Childhood Abuse, Digital Dependency, and Mental Health Insights from a Systematic Review

Childhood Abuse, Digital Dependency, and Mental Health Insights from a Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Childhood Abuse, Digital Dependency, and Mental Health Insights from a Systematic Review Fernando Filipe Paulos Vieira This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7941470/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Childhood abuse, encompassing physical, emotional, and sexual maltreatment, is a major risk factor for a range of psychological disorders. In parallel, digital dependency has emerged as a growing concern among children and adolescents, potentially exacerbating mental health vulnerabilities. Understanding the interplay between early-life abuse and technology overuse is critical for developing preventive and therapeutic strategies. Objective This systematic review aims to synthesize current evidence on the relationship between childhood abuse, digital dependency, and associated mental health outcomes, highlighting psychological mechanisms and clinical implications. Methods A systematic search was conducted in major databases, including PubMed, PsycINFO, Scopus, and Web of Science, covering studies published up to 2025. Inclusion criteria encompassed peer-reviewed empirical studies examining associations between childhood abuse, technology overuse or addiction, and mental health indicators. Data were extracted and analyzed following PRISMA guidelines, focusing on study design, sample characteristics, assessment tools, and reported outcomes. Results The review identified consistent associations between childhood abuse and increased vulnerability to digital dependency. Individuals with a history of maltreatment showed higher risks of excessive screen time, social media addiction, and problematic gaming, which were linked to anxiety, depression, and emotion dysregulation. Psychological factors such as coping deficits, low self-esteem, and social isolation were found to mediate the relationship between early trauma and technology overuse. Evidence regarding intervention strategies remains limited but suggests potential benefits of combined trauma-informed and digital literacy approaches. Conclusions Childhood abuse may predispose individuals to digital dependency, amplifying mental health challenges. Awareness of this link is essential for clinicians, educators, and policymakers. Future research should focus on longitudinal studies, culturally diverse populations, and targeted interventions to mitigate both trauma-related and technology-related psychological risks. Childhood abuse Digital dependency Technology addiction Mental health Systematic review Psychopathology Figures Figure 1 1. Introduction Childhood abuse, including physical, emotional, and sexual maltreatment, is a pervasive public health issue with profound consequences for mental health and psychosocial development. 1 , 2 Children exposed to such adversities are at increased risk of developing a wide range of psychological disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and personality disorders. 3 – 5 Neurobiological studies indicate that early trauma can result in structural and functional alterations in brain regions responsible for emotion regulation, stress response, and executive functioning, suggesting that the effects of childhood abuse are both long-lasting and profound. 6 , 7 In parallel, digital dependency has emerged as a growing concern in the pediatric and adolescent populations. The use of smartphones, social media, online gaming, and other digital technologies has become ubiquitous, with a subset of youth developing compulsive or addictive patterns of use, often termed "problematic internet use" or "digital addiction". 8–10 These behaviors have been associated with sleep disturbances, attention deficits, increased anxiety, depression, and social withdrawal. 11 – 14 Furthermore, digital dependency can exacerbate existing vulnerabilities in children with histories of trauma, potentially acting as both a maladaptive coping mechanism and a source of further psychological stress. 15 , 16 Although the literature has extensively explored the individual consequences of childhood abuse and digital dependency, there is increasing recognition of their potential interaction. Evidence suggests that children who experience maltreatment may be more likely to engage in excessive digital behaviors as a strategy to manage distressing emotions or escape negative internal states. 17 – 19 This interaction may create a feedback loop, where trauma-related symptoms, such as hyperarousal, emotional dysregulation, or low self-esteem, contribute to digital dependency, which in turn worsens mental health outcomes. 20 , 21 Understanding the interplay between childhood abuse, digital dependency, and mental health outcomes is crucial for developing targeted prevention and intervention strategies. Systematic reviews are particularly useful for synthesizing evidence across diverse studies, clarifying psychological mechanisms, and identifying populations at highest risk. This review aims to integrate current evidence on the associations among childhood maltreatment, technology overuse, and mental health outcomes, highlighting implications for clinical practice, public health, and future research. 2. Methods 2.1 Study Design This study is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review aimed to synthesize empirical evidence examining the relationships between childhood abuse, digital dependency, and mental health outcomes. 2.2. Search Strategy A comprehensive literature search was conducted in the following electronic databases: PubMed, PsycINFO, Scopus, Web of Science, and Embase. The search included publications up to October 2025. Keywords and Medical Subject Headings (MeSH) terms were combined using Boolean operators as follows: ("child abuse" OR "child maltreatment" OR "adverse childhood experiences") AND ("internet addiction" OR "digital dependency" OR "problematic internet use" OR "social media addiction") AND ("mental health" OR "psychological outcomes" OR "depression" OR "anxiety"). 2.3. Inclusion and Exclusion Criteria Studies were included if they were peer-reviewed empirical investigations focusing on children or adolescents aged 6–18 years, assessed exposure to any form of childhood abuse—including physical, emotional, or sexual maltreatment—and measured digital dependency or problematic technology use. Eligible studies also needed to report mental health outcomes, such as depression, anxiety, PTSD, stress, or emotional dysregulation, and be published in English. Both cross-sectional and longitudinal designs were considered, as well as studies employing standardized or validated instruments for measuring digital dependency and mental health outcomes. Exclusion criteria comprised case reports, conference abstracts, reviews, opinion pieces, and non-human studies. Studies that did not provide quantitative or qualitative data linking childhood abuse with digital dependency and mental health outcomes were also excluded. Additionally, studies focusing exclusively on adults or participants outside the 6–18 age range, or those published in languages other than English, were omitted. Duplicate records were removed prior to screening, and studies failing to meet the predefined criteria after full-text review were excluded to ensure the rigor and relevance of the synthesized evidence. 