Problematic Internet use among residential college students during the COVID-19 lockdown: A social network analysis approach

Emerging Adult Resilience to the Early Stages of the COVID-Pandemic: A Systematic Scoping Review

Human resilience to COVID-19 related stressors remains a pressing concern following the aftereffects of the pandemic and in the face of probable future pandemics. In response, we systematically scoped the available literature (n = 2030 records) to determine the nature and extent of research on emerging adults' adaptive responses to COVID-19 stressors in the early stages of the pandemic. Using a multisystem resilience framework, our narrative review of 48 eligible studies unpacks the personal, relational, institutional and/or physical ecological resources that enabled positive emerging adult outcomes to COVID-18 stressors. We found that there is a geographical bias in studies on this topic, with majority world contexts poorly represented. Resources leading to positive outcomes foregrounded psychological and social support, while institutional and ecological supports were seldom mentioned. Multisystemic combinations of resources were rarely considered. This knowledge has valuable implications for understanding resilience in the context of other large-scale adverse conditions.

The relationship between problematic internet use and psychological distress in older Chinese teachers (40+) during different stages of the COVID-19 pandemic: three cross-sectional studies

Background

Despite a consensus on the negative implications of problematic internet use (PIU) for mental health, there is a notable gap in research concerning older demographics, particularly older teachers. This study aimed to investigate the prevalence of PIU and its impact on the mental wellbeing of this population.

Methods

Three sub-studies were conducted: Study 1 (2020) investigated how fear induced by COVID-19 influenced PIU and psychological distress among 3,929 older teachers. Study 2 (2021) examined the effects of PIU on psychological needs thwarting (the frustration of basic psychological needs) and psychological distress, involving 3,502 participants. Study 3 (2022) explored the impact of PIU on occupational burnout and psychological distress, with 1,276 participants. The Generalized Linear Model in Jamovi 2.3.23 was used to evaluate the three mediation models.

Results

The three sub-studies revealed a high prevalence of PIU among older teachers (27.4% in Study 1, 27.4% in Study 2, and 24.5% in Study 3). High levels of PIU were associated with elevated psychological distress during the 3 years of the COVID-19 pandemic. In Study 1, fear of COVID-19 indirectly influenced psychological distress through PIU as a mediator. In Studies 2 and 3, respectively, psychological needs thwarting and occupational burnout mediated the relationship between PIU and psychological distress.

Conclusion

This study confirmed the high prevalence of PIU among older school teachers and the detrimental effect of PIU on psychological needs thwarting, occupational burnout, and psychological distress. Given these findings, education authorities and school management should take proactive steps to mitigate PIU and ensure the health and wellbeing of older teachers.

Prevalence, predictive factors, and impacts of internet gaming disorder among adolescents: A population-based longitudinal study

BACKGROUND

Internet gaming disorder (IGD) becomes a growing concern during the digital era, especially with the pandemic's social distancing measures. It is essential to comprehend the psychosocial predictors and impacts of IGD.

METHODS

A two-wave annual panel study was conducted in Zigong, China, utilizing regional sampling through school-based surveys involving upper primary school to high school students. Data were collected in October 2020 (T1, N = 94,020) and October 2021 (T2, N = 60,551). Self-report data were collected on demographic information, internet gaming behavior, and other mental health factors. Cross-lagged panel models (CLPM) were employed to estimate the bidirectional relationships between the variables.

RESULTS

At T1, 65,643 (72.6 %) participants identified as gamers; at T2, this number decreased to 42,213 (69.7 %). T1 IGD symptoms demonstrated predictability for all T2 psychological variables. Within the framework of the CLPM examining the interplay between IGD symptoms, anxiety symptoms, and hyperactivity/inattention, we uncovered significant reciprocal cross-lagged effects between these variables over time. The relationship between T1 IGD symptoms and T2 anxiety symptoms had age-specific differences, with 13-15-year-old boys displaying the highest coefficient, which decreased for the 16-18 age group.

LIMITATIONS

Our study is subject to potential recall bias associated with self-reported retrospective data. Additionally, our analysis assumes temporal ordering between variables, an assumption that may not always hold in complex systems.

