The effect of loneliness on interpersonal sensitivity among nursing undergraduates: a chain mediation role of problematic internet use and bedtime procrastination 孤独感对护理专业本科生人际关系敏感度的影响：问题性网络使用和睡前拖延症的连锁中介作用
Xinji Shi ^(1+){ }^{1+} (D), Yibo Wu ^(2+){ }^{2+} (D), Fukai Cao ^(3){ }^{3}, Xue Wang ^(1*){ }^{1 \cdot} (Dunshuo Du ^(1*){ }^{1 \cdot}, K and Shuang Zang ^(1**){ }^{1 *} (D) Xinji Shi ^(1+){ }^{1+} （D）、Yibo Wu ^(2+){ }^{2+} （D）、Fukai Cao ^(3){ }^{3} 、Xue Wang ^(1*){ }^{1 \cdot} （Dunshuo Du ^(1*){ }^{1 \cdot} 、K and Shuang Zang ^(1**){ }^{1 *} （D）
Abstract 摘要
Background Loneliness was associated with interpersonal sensitivity, but the factors contributing to this relationship in nursing students remain unclear. This study investigated the relationship between loneliness and interpersonal sensitivity among nursing undergraduates, with a specific focus on the mediating roles played by problematic internet use and bedtime procrastination. Method This study was conducted as a cross-sectional survey at a university in China between November and December 2022. Data were collected using a self-administered online questionnaire that included demographic characteristics, the Three-Item Loneliness Scale (T-ILS), the Chinese Version of Short Form of Interpersonal Sensitivity Measure (IPSM-CS), the 6-item short form of the Problematic Internet Use Questionnaire (PIUQ-SF-6), and the Bedtime Procrastination Scale (BPS). Pearson correlation analysis was employed to explore the relationships among loneliness, interpersonal sensitivity, problematic internet use, and bedtime procrastination. Structural equation modeling (SEM) was conducted using AMOS software to examine the mediating role of problematic internet use and bedtime procrastination between loneliness and interpersonal sensitivity. 背景 孤独与人际敏感度有关，但导致护理专业学生产生这种关系的因素仍不清楚。本研究探讨了护理专业本科生的孤独感与人际关系敏感性之间的关系，并特别关注了问题性网络使用和睡前拖延所起的中介作用。方法 本研究于 2022 年 11 月至 12 月在中国某大学进行横断面调查。问卷内容包括人口统计学特征、孤独感三项目量表（T-ILS）、人际关系敏感性测量简表中文版（IPSM-CS）、问题性网络使用问卷简表（PIUQ-SF-6）和睡前拖延量表（BPS）。研究采用了皮尔逊相关分析来探讨孤独感、人际关系敏感性、问题性网络使用和睡前拖延之间的关系。使用 AMOS 软件进行了结构方程建模（SEM），以研究问题性上网和就寝拖延在孤独感和人际敏感性之间的中介作用。
Results Loneliness was positively related to interpersonal sensitivity among nursing undergraduates ( beta=0.44\beta=0.44, P < 0.001P<0.001 ). There was a significant chain mediation role of problematic internet use and bedtime procrastination in the relationship between loneliness and interpersonal sensitivity. Conclusions The study contributed to deepening the understanding of the relationship between loneliness and interpersonal sensitivity and provided valuable insights into the improvement of interpersonal sensitivity in nursing undergraduates. 结果 护理专业本科生的孤独感与人际关系敏感度呈正相关（ beta=0.44\beta=0.44 ， P < 0.001P<0.001 ）。在孤独感与人际敏感性的关系中，问题性网络使用和睡前拖延具有明显的连锁中介作用。结论 该研究有助于加深对孤独感与人际关系敏感性之间关系的理解，并为提高护理专业本科生的人际关系敏感性提供了有价值的启示。
Interpersonal sensitivity, considered inappropriate or excessive awareness and responsiveness to the behaviors and emotions of others, is a widely researched personality trait often associated with a “depressive-prone personality” [1]. Interpersonal sensitivity was one of the most prominent psychological symptoms among medical students, with negative impacts on both individual psychological well-being and social adaptation functions [2]. Meanwhile, interpersonal sensitivity was a susceptibility factor for many mental disorders, such as anxiety and depression [3]. Individuals possessing this personality trait tend to experience discomfort and feelings of inadequacy in interpersonal communication, leading to a frequent avoidance of social interactions [2]. 人际敏感被认为是对他人行为和情绪的不恰当或过度的意识和反应，是一种被广泛研究的人格特质，通常与 "易抑郁人格 "相关[1]。人际关系敏感是医学生最突出的心理症状之一，对个体心理健康和社会适应功能都有负面影响[2]。同时，人际关系敏感是焦虑和抑郁等多种精神障碍的易感因素[3]。具有这种人格特质的个体往往在人际交往中体验到不适和不足感，从而导致经常回避社会交往[2]。
Loneliness refers to a subjective state of feeling isolated or disconnected from others [4]. Research has shown that loneliness is associated with interpersonal sensitivity [5]. According to the social needs approach, the emergence of loneliness is attributed to the absence of a social need for relationships or a set of relationships [6]. When individuals are unable to satisfy their social and/or intimacy needs within relationships, feelings of loneliness arise. Research has indicated that lonely individuals are more prone to social withdrawal [7]. On the other hand, the Choking Under Social Pressure theory [8] offers another perspective, suggesting that individuals with high levels of loneliness experience excessive anxiety in social interactions as they strive to establish positive interpersonal relationships. This heightened anxiety restricts their interpersonal abilities, resulting in adverse social consequences, and making them more cautious and sensitive in social interactions. Additionally, loneliness has been shown to impair executive functioning, increase sensitivity to negative social stimuli, and undermine interpersonal trust [9]. Although the impact of loneliness on interpersonal sensitivity has not been extensively studied, this study, integrating the theoretical frameworks and existing research findings, hypothesizes a significant positive correlation between loneliness and interpersonal sensitivity. 