JMIR MENTAL HEALTH Han et al

Review

Factors Associated With Digital Addiction: Umbrella Review

Yun Han1*, PhD; Jiamin Qiu2*, BBA; Chengbin Shi2, BBA; Shiqi Huang2, BSc; Haokun Huang2, BSc; Xinman
Wang3, UG; Sui Zhu2, MD; Da-lin Lu2*, MD; Peng Lu3*, PhD; Fangfang Zeng2*, MD
1
School of Marxism, Huaqiao University, Xiamen, China
2
Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
3
Chinese Language and Culture College, Huaqiao University, Xiamen, China
*these authors contributed equally

Corresponding Author:
Fangfang Zeng, MD
Department of Public Health and Preventive Medicine
School of Medicine, Jinan University
No. 601, Huangpu Avenue West, Tianhe District
Guangzhou 510632
China
Phone: 86 2085221343
Email: zengffjnu@[Link]

Abstract
Background: Digital addiction, affecting a significant portion of the population, particularly young people, is linked to
psychological issues and social problems, making its prevention and management a crucial public health issue.
Objective: This umbrella review aimed to comprehensively analyze the factors influencing digital addiction by re-evaluating
the methodologies and evidence quality of existing meta-analyses.
Methods: Databases including PubMed, Web of Science, the Cochrane Library, and Embase were systematically searched for
reviews and meta-analyses related to factors associated with digital addiction up to September 24, 2024. The methodological
quality of the identified studies was assessed using the modified “A Measurement Tool to Assess Systematic Reviews 2”
(AMSTAR 2) tool, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was
used to evaluate the quality of the evidence presented in the literature.
Results: A total of 18 articles were included in the review, with AMSTAR 2 assessments revealing 6 moderate-quality, 4
low-quality, and 8 very low-quality studies. In total, 29 significant factors associated with digital addiction were identified.
Notably, 4 studies achieved both moderate AMSTAR 2 and GRADE ratings, indicating that positive parent-child relationship
(r=−0.15, 95% CI−0.18 to −0.11; P<.05) effectively mitigate the risks of digital addiction. Conversely, urban residence
(odds ratio [OR] 2.32, 95% CI 1.19-4.53; P<.001), adverse childhood experiences (r=0.21, 95% CI 0.18-0.24; P<.001), and
social anxiety (r=0.34, 95% CI 0.19-0.48; P<.001) were identified as factors that may increase the risk of developing digital
addiction.
Conclusions: This study found that social factors such as urban residence were associated with an increased risk of digital
addiction, whereas social support served as a protective factor against this risk. Nonetheless, the methodologies used in
analyzing the factors related to digital addiction require further refinement.
Trial Registration: PROSPERO CRD42024594911; [Link]

JMIR Ment Health 2025;12:e66950; doi: 10.2196/66950

Keywords: digital addiction; influencing factor; umbrella review; meta-analysis; youth; adolescents; teenager; urban;
AMSTAR 2; GRADE; adverse childhood experiences; social anxiety; psychological; psychology; social problem; social
support; methodologies; public health; digital health; mental health

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 1

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Introduction Methods
Digital addiction is characterized by a detrimental depend- Study Design
ence on digital media and high-tech devices, including
social networking, smartphone, and internet addictions [1,2]. This umbrella review was conducted in accordance with
Although digital addiction is not officially classified as a the registered protocol (Open Science Framework Registry)
diagnosable disorder, some psychologists argue that it bears and the PRISMA (Preferred Reporting Items for Systematic
similarities to substance use disorders [3]. It is estimated that Reviews and Meta-Analyses) 2020 statement [13]. Our study
smartphone addiction affected 26.99% of individuals, social protocol has been registered with PROSPERO (registration
media addiction 17.42%, and internet addiction 14.22%, number CRD42024594911).
with notably higher rates among young people [2,4]. A Literature Search Strategy
cross-sectional study involving 31,659 university students
from 2015 to 2018 revealed prevalence rates of 37.93% This study followed the umbrella review process estab-
(12,009/31,659) for mild, 6.33% (2003/31,659) for moder- lished by Aromataris et al [12], searched databases such
ate, and 0.20% (63/31,659) for severe internet addiction as PubMed, Web of Science, the Cochrane Library, and
[5]. Digital addiction contributes to psychological issues, Embase, and selected systematic reviews and meta-analyses
including attention deficits, depression, and anxiety, while on the influencing factors of digital addiction included in
also exacerbating social isolation, sleep disorders, and the databases up to September 24, 2024. The keywords used
diminishing academic and occupational performance [6]. included digital addiction, digital overuse, internet addiction,
Consequently, the effective prevention and management of internet-based addiction, problematic internet use, gaming
digital addiction has emerged as a critical public health disorder, social media addiction, influencing factors, risk
concern [7]. factors, causative factors, contributing factors, meta-analysis,
and systematic review, etc, and the search was conducted
Studies have sought to identify modifiable risk and using a combination of subject words and free words. Taking
protective factors associated with digital addiction, catego- the PubMed database as an example, the search strategy was
rizing them into three main domains, namely individual, shown in Multimedia Appendix 1. We also hand-searched the
digital media, and environment [7-11]. The emphasis has references of eligible included studies and google scholar to
primarily been on individual and social determinants, which identify further relevant articles.
encompass intrapersonal and interpersonal factors, including
gender differences, psychological traits, and health behaviors, Inclusion and Exclusion Criteria
as well as broader social influences. Despite the existence We included studies on the influencing factors of digital
of numerous systematic reviews and meta-analyses address- addiction if they met the following inclusion criteria: (1)
ing factors linked to digital addiction, these investigations study type was systematic reviews and meta-analyses; (2)
often focus on specific individual factors without provid- studies that focused on the various determinants of any type
ing updated, comprehensive insights. It is notable that 1 of digital addiction across different populations; (3) studies
study identified 34 modifiable factors such as intrapersonal that reported the overall effect size, including but not limited
factors (eg, time spent playing and psychological condition- to pooled Pearson correlation coefficients or Spearman rank
ing), interpersonal factors, and social factors and concluded correlation coefficients (r), standardized mean difference,
that intrapersonal factors were more likely to have a greater and odds ratio (OR) along with their 95% CIs or credible
impact on internet gaming disorder [8]. However, this study’s intervals.
focus on internet gaming disorder represents only 1 facet of
the broader spectrum of digital addiction. Meta-analyses focusing exclusively on a single influencing
factor were selected, prioritizing the most recent study with
Umbrella review is an emerging evidence synthesis the largest number of included studies when duplicates were
method that evaluates multiple meta-analyses on related present [14]. When multiple systematic reviews addressed the
topics to derive more comprehensive conclusions. Unlike same influencing factor, only the most recent review with
traditional meta-analyses, umbrella reviews assess the the largest number of individual studies providing study-level
methodological quality and risk of bias across various studies, estimates was included to prevent sample duplication. No
enhancing the ability to detect inconsistencies and differences language or date restrictions were applied. Articles lacking
in findings [12]. This approach offers a broader understanding study-level effect sizes and 95% CIs for systematic reviews,
of the credibility and robustness of the evidence, helping to or those based on animal models, were excluded. In addi-
identify potential heterogeneity and diversity among studies. tion, we excluded conference abstracts, editorials, narrative
This study aimed to further promote the integration of reviews, and systematic review protocols.
different research findings by conducting a comprehensive Literature Screening and Data Extraction
analysis of existing influences on digital addiction through
umbrella analyses, while also evaluating the methodology and This study was conducted by 2 researchers who screened the
quality of existing meta-analyses and systematic reviews. literature and extracted data according to the inclusion and
exclusion criteria. In case of disagreement, consulting a third
researcher (ZFF) assisted in making the decision. Duplicate
literatures were eliminated through the title and abstract,
[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 2
(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

