females tended to perceive a greater risk of communicating with others on the Internet, while males were more reluctant to express fear, vulnerability and insecurity when asked about their cyberbullying experiences ( 46). Females were more intolerant when experiencing cyberstalking and were more likely to report victimization experiences than males ( 13). Meanwhile, many researchers suggested that females are frequent users of emerging digital communication platforms, which increases their risk of unpleasant interpersonal contact and violence. From the perspective of cultural norms and masculinity, the reporting of cyberbullying is also widely acknowledged ( 37). For example, in addition, engaging in online activities is also regarded as a critical predictor for cyberbullying victimization. Enabled by the Internet, youths can easily find potential victims and start harassment at any time ( 49). Participating in online activities directly increases the chance of experiencing cyberbullying victimization and the possibility of becoming a victim ( 36, 45). As for age, earlier involvement on social media and instant messaging tools may increase the chances of experiencing cyberbullying. For example, in Spain, these tools cannot be used without parental permission before the age of 14 ( 55). Besides, senior students were more likely to be more impulsive and less sympathetic. They may portray more aggressive and anti-social behaviors ( 55, 72); hence senior students and students with higher impulsivity were usually more likely to become cyberbullying perpetrators.

Past experiences of victimization and family-related factors are another risk for cyberbullying crime. As for past experiences, one possible explanation is that young people who had experienced online or traditional school bullying may commit cyberbullying using e-mails, instant messages, and text messages for revenge, self-protection, or improving their social status ( 35, 42, 49, 55). In becoming a cyberbullying perpetrator, the student may feel more powerful and superior, externalizing angry feelings and relieving the feelings of helplessness and sadness produced by past victimization experiences ( 51). As for family related factors, parenting styles are proven to be highly correlated to cyberbullying. In authoritative families, parents focus on rational behavioral control with clear rules and a high component of supervision and parental warmth, which have beneficial effects on children's lifestyles ( 43). Conversely, in indulgent families, children's behaviors are not heavily restricted and parents guide and encourage their children to adapt to society. The characteristics of this indulgent style, including parental support, positive communication, low imposition, and emotional expressiveness, possibly contribute to more parent-child trust and less misunderstanding ( 75). The protective role of warmth/affection and appropriate supervision, which are common features of authoritative or indulgent parenting styles, mitigate youth engagement in cyberbullying. On the contrary, authoritarian and neglectful styles, whether with excessive or insufficient control, are both proven to be risk factors for being a target of cyberbullying ( 33, 76). In terms of geographical location, although several studies found that children residing in urban areas were more likely to be cyberbullying victims than those living in rural or suburban areas, we cannot draw a quick conclusion here, since whether this difference attributes to macro-level differences, such as community safety or socioeconomic status, or micro-level differences, such as teacher intervention in the classroom, courses provided, teacher-student ratio, is unclear across studies ( 61). An alternative explanation for this is the higher internet usage rate in urban areas ( 49).

Regarding health conditions, especially mental health, some scholars believe that young people with health problems are more likely to be identified as victims than people without health problems. They perceive health condition as a risk factor for cyberbullying ( 61, 63). On the other hand, another group of scholars believe that cyberbullying has an important impact on the mental health of adolescents which can cause psychological distress consequences, such as post-traumatic stress mental disorder, depression, suicidal ideation, and drug abuse ( 70, 87). It is highly possible that mental health could be risk factors, consequences of cyberbullying or both. Mental health cannot be used as standards, requirements, or decisive responses in cyberbullying research ( 13).

The Joint Effort Between Youth, Parents, Schools, and Communities to Form a Cyberbullying-Free Environment

This comprehensive review suggests that protecting children and adolescents from cyberbullying requires joint efforts between individuals, parents, schools, and communities, to form a cyberbullying-free environment. For individuals, young people are expected to improve their digital technology capabilities, especially in the use of social media platforms and instant messaging tools ( 55). To reduce the number of cyberbullying perpetrators, it is necessary to cultivate emotional self-regulation ability through appropriate emotional management training. Moreover, teachers, counselors, and parents are required to be armed with sufficient knowledge of emotional management and to develop emotional management capabilities and skills. In this way, they can be alert to the aggressive or angry emotions expressed by young people, and help them mediate any negative emotions ( 45), and avoid further anti-social behaviors ( 57).

For parents, styles of parenting involving a high level of parental involvement, care and support, are desirable in reducing the possibility of children's engagement in cyberbullying ( 74, 75). If difficulties are encountered, open communication can contribute to enhancing the sense of security ( 73). In this vein, parents should be aware of the importance of caring, communicating and supervising their children, and participate actively in their children's lives ( 71). In order to keep a balance between control and openness ( 47), parents can engage in unbiased open communication with their children, and reach an agreement on the usage of computers and smart phones ( 34, 35, 55). Similarly, it is of vital importance to establish a positive communication channel with children ( 19).

For schools, a higher priority is needed to create a safe and positive campus environment, providing students with learning opportunities and ensuring that every student is treated equally. With a youth-friendly environment, students are able to focus more on their academic performance and develop a strong sense of belonging to the school ( 79). For countries recognizing collectivist cultural values, such as China and India, emphasizing peer attachment and a sense of collectivism can reduce the risk of cyberbullying perpetration and victimization ( 78). Besides, schools can cooperate with mental health agencies and neighboring communities to develop preventive programs, such as extracurricular activities and training ( 44, 53, 62). Specifically, school-based preventive measures against cyberbullying are expected to be sensitive to the characteristics of young people at different ages, and the intersection of race and school diversity ( 29, 76). It is recommended that school policies that aim to embrace diversity and embody mutual respect among students are created ( 26). Considering the high prevalence of cyberbullying and a series of serious consequences, it is suggested that intervention against cyberbullying starts from an early stage, at about 10 years old ( 54). Schools can organize seminars to strengthen communication between teachers and students so that they can better understand the needs of students ( 61). In addition, schools should encourage cyberbullying victims to seek help and provide students with opportunities to report cyberbullying behaviors, such as creating online anonymous calls.

Conclusions and Limitations

The comprehensive study has reviewed related research on children and adolescents cyberbullying across different countries and regions, providing a positive understanding of the current situation of cyberbullying. The number of studies on cyberbullying has surged in the last 5 years, especially those related to risk factors and protective factors of cyberbullying. However, research on effective prevention is insufficient and evaluation of policy tools for cyberbullying intervention is a nascent research field. Our comprehensive review concludes with possible strategies for cyberbullying prevention, including personal emotion management, digital ability training, policy applicability, and interpersonal skills. We highlight the important role of parental control in cyberbullying prevention. As for the role of parental control, it depends on whether children believe their parents are capable of adequately supporting them, rather than simply interfering in their lives, restricting their online behavior, and controlling or removing their devices ( 50). In general, cyberbullying is on the rise, with the effectiveness of interventions to meet this problem still requiring further development and exploration ( 83).

Considering the overlaps between cyberbullying and traditional offline bullying, future research can explore the unique risk and protective factors that are distinguishable from traditional bullying ( 86). To further reveal the variations, researchers can compare the outcomes of interventions conducted in cyberbullying and traditional bullying preventions simultaneously, and the same interventions only targeting cyberbullying ( 88). In addition, cyberbullying also reflects a series of other social issues, such as personal privacy and security, public opinion monitoring, multinational perpetration and group crimes. To address this problem, efforts from multiple disciplines and novel analytical methods in the digital era are required. As the Internet provides enormous opportunities to connect young people from all over the world, cyberbullying perpetrators may come from transnational networks. Hence, cyberbullying of children and adolescents, involving multiple countries, is worth further attention.

Our study has several limitations. First, national representative studies are scarce, while few studies from middle and low income countries were included in our research due to language restrictions. Many of the studies included were conducted in schools, communities, provinces, and cities in high income countries. Meanwhile, our review only focused on victimization and perpetration. Future studies should consider more perspectives, such as bystanders and those with the dual identity of victim/perpetrator, to comprehensively analyze the risk and protective factors of cyberbullying.

Data Availability Statement

The original contributions presented in the study are included in the article/ Supplementary Material, further inquiries can be directed to the corresponding author/s.

Author Contributions

SH, CZ, RE, and WZ conceived the study and developed the design. WZ analyzed the result and supervised the study. CZ and SH wrote the first draft. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

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Articles from Frontiers in Public Health are provided here courtesy of Frontiers Media SA

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Cyberbullying Among Adolescents and Children: A Comprehensive Review of the Global Situation, Risk Factors, and Preventive Measures

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Background: Cyberbullying is well-recognized as a severe public health issue which affects both adolescents and children. Most extant studies have focused on national and regional effects of cyberbullying, with few examining the global perspective of ...

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(Qualitative) This article talks about the physical and mental stress someone can undergo because of cyberbullying.

-Eric Stephenson

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Cyberbullying is a very serious issue affecting not just the young victims, but also the victims' families, the bully, and those who witness instances of cyberbullying. However, the effect of cyberbullying can be most detrimental to the victim, of course, as they may experience a number of emotional issues that affect their social and academic performance as well as their overall mental health.

As parents today, you may not have ever experienced cyberbullying yourself. It may be hard to fathom how some words of text on a computer screen can lead to such trauma. After all, bullying has seemingly always been a facet of school and on the playground. Perhaps you have seen or experienced bullying when you were in school. Maybe you feel that bullying is just a normal part of school life.

You might also think that face-to-face bullying is much worse than cyberbullying since the victims of real-world bullying have more difficulty escaping their tormentors, while a victim of cyberbullying can simply turn off the computer or block a bully on a social media platform.

Unfortunately, it's not that simple. And while the effects of real-world bullying behavior are not to be dismissed, the effects of cyberbullying can actually be much worse. As parents, it is up to you to understand the true impact of cyberbullying, to recognize a change in your child's behavior as a result of cyberbullying, and to find a way to help your child in a supportive manner.

How can cyberbullying be worse than real-world bullying?

In a real-world bullying situation, most incidents of bullying occur between the victim and a bully (or group of bullies) in school. These incidents can range from simple name-calling to more significant acts of bullying, such as rumor-spreading, harassment, threats, and incidents of physical harm. However, whereas victims of real-world bullying can be granted a reprieve when they go home, there simply is no escape from cyberbullying.

Cyberbullying doesn't end when the school bell rings. It can continue at any time, throughout all hours of the night. It can come in the form of text messages, social media posts, chatroom messages, images and videos that have been altered, and many other digital forms.

Cyberbullying leaves little opportunity for victims to defend themselves. There are no teachers or parents to see what is happening and intervene to put a stop to it. Cyberbullying can also be anonymous, leaving the victim little recourse to even report the bully to an authority figure. And cyberbullying can showcase the incidents of bullying to hundreds, or potentially even thousands, within a short period of time using social media platforms.

If the victim does know who the bully is and chooses to block them on social media, the bully can simply create a new account. Or they can text, message, or use a friend's account. Kids today are extremely resourceful and savvy with technology. If they are intent on cyberbullying, there's not much a victim can do to stop them.

"People will do and say hurtful or demeaning things online that they would never say in person," says Eric Alcera, M.D., medical director for Hackensack Meridian Behavioral Health. Eric also says, "If a cyberbully decides to spread rumors or share embarrassing photos on social media, the words or images can go viral, hitting the radar of many more kids within minutes."

In essence, cyberbullying is more relentless, crueler, and more damaging than real-world bullying. It is also one of the most significant stressors in a young individual's life. And while children who are bullied often attempt to hide such events from their parents, there can be very noticeable changes in your child's behavior if they are a continuous victim of cyberbullying.

Changes in behavior due to the effects of cyberbullying

The changes might not be readily apparent at first, but as time goes on, you may notice one or more of the following behavioral changes that can be strong indicators of cyberbullying.

A drop in social behavior - avoiding friends or social events

Isolating his or herself in their room more than usual

Becoming more quiet or withdrawn

Finding it hard to concentrate on schoolwork

Grades dropping

Losing interest in activities that they normally enjoy

Skipping school or expressing a desire to skip school

Appearing angry when looking at their phone, tablet, or computer

Hiding their phone or computer screen from view

Avoiding using their phone

Using drugs or alcohol

Expressing dark thoughts or emotions

Talking about suicide

If you think that some of these behavioral changes seem a bit extreme, such as thoughts of suicide, you should know that the relationship between bullying and suicide is a strong one. In some cases, bullying alone may not always be the sole cause. The child may already be experiencing feelings of depression or anxiety due to problems at home or a previous history of trauma.

However, a recent study concluded that victims of cyberbullying are twice as likely to attempt suicide or engage in acts of self-harm. Additionally, recent statistics reveal that 59% of U.S. teens have been bullied or harassed online, and over 90% believe it's a major problem for people their age.

Even more alarming, current research suggests that suicide attempts among adolescents have nearly doubled since 2008.

The effects of cyberbullying also include mental health issues, increased stress and anxiety, depression, acting out violently, and low self-esteem. Cyberbullying can also result in long-lasting emotional effects, even if the bullying has stopped.

These effects of cyberbullying can result in enduring feelings of embarrassment. Online bullying feels more permanent, especially when it is performed through social media posts that don't immediately disappear. It can lead to overwhelming feelings of exposure and distress.

Another side effect of cyberbullying is that the victims may be excluded by others who also fear cyberbullying if they continue to remain friends with the victim. This causes the victim to become isolated and ostracized, with no one to turn to at school or at home.

It's no surprise that one of the effects of cyberbullying is also anger. The range of emotions a victim may be feeling often devolves into anger. Some children may even begin plotting schemes of revenge, as has been evidenced in incidents of school shootings and other acts of aggression performed by bullying victims that couldn't take it anymore.

The act of revenge also comes about as a way for a child to regain some sense of power because victims of cyberbullying often feel powerless to stop what is happening.

Physical effects of cyberbullying

Behavioral and mental changes aren't the only effects of cyberbullying. There can be physical effects as well. Intense feelings of stress and anxiety due to cyberbullying can result in physical issues such as insomnia, gastrointestinal issues, and harmful eating patterns.

Why do people cyberbully?

There have always been people who choose to behave like a bully and those who are unfortunate targets. But what is it that makes one not just choose to bully another online, but to engage in the act in such a relentless and cruel manner?

One theory is that cyberbullies have difficulty feeling empathy for others. Low empathy has certainly been attributed to increased use of technology and less real-world social interaction. But this is only one facet of the cyberbullying problem.

Cyberbullying also allows a bully to feel more powerful. Through the use of technology, a cyberbully can easily and effortlessly unleash a torrent of torment at any time, all from the safe harbor of their own home, with little concern or repercussions. A lack of parental monitoring is another contributing factor, as is the desire to achieve popularity through acts they feel resonate well with their peers and associates.

Regardless of the reasons, cyberbullies sometimes face their own dark futures. Studies show that kids who bully others are more likely to abuse drugs and alcohol, engage in fights and criminal behavior, drop out of school, or be abusive toward their romantic partners and/or their children.

Even the bystanders and witnesses are not immune to the effects of cyberbullying. They may also have an increased likelihood of experimenting with drugs and alcohol at an early age or suffering emotional distress and mental health problems.

As an interesting side note, one study states that cyberbullying is more likely to occur between current or former friends. The report further states that cyberbullying occurs seven times more frequently among teens who know each other than among people who had never been friends or dated. This often occurs due to a simple argument that escalates. Or it could simply be because one person has a secret about another that they are dying to tell. It could also be a case of revenge in response to some transgression the bully feels was committed. Jealousy is another factor, as is the desire to improve their social standing.

In many of these cases, girls are twice as likely as boys to be victims of cyberbullying. And because the bully and the victim were once friends, it often results in the effects of cyberbullying being much more traumatic.

What can parents do about cyberbullying?

Unfortunately, there is no quick, one-size-fits-all solution to the cyberbullying problem. But, at the very least, as parents, you can be there for your children. It is highly probable that your child will not be forthcoming about any incidences of cyberbullying they may be experiencing.

However, if you recognize any of the signs described above, take the time to sit with your child and attempt to coax them to open up about any problems they are having in or out of school. By being supportive and understanding, you may aid your child in feeling as though they are not wholly alone.

Try to instill a sense of understanding that, as harsh and cruel as the bullying may be, the bullying is not a reflection of your child's worth, but rather it is more representative of the issues the bully may have in their own life.

Understandably, a child is not going to be very receptive to that train of thought, but that is not your only recourse. The first step is to make every attempt to adjust the privacy settings on your child's social media and chat accounts and to block any known cyberbullies.

Next, gather all evidence of cyberbullying, being sure to take screenshots, since many posts can be deleted. Report incidences of cyberbullying to the app or platform administrators, since cyberbullying often violates the terms of services.

With your evidence, you can also contact school administrators. Just because the incidents may not always happen at school is no reason the school administrators should not be made aware of the actions. Many schools have strict anti-bullying/cyberbullying policies.

If cyberbullying contains any threats of physical violence, it can also be reported to your local police department.

Finally, find ways to help your child heal emotionally. You may need to engage the services of a mental health professional. Do not simply dismiss the effects of cyberbullying or consider them over if the cyberbullying stops. The effects can be long-lasting, and if the cyberbullying has been severe, it may take more than your kind words and advice to rectify the damage that has taken a toll.

Today's technology also comes with a number of parental controls to help safeguard kids from harmful or inappropriate online material. You can also avail yourself of third-party apps such as Kaspersky Safe Kids, which offers protection from harmful content, as well as enables you to set screen time limits, monitor their online activity, or track their location with GPS.

The digital landscape can be a vast and harsh environment. It is filled with adult content that can be discovered all too easily by curious youngsters. With Kaspersky Safe Kids, you can easily block your children from accidentally (or purposefully) viewing adult content while also ensuring they don't spend an unhealthy amount of time online.

In conclusion

Remember, it can be a very small step to go from what is intended to be a harmless joke to a full-blown cyberbullying campaign. The lack of face-to-face interaction and the feeling of power one gains from sitting behind a computer screen can turn what might normally be a traditional case of schoolyard teasing into a steady onslaught of harassment, shaming, and threats of bodily harm. The impact can leave lasting emotional harm and, as mentioned above, lead to suicide.

If you suspect your child is a victim of cyberbullying, don't wait until it's too late. Don't be afraid to broach the subject with your child for fear that they will repel your attempt to help. Cyberbullying affects all types of children, in all facets of society. Campaigns, legislation, school administrative programs, and other movements to recognize and stop cyberbullying are a good first step toward tackling this problem. But only you, as a parent, can directly offer advice and assistance immediately.

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The effects of cyberbullying can be emotional, physical, and mental. Recognize the behavioral changes in your child if they are a victim of cyberbullying.

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In this article it talks about how pretty privilege and how people want to be around others who look beautiful as they view them as more desirable unlike ugly people. With that they are able to get better social and economic privileges. With Anna Delvey she was able to look and play the part of a wealthy woman who had lots of money. So people didn't question if she had the money or not for a long time. The same is said about Elizabeth Holmes who was able to go for over a decade without telling anyone really proving the company wrong. Moreover, on top of her looks she came from a wealthy background.

