Childhood Maltreatment, Bullying, and Internet Addiction in Relation to Suicidal Ideation Among Adolescents: Cross-Sectional Mediation and Network Analysis

Background: Internet addiction (IA), childhood maltreatment (CM), and bullying are prevalent psychosocial stressors among adolescents and have each been associated with suicidal ideation (SI). However, existing research often treats these factors in isolation, overlooking their potential interrelationships and joint associations with SI. Objective: This study aimed to examine how CM, IA, and bullying are jointly related to SI at both the scale and symptom levels and identify key symptoms within the CM-IA-bullying-SI network that may serve as intervention targets to disrupt maladaptive associations across the network. Methods: A total of 6573 adolescents were recruited through cluster sampling. Mediation analyses were conducted to assess direct and indirect effects of CM on SI via IA and bullying. Network analysis was conducted to examine symptom-level associations among CM, IA, bullying, and SI and identify core and bridge symptoms within the network. Network comparison tests were conducted to assess differences in network structure by gender and history of nonsuicidal self-injury. Results: Mediation analyses revealed that both IA and bullying partially mediated the association between CM and SI, with significant indirect effects via IA (c'=0.010, 95% CI 0.008-0.011; P<.001) and bullying (c'=0.004, 95% CI 0.002-0.005; P<.001). In the network, tolerance, time management, and compulsive internet use were identified as central symptoms, whereas SI, emotional abuse, and traditional bullying victimization served as bridge symptoms. Emotional abuse and cyberbullying victimization were most strongly linked to SI. Among individuals with a history of nonsuicidal self-injury, emotional abuse and emotional neglect showed stronger associations with SI. Sex subgroup analysis showed no significant difference in global strength (S=0.095; P=.69) but a significant difference in network structure (M=0.174; P=.01). Conclusions: This study revealed how CM, bullying, and IA are jointly related to SI among adolescents at both the scale and symptom levels. Key symptoms, including tolerance and time management, played central roles within the symptom network, with SI bridging multiple psychosocial domains. These findings underscore the need for multilevel, targeted interventions to disrupt maladaptive links and reduce suicide risk in adolescents.