Alexithymia and Internet Addiction in Children: Meaning in Life as Mediator and Reciprocal Filial Piety as Moderator

Introduction

With the advent of the digital age, the Internet has penetrated into every aspect of people’s lives. The Internet facilitates teenagers’ studies and lives, but it also brings about negative effects, such as the spread of adverse information, cyberbullying and Internet addiction. Among the numerous harmful effects, Internet addiction has received widespread attention.¹ Internet addiction refers to the uncontrollable and compulsive use of the Internet, which leads to impairment in personal physical and mental health, academic, professional, life and social functioning.² The physical and psychological development of middle school students is undergoing rapid growth, which is a crucial time for shaping their personalities and values. However, their physical and mental development is not mature enough, and they lack sufficient ability to identify explosive network information. Additionally, their self-control ability in the face of temptation is limited, which may easily lead to excessive reliance on the Internet.³

The problem behavior theory (PBT) provides a scientific basis for us to explore the deep causes of adolescent Internet addiction. PBT points out that the generation of problem behavior is influenced by personality system, environment system and other aspects.⁴ The personality system is composed of factors such as individual traits and values, emphasizing individual characteristics and personal growth and development.⁴ The environment system includes the social environment and the perceptual environment, such as family relationships, peer relationships, social support and parental control.⁵ The environment systems emphasize the importance of adolescent interpersonal relationships.⁴ Adolescent problem behavior is produced by the dynamic and continuous effect of personality characteristics and environment.⁵ Therefore, this study aimed to explore the effects of alexithymia (personality system), meaning in life (personality system) and dual filial piety (environment system) on Internet addiction among middle school students.

Alexithymia and Internet Addiction

Alexithymia is a multidimensional personality construct.¹ The salient features of this construct include the following four aspects: 1) difficulty in identifying and describing subjective feelings; 2) difficulty distinguishing between emotion and emotionally arousing physical sensations; 3) limited imagination, manifested as lack of fantasy; 4) extroverted cognitive style.⁶ The detection rate of adolescent alexithymia ranges from 7.3% to 20.9%,⁷ which brings a series of internalization or externalization problems to the healthy growth of adolescents.⁸ On the one hand, alexithymia often leads to high levels of negative emotions such as anxiety and depression due to cognitive impairment and emotional regulation dysfunction.^8,9 The self-medication hypothesis considers addictive behavior as a maladaptive strategy designed to gain relief from painful emotions or experiences.¹⁰ On the other hand, individuals with alexithymia often lack social support and face interpersonal barriers.^1,11 In accordance with the cognitive-behavioral model of pathological Internet use, psychological causes (such as depression, anxiety, material dependence, etc.) are remote factors of pathological Internet behavior, and the negative social environment (lack of social support) of individuals is the important factor of network deviant behavior.¹² Furthermore, alexithymia is closely related to various types of addictions and can predict the individual’s addictive status, including gambling addiction, alcohol addiction, cell phone addiction, and Internet addiction.^13–16 Therefore, it was expected that alexithymia would have a negative relationship with Internet addiction (Hypothesis 1).

The Mediating Role of Meaning in Life

Previous studies on the potential pathways of alexithymia and Internet addiction have focused on negative factors. This study is based on the positive factor of meaning in life. The existential theory emphasizes the meaning of life as the foundation of mental health.¹⁷ Loss of meaning could cause mental health problems.¹⁸ Meaning in life is one’s own subjective purpose or goal,¹⁹ which is an important protective factor for individuals’ physical and mental health,²⁰ and enhance individuals’ positive psychological experiences.²¹ First, alexithymia predicts meaning in life directly.²² The attention-appraisal model of alexithymia holds that the difficulty in regulating attention and emotion is the main manifestation of patients with deficient alexithymia.¹¹ According to the attention theory of boredom proneness, the individual susceptibility to boredom is rooted in the disruption of attentional regulation, that is, the inability to maintain and regulate attention.²³ Individuals with high levels of alexithymia experience more feelings of emptiness and boredom,²⁴ not to mention pursuing the meaning of life. Furthermore, alexithymia may have an effect on meaning in life through quality of life. It has been found that alexithymia often appears in patients with Systemic Lupus Erythematosus and Raynaud’s disease, and the degree of alexithymia is highly linearly related to the impairment of quality of life.^25,26 A study conducted by Karayağiz and Baştürk showed that people in the unipolar depression group and bipolar affective disorder depressive episode group have higher alexithymia scores and worse quality of life than the control group.²⁷ Usually, people who have a low quality of life struggle to find the purpose and meaning in their lives.^28,29 Second, the meaning in life serves as a protective factor in the personality system of PBT, which can effectively reduce the occurrence of problematic behaviors.⁴ The broaden-and-build theory emphasizes that positive psychological factors can broaden the scope of the individual’s cognition and enhance the flexibility of cognition, which is conducive to the construction of individual psychological and social resources and the adjustment of cognition and behavior.³⁰ For instance, Cevik found that meaning in life negatively predicts Internet addiction.³¹ The authors have conducted a study regarding Internet addiction and impulsivity, which demonstrates that there is a negative association exists between meaning in life and Internet addiction.³² Consequently, we hypothesized that meaning in life would mediate the relationship between alexithymia and Internet addiction (Hypothesis 2).

