Nan Liu
Huaxiang Li
Lin Wang1*- 1Nursing Department, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yang Zhou, China
- 2School of Food Science and Engineering, Yangzhou University, Yang Zhou, China
Background: Both Internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, association between internet addiction and non-suicidal self-injury have been observed among adolescents. However, it is unclear how, and under what conditions, internet addiction relates to non-suicidal self-injury. According to our hypothesis, there is a positive relationship between IA and NSSI among Chinese adolescents, but this relationship is affected by the mediating role of loneliness and the moderating role of cognitive reappraisal.
Method: A cross-sectional survey was conducted on 1046 Chinese adolescents from 3 middle schools. Measurements: Adolescent Self-Harm Scale; Young’s Internet Addiction Test (IAT); University of California at Los Angels (UCLA) Loneliness Scale; Emotional Regulation Questionnaire (ERQ), They were asked to complete self-report questionnaires.
Results: In our sample, the detection rate of NSSI was 12.3%. IA was positively associated with NSSI, and loneliness partially mediated the association between them. In addition, cognitive reappraisal moderated the first half path of the mediation model. Specifically, the higher the level of cognitive reappraisal, the weaker the positive effect of IA on NSSI through loneliness.
Conclusion: Interventions targeted to reduce loneliness and increase cognitive reappraisal strategies may reduce the risk of NSSI in adolescents with Internet addiction.
1 Introduction
Non-suicidal self-injury (NSSI) refers to behavior that causes damage to the surface of the body repeatedly in order to achieve a certain purpose without the explicit intention of suicide (1). The results of epidemiological investigation showed that NSSI behavior occurs in individuals of all age groups, with adolescents being the group with the highest frequency of occurrence (2). NSSI has become an important public health issue that significantly affects the health of adolescents globally (3). Currently, the detection rate of NSSI in China is showing a gradual upward trend. A meta-analysis of the prevalence of NSSI among adolescents in mainland China showed that the total detection rate of NSSI was 27.4% (4). This issue not only causes significant physiological and psychological harm to adolescents but also increases the risk of future suicide among individuals who engage in self-injury (5). Given the high prevalence and serious consequences of NSSI, further understanding the influencing factors and underlying mechanisms of NSSI in adolescents is necessary.
With the rapid development of the Internet, adolescents now view it as a tool that provides various opportunities for communication, education, and entertainment (6). The Internet penetration rate among minors reached 94.9% by the end of 2020, according to the data released by the China Internet Network Information Center (2021). During the COVID-19 pandemic, the Internet has become an indispensable part of adolescents’ lives, entertainment, and learning. However, while the Internet meets their increasing online entertainment and social needs, the Internet addiction (IA) is also becoming increasingly prominent (7). It is important to note that currently (2024), Internet addiction is yet to be recognized by the World Health Organization or the American Psychiatric Association as an addiction or any other disease class (8). The latest version of the International Classification of Diseases (ICD-11) includes only gaming disorder (9). However, the term has become so well-established in specialist language that it is commonly used in literature. In this paper, too, we will be using the term “Internet addiction” as a generic, non-clinical term to refer to various disorders associated with problematic Internet use. Problematic Internet use (PIU) is an umbrella construct that refers to a wide range of online behaviors (shopping, pornography viewing, social networking, cyberbullying, “cyberchondria”) that can become uncontrolled and engender negative consequences (social, occupational, familial, educational), and associated with functional impairment in a subgroup of vulnerable users (10, 11). PIU and IA are often used as synonyms (12). IA or PIU not only affects the development of adolescents’ physical health, but also endangers their mental health (13), such as insomnia, depression, anxiety. Recent studies have focused on the association of IA with NSSI (12). A European study reported that PIU among adolescents was significantly associated with self-harming/suicidal behavior (14). Empirical evidence indicated that negative emotions and inappropriate coping strategies are characteristics of IA (15) and Nock et al. (16) proposed that bad emotions and cognition combined with inappropriate coping strategies could lead to NSSI. In addition, Pan (17) showed that adolescents with IA may have neuropsychological defects, and they likely show a tendency to make risky decisions, which leads to individuals with IA adopting limited and extreme ways to cope with maladjustment or stressful events, ultimately resulting in the occurrence of NSSI. The Internet also provides convenient access to obtain information related to NSSI, promoting the occurrence of NSSI (18). According to a cross-sectional investigation in China, IA and suspicious IA behavior are independent risk factors for NSSI behavior (3). The relationship between IA and NSSI has been explored in existing research, but the results remain controversial. For example, Meszaros et al. (12) found that no direct association exists between IA and NSSI, but the relationship between the two is mediated through pathological mental disorders. Liu et al. (18) observed that after certain demographic variables were controlled, the correlation between IA and NSSI was weakened. Moreover, limited exploration has been conducted on the mechanism of action between the two. Given the harmful consequences of IA and NSSI on the healthy development of adolescents, further exploration of the mechanisms and influencing factors between these two behaviors could enhance our understanding of the trajectory and consequences of IA in adolescents.
Loneliness is a kind of negative emotion produced by an individual’s desire for interpersonal communication and intimate relationship in the social relationship network but unable to meet it (19). Several studies have shown that IA is predictive of loneliness in adolescents (20–22). Yao and Zhong (21) conducted a cross-lagged analysis and found that excessive and unhealthy Internet use increases individuals’ feelings of loneliness. Zheng et al. (22) determined through a cross-sectional study that Internet addicts experience a stronger sense of loneliness than non-Internet addicts. The Internet, which ostensibly promotes interpersonal interaction, actually makes users more distant from each other and increases their feelings of loneliness, which is called the “Internet paradox” by researchers (23). Adolescents’ internet use takes away time that might be used for social interaction. However, the relationships created and maintained through the Internet are often superficial. The substitution of lower-quality relationships through the Internet for higher-quality relationships in face-to-face interactions leads to lower levels of social involvement and increased loneliness (24). Adolescence is a high-risk period for loneliness, and loneliness is the most common of health risk behaviors among adolescents (25). Ma et al. (3) emphasized that high loneliness and low emotional management in adolescents are independent risk factors for NSSI.
