{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T02:24:16Z","timestamp":1782354256935,"version":"3.54.5"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Smartphone-based online education gained popularity during and after the COVID-19 pandemic. Although recent studies have highlighted the association between problematic smartphone use (PSU) and mental health symptoms, the potential role of online learning in this relationship remains unclear. This study aimed<jats:bold>t<\/jats:bold>o analyze the relationships between higher education modes, PSU, and related psychological symptoms in university students.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 1,629 Chinese university students from five provinces completed a web-based questionnaire survey between March 2020 and October 2021. Demographic characteristics and learning conditions were recorded. All participants completed the Smartphone Addiction Scale-Short Version, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Athens Insomnia Scale. Multiple regressions models and stratified analyses were used to examine the association between online education mode, PSU, and symptoms of depression, anxiety, and insomnia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of PSU was 58.5%. Students who relied primarily on online learning had a higher prevalence of depressive symptoms (29.95% vs. 22.24%), anxiety symptoms (25.13% vs. 18.91%), and insomnia symptoms (75.89% vs. 70.27%) than those who relied on traditional face-to-face learning (<jats:italic>Ps<\/jats:italic>&amp;lt; 0.05). After adjusting for covariates, subjects with PSU were more likely to report depressive symptoms (AdjOR = 3.14, 95% CI = 2.26\u20134.37), anxiety symptoms (AdjOR = 3.73, 95% CI = 2.13\u20134.59), and insomnia symptoms (AdjOR = 2.96, 95% CI = 2.23\u20133.92) than those without PSU. Furthermore, the associations of PSU with depressive symptoms (OR = 4.66 vs. 2.33,<jats:italic>P<\/jats:italic>for interaction = 0.015) and anxiety symptoms (OR = 6.05 vs. 2.94,<jats:italic>P<\/jats:italic>for interaction = 0.021) were more pronounced in the online learning group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study provides preliminary evidence that Chinese university students have serious smartphone addiction problems, which are associated with depressive, anxiety, and insomnia symptoms. Online learning is found to exacerbate PSU and mental health problems. Our findings provide valuable information for targeted psychological interventions in the post-COVID-19 era.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.881074","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T06:02:22Z","timestamp":1651644142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":39,"title":["Associations Between Online Learning, Smartphone Addiction Problems, and Psychological Symptoms in Chinese College Students After the COVID-19 Pandemic"],"prefix":"10.3389","volume":"10","author":[{"given":"Chi","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinjuan","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"m2491","DOI":"10.1136\/bmj.m2491","article-title":"Covid-19: healthcare students face unique mental health challenges","volume":"369","author":"Smith","year":"2020","journal-title":"BMJ."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10311-021-01369-7","article-title":"Will the COVID-19 pandemic end with the Delta and Omicron variants?","volume":"15","author":"Wang","year":"2022","journal-title":"Environ Chem Lett."},{"key":"B3","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.jad.2021.04.050","article-title":"Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries","volume":"290","author":"Lee","year":"2021","journal-title":"J Affect Disord."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e2286","DOI":"10.6061\/clinics\/2020\/e2286","article-title":"Online learning and COVID-19: a meta-synthesis analysis","volume":"75","author":"Camargo","year":"2020","journal-title":"Clinics (S\u00e1o Paulo)."},{"key":"B5","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12909-020-02208-z","article-title":"The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: a qualitative study exploring medical students' perspectives","volume":"20","author":"Khalil","year":"2020","journal-title":"BMC Med Educ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"103833","DOI":"10.1016\/j.compedu.2020.103833","article-title":"Formative assessment with interactive whiteboards: A one-year longitudinal study of primary students' mathematical performance","volume":"150","author":"Chen","year":"2020","journal-title":"Comput Educ."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1111\/ppc.12710","article-title":"The relationship between nursing students' technology addiction levels and attitudes toward e-learning during the COVID-19 pandemic: a cross-sectional study","volume":"57","author":"Guven Ozdemir","year":"2021","journal-title":"Perspect Psychiatr Care."