Association of smartphone overdependence with depression and suicidal ideation among multicultural adolescents: A propensity score matching study

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Objectives: Smartphone overdependence is a major threat to the mental health of adolescents, particularly individuals with a multicultural family background whose vulnerability is compounded owing to language barriers and cultural alienation. In this study, we examined the associations of smartphone overdependence with depression and suicidal ideation among multicultural and non-multicultural adolescents and additionally performed a gender-stratified analysis. Methods: Data from the 16th and 19th Korea Youth Risk Behavior Survey were analyzed. After 1:1 propensity score matching, 2,769 multicultural and 2,769 non-multicultural adolescents were included. Overdependence was classified using the National Information Society Agency scale (score ≥23). Data were analyzed using the chi-square test and logistic regression, performed using SAS ver. 9.4, with statistical significance set at p<0.05. Results: Among the multicultural adolescents, those exhibiting smartphone overdependence showed higher odds of depression (aOR=1.32; 95% CI: 1.08-1.61) and suicidal ideation (aOR=1.38; 95% CI: 1.07-1.78). In the non-multicultural group, smartphone overdependence was similarly associated with elevated odds of depression (aOR=1.42; 95% CI: 1.16-1.74) and suicidal ideation (aOR=1.46; 95% CI: 1.15-1.87). Gender-stratified analysis revealed significant associations in multicultural males (depression: aOR=1.39; 95% CI: 1.01-1.91; suicidal ideation: aOR=1.88; 95% CI: 1.24-2.87) and non-multicultural females (depression: aOR=1.44; 95% CI: 1.11-1.87; suicidal ideation: aOR=1.44; 95% CI: 1.05-1.97). Conclusion: Smartphone overdependence was associated with depression and suicidal ideation in both cultural groups, with distinct risk patterns according to gender. Taken together, these results indicate the need for gender- and culture-specific prevention strategies.