CONCLUSIONS

There are reciprocal relationships between IGD symptoms, anxiety symptoms, and hyperactivity/inattention in adolescents, underscoring the imperative need for comprehensive strategies aimed at addressing the impact of IGD on mental health and overall well-being.

Low self-control, perceived social support and internet gaming addiction: findings from an ethnicity minority region in China

Background

Adolescent Internet gaming addiction (IGA) is an pincreasing global concern. Drawing on self-control theory, social support theory, and problem behavior theory, this study aimed to examine the relationships between low self-control, perceived social support, and IGA among Chinese Yi and Non-Yi adolescents, with a focus on the moderating role of perceived social support and ethnic differences.

Methods

A cross-sectional study was conducted among 1,997 adolescents (53.78% female, mean age 14.70 years) in Liangshan Yi Autonomous Prefecture, Sichuan Province, China, using a multi-stage cluster random sampling method. Participants completed questionnaires assessing IGA (Internet Gaming Disorder Scale-Short Form), low self-control (Low Self-Control Scale), and perceived social support (Multidimensional Scale of Perceived Social Support). Data were analyzed using descriptive statistics, t-tests, OLS regression, and the seemingly unrelated estimator (SUE).

Results

Low self-control was positively associated with IGA (β = 0.35, p < 0.001), while perceived social support was negatively associated with IGA (β = -0.27, p < 0.001). Perceived social support, particularly from family (β = -0.43, p < 0.05) and significant others (β = -0.49, p < 0.01), moderated the relationship between low self-control and IGA. These associations were more salient among Yi adolescents compared to non-Yi adolescents.

Conclusions

This study highlights the protective role of perceived social support, especially from family and significant others, in buffering the risk of low self-control on IGA. The findings extend self-control theory and social support theory, and provide empirical support for problem behavior theory in a cross-cultural context. The results underscore the importance of considering cultural contexts in understanding IGA and developing targeted interventions for ethnic minority adolescents.

Association of 24-hour movement guideline adherence, mental health and quality of life in young adults: the role of e-Health literacy

Background

The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.

Objective

This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.

Methods

1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.

Results

Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.

Conclusion

This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

Relationship between fruit and vegetable consumption and internet addiction with insomnia and depression as multiple mediators during the COVID-19 pandemic: a three-wave longitudinal study in Chinese college students

BACKGROUND

The relationships between fruit and vegetable consumption (FV) and Internet addiction (IA) in college students still remained unknown together with the internal mechanisms. Given the limitations of previous cross-sectional design, longitudinal research was necessary to be conducted to explore more precise correlations. Using the three-wave data in a longitudinal design, this study aimed to explore the association between FV and IA among Chinese college students and potential multiple mediators of insomnia and depression during the COVID-19 pandemic.

METHODS

A total of 579 college students were recruited during three waves (T1: August 2020; T2: November 2020; T3: February 2021). FV (T1), insomnia (T2), depression (T2) and IA (T3) symptoms were reported. The descriptive statistics of the sociodemographic characteristics and correlation analyses of the study variables were calculated. The significance of the mediation effects was measured conducting a bootstrap method with SPSS PROCESS macro.

RESULTS

FV was negatively correlated with IA, and lower FV predicted higher risk of IA. Depression mediated the association between FV and subsequent IA. Insomnia and depression were multiple mediators, which in turn mediated the links between FV and subsequent IA.

CONCLUSIONS

The three-wave longitudinal study has revealed that FV had indirect effects on IA through individual mediating factor of depression and multiple mediating roles of insomnia and depression sequentially. The policy makers, educators and researchers should pay attention to the impact of the interventions from healthy diet, in order to optimize the coping strategies for preventing college students from IA.

The Predictive Role of Tolerance and Health Problems in Problem Gambling: A Cross-Sectional and Cross-Lagged Network Analyses

