JMIR Publications

ABSTRACT

Background:

Internet addiction (IA), childhood maltreatment (CM), and bullying are critical mental health challenges contributing to adolescent suicide ideation (SI). Despite their interconnectedness, few studies have used network analysis to explore symptom-level relationships among these factors and SI.

Methods:

A total of 6,573 adolescents (51.1% female) were included through cluster sampling. Network analysis examined relationships between SI, bullying, IA, and CM, identifying core and bridge symptoms. Mediation analysis assessed the role of core symptoms, and network comparisons were conducted based on gender and history of non-suicidal self-injury (NSSI).

Results:

"Tolerance," "time management," and "compulsive Internet use" were identified as central symptoms, while "suicide ideation," "emotional abuse," and "traditional bullying victimization" served as bridge symptoms. "Emotional abuse" and "cyberbullying victimization" showed the strongest links to SI. "Tolerance," "time management," and "compulsive Internet use" mediated the relationship between "emotional abuse" and SI. In adolescents with NSSI history, "emotional abuse" and "emotional neglect" were more strongly associated with SI, while "traditional bullying victimization" and "interpersonal and health-related problems" were more prominent in those without NSSI. Gender did not affect the network structure.

Conclusions:

"Tolerance" and "time management" were pivotal in sustaining the network, with "suicide ideation" acting as a key bridge symptom. "Emotional abuse" and "cyberbullying victimization" exhibited the strongest SI associations, mediated by IA symptoms. These findings highlight the complex interplay of factors driving SI and inform targeted prevention strategies for adolescents.