Journal of Affective Disorders 225 (2018) 761766

Contents lists available at ScienceDirect

Journal of Aective Disorders

journal homepage: www.elsevier.com/locate/jad

Research paper

The inuence of alexithymia on mobile phone addiction: The role of MARK

depression, anxiety and stress
Tingting Gao, Jiaomeng Li, Han Zhang, Jinglei Gao, Yixi Kong, Yueyang Hu, Songli Mei
School of Public Health, Jilin University, Changchun, Jilin Province, China

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Alexithymia is an important predictor of mobile phone addiction. Enhancing and improving college
Alexithymia students mental health can reduce the rate of mobile phone addiction. However, it is not clear about the role of
Mobile phone addiction depression, anxiety and stress in the relationship between college students alexithymia and mobile phone ad-
Depression diction.
Anxiety
Methods: A total of 1105 college students were tested with the Toronto Alexithymia Scale, the Depression
Stress
Anxiety Stress Scale and the Mobile Phone Addiction Index.
Results: An individuals level of alexithymia was signicantly correlated with depression, anxiety, stress and
mobile phone addiction. Alexithymia had a signicantly positive prediction eect on mobile phone addiction,
and depression, anxiety, and stress on mobile phone are positive predictors. Depression, anxiety or stress had
partially mediating eects between alexithymia and mobile phone addiction. Alexithymia not only directly had a
positively impact on mobile phone addiction, but both also had an indirect eect on mobile phone addiction
through depression, anxiety or stress.
Limitations: Limitations included sampling method and modest sample size, self-report measures, and un-
measured potential confounders.
Conclusion: Alexithymia is an important correlate of mobile phone addiction, and depression, anxiety or stress is
an important mediator in this relationship.

1. Introduction
The concept of alexithymia is characterized by diculties in iden-
tifying and describing feelings, a decreased ability to dierentiate be-
tween emotional states and physical sensations, a limited imaginative
capacity, and an externally orientated cognitive style (Sifneos, 1973).
The initial study of alexithymia originated from the clinical observation
of patients with classical psychosomatic disorders (Taylor, 1984).
People with alexithymia are prone to anxiety, stereotyped, inexible,
no humor, and lack a sense of personal value in life. Their anxiety and
tension are mainly manifested through physical symptoms (Haviland,
1996). Studies showed that improving the alexithymia of college stu-
dents is of great signicance for improving their mental health level
(Niu et al., 2011). Enhancing and improving college students mental
health can reduce the rate of mobile phone addiction (Babadi-Akashe
et al., 2014).
Mobile phone use is a global problem, and most Western countries
use the mobile Internet at rates of up to 50% or more (Donvan, 2013).
In the Netherlands, 70% of the general population and more than 90%
of teenagers have their own mobile phones (CBS Statistics, 2013). As of
December 2016, there are 695 million Chinese mobile phone users, of
which the highest proportion is student at up to 25.0% (China Internet
Network Information Center, 2017). The use of mobile phones is of
great concern, and studies of students mobile phone addiction are
becoming more widespread. Mobile phone addiction, also known as
mobile phone dependence, refers to the individuals behavior being out
of control because of the use of mobile phones, resulting in a state of
obsession. The persons physical, psychological and social function is
signicantly impaired (Yen et al., 2009). The criteria to determine
whether an individual has mobile phone dependence are the following
conditions. First, determine whether the time spent using the mobile
phone exceeds the upper limit. Second, determine whether the use of
mobile phones has a negative impact on physical, psychological health
and behavior. If the individual satises both conditions, they can be
identied as a user with mobile phone addiction (Jiang and Bai, 2014).
According to the ndings of the China Internet Network Information
Center (2017), mobile phone use over the time dimension can be used
to dene the addiction to mobile phones. The use of mobile phones

Corresponding author.
E-mail addresses: gaoting1123@sina.com (T. Gao), ljm19900604@163.com (J. Li), zhanghanwf@163.com (H. Zhang), 13194312508@163.com (J. Gao),
13904412998@163.com (Y. Kong), 18844194244@163.com (Y. Hu), meisongli@sina.com (S. Mei).

