Received: 26 September 2018 | Revised: 12 May 2019 | Accepted: 24 June 2019

DOI: 10.1111/jcap.12244

ORIGINAL ARTICLE

Virtual behaviors affecting adolescent mental health: The

usage of Internet and mobile phone and cyberbullying

Pelin Calpbinici RN, MSc,1 Research Assistant | Fatma Tas Arslan RN, PhD,2 Professor

1
Department of Nursing, Semra and Vefa
Kucuk Health College, Nevsehir Haci Bektas
Veli University, Nevsehir, Turkey
2
Department of Nursing, Faculty Health
Sciences, Selçuk University, Konya, Turkey
Correspondence
Pelin Calpbinici, Semra and Vefa Kucuk Health
College, Nevsehir Haci Bektas Veli University,
2000 Evler District, Zubeyde Hanım Street,
50300 Nevsehir, Turkey.
Email: pelince2@yandex.com
Abstract
Problem: An important environmental factor affecting adolescents today is
undoubtedly technological tools. This descriptive and cross‐sectional study was
conducted to evaluate the relationship of adolescents’ Internet and mobile phone
usage, cyberbullying behaviors, and their self‐reported mental health.
Methods: The sample of the study consisted of a total of 426 students including 215
male students and 211 female students. A questionnaire was prepared by the
researcher to determine the sociodemographic and personal characteristics and
virtual behavioral characteristics of individuals. The Brief Symptom Inventory was
used to determine the participants’ mental status.
Findings: It was found that adolescents’ daily Internet usage duration, Internet usage
purpose, the place where they use Internet, cyberbullying, and exposure to
cyberbullying were related to the adolescents’ self‐reported mental health (p < .05).
Conclusion: Several aspects of the virtual behaviors of the adolescents were
associated with their sense of mental health issues. In this context, the school health
nurse should raise awareness among adolescents about the use of technology and
how it might impact their mental wellbeing.

KEYWORDS
adolescent, mental health, virtual behavior

Adolescents’ mental health problems have increased over the last
20–30 years such that it is now seen as a public health problem that
needs to be addressed (Dean, Britt, Bell, Stanley, & Collings, 2016;
Kieling et al., 2011; UNİCEF, 2011). Even though adolescents are
generally perceived as a healthy age group, mental health problems
in all societies constitute a great part of the illness burden among this
age group. According to WHO (2017), depression is the third leading
cause of illness and disability in adolescents and suicide is the third
cause of death in adolescents. A UNICEF report (2011) documented
that 20% of adolescents in the world experience mental health or
behavior problems.
Adolescence is a period in which mental health problems and
various health‐threatening behaviors tend to occur (Sampasa‐Kanyinga
& Hamilton, 2015). Many factors are seen to affect the adolescent’s
mental health in this period (Patel, Flisher, Hetrick, & McGorry, 2007).
Studies have demonstrated that inappropriate use of technological tools
by the adolescents such as mobile phones, computers, and the
Internet negatively affects their mental health (Pantic et al., 2012;
Sampasa‐Kanyinga & Lewis, 2015). Computer, Internet, and mobile
phone have a place in the lives of adolescents and indeed adolescents
use these technological tools intensively (Gallimberti et al., 2016;
Lenhart, 2015; Muñoz‐Miralles et al., 2016; Sinkkonen, Puhakka, &
Meriläinen, 2014). However, adolescents’ uncontrolled and improper
use of these technological tools is found to be associated with negative
mental and behavioral problems such as Internet addiction
(Mueller et al., 2017), inappropriate online behaviors (Lau & Yuen,
2013), decreased face‐to‐face communication and social anxiety

