Study flow and final analytic retention
The results demonstrate the execution of the standardized questionnaire workflow rather than independent validation of the Internet addiction test or the DERS-16. During the 14-day survey window, 520 university students were invited to participate, and 480 questionnaires were returned. Screening was conducted in the prespecified order. First, 8 duplicate submissions were removed, followed by 9 questionnaires with a completion time of less than 180 s, 4 questionnaires that failed the directed-response attention-check item, 3 questionnaires showing patterned responding, 2 questionnaires with logical inconsistency, and 2 questionnaires with missing core data. After completion of the full screening sequence, 452 valid questionnaires were retained in the final analytic dataset. The final retention rate was 94.2% among returned questionnaires and 86.9% among invited students. The questionnaire flow from invitation to final analytic retention is presented in Figure 1.
Participant characteristics
The final analytic sample included 452 students, with a mean age of 20.41 ± 1.58 years. Female respondents constituted the larger share of the sample, including 279 female students, 167 male students, and 6 students selecting “prefer not to say.” Participants were drawn from all academic years and multiple disciplines, with second- and third-year students accounting for the largest proportions. Most respondents lived in on-campus dormitories, and monthly living expenses were concentrated in the 1,000–1,999 and 2,000–2,999 categories. The retained sample also showed substantial routine internet exposure. On weekdays, the distribution was centered mainly in the 2–3.9 h and 4–5.9 h categories, whereas weekend use shifted upward, with 322 of 452 students reporting at least 4 h per day. Smartphone access was the dominant access mode. The most frequently reported primary online activities were social media, entertainment/video, and study-related use. Late-night use after 23:00 was common, with 228 of 452 students reporting late-night use on at least 3 nights per week. Sleep duration was concentrated between 6 and 7.9 h, physical activity most often fell in the 1–2 sessions per week category, and moderate academic stress was the modal response. The demographic and behavioral profile of the retained sample is shown in Table 3.
| Characteristic | Category | n | % |
| Sex | Male | 167 | 36.9 |
| Female | 279 | 61.7 |
| Prefer not to say | 6 | 1.3 |
| Academic year | First year | 88 | 19.5 |
| Second year | 124 | 27.4 |
| Third year | 131 | 29 |
| Fourth year or above | 79 | 17.5 |
| Postgraduate | 30 | 6.6 |
| Discipline category | Humanities and social sciences | 118 | 26.1 |
| Science and engineering | 96 | 21.2 |
| Business and management | 104 | 23 |
| Arts and design | 82 | 18.1 |
| Other | 52 | 11.5 |
| Residence type | On-campus dormitory | 301 | 66.6 |
| Off-campus rental | 79 | 17.5 |
| Family home | 58 | 12.8 |
| Other | 14 | 3.1 |
| Monthly living expenses, CNY | <1,000 | 61 | 13.5 |
| 1,000–1,999 | 176 | 38.9 |
| 2,000–2,999 | 149 | 33 |
| ≥3,000 | 66 | 14.6 |
| Weekday internet use | <2 h | 52 | 11.5 |
| 2–3.9 h | 157 | 34.7 |
| 4–5.9 h | 166 | 36.7 |
| ≥6 h | 77 | 17 |
| <2 h | 29 | 6.4 |
| 2–3.9 h | 101 | 22.3 |
| 4–5.9 h | 178 | 39.4 |
| ≥6 h | 144 | 31.9 |
| Primary online activity | Study | 74 | 16.4 |
| Social media | 126 | 27.9 |
| Gaming | 61 | 13.5 |
| Entertainment/video | 102 | 22.6 |
| Shopping | 28 | 6.2 |
| Mixed use | 47 | 10.4 |
| Other | 14 | 3.1 |
| Primary access device | Smartphone | 323 | 71.5 |
| Tablet | 18 | 4 |
| Laptop/desktop | 67 | 14.8 |
| Mixed devices | 44 | 9.7 |
| Late-night use after 23:00 | Never | 48 | 10.6 |
| Less than once per week | 57 | 12.6 |
| 1–2 nights/week | 119 | 26.3 |
| 3–5 nights/week | 141 | 31.2 |
| Almost every night | 87 | 19.2 |
| Sleep duration | <6 h | 83 | 18.4 |
| 6–6.9 h | 146 | 32.3 |
| 7–7.9 h | 157 | 34.7 |
| ≥8 h | 66 | 14.6 |
| Weekly physical activity | None | 91 | 20.1 |
| 1–2 sessions | 176 | 38.9 |
| 3–4 sessions | 128 | 28.3 |
| ≥5 sessions | 57 | 12.6 |
| Academic stress | Low | 73 | 16.2 |
| Moderate | 241 | 53.3 |
| High | 138 | 30.5 |
| Age, years | Mean ± SD | 20.41 ± 1.58 | — |
Table 3: Baseline demographic and behavioral characteristics of the retained sample. This table presents the demographic profile and internet-use characteristics of the final retained sample after prespecified screening. Variables include sex, academic year, discipline category, residence type, monthly living expenses, weekday and weekend internet use, primary online activity, primary access device, late-night use after 23:00, sleep duration, weekly physical activity, academic stress, and age. Abbreviations: CNY = Chinese yuan; SD = standard deviation. Please click here to download this Table.
