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Review

Anhedonia in Youth and the Role of Internet-Related Behavior: A Systematic Review

by
Giovanni Cangelosi
1,
Federico Biondini
2,
Marco Sguanci
3,*,
Cuc Thi Thu Nguyen
4,
Gaetano Ferrara
5,
Orejeta Diamanti
6,
Sara Morales Palomares
7,
Stefano Mancin
8 and
Fabio Petrelli
9
1
Unit of Diabetology, Asur Marche, Area Vasta 4, 63900 Fermo, Italy
2
Units of Psychiatry, Ast Fermo, 63900 Fermo, Italy
3
A.O. Polyclinic San Martino Hospital, Largo R. Benzi 10, 16132 Genova, Italy
4
Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi 10000, Vietnam
5
Nephrology and Dialysis Unit, Ramazzini Hospital, 41012 Carpi, Italy
6
Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
7
Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy
8
IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
9
School of Pharmacy, Polo Medicina Sperimentale e Sanità Pubblica, 62032 Camerino, Italy
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2025, 6(1), 1; https://doi.org/10.3390/psychiatryint6010001
Submission received: 30 October 2024 / Revised: 27 November 2024 / Accepted: 23 December 2024 / Published: 26 December 2024
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Abstract

:
Introduction: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines depression as a persistent period of sadness or a reduced interest in everyday activities lasting at least two weeks. Anhedonia, a key symptom of depression, is notable for its significance and is regarded as the second most important factor related to non-somatic issues, following closely behind a depressed mood. This study primarily investigates how excessive or problematic use of Internet-connected devices affects the mood and emotions of young people, with a specific emphasis on anhedonia. Additionally, it explores associated socio-behavioral changes and examines the interaction between IA and depression. Methods: This systematic review was conducted following PRISMA international guidelines. Searches were performed in PubMed, Cochrane Library (Clinical Trials section), Scopus, Embase, PsycInfo, and grey literature sources like Google Scholar. A predefined search strategy using Boolean operators was employed, and two researchers independently selected papers, with a third researcher resolving any discrepancies. Manual reviews were conducted to minimize selection bias. Results: Out of 3812 records, 7 studies were included. The findings suggest that social anhedonia correlates with higher levels of IA, particularly among adolescents and young adults. In some studies, loneliness was identified as a mediator between social anhedonia and social functioning, indicating a complex interplay of emotional factors. Other investigations revealed that increased screen time is associated with a heightened risk of developing addiction-related behaviors. Practical Implications and Conclusions: This review highlights the key role of anhedonia in the development of Internet addiction (IA) among young people, particularly through its impact on emotional regulation and social interactions. Addressing psychological and environmental factors is essential for developing targeted strategies to prevent and manage IA and its related mental health challenges.

