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Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents
Open accessAbstract
Background and aims: This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior. Methods: Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students’ questionnaires were qualified for analysis. The Young’s Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses. Results: Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03−1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02−1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082−0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068−0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU. Discussion and conclusions: There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.
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“PIU was associated with suicide attempts, (adjusted OR 1.03, 95% CI 1.02-1.04, P <0.5) on multivariable, multilevel logistic regression”
From Social media, internet use and suicide attempts in adolescents (2019) · cites this paper as Guo, 2018
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“Severely addicted internet users had greater risk of suicide attempt (14.0%) than moderately addicted (4.3%) and average (1.5%) internet users.”
From Social media, internet use and suicide attempts in adolescents (2019) · cites this paper as Guo, 2018
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“The Internet brings a wide variety of information and provides a convenient platform for communication, and Internet use has grown significantly in the recent two decades.(1) As of March 2020, approximately 4.”
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“to daylight, healthy exercise, eating patterns, and mood-regulated social activities [58].”
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“These findings are consistent with the conclusions drawn from previous empirical studies (Bhandari et al., 2017; Guo et al., 2018; Wu et al., 2015).”
ResultThe effect of Internet addiction on sleep quality in adolescents
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“In addition, Liu et al. (2018) reported that the prevalence of anxiety symptoms was 7% in a sample of 50 361 young people in rural China.”
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“The use of new technologies has been added to the many risk factors [33, 2, 34–36] because their use is associated with isolation [37] and depression [38–39], as well as facilitating interaction with other individuals experiencing suicidal ideation or having access to information regarding suicide…”
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“Other studies showed that sleep quality also played a mediating role on SI, such as the relationship between school climate and SI, problematic Internet use and suicidal behavior [27, 28].”
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Fan, B., Wang, W., Wang, T., Xie, B., Zhang, H., Liao, Y., Lu, C., & Guo, L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17030774 · Cited by 14
“The 2017 SCAHS utilized a multi-stage stratified cluster random sampling method to recruit a representative sample of adolescents in Guangdong province, and the procedures for data collection have been described in detail in previous publications [21].”
MethodSelf-citationPan, Z., & Zhang, D. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.04.026 · Cited by 14
Zheng, Y., Xiao, L., Wang, H., Chen, Z., & Wang, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.895892 · Cited by 14
“In a large-scale study by Lan Guo, problematic Internet use was related to suicidal ideation or attempts (11), and we wondered if an association could be found between NSSI and mobile phone use likewise.”
BackgroundÖzarıcı, E., & SÖGÜT, S. C. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12872 · Cited by 15
Wang, Y., Xu, J., & Xie, T. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.934306 · Cited by 17
“It’s acknowledged that internet overuse and problematic internet use are associated with lifestyle behaviors such as sedentary behavior (111), lack of exercise (75), sleep disturbance (112), eating disorder (113).”
BackgroundProblematic internet use and safety behavior: The moderating role of safety climate
Ghasemi, F., Aghaei, H., & Nikravesh, A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0279767 · Cited by 13
“[52] found that PIU can increase the risk of suicidal behavior.”
BackgroundTsegay, L., Tesfaye, G., & Ayano, G. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09790-x · Cited by 13
He, X., Chen, S. E., Yu, Q., Yang, P., & Yang, B. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1484809 · Cited by 16
Peng, P., Chen, Z., Ren, S., Liu, Y., Li, J., Liao, A., Zhao, L., He, R., Liang, Y., Tan, Y., et al. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02675-z · Cited by 12
“Consistent with prior studies on internet addiction and smartphone addiction [ 21–23], we found that sleep disturbance partially mediated the relationship between IGD and suicidal risk.”
Liu, C., Liu, Y., Liu, C., Lin, R., Wang, X., Zhang, X., Wu, Y., & Wang, D. (2025) · Journal of Medical Internet Research · doi:10.2196/57907 · Cited by 11
“Existing evidence has suggested that sleep disturbance may be a potential pathway through which PIU affects mental health [79,80].”
