Social Behavior and Personality, Volume 47, Issue 1, e7446

https://doi.org/10.2224/sbp.7446
www.sbp-journal.com

Sedentary behaviors, psychological status, and sleep quality in

Chinese university students
Kun Wang1, Yue Xue1, Xiang Fan1, Tao Huang1, Zuosong Chen1
1
Department of Physical Education, Shanghai Jiao Tong University

How to cite: Wang, K., Xue, Y., Fan, X., Huang, T., & Chen, Z. (2019). Sedentary behaviors, psychological status, and sleep quality in
Chinese university students. Social Behavior and Personality: An international journal, 47(1), e7446

Keywords
We investigated the independent associations of 3 types of sedentary sedentary behavior;
behavior with depression, anxiety, and sleep quality among 214 Chinese smartphone use;
university students. Self-reported sedentary behavior was assessed by television viewing;
the length of time that participants spent on television computer use; anxiety;
viewing/computer use, and smartphone use. We used the Self-Rating depression; sleep quality;
Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) to Chinese university
evaluate depressive status and anxiety symptoms, respectively, and the students
Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. The
results showed that longer smartphone use was associated with worse
SDS, SAS, and PSQI scores. There was no association between the time
spent on television viewing and computer use, and depression, anxiety,
and poor sleep quality.

Sedentary behavior, which is prevalent in contemporary society (Dumith, Hallal, Reis, & Kohl, 2011;
Hadgraft & Owen, 2017; Owen, Salmon, Koohsari, Turrell, & Giles-Corti, 2014), refers to bodily movement
with low energy expenditure (≤ 1.5 metabolic equivalents). This includes behavior such as watching
television, and computer and smartphone use (Owen, Healy, Matthews, & Dunstan, 2010). Researchers
have suggested that sedentary behavior, in addition to involving insufficient exercise, is associated with
increased risk of obesity (ten Hacken, 2009; Vandelanotte, Sugiyama, Gardiner, & Owen, 2009), type 2
diabetes and cardiovascular disease (Healy et al., 2008), and premature mortality (Katzmarzyk, Church,
Craig, & Bouchard, 2009), thereby imposing a substantial economic burden worldwide (Ding et al., 2016).

Recently researchers have also examined the association between sedentary behavior and psychological
health. Because depression and anxiety have symptom overlap and comorbidity, they are often studied
together. Indeed, researchers have shown that longer duration of sitting is correlated with elevated risk of
anxiety and depression (Asztalos, Cardon, De Bourdeaudhuij, & De Cocker, 2015; Rebar, Vandelanotte, van
Uffelen, Short, & Duncan, 2014). However, type-specific associations of sedentary behavior with
psychological health have not been thoroughly identified and study results are mixed. Researchers have
often used time spent on screen viewing as an indicator of sedentary behavior, and some have found an
association of prolonged television viewing and computer use with an elevated risk of depressive symptoms
and anxiety (Cao et al., 2011; de Wit, van Straten, Lamers, Cuijpers, & Penninx, 2011). However, Griffiths,
Dowda, Dezateux, and Pate (2010) did not observe an association between children’s screen entertainment
use and mental health problems.
Further, researchers have shown that sufficient sleep is important for both physical and mental health
(Åkerstedt, Narusyte, Alexanderson, & Svedberg, 2017; Wang et al., 2017). Researchers have also
demonstrated a negative association between sleep quality in adults and both television viewing and
computer use (Feng, Zhang, Du, Ye, & He, 2014; Kakinami et al., 2017; Lewis, Odeyemi, Joseph, Mehari, &
CORRESPONDENCE Tao Huang or Zuosong Chen, Department of Physical Education, Shanghai Jiao Tong University, No. 800
Dongchuan Rd., Shanghai 200240, People’s Republic of China, 200240. Email: taohuang@sjtu.edu.cn or zschen1971@126.com

© 2019 Scientific Journal Publishers Limited. All Rights Reserved.

