Adolescents' electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age

Bedtime Screen Use Behaviors and Sleep Outcomes in Early Adolescents: A Prospective Cohort Study

PURPOSE

To determine prospective associations between bedtime screen use behaviors and sleep outcomes one year later in a national study of early adolescents in the United States.

METHODS

We analyzed prospective cohort data from 9,398 early adolescents aged 11-12 years (48.4% female, 45% racial/ethnic minority) in the Adolescent Brain Cognitive Development Study (Years 2-3, 2018-2021). Regression analyses examined the associations between self-reported bedtime screen use (Year 2) and sleep variables (Year 3; self-reported sleep duration; caregiver-reported sleep disturbance), adjusting for sociodemographic covariates and sleep variables (Year 2).

RESULTS

Having a television or Internet-connected electronic device in the bedroom was prospectively associated with shorter sleep duration one year later. Adolescents who left their phone ringer activated overnight had greater odds of experiencing sleep disturbance and experienced shorter sleep duration one year later, compared to those who turned off their phones at bedtime. Talking/texting on the phone, listening to music, and using social media were all prospectively associated with shorter sleep duration, greater overall sleep disturbance, and a higher factor score for disorders of initiating and maintaining sleep one year later.

DISCUSSION

In early adolescents, several bedtime screen use behaviors are associated with adverse sleep outcomes one year later, including sleep disturbance and shorter weekly sleep duration. Screening for and providing anticipatory guidance on specific bedtime screen behaviors in early adolescents may be warranted.

The mediating role of social connectedness and negative cognitive emotion regulation in the association between problematic Internet use and depression among adolescents

Introduction

While the relationship between adolescent problematic Internet use (PIU) and depression has been extensively researched, few studies have investigated the role and mechanisms of social connectedness (SC) in this context. This study aimed to investigate the mediating effect of social connectedness (SC) and cognitive emotion regulation (CER) in the relationship between PIU and depression.

Methods

We conducted a cross-sectional study involving 9,407 adolescents aged 12-18 years in China from September 2022 to March 2023. We employed Young's 20-item Internet Addiction Test (IAT-20), the Social Connectedness Scale-Revised (SCS-R), the Cognitive Emotion Regulation Scale (CER), and the DSM-5 Level-2 Depression Scale to assess mental health outcomes. Logistic regression analysis was also performed to examine the independent association between the measured variables and depression. Mediation analysis was then conducted to evaluate the mediating roles of social connectedness and cognitive emotion regulation in the relationship between PIU and depression.

Results

We found that the prevalence of PIU was 21.8%. Offline SC (indirect effect: 0.112, 95% CI: 0.104-0.121) and negative CER (indirect effect: 00.140, 95% CI: 0.129-0.152) mainly played a parallel mediating role in the relationship between PIU and depression, along with online SC (on_SC) (indirect effect: 0.007, 95% CI: 0.005-0.010).

Discussion

These findings provide valuable insights into how PIU is associated with depression and highlight the importance of fostering real-life interpersonal interactions. However, the generalizability of this study's findings to other populations may be limited due to cultural factors.

Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study

Background

Children's lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear.

Objective

This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province.

Methods

Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations.

Results

A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34-1.74) and girls using internet for 1.1-2 hours/day (OR 1.22, 95% CI 1.06-1.39) and >2 hours/day (OR 1.70, 95% CI 1.50-1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83-2.21; 2 IA behaviors: 2.91, 95% CI 2.57-3.29; and ≥3 IA behaviors: 4.72, 95% CI 4.26-5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively).

Conclusions

Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence.

Exploring the impact of smartphone addiction on mental health among college students during the COVID-19 pandemic: The role of resilience and parental attachment

Smartphone addiction is an increasingly severe issue in modern society, particularly impacting the mental health of college students during the COVID-19 pandemic. This study aims to explore the relationship between smartphone addiction and mental health issues among college students, and the mediating and moderating roles of psychological resilience and parental attachment. We employed a cross-sectional study design with 100,097 college Chinese students to examine the relationships between smartphone addiction, mental health (anxiety and depression), and the mediating role of psychological resilience. Parental attachment was assessed as a moderator within these relationships. Data were analyzed using multiple regression and mediation/moderation models, controlling for relevant covariates. Our findings revealed a significant positive correlation between smartphone addiction and both anxiety and depression. Psychological resilience mediated these relationships, suggesting that higher resilience levels can mitigate the negative psychological impacts of smartphone addiction. Additionally, parental attachment moderated the effects of smartphone addiction on psychological outcomes; stronger attachment was associated with less pronounced effects of addiction on anxiety and depression. Specifically, for students with low parental attachment, the predictive effect of smartphone addiction on anxiety and depression was more pronounced, whereas higher attachment levels were protective.

Screen Use at Bedtime and Sleep Duration and Quality Among Youths

Importance

Although questionnaire-based cross-sectional research suggests that screen time before bed correlates with poor sleep, self-reported data seem unlikely to capture the complexity of modern screen use, requiring objective night-by-night measures to advance this field.

Objective

To examine whether evening screen time is associated with sleep duration and quality that night in youths.

Design, Setting, and Participants

This repeated-measures cohort study was performed from March to December 2021 in participant homes in Dunedin, New Zealand. Participants included healthy youths aged 11 to 14.9 years. Data were analyzed from October to November 2023.

Exposure

Objectively measured screen time, captured using wearable or stationary video cameras from 2 hours before bedtime until the first time the youth attempted sleep (shut-eye time) over 4 nonconsecutive nights. Video data were coded using a reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type.

Main Outcomes and Measures

Sleep duration and quality were measured objectively via wrist-worn accelerometers. The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends.

Results

Of the 79 participants (47 [59.5%] male; mean [SD] age, 12.9 [1.1] years), all but 1 had screen time before bed. Screen use in the 2 hours before bed had no association with most measures of sleep health that night (eg, mean difference in total sleep time, 0 minutes [95% CI, -3 to 20 minutes] for every 10 minutes more total screen time). All types of screen time were associated with delayed sleep onset but particularly interactive screen use (mean difference, 10 minutes; 95% CI, 4 to 16 minutes for every additional 10 minutes of interactive screen time). Every 10 minutes of additional screen time in bed was associated with shorter total sleep time (mean difference, -3 minutes; 95% CI, -6 to -1 minute). The mean difference in total sleep time was -9 minutes (95% CI, -16 to -2 minutes) for every 10 minutes of interactive screen use and -4 minutes (95% CI, -7 to 0 minutes) for passive screen use. In particular, gaming (mean difference, -17 minutes; 95% CI, -28 to -7 minutes for every 10 minutes of gaming) and multitasking (mean difference, -35 minutes; 95% CI, -67 to -4 minutes on nights with vs without multitasking) were associated with less total sleep time.

Conclusions and Relevance

In this repeated-measures cohort study, use of an objective method showed that screen time once in bed was associated with impairment of sleep, especially when screen time was interactive or involved multitasking. These findings suggest that current sleep hygiene recommendations to restrict all screen time before bed seem neither achievable nor appropriate.

Trends and Influencing Factors in Problematic Smartphone Use Prevalence (2012-2022): A Systematic Review and Meta-Analysis

Given that problematic smartphone use (PSU) has been researched for a long time, it becomes necessary to assess how the trends of PSU prevalence have evolved over time. In total, 106 articles from 2012 to 2022 with 109 studies covering 97,748 individuals were included in this systematic review and meta-analysis. The estimation of the global pooled PSU prevalence was 37.1% (95% confidence interval, 33.5 - 40.8%) and the PSU prevalence is growing over time in total. Although the PSU prevalence exhibited wide variation between regions and measurement scales, the increasing trend remained. In addition, the regression slope of the PSU prevalence trend in males was higher than that in females. Males initially had a lower prevalence of PSU than females, but this steadily changed over time until it was greater in males than in females. Moreover, the prevalence of PSU showed an increasing trend across all age groups, with a faster growth rate in the older age group. Considering the aforementioned results, it's necessary to implement proper interventions to do with this phenomenon. In addition, considering the differences in prevalence brought by regions, and measurement scales, in practice and research, we should not only take into account the disparities of PSU between countries or cultures, but also to concern about establishing unified standard and measurement tools to confirm it.

