| Objective:Firstly,problematic smartphone usage(PSU)is frequently reported tobe correlated with anxiety,depression,stress,impulsivity,and sleep quality among college students.However,to date,there is no consensus on the extent to which those factors are correlated with PSU among college students.We thus performed a meta-analysis to quantitatively synthesizethe previous findings.Secondly,with the rapid increase of researchers’interest in mobile phone addiction research,researchers have found that there is not only a direct relationship between college students’depression tendency and PSU,but also an indirect effect(mediating effect or moderating effect).Therefore,based on the theoretical model of the Interaction of Person-Affect-Cognition-Execution(I-PACE model)and previous studies,we would explorethat whether psychological factors such as fear of missing out(FoMO)and rumination in college students could be used as mediators to indirectly affect the relationship between depression tendency and PSU,as well as the moderated mediation effectof gender and self-efficacy.To determine the causal relationships between study variables such as depressive symptoms,FoMO,and rumination,and PSU,we further conducted a cohort study.Additionally,the causal relationships between these four main research variables and sleep duration,dual-system dimension of self-control,social fear,and interpersonal relationships were also examined so as to provide solid evidence for future research on the relationships between PSU,personal characteristics,and mental health.Methods:A systematic review and meta-analysis was conducted by searching Pub Med,Embase,Cochrane Library,Wanfang,CNKI,VIP,and CBM databases from inception to August 1,2020.Pooled Pearson’s correlation coefficients between MPA and anxiety,depression,impulsivity,and sleep quality were calculated by R software using randomeffects model.Second,we carried out a cross-sectional study based on China Medical University on May 2021(the first round).Medical students were recruited through an online survey platform(Wenjuanxing platform)using the convenience sampling strategy.A total of 1837 study subjects were enrolled.After the exclusion of 202 study subjects who aged over 24 years old and did not complete the questionnaires.Finally,1635subjects met the inclusion criteria(572 males and 1063 females),and the effective response rate was 89.0%.The average age of the study subjects was 20.65±1.70 years.The survey contents included basic information,short version of the Smartphone Addiction Scale(SAS-SV),Center for Epidemiological Survey Depression Scale(CES-D),Ruminative Responses Scale(RRS),Fear of Missing Out Scale(FoMOs),and the General Self-Efficacy Scale(GSES).Continuous variables can be expressed as mean(standard deviation)or median(interquartile range)depending on the distribution of the data.The comparisons between groups were conducted using Student’st test,analysis of variance(ANOVA),or Wilcoxon rank sum testasappropriate.Categorical variables were depicted as frequencies and percentages.And the Chi-square tests was used to examinethe differences between groups.Data analyses were mainly conducted using SPSS software version 22.0.Pearson’s correlation matrix heat map was drawn using R software.The mediating,moderating,and moderated mediating effect of FoMO,RRS,and self-efficacy were analyzed by PROCESS v4.0.Meanwhile,if the moderating effect is statistically significant,a simple slope test was then subsequently conducted.The structural equation model was conducted using SPSS AMOS.On the basis of the cross-sectional study,the Mental Health and Behavioral Addiction Scale of College Students was followed up with an interval of three months.In total,college students were investigated at three timepoints(mid-semester,beginning of school and winter vacation).The AMOS plug-in was used to analyze the path analysis of the ternary cross-lag regression models between the depressive symptoms-FoMO-PSU and the depressive symptoms-rumination-PSU of college students at different timepoints.To ensure the consistency of the path coefficients(regression coefficients)of the same causal relationship under the three timepoints,the path coefficients were first set to be equivalent,and then the cross-lag regression models were estimated.Results:1.Inour meta-analysis,forty studies involving a total of 33,650 college students were identified.Weak-to-moderate positive correlations were found between PSU and anxiety,depression,impulsivity and sleep quality(anxiety:summary r=0.39,95%CI=0.34-0.45,P<0.001,I~2=84.9%;depression:summary r=0.36,95%CI=0.32-0.40,P<0.001,I~2=84.2%;impulsivity:summary r=0.38,95%CI=0.28-0.47,P<0.001,I~2=94.7%;sleep quality:summary r=0.28,95%CI=0.22-0.33,P<0.001,I~2=85.6%).The pooled correlations revealed some discrepancies when stratified by some moderators.The robustness of our findings was further confirmed by sensitivity analyses.2.The overall average SAS-SV score was 35.43±8.16 points.The prevalence of PSU was 70.58%(1154/1635).Depressive symptoms,FoMO,and RRS were all positively correlated with each other.They were also positively correlated with PSU(r=0.382,0.262,0.382,P<0.01).Conversely,self-efficacy was inversely associated with depressive symptoms,FoMO,rumination,and PSU severity(r=-0.331,-0.055,-0.260,and-0.277,respectively;P<0.05).FoMO played a partial mediating role in the relationship between depressive symptoms and PSU among college students and the mediating effect accounted for 15.07%of the total effect.Self-efficacy moderated the mediating role of FoMO in the relationship between depressive symptoms and PSU.Rumination played a partial mediating role in the relationship between depressive symptoms and PSU,and the mediating effect accounted for 15.5%of the total effect.Self-efficacy moderates the relationship between depression and PSU.However,the moderated mediating effect of RSS on the relationship betweend epression and PSU wasinsignificant.3.Totally,321 groups of subjects completed all three follow-up surveys.Our findings suggested that the depressive symptoms,FoMO,rumination and PSU of college students were positively correlated at T1,T2,and T3.The longitudinal cross-lagged regression model showed that there was a bidirectional causal relationship between depressive symptoms and PSU in college students.There was also a causal relationship between depressive symptoms and FoMO in college students.The higher the level of depressive symptoms,the more likely to have FoMO.In addition,depressive symptoms predicted rumination,but no predictive effect was found in the opposite direction.However,no mutual predictive effect was found between FoMO and PSU.Conclusion:The meta-analysis suggested that college students with PSU were more likely to develop high levels of anxiety,depression,and impulsivity and suffer from poor sleep quality.The depressive symptoms are independent influencing factors for PSU among college students.FoMO and RSS play a mediating role in the depression-PSU relationship.That is to say,college students with higher level of depressive symptoms are more susceptible to RSS.Self-efficacy moderates the mediating effect of FoMO on the relationship between depression symptoms and PSU in college students.Self-efficacy directly moderated the depression-PSU relationship,but could not the moderated the mediating effect of RRS.Established evidence showed that early life is a critical period for the formation and development of the body’s thoughts and behaviors.Adolescence and early youth are important periods for the development of mental health and PSU.Enforcing positive psychological factors(self-efficacy)might help college students fight against PSU.Our studies provided empirical experience for the government,schools,and families to manage PSU. |
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