Internet Addiction and Suicidal Ideation in Chinese Adolescents: Sex Differences and the Interactive Roles of Trauma and Depression

This study investigated the association between Internet addiction (IA) and suicidal ideation (SI) among Chinese adolescents, focusing on sex differences and the interactive roles of childhood trauma and depressive symptoms. A large-scale multicenter survey involving 24,470 students (mean age = 14.37 ± 1.52 years; 48.40 percent female) from three Chinese cities was conducted using standardized instruments to assess IA, SI, childhood trauma, and depression. Logistic regression and interaction analyses showed that IA was significantly associated with a higher likelihood of SI, with stronger associations observed among female adolescents. Childhood trauma and depressive symptoms significantly moderated the IA-SI relationship (interaction odds ratio [OR] = 6.81/6.88). However, stratified analysis showed that the association between IA and SI was stronger among adolescents without childhood trauma (OR = 3.38) than among those with childhood trauma (OR = 2.63), and the association was also stronger among adolescents without depressive symptoms (OR = 2.88) compared to those with depressive symptoms (OR = 1.80). These differences were primarily attributed to the higher baseline risk of SI among adolescents with childhood trauma and depressive symptoms, which attenuated the relative effect of IA. This effect was more pronounced during early adolescence. These findings suggest that IA may represent a potentially modifiable behavioral risk factor for SI in adolescents, particularly among females. The results highlight the importance of integrating digital behavior and mental health factors in adolescent suicide risk prevention, with a focus on comprehensive intervention strategies for adolescents with psychological vulnerabilities.