Qualitative Data

In the article it talks about how there were studies about pretty privilege and how they can help a person in life. ". In a study published in the "American Economic Review," researchers not only found that workers deemed more attractive are considered more capable by employers, but also that physically attractive workers have oral skills (such as social and communication skills) that have led to higher wages." Which is how these women have been able to go on for so with out being caught.

Quantitative Data

Written By: Gianna Romulus

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Since the premiere of real-life criminal-drama shows " The Dropout" and "Inventing Anna," America has become enraptured with the stories of Elizabeth Holmes and Anna Sorokin. Each series resulted in numerous hot takes on social media and discourse around how two women managed to dupe the country's "elite" and heads of multimillion-dollar companies using what turned out to be elaborate schemes.

We are not here to discuss whether the victims of these scams deserved their fates or whether the consequences matched the crime, but rather illuminate one fact that has become clear with these stories: these women were only able to execute scams of this magnitude because of the way they look. It simply would not have been possible had they been Black.

No, it's not that Black people should have equal opportunity to be scammers. However, the reality is that Holmes and Sorokin were able to commit these crimes because they met the outdated criteria of societally accepted beauty standards that favors white, Eurocentric features. Historically, white women have been valued as more beautiful, more trustworthy, and more feminine than their counterparts. (It's true: until 1940, the rules for Miss America - a pageant dedicated to valuing someone's "beauty" - stated that contestants must be "of good health and of the white race.")

As a result, both Holmes and Sorokin were able to fly under the radar as they committed large-scale fraud.

Because whiteness is considered the standard of beauty, Sorokin and Holmes could be perceived as financially reliable and of a certain socioeconomic class simply by existing.

Studies show that beauty is directly related to financial success, with attractive people getting more callbacks for job offers, better results when negotiating, and, quite frankly, the benefit of the doubt. In a study published in the "American Economic Review," researchers not only found that workers deemed more attractive are considered more capable by employers, but also that physically attractive workers have oral skills (such as social and communication skills) that have led to higher wages.

Because whiteness is considered the standard of beauty, Sorokin and Holmes - despite their varied appearances and approach to their beauty rituals - could be perceived as financially reliable and of a certain socioeconomic class simply by existing. The preconceived notion that they could be financially reliable or well-off never seemed too outlandish because they looked the part.

Along with the general privileges that come with fitting within certain beauty ideals, studies also show that people like people who look like them. One sentiment that was often repeated in "Inventing Anna," the story about how Sorokin came to scam some of New York City's wealthiest, was that Sorokin just looked like she belonged to the upper echelons of society. One quick Google search will show you that this phenotype is typically white and skinny.

In an interview on the "Call Her Daddy" podcast, Sorokin herself said that she found it easier to go into high-net-worth spaces and ask for large sums of money because people already assumed that she was rich, so they were more inclined to give her what she asked for.

Holmes, meanwhile, had fans show up to her trial wearing her signature low bun and black turtleneck even after it was revealed that she scammed her investors out of money. This is just further proof that fitting mainstream Eurocentric beauty standards grants you social capital that can ensure your success regardless of your criminal record.

When wealth in the US is divided among a fairly homogeneous group - white people - and the country's beauty standards are equally Westernized, this leaves little to no opportunity for Black women to enter the spaces that these women did without the scrutiny that comes with being seen as an "other" both physically and socioeconomically.

The way that Black women have been displaced from conversations surrounding "conventional" beauty, as well as its accompanying advantages, is systematic. In the 18th century, Louisiana Governor Esteban Rodríguez Miró enacted the Tignon Laws requiring Black women in New Orleans to wear a tignon, a type of headdress or scarf, to completely conceal their hair. The law was enacted because white women complained that freed Black women could entice white men with their hair. The scarves would also serve as a social indicator, to not have light-skinned Black women be mistaken for white women. It is only recently that the CROWN Act, a law that aims to ban race-based hair discrimination, has picked up momentum after being passed by the House of Representatives.

Historically, Black women have never been afforded the opportunity to "blend in" culturally, socially, or physically, because the canvas has always been white. The struggle for greater society to see and accept Black as beautiful - and to assign it the same social capital and benefits of whiteness - has cost Black women funding for their businesses, their lifetime earning potentials, and a host of other socioeconomic advantages that their white counterparts enjoy.

At the end of the day, Holmes and Sorokin are not outrageously beautiful women. Instead, they are beneficiaries of a racist society that allows them the gift of unremarkability. This in turn allowed them room to be audacious - and borderline delusional - in the pursuit of their desires. These women used whiteness as their springboards as well as their protection.

Black people, and Black women in particular, are not afforded that luxury. Holmes and Sorokin represent the very racism that keeps Black people away from the opportunities that their counterparts are afforded, but also the society that accepts it as normal - so long as there's a TV show they can watch afterward.

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How Outdated Beauty Standards Fueled Elizabeth Holmes and Anna Sorokin's Scams

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Elizabeth Holmes and Anna Sorokin benefited from racism in a specific way that only white women could. Read about why ahead.

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In this article it talks about how manipulation and control has helped Anna Delvey scam banks, hotels, and friends out of thousands of dollars out of money. As she made sure that. In addition, to that Elizabeth Holmes did the exact same thing with the public when she was trying to launch her company Theranos .

Qualitative Data

The estimated amount of money that Anna stole was about $275,000 by coning ignorant people who believe her lies. She kept on telling them that she was going to inherit $67 million from her family and that she would pay them all back. At one point she owed $62,000 to her friend for a vacation she didn't pay for. While Elizabeth used her power as she kept departments away from each other and anyone who tried to tell the truth about what is going one with Theranos would be threatened by her lawyers.

Quantitative Data

Written By: Gianna Romulus

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From Elizabeth Holmes To Anna Delvey What Scammers Teach Us

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From Elizabeth Holmes to Anna Delvey What Scammers Teach Us 2022 is overrun with TV shows about scammers. Be it Tinder Swindler, Inventing Anna,

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The data presented in this article demonstrates how peer pressure has a significant impact on behavior and drives teenagers to engage in particular actions in an attempt to fit in.

-posted by tori g.

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According to Merriam-Webster, peer pressure is defined as “a feeling that one must do the same things as other people of one’s age and social group in order to be liked or respected by them.

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This article explains that group dynamics play an important role in being able to better understand human behavior. They state that teens are still figuring out how to function in the social world which makes it easy for them to be influenced by the values and norms of others. Behavioral changes commonly occur in an attempt to fit in and make friends.

-posted by tori g.

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Who Influences Your Health?

Do birds of a feather really flock together? The science says yes. People do tend to choose friends who are similar to them. You also become more like your friends over time. And that can influence your health.

Many behaviors spread socially. Examples include how much you exercise, how much alcohol you drink, whether you smoke, and what foods you eat.

Scientists are still trying to untangle why that is. Studies have found that activity in certain brain areas changes when other people are around. That can affect what you choose to do.

But this work also suggests that you can harness the power of social relationships to gain healthier habits-and motivate others to do the same.

Social Influence

"People care about what others think across all different age groups-and that influences how much they value different ideas and behaviors," says Dr. Emily Falk at the University of Pennsylvania. She studies how social networks affect decision making. This is called social, or peer, influence.

Teens are especially responsive to peer influence. That's because their brains undergo changes that make them highly attuned to social situations. At the same time, the reward system in the teen brain becomes extra sensitive.

The reward system is a brain circuit that causes feelings of pleasure. It's activated by things we enjoy, like eating good food. It's also activated by social rewards, like getting a compliment.

And teens are just learning to navigate the social world. Understanding other people's values and being influenced by them are important parts of socializing. Being influenced on things like clothing choices and musical taste can help teens learn to fit in and make friends. But taking part in risky behaviors, like drinking alcohol or smoking, can lead to health or legal consequences.

"Research shows that even just having another peer around can change the reward response in the brain and also the risk-taking tendencies of teenagers," says Falk. Her team studies how peers affect teens' driving behaviors and smoking decisions.

Some people seem to be more easily influenced than others, too. They may be more sensitive to feeling included or excluded by others. Or they may be more sensitive to social signals, like the tone of someone's voice or their body language.

Dr. Mary Heitzeg's team at the University of Michigan is doing research to better understand how a person's biology and reactions to social situations affect whether they develop substance use or mental health problems later in life.

Using brain scans, the team is looking at how teens' brains respond to being socially included or excluded. They're also looking at how the brain's reward system responds to different situations.

Heitzeg's team is part of a large 10-year effort, called the ABCD Study, to understand the factors that influence teens' health and risk behavior in the long term. Factors can include families, friends, schools, neighborhoods, and communities.

"Adolescence is such a risky period," says Heitzeg. "That's when sexual initiation happens, initiation and escalation of substance use happens, as well as other types of risky and delinquent behaviors, like risky driving."

But it's also a time that peer influence can help teens thrive if it gets them more involved with their community or helps them learn behaviors to get along with others, like how to cooperate or be empathetic.

Peer Quality, Not Quantity

Positive and negative peer influences can affect more than just your behavior. They can also change the way you feel.

Studies show that, in general, the more friends you have and the more time you spend with them, the happier you are. Friends give you people to share your feelings with, to get new perspectives from, or to just do fun activities with.

But it's the quality of those friendships-not quantity-that really makes the difference. Quality of friendships has been linked to higher life satisfaction and better mental health.

"We've all experienced letting a friendship go because it didn't feel great," says Dr. Rebecca Schwartz-Mette of the University of Maine. Her lab studies how peer relationships affect the emotional development of children and teens.

Friendships you feel you want to let go of may be low quality. They might be fraught with conflict, criticism, and aggression. For youth, low quality friendships are linked to poor academic performance and behavioral issues.

High quality friendships provide understanding, support, and validation of your self-worth. These types of friendships are more stable and are more satisfying.

Spending time with friends can be especially helpful for people with anxiety or depression. However, Schwartz-Mette's studies have shown that depression can also be worsened by certain friendship qualities. One is called co-rumination.

"Co-rumination is basically when people get together and talk excessively about everything that's going wrong and how bad they feel," she explains. "With that person, they feel understood, validated, and that this person is emotionally close to them. But they get more depressed because they're focusing their attention on negative things."

Research suggests that it may help to refocus such friendships. Talk about both positive and negative things in your day. Look for healthy activities to get out and do together, like going for a walk. Encourage each other to keep up healthy habits like physical activity, healthy eating, and getting a good night's sleep.

"Noticing that our behavior is influenced by other people, we can be intentional and try to focus on the people who are doing the things we want to get into ourselves," Falk explains. "Sharing your healthy habits with other people could make a real difference to somebody else." And to yourself.

Parents can help guide their kids toward more positive social experiences, too (see the Wise Choices box for tips). But everyone can benefit from high quality friendships that help you nurture healthy habits.

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Harness the power of social relationships to gain healthier habits-and motivate others to do the same.

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This article demonstrates how the development of social media has affected our lives. According to the article, it improved our quality of life by providing us with a quick and dependable method of communication which changed our old methods of how we communicate. Now, most people heavily depend on social media as their main source of communication and how they interact with others.

-posted by tori g.

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The modern world is powered by technology. From communication to entertainment and healthcare to transportation, technology has revolutionized every aspect of our lives. As technology continues to advance, it has also brought about changes in human behavior, organizational structure, and communication.

One of the primary ways technology has impacted human behavior is by making our lives more convenient. With the advent of smartphones, we can now access information and connect with people from virtually anywhere. This has led to a shift in the way we communicate and interact with others, with many people relying on text messages and social media to stay in touch.

The rise of technology has also changed the way organizations operate. In today's world, many companies rely heavily on computer networks to run their business operations. This has led to an increased need for skilled professionals in the areas of computer science, software engineering, and network administration.

At the same time, the increasing reliance on technology has also created new challenges for organizations. Cybersecurity threats, data breaches, and other types of digital attacks are becoming more frequent, forcing companies to invest in advanced security systems to protect their assets and customer data.

In the field of electronics, advancements in technology have led to the development of new devices and gadgets that have transformed the way we live. From smart homes to wearable devices, electronics have made our lives easier and more convenient.

However, the growing use of electronics has also raised concerns about the impact of electromagnetic radiation on human health. As electronic devices become more ubiquitous, it is important to understand the potential risks and take steps to mitigate them.

As technology continues to evolve, it will undoubtedly have a profound impact on human behavior, organizational structure, and communication. It is up to us to adapt and embrace these changes, while also being mindful of the potential risks and challenges that may arise.

To stay ahead in today's fast-paced world, it is important to study hard and acquire the necessary skills and knowledge to succeed. Whether you are interested in computer science, network administration, electronics, or any other technology-related field, there are many opportunities available to help you achieve your goals.

By staying informed, staying up-to-date with the latest trends and advancements, and continuing to learn and grow, you can take advantage of the many opportunities that technology has to offer and build a successful and rewarding career in this exciting and ever-changing field.

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The modern world is powered by technology. From communication to entertainment and healthcare to transportation, technology has revolutionized every aspect of our lives.

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This article showcases how social changes, in this case, COVID-19, changed the behaviors and norms of many. Throughout the article, they mention that it led to anxiety issues as well as major depressive disorders. But on a more positive note, the report highlights a significant portion of the population that has increased their engagement in healthy behaviors such as exercising and spending more time with their families.

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A Closer Look at Behavioral Health and the Impact of COVID-19

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A CLOSER LOOK AT BEHAVIORAL HEALTH And the impact of COVID-19 The increasing prevalence of behavioral health conditions continues to be a top concern for employers. Meeting the needs of your employees facing mental health challenges takes looking at the bigger picture, in order to better treat the whole person.

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Why do People Cope with Situations Differently?

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Why do People Cope with Situations Differently?

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Quantitative Data:

This article is a study that aimed to examine three types of resiliences, among six coping mechanisms among the same sample of people that faced across two problems. They used two repeated measurements of the same Israeli sample (N = 593) through an internet panel to do their research.

Done by: Saidah Brown

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BMC Public Health 22, Article number: 2151 (2022) Cite this article

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Abstract

Background

Varied populations may react differently to similar crises, depending on their social, cultural, and personal backgrounds; conversely, the same populations may respond differently to varied adversities. The current study aimed to examine three types of resilience (individual, community, and societal resilience) predicting six coping mechanisms (sense of danger, anxiety and depressive symptoms, well-being, hope, and morale) among the same sample of people that faced across two different adversities-COVID-19 and an armed conflict.

Methods

Two repeated measurements of the same Israeli sample ( N  = 593) were employed, through an internet panel. The research variables were examined through a structured, quantitative questionnaire that consisted of nine scales, based on validated and reliable questionnaires.

Results

Results indicated that: (a) respondents reported more difficulties in coping with the COVID-19 crisis, compared to the armed conflict, in all variables but morale. (b) similar patterns of correlations among the study variables were found in both measurements. (c) path's analysis indicated similar patterns of prediction of distress and well-being by individual and societal resilience. Use of the coping mechanism varied depending on the perception of the threat: COVID -19 is perceived as a less familiar and predictable adversity, which is harder to cope with, compared with the more familiar risk - an armed conflict, which is a recurrent threat in Israel. The correlations between the investigated psychological responses and the impacts of resilience on the coping and distress mechanism were similar in both adversities.

Conclusions

The results indicate that respondents tend to react in a similar pattern of associations among resilience, distress, and well-being across different adversities, such as COVID and armed conflict. However, individuals tend to regard unfamiliar, less predictable adversities as more complex to cope with, compared to better-known crises. Furthermore, respondents tend to underestimate the risks of potential familiar adversities. Healthcare professionals must be aware of and understand the coping mechanisms of individuals during adversities, to appropriately design policies for the provision of medical and psychological care during varied emergencies.

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Introduction

Populations worldwide need to manage varied types of hazards resulting from different adversities, such as natural disasters, pandemics, and/or human-made events. Adversities impact the resilience and well-being of individuals and communities, subsequently followed by elevated levels of distress symptoms [ 1]. Varied populations may react differently to similar crises, dependent on their social, cultural, and personal backgrounds and experiences [ 2, 3]. Furthermore, the same population may respond differently to varied adversities, presenting different levels of distress, resilience, and well-being in each event. At times, different types of adversities may occur simultaneously, for example, hurricanes, flooding, earthquakes, armed conflicts, etc. that occurred in numerous countries, in parallel to the ongoing global COVID-19 pandemic [ 4, 5]. It is thus of value to identify similarities and differences in coping with varied adversities.

Two types of adversities that occurred concurrently

The COVID-19 pandemic started in Israel upon the initial identification of confirmed cases in February 2020. It continued in three main waves and substantially receded at the beginning of 2021, following a successful vaccination campaign. By April 19 th, 2021, 88% of individuals the age of 50 years or higher were vaccinated with two vaccine doses [ 6]. By June 21 Israel faced the fourth wave of morbidity which led to a decision to inoculate the adult population with a third (booster) vaccination. As of February 7 th, 2022, Israel was at the peak of the fifth wave resulting from the Omicron variant, leading to the overall accumulated deaths resulting from COVID of 8,272 Israelis.

Concurrently, an armed conflict between Israel and the Palestinians in Gaza Strip erupted, starting on May 10, 2021, and ending in a ceasefire that was declared 11 days later, on May 21, 2021. Ten civilians and one Israeli soldier were killed. During the data collection process that was conducted during the armed conflict, the coronavirus was in a significant decline in Israel ( https://www.worldometers.info/coronavirus/country/israel). For example, the number of new cases discovered during the operation was about 30 people per day, while during the third wave that preceded this period (December 2020 to March 2021) there were thousands of new cases per day (://coronavirus.jhu.edu/region/israel).

The two adversities that our respondents coped with posed different challenges: The COVID-19 pandemic was characterized by great uncertainty, especially before the development of a vaccine, affecting many aspects of life [ 7]. Among the varied uncertainties, the following should be noted: a high death toll was witnessed due to the pandemic, it was an emerging threat, unfamiliar to most people, the virus was invisible and concerning, it was unclear when a vaccine will be available, carriers that did not show symptoms could not be identified, and more [ 8]. Furthermore, this was the first pandemic with massive consequences that negatively impacted the daily lives of most people worldwide by requiring social distancing, isolation, and national lockdowns [ 9].

The period of an armed conflict (Operation Guardian of the Walls) that occurred approximately seven months after the peak of the COVID-19 pandemic in Israel, posed a direct threat to the lives of civilians in large areas of Israel [ 10, 11]. Residents of many communities were instructed to remain in or near sheltered infrastructures throughout the conflict. Based on previous experience with such rounds of conflicts, most residents had a high level of trust in the missile defense system (Iron Dome) [ 12], believing that it will protect them by intercepting most of the rockets aimed at their area. They also assumed, based on the former conflicts, that the hostilities will be relatively short, and that the various authorities (military, hospitals, municipalities) will come to their aid immediately if needed. During the military conflict, the various media in Israel dealt solely, and on a daily basis, with this round of fighting (e.g., https://www.kan.org.il/tags/tag.aspx?tagid=2426).

