(CNN) "I hope she sees this and kills herself." - message to Amanda Todd
"The world would be a better place without you." - message to Megan Meier
Infamous quotes from famous cases of teenage cyberbullying, each ending tragically with the victim taking her life. Heartbreaking cases like these galvanized research and today much more is known about the damaging effects of cyberbullying among middle and high school students -- including an increased risk for depression, substance abuse, suicidal thoughts, hostility and delinquency.
Not so much, according to a new study from the University of Washington. Questioning 265 girls enrolled in four colleges, researchers found college-age females just as likely to suffer the negative effects of cyberbullying as younger adolescents.
"That's a jump off the page," said study co-author Dr. Megan Moreno. "This is the type of bullying that is going beyond those childhood and adolescent years and into young adulthood."
The study found college girls who reported being cyberbullied were three times more likely to meet clinical criteria for depression. And if the cyberbullying was connected to unwanted sexual advances, the odds of depression doubled.
"A six-fold increase in the odds for depression when there was fallout from unwanted sexual advances or fallout from a romantic relationship was very striking," said Moreno. "These are not innocuous actions. These are actions that really can trigger depression and really can lead to damage to the people who are involved. "
A 2014 survey about online harassment by the Pew Research Center found 26% of 18-24 year-old-women say they've been stalked online, while 25% say they were the target of online sexual harassment.
"Some people have hypothesized that cyberbullying in that context -- unwanted sexual advances — really starts to look like it should be on the spectrum of sexual violence rather than bullying," said Moreno.
Cyberbullies suffer too. Girls who bully have a four times higher risk for depression than those who don't. The study also found they're also more likely to have a drinking problem.
"For problem alcohol abuse, it was really the bullies that struggled, and not the victims," said Moreno.
The study didn't take a look at other mental health impacts, such as suicidal thoughts. Moreno says that was deliberate.
"Those cases are so extreme — and they are so horrible — but at the same time what we were hearing [from girls] in our studies is this is something that is happening all the time to a lot of us and we want to know what else can happen," said Moreno.
"If we don't kill ourselves are we at risk for something else?" is a frequent question Moreno hears. "Is there something else bad that happens to me as a victim, or does something bad happen to that bully that's been picking on me?"
Girls who experience cyberbullying are encouraged to get help by visiting their college clinic to talk about their experience, their growing feelings of depression or their substance abuse.
"There are potential health impacts," says Moreno. "This should be in the public health arena. Girls should not feel like they can't go to clinic and talk about their feelings."
Atlanta advocate Helen Ho agrees. She's the founding director of Asian Americans Advancing Justice and spends a good deal of her time on cyberbullying issues. Research shows Asian Americans are digitally bullied at least four times as often as other ethnicities.
One of the frustrating things about being an advocate against cyberbullying," says Ho, "is that a lot of people don't realize how intense cyberbullying can be in this kind of high-technology age and the physical as well as mental impact it can have."
"For many of us who are adults and didn't grow up with online access, we can see that distinction between online and offline very clearly," adds Moreno. "But for youth, there isn't a distinction. We used to say either online or real world, and youth say 'No, no, you don't get it, online IS my real world'."