The association between bedtime smartphone use and anxiety symptoms: a network analysis of Chinese residents

Bedtime smartphone use has become a common practice among modern individuals. The mechanisms underlying the association between bedtime smartphone use and anxiety are not fully understood in the whole population and across genders. Additionally, it remains unclear whether reducing problematic internet use (PIU) can lessen the association between bedtime smartphone use and anxiety.

30,504 subjects were recruited from the Psychology and Behavior Investigation of Chinese Residents (PBICR). Logistic regression models were used to analyze the association between bedtime smartphone use and the risk of developing anxiety, as well as the interaction effect of problematic internet use (PIU) on this association. Multiple linear regression models were conducted to analyze the association between bedtime smartphone use and the severity of anxiety symptoms. Network analysis was utilized to identify core symptoms and to distinguish gender differences in the association between bedtime smartphone use and anxiety symptoms.

Compared to participants who used their smartphones for one hour or less before bedtime, using smartphones for more than one hour before bedtime was associated with a 9.1% higher likelihood of experiencing anxiety (OR = 1.091). The duration of bedtime smartphone use was positively correlated with anxiety severity ([Formula: see text]0.116, P < 0.001). In the network of bedtime smartphone use and anxiety symptoms in the general population, "Inability to stop or control worrying (GAD2)" and "Worrying too much about a variety of things (GAD3)" exhibited the highest centrality. The path coefficient between the duration of bedtime smartphone use and "Becoming annoyed or easily irritated (GAD6)" was the largest. Compared to males, the centrality of "Difficulty relaxing (GAD4)" was higher in females, and the path coefficients between the "The duration of mobile phone use before bedtime (phone)" and "Feeling nervous, anxious, or on edge (GAD1)", "Inability to sit still due to restlessness (GAD5)", and "Becoming annoyed or easily irritated (GAD6)" were greater in females. The centrality of "Feeling scared because something terrible seems to be about to happen (GAD7)" was higher in males. Individuals who reported both bedtime smartphone use of more than 1 h and PIU were associated with a 276.2% higher likelihood of experiencing anxiety. Those who reported bedtime smartphone use of more than 1 h and did not have PIU were associated with a 35.3% lower likelihood of experiencing anxiety (OR = 0.647).

Using smartphones before bedtime was associated with a higher likelihood of experiencing anxiety and was positively correlated with the severity of anxiety in the general population. Worry symptoms showed the strongest association with bedtime smartphone use. The association between bedtime smartphone use and anxiety symptoms was stronger in women than in men. Using smartphones before bedtime for more than 1 h combined with PIU was associated with a higher likelihood of experiencing anxiety, while using a smartphone before bedtime for more than 1 h without PIU was associated with a lower likelihood of experiencing anxiety.