The current study aimed to examine whether there are differences in coping with these two different types of adversities: the COVID-19 pandemic (global adversity resulting from a natural cause) versus a human-made armed conflict. The levels of distress, resilience, and well-being were assessed among the same sample of the population to examine commonalities and differences in dealing with the two different crises, that occurred within a relatively short period. To the best of our knowledge, to date, these issues have hardly been explored as it is infrequent that two varied adversities materialize concurrently.

Distress symptoms

In 1950, Selye argued that "anything that causes stress endangers life unless it is met by adequate adaptive responses; conversely, anything that endangers life causes stress and adaptive responses" [ 13], p. 1383]. Since this pioneered publication the concept of distress-related health implications has been widely studied (see comprehensive review in [ 14]). Distress is a broad concept that refers to a wide range of individual reactions in response to environmental demands, such as various threats. Of the potential mechanism of distress, two were frequently investigated: (a) Distress symptoms, which form a common reaction to crises characterized by physical or mental threats to the integrity of life. Such symptoms comprise continuous emotional and behavioral difficulties [ 15] including depression, anxiety, and grief [ 16]. Anxiety and depression symptoms were identified as a common response to both COVID-19 [ 17] and armed conflicts [ 18]. (b) A sense of danger is likely to enhance a continuous state of fear that strongly and negatively reduces the capacity to effectively cope with adversities [ 19].

Resilience

The concept of resilience has received a great deal of research attention in the past decades, and even more so in the last few years. Presumably, this is related to the onset of several pandemics as well as the rising climate change crises and disasters that follow [ 4]. Despite the numerous definitions of resilience that can be found in the literature, there is a broad consensus that human resilience mainly refers to the human ability to cope with crises successfully and effectively recover as quickly as possible [ 20].

The study focused on three main types of resilience, as follows: (a) Individual resilience (IR), which relates to the capacity of the individual to endure adversities, recuperate and bounce back (or forward) to routine function [ 21]. Cacioppo et al., [ 22] described the concept of individual resilience as "the capacity to foster, engage in, and sustain positive relationships and to endure and recover from life stressors and social isolation" (p. 44). (b) Community resilience (CR), relates to the relationships between the people and their community, mainly focusing on the effectiveness of the community to successfully attend to the specific requirements of its population and the degree to which people receive assistance from their neighbors, peers, and entities on which their community consists of [ 23]. (c) National resilience (NR), is a comprehensive concept that focuses mainly on social sustainability and empowerment concerning the following components: confidence (trust) in the government, the parliament, and other societal entities, faith in social cohesion, and patriotism [ 24]. Previous studies [ 25] have revealed that the three resilience measurement tools (regarding IR, CR, and SR) positively predicted both hope and morale and negatively predicted distress during COVID-19.

Well-being

The concept of well-being (WB) is complex, characterized by many definitions, and varied in how it is measured (see an extensive review in [ 26]. Beyond the various definitions, this concept includes several aspects such as positive versus negative affect, life satisfaction, relationships with others, purpose in life, happiness, and more. Above all, it is a measurement of the individual's subjective assessment of his/her life. Earlier studies have examined well-being during COVID-19 [ 27] as well as during armed conflicts [ 28].

Morale

Shaban et al., [ 29] defined morale as "a quality which involves feelings, emotions, attitude, and perception towards the organization and its members". The concept of morale emerged in the military context (also known as 'esprit de corps, [ 30]). Morale is defined in terms of the mental, spiritual, emotional, and general state of the individual, rather than in terms of a personality attribute [ 31].

Hope

Snyder et al., [ 32] emphasized the cognitive aspect of hope and defined it as a positive motivational state that is based on an interactively derived sense of successful (a) agency (goal-directed energy) and (b) pathways (planning to meet goals). Fredrickson [ 33] referred to hope mainly as an emotional aspect. Research has indicated a significant association between hope and stressful life events [ 34]. Gallagher et a., [ 35] suggest that hope is positively associated with resilience that enables one to successfully cope with the chronic stressors that are caused by the COVID-19 pandemic.

Risk perception

The risk perception theory [ 36] claims that personal experience and social factors, along with connection with close environments, may exert significant effects on risk perception about adversities. Armed conflict crises have occurred many times in Israel and the population is thus familiar with the characteristics of these adversities including how they are expected to behave throughout these incidents. The COVID-19 pandemic, which is unexpectedly enhanced and decreased throughout the varied waves of infectivity, is a new experience for the Israeli public. Accordingly, the population lacks the means for assessing if, when, and how it will end, or what side effects will materialize. It is expected, therefore, that coping with this (previously unknown) pandemic will be regarded by the investigated public as a more complex task than coping with a (familiar) struggle with the Gaza Strip.

Moreover, the scientific relevance of the current study is related, among others, to the fact that different disasters may occur simultaneously (e.g., a severe wave of heat and drought and at the same time a pandemic crisis) and affect how one copes with the varied situations. Hence the importance of this study is the capacity to follow the same people, concerning their coping with two adversities, in a relatively short period. To date, it seems that this issue has not received extensive research coverage.

Research hypotheses

Based on the above the following hypotheses were examined:

1. a.
The level of anxiety and depressive symptoms, as well as the sense of danger will be higher during the COVID-19 pandemic, compared with their level during the armed conflict. .

2. b.
The levels of resilience (IR, CR, and SR), Well-being, morale, and hope will be lower during the COVID-19 pandemic, compared with their level during the armed conflict.

3. c.
The three types of resilience will positively predict the coping mechanism (WB, morale, and hope), and negatively predict the markers of distress (anxiety and depressive symptoms, and sense of danger) in each of the two investigated adversities.

Method

Study design

The present study is longitudinal research, based on two repeated measurements that were conducted among the same sample. The first measurement (T1) was carried out at the peak of the COVID-19 pandemic in mid-October 2020 (October 12-14) towards the end of the second lockdown, before the beginning of the vaccination campaign. The second measurement (T2) took place between 14-16 May 2021, at the end of the armed conflict between Israel and the Gaza Strip. A previous study explored the associations between morale and perceived threats to the Israeli population in each of these two adversities, using two different cohorts of respondents [ 37].

Participants

To collect our data, we used an internet panel company that consists of over 65,000 panelists, representing all demographic sectors and geographic locations in Israel ( https://sekernet.co.il/). Our sample included 593 Jewish Israeli respondents, who answered the online questionnaire twice. An informed consent form was signed by all participants. The questionnaire was approved by the Ethics Committee of Tel Aviv University. All methods were carried out following relevant guidelines and regulations. The sociodemographic characteristics of the sample are detailed in Table 1.

Table 1 Sociodemographic characteristics of participants (N = 593)

Study tool

The research variables were examined with a structured, quantitative questionnaire that consisted of the following eight categories, based on validated and reliable questionnaires. The following are details of the same scales (research variables) in each of the measurements (T1 = COVID-19 and T2 = armed conflict).

Sense of danger

The initial six-item Sense of Danger Scale was used based on Solomon and Prager's [ 38] scale, to measure a lingering sense of danger in the context of security threats. In our COVID-19 studies [ 18], we modified the threat in each of the items from security to the COVID-19 pandemic threat (e.g., "To what extent are you worried about the increase of the COVID-19 global crisis?"). To the six items' original scale we added four items, for example, "To what extent are you afraid that you will have difficulty finding work after the coronavirus crisis?" In the armed conflict questionnaire, the original "security" threat was measured. These ten items were rated on a scale ranging from 1 = Not at all, to 5 = Very much. The scale's Cronbach's alpha reliability in the current study was α = 0.88 in both measurements).

Distress symptoms

The level of individual distress symptoms, in the context of the two adversities, was determined by nine items from the Brief Symptom Inventory (BSI, [ 39] regarding anxiety (four items) and depression (five items). This scale was scored on a Likert scale ranging from 1 = not suffering at all to 5 = suffering very much. An example of an item is: "Lack of interest in anything" The Cronbach alpha reliabilities of this scale in the present study were high: α = 0.91 at T1 and T2.

Individual resilience (IR)

The original Connor-Davidson scale consists of 25 items [ 40]. In this study, we used an abbreviated version of the questionnaire, based on ten items [ 41]. Responses to the questionnaire items represent a 5-point scale, ranging from 1 = not true at all, to 5 = true almost all the time. Example of an item: "I can adapt when changes occur." In the present study, the internal reliability of the scale was high: α = 0.91 (T1 and T2).

Community resilience (CR)

This resilience scale includes 10 items [ 42]. Responses to the questionnaire items represent a 5-point scale, ranging from 1 = do not agree at all, to 5 = agree to a very large extent. Example of an item: "The municipal authority in my locality is functioning properly in the crisis". The current study's internal scale reliabilities were high (α = 0.94 at T1 and T2).

Societal (national) resilience (SR)

The scale includes 16 items [ 43]. Example of an item: "I have full confidence in the ability of the Israeli healthcare system to take care of the population during the crisis". The response scale for the national resilience items ranges from 1 = do not agree at all to 6 = strongly agree. The internal reliability of the scale was high: α = 0.90 (T1) and α = 0.91 (T2).

Subjective well-being

This scale consists of nine items concerning individuals' perceptions of their lives in the present regarding various contexts, such as work, family life, health, free time, and others [ 44]. Responses to these items range from 1 = very bad to 6 = very good. Example of an item: "How is your health today?". The reliabilities in the current study were found to be good in both measurements (α = 0.88 at T1 and α = 0.90 at T2).

Morale

The level of personal morale was examined by a single item: "How would you define your morale these days?" The response scale ranges from 1 = not good at all, to 5 = very good.

Level of hope

This tool, which was constructed specifically for the present study, is based on an earlier scale [ 45]. The scale contains two dimensions: personal and collective hope. The scale includes five items. Two of them refer to the personal level (e.g., "I hope that I will emerge strengthened from the coronavirus crisis") and three items refer to the collective level (e.g., "I hope that Israeli society will emerge strengthened from the coronavirus crisis"). The response scale ranges from 1 = very little hope to 5 = high hope. The internal reliability of the scale in the present study was found to be high: α = 0.93 (T1 and T2).

Demographic characteristics

The demographic characteristics included: age group, gender, income relative to the average income in Israel (1 = much below the average, 5 = much above the average), political positions (1 = strong left, 5 = strong right), degree of religiosity (1 = secular, 4 = very religious/orthodox), education (1 = elementary school, 5 = academic master's degree).

Statistical analysis

Three analysis methods were employed: (a) General linear Model repeated measures examined differences between the coping mechanisms across the two adversities. (b) Pearson correlations among the research variables examined the pattern of associations among the coping mechanisms, across the two adversities. (c) Two path analyses examined the prediction of six coping mechanisms, by the three types of resilience, across the two adversities. For the repeated measures, the mean scores of each of the scales were used. P-values lower than 0.05 were considered statistically significant.

Results

To examine our first hypothesis, regarding the differences in coping mechanisms, we used General Linear Model (GLM) repeated measures (Table 2). Results indicated that in agreement with our hypothesis, respondents reported more difficulties in coping with the COVID-19 crisis, compared to the armed conflict, in all nine variables except for morale. They reported a higher level of stress symptoms during this pandemic (F = 7 0.84, p < 0.05), and a higher level of sense of danger, with the largest difference between the two adversities (F = 196.11, p < 0.001, with a medium-size effect). Respondents reported significantly higher levels of individual (F = 5.65, p < 0.01) (small effect size), community (F = 63.54, p < 0.001, small effect size), and societal (F = 60.41, p < 0.001, large effect size) resilience during the armed conflict measurement, compared to the COVID-19 measurement. Furthermore, higher levels of subjective well-being (F = 110.26, p < 0.001) and hope (F = 58.05, p  < 0.001, small effect sizes), were expressed in the armed conflict crisis compared to the COVID-19 calamity. The only indicator which did not differ between the two measurements was the level of morale.

Table 2 General Linear Model - repeated measures, mean and standard deviation of coping mechanism (N = 593)

To examine our second hypothesis, we used Pearson correlations among the seven coping mechanisms (Table 3). Results supported our hypothesis indicating similar patterns of correlations among the study variables across the two measurements: (a) The two-distress mechanism (distress symptoms and sense of danger) significantly and positively correlated with each other. (b) The three types of resilience (individual, community, and national) correlated significantly and positively with each other, and with the well-being mechanism. (c) The distress mechanism negatively correlated with both resilience and well-being measures.

Table 3 Pearson correlations among the coping mechanism across the two measurements

Two similar path analyses [ 46] were conducted on the data collected during the two adversities-COVID-19 and the armed conflict, to examine the third hypothesis on predicting the seven psychological coping mechanisms by the three types of resilience. Maximum likelihood estimates and a saturated model were employed, as we did not find any studies that supported an alternative model. It is important to note that in a saturated model, there is no need to examine the model fit, as the default and saturated models are the same [ 47] (Table 4 and Fig. 1). The results indicated the following: (a) Individual resilience predicted significantly and negatively the sense of danger, anxiety, and depression symptoms in each of the two adversities: The higher the IR, the lower the sense of danger, anxiety, and depressive symptoms. (b) Individual resilience predicted significantly and positively well-being, hope, and morale in both adversities: The higher the IR, the higher well-being, hope, and morale. (c) Societal resilience (SR) significantly predicted the investigated coping mechanism in the same direction, although its prediction of anxiety was not significant. (d) Less consistent results were obtained for community resilience. CR predicted positive and significant well-being and hope in both adversities but predicted positive morale only in the COVID-19 context. CR did not predict significantly the three negative mechanisms of adjustment: the sense of danger, anxiety, and depression.

Table 4 Standardized estimated path analysis of three types of resilience predicting six coping mechanisms during COVID-19 and armed conflict (N = 539)

Example model of path analysis-Three types of resilience predicting six coping during COVID-19 and armed conflict

To ensure that each construct measures the variables it is planned to assess, the discriminant validity of the three resilience measures was assessed. As can be seen in Table 5, discriminant validity was found concerning all three measures.

Table 5 Checking for the discriminant validity of the three resilience constructs

Discussion

The uniqueness of the current study lies in examining responses of the same sample of the population, during two different types of adversities. The levels of distress, resilience, and well-being were assessed during the peak phase of the COVID-19 pandemic and were re-assessed seven months later, during an armed conflict. Our main aim was to identify similarities and differences in coping indicators mechanism among this sample, in dealing with these two different adversities that co-existed within a relatively short period.

The review of the existing literature regarding coping with different types of adversities indicates that this issue has received little research coverage. The present study is designed to add to the existing knowledge on this subject, to improve the ability of the professionals to provide help, as well as to deal with various types of adversities and types of disasters (e.g., [ 48, 49].

Our main hypothesis that the participants sensed a greater difficulty in coping with COVID-19 compared to an armed conflict, was supported by most of the examined coping mechanisms. Responses during this pandemic were characterized by higher levels of sense of danger and distress symptoms, accompanied by lower levels of individual, community, and national resilience, well-being, and hope. The only exception to this rule was the level of morale that did not differ between the two examined adversities.

There is reason to believe that the greater difficulty of coping with the COVID-19 pandemic, which was found in this study, portrays the perceived difference in the characteristics of these adversities in the eyes of the investigated sample, rather than an actual greater threat posed by the pandemic compared to the armed conflict. These characteristics include (a) Familiarity with the threat. Israeli citizens are more familiar with repeated rounds of armed conflicts between Israel and the Gaza Strip, as they erupted several times in the past decade [ 50]. In contrast, the COVID-19 pandemic was an emerging threat, that occurred for the first time in recent years, which involves unknown immediate consequences and future impacts. (b) The duration of the adversity. Most armed conflicts in the region last for a relatively short duration, from a few days to a few weeks [ 51]. In contrast, the COVID-19 pandemic, at the time of measurement, had lasted for over a year, and its end is still not foreseen. (c) The number of casualties. The number of confirmed cases of the pandemic, as well as the overall mortality and morbidity, were much higher, compared with the regional armed conflicts, and future cases cannot as yet be predicted. (d) Consequently, the level of uncertainty due to the COVID-19 pandemic was much higher, compared with the armed conflicts in the Middle East [ 7].

A similar pattern of associations was found among the six coping mechanisms, across the two adversities. As expected, positive coping mechanisms were positively correlated with each other, distress mechanisms were positively correlated with each other, and these two groups of variables negatively correlated with each other. These associations were repeated in the two investigated adversities. These results suggest that the associations between distress, resilience, and well-being are stable, beyond the specific type of adversity [ 9, 10]. Our study suggests that those who found it difficult to cope with the COVID-19 crisis also found it difficult to cope with the armed conflict that followed and vice versa.

As previously identified, people who show high levels of stress and low resilience, for example, are likely to show similar responses across different adversities [ 25]. It is recommended that this conjecture be further researched by studies that will compare the coping mechanisms of individuals across different adversities and different cultures. These results support other studies that used a different method of analyzing repeated measures, such as Latent Growth Mixture Modeling (LGMM), tracking patterns of change over time [ 52, 53, 54]. These studies have indicated that most people who cope with adversity present a similarly low level of distress across time and types of adversity [ 23, 55]. However, these studies did not compare repeated measurements across varied adversities but concentrated on the same sample at different times of the same single adversity.

Resilience is vital for individuals and societies at large, regardless of the type of adversity, because all crises disrupt the social, cultural, and organizational systems and practices [ 56]. The importance of resilience for psychological adjustment during adversity is investigated in this study, by examining the extent to which the three kinds of resilience predict the investigated coping and the distress mechanism. The results clearly show that both IR and SR are strong and consistent predictors of coping and maintaining psychological adjustment in each of the two adversities examined in the current study. CR was found to be a less consistent predictor of efforts to cope with these risky circumstances.

Limitations

Three main limitations, concerning the present study, should be noted: First, the study is based on self-report measures, and thus there may be a reporting bias. Second, it is a correlative study that does not allow for inference to conclude causalities. Third, the study sample is based on an online internet panel that does not necessarily represent a random sample of the entire population, most likely it does not include individuals without digital literacy.

Conclusions

Our results show that psychological coping with different crises mainly reflects the perceived characteristics of each crisis, rather than its objective level of risk for the individual. People seem to regard unfamiliar, less predictable adversities, whose future development and implications are less well-known, as more complex to cope with, compared to better-known crises. Consequently, they often tend to underestimate the risks of a potential familiar adversity. These results further suggest that the associations between stress, resilience, and well-being mechanisms tend to be stable across two different adversities (the COVID pandemic and an armed conflict).