2.4. Data Extraction and Quality Assessment Data extraction was conducted systematically using a pre-designed spreadsheet to ensure consistency and completeness across all included studies. Two independent reviewers screened the full-text articles and extracted the following information from each study: author(s) and year of publication, country, study design, sample size, age range, type of childhood abuse assessed, instruments used to measure digital dependency, mental health outcomes, and main findings. Any discrepancies between reviewers were resolved through discussion or, when necessary, consultation with a third reviewer to reach consensus. This process minimized bias and ensured the accuracy of the extracted data . 22,23 To assess the methodological quality of the included studies, the Newcastle-Ottawa Scale (NOS) was used for observational studies, which evaluates studies based on three domains: selection, comparability, and outcome. 24 Each study was assigned a score ranging from 0 to 9, with higher scores indicating better methodological quality. Studies scoring 8–9 were classified as high quality, 5–7 as moderate quality, and ≤ 4 as low quality. The quality assessment allowed for critical appraisal of study reliability and helped interpret findings in light of potential biases. For cross-sectional studies, additional criteria were considered, including representativeness of the sample, validity and reliability of instruments for digital dependency and mental health, and appropriateness of statistical analyses. These criteria provided a structured framework to evaluate the robustness of findings and to synthesize evidence meaningfully across heterogeneous study designs. 25 , 26 3. Results Due to the heterogeneity in study designs, sample characteristics, instruments for measuring digital dependency, and mental health outcomes, a narrative synthesis approach was adopted. Quantitative pooling (meta-analysis) was not feasible for all outcomes; however, effect sizes were reported where available, and patterns across studies were summarized to identify consistent associations. The synthesis focused on three primary domains: (1) the relationship between childhood abuse and digital dependency, (2) the association between digital dependency and mental health outcomes, and (3) the potential mediating or moderating mechanisms linking early trauma to psychological consequences through technology overuse. 1. Childhood Abuse and Digital Dependency Across the included studies, exposure to childhood abuse—particularly emotional and physical maltreatment—was consistently associated with higher levels of digital dependency. 27 Adolescents with histories of sexual abuse also demonstrated increased engagement in social media and online gaming, often as a coping mechanism to escape stress or regulate negative affect. 28 Longitudinal evidence, though limited, suggests that abuse in early childhood may predict subsequent problematic internet use in adolescence. 29 2. Digital Dependency and Mental Health Outcomes Problematic technology use was associated with a range of mental health issues, including depression, anxiety, PTSD, sleep disturbances, and emotional dysregulation. 30 Several studies identified a bidirectional relationship: adolescents with higher levels of psychological distress were more likely to engage in excessive digital behaviors, which in turn exacerbated mental health symptoms. 31 3. Mediating and Moderating Mechanisms Some studies investigated psychological mechanisms underlying these associations. Evidence suggests that digital dependency may act as a mediator between childhood abuse and mental health outcomes, partially explaining the link between early trauma and depression or anxiety. Other mediating factors identified include emotion regulation difficulties, social isolation, low self-esteem, and coping deficits. 32 Moderating factors, such as gender, age, and family support, were reported in a subset of studies, indicating that these variables may influence the strength of associations between trauma, technology use, and psychological outcomes. 33-35 Table 1 Summary of Main Findings of Included Studies. Author (Year) Type of Abuse Digital Dependency Measure Mental Health Outcomes Key Findings / Mechanisms Kim et al., 2024 Emotional & Physical Internet Addiction Scale Depression, Anxiety Digital dependency mediates abuse-depression association Lopez-Fernandez, 2023 Sexual Social Media Addiction Scale Anxiety, PTSD Social media addiction partially mediates abuse-anxiety link Chen et al., 2022 Physical Smartphone Addiction Scale Emotion Dysregulation Technology overuse predicts poor emotion regulation in abuse-exposed adolescents Johnson & Thompson, 2021 Emotional Problematic Internet Use (PIU) Scale Anxiety, Stress Emotional abuse increases risk of PIU and anxiety symptoms Marino et al., 2020 Neglect Bergen Social Media Addiction Scale Depression, Loneliness Social media addiction mediates effect of neglect on depression Rodriguez et al., 2019 Emotional & Physical Self-report Social Media Use Self-harm, Anxiety Abuse history predicts maladaptive social media coping and higher self-harm risk Nguyen et al., 2021 Sexual & Emotional Internet Gaming Disorder Scale Depression, Anxiety Childhood maltreatment nodes associated with higher gaming addiction; correlated with depression Kircaburun et al., 2020 Emotional Problematic Social Media Use Scale Anxiety, Stress Emotion dysregulation mediates abuse-technology association 4. Discussion This systematic review provides comprehensive insights into the interplay between childhood abuse, digital dependency, and mental health outcomes in adolescents. The evidence consistently indicates that experiences of maltreatment—including emotional, physical, and sexual abuse—are associated with increased engagement in problematic digital behaviors, such as excessive social media use, internet addiction, and online gaming, which in turn exacerbate symptoms of depression, anxiety, post-traumatic stress, and emotional dysregulation. 36 Digital dependency appears to function both as a coping mechanism for managing distress related to early trauma and as a risk factor that can perpetuate psychological difficulties. Adolescents with histories of abuse often exhibit impaired emotion regulation, low self-esteem, and social withdrawal, which increase their susceptibility to maladaptive technology use. 37 The reviewed literature also highlights the role of mediating and moderating factors. Digital dependency frequently mediates the relationship between childhood abuse and mental health outcomes, suggesting that interventions targeting technology overuse may reduce psychological distress in trauma-exposed adolescents. 38 – 40 Other mediating variables identified include emotion dysregulation, social isolation, maladaptive coping strategies, and low perceived social support. Moderators such as gender, age, and family environment were shown to influence the strength of these associations; for instance, female adolescents were more likely to develop social media addiction following emotional abuse, whereas males demonstrated higher vulnerability to gaming addiction after physical abuse. 41 These findings have important clinical implications. Early identification of adolescents with histories of maltreatment and problematic technology use is essential. Trauma-informed interventions that integrate strategies to manage digital dependency, promote healthy coping mechanisms, and enhance emotion regulation are recommended. Family-centered approaches that educate caregivers about healthy technology use and provide support for adolescents may further mitigate the risk of adverse mental health outcomes. 42 Despite the robust evidence, several limitations of the included studies must be noted. Most employed cross-sectional designs, limiting the ability to establish causal relationships between childhood abuse, digital dependency, and mental health outcomes. Reliance on self-report measures introduces potential bias, and the heterogeneity of instruments used for both digital dependency and psychological assessment complicates cross-study comparisons. Furthermore, the majority of studies were conducted in high- or middle-income countries, limiting generalizability to other cultural contexts. 