Advancing Patient-Centered Care: An International Survey of Adolescent Perspectives on Insomnia

OBJECTIVE

The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.

METHOD

A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.

RESULTS

Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.

CONCLUSIONS

Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Excessive smartphone use increases self-reported auditory and vestibular symptoms

BACKGROUND

With widespread smartphone use, there is growing concern about their potential impact on human health.

OBJECTIVE

The effects of smartphone use on self-reported hearing ability, tinnitus, balance, falls, and anxiety level were investigated in this study.

METHODS

This study included 682 participants who were divided into 2 groups: a high smartphone use (HSU) group and a low smartphone use (LSU) group. Both groups were evaluated for hearing ability using the Amsterdam inventory for auditory disability and handicap; balance status using the vertigo, dizziness, imbalance symptom scale; anxiety status using the Beck anxiety index; and fall and tinnitus status using the visual analog scale.

RESULTS

The HSU group showed significantly worse hearing ability, tinnitus, balance, falling, and anxiety status results than the LSU group (p < 0.001). There was a positive correlation between smartphone addiction severity and auditory impairment, tinnitus, risk of falling, and anxiety, as well as a negative correlation with balance score (p < 0.001).

CONCLUSION

The findings suggest that individuals with excessive smartphone use are more likely to experience hearing, tinnitus, balance, falling, and anxiety problems than those who use smartphones less frequently. Excessive smartphone use may be considered a potential risk factor for these problems.

Social Media Use, Emotional Investment, Self-Control Failure, and Addiction in Relation to Mental and Sleep Health in Hispanic University Emerging Adults

The number of social media users has increased dramatically in recent years. Common correlates of social media use may be poor mental and sleep health which are pressing issues among emerging adults and Hispanic groups. This study investigated the relationships between five different forms of social media use and mental and sleep health in Hispanic university emerging adults. Hispanic university emerging adults (n = 358) completed a survey assessing sociodemographics, overall social media use frequency, nighttime in-bed social media use, social media addiction, social media self-control failure, emotional investment in social media, depression, anxiety, stress, and sleep quality. Findings demonstrated that social media addiction and social media self-control failure were positively associated with stress and poor sleep quality. Emotional investment in social media was positively associated with depression. Findings may suggest that Hispanic university emerging adults may use social media emotionally and problematically to cope with negative affect and poor sleep quality, or that negative affect and poor sleep quality stem from using social media emotionally and problematically. The clinical implications of these results are discussed. Prospective studies are warranted to assess temporality.

How is parental psychological control associated with adolescent mental health in economically disadvantaged areas? The serial mediating role of psychological reactance and problematic smartphone use

Introduction

Adolescent mental health has been an issue of global concern, and the mental health of adolescents in economically disadvantaged areas may require additional research. The research delves into factors associated with economically disadvantaged areas' adolescent mental health, employing family systems theory, self-determination theory, and psychological reactance theory. Specifically, the present study which was done in Jingzhou country, an economically disadvantaged area of Hunan Province, China, aimed to examine the link between parental psychological control and adolescent mental health, as well as the mediating roles of psychological reactance and problematic smartphone use in this relationship.

Methods

A sample of 1300 Chinese middle school students (620 girls, mean age = 14.22 ± 1.29) completed self-reported measures of parental psychological control, psychological reactance, problematic smartphone use, and adolescent mental health.

Results

Results showed that parental psychological control was negatively associated with adolescent mental health. Psychological reactance and problematic smartphone use mediated the association between parental psychological control and adolescent mental health, separately and serially.

Discussion

The findings of the present study enrich the literature on parenting styles and adolescent mental health in economically disadvantaged areas, and this provides an intervention perspective to reduce the negative impact of poor parenting on adolescent mental health in economically disadvantaged areas.

Nomophobia, loneliness and depressive symptom levels of adults living in a district of Türkiye

This study was conducted to evaluate whether smart cell phones detach people from social life, make them lonely, cause depressive symptoms and whether there is a relationship between them. This is a cross-sectional study using face-to-face survey method. The sample was determined as 376 participants, with 95% confidence interval, 50% probability depending on the probability of having a smartphone or not. Participants in the sample were determined by systematic random sampling from adults aged 20 and over in Çiftlik district of Niğde province. The NMP-Q, DASS-42 and UCLA-LS were used. The median age of the 376 participants (192 male, 184 female) was 30 and the mean age was 32.0 (±10.94) years. Participants that had social media accounts were 68.9% of the population. Over 70% of the participants had mild, moderate or severe nomophobia. Nomophobia status of the participants was affected by the mean duration of the first-time smartphone use (P = .017), the mean daily smartphone usage time of the participants (P < .001), the mean number of smartphone users in the participants' families (P = .003), the mean depression and stress scores of the participants (P < .001), having social media account (P = .001), and declaration of smart phone dependency (P = .005). Nomophobia status was not affected by participants' gender, mean age, educational level, employment status, economic status and marital status (P > .05). The duration of daily smartphone use, the duration of first-time smartphone use, and having multiple smartphone users in family increased nomophobia. Also, having active social media accounts and self-reported smartphone addiction found correlated to nomophobia. Smartphone addiction increases depression, anxiety, and stress scores of the participants.

Daily Electronic Media Use and Sleep in Late Life

OBJECTIVES

Daily electronic media use, including television viewing and computer use, is common in older adulthood. Yet, increased electronic media usage may disrupt nightly sleep, leading to sleeping fewer hours and more sleep disruptions. The current study examined these relationships in older adulthood, as well as the potential buffering effect of having a regular sleep schedule.

METHODS

Older adults (N = 273) from the Daily Experiences and Well-Being Study (DEWS) completed 5-6 days of data collection where they answered questions at the beginning of the day about the previous night's sleep as well as questions throughout the day about daily electronic media use. They also wore Actical accelerometers to capture sleep regularity.

RESULTS

Older adults reported sleeping fewer hours and having more sleep disturbances on days when they reported more instances of computer use. Sleep regularity moderated the daily association between TV viewing and sleep disturbances such that daily TV viewing was associated with more sleep complaints only for older adults who had less regular sleep patterns. However, sleep regularity no longer moderated this association when accounting for napping behavior.

DISCUSSION

These findings provide evidence that older adults sleep worse after days when they engage in more electronic media use. The association with TV viewing with sleep disturbances on any given day is somewhat mitigated by engaging in regular sleep patterns. Researchers discuss the importance of assessing electronic media use and sleep in daily life as the role of sleep regularity may be a modifiable protective factor.

Problematic smartphone use and mental health outcomes among Singapore residents: The health and lifestyle survey

BACKGROUND

The excessive use of smartphones and its association with adverse outcomes has been widely reported, with several studies showing an association between smartphone overuse, depression, anxiety, and sleep-related problems.

METHODS

The study used data from the Health and Lifestyle Survey, a nationwide population survey. It examined the prevalence of Problematic Smartphone Use (PSU) and its association with mental health outcomes among Singapore residents aged 15-65 years.

PARTICIPANTS

Participants were assessed for PSU using the Smartphone Addiction Scale-Short Version, psychological distress with the Patient Health Questionnaire-9, and Generalised Anxiety Disorder -7 questionnaire, sleep problems using the Insomnia Severity Index, and positive mental health with Rapid Positive Mental Health Instrument.

RESULTS

In all, 6509 participants completed the survey, giving a survey response rate of 73.2 %. The prevalence of PSU was 30.2 % in the population. Individuals with PSU were more likely to have symptoms of moderate or severe depression (OR: 3.2, 95 % CI: 2.4-4.4), anxiety (OR: 3.4, 95 % CI: 2.4-4.8), insomnia (OR: 3.4, 95 % CI: 2.8-4.2), and poorer positive mental health (β: -0.3, 95 % CI: -0.4 to -0.2).