孤独感是指一种感觉与他人隔离或脱节的主观状态[4]。研究表明，孤独感与人际关系敏感度有关 [5]。根据社会需求法，孤独感的出现是由于缺乏对人际关系或一系列人际关系的社会需求[6]。当个人无法在人际关系中满足其社交和/或亲密需求时，孤独感就会产生。研究表明，孤独的人更容易退缩[7]。另一方面，"社会压力下的窒息 "理论[8] 提供了另一种视角，认为高度孤独的人在努力建立积极的人际关系时，会在社会交往中过度焦虑。这种高度焦虑限制了他们的人际交往能力，导致不良的社会后果，使他们在社会交往中更加谨慎和敏感。此外，孤独还被证明会损害执行功能，增加对负面社会刺激的敏感性，破坏人际信任[9]。虽然孤独感对人际敏感度的影响尚未得到广泛研究，但本研究结合理论框架和现有研究成果，假设孤独感与人际敏感度之间存在显著的正相关。
Problematic internet use is defined as persistent and compulsive internet use that disrupts daily life [10]. The increased reliance on digital devices and online resources for entertainment or education has led to students’ difficulties in regulating internet use, potentially resulting in discomfort, hindrance in daily activities, and the emergence of problematic internet use [11, 12]. A previous systematic review reported a prevalence range of 0.8-26.7%0.8-26.7 \% for problematic internet use in adolescents and adults [13]. According to the Compensatory Internet Use theory [14], individuals experiencing unfavorable circumstances may choose to mitigate negative emotions by engaging in virtual online activities, showing a 问题性网络使用被定义为干扰日常生活的持续性和强迫性网络使用[10]。学生越来越依赖数字设备和网络资源进行娱乐或教育，这导致他们难以控制互联网的使用，并可能因此产生不适感、妨碍日常活动以及出现问题性网络使用[11, 12]。之前的一项系统综述报告称，青少年和成人问题性网络使用的流行率范围为 0.8-26.7%0.8-26.7 \% [13]。根据补偿性网络使用理论[14]，个人在遇到不利情况时，可能会选择参与虚拟网络活动来缓解负面情绪，表现出一种
tendency to compensate for interpersonal deficiencies in real-life communication through internet engagement. Additionally, previous research has shown that loneliness was a significant predictor of problematic internet use, with higher levels of loneliness associated with increased social interaction online [15]. Meanwhile, research has also indicated that individuals who engage in problematic internet use often neglect real-life interpersonal interactions, leading to negative relational outcomes [16]. Therefore, we hypothesize that loneliness may drive individuals to seek emotional support online, and this compensatory behavior could further enhance interpersonal sensitivity. 通过参与互联网来弥补现实生活中人际交往不足的倾向。此外，以往的研究表明，孤独感是预测问题性网络使用的一个重要因素，孤独感越高，网络社交互动越多[15]。同时，研究还表明，有问题地使用互联网的人往往会忽视现实生活中的人际交往，从而导致负面的关系结果[16]。因此，我们假设孤独感可能会驱使个体在网上寻求情感支持，而这种补偿行为会进一步提高人际敏感度。
Bedtime procrastination refers to the phenomenon where individuals, without external impediments, are unable to retire to bed at the scheduled time, representing an unhealthy behavior associated with sleep habits [17]. According to the annual sleep report of China 2022, a mere 6.41%6.41 \% of college students reported never encountering bedtime procrastination [18]. Previous studies have suggested that individuals experiencing loneliness were more likely to ruminate on their feelings of isolation, particularly at night, thereby delaying the onset of sleep [19]. Bedtime procrastination may lead to poor sleep quality, negative emotions, and adverse impacts on interpersonal relationships [20-22]. 就寝拖延症是指个体在没有外界阻碍的情况下，无法在预定时间就寝的现象，是一种与睡眠习惯相关的不健康行为[17]。根据《中国 2022 年度睡眠报告》，仅有 6.41%6.41 \% 的大学生表示从未遇到过睡前拖延症[18]。以往的研究表明，经历过孤独的人更有可能反刍自己的孤独感，尤其是在夜间，从而推迟入睡时间[19]。睡前拖延可能会导致睡眠质量差、负面情绪以及对人际关系的不利影响[20-22]。
During the COVID-19 pandemic, students faced increased academic pressure and social restrictions, contributing to heightened feelings of loneliness [23]. This may prompt them to seek social satisfaction through the internet, potentially leading to problematic internet use [15]. A study involving 1000 medical students revealed that 17.8%17.8 \% of participants use their smartphones for more than 3 h daily, often engaging with them late into the night, making it difficult for them to disengage even when attempting to sleep [24]. When individuals are susceptible to problematic internet use, they tend to reduce their bedtime to allocate additional time for mobile phone usage [25]. The Temporal Motivation Theory suggests that individuals when faced with tasks or behavioral choices, weigh the importance of achieving long-term objectives against the allure of immediate gratification [26]. Individuals with problematic internet use exhibit higher psychological cravings for internet use [27]. According to this theory, as the health benefits of sleep manifest at a later time point, this diminishes their motivation to go to bed at a reasonable hour, leading to bedtime procrastination. In addition, bedtime procrastination was strongly associated with poorer sleep quality and sleep insufficiency [17, 28]. The negative impacts of bedtime procrastination may further affect interpersonal relationships and potentially affect interpersonal sensitivity [21, 22]. 在 COVID-19 大流行期间，学生们面临着更大的学业压力和社会限制，导致孤独感加剧[23]。这可能促使他们通过互联网寻求社交满足感，从而可能导致有问题的互联网使用[15]。一项涉及 1000 名医学生的研究显示， 17.8%17.8 \% 参与者每天使用智能手机的时间超过 3 小时，经常使用手机到深夜，即使在试图入睡时也很难脱离手机[24]。当个人容易出现使用互联网的问题时，他们往往会缩短就寝时间，以分配更多时间使用手机[25]。时间动机理论（Temporal Motivation Theory）认为，个人在面对任务或行为选择时，会权衡实现长期目标的重要性和即时满足的诱惑[26]。有网络使用问题的人对网络使用表现出更高的心理渴望[27]。根据这一理论，由于睡眠对健康的益处体现在较晚的时间点，这就削弱了他们在合理时间上床睡觉的动力，从而导致睡前拖延。此外，睡前拖延与较差的睡眠质量和睡眠不足密切相关[17, 28]。睡前拖延的负面影响可能会进一步影响人际关系，并可能影响人际敏感度[21, 22]。
