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Examining the relationship between internet addiction and the willingness to continue living, mediated by life satisfaction and negative suicidal ideation, with depression as a mediator

  • Maryam Ramezanpour ORCID logo , Leili Salehi ORCID logo EMAIL logo , Khodabakhsh Karami ORCID logo and Abbas Moghimbeigi ORCID logo
Published/Copyright: April 7, 2025
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International Journal of Adolescent Medicine and Health
From the journal International Journal of Adolescent Medicine and Health Volume 37 Issue 2

Abstract

Objectives

This study investigates the relationship between internet addiction and suicidal Ideations among adolescents, aiming to understand the connection between these two phenomena.

Methods

This cross-sectional study was conducted in 2023 on 333 adolescent boys and girls aged 14 to 19, who were studying in Ahvaz city, using a cluster random sampling method. Data were collected using a multi-section questionnaire comprising demographic characteristics, internet addiction, suicidal Ideations, the adolescent depression questionnaire, and life satisfaction. Data were analyzed using path analysis modeling, Chi-square test, and Fisher’s exact test, with the help of SPSS 21 and Amos version 24 software.

Results

In total, 10.5% were regular users, 40.5% had mild addiction, 44.7% had moderate addiction, and 4.2% had severe internet addiction. The results showed that internet addiction affects negative suicidal Ideations through the mediation of depression and positive suicidal Ideations (desire to live) through the mediation of life satisfaction. The average depression score among adolescents was 8.82 ± 8.76, and the average life satisfaction was 21.25 ± 7.76.

Conclusions

Based on the results of the present study, suicidal Ideations among adolescents cannot be directly attributed to their internet addiction. The component of depression acts as a mediating factor in creating negative suicidal Ideations, while life satisfaction serves as a supportive factor in the relationship between internet addiction and positive suicidal Ideations (desire to continue living) in adolescents.

Keywords: internet addiction; suicidal ideations; depression; life satisfaction; adolescents

Background

In today’s world, the internet has become an inseparable part of everyday life [1]. The number of internet users and the hours spent online have exponentially increased, especially among educated individuals, most of whom are young [2], because it is the most suitable tool for global communication, a source of information, and entertainment [3]. Internet dependency is termed modern addiction and is essentially a real dependency akin to drug addiction and other dependencies [4]. Although this type of dependency does not have the physical problems associated with chemical addiction, it does result in similar social problems as other addictions [5]. The prevalence of Internet addiction among Iranian youth and adolescents was 2.5 percent [6].

The American Psychological Association defines internet addiction as a pattern of internet use that causes functional impairment and internal discomfort over a two-month period, characterized by at least 3 criteria during 1 month: 1. Tolerance, 2. Withdrawal symptoms, 3. Using the internet for longer periods than initially intended, 4. Persistent desire to control behavior, 5. Significant time spent on internet-related activities, 6. Reduction in social, occupational, and recreational activities due to internet use, and 7. Continued use despite awareness of its negative effects [7]. Internet addiction is associated with many adverse effects such as emotional disorders [8], insomnia [9], aggression [10], and self-harming behaviors [11].

Understanding the factors influencing suicide and the mechanisms of suicidal thoughts is obvious [12]. Factors such as life satisfaction as a protective factor [13] and depression as a guiding factor are mentioned in the relationship between internet addiction and suicidal thoughts [14]. However, a study found that citizens living in developed countries are less likely to be at risk of internet addiction [15].

In fact, countries like Iran, which import new technologies such as the internet, show greater vulnerability due to not learning the culture of proper use of this technology and a lack of basic life skills. Therefore, examining the current state of internet usage and related factors is essential for achieving larger and long-term goals [16]. The results of a study by Kim and colleagues, conducted on 1,573 Korean high school students, indicate that levels of depression, thoughts, planning, and attempts at suicide are significantly higher among students with internet addiction compared to regular students [17].

Suicidal thoughts may be the first sign of potential future suicidal behavior; therefore, measuring early suicidal thoughts is necessary for preventing self-harming behaviors [18]. A review of existing literature shows that various studies have been conducted in this area, especially during the COVID-19 pandemic [12], 19], 20], but according to researchers, limited studies have been conducted on students in this regard, particularly after the pandemic, considering internet addiction as a consequence of this pandemic for human societies.