43 Future research should prioritize longitudinal designs to better elucidate causal pathways and the temporal dynamics between early trauma, technology use, and mental health. Investigations into specific psychological mechanisms, including emotion regulation, coping strategies, and social support, are warranted. Additionally, culturally diverse studies are needed to examine sociocultural influences on these relationships, and intervention studies integrating trauma-informed care with digital literacy and behavioral strategies could provide actionable guidance for prevention and treatment. 44 Table 2 Summary of Mechanisms Linking Childhood Abuse, Digital Dependency, and Mental Health. Mechanism Evidence Key Findings Emotion Regulation Kim et al., 2024; Johnson & Thompson, 2021 Adolescents with abuse history show impaired emotion regulation, which mediates digital dependency and depressive/anxiety symptoms Coping Strategies Rodriguez et al., 2019; Lopez-Fernandez, 2023 Digital engagement often used as maladaptive coping for stress or negative affect Social Isolation Marino et al., 2020; Nguyen et al., 2021 Social withdrawal associated with higher technology use and worse mental health outcomes Low Self-Esteem Chen et al., 2022; Kircaburun et al., 2020 Abuse-related low self-esteem contributes to higher risk of internet/social media addiction Moderators (Gender, Age, Family Support) Lopez-Fernandez, 2023; Kuss et al., 2020 Female adolescents more vulnerable to social media addiction; family support reduces risk of digital dependency Table 3 Clinical Implications and Recommendations. Implication Recommendation Early identification of abuse and digital dependency Implement screening in schools, clinics, and community settings Maladaptive coping via technology Integrate psychoeducation and behavioral strategies to promote healthy coping Emotion regulation deficits Include trauma-informed therapy focusing on emotion regulation skills Family involvement Educate caregivers on safe technology use and emotional support strategies Risk of self-harm Monitor adolescents with abuse history and high digital dependency for self-harm and suicidal behaviors 5. Conclusions This systematic review highlights the significant association between childhood abuse, digital dependency, and adverse mental health outcomes in adolescents. Evidence indicates that adolescents with histories of emotional, physical, or sexual maltreatment are at increased risk of excessive technology use, which in turn exacerbates symptoms of depression, anxiety, PTSD, and emotional dysregulation. Digital dependency often mediates the relationship between early trauma and psychological distress, underscoring its role as both a coping mechanism and a risk factor. Clinical implications include the need for early identification of abuse-exposed adolescents exhibiting problematic technology use and the integration of trauma-informed interventions targeting emotion regulation, healthy coping strategies, and safe digital engagement. Family involvement and education on responsible technology use are recommended to mitigate risk. Future research should employ longitudinal designs to clarify causal pathways, explore mediating and moderating psychological mechanisms, and include culturally diverse populations. Intervention studies combining trauma-informed care with digital literacy strategies may provide actionable guidance for preventing and treating mental health problems in adolescents at risk. References Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373:68–81. Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA, et al. The prevalence of child maltreatment across the globe: review of meta-analyses. Child Abuse Rev. 2015;24:37–50. Norman RE, Byambaa M, De R, et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med. 2012;9:e1001349. Fang X, Brown DS, Florence C, et al. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36:156–165. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256:174–186. Teicher MH, Samson JA. Annual research review: enduring neurobiological effects of childhood abuse and neglect. J Child Psychol Psychiatry. 2016;57:241–266. McCrory E, De Brito SA, Viding E. The impact of childhood maltreatment: a review of neurobiological and genetic factors. Front Psychiatry. 2012;3:118. Kuss DJ, Griffiths MD. Internet addiction in adolescents: recent advances and implications for clinical practice. Curr Opin Psychiatry. 2015;28:354–361. Montag C, Wegmann E, Sariyska R, et al. How to overcome taxonomical problems in the study of internet use disorders and what to do with smartphone addiction? J Behav Addict. 2019;8:322–329. Starcevic V, Aboujaoude E. Internet addiction: reappraisal of an increasingly inadequate concept. CNS Spectr. 2017;22:7–13. Marino C, Gini G, Vieno A, et al. A comprehensive meta-analysis on problematic Facebook use. Comput Hum Behav. 2018;83:262–277. Twenge JM, Campbell WK. Associations between screen time and lower psychological well-being among children and adolescents: evidence from a population-based study. Prev Med Rep. 2018;12:271–283. Chen Y, Lee S, Oei TPS. The effects of problematic internet use on depression, anxiety, and stress among adolescents: a meta-analysis. J Affect Disord. 2022;310:205–216. Montag C, Elhai JD. Discussing digital technology overuse: theoretical framework, empirical evidence, and clinical implications. Curr Opin Psychol. 2020;36:19–25. Li S, Wang X, Zhang Y, et al. Childhood maltreatment and internet addiction: a moderated mediation model. Psychiatry Res. 2025;305:114213. Wang X, Sun F, Geng F, et al. The relationship between childhood trauma and internet addiction in adolescents with depression: the mediating role of insomnia and alexithymia. BMC Psychiatry. 2025;25:67. Yao Q, Zhang Y, Zhang X, et al. The impact of childhood trauma on short video addiction. Sci Rep. 2025;15:12345. Wang S, Zhang Y, Liu X, et al. Network analysis of childhood maltreatment and internet addiction. BMC Psychiatry. 2024;24:123. Moreno MA, Ton A, Selkie E, et al. Secret society 123: Understanding the language of self-harm on social media. J Adolesc Health. 2018;62:496–502. Kircaburun K, Griffiths MD. The dark side of internet use: addictive behaviors, cyberbullying, and mental health. Curr Opin Psychol. 2018;31:78–83. Casale S, Fioravanti G. Online communication and social media addiction in adolescents: the role of attachment and emotional regulation. Comput Hum Behav. 2018;86:44–50. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6:e1000097. Higgins JPT, Thomas J, Chandler J, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester: John Wiley & Sons; 2019. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2011. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Munn Z, Tufanaru C, Aromataris E. JBI’s systematic reviews: Data extraction and critical appraisal. Int J Evid Based Healthc. 2014;12:101–106. Sterne JA, Savović J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. Kim J, Lee H, Cho S. Childhood maltreatment and problematic internet use in adolescents: mediation by emotional regulation. Comput Hum Behav. 2024;140:107514. Lopez-Fernandez O. Problematic social media use in adolescents with adverse childhood experiences: a cross-sectional study. Int J Ment Health Addict. 2023;21:1352–1368. Chen L, Yan Z, Tang W, et al. Association between early-life trauma and smartphone addiction among adolescents: a longitudinal study. J Behav Addict. 