1. Background

Depression is universally acknowledged as a severe and debilitating disorder, with its incidence on the rise in recent years. This increase has led to depression becoming one of the conditions with the highest direct and indirect societal costs, particularly in industrialized nations [1,2,3,4]. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depression is characterized by a prolonged state of sadness or a diminished interest in routine activities lasting for a minimum of two weeks, often accompanied by various symptoms such as appetite or weight changes, sleep disturbances, fatigue, feelings of worthlessness or overwhelming guilt, difficulty concentrating, and recurring thoughts of death or suicidal ideation [5]. The World Health Organization (WHO) forecasts that by 2030, depression will become the primary cause of workday loss, overtaking even ischemic heart disease [1,2,3,4,6,7]. The global prevalence of depression is around 4.4%, with women affected at twice the rate of men [8,9,10].
Despite the higher incidence of major depressive disorder (MDD) among first-degree relatives—ranging from 31% to 42%—the exact genetic mechanisms predisposing individuals to depression remain unclear [11,12,13,14,15]. The wide array of depressive symptoms, encompassing biological, cognitive, and behavioral aspects, underscores the condition’s heterogeneity [16]. Among these symptoms, cognitive impairments—such as difficulties with concentration and reduced working memory—significantly hinder daily functioning across age groups. These cognitive deficits impact various areas of life, including work, social relationships, and family dynamics, typically lasting at least two weeks, with an average duration of around three months. In some cases, however, depressive episodes persist for over a year, with approximately 20% of individuals still experiencing symptoms two years later [17].
Anhedonia, a hallmark symptom of depression, is notable for its significance and ranks as the second most important factor related to non-somatic concerns, following closely behind a depressed mood [18]. Anhedonia refers to a reduced capacity to find pleasure or interest in previously rewarding activities, affecting both the desire to engage in activities and the ability to derive satisfaction from them. Scientifically, anhedonia is divided into two types: consummatory anhedonia, indicating reduced pleasure during an activity, and anticipatory anhedonia, describing diminished excitement or expectation of future pleasure [19]. Differentiating between these types is essential for understanding the neural basis of anhedonia and for developing tailored treatment approaches [20].
The interplay between depression and anhedonia is particularly crucial, as cognitive deficits like decreased concentration and memory can worsen anhedonia, leading to difficulty finding pleasure in previously enjoyable activities. This reciprocal relationship creates a vicious cycle: cognitive impairment exacerbates anhedonia, further deepening the depressive state [21]. Neurobiologically, anhedonia is linked to disruptions in the brain’s reward system, particularly in the mesolimbic pathway. Dopamine, a key neurotransmitter involved in pleasure and reward, plays a central role. Anhedonia, marked by reduced pleasure capacity, is often associated with dopaminergic dysfunctions in the mesolimbic circuit, which includes essential structures like the ventral tegmental area (VTA) and the nucleus accumbens, crucial for processing rewards and regulating mood [22].
In conditions such as schizophrenia, altered dopamine pathways contribute to negative symptoms like anhedonia, while in bipolar disorder, dopamine fluctuations are linked to manic and depressive episodes. In substance abuse, drugs artificially elevate dopamine levels, leading to addiction and subsequent anhedonia [23,24]. Clinical studies indicate that anhedonia is multifaceted, involving deficits in reward processing, typically categorized into reward liking (actual enjoyment), reward wanting (motivation to seek pleasure), and reward learning (ability to adjust behavior based on past rewards). Anhedonia extends beyond depression and is a core symptom in psychiatric conditions like schizophrenia, bipolar disorder, and substance use disorders. Its prevalence across various disorders underscores its significance in mental health research and the need for a deeper understanding of its mechanisms and impacts [24,25,26,27].
Anhedonia, defined as the inability to experience pleasure or interest in previously rewarding activities, significantly affects individuals by impairing daily functioning, straining interpersonal relationships, and hindering the pursuit of personal goals. These challenges often intensify depressive symptoms, perpetuating a cycle of worsening mental health [28]. Individuals with anhedonia may withdraw socially, increasing isolation and exacerbating feelings of loneliness and depression [29]. Regarding treatment, pharmacological options such as selective serotonin reuptake inhibitors (SSRIs) and atypical antipsychotics have shown mixed results. While SSRIs are commonly prescribed for depression, their direct effectiveness in treating anhedonia remains uncertain. Similarly, atypical antipsychotics have produced variable outcomes, offering partial relief to some patients while providing little to no improvement for others [30]. Non-pharmacological interventions are also being explored for anhedonia management. Cognitive behavioral therapy (CBT) helps address negative thought patterns linked to anhedonia, while behavioral activation encourages engagement in rewarding activities. Emerging neurostimulation techniques, such as transcranial magnetic stimulation (TMS), show promise, particularly for treatment-resistant depression. Although research on these approaches is ongoing, they present viable alternatives for individuals unresponsive to traditional treatments [31].
Anhedonia in adolescents is a critical marker of psychiatric disorders, particularly major depressive disorder [32]. The inability to experience pleasure from previously enjoyable activities is associated with neurobiological dysfunctions, emotional dysregulation, and psychological stress, all of which can negatively impact overall health [33,34,35]. External factors such as excessive technology use, social pressures, and academic stress further exacerbate symptoms, heightening the risk of severe psychiatric outcomes and adversely affecting the psychological and social well-being of young individuals [36,37].
The pervasive influence of technology and the Internet has profoundly impacted the emotional and behavioral patterns of young people. Research conducted during the COVID-19 pandemic revealed a significant increase in Internet use among adolescents, strongly correlating with the exacerbation of psychological and emotional difficulties. The pandemic, by limiting physical social interactions and heightening reliance on digital platforms, intensified activities such as social media engagement, online gaming, and general browsing. This shift contributed to a marked worsening of mental health symptoms in this population [38,39]. These findings highlight the broader societal implications of anhedonia and the importance of addressing it within the context of evolving digital behaviors, especially among young people. Recent research has increasingly focused on the relationship between technology use, emotional well-being, mood, and the onset of conditions like depression and anhedonia [17,40]. Studies indicate that excessive or problematic use of Internet-connected devices is linked to negative emotional outcomes, including heightened anxiety, depression, and anhedonia. For example, excessive social media use can lead to constant social comparison, lowering self-esteem and fostering feelings of inadequacy and dissatisfaction. While online gaming provides entertainment and a sense of community, it may also contribute to addictive behaviors and social isolation, exacerbating anhedonia symptoms [40,41]. The pandemic has further intensified these trends, with increased online activity due to social isolation and restrictions. This shift has resulted in prolonged exposure to potentially harmful content and an elevated risk of developing technology-related disorders [38,39]. Additionally, excessive reliance on digital devices disrupts critical aspects of physical and emotional health, including sleep, physical activity, and face-to-face social interactions, all of which are essential for psychological well-being [42]. Given the deep integration of technology into daily life, particularly among younger generations, understanding the emotional consequences of online behaviors is crucial. Addressing anhedonia, therefore, is vital for providing comprehensive care for depression and related psychiatric disorders, especially among the youth. The uniqueness of the conducted study lies in the current lack of systematic studies on this study’s topic.

