While judicious internet use enhances communication efficiency and facilitates knowledge acquisition, thereby supporting human development, its multifunctional nature simultaneously engenders problematic usage patterns that prove challenging to regulate. Notably, excessive engagement with internet-based technologies may impede developmental progress, compromise mental health, and impair social functioning, with severe cases potentially culminating in behavioral addiction (1, 2). Internet addiction has emerged as a prevalent public health concern among adolescents and young adults in recent decades. Clinically defined as an inability to control internet use accompanied by maladaptive behavioral patterns, internet addiction may lead to clinically significant impairment or distress (3, 4). Substantial evidence links internet addiction to multiple adverse health outcomes, including: (a) deteriorated mental health status (particularly anxiety and depression), (b) reduced physical activity levels, (c) altered dietary patterns, (d) cognitive impairment, (e) poor academic performance, and (f) increased risks of obesity and diabetes (5–7). The internet addiction phenomenon among nursing students deserves attention as it may affect their academic and future professional performance. Internet addiction is characterized by an uncontrollable desire to go online, which can cause harmful consequences in all aspects of life (8). Previous studies have found that Internet addiction among nursing students is at a moderate level (8, 9). The occurrence of Internet addiction among nursing students can reduce academic performance, interfere with daily life activities, increase feelings of loneliness and isolation, and lead to personality distortion (10), which is not conducive to the development of the nursing profession. Understanding the factors influencing Internet addiction among nursing students is helpful for formulating targeted intervention measures, thereby promoting the development of talents in the nursing profession. Current research on the factors of Internet addiction among nursing students mainly focuses on external factors, such as sociodemographic characteristics and Internet usage time (11). This attention largely neglects the crucial role of internal personal traits. Therefore, this study aims to further expand the existing knowledge system of Internet addiction among nursing students by investigating the influence of the intrinsic personal traits of nursing students on their Internet addiction.

Childhood trauma plays an indispensable role in the formation and development of Internet addiction behaviors (12, 13). Childhood trauma is defined as physical or emotional abuse, neglect, and sexual abuse experienced by an individual before the age of 16 (14). Previous studies have shown that childhood trauma is closely related to Internet addiction. Individuals who have suffered childhood trauma are more likely to develop Internet addiction, and factors such as the type of trauma, the severity of trauma, and cultural background may play a moderating role in this (15, 16). Childhood trauma encompasses both physical and psychological aspects. The emotional and affective neglect and abuse that an individual experiences during childhood can have a greater impact on their bad behavior in adulthood than physical harm. At every stage of life, there is a significant correlation between traumatic experiences and mental illness.

Similarly, traumatic experiences can effectively predict an individual’s Internet addiction behavior (17). Not only child abuse, but also many other types of trauma can increase an individual’s risk of addictive behavior (18). The compensatory Internet usage model holds that individuals may compensate for unmet needs in real life in the online world (19), and childhood trauma can undermine the acquisition of individual emotional regulation ability (20). When negative emotions cannot be effectively vented in real life, individuals may use the Internet as an escape or coping strategy to mitigate the impact of negative emotions. If this continues for a long time, it may lead to Internet addiction (19). Latent Profile Analysis (LPA) is a human-centered statistical method that classifies individuals based on common attributes, behaviors, or characteristics of individuals and occupations, which stem from their responses to specific observations (21). The advantage of applying LPA in this study lies in its ability to provide a more precise understanding of childhood trauma among nursing students by identifying different subgroups that might be overlooked in the overall score. This method provides valuable insights for improving the pattern of Internet addiction among nursing students and informs for future research and the development of targeted intervention measures.

The main feature of alexithymia is the difficulty in recognizing, distinguishing and expressing emotions (22). It is a common psychosomatic phenomenon that brings a series of problems to the healthy growth of teenagers (23). The prevalence of alexithymia is 10% in the general population and 36% among adolescents (24, 25). Alexithymia is significantly positively correlated with Internet addiction (26, 27). Individuals with alexithymia have difficulty recognizing emotions, expressing them in appropriate words, and understanding the reasons for others’ emotional changes, which leads to a series of problems in their interpersonal relationships, such as social phobia and social avoidance (28). The indirectness of online social interaction to some extent compensates for the deficiency of alexithymia in emotional cognition and expression ability, but it also makes alexithymia overly dependent on the Internet, making the phenomenon of their detachment from the real society more serious (29).