A part of this study was presented at the 5th National and 2nd International Mediterranean
(Selfhout, Branje, Delsing, ter Bogt, & Meeus, 2009), loneliness (Ostovar
Pediatric Nursing Congress, 15–18 November 2015, Ankara, Turkey. et al., 2016; Yao & Zhong, 2014), depression and suicidal ideation
J Child Adolesc Psychiatr Nurs. 2019;1–10. wileyonlinelibrary.com/journal/jcap © 2019 Wiley Periodicals, Inc. | 1
2 |
(Kim et al., 2006; Lam & Peng, 2010; Pantic et al., 2012), narcissistic
personality disorder, and low self‐esteem (Mehdizadeh, 2010).
Cyberbullying is one of the virtual behaviors associated with
technology that affects mental health and has potentially devastating
effects on adolescents’ wellbeing (Spears, Taddeo, Daly, Stretton, &
Karklins, 2015). Cyberbullying is defined as aggressive and inten-
tional actions made by an individual or a group to others via e‐mail,
mobile phone, short message service, and Internet sites for
threatening, embarrassing, exclusion, and condescending purposes
(Smith et al., 2008; Ybarra & Mitchell, 2004). Studies conducted in
different countries about the prevalence of cyberbullying among
adolescents have demonstrated that cyberbullying behaviors are a
problem experienced at schools in an amount that cannot be ignored
(Aricak et al., 2008; Khoury‐Kassabri, Mishna, & Massarwi, 2016;
Mishna, Cook, Gadalla, Daciuk, & Solomon, 2010; Selkie, Fales, &
Moreno, 2016; Tsitsika et al., 2015). Mental problems like depression
(Landoll, La Greca, Lai, Chan, & Herge, 2015; Wang, Nansel, &
Iannotti, 2011), social anxiety (Fahy et al., 2016), insomnia
(Kubiszewski, Fontaine, Huré, & Rusch, 2013), suicidal ideation
(Litwiller & Brausch, 2013 Schenk & Fremouw, 2012), low self‐
esteem (Brewer & Kerslake, 2015; Cénat et al., 2014), and loneliness
(Larrañaga, Yubero, Ovejero, & Navarro, 2016) can be seen in
adolescents exposed to cyberbullying. Conversely, adolescents who
initiate cyberbullying are more prone to violence (Sari & Camadan,
2016), more aggressive (Ybarra & Michell, 2004), have low social
competence and low empathy skills (Ang & Goh, 2010; Steffgen,
König, Pfetsch, & Melzer, 2011), and demonstrate more antisocial
behaviors (Sticca, Ruggieri, Alsaker, & Perren, 2013).
The aim of this study was to investigate the relationship of virtual
behaviors of adolescents such as Internet and mobile phone usage
and cyberbullying and their perceived mental health.
1 | METHODS
This study was conducted as descriptive and cross‐sectional to assess
the relationship of Internet and mobile phone usage and cyberbully-
ing behaviors of adolescents on their mental health.
1.1 | Population and sample
The population of the study consisted of 8,311 high school students
including 4,199 male students and 4,112 female students attending
ninth–twelfth grade of public and private high schools located in
Nevşehir city in Turkey in academic year of 2013–2014. Schools
were determined by a stratified sampling method and then one
branch from classes ninth–twelfth was selected according to the
simple random sampling method. Selected cohorts who used
computer, Internet, and mobile phone, and agreed to participate
were included in the sample. A total of 426 students (215 male and
211 female) aged between 14 and 18 (16.05 ± 1.26) years were
reached and asked to participate in the study.
CALPBINICI AND TAS ARSLAN
1.2 | Data collection tools
A questionnaire prepared by the researcher in accordance with the
literature was used to collect data (Arıcak, Kınay, & Tanrıkulu, 2012;
Çiftçi, 2010; M. Şahin, Sarı, Ömer & Er, 2010; Sarak, 2010,).
The questionnaire consisted of two parts: the sociodemographic
characteristics of the students were in the first section and questions
investigating their virtual behaviors were in the second section. The
questions about virtual behaviors were organized into in three main
topics areas. Questions about students’ mobile phone and Internet
usage were collected in one section. Using a 3‐point Likert‐type
questions (never, sometimes, often) the second section contained
questions related to cyberbullying behaviors such as threat, mockery,