1.1. Objective

The objectives of this study were to address both the primary and secondary research questions related to the interplay between Internet-related behaviors, mood, and anhedonia in youths.

1.1.1. Primary Aim

To investigate how excessive or problematic use of Internet-connected devices affects the mood and emotions of young people, with a specific focus on anhedonia.

1.1.2. Secondary Aims

  • To explore the socio-behavioral changes associated with the extensive use of Internet-connected devices, such as smartphones, tablets, and computers, among adolescents and young adults.
  • To examine the interaction between depression and IA, investigating whether anhedonia acts as a mediator or moderator in this relationship.

2. Methods

To ensure a rigorous and relevant methodological approach, a preliminary study protocol for the systematic review (SR) was developed [43]. The SR will be reported in accordance with the PRISMA guidelines [44,45] (Check List, Supplementary File S1) and initially followed recommendations from the Cochrane Handbook for SRs [46].

2.1. Protocol Registration

The protocol for this SR has been registered in the Open Science Framework (OSF) database [47].

2.2. Search Strategy

Before initiating the SR, relevant international guidelines and existing SRs from the Cochrane Library were examined to ensure alignment with the research question [48,49,50]. The search covered databases such as PubMed, Cochrane Library (Clinical Trials section), Scopus, Embase, and PsycInfo, with additional searches in grey literature sources like Google Scholar. A predefined list of keywords and customized search strings was used for each database, employing Boolean operators (AND/OR) to optimize search results. Two researchers (G.C. and F.B.) independently performed a double-blinded selection of papers, with a third researcher (S.M.) resolving any discrepancies. Mendeley Reference Management Software (Version 2.120.0, free version) was used to compile the database and eliminate duplicates [51]. To minimize selection bias, articles also underwent a manual review, and the reference lists of the included studies were carefully examined.