and the full texts were carefully read to extract information By doing so, we aimed to provide a comprehensive evaluation
such as the first author, publication time, number of studies of the credibility and robustness of the findings related to
included and sample size, exposure factors, main outcome digital addiction.
indicators, meta-analysis effect model, effect size and its 95%
CI. When the same meta-analysis contained multiple health Data Analysis
outcome indicators, each outcome indicator was extracted This study conducted a methodological assessment using
separately. AMSTAR 2 and evaluated the quality of evidence with
GRADE, aiming to identify high-quality and significant
Literature Quality Assessment results from the most up-to-date and comprehensive available
In this study, the modified version of the systematic evidence. Significant heterogeneity was defined as present
review methodology quality assessment tool (AMSTAR 2 when the I²>50% or the P<.1 [20]. A meta-analysis was
[A Measurement Tool to Assess Systematic Reviews 2]) considered to have a small sample size if there were fewer
was used to assess the methodological quality of system- than 1000 participants in the meta-analysis [21,22]. Nota-
atic studies [15]. AMSTAR 2 evaluated the methodological bly, a significant publication bias was inferred if the largest
quality and credibility of the study from 16 items in 3 weighted effect size in the meta-analysis was subordinate to
dimensions (including 7 key items and 9 non–key items) the overall effect size, indicating a significant small study
such as research design and registration, literature search and effect (SSE) [21,23]. Publication bias was quantitatively
selection, quality assessment of the study, and data extraction. assessed using the Egger test [24] and the Begg test [25], with
It demonstrated good inter-rater consistency, practicality, and a P value <.05 [26] indicating the presence of statistically
a wide range of applications. Referencing the interpretation significant bias.
by Zeng et al [16], it was considered that ≤1 non–key item not
met was high-quality research, ≥2 non–key items not met was
medium-quality research, 1 key item not met was low-quality
Results
research, and ≥2 key items not met was extremely low-quality
research. Literature Screening Results and Basic
Characteristics
The Grading of Recommendations Assessment, Develop-
ment, and Evaluation (GRADE) tool was used to evalu- Through a database search and additional manual search, a
ate the evidence quality level of the literature [17]. The total of 912 relevant articles were initially identified. After
GRADE grading system evaluated the outcome indicators removing duplicates, 536 articles remained. Following a
based on 5 downgrade factors such as limitations, heteroge- review of titles and abstracts, 387 articles were excluded (266
neity, indirectness, imprecision, and publication bias. This due to mismatched study types and 151 for being irrele-
study stipulated that no downgrade factors were high-quality vant). After full-text screening and reviewing in Multime-
evidence, the existence of 1 downgrade factor was medium- dia Appendix 1, 101 articles were further excluded due to
quality evidence, the existence of 2 downgrade factors incomplete data or lack of effect size. As illustrated in Figure
was low-quality evidence, and downgrade factors ≥3 were 1, the final selection process resulted in the inclusion of 18
extremely low-quality evidence [18,19]. While the GRADE articles that met the inclusion criteria.
system typically assigns an initial “very low” quality rating to The included meta-analyses were published between 2020
evidence derived from observational studies due to inherent and 2024, reporting on 24 potential influencing factors related
limitations such as potential confounding and bias, it allows to digital addiction, with personality traits further subdivided
for upgrading or downgrading based on additional factors into 8 categories. The sample sizes of the studies ranged from
such as the magnitude of effect, dose-response relation- 300 to 159,425 participants. The included literature mainly
ships, and the presence of plausible confounding factors. In used the New Castle-Ottawa scale (NOS) and the Joanna
this umbrella review, we applied the GRADE framework Briggs Institute (JBI) systematic review checklist to assess
to evaluate the quality of evidence across meta-analyses, research quality. A total 6 studies did not specify the methods
which often include a mix of observational and other study used for quality evaluation or risk of bias assessment. The
designs. This approach enables a more nuanced assessment basic characteristics of the included literatures are seen in
of the evidence, considering factors such as risk of bias, Table 1.
inconsistency, indirectness, imprecision, and publication bias.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 3

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Figure 1. PRISMA flow diagram of the search and selection process.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 4

(page number not for citation purposes)
 Table 1. The basic characteristics of the studies.
Study design of I2 values P value of
Study Region included study Studies Cases Influencing factor Outcomes Quality assessment (%) publication bias SSEa

Akbari et al [27] Iran Case-control, cohort, 85 55,134 Fear of missing out Internet addiction —b 58.37 0.23 No
experimental study,
cross-sectional
Chung et al [7] Taiwan — 5 300 Probability discounting Internet gaming disorder — 85.66 <.01 Yes
(China)

[Link]
JMIR MENTAL HEALTH

Mak et al [28] Korea — 37 34,438 Neuroticism Facebook addiction — 96 >.05 Yes

Noroozi et al [29] Iran Cross-sectional, case- 18 2589 Quality of life Internet addiction STROBEc 85.23 0.6 Yes
control, and cohort
Bäcklund et al [30] Sweden Cross-sectional, 46 49,192 Gaming motivations Gaming disorder JBI checklistd 96 ND No
longitudinal
Ding et al [31] China Cross-sectional 14 11,561 Self-esteem Smartphone addiction JBI checklist 74 0.9 No
Eirich et al [32] Canada Observational, 87 159,425 Behavior problems Screen time overuse JBI checklist 87.8 ND No
experimental
Hao et al [33] China Case-control, cross- 26 14,638 Personal relationship Internet addiction NOSe 94.1 >.05 Yes
sectional
Li et al [34] China — 50 38,488 Academic burnout Problematic mobile phone — 91.71 0.83 No
use
Rajesh et al [35] India — 96 35,608 Personality traits Facebook addiction — 84.27 >.05 No
Wang et al [36] China Observational 31 29,692 Negative life events Internet addiction NOS 97.8 0.36 No
Zewde et al [37] Ethiopia — 145 15,316 Male Internet addiction — <0.01 .82 Yes
7234 Urban residence Internet addiction — 51.81 .94 No
Hidalgo-Fuentes et al Spain Original empirical, 19 93,859 Resilience Problematic internet use NOS 97.46 0.76 No
[38] quantitative cross-
sectional, longitudinal
Niu et al [39] China — 3424 32,587 Positive parenting styles Problematic internet use NOS 41.77 .45 No
21,366 Negative parenting styles Problematic internet use NOS 30.43 .39 No
Wan et al [40] China Observational 9229 59,716 Social support Mobile phone addiction JBI checklist 96.10 .81 No
21,844 Self-control Smartphone addiction JBI checklist 96.30 .19 No
Zhuang et al [8] China Longitudinal, 12 9113 Depression Internet gaming disorder NOS 89.32 .58 No
prospective, cohort 7 8444 Gaming time Internet gaming disorder NOS 97.07 .80 No
10 9364 Parent-child relationship Internet gaming disorder NOS 62.54 .34 No
5 5819 Grade point average Internet gaming disorder NOS 92.46 .47 No
Hao et al [41] China Longitudinal, cross- 37 45,364 Childhood adverse Internet addiction NOS 91 >.05 No
sectional experiences

(page number not for citation purposes)

JMIR Ment Health 2025 | vol. 12 | e66950 | p. 5
Han et al
 Study design of I2 values P value of
Study Region included study Studies Cases Influencing factor Outcomes Quality assessment (%) publication bias SSEa
Wu et al [42] China — 53 59,928 Social anxiety Problematic social media The Agency for 92.91 <.01 No
use Healthcare Research
and Quality’s Research
Literature Quality
Assessment Inventory
aSSE: small study effect.