The experiential avoidance model (EAM) of NSSI supposes that when an individual encounters an external stimulus that triggers the negative emotional response, the interaction between certain characteristics (such as high emotional intensity caused by the event and lack of emotion regulation strategies) of the individual and environment and other factors can prompt an individual to choose self-injury to avoid the negative experiences caused by negative emotions. Self-injury temporarily relieves their negative emotional experiences and further strengthens NSSI, which ultimately promotes the maintenance of NSSI (26). From this perspective, negative emotions are not only the result of external stimuli but also a contributing factor to hazardous behavior, which is the intermediary variable between external stimuli and behavioral consequences. On the basis of EAM, we speculate that adolescents in the period of drastic physical and mental changes with prominent rebellious psychology are prone to negative emotional experiences, such as loneliness, under the stimulation of IA. To avoid this negative emotional experience (loneliness), self-harming behavior is adopted, that is, loneliness may play a mediating role in the relationship between IA and NSSI.
Lack of effective emotion regulation strategies is one of the important factors in the development of NSSI (27). According to the model of emotion regulation process proposed by Gross (28), emotion regulation is developed in the process of emotion occurrence and development. At different stages of emotion development, there are different emotion regulation strategies. Cognitive reappraisal and expression suppression are the two most representative emotion regulation strategies (28). Both emotional regulation strategies were closely related to the occurrence and development of NSSI (29). Cognitive reappraisal is a positive emotion regulation strategy that generally occurs before the emotional response (28), that is, by changing the cognition and understanding of emotional events (e.g. interpreting a remark as benign/neutral instead of insulting/personal), individuals reduce the negative emotions associated with situations to reduce their negative emotions and psychological pain (30). It belongs to antecedent-focused emotion regulation strategy. Cognitive reappraisal strategies could help individuals understand the events that cause negative emotions in a positive way to reduce the experience of negative emotions and the expression of negative behaviors (e.g., self-harm) (31, 32). Evidence suggested that cognitive reappraisal played a significant protective role in self-harm because individuals who employ cognitive reappraisal could effectively reduce the risk and severity of self-injury (31, 33). A 3-year longitudinal study found that cognitive reappraisal was still significantly negatively associated with NSSI while controlling for negative life events, psychological stress, and other ways of emotional regulation (34). However, expression suppression, a response-focused emotion regulation strategy, generally occurs after emotions have been formed or the emotional response is activated. It suppresses individuals’ emotional expression by mobilizing their self-control ability (e.g. when someone steps on your foot and he doesn’t apologize, you try to control your anger even though you are angry). Although expression suppression could reduce individuals’ emotional expression, it does not reduce the individuals’ psychological experience of emotion (35). It is a significant positive predictor of adolescent NSSI behavior (36).
Therefore, cognitive reappraisal may weaken the association between IA (emotional situation) and loneliness (negative emotional response to the situation) when a situation may cause emotional fluctuations of individuals (IA). That is, individuals with high levels of cognitive reappraisal may adjust their cognition and understanding of the current situation to change the consequent negative emotional (loneliness) effect and increase the experience and expression of positive emotions, thereby reducing the occurrence of NSSI. When the emotional response is activated, individuals try to suppress the negative emotion using expressive suppression. However, this inhibition may paradoxically promote the lingering and accumulation of negative emotions, which exacerbates negative psychological experiences and thus increases the risk of NSSI.
The cognitive-emotional model of NSSI (1) further supports the role of emotion regulation played by cognitive reappraisal in the NSSI. This model proposes that emotion and cognition can work in concert to govern NSSI. Cognitive reappraisal, as an adaptive emotion regulation strategy, changes the trajectory of emotional responses by reinterpreting emotional events, which may weaken the association between a perceived emotionally volatile situation and a person’ s emotional response to it, ultimately reducing self-harming behaviors.
On the basis this model, Gu et al. (33) found that the direct impact of harsh parenting on adolescents’ self-injurious behavior and the indirect impact of alienation are moderated by cognitive reappraisal. In other words, adolescents with high cognitive reappraisal level have lower feelings of helplessness, loneliness, and other alienation even though they are subjected to high levels of harsh parenting. They are less likely to have self-harming behaviors. Another related study by Gu et al. (37) showed that the indirect effect of self-criticism on NSSI through psychological pain is moderated by cognitive reassessment, which can weaken the indirect effect of self-criticism on NSSI.
Based on the above theoretical model and previous research results, cognitive reappraisal generally occurs in the early stage of emotion generation, and has a significant easing effect on negative emotions caused by emotional situations. We supposed that cognitive reappraisal should be able to moderate the mediating (loneliness) process by weakening the relationship between IA and loneliness, namely, the first paragraph of the mediation pathway.
Based on these findings, we hypothesized the following:
H1. Adolescent IA is positively associated with NSSI.
H2. Loneliness will mediate the relationship between IA and NSSI.
H3. The mediating role of loneliness between IA and NSSI will be moderated by cognitive reappraisal. Specifically, cognitive reappraisal negatively moderates the first half of the mediating model (Figure 1).
Figure 1 A moderated mediation model of Internet Addiction (IA), Loneliness, Cognitive Reappraisal, and Non-Suicidal Self-Injury (NSSI).
The findings of this study will contribute to understanding the relationships between IA, loneliness, cognitive reappraisal, and NSSI. This understanding could help in timely interventions to prevent further negative behaviors among adolescents. At the same time, it would provide ideas for formulating intervention strategies to reduce NSSI behavior, which in turn would decrease the occurrence of negative events and help adolescents grow up healthily.
2 Materials and methods
2.1 Participants
In this study, 1118 students from 3 middle schools in Yangzhou, Jiangsu Province were investigated using a convenience sampling method. The three secondary schools include a general middle school, a general high school, and a vocational high school (vocational high school is a secondary school that combines ordinary high school education with vocational education. It not only provides students with general high school education but also implements vocational knowledge and skill education in accordance with the requirements of vocational positions).
2.2 Procedures
First, the researchers involved in the study were trained uniformly. In the selected secondary schools, group testing was conducted on a class basis. Prior to data collection, students and their parents were invited to attend a parent-teacher conference where the researchers would explain the purpose, method, and significance of this study. Then, the researchers would ask students and their parents about their willingness to participate in the study and inform them that they could voluntarily choose whether to take part in this study or not. After the permission of students and their parents, they signed written informed consent. Secondly, under the supervision and guidance of trained researchers, students filled out self-reported questionnaires on demographics, IA, loneliness, cognitive reappraisal, and NSSI in an organized classroom setting, and students were told that the questionnaire was anonymous. Finally, after students completed the questionnaire, the researchers collected the questionnaire on the spot. The questionnaires took about 20 minutes to complete. No reward or compensation was given. Seventy two of these participants were excluded from the sample because they showed an obvious pattern of response (e.g., selecting “1” for all items). The final valid questionnaires were 1046.