2.2.1. PICOS

The research question was framed using the PICOS framework [52], consolidated in previous studies [53,54,55]. The specific components of the PICOS framework for this study were as follows: Population (P): Youth aged 8 to 21 years; Intervention (I): Internet addiction; Comparison (C): Internet addiction vs. no Internet addiction and/or no alternative intervention; Outcome (O): Qualitative/quantitative outcomes; Study Design (S): Primary studies.

2.2.2. Query Search

The detailed query search is provided in Supplementary File S2.

2.3. Inclusion and Exclusion Criteria

To ensure the relevance of the included studies, the following inclusion criteria were applied:
  • Type of Study: Primary literature only. All other study types (e.g., editorials, commentaries, reviews, and protocol studies) were excluded;
  • Population: The focus was on youth aged 8–21 years, encompassing children, adolescents, and young adults. This age range was chosen based on scientific rationale, as it represents the complete transition from pre-pubertal development to legal adulthood, defined as 21 years in many U.S. states. Studies involving adults or mixed-age populations were excluded to maintain specificity.
    ○
    Relevance: Studies pertinent to the objectives of this review. Irrelevant studies were excluded;
    ○
    Temporal Limit: No restrictions on publication date;
    ○
    Language: Primarily in English. Studies in other languages (except Chinese) were considered if deemed relevant based on an English abstract;
    ○
    Internet Usage: At least 3 h per day or 21 h per week using Internet-connected devices; participation in online activities during meals, school hours, or sleep time at least twice a week; spending at least 2 h daily on recreational online activities like social media, gaming, or streaming; and reporting significant negative impacts on daily life, including academic performance or interpersonal relationships, due to Internet use.

2.4. Quality Assessment and Risk of Bias Evaluation

The risk of bias and methodological quality of the included studies were evaluated using the Critical Appraisal Skills Programme (CASP) checklists [56]. These tools provide a comprehensive framework for assessing the validity, relevance, and reliability of research findings. Specifically, CASP checklists allow for a detailed examination of the study design and methodology, focusing on aspects such as validity (the robustness and absence of bias in study design), relevance (the applicability of the study’s findings to the research question), and results (the clarity, reliability, and statistical integrity of the reported outcomes). Each study underwent a comprehensive assessment following the CASP criteria (Supplementary File S3), with scores recorded in a standardized format to facilitate systematic comparison and synthesis.

2.5. Data Extraction

To develop this SR, several critical elements were meticulously identified and documented to ensure a comprehensive and detailed synthesis of the literature. This process involved extracting key information from each included study, which was crucial for data analysis and interpretation. Specifically, the following data were extracted: Author(s); Year and country of study; Type of study; Population; Setting; Primary and secondary outcome(s); Results.

2.6. Data Synthesis

The included studies were categorized based on their primary and secondary objectives to ensure precise alignment with the SR’s research aims. Extracted information was presented according to the original research findings. When substantial variability was observed among the studies, a meta-analysis was deemed infeasible.

3. Results

3.1. Study Selection

A comprehensive search across biomedical databases yielded a total of 3838 records: PubMed/Medline (n = 101), Embase (n = 40), Scopus (n = 283), Cochrane Library Registered Trials (n = 3308), and PsycInfo (n = 80). The search of grey literature identified an additional 26 records. Initially, 325 records were excluded due to duplication; the subsequent screening process began with a thorough examination of 3513 article titles, resulting in the selection of 1102 articles deemed pertinent, while 2411 were excluded. Subsequently, all abstracts were analyzed, leading to the exclusion of 1037 irrelevant articles, leaving 65 records for full analysis. Of these, 58 articles were excluded for the following reasons: (a) secondary studies (n = 8); (b) expert opinion (n = 9); (c) not relevant (n = 41). Ultimately, following the screening process, seven articles were deemed eligible for inclusion in this SR (Figure 1).