Compared to other undergraduates, nursing students encounter unique psychological and emotional pressures 与其他本科生相比，护理专业学生会遇到独特的心理和情感压力
[29]. They undergo emotional challenges from patients and families and the psychological burdens of professional responsibility [30]. Nursing students have played a critical role in healthcare settings, serving as volunteers and even engaging as frontline healthcare workers amid the COVID-19 pandemic [31, 32]. As the pandemic gradually came under control, the learning and living environments of nursing undergraduates began to return to normal. However, psychological shadows and behavioral patterns left by the pandemic may persist [33]. The uncertainty, fear, and isolation brought about by the COVID-19 pandemic may aggravate the loneliness of nursing students and profoundly affect their social interaction and psychological well-being [29, 33]. As an essential reserve force in the healthcare field, nursing students’ psychological well-being significantly affects not only their academic achievements and personal lives but also plays a crucial role in shaping their future career decisions, personal development, and the quality of their prospective clinical nursing work [34]. Meanwhile, nursing roles typically demand effective collaboration within teams, necessitating communication with other healthcare professionals, nursing colleagues, and medical management [35]. For nursing undergraduates, cultivating positive interpersonal relationships contributes to a supportive and collaborative learning environment, fostering personal growth and adaptability [36], and ultimately preparing them for the intricate demands of their future clinical roles. However, nursing students with high interpersonal sensitivity may experience social anxiety and feelings of inferiority, which not only affect their psychological well-being but also potentially hinder their performance in the workplace, academic settings, and daily life [2,3][2,3]. Therefore, it is crucial to identify effective interventions to mitigate the negative impacts of interpersonal sensitivity for nursing students. [29].他们经受着来自病人和家属的情感挑战以及职业责任的心理负担[30]。在 COVID-19 大流行期间，护理专业学生在医疗机构中发挥了关键作用，他们担任志愿者，甚至是一线医疗工作者[31, 32]。随着疫情逐渐得到控制，护理本科生的学习和生活环境开始恢复正常。然而，大流行留下的心理阴影和行为模式可能会持续存在[33]。COVID-19 大流行带来的不确定性、恐惧和孤独感可能会加剧护理专业学生的孤独感，并深刻影响他们的社会交往和心理健康[29, 33]。作为医疗卫生领域不可或缺的后备力量，护生的心理健康不仅对其学业成绩和个人生活产生重要影响，而且对其未来的职业决策、个人发展以及未来临床护理工作的质量也起着至关重要的作用[34]。同时，护理工作通常需要团队内的有效协作，需要与其他医护人员、护理同事和医疗管理人员进行沟通[35]。对于护理专业的本科生来说，培养积极的人际关系有助于营造一个支持性和协作性的学习环境，促进个人成长和适应能力[36]，并最终使他们为未来临床角色的复杂要求做好准备。 然而，人际关系敏感度高的护生可能会出现社交焦虑和自卑感，这不仅会影响他们的心理健康，还可能妨碍他们在工作场所、学术环境和日常生活中的表现 [2,3][2,3] 。因此，确定有效的干预措施来减轻人际关系敏感对护理专业学生的负面影响至关重要。
Currently, existing studies have primarily focused on exploring relationships between pairs of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity. For instance, Jiang et al. [5] identified a positive correlation between loneliness and interpersonal sensitivity. Boursier et al. [15] found that loneliness is one of the most significant predictors of problematic internet use, with higher levels of loneliness associated with increased online social interactions. Xu et al. [37] confirmed a positive correlation between loneliness and bedtime procrastination among college students. Additionally, a longitudinal study on Chinese college students revealed a significant bidirectional relationship between problematic internet use and bedtime procrastination [38]. Numerous studies have also explored the relationship between problematic internet use and interpersonal sensitivity [39, 40]. Despite these important findings, there remains a significant gap in understanding how 目前，现有的研究主要集中于探讨孤独感、问题性网络使用、就寝拖延和人际敏感度这几对关系。例如，Jiang 等人[5] 发现孤独感与人际敏感度之间存在正相关。Boursier 等人[15] 发现，孤独感是预测有问题网络使用的最重要因素之一，孤独感越强，网络社交互动越多。Xu 等人[37] 证实，大学生的孤独感与就寝拖延之间存在正相关。此外，一项针对中国大学生的纵向研究显示，问题性网络使用与就寝拖延之间存在显著的双向关系[38]。许多研究也探讨了问题性网络使用与人际敏感性之间的关系[39, 40]。尽管有这些重要的研究结果，但对于如何理解