[Link]
JMIR MENTAL HEALTH

bNot mentioned.
cSTROBE: Strengthening the Reporting of Observational Studies in Epidemiology.
dJBI checklist: Joanna Briggs Institution Critical Appraisal Checklist.
eNOS: Newcastle-Ottawa scale.

(page number not for citation purposes)

JMIR Ment Health 2025 | vol. 12 | e66950 | p. 6
Han et al
JMIR MENTAL HEALTH Han et al

Methodological Quality Evaluation #9 (whether a satisfactory technique for assessing the risk
of bias in individual studies was used) all had a compliance
Through evaluation with the AMSTAR-2 tool, all included rate of 83.33% (15/18); the compliance rate for item #11
meta-analyses exhibited some methodological deficiencies. (whether appropriate methods were used to combine results)
Specifically, 6 were of moderate quality, 4 of low quality, was 72.22% (13/18); item #13 (whether bias was explained)
and 8 of very low quality, with none classified as high had a compliance rate of 33.33% (6/18); and item #15
quality. For key items, the compliance rates were as follows: (whether the authors properly investigated and discussed the
item #2 (whether the review reported that its methods were potential impact of publication bias) was 55.56% (10/18). The
established a priori and explained any major changes to results of the methodological quality evaluation are presented
the protocol), item #4 (whether a comprehensive literature in Table 2.
search was conducted), item #7 (whether a list of excluded
studies and reasons for exclusion were provided), and item

Table 2. Methodological quality evaluation.

Items
Study #1a #2b #3c #4d #5e #6f #7g #8h #9i #10j #11k #12l #13m #14n #15o #16p Methodological quality

Akbari et al [27] Yq Y Y Y Y Nr Y Y Y N N Y N Y Y N Very low

Chung et al [28] Y Y Y Y N Y Y Y Y Y Y Y N Y N N Low
Mak et al [29] Y N Y Y Y Y Y Y Y N N N N Y N N Very low
Noroozi et al [30] Y Y N N N Y N Y Y N Y N N N N N Very low
Bäcklund et al [31] Y Y N PY Y Y Y PY N Y N Y N N Y Y Very low
s

Ding et al [32] Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Moderate

Eirich et al [33] Y Y Y N N Y Y Y Y Y Y N N N N N Very low
Hao et al [34] Y N Y Y Y Y N Y Y Y Y N N Y N N Very low
Li et al [35] Y N N Y N N Y Y N Y N Y N Y N N Very low
Rajesh et al [36] Y Y Y Y N Y Y Y Y N Y Y N Y Y N Low
Wan et al [37] Y Y Y Y Y Y Y Y Y N Y N Y N Y N Moderate
Wang et al [38] Y Y Y PY Y Y Y Y Y Y Y Y N N Y N Low
Zewde et al [39] Y Y Y Y Y N Y Y Y Y Y Y N Y Y N Moderate
Hidalgo-Fuentes et al Y Y Y Y Y Y Y Y N Y Y Y N Y N N Very low
[40]
Niu et al [41] Y Y Y Y Y Y Y N PY Y N Y Y Y Y N Low
Zhuang et al [8] Y Y Y Y Y Y Y N Y Y Y Y Y Y Y N Moderate
Hao et al [42] Y Y Y Y Y Y Y Y Y Y Y Y Y N N Y Moderate
Wu et al [43] Y Y Y Y Y Y PY Y Y Y Y Y Y Y Y Y Moderate
a#1-Did the research questions and inclusion criteria for the review include the components of PICO?
b#2-Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the
report justify any significant deviations from the protocol?
c#3-Did the review authors explain their selection of the study designs for inclusion in the review?
d#4-Did the review authors use a comprehensive literature search strategy?
e#5-Did the review authors perform study selection in duplicate?
f#6-Did the review authors perform data extraction in duplicate?
g#7-Did the review authors provide a list of excluded studies and justify the exclusions?
h#8-Did the review authors describe the included studies in adequate detail?
i#9-Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?
j#10-Did the review authors report on the sources of funding for the studies included in the review?
k#11-If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?
l#12-If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the
meta-analysis or other evidence synthesis?
m#13-Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review?
n#14-Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
o#15-If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and
discuss its likely impact on the results of the review?
p#16-Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?
qY: complaint.
rN: not complaint.
sPY: partially complaint.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 7

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Evidence Quality Grading moderate-quality evidence, 11 were of low quality, and 7

were of very low quality. The detailed results of the evidence
Based on the GRADE evaluation system, of the 24 outcome quality assessment are presented in Table 3.
indicators, 1 study provided high-quality evidence, 5 provided

Table 3. Evidence quality grading.

Downgrading factors
Risk of Inconsistency Indirectness Publication Evidence
Study Influencing Factor Biasa b c Imprecisiond Biase Quality

Akbari et al [27] Fear of missing out Yf Y Y Ng N Very low

Chung et al [28] Probability discounting N N N N N High
Mak et al [29] Personality traits N Y N N Y Low
Noroozi et al [30] Quality of life Y Y Y Y Y Very low
Bäcklund et al [31] Gaming motivations Y N Y Y N Very low
Ding et al [32] Self-esteem N Y N N Y Low
Self-control Y Y Y Y Y Very low
Eirich et al [33] Behavior problems Y N Y Y N Very low
Hao et al [34] Personal relationship N Y N N Y Low
Li et al [35] Academic burnout N Y N Y N Low
Rajesh et al [36] Personality traits N N N N Y Moderate
Wan et al [37] Social support Y N Y N N Low
Wang et al [38] Negative life events N Y N N Y Low
Zewde et al [39] Gender N Y N N Y Low
Urban residence N N Y N N Moderate
Hidalgo-Fuentes et Resilience Y Y Y Y Y Very low
al [40]
Niu et al [41] Positive parenting styles N Y N Y N Low
Negative parenting styles N Y N Y N Low
Zhuang et al [8] Depression N Y N N Y Low
Gaming time Y Y Y Y Y Very low
Parent-child relationship N Y N N N Moderate
Grade point average N Y Y N N Low
Hao et al [42] Childhood adverse Y N N N N Moderate
experiences
Wu et al [43] Social anxiety N N N N Y Moderate
aRisk of bias: bias occurs when the results of a study do not represent the truth because of inherent limitations in design or conduct of a study
bInconsistency: this refers to unexplained variability among the results of the included studies.
cIndirectness: it refers to the extent to which the people, interventions, and outcome measures are similar to those of interest.
dImprecision: the authors have the option of decreasing their level of certainty one or two levels if the confidence intervals are wide.
ePublication Bias: this occurs when the dissemination of research findings is influenced by the nature and direction of results.
fY: compliant.
gNY: not compliant.