3.2. General Characteristics of Included Studies

Of the seven included studies, five employed a cohort approach [57,58,59,60,61] (Table 1 summarized), while two were developed using a case–control method [62,63]. The studies were conducted as follows: two in China [57,58], three in the USA [59,60,61], one in Turkey [62], and one in Korea [63]. The study with the largest sample size observed 3577 subjects [57], while the study with the smallest sample size included 53 cases and 55 controls [62]. The reported average age ranged from 9 years [60] to 21 years [59,61].

3.3. Synthesis of Evidence from Included Studies

The study conducted by Yu et al. [57] investigated the significant impact of both social and physical anhedonia on Internet addiction (IA) in a substantial sample of 3577 Chinese college students, with a mean age of 18.01 years, of which 65.4% were female. This research was carried out over an extensive two-year follow-up period. The results revealed that social anhedonia was a strong predictor of higher initial levels of IA (p < 0.001) as well as a slower decline in addiction levels (p < 0.05). Interestingly, physical anhedonia did not exhibit any significant associations with Internet addiction. Additionally, the study found no notable gender differences in either the initial levels of Internet addiction or the rate of change observed over time.
Similarly, Cai et al. [58] focused on the complex network structures linking IA and depression in a sample of 1009 adolescents. The study used the Internet Addiction Test (IAT) and the 9-item Patient Health Questionnaire (PHQ-9) to collect data. Key central symptoms identified included IAT-15, indicating preoccupation with the Internet, and IAT-2, reflecting neglect of chores. The primary bridge symptom was IAT-11, associated with anticipation of online activities. Notably, gender did not significantly affect the network structure, which remained stable throughout the study.
In another study [59], researchers explored whether loneliness mediated the relationship between social anhedonia and social functioning among 824 young adults, with a mean age of 21.03 years, 72.3% of whom were female. Participants completed the Revised Social Anhedonia Scale (RSAS), the UCLA Loneliness Scale, and the Social Functioning Scale (SFS). The results indicated negative correlations between RSAS and SFS scores. Mediation analyses suggested that loneliness partially mediated the relationship across all social functioning subscales, except for Recreational Activities, and fully mediated overall social functioning.
Additionally, the study by Christodoulou et al. [60] examined the role of anhedonia in mediating the relationship between screen time and substance use among 709 students aged 9 to 11 years, including 354 males, in Southern California. Utilizing structural equation modeling, the findings revealed that anhedonia significantly mediated the association between screen time—comprising TV, internet, and video games—and substance use, specifically alcohol and cigarettes. This mediation effect persisted even after controlling for baseline factors. Importantly, gender was not found to be a significant moderator. The research suggested that increased screen time might lead to desensitization and heightened anhedonia, thereby increasing the risk of substance use as adolescents seek to compensate for diminished reward experiences.
Moreover, the study by Casey et al. [61] investigated longitudinal associations between anhedonia and IA in a sample of 503 at-risk emerging adults, former students of alternative high schools. Participants completed surveys at baseline and again approximately one year later. The results indicated that trait anhedonia predicted higher levels of compulsive internet use and addiction to various online activities, including video games. Among the psychometric tools used in this study was the Snaith–Hamilton Pleasure Scale, specifically useful for assessing anhedonia. Video game addiction was assessed with a single-item measure created by the authors, which has not yet been validated and uses a dichotomous response format, limiting statistical power.
The study by Akkın Gürbüz et al. [62] explored the relationship between social network sites (SNSs) and depression among adolescents. The study involved 53 adolescents diagnosed with depressive disorders and compared them with 55 non-depressed peers. The findings indicated that depressed adolescents spent significantly more time on the Internet and various SNSs. Additionally, these adolescents reported higher levels of depressive disclosures, including symptoms such as anhedonia, feelings of worthlessness, guilt, loss of concentration, irritability, and suicidal thoughts. Notably, the intensity of depressive sharing was significantly greater in the depressed group.
Finally, the research by Lee et al. [63] assessed the prevalence of IA among middle school students in Osan, South Korea, while also identifying related psychosocial risk factors and instances of depression. The study involved 1217 participants, utilizing the Internet Addiction Scale (IAS), the K-Youth Self Report (K-YSR), and the K-Children’s Depression Inventory (K-CDI) to evaluate emotional and behavioral issues. The findings showed that 2.38% of participants were classified as addicted to the Internet, 36.89% as over-users, and 60.72% as normal users. Predictive factors identified in the study included attention problems, delinquent behavior, and elevated K-CDI scores, while an earlier age of Internet use was negatively associated with addiction risk.