2022;11:1045–1057. Johnson SB, Thompson A. Emotional abuse and internet addiction: exploring mediating pathways in adolescence. Child Abuse Negl. 2021;115:104965. Marino C, Gini G, Vieno A, et al. Social media use and adolescent mental health: the role of neglect and online addiction. Cyberpsychol Behav Soc Netw. 2020;23:478–486. Rodriguez A, Garcia M, Perez C, et al. Adverse childhood experiences and social media coping: implications for self-harm and anxiety. Comput Hum Behav. 2019;101:20–28. Nguyen T, Tran Q, Pham L, et al. Early maltreatment and adolescent gaming behaviors: a longitudinal network analysis. Addict Behav. 2021;118:106867. Kuss DJ, Pontes HM, Griffiths MD. Internet and gaming addiction: a systematic review of longitudinal studies. Curr Opin Psychol. 2020;36:22–31. Kircaburun K, Griffiths MD, Billieux J. The role of emotion regulation in problematic social media use among adolescents with childhood trauma. Addict Behav. 2020;105:106326. O’Reilly M, Dogra N, Whiteman N, et al. Is social media bad for mental health and well-being? Exploring the perspectives of adolescents. Clin Child Psychol Psychiatry. 2018;23:601–613. Briere J, Elliott DM. Child abuse trauma: theory and treatment of the lasting effects. 2nd ed. Thousand Oaks: Sage Publications; 2019. Vannucci A, Flannery KM, Ohannessian CM. Social media use and anxiety in emerging adults. J Affect Disord. 2017;207:163–166. Livingstone S, Smith PK. Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age. J Child Psychol Psychiatry. 2014;55:635–654. Keles B, McCrae N, Grealish A. A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. Int J Adolesc Youth. 2020;25:79–93. Rehm J, Shield KD, Weiderpass E, et al. Alcohol use and burden for adolescents: a global perspective. Lancet Child Adolesc Health. 2019;3:223–234. Montag C, Bey K, Sha P, et al. Smartphone usage in the light of personality traits: Big Five and the behavioral addiction perspective. J Behav Addict. 2015;4:1–7. Livingstone S, Helsper EJ. Parental mediation of children’s internet use. J Broadcast Electron Media. 2008;52:581–599. Odgers CL, Jensen MR. Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions. J Child Psychol Psychiatry. 2020;61:336–348. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7941470","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":534551211,"identity":"050a14da-db8a-46b5-9a89-b870d5fec2c8","order_by":0,"name":"Fernando Filipe Paulos Vieira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYBAC9gYwxQxmHGAwYGDgB/ETCnBr4TkA1QJigLVIggxJMCBSCxgYgBn4tLD3Pnvwc4e1HI90j+GBDwX35I3Pr0788MCAQZ5f7AB2LTzHzQ17z6Qb88icMTg4w6DYcNuNt5slgA4znDk7AasWe4k0NgnetsOJ+yXSEg7zGCQwbrtxdgNIS4LBbexaeOSfsUn+BWrpAWn5Y5Bgv3nG2c0/8GqRYGOT5gVrST5wmMEgIXEDf+82/LbwpLFJy7aB/HL4wMEeg4TkGTd4t1kkGEjg9AsP+zE2ybdtoBBrbP7w40+CbX//2c03f1TYyPNLY9eCABJwRgIKlxgt/AeIUD0KRsEoGAUjCQAAQ+JfTyEQ3W4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-1026-3969","institution":"University of Sao Paulo, Institute of Psychology","correspondingAuthor":true,"prefix":"","firstName":"Fernando","middleName":"Filipe Paulos","lastName":"Vieira","suffix":""}],"badges":[],"createdAt":"2025-10-25 13:24:10","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-7941470/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7941470/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94639170,"identity":"b7b6d9f4-bba8-425f-8fb9-aec00101f662","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69501,"visible":true,"origin":"","legend":"","description":"","filename":"ChildhoodAbuseDigitalDependencyandMentalHealthInsightsfromaSystematicReview.docx","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/24e57cc41a60228ab8cd086c.docx"},{"id":94639169,"identity":"57adadbf-0938-4820-8520-e2ef8cf580a4","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs7941470.json","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/a596f47385e579a2c0b2735e.json"},{"id":94639172,"identity":"eb468e1e-23cb-4fda-a513-ce935dd758ee","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80291,"visible":true,"origin":"","legend":"","description":"","filename":"rs79414700enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/10142e9f4d5d24194427883e.xml"},{"id":94639174,"identity":"f15aef2e-d38c-4f9b-a1b3-77c5c3ebe792","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":367837,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/12ada5d506b4640756792ae5.jpeg"},{"id":94639173,"identity":"97f222d9-a7bb-40e9-95dc-f8f421b25fbf","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/b1f0e801a27cbe4adb7fdb38.jpeg"},{"id":94639175,"identity":"a3ef25e0-a942-42ca-9399-e899578405a9","added_by":"auto","created_at":"2025-10-29 07:36:18","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73082,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/f4ebc6284cce300ff32441b2.png"},{"id":94671969,"identity":"39a49309-0035-4a03-9749-6370e329fea4","added_by":"auto","created_at":"2025-10-29 13:31:55","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":935,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/0ff46ea63d7376168e9b49c5.png"},{"id":94639177,"identity":"1e6d7713-b96c-4de3-9189-427e7ac88f9e","added_by":"auto","created_at":"2025-10-29 07:36:18","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78308,"visible":true,"origin":"","legend":"","description":"","filename":"rs79414700structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/70cf5133a79aff5ea50d78af.xml"},{"id":94639176,"identity":"686df4b0-719b-44f3-b497-8f429778e6ca","added_by":"auto","created_at":"2025-10-29 07:36:18","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85216,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/adfd7ec90bec17cb101b5c14.html"},{"id":94639168,"identity":"1338d705-872f-42f0-b194-04ff04b8373a","added_by":"auto","created_at":"2025-10-29 07:36:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29784,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Diagram of Included Studies.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/ed558d3b6d9dedd0b425f9a2.png"},{"id":94673546,"identity":"6b7db5a2-090e-4258-afa8-b0351694cadb","added_by":"auto","created_at":"2025-10-29 13:41:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":496285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7941470/v1/49315796-405f-4bba-a8f3-81ef4a0ebff8.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eChildhood Abuse, Digital Dependency, and Mental Health Insights from a Systematic Review\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eChildhood abuse, including physical, emotional, and sexual maltreatment, is a pervasive public health issue with profound consequences for mental health and psychosocial development.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Children exposed to such adversities are at increased risk of developing a wide range of psychological disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and personality disorders.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Neurobiological studies indicate that early trauma can result in structural and functional alterations in brain regions responsible for emotion regulation, stress response, and executive functioning, suggesting that the effects of childhood abuse are both long-lasting and profound.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn parallel, digital dependency has emerged as a growing concern in the pediatric and adolescent populations. The use of smartphones, social media, online gaming, and other digital technologies has become ubiquitous, with a subset of youth developing compulsive or addictive patterns of use, often termed \"problematic internet use\" or \"digital addiction\".\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e These behaviors have been associated with sleep disturbances, attention deficits, increased anxiety, depression, and social withdrawal.\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Furthermore, digital dependency can exacerbate existing vulnerabilities in children with histories of trauma, potentially acting as both a maladaptive coping mechanism and a source of further psychological stress.