The Moderating Role of Filial Piety

The dual filial piety model indicates that filial piety refers to the thoughts that children hold during their interactions with their parents, which can be divided into two types, including authoritarian filial piety and reciprocal filial piety.³³ During the developmental stages from infancy to adolescence, the specific manifestations of the two filial piety beliefs differ. Authoritarian filial piety emphasizes control and obedience, and children learn to obey their parents’ demands in order to avoid punishment and obtain social rewards (such as praise from their parents).³⁴ Reciprocal filial piety emphasizes consideration, care, and support, and children feel emotionally secure and emotionally connected to their parents by expressing love or affection.³⁴ Filial piety is rooted in the intimacy and quality of the parent-child relationship and has lasting effects on psychosocial adjustment and the parent-child relationship, essentially reflects the underlying psychological mechanisms that link individuals to their environment in the context of the parent-child relationship.^33,34

High-quality family function is a protective factor for middle school students’ Internet problem behaviors.⁵ Reciprocal filial piety predicts a reduction in adolescent problem behaviors,³⁵ including Internet addiction.^36,37 Moreover, reciprocal filial piety plays a mediating role in the relationship between supportive parenting and young people’s well-being,³⁸ and is positively associated with life satisfaction.^39,40 Authoritative filial piety has a positive indirect effect on life satisfaction through related autonomy.⁴⁰ Familism moderates the relationship between stress and internalizing and externalizing behaviors.⁴¹ Socioecological theory emphasizes the role of interaction between environmental variables and individual variables on individual psychosocial outcomes.⁴² The interaction between filial piety and meaning in life may modify Internet addiction in adolescents. Accordingly, the present study hypothesized that filial piety may have a moderating effect between meaning in life and Internet addiction (Hypothesis 3).

The Present Study

The purpose of this study was to construct a model of moderated mediation, that explored the effect of alexithymia on middle school students’ Internet addiction, and tested the mediating effect of meaning in life as well as the moderating effect of filial piety for the first time. The hypothesized model was shown in Figure 1.

Figure 1 The hypothesized model.

Method

Participants

A total of 970 questionnaires were distributed to students in grades 7–9 from three middle schools in a province of Central China. Stratified random cluster sampling method was used to determine the survey sample. After deleting the missing data questionnaires, there were 899 valid questionnaires with an effective recovery rate of 92.68%. The participants’ ages ranged from 11 to 17 years old (M_age=13.95, SD=1.10). There were 432 boys and 467 girls, including 246 in rural areas, 307 in towns and 346 in cities.

Procedures

Prior to the questionnaire investigation, we received permission to conduct this survey by the Ethical Committee for Scientific Research in Xinyang Normal University. We also sought consent from the participants, school leaders, and their parents. The study was conducted according to the guidelines of the Declaration of Helsinki.

The main test of this study was conducted by trained psychology graduate students. The completion of the questionnaire was anonymous without collection of the participants’ names and their student numbers. After the test, the questionnaires were collected on site. It took about 15 minutes for the subjects to complete the entire questionnaire.

