The associations between perceived expressed emotion, digital game addiction, internet addiction, and anxiety disorders in adolescents

Anxiety disorders are among the most prevalent psychiatric conditions during adolescence and are frequently associated with functional impairment and psychiatric comorbidity [1]. Increasing evidence has also highlighted potential associations between anxiety disorders, internet addiction, and digital game addiction [2,3]. However, the role of perceived expressed emotion, reflecting adolescents’ perceptions of the family emotional climate and parent–child relationship, remains insufficiently understood in this context [4]. Previous studies have suggested that inadequate parent–child communication and elevated parental criticism may contribute to problematic internet use [5]. The present study aimed to examine the relationships between perceived expressed emotion, internet addiction, digital game addiction, irritability, and anxiety disorders in adolescents. In addition, maternal depression, anxiety, and stress symptoms were evaluated as factors potentially associated with perceived expressed emotion. This cross-sectional study included 77 adolescents aged 12–17 years, comprising 45 adolescents diagnosed with anxiety disorders and 32 healthy controls. Psychiatric diagnoses were established using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version administered by a child and adolescent psychiatrist. Drug-naive adolescents without psychiatric comorbidity were included in the anxiety disorder group. Participants completed the Revised Child Anxiety and Depression Scale–Child Version, the Shortened Level of Expressed Emotion Scale, the Affective Reactivity Index Self-Report, the Digital Game Addiction Scale, and the Internet Addiction Scale. Mothers completed the Depression Anxiety and Stress Scale-21. Confirmatory factor analysis demonstrated acceptable-to-good model fit for all scales (comparative fit index = 0.91–0.97; root mean square error of approximation = 0.05–0.08). Group comparisons, Pearson correlation analyses, and hierarchical regression analyses were conducted. The anxiety disorder group demonstrated significantly higher anxiety symptom levels (t = −7.475, p < 0.001), irritability scores (t = −3.426, p = 0.001), and maternal depression, anxiety, and stress scores (all p ≤ 0.008) compared with controls. However, no significant group differences were observed regarding internet addiction (p = 0.583), digital game addiction (p = 0.568), or perceived expressed emotion scores. Correlation analyses across the total sample revealed that internet addiction scores were positively correlated with total anxiety symptoms (r = 0.307, p = 0.007), perceived expressed emotion (r = 0.369, p = 0.001), irritability (r = 0.305, p = 0.008), and digital game addiction (r = 0.748, p < 0.001). Perceived expressed emotion scores were also positively correlated with maternal depression (r = 0.248, p = 0.043) and stress levels (r = 0.247, p = 0.045). Hierarchical regression analysis demonstrated that perceived expressed emotion (β = 0.195, p = 0.006) and digital game addiction (β = 1.795, p < 0.001) were independently associated with internet addiction after controlling for gender, anxiety disorder diagnosis, and irritability. The final model explained 67.3% of the variance in internet addiction scores. The findings suggest that perceived family emotional climate and digital gaming behaviours may contribute to internet addiction independently of anxiety disorder diagnosis. These results highlight the importance of evaluating adolescents’ perceptions of the parent–child relationship in the assessment and management of problematic internet use. Longitudinal studies are needed to clarify developmental pathways and causal mechanisms underlying these associations.

References

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