these variables interact collectively rather than merely in pairs. This gap hinders the ability to develop targeted interventions. Moreover, research specifically targeting nursing undergraduates is scarce. Given the unique challenges faced by this population, understanding the interactions between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity is crucial for promoting their mental health and professional development. To address these gaps and extend previous studies, this research comprehensively investigates the interrelationships among loneliness, problematic internet use, bedtime procrastination, and their combined effects on interpersonal sensitivity among nursing undergraduates. By exploring how these variables interact with one another, we aim to gain a better understanding of the needs and challenges faced by nursing students, provide insights into improving their interpersonal sensitivity, and offer targeted recommendations and guidance for future educational practices to help them adapt to the post-pandemic new normal. 这些变量的相互作用是集体的，而不仅仅是成对的。这一差距阻碍了制定有针对性干预措施的能力。此外，专门针对护理专业本科生的研究也很少。鉴于这一群体所面临的独特挑战，了解孤独感、有问题的网络使用、就寝拖延症和人际敏感性之间的相互作用对于促进他们的心理健康和职业发展至关重要。为了填补这些空白并扩展以往的研究，本研究全面调查了护理专业本科生的孤独感、有问题的网络使用、睡前拖延以及它们对人际敏感性的综合影响之间的相互关系。通过探讨这些变量之间如何相互作用，我们希望更好地了解护理专业学生的需求和面临的挑战，为提高他们的人际敏感性提供见解，并为未来的教育实践提供有针对性的建议和指导，以帮助他们适应流行病后的新常态。
Considering the existing studies, this study’s particular research hypotheses are as follows (Fig. 1): 考虑到现有研究，本研究的具体研究假设如下（图 1）：
H1: Loneliness is positively related to interpersonal sensitivity. H1：孤独感与人际敏感度呈正相关。
H2: Problematic internet use serves as a mediating role between loneliness and interpersonal sensitivity. H2：有问题的互联网使用在孤独感和人际敏感性之间起到中介作用。
H3: Bedtime procrastination serves as a mediating role between loneliness and interpersonal sensitivity. H3：睡前拖延症是孤独感和人际敏感度之间的中介。
H4: Problematic internet use is positively related to bedtime procrastination, which plays a chain mediating role between loneliness and interpersonal sensitivity. H4：有问题的互联网使用与睡前拖延症呈正相关，而睡前拖延症在孤独感和人际敏感性之间起着连锁中介作用。
The survey questionnaire was distributed to all students anonymously through the college’s official channels. Data collection was conducted through the distribution of a self-administered online questionnaire, utilizing WeChat (a widely employed social platform in China with over one billion users) and Questionnaire Star (a free online survey program). Students were informed about the study and fully understood its purpose. Informed consent was obtained from all participants. 调查问卷通过学院的官方渠道匿名发放给所有学生。数据收集是通过微信（中国广泛使用的社交平台，用户超过 10 亿）和问卷星（免费在线调查程序）发放自填式在线问卷的方式进行的。学生们被告知了这项研究，并充分理解了其目的。所有参与者均已知情同意。
Fig. 1 Hypothesized model of the interrelationships of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity 图 1 孤独感、问题性网络使用和睡前拖延症对人际敏感度相互关系的假设模型
In compliance with the Declaration of Helsinki and the Measures for Ethical Review of Biomedical Research Involving Human Beings [41], this study obtained ethical approval from the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002). 根据《赫尔辛基宣言》和《涉及人的生物医学研究伦理审查办法》[41]，本研究获得了华北科技学院济棠学院伦理审查委员会的伦理批准（JTXY-2022-002）。
Sample size and sampling 样本量和抽样
According to the sample size estimation formula of structural equation modeling (SEM), the sample size should ideally be 10 to 15 times the number of dimensions [42]. In this study, the sample size was calculated 15 times with 10 dimensions. The minimum sample size was 150 . Meanwhile, to ensure stable estimation in SEM, a minimum of 200 participants is required [43]. Considering a potential 20%20 \% rate of invalid questionnaires, a total sample size of 240 participants was deemed necessary. 根据结构方程建模（SEM）的样本量估算公式，样本量最好是维度数的 10 到 15 倍[42]。在本研究中，样本量按 10 个维度的 15 倍计算。最小样本量为 150 个。同时，为确保 SEM 估算的稳定性，至少需要 200 名参与者 [43]。考虑到潜在的 20%20 \% 无效问卷率，我们认为总样本量为 240 人是必要的。
The original study included 5475 participants. In this study, we exclusively selected nursing undergraduates as the study population, initially enrolling 864 participants. Then, 127 participants were excluded due to the obvious regularity of their answers. Finally, this study included a total of 737 participants. 最初的研究包括 5475 名参与者。在本研究中，我们专门选择了护理专业的本科生作为研究对象，最初招募了 864 名参与者。随后，有 127 名参与者因其答案具有明显的规律性而被排除在外。最后，本研究共纳入 737 名参与者。
Measures 措施
Demographic characteristics 人口特征
Demographic characteristics of participants included age (years), gender (female, male), academic year (first, second, third, fourth), ethnicity (Han, minority), hukou (agricultural, non-agricultural), and place of residence (rural, urban). 参与者的人口统计学特征包括年龄（岁）、性别（女性、男性）、学年（第一、第二、第三、第四学年）、民族（汉族、少数民族）、户口（农业、非农业）和居住地（农村、城市）。
Loneliness 孤独
