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Abstract

At present, the prevalence of social networks provides academic support for female high school students by addressing their educational queries. However, cyberbullying has also emerged as a widespread issue among this demographic. For some individuals who have experienced cyberbullying, the malicious behavior encountered on social platforms contributes to the development of academic burnout. To address this phenomenon, sports engagement—given its psychological adjustment benefits—may serve as an effective intervention to alleviate their academic burnout. Based on this premise, this study collected a sample of 503 female high school students who had experienced cyberbullying and employed structural equation modeling (SEM) to analyze the impact of cyberbullying on their academic burnout, as well as the moderating role of sports engagement. The results indicate that cyberbullying significantly increases emotional exhaustion and de-individuation among female high school students while markedly reducing their sense of learning effectiveness. On the other hand, sports engagement demonstrates an overall positive moderating effect, mitigating the influence of cyberbullying on their overall academic burnout. This study reasonably concludes that cyberbullying is a significant contributing factor to academic burnout among female high school students, adversely affecting both their academic performance and psychological well-being. In the digital era, these findings provide a valid basis for high schools to adopt innovative pedagogical strategies that encourage active sports engagement, thereby counteracting the negative effects of academic burnout. Additionally, the study offers insights for preventing cyberbullying in high school settings and mitigating its subsequent adverse consequences.

Keywords

cyberbullying victimization female high school students academic burnout sports engagement moderating role

Introduction

Bullying constitutes a severe public health problem, with mounting evidence indicating its detrimental effects on students’ physical and mental well-being, as well as their academic progress and development (Le Menestrel, 2020). According to a UNICEF survey encompassing more than 170,000 adolescents across 30 countries, one-third of respondents reported experiencing cyberbullying, while one-fifth explicitly stated that cyberbullying had hindered their academic performance—for instance, by directly causing school absenteeism (UNICEF, 2019). These findings underscore the severity of cyberbullying’s impact on adolescents’ education. Among the various factors impeding academic progress, burnout has become increasingly prevalent among students (Lin & Yang, 2021). Prior research highlights that internal psychological factors—such as anxiety, depression, and stress—play a prominent role in academic burnout (Jang et al., 2019; Lee, 2019). These psychological burdens may be closely linked to the escalating issue of cyberbullying in recent years.

Studies suggest that under the weight of such psychological distress, a growing number of students disengage academically, leading to physical or emotional exhaustion, diminished sense of learning effectiveness, and an indifferent attitude toward learning (Wang et al., 2021). Furthermore, research has established connections between cyberbullying, academic stress, and avoidance behaviors, proposing that academic pressure may be directly influenced by the negative effects of cyberbullying (Peled, 2019), thereby fostering psychological withdrawal and burnout. This implies that stress mechanisms may serve as one pathway through which cyberbullying exacerbates academic burnout, potentially accelerating its prevalence among high school students.

Research on “burnout” has traditionally been closely associated with the concept of “profession.” However, as the definition of burnout expands into educational contexts, academic burnout among students has gained international attention (Herrmann et al., 2019). Academic burnout is a syndrome that encompasses the fatigue caused by academic demands, a cynical attitude toward academic work, and a sense of inadequacy in one’s academic abilities (Salmela-aro et al., 2004). In students’ daily trajectories, academic burnout manifests primarily through diminished motivation, class avoidance, procrastination, and even a complete loss of drive (Garavand, 2022). This condition not only induces physical health issues but also exacerbates emotional and attitudinal problems such as depression, apathy, and heightened tension (Hwang & Kim, 2022). Notably, academic burnout arises from multiple triggers. In the digital era, social media networks have become indispensable across all age groups. Prolonged exposure to these platforms can lead to addictive behaviors that deplete mental vitality, subsequently fostering negative psychological states including depression, pessimism, and reduced self-esteem (He et al., 2017). These adverse mental conditions significantly impair students’ academic engagement (Landa-Blanco et al., 2024), while psychological factors like anxiety further degrade learning effectiveness (Lizarte Simón et al., 2024).

From a gender perspective, studies based on the gender intensification hypothesis have reported differences in levels of burnout between males and females. The societal emphasis on femininity increases women’s susceptibility to internalizing symptoms, rendering them more reactive to negative stimuli (Klaczynski et al., 2020). Consequently, this heightened sensitivity elevates their vulnerability to burnout. Furthermore, empirical evidence indicates that female students exhibit relatively higher levels of academic burnout, attributable to their increased stress sensitivity (Vansoeterstede, 2023). Given that cyberbullying constitutes a potent stressor, female students warrant particular attention in this context.

Supporting this observation, Baier et al. (2019), in a study investigating cyberbullying victimization among students transitioning to high school, found that female students tend to exhibit a certain degree of emotional sensitivity, making them more likely to internalize negative experiences. This suggests that when adverse experiences accumulate persistently, female high school students are more likely to be affected—though the magnitude of impact may vary depending on individual stress resilience and psychological regulatory capacity. Regarding this, existing studies have confirmed that females generally exhibit more pronounced academic burnout (Vinter et al., 2021), with emotional exhaustion being particularly significant when they are experiencing burnout (Worly et al., 2019). Therefore, without timely interventions to mitigate academic burnout, prolonged exposure to such negative stressors may prove detrimental to female high school students’ psychological well-being and academic advancement. A growing number of high school students now possess unrestricted access to smartphones, a trend that has escalated the risk of cyberbullying incidents (Smale et al., 2021). Recent research examining gender differences in cyberbullying victimization reveals divergent psychological responses between genders, with female students reporting significantly higher levels of psychological distress (B. Yang et al., 2021). This distress often manifests as pervasive negativity toward both daily life and academic pursuits, fostering intense emotional suffering and depressive symptoms (Erbiçer et al., 2023).

Against this backdrop, sports engagement has been identified as a potential protective factor, empirically demonstrated to generate positive affect, regulate negative emotions, and mitigate adverse psychological effects (Martín-Rodríguez et al., 2024). Its moderating function can be interpreted through multiple theoretical lenses. Sports engagement, defined as participation in physical activities over recent weeks, serves as a catalyst for positive emotions among students, facilitating emotional resource recovery and fostering psychological well-being (Ekkekakis, 2023; Humphreys & Ruseski, 2009). Fredrickson’s (2001) Broaden-and-Build Theory of Positive Emotions posits that the accumulation of positive affect expands an individual’s capacity to derive meaning from future experiences while buffering against the detrimental impact of negative events. This theoretical framework suggests that sports-induced positive emotions may counteract the psychological consequences of cyberbullying through emotional offsetting mechanisms. In addition, Lazarus and Follman’s (1984) Transactional Model of Stress and Coping highlights emotion-focused coping as a critical adaptive strategy. Sports participation aligns with this paradigm by enabling stress alleviation through positive emotional experiences. Collectively, these theories and prior research elucidate the potential pathways through which physical activity may neutralize the psychological harm inflicted by cyberbullying.

