Mobile Phone Dependency and Sleep Quality in College Students during COVID-19 Outbreak: The Mediating Role of Bedtime Procrastination and Fear of Missing Out

doi:10.21203/rs.3.rs-2497672/v1

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Research Article

Mobile Phone Dependency and Sleep Quality in College Students during COVID-19 Outbreak: The Mediating Role of Bedtime Procrastination and Fear of Missing Out

https://doi.org/10.21203/rs.3.rs-2497672/v1

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Journal Publication

published 21 Jun, 2023

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Objective

The purpose of the study was to examine the associations between mobile phone dependency and sleep quality among college students during COVID-19 outbreak. The potential mediation roles of bedtime procrastination and fear of missing out (FoMO) were investigated.

Methods

A total of 881 college students completed an online survey in May 2022 in Shanghai, China. Mobile Phone Involvement Questionnaire, Bedtime Procrastination Scale, Bedtime Procrastination Scale and Pittsburgh Sleep Quality Index were used to assess mobile phone dependency, bedtime procrastination, fear of missing out, and sleep quality, respectively. Multiple linear regression and mediation analysis were conducted.

Results

The correlation analyses indicated mobile phone dependency was positively associated with fear of missing out, bedtime procrastination, and sleep quality among college students. The structural equation modeling analyses revealed that mobile phone dependency had significant indirect effects on sleep quality through bedtime procrastination (indirect effect: 0.030, 95%CI: 0.022–0.041) and fear of missing out (indirect effect: 0.013, 95%CI: 0.003–0.023).

Conclusion

The findings indicated that bedtime procrastination and fear of missing out partially mediated on the association between mobile phone dependency and sleep quality. Bedtime procrastination and fear of missing out should be considered as potential intervention targets for reducing mobile phone dependency and improving sleep quality in college students.

Mobile phone dependency

Bedtime procrastination

Fear of missing out

Sleep quality

The advent of mobile phones, especially smartphones, have led to dramatic changes in our daily life. With its capability of accessing internet, communicating online, paying bills, watching videos, and playing games, mobile phone now is considered as an essential electronic device for contemporary people. It was reported that about 83% of the world’s population having smartphones. According to the 50th China Internet Development Statistics Report released by China Internet Network Information Center (2022) (CNNIC), as of June 2022, the number of mobile phone users in China was 1.05 billion. The proportion of Internet users using mobile phones to access the Internet was 99.6%. Among them, the age group of 20–29 years old accounted for 17.2% ¹. Despite the positive influences of mobile phone, a growing number of research evidence has indicated that the level of mobile phone dependency was closely linked to some adverse psychological and behavioral problems, such as depression, anxiety, impulsivity, and poor sleep quality ^2–4. The terms “mobile phone addiction,” “problematic smartphone use,” “excessive mobile phone use,” and “mobile phone dependency” were all referred to inability to regulate one’s mobile phone usage, which would eventually lead to negative consequences in daily life ⁵.

Nowadays, college students are the generation who grow up with the surroundings of mobile phones and more vulnerable to mobile phone dependency. Reports from recent studies including large sample size have revealed that over 50% of Chinese college students were mobile phone dependency ^6,7. Previous studies indicated that college students may have relatively lower self-regulation as they were in the transition from adolescence to young adulthood ^8,9. Especially during the outbreak of the Covid-19 pandemic and the control measures such as quarantine, lockdowns, social distancing, and home confinement have changed people incapable of living without mobile phones ^10,11. For example, university courses were switched to online during the pandemic, college students were relying on mobile phone applications to participate online classes and complete their homework. Moreover, mobile phones have become the predominant means to access information and communicate with others during quarantine period ^12,13. Without doubt, the Covid-19 pandemic related control measures have caused the dramatic increase in mobile phone use and induced a greater level of mobile phone dependency.

Several cross-sectional studies have observed significant relationship between mobile phone dependency and sleep quality ^14,15. The findings revealed that college students who had higher level of mobile phone dependency were more likely to have lower sleep quality. In addition, overexposure to screens at night may disrupt circadian rhythms and sleep ^16,17. Meanwhile, it is well-known that poor sleep quality can lead to a series of psychological and physiological problems ^18,19. Thus, it is crucial to explore the potential influencing factors and their relationships between mobile phone dependency and sleep quality for developing effective strategies among college students.