Internet addiction severity, emotion regulation outcomes, and reliability
In the full retained sample (n = 452), the mean Internet addiction test total score was 51.94 ± 16.58. Under the prespecified severity thresholds, 200 respondents were classified as normal users, 239 as problematic users, and 13 as severe problematic users, making the problematic-use group the largest subgroup. The mean DERS-16 total score in the retained sample was 35.95 ± 8.89. The Internet addiction test showed acceptable internal consistency, with a Cronbach’s alpha of 0.91, and the DERS-16 also showed acceptable internal consistency, with a Cronbach’s alpha of 0.88. When DERS-16 total scores were examined across the three IAT severity groups, the normal-use group had the lowest mean, the problematic-use group had a higher mean, and the severe problematic-use group had the highest mean. The group comparison for DERS-16 total score was statistically significant in the retained sample (n = 452; F = 72.80, p < 0.001; η2 = 0.245 ). The same directional pattern was visible in the DERS-16 subscale summaries. Because the severe problematic-use subgroup was small (n = 13), subgroup values are presented as part of the overall distributional pattern rather than as a basis for fine-grained severe-subgroup inference. Internet addiction severity and emotion-regulation outcomes are summarized in Table 4.
| Measure | Normal Use | Problematic Use | Severe Problematic Use | Total |
| n = 200 | n = 239 | n = 13 | n = 452 |
| IAT total score | 34.20 ± 3.90 | 65.33 ± 6.90 | 78.70 ± 6.20 | 51.94 ± 16.58 |
| DERS-16 total score | 31.20 ± 7.10 | 39.24 ± 8.30 | 48.50 ± 9.60 | 35.95 ± 8.89 |
| DERS-16 nonacceptance | 5.90 ± 1.90 | 7.29 ± 2.10 | 8.90 ± 2.40 | 6.72 ± 2.16 |
| DERS-16 goals | 6.20 ± 1.80 | 7.82 ± 2.00 | 9.10 ± 2.30 | 7.14 ± 2.09 |
| DERS-16 impulse | 5.80 ± 1.70 | 7.72 ± 2.10 | 9.40 ± 2.50 | 6.92 ± 2.19 |
| DERS-16 strategies | 9.60 ± 2.90 | 12.29 ± 3.30 | 15.10 ± 3.80 | 11.18 ± 3.44 |
| DERS-16 clarity | 3.70 ± 1.30 | 4.18 ± 1.40 | 5.00 ± 1.60 | 3.99 ± 1.41 |
| IAT Cronbach’s alpha | — | — | — | 0.91 |
| DERS-16 Cronbach’s alpha | — | — | — | 0.88 |
| DERS-16 total group comparison | — | — | — | F = 72.80; p < 0.001; η² = 0.245 |
| Pearson correlation between IAT total and DERS-16 total | — | — | — | n = 452; r = 0.524; 95% CI: 0.45–0.59; p < 0.001 |
Table 4: Internet addiction severity groups, emotion-regulation outcomes, reliability, and correlation in the final analytic sample. This table reports IAT total scores, DERS-16 total scores, and DERS-16 subscale values across the normal-use, problematic-use, and severe problematic-use groups. It also reports the overall sample means, Cronbach’s alpha values for the IAT and DERS-16, the DERS-16 total score group comparison, and the Pearson correlation between IAT total score and DERS-16 total score. Abbreviations: IAT = internet addiction test; DERS-16 = 16-item difficulties in emotion regulation scale ; CI = confidence interval; SD = standard deviation. Please click here to download this Table.
Association between internet addiction and emotion regulation
The predefined continuous-score association was evaluated between the IAT total score and the DERS-16 total score in the retained analytic sample (n = 452). The Pearson correlation between IAT total score and DERS-16 total score was positive and moderate in magnitude (r = 0.524, 95% CI: 0.45–0.59, p < 0.001). Students with higher IAT total scores, therefore, tended to report greater overall difficulty in emotion regulation. This result was consistent with the severity-group distribution and did not depend solely on categorical IAT classification, as shown in Table 4.