Measures

20-Item Toronto-Alexithymia-Scale

Alexithymia was measured by 20-item Toronto-alexithymia-scale.⁴³ The Chinese version of the revised scale has good reliability and validity among Chinese participants.^44,45 Likert’s five-point scoring method is adopted on the scale, with 1 representing “strongly disagree” and 5 “strongly agree”. The higher a participant’s score, the more severe alexithymia is. In this study, Cronbach’s alpha in this research was 0.739, with good reliability.

Meaning in Life

The meaning in life questionnaire was developed by Steger which is used for measurement.⁴⁶ The Chinese version of this scale has good reliability and validity in Chinese subjects.⁴⁷ The scale consists of 9 items, which are scored by Likert’s 7-point method, where 1 point indicates complete disagreement and 7 points indicates complete agreement. The higher the score, the more meaningful life is. In this study, Cronbach’s alpha was 0.787, which indicates good reliability.

Filial Piety

Filial piety was measured by the revised dual filial piety scale, which has good reliability and validity among Chinese subjects.⁴⁸ The scale consists of 16 items, divided into two dimensions: authoritarian filial piety and reciprocal filial piety. Likert’s 6-point scoring was used, with 1 indicating complete disagreement and 7 indicating complete agreement. The higher the score, the better the filial piety. In this study, Cronbach’s alpha of authoritarian filial piety and reciprocal filial piety were 0.744 and 0.808 respectively, suggesting good reliability.

Internet Addiction

Internet addiction disorder diagnostic scale was adopted, which has good reliability and validity for Chinese middle school students.⁴⁹ The scale consists of 13 items, scored by Likert’s two-point scoring method, with 0 representing no and 1 representing yes. The higher the score, the more serious the Internet addiction of middle school students. In this study, Cronbach’s alpha was 0.854, which shows that its reliability is good.

Controlled Variables

Our research has controlled age, sex and family residence, because previous studies showed that these variables are related to Internet addiction.⁵⁰ Gender was coded as girls 0 and boys 1. Students’ home residences in rural areas were coded as 1, those in town as 2, and those in urban areas as 3.

Data Analyses

Descriptive statistics and Pearson correlation analysis were also conducted using SPSS 20.0. Then, a hierarchical regression analysis was performed to examine the main effects of the independent variables on the dependent variable. The hypothesized mediating role of meaning in life and moderating effect of filial piety were examined using the PROCESS macro in SPSS (Model 4 and Model 14).⁵¹ All continuous variables were standardized and the interaction terms were computed from these standardized scores. The bias-corrected bootstrapping method generates 95% confidence intervals for these effects from 5000 resamples of the data.⁵² The 95% confidence interval excluding zero indicates a significant effect.

Results

Common Method Biases Test

In our research, all of the data were collected from the subjects’ self-reports, which may have introduced a common method bias. In order to reduce the influence of this bias on research results, we set up different answer statements for each questionnaire in terms of program control. In statistics, Harman’s single-factor test was used to measure the common method biases degree of data. The results showed that there were 13 factors with eigenvalues greater than 1, and the variance explained by the first factor was only 11.77%, which is far less than the critical value of 40%, indicating that there is no serious common method bias in each of the variables in this study.

Descriptive Statistics and Correlations

The matrix of the mean, standard deviation, and Pearson correlation of the variables were presented in Table 1. Alexithymia was negatively correlated with meaning in life and reciprocal filial piety, and positively correlated with Internet addiction. Meaning in life was positively associated with reciprocal filial piety, but negatively related to Internet addiction. Reciprocal filial piety was positively related to authoritarian filial piety, but negatively associated with Internet addiction.

Table 1 Means, Standard Deviations and Correlations Among the Variables

Testing for Moderated Mediation

The first step was to test the mediating effect of meaning in life in the relationship between alexithymia and Internet addiction by using model 4 in PROCESS.^52,53 As displayed in Table 2, alexithymia had a significant positive predictive effect on Internet addiction (Equation 1, β=0.17, p<0.001, 95% CI 0.09 to 0.24), and the direct prediction effect of alexithymia on Internet addiction remained significant when the mediating variable of meaning in life was added (Equation 3, β=0.14, p<0.001, 95% CI 0.06 to 0.22). Alexithymia negatively predicted the meaning in life (Equation 2, β=−0.26, p<0.001, 95% CI −0.33 to −0.19), and the meaning in life had a significant negative predictive effect on Internet addiction (Equation 3, β=−0.10, p<0.01, 95% CI −0.17 to −0.03). Furthermore, the bootstrap 95% CI for the direct effect of alexithymia on Internet addiction and the mediating effect of meaning in life did not contain 0 (see Table 3), which indicates that alexithymia can directly predict Internet addiction as well as predict it through the mediating effect of meaning in life. The direct effect and the mediating effect accounted for 84.92% and 15.08% of the total effect, respectively.

