Afei Qin, Meiqi Wang, Lianlong Yu, Suyun Li, Zhaolu Liu, Shoujuan Zheng, Ziming Shao, Cuixia Lv, Long Sun
Adolescents with IA had a substantially higher prevalence of clinically significant depressive and anxiety symptoms and were less likely to report mental health help-seeking, especially formal help-seeking. These findings highlight a high-burden, low help-seeking subgroup and suggest strengthening school-based mental health services, improving linkage between informal and formal support, reducing stigma, and developing low-threshold digital mental health pathways.
BACKGROUND: Internet addiction (IA) has been consistently associated with adverse mental health outcomes, but less is known about whether adolescents with IA seek mental health support, and whether associations between help-seeking and mental health problems differ across pathways.
OBJECTIVE: This study aimed to describe mental health help-seeking patterns across internet use and IA status, and examine the independent and interactive associations of IA and help-seeking with mental health problems.
METHODS: Data were drawn from 2 repeated cross-sectional surveys conducted in Shandong Province in 2023 and 2024. A total of 171,970 junior middle school students were included. IA was assessed using a 9-item scale adapted from DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) Internet Gaming Disorder criteria to assess internet use-related symptoms. Students using the internet for at least 4 hours per day and endorsing at least 4 symptoms were classified as having IA. Help-seeking was categorized as no help-seeking, informal-only help-seeking, and any formal help-seeking. Mental health problems were defined as clinically significant depressive or anxiety symptoms. Pairwise logistic regression compared help-seeking patterns, and Poisson regression with school-clustered CR2 robust SEs estimated adjusted prevalence ratios (PRs).
RESULTS: Overall, 1.4% (2406/171,970) met the definition of IA; 47.9% (82,402/171,970), 42.1% (72,461/171,970), and 9.9% (17,107/171,970) reported no help-seeking, informal-only help-seeking, and any formal help-seeking, respectively. Among adolescents with IA, 59.9% (1440/2406) reported no help-seeking, 33.8% (814/2406) reported informal-only help-seeking, and only 6.3% (152/2406) reported any formal help-seeking. Compared with nonaddictive internet users, adolescents with IA had lower odds of informal-only versus no help-seeking (OR [odds ratio] 0.690, 95% CI 0.631-0.754), any formal versus no help-seeking (OR 0.540, 95% CI 0.455-0.640), and any formal versus informal-only help-seeking (OR 0.786, 95% CI 0.659-0.937). Compared with nonaddictive internet users, adolescents with IA had a higher prevalence of mental health problems (PR 3.662, 95% CI 3.428-3.912). Informal-only (PR 0.581, 95% CI 0.550-0.614) and any formal help-seeking (PR 0.461, 95% CI 0.420-0.505) were associated with lower prevalence overall. Interaction terms for IA with informal-only help-seeking (PR 1.469, 95% CI 1.336-1.616) and any formal help-seeking (PR 2.033, 95% CI 1.696-2.437) indicated weaker inverse associations among adolescents with IA. Within the IA group, informal-only help-seeking was associated with lower prevalence (PR 0.848, 95% CI 0.784-0.917), whereas any formal help-seeking was not clearly associated with lower prevalence (PR 0.945, 95% CI 0.814-1.097). Sensitivity analyses supported these patterns.
CONCLUSIONS: Adolescents with IA had a substantially higher prevalence of clinically significant depressive and anxiety symptoms and were less likely to report mental health help-seeking, especially formal help-seeking. These findings highlight a high-burden, low help-seeking subgroup and suggest strengthening school-based mental health services, improving linkage between informal and formal support, reducing stigma, and developing low-threshold digital mental health pathways.