Childhood trauma is considered to be the main risk factor of alexithymia, which hinders the ability to identify and express emotions, thus increasing the psychological distress of adolescents, and is closely associated with the occurrence and development of psychotic symptoms (30). Alexithymia can increase the susceptibility of adolescents to Internet addiction through deficiencies in cognitive processing and emotional regulation (31, 32), and has been proven to be a significant positive predictor of Internet addiction. However, it remains unclear whether alexithymia plays a mediating role between childhood trauma and Internet addiction among nursing students.

This study aims to explore the relationship between childhood trauma and Internet addiction among nursing students, emphasizing the mediating role of alexithymia. This study is based on the existing literature in several key fields (8, 11, 33). Although there is growing interest in childhood trauma (34, 35), research on nursing students remains limited. Furthermore, most of the current research both domestically and internationally tends to focus on the analysis at the group level, while neglecting the variability of individuals. This approach often fails to provide tailor-made guidance for personalized practices. To address this issue, we employed latent category analysis to determine the heterogeneity in childhood trauma among nursing students. This study employed a mediating model to analyze the mediating role of alexithymia between childhood trauma and Internet addiction. Based on these goals and theoretical frameworks, three hypotheses are proposed: H1: Childhood trauma is significantly associated with Internet addiction; H2: The heterogeneity of childhood trauma among nursing students can be identified through LPA. H3: Alexithymia plays a mediating role between childhood trauma and Internet addiction, Figure 1.

This study took 3,697 nursing students from 10 universities as samples to investigate the interaction between childhood trauma, alexithymia and Internet addiction, as well as the variability of childhood trauma. All the hypotheses have been confirmed. Firstly, the research results show that there is a positive correlation between childhood trauma and Internet addiction (13), which is consistent with previous research findings. Adolescents who have experienced trauma in childhood may develop insecure attachments, which can lead to negative emotional and behavioral consequences (45). Teenagers who grow up in an unsafe family environment and experience childhood trauma may relieve negative emotions by overusing the Internet, eventually leading to Internet addiction. From the perspective of neurophysiology, family stressors (such as childhood trauma) can disrupt the stress response system of adolescents, alter neural structure and function, and increase susceptibility to Internet addiction (45, 46). This emphasizes the importance of improving childhood trauma and suggests that nursing educators actively identify childhood trauma among nursing students, prevent the occurrence of Internet addiction problems, and promote the healthy development of nursing students.

Consistent with the second hypothesis, LPA classified the samples into three distinct profiles: low childhood trauma, moderate childhood trauma, and high childhood trauma. More than half of the nursing students showed low childhood trauma, which is consistent with the results of earlier studies (47). Comparative analysis revealed that female nursing students were significantly more likely to report low childhood trauma. This may be attributed to greater societal acceptance and nurturing towards girls in Chinese culture. Additionally, girls’ generally compliant temperament and lower propensity for disruptive behaviors likely reduced caregiver antagonism, thereby decreasing their exposure to traumatic experiences. The comparative group analysis shows that low-income families are more prone to childhood trauma. Our research results are the same as those of previous studies (48). Children from low-income families are more likely to suffer emotional and physical neglect from their parents (49). Economic pressure leads to parents’ lack of energy. Low-income parents mostly engage in high-intensity and low-pay work and have no time to take care of their children when they return home. Due to deviations in educational concepts, low-income parents often only meet their children’s material needs and neglect their emotional needs (50).

The third hypothesis was supported by the significant mediating effect of alexithymia, indicating its crucial role in the association between childhood trauma and internet addiction. This finding aligns with the cumulative situational risk model, which posits that increased exposure to adverse childhood experiences elevates the likelihood of maladaptive outcomes in adulthood (51). Self-determination theory (52) provides a mechanistic explanation: Childhood trauma may compromise the fulfillment of three fundamental psychological needs—autonomy, relatedness, and competence—thereby increasing vulnerability to problematic internet use as a compensatory behavior.