In recent years, some scholars have explored the connection between physical exercise and academic burnout, finding that exercise may be one of the most effective ways to alleviate the emotional effects of burnout (Tang et al., 2021). Research has demonstrated that active engagement in sports can effectively enhance learning motivation and improve academic performance (Fu et al., 2023). Moreover, a recent study by Raimundi et al. (2024) confirmed that athletes’ investment in training not only enhances their sports experience but also significantly reduces their professional burnout. Thus, an important question arises: Can regular physical activity among female high school students effectively reduce the academic burnout that may result from cyberbullying victimization?

Based on this, the present study employs a structural equation model to construct the research model shown in Figure 1, examining the impact of cyberbullying victimization on academic burnout among female high school students, as well as the moderating role of sports engagement. Through this research, we aim to further explore the mechanisms by which cyberbullying affects academic burnout in female high school students and investigate the potential of sports engagement to mitigate or eliminate the negative effects of cyberbullying-induced academic burnout. For a long time, “burnout” has been a common topic in sports literature, but most studies have focused on professional burnout (Ozcan, 2022), with relatively few addressing academic burnout, particularly in female high school students. Furthermore, in the limited research on alleviating student burnout, scholars have mostly emphasized the importance of enhancing emotional regulation skills and cultivating rational thinking (Charbonnier et al., 2022; Ezeudu et al., 2020). Few studies have explored the role of physical exercise as a strategy to alleviate academic burnout. Therefore, this study focuses on female high school students, connecting cyberbullying victimization, sports engagement, and academic burnout, aiming to provide theoretical insights and guidance on encouraging female students to engage in physical exercise to mitigate academic burnout after experiencing cyberbullying. At the same time, it also provides theoretical support for creating a supportive sports social environment, strengthening school physical activity programs, and developing more targeted mental health policies.

Figure 1.

Research model.

Literature Review and Research Hypotheses

The Relationship Between Cyberbullying Victimization and Academic Burnout

Cyberbullying refers to malicious activities in which certain internet users intentionally insult or mock others by posting or using abusive language (Urbaniak et al., 2022). It has become a new means for bullies to attack in the era of the increasingly developed Internet (Campbell, 2005). As students age, their opportunities to use the internet increase, as does the likelihood of experiencing cyber-bullying. For victims of bullying, any form of victimization is repetitive and persistent, having profound effects on students’ physical and psychological well-being. Cyber-bullying, in comparison to traditional school bullying, more significantly affects individuals’ emotional and psychological states (Beran & Li, 2007). Although cyberbullying has been proven to significantly harm adolescents, its specific threats during particular developmental stages (e.g., high school) remain unclear. For high school students, academics constitute a primary focus. However, it should be noted that cyberbullying victimization exerts long-term effects, with victims facing severe academic challenges including, but not limited to, emotional depression, diminished self-esteem, and reduced learning efficiency (Kaur & Saini, 2023). Under such circumstances, high school students subjected to cyberbullying frequently exhibit declining academic performance, increased truancy, and a corresponding elevation in their risk of developing academic burnout.

Academic burnout refers to the emotional exhaustion, de-individuation, and reduced learning effectiveness that students experience as a result of the pressure and burden of their academic responsibilities, alongside other psychological factors (Yang, 2004). It not only affects academic performance, reducing students’ expectations and engagement with school, but can also lead to self-doubt and, in extreme cases, result in dropout (Bask & Salmela-Aro, 2013). When academic burnout occurs, it typically manifests in three key dimensions: emotional exhaustion, de-individuation or cynicism, and low learning effectiveness (Moghadam et al., 2020; Von Harscher et al., 2018). Emotional exhaustion refers to feelings of fatigue or depletion when dealing with academic work (Kilic et al., 2021). De-individuation involves adopting a detached, indifferent, or cynical attitude toward one’s academic work. Low learning effectiveness refers to a diminished interest in academic tasks and a sense of helplessness or incompetence (Schaufeli et al., 2002).

Does a causal mechanism exist between cyberbullying and academic burnout? Some scholars have addressed this question in their research. First, Mostert and Pienaar’s (2020) study confirmed that negative emotions—such as frequent anxiety, tension, and even depression—are significant contributors to academic burnout, and cyberbullying victimization is precisely one of the sources of these negative emotions. These adverse emotional states deplete the limited psychological resources of cyberbullying victims, leading to persistent emotional exhaustion, which may likely trigger burnout. Furthermore, cyberbullying can induce social anxiety and social withdrawal in victims, significantly increasing the likelihood of difficulty in forming close friendships and reducing interest and motivation in extracurricular activities (Coelho et al., 2022). This exacerbates their sense of alienation from academic work, further contributing to burnout. From another perspective, the onset of burnout may also be linked to cognitive resource depletion caused by cyberbullying (Kalyar et al., 2021). This suggests that persistent cyberbullying may trap victims in rumination, where repeated recollection of bullying experiences consumes finite cognitive resources, resulting in decreased attention span, reduced learning efficiency, and other burnout-related symptoms. In summary, evidence indicates that cyberbullying may establish a causal relationship with academic burnout through multiple potential mechanisms: accumulation of negative emotions, impairment of social functioning, and depletion of cognitive resources.

Moreover, Morgan et al. (2023) further confirmed that victims of bullying tend to develop an aversion to school life, which hinders their ability to adapt and ultimately leads to a decline in motivation and academic performance. Based on this, it is hypothesized that the effects of cyberbullying victimization on academic burnout in female high school students—manifested through emotional exhaustion, de-individuation, and reduced learning effectiveness—share a similar and specific impact mechanism. Therefore, this study proposes the following hypotheses:

H1: Cyberbullying victimization in female high school students has a significant impact on emotional exhaustion.

H2: Cyberbullying victimization in female high school students has a significant impact on de-individuation.

