The Role of Problematic Smartphone Uses and Psychological Distress in the Relationship Between Sleep Quality and Disordered Eating Behaviors Among Chinese College Students

The Impact of Problematic Smartphone Use on Sleep Quality Among Chinese Young Adults: Investigating Anxiety and Depression as Mediators in a Three-Wave Longitudinal Study

Background

Sleep disorders are a significant health issue that urgently needs to be addressed among undergraduate students, and one of the potential underlying problems could be problematic smartphone use (PSU). This study aimed to clarify the relationship between PSU and poor sleep quality by investigating the independent and serial mediating roles of anxiety and depressive symptoms in a population of university students in Tibet, China.

Methods

A total of 2993 Tibetan college students completed three waves of data surveys, with all participants completing questionnaires on PSU, anxiety, depressive symptoms, and sleep quality (Time 1 (T1) -Time 3 (T3)). Bootstrapped mediation analysis was used to explore the mediating role of anxiety and depressive symptoms in the longitudinal relationship between PSU and sleep quality.

Results

Both direct and indirect effects of PSU on poor sleep quality were found. PSU (T1) can had not only a direct negative influence on poor sleep quality (T3) among young adults (direct effect = 0.021, 95% CI = 0.010-0.033) but also an indirect negative impact via three pathways: the independent mediating effect of anxiety symptoms (T2) (indirect effect 1 = 0.003, 95% CI = 0.001-0.006), the independent mediating effect of depressive symptoms (T2) (indirect effect 2 = 0.004, 95% CI = 0.002-0.006), and the serial mediating effects of anxiety (T2) and depressive symptoms (T2) (indirect effect 3 = 0.008, 95% CI=0.005-0.011).

Conclusion

These findings highlight the role of anxiety and depression symptoms as joint mediating factors in the relationship between PSU and sleep disturbances. Interventions focused on improving sleep that incorporate behavioural measures could benefit from treatment approaches targeting mental disorders.

The Impact of Family Functioning Factors on Smartphone Addiction and Phubbing among Muslim Adolescents in Thailand

BACKGROUND

While there is research on protective factors against smartphone addiction (SA) and phubbing, which impact adolescents' physical, psychological, interpersonal, and academic well-being, focused studies on these issues among Thai Muslim students in Southern Thailand remain scarce.

OBJECTIVES

To bridge this gap, this research aimed to explore the influence of five family functioning factors-discipline, communication and problem-solving (CPS), relationship, emotional status, and family support-guided by family systems theory and the McMaster Model, on SA and phubbing.

METHODS

Data from 825 Thai Muslim adolescent secondary school students (Female N = 459 (55.7%), Mage = 15.11 ± 1.78) across three southern Thai provinces were analyzed utilizing structural equation modeling (SEM).

RESULTS

Significant connections were identified between family functioning factors, particularly emotional status and discipline, and SA, and their impact on phubbing behavior. SA was found to mediate the relationship between these two family factors and phubbing. Interestingly, a higher quality of family relationships was found to be associated with an increased risk of SA, while the other two family functions-CPS and family support-demonstrated no significant association with these digital behaviors.

CONCLUSIONS

Despite its limitations, including a cross-sectional design and reliance on self-reports, the study underscores the importance of specific family functions in preventing and addressing adolescent SA and phubbing.

Eating disorders symptoms and depressive symptoms in Chinese Tibetan University students: a network analysis

BACKGROUND

Depression is being increasingly acknowledged as a global public health concern, and following this trend, attention towards eating disorders (EDs) has surged within China's national consciousness. EDs symptoms frequently coexist with various mental health conditions, including depression. However, research focusing on EDs symptoms and depressive symptoms among Tibetan students in China remains scant. This study employs network analysis to estimate the relational network between EDs and depressive symptoms.

METHODS

Tibetan (n = 2,582) and Han (n = 1,743) students from two universities in the Xizang Autonomous Region, China, completed the Eating Attitude Test-26 (EAT-26) and the Patient Health Questionnaire-9 (PHQ-9). We estimated the network structure of EDs symptoms and depressive symptoms, identified central and bridge symptoms, and examined whether network characteristics differed by gender and ethnic.

RESULTS

The core symptoms identified within this study were Calorie_awareness, Desire_to_thin and Fatigue. Conversely, bridge symptoms included Appetite, Suicide, Anhedonia, Guilty, Body_fat_awareness, and Food_preoccupation. The study also revealed no significant gender differences within the network model. However, disparities among ethnic groups were observed within the network structure.

CONCLUSIONS

Our study examined the correlation between EDs symptoms and depressive symptoms in Tibetan college students. Focusing on the individual's quest for the perfect body shape and some Tibetan students' appetite problems - potentially stemming from transitioning to a new university environment, adapting to the school canteen's diet, or being away from their hometown - could aid in the prevention and management of EDs and depression symptoms. It could reduce the incidence of complications by helping students maintain good physical and mental health. Concurrently, our research provides insights into the relatively higher levels of depression triggered by the unique plateau environment.