2.3 Measure
2.3.1 Non-suicidal self-injury
NSSI was assessed using the Adolescent Self-Harm Scale, which was developed by Zheng (38) and revised by Feng (39). The scale measures the frequency and severity of 18 kinds of NSSI, such as cutting, burning, stabbing, and rope wound, in the past year. Participants rated how often these items occurred on a 0–3 scale (0 = never, 1 time = 1, 2–4 times = 2, 5 or more times = 3). At the same time, they rated the severity with which these items occurred on a 0–4 scale (0 = none, mild = 1, moderate = 2, severe = 3, extremely severe = 4). The level of NSSI was assessed using the composite score, which was calculated by multiplying the frequency of self-harming incidents with the severity of physical harm. A higher score indicated a more severe level of NSSI. In this study, Cronbach’s α for this scale was 0.754.
2.3.2 Internet addiction
Young’s Internet Addiction Test (ITA) (40) was used to assess adolescent Internet addiction. The scale comprises 20 items using a 5–point Likert scale (1 = rarely; 2 = occasionally; 3 = frequently; 4 = often; 5 = always). The total scores ranges from 20 to 100. Three types of internet user groups were identified based on the original cutoff points proposed by Young, namely “average online users” (20–49 points), “moderate IA” (50–79 points), and “severe IA” (80–100 points). In this study, Cronbach’s α for this scale was 0.982.
2.3.3 Loneliness
The UCLA Loneliness Scale (UCLA Loneliness Scale, University of California at Los Angels) revised by Russell et al. (41) was used to assess adolescents’ loneliness. The scale comprises 20 items using a 4–point Likert scale (1 = never; 2 = rarely; 3 = often; 4 = always). Higher scores indicated higher levels of loneliness. Based on the actual scores, loneliness levels were divided accordingly. Scores below 28 indicated low levels of loneliness, scores ranging from 18 to 33 indicated mild to moderate levels of loneliness, scores between 33 and 39 indicated moderate levels of loneliness, scores from 39 to 44 indicated moderate to high levels of loneliness, and scores above 44 indicated high levels of loneliness. In the present study, Cronbach’s α for this scale was 0.959.
2.3.4 Cognitive reappraisal
Cognitive reappraisal was assessed using the cognitive reappraisal subscale of the Emotional Regulation Questionnaire (28). The scale comprises six items using a 5–point Likert scale (1 = strongly disagree; 5 = strongly agree). Higher scores indicated higher levels of cognitive reappraisal. A Chinese version of the scale (42) was used in the present study, and Cronbach’s α for this scale was 0.943.
2.3.5 Control variables
Previous studies have shown that NSSI in adolescents is significantly correlated with gender and age (3, 43). Hence, we included these variables as control variables in the statistical analysis.
2.4 Data analysis
The data were analyzed using the SPSS 23.0 software and PROCESS macro 3.3 (44).
First, statistical descriptions of demographic data and study variables were presented using M (means) ± SD (standard deviations), rate or component ratio. NSSI scores were performed in univariate analysis in different demographic variables, independent sample t-test or one-way ANOVA and non-parametric test (Kruskal-Wallis H test) were used according to the normal distribution and/or homogeneity of variance of the data. Pearson correlations among variables were calculated. Second, following the two preliminary data analyses, PROCESS Model 4 (44) was used to test the mediation of loneliness. The bias-corrected bootstrapping method based on 5000 samples was used to test the significance of the indirect effect, which was regarded as significant if the 95% confidence interval (CI) did not include zero. Third, the moderated mediation was analyzed using PROCESS Model 7 (44). All continuous variables were normalized, and interaction terms were calculated on the basis of these normalized scores. Finally, a simple slope analysis was used to test whether the mediation effect of loneliness differed at various levels of the moderator variable. In addition, we used the Johnson-Neyman technique to determine in which regions of cognitive reappraisal the effect of IA on loneliness is significant and non-significant.
2.5 Common method bias
This study followed a previous method proposed to regulate the deviation of common methods (such as anonymous method and reverse scoring) to control the testing process (45). The common method bias was tested by Harman’s single-factor test. The results showed that 13 factors had feature roots greater than 1, and the explanation rate of the first common factor was 30.55%, which was less than the critical standard of 40% (46). Hence, no serious common method bias occurred in this study.
3 Results
3.1 Descriptive analysis
The demographic data of 1046 participants were displayed in Tables 1, 2. The participants ranged in age from 12 to 18 years (M = 15.69, SD = 1.594), of whom 57.6% (n = 603) were male. The proportion of students in grades 7–9 was 10.8% (n = 113), 15.7% (n = 164), and 12.8% (n = 134), respectively. The proportion of students in general high schools was 13.9% (n = 145), 9.1% (n = 95), and 7.8% (n = 82), while the proportion of students in vocational high schools was 10.2% (n = 107), 10.3% (n = 108), and 9.4% (n = 98). Of the participants, 49% (n = 513) were single child family, and 79.9% (n = 836) reported that their place of residence was urban, 54.4% (n = 569) of families are nuclear families, 71.7% (n = 750) of the participants self-perceived the family atmosphere as good, and 49.24% of the participants considered their family economic conditions to be average.
Table 1 Demographicl Information of samples (n=1046).
Table 2 Demographicl Information of samples (n=1046).
In terms of the Adolescent Self-Harm Scale, the total score of 1,046 participants was 1.89 ± 7.515. 12.3% of participants (n = 129) reported at least one incidence of NSSI in the previous 12 months.
3.2 Preliminary analyses
Table 3 indicates the descriptive statistics of related variables, including Mean (M), standard deviations (SD), and the bivariate correlation analysis between above variables. After controlling for two general demographic variables, gender and age, the results of correlation analysis showed that IA, loneliness and NSSI were significantly positively correlated with each other (r = 0.290 ∼ 0.476, p < 0. 01), and cognitive reappraisal was negatively correlated with these variables (| r | = 0. 195 ∼ 0. 494, p < 0. 01). The prima facie evidence for the assumed moderated mediation model was offered by the findings of the above correlation analysis.
Table 3 Descriptive statistics and correlation analysis of variables.