4. Discussion

The literature highlights significant discrepancies in understanding the role of anhedonia in the development of IA. Anhedonia, a complex psychopathological construct, has been extensively studied, particularly regarding its neurobiological mechanisms [64,65]. Neuroimaging studies reveal that anhedonia may stem from deficits in the brain’s reward system, impairing the ability to derive pleasure from typically rewarding stimuli [66,67]. These findings align with those of Christodoulou et al. [60], who identified anhedonia as a substantial risk factor for substance use disorders—conditions closely associated with dysfunctions in reward processing. Recent research suggests that individuals with pronounced anhedonic traits may engage in maladaptive behaviors, such as substance abuse, as a compensatory mechanism for their diminished capacity to experience reward [68]. This connection underscores the critical role of the reward system in understanding both substance use and behavioral addictions, including IA. In this context, IA may be conceptualized as an adaptive response to impaired reward processing, highlighting shared neurobiological underpinnings between substance use disorders and behavioral addictions [69,70]. Yu et al. [57] further identified anhedonia as a significant vulnerability factor for IA, noting that individuals with anhedonic tendencies are at a markedly increased risk of developing this behavioral addiction [71]. Notably, this association was found to exist independently of depressive symptomatology, suggesting that anhedonia contributes to the onset and progression of IA through mechanisms distinct from those traditionally associated with depression. This highlights anhedonia as an independent risk factor for IA, separate from its role in depressive disorders. Given the shared characteristics between IA and other behavioral addictions, such as impaired impulse control, these findings have critical implications for understanding IA within the broader framework of mental health disorders [72,73].
Despite these significant insights, the literature also reveals contrasting findings, adding complexity to the understanding of anhedonia’s influence on IA. For instance, Cai et al. [49] investigated the intricate relationship between IA and depression, demonstrating that while anhedonia frequently co-occurs with depressive symptoms, it may not serve as a direct mediating factor between the two disorders [74]. Their findings suggest that the relationship between depression and IA is multifaceted, potentially influenced by additional factors such as social isolation, personality traits, and environmental variables [75]. These results underscore the need for a more nuanced and holistic understanding of the interplay between anhedonia, depression, and IA. While anhedonia has been firmly established as a significant predictor of substance use disorders [25] and is implicated in behaviors associated with IA [76,77], other psychological constructs, including impulsivity and social functioning, must also be considered to fully capture the complexities of these interconnected relationships [78,79]. The reduction in the subjective experience of pleasure, a core symptom of depression, thus falls within the spectrum of symptoms closely related to IA [80]. Other associated symptoms and signs may define a new paradigm of mental distress linked to mood disorders [81]. The increased risk of substance use among the IA population, aimed at compensating for the anhedonic component secondary to the disorder, can exacerbate social isolation and shows a strong correlation, as evidenced by various studies, with a reduction in executive function performance [82,83,84]. Deficits in executive functions are also typical of major depressive disorders and are among the symptoms most implicated in reduced social functioning. Furthermore, IA and depression appear to share the experience of loneliness, a central emotional component of depression itself [85]. We are thus faced with a nosographic entity that has many points in common with depression, but given the absence of associated mood disturbances and the differing core symptoms, it presents as a clinical entity in its own right.
A critical yet often overlooked factor in the potential development of IA among younger individuals is the role of direct social interactions, particularly face-to-face encounters, within broader psychopathological dynamics [86]. Intensive Internet use may substitute or restrict such interactions, fostering an environment perceived as safer but less conducive to the development of social skills. This may initiate a self-reinforcing cycle, where reduced social competence exacerbates social anxiety and encourages avoidance behaviors [87]. Consequently, this phenomenon could contribute to the emergence of relational disorders and addictive behaviors, diminishing the perceived gratification derived from social interactions.
Incorporating variables that assess the frequency and intensity of direct social interactions in future studies could provide greater clarity on causal relationships and support the development of targeted therapeutic interventions [88].