CONCLUSIONS

The study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners.

Turn off that night light! Light-at-night as a stressor for adolescents

Light-at-night is known to produce a wide variety of behavioral outcomes including promoting anxiety, depression, hyperactivity, abnormal sociability, and learning and memory deficits. Unfortunately, we all live in a 24-h society where people are exposed to light-at-night or light pollution through night-shift work - the need for all-hours emergency services - as well as building and street-lights, making light-at-night exposure practically unavoidable. Additionally, the increase in screentime (tvs and smart devices) during the night also contributes to poorer sleep and behavioral impairments. Compounding these factors is the fact that adolescents tend to be "night owls" and prefer an evening chronotype compared to younger children and adults, so these teenagers will have a higher likelihood of being exposed to light-at-night. Making matters worse is the prevalence of high-school start times of 8 am or earlier - a combination of too early school start times, light exposure during the night, and preference for evening chronotypes is a recipe for reduced and poorer sleep, which can contribute to increased susceptibility for behavioral issues for this population. As such, this mini-review will show, using both human and rodent model studies, how light-at-night affects behavioral outcomes and stress responses, connecting photic signaling and the circadian timing system to the hypothalamic-pituitary adrenal axis. Additionally, this review will also demonstrate that adolescents are more likely to exhibit abnormal behavior in response to light-at-night due to changes in development and hormone regulation during this time period, as well as discuss potential interventions that can help mitigate these negative effects.

The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students

BACKGROUND

The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.

METHOD

A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.

RESULTS

Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.

CONCLUSIONS

These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

Exploring the Interplay between Sleep Quality, Stress, and Somatization among Teachers in the Post-COVID-19 Era

(1) Background. The post-COVID-19 era has imposed unique challenges on educators, significantly impacting their psychological and physical well-being. This study examines the interrelationships among psychological stress, sleep quality, and somatization in a sample of teachers, elucidating the impact of these factors during the ongoing recovery from the pandemic. (2) Methods. Using validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) and the Mesure du Stress Psychologique (MSP), this research investigates how stress and sleep disturbances correlate with somatization among teachers. The study also considers the influence of demographic factors such as age, gender, and years of experience. (3) Results. The results indicated that sleep quality significantly correlates with both psychological stress and somatic pain, emphasizing the crucial role of sleep in managing stress-induced physical symptoms. Additionally, the fear of COVID-19 significantly exacerbates these effects, illustrating the complex interplay of psychological and physical health factors during the pandemic. Contrary to initial hypotheses, demographic factors such as gender, age, and years of experience did not significantly influence these primary relationships. (4) Conclusions. The findings emphasize the necessity of addressing both psychological stress and sleep quality to mitigate their combined effects on somatization. Educational institutions and policymakers are urged to develop targeted interventions that address these issues to support teachers' health and well-being in a post-pandemic landscape.

The Associations Between Social Support and Problematic Mobile Phone Use Among Children and Adolescents: A Three-level Meta-analysis

Numerous studies have investigated the relationship between social support and problematic mobile phone use among adolescents, yet a definitive consensus remains elusive. The high prevalence of problematic mobile phone use among children and adolescents requires urgent clarity on this issue. However, previous meta-analyses on this topic have primarily focused on college students, overlooking this association in younger age groups. The present study thus concentrated on children and adolescents, conducting a three-level meta-analysis to combine existing research findings and analyze various moderators to identify sources of research heterogeneity. A systematic literature search retrieved a total of 33 studies with 135 effect sizes for this meta-analysis, and 25,537 students (53.83% female, age range 7-19, grades range 3rd-12th) were included. The results showed a negative correlation (r = -0.139) between social support and problematic mobile phone use in children and adolescents. Age, social support measurement, sources of social support, and symptoms of problematic mobile phone use were found to have a significant moderating influence. Specifically, social support showed a stronger negative correlation with problematic mobile phone use in older adolescents compared to their younger counterparts. The correlation was more pronounced when using the Multidimensional Scale of Perceived Social Support than other scales. Family support exhibited a stronger negative correlation with problematic mobile phone use compared to other sources of support. Among the symptoms of problematic mobile phone use, the inability to control craving has the strongest negative correlation with social support. This meta-analysis suggested that providing more social support, particularly in the form of family support, during the development of children and adolescents may help alleviate problematic mobile phone use.

Effective parental strategies against problematic smartphone use among adolescents: A 6-month prospective study

Problematic Smartphone Use (PSU) among adolescents is growing problem worldwide and multiple studies investigated its associated parental risk and protective factors. The available studies, however, typically do not address the multidimensional nature of PSU. They also rely heavily on cross-sectional designs with a small number of potentially contributing variables. This 6-month prospective study examines the relationships between a large range of parental factors with the three known dimensions of PSU: social environment pressure, emotional gain, and addiction-like behaviors. Specifically the study examines whether, and to what extent, the various dimensions of current and future PSU are related to parental support giving, general quality of communication, specific communication about smartphone use, and the four common mediation strategies. The sample comprised 1187 triads of mothers, fathers, and adolescents. The data-analysis pipeline consisted of three consecutive phases: (1) analyses of parental factors at baseline, (2) analyses of parental factors change over 6-months, and (3) interaction analyses between parental factors and the time-period of the study. The pipeline elicited three factors that moderated the change in PSU over time: Communication about smartphones with mothers, parental support giving, and parental co-use. The implications of these findings are discussed in the context of the existing literature and the familial, microsystem theoretical framework. Altogether, this prospective study scrutinized key parental factors and strategies that could be utilized by parents for coping with one of the most difficult parenting challenges of the digital era. Further research may build upon these findings to develop designated interventions to reduce PSU.

Validation of the Korean version of the Sleep Hygiene Practice Scale in a Non-Clinical Population

OBJECTIVES

This study aimed to validate the Korean version of the sleep hygiene practice scale (SHPS-K) and determine its effectiveness in screening poor sleepers with insomnia.

METHODS

Online survey was conducted using translated SHPS in Korean, the Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS) in a non-clinical population. The internal consistency and test-retest reliability of the SHPS-K were assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), respectively. Construct validity was evaluated using correlation analyses with other questionnaires and confirmatory factor analysis. We determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K > 5 and ISI-K ≥ 15) using receiver operating characteristic analysis.

RESULTS

A total of 484 participants (242 women, mean age of 43.8 years) were enrolled. The average SHPS-K score was 71.2, with no significant sex differences. Women had poorer sleep scheduling and timing behaviors, and men had poorer eating and drinking behaviors. Good internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (ICC = 0.80) were observed. The SHPS-K was positively correlated with the PSQI-K (r = 0.55), ISI-K (r = 0.54), and KESS (r = 0.42). A cutoff value of 73 identified poor sleepers with insomnia (area under the curve = 0.828).

CONCLUSIONS

The SHPS-K is a reliable instrument for evaluating sleep hygiene in non-clinical Korean populations.

Impact of mobile phones and wireless devices use on children and adolescents' mental health: a systematic review

Growing use of mobiles phones (MP) and other wireless devices (WD) has raised concerns about their possible effects on children and adolescents' wellbeing. Understanding whether these technologies affect children and adolescents' mental health in positive or detrimental ways has become more urgent following further increase in use since the COVID-19 outbreak. To review the empirical evidence on associations between use of MP/WD and mental health in children and adolescents. A systematic review of literature was carried out on Medline, Embase and PsycINFO for studies published prior to July 15th 2019, PROSPERO ID: CRD42019146750. 25 observational studies published between January 1st 2011 and 2019 were reviewed (ten were cohort studies, 15 were cross-sectional). Overall estimated participant mean age and proportion female were 14.6 years and 47%, respectively. Substantial between-study heterogeneity in design and measurement of MP/WD usage and mental health outcomes limited our ability to infer general conclusions. Observed effects differed depending on time and type of MP/WD usage. We found suggestive but limited evidence that greater use of MP/WD may be associated with poorer mental health in children and adolescents. Risk of bias was rated as 'high' for 16 studies, 'moderate' for five studies and 'low' for four studies. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of MP/WD use (e.g. social media) on mental health trajectories in children and adolescents.