3.3 Tests of mediating effect of loneliness
According to Hayes (44), we tested the mediating effect of loneliness on IA and NSSI. The mediating role of loneliness was upheld. After controlling for gender and age, IA positively affected NSSI, c = 0.171, p < 0.001; then, IA and loneliness entered the regression equation at the same time, the result showed that IA positively affected loneliness, a = 0.245, p < 0.001; loneliness positively affected NSSI, B= 0.122, p < 0.001; IA positively affected NSSI, c’ = 0.141, p < 0.001 (see Table 4 for details). Finally, the bias corrected percentile Bootstrap method test showed that loneliness play a significant mediated role between IA and NSSI, ab = 0.030, SE = 0.005, and 95% CI = [0.021, 0.040] (see Table 5 for details). Thus, loneliness partially mediated the relationship between IA and NSSI. The mediation effect accounts for 18% of the total effect. Therefore, Hypotheses 1 and 2 were validated.
Table 4 The moderated-mediating effect of IA on NSSI.
Table 5 The Bootstrapping analysis of the mediating effects.
3.4 Test of moderated mediation model effect
Model 7 of PROCESS macro 3.3 was used to test the moderating effect of cognitive reappraisal. The results are shown in Table 4, IA had a positive predictive effect on loneliness(β = 0.152, p < 0.001), Cognitive reappraisal has a negative predictive effect on loneliness (β = -0.565, p < 0.001). The interaction between Internet addiction and cognitive reappraisal significantly predicted loneliness (β = -0.010, p < 0.001), and the index of the moderated mediation was -0.0012, SE = 0.0003, 95% CI = [-0.0018, -0.0007], suggesting cognitive reappraisal moderated the association between IA and loneliness.
To clarify the essence of the interaction effect between IA and loneliness, we divided cognitive reappraisal into high and low groups in accordance with the average plus or minus an SD and used a simple slope analysis to explore the role of cognitive reappraisal in the relationship between IA and loneliness. The specific moderating effect is shown in Figure 2. When the level of cognitive reappraisal was low, IA had a significant positive predictive effect on loneliness (Bsimple = 0.267, SE = 0. 027, p < 0. 001, 95% CI = [0.214, 0.319]). However, when the level of cognitive reappraisal was high, IA had no significant predictive effect on loneliness (Bsimple = 0.038, SE = 0. 038, p = 0.319, 95% CI = [−0.037, 0.113]). The indirect effect of loneliness on adolescents with low cognitive reappraisal level (M − 1SD) was significant (index = 0.033, Boot SE = 0.005, 95% CI = [0.023, 0.044]), whereas the indirect effect on adolescents with high cognitive reappraisal level (M + 1SD) was in significant (index = 0.005, Boot SE = 0.005, 95% CI = [−0.004, 0.014]), as shown in Table 6. Thus, we concluded that the mediating effect of loneliness decreased significantly with the increasing level of cognitive reappraisal, which plays a buffering role in the indirect effects of IA on NSSI.
Figure 2 Cognitve reappraisal as a moderator on the relationship between internet addiction and loneliness. IA, Internet addiction.
Table 6 Conditional indirect effect of cognitive reappraisal when loneliness mediated between IA and NSSI.
Furthermore, we used the Johnson-Neyman technique to identify the regions in the range of the moderator variable where the effect of the IA on loneliness is statistically significant and not significant (47, 48). The results may help provide more preventive interventions and pointed suggestions. As shown in Figure 3, the positive correlation between IA and loneliness was significant when the cognitive reappraisal value was less than 32, and the association was relatively stronger for adolescents who had lower cognitive reappraisal. However, when the cognitive reappraisal value was higher than 32, the effect of IA on loneliness was not significant.
Figure 3 The conditional effect of IA on Loneliness as linear function of cognitive reappraisal. IA, Internet addiction; CI, 95% confidence interval; LL, low limit; UL, upper limit.
Overall, these results suggested that cognitive reappraisal moderated the relationship between IA and NSSI via loneliness. Hypothesis 3 was supported.
4 Discussion
IA and NSSI are serious public health problems that endanger the physical and mental health of adolescents. In this study, the moderating mediation model was used to reveal the relationship between IA and NSSI and to clarify the underlying predictive mechanism of IA to NSSI. First, it illustrated how IA affects NSSI, including its direct effects and the mediating role of loneliness. Second, it analyzed “how it works further.” In other words, the mediating effect of loneliness was distinguished as being influenced by different levels of cognitive reappraisal.
According to our survey, the detection rate of NSSI among participants was 10.6%, which was lower than the results of previous studies on middle school students (49), but was still within the range of detection rates of 5.4% – 23.2% obtained by domestic studies (50). The variation was probably caused by different researchers’ criteria for defining NSSI and the different measurement tools used in studies. Nevertheless, these findings reminded us that NSSI cannot be ignored among middle school students.
In our study, the results showed a significant positive correlation between IA and NSSI. Specifically, the higher the level of IA, the higher the likelihood of NSSI, which supported Hypothesis 1. These results were consistent with the results of most previous studies (51, 52).
As for the reasons why IA affects NSSI, Liu et al. (18) believed that the deindividuation caused by IA affected adolescents’ normal social function and reduced their emotions such as alertness and fear. They were prone to impulse control disorder, which is characterized by repetitive and uncontrollable actions harmful to oneself or others. This phenomenon leads to impulsive behaviors, such as self-injury. The Internet provides a way for NSSI; with the increasing use of the Internet in our daily lives, more interactive online activities provide adolescents with social networking opportunities that are not restricted by traditional physical boundaries or monitored by adults. Adolescents addicted to the Internet likely obtain information about NSSI through relevant websites and forums, thus promoting the occurrence of NSSI (18). In addition, adolescents with IA tend to show decreased confidence and poor ability to resist pressure in the face of frustration and bad emotions (53). These characteristics provide a prerequisite for adolescents to develop NSSI behaviors (53). Therefore, we should take corresponding measures to protect teenagers against IA. Effective control of adolescents’ Internet use may reduce the risk of NSSI and promote the healthy development of adolescents. For example, exercise intervention, several studies have pointed out that moderate-intensity physical exercise (54) and high-intensity interval exercise (55) can relieve the symptoms of IA. The forms of movement mainly include a single sports form and “sports +” two types. The single sports form mainly includes three types: Group confrontation sports (e.g., football and basketball) (56, 57); Aerobic exercise (e.g., Tai Chi) (58); Leisure sports (e.g., sports games, outward bound training) (59). The intervention form of “sports +” mainly includes the combination of sports and psychological counseling (60).