Future research direction

As the commonalities and diversities in coping with different adversities have hardly been studied to date, it is recommended that additional research will be made, considering varied cultural contexts, types of societies, and different types of adversities. Furthermore, future research should investigate coping with adversities different from those examined in the present study, as well as in other cultures.

Availability of data and materials

The processed data that support the findings of this study are available from the corresponding author upon reasonable request. Requests to access the datasets should be directed to adini@tauex.tau.ac.il.

References

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Funding

This study received partial financial support from the Ministry of Science and Technology. The funder did not interfere in the study in any way, nor influenced the collection of data, its analysis, or its conclusions.

Author information

Authors and Affiliations

1. ResWell Research Collaboration, Tel Aviv University, Tel Aviv, Israel

Shaul Kimhi & Bruria Adini

2. Stress and Resilience Research Center, Tel-Hai College, Tel-Hai, Israel

Shaul Kimhi, Hadas Marciano & Yohanan Eshel

3. The Institute of Information Processing and Decision Making, University of Haifa, Haifa, Israel

Hadas Marciano

4. The Psychology Department, University of Haifa, Haifa, Israel

Yohanan Eshel

5. Department of Emergency and Disaster Management, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Bruria Adini

Contributions

SK and BA conceptualized the study and collected the data; SK and HM analyzed the data; SK drafted the first version of the manuscript; YE contributed to writing additional versions; All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.

Corresponding author

Correspondence to Bruria Adini.

Ethics declarations

Ethics approval and consent to participate

The studies and all methods involving human participants were performed following the relevant guidelines and regulations; the study was approved by the Tel Aviv University ethics committee, #0001150-2 from May 13th, 2021; informed consent was received from all participants.

The informed consent included the following information:

"You are invited to participate in an online questionnaire concerning the attitudes and feelings among the Israeli public concerning resilience to the current situation. The study is conducted by researchers from Tel Aviv University.

Your participation in the study is voluntary and you may stop responding without infringing on your rights in any way. The answers are anonymous, and we will maintain the confidentiality of all answers. The publication of the findings will include only overall combined answers from all respondents, so that information about a given respondent cannot be identified.

Filling out the questionnaire will take less than 15 minutes. No risk is expected from completing the questionnaire. If any question arises, you may contact Prof. Bruria Adini or Prof. Shaul Kimhi at the following email addresses: adini@tauex.tau.ac.il or shaulkim@gmail.com.

Thank you very much for your participation!

The research team."

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Competing interests

There are no conflicts of interest for any of the authors.

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Kimhi, S., Marciano, H., Eshel, Y. et al. Do we cope similarly with different adversities? COVID-19 versus armed conflict. BMC Public Health 22, 2151 (2022). https://doi.org/10.1186/s12889-022-14572-0
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DOI: https://doi.org/10.1186/s12889-022-14572-0

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# data[].attributes.attachment_link.title
Do we cope similarly with different adversities? COVID-19 versus armed conflict - BMC Public Health

# data[].attributes.attachment_link.description
Background Varied populations may react differently to similar crises, depending on their social, cultural, and personal backgrounds; conversely, the same populations may respond differently to varied adversities. The current study aimed to examine three types of resilience (individual, community, and societal resilience) predicting six coping mechanisms (sense of danger, anxiety and depressive symptoms, well-being, hope, and morale) among the same sample of people that faced across two different adversities-COVID-19 and an armed conflict.

# data[].attributes.headline
Why do People Cope with Situations Differently?

# data[].attributes.subject
Why do People Cope with Situations Differently?

# data[].attributes.body
Qualitative Data:

This video is speaking about how past trauma can explain how you cope with situations. They delve into seven different trauma types people go through and gives us the common coping mechanism they may have.

Done by: Saidah Brown

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How Your Trauma Explains Your Coping Mechanisms

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This article provides detailed statistics about narcissism and the emotions in relation to the mental condition. Really emphasizing the negative emotions that correlate with narcissism.

QUANTITATIVE DATA

WRITTEN BY: Bran'niya Myrick

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This article covers the aftermath of child bearing at a young age. It speaks on what will most likely happen when a teen experiences pregnancy at young, and the long-term effects of having a child at a young age.

QUALITATIVE DATA

Written by: Bran'niya Myrick

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Official websites use .gov A.gov website belongs to an official government organization in the United States.

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In summary, this article presents the number of teen pregnancies in the United States and the rate at which they accrue. This article also goes into depth and provides statistics about different racial groups, and age brackets that experience teen pregnancy on a national scale.

QUANTITATIVE DATA

Written by: Bran'niya Myrick

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The US teen birth rate (births per 1,000 females aged 15 to 19 years) has been declining since 1991. Teen birth rates continued to decline from 17.4 per 1,000 females in 2018 to 16.7 per 1,000 females in 2019. This is another record low for US teens and a decrease of 4% from 2018. 1,2 Birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years. ²

Although reasons for the declines are not totally clear, evidence suggests these declines are due to more teens abstaining from sexual activity, and more teens who are sexually active using birth control than in previous years. 3, 4

Still, the US teen birth rate is substantially higher than in other western industrialized nations, 5 and racial/ethnic and geographic disparities in teen birth rates persist. 1,2

Disparities in Teen Birth Rates

Teen birth rates declined from 2018 to 2019 for several racial groups and for Hispanics. 1,2 Among 15- to 19-year-olds, teen birth rates decreased:

5.2% for Hispanic females.

5.8% for non-Hispanic White females.

1.9% for non-Hispanic Black females.

Rates for non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic Asians, and non-Hispanic Native Hawaiian, and other Pacific Islander teenagers were unchanged.

In 2019, the birth rates for Hispanic teens (25.3) and non-Hispanic Black teens (25.8) were more than two times higher than the rate for non-Hispanic White teens (11.4). The birth rate of American Indian/Alaska Native teens (29.2) was highest among all race/ethnicities. 1

Birth Rates for Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019

Data source: Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1-50.

Geographic differences in teen birth rates persist, both within and across states. Although among states with low overall teen birth rates, some counties have high teen birth rates. ⁶

Social determinants of health, such as low education and low income levels of a teen's family, may contribute to high teen birth rates. ⁷ Teens in certain settings are at higher risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant than young women not in foster care. ⁸

To improve the life opportunities of adolescents facing significant health disparities and to have the greatest effect on overall US teen birth rates, CDC uses data to inform and direct interventions and resources to areas with the greatest need.

The Importance of Prevention

Teen pregnancy and childbearing are associated with increased social and economic costs through immediate and long-term effects on teen parents and their children.

Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school.¹⁰

The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.¹¹

On a positive note, between 1991 and 2015, the teen birth rate dropped 64%, which resulted in $4.4 billion in public savings in 2015 alone.¹²

Evidence-based teen pregnancy prevention programs have been identified by the US Department of Health and Human Services (HHS) Teen Pregnancy Prevention Evidence Review, which used a systematic process for reviewing evaluation studies against a rigorous standard. The Evidence Review covers a variety of diverse programs, including sexuality education programs, youth development programs, abstinence education programs, clinic-based programs, and programs specifically designed for diverse populations and settings. In addition to evidence-based prevention programs, teens need access to youth-friendly reproductive health services and support from parents and other trusted adults, who can play an important role in helping teens make healthy choices about relationships, sex, and birth control. Efforts at the community level that address social and economic factors associated with teen pregnancy also play a critical role in addressing racial/ethnic and geographical disparities observed in teen births in the United States.

References

1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1-50.

2. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2018. Natl Vital Stat Rep. 2019;68(13):1-47.

3. Santelli J, Lindberg L, Finer L, Singh S. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. 2007;97(1):150-6.

4. Lindberg LD, Santelli JS, Desai S. Understanding the decline in adolescent fertility in the United States, 2007-2012. J Adolesc Health. 2016:1-7.

5. Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health. 2015;56(2):223-30.

6. Romero L, Pazol K, Warner L, et al. Reduced disparities in birth rates among teens aged 15 to 19 Years-United States, 2006-2007 and 2013-2014. MMWR Morbid and Mortal Wkly Rep. 2016;65(16):409-414.

7. Penman-Aguilar A, Carter M, Snead M, Kourtis A. Socioeconomic disadvantage as a social determinant of teen childbearing in the US Public Health Rep. 2013;128(suppl 1):5-22.

8. Boonstra HD. Teen pregnancy among women in foster care: a primer. Guttmacher Policy Review. 2011; 14(2).

9. National Campaign to Prevent Teen and Unplanned Pregnancy, Counting It Up: The Public Costs of Teen Childbearing 2013. Accessed March 31, 2016.

10. Perper K, Peterson K, Manlove J. Diploma Attainment Among Teen Mothers. Child Trends, Fact Sheet Publication #2010-01: Washington, DC: Child Trends; 2010.

11. Hoffman SD. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Washington, DC: The Urban Institute Press; 2008.

12. Power to Decide. Progress Pays Off. Accessed January 10, 2019.

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Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.

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Do females rely on males in a relationship.

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Do females rely on males in a relationship.

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QUALITATIVE:

the idea of women and men gender roles is outdated but it has been placed in a more she does this, and he does that scenario.

Understanding Gender Roles and Their Effect On Our Relationships (verywellmind.com)

QUANTITATIVE:

Relationships are becoming harder to find and trust, and so the rise of dating apps help people find others that meet their wants and needs.

Dating and relationships: Key findings on views and experiences in the US | Pew Research Center

-published by Carla

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QUALITATIVE:

The way criminals think or propose that.

what they committed was right and what values they used to agree with the crime.

Criminals Explain How They Justified Their Crimes to Themselves (vice.com)

QUANTITATIVE:

Five techniques that are used for neutralization are denial of responsibility, denial of injury, denial of the victim, condemnation of the condemners, and appeal to higher loyalties.

Techniques of neutralization: How to rationalize dviant behavior - SozTheo

-Posted by Carla

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Impacts, Treatments, and Statistics of PTSD in the US

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For quantitative research, the article gives statistics about the percentage of people in different categories that have PTSD, categories include sex, age, minorities, etc.

For qualitative research, the article gives some facts as to how trauma can cause PTSD depending on the severeness and also impacts and treatments to PTSD.

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This is an interview with Alex who has ended up with many health problems due to drinking alcohol. As he started drinking at 15, it got worse because it also got him into drugs when under the influence of alcohol. Where he realizes his mistake and stops.

- Jinrui Zhou

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Alex drank as a teenager and his parents didn't mind as long as it wasn't in excess. When he was about fifteen, there were times that his mother worried that he was drinking too much. He had suffered from depression and anxiety during adolescence, and used alcohol to build up his confidence. He is still on medication, although he isn't supposed to drink when he is on his meds.

He says that drinking patterns change when you go to university. You're away from home, living independently, and with more freedom. You don't have to worry about drinking and going home to your family. He drinks every other night and usually with a group of friends.

He and his friends often have fun doing drinking games, where a lot of alcohol is drunk. Alex has never been a regular drug user, but he very occasionally takes cocaine or MDMA when offered it at a friend's house or at a night club. He knows a lot of people who take drugs regularly, especially cannabis. He avoids cannabis now because he had a bad experience with it when he was about fifteen. Nearly every time he has taken drugs, it has been under the influence of alcohol. He says that he probably would be less likely to take drugs when sober. He thinks that he has enough bad habits already, and would rather not get a drug habit in future.

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Alex drinks several nights a week with friends, and occasionally takes drugs under the influence of alcohol. He knows a lot of people who take drugs regularly, especially marijuana (cannabis).

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Statistics of alcoholism on the amount of alcohol consumed in each state and the amount of deaths caused by excessive alcohol consumption in each state.

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This article goes into detail discussing the statistics on the amount of alcohol consumed by both adolescents and adults in each state in the US, and also the deaths caused by excessive alcohol consumption on both adolescents and adults in each state.

- Jinrui Zhou

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Gaming addiction is something that a lot of people have and it isolates people from realty. The qualitative data that can be collected is to see how people who got the addiction behavior changed and see how they socialize with other people. The quantitative data is to see how many hours they could constantly play the games and how long they can stay without it.

https://www.mcleanhospital.org/essential/bullying-kids-teens

Bullying happens to a lot of adolescents and can lead to a lot of problems and , though it happens to a lot of people their is little that people can do to stop it. The qualitative data that can be collected is to see the behavior change in the kids that bully and the ones that are being bullied, and to also her story from people who went through it. The quantitative data is the amount of kids that get bullied on average and how many times it gets caught early.

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Internet and Gaming Addiction: A Systematic Literature Review of Neuroimaging Studies

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In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction. A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches.

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Behavioral impact of single parent households on children.

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Behavioral impact of single parent households on children.

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This source includes how children living in a single parent household shows examples of poor academic performances, low social interactions and emotional and behavioral behaviors.

-Posted by Jayda

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Impacts of children being exposed to domestic violence

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Impacts of children being exposed to domestic violence

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Children who grow up and witness abuse within their home are impacted by this exposure when they're older. These children grow up to struggle with their mental health, such as suffering from depression, PTSD, or anxiety.

Post by Ashley

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For victims of domestic violence -the physical attacks, emotional maltreatment, and other abuse endured are certain to take a toll on well-being.

However, while the horrors of abuse are apparent in primary victims-children who witness the abuse of their mothers, fathers, or other family members, are impacted.

This article will look into the lasting psychological and physical effects of a child's exposure to domestic violence. To reduce the risk of these effects, it is also important to highlight ways that children can be protected from harm's way.

Short-Term Effects of Witnessing Domestic Violence as a Child

As an all-too-common occurrence across the country, domestic violence is an uncomfortable feature of many American homes. An estimated 10 million people are affected by incidents of domestic abuse annually, a number that widens when silent victims, like children, are considered.

In 2010, 1 in 15 children were exposed to cases of intimate partner violence, with a worrying 1 in 3 children also experiencing acts of violence.

The effects of domestic abuse on children may be apparent within a short period of time, while other damages may be noticed in the long run. Some of the immediate effects that children experience after witnessing domestic violence are discussed below.

Children are likely to remain on edge if they are always surrounded by the abuse of one parent by the other. These children will live in bated breath for the next time physical or verbal assault might take place in their home. This can breed a state of perpetual anxiety.

For pre-schoolers who witness this, it isn't uncommon to revert to the habits of younger children. Thumb sucking, bedwetting, increased crying, and whining may result from observing abuse.

School-aged children can develop anti-social traits and may struggle with guilt over the abuse witnessed. These children typically take on the blame for the abuse their parent deals with, a belief that can strongly bruise their self-esteem.

Post-Traumatic Stress Disorder

One of the most devastating effects of domestic violence is its ability to cause post-traumatic stress disorder in children that are raised around it.

Despite being spared from physical abuse, the trauma of domestic violence is enough to cause dangerous changes in the developing brains of children. These changes may cause nightmares, changes in sleep patterns, anger, irritability, difficulty concentrating, and children may sometimes have the ability to re-enact aspects of the traumatizing abuse observed.

Physical Challenges

Mental health strains are a common result of witnessing the abuse of a parent. However, these consequences may sometimes be apparent in their physical well-being.

School-aged children may report headaches and stomach pains which are traceable to the tense situation back home. In infants, there is a higher risk of experiencing physical injury following the constant stream of abuse on a parent.

Aggressive Behavior

When teenagers witness domestic abuse, they tend to act out in reaction to the situation . They may fight, skip school, engage in risky sexual activities, or dabble in drugs and alcohol. These teenagers are also very likely to get in trouble with the law.

Physical Abuse

In many instances, children that live in abusive households are also likely to fall victim to this treatment themselves.

An abusive partner can very easily become an abusive parent or guardian-physically, verbally, and emotionally harming their children.

Long-Term Effects of Witnessing Domestic Violence as a Child

As helpful as distance might be, simply moving away from domestic violence isn't enough to undo the damage caused by witnessing it.

Children that grew up watching a parent experience abuse are likely to deal with effects that last well into adulthood. Some of the long-term effects that children experience after witnessing domestic violence are addressed below.

Depression

The anxious child raised in a toxic, abusive environment may grow to become a depressed adult. The trauma of routinely witnessing domestic violence places children at a high risk of developing depression, sadness, concentration issues, and other symptoms of depression into adulthood.

Health Problems

A poor diet or environmental risks may not always be the primary causes of conditions like heart disease, obesity, and diabetes in adulthood.

In some cases, these illnesses have direct links to the physical, emotional, and verbal abuse a child witnesses or is subjected to.

Repeating Abusive Patterns
While abusive behavior can be repetitive, it's important to note that abuse does not always occur in a cyclical pattern. In fact, assuming that violence occurs in cycles can lead to victim-blaming. Abuse can be unpredictable and is it never OK.
Feeling the pain and anguish of witnessing violence doesn't always guarantee that children will toe a different path. In some cases, early exposure to abuse simply sets the stage for children to walk that same line in adulthood.

In these cases, male children might physically abuse their partners after watching their fathers do the same. Likewise, women from homes that witness domestic violence are more likely to be sexually assaulted by their partners in adulthood.

Protecting Children from Domestic Abuse

Knowing that domestic violence can have lasting effects on the physical, mental, and later life of children-it's important to properly shield them from abuse. The following are ways to protect a child from domestic abuse.

Make Safety a Priority

One of the best ways to protect the interest and well-being of a child is for victims to receive the necessary support they need to leave the abusive environment.

By doing this, children are spared further exposure to violence and are given a chance to grow up within healthier structures.

Teach Children Healthy Relationship Dynamics

With a skewed view about romantic dynamics, talking to children about healthier interactions between partners can help to manage the damage caused after witnessing domestic violence.

Children should be taught healthy ways to resolve disputes in friendships. It's important that they learn wholesome ways that partners can relate with each other, taking care to share why violence has no place in relationships.

Educating Children About Boundaries

An effective way to manage the damage, and prevent a cycle of domestic violence is to teach children healthy boundaries.

Teaching children about autonomy (that no one has a right to touch their bodies or vice-versa) is a step in the right direction. Children should also be taught to always tell a trusted adult if another person is making them uncomfortable in any way.

A Word From Verywell

Domestic violence has the potential to leave lasting marks on direct and indirect victims. With psychological challenges like anxiety and depression likely to develop from domestic violence- receiving appropriate care from a mental health professional can help to manage these effects in children. Therapy can also help with navigating the emotional strain and trauma of living in a toxic environment.

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How Witnessing Domestic Violence Affects Children

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Domestic violence can have many negative mental and physical effects on children. Learn the short and long-term effects of witnessing domestic violence as a child.

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Cyberbullying is the threating or disrespecting of another person via electronic devices. Its just as impactful on a person as bullying is. Its been proven that people who cyberbully were formerly bullied in real life.

By: Juliana B

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In recent years, the term 'cyberbullying' has become relatively common in the media, often cited as a contributor to several high-profile suicides of young adolescents. A review of the literature published in 2010 ( 1) showed that no articles referenced 'cyberbullying' before 2004, confirming its recent emergence. There is no universally accepted definition; however, most definitions describe a repeated activity conducted via electronic means with an intent to cause psychological torment.