and harassment through both Internet and mobile phone. Under the
third title, 2‐point (yes/no‐type) questions assessed the cyber
victimization of the adolescents and the status of exposure to
behaviors like threat, mocking, and harassment through both the
Internet and mobile phone.
The Brief Symptom Inventory (BSI) was used for self‐report of
the adolescents. The Brief Symptom Inventory (BSI) is a Likert‐type
self‐assessment inventory developed by Derogatis (1992) for the
purpose of screening mental health symptoms. The BSI comprises
nine subscales; somatization, obsession compulsion, interpersonal
sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid
ideation, and psychoticism (Derogatis, 1992). The validity and
reliability study of the scale in turkish adolescents was carried out
by N. H. Şahin and Durak (1994). N. H. Şahin and Durak (1994)
reported that five subscales (anxiety, depression, negative self‐
esteem, somatization, and hostility) was more suitable for student
group. High total scores obtained from the scale indicates the
frequency of the symptoms experienced by the individual. In each
subscale, an individual can obtain maximum four and minimum zero
points. Mean scores that approach four reflect severe symptoms;
scores that approach zero reflect low symptom profiles. The
Cronbach’s α reliability coefficient of the BIS was .94 in the Turkish
version. In this study Cronbach’s α coefficient of the scale was
calculated as .96.
1.3 | Data collection
Before starting to the study, the data collection form was trailed
by the researcher with 10 adolescents studying in another high
school outside the region where the study was conducted. As a
result of the preliminary application, no changes were made in the
data collection form. A brief explanation was provided to the
students by the researcher and then verbal consents were
obtained from the students who agreed to participate in the
study. The data collection tools were distributed to the students
by the researchers. A researcher stayed in the class during the
completion of the forms to ensure that there is no interaction
between the students. The standard instruction and procedure
was repeated by the researcher in all student groups. All forms
were completed within one course hour.
CALPBINICI AND TAS ARSLAN
1.4 | Data analysis
The data obtained in the study were analyzed using the SPSS/20.0
(Statistical Package for the Social Sciences) program. While the
obtained data were evaluated using descriptive statistics (mean,
standard deviation, percentage), the data showing normal distribu-
tion were evaluated by using one‐way analysis of variance and
independent samples t test. Significance level was accepted as p < .05.
1.5 | Ethical considerations
Before starting the study, ethics committee approval from Non-
invasive Clinical Trials Ethics Committee and written permission
from the schools where the study was conducted were obtained. In
addition, permission was obtained from the authors for the
availability of the scale. Consents of the individuals participating in
the study were obtained by reading the consent form to the students;
their voluntary participations were ensured.
2 | RES U LTS
2.1 | Virtual behaviors of the adolescents
It was found that 77% of the adolescents had computers in their
homes, 46% had their own computers and 60% started to use
computer between the ages of 8–11. Adolescents use computers
daily on average approximately 49 min and Internet with a daily
average of 139.94 min. It was also determined that 76% of the
adolescents used the Internet at home, 16% used it in an Internet
café, and 8% used Internet in the school.
When their distributions of the adolescents according to the
purposes of Internet use were examined, it was determined that the
majority of the adolescents (80%) used Internet for social media
(Facebook/Skype/Twitter, etc.), 75% for studying, and 51% for
gaming. When the rules established by the family about the Internet
usage were questioned, it was found that 47% had rules established
by the family about using the Internet.
Eighty seven percent of the adolescents had their own mobile
