JMIR Publications

ABSTRACT

Background:

The internet has become deeply embedded in the daily lives and social interactions of adolescents. Moderate internet use may provide psychological support and access to online help-seeking channels, thereby compensating for offline help-seeking behaviors. However, whether adolescents with internet addiction (IA) are more likely to seek mental health help remains unclear. Furthermore, empirical evidence is still lacking regarding whether different types of help-seeking behaviors (formal and informal) can serve as protective factors for this high-risk group.

Objective:

This study aimed to describe mental health help-seeking patterns across different levels of internet use and IA, and to examine the independent and interactive associations of IA and help-seeking behaviors with mental health problems among Chinese adolescents.

Methods:

Data were drawn from two 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 DSM-5–based nine-item scale; students who used the internet for at least 4 hours per day and endorsed more than four addiction-related criteria were classified as having IA. Help-seeking was categorized as none, informal, or formal. Mental health problems were defined as the presence of either clinically significant depressive symptoms or anxiety symptoms. Associations and interactions were estimated using generalized linear mixed-effects models and Poisson regression with the cluster-robust variance estimator to account for school-level clustering.

Results:

Overall, 1.4% of students met IA criteria; 47.9% reported no help-seeking, 42.1% informal help-seeking, and 9.9% formal help-seeking. Among adolescents with IA, 59.9% reported no help-seeking, 33.8% informal help-seeking, and only 6.3% formal help-seeking. Compared with non–internet users, adolescents with IA were less likely to seek informal help (RRR=0.774, 95% CI 0.707–0.847) and formal help (RRR=0.557, 95% CI 0.468–0.661), and were less likely to choose formal vs informal help (RRR=0.729, 95% CI 0.610–0.871). Compared with non–internet users, non-addicted internet users had higher odds of mental health problems (OR=1.680, 95% CI 1.622–1.740), and adolescents with IA had markedly higher odds (OR=14.916, 95% CI 13.593–16.368). Help-seeking showed protective associations: informal help-seeking (OR=0.499, 95% CI 0.484–0.514) and formal help-seeking (OR=0.400, 95% CI 0.378–0.424) vs no help-seeking. Compared with the “IA × no help-seeking” group, students who were non-addicted internet users and engaged in informal help-seeking had a 22.9% lower risk of mental health problems (OR = 0.771, 95% CI 0.641–0.928), while non-internet-users with informal help-seeking had a 32.1% lower risk (OR = 0.679, 95% CI 0.559–0.825). Among formal help-seekers, risk reductions were more pronounced.

Conclusions:

Adolescents with IA show a marked gap in help-seeking, highlighting an urgent need to promote timely and appropriate help-seeking behaviors. Enhancing school-based mental health services, improving access to formal support, and reducing help-seeking stigma may help mitigate the mental health burden associated with IA. Clinical Trial: Not applicable.