Exploring depressive symptoms, internet addiction, and sleep disturbance in adolescents: A network analysis

To examine the coexistence of depressive symptoms, internet addiction, and sleep disturbance in adolescents using network analysis, and to derive actionable implications for psychiatric nursing practice.

A total of 882 adolescents, comprising 474 with depressive disorders and 408 healthy controls, participated in the study. Participants completed the Children's Depression Inventory, Young's Internet Addiction Test, and the Pittsburgh Sleep Quality Index. Network analysis was used to identify key symptoms and bridge symptoms in a combined network of depressive symptoms, internet addiction, and sleep disturbance. A network comparison was conducted to analyze differences between adolescents with depressive disorders and healthy controls.

The network analysis identified anhedonia and negative mood as key symptoms, while sleep disturbance emerged as a bridge between depressive symptoms and internet addiction. The network of adolescents with depressive disorders showed distinct patterns of symptom connectivity compared to the network of healthy controls; this structural difference remained after propensity score matching, whereas the initial difference in overall connectivity strength did not.

Sleep disturbance bridges internet addiction and depressive affect, while anhedonia and negative mood are the most central symptoms. Group differences should be interpreted primarily in terms of symptom connectivity patterns rather than stronger overall network connectivity. These data support integrated screening and multi-domain interventions that nurses can deliver in practice to address mood, sleep, and internet addiction symptoms, aiming to improve adolescents' psychosocial well-being.