H3: Cyberbullying victimization in female high school students has a significant impact on learning effectiveness.

The Moderating Role of Sports Engagement

Engaging in physical exercise has been shown to produce lasting positive cognitive and emotional experiences, characterized by confidence, commitment, vitality, and enthusiasm (Lonsdale et al., 2007). Besides, students involved in sports are more likely to perceive a positive self-concept compared to those who do not participate in physical activities (Tubić et al., 2012). Erwin et al.(2012) confirmed that moderate participation in physical activities during the academic process can promote physical and mental health and even improve academic performance to some extent. Therefore, it is possible for female high school students involved in physical activities to reduce academic burnout and achieve academic progress.

Previous studies have indicated that there are differences in how an individual’s participation, or lack thereof, in physical exercise affects their emotional state and other psychological factors. Li et al. (2024) highlighted in their research on student mental health that engaging in physical exercise can effectively improve emotional states, including alleviating stress, and promoting good interpersonal relationships. Additionally, school-based physical education and exercise have been found to contribute to emotional stability and overall physical and mental health (Siedentop & Van der Mars, 2022). These studies collectively suggest that sports engagement brings positive emotional experiences and is effective in fostering positive emotional states (Hansen et al., 2023). On the other hand, reduced or long-term lack of physical activity may lead to emotional fluctuations and depressive symptoms (Violant-Holz et al., 2020). In summary, engaging in physical exercise as an effective stress-relief method helps students develop positive emotional attitudes while also improving physical health. Given the strong correlation between sports engagement and the promotion of positive emotional states, it is highly likely that sports engagement plays a positive role in moderating the relationship between cyberbullying victimization and emotional exhaustion. Therefore, we hypothesize:

H4: Sports engagement has a significant moderating effect on the relationship between cyberbullying victimization and emotional exhaustion in female high school students.

Existing literature demonstrates that physical exercise often serves as a moderating variable that is related to enhancing individual cognition and emotional development (Haverkamp et al., 2020; Ludyga et al., 2020), and this relationship extends to de-individuation levels in students. Rosales-Ricardo and Ferreira (2022) found in their research that physical exercise is linked to burnout syndrome and concluded that exercise can effectively reduce a student’s indifference and nonchalant attitude, thus reversing a cynical or detached approach to academic work. In earlier studies, the same scholars had also identified physical exercise as one of the most effective methods for addressing student burnout syndrome (Rosales-Ricardo & Ferreira, 2022). Moreover, regarding the state of “de-individuation,” studies suggest that it frequently emerges in response to stress or perceived threats. This implies that reducing an individual’s stress levels may help mitigate de-individuation—a benefit that sports participation has been empirically shown to provide (Li et al., 2024; Schweden et al., 2018). Based on this, Zhu et al. (2021) conducted research specifically targeting female college students and concluded that physical exercise can help alleviate stress and reduce a detached, irresponsible attitude. Building on this, we can hypothesize that if cyberbullying victimization affects the de-individuation levels of female high school students, their active participation in exercise may play a positive role in mitigating these effects. Therefore, this study proposes the following hypothesis:

H5: Sports engagement has a significant moderating effect on the relationship between cyberbullying victimization and deindividuation in female high school students.

Whether or not an individual participates in physical exercise also influences how effectively they cope with academic pressures. A study in sports psychology demonstrates that physical exercise, as a personal resource, serves as one of the most effective interventions for addressing academic burnout (Fu et al., 2023). It facilitates the restoration of emotional resources, alleviates tension, enhances willpower and endurance, and proves particularly compelling in boosting individuals’“sense of effectiveness” (Liu, 2020). Given that cyberbullying victimization similarly induces tension and stress in individuals, we reasonably hypothesize that the mechanism through which sports engagement enhances one’s general “sense of effectiveness” may likewise apply to improving academic-specific “sense of effectiveness.”

From another perspective, appropriate sports engagement can indirectly contribute to academic performance. Specifically, physical exercise has been found to improve long-term memory, and exercising after studying can consolidate existing memories, thereby enhancing learning efficiency and leading to better academic outcomes (Van Dongen et al., 2016). In contrast, individuals who lack exercise often show signs of slow thinking and reduced cognitive function (Aprilia & Aminatun, 2022). This suggests that physical exercise is a reliable method for reducing ineffective learning and promoting academic progress (Du et al., 2023). Based on this, we hypothesize that sports engagement will have a positive impact on improving the learning effectiveness of female high school students, mitigating their feelings of helplessness in academic performance due to the negative effects of cyberbullying, and ultimately leading to academic progress. Therefore, this study proposes the following hypothesis:

H6: Sports engagement has a significant moderating effect on the relationship between cyberbullying victimization and learning effectiveness in female high school students.

Research Methods

Research Participants

This study used a random sampling method to select 20 high schools from the Jiangsu, Zhejiang, and Shanghai regions of China. From each high school, 1 to 2 classes of female students were randomly chosen to participate in the survey. The survey was conducted in strict accordance with the standards of the 1964 Helsinki Declaration and was reviewed and approved by the Academic Ethics and Morality Committee of Shanghai Normal University (Approval Number: 2024053). Prior to distributing the survey, all participants were informed about the study’s purpose, background, and the intended use of the data. Participants were assured that the collected statistical data and personal information would be kept strictly confidential. The guardians, homeroom teachers, and school administrators, after being informed of this information, provided their consent for the distribution of the questionnaires. The questionnaire’s cover page included an informed consent form and the definition of cyberbullying victimization. Participants who objected to any consent terms or had never experienced cyberbullying could select “disagree” or “never experienced cyberbullying” to terminate the survey.

Through the aforementioned measure, a total of 530 questionnaires were collected, and only those students who had relevant experiences of cyberbullying victimization were included as participants in this study. Among the responses collected, 27 questionnaires were deemed invalid due to missing or duplicate answers. After excluding the invalid questionnaires, 503 valid responses were used for statistical analysis. The minimum required sample size was determined using G*Power 3.1 (Faul et al., 2009), with effect size = .15, α = .05, and power = .95, predictors = 32, resulting in a recommended sample size of 267. Our final sample exceeded this requirement. The distribution of valid samples was as follows: 296 students from the first year of high school, 155 from the second year, and 52 from the third year.

