The scale of the problem surprised even the investigators. In this clinical sample, 63.1 percent of participants reported experiencing at least one form of bullying in their lifetime. In-person bullying alone was the most common experience, reported by 39.2 percent of the sample, while 4.1 percent reported cyberbullying only. But nearly one in five — 19.8 percent — reported the combination of both in-person and online bullying, a category that national surveillance data has largely failed to track. Only 36.9 percent of these already-vulnerable youth reported no bullying history at all. The figures align with broader national trends: according to the U.S. School Survey on Crime and Safety for 2021–2022, 28 percent of middle schools, 15 percent of high schools, and 10 percent of elementary schools reported bullying occurring at least weekly.

The study’s theoretical backbone comes from Urie Bronfenbrenner’s ecological systems theory, which frames development as the product of nested environments — from the microsystem of immediate peer interactions to the macrosystem of cultural norms and the chronosystem of societal change. Cyberbullying, the authors argue, is a uniquely modern illustration of this framework: it involves direct peer aggression, is shaped by school climate and family dynamics, and has been amplified by the rapid proliferation of smartphones and social media. Unlike traditional bullying, online abuse offers unlimited access to victims and the potential for anonymity, allowing harassment to continue around the clock and often to go unnoticed by adults who might otherwise intervene.

To capture bullying experiences, the researchers modified the Traumatic Events Screening Inventory for Children, a semi-structured clinical interview, adding two items: one asking whether a child had ever been picked on repeatedly — called names, left out — and another asking whether someone had used social media, text messaging, or group chats to bully them. Clinical presentations were measured with validated instruments, including the PHQ-A for depression, the GAD-7 for anxiety, the CHRT-SR for suicidal thinking, the PROMIS Pediatric peer relationship scale, and the school module of the Social Adjustment Scale. All scales showed good to excellent internal consistency in the sample, lending statistical weight to the comparisons that followed.

The analytical strategy was threefold. Chi-square tests compared the prevalence of each bullying type across age bands — elementary (8–10), middle school (11–13), and high school (14–17) — and across demographic and identity groups. A multivariate analysis of variance then compared depression, anxiety, suicidality, and functional impairment across the four exposure groups: no bullying, in-person only, cyberbullying only, and combined. Finally, a moderation analysis tested whether resilience, measured with the 10-item Connor-Davidson Resilience Scale, could buffer the link between bullying and depression. A post-hoc power calculation indicated the study had over 99 percent power to detect the observed multivariate differences.

The clinical results were unambiguous. Youth who experienced combined bullying reported significantly more severe depression symptoms — a mean PHQ-A score of 14.3 — than non-bullied peers (11.9) and those bullied in person only (12.6). Those cyberbullied alone also fared worse than non-bullied youth. Anxiety told a similar story: all three bullied groups reported more severe symptoms than non-bullied youth, and the combined group exceeded the in-person-only group. Functioning suffered as well. Combined bullying was associated with greater school impairment and worse peer relationships, with every bullied group showing poorer social functioning than their non-bullied counterparts. Notably, suicidal thinking did not differ across bullying categories — a finding the authors attribute to the fact that the entire sample was drawn from a depression and suicide research network, where baseline suicidality was already elevated, and to evidence that bullying’s link to suicidal thoughts may run indirectly through emotional distress.

The demographic patterns carried their own significance. Female youth were overrepresented in the combined bullying group, making up 79 percent of it compared with 66.4 percent of non-bullied youth. Sexual minority youth were similarly concentrated in the cyberbullying-only and combined groups, comprising 71.5 percent of the combined group versus 57.8 percent of non-bullied participants. This is consistent with prior research: The Trevor Project has reported that 52 percent of LGBTQ middle and high school students experienced bullying in the past year, and earlier work found that 74.1 percent of LGBT students experienced in-person harassment tied to their sexual orientation. Intriguingly, the study found no significant associations between bullying type and race or ethnicity, a null result the authors flag as deserving further study given prior evidence that stigma-based bullying compounds mental health harm among minoritized youth.

Perhaps the most sobering finding concerned resilience. Higher resilience scores were independently associated with lower depressive symptoms, and combined bullying was associated with higher symptoms, after adjusting for age, sex, race, and ethnicity. But the interaction terms — resilience multiplied by each bullying type — were not statistically significant. In other words, resilience did not differentially buffer the impact of any particular form of bullying in this clinical sample. The authors offer two explanations: earlier studies suggesting resilience protects cyberbullied youth more than in-person victims may have suffered from inconsistent definitions and measures, and depressed youth are known to report significantly lower resilience than their non-depressed peers, potentially muting any moderating effect. The practical implication is pointed: prevention programs should not place the burden of coping on the individual child.

The study’s limitations frame its conclusions carefully. The sample was predominantly female (70.8 percent) and White (69.8 percent), and consisted entirely of youth already experiencing depressive or suicidal symptoms, limiting generalizability to community populations. The cross-sectional design cannot establish whether bullying preceded symptom onset, and bullying was assessed only as a lifetime experience without accounting for frequency, chronicity, or timing. The in-person bullying item captured relational but not physical aggression. Still, the authors argue, the findings carry a clear mandate: because combined bullying confers the greatest risk, schools and clinicians should routinely screen for both modes of victimization, and prevention programs must operate at a systemic level — addressing school climate, family dynamics, and the digital environments where a child’s day no longer ends when the school bell rings.

Subject of Research: Associations between in-person bullying, cyberbullying, and clinical presentations among depressed and suicidal youth in Texas

Article Title: In-Person Bullying and Cyberbullying in the Texas Youth Depression and Suicide Research Network: Associations with Clinical Presentations

Article References: Foshee, K. L., Trent, E. S., Pinciotti, C. M., Minhajuddin, A., Soares, J. C., Goodman, W. K., Walker, R. A., Goodman, L. C., Wakefield, S. M., Trivedi, M. H., & Storch, E. A. (2026). In-Person Bullying and Cyberbullying in the Texas Youth Depression and Suicide Research Network: Associations with Clinical Presentations. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-026-02083-7

Image Credits: AI Generated

DOI: 10.1007/s10578-026-02083-7

Keywords: bullying, cyberbullying, youth depression, suicidality, adolescent mental health, Texas Youth Depression and Suicide Research Network, anxiety, resilience, school functioning, sexual minority youth, ecological systems theory, digital harassment