In addition to the clear link between mobile phone dependency and sleep quality, recent studies found that the bedtime procrastination may be the risk factor mediating the relationship between them ^20–22. Bedtime procrastination is defined as going to bed later than intended time, while there is no external situation prevent individuals from doing so ²³. Such phenomenon is prevalent among college students. One study surveyed 2741 Chinese college students and found that 57.5% of them using their mobile phones while in bed ⁶. In addition, researchers in one cross-sectional study surveyed 815 college students and found over 12% of them used mobile phones for 3 to 5 hours during late night instead of sleep ²⁴. Recently, health researchers investigating relationship between internet addiction and sleep quality reported that the internet addiction was positively correlated with poor sleep quality through bedtime procrastination ^21,22. That is, individuals who have internet addition may delay their intended sleep time, which lead to poor sleep quality. Accessing to internet by mobile phones are common, however, the mediating effects of bedtime procrastination between mobile phone dependency and sleep quality has not been studied yet.

Notably, recent research has shown that fear of missing out (FoMO) may also linked to mobile phone dependency and sleep quality ^25–27. The FoMO is a relative new term that developed based on the widespread of social media use. It is characterized by the desire to stay continually connected with what others are doing ²⁸. For example, individuals who fear of missing our online information and afraid of missing social media interactions. Recent cross-sectional study surveyed 3189 Chinese college students and observed significant association between problematic smartphone use and FoMO ²⁵. Moreover, one study with 1164 college students found FoMO as a significant mediator mediating the association between smartphone-related negative affect and poor sleep quality ²⁷. Similarly, the findings from another study found that adolescents’ nighttime social media use would increase the level of FoMO, which in turn postpone their sleep time and lead to shorter sleep duration ²⁹. As smartphone addiction were linked to FoMO, and FoMO was associated with sleep quality, it is reasonable to speculate the role of FoMO between mobile phone dependency and sleep quality.

Taken together, although research evidence has shown that mobile phone dependency was associated with poor sleep quality, the potential influencing factors between them were not fully understood. Given the new concepts of bedtime procrastination and FoMO, there is no study to explore the mediating role of those two variables between mobile phone dependency and sleep quality. Therefore, the aim of the present study was to examine the mediation effects of bedtime procrastination and FoMO between mobile phone dependency and sleep quality among Chinese college students. It was hypothesized that a) mobile phone dependency, bedtime procrastination, FoMO would be associated with sleep quality; b) bedtime procrastination would mediate the association between mobile phone dependency and sleep quality; c) FoMO would mediate the association between mobile phone dependency and sleep quality.

Participants

An online survey was conducted in several universities to collect data during the Covid-19 outbreak in May of 2022 in Shanghai, China. Undergraduate and master students who volunteered to participate in the study were invited to complete the survey. A total of 881 respondents completed the online questionnaires. 862 participants (mean age = 20.51 ± 2.58, female 45%) provided valid responses and included in the analyses. Ethical approval was obtained from the Institional Review Board for Human Research Protections at Shanghai Jiao Tong University.

Measures

Mobile Phone Involvement Questionnaire (MPIQ)

The Mobile Phone Involvement Questionnaire was compiled by WALSH ³⁰, which has been translated in the Chinese version and validated (Cronbach's α = 0.849) in the university population by Lin et al. ³¹. The MPIQ contains 8 items related to the perception and behavior towards mobile phone. Each item was scored based on a 7-Likert scale and the total score ranges from 8 to 56 points. A higher total score indicates the greater mobile phone dependency, and 32 points was used as cut-off points for distinguishing the mobile phone dependent.

Bedtime Procrastination Scale (Bps)

The Bedtime Procrastination Scale was compiled by Kroese ²³ which has been used for assessing bedtime procrastination behavior of the participants. The Chinese version of the BPS has been validated among Chinese university students (Cronbach's α = 0.91)³². The BPS contains 9 items related to the contexts associated with bedtime procrastination behavior and each item was scored based on a 5-point Likert scale, notably, item 2, 3, 7 and 9 were reverse scored. The total score ranges from 9 to 45 points, which the higher total score indicates more severe bedtime procrastination.

Fear Of Missing Out Scale (Fomos)

The Fear of Missing Out Scale was compiled by Przybylski ²⁸ and the Chinese version ³³ (Cronbach's α = 0.72) has been widely used for measuring the level of fear of missing out in online and offline contexts. The Chinese version of FoMOs contains 8 items and each item is scored based on a 5-point Likert scale (1 = totally not true for me; 5 = extremely true for me). The total score ranges from 8 to 40 points and a higher score indicates the higher level of fear for missing out.