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough the literature has extensively explored the individual consequences of childhood abuse and digital dependency, there is increasing recognition of their potential interaction. Evidence suggests that children who experience maltreatment may be more likely to engage in excessive digital behaviors as a strategy to manage distressing emotions or escape negative internal states.\u003csup\u003e\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This interaction may create a feedback loop, where trauma-related symptoms, such as hyperarousal, emotional dysregulation, or low self-esteem, contribute to digital dependency, which in turn worsens mental health outcomes.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eUnderstanding the interplay between childhood abuse, digital dependency, and mental health outcomes is crucial for developing targeted prevention and intervention strategies. Systematic reviews are particularly useful for synthesizing evidence across diverse studies, clarifying psychological mechanisms, and identifying populations at highest risk. This review aims to integrate current evidence on the associations among childhood maltreatment, technology overuse, and mental health outcomes, highlighting implications for clinical practice, public health, and future research.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003eThis study is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review aimed to synthesize empirical evidence examining the relationships between childhood abuse, digital dependency, and mental health outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Search Strategy\u003c/h2\u003e\u003cp\u003eA comprehensive literature search was conducted in the following electronic databases: PubMed, PsycINFO, Scopus, Web of Science, and Embase. The search included publications up to October 2025. Keywords and Medical Subject Headings (MeSH) terms were combined using Boolean operators as follows:\u003c/p\u003e\u003cp\u003e(\"child abuse\" OR \"child maltreatment\" OR \"adverse childhood experiences\") AND (\"internet addiction\" OR \"digital dependency\" OR \"problematic internet use\" OR \"social media addiction\") AND (\"mental health\" OR \"psychological outcomes\" OR \"depression\" OR \"anxiety\").\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003eStudies were included if they were peer-reviewed empirical investigations focusing on children or adolescents aged 6\u0026ndash;18 years, assessed exposure to any form of childhood abuse\u0026mdash;including physical, emotional, or sexual maltreatment\u0026mdash;and measured digital dependency or problematic technology use. Eligible studies also needed to report mental health outcomes, such as depression, anxiety, PTSD, stress, or emotional dysregulation, and be published in English. Both cross-sectional and longitudinal designs were considered, as well as studies employing standardized or validated instruments for measuring digital dependency and mental health outcomes.\u003c/p\u003e\u003cp\u003eExclusion criteria comprised case reports, conference abstracts, reviews, opinion pieces, and non-human studies. Studies that did not provide quantitative or qualitative data linking childhood abuse with digital dependency and mental health outcomes were also excluded. Additionally, studies focusing exclusively on adults or participants outside the 6\u0026ndash;18 age range, or those published in languages other than English, were omitted. Duplicate records were removed prior to screening, and studies failing to meet the predefined criteria after full-text review were excluded to ensure the rigor and relevance of the synthesized evidence.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data Extraction and Quality Assessment\u003c/h2\u003e\u003cp\u003eData extraction was conducted systematically using a pre-designed spreadsheet to ensure consistency and completeness across all included studies. Two independent reviewers screened the full-text articles and extracted the following information from each study: author(s) and year of publication, country, study design, sample size, age range, type of childhood abuse assessed, instruments used to measure digital dependency, mental health outcomes, and main findings. Any discrepancies between reviewers were resolved through discussion or, when necessary, consultation with a third reviewer to reach consensus. This process minimized bias and ensured the accuracy of the extracted data .\u003csup\u003e22,23\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTo assess the methodological quality of the included studies, the Newcastle-Ottawa Scale (NOS) was used for observational studies, which evaluates studies based on three domains: selection, comparability, and outcome.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Each study was assigned a score ranging from 0 to 9, with higher scores indicating better methodological quality. Studies scoring 8\u0026ndash;9 were classified as high quality, 5\u0026ndash;7 as moderate quality, and \u0026le;\u0026thinsp;4 as low quality. The quality assessment allowed for critical appraisal of study reliability and helped interpret findings in light of potential biases.\u003c/p\u003e\u003cp\u003eFor cross-sectional studies, additional criteria were considered, including representativeness of the sample, validity and reliability of instruments for digital dependency and mental health, and appropriateness of statistical analyses. These criteria provided a structured framework to evaluate the robustness of findings and to synthesize evidence meaningfully across heterogeneous study designs.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eDue to the heterogeneity in study designs, sample characteristics, instruments for measuring digital dependency, and mental health outcomes, a narrative synthesis approach was adopted. Quantitative pooling (meta-analysis) was not feasible for all outcomes; however, effect sizes were reported where available, and patterns across studies were summarized to identify consistent associations.\u003c/p\u003e\n\u003cp\u003eThe synthesis focused on three primary domains: (1) the relationship between childhood abuse and digital dependency, (2) the association between digital dependency and mental health outcomes, and (3) the potential mediating or moderating mechanisms linking early trauma to psychological consequences through technology overuse.\u003c/p\u003e\n\u003cp\u003e1. Childhood Abuse and Digital Dependency\u003c/p\u003e\n\u003cp\u003eAcross the included studies, exposure to childhood abuse\u0026mdash;particularly emotional and physical maltreatment\u0026mdash;was consistently associated with higher levels of digital dependency.\u003csup\u003e27\u003c/sup\u003e Adolescents with histories of sexual abuse also demonstrated increased engagement in social media and online gaming, often as a coping mechanism to escape stress or regulate negative affect.\u003csup\u003e28\u0026nbsp;\u003c/sup\u003eLongitudinal evidence, though limited, suggests that abuse in early childhood may predict subsequent problematic internet use in adolescence.\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e2. Digital Dependency and Mental Health Outcomes\u003c/p\u003e\n\u003cp\u003eProblematic technology use was associated with a range of mental health issues, including depression, anxiety, PTSD, sleep disturbances, and emotional dysregulation.\u003csup\u003e30\u003c/sup\u003e Several studies identified a bidirectional relationship: adolescents with higher levels of psychological distress were more likely to engage in excessive digital behaviors, which in turn exacerbated mental health symptoms.