A network analysis of depressive symptoms, problematic internet use, and social support in relation to suicidal behaviors among Chinese adolescents

ABSTRACT Objectives The rapid growth of digital screen exposure has reshaped childhood and adolescence, raising concerns about mental health. This systematic review synthesises peer-reviewed studies (2013–2025) on screen use (social media, gaming, problematic internet use) and psychological outcomes in children and adolescents aged 2–18, focusing on depression, anxiety, and attention-related problems. Method Following PRISMA, searches in PubMed, PsycINFO, ScienceDirect, Scopus, and Web of Science identified eligible articles. Studies were appraised with the Newcastle – Ottawa Scale and thematically synthesised. Results Across 50 studies, heavier screen exposure was consistently associated with poorer outcomes, including higher depressive and anxiety symptoms, psychological distress, and broader emotional/behavioural difficulties. Social media use showed the most consistent links with depression, commonly alongside low self-esteem, body dissatisfaction, and online harassment. Sleep disruption and reduced physical activity frequently co-occurred with higher screen exposure and, when formally tested, sleep partially explained screen – mental health associations. Evidence also linked higher screen exposure and problematic use with attention difficulties and ADHD-type symptoms, with longitudinal findings suggesting screen exposure increases the prediction of symptom growth in vulnerable adolescents. Conclusion Overall, guidance should move beyond duration to screen type, timing, content, and individual vulnerability, while protecting sleep and activity. This review is registered in PROSPERO (CRD420251245554).

Problematic Internet Use (PIU) is a critical public health issue, especially among children and adolescents. The Dual Systems Model posits that imbalances between reward processing and self-control systems increase PIU vulnerability, with potential reciprocal effects of PIU on these systems. However, previous studies have primarily employed variable-centered approaches, neglecting within-system heterogeneity, and longitudinal studies on bidirectional relationships have mostly focused on single system, with limited evidence in children. The present study fills these research gaps by utilizing person-centered approaches to explore bidirectional relationships in 1341 children (9-11 years) and adolescents (13-16 years). A 1-year longitudinal survey measuring reward sensitivity, self-control, and PIU was conducted, combined with latent profile transition analysis and supervised machine learning. The results showed developmental similarities and differences. First, dual systems patterns predicted PIU in both age groups, but the underlying mechanisms were different. Low reward sensitivity and low self-control in children and adolescents increased PIU risk, while adolescents also uniquely affected by high reward sensitivity and low self-control. Second, PIU only reduced reward sensitivity and self-control over time in children. The present study enriches the Dual Systems Model by demonstrating bidirectional relationships from a person-centered perspective and informs tailored PIU interventions based on developmental stage and dual-system profiles.

Internet addiction (IA) has become an increasingly prevalent behavioral health concern among university students, with previous studies reporting substantial levels of problematic internet use among nursing students, including a multicenter study in China that found a prevalence of 23.3%. Because problematic internet use may be associated with poorer quality of life (QL), QL represents an important well-being outcome in this population. Mindfulness exercise (ME), as a movement-based mindfulness practice, may serve as a protective factor associated with better self-regulation and healthier behavioral functioning. However, limited research has examined whether ME is associated with QL directly and indirectly through self-control (SC) and IA among nursing students. A cross-sectional survey was conducted among 480 nursing students using validated measures of mindfulness exercise, self-control, internet addiction, and quality of life. Data were analyzed using partial least squares structural equation modeling (PLS-SEM). Reliability, convergent validity, and discriminant validity of the measurement model were confirmed. Bootstrapping with 5,000 resamples was applied to examine direct and mediating effects among the study variables. The results showed that mindfulness exercise was positively associated with self-control (β = 0.435, p < 0.001) and quality of life (β = 0.181, p < 0.001). Self-control was negatively associated with internet addiction (β = -0.304, p < 0.001), and internet addiction was negatively associated with quality of life (β = -0.215, p < 0.001). In addition, self-control significantly mediated the association between mindfulness exercise and internet addiction (β = -0.132, p < 0.001), as well as the association between mindfulness exercise and quality of life (β = 0.163, p < 0.001). Furthermore, a significant sequential mediating effect of self-control and internet addiction was found in the association between mindfulness exercise and quality of life (β = 0.028, p = 0.001). Mindfulness exercise was associated with better quality of life among nursing students, both directly and indirectly through self-control and internet addiction. In particular, the findings support a sequential mediation pathway in which higher mindfulness exercise was associated with higher self-control, which in turn was associated with lower internet addiction and better quality of life. Given the cross-sectional design, these findings should be interpreted as associative rather than causal. Not applicable.

