Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 18;24(1):929.
doi: 10.1186/s12888-024-06357-z.

Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences

Lewei Liu  1   2 , Yinghan Tian  1   2 , Haojie Fan  1   2   3 , Jiawei Wang  4 , Changhao Chen  5 , Zhiwei Liu  6 , Feng Geng  7 , Daming Mo  8 , Xiangfen Luo  9 , Xiangwang Wen  10 , Xin Zhao  1   2   3 , Mingru Hao  1   2   3 , Lei Xia  11   12 , Huanzhong Liu  13   14   15
Affiliations

Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences

Lewei Liu et al. BMC Psychiatry. .

Abstract

Background: Insomnia may mediate the association between internet addiction (IA) and suicidal ideation (SI). However, such association has not been thoroughly investigated in adolescents with major depressive disorder (MDD). Thus, our study aimed to explore whether insomnia significantly affects the association between IA and SI in adolescents with MDD, as well as any sex differences.

Methods: From January 2021 to September 2023, this cross-sectional study included 502 adolescents with MDD and 123 healthy controls (HCs). The Clinical Global Impression-Severity (CGI-S), the Internet Addiction Test (IAT), the Insomnia Severity Index Scale (ISI) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess subjects' severity of depression, IA, insomnia and SI. And we employed the PROCESS macro program to examine the mediating role of insomnia between IA and SI.

Results: Compared to HCs, adolescents with MDD had significantly higher levels of SI and their prevalence of IA and insomnia were 50.0% and 35.7%. In patients, PANSI scores correlated negatively with age and age of onset, and positively with disease duration as well as the scores of the CGI-S, IAT, and ISI (all p < 0.01). Moreover, above-mentioned correlations were more significant in girls. Mediation analyses showed that insomnia mediated the effect of IA on SI, and the total, direct, and indirect effects were 0.197 (95% CI: 0.132-0.262), 0.157 (95% CI: 0.096-0.218) and 0.040 (95% CI: 0.014-0.068), respectively. In female patients, the total, direct, and indirect effects were 0.224 (95% CI: 0.151-0.296), 0.191 (95% CI: 0.124-0.257) and 0.033 (95% CI: 0.002-0.068), respectively. In male patients, insomnia acted as a fully mediated effect between IA and SI, with an effect value of 0.045 (95% CI: 0.008-0.093).

Conclusion: Depressed adolescents have higher suicide risk, and SI is significantly associated with IA and insomnia, especially in girls. Moreover, insomnia may mediate the association between IA and SI. However, given the small sample size of this study and the limitations of assessment tools used, the results need to be viewed with caution. Regardless, clinical interventions should be strengthened for IA and insomnia in adolescents with MDD to reduce suicide risk.

Keywords: Adolescents; Insomnia; Internet addiction; Major depressive disorder; Suicidal ideation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The current study received approval from the Ethics Committee of Chaohu Hospital, Anhui Medical University after review (202009-KYXM-04). Before this study, all subjects and their parents signed written informed consent forms. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Direct and indirect relationship models with unstandardized beta values of Internet addiction, insomnia on suicidal ideation in the total patient sample. *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 2
Fig. 2
Direct and indirect relationship models with unstandardized beta values of Internet addiction, insomnia on suicidal ideation in female patients. *p < 0.05, **p < 0.01, ***p < 0.001
Fig. 3
Fig. 3
Direct and indirect relationship models with unstandardized beta values of Internet addiction, insomnia on suicidal ideation in male patients. *p < 0.05, **p < 0.01, ***p < 0.001
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Daly M. Prevalence of Depression Among Adolescents in the U.S. From 2009 to 2019: Analysis of Trends by Sex, Race/Ethnicity, and Income. J Adolesc Health. 2022;70(3):496–9. - PubMed
    1. Jeong SC, Kim JY, Choi MH, Lee JS, Lee JH, Kim CW, Jo SH, Kim SH. Identification of influencing factors for suicidal ideation and suicide attempts among adolescents: 11-year national data analysis for 788,411 participants. Psychiatry Res. 2020;291: 113228. - PubMed
    1. Bao X, Guo T, Xu L, Chen W, Luan L, Yang H, Zhang X. Suicidal ideation in Chinese adolescents: prevalence, risk factors, and partial mediation by family support, a cross-sectional study. Front Psych. 2024;15:1427560. - PMC - PubMed
    1. Liu J, Yang L, Zheng Y, Kang C, Wang X, Shi J, Qiu S, Zhao Y, Yu J, Zhao N. Rural-urban differences in prevalence and correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese. J Affect Disord. 2023;322:118–24. - PubMed
    1. Musci RJ, Hart SR, Ballard ED, Newcomer A, Van Eck K, Ialongo N, Wilcox H. Trajectories of Suicidal Ideation from Sixth through Tenth Grades in Predicting Suicide Attempts in Young Adulthood in an Urban African American Cohort. Suicide & Life-threatening Behavior. 2016;46(3):255–65. - PubMed

MeSH terms

LinkOut - more resources