The relationship between mobile phone dependence and academic burnout in Chinese college students: a moderated mediator model

Objective

The aim of this study was to examine the correlation between the level of mobile phone dependence among college students and their experience of academic burnout. Additionally, the study sought to explore the potential mediating effect of study engagement and the moderating role of love.

Methods

During October and December 2023, a cross-sectional study measuring mobile phone dependence, academic burnout, and study engagement among Chinese college students, using the UtrechtWork Engagement Scale-student (UWES-S), College Student Mobile Phone Dependence Questionnaire (CSMPDQ), and Academic Burnout Questionnaire (ABQ). To examine the hypothesis of mediating and moderating effect, SPSS PROCESS was utilized.

Results

The predictive effect of mobile phone dependence on academic burnout was significant (β = 0.410, t = 14.236, p < 0.001), and the predictive effect of mobile phone dependence on academic burnout remained significant when the mediating variable study engagement was introduced (β = 0.308, t = 10.288, p < 0.001), mobile phone dependence had a significant predictive effect on study engagement (β = -0.292, t = -11.639, p < 0.001), and study engagement had a significant positive predictive effect on academic burnout (β = -0.270, t = -9.028, p < 0.001). Love significantly negatively predicted study engagement (β = -0.564, t = -9.641, p < 0.001); and the interaction term for mobile phone dependence and love was significant (β = -0.211, t = -3.688, p < 0.001), indicating a significant moderating effect of love between mobile phone dependence and study engagement.

Conclusion

Mobile phones among college students has been found to have a direct correlation with academic burnout. It can also indirectly contribute to academic burnout by diminishing levels of academic engagement. This indirect relationship is further influenced by love. These findings can help researchers and educators better understand the underlying mechanisms between smartphone dependence and learning burnout in undergraduates.

Night Screen Time is Associated with Cognitive Function in Healthy Young Adults: A Cross-Sectional Study

Background

In recent years, a significant shift toward remote work, virtual education, and social distancing measures was witnessed, thereby leading people to increasingly depend on digital devices for communication, work, and entertainment. This increased exposure to screens has raised concerns regarding its potential impact on cognitive function.

Purpose

This study investigated the relationship between screen time and cognitive function among healthy young adults.

Methods

One hundred forty-five healthy individuals (mean age 21.55 ± 2.84 years) participated in this cross-sectional study. Sociodemographic information including age, sex, height, weight, and level of education were obtained. Participants reported screen time using a screen time questionnaire. Cognitive function tests including, Paced Auditory Serial Addition Task (PASAT), Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) were conducted. Multilinear regression analyses were used to examine the associations between age, sex, level of education, screen time, and cognitive function.

Results

One hundred thirty-nine participants (76 women) completed the study. Increased night screen time, bachelor's educational level, and women were associated with lower PASAT scores (R2=0.258; p≤0.047). Moreover, increased night screen time was associated with lower MoCA scores (R2=0.029; p=0.035). However, no associations were found between night screen time and SDMT scores.

Conclusion

Participants who had higher night screen exposure had lower cognitive scores in the information speed processing, working memory, calculation, and attention domains. Considering these findings, this study emphasizes on the importance of setting a future recommended screen time guidelines for young adults as well as to promote healthy cognitive habits in order to preserve cognitive function and reduce the risk of developing neurodegenerative disease in the future. Future prospective cohort studies involving a more diverse age range is needed.

Longitudinal associations of screen time, physical activity, and sleep duration with body mass index in U.S. youth

BACKGROUND

Youth use different forms of screen time (e.g., streaming, gaming) that may be related to body mass index (BMI). Screen time is non-independent from other behaviors, including physical activity and sleep duration. Statistical approaches such as isotemporal substitution or compositional data analysis (CoDA) can model associations between these non-independent behaviors and health outcomes. Few studies have examined different types of screen time, physical activity, and sleep duration simultaneously in relation to BMI.

METHODS

Data were baseline (2017-2018) and one-year follow-up (2018-2019) from the Adolescent Brain Cognitive Development Study, a multi-site study of a nationally representative sample of U.S. youth (N = 10,544, mean [SE] baseline age = 9.9 [0.03] years, 48.9% female, 45.4% non-White). Participants reported daily minutes of screen time (streaming, gaming, socializing), physical activity, and sleep. Sex-stratified models estimated the association between baseline behaviors and follow-up BMI z-score, controlling for demographic characteristics, internalizing symptoms, and BMI z-score at baseline.

RESULTS

In females, isotemporal substitution models estimated that replacing 30 min of socializing (β [95% CI] = -0.03 [-0.05, -0.002]), streaming (-0.03 [-0.05, -0.01]), or gaming (-0.03 [-0.06, -0.01]) with 30 min of physical activity was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing (-0.03 [-0.05, -0.01]), streaming (-0.02 [-0.03, -0.01]), or gaming (-0.02 [-0.03, -0.01]) with 30 min of sleep was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing with 30 min of gaming was associated with a lower follow-up BMI z-score (-0.01 [-0.03, -0.0001]). CoDA estimated that in males, a greater proportion of time spent in baseline socializing, relative to the remaining behaviors, was associated with a higher follow-up BMI z-score (0.05 [0.02, 0.08]). In females, no associations between screen time and BMI were observed using CoDA.

CONCLUSIONS

One-year longitudinal associations between screen time and BMI may depend on form of screen time, what behavior it replaces (physical activity or sleep), and participant sex. The alternative statistical approaches yielded somewhat different results. Experimental manipulation of screen time and investigation of biopsychosocial mechanisms underlying the observed sex differences will allow for causal inference and can inform interventions.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents

PURPOSE

To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents.

METHODS

Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data.

RESULTS

Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05).

DISCUSSION

Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

Sleep quality and its association with anxiety, stress, sleep-related beliefs and attitudes and postural control in young adults: a cross-sectional study

OBJECTIVES

Adequate sleep is essential for young adults, as this age group primarily consists of students, job seekers, and working people constantly managing a hectic lifestyle. Poor quality of sleep, which is essential for physical and mental well-being in the short and long term, can result in impaired overall health. However, there exists a gap in the literature regarding the factors affecting sleep among young adults. Hence, the objective of this study was to find the prevalence of sleep-related parameters (sleep health, hygiene, and sleep-related beliefs and attitudes) and potential risk factors for sleep quality and to investigate the association between sleep and postural control in young adults.

METHODS

This prospective, cross-sectional, analytical study included 181 young adults, 113 (62.43 %) females, and 68 (37.57 %) males, with a mean age of 23.82 ± 2.88 years. Sleep quality, health, beliefs, hygiene, stress, anxiety, and depression were assessed using questionnaires. Postural control was assessed using center of pressure (COP) indices.

RESULTS

The overall prevalence of poor sleep quality was 79.01 % among young adults. Multiple linear regression showed that predictors explained 44 % of sleep quality variance (adjusted R square=0.44, f (12,168) = 20.91, p<0.05). Poor sleep-related beliefs and attitudes (95 % CI [0.037, 0.679], p=0.029), higher perceived stress (95 % CI [0.005, 0.219], p=0.039), higher anxiety severity (95 % CI [0.108, 0.526], p=0.003), and poor COP stability index A/P (95 % CI [4.986, 11.248], p=0.00) were found to be significant predictors of poor sleep quality.

