Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 24, 2025
Date Accepted: Apr 3, 2026
The association between Internet addiction and nonsuicidal self-injury among Chinese middle school students: a prospective cohort study
ABSTRACT
Background:
Nonsuicidal self-injury (NSSI) has been reported to be related to internet addiction (IA).
Objective:
However, few studies have examined the potential causal relationship between NSSI and IA with a cohort design.
Methods:
In this study, 704 students completed the survey both at baseline and follow-up after 6 months with a prospective cohort design. Logistic regression analysis was carried out to examine the association between IA exposure and NSSI, and restricted cubic spline regression was employed to examine the associations between distinct states of IA and the risk of subsequent NSSI.
Results:
The new incidence rate of NSSI was 9.8% at the 6-month follow-up. The relation between the IA and subsequent NSSI was linear in restricted cubic spline regression. IA was a significant predictor of NSSI, especially in female students, demonstrating pronounced gender differences.
Conclusions:
NSSI was prevalent among Chinese junior high school students, and IA was a significant risk factor for NSSI for female students. This result hints at the importance of addressing IA during clinical work and school screening for NSSI, especially in female adolescents. Clinical Trial: ChiCTR2300078054 and ChiCTR2500103867
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