BACKGROUND: Problematic Internet Use (PIU) is increasingly recognized as a significant public health concern among adolescents, often leading to anxiety symptoms and somatic symptoms. However, the underlying interrelationships between these symptom domains remain insufficiently understood, particularly at the symptom level.
METHODS: This study applied network analysis to investigate the complexity of associations among PIU, anxiety, and somatic symptoms in a large, cross-sectional sample of 5221 adolescents aged 10-19 years from Shandong Province, China. Validated self-report instruments were used to assess PIU (IAT), anxiety (MASC), and somatic complaints (PHQ-13). Gaussian Graphical Models were constructed to identify central and bridge symptoms across the network, and sex differences were explored using the Network Comparison Test.
RESULTS: The prevalence of PIU was 11.91%. Network analysis revealed dense interconnections among symptoms, with 64.7% of edges being non-zero. "Physical symptoms" of anxiety (MASC1) emerged as the most central and bridging symptom across the network, demonstrating the highest node strength and expected influence. The strongest edge linking PIU, anxiety, and somatic symptoms was between "physical symptoms" and "cannot breathe". Although no significant gender differences were found in global network strength, the structure of symptom networks differed significantly between males and females. In males, the strongest bridge linked "time management & performance" with "sleep problems", whereas in females, "withdrawal & social problems" was strongly linked to "indigestion symptoms".
CONCLUSIONS: This study is the first to employ network analysis to map symptom-level associations between PIU, anxiety, and somatic symptoms in adolescents. The findings underscore the central role of anxiety-related physical symptoms in the network and highlight gender-specific symptom bridges. These insights offer novel directions for targeted interventions, emphasizing the need for symptom-focused and gender-sensitive treatment strategies for adolescents affected by PIU.