Research Instruments

The scales used in this study originated from previously validated English versions with good reliability and validity. All scales were cross-culturally adapted to form the final Chinese versions following the translation procedures outlined by Beaton et al. (2000). First, two native Chinese-speaking professionals proficient in English independently translated the original scales into Simplified Chinese (Mandarin). Subsequently, the research team compared and discussed the translations to develop the initial Chinese version. Next, two native English-speaking graduate students proficient in Chinese independently back-translated the Chinese draft into English. With the assistance of English experts, the research team evaluated the back-translated versions and finalized the Chinese scales. Finally, two professors of sports psychology and two professors of sports education—all with extensive experience in the field and familiarity with the research context—reviewed the original scales, translated versions, and back-translated versions. Their review focused on ensuring that the translations retained the original meaning, aligned with the research objectives, and were culturally appropriate for the Chinese context.

Cyberbullying Victimization Scale

This scale was developed by Shapka and Maghsoudi (2017) and further revised by Shapka et al. (2018), to measure the degree to which individuals experience cyberbullying victimization while using the Internet. The scale consists of 6 items and uses a 5-point Likert scale, ranging from 1 (“strongly disagree”) to 5 (“strongly agree”), with higher scores indicating a higher degree of cyberbullying victimization of the female high school students. In this study, Confirmatory Factor Analysis (CFA) results supported the scale’s validity, with factor loadings >.5, χ² = 86.9, df = 9, TLI = .971, CFI = .982, SRMR = .011, Average Variance Extracted (AVE) > .5, and Composite Reliability (CR) > .7, indicating excellent validity. The reliability analysis showed a Cronbach’s α of .976 for the School Bullying scale, confirming its excellent internal consistency.

Academic Burnout Scale

Maslach et al. (1996) revised the initial burnout scale developed by Maslach and Jackson (1981) and validated the inclusion of three dimensions—“emotional exhaustion,”“de-individuation,” and “professional efficacy”—in the Maslach Burnout Inventory – General Survey (MBI-GS). For the purposes of this study and considering the specific population of female high school students, appropriate modifications were made to the MBI-GS. The scale was modified to include three dimensions: “Emotional exhaustion,”“de-individuation,” and “learning effectiveness,” to measure academic burnout among female high school students. The adapted scale consists of 16 items, using a 5-point Likert scale, where 1 = “Strongly disagree” to 5 = “Strongly agree.” Higher scores in the emotional exhaustion and de-individuation dimensions, along with lower scores in the learning effectiveness dimension, indicate a higher level of academic burnout. In this study, Confirmatory Factor Analysis (CFA) results supported the scale’s validity, with factor loadings > .5, χ² = 533, df = 101, TLI = .945, CFI = .954, SRMR = .032, Average Variance Extracted (AVE) > .5, and Composite Reliability (CR) > .7, indicating excellent validity. Reliability testing using Cronbach’s α further confirmed the scale’s robustness, with values as follows: Emotional Exhaustion = .948, De-individuation = .948, and Learning effectiveness = .959. These results demonstrate excellent reliability.

Sports Engagement Scale

Developed by Skinner et al. (2008), this scale measures the degree of individual engagement in physical activity. It consists of two dimensions: behavioral engagement and emotional engagement, with a total of 10 items. The scale uses a 5-point Likert scale, with scoring ranging from 1 (“strongly disagree”) to 5 (“strongly agree”), and total scores fluctuating between 10 and 50. Higher scores indicate a deeper level of engagement in physical activity. In this study, Confirmatory Factor Analysis (CFA) results supported the scale’s validity, with factor loadings > .5, χ² = 215, df = 34, TLI = .956, CFI = .967, SRMR = .032, Average Variance Extracted (AVE) > .5, and Composite Reliability (CR) > .7, indicating excellent validity. Reliability testing using Cronbach’s α further confirmed the scale’s robustness, with values as follows: Behavioral Engagement = .922, and Emotional Engagement = .962. These results demonstrate excellent reliability.

Data Analysis

After excluding samples with irregular responses and missing data, the data were imported into SPSS 27.0 and AMOS 24.0 statistical software. Initially, the validity of the scales was verified through confirmatory factor analysis and Cronbach’s α coefficient for reliability and validity analysis. Additionally, the correlations and normal distribution of various dimensions were verified. Subsequently, the hypotheses’ structural model was tested using Structural Equation Modeling (SEM). Finally, the moderating effect of Sports Engagement was tested using Hayes’s PROCESS macro model 1, with a significance level of α < .05.

Research Results

Measurement Model Testing

This study conducted a confirmatory factor analysis to test the structural validity of the scales used. As indicated in Table 1, the results of the confirmatory factor analysis showed: χ² = 1,228.020, p < .001, df = 449, RFI = .932, NFI = .938, IFI = .960, TLI = .956, CFI = .960, RMSEA = .059, SRMR = .033. The RMSEA value was less than .08, and the SRMR value was less than .1, with NFI, IFI, TLI, and CFI values all greater than .9 (Netemeyer et al., 1997). The standardized factor loadings for each measurement item in the scale were all above .5, and the Average Variance Extracted (AVE) values were greater than .5, while the Composite Reliability (CR) values were all above .7. These findings confirm the model’s excellent convergent validity (Hair et al., 2004). The discriminant validity was tested using the Heterotrait–Monotrait ratio of correlations (HTMT) method proposed by Henseler, Ringle, and Sarstedt, which indicated that the correlations between all latent variables, that is, HTMT values, were below 1. Thus, the data’s discriminant validity was established.

Table 1.

The Measurement Model Testing and Reliability and Validity Testing.

