Both excessive leisure screen time and internet gaming disorder are independently associated with mental health disorders in adolescents, with IGD showing substantially stronger associations, and adolescents with both conditions demonstrating the highest odds of poor mental health.
Key Findings
Results
The prevalence of excessive LST, IGD, and any mental health disorder was high among Chinese adolescents.
Excessive LST prevalence: 48.2% (6378/13,240; 95% CI 47.3%-49.0%)
IGD prevalence: 1.4% (188/13,240; 95% CI 1.2%-1.6%)
Any mental health disorder prevalence: 55.8% (7387/13,240; 95% CI 54.9%-56.7%)
Sample comprised 13,240 adolescents (50.3% girls) with a mean age of 15.4 (SD 1.6) years recruited from 20 public schools in Sichuan Province, China via random cluster sampling
Results
Excessive leisure screen time was independently associated with poor overall mental health after adjustment.
Adjusted OR for excessive LST and poor mental health: 1.18 (95% CI 1.09-1.27)
A statistically significant dose-response relationship existed across LST quartiles (Ptrend<.001)
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)
Excessive LST was significantly associated with depression (OR 1.16, 95% CI 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), but not significantly with psychological distress or insomnia
Results
Internet gaming disorder was independently associated with poor overall mental health and all five specific mental health disorders.
Adjusted OR for IGD and poor mental health: 6.58 (95% CI 5.02-8.62)
IGD was most strongly associated with depression (OR 6.43, 95% CI 4.56-9.06) and paranoia (OR 5.77, 95% CI 4.05-8.21)
IGD was also associated with psychological distress (OR 4.40, 95% CI 3.12-6.19), suicidal ideation (OR 3.85, 95% CI 2.76-5.37), and insomnia (OR 2.90, 95% CI 2.09-4.05)
IGD was assessed using the Internet Gaming Disorder Scale-9 Item Short Form (IGDS9-SF)
Results
IGD consistently demonstrated substantially stronger associations with all mental health outcomes compared to excessive LST.
For depression: IGD OR 6.43 (95% CI 4.56-9.06) vs. excessive LST OR 1.16 (95% CI 1.05-1.29)
For paranoia: IGD OR 5.77 (95% CI 4.05-8.21) vs. excessive LST OR 1.22 (95% CI 1.11-1.34)
For psychological distress: IGD OR 4.40 (95% CI 3.12-6.19) vs. excessive LST OR 1.14 (95% CI 0.98-1.33)
For suicidal ideation: IGD OR 3.85 (95% CI 2.76-5.37) vs. excessive LST OR 1.15 (95% CI 1.04-1.28)
For insomnia: IGD OR 2.90 (95% CI 2.09-4.05) vs. excessive LST OR 1.12 (95% CI 1.02-1.22)
Results
Adolescents with both excessive LST and IGD demonstrated the highest odds of mental health disorders, though no significant interaction was found.
Combined excessive LST and IGD was associated with an OR of 7.35 (95% CI 5.29-10.22) for any mental health disorder
No significant interaction was found on either additive or multiplicative scales
The joint association suggests co-occurrence of both risk factors compounds mental health risk beyond either factor alone
Methods
The study design involved a large-scale school-based cross-sectional survey using validated instruments for all outcomes.
13,240 adolescents recruited from 20 public schools in Sichuan Province, China by random cluster sampling
LST was self-reported; 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 conditions: psychological distress, depression, paranoia, insomnia, and suicidal ideation, all assessed using validated scales
Mean participant age was 15.4 (SD 1.6) years; 50.3% were girls
Deng Q, Sha L, Hou J, Zhao X, Xiang R, Zhu J, et al.. (2026). Leisure Screen Time, Internet Gaming Disorder, and Mental Health Among Chinese Adolescents: Large-Scale Cross-Sectional Study.. Journal of medical Internet research. https://doi.org/10.2196/80737