The existing symptomatic networks of problem gambling are all based on cross-sectional data. Thus, there is a need to explore longitudinal symptom networks of problem gambling. Moreover, the replicability of cross-sectional symptom networks can be limited; therefore, further research should assess the convergence between cross-sectional networks of problem gambling symptoms. The present study aimed (i) to examine cross-sectional networks of problem gambling symptoms and evaluate their replicability and (ii) to examine a longitudinal cross-lagged network of problem gambling symptoms. The study included a representative sample of young adult gamblers (born between 1984 and 2000) from the first two waves of the Budapest Longitudinal Study (original sample: N = 2777; final sample: N = 335). The Problem Gambling Severity Index was used to assess symptoms of problem gambling. Cross-sectional symptom networks showed differences in the centrality of nodes. Correlations between the two cross-sectional networks were low in the presence vs. absence of edges, rank order of edge weights, and centrality estimates. However, network invariance tests indicated non-significant differences between them. The cross-lagged network revealed that the symptoms of tolerance and health problems could predict the subsequent presence of multiple problem gambling symptoms. Overall, limited evidence demonstrated the replicability of cross-sectional symptom networks of problem gambling. Future research needs to explore the utility of cross-sectional networks of problem gambling and assess more precisely causal relationships between problem gambling symptoms by distinguishing within- and between-subject effects.

The Psychometric Properties of the DASS-21 and Its Association with Problematic Internet Use among Chinese College Freshmen

During transitional periods, college freshmen may experience mental health issues. The Depression, Anxiety, and Stress Scale-21-item version (DASS-21) is commonly used for mental health assessment in China. However, evidence is lacking regarding its applicability with freshmen as a demographic. Debates also exist regarding its factor structure. This study aimed to evaluate the DASS-21's psychometric properties with Chinese college freshmen and investigate its association with three kinds of problematic Internet use. A convenience sampling method was used to recruit two samples of freshmen-one of 364 (female 248; mean age 18.17 years) and the other of 956 (female 499; mean age 18.38 years) participants. McDonald's ω and confirmatory factor analysis were conducted to evaluate both the scale's internal reliability and construct validity. The results indicated acceptable reliability, with a one-factor structure inferior to a three-factor structure in terms of model fit. Furthermore, it was demonstrated that problematic Internet use was significantly and positively associated with depression, anxiety, and stress among Chinese college freshmen. Based on the prerequisite of measurement equivalence across two samples, the study also found that freshmen's problematic Internet use and psychological distress were likely to be affected by the strict measures put in place during the COVID-19 pandemic.

Knowledge mapping of students' mental health status in the COVID-19 pandemic: A bibliometric study

Objective

The purpose of this study was to investigate the international scientific output on mental health of students during COVID-19 from 2020 to 2022 through a bibliometric analysis and to explore trend and research hotspots in this field.

Methods

We searched the Web of Science Core Collection for publications and used a variety of software to analyze and visualize the data such as R, CiteSpace, VOSviewer and Scimago.

Results

A total of 2,734 publications were retrieved as of June 4, 2022, published by 3,894 institutions from 120 countries/regions. China and the United States lead in the quantity and quality of publications in this field. According to Bradford's Law, 16 journals are considered core journals in the field. Co-cited references indicate the main psychological problems of students under the epidemic revolve around anxiety, poor sleep and financial difficulty. Their behavior might also be influenced by increased internet and alcohol use.

Conclusion

Mental health of students during COVID-19 is attracting increasing attention. It is identified that the research hotspots in this field continue to revolve around emotional anxiety and unhealthy behaviors. Due to the different troubles faced by different groups under COVID-19, further exploration of the relevant factors specific for students are needed, with a hopeful view to providing ideas for intervention measures.

Intervention Effect of Mindful Self-Compassion Training on Adolescents' Psychological Stress during the Pandemic

Background

COVID-19 has been confirmed as a public health emergency and may give rise to adverse emotions such as anxiety and fear, and even stress reactions in serious cases. In a critical period of emotional development, adolescents experience more psychological stress fluctuations. Mindful self-compassion training is a simple and easy psychological assistance technology that has been recognized as effective, but it has not been applied to adolescents' psychological problems caused by the epidemic.

Methods

From September 2021 to January 2022, adolescent volunteers were recruited in this study from four communities in Chongqing, China. A total of 107 adolescents volunteered to participate in this intervention experiment and were divided by the table of random numbers into 53 in the experiment group and 54 in the control group. The experiment group was intervened using mindful self-compassion training in combination with aerobic exercise for two months, while no intervention measures were taken in the control group. Stress Appraisal Measure, Profile of Mood States and Pittsburgh Sleep Quality Index were the scales adopted to evaluate the effect before and after the intervention.