Variables	Items	β	AVE	CR
Cyberbullying victimization	Someone posted rumors about you online	.932	.870	.976
	Someone posted your personal information online	.899
	Someone made hurtful comments on your photos or videos	.941
	Someone posted or shared embarrassing videos or photos of you	.939
	You received a hurtful text message from someone online	.942
	Someone posted or shared something embarrassing or mean about you online	.943
Behavioral engagement	I am very serious when I am doing physical activities	.781	.709	.924
	I concentrate on what I am doing during physical activities	.841
	I engage in discussions when I am participating in physical activities	.801
	I try my best to practice during physical activities	.906
	I strive to achieve good results in physical activities	.875
Emotional engagement	I get involved in activities during physical activities	.902	.838	.963
	I enjoy learning new things in physical activities	.893
	Physical activity is fun	.903
	I am interested in what we are doing during physical activities	.931
	I feel good when I am doing physical activities	.947
Emotional exhaustion	I am overwhelmed by my studies	.908	.786	.948
	Studying is a very tiring task	.871
	Just thinking about starting a new day of study makes me feel tired	.879
	I feel exhausted after a day of studying	.925
	Studying makes me feel drained	.847
De-individuation	I doubt the significance of learning	.950	.779	.946
	I am indifferent to the outcomes of my studies	.954
	My only purpose in studying is to get it done as a task	.867
	My enthusiasm for my studies has decreased	.797
	My interest in my studies has diminished	.832
Learning effectiveness	I am confident in my learning efficiency	.892	.797	.959
	I engage in valuable learning	.918
	I feel pleased with every learning task I complete	.908
	I find learning to be easy for me	.847
	I can make positive contributions through my learning	.891
	I can study efficiently	.900

Test for Common Method Bias

To examine whether the data in this study suffered from common method bias, Harman’s single-factor test was employed. Excluding demographic variables, all items in the questionnaire were subjected to an exploratory factor analysis without rotation. The analysis extracted six factors with eigenvalues greater than 1, with the first factor accounting for 41.442% of the variance, which is less than 50%. This indicates that there is no significant common method bias present in the data (Shiau & Luo, 2012).

Preliminary Analysis

Pearson’s correlation analysis was utilized to explore the correlations among the variables. As shown in Table 2, there were significant correlations among the variables, with all correlation coefficients below .8, indicating that there were no issues with multicollinearity among the variables. Analysis of skewness and kurtosis values within the ±2 and ±4 range, respectively, confirmed the normal distribution of the data (Hong et al., 2003).

Table 2.

The Correlation Analysis and Tests for Normal Distribution.

Variable	A	B	C	D	E	F
A	1
B	.175**	1
C	.147**	.783**	1
D	.297**	.290**	.308**	1
E	.364**	.317**	.315**	.798**	1
F	−.138**	−.446**	−.509**	−.492**	−.515**	1
Mean	1.688	2.254	2.160	2.949	2.606	3.524
SD	1.117	.835	1.028	1.103	1.132	.927
Kurtosis	1.633	1.113	.721	−.169	.295	−.237
Skewness	1.385	1.379	.079	−.685	−.634	−.151

Note. A = cyberbullying victimization; B = behavioral engagement; C = emotional engagement; D = emotional exhaustion; E = de-individuation; F = learning effectiveness.

p < .01.

Hypothesis Testing

To test whether the model setting and sample data fit meet statistical requirements, this study conducted data testing after building the model. The results showed that χ² = 743.753, p < .001, df = 203, RFI = .940, NFI = .947, IFI = .961, TLI = .955, CFI = .961, RMSEA = .073, SRMR = .037. This meets the criteria of RMSEA < .08, SRMR < .1, NFI, IFI, TLI, CFI > .9 (Netemeyer et al., 1997); therefore, it is inferred that the data of this study fit the hypothesized model well, and the hypothesized causal model can be accepted (Browne & Cudeck,1992; Hu & Bentler, 1999).

The hypothesis testing results for H1, H2, and H3 are presented in Table 3. For Hypothesis 1, cyberbullying has a significant positive effect on emotional exhaustion (β = .309, p < .001), supporting H1. For Hypothesis 2, cyberbullying has a significant positive effect on de-individuation (β = .350, p < .001), supporting H2. For Hypothesis 3, cyberbullying has a significant negative effect on learning effectiveness (β = −.137, p < .01), supporting H3.

Table 3.

Direct Path Analysis Results.

Hypothesis	Path	B	β	SE	t	Result
H1	Cyberbullying victimization → emotional exhaustion	.315	.309	.046	6.894***	Supported
H2	Cyberbullying victimization → de-individuation	.386	.350	.048	7.970***	Supported
H3	Cyberbullying victimization→ learning effectiveness	−.119	−.137	.040	−2.997**	Supported

χ² = 743.753***, df = 203, NFI = .947, RFI = .940, IFI = .961, TLI = .955, CFI = .961, SRMR = .037, RMSEA = .073.

p < .01. ***p < .001.

The Moderating Role of Sports Engagement in the Impact of Cyberbullying Victimization on Academic Burnout

To analyze whether sports engagement has a significant moderating effect on the path through which cyberbullying victimization affects the various dimensions of academic burnout, this study used Hayes PROCESS model 1. The research results are shown in Table 4.

Table 4.

Results of the Moderating Effect of Sports Engagement.

Hypothesis	Dependent variable	Independent variable	Coeff.	SE	t	p
H4	Emotional exhaustion	Cyberbullying victimization	.262	.041	6.376	.000
		Sports engagement	.363	.052	6.965	.000
		Cyberbullying victimization * sports engagement	−.109	.039	−2.826	.005
F(3, 499) = 35.290, p < .001, R² = .175
H5	De-individuation	Cyberbullying victimization	.340	.041	8.359	.000
		Sports engagement	.385	.052	7.466	.000
		Cyberbullying victimization * sports engagement	−.144	.038	−3.758	.000
F(3, 499) = 50.055, p < .001, R² = .231
H6	Learning effectiveness	Cyberbullying victimization	−.057	.032	−1.752	.080
		Sports engagement	−.543	.041	−13.232	.000
		Cyberbullying victimization * sports engagement	.096	.031	3.136	.002
F(3, 499) = 63.503, p < .001, R² = .276

In hypothesis H4, both cyberbullying victimization (β = .262, p < .001) and sports engagement (β = .363, p < .001) have a significant impact on emotional exhaustion. The interaction between cyberbullying victimization and sports engagement (β = −.109, p < .01) has a significant negative moderating effect on emotional exhaustion, indicating the moderating effect of sports engagement in the impact of cyberbullying victimization on emotional exhaustion is valid. As shown in the moderation effect graph in Figure 2, compared to the group with lower sports engagement, the group with higher sports engagement experiences a lower impact of cyberbullying victimization on emotional exhaustion.

Figure 2.

The moderating role of sports engagement in the impact of cyberbullying victimization on emotional exhaustion.

