Anxiety and its relationship with sleep disturbance and smartphone addition among Chinese medical students during COVID-19 home confinement — A Structural Equation Model Analysis (Preprint)
Authors: Song Yang , Sznajder Kristin , Cui Can , Jia Yajing , Yang Yilong , Li Ying , Yang Xiaoshi 
Published: January 2021

BACKGROUND

Medical students, the majority of whom have experienced home confinement and a reliance on online resources to study medicine since the outbreak of COVID-19, have been found to suffer increased level of anxiety. Since smartphones have become the most commonly used device for accessing the internet, more time spent studying online during the COVID pandemic may be a potential risk factor for unconscious smartphone addiction, which could lead to elevated levels of sleep disturbance and anxiety. However, there is a dearth of research examining anxiety and its relationship with sleep disturbance and smartphone addition among medical students during the COVID-19 pandemic. Further, no existing literature has examined sleep disturbance as a mediator in the relationship between smartphone addiction and anxiety.

OBJECTIVE

This study aimed to assess the association between anxiety, smartphone addiction and sleep disturbance among medical students during COVID-19 home confinement and to examine the mediating role of sleep disturbance between smartphone addiction and anxiety.

METHODS

This cross-sectional study was performed among medical students attending a university located in the northeast of China in April 2020, when all universities in China began to deliver live-streaming courses via various online platforms as part of the national COVID-19 prevention strategy (Ministry of Education of China, 2020). Altogether, 666 medical students validly answered a self-administered questionnaire, which included demographic information, the Chinese version of the Generalized Anxiety Disorder 7-item scale, Smartphone addiction scale - short version, and PROMIS Sleep Disturbance (short form). Hierarchical multiple regression analyses were employed to determine the extent to which each involved independent variable could contribute to the variance of anxiety. Structural equation modeling was conducted to test whether the hypothesized associations existed.

RESULTS

Anxiety exhibited robust positive associations with both smartphone addiction and sleep disturbance among medical students during the COVID-19 pandemic. Smartphone addiction not only directly affected anxiety but also exerted a significant indirect effect on anxiety via sleep disturbance. A significant decrease of the path coefficient of smartphone addiction on anxiety (from β=0.53 to β=0.22, P< .01) was observed with sleep disturbance being modeled as a mediator.

CONCLUSIONS

This study demonstrated a robust positive association between anxiety, smartphone addiction, and sleep disturbance among medical students during COVID-19 home confinement. Smartphone addiction exerted not only a direct effect on anxiety but also an indirect impact on anxiety through the mediating effect of sleep disturbance. Therefore, professional assistance and timely intervention should be provided to alleviate anxiety among medical students during the COVID-19 pandemic. The detrimental impact of smartphone addiction and the importance of sleep health on mitigating anxiety should be highlighted and incorporated into medical education.