Influencing Factors for Digital Addiction digital addiction. Similarly, Zewde et al [39] found that men
are at a higher risk of digital addiction compared with women
Intrapersonal Factors (OR 1.92, 95% CI 1.43-2.75; P<.001). Furthermore, Zhuang
As shown in Table 4 and Figure 2, most of the included et al [8] reported that individuals with a higher grade point
studies were highly significant. In this study, Ding et al [32] average (r=−0.15, 95% CI −0.25 to −0.16; P<.05) are less
discovered that individuals with higher levels of self-esteem likely to be threatened by digital addiction. These findings
(r=−0.25, 95% CI−0.29 to −0.22; P<.001) and self-control were rated as moderate evidence in terms of methodological
(r=−0.48, 95% CI−0.53 to −0.42; P<.001) are more prone to quality with AMSTAR 2 tool.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 8

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Table 4. Factors associated with digital addiction.

Author (Year) Influencing factor Model Confounding adjusted ESa (95% CI) P value
Intrapersonal factors
Akbari et al [27] Fear of missing out Random No r=0.41 (0.38-0.44) <.001
Li et al [35] Academic burnout Random Yes r=0.41 (0.38-0.44) <.001
Chung et al [28] Probability discounting Random Yes Hedges g=−0.32 (–0.85 to −0.20) .470
Mak et al [29] Neuroticism Random No SMD=0.54 (0.38-0.69) <.001
Bäcklund et al [31] Gaming motivations Random No r=0.50 (0.45-0.54) <.001
Ding et al [32] Self-esteem Random Yes r=−0.25 (−0.29 to −0.22) <.001
Self-control Random Yes r=−0.48 (−0.53 to −0.42) <.001
Rajesh et al [36] Openness Random Yes r=−0.05 (−0.08 to −0.01) <.05
Agreeableness Random Yes r=−0.07 (−0.10 to −0.04) <.05
Conscientiousness Random Yes r=−0.15 (−0.18 to −0.11) <.001
Loneliness Random Yes r=0.23 (0.18-0.27) <.001
Narcissism Random Yes r=0.23 (0.12-0.33) NSb
Impulsivity Random Yes r=0.25 (0.18-0.32) <.001
Shyness Random Yes r=0.20 (0.14-0.25) <.001
Extraversion Random Yes r=0.01 (0.02-0.04) NS
Eirich et al [33] Behavior problems Random Yes r=0.11 (0.09-0.12) <.05
Zewde et al [39] Male sex Fix No ORc 1.92 (1.43-2.75) <.001
Hidalgo-Fuentes et al Resilience Random No r=−0.27 (−0.32 to −0.22) <.001
[40]
Zhuang et al [8] Depression Random No r=0.18 (0.13-0.23) <.05
Grade point average Random No r=−0.15 (−0.25 to −0.16) <.05
Gaming time Random No r=0.33 (0.21-0.44) <.05
Interpersonal factors
Hao et al [34] Personal relationship troubles Random No r=0.36 (0.35-0.38) <.001
Niu et al [41] Positive parenting styles Fix Yes r=−0.14 (−0.17 to −0.11) <.001
Niu et al [41] Negative parenting styles Fix Yes r=0.18 (0.14-0.22) <.001
Zhuang et al [8] Parent-child relationship Random No r=−0.15 (−0.18 to −0.11) <.05
Social factors
Noroozi et al [30] Quality of life Random No OR 0.39 (0.27-0.55) <.001
Wang et al [38] Negative life events Random Yes r=0.31 (0.28-0.34) <.001
Wan et al [37] Social support Random Yes r=−0.17 (−0.21 to −0.13) <.001
Zewde et al [39] Urban residence Random No OR 2.32 (1.19-4.53) <.001
Hao et al [42] Childhood adverse experiences Random Yes r=0.21 (0.18-0.24) <.001
Wu et al [43] Social anxiety Random Yes r=0.34 (0.19-0.48) <.001
aES: effect size.
bNS: not significant.
cOR: odds ratio.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 9

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Figure 2. Forest plot of factors associated with digital addiction. AMSTAR 2: a measurement tool to assess systematic reviews version 2; ES:
effect size; g: Hedge’s g; GRADE: Grading of Recommendations Assessment, Development, and Evaluation; NS: not significant; OR: odds ratio; *:
classified as moderate with AMSTAR 2 or GRADE; **: classified as high with AMSTAR 2 or GRADE.

On the other hand, the quality assessment conducted using the bias was found in the above analyses, it is important to
GRADE tool revealed that Chung’s analyses, which identified emphasize that none of the analyses addressing intraperso-
a protective impact of the discount probability against digital nal factors achieved moderate or high ratings in terms of
addiction (r=−0.32, 95% CI −0.85 to −0.20; P<.47), was methodology and quality of evidence.
graded as high-quality evidence [28]. However, the statistical
results were not significant. In addition, Rajesh et al [36] Interpersonal Factors
found that different personality traits have varying impacts on Of the 5 analyses examining interpersonal factors associated
digital addiction was also rated as moderate evidence quality. with digital addiction, only 1 study by Zhuang et al [8]
Specifically, they suggested that individuals with openness met the criteria for moderate methodological and evidence
(r=−0.05, 95% CI −0.08 to −0.01; P<.05), agreeableness quality with AMSTAR 2 tool. This study focused on parent-
(r=−0.07, 95% CI −0.10 to −0.04; P<.05), and conscien- child relationship and showed that the stronger the parent-
tiousness (r=−0.15, 95% CI −0.18 to −0.11; P<.001) were child relationship (r=−0.15, 95% CI −0.18 to −0.11, P<.05),
protected against the addictive potential of digital media. the lower the probability of digital addiction. No risk of
Conversely, those experiencing loneliness (r=0.23, 95% CI publication bias was identified in this analysis (Table 4 and
0.19-0.27; P<.001), depression (r=0.18, 95% CI 0.13-0.23; Figure 2).
P<.05), impulsivity (r=0.25, 95% CI 0.18-0.32; P<.001), and
shyness (r=0.20, 95% CI 0.14-0.25; P<.001) are at a greater
risk of developing digital addiction. Although no publication

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 10

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Social Factors in digital interactions, favoring real-life experiences [47].