CONCLUSIONS

High anxiety and stress, and poor dysfunctional beliefs and attitudes about sleep are predictors of poor sleep quality in young adults. These factors may significantly affect sleep quality and the experience of restful sleep among young adults. Also, poor sleep quality is associated with reduced postural control (decreased stability in the A/P direction). These findings are crucial for improving young adults' overall health and well-being, as poor sleep is highly prevalent among this age group.

The relationship between mobile phone addiction and depression, anxiety, and sleep quality in medical students

This study investigates the prevalence of mobile phone addiction among medical students and its relationship with depression, anxiety, and sleep quality. The study was conducted at Mashhad University of Medical Sciences from 2019 to 2021, and it included medical students at four different levels of training. Participants were selected using a stratified random sampling method. All subjects completed the Mobile Phone Addiction Scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and Beck Anxiety Inventory through online electronic self-report questionnaires. Overall, 355 medical students were included in the study, with 203 (57.2%) being female. Mild and severe mobile phone addiction was reported by 83.7 and 2.5% of the students, respectively. Furthermore, the study's findings revealed significantly higher sleep quality disorder, depression, and anxiety scores among students with severe mobile phone addiction compared to other participants ( P  < 0.001, P  = 0.007, and P  < 0.001, respectively). Although mobile phone addiction was prevalent, severe addiction was rare among medical students. Nevertheless, severe addiction was associated with an increased prevalence of mental health problems and sleep disturbances, emphasizing the importance of interventions aimed at reducing mobile phone addiction and improving mental health.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

The Relationship Between Harsh Parenting and Smartphone Addiction Among Adolescents: Serial Mediating Role of Depression and Social Pain

Purpose

With the increasing prevalence of smart phones, adolescent smartphone addiction has garnered significant attention from researchers. Previous studies have revealed that smartphone addiction is associated with various internalization and externalization problems. Therefore, this present study aims to investigate the risk factors contributing to adolescent smartphone addiction.

Methods

Study 1 recruited a sample of 540, 690, and 470 Chinese students aged between 10-17 years for exploratory factor analysis, confirmatory factor analysis, and predictive validity analysis of the social pain scale. Study 2 utilized data from a sample of 718 Chinese students aged between 10-17 years to examine the measurement model used revised social pain scale, smartphone addiction scale, harsh parenting scale, and depression sub-scale.

Results

The present study revealed that (1)The Social Pain Scale had good applicability in Chinese adolescents; (2) There were significant, positive correlations among harsh parenting, smartphone addiction, depression and social pain; (3) Social pain and depression played a partially serial mediating role in the relationship between harsh parenting and smartphone addiction, and similarly the relationship between paternal harsh parenting and smartphone addiction, while a completely serial mediating role in the relationship between maternal harsh parenting and smartphone addiction.

Conclusion

This study provides a direct path (improving parenting style) and an indirect path (reducing social pain to reduce depression) regarding interventions for adolescents with smartphone addiction, and establishes a basis for improving the situation of adolescent smartphone addiction.

The relationship between nighttime exercise and problematic smartphone use before sleep and associated health issues: a cross-sectional study

OBJECTIVE

Physical exercise has the potential to mitigate addictive behaviors and relevant health issues. However, the nighttime exercise has not been studied regarding this research topic. This study aims to explore the association between nocturnal physical exercise and problematic smartphone use before sleep, as well as related health issues.

METHODS

To explore the association between nighttime physical exercise and problematic smartphone use before sleep as well as related health issues, we conducted a cross-sectional survey among 1,334 college students. Their daily exercise behaviors (including timeframe, rationale, frequency, and duration), smartphone use before sleep, sleep quality, smartphone addiction, anxiety, and depression were measured by questionnaires. The associations were assessed using generalized linear models.

RESULTS

Our findings indicate that nearly 70% of participants chose to perform exercise at nighttime. Among these individuals who exercised at nighttime, the frequency and duration of nighttime exercise were significantly associated with decreased probabilities of smartphone use before sleep. Additionally, the frequency and duration of nighttime exercise were associated with lower levels of smartphone addiction and anxiety disorders.

CONCLUSION

Nighttime Exercise behaviors can effectively reduce sleep delays caused by problematic smartphone use before bedtime. These findings contribute to understanding the potential effects of nighttime exercise on problematic smartphone use and relevant health issues. Future research should employ more precise methodologies to examine these associations.

Mobile phone problem use and depressive symptoms: the mediating role of social support and attitude to aging among Chinese older adults

BACKGROUND

Little is known about mobile phone problem use (MPPU) among older adults. This study investigated critical factors affecting MPPU and filled the gap between MPPU and depressive symptoms in older people.

METHODS

A cross-sectional study was conducted in community (n = 376) with questionnaires of Multidimensional Scale of Perceived Social Support (MSPSS), Geriatric Depression Scale (GDS-15), Attitudes to Aging Questionnaire (AAQ) and Mobile Phone Problem Use Scale (MPPUS).

RESULTS

80.9% of older people used smartphones and spend less than three hours on mobile phone per day. The average MPPU score of Chinese elderly is greater than the cut off to 41. Female (β = -0.11, P = 0.037), living with spouse (β = -0.17, P = 0.03), and late marriage age (β = -0.16, P = 0.007) are less likely to develop MPPU. The relationship between MPPU and depressive symptoms was partially mediated by social support and attitude to aging.

CONCLUSION

Elderly people generally have higher MPPU scores. MPPU was associated with depressive symptoms, through social support and attitude to aging.

The association between the deviation from balanced time perspective on adolescent pandemic mobile phone addiction: the moderating role of self-control and the mediating role of psychological distress

Background

Few studies have examined the impact that the deviation from balanced time perspective (DBTP) had on mobile phone addiction during the COVID-19 normalization prevention and control phase. Therefore, this study sought to determine the associations between DBTP, depression and anxiety, self-control, and adolescent mobile phone addiction.

Methods

The moderated mediating model was tested using the SPSS PROCESS model. The sample was 1,164 adolescents from different regional areas of Sichuan, China. From February to March 2020, participants completed the Zimbardo time perspective inventory (ZTPI), the brief symptom inventory for physical and mental health (BSI-18), the self-control scale (SCS), and the Chinese version of the mobile phone addiction index (MPAI).

Results

The DBTP was significantly and positively correlated with mobile phone addiction, depressive and anxiety symptoms mediated the relationship between DBTP and mobile phone addiction, self-control moderated the indirect effect of DBTP on mobile phone addiction, and as the level of self-control increased, the effect of DBTP on anxiety and depression and the effect of depression and anxiety on mobile phone addiction weakened.

Conclusion

During the COVID-19 pandemic, DBTP and lower self-control were risk factors for higher mobile phone addiction in adolescents. Therefore, guiding adolescents to balance their time perspective and enhance their self-control could strengthen their psychological well-being and reduce addictive mobile phone behaviors. This research was supported by "Youth Fund of the Ministry of Education" (18YJCZH233): "Research on the plastic mechanism of decision-making impulsiveness of anxious groups in the context of risk society."

The relationship of smartphone addiction with depression, anxiety, and stress among medical students

Introduction

An increasing amount of research has shown a link between psychopathological behaviors such as smartphone addiction, depression, anxiety, and stress. The aim of this study was to assess the association of smartphone addiction with depression, anxiety, and stress.

Methods

A cross-sectional study was conducted between 26th January and 3rd March 2021. The sample was chosen using a convenient sampling technique and Raosoft tool. The survey assessed smartphone addiction using abbreviated versions of the Addiction Scale Short Version, a self-administered questionnaire that has been validated in the English and Arabic languages. Also, Depression and Anxiety Stress Scale was used to measure the level of depression, anxiety, and stress among the university students.

Results

A total of 367 university students from the Medical and Health Sciences College participated. Our findings showed that smartphone addiction exhibited positive correlations with depression (r = 0.375, p < 0.01), anxiety (r = 0.253, p < 0.01), and stress (r = 0.328, p < 0.05). In addition, there was a strong positive correlation between depression and both anxiety and stress (r = 0.731, p < 0.01) (r = 0.778, p < 0.01), respectively. Finally, stress and anxiety showed a positive correlation (r = 0.708, p < 0.01).

