Psychosocial correlates of internet addiction in adolescents with depression and non-suicidal self-injury: a cross-sectional study.

BACKGROUND

Adolescents with depression and non-suicidal self-injury (NSSI) represent a clinically vulnerable population with substantial emotional and behavioral difficulties. Although internet addiction is increasingly recognized among adolescents, its associated factors in adolescents with depression and NSSI, particularly peer-related stressors, remain insufficiently understood.

METHODS

This cross-sectional study included adolescent psychiatric outpatients aged 12-17 years with depressive disorders and NSSI. Internet addiction was assessed using Young's Internet Addiction Test (IAT). Depressive symptoms and anxiety symptoms were evaluated using the Beck Depression Inventory (BDI-13) and Beck Anxiety Inventory (BAI), respectively. Peer bullying was assessed using the victimization subscale of the Chinese revised Olweus Bully/Victim Questionnaire. Participants were categorized into low internet addiction (IAT ≤ 59) and moderate-to-severe internet addiction (IAT ≥ 60) groups. Group differences were examined using independent-samples t tests, and Pearson correlation analyses were conducted to assess bivariate associations. Multiple linear regression analyses were conducted to identify factors associated with internet addiction severity after adjusting for age and sex. Female-only sensitivity analyses were conducted to address the marked sex imbalance.

RESULTS

Of the 92 participants, 53.4% exhibited moderate-to-severe internet addiction. Internet addiction severity was positively correlated with depressive symptoms, anxiety symptoms, and peer bullying. In the hierarchical regression analyses, peer bullying remained significantly associated with internet addiction in both the depressive symptom model (β = 0.310, p = 0.008) and the anxiety symptom model (β = 0.316, p = 0.008). Depressive symptoms also remained independently associated with internet addiction severity (β = 0.229, p = 0.034), whereas anxiety symptoms were no longer statistically significant after peer bullying was added to the final model (β = 0.193, p = 0.077). Female-only sensitivity analyses showed a broadly consistent pattern of findings.

CONCLUSIONS

Internet addiction is highly prevalent among adolescents with depression and NSSI. Peer bullying was a consistent psychosocial correlate of internet addiction, and depressive symptoms showed an independent association with internet addiction severity. These findings suggest that peer victimization may provide clinically relevant information beyond emotional symptoms when assessing internet addiction in this high-risk population.