title: The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents.
abstract: OBJECTIVE
  This study used a sample of Korean adolescents to evaluate: (a) associations between problematic internet use and depression, bipolar disorder symptoms and suicidal ideation; and (b) whether mood disorders mediate the relationship between problematic internet use and suicidal ideation.
  
  
  METHODS
  A total of 795 middle and high school students were recruited (538 girls; mean age, 13.87 ± 1.51 years). The Internet Addiction Proneness Scale for Youth-Short Form (KS-scale) was used to evaluate the presence and severity of problematic internet use. The frequencies of depression, suicidal ideation and probable bipolar disorder were compared between adolescents with and without internet addiction. The associations between the severity of problematic internet use and the severity of depressive symptoms, bipolar symptoms and suicidal ideation were also analyzed.
  
  
  RESULTS
  Seventy-five adolescents (9.4%) met the criteria for problematic internet use. The presence of problematic internet use was significantly associated with suicidal ideation (OR = 5.82, 95% CI = 3.30-10.26, p < 0.001) as well as depression (OR = 5.00, 95% CI = 2.88-8.66, p < 0.001). There was a marginally significant association between problematic internet use and probable bipolar disorder (OR = 3.05, 95% CI = 0.96-9.69, p = 0.059). In the path model, problematic internet use significantly predicted depressive symptoms (β = 0.296, 95% CI = 0.214-0.367, p = 0.005), which predicted suicidal ideation (β = 0.699, 95% CI = 0.631-0.751, p = 0.009). Problematic internet use also predicted suicidal ideation directly (β = 0.115, 95% CI = 0.052-0.193, p = 0.006). Conversely, depressive symptoms (β = 0.119, 95% CI = -0.005-0.219, p = 0.040) and suicidal ideation (β = 0.215, 95% CI = 0.089-0.346, p = 0.005) predicted problematic internet use.
  
  
  CONCLUSIONS
  There is a complex transactional relationship between problematic internet use, depressive symptoms, bipolar symptoms and suicidal ideation, so these conditions must be assessed together during the evaluation of adolescents. Prospective studies are warranted to elucidate the causal relationships between problematic internet use, mood symptoms and suicidal ideation.
authors.affiliation: 1Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Subin
authors.initials: S
authors.lastname: Park
authors.forename: Kang-E M
authors.initials: KE
authors.lastname: Hong
authors.forename: Eun J
authors.initials: EJ
authors.lastname: Park
authors.forename: Kyoo S
authors.initials: KS
authors.lastname: Ha
authors.forename: Hee J
authors.initials: HJ
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D016739:Behavior, Addictive / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D002648:Child; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D012720:Severity of Illness Index; D059020:Suicidal Ideation