Conclusion

When combined, our data offer strong support for a bidirectional hybrid theory that takes into account the link between smartphone addiction and depression, anxiety, and stress. The current study's findings might assist national health authorities in strengthening their efforts to prevent depression, anxiety, and stress associated with the use of modern technology.

Effect of short video addiction on the sleep quality of college students: chain intermediary effects of physical activity and procrastination behavior

Introduction

The purpose of this study was to examine the impact of short video addiction on college students' sleep quality and to elucidate the mechanism underlying this relationship. Thus, we examined the correlation between short video addiction and sleep quality and analyzed the roles of physical activity and procrastination.

Methods

The Short Video Addiction Scale, Pittsburgh Sleep Quality Index, Aitken Procrastination Inventory, and Physical Activity Rating Scale were administered to 337 college students. Data were analyzed using SPSS 27.0. Pearson's correlation analysis and mediation analysis using the bootstrapping test were performed for the standard method bias test.

Results

(1) Overall, 25.2% of college students had problems with sleep quality (indicated by a PSQI score ≥ 8). (2) Short video addiction score is positively correlated with college students' sleep quality score; procrastination score was positively associated with both short video addiction score and sleep quality score, and physical activity score was negatively associated with them. (3) Short video addiction significantly positive predicted sleep quality (β = 0.458, P < 0.001), a significant negative predictive effect on physical exercise (β = -0.183, P < 0.001), and a significant positive effect on procrastination behavior (β = 0.246, P < 0.001). After physical exercise and procrastination behavior were entered into the regression equation, short video addiction and procrastination were significantly positive predictors of sleep quality, and physical activity was significantly negative predictor of sleep quality. (4) After accounting for the variables of age, gender, and grade, physical activity and procrastination behaviors independently mediated the association between short-video addiction and sleep quality. Physical activity and procrastination behavior acted as chain mediators in the association between short video addiction and sleep quality, with a chain mediation effect percentage of 1.04%. Short video addiction directly affects college students' sleep quality, indirectly through physical activity and procrastination behavior.

Adolescents' electronic devices use during the COVID-19 pandemic and its relationship to anxiety and depression levels: a cross-sectional study

BACKGROUND

The aim of this study is to assess the prevalence of anxiety and depression symptoms among adolescent students in the West Bank region of Palestine, with a particular focus on the impact of electronic device usage on their mental well-being.

METHODS

This cross-sectional study included a representative sample of 1,140 adolescents enrolled in governmental secondary schools. We targeted schools located in Nablus, Ramallah, and Hebron districts, which, respectively, represent the northern, central, and southern regions of the West Bank. We collected data on their sociodemographic characteristics, patterns of electronic device usage, scores from the Beck Depression Inventory-II, and the 7-item Generalized Anxiety Disorder scale, all gathered through a self-administered online questionnaire. To explore the independent relationship between anxiety, depression, and various factors, we calculated odds ratios and their corresponding 95% CI using a binary logistic regression model.

RESULTS

The study revealed a prevalence of moderate to severe anxiety at 35.4% [95% CI: 32.7-38.3%] and moderate to severe depression at 23.9% [95% CI: 21.4-26.4%]. Notably, anxiety scores were significantly higher among females [OR = 3.8, 95% CI: 2.5-5.9], individuals with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.1-3.0]. Similarly, significantly elevated depressive scores were observed among females [OR = 2.0, 95% CI: 1.3-3.1], those with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.3-2.8]. Conversely, students who used electronic devices for shorter durations were less likely to experience depression [OR = 0.49, 95% CI: 0.32-0.76] or anxiety [OR = 0.47, 95% CI: 0.32-0.69].

CONCLUSION

Considering the alarming rates of anxiety and depression in adolescents, along with their connection to the time spent using electronic devices, we strongly recommend the creation of initiatives and support networks to alleviate this issue's impact. Encouraging healthier lifestyles, such as reducing screen time and increasing physical activity, could potentially enhance the mental well-being of adolescents.

The Relationships between Effortful Control, Mind Wandering, and Mobile Phone Addiction Based on Network Analysis

BACKGROUND

The prevailing mobile phone use brought the problem of addiction, which might cause negative consequences. Effortful control and mind wandering were associated with addictive behavior. The present study aimed to investigate the dimension-level relationships between effortful control, mind wandering, and mobile phone addiction.

METHODS

A total of 1684 participants participated this study. The mobile phone addiction, effortful control, and mind wandering were measured through self-report scales, respectively. Dimension-level network of these psychological variables was estimated and bridge expected influence (BEI) values for each node was calculated.

RESULTS

Dimensions of mobile phone addiction, effortful control, and mind wandering exhibited distinct and complex links to each other. The node "activation control" exhibited the highest negative BEI value (BEI = -0.32), whereas "spontaneous thinking" showed the highest positive BEI value (BEI = 0.20).

CONCLUSIONS

Different dimensions of effortful control and mind wandering had varied yet significant connections with distinct dimensions of mobile phone addiction, facilitating understanding of the specific pathways underlying the three constructs. The identified dominant bridge nodes can provide potential targets for the intervention of mobile phone addiction.

Association between mobile phone addiction, sleep disorder and the gut microbiota: a short-term prospective observational study

Bidirectional communication between the gut microbiota and the brain has sparked interest in exploring the link between mobile phone addiction (MPA) and sleep disorders (SD) in microbiome research. However, investigating the role of gut microbiota in this relationship using animal models presents challenges due to the unique nature of MPA, and human research in this area is scarce. We recruited 99 healthy college students to evaluate the gut microbiome using 16S rRNA gene amplicon sequencing and assess MPA and SD at baseline and after a two-month follow-up. Multiple covariate-adjusted statistical models, including linear regression, permutational multivariate analysis of variance and so on, were employed to determine microbiome associations with MPA at baseline and changes in SD at follow-up. Our findings revealed negative associations between MPA and three alpha diversity metrics, along with alterations in bacterial composition. MPA showed negative associations with the relative abundance of Bacteroidetes, while displaying positive associations with Actinobacteria and Bifidobacteriales. Conversely, Actinobacteria exhibited a negative association with increased SD. This study has established a significant link between MPA and a decrease in the alpha diversity of the gut microbiota. Actinobacteria was associated with MPA and SD, respectively. Additional investigation is needed to fully comprehend the relationship between comorbid behavioral disorders and the gut microbiota.

Patient's punctuality in an outpatient clinic: the role of age, medical branch and geographical factors

BACKGROUND

The efficiency of the management of an outpatient clinic largely depends on the administration of patient flows and waiting times increase costs and affect clinical quality. In this study, we verify if the visit acceptance times are influenced by demographic or geographical factors in a large cohort of patients referred to a city and suburban private outpatient multidisciplinary clinic.

METHODS

We included all scheduled visits of patients aged from 18 to 75 years who arrived in 2021, 2022 and 2023 in our private outpatient clinics, consisting of 34 medical clinics scattered in Milan metropolitan city and hinterland. The variables collected were age, visit time, check-in time, address of the medical clinic and its distance from the closest underground station, patient typology (new business vs. follow-up patient), and the medical branch of the visit. Outcome is'punctuality', defined as check-in time minus visit time (in minutes).

RESULTS

We considered a sample of 410.808 visits from January 2021 to April 2023. The majority of patients check-in early (84.4%) and we found that the percentage of punctual patients increases linearly with age. Earlier hours in the morning show the worst punctuality pattern as well as Blood Draws in the analysis of different medical branches. We also observed that patients who already had some activity recorded in our systems show the worst pattern of punctuality. No particular differences emerged considering the geographical location of the clinics.