Methods

Design

The present study is cross-sectional, and the research data was collected via an online questionnaire. The research population included all male and female secondary school students, aged 14–19, in public high schools in Ahvaz for the academic year 2023–2024. The sample size was estimated at 333, which was determined through cluster random sampling. Initially, 420 participants were selected by selecting 10 schools (clusters), with 42 people from each school. However, with 87 people dropping out and being excluded from the study, 333 people responded to the questionnaire in full and participated in the study.

Following formula is used to calculate Sample size [21].

n=Z1−α/22 P1−Pd2

P=10 %?

z 1−a/2=1.96

d %=4

Sampling method

Schools in each district were selected, and then students were chosen randomly within each school (cluster). Research tools were distributed to students who met the study inclusion criteria (enrolled in first and second secondary levels, possessing a mobile phone, tablet, or computer, not suffering from chronic diseases, and not having physical disabilities or psychological disorders based on observation and self-reporting) for their responses. Students who were involved in any accidents or problems or who filled out the questionnaire incompletely were excluded from the study The questionnaire was filled out by the students themselves.

Data gathering

Research tools were distributed to students who met the study inclusion criteria (enrolled in first and second secondary levels, possessing a mobile phone, tablet, or computer, not suffering from chronic diseases, and not having physical disabilities or psychological disorders based on observation and self-reporting) for their responses.

Questionnaires

The data collection utilized a multi-part questionnaire including the following sections:

  1. Demographic characteristics questionnaire

Including: age, gender, educational level, parents’ education, type of social network used, and topics and interests searched on the internet.

  1. Young’s Internet Addiction Test

Which consists of 20 items measuring various aspects of addiction to determine whether excessive internet use affects different aspects of an individual’s life, rated on a 5-point Likert scale from rarely (0) to always (5). Scores from 0 to 30 are considered as no internet addiction and regular users, scores from 31 to 49 as mild addiction, scores from 50 to 79 as moderate internet addiction, and scores of 80 and above as a threshold for severe internet addiction. A reliability assessment of this questionnaire yielded a Cronbach’s alpha coefficient of 0.79 [22].

Morales’ suicidal ideations questionnaire

This questionnaire was designed and psychometrically evaluated by Morales and Yuz in 2017. It consists of nine items, including 4 positive scenarios indicating no readiness for suicidal action, interpreted as a willingness to live, and 5 negative scenarios indicating the presence of suicidal thoughts and tendencies, rated on a 5-point Likert scale from very little (1) to a lot (5). In adolescents, the convergent and divergent validity of this questionnaire was assessed using tools such as life satisfaction, depression questionnaire, and psychological maturity questionnaire in 435 Spanish adolescents aged 14–19 [23]. The validity of this tool was evaluated and confirmed using content validity by ten psychological and psychiatric specialists and its reliability by Cronbach’s alpha coefficient alpha above (0.7).

Kutcher adolescent depression scale (KADS)

This scale consists of 11 questions designed to measure the severity of depression in adolescents aged 12–20, using a 4-point Likert scale from rarely (0) to always (3) [24]. The scores of this questionnaire range from 0 to 33. This self-report scale is highly capable of distinguishing between different levels of depression, with a threshold to distinguish between depressed and non-depressed individuals. Its validity has been assessed in Iran [25].

Diener’s satisfaction with life scale (SWLS)

A 5-item tool measuring an individual’s cognitive and global judgment of their life, rated on a 7-point Likert scale from strongly disagree (1) to strongly agree (7) [26]. The total score of this scale, obtained by summing the item scores, ranges from 5 to 35, with higher scores indicating greater life satisfaction. This tool has been validated in Iran [27].

Statistical analysis

The data from this study was analyzed using Amos software version 24. The study was approved by the Ethics Committee of Alborz University of Medical Sciences (Ethics code: IR.ABZUMS.REC.1402.170). Participation of all individuals in the study was informed and voluntary, with complete explanations of the study’s goals and methods, and the possibility of withdrawal at any stage was ensured, adhering to the principles of the Helsinki Declaration throughout the study. This study is part of the MS thesis in Alborz University of Medical Sciences.

Results

In the present study, a total of 333 students with an average age of 15.79 ± 1.53 years were surveyed, comprising 52.6 % girls. The majority of the participants (44.7 %) had a moderate addiction to the internet. Among the parents of the students surveyed, 31.9 % of fathers and 25.8 % of mothers had education below high school level. All participants used online social networks, with at least one social media account. The most common reason for internet use and the topics searched were related to finding happy and entertaining content, accounting for 43.2 %, while the least searched topics were religious content, at 6.4 %. Furthermore, the most commonly used platform was WhatsApp at 69.1 %, while Facebook was the least used at 0.3 %. Additionally, 64 % of the students had a network of connections with more than three people on social media (Table 1).

