Are Rural–Urban Differences in Bullying and Poly-Bullying Victimization Associated with Internet Addiction or Depressive Symptoms among Adolescents in Jiangsu Province of China

Background: School bullying is a global problem. Although previous studies showed rural adolescents were at higher risk of being bullied compared to their urban counterparts, the rural–urban differences in the risk of bullying or poly-bullying victimization in relation with different characteristics and the joint association of internet addiction and depressive symptoms with the observed urban–rural disparities are unclear. Objective: We aim to investigate the rural–urban differences in bullying or poly-bullying victimization among adolescents and whether the observed rural–urban differences are associated specifically with internet addiction or depression. Methods: This cross-sectional study considered a total of 25,377 Grade 7 to 12 adolescents from the ‘Surveillance for Common Disease and Health Risk Factors among Students’ project implemented in Jiangsu Province in 2019. Rurality of residence was ascertained via the Regulation of Statistical Classification. We used Poisson regression to estimate the age–sex adjusted rate ratios (RRs) and 95% confidence interval (CI) for bullying and poly-bullying victimization. Results: Approximately 20.26% (95%CI: 16.11–25.47%) and 7.67% (5.48–10.74%) rural adolescents experienced bullying and poly-bullying, in comparison with 16.50% (12.65–21.52%) and 5.81% (4.34–7.78%) urban adolescents, respectively. Rural adolescents had 14% and 23% higher rates of bullying victimization (RR: 1.14, 95%CI: 1.03–1.26) and poly-victimization (RR: 1.23, 95%CI: 1.05–1.44) than their urban counterparts. When further controlled for internet addiction, the observed rural–urban disparities increased among adolescents with depressive symptoms, whereas diminished among those without depressive symptoms.