In addition to the direct effect of IA on NSSI, this study also found that IA can indirectly affect adolescents’ NSSI through loneliness. Some adolescents with IA do not directly exhibit NSSI, but rather a sense of loneliness that is associated with an increased risk of NSSI. Hypothesis 2 was verified. Therefore, the increase in loneliness could be used as a mechanism to explain the relationship between IA and NSSI in adolescents. Adolescents with IA indulge in the virtual world for a long time, which greatly reduces their face-to-face social time with their families or peers. However, most network communications have the characteristics of surface and weak connection strength (61). Weak social bonds online are not enough to replace offline socializing, nor can they provide adequate emotional support, leading to a rising sense of loneliness among them (62). In China, students’ academic performance is highly valued. Students with high academic achievement are often regarded as successful, so they are more likely to be respected by their peers and have a higher status in their peers; by contrast, students with poor academic performance tend to have a certain disadvantage in peer relationships (63) and have a lower social status in their peers (64). Some studies have shown that many students with IA have low academic achievement. In real life, they tend to experience culturally defined failures (65), which makes them likely feel inadequate social support (12) and leads to increased loneliness. Low academic achievement also tends to make them feel inferior (66), which increases the tendency of social avoidance in the real society (67) and the negativity toward social relations (20). Consequently, they hardly achieve satisfaction in normal social interactions, which aggravates their loneliness (20).
According to the two-dimensional four-function model proposed by Nock (16), self-negative reinforcement is the most common function of NSSI, that is, NSSI is the management and regulation of negative emotions (such as loneliness) to obtain emotional relief and balance. Applied to our study, NSSI is a form of management and regulation of negative emotions such as loneliness, wherein loneliness caused by IA can in turn lead to NSSI as a means to reduce emotional pain. In addition, adolescents with a strong sense of loneliness are usually accompanied with low self-esteem and low self-evaluation and are prone to choosing extreme ways to cope with things (such as self-injurious behavior) (68). Therefore, interventions that focus on alleviating loneliness in adolescents may be a potential strategy for preventing NSSI. Peer support is one of the main sources of social support for adolescents. Several studies have shown that friendship quality is strongly associated with loneliness in adolescents (69). Zhou (70) conducted focused group counseling for junior middle school students with the theme of “Friendship Quality”, which improved the quality of friendship among them and alleviated their loneliness. Therefore, schools should not only pay attention to students’ academic achievements, but also pay attention to the cultivation of good peer relationships among classmates. Teachers should establish good teacher-student relationship with teenagers and improve their own teacher justice quality. Teachers’ justice quality includes treating students equally, treating them equally, teaching them according to their aptitude, and rationally distributing the educational resources they have in specific educational activities (71). Research has shown that teacher justice can help students get more teacher support and peer support, which can reduce adolescents’ experience of loneliness and ultimately avoid the occurrence of self-harming behaviors (72). Family is a place for teenagers to relax and relax. Parents could improve co-parenting awareness and skills to reduce parental conflict, thereby reducing loneliness and depression symptoms, and preventing NSSI in adolescents (73).
This study confirmed that cognitive reappraisal moderated the indirect role of loneliness in the association of IA and NSSI. Its regulatory effect occurred in the first half of the mediation pathway.
Specifically, at a low cognitive reappraisal level (cognitive reappraisal value was less than 32), the positive effect of IA on loneliness was enhanced; at a high cognitive reappraisal level, IA and loneliness were uncorrelated. In other words, a higher level of cognitive reappraisal could serve as a protective factor for NSSI, buffering the effect of IA on NSSI through loneliness. This finding is consistent with that of previous research (33), which showed that in the context of emotional stimuli, adolescents with low cognitive reappraisal ability were likely to experience negative emotions and were inclined to relieving these negative emotions through self-injury.
Gross on the basis of the emotional regulation process model, proposed that cognitive reappraisal is a process in which individuals reduce their emotional responses by changing their understanding of emotional events. The study has shown that adolescents with high cognitive reappraisal have good interpersonal functioning and social adjustment (28).
They can review the relationship between the Internet and social satisfaction and then change their cognition that online virtual socialization is the main social way to meet their social needs, properly use Internet tools to maintain and expand social relations in reality, diversify their social avenues, take the initiative to increase opportunities for face-to-face communication and interaction, and gain genuine emotional support. In this way, the alienation of interpersonal relationship caused by IA and the loneliness caused by the reduction in social reality can be alleviated.
Fritz (74) argued that the frequent use of cognitive reappraisal strategies can help people not only identify the positive aspects of stressors but also show other forms of positive thinking. Long-term addiction to the Internet has a great impact on teenagers’ studies, who tend to have low academic achievement. On the contrary, adolescents who are good at applying cognitive reappraisal as an emotion regulation strategy may reinterpret low academic achievement (possible emotional stimulation situations) and improve their self-awareness in interpersonal communication (75). Instead of associating low academic achievement with low social status among peers and low self-esteem, they may take the initiative to increase communication with peers and seek possible social support systems. This approach helps them gain positive feedback and a sense of belonging, which reduces their loneliness, ultimately reducing the probability of NSSI occurring. Therefore, improving cognitive reappraisal skills in adolescents may be particularly useful for the treatment of NSSI (34). For example, Bentley et al. (76) found that a cognitive reappraisal intervention effectively reduced the urges and acts of NSSI.
5 Limitations
This study exhibits several limitations. First, the conclusions of this research were based on the analysis of data, and the collection of data was based on self-report. Therefore, the results might be limited by social desirability and recall bias. In the future, the impact of IA on NSSI could be further explored by integrating various data collection approaches. Second, this research adopted a cross-sectional research design. The tracking research method could be applied in the future to reveal the relationship between variables in depth. In addition, this research found that loneliness played a partial mediating role in the relationship between IA and NSSI. There may be other mediating variables in the relationship between the two, so the comprehensive influence of multiple mediating variables could be considered in the future. Third, in this study, only “gender and age” were used as control variables, and other potential confounders such as school nature, socioeconomic status, and family dynamics were not considered. In future studies, we will combine existing literature and research results, and fully consider potential confounding factors that may exist to strengthen the validity of the study. Lastly, the participants in this study were from Yangzhou, China; whether our findings could be generalized to adolescents from other regions of China or other cultures needs to be tested in the future.
