# Leisure Screen Time, Internet Gaming Disorder, and Mental Health Among Chinese Adolescents: Large-Scale Cross-Sectional Study

## TL;DR

This study finds that excessive screen time and internet gaming disorder are both linked to mental health issues in Chinese adolescents, with gaming disorder having a stronger impact.

## Contribution

The study uniquely examines both the quantity of screen time and addictive gaming patterns alongside multiple mental health outcomes in a large adolescent sample.

## Key findings

- Excessive leisure screen time and internet gaming disorder are independently linked to poor mental health in adolescents.
- Internet gaming disorder shows stronger associations with mental health disorders than leisure screen time alone.
- Adolescents with both excessive screen time and gaming disorder have the highest risk of mental health issues.

## Abstract

Adolescence is a critical period for mental health vulnerability alongside rising digital media exposure. Current evidence often fails to distinguish the distinct roles of leisure screen time (LST) quantity and addictive patterns like internet gaming disorder (IGD) on a comprehensive range of mental health outcomes.

This study aimed to investigate the independent and joint associations of LST and IGD with multiple mental health conditions among Chinese adolescents.

We conducted a school-based, cross-sectional survey in Sichuan Province, China. Participants were recruited by random cluster sampling from 20 public schools. The sample comprised 13,240 adolescents (6659/13,240, 50.3% girls) with a mean age of 15.4 (SD 1.6) years. LST was self-reported, and IGD was evaluated using the Internet Gaming Disorder Scale-9 Item Short Form (IGDS9-SF). Mental health outcomes included overall mental health status and 5 specific diseases: psychological distress, depression, paranoia, insomnia, and suicidal ideation, all assessed using validated scales.

The prevalence of excessive LST, IGD, and any mental health disorder was 48.2% (6378/13,240; 95% CI 47.3%-49.0%), 1.4% (188/13,240; 95% CI 1.2%-1.6%), and 55.8% (7387/13,240; 95% CI 54.9%-56.7%), respectively. After adjustment, excessive LST (odds ratio [OR] 1.18, 95% CI 1.09-1.27) and IGD (OR 6.58, 95% CI 5.02-8.62) were independently associated with poor mental health. A dose-response relationship existed for LST quartiles (Q2: OR 1.15, 95% CI 1.04-1.26; Q3: OR 1.24, 95% CI 1.12-1.37; Q4: OR 1.31, 95% CI 1.18-1.46; Ptrend<.001). Excessive LST was associated with depression (OR 1.16, 95% CIs 1.05-1.29), paranoia (OR 1.22, 95% CI 1.11-1.34), and suicidal ideation (OR 1.15, 95% CI 1.04-1.28), while IGD was associated with all 5 disorders, most notably depression (OR 6.43, 95% CI 4.56-9.06) and paranoia (OR 5.77, 95% CI 4.05-8.21). IGD consistently demonstrated stronger associations than LST: psychological distress (OR 4.40, 95% CI 3.12-6.19 vs OR 1.14, 95% CI 0.98-1.33), depression (OR 6.43, 95% CI 4.56-9.06 vs OR 1.16, 95% CI 1.05-1.29), paranoia (OR 5.77, 95% CI 4.05-8.21 vs OR 1.22, 95% CI 1.11-1.34), insomnia (OR 2.90, 95% CI 2.09-4.05 vs OR 1.12, 95% CI 102-1.22), and suicidal ideation (OR 3.85, 95% CI 2.76-5.37 vs OR 1.15, 95% CI 1.04-1.28). Adolescents with both excessive LST and IGD demonstrated the highest odds of mental health disorders (OR 7.35, 95% CI 5.29-10.22). No significant interaction was found on additive or multiplicative scales.

Both excessive LST and IGD are independently associated with mental health disorders in adolescents, with IGD showing a substantially stronger association. This study is distinct from prior research by simultaneously investigating both screen time quantity and addictive usage patterns, and by comprehensively assessing 5 distinct mental health outcomes. Longitudinal studies are needed to better understand the long-term effects.