Table 1:

Demographic characteristics of the participant students.

Statistical index Frequency Percentage
Age, y 14 98 29.42
15 61 18.31
16 53 15.91
17 62 18.61
18 50 15.01
19 9 2.70
Sex Female 175 52.55
Male 158 47.44
Father’s education <12 106 31.83
12 127 38.13
>12 100 30.03
Mother’s education <12 86 25.82
12 138 41.44
>12 109 32.73
Social media using WhatsApp 210 63.06
Telegram 10 3.00
Instagram 65 19.51
Facebook 27 8.10
Domestic 1 3.00
Friend’s number on social media 1 75 22.52
2 45 13.51
3 or more 213 63.96
Purpose of internet use Scientific activity 78 23.42
Entertainment 144 43.23
Religious 21 6.32
Communication 90 27.03
Internet addiction status Ordinary 35 10.51
Mild 135 40.54
Moderate 149 44.74
Severe 14 4.20

To examine the relationship between the research variables, path analysis based on the variance-covariance or correlation matrix between the variables has been used (Table 2).

Table 2:

Correlation matrix of the research variables.

1 2 3 4 5
1 1
2 0.64b 1
3 −0.37b −0.047b 1
4 0.02 −0.08 0.15 1
5 0.47b 0.060b −0.39b −0.15b 1

  1. 1. Internet addiction; 2. depression: 3. life satisfaction; 4. Suicidal negative ideation; 5. Suicidal positive ideation (desire to live), bsignificant at 0.001.

The results of the correlation matrix of the research variables indicate a significant correlation of 0.64 between depression and internet addiction. This finding suggests that as internet addiction increases among students, their level of depression significantly rises. Conversely, there is a significant inverse relationship of −0.37 between life satisfaction and internet addiction. The results from Table 2 also show that positive suicidal thoughts (desire to live) have a negative relationship with depression and a positive but weak relationship with internet addiction, although these relationships were not significant. Furthermore, negative suicidal thoughts show a significant positive relationship with internet addiction (0.47) and depression (60 %) Table 3.

Table 3:

Model fitting indicators.

Indices χ2/df GFI PCFI PNFI CFI IFI RMSEA
Model index 3.490 0.994 0.920 0.915 0.970 0.971 0.007
Acceptable range 1–5 >0.9 >0.9 >0.9 >0.9 >0.9 <0.05

The results of the bootstrap test to examine the effect of internet addiction on negative suicidal thoughts showed that the lower limit of the confidence interval for depression, as a mediating variable between internet addiction and negative suicidal thoughts, is 0.081 and the upper limit is 0.135. Therefore, depression plays a mediating role in the relationship between internet addiction and negative suicidal ideations (Table 4).

Table 4:

The coefficients and significance of the indirect effect of internet addiction on negative suicidal ideation.

Criterion variable Predictor variable Effect’s type Index Sig
Data Boot Bias Error Lower limit Upper limit
Suicidal negative ideation Internet addiction Through depression 0.135 0.081 0.014 0.001 0.107 0.106 0.001

The results of the bootstrap test regarding the effect of internet addiction indicate that the lower limit of the confidence interval for life satisfaction, as a mediating variable between internet addiction and positive suicidal thoughts (desire to live), is −0.022 and the upper limit is −0.004; therefore, life satisfaction plays a mediating role in the relationship between internet addiction and positive suicidal Ideations (desire to live) (Table 5).

Table 5:

The coefficients and significance of the indirect effect of internet addiction on Life satisfaction.

Criterion variable Predictor variable Effect’s type Index Sig
Data Boot Bias Error Lower limit Upper limit
Suicidal positive ideation Internet addiction Through life depression −0.012 −0.013 0.001 0.004 −0.022 −0.004 0.006

What can be inferred from the results in the table above is that the effect of internet addiction on negative suicidal thoughts is statistically significant (2.70=t and 0.15=β), while the effect of internet addiction on positive thoughts (desire to live) was not statistically significant (1.08=t and 0.09=β) (Table 6) (Figure 1).

Table 6:

Coefficients and significance of the direct effect of suicidal ideation (positive ideation and negative ideation) and Internet addiction.