In hypothesis H5, cyberbullying victimization (β = .340, p < .001) and sports engagement (β = .385, p < .001) both significantly affect de-individuation. The interaction between cyberbullying victimization and sports engagement (β = −.144, p < .001) has a significant negative moderating effect on de-individuation, indicating the moderating effect of sports engagement in the impact of cyberbullying victimization on de-individuation is valid. As shown in the moderation effect graph in Figure 3, compared to the group with lower sports engagement, the group with higher sports engagement experiences a lower impact of cyberbullying victimization on deindividuation.

Figure 3.

The moderating role of sports engagement in the impact of cyberbullying victimization on de-individuation.

In hypothesis H6, cyberbullying victimization does not have a significant impact on learning effectiveness (β = −.057, p > .05), but sports engagement has a significant impact on learning effectiveness (β = −.543, p < .001). The interaction between cyberbullying victimization and sports engagement (β = .096, p < .01) has a significant positive moderating effect on learning effectiveness, indicating the moderating effect of sports engagement in the impact of cyberbullying victimization on learning effectiveness is valid. As shown in the moderation effect graph in Figure 4, for the group with high sports engagement, cyberbullying victimization has almost no impact on learning effectiveness. For the group with low sports engagement, cyberbullying victimization has an impact on learning effectiveness, and the more severe the cyberbullying victimization, the lower the learning effectiveness. Finally, the path impact effect graph for all the research hypotheses in this study is shown in Figure 5.

Figure 4.

The moderating role of sports engagement in the impact of cyberbullying victimization on learning effectiveness.

Figure 5.

Path impact effect graph.

Discussion

In the rapidly evolving internet era, the number of young people using the internet is gradually increasing. So far, there are indications that with the rise in the number of online participants, the cases of cyberbullying victimization are also continually increasing (Smith et al., 2008). This study introduced sports engagement as a moderating variable to explore the impact of cyberbullying victimization on academic burnout among female high school students, and yielded certain results. Regarding the potential mechanisms underlying the findings, this study provides appropriate discussion and elaboration.

Cyberbullying Victimization has a Significant Positive Impact on Emotional Exhaustion and De-individuation, and a Significant Negative Impact on Learning Effectiveness

Research by Anwar et al. (2020) indicates that due to the continuous repetition of bullying, individuals may suffer from adverse emotional states such as mental stress, leading to phenomena of emotional exhaustion, which aligns with the findings of this study. In addition, this study confirms that certain gender-specific factors amplify this effect. We observed that female high school students exhibit heightened sensitivity to online hostility, yet their psychological resilience remains insufficient to readily tolerate malicious attacks. This increases the likelihood of emotional distress among those who experience cyberbullying. Persistent cyberbullying impedes emotional recovery, and emotional exhaustion subsequently diminishes female students’ focus on academic performance—a finding partially supported by Collen and Onan’s (2021) research.

Furthermore, unlike Park and Choi’s (2019) observations of workplace populations, this study—focusing on female high school students—revealed similar outcomes: we found that the negative effects of cyberbullying directly reduced their learning effectiveness. The inherent academic pressure in high school already operates at a high threshold, while cyberbullying introduces an additional stressor. According to Zimmer-Gembeck and Skinner’s (2016) theoretical discussion on stress coping mechanisms, negative emotions and exposure to “adversity” constitute potential pathways for stress development. For female high school students, cyberbullying experiences represent such “adversity,” triggering increased stress and consequent declines in learning effectiveness. We therefore recommend prioritizing primary prevention of cyberbullying to intercept stress transmission and contain stress within manageable levels. This approach would establish a necessary precondition for the implementation of subsequent interventions such as psychological counseling.

The findings of this study indicate that, in addition to emotional exhaustion, cyberbullying significantly increases the level of de-individuation among female high school students. Regarding the underlying reasons for this result, it is necessary to address certain inherent characteristics of the internet. The anonymity of the internet allows individuals with lower moral consciousness to ignore basic behavioral boundaries, leading to an increase in barbaric behaviors, fostering the phenomenon of de-individuation (Dan & Alexander, 1996). According to a more specific study by Valkenburg and Peter (2011), de-individuation can trigger a series of chain reactions, such as diminished self-evaluation and loss of individual pursuit of self-identity. These effects, in turn, exacerbate academic burnout. Furthermore, cyberbullying is often persistent - during this process, victims gradually lose enthusiasm and motivation for all aspects of academic activities, ultimately leading to a depersonalized state of “studying merely for the sake of studying.”

Overall, this study concludes that cyberbullying victimization leads to academic burnout among female high school students, a finding similar to that of Yang et al. (2013). However, some studies suggest that female students who have experienced cyberbullying may actually demonstrate higher academic achievement probabilities. This phenomenon could potentially be attributed to their enhanced capacity for perceived social support (Renk & Smith, 2007), indicating their ability to obtain necessary social support to overcome difficulties. Therefore, actively seeking social support and assistance could serve as a viable approach to mitigate academic burnout. Nevertheless, it is crucial to emphasize that when addressing cyberbullying-induced academic burnout, all parties involved must avoid gender-biased differential treatment. Improper or unfair handling may foster psychological barriers among students, ultimately compromising their mental health.

Sports Engagement has a Moderating Role Between Cyberbullying Victimization and Emotional Exhaustion and De-individuation

The study by McInman and Berger (1993) demonstrated that physical exercise can modulate individuals’ state anxiety, tension, and depressive moods, providing psychological evidence supporting this study’s finding that “sports engagement can alleviate emotional exhaustion in female high school students.” The research proposed that physical activity generates substantial psychological pleasure and enhanced vitality in individuals—precisely the mental resources required to counteract the depressive effects of cyberbullying.

Physical activity possesses unique characteristics. When female high school students engage in sports, they experience increased close communication and cooperative opportunities with peers. These interactions feature more vivid and dynamic communicative experiences that facilitate the expression of goodwill. Such positive social engagement can counteract the malicious effects of cyberbullying and reignite their enthusiasm for life.

From another perspective, sports engagement influences body image by enhancing satisfaction with one’s physical appearance, thereby effectively mitigating the negative self-perceptions triggered by cyberbullying. This effect enables female high school students to demonstrate confidence and individuality while confronting malicious experiences with a positive life attitude. Marsh and Kleitman’s (2003) research on body image provides collateral evidence supporting this viewpoint. The current study appropriately extends this finding by demonstrating that the de-individuation caused by cyberbullying can be positively moderated through sports engagement. Research indicates that among female high school students who have experienced cyberbullying, the most common forms tend to be indirect, such as psychological and emotional harassment (Hinduja & Patchin, 2008). Based on these findings, we recommend that school teachers and parents should pay greater attention to the psychological and emotional well-being of female high school students. Strengthen daily communication with these students to better understand their emotional states and help them maximize stress relief in familiar and supportive environments. In addition, offering constructive outlets for emotional expression—such as incorporating more engaging and interactive elements into physical education classes—may provide an effective way to relieve psychological pressure, reduce emotional exhaustion, and mitigate feelings of de-individuation.