Sleep disturbance and quality of life among university freshmen in Qinghai–Tibet Plateau of China
Zhang, T., Lu, L., Ren, Y.-M., Liu, Y., Hynek, K. A., Gao, J., Chen, H., Shen, H., Gai, X., Dang, Z.-C., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.996996 · Cited by 10
“The association between Internet dependence and sleep disturbance was also reported among Japanese adolescents (43) and another large-scale study among Chinese adolescents (44).”
BackgroundWang, J., Zhang, H., Tian, D., An, Y., Wang, Y., & Zheng, Y. (2024) · BMC Public Health · doi:10.1186/s12889-024-20386-z · Cited by 10
“The excessive use of the internet by adolescents has received widespread attention due to its negative effects on health [71, 72].”
BackgroundDigital divides in China: evidence from CGSS2005–2021
Zhao, Y., & Kuang, M. (2025) · Chinese Sociological Review · doi:10.1080/21620555.2025.2475430 · Cited by 10
Li, J., Wang, D., Bai, S., & Yang, W. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314211 · Cited by 15
“The sample size determination was informed by prior smartphone addiction intervention studies [31,32] and feasibility constraints.”
Possible sleep bruxism and biological rhythm in school children
Marceliano, C. R. V., & Gavião, M. B. D. (2023) · Clinical Oral Investigations · doi:10.1007/s00784-023-04900-y · Cited by 10
“Previous studies report that possible sleep bruxism is more common in children with sleep deprivation and microarousals [54, 55].”
BackgroundInfante, J. A. C., Romero, M., Amaya, P. M. D. C., Lara, D. C. I., & Saravia, H. E. M. (2022) · ALERTA Revista Científica del Instituto Nacional de Salud · doi:10.5377/alerta.v5i1.11247 · Cited by 9
Liu, L., Tian, Y., Fan, H., Wang, J., Chen, C., Liu, Z., Geng, F., Mo, D., Luo, X., Wen, X., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06357-z · Cited by 9
Интернет и самоповреждения подростков: кто виноват – что делать
Любов, Е. Б., & Zotov, P. B. (2019) · Суицидология · doi:10.32878/suiciderus.19-10-03(36)-3-18 · Cited by 7
Problematic Internet Use and Suicidal Behavior in Adolescents: A Review
Jolin, E. M., & Weller, R. A. (2023) · Annals of Clinical Psychiatry · doi:10.12788/acp.0119 · Cited by 10
Damanik, M. P., Nugroho, A. C., Mahmudah, D., & Purwaningsih, E. H. (2020) · Jurnal Studi Komunikasi dan Media · doi:10.31445/jskm.2020.3575 · Cited by 7
The Biopsychosocial Impact of Abusive Use of Digital Media
Martins, G. D. G., Caricati, V. V., BARBUGLI, B. C., Ribeiro, C. M. D. S., Lobato, F. B. H., Scatena, A., Lessa, R. T., de MICHELI, D., & Andrade, A. L. M. (2021) · Springer eBooks · doi:10.1007/978-3-030-62855-0_33 · Cited by 6
Tsai, Y., Chuang, T.-J., Mudiyanselage, S. P. K., Ku, H., Wu, Y., Li, C., & Ko, N. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.045 · Cited by 6
Jin, L., Pan, C., Li, D., Zhang, T., Zhao, C.-H., & Wu, Y. (2025) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2025.057962 · Cited by 6
“In more severe instances, it can also precipitate the development of PIU or Internet addiction [59].”
Zhang, J., Mi, L., Zhao, J., Chen, H., Wang, D., Ma, Z., & Fan, F. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.830383 · Cited by 6
“Emerging evidence have revealed relationships between different aspects of lifestyle and insomnia, such as food intake (18, 19), exercise (20–22), and Internet use (23, 24).”
BackgroundPetrović, Z. K., Peraica, T., Blažev, M., & Kozarić‐Kovačić, D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1227182 · Cited by 6
“In the last two decades, the use of the Internet has significantly increased (27), especially between 2020 and 2022 (28).”