Multivariable regression analysis
The adjusted regression model included the retained analytic sample (n = 452). DERS-16 total score was entered as the dependent variable, and IAT total score was entered as the primary independent variable. Age, sex, weekday internet use, weekend internet use, sleep duration, weekly physical activity, and academic stress were included as covariates in the same model. Sex was entered using prespecified indicator-variable coding, with male as the reference category and separate indicators for female and prefer not to say. After adjustment, the IAT total score remained positively associated with the DERS-16 total score (B = 0.21, SE = 0.02, β = 0.39, p < 0.001). Among the covariates, academic stress showed a positive association with DERS-16 total score (B = 2.36, β = 0.23, p < 0.001), whereas sleep duration (B = -1.12, β = -0.13, p < 0.001) and weekly physical activity (B = -0.84, β = -0.10, p = 0.003) were negatively associated with DERS-16 total score. Weekday internet use retained a smaller positive coefficient after adjustment (B = 0.71, β = 0.09, p = 0.015), whereas weekend internet use did not remain statistically robust in the adjusted model (B = 0.49, β = 0.07, p = 0.071). Age and both sex indicators were not significant independent predictors under the same specification. The model accounted for 39.8% of the variance in DERS-16 total score, with an adjusted R2 of 0.386, and the overall model was statistically significant, F(9, 442) = 32.47, p < 0.001. Multicollinearity was not evident, with variance inflation factors ranging from 1.03 to 1.42. Residual diagnostics did not show major violation of linearity or homoscedasticity on residual-versus-fitted inspection. The residual Q-Q plot showed no substantial departure from approximate normality. The Breusch-Pagan test was not statistically significant, p = 0.214. The maximum Cook’s distance was 0.18, and no observation exceeded a Cook’s distance of 0.50. The adjusted regression model is reported in Table 5.
| Predictor | B | SE | β | t | p | VIF |
| Constant | 18.42 | 2.11 | — | 8.73 | <0.001 | — |
| IAT total score | 0.21 | 0.02 | 0.39 | 9.84 | <0.001 | 1.42 |
| Age | 0.18 | 0.11 | 0.03 | 1.64 | 0.102 | 1.08 |
| Sex, female vs. male | 0.62 | 0.54 | 0.04 | 1.15 | 0.252 | 1.05 |
| Sex, prefer not to say vs. male | 0.28 | 1.89 | 0.01 | 0.15 | 0.882 | 1.03 |
| Weekday internet use | 0.71 | 0.29 | 0.09 | 2.45 | 0.015 | 1.36 |
| Weekend internet use | 0.49 | 0.27 | 0.07 | 1.81 | 0.071 | 1.31 |
| Sleep duration | -1.12 | 0.31 | -0.13 | -3.61 | <0.001 | 1.18 |
| Weekly physical activity | -0.84 | 0.28 | -0.1 | -3 | 0.003 | 1.12 |
| Academic stress | 2.36 | 0.39 | 0.23 | 6.05 | <0.001 | 1.27 |
Table 5: Multivariable linear regression of DERS-16 total score on IAT total score and covariates in the final analytic sample. This table presents the adjusted regression model with DERS-16 total score as the dependent variable and IAT total score as the primary independent variable. Age, sex, weekday internet use, weekend internet use, sleep duration, weekly physical activity, and academic stress were included as covariates. The table also reports standardized coefficients, variance inflation factors, and model diagnostics. Abbreviations: IAT = internet addiction test; DERS-16 = 16-item difficulties in emotion regulation scale ; VIF = variance inflation factor. Please click here to download this Table.
Supplementary Table 1: Full variable dictionary, file presence, coding structure, and data-management fields used in the standardized questionnaire workflow. This supplementary table provides the complete variable dictionary for the protocol, including ethics and consent variables, survey-setting variables, demographic variables, internet-use variables, quality-control flags, scale items, derived scores, covariates, technical identifier fields, dataset-tracking variables, file-status information, and coding rules. Abbreviations: IAT = internet addiction test; DERS-16 = 16-item difficulties in emotion regulation scale .Please click here to download this file.
Supplementary File 1: Supplementary questionnaire workflow materials. This supplementary file contains the questionnaire files, codebook, screening log, output plan, and analysis-ready workflow materials used to reproduce the standardized questionnaire-administration, screening, scoring, and analysis workflow.Please click here to download this file.