Background: The high rate at which online technologies are becoming part of normal operations has heightened the anxieties over Problematic Internet Use (PIU), especially in young adults. PIU has been attributed to impaired self-regulatory ability, distorted reward sensitivity, and adverse psychological consequences. According to neurobehavioral perspective, the differences in sensation seeking and self-efficacy could impact the susceptibility to PIU by the mechanisms of reward sensitivity, impulse modulation, and executive control. Although these constructs are increasingly gaining interest, their combined relationship with PIU is not well studied, particularly in Indian socio-cultural setting. Purpose: The current research aimed to investigate the interrelations between problematic internet use, sensation seeking and self efficacy among young adults with the intention of establishing psychologically based correlates applicable to neuro behavioral explanations of PIU. Methods: It took the form of a correlational research design that entailed a sample of 60 undergraduate and postgraduate students aged 18-25 years. The participants were provided with self-report measures, such as the General Self-Efficacy Scale (GSE), Zuckerman Sensation Seeking Scale (SSS), and Problematic and Risky Internet Use Screening Scale (PRIUSS18) that are standardized and self-report. The product-moment correlation test conducted by Pearson was used to evaluate relations between the variables of the study. Results: The results of the analysis showed that there was a large negative correlation between sensation seeking and problematic internet use (r = -.344, p &lt;. 01), which means that the higher the sensation-seeking behavior, the lower the PIU. Problematic internet use had a negative relationship with self-efficacy (r = -.092) and sensation seeking (r = -.273, p &lt;.05) developed a significant negative relationship with self-efficacy. These results are in contrast to what has been widely reported about sensation seeking as a direct risk factor to PIU. Conclusion: The findings indicate that sensation seeking and self-efficacy play different roles in problematic internet use among the young adults. A neurobehavioral viewpoint indicates that self-efficacy can manifest executive regulation mechanisms that counter maladaptive digital usage and sensation-seeking requirements can be more favourably achieved when offline. The paper has provided initial psychological indicators that can also inform potential neurocognitive and translational studies of problematic internet use.

This study applied the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the Relational Development System Theory (RDS) to identify key individual and contextual correlates of adolescents' problematic Internet use (PIU) with machine learning approaches. Data from 68,425 adolescents were analyzed using five ensemble models (AdaBoost, Random Forest, LightGBM, Bagging, CatBoost) within a nested cross-validation framework. Key factors were identified through SHapley Additive exPlanations (SHAP), while bivariate partial dependence analyses were used to identify interactions. The prevalence of PIU risk was 23.2%. Five algorithms achieved comparable performance. CatBoostachieved the best performance and was selected as the final predictive model. SHAP values showed that the top 17 features explained nearly 80% of the model. At the individual level, intolerance of uncertainty was the strongest risk factor, whereas mindfulness was the main protective factor. Additionally, weekend video game time was a major behavioral risk contributor. At the contextual level, home-leaving intentions and bullying perpetration were identified as key family- and peer-related risk factors, respectively. Bivariate partial dependence analyses found both within-individual (e.g., mindfulness * intolerance of uncertainty) and individual-contextual (e.g., mindfulness * home-leaving intentions) interaction effects. This study applied five machine learning algorithms to identify key individual and contextual factors associated with adolescent PIU risk and their interactions. The results suggest that risk factors accumulate across systems and impair adolescents' adaptive capacity, whereas mindfulness exerts cross-system effects that buffer these risks, offering implications for targeted interventions.

