Problematic internet use and depression among healthcare students in Macau: the mediating role of insomnia

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BACKGROUND: Depression is common in healthcare students, severely affecting their academic performance and daily life. Problematic internet use and insomnia are related to depression, yet underlying mechanisms remain unclear in Macau, China. This study aims to explore associations among problematic internet use, insomnia, and depression, and to examine the mediating role of insomnia. METHODS: This cross-sectional study was implemented during January and February 2025. Two hundred and sixty-four healthcare students in Macau completed self-report questionnaires on sociodemographic variables, problematic internet use, insomnia, and depression using an online platform. Model 4 of the PROCESS macro was applied to explore the mediating effect. RESULTS: In this study, 40.2%, 18.6%, 6.4% and 3.4% of Macau healthcare students sustained mild, moderate, moderately severe, and severe depression, respectively. Problematic internet use was positively correlated with insomnia (r = 0.363, p < 0.001) and depression (r = 0.484, p < 0.001). Insomnia and depression were positively correlated (r = 0.666, p < 0.001). Insomnia served as a partial mediator between problematic internet use and depression, accounting for 35.6% of the total effect (95% Boot CI: 0.027-0.082). CONCLUSIONS: Depression is prevalent among Macau healthcare students. Improving sleep quality may reduce depression in students with problematic internet use. Clinical focus should shift toward assessing and treating insomnia as a core component of care for students with problematic internet use.

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