Beyond Screen Time: Smartphone Dependency, Sleep Disruption, and Emotional Regulation Among Young Adults-A...

Background: Smartphones are ubiquitous among young adults today. However, many young adults exhibit characteristics of problematic or dependent phone use. These individuals often have sleep disturbances and difficulties with emotional regulation. Currently, the research on the connection between these three variables is scarce, with particular gaps in studies of nursing professionals in this population. Objective: The study aimed to identify the prevalence of problematic phone use among young adults and the relationship between these three variables: problematic phone use, sleep disturbances, and difficulties with emotion regulation. The study will also investigate the potential of sleep disturbances to mediate the relationship between problematic phone use and difficulties with emotion regulation. Methods: Data was collected from participants aged 18 years or older through a self-administered, anonymous web survey. The web survey was disseminated via social media and used snowball sampling to collect responses from individuals from various regions. There were no investigators involved in data collection from any particular institution or to reduce researcher bias. A power analysis was performed to determine the ideal sample size; the results from the 167 participants exceeded the ideal sample size requirement. The Smartphone Addiction Scale-Short Version (SAS-SV), a sleep disruption score derived from the Pittsburgh Sleep Quality Index (PSQI), and the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) were used to collect data. Data were analyzed using descriptive and inferential statistics, including Cronbach's alpha, Pearson correlations, independent-samples t tests, one-way ANOVA, multiple linear regression, and bootstrapped mediation (n = 5000 resamples). The CHERRIES guidelines were adhered to throughout the research study. Results: The participants were aged a mean of 21.6 years old (SD = 4.6). The majority of the participants (n = 117, 70.1%) identified as female. The internal consistency reliability for the SAS-SV and DERS-SF was high (SAS-SV α = 0.94; DERS-SF α = 0.88). Based upon the sex-specific cutoffs for the SAS-SV, a total of 63 participants (37.7%) screened positive for problematic phone use. There were significant positive correlations between problematic phone use and sleep disturbances (r = 0.41, p < 0.001) as well as problematic phone use and difficulties with emotion regulation (r = 0.54, p < 0.001). There was a significant positive correlation between sleep disturbances and difficulties with emotion regulation (r = 0.37, p < 0.001). The amount of time each individual spent on their smartphone on an average daily basis differed significantly across self-reported daily use bands (F_2,164 = 6.26, p = 0.002), with dependency highest among those reporting more than 5 h of daily use. There were no significant differences in this relationship based upon sex. Multiple linear regression analysis revealed that problematic phone use was a significant predictor of difficulties with emotion regulation (β = 0.47, p < 0.001); once the effects of problematic phone use were accounted for, sleep disturbances also significantly predicted difficulties with emotion regulation (β = 0.18, p = 0.01). In a complete-case analysis excluding 12 participants with uninterpretable sleep-duration data (n = 155), the bootstrapped indirect effect of sleep disturbances on the relationship between problematic phone use and difficulties with emotion regulation was statistically significant (ab = 0.081, 95% CI = 0.015 to 0.174, adjusting for age and sex); an earlier analysis that had scored these 12 cases as zero rather than excluding them found a smaller, non-significant indirect effect (ab = 0.060, 95% CI = -0.014 to 0.140). Conclusions: Problematic phone use is common among young adults today. The use of problematic phone behavior is positively associated with sleep disturbances and difficulties with emotion regulation. In a corrected complete-case analysis, sleep disturbances significantly mediated part of this relationship, though this cross-sectional association should not be interpreted as demonstrating a causal mechanism, and it should be weighed against a smaller, non-significant estimate obtained before this missing-data correction. These findings suggest that both problematic phone use and, cautiously, sleep health may be relevant targets for nursing-led digital-wellness interventions, though the effectiveness of such interventions would need to be established in prospective studies before implementation.