Sex differences among U.S. high school students in the associations of screen time, cyberbullying, and suicidality: A mediation analysis of cyberbullying victimization using the Youth Risk Behavioural Surveillance Survey 2021

The objective of the study is to explore the associations of screen time, cyberbullying victimization, and suicidality during the COVID-19 pandemic in female and male high school schools, especially the sex differences in the mediation effect of cyberbullying on the relation between screen time and suicidality. This study analysed the direct paths and mediation effects between variables among the 13,982 participants (female: 49%; male: 51%; age 15–17: 74%) in the Youth Risk Behaviour Survey 2021 (YRBS) using the Structural Equation Model and the Monte Carlo methods in Stata. Multiple-group analysis was conducted to compare sex differences in the mediation effects. Elevated screen time increased the likelihood of suicide ideation (male: OR: 1.50, 95% CI: 1.26–1.79; female: OR: 1.47, 95% CI: 1.28–1.70), suicide plan (male: OR: 1.56, 95% CI: 1.29–1.89; female: OR: 1.45, 95% CI: 1.24–1.69), suicide attempts (female: OR: 1.23, 95% CI: 1.02–1.48). Cyberbully victims had higher odds of suicide ideation (female: OR: 3.69, 95% CI: 3.25–4.17; male: OR: 4.50; 95% CI: 3.80–5.34), suicide plan (female: OR: 3.74; 95% CI: 3.28–4.25; male: OR: 5.03; 95% CI: 4.22–6.01), and suicide attempt (female: OR: 4.24; 95% CI: 3.66–4.92; male: OR: 4.70; 95% CI: 3.81–5.79). Sex differences were revealed in the mediation effects on suicide ideations (χ²(2) = 8.72, p < .05), suicide attempts (χ²(2) = 8.80, p < .05), and suicide overall (χ²(2) = 6.42, p < .05), where the effects were stronger in female students than in males. Screen time and cyberbullying victimization were directly associated with suicide-related behaviours in adolescents. Cyberbullying victimization in females had stronger mediation effects than in males. These findings emphasized the importance of understanding the new hybrid psychosocial dynamics and creating a healthy hybrid psychosocial environment, especially for female adolescents.