Pittsburgh Sleep Quality Index (Psqi)

The Pittsburgh Sleep Quality Index was compiled by Buysee ³⁴, which has been widely used for assessing the sleep quality of the participants. The Chinese version has been translated by Lu et al. ³⁵. The 19-item PSQI scale was stratified to 7 components including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The score of each component ranges from 0 to 3 points and the total score ranges from 0 to 21 points. The higher total scores indicate the poorer the sleep quality.

Statistical Analyses

Potential differences on participant characteristics between female students and male students were evaluated by independent sample T-test and Chi-squared test. Correlations among the main variables were analyzed using Pearson correlations. Structural equation modeling was used to assess the mediating effects of fear of missing out and bedtime procrastination. The statistical analysis was performed using a commercial statistical package SPSS. The null hypothesis was rejected for two-sided values of P < 0.05.

Descriptive statistics and correlation analysis

As presented in Table 1, the mean age of participants was 20.51 ± 2.58 years old. The mean score of mobile phone dependency, bedtime procrastination, fear of missing out and sleep quality was 33.79 ± 8.32, 30.10 ± 7.09, 23.85 ± 6.14, 5.58 ± 2.79, respectively. For mobile phone dependency, more than half of all participants met the criteria for mobile phone dependent (63.7%). For fear of missing out, most participants had a total score in the range of 16 to 32 (85.6%). For bedtime procrastination, more than half of the participants had some degree of bedtime procrastination (65.7%). For sleep quality, more than half of the participants achieved very good sleep quality (51.5%). Furthermore, with the exception of mobile phone dependency, the other three variables were statistically different between male and female (P < 0.05).

Table 1

Descriptive statistics (N = 862)
		Male	Female	Total	t test
Age	Mean ± SD	20.10 + 0.11	21.01 ± 0.14	20.51 ± 2.58
Mobile phone dependency	Mean ± SD	33.33 ± 0.41	34.35 ± 0.378	33.79 ± 8.32	1.82
Fear of missing out	Mean ± SD	23.44 ± 0.30	24.35 ± 0.29	23.85 ± 6.14	2.19^*
Bedtime procrastination	Mean ± SD	29.63 ± 0.32	30.67 ± 0.36	30.10 ± 7.09	2.16^*
Sleep quality	Mean ± SD	5.39 ± 0.13	5.81 ± 0.14	5.58 ± 2.79	2.21^*
Note: ^*p < 0.05 (Two-tailed test).

The correlation among the following 4 variables, MPIQ (mobile phone dependency), FoMOs (fear of missing out), BPS (bedtime procrastination) and PSQI (sleep quality), was analyzed by Pearson correlation analysis. As showed in Table 2, there were positive correlation between MPIQ and FoMOs (r = 0.441, P < 0.01), MPIQ and BPS (r = 0.306, P < 0.01), MPIQ and PSQI (r = 0.291, P < 0.01), respectively. The results indicated mobile phone dependency was separately associated with fear of missing out, bedtime procrastination, and sleep quality. FoMOs was positively correlated with BPS (r = 0.174, P < 0.01) and PSQI (r = 0.209, P < 0.01), suggesting severe bedtime procrastination and poor sleep quality were related to higher level of fear of missing out. In addition, the positive correlation was also found between BPS and PSQI (r = 0.360, P < 0.01), which indicated bedtime procrastination was associated with poor sleep quality.

Table 2

Pearson correlation analysis for study outcomes
Variable	MPQI	FoMOs	BPS	PSIQ
MPIQ	1
FoMOs	.441^**	1
BPS	.306^**	.174^**	1
PSQI	.291^**	.209^**	.360^**	1
Note: ^**p < 0.01 (Two-tailed test).

Testing For Mediation Effects

The results of mediation analysis were shown in Fig. 1. After controlling for age and sex, the structural equation model demonstrated a good level of fit: (χ²/df = 6.71, GFI = 0.98, AGFI = 0.95, NFI = 0.88, CFI = 0.90, IFI = 0.90, RMSEA = 0.08). To examine the mediated effects associated with mobile phone dependency and sleep quality, using bias-corrected bootstrap 95% confidence intervals in 5000 samples. Bootstrap analysis results indicated that confidence intervals for the mediated effects of bedtime procrastination did not contain zero and the same result appeared in the mediated effects of fear of missing out. Therefore, bedtime procrastination and fear of missing out both mediated the link between mobile phone dependency and sleep quality, which indicated that mobile phone dependency had a significant indirect effect on sleep quality through bedtime procrastination and fear of missing out.