4.1. Practical Implications

The findings of this study have important clinical implications, emphasizing the need to prioritize anhedonia as a significant predictive factor for IA during diagnosis and treatment. A deeper understanding of the neurobiological mechanisms underlying anhedonia could inform the development of targeted therapeutic interventions, such as CBT. Additionally, an integrated treatment approach that incorporates environmental and social factors may further enhance the effectiveness of interventions for individuals with IA.

4.2. Strengths and Limitations

Our study has several limitations. Firstly, the heterogeneity of the included studies made it challenging to integrate the results, thus preventing a final meta-analysis. The selected research varied in design, sample characteristics, and methodologies, complicating the synthesis of findings. Additionally, the reliance on self-reported data in many studies may have introduced biases that could have affected the results’ accuracy. Furthermore, the extreme heterogeneity of the studies limits the generalizability of the results to broader populations. Expanding research to include more diverse cultural samples could also shed light on how IA and anhedonia manifest across different social contexts. Despite these limitations, our study highlights the significant relationship between anhedonia and IA in a highly exposed population, youths.

5. Conclusions

This systematic review highlights the significant role of anhedonia in the development and maintenance of IA, particularly among young individuals. Anhedonia, a complex psychopathological construct, emerges not only as a key feature of depression but also as an independent risk factor for IA. Its connection to neurobiological dysfunctions in the brain’s reward system underscores the intricate interplay between emotional regulation, social behaviors, and digital dependencies.
The findings reveal that excessive Internet use, often exacerbated by social isolation and environmental stressors, creates a self-reinforcing cycle of maladaptive behaviors, including diminished social interactions and increased IA. Social anhedonia consistently correlates with IA, further complicating its relationship with depression and other psychosocial factors, such as loneliness and impulsivity. This highlights the importance of addressing both emotional and social dimensions in understanding IA and its psychological underpinnings.
By emphasizing the shared mechanisms between IA and other mental health conditions, this review contributes to a more comprehensive understanding of IA and underscores the importance of addressing anhedonia and associated factors in clinical and preventive contexts.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/psychiatryint6010001/s1, File S1. PRISMA checklist [44,45]; File S2. Search strategy; File S3. CHASP checklists [56].

Author Contributions

Conceptualization, G.C. and F.P.; methodology, G.C. and F.B.; software, G.C.; validation, S.M. and G.C.; formal analysis, G.C.; investigation, G.C.; data curation, G.C.; writing—original draft preparation, G.C., O.D., S.M., M.S., G.F. and S.M.P.; writing—review and editing, G.C., S.M. and F.P.; visualization, G.C., S.M., O.D., M.S., G.F. and C.T.T.N.; supervision, G.C. and F.P.; project administration, G.C. and F.P.; Overall, G.C. and F.B. contributed equally as first authors, while S.M. and F.P. contributed equally as last authors. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data supporting this research are available upon request from the corresponding author for data protection reasons.

Conflicts of Interest

The authors declare no conflicts of interest.