 Wang, Xue, Fan, Huang, Chen

Gillum, 2017).
However, relatively little is known about the relationship between the use of newer digital media (e.g.,
smartphones), and psychological status and sleep quality in young adults, among whom smartphones are
popular mobile devices. As well as their basic communication function, smartphones provide easy internet
access and multiple features, such as games, videos, and social networking. The easy accessibility and
unique features of smartphones, in comparison to television and computers, may lead to problematic
behavior. Therefore, the psychological consequences of smartphone use may be different from that of other
forms of screen-related behavior, such as television viewing and computer use.
Only three teams of researchers have recently demonstrated an association between prolonged
smartphone use and mental health issues in young adults (Aker, Şahin, Sezgin, & Oğuz, 2017; Demirci,
Akgönül, & Akpinar, 2015; Matar Boumosleh & Jaalouk, 2017). Matar Boumosleh and Jaalouk (2017)
showed that poor scores on depression and anxiety scales were associated with smartphone addiction.
Demirci et al. (2015) reported that smartphone use severity was positively correlated with depression,
anxiety, and poor sleep quality. Aker et al. (2017) showed that depression, anxiety, and insomnia were
associated with smartphone addiction among university students. Because these researchers primarily
focused on the effects of smartphone addiction, it is not clear if poor mental health and sleep quality
occurred as a linear function of the length of time using a smartphone. In addition, because participation in
physical activity is beneficial to psychological health and sleep quality (Kelley & Kelley, 2017; Paluska &
Schwenk, 2000), it is important to control for physical activity when the associations among sedentary
behavior, psychological status, and sleep quality are being assessed. However, most previous researchers
have not controlled for physical activity levels.
Therefore, these findings indicate that more investigation of the associations among sedentary behavior,
psychological status, and sleep quality is needed. We thus investigated the independent associations of three
types of sedentary behavior (television viewing, computer use, and smartphone use), with psychological
status (depression and anxiety) and sleep quality among a group of Chinese university students.

Method
Participants and Procedure
Participants were students recruited from a university in Shanghai, China. They were informed of the
opportunity of participation in the study by their lecturers and by advertisements on campus. Of the 222
students (aged 17 to 23 years old) whom we recruited, 214 (46.3% women) completed the surveys and
formed the final sample. All participants provided informed consent. Ethical approval was obtained from
the Ethics Committee of Bio-X Institutes at Shanghai Jiao Tong University.
We measured participants’ body height and weight following standardized procedures. Their body mass
index was calculated according to their weight and height. We measured daily physical activity using the
International Physical Activity Questionnaire-Short Form (IPAQ-SF; Fan, Lyu, & He, 2014). We used total
metabolic equivalent-minute scores for calculation according to the guidelines for the data processing and
analysis of IPAQ-SF (see www.ipaq.ki.se).

Measures
Screen-Related Behavior and Smartphone Use. We assessed screen-related time (television viewing and
computer use) and smartphone use using a questionnaire that we had developed. Participants responded to
the two questions on a 6-point scale (1 = less than 1 hour, 2 = 1 to 2 hours, 3 = 2 to 3 hours, 4 = 3 to 4 hours,
5 = 4 to 5 hours, 6 = more than 5 hours). The questions are “During the past 6 months, how many hours did
you spend on television viewing and computer use each day?” and “During the past 6 months, how many
hours did you spend on smartphone use each day?” For analysis, we grouped the scores into three categories
(0 to 2 hours, 2 to 3 hours, and more than 3 hours).
Depression. We assessed depressive symptoms using the Self-Rating Depression Scale (SDS; Zung, 1965),
which comprises 20 items (e.g., “I get tired for no reason”). Participants rated each item on a 4-point Likert-

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 Social Behavior and Personality: an international journal

type scale (1 = a little of the time, 2 = some of the time, 3 = a good part of the time, 4 = most of the time).
Thus, the raw test scores range from 20 to 80, with a higher score indicating more depressive symptoms. As
a standardized assessment instrument, its reliability and validity in a Chinese population have been
established (Peng et al., 2013). A total standard score of 53 has been set as a cut-off point for depression
based on the Chinese norm of SDS (Xu & Wei, 2013).
Anxiety. We evaluated anxiety symptoms using the 20-item Self-Rating Anxiety Scale (SAS; Zung, 1971) to
quantify participants’ severity of anxiety during the past several days. Participants assessed each item on a
4-point Likert-type scale (1 = a little of the time, 2 = some of the time, 3 = a good part of the time, 4 = most
of the time). A sample item is “I am bothered by dizzy spells.” Thus, the raw test scores range from 20 to 80,
with a higher score indicating greater anxiety. As a standardized assessment instrument, its reliability and
validity in a Chinese population have been established (Tao & Gao, 1994). A total standard score of 50 has
been set as a cut-off point for anxiety based on the Chinese norm of SAS (Xu & Wei, 2013).