},{"key":"B8","doi-asserted-by":"publisher","first-page":"349","DOI":"10.3390\/ijerph18010349","article-title":"Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students' Burnout and Mental Health","volume":"18","author":"Zis","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1097\/ADM.0000000000000845","article-title":"The relationship between children's problematic internet-related behaviors and psychological distress during the onset of the COVID-19 pandemic: a longitudinal study","volume":"16","author":"Chen","year":"2022","journal-title":"J Addict Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/j.jaac.2020.06.007","article-title":"Internet-related behaviors and psychological distress among schoolchildren during COVID-19 school suspension","volume":"59","author":"Chen","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e8966","DOI":"10.7759\/cureus.8966","article-title":"Challenges to online medical education during the COVID-19 pandemic","volume":"12","author":"Rajab","year":"2020","journal-title":"Cureus."},{"key":"B12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jad.2020.06.029","article-title":"An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19","volume":"275","author":"Duan","year":"2020","journal-title":"J Affect Disord."},{"key":"B13","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1080\/10550887.2021.1889751","article-title":"Smartphone addiction across the lifetime during Italian lockdown for COVID-19","volume":"39","author":"Caponnetto","year":"2021","journal-title":"J Addict Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1666538","DOI":"10.1080\/10872981.2019.1666538","article-title":"Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis","volume":"24","author":"Pei","year":"2019","journal-title":"Med Educ Online."},{"key":"B15","doi-asserted-by":"publisher","first-page":"105355","DOI":"10.1016\/j.childyouth.2020.105355","article-title":"Impact of \u201ce-Learning crack-up\u201d perception on psychological distress among college students during COVID-19 pandemic: A mediating role of \u201cfear of academic year loss\u201d","volume":"118","author":"Hasan","year":"2020","journal-title":"Child Youth Serv Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/j.dsx.2020.05.033","article-title":"COVID-19 and applications of smartphone technology in the current pandemic","volume":"14","author":"Iyengar","year":"2020","journal-title":"Diabetes Metab Syndr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.hlpt.2021.01.002","article-title":"Smartphone overuse: a hidden crisis in COVID-19","volume":"10","author":"Ratan","year":"2021","journal-title":"Health Policy Technol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"85","DOI":"10.4103\/shb.shb_32_21","article-title":"The psychological impact of COVID-19 on health-care workers in African Countries: A systematic review","volume":"4","author":"Olashore","year":"2021","journal-title":"Asian J Soc Health Behav."},{"key":"B19","doi-asserted-by":"publisher","first-page":"51","DOI":"10.4103\/shb.shb_24_21","article-title":"Impact of COVID-19-related fear and anxiety on job attributes: A systematic review","volume":"5","author":"Rajabimajd","year":"2021","journal-title":"Asian J Soc Health Behav."},{"key":"B20","doi-asserted-by":"publisher","first-page":"113193","DOI":"10.1016\/j.psychres.2020.113193","article-title":"The psychological impact of quarantine on coronavirus disease 2019 (COVID-19)","volume":"291","author":"Luo","year":"2020","journal-title":"Psychiatry Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e19007","DOI":"10.2196\/19007","article-title":"Impact of home quarantine on physical activity among older adults living at home during the COVID-19 pandemic: qualitative interview study","volume":"3","author":"Goethals","year":"2020","journal-title":"JMIR Aging."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1016\/j.numecd.2020.05.020","article-title":"Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease","volume":"30","author":"Mattioli","year":"2020","journal-title":"Nutr Metab Cardiovasc Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jad.2020.11.032","article-title":"Mental health of college students during the COVID-19 epidemic in China","volume":"280","author":"Fu","year":"2021","journal-title":"J Affect Disord."},{"key":"B24","doi-asserted-by":"publisher","first-page":"113041","DOI":"10.1016\/j.psychres.2020.113041","article-title":"Role of electronic media in mitigating the psychological impacts of novel coronavirus (COVID-19)","volume":"289","author":"Bilal","year":"2020","journal-title":"Psychiatry Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e20185","DOI":"10.2196\/20185","article-title":"Mental health and behavior of college students during the early phases of the COVID-19 pandemic: longitudinal smartphone and ecological momentary assessment study","volume":"22","author":"Huckins","year":"2020","journal-title":"J Med Internet Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e181","DOI":"10.1017\/S2045796020000931","article-title":"Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China","volume":"29","author":"Ma","year":"2020","journal-title":"Epidemiol Psychiatr Sci."