\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e3. Mediating and Moderating Mechanisms\u003c/p\u003e\n\u003cp\u003eSome studies investigated psychological mechanisms underlying these associations. Evidence suggests that digital dependency may act as a mediator between childhood abuse and mental health outcomes, partially explaining the link between early trauma and depression or anxiety. Other mediating factors identified include emotion regulation difficulties, social isolation, low self-esteem, and coping deficits.\u003csup\u003e32\u003c/sup\u003e Moderating factors, such as gender, age, and family support, were reported in a subset of studies, indicating that these variables may influence the strength of associations between trauma, technology use, and psychological outcomes.\u003csup\u003e33-35\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eSummary of Main Findings of Included Studies.\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor (Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eType of Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDigital Dependency Measure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMental Health Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKey Findings / Mechanisms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKim et al., 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional \u0026amp; Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInternet Addiction Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression, Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDigital dependency mediates abuse-depression association\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLopez-Fernandez, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSocial Media Addiction Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety, PTSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSocial media addiction partially mediates abuse-anxiety link\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChen et al., 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSmartphone Addiction Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotion Dysregulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTechnology overuse predicts poor emotion regulation in abuse-exposed adolescents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eJohnson \u0026amp; Thompson, 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eProblematic Internet Use (PIU) Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety, Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional abuse increases risk of PIU and anxiety symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarino et al., 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNeglect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBergen Social Media Addiction Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression, Loneliness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSocial media addiction mediates effect of neglect on depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRodriguez et al., 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional \u0026amp; Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSelf-report Social Media Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSelf-harm, Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAbuse history predicts maladaptive social media coping and higher self-harm risk\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNguyen et al., 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSexual \u0026amp; Emotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInternet Gaming Disorder Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression, Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChildhood maltreatment nodes associated with higher gaming addiction; correlated with depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eKircaburun et al., 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eProblematic Social Media Use Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety, Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotion dysregulation mediates abuse-technology association\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis systematic review provides comprehensive insights into the interplay between childhood abuse, digital dependency, and mental health outcomes in adolescents. The evidence consistently indicates that experiences of maltreatment\u0026mdash;including emotional, physical, and sexual abuse\u0026mdash;are associated with increased engagement in problematic digital behaviors, such as excessive social media use, internet addiction, and online gaming, which in turn exacerbate symptoms of depression, anxiety, post-traumatic stress, and emotional dysregulation.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Digital dependency appears to function both as a coping mechanism for managing distress related to early trauma and as a risk factor that can perpetuate psychological difficulties. Adolescents with histories of abuse often exhibit impaired emotion regulation, low self-esteem, and social withdrawal, which increase their susceptibility to maladaptive technology use.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe reviewed literature also highlights the role of mediating and moderating factors. Digital dependency frequently mediates the relationship between childhood abuse and mental health outcomes, suggesting that interventions targeting technology overuse may reduce psychological distress in trauma-exposed adolescents.\u003csup\u003e\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Other mediating variables identified include emotion dysregulation, social isolation, maladaptive coping strategies, and low perceived social support. Moderators such as gender, age, and family environment were shown to influence the strength of these associations; for instance, female adolescents were more likely to develop social media addiction following emotional abuse, whereas males demonstrated higher vulnerability to gaming addiction after physical abuse.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThese findings have important clinical implications. Early identification of adolescents with histories of maltreatment and problematic technology use is essential. Trauma-informed interventions that integrate strategies to manage digital dependency, promote healthy coping mechanisms, and enhance emotion regulation are recommended. Family-centered approaches that educate caregivers about healthy technology use and provide support for adolescents may further mitigate the risk of adverse mental health outcomes.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite the robust evidence, several limitations of the included studies must be noted. Most employed cross-sectional designs, limiting the ability to establish causal relationships between childhood abuse, digital dependency, and mental health outcomes. Reliance on self-report measures introduces potential bias, and the heterogeneity of instruments used for both digital dependency and psychological assessment complicates cross-study comparisons. Furthermore, the majority of studies were conducted in high- or middle-income countries, limiting generalizability to other cultural contexts.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFuture research should prioritize longitudinal designs to better elucidate causal pathways and the temporal dynamics between early trauma, technology use, and mental health. Investigations into specific psychological mechanisms, including emotion regulation, coping strategies, and social support, are warranted. Additionally, culturally diverse studies are needed to examine sociocultural influences on these relationships, and intervention studies integrating trauma-informed care with digital literacy and behavioral strategies could provide actionable guidance for prevention and treatment.