Sleep Quality. Sleep quality was self-reported with the Pittsburgh Sleep Quality Index (PSQI; Buysse,
Reynolds, Monk, Berman, & Kupfer, 1989). Participants were required to assess the 19 items on the basis of
their sleep habits during the past month. The seven component scores generated by the items are derived
from subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use
of sleeping medication, and daytime dysfunction. The global PSQI score, which ranges from 0 to 21, is
calculated by summing the seven component scores. We used an openly available scoring algorithm, with a
higher score indicating more disturbed sleep. PSQI global scores > 5 indicate poor sleep quality (Carney,
Edinger, Meyer, Lindman, & Istre, 2006). The PSQI Chinese version has good reliability and validity among
Chinese university students (Zheng, Li, Wang, & Lv, 2016).

Data Analysis
We used STATA 14 statistical software for all analyses. The potential differences in participants’
characteristics between genders were assessed using an unpaired t test (continuous variables) or chi-square
test (categorical variables). Correlations among the SDS, SAS, and PSQI scores were assessed using
Pearson’s correlation coefficient. We assessed the potential associations between length of time spent on
television viewing/computer use, and smartphone use, with the SDS, SAS, and PSQI scores, using multiple
linear regression modeling. The potential gender interaction was assessed by adding a gender × exposure
variable interaction term in the models. Because no significant interaction was observed, the interaction
terms were removed, and the analyses were not stratified by gender. Standardized correlation coefficients
were reported. An alpha level was set at .05 for all analyses.

Results
Participants’ characteristics are summarized by gender (see Table 1). Female participants were younger,
shorter, and lighter than male participants (p < .01). Female participants also had a lower body mass index
(p = .01) and higher levels of daily physical activity than did their male counterparts (p = .02). Male
participants spent more time on television viewing and computer use than did female participants (p < .01).
Although we observed no significant differences in smartphone use or in SDS, SAS, and PSQI scores
between female and male participants, there was a trend toward better sleep quality in male than in female
participants (p = .05).

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 Wang, Xue, Fan, Huang, Chen

Table 1. Characteristics of Participants

Note. BMI = body mass index, PSQI = Pittsburgh Sleep Quality Index, SAS = Self-Rating Anxiety Scale, SDS
= Self-Rating Depression Scale.

In this study, the rate of depression was 17.4%, the rate of anxiety was 17.5 %, and the rate of poor sleep
quality was 39.5% (PSQI score > 5). SDS scores were positively correlated with SAS (r = .81, p < .001) and
PSQI scores (r = .48, p < .001). SAS scores were also correlated with PSQI scores (r = .49, p < .001).

The correlation coefficients for the associations among the length of time spent on television viewing and
computer use, psychological measures, and sleep are presented in Table 2. No significant associations of
television viewing and computer use with depression, anxiety, and all PSQI scores were observed in the
linear regression analysis. The correlation coefficients of the associations between smartphone use and
psychological measures and sleep are presented in Table 3. In Model 1, with adjustment for age and gender,
compared with the reference group (0 to 2 hours), the two groups with longer duration of smartphone use
had higher SDS and SAS scores (both p < .001). The test results for trend showed that the duration of
smartphone use was associated with SDS and SAS scores (for trend p < .001), indicating a dose-response
effect of the observed associations. Similarly, longer duration of smartphone use was also positively
associated with sleep latency, daytime dysfunction, and PSQI global score (for trend p < .05). In Model 2,
with additional adjustment for physical activity, the observed significant associations persisted (all p <
.05), indicating that the observed associations were independent of physical activity.

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 Social Behavior and Personality: an international journal

Table 2. Associations of Time Spent on Television Viewing and Computer Use With the SDS, SAS, and PSQI

Note. Values are expressed as standardized beta coefficients (β). Model 1 was controlled for age and gender.
Model 2 was controlled for age, gender, and physical activity levels. The analyses were adjusted for age and
gender. PSQI = Pittsburgh Sleep Quality Index, SAS = Self-Rating Anxiety Scale, SDS = Self-Rating
Depression Scale.

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 Wang, Xue, Fan, Huang, Chen

Table 3. Associations Between Smartphone Use and the SDS, SAS, and PSQI

Note. Values are expressed as standardized beta coefficients (β). Model 1 was controlled for age and gender.
Model 2 was controlled for age, gender, and physical activity levels. PSQI = Pittsburgh Sleep Quality Index,
SAS = Self-Rating Anxiety Scale, SDS = Self-Rating Depression Scale.

Discussion
Our main finding was that longer smartphone use was associated with worse scores for depression, anxiety,
and sleep quality in Chinese university students. There was no significant association between the time
spent on television viewing and computer use, and depression, anxiety, and sleep quality.