http://dx.doi.org/10.1016/j.jad.2017.08.020
Received 13 April 2017; Received in revised form 25 June 2017; Accepted 10 August 2017
Available online 01 September 2017
0165-0327/ 2017 Elsevier B.V. All rights reserved.
T. Gao et al.
more than four hours every day denes a potential mobile phone ad-
dict. Although mobile phones are convenient to people, their negative
impact is becoming more obvious. College students with mobile phone
addiction have poor control ability (Wang et al., 2015). They may
spend much time on interaction with the mobile phone, limiting the
time to bear the responsibilities of their daily life. The higher the degree
of mobile phone addiction, the greater the likelihood that college stu-
dents academic performance will decline (aan et al., 2014). Ex-
cessive use of mobile phones is prone to problems such as ear pain,
headache, sleep disorders, irritability, auditory hallucinations and other
physical and mental health problems (Sahin et al., 2013; Subba et al.,
2013).
A large number of studies have shown a certain correlation between
alexithymia and addiction behavior. For example, there are signicant
and positive correlations between alexithymia and alcohol addiction
severity, eating disorders, and pathological gambling (Barth, 2016; Gori
et al., 2016; Stasiewicz et al., 2012). Using a stratied regression ana-
lysis, alexithymia was an important predictor of Internet addiction
(Scimeca et al., 2014). A previous study suggested that the scores of
alexithymia of potential mobile phone addicts are signicantly higher
than the control group and the potential addicts have diculty con-
trolling the use of mobile phones (Ha et al., 2008). Mobile phone ad-
dicts might have emotional recognition diculties, which may lead to
more interpersonal problems. These people more dependent on mobile
phones or other media are more likely to escape and cover their true
emotions. According to compensatory Internet use theory, negative life
situations can give rise to a motivation to go online to alleviate negative
feelings (Kardefelt-Winther, 2014c). When the motivation to go online
is grounded in an unmet real life need and when Internet use alleviates
the real-life problem, an individual may feel a strong desire to spend
more time online, which could lead to problematic outcomes
(Kardefelt-Winther, 2014a). Life problems, escapism and negative
outcomes are all connected, and a higher degree of life problems in
conjunction with the escapist use of online games may lead to more
negative outcomes (Kardefelt-Winther, 2014b). They use online gaming
as a coping strategy for psychosocial issues. If the physical feelings and
emotional state of the individual with alexithymia are dicult to ex-
press, they will be likely to meet their own psychological needs through
a compensation mechanism. They try to maintain the balance of their
mental state and change the loss of compensation. If it becomes
pathological compensation, individuals tend to take a more extreme
approach to achieve their ultimate goal, and thus fall into a vicious
cycle of psychological crisis (Gao and Chen, 2006).
Research on the relationship between alexithymia and negative
emotions found that there are signicant dierences in depressive
symptoms among adolescents with dierent levels of alexithymia (Ling
et al., 2015). With the increase of alexithymia symptoms, individuals
showed more negative emotions. Alexithymia was a signicant pre-
dictor of anxiety, and alexithymia reduction can relieve anxiety
symptoms (Ashley et al., 2011). There is also a signicant and positive
correlation between alexithymia and stress. Individuals with alex-
ithymia have diculty in identifying and describing their feelings and
have poor ability to address stressful situations (Hisli Sahin et al.,
2009). A previous study veried the alexithymia-stress hypothesis
that an individual with alexithymia traits because of the improper de-
scription of emotion made negative and exaggerated evaluations of the
environment, which aected the assessment of challenges and threats,
and ultimately put himself in a state of stress (de Timary et al., 2008).
Further study showed that alexithymia is a risk factor for increased
anxiety, depression, stress, and may lead to negative emotions, re-
sulting in mental illness (Nekouei et al., 2014). As the self-medication
model for substance use disorders indicates, adolescents with depres-
sion may modify their emotional condition via Internet use or text-
messaging because it is perceived as less harmful than illegal substances
and is more available (Lu et al., 2011). Happiness from control and
respect of others can help teenagers gain positive emotions, and make
762
Journal of Affective Disorders 225 (2018) 761766
up for the imperfections in real life. However, if their depression is not
improved, they may spend increasing amounts of time on the Internet,
and this may become a real addiction. A recent study suggested that the
level of depression and anxiety in high mobile phone use group was
signicantly higher than in the low use group. And the intensity of the
use of mobile phones was signicantly and positively correlated with
depression and anxiety (Demirci et al., 2015). Students with high stress
are also prone to excessive use of mobile phones; however, anxiety can
moderate the relationship between stress and mobile phone addiction
(Kang, 2015).
Although the researchers established correlations between the in-
vestigated variables, there was little research on the internal mechan-
isms between alexithymia and mobile phone addiction. Based on the
above analysis, this study will explore the impact of alexithymia on
mobile phone addiction and the role of depression, anxiety and stress
between the two. We make three hypotheses. Hypothesis 1:
Alexithymia could predict mobile phone addiction through the indirect
path of depression. Hypothesis 2: Alexithymia could predict mobile
phone addiction through the indirect path of anxiety. Hypothesis 3:
Alexithymia could predict mobile phone addiction through the indirect
path of stress.
2. Method
2.1. Participants
A cross-sectional survey was conducted in Jilin University, which is
a comprehensive key university, aliated with the Ministry of the
Education, from April to May 2015. The university is located in
Changchun, Jilin Province, China. It used a convenience sampling
method to produce a sample of college students. Students were re-
cruited via ads and asked to complete the paper questionnaire in the
classroom. A total of 1200 students were approached, and 1105 com-
pleted the survey; thus, the valid response rate was 92.08%.
The study obtained support and permission from the research ethics
board at Jilin University. It took the respondents approximately 30 min
to complete the evaluation questions. During this process, all invited
participants were voluntary and were guaranteed condentially. A
small gift was given to compensate for the time spent on the survey.
2.2. Measures
2.2.1. Toronto Alexithymia Scale (TAS-20)
The Toronto Alexithymia Scale-20 is a self-report scale developed by
Bagby et al. (1994) and is composed of three factors: diculty in
identifying feelings, diculty in describing feelings, and externally
oriented thinking. The instrument consists of 20 items rated using a
ve-point Likert scale. The total score range from 20 to 100, with
higher scores indicating a greater level of alexithymia traits. The
Cronbachs alpha ranged from 0.581 to 0.739. Research suggests the
TAS-20 is appropriate for use with Chinese persons (Yuan et al., 2013).
2.2.2. Depression, anxiety, stress scale (DASS-21)
The validated Chinese version of the DASS-21 scale was used to
evaluate symptoms of depression, anxiety, and stress over the previous
week (Gong et al., 2010). It is a self-reporting instrument, presenting 21
items on three subscales, each yielding 7 items. Items are rated on a
four-point Likert scale indicating the frequency or severity of the par-
ticipants experiences. Higher scores indicate more severe sympto-
mology. The scale has demonstrated adequate internal consistency and
diagnostic validity. The Cronbachs alpha was 0.89.
2.2.3. Mobile phone addiction index(MPAI)
Mobile phone addiction was measured using the Mobile Phone
Addiction Index(MPAI)(Leung, 2008). This is a self-report ques-
tionnaire that involves rating 17 items on a 5-point Likert scale. The
T. Gao et al. Journal of Affective Disorders 225 (2018) 761766

four factorial components of the scale were inability to control craving,
feeling anxious and lost, withdrawal or escape and productivity loss.
The instrument was graded from one to ve, with higher scores in-
dicating higher levels of mobile phone addiction. The Cronbachs alpha
was 0.87.
2.3. Data analyses
depression, anxiety, stress and mobile phone addiction, we
set alexithymia, depression, anxiety, and stress as the specic predictor
variables and the domain of mobile phone addiction as the dependent
variable when performing linear regression analyses. The results
showed that alexithymia, depression, anxiety, and stress signicantly
predicted the inability to control cravings, feeling anxious and lost,
withdrawal or escape and productivity loss, respectively (see Table 3).

The Pearson correlation coecient was used to examine the asso- 3.4. The mediating model
ciations of the research variables in the current study. The structural
equation model (SEM) was used to study the relationship among alex- According to the procedure of mediation (Wen et al., 2004), the
ithymia, depression, anxiety stress and mobile phone addiction. The following conditions must be met. First, the independent variable must
bootstrapping method was used to verify mediation eects. In this have a signicant impact on the dependent variable. Second, the in-
study, 5000 bootstrapped samples were drawn from the data, and 95% dependent variable must have a signicant impact on the mediator.
bootstrap condence intervals (CI) were calculated. Statistical analysis Third, the mediator must signicantly aect the dependent variable.
was conducted using the SPSS 18.0 version program and Amos 17.0 Fourth, the independent variable and the mediator were included in the
software. model at the same time. If the independent variable could signicantly
aect the dependent variable, and the prediction of the independent
3. Results variable is weakened, the mediator will play a partial mediating eect.
If the eect of the independent variable on the dependent variable
3.1. Participant characteristics becomes insignicant, the mediator variable will play a full mediation
eect.
Of the sample, there were 528 males (47.8%), and 577 females The results for the mediation tests can be veried. We constructed
(52.2%). The participants ranged in age from 15 to 24 years with a and evaluated three separate hypothetical models (1, 2 and 3), each
mean age of 20.001.20 years. There was little dierence in the per- containing only one mediating variable. In the rst equation, alex-
centage of whether the participant was a single child (n = 578, 52.3%) ithymia signicantly aected the dependent variable mobile phone
or not (n = 527, 47.7%). Regarding residence, the study included 614 addiction ( = 0.330, t = 11.593, P < 0.001). In the second equation,
urban participants (55.6%) and 491 rural participants (44.4%). A sig- alexithymia signicantly aected depression ( = 0.503, t = 19.311,
nicant proportion of participants were sophomores(n = 499, 45.2%) P < 0.001). Alexithymia signicantly aected anxiety ( = 0.524, t =
and freshmen (n = 373, 33.8%), followed by juniors (n = 135, 12.2%), 20.411, P < 0.001). Alexithymia signicantly aected stress
with senior students constituting 8.9% of the sample (n = 98). Family ( = 0.508, t = 19.586, P < 0.001). In the third equation, the mediator
monthly income was of 30005000 RMB, accounting for 31.7% (n = (depression, anxiety or stress) signicantly aected mobile phone
350). See Table 1. addiction (depression: = 0.407, t = 14.799,
P < 0.001, anxiety: = 0.447, t = 16.575, P < 0.001, stress:
= 0.462, t = 17.285, P < 0.001) of the variance in mobile phone
3.2. Descriptive analyses
addiction, respectively. In the fourth equation, alexithymia and the
mediator (depression, anxiety or stress) as independent variables were
The correlations between the investigated variables were examined
included in the model at the same time and signicantly aected mo-
(see Table 2). All study variables were signicantly and positively
bile phone addiction ( = 0.167t = 5.321P < 0.001;
correlated with each other (P < 0.05).
= 0.132t = 4.203P < 0.001; = 0.128t = 4.162P <
0.001). In addition, after depression, anxiety or stress was entered into
3.3. Linear regression analyses the equation, and the explanation of mobile phone addiction was in-
creased from 10.9% to 18.7%, 21.2% and 22.5%, respectively. The
To further investigate the relationship between alexithymia, growth rates were 7.8%, 10.3% and 11.6%, respectively. The propor-
tion of the mediating eect of depression was only 0.503 0.407/
Table 1 0.330 = 62.04%. The proportion of mediating eect of anxiety was
Demographic characteristics of the college students.
only 0.524 0.447/0.330 = 70.98%. The proportion of mediating
Variables n % eect of stress was only 0.508 0.462/0.330 = 71.12%. The above
regression equation showed that in the equation, depression, anxiety or
Gender stress increased the explanation of mobile phone addiction, but the
Male 528 47.8
Female 577 52.2
standard regression coecient of alexithymia on mobile phone addic-
Single child tion was reduced from 0.330 gradually to 0.167, 0.132, and 0.128, and
Yes 578 52.3 remained signicant. Thus, depression, anxiety or stress could mediate
No 527 47.7 the relationship between alexithymia and mobile phones and play a
Residence
partial mediating eect.
Urban 614 55.6
Rural 491 44.4 The assessments of tness indices for all measurement models are
Grade shown in Table 4. Model 1, model 2 and model 3 were adequate. By
One 373 33.8 contrast, model 4 was not a good t. The mediation models are pre-
Two 499 45.2 sented in Fig.s 13. To gain an improved understanding of the media-
Three 135 12.2
Four 98 8.9
tion eects, we evaluated the signicance of each indirect eect of
Family income per month depression, anxiety and stress by applying a bootstrapping procedure,
< 3000 RMB 306 27.7 respectively. This involved drawing 5000 bootstrapping samples and
30005000 RMB 350 31.7 computing 95% condence intervals(95%CI). The corresponding con-
50007000 RMB 212 19.2
dence interval for each path of every model excluded zero, which
70009000 RMB 126 11.4
>9000 RMB 111 10.0 explained the mediating eect of depression(95%CI: 0.15,0.25), an-
xiety (95%CI: 0.20,0.29) or stress (95%CI: 0.19,0.30) between

763
T. Gao et al. Journal of Affective Disorders 225 (2018) 761766

Table 2
Means, standard deviations and bivariate correlations among study variables (n=1105).

Variables 1 2 3 4 5 6 7 8 9 10

1. Diculty in Identifying Feelings 1

2. Diculty in Describing Feelings 0.68** 1
3. Externally Oriented Thinking 0.29** 0.32** 1
4. Depression 0.45** 0.39** 0.34** 1
5. Anxiety 0.51** 0.43** 0.27** 0.76** 1
6. Stress 0.53** 0.42** 0.22** 0.72** 0.79** 1
7. Inability to Control Craving 0.32** 0.27** 0.20** 0.41** 0.41** 0.41** 1
8. Feeling Anxious and Lost 0.20** 0.16** 0.09** 0.29** 0.35** 0.33** 0.48** 1
9. Withdrawalor Escape 0.21** 0.16** 0.06* 0.22** 0.26** 0.32** 0.38** 0.45** 1
10. Productivity Loss 0.30** 0.25** 0.13** 0.32** 0.32** 0.36** 0.60** 0.38** 0.40** 1
M 17.29 13.23 20.07 10.74 11.70 12.46 14.90 12.15 7.60 5.21
SD 5.17 3.21 3.94 3.90 3.63 3.89 4.90 4.95 3.14 2.21

*P < 0.05.
**P < 0.01.
***P < 0.001.

Table 3
Linear regression model with alexithymia, depression, anxiety, stress as predictor variables predicting mobile phone addiction.

Dependent Variables Predictors Parameter estimate (B) Standardized estimate () t R2 F

Inability to control Craving Alexithymia 0.17 0.34 12.116*** 0.117 46.786***

Depression 0.51 0.41 14.705*** 0.164 216.246***
Anxiety 0.55 0.41 14.898*** 0.168 221.943***
Stress 0.52 0.41 15.064*** 0.171 226.914***
Feeling Anxious and Lost Alexithymia 0.10 0.19 6.569*** 0.038 43.148***
Depression 0.36 0.29 9.860*** 0.081 97.217***
Anxiety 0.47 0.35 12.304*** 0.121 151.389***
Stress 0.42 0.33 11.470*** 0.107 131.570***
Withdrawalor Escape Alexithymia 0.06 0.19 6.271*** 0.034 39.329***
Depression 0.18 0.22 7.447*** 0.048 55.462***
Anxiety 0.23 0.26 9.053*** 0.069 81.961***
Stress 0.26 0.32 11.107*** 0.101 123.358***
Productivity Loss Alexithymia 0.07 0.01 10.393*** 0.089 108.015***
Depression 0.18 0.32 11.360*** 0.105 129.052***
Anxiety 0.20 0.32 11.269*** 0.103 126.982***
Stress 0.21 0.36 12.954*** 0.132 167.817***

*P < 0.05.
**P < 0.01.
***
P < 0.001.

Table 4 regulation. In the general population, the prevalence rate is approxi-

The model ts for the estimated models. mately 10%. This proportion of people is not good at identifying and
expressing their inner feelings, so that bad moods cannot be avoided
Model Fits 2/df NFI TLI GFI RESEA
(Evren et al., 2008). The so-called introverted people are likely to
Model 1 2.76 0.99 0.98 0.99 0.04 have alexithymia. They are afraid of face to face communication. They
Model 2 2.53 0.99 0.98 0.99 0.04 might make up the gap in the virtual space. However, this type of
Model 3 1.78 0.99 0.99 0.99 0.03 psychology may have a signicant impact on college students mobile
Model 4 7.79 0.96 0.94 0.97 0.08
phone addiction.
Note: Model 1 tested the mediator role of depression. Model 2 tested the mediator role of Results were consistent with previous ndings of positive relation-
anxiety. Model 3 tested the mediator role of stress. Model 4 tested the collective mediator ships of alexithymia with depression, anxiety and stress (Lyvers et al.,
role of depression-anxiety-stress. 2017). There is a signicant and positive correlation between mobile
NFI: normed t index; TLI: Tacker-Lewis index; GFI: goodness-of-t index; RESEA: root phone addiction and depression, anxiety and stress, which is consistent
mean square error of approximation. with previous studies (Nassehi et al., 2016). Individuals with alex-
ithymia lose control of their emotional cognitive system, which results
alexithymia and mobile phone addiction. in emotional cognitive impairment, weaken emotional adjustment,
emotional cognitive processing, concentration of emotional cognition,
4. Discussion and the ability to process and evaluate. Thus, they cannot address
stressful situations well, exacerbating negative emotions, such as de-
Alexithymia, as a non-independent psychological disorder, can be pression and anxiety (Nekouei et al., 2014). To release these negative
considered as a personality trait and regarded as a more common emotions, communication must occur. To some certain extent, they will
psychological characteristic or secondary symptom when one is suf- follow their favorite way to solve the troubles in real life. This also
fering from some physical and mental illness (Joyce et al., 2013; increases the likelihood of college students mobile phone addiction.
Mingarelli et al., 2013). It often leads to inappropriate disease behavior The study also found that alexithymia, depression, anxiety and
and aects the psychological and physical treatment eects. Alex- stress have a signicant predictive eect on the inability to control
ithymia is a defect in the process of emotional cognition, processing and cravings, feeling anxious and lost, withdrawal or escape, productivity

764
T. Gao et al.
Fig. 1. Indirect eects of alexithymia on mobile phone addiction via depression.
Fig. 2. Indirect eects of alexithymia on mobile phone addiction via anxiety.
Fig. 3. Indirect eects of alexithymia on mobile phone addiction via stress.
loss and total mobile phone addiction scores. In other words, in-
dividuals with alexithymia tend to exhibit symptoms of mobile phone
addiction, which is consistent with the ndings of the study on the use
of pathological Internet (Schimmentia et al., 2017). Individuals with
alexithymia have diculty understanding the feelings of others;
therefore, the eectiveness of communication between the two sides is
greatly reduced. To some extent, interpersonal disharmony may occur,
and the social skills of college students will gradually weaken over time.
The powerful function of mobile phones provides a great opportunity
for interpersonal communication on the surface. In fact, the users might
only use very few words and a plain manner to express themselves.
However, it cant replace face to face commuciation, which will only
make mobile phone addiction and alexithymia more serious (aan
et al., 2014). The study also showed that depression, anxiety and stress
are individuals negative emotions, all of which impact college students
mobile phone addiction. When the individuals depression, anxiety and
stress levels are high, the individual is prone to mobile phone addiction.
The study has examined the role of depression, anxiety, and stress
between alexithymia and mobile phone addiction. The results showed
that depression, anxiety and stress are the mediating variables between
alexithymia and mobile phone addiction, respectively. After depression,
anxiety or stress was added for alexithymia and mobile phone addic-
tion, respectively. The standard regression coecient between alex-
ithymia and mobile phone addiction decreased from 0.330 to 0.167,
0.132 and 0.128, respectively. The eect was increased from 10.9% to
765
Journal of Affective Disorders 225 (2018) 761766
18.7%, 21.9%, and 23.9%, respectively. Consequently, alexithymia
relied on both the direct impact on mobile phone addiction, both also
by depression, anxiety, or stress.
Therefore, to reduce the negative impact of mobile addiction on
college students, not only should mobile phone use time be controlled,
attention should be paid for timely screening and to identify the high
level of alexithymia among college students. Starting with students
emotional training, we can stimulate emotion, inspire association, pay
attention to their emotional experience, and let students master emo-
tion types and understand emotion characteristics (Li et al., 2014). The
enhancement of identifying and describing emotions may reduce ne-
gative emotions (Guo et al., 2015). Additionally, the satisfaction of
college students psychological needs may be few. Furthermore, it is
necessary to balance their mental state and prevent the formation of
pathological compensation mechanisms.
4.1. Limitations and future research
Because the study is based on a self-reported questionnaire, there
may be a large number of confounding factors. More objective data
collection methods can be used to improve credibility in the future. In
addition, a cross-sectional survey cannot draw denitive conclusion.
Therefore, future studies require a longitudinal design. Besides, con-
venience sampling was used in this study, which might lead to potential
selection bias. A large sample and stratied randomed sampling might
T. Gao et al.
be carried out in the future. Finally, except for the inuence of de-
pression, anxiety and stress, there must be other variables that aect
the relationship between alexithymia and mobile phone addiction, and
must be further discussed.
Role of funding sources
This research received support from Science Education Program
Project Thirteenth Five- Year Plan of Jilin Province No. 441,2016,
Science and Technology International Cooperation Project of Jilin
Province 20160414035GH and Graduate Innovation Fund of Jilin
University 2017163.
Acknowledgements
We would like to thank all participants at Jilin University for their
participation in the study.
References
Ashley, L., O'Connor, D.B., Jones, F., 2011. Eects of emotional disclosure in caregivers:
moderating role of alexithymia. Stress Health 27, 376387.
Babadi-Akashe, Z., Zamani, B.E., Abedini, Y., Akbari, H., Hedayati, N., 2014. The re-
lationship between mental health and addiction to mobile phones among university
students of Shahrekord, Iran. Addict. Health 6, 9399.
Bagby, R.M., Parker, J.D., Taylor, G.J., 1994. The twenty-item Toronto Alexithymia Scale-
I. Item selection and cross-validation of the factor structure. J. Psychosom. Res. 38,
2332.
Barth, F., 2016. Listening to words, hearing Feelings: links between eating disorders and
alexithymia. Clin. Soc. Work J. 44, 3846.
aan, ., nsal, A., elik, N., 2014. Evaluation of college students' the level of addiction
to cellular phone and investigation on the relationship between the addiction and
level of depression. Proc. Soc. Behav. Sci. 114, 831839.
CBS Statistics, 2013. Mobile Internet Use Continues To Grow. Statistics Netherlands Press
Release, Den Haag, PB12-060.
China Internet Network Information Center, 2017. China Statistical Report on Internet
Develpment.http://49.140.187.1/cache/8/03/cnnic.cn/
5e3c9654a7d9a35535d47314210f46ce/P020170123364672657408.pdf.
de Timary, P., Roy, E., Luminet, O., Fille, C., Mikolajczak, M., 2008. Relationship be-
tween alexithymia, alexithymia factors and salivary cortisol in men exposed to a
social stress test. Psychoneuroendocrinology 33, 11601164.
Demirci, K., Akgnl, M., Akpinar, A., 2015. Relationship of smartphone use severity with
sleep quality, depression, and anxiety in university students. J. Behav. Addict. 4,
8592.
Donvan, M., 2013. Mobile Future in Focus. ComScore Webinar, Chicago.
Evren, C., Sar, V., Evren, B., Semiz, U., Dalbudak, E., Cakmak, D., 2008. Dissociation and
alexithymia among men with alcoholism. Psychiatry Clin. Neurosci. 62, 4047.
Gao, W., Chen, Z., 2006. A study on psychopathology and psychotherapy of Internet
addiction. Adv. Psychol. Sci. 14, 596604.
Gong, X., Xie, X., Xu, R., Luo, Y., 2010. Psychometric properties of the Chinese versions of
DASS-21 in Chinese college students. Chin. J. Clin. Psychol. 18, 443446.
Gori, A., Craparo, G., Caretti, V., Giannini, M., Iraci-Sareri, G., Bruschi, A., Janiri, L.,
Ponti, L., Tani, F., 2016. Impulsivity, alexithymia and dissociation among patholo-
gical gamblers in dierent therapeutic settings: a multisample comparison study.
Psychiatry Res. 246, 789795.
Guo, S., Xu, K., He, W., 2015. The study on the relationship between alexithymia and
mental health of middle school students. Sci. Soc. Psychol. 30, 6268.
Ha, J.H., Chin, B., Park, D.H., Ryu, S.H., Yu, J., 2008. Characteristics of excessive cellular
phone use in Korean adolescents. Cyber. Behav. 11, 783784.
Haviland, M.G., 1996. Structure of the twenty-item Toronto Alexithymia Scale. J. Pers.
Assess. 66, 116125.
Hisli Sahin, N., Gler, M., Basm, H.N., 2009. The relationship between cognitive in-
telligence, emotional intelligence, coping and stress symptoms in the context of type
A personality pattern. Turk. Psikiyatr. Derg. 20, 243254.
Jiang, Y., Bai, X., 2014. College students rely on mobile Internet making impact on
alienation: the role of society supporting systems. Psychol. Dev. Educ. 30, 540549.
766
Journal of Affective Disorders 225 (2018) 761766
Joyce, A.S., Fujiwara, E., Cristall, M., Ruddy, C., Ogrodniczuk, J.S., 2013. Clinical cor-
relates of alexithymia among patients with personality disorder. Psychother. Res. 23,
690704.
Kang, G.H., 2015. The eects of student's stress and personal relationship on smartphone
addiction. J. Korea Soc. Comput. Inf. 20, 147153.
Kardefelt-Winther, D., 2014a. A conceptual and methodological critique of internet ad-
diction research: towards a model of compensatory internet use. Comput. Hum.
Behav. 31, 351354.
Kardefelt-Winther, D., 2014b. The moderating role of psychosocial well-being on the
relationship between escapism and excessive online gaming. Comput. Hum. Behav.
38, 6874.
Kardefelt-Winther, D., 2014c. Problematizing excessive online gaming and its psycholo-