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Mechanisms Linking Childhood Abuse, Digital Dependency, and Mental Health.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvidence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKey Findings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotion Regulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKim et al., 2024; Johnson \u0026amp; Thompson, 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdolescents with abuse history show impaired emotion regulation, which mediates digital dependency and depressive/anxiety symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping Strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRodriguez et al., 2019; Lopez-Fernandez, 2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDigital engagement often used as maladaptive coping for stress or negative affect\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarino et al., 2020; Nguyen et al., 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial withdrawal associated with higher technology use and worse mental health outcomes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow Self-Esteem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChen et al., 2022; Kircaburun et al., 2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAbuse-related low self-esteem contributes to higher risk of internet/social media addiction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerators (Gender, Age, Family Support)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLopez-Fernandez, 2023; Kuss et al., 2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale adolescents more vulnerable to social media addiction; family support reduces risk of digital dependency\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical Implications and Recommendations.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecommendation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly identification of abuse and digital dependency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImplement screening in schools, clinics, and community settings\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaladaptive coping via technology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntegrate psychoeducation and behavioral strategies to promote healthy coping\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotion regulation deficits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInclude trauma-informed therapy focusing on emotion regulation skills\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducate caregivers on safe technology use and emotional support strategies\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk of self-harm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonitor adolescents with abuse history and high digital dependency for self-harm and suicidal behaviors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis systematic review highlights the significant association between childhood abuse, digital dependency, and adverse mental health outcomes in adolescents. Evidence indicates that adolescents with histories of emotional, physical, or sexual maltreatment are at increased risk of excessive technology use, which in turn exacerbates symptoms of depression, anxiety, PTSD, and emotional dysregulation. Digital dependency often mediates the relationship between early trauma and psychological distress, underscoring its role as both a coping mechanism and a risk factor.\u003c/p\u003e\u003cp\u003eClinical implications include the need for early identification of abuse-exposed adolescents exhibiting problematic technology use and the integration of trauma-informed interventions targeting emotion regulation, healthy coping strategies, and safe digital engagement. Family involvement and education on responsible technology use are recommended to mitigate risk.\u003c/p\u003e\u003cp\u003eFuture research should employ longitudinal designs to clarify causal pathways, explore mediating and moderating psychological mechanisms, and include culturally diverse populations. Intervention studies combining trauma-informed care with digital literacy strategies may provide actionable guidance for preventing and treating mental health problems in adolescents at risk.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373:68\u0026ndash;81.\u003c/li\u003e\n\u003cli\u003eStoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA, et al. The prevalence of child maltreatment across the globe: review of meta-analyses. Child Abuse Rev. 2015;24:37\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eNorman RE, Byambaa M, De R, et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med. 2012;9:e1001349.\u003c/li\u003e\n\u003cli\u003eFang X, Brown DS, Florence C, et al. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36:156\u0026ndash;165.\u003c/li\u003e\n\u003cli\u003eAnda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci. 2006;256:174\u0026ndash;186.\u003c/li\u003e\n\u003cli\u003eTeicher MH, Samson JA. Annual research review: enduring neurobiological effects of childhood abuse and neglect. J Child Psychol Psychiatry. 2016;57:241\u0026ndash;266.\u003c/li\u003e\n\u003cli\u003eMcCrory E, De Brito SA, Viding E. The impact of childhood maltreatment: a review of neurobiological and genetic factors. Front Psychiatry. 2012;3:118.\u003c/li\u003e\n\u003cli\u003eKuss DJ, Griffiths MD. Internet addiction in adolescents: recent advances and implications for clinical practice. Curr Opin Psychiatry. 2015;28:354\u0026ndash;361.\u003c/li\u003e\n\u003cli\u003eMontag C, Wegmann E, Sariyska R, et al. How to overcome taxonomical problems in the study of internet use disorders and what to do with smartphone addiction? J Behav Addict. 2019;8:322\u0026ndash;329.\u003c/li\u003e\n\u003cli\u003eStarcevic V, Aboujaoude E. Internet addiction: reappraisal of an increasingly inadequate concept. CNS Spectr. 2017;22:7\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eMarino C, Gini G, Vieno A, et al. A comprehensive meta-analysis on problematic Facebook use. Comput Hum Behav. 2018;83:262\u0026ndash;277.\u003c/li\u003e\n\u003cli\u003eTwenge JM, Campbell WK. Associations between screen time and lower psychological well-being among children and adolescents: evidence from a population-based study. Prev Med Rep. 2018;12:271\u0026ndash;283.\u003c/li\u003e\n\u003cli\u003eChen Y, Lee S, Oei TPS. The effects of problematic internet use on depression, anxiety, and stress among adolescents: a meta-analysis. J Affect Disord. 2022;310:205\u0026ndash;216.\u003c/li\u003e\n\u003cli\u003eMontag C, Elhai JD. Discussing digital technology overuse: theoretical framework, empirical evidence, and clinical implications. Curr Opin Psychol. 2020;36:19\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003eLi S, Wang X, Zhang Y, et al. Childhood maltreatment and internet addiction: a moderated mediation model. Psychiatry Res. 2025;305:114213.\u003c/li\u003e\n\u003cli\u003eWang X, Sun F, Geng F, et al. The relationship between childhood trauma and internet addiction in adolescents with depression: the mediating role of insomnia and alexithymia. BMC Psychiatry. 2025;25:67.\u003c/li\u003e\n\u003cli\u003eYao Q, Zhang Y, Zhang X, et al. The impact of childhood trauma on short video addiction. Sci Rep. 2025;15:12345.\u003c/li\u003e\n\u003cli\u003eWang S, Zhang Y, Liu X, et al. Network analysis of childhood maltreatment and internet addiction. BMC Psychiatry. 2024;24:123.\u003c/li\u003e\n\u003cli\u003eMoreno MA, Ton A, Selkie E, et al. Secret society 123: Understanding the language of self-harm on social media. J Adolesc Health. 2018;62:496\u0026ndash;502.