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Psychiatryint 06 00001 g001
Figure 1. PRISMA flow-chart of the selection process.
Figure 1. PRISMA flow-chart of the selection process.
Psychiatryint 06 00001 g001
Table 1. Characteristics of included studies.
Table 1. Characteristics of included studies.
AuthorsYear of
Publication,
Country		Type of StudyPopulationSettingKey FindingsResults
Yu et al. [57] 2023
China		Cohort studyN = 3577
mean age = 18.01 (65.4% female) 		College
students		Social and physical anhedoniaSocial anhedonia predicted higher initial IA levels (p < 0.001) and a slower decline (p < 0.05). No significant associations for physical anhedonia
Cai et al. [58]2022
China		Cohort studyN = 1009
mean age = 15.32 (50.8% males)		AdolescentsDepression symptomsGender did not significantly affect the network structure
Tan et al. [59]2020
USA		Cohort studyN = 824
mean age = 21.03
(72.3% female)		Psychology studentsRSAS, SFS, UCLA Loneliness Scale 3, DASS-21Results indicated negative correlations between RSAS and SFS scores. Mediation analyses showed that loneliness partially mediated the relationship for all subscales except Recreational Activities, while fully mediating overall social functioning
Christodoulou et al. [60]2020
USA		Cohort studyN = 709
9–11 age
(534 males)		Early
adolescents		Relationship between screen time and substance use and anhedoniaAnhedonia mediates the link between screen time and substance use, with an increased screen time leading to desensitization and a heightened risk
Casey et al. [61]2016
USA		Cohort studyN = 503
mean age = 20.8
(47.7% males)		Former
alternative
high school students		Associations between anhedonia and IAThe results indicated that trait anhedonia was associated with increased levels of compulsive Internet use and addiction to online activities and video games
Akkın Gürbüz et al. [62]2016
Turkey		Case–control53 cases
(depressed)
55 controls
(not depressed)
Mean age = 15.2
(65 female)		AdolescentsSNSs and depressionDepressed adolescents spent more time on the Internet and SNSs, reporting higher depressive disclosures, including anhedonia, guilt, irritability, and suicidal thoughts
Lee et al. [63]2014
South Korea		Case–controlCase 1 (Addiction N = 29)
Case 2 (over-user N = 449)
Control (normal user N = 739)
13–15 age
(525 males)		Middle school
students		Prevalence of IA and identifying
related psychosocial risk factors and instances of depression		The study found 2.38% were addicted, 36.89% over-users, and 60.72% normal users, with attention problems and delinquent behavior as predictive factors
Legend. N: number; p = p-value; RSAS: Revised Social Anhedonia Scale; SFS: Social Functioning Scale; UCLA: University of California Los Angeles; DASS-21: Depression, Anxiety, and Stress Scales; IA: Internet addiction; SNSs: social networking sites.
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Cangelosi, G.; Biondini, F.; Sguanci, M.; Nguyen, C.T.T.; Ferrara, G.; Diamanti, O.; Palomares, S.M.; Mancin, S.; Petrelli, F. Anhedonia in Youth and the Role of Internet-Related Behavior: A Systematic Review. Psychiatry Int. 2025, 6, 1. https://doi.org/10.3390/psychiatryint6010001

AMA Style

Cangelosi G, Biondini F, Sguanci M, Nguyen CTT, Ferrara G, Diamanti O, Palomares SM, Mancin S, Petrelli F. Anhedonia in Youth and the Role of Internet-Related Behavior: A Systematic Review. Psychiatry International. 2025; 6(1):1. https://doi.org/10.3390/psychiatryint6010001

Chicago/Turabian Style

Cangelosi, Giovanni, Federico Biondini, Marco Sguanci, Cuc Thi Thu Nguyen, Gaetano Ferrara, Orejeta Diamanti, Sara Morales Palomares, Stefano Mancin, and Fabio Petrelli. 2025. "Anhedonia in Youth and the Role of Internet-Related Behavior: A Systematic Review" Psychiatry International 6, no. 1: 1. https://doi.org/10.3390/psychiatryint6010001

APA Style

Cangelosi, G., Biondini, F., Sguanci, M., Nguyen, C. T. T., Ferrara, G., Diamanti, O., Palomares, S. M., Mancin, S., & Petrelli, F. (2025). Anhedonia in Youth and the Role of Internet-Related Behavior: A Systematic Review. Psychiatry International, 6(1), 1. https://doi.org/10.3390/psychiatryint6010001

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