Furthermore, individuals exhibiting higher levels of agree-
The findings revealed that urban residence (OR 2.32, 95% ableness and openness are less likely to encounter risks
CI 1.19‐4.53; P<.001) by Zewde et al [39], exposure to associated with digital addiction [36,47]. Conversely, traits
adverse childhood experiences (r=0.21, 95% CI 0.18‐0.24; such as narcissism, characterized by self-centeredness and
P<.001) by Hao et al [42], and the presence of social anxiety lack of empathy, may drive individuals to seek internet-based
(r=0.34, 95% CI 0.19‐0.48; P<.001) by Wu et al [43] were validation, increasing addiction susceptibility [48]. Consis-
significant predictors of digital addiction. Notably, all 3 tent with previous research [49-53], impulsivity is a notable
analyses were accorded moderate ratings in the evaluation risk factor for digital addiction, as highly impulsive indi-
of methodological and the quality of evidence rating with viduals often struggle to resist internet-based temptations.
AMSTAR 2 and GRADE tools, and no evidence of publica- Shyness may prompt individuals to engage more in digi-
tion bias was identified in the analyses. Furthermore, Wan tal socialization to avoid in-person interactions, potentially
et al [37] suggesting that individuals with stronger social heightening addiction risk [54]. Thus, our results suggest
support networks (r=−0.17, 95% CI −0.21 to −0.13, P<.001) that while positive personality traits may buffer against
exhibited a reduced likelihood of developing digital addic- digital addiction, negative traits can increase vulnerability.
tion. However, this particular analysis did not achieve a At present, cognitive behavioral therapy and psychosocial
similar assessment in the quality of evidence, although it was interventions are recognized as efficacious strategies for
recognized for its moderate methodological quality (Table 4 mitigating the symptoms of internet addiction. Cognitive
and Figure 2). behavioral therapy has been shown to substitute impulsive
behaviors with more reasoned actions and improve self-con-
trol [55], thereby contributing to the prevention and manage-
Discussion ment of digital addition [56]. Psychosocial interventions have
been effective in addressing internet addiction and enhanc-
Principal Findings ing self-esteem. By focusing on the psychological and social
This umbrella review identified a range of intra-personal, dimensions of the individual, these approaches promote the
interpersonal, and social factors influencing digital addic- development of a positive personality and can be effective
tion. In a comprehensive examination of the aforementioned in curbing digital addition behaviors [57,58]. Furthermore,
factors, several studies were noted for their methodological gender differences are crucial, as males are more likely to
assessment. The studies conducted by Ding et al [32] on develop digital addictions, likely due to their preference for
self-esteem and self-control, by Zewde et al [39] on male strategy, role-playing, and action genres, which are inherently
gender, and by Wan et al [37] on social support, all ach- more addictive [59].
ieved moderate rankings for methodological rigor. However, Among the 4 interpersonal factors associated with digital
the evidence for these factors was considered circumstantial addiction, 1 study was rated as moderate on both the
or questionable in accuracy, resulting in a classification of AMSTAR 2 and GRADE scales, indicating that it provi-
low quality. On the other hand, study by Zhuang et al [8] ded reasonably convincing evidence through robust method-
concluded that a strong parent-child relationship significantly ology [8]. This finding is consistent with previous research,
mitigated digital addiction, while study by Zewde et al [39] which has demonstrated that enhanced parent-child relation-
identified urban living as a risk factor. In addition, study by ships can effectively reduce the risk of digital addiction
Hao et al [42] on childhood adverse experiences, and study by among adolescents [60,61]. Research suggests that there is
Wu et al [43] on social anxiety, findings from both of these a link between excessive parental screen time and problem-
studies received ratings of moderate methodological quality. atic screen behaviors in their offspring. Excessive use of
Intrapersonal factors significantly influence digital digital devices by parents reduces interaction with their
addiction, with our study evaluating 21 such factors, of children; this, along with their children’s emulation of
which only 3 received moderate ratings on the AMSTAR their parents’ screen-using habits, contributes to the develop-
2 and 8 on the GRADE scale, all focusing on the asso- ment of screen-using behaviors in adolescents. This pattern
ciations between personality traits and digital addiction. of behavior has the potential to evolve into digital addic-
Despite some methodological limitations, our findings were tion [62,63]. Therefore, providing guidance on the use of
consistent with finding by Geng et al [44], indicating digital devices, especially for parents of young children,
that self-control inversely associated with digital addiction, may become a viable intervention strategy to counteract the
suggesting that individuals with lower self-regulation are emergence of digital addiction in children.
more prone to emotional and impulsive behaviors, thereby Six of the included studies explored examined the
fostering harmful digital usage patterns. In addition, specific influence of social factors on digital addiction, with 4 rated
personality traits can serve as protective factors against as moderate quality based on AMSTAR 2 criteria. How-
digital addiction [44,45]. As previous research has indica- ever, only 3 of these studies received a moderate rating
ted, self-esteem, which is a reflection of an individual’s from GRADE. Evidence indicates that urbanization uniquely
sense of perceived value, is associated with higher self-effi- affects addiction; urban residents often face environmental
cacy and self-control, ultimately reducing addiction risk [46]. pollution and discomfort associated with city life, which
Traits such as self-consciousness, characterized by self-dis- can heighten psychological stress and contribute to digital
cipline and organizational skills, tend to promote caution
[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 11
(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

addiction [64]. In addition, a lack of social support emerges as For example, Malak et al [71] used structural modeling to
a critical risk factor for internet addiction. Insufficient social show that social support mediates the relationship between
connections can lead to unhappiness, prompting individuals to anxiety and stress, contributing to internet-based gaming
seek emotional fulfillment through social media, potentially disorders, a form of digital addiction [66]. Thus, it is
worsening addiction issues [65,66]. Late childhood, a pivotal misleading to solely consider interpersonal and social factors
period for social and emotional development, shows a marked when exploring correlates of digital addiction. Instead, this
negative association between internet engagement and various indicates the need for further research to elucidate the
well-being dimensions. This correlation suggests that the complex interplay between these domains.
rising levels of unhappiness and anxiety in children are
closely linked to increased internet use. Furthermore, adverse Limitations
childhood experiences related to home environments and While this umbrella review evaluated numerous factors
parental pressures significantly influence children’s devel- associated with digital addiction, several limitations persist.
opment, leading to increased time spent on digital media First, the focus on published meta-analyses may lead to
[[67,68]]. In addition to the previously mentioned parental the omission of factors that are less studied or have not
digital guidance, group counseling has also been reported to garnered significant attention [72]. Second, the broad scope
play a significant role in enhancing the self-control abili- of the review complicates the generalization of results due
ties of school-aged children with internet addiction [69]. to the diversity of research findings included. Finally, many
However, when parents are also involved in group counsel- systematic reviews analyzed similar exposure factors and
ing, research has proven that it requires parents to have were conducted within a relatively short timeframe, resulting
previously successfully dealt with challenges such as social in potential overlap among initial studies. To mitigate this,
anxiety, social isolation, and social skill deficits, or else group we prioritized the inclusion of the most recent meta-analyses
counseling will be much less effective [69]. with the highest number of studies and aimed to exclude those
Intrapersonal factors influencing digital addiction have exhibiting considerable overlap with original studies.
been extensively studied, predominantly focusing on Conclusion
personality traits. However, most meta-analyses seem to
suffer from methodological flaws, and even those with- In conclusion, a range of intrapersonal, interpersonal,
out serious issues often reveal publication bias in original and social factors significantly influences an individual’s
studies, thereby diminishing the quality of the evidence susceptibility to digital addiction. A rigorous evaluation using
[32,39]. Therefore, it raises concerns about the risk of the AMSTAR and GRADE frameworks identified negative
publication bias, where positive results are more readily parent-child relationships, urban residence, adverse childhood
published, potentially obscuring the true nature of the experiences, and social anxiety as credible risk factors. These
cause-and-effect relationship [70]. In contrast, fewer studies findings are essential for informing effective public health
examining interpersonal and social factors demonstrate better strategies aimed at preventing digital addiction. However,
methodological rigor and evidence quality. These factors further refinement of the methodologies used to analyze
often exert their influence on digital addiction indirectly by these factors is necessary to enhance the robustness of future
affecting psychological traits or personality characteristics. research.