6 Conclusion
This research identified a significant moderated mediation model through cross-sectional design that explained the effect of IA on NSSI in adolescents. Our findings suggest that IA is associated with an increased risk for adolescents’ NSSI. Schools, families and society should pay more attention to the rational use of the Internet for adolescents. Secondly, this study found that loneliness is an important “bridge” linking IA to NSSI. Therefore, interventions that focus on alleviating loneliness in adolescents may be a potential strategy for preventing NSSI. Finally, the tests of our moderated mediation model contribute to the literature by providing evidence in support of the emotional regulation process model and the cognitive emotional model of NSSI. We found that cognitive reappraisal, as an individual difference, could explain the heterogeneity of the relationship between IA and NSS in adolescents. Thus, improving adolescents’ skills in cognitive reappraisal may be particularly useful in the treatment of NSSI (34). This model provides new information on the relationship between IA and NSSI in adolescents and offers potential ways to prevent the harmful consequences of IA on adolescents.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by Affiliated WuTaiShan Hospital of Medical College of Yangzhou University before the survey (Reference number: WTSLL20222009). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.
Author contributions
NL: Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization. HL: Writing – review & editing, Supervision, Project administration. LW: Writing – review & editing, Supervision, Investigation, Data curation. JY: Writing – review & editing, Supervision, Investigation, Data curation. AP: Writing – review & editing, Project administration, Investigation, Data curation.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Acknowledgments
We would like to thank all of the school partners, many nursing peers who participated in this research for providing valuable time and contributions to this research and adolescents who participated in our study.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Hasking P, Whitlock J, Voon D, Rose A. A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure. Cognit Emot. (2017) 31:1543–56. doi: 10.1080/02699931.2016.1241219
2. He H, Yue F, Hu M, Tang J, Luo R, Ren Q, et al. Foreign research status of nonsuicidal self-injury based on CiteSpace visualization analysis. Modern Prev Med. (2020) 47:3660–4.
3. Ma Y, Chen Y, Zhang M, Guo H, Yi Y, Tang J. Association of nonsuicidal self-injury with Internet addictive behavior among adolescents. Chin J School Health. (2019) 40:972–6. doi: 10.16835/j.cnki.1000-9817.2019.07.004
4. Han A, Xu G, Su P. A meta-analysis of characteristics of nonsuicidal self-injury among middle school students in mainland China. Chin J School Health. (2017) 38:1665–70. doi: 10.16835/j.cnki.1000-9817.2017.11.019
5. Mars B, Heron J, Crane C, Hawton K, Lewis G, Macleod J, et al. Clinical and social outcomes of adolescent self harm: population based birth cohort study. BMJ. (2014) 349:g5954. doi: 10.1136/bmj.g5954
6. Tsitsika A, Janikian M, Schoenmakers TM, Tzavela EC, Olafsson K, Wójcik S, et al. Internet addictive behavior in adolescence: a cross-sectional study in seven European countries. Cyberpsychology Behav Soc networking. (2014) 17:528–35. doi: 10.1089/cyber.2013.0382
7. Shi Z, Xie T. Effect of problematic internet use on suicidal ideation among junior middle school students: A moderated mediation model. psychol Dev Education. (2019) 8.35:581–8. doi: 10.16187/j.cnki.issn1001-4918.2019.05.09
8. Ryding FC, Kaye LK. Internet addiction”: A conceptual minefield. Int J Ment Health addiction. (2018) 16:225–32. doi: 10.1007/s11469-017-9811-6
9. Reed GM, First MB, Billieux J, Cloitre M, Briken P, Achab S, et al. Emerging experience with selected new categories in the ICD -11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry. (2022) . 21:189–213. doi: 10.1002/wps.20960
10. Fineberg N, Demetrovics Z, Stein D, Ioannidis K, Potenza M, Grünblatt E, et al. Manifesto for a European research network into Problematic Usage of the Internet. Eur Neuropsychopharmacol. (2018) 28:1232–46. doi: 10.1016/j.euroneuro.2018.08.004
11. World Health Organization. International statistical classification of diseases and related health problems (2019). Available online at: https://icd.who.int.
12. Mészáros G, Győri D, Horváth LO, Szentiványi D, Balázs J. Nonsuicidal self-injury: its associations with pathological internet use and psychopathology among adolescents. Front Psychiatry. (2020) 11:814. doi: 10.3389/fpsyt.2020.00814
13. Mendez I, Sintes A, Pascual JC, Puntí A, Lara L, Briones-Buixassa S, et al. Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents. J Affect Disord. (2022) 302:204–13. doi: 10.1016/j.jad.2022.01.065
14. Kaess M, Durkee T, Brunner R, Carli V, Parzer P, Wasserman C, et al. Pathological Internet use among European adolescents: psychopathology and self-destructive behaviors. Eur Child Adolesc Psychiatry. (2014) 23:1093–102. doi: 10.1007/s00787-014-0562-7
15. Chwaszcz J, Lelonek-Kuleta B, Wiechetek M, Niewiadomska I, Palacz-Chrisidis A. Personality traits, strategies for coping with stress and the level of internet addiction-A study of polish secondary-school students. Int J Environ Res Public Health. (2018) 15:987. doi: 10.3390/ijerph15050987
16. Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Curr Dir psychol Sci. (2009) 18:78–83. doi: 10.1111/j.1467-8721.2009.01613.x
17. Pan PY, Yeh CB. Internet addiction among adolescents may predict self-harm/suicidal behavior: A prospective study. J Pediatr. (2018) 197:262–7. doi: 10.1016/j.jpeds.2018.01.046
18. Liu HC, Liu SI, Tjung JJ, Sun FJ, Huang HC, Fang CK. Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents. J Formosan Med Assoc. (2017) 116:153–60. doi: 10.1016/j.jfma.2016.03.01014变18
19. Nilsson B, Lindström UA, Nåden D. Is loneliness a psychological dysfunction? A literary study of the phenomenon of loneliness. Scandinavian J caring Sci. (2006) 20:93–101. doi: 10.1111/j.1471-6712.2006.00386.x
