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Adolescent Internet Use, Social Integration, and Depressive Symptoms

Analysis from a Longitudinal Cohort Survey

Strong, Carol, PhD*; Lee, Chih-Ting, MD; Chao, Lo-Hsin, MSc*; Lin, Chung-Ying, PhD; Tsai, Meng-Che, MD, MSc§

Journal of Developmental & Behavioral Pediatrics: May 2018 - Volume 39 - Issue 4 - p 318–324
doi: 10.1097/DBP.0000000000000553
Original Articles
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Objective: To examine the association between adolescent leisure-time Internet use and social integration in the school context and how this association affects later depressive symptoms among adolescents in Taiwan, using a large nationwide cohort study and the latent growth model (LGM) method.

Methods: Data of 3795 students followed from the year 2001 to 2006 in the Taiwan Education Panel Survey were analyzed. Leisure-time Internet use was defined by the hours per week spent on (1) online chatting and (2) online games. School social integration and depressive symptoms were self-reported. We first used an unconditional LGM to estimate the baseline (intercept) and growth (slope) of Internet use. Next, another LGM conditioned with school social integration and depression was conducted.

Results: Approximately 10% of the participants reported engaging in online chatting and/or gaming for more than 20 hours per week. Internet use for online chatting showed an increase over time. School social integration was associated with the baseline amount (coefficient = −0.62, p < 0.001) but not the growth of leisure-time Internet use. The trend of Internet use was positively related to depressive symptoms (coefficient = 0.31, p < 0.05) at Wave 4.

Conclusion: School social integration was initially associated with decreased leisure-time Internet use among adolescents. The growth of Internet use with time was not explainable by school social integration but had adverse impacts on depression. Reinforcing adolescents' bonding to school may prevent initial leisure-time Internet use. When advising on adolescent Internet use, health care providers should consider their patients' social networks and mental well-being.

Departments of *Public Health,

Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;

Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong;

§Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Address for reprints: Meng-Che Tsai, MD, MSc, Department of Pediatrics, National Cheng-Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, 704 Taiwan; e-mail:

This study was funded partly by the Medical Science and Technology Research Grant awarded to C. T. Lee from the National Cheng Kung University Hospital (NCKUH-10408025) and partly by the research grant awarded to C. Strong from the Taiwan Ministry of Science and Technology (MOST 103-2410-H-006-001).

Disclosure: The authors declare no conflict of interest.

C. Strong and C. T. Lee contributed equally to this work.

M. C. Tsai and C. Strong conceived and supervised the entire study. L. H. Chao and C. Y. Lin were responsible for data analysis. C. T. Lee and C. Strong drafted the manuscript. All the authors have seen and approved the submission of this version of the manuscript and take full responsibility of the manuscript.

See the Video Abstract at

Received July 13, 2017

Accepted December 20, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.