Results

The experimental group had significantly lower negative mood, stress, sleep scores than the control group (P < 0.001) and significantly higher differences before and after treatment than the control group (P < 0.001).

Conclusion

The intervention in this study can effectively reduce the level of negative mood and stress in individuals, and improve their vitality and sleep quality and provides new insights for the implementation and improvement of psychological assistance technology.

Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis

Purpose of Review

The COVID-19 pandemic changed people’s lifestyles and such changed lifestyles included the potential of increasing addictive behaviors. The present systematic review and meta-analysis aimed to estimate the prevalence of different behavioral addictions (i.e., internet addiction, smartphone addiction, gaming addiction, social media addiction, food addiction, exercise addiction, gambling addiction, and shopping addiction) both overall and separately.

Recent Findings

Four databases (PubMed, Scopus, ISI Web of Knowledge, and ProQuest) were searched. Peer-reviewed papers published in English between December 2019 and July 2022 were reviewed and analyzed. Search terms were selected using PECO-S criteria: population (no limitation in participants’ characteristics), exposure (COVID-19 pandemic), comparison (healthy populations), outcome (frequency or prevalence of behavioral addiction), and study design (observational study). A total of 94 studies with 237,657 participants from 40 different countries (mean age 25.02 years; 57.41% females). The overall prevalence of behavioral addiction irrespective of addiction type (after correcting for publication bias) was 11.1% (95% CI: 5.4 to 16.8%). The prevalence rates for each separate behavioral addiction (after correcting for publication bias) were 10.6% for internet addiction, 30.7% for smartphone addiction, 5.3% for gaming addiction, 15.1% for social media addiction, 21% for food addiction, 9.4% for sex addiction, 7% for exercise addiction, 7.2% for gambling addiction, and 7.2% for shopping addiction. In the lockdown periods, prevalence of food addiction, gaming addiction, and social media addiction was higher compared to non-lockdown periods. Smartphone and social media addiction was associated with methodological quality of studies (i.e., the higher the risk of boas, the higher the prevalence rate). Other associated factors of social media addiction were the percentage of female participants, mean age of participants, percentage of individuals using the internet in country, and developing status of country. The percentage of individuals in the population using the internet was associated with all the prevalence of behavioral addiction overall and the prevalence of sex addiction and gambling addiction. Gaming addiction prevalence was associated with data collection method (online vs. other methods) that is gaming addiction prevalence was much lower using online methods to collect the data.

Summary

Behavioral addictions appeared to be potential health issues during the COVID-19 pandemic. Healthcare providers and government authorities should foster some campaigns that assist people in coping with stress during COVID-19 pandemics to prevent them from developing behavioral addictions during COVID-19 and subsequent pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40429-022-00435-6.

Prevalence of Problematic Internet Use during the COVID-19 Pandemic

The present paper reviews recent studies on problematic Internet use (PIU) prevalence before and during the coronavirus disease 2019 (COVID-19) pandemic. Several pre-pandemic meta-analyses reported PIU prevalence estimates ranging from 6% to 9.7%. Experts in the field of online addictions speculated that PIU would increase during the pandemic because of increased time spent on the Internet. However, it is still unclear if increased time on the Internet resulted in higher PIU prevalence estimates during the pandemic. Prevalence estimates differed greatly across studies during the COVID-19 pandemic. Possible inconsistencies are outlined together with future directions for PIU prevalence studies.

Network Analysis of Time Use and Depressive Symptoms Among Emerging Adults: Findings From the Guizhou Population Health Cohort Study

Background

To date, the relationship between diverse time use behaviors and depression status among emerging adults have not been disentangled in the literature. Therefore, if and how the time displacement mechanism activates depressive symptoms among emerging adults remains unclear.

Methods

To fill this gap in the literature, we employed a network analysis to make estimations. The emerging adult sample (N = 1,811) was collected by the Guizhou Population Health Cohort Study. Time use behaviors were measured by an adaption of the self-administered International Physical Activity Questionnaire, and depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9).

Results

The results revealed that the time displacement mechanism of emerging adults differed from that of adolescents. Sleep duration was not crowded out by other activities, while the time spent on computer use was found to be negatively related to time spent on heavy work activities. Moreover, computer use behavior triggered three depressive symptoms ("Anhedonia," "Guilt," and "Motor"), but inhibited "Suicide." The results of the directed acyclic graph revealed that females and heavy drinkers were at risk of depression.

