The mediating role of Internet addiction in depression, social anxiety, and psychosocial well-being among adolescents in six Asian countries: a structural equation modelling approach

C M Lai; K K Mak; H Watanabe; J Jeong; D Kim; N Bahar; M Ramos; S H Chen; C Cheng

doi:10.1016/j.puhe.2015.07.031

The mediating role of Internet addiction in depression, social anxiety, and psychosocial well-being among adolescents in six Asian countries: a structural equation modelling approach

Public Health. 2015 Sep;129(9):1224-36. doi: 10.1016/j.puhe.2015.07.031. Epub 2015 Sep 4.

Authors

C M Lai¹, K K Mak², H Watanabe³, J Jeong⁴, D Kim⁵, N Bahar⁶, M Ramos⁷, S H Chen⁸, C Cheng⁹

Affiliations

¹ Department of Psychology, Chinese University of Hong Kong, Hong Kong.
² Department of Psychology, University of Hong Kong, Hong Kong. Electronic address: kkmak@graduate.hku.hk.
³ Department of Children and Women's Health, Osaka University Graduate School of Medicine, Japan.
⁴ Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea.
⁵ Department of Education, Seoul National University, Republic of Korea.
⁶ Department of Psychiatry, Selayang Hospital, Malaysia.
⁷ Department of Psychiatry, National University Hospital at Manila, Philippines.
⁸ Department of Psychology, National Taiwan University, Taiwan.
⁹ Department of Psychology, University of Hong Kong, Hong Kong.

PMID: 26343546
DOI: 10.1016/j.puhe.2015.07.031

Abstract

Objectives: This study examines the associations of Internet addiction with social anxiety, depression, and psychosocial well-being among Asian adolescents. A self-medication model conceptualizing Internet addiction as a mediating role in relating depression and social anxiety to negative psychosocial well-being was tested.

Study design: A cross-sectional survey.

Methods: In the Asian Adolescent Risk Behavior Survey (AARBS), 5366 adolescents aged 12-18 years from six Asian countries (China, Hong Kong, Japan, South Korea, Malaysia, and Philippines) completed a questionnaire with items of the Internet Addiction Test (IAT), Social Anxiety Scale for Adolescents (SAS-A), Center for Epidemiological Studies Depression Scale (CESD), Self-Rated Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA-SR) in the 2012-2013 school year. Structural equation modelling was used to examine the mediating role of Internet addiction in depression, social anxiety, and subjective psychosocial well-being.

Results: Significant differences on the scores of IAT, SAS-A, CESD, and HoNOSCA-SR across the six countries were found. The proposed self-medication model of Internet addiction received satisfactory goodness-of-fit with data of all countries. After the path from social anxiety to Internet addiction had been discarded in the revised model, there was a significant improvement of the goodness-of-fit in the models for Japan, South Korea, and the Philippines.

Conclusions: Depression and social anxiety reciprocally influenced, whereas depression associated with poorer psychosocial well-being directly and indirectly through Internet addiction in all six countries. Internet addiction mediated the association between social anxiety and poor psychosocial well-being in China, Hong Kong, and Malaysia.

Keywords: Adolescents; Asian; Depression; Internet addiction; Social anxiety; Structural equation modelling.

MeSH terms

Adolescent
Adolescent Behavior / psychology*
Anxiety / epidemiology*
Asia / epidemiology
Behavior, Addictive / psychology*
Child
Cross-Sectional Studies
Depression / epidemiology*
Female
Humans
Internet / statistics & numerical data*
Male
Models, Psychological
Social Behavior*
Surveys and Questionnaires