20. Usta E, Korkmaz Ö, Kurt I. Examination of individuals’ virtual loneliness states in Internet addiction and virtual environments in terms of interpersonal trust levels. Comput Hum Behav. (2014) 36:214–24. doi: 10.1016/j.chb.2014.03.072
21. Yao MZ, Zhong Z. Loneliness, social contacts and Internet addiction: A cross-lagged panel study. Comput Hum Behav. (2014) 30:164–70. doi: 10.1016/j.chb.2013.08.007
22. Zheng T, Shao YJ, Chen Y, Ai D, Ma SY, Yao YS. Study on relationship between internet addiction disorder and loneliness among students. Chin J Soc Med. (2021) 38:285–8. doi: 10.3969/j.issn.1673-5625.2021.03.013
23. Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W, et al. A social technology that reduces social involvement and psychological well-being? Am Psychol. (1998) 53:1017–31. doi: 10.1037//0003-066X.53.9.1017
24. Wang J. The freedom and loneliness of individuals in the Internet era:The perspective of the social theory. Tianjin Soc Sci. (2013) 5:74–9. doi: 10.16240/j.cnki.1002-3976.2013.05.015
25. Heinrich LM, Gullone E. The clinical significance of loneliness: a literature review. Clin Psychol Rev. (2006) 26:695–718. doi: 10.1016/j.cpr.2006.04.002
26. Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behav Res Ther. (2006) 44:371–94. doi: 10.1016/j.brat.2005.03.005
27. Wen YJ, Xu YF, Qiao D, Liu ZF. An explanatory model and intervention study of psychosocial factors in adolescents’ non-suicidal self-injury behavior. J Int Psychiatry. (2020) 47:885–8. doi: 10.13479/j.cnki.jip.2020.05.010
28. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. (2003) 85:348–62. doi: 10.1037/0022-3514.85.2.348
29. Andrews T, Martin G, Hasking P, Page A. Predictors of continuation and cessation of non-suicidal self-injury. J Adolesc Health. (2013) 53:40e46. doi: 10.1016/j.jadohealth.2013.01.009
30. Wang H, Zhang S. The relationship between social trauma and depression in college students: mediated moderating effect. J Heilongjiang Vocational Institute Ecol Eng. (2023) 36:125–30. doi: 10.3969/j.issn.1674-6341.2023.03.22
31. Wang Y, Chen H, Yuan Y. Effect of social exclusion on adolescents’ Self-injury: the mediation effect of shame and the moderating effect of cognitive reappraisal. J psychol Sci. (2020) 43:333–9. doi: 10.16719/j.cnki.1671-6981.20200211
32. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev. (2010) 30:217–37. doi: 10.1016/j.cpr.2009.11.004
33. Gu H, Yao Y, He F, Cheng Y. Harsh parenting and adolescent nonsuicidal self-injury: A moderated mediation model of alienation and cognitive reappraisal. Child Abuse Negl. (2023) 141:106188. doi: 10.1016/j.chiabu.2023.106188
34. Voon D, Hasking P, Martin G. Change in emotion regulation strategy use and its impact on adolescent nonsuicidal self-injury: a three-year longitudinal analysis using latent growth modeling. J Abnormal Psychol. (2014) 123:487–98. doi: 10.1037/a0037024
35. Wang Z, Guo D. Review of gross’s research on emotion regulation process and strategy. Adv psychol Sci. (2003) 06):629–34. doi: 10.3969/j.issn.1671-3710.2003.06.005
36. Nicol A, Kavanagh PS, Murray K, Mak AS. Emotion regulation as a mediator between early maladaptive schemas and non-suicidal self-injury in youth. J Behav Cogn Ther. (2022) 32:161–70. doi: 10.1016/j.jbct.2022.05.001
37. Gu H, Ding Z, Xia T, Wang L. Self-criticism and adolescent nonsuicidal self-injury: moderated mediation effect. psychol Dev Educ. (2022) 38:418–26. doi: 10.16187/j.cnki.issn1001-4918.2022.03.13
38. Zheng Y. Epidemiologic Investigation of Self-Mutilation Behavior among Adolescen in Wuhan and Its Functional Model. Wuhan, Hubei, China: Central China Normal University (2006). doi: 10.7666/d.y875431
39. Feng Y. The Relation of Adolecents’ Self-Harm Behaviors, Individual Emotion Characteristics and Family Environment Factors. Wuhan, Hubei, China: Central China Normal University (2008). doi: 10.7666/d.y1289102
40. Lu Q, Wu O, Zhao Z, Guo F. Validation study of young’s Chinese version of internet addiction scale. Injury Med (Electronic Edition). (2019) 8:17–23. doi: 10.3868/j.issn.2095-1566.2019.01.004
41. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. (1980) 39:472–80. doi: 10.1037//0022-3514.39.3.472
42. Wang L, Liu H, Li Z, Du W. Reliability and validity of emotion regulation questionnaire Chinese revised version. China J Health Psychol. (2007) 15:503–5. doi: 10.13342/j.cnki.cjhp.2007.06.012
43. Jin M, Wang X, Wang R, Cheng S, Yang S, Zhang S, et al. A systematic review and meta-analysis of factors related to nonsuicidal self-injury among Chinese adolescents. Psychiatry Res. (2023) 326:115329. doi: 10.1016/j.psychres.2023.115329
44. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guliford Press: New York, NY (2013) p. 335–7. doi: 10.1111/jedm.12050
45. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. (2003) 88:879–903. doi: 10.1037/0021-9010.88.5.879
46. Bolin JH. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. J Educ Measurement. (2014) 51:335–7. doi: 10.1111/jedm.12050
47. Preacher KJ, Rucker DD, Hayes AF. Addressing moderated mediation hypotheses: theory, methods, and prescriptions. Multivariate Behav Res. (2007) 42:185–227. doi: 10.1080/00273170701341316
48. Li J, Zhang J, Yang Z. Associations between a leader's work passion and an employee's work passion: A moderated mediation model. Front Psychol. (2017) 8:1447. doi: 10.3389/fpsyg.2017.01447
49. Tao M, Fen L, Guo F, Hai F, Yang S. Meta-analysis on the detection rate and influencing factors of nonsuicide self-injury among adolescents in China. J Guangxi Med Univ. (2023) 40:1627–34. doi: 10.16190/j.cnki.45-1211/r.2023.10.005
50. Tang H, Fu Y, Chen X, Hu W, Huang P. Research progress on the relationship between bullying victimization and nonsuicidal self-injury in adolescents. Chin J Dis Control Prev. (2018) 22:89–93. doi: 10.16462/j.cnki.zhjbkz.2018.01.020
51. Jolin E, Weller R. Problematic internet use and suicidal behavior in adolescents: A review. Ann Clin Psychiatry Off J Am Acad Clin Psychiatrists. (2023) 35:272–9. doi: 10.12788/acp.0119
52. Liu S, Lin MP, Lee YT, Wu JY, Hu WH, You J. Internet addiction and nonsuicidal self-injury in adolescence: Associations with offline and online social support. J Clin Psychol. (2022) 78:971–82. doi: 10.1002/jclp.23264