The Three-Item Loneliness Scale (T-ILS) developed by Hughes et al. [4] was used to measure loneliness. This study used the version translated into Chinese by Liu et al. [44] An example item was “How often do you feel that you lack companionship?” Responses ranged from 1 (hardly ever) to 3 (often). The overall score was calculated as the sum of all three items (range: 3-93-9 ). Higher scores reflected a higher level of loneliness. The Cronbach’s alpha\alpha of the original scale was 0.72 [4] and the translated version of the scale was 0.87 in Chinese samples [44]. In this study, Cronbach’s alpha\alpha for the T-ILS was 0.87 . 本研究使用 Hughes 等人[4] 编制的孤独感三项目量表（T-ILS）来测量孤独感。本研究使用的是 Liu 等人翻译成中文的版本[44]，其中的一个例子是 "你多久会觉得自己缺乏陪伴？回答从 1（几乎没有）到 3（经常）不等。总分以三个项目的总和计算（范围： 3-93-9 ）。得分越高，孤独感越强。原量表的 Cronbach's alpha\alpha 为 0.72[4]，在中国样本中，该量表的翻译版本为 0.87[44]。在本研究中，T-ILS 的 Cronbach's alpha\alpha 为 0.87。
Interpersonal sensitivity 人际关系敏感性
Interpersonal sensitivity was measured with the Chinese Version of the Short Form of Interpersonal Sensitivity Measure (IPSM-CS), which was developed by You et al. [1] The IPSM-CS was a 15 -item scale with five dimensions: interpersonal awareness (e.g., “I worry about what others think of me”), fragile inner-self (e.g., “If others knew the real me, they would not like me”), separation anxiety (e.g., “I feel insecure when I say goodbye to people”), need for approval (e.g., “I feel happy when someone compliments me”), and timidity (e.g., “I find it hard to get angry with people”). Responses to each item were rated on a 5 -point Likert scale ranging from 1 (very unlike me)\mathrm{me}) to 5 (very like me). The range of possible scores is between 15 and 75, with a higher score indicating a higher interpersonal sensitivity degree. The Cronbach’s alpha\alpha of the original scale was 0.74 [1]. In this study, Cronbach’s alpha\alpha for the IPSM-CS was 0.90 . 人际关系敏感度采用 You 等人开发的人际关系敏感度测量简表（IPSM-CS）中文版进行测量、例如，"如果别人知道真实的我，他们会不喜欢我"）、分离焦虑（例如，"当我与人告别时，我感到不安全"）、需要认可（例如，"当有人夸奖我时，我会感到高兴"）和胆怯（例如，"我发现很难对人发火"）。对每个项目的回答均采用李克特 5 点量表评分，从 1 分（非常不像 me)\mathrm{me}) 到 5 分（非常像我）。评分范围在 15 到 75 分之间，分数越高，人际敏感度越高。原始量表的 Cronbach's alpha\alpha 为 0.74 [1]。在本研究中，IPSM-CS 的 Cronbach's alpha\alpha 为 0.90。
Problematic internet use 有问题的互联网使用
Problematic Internet use was measured using the 6-item short form of the Problematic Internet Use Questionnaire (PIUQ-SF-6) [45]. The original version was developed by Demetrovics et al. and has demonstrated appropriate validity and reliability [45]. The Chinese version of the scale was translated by Koronczai et al. [46], with a Cronbach’s alpha\alpha of 0.84 . PIUQ-SF- 6 was divided into three dimensions: obsession (e.g., “How often does it happen to you that you feel depressed, moody, or nervous when you are not on the Internet and these feelings stop once you are back online?”), neglect (e.g., “How often do people in your life complain about spending too much time online?”), and control disorder (e.g., “How often does it happen to you that you wish to decrease the amount of time spent online but you do not succeed?”). Responses to each item were assessed on a 5-point Likert scale ranging from 1 (never) to 5 (almost). The range of possible scores is between 6 and 30, with a higher score indicating increased problematic internet use. In this study, Cronbach’s alpha\alpha for the PIUQ-SF-6 was 0.92 . 有问题的互联网使用情况使用有问题的互联网使用情况问卷（PIUQ-SF-6）的 6 个项目简表[45]进行测量。该问卷的原始版本由 Demetrovics 等人编制，已证明具有适当的效度和信度[45]。中文版量表由 Koronczai 等人翻译[46]，Cronbach's alpha\alpha 为 0.84。PIUQ-SF- 6 分为三个维度：强迫症（例如，"当您不上网时，您会经常感到沮丧、情绪低落或紧张，而一旦您重新上网，这些感觉就会消失？"）、忽视症（例如，"您生活中的其他人会经常抱怨您上网时间过长吗？"）和控制障碍症（例如，"您会经常希望减少上网时间但却没有成功吗？）对每个项目的回答都采用 5 点李克特量表进行评估，从 1 分（从不）到 5 分（几乎）不等。可能的得分范围在 6 到 30 分之间，得分越高，说明使用互联网的问题越多。在本研究中，PIUQ-SF-6 的 Cronbach's alpha\alpha 为 0.92。
Bedtime procrastination 睡前拖延症
The 9-item Bedtime Procrastination Scale (BPS) developed by Kroese et al. [17] was used to assess bedtime procrastination. The Chinese version of the scale was translated by Ma et al. [28] An example item was “I go to bed later than I had intended.” Items were scored on a 5 -point Likert scale ranging from 1 (never) to 5 (always). The second, third, seventh, and ninth items were scored in reverse (e.g., "I can easily stop with my activities when 由 Kroese 等人[17] 编制的睡前拖延量表（BPS）共有 9 个项目，用于评估睡前拖延。该量表的中文版由 Ma 等人翻译[28] 。项目采用李克特五点量表计分，从 1 分（从不）到 5 分（总是）不等。第二、第三、第七和第九个项目的得分是反向的（例如，"我可以很容易地在下列情况下停止活动
Table 1 Demographic characteristics of the participants 表 1 参与者的人口统计学特征
( N=737N=737 )
Note: SD means standard deviation 注：SD 指标准偏差
it is time to go to bed"). The range of possible scores is between 9 and 45. Higher scores reflected a higher bedtime procrastination degree. The Cronbach’s alpha\alpha of the original scale was 0.92 [17] and the Chinese version of the scale was 0.91 [28]. In this study, Cronbach’s alpha\alpha for the BPS was 0.77. 该睡觉了"）。可能的得分范围在 9 到 45 分之间。分值越高，上床拖延的程度越严重。原量表的 Cronbach's alpha\alpha 为 0.92 [17]，中文版量表的 Cronbach's alpha\alpha 为 0.91 [28]。在本研究中，BPS 的 Cronbach's alpha\alpha 为 0.77。