Behavioral addictions, including problematic internet use, gaming, and gambling, are emerging as significant public health concerns in Africa, driven by rapid digitalization and socioeconomic shifts. This commentary provides a critical overview of the current state of behavioral addictions in Africa, examining prevalence, cultural influences, and systemic barriers to research and intervention. Despite growing evidence of harm, particularly among youth, the continent faces significant challenges, including limited epidemiological data, cultural biases in assessment tools, and an underdeveloped mental health infrastructure. Drawing on regional studies and global frameworks, the need for culturally sensitive research, evidence-based interventions, and robust policy frameworks is highlighted. The paradoxical coexistence of rising addiction risks and minimal regulatory oversight underscores the urgency of addressing behavioral addictions in African contexts.

Problematic internet use has recently become a major global public health concern. The intensity of the relations between interparental conflict and problematic internet use differs considerably among studies, despite the fact that abundant research has observed this relationship. Therefore, this study employs three-level meta-analysis to examine the relationship between interparental conflict and problematic internet use, along with potential moderating factors. Based on the PRISMA method, we searched seven databases to identify studies that had been published before June 2025 that explore the association between interparental conflict and problematic internet use. The present study identified 33 studies, with 34,875 participants and 281 effect sizes. The analysis reveals a positive correlation between interparental conflict and problematic internet use (r = 0.239). Additionally, the present study finds a significant moderating effect of gender: men are more likely to develop problematic internet use in response to perceived parental conflict. Age is also an important moderator; the association between interparental conflict and problematic internet use is stronger among adolescents (12-18 years) compared to adults (over 18 years). Finally, the publication year is a significant moderator; recent studies showed a stronger relationship between the two variables. The results support the conclusion that interparental conflict is a significant risk factor for problematic internet use, and interparental conflict particularly affects problematic internet use among adolescent males. This connection is likely to be influenced by the publication year.

Reciprocal association and bridge symptoms in the comorbidity between social anxiety and problematic internet use: A four-wave longitudinal study.

How School-Related Internet Use Shapes Teens' Learning, Communication, Academic Stress, Online Behavior: A Qualitative Study.

The study aims to identify predictors of Problematic internet use (PIU) among Bangladeshi adolescent samples based on a public health model. This cross-sectional study was conducted in a sample of 268 college students selected from two colleges in Dhaka city, Bangladesh, selected by convenience sampling technique. Each participant who has given written consent responded to a pretested self-administered questionnaire. PIU was assessed by the Bangla version of Young's Internet Addiction Test scale and depression was assessed using the Bangla version of the Patient Health Questionnaire. The results indicated that 96.0% of the respondents used the internet and 24.4% identified as problematic users. The study analyzed psychological factors, family, school factors and environmental factors. The study analyzed accessibility and availability of the internet as environmental factors. Logistic regression showed that depression odds ratio (OR) = 4.70 was identified as increasing the odds of PIU. No family and school factors found significantly associated with internet use. Among Internet use behavior, a high perception of internet use for social networking (OR = 3.72) and relieving loneliness (OR = 3.70) increased the odds of PIU as well as internet use for getting information and news (OR = 0.41) decreased the odds of PIU. Primary prevention-based interventions are to be designed to prevent PIU considering it a public health problem.

Problematic Internet use, defined as excessive, disproportionate, or inappropriate use of the Internet leading to distress, significant time consumption, and impaired normal functioning in various crucial life domains, is emerging as a major issue in many developed countries. The growing interest in exploring this phenomenon has led to the proliferation of assessment tools designed to evaluate it. The present study aims to adapt Basque the Generalized Problematic Internet Use Scale-2 (GPIUS-2), a questionnaire specifically designed to assess the cognitive and behavioral aspects of problematic Internet use and its associated consequences, and to evaluate the psychometric properties of the new instrument. The study was carried out with two independent samples, one composed of adults (n=283, 18-62years of age, 56.5% female) and the other of adolescents (n=943, 11-16years of age, 52.0% female). Three models were tested by confirmatory factor analysis: a one-dimensional model, the original five-factor model, and a four-factor model. The results indicated that both the 4-factor and 5-factor models obtained adequate fit indices, and consequently, the most parsimonious model was chosen. Invariance testing revealed comparable measurement properties of the GPIUS-2 in both men and women, and adults and adolescents. Furthermore, the scores of the GPIUS-2 subscales revealed strong positive correlations with Internet addiction and moderate positive correlations with depression, anxiety, and stress. The results therefore indicate that the Basque version of GPIUS-2 is a reliable instrument with adequate evidence of validity that will enable professionals to assess problematic Internet use in this population.

