JMIR Publications

ABSTRACT

Background:

Children’s lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear.

Objective:

This study aimed to investigate the dose-response association between internet use, including duration and addition, and depressive symptoms among children and adolescents in Zhejiang Province.

Methods:

Data were collected from a school-based health survey “China Common Disease and Risk Factor Surveillance among Students”, encompassing 21336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restrict cubic spline curves were used to determine the dose-response associations.

Results:

A total of 6225 (29.2%) students had depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (P non-linear values were 0.006, 0.003, <0.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: odds ratio [OR] 2.01, 95% confidence interval [CI] 1.83-2.21; 2 IA behaviors: 2.91, 2.57-3.29; ≥3 IA behaviors: 4.72, 4.26-5.22). A positive non-linear association between the number of IA behaviors and depressive symptoms was found in girls and primary school students (P non-linear values were 0.015, 0.002, 0.007, respectively).

Conclusions:

Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence.