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Empirical research has linked psychological distress with fatigue. However, few studies have analyzed the factors (eg, stimuli from bedtime media use) that affect the relationship between psychological distress and fatigue.
The aim of this study was to examine whether visual stimuli from bedtime media use mediate the relationship between psychological distress and fatigue among college students.
The sample included 394 participants (92 males, 302 females) with a mean age of 19.98 years (SD 1.43 years), all of whom were Chinese college students at an occupational university in Sichuan Province, China. Data were collected using a paper-based questionnaire that addressed psychological distress, stimuli from bedtime media use, and fatigue. Mediation analysis was conducted using the PROCESS macro version 2.16.2 for SPSS 22, which provided the 95% CIs.
Both psychological distress (r=.43,
The findings imply that psychological distress has an indirect effect on fatigue via visual stimuli from bedtime media use. In contrast, auditory stimuli from bedtime media use did not have the same effect. We suggest that college students should reduce bedtime media use, and this could be achieved as part of an overall strategy to improve health. Mobile health apps could be an option to improving young students’ health in daily life.
Fatigue is a subjective feeling of tiredness or a sustained sense of exhaustion [
Fatigue has attracted considerable research interest in recent years. The large proportions of students who experience fatigue and the serious consequences of fatigue highlight the need to explore the psychological mechanisms that underlie fatigue. Although most of the published studies have attempted to estimate the negative consequence of fatigue, relatively few studies have analyzed the factors influencing fatigue. Some research has focused on the risk factors for fatigue, such as daily activities [
Psychological distress is a composite concept that describes the negative symptoms of a person’s mental health, such as depression, anxiety, or other emotional dysregulation [
Despite the association between psychological distress and fatigue, the mediating mechanism related to bedtime media use has not been explored. Research on media use has recently become a hot topic. Media use is prevalent among youth [
Many studies have shown that media use is related to fatigue [
In summary, psychological distress has a positive relationship with fatigue. Visual stimuli from bedtime media use have a potential mediating role between psychological distress and fatigue. This study aimed to explore the mediating effect of stimuli from bedtime media use on the relationship between psychological distress and fatigue among Chinese college students. First, we aimed to confirm the results of previous studies by testing the relationship between psychological distress and fatigue. Second, we aimed to extend the existing literature by examining the role of bedtime media use in the relationship between psychological distress and fatigue. We had two hypotheses: (1) psychological distress is positively correlated with fatigue, and (2) visual stimuli from bedtime media use mediate the positive correlation between psychological distress and fatigue. This paper not only provides new insight in this area but also provides practical methods to improve college students’ health in China. The theory model is shown in
Theory model of the mediating effect of a visual stimulus from bedtime media on the relationship between psychological distress and fatigue.
A power analysis was conducted to estimate the minimum sample size using G Power software [
Results from the hierarchical regression analyses of the effects of the demographic variables, psychological distress, and stimuli from bedtime media use on the dependent variable, fatigue.
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Step 1 | Step 2 | Step 3 | ||||||
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beta |
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beta |
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beta |
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Constant | 47.15 | 12.68 | <.001 | 46.70 | 13.80 | <.001 | 45.29 | 13.14 | <.001 |
Sex (male, female) | –1.61 | –2.57 | .01 | –1.14 | –1.99 | .047 | –1.46 | –2.50 | .01 |
Age (years) | 0.29 | 1.56 | .12 | 0.12 | 0.69 | .49 | 0.09 | 0.54 | .59 |
Psychological distress |
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0.25 | 9.04 | <.001 | 0.24 | 8.65 | <.001 |
Visual stimuli |
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0.92 | 2.59 | .01 |
Auditory stimuli |
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–0.18 | –0.64 | .52 |
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.02 |
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.19 |
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.21 |
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.01 |
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<.001 |
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<.001 |
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Flow chart of eligibility and participation.
The Depression Anxiety Stress Scales (DASS) can be used to measure general psychological distress [
Based on previous studies [
The PROMIS Fatigue Short-Form 7a measures self-reported fatigue using a single total score [
The pairwise method was used to handle missing data. First, descriptive statistics and the correlation matrix were calculated. We expected that psychological distress, stimuli from bedtime media use, and fatigue would be positively related to each other. Second, hierarchical regressions were performed using the entry method to explore the roles of psychological distress and stimuli from bedtime media use on fatigue. In the hierarchical regression, fatigue acted as the dependent variable. Demographic variables (ie, age and sex, coded as 1 for male and 0 for female) were entered in step 1, followed by psychological distress in step 2. The two types of stimuli from bedtime media use were entered in step 3. Third, using the results from the hierarchical regressions, the mediating effect was examined using the PROCESS macro version 2.16.2 for SPSS 20.0 (IBM Corp, Armonk, NY) [
The mean age was 19.98 years (SD 1.43 years, range 18-26 years), and 76.6% (302/394) of the participants were female.
The mean (SD) points for visual stimuli from bedtime media use, the auditory stimuli from bedtime media use, psychological distress, and fatigue were 3.08 points (0.84 points), 3.76 points (1.04 points), 15.19 points (8.89 points), and 52.55 points (5.32 points), respectively. Visual and auditory stimuli from bedtime media use had a significant positive relationship (r=.56,
The results of the hierarchical regression analyses are shown in
The results of the analyses of the mediating effects of stimuli from bedtime media use are shown in
Based on the bivariate analysis, psychological distress was correlated with fatigue (path c: beta=.24, SE 0.03,
Mediating effect of the visual stimuli from bedtime media use on the relationship between psychological distress and fatigue.
Path |
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beta | SE | 95% CI | |
Psychological distress and visual stimuli | .05 | .01 | 0.01 | .006 | 0.0039-0.0225 |
Visual stimuli and fatigue | .21 | .79 | 0.29 | .007 | 0.2152-1.3622 |
Psychological distress and fatigue (direct effect) |
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.24 | 0.03 | <.001 | 0.1842-0.2926 |
Psychological distress and visual stimuli and fatigue (indirect effect) |
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.01 | 0.01 |
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0.0023-0.0253 |
Direct effects (paths a, b, and c) of psychological distress and visual stimuli from bedtime media use on fatigue and an indirect effect (path c’) of psychological distress on fatigue through the visual stimuli from bedtime media use. The control variables were age and sex.
To improve college students’ health and ability to study efficiently, fatigue should not be neglected, especially when fatigue is associated with psychological health. This study explored the association between psychological distress and fatigue. The mediating mechanism of bedtime media use was also analyzed.
In line with our first hypothesis, there was a significant positive association between psychological distress and fatigue, which is consistent with results from previous studies [
Supporting our second hypothesis, the association between psychological distress and fatigue was mediated by visual stimuli from bedtime media use. Due to the pressure from learning activities, it is common for young students to have mental health concerns [
This paper provides practical strategies to improve the health of college students. First, administrators should consider the negative effect of stimuli from bedtime media use and provide students with an intervention to control bedtime media use. Equally important is students’ awareness of ways to promote mental health. Educators who work to improve students’ emotion regulatory abilities could teach skills to relieve psychological distress and address habitual excessive bedtime media use, such as through the practice of mindfulness [
Several limitations of this study should be noted. First, the sex distribution and generalizability need to be considered. Further data are needed to extend the results to students outside of China. Future research should improve the representativeness of the sample. Second, the items to measure media use and the content of media use need improvement, and further investigation is required. Although there were 7 items to measure visual stimuli from bedtime media use, there were only 2 items to measure auditory stimuli from bedtime media use. This might affect the validity of the results. As a result, future studies should improve the sample and measurements. Third, parents are an important influence on college students’ daily behavior and mental health. Future research should consider controlling the effects of parental education level and occupation.
This paper contributes and expands the current research about the effects of stimuli from bedtime media use and psychological distress on fatigue among Chinese college students. Specifically, the results suggest that visual stimuli from bedtime media use can serve as a mediating factor to understand the association between psychological distress and fatigue. Further research should investigate the effects of the type (ie, playing games and social communication) of bedtime media use on mental and physical health.
Depression Anxiety Stress Scale
The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: “Application of Strength-Based Intervention in Multiple Groups,” a research supporting project for high-level talent at East China University of Science and Technology (PI: Wenjie Duan).
None declared.