Problematic Internet Use Among Higher Secondary School Students in Nepal: A School-Based Study

Insomnia is a significant problem that has detrimental effects on both mental and physical health. Therefore, it is important to identify the factors associated with it. The present cross-sectional study investigates the mediating roles of problematic internet use (PIU) and psychological distress in the relationship between loneliness and insomnia. The study sample consisted of 546 adults (69.41% female, Mage=29.99 years, SD=8.37) from various occupational backgrounds residing in Türkiye, aged between 18 and 55. Participants completed a Demographic Information Form, the Kessler Psychological Distress Scale, the Problematic Internet Use Scale, and the UCLA Loneliness Scale. Pearson correlation analysis was conducted to examine the associations among the variables. The hypothesized mediation model was tested using a two-step structural equation modeling (SEM) approach. The results of the multiple serial mediation analysis showed that PIU and psychological distress fully mediated the relationship between loneliness and insomnia. In other words, loneliness is associated with higher levels of problematic internet use, which is linked to increased psychological distress, which in turn is linked to increased insomnia severity. Therefore, it is recommended that preventive and intervention efforts aimed at reducing insomnia focus on loneliness, PIU, and psychological distress. The findings of this study point to a multidimensional mechanism underlying the onset and maintenance of insomnia.

This research investigated the mediating role of self-compassion in the relationship between problematic internet use and depression, anxiety, and stress. A correlational model was used for the research. The research group comprised 371 adults, of whom 285 were women (76.8%) and 86 were men (23.2%). The ages of the participants varied from 18 to 57 years (mean = 21.59, SD = 2.09). The scale tools used in the study included the Personal Information Form, the Problematic Internet Use Scale, the Depression Anxiety Stress Scale-21, and the Self-Compassion Scale. Data analysis was performed using the SPSS and JAMOVI programs. Descriptive statistics, Pearson correlation analysis and the GLM mediation model were used to analyse the data. According to the results of the Pearson correlation analysis, there were positive correlations between problematic internet use and depression, anxiety and stress, and a negative correlation between problematic internet use and self-compassion. Additionally, negative correlations were observed between self-compassion and depression, anxiety, and stress. The results of the GLM mediation model showed that self-compassion played a mediating role in the relationships between problematic internet use and depression, anxiety and stress.

Cannabis, the most consumed illicit drug globally, has been legal for non-medical use in Canada since 2018. Problematic internet use is considered a behavioral addiction involving excessive online activities (e.g., social media, video watching), which can cause social isolation, family issues, psychological distress, and even suicide ideation. Studies mainly conducted with adolescents indicate a link between cannabis use disorder and problematic internet use. This exploratory study with a qualitative component aims to investigate the experiences of adult cannabis users in Quebec regarding their internet use and cannabis consumption. Data were collected via an open-ended question in a self-reported online questionnaire assessing the participants’ perceived impact of cannabis consumption and internet use on their lives. The 1,388 responses to the open-ended question were subjected to a thematic analysis. The analysis yielded four main themes: (1) no impact and no link, (2) link between cannabis consumption and internet use, (3) psychological and physical health and (4) lifestyle habits. Some participants noted a direct association between cannabis use and increased online activity, including online pornography use. The participants experienced both positive and negative effects from cannabis consumption and internet use. Many reported benefits, such as relaxation, positive emotions, improved mental skills, and pain relief, while others experienced negative impacts, such as increased anxiety, procrastination, social isolation, and impaired cognitive functions. Additionally, these behaviors affected aspects of their daily lives, including finances, sleep, eating habits, and relationships. This study provides insights into the participants’ experiences and reflects the aspects they considered essential to share regarding cannabis consumption and internet use. Not applicable.