Can restricting while-in-bed smartphone use improve sleep quality via decreasing pre-sleep cognitive arousal among Chinese undergraduates with problematic smartphone use? Longitudinal mediation analysis using parallel process latent growth curve modeling

BACKGROUND AND AIM

Problematic smartphone use (PSU) has become a global public health problem. Excessive while-in-bed smartphone use may result in poor sleep quality. The present study aimed to examine whether restricting while-in-bed smartphone use can improve sleep quality and the mediating role of pre-sleep cognitive arousal in this process.

METHODS

A total 152 Chinese undergraduates with symptoms of PSU (Smartphone Addiction Scale-Short Version [SAS-SV] > 31) were recruited and randomly assigned to the intervention group (N = 76) and the control group (N = 76) for a 4-week follow-up experiment. Sleep quality (assessed by the Pittsburgh Sleep Quality Index) and pre-sleep cognitive arousal (assessed by the Pre-sleep Arousal Scale-Cognitive Arousal) were measured at baselime, Week1, Week2, Week3, and Week4. The longitudinal mediation model was analyzed using parallel process latent growth curve modeling. The significance of indirect effect was tested by 95% biascorrected accelerated confidence intervals on the basis of 5000 bootstrap samples.

RESULTS

The initial level of sleep quality was positively associated with the initial level of pre-sleep cognitive arousal. The intervention decreased pre-sleep cognitive arousal and increased sleep quality. The slope of pre-sleep cognitive arousal was positively associated with the slope of sleep quality. The mediating effect of pre-sleep cognitive arousal was significant.

DISCUSSION

Restricting while-in-bed smartphone use can improve sleep quality via decreasing pre-sleep cognitive arousal among Chinese undergraduates with symptoms of PSU. These results suggests that restricting while-in-bed smartphone use is a potential remedy for sleep disturbance induced by PSU.

Translation and psychometric evaluation of Smartphone Addiction Scale-Short Version (SAS-SV) among Chinese college students

BACKGROUND

Smartphone addiction is very prevalent among college students, especially Chinese college students, and it can cause many psychological problems for college students. However, there is no valid research instrument to evaluate Chinese college students' smartphone addiction.

OBJECTIVE

This study aimed to translate the Smartphone Addiction Scale-Short Version (SAS-SV) into Chinese and evaluate the psychometric characteristics of the Smartphone Addiction Scale- Chinese Short version (SAS-CSV) among Chinese college students.

METHODS

The SAS-SV was translated into Chinese using the forward-backward method. The SAS-CSV was completed by 557 Chinese college students (sample 1: n = 279; sample 2: n = 278). 62 college students were randomly selected from the 557 Chinese college students to be meas- ured twice, with an interval of two weeks. The reliability of the SAS-CSV was evaluated by internal consistency reliability and test-retest reliability, and the validity of the SAS-CSV was evaluated by content validity, structural validity, convergent validity, and discriminant validity.

RESULTS

The SAS-CSV presented good content validity, high internal consistency (sample 1: α = 0.829; sample 2: α = 0.881), and good test-retest reliability (ICC: 0.975; 95% CI: 0.966-0.985). After one exploratory factor analysis, three components (tolerance, withdrawal, and negative effect) with eigenvalues greater than 1 were obtained, and the cumulative variance contribution was 50.995%. The results of confirmatory factor analysis indicated that all the fit indexes reached the standard of good model fit (χ2/df = 1.883, RMSEA = 0.056, NFI = 0.954, RFI = 0.935, IFI = 0.978, TLI = 0.969, CFI = 0.978). The SAS-CSV presented good convergent validity for the factor loading of all the items ranged from 0.626 to 0.892 (higher than 0.50), the three latent variables' AVE ranged from 0.524 to 0.637 (higher than 0.50), and the three latent variables' CR ranged from 0.813 to 0.838 (higher than 0.70). Moreover, the square roots of the AVE of component 1 (tolerance), component 2 (withdrawal) and component 3 (negative effect) were 0.724, 0.778, and 0.798, respectively, higher than they were with other correlation coefficients, indicating that the SAS-CSV had good discrimination validity.

CONCLUSION

The SAS-CSV is a valid instrument for measuring smartphone addiction among Chinese college students.

Exploring the connection between parental bonding and smartphone addiction in Chinese medical students

BACKGROUND

Smartphone addiction bodes adverse consequences, affecting different populations, including medical students. Parental bonding in childhood had been associated with addiction and recovery in later life. Therefore, this study aimed to examine the associations between parental bonding and smartphone addiction among Chinese medical students.

METHOD

Binary logistic regressions were used to investigate the associations between parental bonding with mothers and fathers, respectively, and smartphone addiction. Interaction terms of care and protection were included in the models.

