Serial multiple mediation of the association between internet gaming disorder and suicidal ideation by insomnia and depr
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RESEARCH ARTICLE
Open Access
Serial multiple mediation of the association between internet gaming disorder and suicidal ideation by insomnia and depression in adolescents in Shanghai, China Yuelin Yu1†, Xue Yang2†, Suping Wang1†, Huwen Wang1, Ruijie Chang1, Lhakpa Tsamlag1, Shuxian Zhang1, Chen Xu1, Xiaoyue Yu1, Yong Cai1* and Joseph T. F. Lau2*
Abstract Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation. Methods: Participants were 1066 adolescents (median age = 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression. Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2, 13.6, 9.2, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well. Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents. Keywords: Internet gaming disorder, Insomnia, Depression, Suicidal ideation, Mediation * Correspondence: [email protected]; [email protected] † Yuelin Yu, Xue Yang and Suping Wang contributed equally to this work and should be considered co-first authors. 1 School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, PR China 2 Centre for Health Behaviors Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong 810016, SAR, China © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are
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