Our finding on the prevalence of depression and anxiety is similar to the levels that Wu, Tao, Zhang, and
Tao (2015) found with Chinese student participants. However, a greater proportion of their participants
reported poor sleep quality than was the case with our sample. This result may point to an increasing
prevalence of poor sleep quality among Chinese university students.

Problematic smartphone use is prevalent (over 20%) among Chinese university students (Long et al., 2016).
Our finding that longer duration of smartphone use was correlated with higher scores for anxiety,
depression, and sleep quality is consistent with that of Demirci et al. (2015), who also demonstrated a
significant association between smartphone overuse, symptoms of anxiety and depression, and poor sleep
quality among university students. Our finding also supports that of Matar Boumosleh and Jaalouk (2017),
who found that smartphone addiction was associated with higher depression and anxiety scores in
university students.

The mechanistic processes linking smartphone overuse with psychological status and sleep quality may be
bidirectional and multifactorial. In their recent review, Elhai, Dvorak, Levine, and Hall (2017) suggested
some explanations for the relationship between smartphone overuse and psychological status, one of which

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 Social Behavior and Personality: an international journal

was that prolonged technology use can cause psychological and behavioral problems. Indeed, it has been
shown that excessive smartphone use at night can interfere with sleep, and can influence stress and
depression (Thomée, Härenstam, & Hagberg, 2011). It is also possible that depression and anxiety can lead
to smartphone overuse. According to the model of compensatory internet use proposed by Kardefelt-
Winther (2014), lonely or depressed people may seek temporary relief from their problems by using the
internet. Using mediation analysis, Kim, Seo, and David (2015) showed that depressed people tended to be
motivated to use smartphones as a coping strategy to alleviate their negative emotions. However, according
to the social enhancement model (Kraut et al., 2002), such compensatory behavior may lead to problematic
smartphone use without relieving the original psychological problems. Therefore, a vicious cycle between
smartphone overuse and mental health may exist (Elhai et al., 2017). That is, smartphone overuse drives
psychological and behavioral problems, which further accelerate smartphone overuse or addiction (Kim et
al., 2015).

We found no association between the time spent on television viewing and computer use, and depression,
anxiety, and sleep quality. In contrast, Feng et al. (2014) observed that, in a similar population, less screen
time was associated with decreased risk of both depressive symptoms and poor sleep quality, but not of
anxiety. In a longitudinal study conducted with young adults, Grøntved et al. (2015) observed a prospective
association between increased duration of television viewing or computer use and greater odds of presence
of depressive symptoms. Kakinami et al. (2017) found that, in young adults, each additional hour of
television viewing and computer use was associated with a 17% and 13% increase, respectively, in the
likelihood of experiencing poor sleep quality.

The discrepancy in these findings may be due, in part, to differences in participants’ background
characteristics and the measures used. We find it interesting that, in this study, our results showed that
prolonged smartphone use, rather than the other types of screen-related time (i.e., television viewing and
computer use), had a negative association with psychological status and sleep quality among the students.
Therefore, our findings suggest that the relationship of sedentary behavior with psychological status and
sleep quality may be dependent on the type of sedentary behavior involved. Thus, strategies for health
interventions and promotions should be specific and targeted at the reduction of smartphone use.

There are several limitations in this study. First, we relied on cross-sectional data, which does not allow for
causal inference. Second, although the participants came from a variety of areas around the country, as they
were recruited from one university, generalizability of the findings to a broader population cannot be
assumed. Third, we surveyed the length of time spent on television viewing and computer use together in
one question. Therefore, we could not examine the associations between the time spent on each of these
activities, and depression, anxiety, and sleep quality. In addition, we surveyed the time spent on television
viewing/computer use, and smartphone use during the past 6 months, which was a different time frame
from that of the psychological instruments we used in the study. However, we used this 6-month time frame
for the screen-related behavior to help participants respond more precisely. Further, the potential influence
of sedentary behavior on mental health may occur over time. Finally, although we found a link between
smartphone use and the mental health of the students, we did not investigate the specific purpose for the
smartphone use. Thus, as the possibility that different smartphone use activities are differentially associated
with psychological consequences cannot be ruled out, this topic needs to be examined in future studies.

Therefore, we have shown that different types of sedentary behavior may be differentially associated with
Chinese university students’ psychological status and sleep quality. The reduction of their smartphone use
may be relevant in the promotion of their mental health and sleep quality.

Acknowledgements
The authors would like to thank the participants in this study, which was financially supported by grants
from the General Administration of Sport of China (2015B014, 2015B062) and the Shanghai Pujiang

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 Wang, Xue, Fan, Huang, Chen

Program (16PJC052).

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