The Moderating Role of Sports Engagement Between Cyberbullying Victimization and Learning Effectiveness

In addition to emotional factors, sports participation demonstrates significant effectiveness in enhancing cognitive functions, directly influencing the learning effectiveness of female high school students. This finding is corroborated by Reed et al.’s (2013) study examining the impact of physical activity on mathematics performance among students.

The potential mechanism underlying these results can be similarly explained through the “stress-energy-attention” linkage framework. Victims of cyber-bullying endure various pressures in daily activities, and when the pressure reaches a certain level, they prefer to focus their limited energy on themselves, making it difficult to maintain a sustained interest in academics (Payne & Schnapp, 2014). However, sports engagement can release these pressures, making high school students more positive in mood and focused in attention, thereby enhancing their interest in learning and initiative. Furthermore, the study by Lumpkin and Favor (2013) explicitly demonstrates that sports participation benefits the academic performance of female high school students, a finding that provides substantive support for the results of this study.

However, research indicates that female students’ participation in physical activities significantly decreases after entering high school (Kimm et al., 2002). This finding appears to deviate from the anticipated outcomes of the present study. Potential explanatory factors for this discrepancy may include: increased academic pressure, adjustments in time allocation, and the development of personal interests. Therefore, to alleviate academic burnout among female high school students experiencing cyberbullying victimization, increasing their engagement in physical activities is crucial. Dindia and Allen (1992) found that students of different genders exhibit distinct self-disclosure tendencies in social interactions, with corresponding variations in their interpersonal behaviors. Taking female students as an example, heightened self-disclosure enables them to demonstrate greater intimacy and friendliness toward others (Reis & Patrick, 1996). Based on this, sports games, team-based activities, and other interactive recreational components demonstrate pronounced efficacy in establishing amicable social relationships. Offering a variety of physical exercise activities can help female high school students relax physically and mentally, improving learning efficiency. In summary, the role of sports engagement cannot be overlooked in preventing the sustained negative impact of cyberbullying victimization on high school students and should be a focal point for schools with a high incidence of cyberbullying victimization.

However, beyond addressing cyberbullying victims, effective interventions targeting bullies’ behaviors remain imperative. Fundamentally, bullies’ actions constitute the primary catalyst for victims’ negative emotional sequelae and subsequent academic burnout. Empirical evidence indicates that adolescents frequently engage in aggressive or bullying behaviors toward peers when driven by elevated psychological distress, depressive symptomatology, or diminished life satisfaction (Estévez et al., 2019). These findings underscore the multifactorial nature of cyberbullying, suggesting that bullies’ behavioral tendencies warrant systematic analysis and contextual understanding rather than unilateral condemnation or social exclusion.

Furthermore, it is important to note that, as a form of self-defense, many adolescents who fall victim to cyberbullying may, in turn, engage in cyberbullying behaviors themselves (Kowalski et al., 2014). This inappropriate coping strategy creates a vicious cycle between bullies and victims, adversely affecting normal academic functioning and mental health across adolescent populations, including female high school students. These findings underscore that psychological rehabilitation and targeted support for perpetrators constitute a critical component in breaking the “bully-victim-bully” cycle. In alignment with these findings, our study suggests that schools and relevant stakeholders should expand their focus beyond supporting female high school students who experience cyberbullying to also address the developmental environments of potential bullies. Through positive educational approaches and healthy emotional outlets such as sports-based activities, these efforts can guide adolescents toward establishing appropriate interpersonal relationships and ultimately modify their behavioral patterns.

Specifically, given that cyberbullying bullies may exhibit psychological defense mechanisms and environmentally acquired mental health disturbances—factors that indirectly contribute to victims’ psychological exhaustion and academic impairments—it becomes imperative to develop targeted interventions for such cases. By implementing bully-focused preventive measures that address the origins of harm, we can effectively mitigate the proliferation of cyberbullying, thereby preventing subsequent academic burnout resulting from such victimization.

Limitations, Recommendations, and Implications for Future Research

This study systematically constructed a theoretical model examining both the direct effects of cyberbullying on academic burnout and the moderating role of sports engagement, achieving partial integration of the “stress generation-psychological imbalance-sports buffering” framework. Through verification and analysis of the results, we demonstrated that cyberbullying induces emotional exhaustion, de-individuation, and reduced learning effectiveness among female high school students via accumulated stress, while sports engagement fulfills their psychological needs through emotional regulation, thereby effectively buffering burnout symptoms. Collectively, the findings suggest that the “stress generation, coping, and buffering” process may serve as a nexus connecting the three primary variables. Within the pathway linking cyberbullying to academic burnout, stress alleviation and emotional regulation emerge as core moderating mechanisms of sports engagement. Nevertheless, the “cyberbullying-academic burnout” pathway may also involve potential mediating factors. Similarly, beyond sports engagement, alternative moderating elements and mechanisms may exist—questions warranting further empirical investigation in subsequent studies.

This study has several limitations in interpreting the results. First, the research exclusively selected female high school students as participants. However, the negative impacts of cyberbullying are not limited to gender, and both male and female students can experience harm from cyberbullying. To address this limitation, future studies could consider investigating cyberbullying’s effects on high school students regardless of gender, or conduct comparative studies between male and female students to better understand the causal relationships between the variables. Moreover, the detrimental effects of cyberbullying extend far beyond academic burnout, potentially manifesting varying degrees of impact on different populations or behavioral manifestations of “burnout.” The potential variations in these effects and their underlying mechanisms require further investigation. Another critical avenue for future research involves the current study’s exclusive focus on the “victim” perspective among female high school students. Notably, the adverse consequences of cyberbullying also significantly affect bullies themselves. Subsequent studies should therefore incorporate the “bully” perspective to examine psychological intervention and support mechanisms. Besides, this study did not control for or exclude potential alternative interventions received by participants (e.g., school-based psychological counseling, anti-bullying educational programs, peer support groups). These “alternative interventions” may have partially mitigated the negative impacts of cyberbullying victimization on students’ emotional well-being and academic performance, thereby potentially influencing the observed moderating effects of sports engagement in this study. Consequently, the findings should be interpreted with caution. Future research should incorporate controls for other school-level or individual-level supportive interventions to more precisely isolate the independent role of sports engagement within this mechanism.