Statistical analysis 统计分析
All statistical analyses were conducted by IBM SPSS 25.0 and Amos 28.0 (IBM Corp., Armonk, NY, USA). Twosided p < 0.05p<0.05 was considered statistically significant. 所有统计分析均由 IBM SPSS 25.0 和 Amos 28.0（IBM Corp., Armonk, NY, USA）进行。双侧 p < 0.05p<0.05 被认为具有统计学意义。
First, a Harman single-factor test was performed to diagnose the common method bias [47]. Second, the normal distribution was tested by the Kolmogorov-Smirnov test and QQ-plot. All continuous variables followed an approximately normal distribution. Descriptive statistics were calculated using means, standard deviations (SD), frequencies, and percentages. Third, Pearson correlation analysis was used to evaluate the correlation between four variables: loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity. Finally, we used AMOS software for SEM analyses to examine the mediating role of problematic internet use and bedtime procrastination between loneliness and interpersonal sensitivity. The model was adjusted and fitted using the maximum likelihood ratio method. Bootstrap tests (sampling was repeated 5,000 times) were conducted to assess the significance of the mediating effect with a 95% confidence interval (CI) not including 0. The models’ goodness of fit was evaluated using the following criteria: minimum discrepancy function based on Chi-squared divided by degrees of freedom (CMIN/DF) (❤️ good, <5 acceptable), comparative fit index (CFI) >= 0.90\geqslant 0.90, Tucker-Lewis index (TLI) >= 0.90\geqslant 0.90, goodness of fit index (GFI) >= 0.90\geqslant 0.90 and root mean square error of approximation (RMSEA) <= 0.08\leqslant 0.08, standardized root mean square residual (SRMR): <= 0.06\leqslant 0.06 [48, 49]. 首先，进行了哈曼单因素检验，以诊断常见方法偏差[47]。其次，通过 Kolmogorov-Smirnov 检验和 QQ 图检验正态分布。所有连续变量均呈近似正态分布。使用均值、标准差（SD）、频率和百分比计算描述性统计。第三，我们使用皮尔逊相关分析来评估四个变量之间的相关性：孤独感、有问题的互联网使用、睡前拖延症和人际关系敏感性。最后，我们使用 AMOS 软件进行 SEM 分析，研究问题性上网和睡前拖延在孤独感和人际关系敏感性之间的中介作用。模型采用最大似然比法进行调整和拟合。进行了 Bootstrap 检验（重复采样 5000 次），以评估中介效应的显著性，95% 置信区间（CI）不包括 0。模型的拟合优度采用以下标准进行评估：基于奇平方除以自由度（CMIN/DF）的最小差异函数（❤️ 良好，<5 可接受）、比较拟合指数（CFI） >= 0.90\geqslant 0.90 、塔克-刘易斯指数（TLI） >= 0.90\geqslant 0.90 、拟合优度指数（GFI） >= 0.90\geqslant 0.90 和均方根近似误差（RMSEA） <= 0.08\leqslant 0.08 、标准化均方根残差（SRMR）： <= 0.06\leqslant 0.06 [48, 49]。
Results 成果
Common method bias test 常用方法偏差测试
The results of the Harman single-factor test showed that there were six factors with eigenvalues exceeding 1. The first factor accounted for 27.11%27.11 \% of the total variance, falling below the critical standard of 40%40 \%, indicating that there is no serious common method bias in this study [47]. 哈曼单因素检验结果显示，有六个因素的特征值超过 1。第一个因子占总方差的 27.11%27.11 \% ，低于临界标准 40%40 \% ，表明本研究不存在严重的普通方法偏差[47]。
Demographic characteristics of participants 参与者的人口特征
Of the 737 participants, the mean age was 20.05 years old ( SD=1.38\mathrm{SD}=1.38 ). Most of the participants were female ( 80.87%80.87 \% ), third-year level ( 28.90%28.90 \% ), Han ethnicity ( 95.93%95.93 \% ), agricultural hukou ( 71.91%71.91 \% ), and lived in rural (53.32%) (Table 1). 在 737 名参与者中，平均年龄为 20.05 岁（ SD=1.38\mathrm{SD}=1.38 ）。大多数参与者为女性（ 80.87%80.87 \% ）、三年级学生（ 28.90%28.90 \% ）、汉族（ 95.93%95.93 \% ）、农业户口（ 71.91%71.91 \% ）和农村居民（53.32%）（表 1）。
Descriptive statistics and Pearson's correlation analysis 描述性统计和皮尔逊相关分析
The descriptive statistics of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity were displayed in Table 2. The nursing undergraduates’ interpersonal sensitivity scores were 43.99+-8.5443.99 \pm 8.54. Among these dimensions of interpersonal sensitivity, the score of the need for approval dimension was the highest (10.38+-2.14)(10.38 \pm 2.14), while the score of the fragile inner-self dimension was the lowest ( 7.31+-2.327.31 \pm 2.32 ). Additionally, the average scores of loneliness, problematic internet use, and bedtime procrastination were 5.22+-1.54,14.78+-4.575.22 \pm 1.54,14.78 \pm 4.57, and 27.31+-6.1227.31 \pm 6.12, respectively. These results denoted that most nursing undergraduates had moderate interpersonal sensitivity, loneliness, problematic internet use, and bedtime procrastination (scores close to the intermediate value of their respective scales). 表 2 列出了孤独感、问题性网络使用、睡前拖延症和人际关系敏感度的描述性统计。护理专业本科生的人际关系敏感度得分为 43.99+-8.5443.99 \pm 8.54 。在这些人际关系敏感维度中，需要认同维度的得分最高 (10.38+-2.14)(10.38 \pm 2.14) ，而内心脆弱维度的得分最低（ 7.31+-2.327.31 \pm 2.32 ）。此外，孤独感、网络使用问题和睡前拖延症的平均得分分别为 5.22+-1.54,14.78+-4.575.22 \pm 1.54,14.78 \pm 4.57 和 27.31+-6.1227.31 \pm 6.12 。这些结果表明，大多数护理专业本科生的人际敏感度、孤独感、上网问题和就寝拖延症处于中等水平（得分接近各自量表的中间值）。
