A network analysis of depressive symptoms, problematic internet use, and social support in relation to suicidal behaviors among Chinese adolescents

Depressive symptoms, problematic internet use (PIU), and suicidal behaviors are common, severe, and interrelated mental health challenges among adolescents, while social support has been reported as a protective factor. However, few studies have examined their symptom-level interactions or identified which symptoms are most directly linked to suicidal behaviors. This study aimed to construct a symptom-level network of depressive symptoms, PIU, and social support, and to identify key symptoms associated with suicidal behaviors in Chinese adolescents. Data were drawn from 85,386 Chinese adolescents (mean age 14.95 years) who completed assessments of depressive symptoms, PIU, social support, and suicidal behaviors (i.e., suicidal ideation and suicide attempts). The ggmModSelect algorithm was used to establish the network structure and identify central and bridge symptoms, and flow networks were used to identify symptoms most directly associated with suicidal behaviors. The prevalence of suicidal ideation and suicide attempts was 17.9% and 5.3%, respectively. Social support was negatively associated with depressive symptoms and PIU. In the network, “depressive affect” and “withdrawal and social problems” were the most central symptoms, while “reality substitute” and “time management and performance” emerged as key bridge symptoms. “Depressive affect” and “interpersonal problems” were most strongly linked to suicidal ideation and suicide attempts, and “objective support” showed direct negative associations. The identified central and bridge symptoms can be prioritized to disrupt the network underlying suicidal behaviors. Targeting these symptoms, together with enhancing social support, may effectively prevent adolescent suicidal behaviors and reduce co-occurring psychological problems. • Depressive affect emerged as the key central and reality as the key bridge symptom. • Social support was negatively associated with depressive symptoms and PIU. • Depressive affect and objective support are directly linked to suicidal behaviors. • Positive affect was linked to suicide attempts among those with suicidal ideation. • Females exhibited higher overall network connectivity compared with males.