Criterion variable Predictor variable Type of effect Unstandardized coefficient β standardized Significant statistic Sig
Internet addiction Positive ideation Directly 0.02 0.09 1.08 0.115
Negative ideation Directly 0.07 0.15 2.70 0.003
Figure 1: Final fitted model.
Figure 1:

Final fitted model.

Discussion

The results of this study indicate a high prevalence of internet addiction among adolescents in Ahvaz (89.4 %), which is higher compared to previous studies in Iran [6], [28], [29], [30]. In comparison with similar studies in Africa and Asia, this prevalence is lower [30], while similar studies in Europe have shown much lower [31] while similar studies in Europe have shown much lower rates [32], 33].

Severe internet addiction was significantly higher in girls compared to boys, although there was no significant difference between the two genders regarding mild and moderate internet addiction. These findings are consistent with other studies [5], 6], 31], 34]. Based on the results of the present study, the relationship between internet addiction and the topics searched for on social media was significant; most participants spent time on the internet for joy and entertainment, and connecting with friends in virtual social networks ranked second, which aligns with similar studies [6], 30], [35], [36], [37], [38], [39], [40].

The findings of the present study also indicate a relationship between internet addiction and positive suicidal thoughts (the desire to continue living) mediated by life satisfaction, as well as negative suicidal thoughts mediated by depression among the adolescents surveyed. Other existing evidence has also shown that there is a statistically significant relationship between internet addiction and suicidal thoughts [35], 36]. Several studies have corroborated the present findings regarding the negative correlation between internet addiction and self-esteem, highlighting the mediating roles of social support and life satisfaction in this relationship. These results suggest that internet addiction may be a risk factor for suicidal thoughts in adolescents, which is moderated by factors such as self-esteem, social support, and mental health. This indicates a negative and significant relationship between suicidal tendencies and life satisfaction [37], 38]. Furthermore, life satisfaction has been emphasized in reducing suicidal thoughts among individuals suffering from depression [39].

Similar studies also indicate that suicidal thoughts have divergent validity with life satisfaction in the elderly [40]. Research has repeatedly shown a negative correlation between the sense of meaning in life and suicidal thoughts among young people. However, while the sense of meaning in life may be a protective factor, it is not the only one, and a comprehensive approach to addressing mental health and well-being among youth is essential [41].

Conclusions

Considering the results of the study, there is no direct relationship between internet addiction and suicidal thoughts in adolescents; rather, depression plays a mediating role in this relationship just as life satisfaction mediates the relationship between internet addiction and the desire to continue living (positive suicidal thoughts).

Strength and weakness of the study

Conducting this study on students, especially after the COVID-19 pandemic in a country like Iran, characterized by cultural poverty regarding internet usage and the stigma of discussing suicide, was a strength of this study. However, this study also had its limitations, including: 1. Issues related to obtaining permission, 2. Lack of cooperation from students and their parents, 3. Use of self-reporting tools which may lead to inaccurate and distorted responses, 4. Not investigating the impact of parents’ occupations, financial status, and divorce on the relationships examined.

Corresponding author: Leili Salehi, Professor, Department of Health Promotion and Education, School of Health, Alborz University of Medical Sciences, Karaj, Iran, E-mail:

Acknowledgements

The present study is the result of a master’s thesis in Health education & promotion was conducted with the support of the Research Deputy and the Education Deputy of Alborz University of Medical Sciences. We wish to express their gratitude to these organizations and all the participating.

  1. Research ethics: Ethical Committee of Alborz University of Medical Sciences approved the study (approval number: IR.ABZUMS.REC.1402.170).

  2. Informed consent: All the participations were assured regarding their privacy in this study and informed about volunteer entering in the study and willingness to exclude from the study at any time.

  3. Author contributions: MR: collected the study data and contributed to conduct study. LS has supervised the study; contributed to the study design and participate in write the manuscript KHK: draft the manuscript and helped data analysis AMB: interpretation and data analysis, the authors read and approved the final manuscript.

  4. Use of Large Language Models, AI and Machine Learning Tools: Not applicable.

  5. Conflict of interest: The authors declare that there is not any conflict of interest.

  6. Research funding: This study conducted without any funding.

  7. Data availability: The current study datasets and analysis sheets are available and will be provided due to reasonable request.

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Received: 2025-02-01
Accepted: 2025-03-08
Published Online: 2025-04-07

© 2025 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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Keywords for this article
internet addiction; suicidal ideations; depression; life satisfaction; adolescents
Creative Commons
BY 4.0

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