Cyberbullying can take many forms. It can include harassment (insults or threats), spreading rumours, impersonation, outing and trickery (gaining an individual's trust and then using online media to distribute their secrets) or exclusion (excluding an individual from activities). These activities can be performed via e-mail, instant messaging, text message, social networking sites such as Facebook or Tumblr, and other websites ( 2).

The prevalence of cyberbullying and cyberbullying victimization is difficult to accurately determine. The variable definitions and the typical challenges of accounting for self-reported activities contribute to this difficulty. A study conducted in the United States involving nearly 4000 students in grades 6 to 8 showed that in the preceding two months, 11% of the students had been cyberbully victims, 4% reported acting as cyberbullies, and 7% had been both a cyberbully and a cyberbully victim ( 3). In a Canadian study published in 2010 involving >2000 students in grades 6, 7, 10 and 11, 25% reported experiencing a cyberbullying event in the previous three months. Eight percent reported acting as a cyberbully, and 25% reported being both a cyberbully and cyberbully victim. The authors postulated that the rates were higher in their study because they did not describe the activity as 'cyberbullying', but instead asked about specific behaviours (name calling, threatening, spreading rumours, etc) ( 4).

Cyberbullying differs from traditional bullying in several key ways. Perhaps the most obvious is that it requires some degree of technical expertise - children who are not 'plugged in', either through computer, cell phone or video games, do not partake in cyberbullying, either as bullies or victims. Cyberbullying also provides anonymity to the bully not possible with traditional bullying. Because of this, bullies cannot see the reactions of their victims and studies have shown that they feel less remorse ( 5). Cyberbullying is opportunistic because it causes harm with no physical interaction, little planning and small chance of being caught. Despite this, 40% to 50% of cyberbully victims report knowing who their tormentor is ( 3).

Cyberbullying can be more pervasive than traditional bullying. While traditional bullying is generally limited to school and home is a reprieve, victims of cyberbullying can be reached anywhere, anytime, and the potential audience is huge. This is compounded by the fact that there is a lack of supervision. With traditional bullying, teachers are regarded as enforcers. With cyberbullying, there is no clear authority, and children express reluctance to tell adults for fear of losing computer privileges or being labelled as an informer ( 6).

Studies have also shown that there is a large amount of overlap among traditional bullying and cyberbullying behaviours. Children who act as cyberbullies report high rates of being a traditional bully, and are also traditional and cyberbully victims. Cyberbully victims report high rates of traditional victimization, but are also involved in traditional bullying and cyberbullying activities ( 3, 7).

The relationship between traditional bullying and cyberbullying is not well understood, but what is clear about children involved in cyberbullying is that they report high rates of Internet use. Juvonen and Gross ( 8) found that cyberbully victims were significantly more likely to be heavy Internet users (>3 h/day) than noncyberbully victims (OR 1.45). A study by Mishna et al ( 4) published in 2012 found that cyberbullies, cyberbully victims and cyberbully/victims were significantly more likely to use the computer for >2 h/day versus students who were not involved in cyberbullying activities.

WHAT ARE THE EFFECTS OF CYBERBULLYING?

Affected children have reported varying rates of informing authorities regarding cyberbullying (2% to 40% would tell a teacher). When asked if they would inform a friend, studies have reported rates of 13% to 74%. When asked about telling a parent, rates vary from 9% to 57%. Anywhere from 9% to 25% of children reported they would not tell anyone about being cyberbullied. Approximately 50% of children report using prevention tactics such as blocking a screen name, changing passwords or restricting their buddy list ( 6, 8, 9).

Cyberbullying behaviour has negative effects on both the victim and the bully. The negative effects increase with the frequency, duration and severity of cyberbullying. Victims who endure frequent cyberbullying can experience a decline in academic performance, begin 'acting out' and some report difficulties at home. These children are at increased risk for depression, anxiety and externalized negative behaviours, as well as an increased risk for suicide ( 10, 11).

As previously mentioned, cyberbullies feel a lack of remorse and have more behavioural difficulties (police contact, property damage, school absenteeism, low grades) than children who are not involved in cyberbullying ( 5, 12). One study has shown that children who act as cyberbullies are also at increased risk for suicide, although they score lower on measures of suicidal ideation than their victims ( 11). Children who are both a cyberbully and a cyberbully victim are at risk for the emotional difficulties associated with being a victim, as well as the behavioural difficulties associated with being a bully ( 13).

CYBERBULLYING AND THE LAW

In Canada, there are currently no laws specifically addressing cyberbullying. A Cybercrime Working Group established in 2012 identified several sections of the Criminal Code that could allow charges relating to cyberbullying, but noted that the Code needed to be modernized to include messages sent via electronic means. The Working Group also recommended a new criminal offense relating to the nonconsensual distribution of intimate images be created. These changes were included in Bill C-13, Protecting Canadians from Online Crime Act, which was introduced in 2013. The bill criminalizes the nonconsensual distribution of intimate images, and updates terminology regarding telecommunications technologies by removing reference to radio, telegram and telephone. This allows for harassment charges to be filed when messages are sent via any electronic means ( 15).

There are privacy concerns regarding Bill C-13 because it also deals with lawful access legislation. The bill, among other things, would allow police to request personal information from Internet service providers without a warrant through a 'preservation demand' ( 15). The Canadian Bar Association has recommended that a preservation demand be allowed only in exigent circumstances, and only for a short period of time until a warrant can be obtained. Overall, the Canadian Bar Association has recommended that the bill be split into two: a bill specific to cyberbullying, and another specific to lawful access. This would enable timely passage of the bill on cyberbullying while allowing for debate and changes to protect privacy in the lawful-access bill ( 16). This has not occurred, and Bill C-13 remains before the government. It has not yet become law.

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In recent years, the term 'cyberbullying' has become relatively common in the media, often cited as a contributor to several high-profile suicides of young adolescents. A review of the literature published in 2010 ( 1) showed that no articles referenced 'cyberbullying' before 2004, confirming its recent emergence.

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How divorced/separated parents affect there child's behavior? (Quantitative data)

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How divorced/separated parents affect there child's behavior? (Quantitative data)

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This research shows that children from divorced families often face more behavioral issues, including school behavior, conflict handling, sexual practices, crime, drugs/alcohol, and suicide, compared to those from intact married families, with low conflict being beneficial for later life development.

-Donella Brown

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Children of divorced or separated parents exhibit increased behavioral problems, and the marital conflict that accompanies parents' divorce places the child's social competence at risk. Even in intact families that have low to medium levels of conflict, children still have "fewer behavior problems than those in the high-conflict, disrupted families." Another study suggests that parental conflict affects the outcomes of children's behavior problems, regardless of parents' marital status, and sometimes "there is no statistical difference in the level of behavior problems observed for children whose parents separated or divorced and for children whose parents remained together." Overall, young adults are best off when raised by two continuously married parents with a low-conflict relationship.

During a divorce, conflict between parents is often accompanied by less affection, less responsiveness, and more inclination to punish their children, which leaves their children feeling emotionally insecure. These children are more likely to perceive their social milieu as unpredictable and uncontrollable. Children who engage in fighting and stealing at school are far more likely to come from broken homes than are well-behaved children. Children of divorced families are more than twice as likely to drop out of high school than children from intact families. Other studies have confirmed that children of divorced parents exhibit more behavioral problems than do children from intact families. Boys whose parents divorced while they were in elementary school tend to develop problems in the years following their parents' separation. While problem behavior increases immediately following the divorce among boys whose parents divorced while they were in middle school, their problem behavior steadily decreases in the year after the divorce.

Divorce and separation correlate positively with diminished school achievement and performance. Children from intact families have fewer behavioral problems in school. For example, first-grade children born to married mothers are less likely to exhibit disruptive behavior, such as disobeying a teacher or behaving aggressively towards peers, than children born to cohabiting or single mothers.

According to the National Survey of Children's Health, children who live with both biological parents are less likely to exhibit behavior problems than those who do not. (See Chart)

Similarly, the National Longitudinal Study of Adolescent Health shows that adolescents from intact married families are less frequently suspended, expelled, or delinquent, and less frequently experience school problems than children from other family structures. (See Chart)

Divorce diminishes children's capacity to handle conflict. The difference between marriages that remain intact and those that end in divorce lies primarily in the couple's ability to handle marital conflict and move towards agreement. Parental modeling in divorce diminishes many children's capacity for stable marriage later in life, though some children may react by doubling their efforts to ensure stability.

For instance, compared to students from intact families, college students from divorced families use violence more frequently to resolve conflict and are more likely to be aggressive and physically violent with their friends, male or female. Parental divorce during adolescence frequently leads to more violent partnerships in adolescence and adulthood.

In their own marriages, children of divorced parents are more likely to be unhappy, to escalate conflict, to communicate less, to argue frequently, and to shout or to physically assault their spouse when arguing. Thus, the likelihood of divorce is transmitted across generations.

According to the National Longitudinal Study of Adolescent Health (Waves I and II), 42.6 percent of adolescents living with one biological, cohabiting parent have been in a fight, whereas only 28.8 percent of those with two married parents have ever been in one. Among other family structures, 32.3 percent of adolescents living in stepfamilies, 36.7 percent of those living with two cohabiting biological parents, 39.5 percent of those whose parents are divorced, and 39.6 percent of those whose parents have never married have ever been in a fight. (See Chart )

(See Effects of Divorce on Children's Sexual Activity)

When parents divorce, their children's approval of premarital sex, cohabitation, and divorce tends to rise dramatically, while their endorsement of marriage and childbearing falls. They are also more likely to believe that marriage is not important prior to having children and to have a child out of wedlock. This holds true even after controlling for socioeconomic status.

(See Effects of Family Structure on Crime)

Children in intact families have lower rates of delinquency than children in non-intact families. Robert Sampson (then professor of sociology at the University of Chicago) reported, after studying 171 cities in the United States with populations over 100,000, that the divorce rate predicted the robbery rate of any given area, regardless of its economic and racial composition. In these communities, he found that lower divorce rates indicated higher formal and informal social controls (such as the supervision of children) and lower crime rates.

In 1994, it was reported in Wisconsin that the incarceration rate of juvenile delinquents was 12 times higher among children of divorced parents than among children of married parents. A 2004 study showed that children from stepparent and single mother families also have significantly higher incarceration rates than children in intact families. In a British longitudinal study of males aged eight to 32, David P. Farrington, professor of criminology at Cambridge University, found experiencing parental divorce before age 10 to be a major predictor of adolescent delinquency and adult criminality. Another study found that boys who go through family transitions at the age of 14 or 15 are more likely to be delinquent when they are 16 or 17. Adolescents from divorced families (particularly those in divorced single-father families) display more antisocial and violent behavior than adolescents in biologically intact families. An Australian parliamentary review of the literature found that divorce increases the likelihood that children will feel hostility and rejection.

Children of divorced parents are significantly more likely than children of intact married families to be delinquent by age 15, regardless of when the divorce took place. A 1985 study that tracked one thousand families with children ages six to 18 for six years found that children living in intact married families exhibited the least delinquency, while children with stepfathers were more likely to exhibit the most disruptive behavior. In this study, the behavior of single-parent children fell between that of children of intact and stepfather families.

Parental divorce contributes to what some studies term "externalizing behaviors," which include weapon carrying, fighting, substance abuse, and binge drinking. Another study found that the sons of divorced parents are at no greater risk of involvement in delinquent behavior than boys living in intact families if the mother and father "engage in competent parenting." Good parenting on the part of divorced fathers achieved no such effects for the daughters of divorce, according to this same study. Among adolescent girls, there is a strong correlation between family structure and delinquency, hostile behavior, drug use, larceny, skipping school, and alcohol abuse.

According to the National Longitudinal Study of Adolescent Health, 13 percent of children who live in an intact married family admit to having stolen at least $50 worth of goods. By comparison, 19 percent of children whose parents never married or are divorced, 20 percent of children living with a stepparent, 15 percent of those living with cohabiting biological parents, and 23 percent of those living with one cohabiting biological parent have stolen at least $50 worth of goods. (See Chart Below)

Parental divorce (as previously stated) predicts externalizing behavior, such as tobacco use, alcohol consumption and binge drinking, and marijuana use. Parental divorce or separation also predicts increased adolescent use of other illegal drugs. The negative effects of divorce on adolescent substance use are not temporary, and tend to persist over time.

Men who experienced their parents' divorce as children (between ages seven and 16) are more likely to smoke as adults. Males who have experienced parental divorce are also more likely to use alcohol and drugs. Women who experienced parental divorce between ages seven and 16 (but not those whose parents divorced later) are more likely to smoke and to drink heavily as adults than women whose parents remained married. One study found that, in families where the mother-daughter relationship was satisfying, parental divorce and maternal nonresidence led to delinquent behavior in girls.

According to the National Longitudinal Study of Adolescent Health (Waves I and II), children who live with both biological parents are less likely to get drunk than adolescents with stepparents, one biological cohabiting parent, or divorced parents. (See Chart Below)

According to the National Longitudinal Study of Adolescent Health, more than 15 percent of adolescents whose parents are divorced have used hard drugs; this figure rises to roughly 18 percent for children living with a stepparent or one biological cohabiting parent. (See Chart)

Child suicide is often triggered by thoughts that his divorced parents reject him or have lost interest in him. The fact that the suicide rate has risen along with the divorce rate is no coincidence. One study reported that risk of a suicide attempt was higher in divorced families, though the association was eliminated after controlling for adverse experiences. As the work of Patricia McCall, a sociology professor at North Carolina State University, shows, the strongest demographic indicator of suicide is the family structure within which a person resides: the divorced family structure has the highest suicide rate. For adults, having children decreases the parents' risk of suicide.

Women from divorced families are 1.46 times as likely to attempt suicide as women from intact families. An earlier study by the same author found that women raised in divorced families are 1.33 times as likely to attempt suicide; this finding holds true even after adjusting for various confounding factors, such as age, race, and income. This link between parental divorce and the rise in adolescent suicide has been found again and again in the literature. Cross-cultural studies of Japan and the United States have clearly demonstrated the link between divorce and suicidal thought.

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Effects of Divorce on Children's Behavior

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Children of divorced or separated parents exhibit increased behavioral problems, and the marital conflict that accompanies parents' divorce places the child's social competence at risk. Even in intact families that have low to medium levels of conflict, children still have "fewer behavior problems than those in the high-conflict, disrupted families."

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QUALITIVE DATA

This article is about how narcissist tend to isolate themselves in order to avoid certain feelings. More specifically how in order to avoid negative emotions like rejection, narcist tend to avoid social relations.

WRITTEN BY: BRAN'NIYA MYRICK

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Vulnerable Isolation and Enmity Concept: Disentangling the blue and dark face of vulnerable narcissism

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A theoretical model of the vulnerable half of the Narcissism Spectrum Model (NSM) - the Vulnerable Isolation and Enmity Concept (VIEC) is presented in...

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Quantitative Data On Social Media effects on Mental Health

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Quantitative Data On Social Media effects on Mental Health

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This research data shows off the link between mental health and social media. In which ways it benifit's and detriment peoples mental health.

------Nichita H Posted

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ABSTRACT

While becoming inextricable to our daily lives, online social media are blamed for increasing mental health problems in younger people. This systematic review synthesized evidence on the influence of social media use on depression, anxiety and psychological distress in adolescents. A search of PsycINFO, Medline, Embase, CINAHL and SSCI databases reaped 13 eligible studies, of which 12 were cross-sectional. Findings were classified into four domains of social media: time spent, activity, investment and addiction. All domains correlated with depression, anxiety and psychological distress. However, there are considerable caveats due to methodological limitations of cross-sectional design, sampling and measures. Mechanisms of the putative effects of social media on mental health should be explored further through qualitative enquiry and longitudinal cohort studies.

Introduction

Children and adolescent mental health

Reasons for the apparently growing psychological morbidity in young people are not known conclusively. McCrae ( Citation2018) suggests that diagnostic activity has been influenced by educational initiatives to raise mental health awareness. Undeterred by stigma, many young people feel free to discuss their psychological difficulties and seek professional help. Another important factor is the ease of sharing personal experiences in the digital information age (Reid-Chassiakos, Radesky, Christakis, & Moreno, Citation2016). Whereas in the past mental health problems were suffered in isolation, today a struggling younger person can readily find others with similar problems, either through social interaction or support groups. Alongside increasing awareness and help-seeking behaviour, doctors may be more inclined to diagnose and treat mental health problems, possibly with the effect of lowering the diagnostic threshold.

Social media

The term 'social media' refers to the various internet-based networks that enable users to interact with others, verbally and visually (Carr & Hayes, Citation2015). According to the Pew Research Centre ( Citation2015), at least 92% of teenagers are active on social media. Lenhart, Smith, Anderson, Duggan, and Perrin ( Citation2015) identified the 13-17 age group as particularly heavy users of social media users, with 87% having access to a computer, and 58% to a tablet device. Almost three-quarters of adolescents aged 15 to17 use a smartphone, and 68% of those aged 13 to 14 (Pew Research Centre, Citation2015).

Impact on mental health

Understanding the impact of social media on adolescents' well-being has become a priority due to a simultaneous increase in mental health problems (Kim, Citation2017). Problematic behaviours related to internet use are often described in psychiatric terminology, such as 'addiction'. However, some activity in younger people could be misconstrued as abnormal. For example, young people who frequently post images of themselves ('selfies') may appear narcissistic, but such behaviour has emerged as a social norm in younger social networks (McCrae, Citation2018). Nonetheless, warnings have been issued by psychologists and other experts on how younger people are engaging with social media and related impairment to personal and social development (Greenfield, Citation2014; Twenge, Citation2006).

Current study

This systematic review examined evidence for the influence of social media use on depression, anxiety and psychological distress in adolescents. The intention was to inform policy and practice and to indicate further research on this topic.

Method

Protocol and registration

For transparency, the protocol for this review was registered with the International Prospective Register of Systematic Reviews (Prospero; CRD42018102770). This report follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher, Liberati, Tetzlaff, & Altman, Citation2009a).

Eligibility criteria

For inclusion in this review, studies fulfilled the following eligibility criteria:

Participants: aged 13 to 18

Exposure: measurement of social media use

Outcome: depression, anxiety or psychological distress, assessed by validated instruments

Studies published in peer-reviewed journals with full text available in English

Studies were excluded if they crossed either boundary of the age range. Studies measuring exposure to other internet activities such as video-gaming were not included unless social media use was also measured. Outcomes of substance misuse, eating disorder, well-being, life satisfaction, self-esteem, body image problems, conduct disorders, loneliness or stress were excluded, unless the outcomes of interest were also measured by the researchers.