phone and they used the mobile phones mostly for communication
(talking and messaging; 63%) followed by social media use (50%) and
game playing (32%), respectively. Adolescents were on the phone
with an average of 53 min/d, received an average of 40 messages,
and send an average of 41 messages.
When cyberbullying behaviors of the adolescents were evalu-
ated; about half (49%) of the students stated that they had engaged
in cyberbullying behaviors, 8% said that they sometimes sent
messages with virus to the other people on the Internet, 20%
expressed that they sometimes mocked other people via mobile
phone or Internet, 8% said that they sometimes published the name
or the photos of a person they wanted to harm without his/her
permission on different sites. In addition 12% stated that they
sometimes introduced themselves as someone else, 12% stated that
they sent insulting messages via mobile phone or Internet to other
| 3
people or friends, 19% stated that they sometimes disturbed other
people from the mobile phone a private number, 9% stated that they
sometimes sent threatening messages to the other people via mobile
phone or Internet, and 11% said that they sometimes distributed the
negative information obtained about someone through Internet
(Facebook/Skype/Twitter). Fifty percent of the students performing
cyberbullying used these behaviors for entertainment, 26% for
revenge, and 24% used them when they were bored.
Of the adolescents, 61% reported that they were exposed to
cyberbullying 31% said that they received messages with viruses,
21% said that they were mocked through mobile phone or Internet
(Facebook/Twitter/Skype), 13% said that their photos were pub-
lished without their permissions, 15% said that they received
threatening messages from mobile phone or Internet, 42% stated
that they were bothered with a private number on their mobile
phone, and 19% stated that unpleasant and untrue rumors were
published in the Internet (Facebook/Twitter/Skype) about them. Of
the students who were exposed to cyberbullying, 48% stated that
they felt anger, 27% stated that they were sad, 23% stated that they
wanted revenge, and 16% stated the they were afraid.
2.2 | BSI mean scores and virtual behaviors
of the adolescents
The mean scores obtained by the adolescents from the Brief
Symptom Inventory (BSI) were found as 1.03 ± 0.76 for anxiety,
1.27 ± 0.96 for depression; 0.96 ± 0.76 for negative self‐esteem;
0.74 ± 0.68 for somatization; and 1.33 ± 0.78 for hostility. No
statistically significant difference was found between the age of
starting to the computer, having their own computer, having rules
established by their families for the Internet usage, the daily speaking
duration with the mobile phone of the adolescents and the subscale
mean scores of the Brief Symptom Inventory (p > .05; see Table 1).
Comparing the daily Internet usage duration and BSI mean scores
of the adolescents, it was found that the anxiety (1.18 ± 0.79),
depression (1.44 ± 0.87), negative self‐esteem (1.11 ± 0.79),
somatization (0.86 ± 0.72), hostility (1.49 ± 0.77) subscale mean
scores of the adolescents who used Internet for >1 hour in a day
were higher than the adolescents who never used Internet and those
who used Internet for ≤1 hr and this difference was statistically
significant (p < .001; Table 1).
When the Internet usage purpose of the adolescents and their
BSI subscale mean scores were compared, it was found that BSI all
subscale mean scores of adolescents who did not use Internet for
studying were higher than those who used Internet for studying. All
BSI subscale mean scores of the adolescents who used Internet for
social media (Facebook/Skype/Twitter, etc.) were higher than those
who did not use it for social media and this result was statistically
significant (p < .05). Anxiety (1.13 ± 0.76), negative self‐esteem
(1.04 ± 0.74), somatization (0.84 ± 0.68), and hostility (1.44 ± 0.78)
mean scores of the adolescents who used the Internet for playing
games were determined to be higher and statistically significant
4 | CALPBINICI AND TAS ARSLAN