Table 2 Testing the Moderated Mediation Effect of Alexithymia on Internet Addiction (Reciprocal Filial Piety)

Table 3 Decomposition Table of Total Effect, Direct Effect and Mediating Effect

The second step was to test the moderating effect of reciprocal filial piety by using model 14.^52,53 The regression results (see Table 2, Equation 4) showed that after the reciprocal filial piety was included in the regression equation, meaning in life had a negative prediction for Internet addiction (β=−0.07, p<0.05, 95% CI −0.14 to −0.01), and reciprocal filial piety had a negative prediction (β=−0.14, p<0.001, 95% CI −0.22 to −0.07). The product item of meaning in life and reciprocal filial piety had a significant predictive effect on Internet addiction (β=0.05, p<0.05, 95% CI 0.01 to 0.09), indicating that reciprocal filial piety moderates the effect of meaning in life on Internet addiction. It showed that reciprocal filial piety played a moderating role in the second half of the “alexithymia → meaning in life → Internet addiction” mediating model (see Figure 2). In order to further explore how reciprocal filial piety moderates the negative predictive effect of meaning in life on Internet addiction. In this study, reciprocal filial piety was divided into two groups: a high group with mean above one standard deviation and a low group with mean below one standard deviation. Further simple slope test (see Figure 3) showed that the participants with low reciprocal filial piety had a significantly negative predictive effect on Internet addiction (b_simple=−0.15, p<0.001, 95% CI −0.23 to −0.07), but those with high reciprocal filial piety did not predict Internet addiction (b_simple=−0.05, p>0.05, 95% CI −0.13 to 0.03).

Figure 2 Moderated mediation analysis. *p<0.05, ***p<0.001.

Figure 3 Meaning in life × reciprocal filial piety interactive effects in relation to Internet addiction. Abbreviations: LMIL (HMIL), low (high) meaning in life; LRFP (HRFP), low (high) reciprocal filial piety.

The third step was to test the moderating model of authoritarian filial piety by using Model 14 in PROSESS.^52,53 The regression results showed that after including authoritarian filial piety in the equation, meaning in life was negatively associated with Internet addiction (β=−0.10, p<0.01, 95% CI −0.16 to −0.03), while authoritarian filial piety also had a negatively association with Internet addiction (β=−0.07, p<0.05, 95% CI −0.13 to −0.01). The product item of meaning in life and authoritarian filial piety had no significant predictive effect on Internet addiction (β=0.04, p>0.05, 95% CI −0.02 to 0.10), which indicates that authoritarian filial piety cannot moderate the predictive effect of meaning in life on Internet addiction. It showed that authoritarian filial piety did not moderate the second half of the “alexithymia → meaning in life → Internet addiction” mediating model.

Discussion

Based on the PBT, this study explored the direct effect of alexithymia on Internet addiction and investigated the mediating role of meaning in life between alexithymia and Internet addiction among middle school students. Additionally, it examined the moderating effect of filial piety on this mediating process. The results could help us understand the mechanism of middle school students’ Internet addiction behavior, and assist in improving their mental health level while preventing risk behavior.

The Relationship Between Alexithymia and Internet Addiction

Alexithymia was shown to be a significant positive predictor of Internet addiction, validating the hypothesis of this study and supporting the PBT,⁴ which is consistent with previous research.⁸ Alexithymia, as a risk factor in PBT personality system, increases the vulnerability of middle school students to Internet addiction.⁴ On the one hand, alexithymia patients have deficits in cognitive processing and empathy, which increases the susceptibility to anxiety and depression.^8,54 Compensatory Internet use theory states that people may use the Internet to cope with negative emotions.⁵⁵ On the other hand, the alexithymia stress hypothesis suggests that alexithymia exacerbates the stress experienced by individuals.⁶ Individuals who suffer from Internet addiction may view the Internet as a tool for reducing stress and tension, which is in line with the propositions of stress reduction theories.^56,57 The direct effect of alexithymia on Internet addiction is stable cross-cultural.