Limitations

The study sample was confined to only one province, which may limit its generalizability. The cross-sectional design impeded the ability to draw causal inferences.

Conclusion

Our results enhance the current understanding of the internal mechanism of how time use behaviors influence depressive symptoms among emerging adults.

Do Academic Stress, Burnout and Problematic Internet Use Affect Perceived Learning? Evidence from India during the COVID-19 Pandemic

Distress in online classrooms and problematic internet use are two issues that have caused student burnout and affect perceived learning during the COVID-19 pandemic. Given the high pressure placed on students throughout COVID-19, it is critical to understand the influence of problematic internet use (PIU), psychological stress, academic burnout, and resilience on perceived learning (PL). A cross-sectional analytical study was chosen to collect data from 350 learners pursuing undergraduate and postgraduate business/management degrees in Karnataka, India. The data were analyzed using SPSS (Statistical Package for Social Science) and Smart PLS 3. The present study reports a non-significant negative total effect of stress on PL, while there was a significant positive direct effect but a significant indirect negative effect of multiple mediators, namely PIU, burnout, and resilience. In the relationship between stress and PL, burnout has full competitive mediation, and the suppressive effect of burnout and resilience wipes out the beneficial benefit of stress on PL, resulting in reduced PL. As a societal problem, a change in educational policy and prevention strategies for students and organizations (reducing the number of courses, number of exams, and handling parental expectations) would be effective. Emotional intelligence to improve resilience, which assists students in sailing through a current challenging situation and using IT for reducing negative and unexpected emotional outbursts should be encouraged.

Multifarious Linkages Between Personality Traits and Psychological Distress During and After COVID-19 Campus Lockdown: A Psychological Network Analysis

BACKGROUND

The novel coronavirus disease pandemic is still proliferating and is not expected to end any time soon. Several lockdowns and social distancing measures might be implemented in the future. A growing body of research has explored the effect of personality on individuals' psychological wellbeing during the pandemic. However, most prior studies have not discussed the dynamic and reciprocal transactions between personality and psychological distress in various situations. Therefore, this study aims to explore the internal mechanisms of the ways in which certain personality traits triggered specific symptoms during and after college lockdown, by using network analysis.

METHODS

Based on survey data from 525 university students in China, the study detected the connection between individual personality and psychological distress through network analysis. Of the participants, 70.1% were female, and 20.9% were male. The mean age of the participants was 19.701 (SD = 1.319) years. We estimated networks via two steps: First, two networks that only contain the Big Five personality traits and the six symptoms of psychological distress during and after the lockdown measure were estimated. Second, we add control variables and re-estimated the networks to check whether the linkages among the Big Five personality traits and the six symptoms of psychological distress observed in the first step were stable. Moreover, we employed strength centrality as the key indicator to present the potential significance of diverse variables within a network.

RESULTS

The findings demonstrate that, first, "depress" was the central symptom in the network during the college lockdown, while "efforts" was the central symptom after the lockdown. Second, the symptoms of "restless" and "worthless" significantly declined after the lockdown. Third, we found that there is an internal mechanism through which personality affected certain psychological symptoms during and after lockdowns. Specifically, neuroticism triggered certain symptoms during and after the lockdown, while extraversion and conscientiousness suppressed certain symptoms. Substantial evidence on internal linkages is imperative to develop effective interventions.

CONCLUSION

This study explores the internal mechanisms of the ways in which certain personality traits trigger specific symptoms. Overall, our results provide empirical evidence that personality traits play a key role in how individuals with certain traits respond to college lockdown during a pandemic. The study makes a significant contribution to the literature because it is among the first few studies which explores the effects of personality traits on individual psychological distress using network analysis during the pandemic.