},{"key":"B27","doi-asserted-by":"publisher","first-page":"100916","DOI":"10.1016\/j.eclinm.2021.100916","article-title":"Sleep problems during COVID-19 pandemic and its' association to psychological distress: a systematic review and meta-analysis","volume":"36","author":"Alimoradi","year":"2021","journal-title":"EClinicalMedicine."},{"key":"B28","doi-asserted-by":"publisher","first-page":"755059","DOI":"10.3389\/fpsyt.2021.755059","article-title":"Relationship of problematic smartphone use, sleep quality, and daytime fatigue among quarantined medical students during the COVID-19 pandemic","volume":"12","author":"Zhang","year":"2021","journal-title":"Front Psychiatry."},{"key":"B29","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1089\/cyber.2011.0580","article-title":"Social implications of smartphone use: Korean college students' smartphone use and psychological well-being","volume":"15","author":"Park","year":"2012","journal-title":"Cyberpsychol Behav Soc Netw."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1556\/2006.2021.00081","article-title":"Is the I-PACE (Interaction of Person-Affect-Cognition-Execution) model valid in South Korea? The effects of adverse childhood experiences (ACEs) on internet gaming disorder and the mediating effect of stress on adolescents","author":"Jhone","year":"2021","journal-title":"J Behav Addict"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jad.2021.09.021","article-title":"Psychological distress, rumination and problematic smartphone use among Spanish adolescents: An emotional intelligence-based conditional process analysis","volume":"296","author":"Arrivillaga","year":"2022","journal-title":"J Affect Disord."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e042378","DOI":"10.1136\/bmjopen-2020-042378","article-title":"Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students","volume":"10","author":"Dost","year":"2020","journal-title":"BMJ Open"},{"key":"B33","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1365-2753.2010.01434.x","article-title":"Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline","volume":"17","author":"Sousa","year":"2011","journal-title":"J Eval Clin Pract."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e83558","DOI":"10.1371\/journal.pone.0083558","article-title":"The smartphone addiction scale: development and validation of a short version for adolescents","volume":"8","author":"Kwon","year":"2013","journal-title":"PLoS One."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1556\/2006.7.2018.105","article-title":"Short version of the smartphone addiction scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates","volume":"7","author":"Luk T","year":"2018","journal-title":"J Behav Addict."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e033211","DOI":"10.1136\/bmjopen-2019-033211","article-title":"Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study","volume":"10","author":"Ye","year":"2020","journal-title":"BMJ Open."},{"key":"B37","doi-asserted-by":"publisher","first-page":"l1476","DOI":"10.1136\/bmj.l1476","article-title":"Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis","volume":"365","author":"Levis","year":"2019","journal-title":"BMJ."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3109\/02813432.2014.920597","article-title":"Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools","volume":"32","author":"Kujanp\u00e4\u00e4","year":"2014","journal-title":"Scand J Prim Health Care."},{"key":"B40","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/S0022-3999(00)00095-7","article-title":"Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria","volume":"48","author":"Soldatos","year":"2000","journal-title":"J Psychosom Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"zsab193","DOI":"10.1093\/sleep\/zsab193","article-title":"Stress and sleep across the onset of the novel coronavirus disease 2019 pandemic: impact of distance learning on US college students' health trajectories","volume":"44","author":"Gusman","year":"2021","journal-title":"Sleep"},{"key":"B42","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"5724","DOI":"10.3390\/ijerph18115724","article-title":"Problematic Smartphone Use during the COVID-19 Pandemic: Its Association with Pandemic-Related and Generalized Beliefs","volume":"18","author":"Zhang","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B44","doi-asserted-by":"publisher","first-page":"720911","DOI":"10.3389\/fpsyg.2021.720911","article-title":"Association Between Online Self-Directed Learning Ability and Negative Emotions Among College Students During the COVID-19 Pandemic: A Cross-Sectional Study in Anhui Province, East China","volume":"12","author":"Chang","year":"2021","journal-title":"Front Psychol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"Collaborators","year":"2021","journal-title":"Lancet."