The results revealed that mobile phone had a significant indirect effect on sleep quality through bedtime procrastination (indirect effect: 0.030, 95%CI: 0.022 ~ 0.041). Meanwhile, mobile phone also had a significant indirect effect on sleep quality through fear of missing out (indirect effect: 0.013, 95%CI: 0.003 ~ 0.023). The total mediated effect from mobile phone dependency to sleep quality was statistically significant (total mediated effect: 0.043, 95%CI: 0.030 ~ 0.057), while the direct path from mobile phone dependency to sleep quality was significant as well (total effect: 0.097, 95%CI: 0.076 ~ 0.120). Thus, bedtime procrastination and fear of missing out played partial mediating role on the association between mobile phone dependency and sleep quality.

The present study examined the associations between mobile phone dependency, bedtime procrastination, FoMO, and sleep quality among college students during the COVID-19 outbreak. Moreover, the present study examined the mediation effects of mobile phone dependency on sleep quality via bedtime procrastination and FoMO. Overall, the findings were in line with previous studies regarding the associations between mobile phone dependency and FoMO, bedtime procrastination, and sleep quality. Furthermore, the bedtime procrastination and FoMO had mediation effects between mobile phone dependency and sleep quality.

The mobile phone dependency was positively correlated with poor sleep quality. Consistent with previous studies, college students with high level of mobile phone dependency were more likely to have poor sleep quality ^15,36−38. The correlation coefficient between mobile phone dependency and sleep quality (r = 0.29) was similar to a recent meta-analysis result (r = 0.28) ². Commonly, the excessive mobile phone use before bedtime would postpone or even replace sleep time ¹⁶. Meanwhile, considering the context of the Covid-19 epidemic, the replacement of sleep time with mobile phone screen may exacerbate the negative effects ³⁹. Also, higher level of mobile phone dependency may result in a higher level of psychological stress or arousal, which may disturb the sleep ^40,41. In addition, it is reported that the blue light emitted from the mobile phone screen may influence the melatonin levels and affect sleep process ⁴².

The mobile phone dependency was positively associated with bedtime procrastination and FoMO, which indicated that college students who had higher level of mobile phone dependency may experience greater bedtime procrastination and FoMO. In line with the findings from a recent meta-analysis, individuals who spent more time on electronic media use were more likely to have greater level of bedtime procrastination ⁴³. Moreover, the present study also revealed that the bedtime procrastination was positively associated with poor sleep quality, which is consistent with the meta-analysis findings ⁴³. In addition, consistent with a previous study ²⁷, mobile phone dependency was positively associated with FoMO, which indicated that college students who had higher level of mobile phone dependency may experience greater level of FoMO. During the epidemic, people may use social media, such as mobile phones, more frequently to access information. When there is a gap between the restrictions of one's own area and the freedom of others, this can create jealousy and trigger fear of missing out ^44,45. Number of studies revealed that mobile phone addiction usually associated with social media addiction since social media use is primarily accessed via mobile phones ^46,47. It is prevalent using social media via mobile phones before bedtime among college students, and the study findings indicated that college students with higher level of mobile phone dependency may stay prolonged time on social media which cause greater level of FoMO.

The present study findings supported the mediation effects of bedtime procrastination between mobile phone dependency and sleep quality. Specifically, the indirect effect effects of mobile phone dependency on sleep quality were partially mediated by the bedtime procrastination. Consistent with the previous study findings, bedtime procrastination was tested to be a risk-enhancing mediator on the association between mobile phone dependency and sleep quality ²⁰. College students who had greater level of mobile phone dependency may have difficulties to stop using mobile phones before bedtime (e.g., pleasure-seeking activities via mobile phones, chatting online, playing games), which may cause higher level of bedtime procrastination and lead to poorer sleep quality such as shorter sleep duration, longer sleep latency, or even insomnia ^40,48. Moreover, in terms of gratification theory of internet use, college students inclined to use their mobile phones to get gratification and pleasure after a long school-day for relaxing themselves ⁴⁹. Bedtime procrastination as a relatively new concept related to health behavior, the present study suggested the mediating role of bedtime procrastination between mobile phone dependency and sleep quality. The indirect effects of mobile phone dependency on sleep quality through bedtime procrastination provided insights and direction for future study investigating the correlates of mobile phone addition and sleep quality.