The impacts of academic stress on college students' problematic smartphone use and Internet gaming disorder under the background of neijuan: Hierarchical regressions with mediational analysis on escape and coping motives

With sluggish economic growth in the post-pandemic era, the phenomenon "neijuan" becomes increasingly severe in many Asian countries like China. Neijuan refers to a hypercompetitive social environment wherein individuals involuntarily get involved in inhumane work or study hours, resulting in a considerable amount of tension and stress. Previous pathology research has shown that stress can trigger the overuse of Internet-based devices and services, which can subsequently lead to problematic smartphone use (PSU) and Internet gaming disorder (IGD). Provided college students are generally deemed one of the groups most susceptible to neijuan, limited attention has been given to the stimuli and the resultant psychological and behavioral ill-beings. Our study examined the impacts of academic stress on Chinese college students' PSU and IGD problems, with the inclusion of escape and coping motives as mediators. Based upon the results of hierarchical regressions and path analysis, we found that whereas academic stress increased IGD tendency mediated through escape and coping motives, excessive use of smartphone might have developed into a habitual behavior rather than effective escape and coping instruments. Demographic and academic characteristics, such as gender and whether studying at a prestigious institution, also exerted influences on college students' IGD intensity.

A case study of university student networks and the COVID-19 pandemic using a social network analysis approach in halls of residence

The COVID-19 pandemic has meant that young university students have had to adapt their learning and have a reduced relational context. Adversity contexts build models of human behaviour based on relationships. However, there is a lack of studies that analyse the behaviour of university students based on their social structure in the context of a pandemic. This information could be useful in making decisions on how to plan collective responses to adversities. The Social Network Analysis (SNA) method has been chosen to address this structural perspective. The aim of our research is to describe the structural behaviour of students in university residences during the COVID-19 pandemic with a more in-depth analysis of student leaders. A descriptive cross-sectional study was carried out at one Spanish Public University, León, from 23th October 2020 to 20th November 2020. The participation was of 93 students, from four halls of residence. The data were collected from a database created specifically at the university to "track" contacts in the COVID-19 pandemic, SiVeUle. We applied the SNA for the analysis of the data. The leadership on the university residence was measured using centrality measures. The top leaders were analyzed using the Egonetwork and an assessment of the key players. Students with higher social reputations experience higher levels of pandemic contagion in relation to COVID-19 infection. The results were statistically significant between the centrality in the network and the results of the COVID-19 infection. The most leading students showed a high degree of Betweenness, and three students had the key player structure in the network. Networking behaviour of university students in halls of residence could be related to contagion in the COVID-19 pandemic. This could be described on the basis of aspects of similarities between students, and even leaders connecting the cohabitation sub-networks. In this context, Social Network Analysis could be considered as a methodological approach for future network studies in health emergency contexts.

Relationship of Problematic Smartphone Use, Sleep Quality, and Daytime Fatigue Among Quarantined Medical Students During the COVID-19 Pandemic

Background: The COVID-19 pandemic brought about great transformation to medical education mode. Although mobile communication devices played a crucial role in online learning among quarantined university students, the potential smartphone addition problems, negative health behaviors, and psychological symptoms need considerable attention. This study examined the relationship of problematic smartphone use (PSU), sleep quality, and daytime fatigue among medical students. Methods: A web-based survey was conducted in six polyclinic hospitals in Beijing between February and May 2020. 1016 participants (26.01 ± 2.46 years, 65.16% female) completed self-report measurements including Short Version Smartphone Addiction Scale (SAS-SV), Athens Insomnia Scale (AIS), and Subjective Fatigue Scale (FS). Spearman correlation coefficients and multiple regression models were used to analyze the association among PSU, sleep quality, and daytime fatigue. We used structural equation modeling to test the mediating effect of sleep quality between PSU and daytime fatigue. Results: 49.70% of the participants had PSU. Significant positive correlations were found among SAS-SV, AIS, and FS scores (r = 0.35-0.61, P _S < 0.001). Subjects with PSU were more likely to report sleep disturbance (β = 1.07, P < 0.001, OR = 2.91, 95%CI = 2.17-3.91), physical fatigue (β = 1.16, P < 0.001, OR = 3.18, 95%CI = 2.45-4.15), and mental fatigue (β = 0.88, P < 0.001, OR = 2.42, 95%CI = 1.86-3.14). The indirect effect of PSU on physical fatigue and mental fatigue mediated by sleep quality accounted for 50.03 and 45.43% of the total effect, respectively. Conclusions: PSU was significantly associated with sleep disturbance and fatigue among medical students during the COVID-19 pandemic. Sleep quality mediated the relationship between PSU and daytime fatigue. Our results provide valuable information for maintaining medical students' health status and constructing online education structures.