The Mediating Effect of Meaning in Life

To our knowledge, our research was the first time to explore the relationship between alexithymia, meaning in life and Internet addiction, and find that alexithymia of middle school students has an effect on Internet addiction through meaning in life. The results verified the hypothesis of this study and supported the PBT theory.⁴ First of all, individuals with alexithymia increase their susceptibility to boredom due to deficiencies in their attention-evaluation cognitive system.^11,23,58 People with alexithymia have a higher tendency to be bored than the general population.²⁴ The higher the degree of alexithymia, the more pronounced the tendency to boredom.⁵⁸ It’s a sign of a lack of meaning. In addition, individuals with high alexithymia often suffer from varying degrees of quality of life impairment,^25,26 and they often have difficulty finding meaning in their lives.^28,29 Secondly, meaning in life as a protective factor reduces susceptibility to Internet addiction.^4,32 This not only demonstrates that protective factors in the PBT personality system reduce the occurrence of problem behaviors,⁴ but also proves the adjustment of cognition and behavior by positive psychological factors in the broaden-and-build theory.³⁰ The five “A” model theory confirms this result from the opposite side. The theory emphasizes that the meaning violation and meaninglessness experienced by individuals motivate them to engage in compensatory behaviors.⁵⁹ As the results of this study, meaning in life has been proved to be a mediating variable between alexithymia and Internet addiction, which brings new inspiration to prevent middle school students from Internet addiction.

The Moderating Effect of Filial Piety

Reciprocal filial piety successfully moderated the linear effect of meaning in life on middle school students’ Internet addiction, supporting the socioecological theory.⁴² As the level of reciprocal filial piety increased, the predictive effect of meaning in life on Internet addiction decreased. Specifically, meaning in life was a significant negative predictor of Internet addiction among children with low reciprocal filial piety, but it no longer predicted Internet addiction among children with high reciprocal filial piety. The possible explanation is that individuals who exhibit highly reciprocal filial piety towards their parents have a reasonable explanation and sincere understanding, think parents’ behavior is motivated by their parents’ “love”. Whether they pursue their own life goals or not, they will follow their parents’ advice and reduce their Internet use. For individuals with low reciprocal filial piety, they may not be able to reasonably understand their parents’ behavior. Those people who possess a purpose and responsibility can easily resist the temptation of the Internet because they have clear goals and direction in their lives. While individuals without meaning are more likely to become addicted to the internet.

Authoritarian filial piety was a failed moderating variable that did not moderate the linear effect of meaning in life on Internet addiction. On the one hand, the strength model of self-control provides potential explanations. The model points out that lack of adequate self-control resources can lead to maladaptive conditions, such as addictive behavior.⁶⁰ Children who have authoritarian filial piety tend to maintain the authority of parents, which leads them to choose to meet the expectations of their parents instead of expressing their own needs. But when they run out of limited self-control resources, it will lead to children not having enough self-control resources to resist the temptation from the Internet, which causes morbid behavior of Internet usage. On the other hand, we can also explain this result from the characteristics of the physical and mental development of middle school students. According to Erikson’s theory of psychosocial development, the main task during adolescence is developing self-awareness while the need for autonomy and independence gradually increases.⁶¹ Individuals with authoritative filial piety choose to obey their parents’ instructions instead of meeting their own needs, which goes against the objective laws of adolescent physical and mental development.³³ Then, in order to meet their inner needs and not directly violate their parents’ instructions, they will give up obeying their parents’ instructions and use the Internet without their parents’ knowledge or permission.

Conclusion

This study explored the relationship between alexithymia, meaning in life, filial piety and Internet addiction among middle school students. Alexithymia has increased the risk of Internet addiction in children. As a protective factor, having meaning in life can decrease the occurrence of Internet addiction among adolescents. The interaction between low-level reciprocal filial piety and meaning in life has an effect on the Internet addiction behavior of middle school students. Therefore, parents and educators should strengthen communication with children, establish high-quality emotional bonds, provide them with more social support, and guide children to establish a correct outlook on life and values, and actively explore the meaning of life. These measures may also have a positive impact in reducing Internet addiction among adolescents.