The correlation analysis showed that interpersonal sensitivity was positively correlated with loneliness ( r=0.45r=0.45, P < 0.01P<0.01 ), problematic internet use ( r=0.35,P < 0.01r=0.35, P<0.01 ), and bedtime procrastination ( r=0.35,P < 0.01r=0.35, P<0.01 ). This suggested that individuals with higher levels of interpersonal sensitivity were more likely to experience increased loneliness, engage in problematic internet use, and exhibit bedtime procrastination. Loneliness was positively correlated with problematic internet use ( r=0.36,P < 0.01r=0.36, P<0.01 ) and bedtime procrastination ( r=0.38,P < 0.01r=0.38, P<0.01 ). This indicated that individuals experiencing higher levels of loneliness were more likely to engage in problematic internet use and delay their bedtime. Problematic internet use was positively correlated with bedtime procrastination ( r=0.45,P < 0.01r=0.45, P<0.01 ), suggesting that those who exhibited problematic internet use were also more prone to delaying their bedtime (Table 3). 相关分析表明，人际关系敏感度与孤独感（ r=0.45r=0.45 ， P < 0.01P<0.01 ）、问题性上网（ r=0.35,P < 0.01r=0.35, P<0.01 ）和就寝拖延（ r=0.35,P < 0.01r=0.35, P<0.01 ）呈正相关。这表明，人际关系敏感度较高的人更有可能体验到更多的孤独感、有问题地使用互联网和表现出睡前拖延症。孤独感与问题性上网（ r=0.36,P < 0.01r=0.36, P<0.01 ）和就寝拖延（ r=0.38,P < 0.01r=0.38, P<0.01 ）呈正相关。这表明，孤独感较强的人更有可能使用问题互联网和推迟就寝时间。有问题地使用互联网与睡前拖延（ r=0.45,P < 0.01r=0.45, P<0.01 ）呈正相关，这表明有问题地使用互联网的人也更容易推迟就寝时间（表 3）。
Structural model and mediating effect analysis 结构模型和中介效应分析
The structural equation model was initially tested, and the correlations between error terms for the dimensions 对结构方程模型进行了初步检验，各维度误差项之间的相关性为
of interpersonal sensitivity were added according to modification indices. The corrected model demonstrated acceptable goodness-of-fit indices: CMIN = 112.382, DF=24,quadCMIN//DF=4.68,quadCFI=0.97,quadTLI=0.95\mathrm{DF}=24, \quad \mathrm{CMIN} / \mathrm{DF}=4.68, \quad \mathrm{CFI}=0.97, \quad \mathrm{TLI}=0.95, GFI=0.97\mathrm{GFI}=0.97, RMSEA =0.07=0.07, and SRMR=0.03\mathrm{SRMR}=0.03. The standardized path coefficients of the final model are shown in Fig. 2. 根据修正指数，增加了人际敏感度。修正后的模型显示了可接受的拟合优度指数：CMIN = 112.382、 DF=24,quadCMIN//DF=4.68,quadCFI=0.97,quadTLI=0.95\mathrm{DF}=24, \quad \mathrm{CMIN} / \mathrm{DF}=4.68, \quad \mathrm{CFI}=0.97, \quad \mathrm{TLI}=0.95 、 GFI=0.97\mathrm{GFI}=0.97 、RMSEA =0.07=0.07 和 SRMR=0.03\mathrm{SRMR}=0.03 。最终模型的标准化路径系数如图 2 所示。
Table 4 showed the results of the mediation effect analysis. First, loneliness could be significantly and positively related to the problematic internet use of nursing undergraduates (beta=0.38,P < 0.001(\beta=0.38, P<0.001, Model 1). Second, loneliness ( beta=0.24,P < 0.001\beta=0.24, P<0.001 ) and problematic internet use ( beta=0.39,P < 0.001\beta=0.39, P<0.001 ) could be significantly and positively related to the bedtime procrastination of nursing undergraduates (Model 2). Third, loneliness ( beta=0.44,P < 0.001\beta=0.44, P<0.001 ), problematic internet use ( beta=0.26,P < 0.001\beta=0.26, P<0.001 ), and bedtime procrastination ( beta=0.11,P < 0.01\beta=0.11, P<0.01 ) could be significantly and positively related to the interpersonal sensitivity of nursing undergraduates (Model 3). 表 4 显示了中介效应分析的结果。首先，孤独感与护理本科生的网络使用问题（ (beta=0.38,P < 0.001(\beta=0.38, P<0.001 ，模型 1）显著正相关。其次，孤独感（ beta=0.24,P < 0.001\beta=0.24, P<0.001 ）和问题性网络使用（ beta=0.39,P < 0.001\beta=0.39, P<0.001 ）与护理本科生睡前拖延有显著正相关（模型 2）。第三，孤独感（ beta=0.44,P < 0.001\beta=0.44, P<0.001 ）、问题性网络使用（ beta=0.26,P < 0.001\beta=0.26, P<0.001 ）和就寝拖延（ beta=0.11,P < 0.01\beta=0.11, P<0.01 ）与护理本科生的人际敏感性呈显著正相关（模型 3）。
Table 5 showed the total, direct, and indirect effects of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity. The mediating effect of problematic internet use and bedtime procrastination was significant, and the total indirect effect value was 0.14 , accounting for 24.14%24.14 \% of the total effect (0.58). Specifically, the mediating effect was composed of indirect effects generated through three pathways. First, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through problematic internet use was 0.10 (Bootstrap 95% CI: 0.06 to 0.15). Second, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through bedtime procrastination was 0.03 (Bootstrap 95% CI: 0.01 to 0.05). Third, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through problematic internet use and bedtime procrastination was 0.02 (Bootstrap 95% CI: 0.01 to 0.03 ). 表 5 显示了孤独感、问题性上网和睡前拖延症对人际敏感度的总效应、直接效应和间接效应。问题性上网和睡前拖延症的中介效应显著，间接效应总值为 0.14，占总效应（0.58）的 24.14%24.14 \% 。具体来说，中介效应由三个途径产生的间接效应组成。首先，孤独感通过使用问题互联网对人际敏感性产生间接影响的路径系数为 0.10（Bootstrap 95% CI：0.06 至 0.15）。其次，孤独感通过睡前拖延对人际敏感性的间接影响的路径系数为 0.03（Bootstrap 95% CI：0.01 至 0.05）。第三，孤独感通过有问题的互联网使用和睡前拖延对人际敏感性的间接影响的路径系数为 0.02（Bootstrap 95% CI：0.01 至 0.03）。
Table 2 Descriptive statistics of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity among the participants ( N=737N=737 ) 表 2 参与者的孤独感、问题性上网、睡前拖延症和人际关系敏感度的描述性统计 ( N=737N=737 )
Note: SD means standard deviation 注：SD 指标准偏差