Search strategy

The databases Medline, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health (CINAHL) and Social Sciences Citation Index (SSCI) were systematically searched in May 2018. A set of search terms was created with truncations, Medical Subject Headings (MESH) and Boolean operators, as shown in Table 1.

Data extraction

All papers from the automated database searches were collated using the Mendeley reference management software. After duplicates were deleted, screening was conducted to ensure that studies fulfilled the eligibility criteria. In a three-stage process, papers were screened on title and on abstract (by BK) and the remaining papers were screened on full text (by BK, NM and AG). Key information relevant to the research question was systematically extracted and tabulated to aid comparison and synthesis of the studies. These data comprised authors, publication date, country of origin, study design and data analysis method, relevant outcome measures, sample size, demographic data and results. The extraction process was conducted by BK and AG and any disagreements resolved through discussion with NM.

Assessment of quality

The quality of eligible studies was assessed using the National Institutes of Health Quality Assessment tool for Observational Cohort and Cross-Sectional Studies (NIH, Citation2014), which covers design, selection bias, data collection, confounders, blinding and attrition. An overall rating of 'good', 'fair' or 'poor' was given for each study. All of the studies were independently rated by BK and AG, and any disagreements were resolved through discussion with NM.

Data analysis

As outcome measures varied across the studies, we were unable to perform meta-analysis. Instead, narrative synthesis was conducted. This enabled consideration of confounding, mediating and moderating variables, which are often not given due attention in meta-analysis (Popay et al., Citation1995). Each study was described, followed by comparative analysis and synthesis.

Results

The literature search yielded 6598 articles from the five databases. After 1818 duplicates were removed, screening on title excluded 4206 of the 4780 unique papers. The remaining 574 articles were screened on abstract, with 475 removed, leaving 99 papers. On reading the full text, 86 papers found to be ineligible, the most common reason being the age range. The PRISMA (Moher, Liberati, Tetzlaff, & Altman; The PRISMA Group, Citation2009b) flowchart ( Figure 1) provides further detail on reasons for exclusion. Ultimately a total of 13 papers were eligible for the review.

Description of studies

The reviewed papers are summarized in Table 2. In design, 12 studies were cross-sectional and only one was longitudinal. The total sample across the studies was 21,231. Three studies were conducted in Australia, three in China, and one each in Serbia, USA, Malaysia, Belgium, Thailand and Canada; one study was conducted in six European counties including Greece, Spain, Poland, the Netherlands, Romania and Iceland. Participant ages ranged from 13 to 18. Nine studies covered exposure to social media in general, while four studies (Banjanin, Banjanin, Dimitrijevic, & Pantic, Citation2015; Dumitrache, Mitrofan, & Petrov, Citation2012; Frison & Eggermont, Citation2016; Hanprathet, Manwong, Khumsri, Yingyeun, & Phanasathit, Citation2015) focused specifically on Facebook use. As well as measuring depression, anxiety or psychological distress, some studies investigated confounding variables (e.g. age and gender) and mediating and moderating factors (e.g. insomnia, rumination and self-esteem). Ten of the studies entailed both correlational and regression analyses; one study (Dumitrache et al., Citation2012) performed correlational analyses and a t-test for gender differences; Vernon, Modecki, and Barber ( Citation2017) used latent growth modelling to test longitudinal mediation.

Quality assessment

The aim was clearly stated for almost all of the studies, but generally, the methodological quality was poor to fair ( Table 3). The cross-sectional design of 12 studies is susceptible to three common sources of bias: selection, information and confounding bias (Yu & Tse, Citation2012). Two studies (Barry et al., Citation2017; Wang et al., Citation2018) recruited by convenience sampling, which raises the risk of selection bias. O'Dea and Campbell ( Citation2011) omitted their sampling procedure. Apart from Hanprathet et al. ( Citation2015), the papers did not state or explain their intended sample size, of which two were small (Barry et al., Citation2017; Dumitrache et al., Citation2012). Five studies did not report the participant response rate. Barry et al. ( Citation2017) had a response rate of 33%, which increases the risk of bias and limits generalizability of the results.

Analysis of results

Key findings of the studies were classified into four common domains of exposure to social media: time spent, activity, investment and addiction. Time spent refers to the amount of time that users spent on social media. Activity can be defined as the quality and quantity of users' engagement and interaction with social media sites and other users. Investment refers to the act of putting effort and time into social media whereas addiction refers to the state of being dependent on social media. For each domain we discuss the relationship with depression, anxiety and psychological distress, with reference to confounding, mediating or moderating variables if measured.

Time spent

The studies produced opposing evidence on the relationship between time spent on social media and mental health problems. With an Australian sample, O'Dea and Campbell ( Citation2011) found an inverse correlation for psychological distress; no relationship between frequency of social media use and depressed mood was reported by Neira and Barber ( Citation2014) in another study in Australia, and Banjanin et al. ( Citation2015) in Serbia. By contrast, Sampasa-Kanyinga and Lewis ( Citation2015) in Canada found that daily social media use of over two hours was associated with psychological distress. A study of 10,930 adolescents from six European countries by Tsitsika et al. ( Citation2014) showed a positive relationship between heavy social media use and both depression and anxiety. Yan et al. ( Citation2017) found that time spent on social media was associated with anxiety in Chinese adolescents.

Activity

Frison and Eggermont ( Citation2016) found that both active and passive use of Facebook, in a sample of Belgian high school pupils, correlated with an increased frequency of depressed mood. In a study of 113 adolescent-parent dyads, Barry et al. ( Citation2017) found that data from parents showed correlation between adolescents' social media activities (i.e. number of accounts, frequency of checking for messages) and both anxiety and depression. However, Banjanin et al. ( Citation2015) did not find any relationship between social media activities (i.e. number of 'selfies') and depression in Serbian high school pupils.

Investment

Dumitrache et al. ( Citation2012) found a significant correlation between the number of identity-related information on Facebook profiles and depressive tendencies in adolescents. The studies by Neira and Barber ( Citation2014) and by Vernon et al. ( Citation2017), both using secondary data from the Youth Activity Participation Study of Western Australia, investigated the relationship between investment in social media and depressed mood. The cross-sectional study by Neira and Barber ( Citation2014) showed that investment in social media sites was associated with an increased depressed mood. Vernon et al. ( Citation2017) conducted a longitudinal investigation and found an association between problematic social media investment and depressed mood, with sleep disruption as a mediating variable.

Addiction

Three studies focused on addictive behaviour. Hanprathet et al. ( Citation2015) found a significant association between Facebook addiction and depression among 972 high school pupils in affluent districts in Thailand. A study of Chinese secondary school students by Li et al. ( Citation2017) showed a mediating influence of insomnia on the statistically significant relationship between social media addiction and depression. In another study in China, Wang et al. ( Citation2018) found that social networking sites addiction was positively associated with depression; rumination mediated the relationship between social networking sites addiction and depression while self-esteem moderated this mediating effect. In other words, low self-esteem compounded the impact of addiction on depression through rumination.

Confounding factors

Four studies measured the effect of gender in the relationship between social media-related variables and mental health outcomes. Neira and Barber ( Citation2014) found that social media might have negative aspects for female youth while being a positive leisure activity for male youth. Frison and Eggermont ( Citation2016) found that girls who passively use Facebook and boys who actively use Facebook in a public setting were more likely to be affected by the negative impacts of Facebook. Banjanin et al. ( Citation2015) did not find any significant effect of gender in the relationship between depression and time spent on social media. Similarly, Barry et al. ( Citation2017) did not find any change in the analysis when controlling for gender in the relationship between social media use and depression as well as between social media use and anxiety.

Two studies measured the effect of age. Tsitsika et al. ( Citation2014) found a significant effect of age in the relationship between heavy social media use and negative internalizing symptoms (anxious/depressed, withdrawn/depressed), with younger heavier social media users being more likely to experience internalizing symptoms compared to older heavier users. Banjanin et al. ( Citation2015) did not find any significant age effect in the relationship between depression and time spent on social media.

Discussion

This systematic review examined the evidence for a putative relationship between social media use and mental health problems in adolescents. In the 13 studies, depression was the most commonly measured outcome. The prominent risk factors for depression, anxiety and psychological distress emerging from this review comprised time spent on social media, activities such as repeated checking for messages, personal investment, and addictive or problematic use.

Although results of the studies were not entirely consistent, this review found a general correlation between social media use and mental health problems. However, most authors noted that the observed relationship is too complex for straightforward statements. Few studies were designed to explore this complexity although some assessed the effect of mediating and moderating factors. Insomnia and other sleep-related factors were most frequently reported as mediators of the relationship between social media use and depressed mood (Li et al., Citation2017; Vernon et al., Citation2017). Perceived social support (Frison & Eggermont, Citation2016) and rumination (Wang et al., Citation2018) were other mediating factors reported in the studies. Researchers suggested further investigation of these factors, and other factors such as personal traits (O'Dea & Campbell, Citation2011), socio-cultural factors that influence the roles of and expectations from adolescents in family and society, environmental factors which may affect development of adolescents and social skills (Tsitsika et al., Citation2014), motivations for social media use (Barry et al., Citation2017; O'Dea & Campbell, Citation2011), social comparison and peer feedback (Neira & Barber, Citation2014), self-esteem (Banjanin et al., Citation2015), contextual factors, lack of physical activity, and cyberbullying (Sampasa-Kanyinga & Lewis, Citation2015).

Other important findings of this review suggest that particular attitudes or behaviours (e.g. social comparison, active or passive use of social media, motives for social media use) may have a greater influence on the symptoms of depression, anxiety and psychological distress than the frequency of social media use or the number of online friends. Although there is evidence of a relationship between time spent on social media and depression as well as social media-related activities and depression, contrary findings have also emerged. For example, Banjanin et al. ( Citation2015) found no relationship between the amount of time spent on social media and depression, or between social media-related activities such as the number of online friends and the number of 'selfies' and depression. Similarly, Neira and Barber ( Citation2014) found that while higher investment in social media (e.g. active social media use) predicted adolescents' depressive symptoms, no relationship was found between the frequency of social media use and depressed mood. Such mixed findings might be explained by confounders, mediators and moderators as discussed above.

This systematic review also sheds light on the influence of age and sex. Although some studies found that these variables had no effect on the relationship between social media use and mental health problems, other studies showed that girls and younger adolescents are more prone to depression and anxiety. Further investigation is needed to assess the effects of age and gender.

Limitations

Although the results of this systematic review contributed to the existing literature in a way of providing considerable evidence for the mental health impact of social media use by focussing on not only the symptoms of depression but also other related outcomes including anxiety and psychological distress among adolescents who are at higher risk of developing anxiety and depression. Several limitations in the evidence emerged from included studies and review process have been identified. First, 12 out of 13 studies did not answer the review question since they were cross-sectional and unable to determine a causal relationship between the variables of interest. Looking evidence emerged from cross-sectional studies, it is not possible to decide whether social media use causes depression, anxiety and psychological distress, or whether those with depression, anxiety and psychological distress are more likely to spend more time on social media; have addictive and problematic social media use behaviour; have negative interaction with social media; and invest on social media. Only one longitudinal study (Vernon et al., Citation2017) investigated the causal relationship between problematic social media use and change in depressed mood, but this study has also limited to show evidence whether social media use causes depressed mood in adolescents. The study did not use a control and a comparison group to differentiate those who exposed to social media sites and those who not. Therefore, it is difficult to determine whether a change in depressed mood was more in those who exposed to social media more compared to those who less or not.

Second, small sample size and the use of convenience sampling in some studies limited the representativeness of and generalizability to a larger adolescent population. Third, all studies included in this review used self-report measures which may not provide reliable outcomes because of some sources of risk of bias. Participants may show positive self-presentation by over- or under-reporting their social media-related behaviours and some mental health-related items, which may directly or indirectly lead to social desirability bias, information bias and reporting bias. Another identified limitation was that some studies made an investigation towards only Facebook use over other social media sites, which also causes a significant bias and limits the generalizability of findings to other social media sites. Finally, despite the fact that the proposed relationship between social media-related variables, depression, anxiety and psychological distress is complex, few studies investigated mediating factors that may contribute or exacerbate this relationship. Further investigations are needed to explain the underlying factors that help determine why social media has negative impact on some adolescents' mental health whereas it has no or positive affect on others' mental health.

Conclusion

The impact of social media use on incidence of depression, anxiety and psychological distress among adolescents, as examined by this review, is likely to be multifactorial. It is important to distinguish between the terms used for the relationship. It is fair to say that there is an 'association' between social media use and mental health problems, on the basis that this means a socially constructed reality. But this is not necessarily scientifically valid. Objective researchers investigate correlations rather than accepting socially assumed truths. Correlation is statistical, not phenomenal. Thirdly, there is causation, which requires directional evidence. The latter has not been adequately investigated in this topic, and we must, therefore, state that the relationship is correlational but not conclusively causative.

Key findings of included studies were classified into four categories of exposure to social media: time spent; activity; investment; and addiction. All these categories were found as correlated with depression, anxiety and psychological distress, with an acknowledgement for the complexity of these relationships. Although there are studies which investigated mediating and moderating factors that may contribute or exacerbate the proposed relationship, there are still several underexplored mediators and moderators, which may explain the direction of this relationship. We also identified gaps in literature in terms of methods, study design and sampling. Causality was unclear due to the cross-sectional study design used in almost all studies and the lack of comparison group in the cohort study. Also, the number of quantitative studies in literature is substantially higher than qualitative studies. Through this systematic review, we hope we contribute to the existing literature in the way of addressing the gaps and highlighting the importance of the phenomenon of the mental health impact of social media use on adolescents.

Acknowledgments

The authors would like to thank Dr Sorina Daniela Dumitrache who supplied us the full-text of their study which was not available online. The authors also declare that there is no conflict of interest regarding the publication of this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Betul Keles

Niall McCrae

Annmarie Grealish

References

Achenbach, T. M., & Resorta, L. A. (2001). Manual for ASEBA school-age forms and profiles (pp. 99-107). Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. doi:10.1080/713932693

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Hanprathet, N., Manwong, M., Khumsri, J., Yingyeun, R., & Phanasathit, M. (2015). Facebook addiction and its relationship with mental health among Thai high school students. Journal of the Medical Association of Thailand, 98, S81-S90.

Morgan, C., Webb, R. T., Carr, M. J., Kontopantelis, E., Green, J., Chew-Graham, C. A., ... Ashcroft, D. M. (2017). Incidence, clinical management, and mortality risk following self harm among children and adolescents: Cohort study in primary care. BMJ (Online), 359. doi:10.1136/bmj.j4351

Primack, B. A., & Escobar-Viera, C. G. (2017). Social media as it interfaces with psychosocial development and mental illness in transitional age youth. Child and Adolescent Psychiatric Clinics of North America, 26(2), 217-233. doi:10.1016/j.chc.2016.12.007

Rosen, L. D. (2011). Social networking's good and bad impacts on kids. Washington, DC: American Psychological Association. Retrieved from http://www.apa.org/news/press/releases/2011/08/social-kids.aspx(open in a new window)

Vandervoort, D. (1999). Quality of social support in mental and physical health. Current Psychology, 18(2), 205. Retrieved from: https://link.springer.com/content/pdf/10.1007%2Fs12144-999-1029-8.pdf(open in a new window)

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A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents

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While becoming inextricable to our daily lives, online social media are blamed for increasing mental health problems in younger people. This systematic review synthesized evidence on the influence ...

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Quantitative

This article shows numerical information of how throughout the years with the different platforms like social media or video games cyberbullying keeps increasing.

Qualitative

https://youtu.be/qA1TJjJgdz8?feature=shared

This video is about a girl talking about her experience with cyber bullying and how it impacted her and how did she dealt with it.

By Barbara

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17 Cyberbullying Facts & Statistics (2024)

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Cyberbullying and online harassment affect children and adults from all walks of life. Here are the latest stats on cyberbullying, both in the US and worldwide.

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Qualitative: This video shows and describes some of the reasons as to why some people get into unhealthy relationships, whether they realize it or not.

-Daniella Maldonado

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Why People get into Unhealthy Relationships

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Suicide is the 10th leading cause of death in the United States overall, and the second and fourth leading cause among persons aged 10–34 and 35–44 years.

Posted by Jorge Sanchez

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Correspondence to: T Niederkrotenthaler thomas.niederkrotenthaler{at}meduniwien.ac.at

Abstract

Objective To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population.

Design Systematic review and meta-analysis.

Data sources PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019.

Review methods Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed.

Results 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature.

Conclusions Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide.

Systematic review registration PROSPERO CRD42019086559.

Introduction

News reporting of suicide has increased substantially in recent decades. 1 2 3 4 A number of studies have shown that media reports of suicide are associated with increased numbers of suicides. 5 6 7 8 9 10 Media related imitation of suicide has been dubbed the Werther effect, based on a reported spike in suicides in young men in Germany and across Europe after the publication of Goethe's The sorrows of young Werther in 1774, depicting the circumstances leading to the suicide of the male protagonist Werther. 11 More than 150 studies have investigated the effects of suicide related to media reports. 10 Most have used before and after comparisons or time series designs, testing whether media reporting was associated with subsequent changes in suicides at an aggregate level across a region of exposure. The Werther effect is discussed mostly in relation to non-fictional news stories, 8 particularly stories about deaths of celebrities by suicide, 6 and stories with a dramatic or romanticised depiction of suicide, or featuring an explicit and detailed description of a suicide method. 12 13 14

In acknowledgment of the Werther effect, mental health and suicide prevention organisations worldwide, including the World Health Organization, have developed guidelines for responsible reporting of suicide by the media with a specific focus on news and information media. 15 16 These guidelines are now a standard component of many national and regional suicide prevention strategies. 16 Typically included in the guidelines are specific suggestions about ways to minimise harm (eg, by avoiding glorification of suicide, discussions of specific suicide methods, and repeated reporting about the same suicide). The guidelines also recommend including information on the role of treatable mental illness, where and how to seek help for suicidal thoughts, and a message of hope that suicide is preventable. But specific information on individual deaths by suicide continues to be published; the suicide of the actor Robin Williams is an example of the guidelines not being fully followed. 17 18

Controversies around suicide and the media remain, despite a global focus on avoiding the Werther effect and compelling associations in the literature. Research shows that not all media coverage of suicide is associated with subsequent increases in suicides, resulting in a debate lasting decades on the impact of media reporting of suicide on subsequent suicides. 9 10 13 14 19 In several countries that have implemented media guidelines, journalists and media professionals have pushed back, arguing that the body of evidence is not compelling enough to warrant changes to the way suicide is reported. 10 20

Meta-analyses can better quantify the combined evidence of a Werther effect across published studies, but these studies are scarce. One meta-analysis of 10 studies examined media reporting on deaths of celebrities by suicide and found an average increase of 2.6 suicides per million people (95% confidence interval 0.9 to 4.3) in the month after the reports of death. 6 In the largest meta-analysis so far, Stack 9 combined findings from 55 studies examining non-fictional reports of suicide as a predictor of suicide, and found that only 36% identified an apparent Werther effect. This meta-analysis did not, however, define clear inclusion and exclusion criteria; consider the quality of the studies; account for potential duplication of results; and, crucially, involve the abstraction of quantitative data on suicides (as is normally the case). The outcome of the meta-analysis was a binary variable of increase versus no increase in suicides.