The present study also observed that mobile phone dependency had an indirect effect on sleep quality through FoMO. College students who had high level of mobile phone dependency may induce higher level of FoMO, which in turn led to poor sleep quality. Similarly, Li et al ²⁷ in a cross-sectional study found that individuals who had higher level of negative affect were more prone to experience higher levels of FoMO and suffer smartphone addiction, eventually, led to poor sleep quality. FoMO was described as a negative psychological state under the social media context, which individuals would continuously worry about missing online information, messages, and social interactions ²⁸. In China, the most popular social media mobile phone application is called WeChat, which facilities people’s daily life, such as messaging, making video calls, chatting online, etc. College students are the “digital natives” who live depend on such social media and stay connected with others. Study evidence has shown the strong correlation between smartphone addiction and FoMO, as the information or message were kind of updated and exchanged constantly, thus, individuals with high level of mobile phone dependency were more likely to frequently checking social media via their mobile phones to avoid of missing out online information, thereby, aggravated the level of FoMO and affecting sleep quality eventually ²⁵. Notably, the current study also observed significant association between bedtime procrastination and FoMO. Bedtime procrastination was considered as health-related behavior, whereas FoMO was defined as health-related psychological state. The present study supported both were mediators mediating the association between mobile phone dependency and sleep quality. Similar findings were also found in one study, which reported that FoMO mediated the association between social media use and sleep outcomes via behavioral and psychological path ²⁹. The late-night social media use aggravated FoMO which led to delayed sleep time, meanwhile, on the cognitive level, social media use at night with FoMO increased cognitive arousal before bedtime and further delayed sleep onset. Corresponding to the present study, it seems that both bedtime procrastination and FoMO may be the important mediators between mobile phone dependency and sleep quality. Future studies may consider both bedtime procrastination and FoMO as influencing factors in order to develop effective interventions coping with mobile phone dependency and improving sleep quality.

The study has its limitations. Firstly, the study was a cross-sectional study. Therefore, no causality can be directly inferred based the observed associations. The experimental studies are needed to further conclude the findings. Second, the sleep quality may also be influenced by other psychological and behavioral factors, which were not considered in this study. Future studies should take them all into account to refine the mechanisms between mobile phone usage and sleep. Despite these limitations, this study has strengths. Third, the data were collected during the campus lockdown. Although it is important period of time to study, the results should be interpreted with caution and generalization may be limited.

The findings of present study indicated that bedtime procrastination and fear of missing out are mediators on the association between mobile phone dependency with poor sleep quality. Bedtime procrastination and fear of missing out should be considered as potential intervention targets for reducing mobile phone dependency and improving sleep quality in college students.

Ethics Approval and Consent to Participate

This study was approved by Shanghai Jiao Tong University Review Board (H2022202I) prior to any data collection. All procedures were performed in accordance with the ethical standards of the Institution and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants have provided informed consent to participate this study.

Consent for publication

Not Applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Competing interests

The authors declare no conflict of interest.

Funding

This research received no external funding.

Authors’ Contributions

T.H. conceptualized the research idea, oversaw data collection and analysis, and wrote the manuscript; Y.L., T.T., D.W., and K.Z played roles in data collection, data extraction, data analysis, and writing the manuscript; W.L. played a role in manuscript writing and revision.

Acknowledgements

The authors sincerely thank all the participants.

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First submitted to journal
19 Jan, 2023

You are reading this latest preprint version

Mobile Phone Dependency and Sleep Quality in College Students during COVID-19 Outbreak: The Mediating Role of Bedtime Procrastination and Fear of Missing Out

Status:

Journal Publication

Version 1

Abstract

Objective

Methods

Results

Conclusion

Figures

Introduction

Methods

Participants

Measures

Mobile Phone Involvement Questionnaire (MPIQ)

Bedtime Procrastination Scale (Bps)

Fear Of Missing Out Scale (Fomos)

Pittsburgh Sleep Quality Index (Psqi)

Statistical Analyses

Results

Descriptive statistics and correlation analysis

Testing For Mediation Effects

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1