BackgroundLin, Y., Ren, Y., Barnhart, W. R., Cui, T., Zhang, J., & He, J. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-023-01212-w · Cited by 5
“PUI shows high prevalence rates, ranging from 18.3% to 50.4% in adolescents (Guo et al., 2018; Xin et al., 2018), and is linked to various negative mental health outcomes such as psychological distress, loneliness, and suicidality (Cai et al., 2023).”
InfluentialNeural response to rewards in youths with insomnia
Ling, J., Lin, X., Li, X., Chan, N. Y., Zhang, J., Wing, Y. K., Hu, X., & Li, S. X. (2021) · SLEEP · doi:10.1093/sleep/zsab238 · Cited by 5
Pontes, H. M., Satel, J., & McDowall, A. (2022) · Studies in neuroscience, psychology and behavioral economics · doi:10.1007/978-3-031-04772-5_5 · Cited by 5
Wang, Y., Jiang, L., Jing, T., Chen, Q., Ma, S., Guo, J., & Wang, X. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00930-x · Cited by 5
“One study conducted among high school students in Guangdong Province showed that the prevalence of moderately addictive Internet use was 28.8% (Guo et al., 2018), while that was 28.4% in Chongqing municipality (Wang et al., 2019).”
InfluentialToumari, R., Ramezani-Badr, F., Bulfone, G., & Amini, K. (2023) · Journal of Multidisciplinary Care · doi:10.34172/jmdc.1132 · Cited by 4
“On the other hand, previous research has shown that the use of the Internet to reduce stress and anxiety has increased during the COVID-19 pandemic, which can directly impact the increase of the Internet and SMA (13-15).”
BackgroundInternet addiction and psychological impact on adolescents: A scoping review
Dermani, H., & Perdikaris, P. (2022) · International Journal of Biological and Pharmaceutical Sciences Archive · doi:10.53771/ijbpsa.2022.4.2.0096 · Cited by 7
Han, X., Zhang, S., Miao, S., Wu, Z., Potenza, M. N., & Su, W. (2024) · Current Addiction Reports · doi:10.1007/s40429-023-00537-9 · Cited by 4
“For example, Li et al. reported a prevalence rate of 14.1% among Chinese adolescents in 2017 [21], whereas another study reported one of 28.8% [22].”
InfluentialYang, Q., Xie, R., Wang, D., Li, J., Zhang, R., Li, W., & Ding, W. (2024) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.13046 · Cited by 5
Lü, J., Xie, J., Chen, J., Zeng, Y., Jiang, Z., Wang, Y., & Zheng, H. (2022) · Brain and Behavior · doi:10.1002/brb3.2510 · Cited by 3
“…is beneficial; however, excessive or unlimited use of the Internet may lead to Internet addiction (IA), also known as problematic Internet use (Guo et al., 2018), which may not only damage individuals’ physical andmental health (El Asam et al., 2019) but also have a serious impact on…”
BackgroundZhang, J., Jiao, C., Yu, C., Qiao, T., & Li, Z. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.526290 · Cited by 4
Mihaliková, V., & Dědová, M. (2024) · Journal of Educational Sciences & Psychology · doi:10.51865/jesp.2024.1.18 · Cited by 4
“Depressive thoughts have been shown to accompany the experience of loneliness (Peerenboom et al., 2015), while also being closely linked to suicidal and self-injurious behavior (Yu et al., 2022; Guo et al., 2018; Zanus et al., 2021).”
InfluentialYe, Y., Zhang, J., Sun, Y., Xu, J., Xu, Q., & Song, C. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1420630 · Cited by 4
“Sleep disturbance, as a mediator variable, was described in self-regulatory resource theory and the three previous studies (23 – 26).”
Zhu, J., Hou, X., Tao, H., Lin, K., Zhou, L., & Niu, L. (2025) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2025.104718 · Cited by 3
Şanlıer, N., Özyalçın, B., Kocabaş, Ş., & Ercan, Ş. N. (2024) · Egyptian Pediatric Association Gazette · doi:10.1186/s43054-024-00322-x · Cited by 3
“In short, the harms brought by these tools seem to outweigh their benefits [1–3].”
