Bhandari Parash Mani, Neupane Dipika, Rijal Shristi, Thapa Kiran, Mishra Shiva Raj, Poudyal Amod Kumar
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
University of Western Australia, School of Population Health, Crawley, WA, Australia.
BMC Psychiatry. 2017 Mar 21;17(1):106. doi: 10.1186/s12888-017-1275-5.
Evidence on the burden of depression, internet addiction and poor sleep quality in undergraduate students from Nepal is virtually non-existent. While the interaction between sleep quality, internet addiction and depressive symptoms is frequently assessed in studies, it is not well explored if sleep quality or internet addiction statistically mediates the association between the other two variables.
We enrolled 984 students from 27 undergraduate campuses of Chitwan and Kathmandu, Nepal. We assessed sleep quality, internet addiction and depressive symptoms in these students using Pittsburgh Sleep Quality Index, Young's Internet Addiction Test and Patient Health Questionnaire-9 respectively. We included responses from 937 students in the data analysis after removing questionnaires with five percent or more fields missing. Via bootstrap approach, we assessed the mediating role of internet addiction in the association between sleep quality and depressive symptoms, and that of sleep quality in the association between internet addiction and depressive symptoms.
Overall, 35.4%, 35.4% and 21.2% of students scored above validated cutoff scores for poor sleep quality, internet addiction and depression respectively. Poorer sleep quality was associated with having lower age, not being alcohol user, being a Hindu, being sexually active and having failed in previous year's board examination. Higher internet addiction was associated with having lower age, being sexually inactive and having failed in previous year's board examination. Depressive symptoms were higher for students having higher age, being sexually inactive, having failed in previous year's board examination and lower years of study. Internet addiction statistically mediated 16.5% of the indirect effect of sleep quality on depressive symptoms. Sleep quality, on the other hand, statistically mediated 30.9% of the indirect effect of internet addiction on depressive symptoms.
In the current study, a great proportion of students met criteria for poor sleep quality, internet addiction and depression. Internet addiction and sleep quality both mediated a significant proportion of the indirect effect on depressive symptoms. However, the cross-sectional nature of this study limits causal interpretation of the findings. Future longitudinal study, where the measurement of internet addiction or sleep quality precedes that of depressive symptoms, are necessary to build upon our understanding of the development of depressive symptoms in students.
关于尼泊尔大学生抑郁症、网络成瘾和睡眠质量差负担的证据几乎不存在。虽然睡眠质量、网络成瘾和抑郁症状之间的相互作用在研究中经常被评估，但睡眠质量或网络成瘾是否在统计学上介导了其他两个变量之间的关联，尚未得到充分探讨。
我们招募了来自尼泊尔奇旺和加德满都27个本科校区的984名学生。我们分别使用匹兹堡睡眠质量指数、杨氏网络成瘾测试和患者健康问卷-9对这些学生的睡眠质量、网络成瘾和抑郁症状进行了评估。在去除缺失字段达5%或更多的问卷后，我们将937名学生的回答纳入数据分析。通过自抽样法，我们评估了网络成瘾在睡眠质量与抑郁症状之间关联中的中介作用，以及睡眠质量在网络成瘾与抑郁症状之间关联中的中介作用。
总体而言，分别有35.4%、35.4%和21.2%的学生在睡眠质量差、网络成瘾和抑郁的有效临界分数之上得分。较差的睡眠质量与年龄较小、不饮酒、是印度教徒、有性活动以及上一年度董事会考试不及格有关。较高的网络成瘾与年龄较小、没有性活动以及上一年度董事会考试不及格有关。年龄较大、没有性活动、上一年度董事会考试不及格以及学习年限较短的学生抑郁症状较高。网络成瘾在统计学上介导了睡眠质量对抑郁症状间接影响的16.5%。另一方面，睡眠质量在统计学上介导了网络成瘾对抑郁症状间接影响的30.9%。
在当前研究中，很大一部分学生符合睡眠质量差、网络成瘾和抑郁的标准。网络成瘾和睡眠质量都介导了对抑郁症状的很大一部分间接影响。然而，本研究的横断面性质限制了对研究结果的因果解释。未来有必要进行纵向研究，在其中网络成瘾或睡眠质量的测量先于抑郁症状的测量，以加深我们对学生抑郁症状发展的理解。