gical predictors. Comput. Hum. Behav. 31, 118122.
Leung, L., 2008. Linking psychological attributes to addiction and improper use of the
mobile phone among adolescents in Hong Kong. J. Child. Media 2, 93113.
Li, J., Zhu, H., Su, B., Lin, M., 2014. Study on the relationship between alexithymia and
pathological Internet use disorder in college students. J. South China Norm. Univ.
(Nat. Sci. Ed.) 46 (1), 108111.
Ling, Y., He, Y., Li, Z., Liu, W., 2015. Features of alexithymia in adolescents: a latent class
analysis. Chin. J. Clin. Psychol. 23, 901905.
Lu, X., Watanabe, J., Liu, Q., Uji, M., Shono, M., Kitamura, T., 2011. Internet and mobile
phone text-messaging dependency: factor structure and correlation with dysphoric
mood among Japanese adults. Comput. Hum. Behav. 27, 17021709.
Lyvers, M., Kohlsdorf, S.M., Edwards, M.S., Thorberg, F.A., 2017. Alexithymia and mood:
recognition of emotion in self and others. Am. J. Psychol. 130, 8392.
Mingarelli, A., Casagrande, M., Pirchio, R.D., Nizzi, S., Parisi, C., Loy, B.C., Solano, L.,
Rampello, A., Paolo, C.D., 2013. Alexithymia partly predicts pain, poor health and
social diculties in patients with temporomandibular disorders. J. Oral. Rehabil. 40,
723730.
Nassehi, A., Arbabisarjou, A., Jafari, M., ghasemi, M., Naja, K., 2016. Surveying the
relationship of Internet addiction with dependence on cell phone, depression, an-
xiety, and stress in collegians (Case study: bam University of Medical Sciences). Int. J.
Adv. Biotech. Res. 7, 22672274.
Nekouei, Z.K., Doost, H.T.N., Yousefy, A., Manshaee, G., Sadeghei, M., 2014. The re-
lationship of Alexithymia with anxiety-depression-stress, quality of life, and social
support in Coronary Heart Disease (A psychological model). J. Educ. Health Promot.
3, 68.
Niu, R., Wang, C., Xue, Y., 2011. Status of alexithymia and mental health among college
students. Chin. J. Health Educ. 27, 610612.
Sahin, S., Ozdemir, K., Unsal, A., Temiz, N., 2013. Evaluation of mobile phone addiction
level and sleep quality in university students. Pak. J. Med. Sci. 29, 913918.
Schimmentia, A., Passanisia, A., Carettib, V., Marcaa, L.L., Granieric, A., Iacolinoa, C.,
Gervasia, A.M., Maganucoa, N.R., Billieuxd, J., 2017. Traumatic experiences, alex-
ithymia, and Internet addiction symptoms among late adolescents: a moderated
mediation analysis. Addict. Behav. 64, 314320.
Scimeca, G., Bruno, A., Cava, L., Pandolfo, G., Muscatello, M.R., Zoccali, R., 2014. The
relationship between alexithymia, anxiety, depression, and Internet addiction se-
verity in a sample of Italian high school students. ScienticWorldJournal 2014,
504376.
Sifneos, P.E., 1973. The prevalence of 'alexithymic characteristics in psychosomatic pa-
tients. Psychother. Psychosom. 22, 255262.
Stasiewicz, P.R., Bradizza, C.M., Gudleski, G.D., Coey, S.F., Schlauch, R.C., Bailey, S.T.,
Bole, C.W., Gulliver, S.B., 2012. The relationship of alexithymia to emotional dys-
regulation within an alcohol dependent treatment sample. Addict. Behav. 37,
469476.
Subba, S.H., Mandelia, C., Pathak, V., Reddy, D., Goel, A., Tayal, A., Nair, S., Nagaraj, K.,
2013. Ringxiety and the mobile phone usage pattern among the students of a medical
college in South India. J. Clin. Diagn. Res. 7, 205209.
Taylor, G.J., 1984. Alexithymia: concept, measurement, and implications for treatment.
Am. J. Psychiatry 141, 725732.
Wang, H.B., Tao, Y.K., Xu, H.T., 2015. Inhibition control characteristics in college stu-
dents with dierent mobile phone addiction. Chin. Ment. Health J. 29, 226229.
Wen, Z., Zhang, L., Hou, J., Liu, H., 2004. Testing and application of the mediating ef-
fects. Acta Psychol. Sin. 36, 614621.
Yen, C.F., Tang, T.C., Yen, J.Y., Lin, H.C., Huang, C.F., Liu, S.C., Ko, C.H., 2009.
Symptoms of problematic cellular phone use, functional impairment and its asso-
ciation with depression among adolescents in Southern Taiwan. J. Adolesc. 32,
863873.
Yuan, Y., Shen, X., Zhang, X., Wu, A., Sun, H., Zhang, N., Zhang, X., Li, H., 2013. The
reliability and validity of Toronto alexithymia scale (TAS-20). Sichuan Ment. Health
16, 2527.