What type of study is this?

This is a Cross-Sectional study.

September 10, 2025Open Access

Internet addiction and anxiety-depressive comorbidity among chinese adolescents: the mitigating effects of physical activity in a large-scale cross-sectional study

Key Points

Adolescents with internet addiction showed significantly higher risks of anxiety, depression, and comorbidity.
Results indicate that internet addiction increases anxiety risk by 80% and depression risk by almost 100% compared to non-affected peers.
Analysis involved a cross-sectional study of over 20,600 adolescents across Tianjin, evaluating mental health outcomes and physical activity.
The findings suggest that while internet addiction is a significant risk factor for mental health issues, the impact of physical activity as a mediator is relatively minor.

Abstract

This study aimed to examine the associations between internet addiction (IA), physical activity (PA), and mental health comorbidities (depression, anxiety, and their co-occurrence) among Chinese adolescents, and assess the mediating role of PA in the IA-mental health relationship. A cross-sectional analysis was conducted using data from the 2024 National Student Common Diseases and Risk Factors Surveillance (NSCDRFS) in Tianjin, China, involving 20,692 adolescents aged 12-19 years. IA was assessed via a DSM-5-derived 9-item scale (cutoff ≥ 5). PA levels were categorized as insufficient (≤ 2 days/week of moderate-to-vigorous activity). Mental health outcomes included depressive symptoms (CES-D ≥ 16), anxiety symptoms (GAD-7 ≥ 10), and anxiety-depression comorbidity (ADC), defined as meeting both depression (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10) diagnostic criteria. Multivariable logistic regression and mediation analyses were performed to evaluate direct and indirect pathways. Adolescents with IA exhibited significantly higher risks of anxiety (OR = 1.80, 95% CI: 1.68-1.91), depression (OR = 1.99, 95% CI: 1.88-2.11), and ADC (OR = 2.12, 95% CI: 2.00-2.25) compared to non-IA peers (all P < 0.001). Insufficient PA independently increased risks of anxiety (OR = 1.17), depression (OR = 1.27), and ADC (OR = 1.23). Mediation analysis revealed that PA accounted for only 3.5-4.3% of the total effects of IA on mental health outcomes, with direct effects remaining predominant (95.7-96.5%). Subgroup analyses highlighted stronger IA-mental health associations in younger adolescents (12-15 years), non-boarding students, and junior high school cohorts. IA is an independent risk factor for mental health comorbidities in Chinese adolescents, with PA serving as a minor yet significant mediator. Targeted interventions should integrate IA screening, culturally adapted PA promotion, and digital literacy education to address this triad. Future longitudinal studies are needed to elucidate causal pathways and neurodevelopmental mechanisms.

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