Mediation of Internet addiction on association between childhood maltreatment and suicidal behaviours among Chinese adolescents

Aims: The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA.
Methods: A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations.
Results: During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively.
Conclusions: CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.