Cyberbullying Among Adolescents with Chronic Illnesses in Thailand: Prevalence and Relationship with Health-Risk Behaviors

Background: The use of social media may enhance the quality of life in adolescents living with chronic illnesses but may increase the risk of cyberbullying. Objective: The aim of this study was to estimate the prevalence of cyberbullying among adolescents with chronic illnesses and relationship with health-risk behaviors. Methods: This is an online survey of randomly recruited adolescents aged 11 to 18 years with chronic illness managed at Siriraj Hospital, Thailand, during 2019 to 2020. Participants were asked to respond anonymously to validated online questionnaires to evaluate health-risk behaviors, experience with cyberbullying, and depression-screening questions. Results: Three hundred forty-one participants with a mean age of 15.02 +/- 2.17 years (interquartile range 12.8, 17.2) responded. Reported risk behaviors included sexual activity in 42 participants (12.3%) with almost half (47.6%) having practiced unsafe sex. Alcohol drinking and polysubstance use were also found in 8.5% and 1.2%, respectively. 38 (11.1%) felt depressed within the previous 2-week period. 56 (16.4%) had been a cyberbully victim. Among the victims, 25 (44.6%) were also cyberbullies themselves. Chronically ill adolescents were more likely to be a victim of cyberbullying if they knew someone who had also been a victim (adjusted odds ratio [aOR] 5.25 [95% confidence interval [CI] = 1.80-15.29], p < 0.001) or had a positive depression screening (aOR 6.182 [95% CI = 2.41-15.85], p < 0.001). Underlying diseases, age, sex, risky behaviors, and time spent online were not associated with being cyberbullied. Conclusion: Thai adolescents with chronic illness were similar to their healthy peers regarding health-risk behaviors and the likelihood of being a victim of cyberbullying. Screening for risky behaviors, evidence of depression, and online activity during routine medical visits was an opportunity to prevent cyberbullying.