A systematic review of internet addiction in hospitalized adolescents: proposing a hospital-adapted moderated dual mediation model of emotional dysregulation and social compensation.

Hospitalized adolescents face unique medical and psychosocial stressors that elevate their risk of internet addiction, yet mainstream theoretical frameworks such as the I-PACE model fail to adequately capture context-specific mechanisms within inpatient medical settings. This narrative systematic review systematically searched four databases (Web of Science Core Collection, PubMed, PsycINFO, Scopus) from database inception to September 30, 2025, in accordance with PRISMA 2020 guidelines, to map existing evidence on the dual mediating pathways of emotional dysregulation and social compensation underlying internet addiction in adolescent inpatient populations. Given significant methodological heterogeneity across included studies (I² >75% in pilot meta-regression), a narrative synthesis approach aligned with ENTREQ guidelines was employed for thematic integration, rather than quantitative meta-analysis. Key findings are as follows (1): Medical stressors prime emotional dysregulation in hospitalized adolescents, lowering their emotional tolerance thresholds and reinforcing online escape behaviors (2); Forced social deprivation in inpatient settings triggers social compensation motivation, while institutional restrictions on electronic device use create a phenomenon of "compensatory frustration" that paradoxically accelerates addiction progression (3); These two pathways form a self-reinforcing loop, the strength of which is amplified by longer hospitalization duration and greater disease severity. The Hospital-Adapted Moderated Dual Mediation Model proposed in this review extends the classic I-PACE framework by integrating inpatient-specific contextual moderators and provides a theoretical foundation for the development of precision mental health interventions in clinical settings.