T A B L E 1 Comparing The Brief Symptom Inventory mean scores and virtual behaviors of the adolescents

Mental symptoms
Characteristic Anxiety X ± SD Depression X ± SD Negative self‐esteem X ± SD Somatization X ± SD Hostility X ± SD
The age of starting to the computer use
≤7 years 1.17 ± 0.73 1.38 ± 0.73 1.07 ± 0.69 0.79 ± 0.66 1.49 ± 0.77
8–11 years 1.01 ± 0.73 1.24 ± 0.87 0.95 ± 0.76 0.71 ± 0.66 1.30 ± 0.72
≥12 years 1.01 ± 0.83 1.28 ± 0.89 0.90 ± 0.78 0.74 ± 0.76 1.29 ± 0.89
F 1.195 0.684 1.011 0.537 1.488
p .304 .505 .365 .585 .227
Having their own computer
Yes 1.04 ± 0.75 1.23 ± 0.85 0.95 ± 0.74 0.70 ± 0.66 1.39 ± 0.80
No 1.02 ± 0.76 1.30 ± 0.86 0.96 ± 0.77 0.77 ± 0.70 1.27 ± 0.75
t 0.259 −0.876 −0.112 −0.938 1.546
p .796 .382 .911 .349 .123
The daily Internet usage duration
None 0.64 ± 0.40 0.87 ± 0.42 0.56 ± 0.39 0.44 ± 0.36 0.93 ± 0.69
≤1 hr 0.86 ± 0.69 1.07 ± 0.80 0.78 ± 0.69 0.59 ± 0.62 1.13 ± 0.74
>1 hr 1.18 ± 0.79 1.44 ± 0.87 1.11 ± 0.79 0.86 ± 0.72 1.49 ± 0.77
F 11.484 11.707 11.987 9.754 14.012
, , , ,
p <.001* ** <.001* ** <.001* ** <.001* ** <.001*,**
The Internet usage purpose
Studying Yes 0.96 ± 0.69 1.19 ± 0.82 0.88 ± 0.69 0.69 ± 0.63 1.25 ± 0.71
No 1.25 ± 0.88 1.48 ± 0.93 1.15 ± 0.89 0.89 ± 0.81 1.57 ± 0.90
t −3.445 −3.080 −2.789 −2.415 −3.344
p .001 .002 .006 .017 .001
Social media (Facebook/ Yes 1.11 ± 0.77 1.34 ± 0.87 1.03 ± 0.78 080 ± 0.71 1.41 ± 0.98
Skype/Twitter, etc.)
No 0.70 ± 0.61 0.98 ± 0.70 0.66 ± 0.58 0.47 ± 0.45 0.78 ± 0.65
t 5.124 3.953 4.909 5.340 4.593
p <.001 <.001 <.001 <.001 <.001
Playing game Yes 1.13 ± 0.76 1.31 ± 0.83 1.04 ± 0.74 0.84 ± 0.68 1.44 ± 0.78
No 0.92 ± 0.74 1.23 ± 0.89 0.86 ± 0.77 0.63 ± 0.67 1.21 ± 0.76
t 2.896 0.998 2.505 3.282 3.009
p .004 .319 .013 .001 .003
The place where they used the Internet
Home 1.03 ± 0.75 1.27 ± 0.84 0.95 ± 0.73 0.75 ± 0.68 1.34 ± 0.77
Internet cafe 1.17 ± 0.87 1.35 ± 0.99 1.09 ± 0.92 0.82 ± 0.78 1.33 ± 0.88
School 0.75 ± 0.55 1.13 ± 0.72 0.79 ± 0.59 0.44 ± 0.39 1.17 ± 0.61
F 3.483 0.758 1.910 3.957 0.824
p .032***,**** 4.69 .149 .020***,**** .440
The rules established by the family about the Internet usage
Yes 1.04 ± 0.78 1.27 ± 0.86 0.99 ± 0.77 0.79 ± 0.74 1.31 ± 0.80
No 1.02 ± 0.74 1.27 ± 0.86 0.93 ± 0.75 0.69 ± 0.63 1.34 ± 0.75
t 0.182 0.114 0.870 1.392 −0.449
p .856 .909 .385 .165 .654
Having their own mobile phones
Yes 1.04 ± 0.76 1.29 ± 0.86 0.97 ± 0.75 0.73 ± 0.68 1.36 ± 0.79
No 0.97 ± 0.76 1.10 ± 0.81 0.88 ± 0.79 0.77 ± 0.69 1.14 ± 0.64
t 0.723 1.691 0.876 −0.444 2.082
(Continues)
CALPBINICI AND TAS ARSLAN | 5