},{"key":"B46","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.jad.2021.05.109","article-title":"Prevalence of anxiety symptom and depressive symptom among college students during COVID-19 pandemic: a meta-analysis","volume":"292","author":"Chang","year":"2021","journal-title":"J Affect Disord."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1589\/jpts.27.1743","article-title":"The effects of smartphone use on upper extremity muscle activity and pain threshold","volume":"27","author":"Lee","year":"2015","journal-title":"J Phys Ther Sci."},{"key":"B48","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/jan.12509","article-title":"A systematic review evaluating the impact of online or blended learning vs face-to-face learning of clinical skills in undergraduate nurse education","volume":"71","author":"McCutcheon","year":"2015","journal-title":"J Adv Nurs."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40670-020-01165-y","article-title":"Online-Learning due to COVID-19 Improved Mental Health Among Medical Students","volume":"31","author":"Bolatov","year":"2020","journal-title":"Med Sci Educ."},{"key":"B50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/brainsci11121578","article-title":"The impact of study mode (online vs. hybrid) on early symptoms of depression and coping strategies among university students in poland in time of covid-19 pandemic-preliminary","volume":"11","author":"Drelich-Zbroja","year":"2021","journal-title":"Study Brain Sci."},{"key":"B51","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s00038-011-0234-z","article-title":"Associations between problematic mobile phone use and psychological parameters in young adults","volume":"57","author":"Augner","year":"2012","journal-title":"Int J Public Health."},{"key":"B52","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1089\/cpb.2008.0096","article-title":"Characteristics of excessive cellular phone use in Korean adolescents","volume":"11","author":"Ha","year":"2008","journal-title":"Cyberpsychol Behav."},{"key":"B53","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1556\/2006.4.2015.010","article-title":"Relationship of smartphone use severity with sleep quality, depression, and anxiety in university students","volume":"4","author":"Demirci","year":"2015","journal-title":"J Behav Addict."},{"key":"B54","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s40359-020-00466-6","article-title":"The relationship of smartphone addiction with psychological distress and neuroticism among university medical students","volume":"8","author":"Lei","year":"2020","journal-title":"BMC Psychol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"e21490","DOI":"10.2196\/21490","article-title":"Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis","volume":"22","author":"Singh","year":"2020","journal-title":"J Med Internet Res."},{"key":"B56","doi-asserted-by":"publisher","first-page":"725740","DOI":"10.3389\/fpsyt.2021.725740","article-title":"Academic burnout and problematic smartphone use during the covid-19 pandemic: the effects of anxiety and resilience","volume":"12","author":"Hao","year":"2021","journal-title":"Front Psychiatry."},{"key":"B57","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1016\/j.adolescence.2008.10.006","article-title":"Symptoms of problematic cellular phone use, functional impairment and its association with depression among adolescents in Southern Taiwan","volume":"32","author":"Yen C","year":"2009","journal-title":"J Adolesc."},{"key":"B58","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4103\/shb.shb_83_21","article-title":"Using occupational therapy process addressing sleep-related problems in neurorehabilitation: A cross-sectional modeling study","volume":"4","author":"Fan","year":"2021","journal-title":"Asian J Soc Health Behav."},{"key":"B59","doi-asserted-by":"publisher","first-page":"2293","DOI":"10.1038\/jcbfm.2011.128","article-title":"GSM mobile phone radiation suppresses brain glucose metabolism","volume":"31","author":"Kwon","year":"2011","journal-title":"J Cereb Blood Flow Metab."},{"key":"B60","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4103\/shb.shb_81_20","article-title":"The effects of internet gaming and social media use on physical activity, sleep, quality of life, and academic performance among university students in Hong Kong: A preliminary study","volume":"4","author":"Kwok","year":"2021","journal-title":"Asian J Soc Health Behav."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.881074\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T18:36:38Z","timestamp":1727116598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.881074\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,4]]},"references-count":60,"alternative-id":["10.3389\/fpubh.2022.881074"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.881074","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,4]]},"article-number":"881074"}}