Acknowledgments
This study was supported by the National Natural Science Foundation of China (No 82473613) and Guangdong Basic and
Applied Basic Research Foundation (No 2023A1515030155). The funding sponsors had no role in the design of the study, the
collection, analyses, or interpretation of data, the writing of the manuscript, and the decision to publish the results.
Authors’ Contributions
Authors YH and JQ are recognized as co-first authors of this paper, as they equally contributed to this work, whereas, authors
D-LL, PL, and FZ are recognized as co-corresponding authors of this paper. The contact details for the co-corresponding
authors are listed below:
Da-lin Lu, Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601, Huangpu
Avenue West, Tianhe District, Guangzhou, 510632, China. Phone: +86 20 85221343; Fax: +86 20 85221343. Email:
dalinlu@[Link]
Peng Lu, Chinese Language and Culture College, Huaqiao University, No. 668 Jimei Avenue, Jimei District, Xiamen, 361021,
China. Phone: +86 18750922477; Fax: +86 0592-6683217. Email: lupeng@[Link]
Fangfang Zeng, Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601,
Huangpu Avenue West, Tianhe District, Guangzhou, 510632, China. Phone: +86 20 85221343; Fax: +86 20 85221343. Email:
zengffjnu@[Link]
Conflicts of Interest
None declared.
Multimedia Appendix 1

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 12

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

Systematic search details in PubMed, Cochrane Library, Scopus, and Web of Science.
[DOCX File (Microsoft Word File), 18 KB-Multimedia Appendix 1]
References
1. Carr N. The Shallows: What the Internet Is Doing to Our Brains. 2020. ISBN: 393358003
2. Meng SQ, Cheng JL, Li YY, et al. Global prevalence of digital addiction in general population: a systematic review and
meta-analysis. Clin Psychol Rev. Mar 2022;92(102128):102128. [doi: 10.1016/[Link].2022.102128] [Medline: 35150965]
3. Hartogsohn I, Vudka A. Technology and addiction: what drugs can teach us about digital media. Transcult Psychiatry.
Aug 2023;60(4):651-661. [doi: 10.1177/13634615221105116] [Medline: 35799499]
4. Block JJ. Issues for DSM-V: internet addiction. Am J Psychiatry. Mar 2008;165(3):306-307. [doi: 10.1176/[Link].
2007.07101556] [Medline: 18316427]
5. Guo W, Tao Y, Li X, et al. Associations of internet addiction severity with psychopathology, serious mental illness, and
suicidality: large-sample cross-sectional study. J Med Internet Res. Aug 11, 2020;22(8):e17560. [doi: 10.2196/17560]
[Medline: 32780029]
6. Lissak G. Adverse physiological and psychological effects of screen time on children and adolescents: literature review
and case study. Environ Res. Jul 2018;164:149-157. [doi: 10.1016/[Link].2018.01.015] [Medline: 29499467]
7. Chung S, Lee HK. Public health approach to problems related to excessive and addictive use of the internet and digital
media. Curr Addict Rep. 2023;10(1):69-76. [doi: 10.1007/s40429-022-00458-z] [Medline: 36589709]
8. Zhuang X, Zhang Y, Tang X, Ng TK, Lin J, Yang X. Longitudinal modifiable risk and protective factors of internet
gaming disorder: a systematic review and meta-analysis. J Behav Addict. Jun 29, 2023;12(2):375-392. [doi: 10.1556/
2006.2023.00017] [Medline: 37224007]
9. Kimball HG, Fernandez F, Moskowitz KA, et al. Parent-perceived benefits and harms associated with internet use by
adolescent offspring. JAMA Netw Open. Oct 2, 2023;6(10):e2339851. [doi: 10.1001/jamanetworkopen.2023.39851]
[Medline: 37883086]
10. Tso WWY, Reichert F, Law N, et al. Digital competence as a protective factor against gaming addiction in children and
adolescents: a cross-sectional study in Hong Kong. Lancet Reg Health West Pac. Mar 2022;20(100382):100382. [doi:
10.1016/[Link].2022.100382] [Medline: 35967602]
11. Hester RK, Miller WR. Handbook of alcoholism treatment approaches: effective alternatives. Pergamon Press; 1989.
ISBN: 0080364284
12. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews:
methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. Sep
2015;13(3):132-140. [doi: 10.1097/XEB.0000000000000055] [Medline: 26360830]
13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic
reviews. BMJ. Mar 29, 2021;372:n71. [doi: 10.1136/bmj.n71] [Medline: 33782057]
14. Grooten WJA, Boström C, Dedering Å, et al. Summarizing the effects of different exercise types in chronic low back
pain - a systematic review of systematic reviews. BMC Musculoskelet Disord. Aug 22, 2022;23(1):801. [doi: 10.1186/
s12891-022-05722-x] [Medline: 35996124]
15. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised
or non-randomised studies of healthcare interventions, or both. BMJ. Sep 21, 2017;358:j4008. [doi: 10.1136/bmj.j4008]
[Medline: 28935701]
16. Zeng X, Zhang Y, Kwong JSW, et al. The methodological quality assessment tools for preclinical and clinical studies,
systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. Feb
2015;8(1):2-10. [doi: 10.1111/jebm.12141] [Medline: 25594108]
17. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of
findings tables. J Clin Epidemiol. Apr 2011;64(4):383-394. [doi: 10.1016/[Link].2010.04.026] [Medline: 21195583]
18. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic treatment of primary osteoporosis or low bone mass
to prevent fractures in adults: a living clinical guideline from the American College of Physicians (version 1, update
alert). Ann Intern Med. Jun 2024;177(6):38710077. [doi: 10.7326/L24-0113] [Medline: 38710077]
19. Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian cardiovascular society/Canadian Heart Rhythm Society
comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol. Dec 2020;36(12):1847-1948. [doi: 10.
1016/[Link].2020.09.001] [Medline: 33191198]
20. JJwc-ho H, The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. 2011;5:1.
21. Solmi M, Köhler CA, Stubbs B, et al. Environmental risk factors and nonpharmacological and nonsurgical interventions
for obesity: an umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest.
Dec 2018;48(12):e12982. [doi: 10.1111/eci.12982] [Medline: 29923186]