Second, this study treated sports engagement as a macro-level variable, but there may be differences in the types of sports or methods of participation chosen by the participants. These differences could limit the extent to which sports engagement serves as a moderating variable in this context. It is suggested that future research focus more closely on the variations in types of sports and methods of participation, which could provide deeper insights into the role of sports in moderating the effects of cyberbullying on academic burnout.

Third, this study employed a cross-sectional survey method, which only provides a snapshot of the variables at a single point in time. Given that the effects of cyberbullying can be long-lasting (Morea & Calvete, 2022) and sports engagement can be seen as an ongoing process (Eman, 2012), the potential influence of time on the study’s results should be considered. Future research could benefit from longitudinal tracking studies to minimize potential temporal interference and provide a more comprehensive understanding of the relationships between the variables.

Overall, this study offers valuable insights into the impact of cyberbullying on academic burnout in female high school students and suggests ways to promote academic success. By confirming the moderating role of sports engagement, this research sheds light on an underexplored perspective in previous studies. The results suggest that encouraging female students to engage in sports can help mitigate the negative effects of cyberbullying and reduce academic burnout, offering valuable guidance for schools and educators. Moreover, this study provides a reference for creating a healthier academic environment and enhancing physical education curricula.

Given the direct impact of cyberbullying victimization on various dimensions of academic burnout in female students, it is crucial for teachers and schools to recognize signs of cyberbullying and implement timely interventions, such as anti-bullying seminars, to prevent further harm. These measures are highly actionable and can have a direct impact. Additionally, organizing mental health programs and sports activities can serve as an emotional outlet, helping students alleviate psychological stress and maintain a positive mindset. Interactive sports that are enjoyable and engaging can capture students’ interest, and schools should ensure a high proportion of such activities in their sports programs. This will help female students relax, maintain their individuality, and reduce academic burnout. Furthermore, we believe that the measures suggested in this study could be effective across all genders, making them highly relevant for reducing the risk of academic burnout due to cyberbullying. The implications of this research are significant for promoting the well-being of high school students and addressing the growing challenge of cyberbullying in educational settings.

Conclusion

With the increasing prevalence of cyberbullying, the academic progress of bullied high school students, particularly female students, has gained significant attention. Against this background, the positive moderating role of sports engagement requires further empirical verification. This study examined the relationship between cyberbullying victimization and academic burnout in female high school students and analyzed the moderating role of sports engagement. The results indicate that cyberbullying victimization significantly impacts emotional exhaustion, de-individuation, and learning effectiveness in female students. Furthermore, it was found that active participation in sports helps mitigate the negative effects of cyberbullying on their academic performance. These findings provide direct evidence supporting the efficacy of sports engagement in helping female high school students regulate negative emotions, alleviate stress, and enhance learning effectiveness, offering significant implications for developing targeted educational programs and implementing necessary intervention measures in school settings.

The impact of cyberbullying victimization on female high school students extends beyond academic burnout, and it is essential to continue addressing other common psychological burdens caused by cyberbullying. For instance, our findings indicate that anxiety, depression, and social impairment constitute significant challenges in high school students’ academic development, all of which warrant sustained attention from educators and subsequent researchers. Additionally, sports engagement in this study has proven to be an effective moderating factor, offering a valuable means to alleviate academic burnout caused by cyberbullying. It is hypothesized that sports engagement could also help alleviate other psychological burdens caused by cyberbullying, which presents an interesting avenue for future research.

Footnotes

Acknowledgements

Before submitting the article, I would like to thank all the members of the research team for their contributions to the data collection and writing of this article, as well as for their suggestions on the topic selection and design of this paper, and for their help in data processing.

Author note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

ORCID iDs

Weinan Zhou

Yurong Lu

Ethical Considerations

The studies involving human participants were reviewed and approved by the Institutional Review Board of Shanghai Normal University (Approval No: 2024053). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Consent for Publication

The questionnaire for this study was completed after obtaining the consent of the head of school and classroom teachers of the relevant study participants, and after the informed consent form was signed by the study participants.

Author Contributions

Conceptualization: Weinan Zhou, Yichi Zhang, and Yurong Lu; Methodology: Weinan Zhou; Software: Weinan Zhou; Data curation: Weinan Zhou; Investigation: Yichi Zhang and Bingbin Xie; Validation: Weinan Zhou; Formal analysis: Weinan Zhou, Yichi Zhang, and Yurong Lu; Supervision: Yurong Lu; Visualization: Weinan Zhou, Yichi Zhang, and Yurong Lu; Project administration: Bingbin Xie and Yurong Lu; Resources: Yurong Lu; Writing – original draft: Yichi Zhang; Writing – review & editing: Weinan Zhou and Yurong Lu.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

If you need the raw data for this study, please contact the authors.

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Balancing the Impact of Cyberbullying on Academic Performance: The Moderating Role of Sports Engagement

Abstract

Keywords

Introduction

Literature Review and Research Hypotheses

The Relationship Between Cyberbullying Victimization and Academic Burnout

The Moderating Role of Sports Engagement

Research Methods

Research Participants

Research Instruments

Cyberbullying Victimization Scale

Academic Burnout Scale

Sports Engagement Scale

Data Analysis

Research Results

Measurement Model Testing

Test for Common Method Bias

Preliminary Analysis

Hypothesis Testing

The Moderating Role of Sports Engagement in the Impact of Cyberbullying Victimization on Academic Burnout

Discussion

Cyberbullying Victimization has a Significant Positive Impact on Emotional Exhaustion and De-individuation, and a Significant Negative Impact on Learning Effectiveness

Sports Engagement has a Moderating Role Between Cyberbullying Victimization and Emotional Exhaustion and De-individuation

The Moderating Role of Sports Engagement Between Cyberbullying Victimization and Learning Effectiveness

Limitations, Recommendations, and Implications for Future Research

Conclusion

Footnotes

Acknowledgements

Author note

ORCID iDs

Ethical Considerations

Consent for Publication

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References