TABLE 1 (Continued)

Mental symptoms

Characteristic Anxiety X ± SD Depression X ± SD Negative self‐esteem X ± SD Somatization X ± SD Hostility X ± SD

p .470 .092 .381 .657 .038
The daily speaking duration with the mobile phone
None 1.00 ± 0.79 1.24 ± 0.90 0.92 ± 0.79 0.76 ± 0.78 1.24 ± 0.74
≤1 hr 0.99 ± 0.73 1.22 ± 0.82 0.94 ± 0.76 0.68 ± 0.64 1.30 ± 0.76
>1 hr 1.17 ± 0.79 1.45 ± 0.89 1.03 ± 0.72 0.89 ± 0.68 1.51 ± 0.84
F 1.597 2.275 0.540 2.982 2.910
p .204 .104 .583 .052 .056
The mobile phone usage purpose
Communication (talking and Yes 0.98 ± 0.71 1.22 ± 0.81 0.91 ± 0.69 0.68 ± 0.63 1.34 ± 0.76
messaging)
No 1.12 ± 0.83 1.36 ± 0.92 1.04 ± 0.85 0.84 ± 0.77 1.32 ± 0.81
t −1.721 −1.679 −1.641 −2.183 0.243
p .086 .094 .102 .030 .808
Social media (Facebook/ Yes 1.17 ± 0.81 1.41 ± 0.88 1.07 ± 0.76 0.85 ± 0.75 1.45 ± 0.82
Skype/Twitter, etc.)
No 0.89 ± 0.67 1.12 ± 0.80 0.84 ± 0.74 0.62 ± 0.59 1.20 ± 0.70
t 3.798 3.580 3.296 3.500 3.406
p <.001 <.001 .001 .001 .001
Playing game Yes 1.12 ± 0.76 1.38 ± 0.84 1.04 ± 0.76 0.81 ± 0.70 1.40 ± 0.79
No 0.99 ± 0.75 1.22 ± 0.86 0.91 ± 0.76 0.70 ± 0.67 1.29 ± 0.77
t 1.744 1.787 1.625 1.575 1.452
p .082 .075 .105 .116 .147
Cyberbullying
Yes 1.27 ± 0.82 1.45 ± 0.91 1.17 ± 0.83 0.89 ± 0.76 1.57 ± 0.83
No 0.79 ± 0.61 1.09 ± 0.76 0.75 ± 0.61 0.58 ± 0.57 1.09 ± 0.64
t 6.746 4.346 5.883 4.906 6.530
p <.001 <.001 <.001 <.001 <.001
Exposed to cyberbullying
Yes 1.22 ± 0.82 1.44 ± 0.91 1.13 ± 0.82 0.88 ± 0.76 1.52 ± 0.79
No 0.74 ± 0.53 1.01 ± 0.69 0.68 ± 0.56 0.52 ± 0.49 1.04 ± 0.65
t 7.451 5.575 6.775 5.913 6.703
p <.001 <.001 <.001 <.001 <.001
Abbreviation: SD, standard deviation.
*p < .05 (none vs. >1 hr).
**p < .05 (≤1 vs. >1 hr).
***p < .05 (home vs. school).
****p < .05 (Internet cafe vs. home).