Media coverage of celebrity deaths by suicide is a small proportion of all suicide reporting 8 9 10 13 14 and the guidelines make recommendations about all forms of reporting of suicide. 16 Meta-analyses on the effects of general reporting of suicide (that is, any reporting related to suicide) are lacking. General reporting of suicide might involve deaths of celebrities or other individuals, or might include more general discussions on the topic of suicide. These studies typically use broad search terms to identify media reports (eg, suicide or various suicide methods).

The aim of this systematic review and meta-analysis was to examine and quantify the findings from the literature on the Werther effect. We aimed to evaluate the effects of three types of media reporting on suicide on the subsequent incidence of suicide. The primary objective was to summarise the evidence on the association of media reporting of deaths of celebrities by suicide on total suicides over a short period of time (up to two months). The secondary objectives were to summarise the association of media reporting of information about the specific methods used by the celebrities on suicides by the same method, and the association of general reporting of suicide on the total number of suicides. We hypothesised that reporting of the deaths of celebrities by suicide would be associated with an increased incidence of suicide in the general population, and that increases by the same method would be strongest. We did not have a clear hypothesis for general reporting of suicide because of the variety of content, some of which might be harmful and some protective. 13 14 For our meta-analysis, we use the term "intervention" to refer to media reporting of suicide. The study was conducted according to the meta-analyses of observational studies in epidemiology (MOOSE) guidelines.

Methods

Search strategy

We defined news and information media as all non-fictional accounts of suicide on TV, in print, in online news, or in educational non-fiction media (eg, non-fiction books or films). Studies on the effects of searching for suicide related information online (eg, Google searches) were not eligible because these studies do not distinguish between positive (eg, for help services) and negative (eg, pro-suicide websites) searching. 21 We searched PubMed/Medline, Embase, PsycInfo, Scopus, Web of Science, and Google Scholar for relevant studies from their inception to September 2019. These databases show modest to strong overlap in coverage. 22 Google Scholar was used specifically to identify grey literature. 23 We used the search terms suicide (suicid*) AND imitation (Werther; Papageno; copycat; imitat*; contagio*; suggesti*); AND media (media; newspaper*; print; press; radio*; televis*; film*; book*; documentar*; internet; cyber*; web*).

The titles and abstracts of the retrieved articles were screened for relevance, and the full text versions of studies that might meet the inclusion criteria were reviewed. The reference lists of the full text articles were also screened for relevant studies, and a cited reference search was conducted for all relevant primary articles with Google Scholar. English and non-English language articles were included. Non-English articles often had English abstracts, and we used Google Translate and consulted with fluent language speakers to assess the inclusion criteria and extract the data.

Study selection

Studies were eligible for inclusion if they used a before-and-after design, compared single or multiple times before-and-after media reports related to suicide, or an interrupted times series design; if they used death by suicide as the outcome variable; and if they reported non-fictional media stories (that is, stories in news and information media).

Exclusion criteria

We excluded studies that did not have original data. We also excluded studies that examined associations in subgroups of the population because the findings might not be representative of the total population. For our analysis of media reporting on the method of suicide, we excluded studies reporting on an emerging new suicide method if the incidence of the respective suicide method at baseline (that is, before onset of media reporting) was low (<5%). These studies also typically measured possible effects over a longer than usual period of time. We excluded studies that provided only associations for a follow-up period of more than two months, because this is beyond the typical time frame for studying imitation effects, and might be based on mechanisms that are different from imitation. 24 Also excluded were studies with data before the second world war; those with media interventions that were not about suicide; those which applied non-eligible designs; those that were at critical risk of bias; or those that duplicated data from another study.

If studies had duplicated data (data on the same celebrities in the same setting reported in more than one study), we included one study. We selected this using a hierarchical approach based on: (1) the lowest risk of bias; (2) covering the longest period of time or the largest number of celebrities; and (3) the most recent. The 31 studies selected were included in the qualitative and quantitative synthesis (supplementary appendix).

Data extraction

We extracted these data from the studies: study location; study period and length; length of the observation period after media reporting; unit of analysis at which outcome data were measured (eg, daily or weekly); how the media intervention was measured (eg, binary variable representing the presence or absence of reporting or a continuous variable representing the number of news stories); whether the study reported on deaths of celebrities by suicide or general reports of suicide; number of interventions (eg, number of media reports over time); type of media (print media v other forms of media, such as television, online, or mixed media); any outcome reported related to the specific suicide method used in a reported suicide (exclusively or in addition to total suicides); whether the analysis was adjusted or unadjusted for confounders (in addition to any adjustments for seasonal or long term time trends); which confounders were measured and adjusted for; type of estimate extracted (rate ratio or expected and observed suicides); study design (single arm before and after comparison, multiple arm before and after comparison, interrupted time series) 25 26 27 28; analysis technique; method to control for time trends; and source of the outcome data. In a single arm before-and-after comparison, suicides were observed in one group before and after the intervention. In a multiple arm before-and-after comparison, suicides were observed in multiple groups because there were multiple sites for one intervention or one site but multiple interventions occurring at different times. 25

Additional information was obtained for studies of deaths of celebrities by suicide: number of celebrities; type of celebrity (eg, entertainer); and level of recognition of the celebrity (local, international). For level of recognition, we used information from the study and online sources (eg, Wikipedia). Local celebrities were famous in one country or region (eg, a local politician) and international celebrities were known in a western or global context or were described in the original publication as international. A mixed code was used for celebrities with different levels of recognition. For studies looking at increases in the incidence of suicide by the same method as reported in the media, we recorded the suicide method.

We obtained rate ratios and standard errors from each study by one of the following methods:

Extracting directly a rate ratio and either a standard error, 95% confidence interval, t value, or other estimate to calculate a standard error

Using the number of expected and observed suicides to calculate rate ratios and standard errors

Extracting the observed number of suicides in the before and after intervention periods (along with the corresponding times) and calculated rate ratios and standard errors

Obtaining a coefficient and standard error from a linear regression model that was converted to a rate ratio with the study's population at the mid-point

The authors of the original study providing us with rate ratios and standard errors.

For each study, we recorded how the estimate was derived (obtained directly from the study, combined estimates using meta-analysis, or reanalysis of the data by the authors).

We aimed for one quantitative outcome, but two studies (table S1) reported multiple quantitative estimates because the results were presented separately for different news sources. Hence we combined these into one estimate using random effects meta-analysis (see below).

The search strategy was performed by two of the authors (TN and MB). Decisions on excluding studies after full text review were made by TN and separately by MJS. Discrepancies were discussed and resolved. Quantitative data were abstracted by MJS and discussed with TN. Metadata of studies were obtained by TN and MB initially, and separately by MJS. Discrepancies were discussed and resolved among the team.

Risk of bias

Risk of bias was assessed for each study based on the Robins-I tool. 29 This tool was originally designed for non-randomised cohort studies, and does not directly apply to our study designs. The general concept, however, is applicable to interrupted time series designs, 30 and the authors of Robins-I have published on issues that will be looked at in a future version for studies of interrupted time series. 31 We developed a specific adaption for this study with six domains of bias: bias as a result of confounding issues; bias in classification of interventions; bias because of preparatory phases; bias because of missing data; bias in measurement of the outcome; and bias in selection of reported results.

Studies were considered at low risk of bias if all domains were coded as low risk; at moderate risk if at least one domain was coded moderate but none as serious; at serious risk if at least one domain was assessed as serious but none as critical; and at critical risk if any domain was coded as critical. Like an earlier study that applied the Robins-I tool to natural experiments, 30 we found that the first domain, risk of bias as a result of confounding, generally determined the overall risk of bias. This domain comprised coding for subdomains if the number of pre-intervention times was sufficient to allow characterisation of the series; appropriate analysis techniques were used to account for time trends and time patterns; seasonality was accounted for; and possible confounders were measured and controlled for. Risk of bias because of selective reporting was also relevant for some studies. We assessed if the outcome measurement and analyses were clearly defined and consistent in the methods and results sections of the studies, and if there was some risk of selective reporting from multiple analysis methods, multiple follow-up times, or multiple subgroups. The full quality assessment plan is in the supplementary appendix.

As recommended in the Robins-I tool, studies with up to moderate risk were included in the primary and secondary analyses, and studies at serious risk were included in sensitivity analyses only. Studies at critical risk of bias were excluded. Assessments of the risk of bias were based only on the data we abstracted. If the authors provided a reanalysis of their data, for example, only the reanalysis was assessed for risk of bias, not the original study. Similarly, if a study reported total suicides as a side outcome, only the components relevant to the abstracted data (total suicides) were assessed. Our quality ratings, therefore, do not always apply to the original studies. Risk of bias was assessed independently by TN and MJS, and discrepancies were discussed and resolved.

Quantitative data synthesis

We described the studies using descriptive statistics. For our primary analysis, we estimated the pooled rate ratio for the effect of media reporting on deaths of celebrities by suicide on total suicides. We also conducted two secondary analyses. In the first (secondary analysis A), we estimated the pooled rate ratio for reporting about the method used in a suicide by a celebrity on suicide by the same method. In the second (secondary analysis B), we estimated the pooled rate ratio for general reporting of suicide on total suicides. The primary and two secondary analyses were restricted to studies at moderate risk of bias. In sensitivity analyses, we repeated these analyses adding studies at serious risk of bias.

All pooled rate ratios were estimated with a random effects model, with standard errors calculated by the Knapp-Hartung method. 32 Heterogeneity of effect sizes was assessed with the I ² statistic and Cochran's Q test. For I ², values around 25% indicated low heterogeneity, around 50% moderate heterogeneity, and around 75% high heterogeneity. 33 Publication bias was assessed visually by contour enhanced funnel plots 34 and quantitatively with Egger's regression test for asymmetry. 35

Sources of heterogeneity

Meta-regression was used to identify the factors that might contribute to heterogeneity. We conducted univariate meta-regressions for each variable and combined significant variables (P<0.05) into a multivariate model. The meta-regressions were estimated with a random effects model with standard errors calculated by the Knapp-Hartung method. We combined the coefficients algebraically (that is, a linear combination of coefficients presented on the exponential scale) so that we could show rate ratios and 95% confidence intervals in each category of a variable. For the studies in the primary analysis, we examined the period published (up to 2005, 2006-10, 2011-15, 2016 or later), follow-up time (≤14 days, ≥15 days) location (Asia, Europe, North America-Australia), design (multiple arm before-and-after comparison, interrupted time series analysis), length (per 1000 days), period of analysis (day, week, month), adjustment for confounders (no, yes), celebrity recognition (local, international, mixed), celebrity type (entertainer, other), and number of celebrities (1, ≥2). We used similar variables for the studies in secondary analysis A, along with a variable on the method of suicide reported (hanging v other methods) but combined several categories where only one study was available for analysis. We did not conduct a meta-regression for studies in secondary analysis B because heterogeneity was low. All analyses were conducted in Stata 16.0. This study was registered with PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/, registration No CRD42019086559, 18 January 2019).

Patient and public involvement

There were no funds or time allocated for patient and public involvement so we were unable to involve patients. We have invited patients to help us develop our dissemination strategy.

Results

Study characteristics

We retrieved 8823 references and 1496 remained after removal of duplicates ( fig 1). After screening the titles and abstracts, the full texts of 143 studies were assessed and 112 were excluded: 26 because suicide was not an outcome; 30 because of strong data duplication with other studies; 17 because the intervention (media story) was not about suicide; 19 because of reports on emerging suicide methods; five because suicide was analysed only in a population subgroup; and five had data from before the end of the second world war. Also excluded were: two case studies; two studies measuring the outcome for longer than the maximum follow-up; one study about a fictional intervention; and two studies with annual outcome data. After quality assessment, three studies were excluded because of a critical risk of bias. The remaining 31 studies were included in our review: 23 were from database searches, three from Google Scholar, and five from cross reference searches.

Study characteristics are summarised in table 1 and table 2 (and table S1). The 31 studies were published between 1974 and 2019 and examined the period 1947 to 2016. Nineteen studies examined the total number of suicides as the outcome and two examined increases in suicides by the same method reported in the media; 10 studies reported both. Twenty two studies examined media reporting of deaths of celebrities by suicide and nine studies evaluated general reporting of suicide. Studies were from Asia (Taiwan, Hong Kong, South Korea, and Japan), Europe (Austria, Germany, Hungary, the Netherlands, Slovenia, France, and Israel), North America (United States and Canada), and Australia. Most studies (n=20) used an interrupted time series design, 10 a multiple arm before-and-after design, and one a single arm before-and-after design. Seven studies had follow-up of 1-7 days, eight had 8-14 days, 12 had 15-30 days, and four had 31-60 days. The median follow-up time was 21 days (range 1-60 days).

Quality assessment

We classified 24 studies as being at moderate risk of bias because of confounding issues and seven at serious risk of bias. We judged 22 studies as being at low risk of bias because of classification of interventions, six at moderate risk, and three at serious risk. All 31 studies were at low risk of bias because of preparatory phases. Twenty eight studies were at low risk of bias because of missing data, two were at moderate risk, and for one the risk was unknown. Thirty studies were at low risk of bias because of measurement of the outcome, and one was at serious risk. Twenty nine studies were judged to be at moderate risk of bias because of selection of reported results, and two were at serious risk. Overall, 20 studies were assessed as moderate risk and 11 as serious risk of bias (table S2).

Quantitative data synthesis

Figure 2, figure 3, and figure 4 show the forest plots for the primary and secondary analyses. For the primary analysis ( fig 2), on the impact of media reporting of deaths of celebrities by suicide on total suicides, 14 studies met the inclusion criteria. The pooled rate ratio was 1.13 (95% confidence interval 1.08 to 1.18, P<0.001) over a median follow-up of 28 days (range 7-60 days). For the secondary analysis A ( fig 3), on reporting of method of suicide of celebrities on suicides by the same method, 11 studies met the inclusion criteria. The pooled rate ratio was 1.30 (95% confidence interval 1.18 to 1.44, P<0.001) over a median follow-up of 28 days (range 14-60 days). For the secondary analysis B ( fig 4), on the impact of general reporting of suicide on total suicides, five studies met the inclusion criteria and the pooled rate ratio was 1.002 (95% confidence interval 0.997 to 1.008, P=0.25) for a one article increase in the number of reports on suicide. The median follow-up was 1 day (range 1-8 days).

Heterogeneity

Estimates of heterogeneity were large and significant for the primary analysis (I ²=83.5%, P<0.001) and the secondary analysis A (I ²=72.1%, P<0.001) but not for the secondary analysis B (I ²=0.02%, P=0.40). We therefore undertook meta-regressions for the first two sets of studies to identify possible sources of heterogeneity.

In univariate analyses of the 14 studies in the primary analysis, differences in the pooled rate ratios between subgroups were observed for three variables ( table 3): publication date (P=0.04, I ²=29.1%), celebrity type (P=0.009, I ²=47.9%), and number of celebrities under investigation (P=0.009, I ²=47.0%). Weak evidence that reporting of deaths of celebrities by suicide was associated with suicides was found for studies published before 2005 (rate ratio 1.12, 95% confidence interval 0.99 to 1.26, two studies) but clear evidence of a positive association was found for the three other times (2006-10: 1.13, 1.04 to 1.23, three studies; 2011-15: 1.06, 1.02 to 1.10, four studies; ≥2016: 1.16, 1.11 to 1.22, five studies). Suicides by entertainers showed a positive association between reporting and suicide (rate ratio 1.17, 1.12 to 1.23, six studies) as did studies about other types of celebrities (1.08, 1.04 to 1.12, eight studies). Studies about one celebrity (1.17, 1.12 to 1.23, seven studies) and multiple celebrities (1.08, 1.04 to 1.12, seven studies) showed positive associations between reporting of deaths of celebrities by suicide and suicide.

Because celebrity type and number of celebrities were collinear, we entered only publication date and number of celebrities in a multivariate meta-regression. We found no differences between subgroups in the pooled rate ratio for either variable (table S3) but the overall I ² for the model was lower, indicating low to moderate heterogeneity compared with the primary analysis (I ²=34.6%). In the meta-regressions of the nine studies in the secondary analysis A, none of the factors was associated with the reporting of method of suicide on total suicides (table S4).

Publication bias

Figure 5 shows the contour enhanced funnel plots for the three analyses. For the primary analysis, the funnel plot was asymmetrical with more study specific rate ratios falling to the right of the pooled rate ratio line than the left. Few rate ratios were within the P value greater than 10% contours of statistical significance. Studies appeared to be missing from the region between the null value and the pooled rate ratio. Egger's regression test for funnel plot asymmetry was significant (P=0.01). The funnel plots for the two secondary analyses were symmetrical around the pooled rate ratio, and Egger's test was not significant for either analysis (P=0.23 for secondary analysis A and P=0.13 for secondary analysis B).

Sensitivity analyses

We undertook sensitivity analyses that included studies at serious risk of bias (fig S1). For media reporting of deaths of celebrities by suicide on total suicides, 20 studies met the inclusion criteria. The pooled rate ratio was 1.10 (95% confidence interval 1.06 to 1.14, P<0.001, I ²=93.4%) over a median follow-up of 28 days (range 7-60 days). Investigation of heterogeneity failed to identify new factors that could account for differences between the studies. Heterogeneity remained large and persisted for all variables (table S5). Egger's regression test for funnel plot asymmetry (fig S2) was close to significance (P=0.06). For reporting of the suicide method used by a celebrity on suicide by the same method (12 eligible studies), the pooled rate ratio was 1.32 (95% confidence interval 1.19 to 1.47, P<0.001, I ²=74.9%) over a median follow-up of 28 days (range 14-60 days). We were unable to find sources of heterogeneity (table S6). Egger's test was not significant (P=0.10). For general reporting of suicide (nine studies, median follow-up 7 days, range 1-30 days), the pooled rate ratio was 1.002 (95% confidence interval 0.999 to 1.005, P=0.11, I ²=0.02%) for an increase of one article. Egger's test was not significant (P=0.60). Because three studies in the primary analysis were about the same celebrity (Robin Williams), we performed a final sensitivity analysis where we excluded two of the studies, retaining the study with the lowest risk of bias. 36 The pooled rate ratio was 1.10 (95% confidence interval 1.06 to 1.15, P<0.001, I ²=61.8%) over a median follow-up of 28 days (range 7-60 days).

