# Peer bullying victimisation and depressive symptoms as serial mediators between attention‐deficit/hyperactivity disorder symptoms and internet gaming disorder among Chinese adolescents: A three‐wave longitudinal study

## TL;DR

This study shows that ADHD symptoms in Chinese adolescents can lead to internet gaming disorder through peer bullying and depression, with these effects varying by sex and age.

## Contribution

The study is the first to show that peer bullying and depressive symptoms sequentially mediate the ADHD-internet gaming disorder link in adolescents.

## Key findings

- ADHD symptoms predict IGD severity both directly and indirectly through peer bullying and depression.
- Peer bullying's role is stronger in boys and early adolescents, while depression mediates across all groups.
- The findings support the dual failure and compensatory internet use models in explaining the ADHD-IGD relationship.

## Abstract

The association between attention‐deficit/hyperactivity disorder (ADHD) symptoms and internet gaming disorder (IGD) is well‐established, yet the psychological mechanisms underlying this comorbidity remain underexplored.

Grounded in the dual failure model and the compensatory internet use model, this study examined peer bullying victimisation and depressive symptoms as serial mediators in the longitudinal association between ADHD symptoms and IGD severity among 20 137 Chinese adolescents.

Participants were assessed at baseline (T1, November 2020) and followed up at one (T2) and two years (T3). Standardised measures assessed peer bullying victimisation (Multidimensional Peer Victimisation Scale), ADHD symptoms (Strengths and Difficulties Questionnaire), depressive symptoms (9‐item Patient Health Questionnaire) and IGD severity (Internet Gaming Disorder Scale–Short Form). Longitudinal path analysis with serial mediation tested the hypothesised pathway, adjusting for baseline covariates and prior symptoms. Subgroup analyses examined sex and developmental (early vs. late adolescence) differences. Sensitivity analyses included alternative mediation models, cross‐lagged panel models and parallel‐process latent growth curve models.

Baseline ADHD symptoms directly predicted IGD severity and indirectly through peer bullying victimisation and depressive symptoms. These mediators accounted for one‐third of the total effect. The bullying‐related mediation pathway was evident only among boys and early adolescents, whereas depressive symptoms consistently mediated the association across sexes and age groups. Sensitivity analyses supported the robustness and temporal specificity of the proposed pathway.

ADHD symptoms increase the risk of subsequent IGD through both direct and indirect pathways operating through peer bullying victimisation and depressive symptoms. This social–emotional mediation process is developmentally and sex contingent. These findings suggest that effective prevention and intervention for IGD in adolescents with ADHD should incorporate developmentally and sex‐sensitive strategies that address peer victimisation and emotional distress in addition to core ADHD symptoms.

WHAT IS ALREADY KNOWN ON THIS TOPIC
Attention‐deficit/hyperactivity disorder (ADHD) symptoms and internet gaming disorder (IGD) are highly comorbid in adolescents and linked to negative outcomes, yet the psychological mechanisms underlying this comorbidity remain underexplored.

Attention‐deficit/hyperactivity disorder (ADHD) symptoms and internet gaming disorder (IGD) are highly comorbid in adolescents and linked to negative outcomes, yet the psychological mechanisms underlying this comorbidity remain underexplored.

WHAT THIS STUDY ADDS
Grounded in the dual failure model and the compensatory internet use model, this large longitudinal study is the first to demonstrate that peer bullying victimisation and depressive symptoms sequentially mediate the relationship between ADHD symptoms and later IGD severity. The bullying‐related pathway is specific to boys and early adolescence, whereas depressive symptoms act as a more pervasive mediator.

Grounded in the dual failure model and the compensatory internet use model, this large longitudinal study is the first to demonstrate that peer bullying victimisation and depressive symptoms sequentially mediate the relationship between ADHD symptoms and later IGD severity. The bullying‐related pathway is specific to boys and early adolescence, whereas depressive symptoms act as a more pervasive mediator.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
These findings highlight critical interpersonal and emotional mechanisms underlying the ADHD‐IGD link, providing empirical support for theoretical models. Clinically, the results underscore the importance of assessing and targeting peer victimisation, depressive symptoms and ADHD symptoms in interventions for IGD, suggesting the need for tailored approaches based on sex and developmental stages.

These findings highlight critical interpersonal and emotional mechanisms underlying the ADHD‐IGD link, providing empirical support for theoretical models. Clinically, the results underscore the importance of assessing and targeting peer victimisation, depressive symptoms and ADHD symptoms in interventions for IGD, suggesting the need for tailored approaches based on sex and developmental stages.