CONCLUSIONS

Younger patients have worse punctuality than older patients. Moreover, earlier hour slots are the most disadvantaged and the medical specialty has an influence on the arrival habits. This data should be considered for better clinical quality and efficiency.

Nighttime smartphone use, sleep quality, and mental health: investigating a complex relationship

STUDY OBJECTIVES

This study investigated the complex relationship between nighttime smartphone use, sleep, and mental health among adult populations in Denmark.

METHODS

Data from three interconnected samples (aged 16-89 years) from the SmartSleep Study included 5798 individuals with survey and register data; 4239 individuals also provided high-resolution smartphone tracking data. Logistic regression models and causal discovery algorithms, which suggest possible causal pathways consistent with the underlying data structure, were used to infer the relationship between self-reported and tracked nighttime smartphone use, self-reported sleep quality, mental health indicators, and register-based psychotropic medication use.

RESULTS

Frequent self-reported nighttime smartphone use was associated with high perceived stress (OR: 2.24, 95% CI = 1.42 to 3.55) and severe depressive symptoms (OR: 2.96, 95% CI = 2.04 to 4.28). We found no clear associations between tracked nighttime smartphone use and mental health outcomes, except for the cluster that used their smartphones repeatedly during the sleep period, which was associated with severe depressive symptoms (OR = 1.69, 95% CI = 1.24 to 2.31). Poor sleep quality (vs. good sleep quality) was associated with high perceived stress (OR = 5.07, 95% CI = 3.72 to 6.90), severe depressive symptoms (OR = 9.67, 95% CI = 7.09 to 13.19), and psychotropic medication use (OR = 2.13, 95% CI = 1.36 to 3.35). The causal discovery models suggest that nighttime smartphone use affects mental health through both problematic smartphone use and poor sleep quality.

CONCLUSION

The complex relationship between nighttime smartphone use, sleep, and poor mental health may create a vicious circle over time, and nighttime smartphone use may constitute a potential leverage point for public health interventions aimed at improving sleep and mental health.

Sleep quality as a mediator of the relationship between screen time and negative emotions among Chinese college freshmen

College freshmen are special populations facing great challenges in adapting to the brand new environment, and their lifestyle and emotional states are worthy of attention. Especially during the COVID-19 pandemic, their screen time and prevalence of negative emotions were significantly increased, but few studies have focused on such situation of college freshmen and illustrated relevant mechanisms. Thus, based on a sample of Chinese college freshmen during the COVID-19 pandemic, the current study aimed to investigate the association between their screen time and negative emotions (depression, anxiety and stress), and further explore the mediating effects of sleep quality. Data from 2,014 college freshmen was analyzed. The screen time was self-reported by participants using predesigned questionnaires. The Pittsburgh Sleep Quality Index (PSQI) and Chinese Version of Depression Anxiety and Stress Scale-21 (DASS-21) were used to assess sleep quality and emotional states, respectively. The mediation analysis was conducted to examine the meditation effect. Results indicated that participants with negative emotions tended to have longer daily screen time and worse sleep quality, sleep quality partially mediated the association between screen time and negative emotions.The critical role of sleep quality and related intervention measures should be recognized and implemented.

Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents

OBJECTIVE

To investigate behavioral sleep habits, self-perceived quality of sleep, and chronotype, and to examine their association with clinically relevant levels of depression in Swedish adolescents.

METHOD

Questionnaire data were obtained from a representative sample of Swedish adolescents (n = 8449; 50.8% girls; aged 12-16). Depression was defined as >13 BDI-II scores. Logistic regression modelling estimated the effects of sleep duration, sleep quality, and chronotype on depression, adjusted for socio-demographic factors.

RESULTS

On weekdays, approximately 46% of adolescents slept less than the recommended length of eight hours per night (depressed: 68%, non-depressed: 40%). On weekends, however, only 17% slept shorter than recommended. Short weekday sleep duration was more common among girls than boys (53% vs. 38%) and girls reported worse sleep quality. The regression model showed that depression was predicted by weekday sleep duration (OR = 0.773, p < .0001), sleep quality (OR = 0.327, p < .0001), and late chronotype (OR = 1.126, p = .0017), but not by weekend sleep duration. A 30-minute increase in weekday sleep duration was associated with about 10% lower odds of depression.

CONCLUSIONS

A substantial proportion of Swedish adolescents do not seem to meet the sleep recommendations of eight hours per night. Short sleep duration on weekdays, poor sleep quality, and late chronotype were associated with increased risk of depression. Interventions promoting longer weekday sleep duration (e.g., later school start times) seem relevant in this context, but further research is needed to investigate the directionality and underlying mechanisms of these associations.

Impact of the COVID-19 pandemic on the mental health of children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Children's and adolescents' mental health has been affected since the onset of the coronavirus disease (COVID-19) pandemic, receiving global attention. We conducted a systematic review and meta-analysis of longitudinal studies to assess the extent of the mental health changes of children and adolescents in the aftermath of the pandemic.

METHODS

We searched PubMed, Embase, Web of Science, and PsycINFO to explore the pandemic's impact on children and adolescents' mental health; longitudinal studies were included. We used the random effects model to estimate the standardized mean differences (SMD) with 95 % confidence intervals (CI).

RESULTS

Twenty articles were included. Results showed that there was an increase in anxiety (SMD = 0.18, 95 % CI 0.05-0.32) and depressive symptoms (SMD = 0.22, 95 % CI 0.13-0.32) in children and adolescents after the pandemic. Anxiety and depressive symptoms noticeably increased from April to May 2020, subsequently decreased, but saw a small resurgence during the second wave of the pandemic. Anxiety change varied by region; highest in Asia (SMD = 0.38, 95 % CI 0.25-0.51).

LIMITATIONS

Heterogeneity was high in this study, with high variability in psychiatric symptoms among individuals.

CONCLUSIONS

This study on changes in children's and adolescents' mental health, anxiety and depression symptoms showed varying degrees of deterioration. Changes in symptoms were influenced by time and region and showed fluctuations.

Relationship between Problematic Smartphone Use, Sleep Quality and Bedtime Procrastination: A Mediation Analysis

The purpose of this investigation was to study the relationship between sleep quality, problematic smartphone use (PSU) and bedtime procrastination, as well as to assess gender and age differences. A total of 313 participants, aged 18-60 (M = 30 ± 10.1; 53.2% males), completed an online survey between February and May 2023 in Spain. The Pittsburgh Sleep Quality Index, Smartphone Addiction Scale-Short Version and Bedtime Procrastination Scale were used to measure sleep quality, PSU and bedtime procrastination, respectively. Additionally, smartphone use habits were evaluated through self-report questions. Pearson correlations, independent samples t-tests, one-way ANOVA, Bonferroni's post hoc tests and mediation analysis were conducted. Correlation analysis showed positive associations between the three main variables. Independent sample t-tests indicated females were more prone to PSU along with higher overall smartphone use. Post hoc analysis of one-way ANOVA exposed age differences between young adults (18-25 years old), adults (26-44 years old) and middle-aged adults (45-60 years old) in PSU and bedtime procrastination. Finally, mediation analysis revealed that PSU had indirect effects on sleep quality through bedtime procrastination, but no direct effects on sleep quality. Therefore, PSU, and especially bedtime procrastination, should be considered as targets in future campaigns or intervention programs to improve sleep quality among the young Spanish population.

Developing and validation of COVID-19 media literacy scale among students during the COVID-19 pandemic

OBJECTIVE

This cross-sectional validation work evaluated the psychometric features of the COVID-19 Media Literacy Scale (C-19MLs) in Students.

METHODS

The study was conducted on 530 students from a medical university in Hamadan, Iran, who were recruited through a stratified cluster random sampling process in June-July 2020. Intraclass Correlation Coefficient (ICC) and internal consistency were used to assess the reliability. Moreover, CFA (Confirmatory Factor Analyses) and EFA (Exploratory Factor Analyses) were carried out to examine construction validity. CVR (Content Validity Ratio) and CVI (Content Validity Index) were used to examine the content validity.