compared to the adolescents who did not use Internet for playing
game (p < .05; Table 1).
A significant difference was found between the anxiety and
somatization subscale mean scores of the adolescents and the place
where they used the Internet (p < .05). The anxiety and somatization
subscale mean scores were lower in the students who used Internet
at school compared to the adolescents who used Internet at home
and in Internet cafes and this was found to be statistically significant
(p < .05; Table 1). Hostility subscale mean scores of the adolescents
who had their own mobile phones (1.36 ± 0.79) were found to be
higher and statistically significant compared to the adolescents who
had no personal mobile phone (1.14 ± 0.64; p < .05; Table 1).
Somatization mean score (0.68 ± 0.63) of the adolescents who
used mobile phone for communication purpose was determined to be
lower and statistically significant compared to the adolescents who
did not use it for communication purpose (0.84 ± 0.77; p < .05). BSI
subscale mean scores of the adolescents who used their mobile
phones for social media (Facebook/Skype/Twitter, etc.) were higher
and statistically significant compared to those who did not use it for
social media (p < .001). No significant difference was found between
6 |
the BSI subscale mean scores of adolescents using their mobile
phones for gaming (p > .05; Table 1).
A significant correlation was found between the all subscale
scores of adolescents and their status of performing cyberbullying
(p < .001). Anxiety (1.27 ± 0.82), depression (1.45 ± 0.91), negative
self‐esteem (1.17 ± 0.83), somatization (0.89 ± 0.76), and hostility
(1.57 ± 0.83) mean scores of the adolescents stating that they
performed cyberbullying were higher than the adolescents stating
that they did not perform any cyberbullying and this difference was
determined to be statistically significant (p < .001; Table 1).
Anxiety (1.22 ± 0.82), depression (1.44 ± 0.91), negative self‐
esteem (1.13 ± 0.82), somatization (0.88 ± 0.76), and hostility
(1.52 ± 0.79) subscale mean scores of the adolescents who stated
that they were exposed to cyberbullying were higher than the
adolescents who stated that they were not exposed to cyberbullying
and this difference was statistically significant (p < .001; Table 1).
3 | D IS C U S S IO N
Adolescent mental health is affected by ever changing and
developing mental, physical and social competences, critical periods,
and environmental factors (Yılmaz & Türkleş, 2015). An important
environmental factor affecting young people today is technological
tools. In this study Internet and mobile phone usage was a very
common behavior among adolescents. Almost half of the adolescents
(49%) who participated in the study performed cyberbullying
behaviors, and more than half of them (61%) were exposed to
cyberbullying. These results were much higher than the level of
cyberbullying reported in previous studies (Lee & Shin, 2017; Ortega
Ruiz, Calmaestra Villén & Mora Merchán, 2008; Schenk & Fremouw,
2012; Smith et al., 2008). However, there are also studies that
support the rates reported in this study (Arıcak, 2009; Calvete, Orue,
Estévez, Villardón, & Padilla, 2010; Juvonen & Gross, 2008). The high
rate of cyberbullying in the present study could be related to the
timing of this study. As new technologies emerge and access of
adolescents to the technological tools increases, the possibility of
being exposed to more cyberbullying also increases; as such
cyberbullying behavior becomes a more common problem (Brewer
& Kerslake, 2015; Calvete et al., 2010; Cénat et al., 2014; Schenk &
Fremouw, 2012).
Even though the development of the Internet is a largely
positive impact, the use of Internet for prolonged periods without
leaving your place or using Internet so that you neglect or delay
the activities related to everyday life brings a number of problems
(Ceyhan, 2008). In the present study, anxiety, depression,
negative self‐esteem, somatization and hostility mean scores
were found to be higher in the adolescents using Internet for
more than 1 hour a day compared to the adolescents using
Internet for an hour or less in a day. Studies support these results
and demonstrate that there is a significant correlation between
the mental health and Internet usage (Choi, Park, & Cha, 2017; Lai
et al., 2015; Ying & Zhang, 2015). In the previous studies,
CALPBINICI AND TAS ARSLAN
excessive Internet use of adolescents was found to be associated
with depression (Ho et al., 2014), hostility (Alpaslan, Avcı, Soylu &
Guzel, 2014), anxiety (Ho et al., 2014), somatization (Cerutti,
Presaghi, Spensieri, Valastro, & Guidetti, 2016), attention‐deficit
hyperactivity disorder (Yen, Ko, Yen, Wu, & Yang, 2007), and
suicidal ideation (Alpaslan et al., 2014; I. H. Lin et al., 2014).
Messias, Castro, Saini, Usman, and Peeples (2011) found that the
sadness, suicidal ideation, and suicide attempts of young people
were significantly higher in adolescents who played Internet or
video games for 5 hr or more in a day. Although the Internet offers
different advantages to the adolescents such as updating
themselves, helping them in their works, solving their problems
and establishing good relationships with others (Rayan et al.,
2017), there is a risk of being affected by its unsupervised use
especially for the individuals with low psychological health (Rayan
et al., 2017) and adolescents (Kuss, van Rooij, Shorter, Griffiths &
van de Mheen, 2013).
In the study, it was found that anxiety, depression, negative
self‐esteem, somatization and hostility mean scores were high for