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 13

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

22. Qiu J, Zhang S, Feng Y, et al. Efficacy and safety of hepatitis B vaccine: an umbrella review of meta-analyses. Expert
Rev Vaccines. 2024;23(1):69-81. [doi: 10.1080/14760584.2023.2289566] [Medline: 38055218]
23. Gao X, Su X, Han X, et al. Unsaturated fatty acids in mental disorders: an umbrella review of meta-analyses. Adv Nutr.
Dec 22, 2022;13(6):2217-2236. [doi: 10.1093/advances/nmac084] [Medline: 36041185]
24. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. Sep
13, 1997;315(7109):629-634. [doi: 10.1136/bmj.315.7109.629] [Medline: 9310563]
25. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. Dec
1994;50(4):1088-1101. [doi: 10.2307/2533446] [Medline: 7786990]
26. Sulaiman SK, Musa MS, Tsiga-Ahmed FI, Dayyab FM, Sulaiman AK, Bako AT. A systematic review and meta-analysis
of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income
countries (LMICs). PLoS ONE. 2022;17(12):e0278224. [doi: 10.1371/[Link].0278224] [Medline: 36455209]
27. Akbari M, Seydavi M, Palmieri S, Mansueto G, Caselli G, Spada MM. Fear of missing out (FoMO) and internet use: a
comprehensive systematic review and meta-analysis. J Behav Addict. Dec 17, 2021;10(4):879-900. [doi: 10.1556/2006.
2021.00083] [Medline: 34935633]
28. Chung W, Sun CK, Tsai IT, et al. A systematic review and meta-analysis on the clinical implications of probability
discounting among individuals with Internet gaming disorder. Sci Rep. Feb 4, 2021;11(1):3177. [doi: 10.1038/s41598-
021-82822-z] [Medline: 33542406]
29. Mak KK, Scheer B, Yeh CH, Ohno S, Nam JK. Associations of personality traits with internet addiction: a cross-cultural
meta-analysis with a multilingual approach. Cyberpsychol Behav Soc Netw. Dec 2021;24(12):777-798. [doi: 10.1089/
cyber.2021.0071] [Medline: 34788555]
30. Noroozi F, Hassanipour S, Eftekharian F, Eisapareh K, Kaveh MH. Internet addiction effect on quality of life: a
systematic review and meta-analysis. ScientificWorldJournal. 2021;2021(2556679):2556679. [doi: 10.1155/2021/
2556679] [Medline: 34912181]
31. Bäcklund C, Elbe P, Gavelin HM, Sörman DE, Ljungberg JK. Gaming motivations and gaming disorder symptoms: a
systematic review and meta-analysis. J Behav Addict. Sep 26, 2022;11(3):667-688. [doi: 10.1556/2006.2022.00053]
[Medline: 36094861]
32. Ding Y, Wan X, Lu G, et al. The associations between smartphone addiction and self-esteem, self-control, and social
support among Chinese adolescents: a meta-analysis. Front Psychol. 2022;13(1029323):1029323. [doi: 10.3389/fpsyg.
2022.1029323] [Medline: 36420390]
33. Eirich R, McArthur BA, Anhorn C, McGuinness C, Christakis DA, Madigan S. Association of Screen Time With
Internalizing and Externalizing Behavior Problems in Children 12 Years or Younger: A Systematic Review and Meta-
analysis. JAMA Psychiatry. May 1, 2022;79(5):393-405. [doi: 10.1001/jamapsychiatry.2022.0155] [Medline: 35293954]
34. Hao QH, Peng W, Wang J, Tu Y, Li H, Zhu TM. The correlation between internet addiction and interpersonal
relationship among teenagers and college students based on Pearson’s correlation coefficient: A systematic review and
meta-analysis. Front Psychiatry. 2022;13(818494):818494. [doi: 10.3389/fpsyt.2022.818494] [Medline: 35356718]
35. Li S, Xu M, Zhang Y, Wang X. The more academic burnout students got, the more problematic mobile phone use they
suffered? A meta-analysis of mainland Chinese adolescents and young adults. Front Psychol.
2022;13(1084424):36726513. [doi: 10.3389/fpsyg.2022.1084424]
36. Rajesh T, Rangaiah B. Relationship between personality traits and facebook addiction: A meta-analysis. Heliyon. Aug
2022;8(8):e10315. [doi: 10.1016/[Link].2022.e10315] [Medline: 36061026]
37. Wan X, Huang H, Jia R, Liang D, Lu G, Chen C. Association between mobile phone addiction and social support among
mainland Chinese teenagers: A meta-analysis. Front Public Health. 2022;10(911560):911560. [doi: 10.3389/fpubh.2022.
911560] [Medline: 36589942]
38. Wang J, Hao QH, Tu Y, et al. The relationship between negative life events and internet addiction disorder among
adolescents and college students in China: a systematic review and meta-analysis. Front Psychiatry.
2022;13(799128):799128. [doi: 10.3389/fpsyt.2022.799128] [Medline: 35573333]
39. Zewde EA, Tolossa T, Tiruneh SA, et al. Internet addiction and its associated factors among African high school and
university students: systematic review and meta-analysis. Front Psychol. 2022;13(847274):847274. [doi: 10.3389/fpsyg.
2022.847274] [Medline: 35386896]
40. Hidalgo-Fuentes S, Martí-Vilar M, Ruiz-Ordoñez Y. Problematic internet use and resilience: a systematic review and
meta-analysis. Nurs Rep. Feb 24, 2023;13(1):337-350. [doi: 10.3390/nursrep13010032] [Medline: 36976684]
41. Niu X, Li JY, King DL, Rost DH, Wang HZ, Wang JL. The relationship between parenting styles and adolescent
problematic Internet use: A three-level meta-analysis. J Behav Addict. Sep 19, 2023;12(3):652-669. [doi: 10.1556/2006.
2023.00043] [Medline: 37725505]
42. Hao F, Li P, Liang Z, Geng J. The association between childhood adverse experiences and internet addiction: A meta-
analysis. Acta Psychol (Amst). Jun 2024;246:104270. [doi: 10.1016/[Link].2024.104270] [Medline: 38631153]
[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 14
(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