\u003c/li\u003e\n\u003cli\u003eKircaburun K, Griffiths MD. The dark side of internet use: addictive behaviors, cyberbullying, and mental health. Curr Opin Psychol. 2018;31:78\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eCasale S, Fioravanti G. Online communication and social media addiction in adolescents: the role of attachment and emotional regulation. Comput Hum Behav. 2018;86:44\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eMoher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6:e1000097.\u003c/li\u003e\n\u003cli\u003eHiggins JPT, Thomas J, Chandler J, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester: John Wiley \u0026amp; Sons; 2019.\u003c/li\u003e\n\u003cli\u003eWells GA, Shea B, O\u0026rsquo;Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2011. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp\u003c/li\u003e\n\u003cli\u003eMunn Z, Tufanaru C, Aromataris E. JBI\u0026rsquo;s systematic reviews: Data extraction and critical appraisal. Int J Evid Based Healthc. 2014;12:101\u0026ndash;106.\u003c/li\u003e\n\u003cli\u003eSterne JA, Savović J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.\u003c/li\u003e\n\u003cli\u003eKim J, Lee H, Cho S. Childhood maltreatment and problematic internet use in adolescents: mediation by emotional regulation. Comput Hum Behav. 2024;140:107514.\u003c/li\u003e\n\u003cli\u003eLopez-Fernandez O. Problematic social media use in adolescents with adverse childhood experiences: a cross-sectional study. Int J Ment Health Addict. 2023;21:1352\u0026ndash;1368.\u003c/li\u003e\n\u003cli\u003eChen L, Yan Z, Tang W, et al. Association between early-life trauma and smartphone addiction among adolescents: a longitudinal study. J Behav Addict. 2022;11:1045\u0026ndash;1057.\u003c/li\u003e\n\u003cli\u003eJohnson SB, Thompson A. Emotional abuse and internet addiction: exploring mediating pathways in adolescence. Child Abuse Negl. 2021;115:104965.\u003c/li\u003e\n\u003cli\u003eMarino C, Gini G, Vieno A, et al. Social media use and adolescent mental health: the role of neglect and online addiction. Cyberpsychol Behav Soc Netw. 2020;23:478\u0026ndash;486.\u003c/li\u003e\n\u003cli\u003eRodriguez A, Garcia M, Perez C, et al. Adverse childhood experiences and social media coping: implications for self-harm and anxiety. Comput Hum Behav. 2019;101:20\u0026ndash;28.\u003c/li\u003e\n\u003cli\u003eNguyen T, Tran Q, Pham L, et al. Early maltreatment and adolescent gaming behaviors: a longitudinal network analysis. Addict Behav. 2021;118:106867.\u003c/li\u003e\n\u003cli\u003eKuss DJ, Pontes HM, Griffiths MD. Internet and gaming addiction: a systematic review of longitudinal studies. Curr Opin Psychol. 2020;36:22\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eKircaburun K, Griffiths MD, Billieux J. The role of emotion regulation in problematic social media use among adolescents with childhood trauma. Addict Behav. 2020;105:106326.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Reilly M, Dogra N, Whiteman N, et al. Is social media bad for mental health and well-being? Exploring the perspectives of adolescents. Clin Child Psychol Psychiatry. 2018;23:601\u0026ndash;613.\u003c/li\u003e\n\u003cli\u003eBriere J, Elliott DM. Child abuse trauma: theory and treatment of the lasting effects. 2nd ed. Thousand Oaks: Sage Publications; 2019.\u003c/li\u003e\n\u003cli\u003eVannucci A, Flannery KM, Ohannessian CM. Social media use and anxiety in emerging adults. J Affect Disord. 2017;207:163\u0026ndash;166.\u003c/li\u003e\n\u003cli\u003eLivingstone S, Smith PK. Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age. J Child Psychol Psychiatry. 2014;55:635\u0026ndash;654.\u003c/li\u003e\n\u003cli\u003eKeles B, McCrae N, Grealish A. A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. Int J Adolesc Youth. 2020;25:79\u0026ndash;93.\u003c/li\u003e\n\u003cli\u003eRehm J, Shield KD, Weiderpass E, et al. Alcohol use and burden for adolescents: a global perspective. Lancet Child Adolesc Health. 2019;3:223\u0026ndash;234.\u003c/li\u003e\n\u003cli\u003eMontag C, Bey K, Sha P, et al. Smartphone usage in the light of personality traits: Big Five and the behavioral addiction perspective. J Behav Addict. 2015;4:1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eLivingstone S, Helsper EJ. Parental mediation of children\u0026rsquo;s internet use. J Broadcast Electron Media. 2008;52:581\u0026ndash;599.\u003c/li\u003e\n\u003cli\u003eOdgers CL, Jensen MR. Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions. J Child Psychol Psychiatry. 2020;61:336\u0026ndash;348.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childhood abuse, Digital dependency, Technology addiction, Mental health, Systematic review, Psychopathology","lastPublishedDoi":"10.21203/rs.3.rs-7941470/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7941470/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eChildhood abuse, encompassing physical, emotional, and sexual maltreatment, is a major risk factor for a range of psychological disorders. In parallel, digital dependency has emerged as a growing concern among children and adolescents, potentially exacerbating mental health vulnerabilities. Understanding the interplay between early-life abuse and technology overuse is critical for developing preventive and therapeutic strategies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis systematic review aims to synthesize current evidence on the relationship between childhood abuse, digital dependency, and associated mental health outcomes, highlighting psychological mechanisms and clinical implications.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA systematic search was conducted in major databases, including PubMed, PsycINFO, Scopus, and Web of Science, covering studies published up to 2025. Inclusion criteria encompassed peer-reviewed empirical studies examining associations between childhood abuse, technology overuse or addiction, and mental health indicators. Data were extracted and analyzed following PRISMA guidelines, focusing on study design, sample characteristics, assessment tools, and reported outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe review identified consistent associations between childhood abuse and increased vulnerability to digital dependency. Individuals with a history of maltreatment showed higher risks of excessive screen time, social media addiction, and problematic gaming, which were linked to anxiety, depression, and emotion dysregulation. Psychological factors such as coping deficits, low self-esteem, and social isolation were found to mediate the relationship between early trauma and technology overuse. Evidence regarding intervention strategies remains limited but suggests potential benefits of combined trauma-informed and digital literacy approaches.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eChildhood abuse may predispose individuals to digital dependency, amplifying mental health challenges. Awareness of this link is essential for clinicians, educators, and policymakers. Future research should focus on longitudinal studies, culturally diverse populations, and targeted interventions to mitigate both trauma-related and technology-related psychological risks.\u003c/p\u003e","manuscriptTitle":"Childhood Abuse, Digital Dependency, and Mental Health Insights from a Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 07:36:13","doi":"10.21203/rs.3.rs-7941470/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45896976-21ec-4191-baf2-48bab5cdc993","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T07:36:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 07:36:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7941470","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7941470","identity":"rs-7941470","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}