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

Abstract

Background: Sleep problems and eating disorders (EDs) are both serious public health concerns often seen in young adults. Yet, the underlying mechanisms for such associations are largely unknown. This study aims to examine potential serial multiple mediation effects of problematic smartphone use (PSU) and psychological distress (i.e., depressive and anxiety symptoms) in the relationship between sleep quality and disordered eating behaviors/attitudes (DEBs).Methods: A total of 4,325 students from two Tibet universities in China (2,657 females and 1,668 males) completed an online survey that included the following measurements: Eating Attitude Test-26 for disordered eating behaviors/attitudes, the Chinese Version of Pittsburgh Sleep Quality Index (CPSQI), Smartphone Addiction Scale—Short Version (SAS-SV) for problematic smartphone use, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for psychological distress.Results: While the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.016, 95% CI = 0.0256~0.0591) and anxiety symptoms (Standardized β = 0.014, 95% CI = 0.0203~0.0526) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -> PSU -> anxiety symptoms -> DEBs” existed(Standardized β = 0.001, 95% CI = 0.0002~0.0012). Similarly, while the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.020, 95% CI = 0.0337~0.0692) and depressive symptoms (Standardized β = 0.015, 95% CI = 0.0139~0.0652) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -> PSU -> depressive symptoms -> DEBs” existed (Standardized β = 0.001, 95% CI = 0.0006~0.0038).Conclusions: Psychological and behavioral factors may comprehensively work together, leading to flow-on effects from sleep problems to disordered eating behaviors among university students. Appropriate interventions that target problematic smartphone use could thus potentially reduce anxiety and depression levels, which in turn will provide a buffer against the negative impact of poor sleep quality on eating disorder symptoms.

Interventions in Chinese Undergraduate Students’ Mental Health: Systematic Review

“…Positive coping strategies were adopted by undergraduate students themselves [ 52 , 82 , 83 , 85 , 86 , 89 , 92 , 93 ]. In addition, negative coping strategies were also reported in a few studies [ 52 , 59 , 74 , 75 , 89 ]. All of the interventions are listed in Table 1 .…”

“…The interventions proposed in the included studies can be divided into two broad categories: social support and coping strategies. Social support was provided by government authorities [ 49 , 52 - 54 , 61 , 62 , 68 , 72 , 84 , 86 - 88 ]; university authorities [ 12 , 48 , 50 , 51 , 53 - 55 , 57 - 59 , 62 , 64 , 65 , 67 , 69 , 91 , 93 ]; students’ affairs counselors and teachers [ 54 , 75 , 83 - 85 , 87 , 93 ]; family members [ 52 , 54 , 57 , 83 , 94 ]; health care authorities and professionals [ 52 , 63 , 66 , 75 , 77 - 79 , 87 ]; researchers [ 70 , 85 ]; and media-, internet-, and smartphone-based interventions [ 26 , 53 , 55 , 56 , 60 , 71 , 73 , 75 , 77 , 80 , 81 ]. Positive coping strategies were adopted by undergraduate students themselves [ 52 , 82 , 83 , 85 , 86 ,…”

“…Previous studies proposed university authorities to make the following interventions in undergraduate students’ mental health concerns, including (1) developing a caring culture and ambience, which backs up undergraduate students to make life adjustments, promoting cultural and sports activities, facilitating the expansion of social networks, strengthening mental health education and counseling (eg, hotlines providing timely help for those in urgent need), early detection and effectively managing mental health concerns [ 12 ]; (2) screening for adverse childhood experiences and providing strength-based, trauma-informed interventions on fostering resilience [ 48 ]; (3) screening for anxiety disorders [ 50 , 57 ]; (4) screening and managing of emotional eating [ 51 ]; (5) organizing health education activities, and encouraging undergraduate students to arrange their time reasonably and find a proper approach to alleviate stress [ 53 ]; (6) encouraging timely, effective communication between family members [ 54 ]; (7) conducting interventions using cognitive behavioral approaches and screening for and addressing excessive social networking service use [ 55 ]; (8) developing psychological help-seeking interventions, strengthening the dissemination of mental health knowledge, and improving the level of mental health perception to improve help-seeking attitudes and increase the probability of seeking psychological help [ 57 ]; (9) being aware of undergraduate students’ coping strategies, organizing programs such as an online experience-sharing competition, encouraging students by offering rewards or financial aids, and supplying necessary food and health care materials [ 58 ]; (10) implementing various interventions such as sleep hygiene, mobile phone and internet use hygiene, mental health education courses, and professional psychological counseling [ 59 , 62 , 64 , 67 , 91 ]; (11) providing positive mental imagery training [ 65 ]; (12) offering relevant online mental health courses [ 67 ]; (13) adopting a web-based positive psychology intervention [ 69 ]; (14) establishing an early warning system for mental health concerns, guiding students to correctly understand their mental health status and individual differences in mental tolerance while encouraging them to seek help if necessary, developing targeted mental health education programs, and creating a new guidance mode to improve the communication between students and counselors [ 91 ]; and (15) promoting stress-coping strategies [ 93 ].…”

“…However, negative coping should be avoided, which can lead to more disastrous consequences [ 75 ]. The reported negative coping strategies include excessive use of social media, which can be counteracted with emotion regulation (eg, reappraisal) to reduce negative emotions induced by news coverage [ 52 ]; problematic smartphone use [ 59 ]; unsupervised, self-initiated intervention [ 74 ]; and maladaptive emotion-focused coping [ 89 ].…”

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

“…As a result, users have become increasingly preoccupied with their smartphones, which is highly likely to have an impact on their daily lives and health [ 26 ]. Recent studies have begun to reveal smartphone addiction as being a predictor of various eating disorders [ 25 , 27 , 28 , 29 ]. Unhealthy or excessive mobile phone use may encourage a sedentary lifestyle which in turn may lead to an insufficient intake of healthy food and a high intake of junk food or fast food [ 30 ].…”