43. Wu W, Huang L, Yang F. Social anxiety and problematic social media use: A systematic review and meta-analysis.
Addict Behav. Jun 2024;153(107995):107995. [doi: 10.1016/[Link].2024.107995] [Medline: 38401423]
44. Geng Y, Gu J, Wang J, Zhang R. Smartphone addiction and depression, anxiety: The role of bedtime procrastination and
self-control. J Affect Disord. Oct 1, 2021;293(415-21):415-421. [doi: 10.1016/[Link].2021.06.062] [Medline: 34246950]
45. Gagné JP, Radomsky AS. Beliefs about losing control, obsessions, and caution: An experimental investigation. Behav
Res Ther. Mar 2020;126(103574):103574. [doi: 10.1016/[Link].2020.103574] [Medline: 32045733]
46. Mei S, Yau YHC, Chai J, Guo J, Potenza MN. Problematic internet use, well-being, self-esteem and self-control: data
from a high-school survey in China. Addict Behav. Oct 2016;61(74-9):74-79. [doi: 10.1016/[Link].2016.05.009]
[Medline: 27249805]
47. Błachnio A, Przepiorka A, Senol-Durak E, Durak M, Sherstyuk L. The role of personality traits in Facebook and Internet
addictions: A study on Polish, Turkish, and Ukrainian samples. Comput Human Behav. Mar 2017;68:269-275. [doi: 10.
1016/[Link].2016.11.037]
48. James C, Davis K, Charmaraman L, et al. Digital life and youth well-being, social connectedness, empathy, and
narcissism. Pediatrics. Nov 2017;140(Suppl 2):S71-S75. [doi: 10.1542/peds.2016-1758F] [Medline: 29093036]
49. Schou Andreassen C, Billieux J, Griffiths MD, et al. The relationship between addictive use of social media and video
games and symptoms of psychiatric disorders: a large-scale cross-sectional study. Psychol Addict Behav. Mar
2016;30(2):252-262. [doi: 10.1037/adb0000160] [Medline: 26999354]
50. Cerniglia L, Guicciardi M, Sinatra M, Monacis L, Simonelli A, Cimino S. The use of digital technologies, impulsivity
and psychopathological symptoms in adolescence. Behav Sci (Basel). Jul 24, 2019;9(8):82. [doi: 10.3390/bs9080082]
[Medline: 31344851]
51. Monacis L, Palo V de, Griffiths MD, Sinatra M. Validation of the Internet Gaming Disorder Scale - Short-Form (IGDS9-
SF) in an Italian-speaking sample. J Behav Addict. Dec 2016;5(4):683-690. [doi: 10.1556/2006.5.2016.083] [Medline:
27876422]
52. Andreassen CS, Griffiths MD, Gjertsen SR, Krossbakken E, Kvam S, Pallesen S. The relationships between behavioral
addictions and the five-factor model of personality. J Behav Addict. Jun 2013;2(2):90-99. [doi: 10.1556/JBA.2.2013.
003]
53. Monacis L, de Palo V, Griffiths MD, Sinatra M. Exploring individual differences in online addictions: the role of identity
and attachment. Int J Ment Health Addict. 2017;15(4):853-868. [doi: 10.1007/s11469-017-9768-5] [Medline: 28798553]
54. Wang P, Pan R, Wu X, et al. Reciprocal associations between shyness, depression, and internet gaming disorder among
Chinese adolescents: a cross-lagged panel study. Addict Behav. Jun 2022;129(107256):107256. [doi: 10.1016/[Link].
2022.107256] [Medline: 35114630]
55. Alimoradi Z, Lin CY, Broström A, et al. Internet addiction and sleep problems: a systematic review and meta-analysis.
Sleep Med Rev. Oct 2019;47(51-61):51-61. [doi: 10.1016/[Link].2019.06.004] [Medline: 31336284]
56. Pu Y, Liu Y, Qi Y, Yan Z, Zhang X, He Q. Five-week of solution-focused group counseling successfully reduces
internet addiction among college students: a pilot study. J Behav Addict. Dec 22, 2023;12(4):964-971. [doi: 10.1556/
2006.2023.00064] [Medline: 37966485]
57. Cain N, Gradisar M. Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Med. Sep
2010;11(8):735-742. [doi: 10.1016/[Link].2010.02.006] [Medline: 20673649]
58. Dresp-Langley B, Hutt A. Digital Addiction and Sleep. Int J Environ Res Public Health. Jun 5, 2022;19(11):6910. [doi:
10.3390/ijerph19116910] [Medline: 35682491]
59. van den Eijnden R, Koning I, Doornwaard S, van Gurp F, Ter Bogt T. The impact of heavy and disordered use of games
and social media on adolescents’ psychological, social, and school functioning. J Behav Addict. Sep 1,
2018;7(3):697-706. [doi: 10.1556/2006.7.2018.65] [Medline: 30264607]
60. Macur M, Pontes HM. Internet Gaming Disorder in adolescence: investigating profiles and associated risk factors. BMC
Public Health. Aug 12, 2021;21(1):1547. [doi: 10.1186/s12889-021-11394-4] [Medline: 34384394]
61. Jeong H, Yim HW, Lee SY, et al. A partial mediation effect of father-child attachment and self-esteem between parental
marital conflict and subsequent features of internet gaming disorder in children: A 12-month follow-up study. BMC
Public Health. Apr 15, 2020;20(1):484. [doi: 10.1186/s12889-020-08615-7] [Medline: 32293368]
62. Wong RS, Tung KTS, Rao N, et al. Parent technology use, parent-child interaction, child screen time, and child
psychosocial problems among disadvantaged families. J Pediatr. Nov 2020;226:258-265. [doi: 10.1016/[Link].2020.07.
006] [Medline: 32629010]
63. Geurts SM, Koning IM, Vossen H, Van den Eijnden R. A qualitative study on children’s digital media use and parents’
self-interest. J Child Fam Stud. 2022;31(7):2015-2026. [doi: 10.1007/s10826-021-02074-3] [Medline: 34580571]

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 15

(page number not for citation purposes)
JMIR MENTAL HEALTH Han et al

64. Yasuma N, Watanabe K, Nishi D, et al. Urbanization and Internet addiction in A nationally representative sample of
adult community residents in Japan: A cross-sectional, multilevel study. Psychiatry Res. Mar 2019;273:699-705. [doi:
10.1016/[Link].2019.01.094] [Medline: 31207855]
65. Graciyal DG, Viswam D. Social Media and Emotional Well-being: Pursuit of Happiness or Pleasure. Asia Pacific Media
Educator. Jun 2021;31(1):99-115. [doi: 10.1177/1326365X211003737]
66. Firat S, Tek S, Erk MA. Cyber mother’s womb: Social support expectation in social network and emotional violence.
Perspect Psychiatr Care. Oct 2022;58(4):2828-2836. [doi: 10.1111/ppc.13130] [Medline: 35726721]
67. Jackson DB, Testa A, Fox B. Adverse childhood experiences and digital media use among U.S. Children. Am J Prev
Med. Apr 2021;60(4):462-470. [doi: 10.1016/[Link].2020.09.018] [Medline: 33323289]
68. McDool E, Powell P, Roberts J, Taylor K. The internet and children’s psychological wellbeing. J Health Econ. Jan
2020;69(102274):102274. [doi: 10.1016/[Link].2019.102274] [Medline: 31887480]
69. Yeun YR, Han SJ. Effects of psychosocial interventions for school-aged children’s internet addiction, self-control and
self-esteem: Meta-analysis. Healthc Inform Res. Jul 2016;22(3):217-230. [doi: 10.4258/hir.2016.22.3.217] [Medline:
27525163]
70. Viechtbauer W. Publication bias in meta-analysis: Prevention, assessment and adjustments. Psychometrika.
2007;72(2):269-271. [doi: 10.1007/s11336-006-1450-y]
71. Malak MZ, Shuhaiber AH, Alsswey A, Tarawneh A. Social support as the mediator for the relationship between internet
gaming disorder and psychological problems among university students. J Psychiatr Res. Aug
2023;164(243-50):243-250. [doi: 10.1016/[Link].2023.06.007] [Medline: 37385003]
72. Ioannidis JPA, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. Jun
21, 2008;336(7658):1413-1415. [doi: 10.1136/bmj.a117] [Medline: 18566080].

Abbreviations
AMSTAR 2: A Measurement Tool to Assess Systematic Reviews 2
GRADE: Grading of Recommendations Assessment, Development, and Evaluation
JBI checklist: Joanna Briggs Institution Critical Appraisal Checklist
NOS: New Castle-Ottawa scale
OR: odds ratio
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SSE: small study effect

Edited by John Torous; peer-reviewed by Dilek Yıldırım Gürkan, Xianpeng Xu, Zhide Liang; submitted 27.09.2024; final
revised version received 21.03.2025; accepted 06.04.2025; published 28.07.2025

Please cite as:

Han Y, Qiu J, Shi C, Huang S, Huang H, Wang X, Zhu S, Lu DL, Lu P, Zeng F
Factors Associated With Digital Addiction: Umbrella Review
JMIR Ment Health 2025;12:e66950
URL: [Link]
doi: 10.2196/66950

© Yun Han, Jiamin Qiu, Chengbin Shi, Shiqi Huang, Haokun Huang, Xinman Wang, Sui Zhu, Dalin Lu, Peng Lu, Fang-
fang Zeng. Originally published in JMIR Mental Health ([Link] 28.07.2025. This is an open-access article
distributed under the terms of the Creative Commons Attribution License ([Link]
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in
JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://
[Link]/, as well as this copyright and license information must be included.

[Link] JMIR Ment Health 2025 | vol. 12 | e66950 | p. 16

(page number not for citation purposes)