RESULTS

According to the factor analysis, it was indicated that the C-19MLs included 21 items measuring five dimensions (constructedness of credible Covid-19 media messages, contractedness of fake media coronavirus messages, fake media coronavirus messages, audience, with three questions in each factor; format, represented lifestyles in fake media coronavirus messages with six questions in each factor) for an explanation of 58.4% of the prevalent variance. The average scores for the CVI and CVR were respectively 0.94 and 0.77. According to confirmatory factor analysis, the studied model had an appropriate fitting to the data; the relative chi-square (x2/df) = 2.706 < 3, RMSEA = 0.093 ≤ 0.1; CFI = 0.893 ≥ 0.9; TLI = 0.874 ≥ 0.9; GFI = 0.816 ≥ 0.9; and SRMR = 0.06 ≤ 0.08. Further analyses represented acceptable findings for internal consistency reliability values with 0.86 of Cronbach's alpha.

CONCLUSIONS

The results proved that the C-19MLs is a reliable and valid tool, and it is suitable and acceptable now and can be utilized in forthcoming investigations. This highlights educators and stakeholders to realize the importance of participating individuals in the new media ecology and new 'Infomedia' ecosystems for enabling people in the current digital society.

Childhood neglect and problematic smartphone use among chinese young adults: the mediating roles of peer attachment and fear of missing out

BACKGROUND

Research has revealed that childhood neglect may be a risk factor for problematic smartphone use among young adults in China. However, few studies have examined the mediating roles of peer attachment and the fear of missing out in the relationship between childhood neglect and problematic smartphone use. To fill this gap, the present study proposes a multiple mediation model to understand the relationships among childhood neglect, peer attachment, fear of missing out, and problematic smartphone use among young adults.

METHODS

A total of 869 young adults in China completed questionnaires for evaluating different levels of the relationships between childhood neglect, peer attachment, the fear of missing out, and problematic smartphone use. The collected data were analyzed using SPSS 23.0 and MPLUS8.3.

RESULTS

The results showed that childhood neglect was positively associated with problematic smartphone use among young adults in China. Moreover, peer attachment and the fear of missing out had partial mediating effects as well as sequential mediating effects in the relationship between childhood neglect and problematic smartphone use among young adults.

CONCLUSION

Based on these findings, peer attachment and the fear of missing out, as mediators, could be considered proximal factors affecting problematic smartphone use among young adults. These findings broaden our understanding of the psychological processes that underlie the association between childhood neglect and problematic smartphone use and afford practical guidance on reducing the risks associated with problematic smartphone use.

Investigating the Effectiveness of Modifying the Parent-Child Interaction Pattern Based on Filial Play Therapy on Internet Addiction, Sleep Quality, and Self-efficacy in 9-12-Year-Old Children

Background

Despite all the positive features of the internet, the risk of addiction threatens users. Sleep disorders and the negative effects on self-efficacy are important risks of this technology. Accordingly, the present study aimed to investigate the effectiveness of modifying the parent-child interaction pattern based on play therapy (filial therapy) on internet addiction, sleep quality, and self-efficacy in 9-12-year-old children.

Methods

This quasi-experimental study was conducted using a pre-test-post-test design with a control group. The statistical population of the study consisted of all 3617 boys and girls aged 9-12 years studying in selected schools in Kerman, Iran (12 elementary schools) in the academic year 2020-2021. A total of 72 students were randomly selected from among the children who met the benchmark score of internet addiction and were not under medical and psychological treatment. The participants were divided into two experimental and control groups (36 students each). A demographic information questionnaire, the Internet Addiction Scale (YIAS), the Self-Efficacy Questionnaire for Children (SEQ-C), and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Data were analyzed using SPSS software.

Findings

The mean scores of internet addiction in the pre-test and post-test were 86.67 and 86.23 in the control group and 88.14 and 75.14 in the experimental group, respectively, which showed a decrease in internet addiction. The scores of sleep quality in the pre-test and post-test were 1.81 and 1.78 in the control group and 1.75 and 0.5 in the experimental group, respectively. Moreover, the overall scores of self-efficacy in the pre-test and post-test were 63.64 and 63.94 in the control group and 62.08 and 81.75 in the experimental group, respectively. The results indicated an improvement in the overall quality of sleep and selfefficacy.

Conclusion

The results showed that the severity of internet addiction in children decreased after the treatment based on modifying the parent-child interaction, and this treatment was also effective on self-efficacy and sleep disorders.

Adolescents' interactive electronic device use, sleep and mental health: a systematic review of prospective studies

Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep.

Narrative review: The role of circadian rhythm on sports performance, hormonal regulation, immune system function, and injury prevention in athletes

Objectives

This study was a narrative review of the importance of circadian rhythm (CR), describes the underlying mechanisms of CR in sports performance, emphasizes the reciprocal link between CR, endocrine homeostasis and sex differences, and the unique role of the circadian clock in immune system function and coordination.

Method

As a narrative review study, a comprehensive search was conducted in PubMed, Scopus, and Web of Science (core collection) databases using the keywords "circadian rhythm", "sports performance", "hormonal regulation", "immune system", and "injury prevention". Inclusion criteria were studies published in English and peer-reviewed journals until July 2023. Studies that examined the role of CR in sports performance, hormonal status, immune system function, and injury prevention in athletes were selected for review.

Results

CR is followed by almost all physiological and biochemical activities in the human body. In humans, the superchiasmatic nucleus controls many daily biorhythms under solar time, including the sleep-wake cycle. A body of literature indicates that the peak performance of essential indicators of sports performance is primarily in the afternoon hours, and the evening of actions occurs roughly at the peak of core body temperature. Recent studies have demonstrated that the time of day that exercise is performed affects the achievement of good physical performance. This review also shows various biomarkers of cellular damage in weariness and the underlying mechanisms of diurnal fluctuations. According to the clock, CR can be synchronized with photonic and non-photonic stimuli (i.e., temperature, physical activity, and food intake), and feeding patterns and diet changes can affect CR and redox markers. It also emphasizes the reciprocal links between CR and endocrine homeostasis, the specific role of the circadian clock in coordinating immune system function, and the relationship between circadian clocks and sex differences.

Conclusion

The interaction between insufficient sleep and time of day on performance has been established in this study because it is crucial to balance training, recovery, and sleep duration to attain optimal sports performance.

Bedtime screen use behaviors and sleep outcomes: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVES

To determine associations between bedtime screen time behaviors and sleep outcomes in a national study of early adolescents.

METHODS

We analyzed cross-sectional data from 10,280 early adolescents aged 10-14 (48.8% female) in the Adolescent Brain Cognitive Development Study (Year 2, 2018-2020). Regression analyses examined the association between self-reported bedtime screen use and self- and caregiver-reported sleep measures, including sleep disturbance symptoms, controlling for sex, race/ethnicity, household income, parent education, depression, data collection period (pre- vs. during COVID-19 pandemic), and study site.

RESULTS

Overall, 16% of adolescents had at least some trouble falling or staying asleep in the past 2 weeks and 28% had overall sleep disturbance, based on caregiver reports. Adolescents who had a television or an Internet-connected electronic device in the bedroom had a greater risk of having trouble falling or staying asleep (adjusted risk ratio 1.27, 95% CI 1.12-1.44) and overall sleep disturbance (adjusted risk ratio 1.15, 95% CI 1.06-1.25). Adolescents who left their phone ringer activated overnight had more trouble falling/staying asleep and greater overall sleep disturbance compared to those who turned off their cell phones at bedtime. Streaming movies, playing video games, listening to music, talking/texting on the phone, and using social media or chat rooms were all associated with trouble falling/staying asleep and sleep disturbance.

CONCLUSIONS

Several bedtime screen use behaviors are associated with sleep disturbances in early adolescents. The study's findings can inform guidance for specific bedtime screen behaviors among early adolescents.