53. Li H, Wang J, Wang L. A survey on the generalized problematic internet use in Chinese college students and its relations to stressful life events and coping style. Int J Of Psychol. (2008) 43:683–4. doi: 10.1007/s11469-008-9162-4
54. Fan H, Qi S, Huang G, Xu Z. Effect of acute aerobic exercise on inhibitory control of college students with smartphone addiction. Evid Based Complement Alternat Med. (2021) 2021:5530126. doi: 10.1155/2021/5530126
55. Li L, Chen Y, Hu Y, Cui B, Jia F. The effects of high-intensity interval training and diet intervention on Internet addiction among obese female college students. Chin J School Health. (2015) 36:1466–8. doi: 10.16835/j.cnki.1000-9817.2015.10.011
56. Fu Y, Liu Y. The situation of Internet addiction among Korean college students and the effect of intervention in football training. Chin J School Health. (2016) 37:1890–2. doi: 10.16835/j.cnki.1000-9817.2016.12.041
57. Li L, Chen Y, Min Li, Jia F. Effect of basketball exercise prescription intervention on middle school students with Internet addiction. Chin J School Health. (2011) 32:551–2. doi: 10.16835/j.cnki.1000-9817.2011.05.017
58. Yang C, Zeng G. Effect of Tai Chi exercise on Internet addiction among college students. Chin J School Health. (2017) 38:292–4. doi: 10.16835/j.cnki.1000-9817.2017.02.041
59. Liu D, Li Z. Advances in research on exercise interventions for internet addiction. Hubei Sports Science. (2024) 43:93–98+114. doi: 10.3969/j.issn.1003-983X.2024.01.016
60. Zhao Y, Hao Y, Jin X. Smartphone addiction intervention through sports combining with group psychological training among college students. Chin J School Health. (2021) 42:556–559+564. doi: 10.16835/j.cnki.1000-9817.2021.04.018
61. Green MC, Hilken J, Friedman H, Grossman K, Gasiewski J, Adler R, et al. Communication via instant messenger: Short- and long-term effects. J Appl Soc Psychol. (2005) 35:445–62. doi: 10.1111/j.1559-1816.2005.tb02130.x
62. Xu Q, Fu Z. Alone together−The impact of social media use on loneliness. J Huazhong Univ Sci Technology(Social Sci Edition). (2023) 37:119–29. doi: 10.19648/j.cnki.jhustss1980.2023.02.12
63. Xin G, Zhang L, Chang R, Zhang Y. Bullying victimization trajectories in early adolescence: the predictive role of depression, self-esteem and academic achievement. psychol Dev Educ. (2023) 39:568–79. doi: 10.16187/j.cnki.issn1001-4918.2023.04.13
64. Zhang X, Pomerantz EM, Qin L, Logis H, Ryan AM, Wang M. Characteristics of likability, perceived popularity, and admiration in the early adolescent peer system in the United States and China. Dev Psychol. (2018) 54:1568–81. doi: 10.1037/dev0000544
65. Yee N. Motivations for play in online games. Cyberpsychology Behav impact Internet multimedia virtual reality Behav Soc. (2006) 9:772–5. doi: 10.1089/cpb.2006.9.772
66. Zhu Q. A comparative study on academic performance and social development of students in mainland Tibetan class and Lhasa Middle School. Nanjing, Jiangsu, China: Nanjing Normal University (2019). doi: 10.27245/d.cnki.gnjsu.2019.001470
67. Pan JX, Zhao BH, Guo JQ. The influence of inferiority on smartphone addiction in college students: the mediating role of social avoidance and distress. J Huaibei Normal University(Philosophy Soc Sci. (2023) 44:111–5. doi: 10.3969/j.issn.2096-8256.2023.01.017
68. Huang SN, Zhang Y, Kong J, Zhang WJ, Hu WS, Wang X. Analysis of non-suicidal self-injury behavior in adolescents with mental disorders and its influencing factors. South China J Prev Med. (2021) 47:1564–7. doi: 10.12183/j.scjpm.2021.1564
69. Wu L, Wang N, Qi X. A meta-analysis of relationship between friendship quality and loneliness. Chin Ment Health Journa. (2015) 29:372–7. doi: 10.3969/j.issn.1000-6729.2015.05.013
70. Zhou W. Design and implementation of focused resolution group counseling to improve the quality of friendship and loneliness of second year students. Jianghan University Hubei China. (2024) 03:1–62. doi: 10.27800/d.cnki.gjhdx.2023.000501
71. Lv C. Theoretical connotation, value implication and practical rationale of teacher justice. Educ Teach Res. (2022) 36:54–66. doi: 10.13627/j.cnki.cdjy.2022.09.006
72. Zhang Y, Chen J, Ren P, Wang Q. The relationship between bullying victimization and non–suicidual self injury: the mediating role of loneliness and the moderating role of teacher justice. psychol Dev Educ. (2024) 40:877–85. doi: 10.16187/j.cnki.issn1001-4918.2024.06.12
73. Wang J, Guo F, Chen Z. Mediating effects of adolescent loneliness and depressive symptoms on interparental conflict and adolescent non-suicidal self-injury. China Prev Med J. (2023) 35:1029–32. doi: 10.19485/j.cnki.issn2096-5087.2023.12.004
74. Fritz HL. Why are humor styles associated with well-being, and does social competence matter? Examining relations to psychological and physical wellbeing, reappraisal, and social support. Pers Individ Dif. (2020) 154:109641. doi: 10.1016/j.paid.2019.109641
75. Schwerdtfeger AR, Heene S, Messner EM. Interoceptive awareness and perceived control moderate the relationship between cognitive reappraisal, self-esteem, and cardiac activity in daily life. Int J Psychophysiol Off J Int Organ Psychophysiol. (2019) 141:84–92. doi: 10.1016/j.ijpsycho.2019.04.003
Keywords: IA: internet addiction, NSSI: non-suicidal self-injury, loneliness, cognitive reappraisal, adolescent
Citation: Liu N, Li H, Wang L, Yin J and Peng A (2024) Relationship between adolescent internet addiction and adolescent non-suicidal self-injury: a moderated mediation model. Front. Psychiatry 15:1413167. doi: 10.3389/fpsyt.2024.1413167
Received: 06 April 2024; Accepted: 05 July 2024;
Published: 23 July 2024.
Edited by:
Padmavati Ramachandran, Schizophrenia Research Foundation, IndiaReviewed by:
Li Chen, Wenzhou University, ChinaVíctor José Villanueva-Blasco, Valencian International University, Spain
Shruti Rao, Schizophrenia Research Foundation, India
Copyright © 2024 Liu, Li, Wang, Yin and Peng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Lin Wang, 1421164395@qq.com; Jiemei Yin, 349735344@qq.com
†These authors share first authorship