RESULTS

A total of 517 medical students were included in the study. The prevalence of smartphone addiction was 48.16% (n = 249). The estimated effects of maternal and paternal parenting on smartphone addiction differed. Maternal protection was positively associated with smartphone addiction (OR, 1.046;95% CI, 1.005-1.087), and maternal care enhanced the estimated effect of protection on smartphone addiction. Paternal care was negatively associated with smartphone addiction (OR, 0.954;95% CI, 0.919-0.989).

CONCLUSIONS

Chinese medical students with overprotective mothers or with indifferent fathers tended to exhibit traits of smartphone addiction. Further studies on factors influencing the associations between parental bonding and smartphone addiction may pave the way for potential family-oriented interventions for smartphone addiction.

Prevalence of anxiety and depression among Palestinian university students: a cross-sectional study during COVID-19 pandemic

Background

Anxiety and depression are more common among university students than in the general population. It is reported internationally that the COVID-19 pandemic increased the prevalence of anxiety and depression among students. This study aimed to measure the prevalence of anxiety and depression among university students in Palestine and to explore the association between anxiety and depression during the COVID-19 pandemic. A cross-sectional questionnaire-based descriptive study was carried out on university students. The Generalized Anxiety Disorder Scale (GAD-7) and the Center for Epidemiological Studies Depression (CES-D) scale were used to evaluate anxiety and depression, respectively. Chi-square was used to evaluate the risk factors associated with the levels of anxiety and depression. The association between anxiety and depression was evaluated using Pearson correlation.

Results

A total of 1049 students were enrolled in the study. The prevalence of depression among them was 55.8%, 26.4%, and 9.8% for severe, moderate, and mild depression, respectively. Depression symptoms were significantly variable based on students’ field and year of study, sleeping period, smoking, and food source. The prevalence of anxiety was 16.1%, 30.7%, and 36.1% for severe, moderate, and mild anxiety, respectively. Anxiety symptoms were significantly variable based on students’ gender, year of study, sleeping period, smoking, and place of residence. A strong positive correlation was observed between the CES-D and GAD-7 scores (R = 0.707).

Conclusion

Palestinian university students suffer from elevated levels of anxiety and depression during the COVID-19 pandemic. This necessitates the need for strategies by stakeholders to take immediate and appropriate interventions.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.

Body Dissatisfaction and Disordered Eating Behaviors: The Mediation Role of Smartphone Addiction and Depression

This study aimed to determine whether smartphone addiction and depression sequentially mediate the relationship between body dissatisfaction and disordered eating behaviors (e.g., restrained eating, emotional eating and external eating). A total of 5986 participants (54.1% females, average age = 19.8 years, age range = 17–32) completed the Satisfaction and Dissatisfaction with Body Parts Scale, the Three-Factor Eating Questionnaire, the Smartphone Addiction Scale and the Patient Health Questionnaire-9. Mediational analysis showed that, after controlling for age, sex and body mass index, body dissatisfaction was related to disordered eating behaviors through (a) the mediating effect of smartphone addiction, (b) the mediating effect of depression, and (c) the serial mediating effect of smartphone addiction and depression. In conclusion, our study showed for the first time that smartphone addiction and depression can be sequential mediator variables in the association between body dissatisfaction and disordered eating. However, this study is a cross-sectional study; future longitudinal studies could further test the causal associations between these study variables.

Research trends in college students' sleep from 2012 to 2021: A bibliometric analysis

BACKGROUND

A great proportion of college students experience various sleep problems, which damage their health and study performance. College students' sleep problems, which are caused by several factors, have been easily ignored before. In the past decade, more research has been published to expand our understanding of undergraduates' sleep. The purpose of the study is to explore the research hotspots and frontiers regarding college students' sleep using CiteSpace5.8.R3 and offer guidance for future study.

METHODS

We retrieved relevant literature from the Web of Science Core Collection Database and imputed the downloaded files into CiteSpace5.8.R3 for visualization analysis. We generated network maps of the collaborations between authors, countries, institutions, the cited journals, and co-occurrence keywords. The analysis of keywords clusters, timeline views, and keywords citation bursts help us identify the hotspots and research trends.

RESULTS

A total of 1,841 articles related to college students' sleep, published from 2012 to 2021, were selected. The number of publications gradually increased. Karl Peltzer was the most prolific authors with 15 publications. The United States and Harvard University separately contributed 680 and 40 articles and had the greatest impact in this field. SLEEP ranked first in the frequency of cited journals. The article published by Lund HG was the most influential publication. Based on the analysis of keywords, we summarized research hotspots as follows: current status, affecting factors, and adverse outcomes of college students' sleep. The frontiers were the further understanding of the relationships between sleep and mental and physical health, and various interventions for sleep disorders.

CONCLUSION

Our study illustrates the research hotspots and trends and calls for more research to expand the findings. In the future, the cooperation between institutions and authors needs to be strengthened. The complex relationships between sleep and mental and physical health and problematic substance use disorders are necessary to be explored. Longitudinal studies or randomized controlled trials should be constructed to verify the current findings or assumptions.