Research indicates that individuals who have experienced childhood trauma often face diminished social support and limited parental social interaction, resulting in a lack of experience in expressing emotional experiences (53). Furthermore, family environments may not encourage the expression of emotions, leading to difficulties in describing, identifying, and differentiating emotions (54). Due to challenges in recognizing their own feelings and deficiencies in emotional expression skills, these individuals tend to focus more on physical discomfort rather than addressing their inner emotional needs when describing their discomfort (55). This obstacle in emotional expression hinders their ability to communicate effectively with others, ultimately impacting the development of interpersonal relationships. In this context, the virtual nature and convenience of the internet provide a platform for these individuals, who repress their emotions in real life, to release their feelings. This allows them to fulfill their emotional needs in a manner that minimizes direct conflict (55). However, this reliance on online platforms simultaneously heightens the risk of developing internet addiction. Furthermore, individuals who have suffered verbal abuse during childhood will have language-related brain regions affected, such as Broca’s and Wernicke’s areas, which in turn leads to a decline in language function and comprehension ability, and their emotional expression ability will also be affected to a certain extent (56). Secondly, psychological trauma experienced by children in their early years can affect an individual’s ability to regulate emotions, impair their imagination, cause a lack of lifelong pleasure, and lead to an insecure attachment style, thereby resulting in alexithymia (57, 58). Individuals with alexithymia have lower self-esteem levels and emotional control abilities than the general population. They have deficiencies in emotional expression, perception of emotions, and emotional imagination, which makes them more prone to negative emotions when frustrated in real social environments. At the same time, they have difficulties in social interaction and find it hard to establish a good social support system (27), thus seeking compensation through the Internet. It increases the risk of Internet addiction (59). Our research results further confirm the previous studies on the mediating role of alexithymia in childhood trauma and Internet addiction (33). Therefore, it is necessary to screen for childhood trauma among nursing students, carry out early intervention, and reduce the occurrence of Internet addiction among nursing students.

This study Outlines strategies for promoting caregiver growth in the field of mental health and emphasizes the importance of understanding the impact of different degrees of childhood trauma on Internet addiction. Taking “high childhood trauma” as a reference, we respectively explored the influences of low childhood trauma and moderate childhood trauma on Internet addiction among Internet care students. Nursing students who are regarded as having “ Moderate childhood trauma” have experienced childhood trauma, which causes them to bear excessive psychological pressure and makes them more prone to sub-health problems. This also suggests that nursing educators should pay attention to those with early traumatic experiences. When necessary, “psychodrama” (60) or the intervention of a psychologist should be adopted to reduce the harm caused by childhood trauma and thereby improve the occurrence of Internet addiction. For nursing students classified as having “low childhood trauma”, their probability of developing Internet addiction is lower than that of those with high childhood trauma. However, alexithymia still plays a certain role. People with alexithymia have obvious deficiencies in emotional processing ability. When it comes to interpersonal communication, there are difficulties in adaptation and they are unable to establish the friendships they need (61). The use of the Internet precisely meets the extensive interpersonal communication needs that cannot be fulfilled in real life, becoming the realistic basis for college students’ tendency towards Internet addiction. For nursing students with alexithymia, nursing educators provide emotional support and psychological counseling to reduce the occurrence of alexithymia. On the other hand, the mindfulness level of nursing students can lower negative cognition and improve their Internet addiction (62).

This study has certain limitations. Although we conducted a large-sample study, the convenient sampling method may not fully represent nursing students from different regions and organizations, which affects the generalization of the current results to all nursing professions. In future research, larger samples can be taken, and the profiles of different regions, cultures and countries can also be investigated to explore possible differences and commonalities. Secondly, since our data was collected through self-reports and there is a social desirability bias, it is difficult to generalize the results. Finally, we recognized the limitations of cross-sectional design in determining causal relationships and plan to use longitudinal design in future studies to better understand the temporal sequence and causal relationships among variables.

This study ultimately established a positive correlation between childhood trauma and Internet addiction, with alexithymia serving as a mediating variable in this dynamic. Furthermore, nursing students have revealed the direct relationship between different groups and Internet addiction based on the heterogeneity of LPA usage, and have put forward different suggestions for different groups. The findings of this study provide crucial guidance for nursing educators and administrators. By categorizing nursing students into distinct risk groups based on their childhood trauma experiences, educators and managers can promptly implement targeted interventions. In particular, for students in the moderate childhood trauma group, educators should maintain heightened vigilance, closely monitor their physical and mental well-being, and strengthen psychological support. For those in the high childhood trauma group, nursing educators and administrators should actively adopt personalized and tailored measures, such as psychotherapy, to mitigate the negative impacts of childhood trauma. This approach will enhance the overall well-being of nursing students and ultimately contribute to the broader healthcare system.