Discussion

Main findings

To our knowledge, this systematic review and meta-analysis is the most comprehensive to date of the effects of media reporting of suicide on subsequent suicides. The evidence indicates an increase in total suicides in the period after the reporting of a death of a celebrity by suicide. When the suicide method used by the celebrity was reported, evidence of a corresponding increase in the number of suicides by the same method was found. This effect appeared to be larger than for increases in total suicides, although suicides by a specific method typically only account for a limited proportion of all suicides. General reporting of suicide did not appear to be associated with increases in total suicides but the evidence was based on a small number of studies, mainly from the same region of the world.

At least three mechanisms might explain the increases in the number of suicides associated with reporting of suicide: identification with the deceased person, which might occur more frequently when the reported suicides are about individuals with high social standing 37 38; increased media reporting of suicide leading to normalisation of suicide as an acceptable way to cope with difficulties 7; and information on suicide methods, which might influence the choice of suicide method by a vulnerable individual. 38 Our findings support several of these mechanisms. Firstly, reporting on deaths of celebrities by suicide appears to increase total suicides, suggesting that the phenomenon goes beyond the influence of knowing the suicide method used by the celebrity. Secondly, some evidence exists of stronger effects in studies focusing on suicide by entertainers, compared with other celebrities, consistent with their strong public identity, which has been previously described for entertainment celebrities in particular. 39 Studies that focused on increases in suicide after one (rather than several) suicide by a celebrity often reported on entertainers, suggesting that these celebrities were well known and of interest to the public. Thirdly, the finding of a pronounced increase in suicide by the same method as that of a celebrity suggests that transfer of information about the method might be another relevant factor in the association. Media reporting on a suicide method increases the cognitive availability of this method, 7 and individuals considering suicide might be more likely to subsequently select the method used by celebrities. The evidence suggests that suicide by hanging, for example, especially among men aged 45-64 years, increased after the suicide of Robin Williams by the same method. 36

Support for the effect of media coverage of suicide also comes from individual level studies that typically used outcomes such as suicidal thoughts rather than suicidal behaviour. Harmful effects on mood, self-esteem, and suicidal thoughts, especially in those who have previously contemplated suicide, have been identified. 40 41 42 Individuals with suicidal thoughts, particularly new thoughts and a suicide plan, have an increased risk of suicidal behaviour. 43 The increases in total suicides, and greater increases in suicides by the same method reported in the media, as identified in our meta-analysis, suggest that media stories on deaths of celebrities by suicide might do both: increase suicidal thoughts and contribute to planning suicide with a specific method. Suicidal thoughts are a common occurrence. A recent survey in the United States estimated that 9.4 million adults (4% of the population) had seriously considered taking their own life in the previous 12 months, and 2.7 million (1% of the population) made plans to do so, 44 suggesting media reports of suicide have the potential to negatively influence many vulnerable people who might be swayed by news items.

We found that the size of the association for suicides after the reporting of deaths of celebrities by suicide was smaller than in a previous meta-analysis that included fewer studies and did not assess the risk of bias comprehensively (based on 10 studies). 6 Reasons for the smaller association might include the broader literature search, exclusion of duplicate data, and exclusion of studies at critical risk of bias. A rate ratio of 8-18% increase in suicide, however, highlights that media exposure relating to deaths of celebrities by suicide has a strong influence on the incidence of suicide in a population. In contrast, the global financial crisis of 2009 was associated with a 6% increase in suicide (although over a longer period of time). 45 The estimated increase for reporting on deaths of celebrities by suicide might also underestimate the effects of media reporting on well known celebrities. Some of the studies included focused on individuals with questionable prominence, including mid-level or regional politicians and others not likely to be known by most of the population. 11 Estimates were higher for well known celebrities, such as Robin Williams. Unlike in fixed effects meta-analyses of drug trials in defined populations, no true single effect exists for the association of media reporting on suicide with the number of subsequent suicides. Associations will probably vary depending on factors such as the prominence of the person in the media reports, the population's connection with that person, and the extent to which the death is reported responsibly by the media in the region where the study is conducted. The World Health Organization has emphasised that media professionals should be cautious when reporting on suicides in general and on deaths of celebrities by suicide in particular. 16

For general reporting on suicide, taking into account all media reporting of suicide, no association with increases in the number of suicides was found. These studies usually evaluated the effect of the number of news articles on suicide on the next day or in the next week whereas studies of reporting on deaths of celebrities reported the presence or absence of a death of celebrity by suicide. The studies on general reporting of suicide also tended to use wide ranging search strategies to identify a broad variety of media reports related to suicide. This search strategy might have resulted in media reports associated with suicides but might have been distorted by inclusion of other reporting types that do not cause harm. Previous research suggests that not all reporting on suicide is associated with increases in the number of suicides. 13 14 The risk appears to vary with reporting characteristics. 13 14 Increases are particularly likely for a subset of media reporting that describes suicide methods 13; depicts suicide as inevitable 14; or publicises false public myths about suicide. 13 Some media reports on suicidal thoughts feature stories of hope and healing, rather than suicide attempts or deaths, and might help to prevent suicides (the so-called Papageno effect). 13 46 47 None of the studies in our meta-analysis considered the qualities of media reports based on media recommendations, and the variability in reporting qualities is likely large. Hence, a resulting underestimation of the effects for media stories that are inconsistent with media recommendations is possible. Future research should aim for a clear definition of the reporting to separate associations for different types of reports.

Our meta-analysis generally took a conservative approach by limiting the analysis to studies at moderate risk of bias and focusing entirely on total suicides (rather than subgroups) as the outcome for the primary analysis. If, for example, a study reported on the effects of news media reporting on the incidence of suicide in teenagers, the data extracted for our meta-analysis were for the total population, even if the study put a focus on its specific findings for the subgroup of teenagers. This approach was to ensure that selective reporting of findings in subgroups did not bias our estimates.

Like previous reviews, 6 9 we found strong heterogeneity in risk estimates across studies on reporting of suicide by celebrities in particular. A large part of the heterogeneity was a result of the type of celebrity or number of celebrities analysed, suggesting that individuals best known to the public are those most likely to trigger more suicides. None of the characteristics explained the method specific increases in suicides. The remaining unexplained heterogeneity suggests that factors out of scope of our analysis might impact on the risk of increases in suicides after suicide reporting, including overall trends in the incidence of suicides in a country or over a period of time when media reporting occurs; socioeconomic conditions that might influence suicide reporting and imitation effects; and precise measurement of social identification with celebrities and other individuals who die by suicide.

We observed a number of significant and positive effect sizes and an absence of non-significant effect sizes in some regions of the funnel plots for studies of reporting on deaths of celebrities by suicide. This lack of symmetry could indicate publication bias. Many factors can contribute to asymmetry in funnel plots, however, and precise interpretation is difficult when the underlying evidence is based on observational data. 48 49 Unpublished studies could have shown no association. If true, this means that our meta-analysis will have overestimated the association between media reporting of suicide by celebrities and subsequent suicides. A sensitivity analysis including studies with serious risk of bias indicated a similar pattern to the overall findings, suggesting that effect estimates for lower risk studies were similar.

Strengths and limitations

The strengths of our meta-analysis included its wide ranging systematic search strategy; screening of more studies than in previous quantitative meta-analyses on this topic; thorough check for duplicate data; and the comprehensive quality assessment of the primary studies. Our approach was intentionally conservative, focusing on studies with a low to moderate risk of bias and only with estimates related to total suicides in the population. This study also looks at the research on the effects of general reporting of suicide on subsequent numbers of suicides, although only five studies were available for this analysis.

Limitations included our inability to test causality because of the before-and-after and interrupted time series designs of the original studies, high levels of heterogeneity that could not be fully accounted for, and possible publication bias. Further, it was not possible to generate absolute risk estimates because the included studies mostly did not report the baseline risk of suicide in their respective settings. Despite the wide ranging search strategy, non-English language studies in the international literature might not have been indexed in the databases we searched. Our analysis covered only a proportion of suicide related media items. Studies on the effects of media items covering the spreading of novel suicide methods, such as charcoal burning in parts of Asia, 50 were not included because of the low prevalence of these methods at baseline. Studies on fictional suicides were not included to avoid a further increase in heterogeneity between studies. Hence we cannot draw conclusions on these types of studies; our meta-analysis included studies with a narrower focus on interventions related to the reporting of suicide and suicidal behaviour. Finally, the only outcome considered in this meta-analysis was suicide. Although this outcome is of highest relevance to suicide prevention, media reports can impact on other domains as well, including help seeking behaviour and stigmatisation that have not been looked at in this meta-analysis. 7

Conclusions

In this large and up-to-date systematic review and meta-analysis, we looked at the impact of suicide reports in news and information media on subsequent numbers of suicides. Our results support the continued use and promotion of guidelines on responsible media reporting of suicide, which are the best available interventions to address and prevent imitation effects in the population. 15 16 Collaboration between suicide prevention experts and media professionals in implementing these guidelines is an essential part of any suicide prevention strategy. Caution should be exercised in reporting suicides by celebrities in particular. The media will continue to report on newsworthy suicides but have a social responsibility to mitigate the likelihood of the Werther effect.

What is already known on this topic

National suicide prevention strategies include guidelines on responsible reporting of suicide but some journalists and editors are unconvinced, and high quality, up-to-date analyses of the research are lacking

Two previous meta-analyses examined the effect of reporting of deaths of celebrities by suicide on the incidence of suicide but did not extract quantitative estimates or focused on a small number of studies of unknown quality

A quantitative summary of the effect of general reporting on suicide on the incidence of suicide is lacking, despite these types of media reports being common

What this study adds

Reporting of deaths of celebrities by suicide appears to increase the number of suicides by 8-18% in the next 1-2 months, and information on method of suicide was associated with an increase of 18-44% in the risk of suicide by the same method

General reporting of suicide does not appear to be associated with suicide although associations for some types of reporting cannot be ruled out

This study provides the clearest evidence so far that reporting on suicide, especially suicides by celebrities, is associated with increases in suicide in the general population

Acknowledgments

We thank Michiko Ueda, Feng Chen, and Shu-Sen Chang who reanalysed data from their studies for the meta-analysis.

Footnotes

Contributors: Substantial contributions to the conception or design of the work (MJS, TN, and JP); acquisition of the data (JP, BT, MB, SS, TN, and MJS); data extraction (MJS, TN, and MB); statistical analyses (MJS); interpretation of the data (all authors); drafting the work (TN, MJS, and MS); revising it critically for important intellectual content (all authors); final approval of the version to be published (all authors); agreement to be accountable for all aspects of the work (all authors). The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. TN and MJS act as guarantors.

Funding: No specific funding for this study. MB is funded by the Austrian Science Fund (FWF), grant No KLI627-B30. MJS is a recipient of an Australian Research Council Future Fellowship (project No FT180100075) funded by the Australian Government. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval: Not required.

Data sharing: No additional data available.

The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

Dissemination to participants and related patient and public communities: The study findings will be disseminated via conference presentations, press releases, and social media. A companion opinion article in The BMJ will serve to further stimulate discussion on the research. The authors will also disseminate findings to media organisations and press councils, and also national and international health organisations that have been instrumental in the development of media recommendations for suicide reporting. The wider public will be informed via media and in lectures and seminars on suicide prevention that target the broader public. Discussions on how the findings will be used to the benefit of the community will involve media professionals, individuals with personal experience of suicidal ideation or suicide attempt, individuals with experience of bereavement from suicide, mental health professionals, and the broader interested public.

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Association between suicide reporting in the media and suicide: systematic review and meta-analysis

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Objective To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. Design Systematic review and meta-analysis. Data sources PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019.

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The effect of stable and unstable household to children 

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The effect of stable and unstable household to children 

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Family stability can promote positive social behavior in children and while instability is associated with social maladjustment, including behaviors such as aggression toward peers, teachers, or parents. This examines the links between family instability during childhood, relationship status at birth, and household income , and social competence and aggression . Today we see more and more single parent raising children by themselves In 2022, among families with children, 31% were single-parent more than three times as common

By Devaun Mangal

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How divorced/separated parents affect there child's behavior? (Qualitative data)

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How divorced/separated parents affect there child's behavior? (Qualitative data)

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Parents should handle divorce gracefully to avoid psychological effects on children. The emotional impact of divorce varies depending on age and circumstances. Middle school-aged children may believe their parents' divorce is their fault. Children with special needs face increased chances of divorce. To prevent long-term psychological effects, parents should teach their children how to manage the emotions caused by divorce. It is crucial for parents to teach their children how to handle the trauma of divorce.

-Donella Brown

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Growing up is complicated enough on its own. Having parents divorce can make it even harder. To avoid the psychological effects of divorce on children, parents should go through the process gracefully.

How Children Perceive the Parents' Divorce

The emotional impact of divorce on children can vary greatly, depending on their age. However, while adults are typically more prepared for what's about to come, it is a whole new experience for children. In many cases, it can be confusing and terrifying.

Kids are the ones that experience the most significant discomfort from their parent's divorce. Typically, new living arrangements cause a lot of stress and confusion for this age group. They cannot understand why their family is being separated and why their parents suddenly stopped loving each other.

Middle school-aged children often believe that their parents' divorce is somehow their fault. Without the proper explanation, such kids often experience extreme guilt.

Teenagers usually understand what's happening, and their most common reaction is anger. The divorce is interfering with their daily lives, and that becomes a reason for rage. It is common for teenagers to try and point fingers, blaming one of the parents for causing a divorce.

Factors That Influence the Psychological Effects

While a couple is ending their marriage, many aspects can influence the kids. One factor is the child's age. The older the child is, the more developed their nervous system is to deal with stressful situations.

The Hoyt et al. (1990) report claims that kids often form different responses to their parents' divorce depending on the age group. For example, kids who are 7-8 years old often experience grieving and sadness. At the same time, an older age group (9-10) gravitates more towards feelings of anger, loneliness, and embarrassment.

The same study showed that if parents divorced while their kids were little, the effects could last even when they're teenagers. The second factor of influence is parental absence. According to McLanahan, Tach, and Schneider, the loss of a parental figure can lead to significant psychological effects.

Such kids tend to show worse social and emotional development and more regularly put themselves in risky situations. The study also proved that the absence of a parent after divorce could become a more triggering factor than death.

The lack of a father in a child's life can cause a substantial negative impact. If a mother leaves a child after the divorce, the negative consequences can worsen, especially for kids in Western cultures. As a result, such children can later develop severe anxiety or depression disorders.

Possible Consequences for Kids Whose Parents Got Divorced

Depending on the child's age and their parent's divorce circumstances, they might face different consequences. Some of the most common ones include the following:

Increased risk of developing mental disorders. Children whose parents got divorced are more likely to develop anxiety, depression, or other types of mental disorders. Kids face many challenges while growing up, and their parents' divorce only adds extra tension in most cases.

Increased chance of developing behavioral problems. Kids who grow up in full families (with both parents) are less likely to indulge in impulsive or aggressive behavior. At the same time, kids with divorced parents have more difficulties communicating with their peers.

Possible drop-in academics. An excellent academic performance takes a lot of focus. It is rather hard to stay focused during the parents' divorce. Such kids often struggle with their studies.

Increased chance of addiction development. Children of divorce have a higher tendency to engage in substance usage at an early age. Quite often, it results in a severe addiction. Such children also tend to start having sexual experiences at an earlier age than their peers.

Impacts of Divorce on a Child With Disabilities

CerebralPalsy.org reports that if a couple has a child with special needs, the probability of their divorce grows by 10%. Children with physical or mental disabilities have quite a few problems to think of other than their parents' divorce. That's why such events usually tend to cause them more distress.

Typically, in a household with a disabled child, their parents are the primary caregivers and provide the majority of assistance. This means that such children rely on their parents emotionally and physically, some for the rest of their lives.

So how to protect such children from the harmful impact of the divorce process? You should consider the severity of the child's case, whether it is a mental or physical disability. Also, try to treat them just as you would any other child in a similar situation.

Ensure they understand that the divorce is not their fault and both parents will love them just the same. Be open to any questions your child might ask, don't lie or try to avoid answering.

Ways to Prevent Long Term Psychological Effects of Divorce on Children

A traumatizing experience like parents' divorce can make a child unintentionally carry the burden for the rest of their life. People who experienced such events with their parents usually try to avoid making the same mistake with their kids. Here are some things to consider to help children adapt to life during and after the divorce:

Avoid putting kids in the middle. Being a parent means that you should think about your kids during the divorce and not compete with your spouse. Doing so will only result in your child being traumatized. Don't try to be a "better parent" or persuade your kid that you love them more than your spouse. It is also wrong to use your child as a communicator between you and your partner. Such behavior might traumatize your child and cause them anxiety and depression in the future.

Co-parenting. Constant yelling and conflicts between parents will do their child no good. Try to find a mutual understanding and a civil way to communicate with your spouse. Even if you have conflicts, protect your child from seeing them.

Make the discipline consistent. Both parents should be on the same team regarding their child's discipline. It's common for many parents to make up for the other parent's absence by letting children behave as they want. Consistency in discipline could reduce the chances of the child engaging in delinquent behavior later.

Spend more time with your child. Parents getting divorced can bring a lot of confusion to a child. Try to explain how things are and that you and your spouse's attitude towards the child won't change. By knowing the truth, your child won't resort to overthinking and will be able to see things for what they are.

Help your children cope with the situation. Divorce can cause lots of emotions, and it is the parent's job to teach their children how to manage them.

Final Thoughts

It is important to remember that parents' separation and divorce can become a traumatizing experience in children's lives. However, that doesn't necessarily mean that it will happen. Sometimes a divorce can do good if the family situation has been unhealthy from the start. It is essential to provide kids with maximum attention and all the necessary explanations during the divorce.

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The Long Term Psychological Effects of Divorce on Children

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Growing up is complicated enough on its own. Having parents' divorce can make it even harder. To avoid the psychological effects of divorce on children, parents should go through the process gracefully.

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This source is going toward all the positives on how people connect with music. Though, Thats not the only thing since the source is also talking about how culture is tied in with music since all cultures have different tones and genres of music and how they tie music into their religion and how they are all connected into how they express their ways of life of people and how they behave. The way people use their music and the way they express themselves with music since they can relate toward the music they are listening to or they just generally like the music that they are listening to. These all can lead to someones behavior and how they react

-Posted by Jaden. C

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The Incredible Role of Music in World Culture | Sound Infusion

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Music is considered a universal language, encompassing the imagination of the human mind; representing a creative freedom whereby artists produce compositions with sound, rhythm and instruments. Research has shown that active engagement with music improves human perceptual, language and literacy ski…

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Quantitative: This article shows the statistics of how many people (more specifically women and young teens) are affected yearly by physical abuse, rape, stalking, and many other forms of abuse.

-Daniella Maldonado

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Unhealthy Relationships Statistics [Fresh Research] • Gitnux

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As gentle as the word ‘relationship’ sounds, it is not always rosy and cherished. Some morph into toxic webs, ensnaring people into a detrimental cycle of