He, J., Haoliang, Z., Kanze, L., & Shuhui, X. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1557781 · Cited by 3
Kwak, Y., Kim, H., & Ahn, J. (2022) · Iranian Journal of Public Health · doi:10.18502/ijph.v51i7.10089 · Cited by 3
“lems, such as an increased body mass index (BMI) (14) and lack of sleep (1,10,15).”
BackgroundInfluentialLi, D., Chen, J., Wu, D., & huazhan, Y. (2025) · Current Psychology · doi:10.1007/s12144-025-08775-y · Cited by 2
“However, NLE depletes individuals’ psychological resources extensively and undermines their capacity for self-control (Guo et al., 2018), thereby manifesting emotional dysregulation dur - ing socialization and triggering anxiety and panic related to interpersonal interactions (You & Qin, 2020 ).”
Luo, Y., Wang, Y., Wang, Y., Wang, Y., Yan, N., Shiferaw, B. D., Mackay, L. E., Zhang, Z., Zhang, C., & Wang, W. (2024) · Psychology Research and Behavior Management · doi:10.2147/prbm.s498396 · Cited by 2
“72 Escape, an important negative manifestation of mobile phone addiction, was associated with suicidal ideation in this study.”
Self-citationYen, C., Tsai, C., Chang, Y., & Wang, P. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000635 · Cited by 2
“In addition, problematic Internet use may increase sleep disturbance (Guo et al. , 2018) and decrease quality of life (Huang et al. , 2020), leading to an increase in the risk of suicide.”
Gholamian, B., Rajabi-Vardanjani, H., & Shagholian, A. (2024) · Journal of Shahrekord University of Medical Sciences · doi:10.34172/jsums.849 · Cited by 1
Exploring suicidal ideation and its correlates among Italian adolescents: the role of sleep quality
Gesi, C., La‐Torraca‐Vittori, P., Madonia, N., Segù, M., Salvi, V., Cerveri, G., Damiani, S., Brondino, N., Politi, P., & Migliarese, G. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106897 · Cited by 1
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“Similar findings were reported in other studies, where the link between IA and self-injurious behavior was shown to be mediated by emotional and cognitive vulnerabilities rather than being a direct effect [107–109].”
Factors Influencing Sleep Disturbances in Adolescent Smokers in South Korea
Kim, S. R., Kim, J. Y., Kim, H. K., & Kim, H. Y. (2023) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000468 · Cited by 1
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O uso de “Smartphones’ e sua influência no processo educativo no Ensino Médio
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Metadata
- Authors
- Guo, L., Luo, M., Wang, W.-X., Huang, G.-L., Xu, Y., Gao, X., Lu, C.-Y., & Zhang, W.-H.
- Affiliations
- Sun Yat-sen University (CN)
- 1 Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
- 3 Department of Drug Abuse Control, Center for ADR monitoring of Guangdong, Guangzhou, People’s Republic of China
- Université Libre de Bruxelles (BE)
- Venue
- Journal of Behavioral Addictions
- Publisher
- Akademiai Kiado Zrt.
- Published
- 2018-11-26
- Volume
- 7
- Issue
- 4
- Pages
- 965-975
- ISSN
- 2062-5871 (ISSN-L)
- 2063-5303
- PMC
- PMC6376369
- OpenAlex
- W2903186237
- Cited by
- 114
- References
- 60
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 15 · 2023: 14 · 2022: 21 · 2021: 13 · 2020: 18 · 2019: 6
- FWCI
- 21.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Behavioral Addictions (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Funders
- National Natural Science Foundation of China (81761128030)
- Sun Yat-sen University
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- problematic internet use, internet addiction, sleep disorders, suicidal ideation, suicide attempts, adolescents, mediation, Chinese adolescents
- MeSH terms
- Adolescent, Adolescent Behavior, China, Female, Health Surveys, Humans, Male, Schools, Sleep Wake Disorders, Students, Suicide, Attempted, Behavior, Addictive, Internet, Suicidal Ideation
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