the adolescents using Internet for social media and or who used
Internet to play games. Researchers have reported that the use of
social networks such as Facebook, Twitter, or Instagram, and
playing game on the Internet are associated with mental health
problems of adolescents such as depression, psychological
distress, and suicidal ideation (Mentzoni et al., 2011; Pantic
et al., 2012; Sampasa‐Kanyinga & Lewis, 2015; L. Y. Lin et al.,
2016). On the contrary, there are studies showing that social
media use is related with less loneliness, higher self‐esteem, and
life satisfaction (Pittman & Reich, 2016; Seabrook, Kern, &
Rickard, 2016). Playing games on the Internet also increases
cooperation and decreases aggressiveness (Gentile, 2009;
Greitemeyer, Agthe, Turner, & Gschwendtner, 2012). However,
it should be kept in mind that for young people with lower
psychological health, use social media in the search for interaction
or support may increase their risk of cyber victimization
(Sampasa‐Kanyinga & Hamilton, 2015).
In the present study, it was found that the place where the
adolescents used the Internet was associated with their self‐
reported mental health. The somatization and anxiety mean
scores of the adolescents using Internet at school was lower than
the adolescents using Internet at home or in Internet café. In this
context, the use of Internet under the supervision of teacher at
school or the family at home seems related to less self‐reported
mental distress among the study participants. Perhaps
adolescents avoided risky virtual behaviors because of measures
taken by schools such as the presence of programs performing
the Internet access, school policies around computer use, and the
supervision of all classroom computers. In the study by Çınkır and
Tan (2010), the possibility of using computer games and
programs containing harmful contents such as violence or
pornography was reported to be higher in Internet cafes with
no supervision. In this context, to eliminate these negative virtual
behaviors, it is important to provide education to families and
CALPBINICI AND TAS ARSLAN
students around safe Internet usage. Families should guide their
children about this issue and establish rules about Internet usage.
Another important issue is mobile phone usage. Mobile phones
can be used for communication everywhere and adolescent can be
online at any time. Mobile phones are used by adolescents to
communicate, message with each other, play games, take pictures,
and connect to the Internet (Tavakolizadeh, Atarodi, Ahmadpour, &
Pourgheisar, 2014). Along with the benefits of using mobile phones,
there are concerns about their overuse (Vacaru, Shepherd, &
Sheridan, 2014). Recently, the problematic use of mobile phones
has attracted the attention of researchers and to some, is considered
equivalent to drug addiction (Nikhita, Jadhav, & Ajinkya, 2015).
Researchers have shown that the use of uncontrolled mobile phone is
associated with loneliness (Tan, Pamuk, & Dönder, 2013), anxiety,
depression (Tavakolizadeh et al., 2014), aggressive behaviors,
insomnia, smoking, suicidality, and low self‐esteem (Yang, Yen, Ko,
Cheng, & Yen, 2010). The present study supports these findings: the
hostility subscale mean score of the adolescents who have their own
mobile phones was found to be high, whereas the anxiety,
depression, negative self‐esteem, somatization, and hostility mean
scores were found to be high in adolescents using their mobile
phones for social media.
Cyberbullying is one of the virtual behaviors associated with
technology that has potentially devastating effects on the wellbeing
of adolescents and affect their mental health (Spears et al., 2015). In
the present study, anxiety, depression, negative self‐esteem, soma-
tization, and hostility subscale mean scores were found to be high for
the adolescents who enacted cyberbullying and those who were
exposed to cyberbullying. The results of the study support the
literature and cyberbullying negatively affects the mental health of
adolescents (Fahy et al., 2016; Holfeld & Sukhawathanakul, 2017;
Landoll et al., 2015; Sari & Camadan, 2016; Ybarra & Michell, 2004;
Vieno et al., 2014; Wang et al., 2011).
4 | LIMITATIONS
There were several limitations in this study. First, the cross‐sectional
research design of this study limited our ability to draw conclusions
regarding causal relationships between mental health and certain
correlates examined in this study. Second, the data were provided by
adolescent participants. Thus, the possible problem of shared method
variance resulting from a sole data source requires careful
consideration. Third, cyberbullying behaviors were self‐report with-
out the use of structured assessment tools. In future research, the
use of structured data collection form will provide objective data
about cyberbullying behaviors.
5 | NU RSING I MPL I CATION S
School health nurses are obligated to ensure the safety of
adolescents from vulnerable groups, as well as balancing the
| 7
response they give to the negative consequences of technology
usage. For this reason, it is very important to determine early the
psychological and behavioral problems which are the result of the
adolescent’s virtual behaviors and to plan to care for them.
AC KNO WL EDG M EN T
The researchers express their sincere appreciation to the partici-
pants who generously shared their experiences and took time to
complete the survey.
CON F LI CT OF IN TE RES T S
The authors declare that there are no conflict of interests.
ORCI D
Pelin Calpbinici http://orcid.org/0000-0001-8242-2773
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