Multimorbidity, defined as the coexistence of at least two chronic diseases in an individual, exhibits spatial heterogeneity in its association with lifestyle factors across different climatic zones. Older adults in frigid zones–defined as areas where the average temperature in the coldest month is ≤ -10℃, or where daily mean temperatures ≤ 5℃ persist for ≥ 145 days per year-face distinct environmental exposures compared to those in non-frigid zones. Nevertheless, few studies have explored multimorbidity and lifestyle differences between frigid and non-frigid zones. This study aims to: (1) identify sociodemographic, lifestyle, and regional factors linked to multimorbidity in Chinese older adults and further to compare them across zones; and (2) assess lifestyle diversity related to multimorbidity in each zone. A total of 10,619 participants aged ≥ 60 years were included from China Health and Retirement Longitudinal Study (CHARLS) collected in 2020. All participants met the inclusion criteria were classified with reference to the 2016 GB50176 climate standard for frigid zone and non-frigid zone. Chi-square test, regression analyses, and subgroup analysis were used to describe and analyze risk factors and difference in multimorbidity between frigid zone and non-frigid zone among Chinese older adults. (1) The prevalence of multimorbidity among older adults is significantly higher in frigid zone (72.69%) than in non-frigid zone (65.63%) and the national level (66.32%). (2) Living zones and lifestyles have association on multimorbidity in older adults. (3) The effect of Internet use on multimorbidity in the older adults demonstrated significant heterogeneity in terms of living zone(I2 = 66.1%). Much attention should be paid to older adults with multimorbidity residing in frigid zone. Especially, targeted interventions for unhealthy lifestyle in frigid zone and non-frigid zone among older adults to decrease multimorbidity prevalences and their catastrophic consequences. For older adults in frigid zone. In parallel, study indicated that appropriate sleep duration, reducing problematic internet use, smoking cessation and alcohol restriction and other healthy lifestyle may contribute to multimorbidity prevention among older adults especially in frigid zone.

Problematic usage of the internet and borderline personality disorder: A survey study in the United States.

Introduction Increasing evidence links problematic internet use and excessive digital engagement with psychosocial vulnerability among youth. While adolescent populations have been extensively studied, preventive interventions targeting late childhood remain limited. This study examined changes in adolescents' internet-related behaviors - social networking time, device use frequency, gaming, and compulsive internet use (10-item Compulsive Internet Use Scale (CIUS-10)) - associated with participation in a school-based intervention. Methods A controlled pre-post design was implemented among 235 fifth- and sixth-grade students (intervention group n = 125; control group n = 110). Twelve peer leaders were selected through voluntary participation and multi-criteria assessment and received structured training in digital literacy and peer facilitation. Behavioral indicators of internet use were assessed at baseline and two months after intervention.Normality of continuous variables was assessed using the Kolmogorov-Smirnov test. Descriptive statistics included means, standard deviations (SD),frequencies (N), and percentages (%), according to the type of variable. Between-group comparisons were performed using Mann-Whitney U (continuous variables), Chi-square or Fisher's exact tests (categorical variables), and Wilcoxon signed-rank tests (pre-post comparisons groups). Results No baseline differences were observed between groups. Post-intervention analyses demonstrated statistically significant reductions in the intervention group in daily social networking time, device use frequency, online interaction behaviors, and gaming activities (p < .001; small to moderate effect sizes). No comparable pattern was observed in the control group. Conclusions Structured peer-led interventions may represent a feasible early preventive approach for promoting healthier digital engagement patterns in primary school settings.

Digital divides continue to become a problem in the educational setting, creating a gap between accessibility, connectivity, and equal opportunity in rural communities. In this study, the researchers aim to evaluate digitalization management, particularly in terms of internet access, devices, and digital skills, in Aklan, Philippines. A mixed-methods design was employed, utilizing both quantitative and qualitative data to collect survey data from 50 respondents and conduct focus group discussions (FGDs) with 13 residents, thereby gathering in-depth insights into Barangay Rizal. The findings indicate that the majority of respondents experienced a problematic internet connection and limited access to digital devices. Most families share smartphones, and only a small number have access to additional devices, such as laptops or tablets. Results revealed a general lack of formal digital literacy training in the community, with a high frequency of respondents claiming they have skill deficiencies in the self-assessed digital skills categories. Recommendations for the study highlight that local governments, policymakers, and development agencies should focus on developing policies and strategies that help rural community residents deal with challenges by improving digital access, device availability, internet accessibility, and digital skills and literacy.