Table 3 The correlation between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity (N=737)(N=737) 表 3 孤独感、问题性上网、睡前拖延症和人际关系敏感度之间的相关性 (N=737)(N=737)
This study explored the relationship between loneliness and interpersonal sensitivity among nursing undergraduates, with a focus on the mediating roles of problematic internet use and bedtime procrastination. The study revealed three important findings. First, loneliness was significantly positively related to interpersonal sensitivity. Second, problematic internet use and bedtime procrastination emerged as pivotal mediating factors between loneliness and interpersonal sensitivity. Finally, loneliness, through the chain mediation of problematic internet use and bedtime procrastination, indirectly affected the interpersonal sensitivity of nursing undergraduates. 本研究探讨了护理专业本科生的孤独感与人际关系敏感度之间的关系，重点关注了问题互联网使用和睡前拖延症的中介作用。研究揭示了三个重要发现。首先，孤独感与人际敏感度呈显著正相关。其次，有问题的网络使用和睡前拖延症成为孤独感和人际敏感度之间关键的中介因素。最后，孤独感通过问题性上网和睡前拖延的连锁中介作用，间接影响了护理专业本科生的人际敏感性。
In this study, we discovered a significant positive relationship between loneliness and interpersonal sensitivity among nursing undergraduates. When they have higher feelings of loneliness, they may have higher interpersonal sensitivity. Therefore, the H1 hypothesis was supported. This result was consistent with a previous study on Chinese gay men [5], which similarly found an association between loneliness and interpersonal sensitivity. The stability of the positive relationship between loneliness and interpersonal sensitivity may be attributed to their inherent nature. Individuals with heightened interpersonal sensitivity often tend to over-interpret others’ attitudes and reactions [1]. Meanwhile, individuals experiencing high levels of loneliness may develop a tendency towards negative interpretations of social interactions, leading to increased sensitivity and vigilance towards others’ evaluations and behaviors [50, 51]. In this study, the relationship between loneliness and interpersonal sensitivity observed in nursing undergraduates can be elucidated through the Choking Under Social Pressure theory [8], which suggests that heightened loneliness in social contexts may restrict interpersonal abilities and lead to adverse social consequences. Nursing undergraduates may engage in clinical practice, academic tasks, and teamwork in their professional training, necessitating the establishment of close relationships with peers, teachers, and patients [35]. However, the changes caused by the COVID-19 pandemic have led to social restrictions, increased interpersonal distance in clinical practice, and apprehension regarding future career uncertainties, which increases the loneliness of nursing undergraduates [33]. Individuals experiencing loneliness manifest a hypervigilant response to negative social stimuli and may be more inclined to interpret ambiguous social cues in a pessimistic manner, which may increase interpersonal sensitivity [50,51]. Our study emphasizes the importance of addressing loneliness within the context of nursing education. Educational institutions and clinical mentors should not only focus on cultivating professional skills but also address the issue of loneliness among nursing undergraduates, thereby fostering more 在本研究中，我们发现护理专业本科生的孤独感与人际敏感度之间存在显著的正相关关系。当他们有更高的孤独感时，他们可能会有更高的人际敏感度。因此，H1 假设得到支持。这一结果与之前对中国男同性恋者的研究[5]一致，后者同样发现孤独感与人际敏感度之间存在关联。孤独感与人际敏感度之间正相关关系的稳定性可能归因于它们的内在性质。人际敏感度高的人往往倾向于过度解读他人的态度和反应[1]。同时，经历过高度孤独的个体可能会对社会交往产生负面解释的倾向，从而导致对他人的评价和行为更加敏感和警惕[50, 51]。在本研究中，通过社会压力下的窒息理论（Choking Under Social Pressure theory）[8]，可以阐明在护理本科生中观察到的孤独感与人际敏感性之间的关系。护理本科生在专业训练中可能会参与临床实践、学术任务和团队合作，有必要与同学、老师和病人建立密切的关系[35]。然而，COVID-19 大流行所引起的变化导致社交受到限制，临床实践中人际距离增加，以及对未来职业不确定性的担忧，这增加了护理本科生的孤独感[33]。 经历过孤独的个体会对消极的社会刺激表现出过度警惕的反应，可能更倾向于以悲观的方式解释模糊的社会线索，这可能会增加人际关系的敏感性[50,51]。我们的研究强调了在护理教育中解决孤独问题的重要性。教育机构和临床导师不仅应注重培养学生的专业技能，还应关注护理专业本科生的孤独感问题，从而培养更多的护理专业本科生。
Fig. 2 Final model for the effects of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity. Note: ^(****)P < 0.01{ }^{* *} P<0.01, ^(******)P < 0.001{ }^{* * *} P<0.001 (two-tailed) 图 2 孤独、有问题的互联网使用和睡前拖延对人际敏感度影响的最终模型。注： ^(****)P < 0.01{ }^{* *} P<0.01 ， ^(******)P < 0.001{ }^{* * *} P<0.001 （双尾）
Table 4 Regression analysis of the relationship between variables in the mediation effect model 表 4 中介效应模型中变量间关系的回归分析
Dependent variable 因变量
Independent variable 自变量
R^(2)R^{2}
beta\boldsymbol{\beta}
SE
tt
Model 1 模型 1
Problematic internet use 有问题的互联网使用
Loneliness 孤独
0.14
0.38
0.04
10.13***
Model 2 模型 2
Bedtime procrastination 睡前拖延症
Problematic internet use 有问题的互联网使用
0.28
0.39
0.15
10.27***
Loneliness 孤独
0.24
0.14
6.79***
Model 3 模型 3
Interpersonal sensitivity 人际关系敏感性
Bedtime procrastination 睡前拖延症
0.43
0.11
0.01
3.17**
Problematic internet use 有问题的互联网使用
0.26
0.05
6.57***
Loneliness 孤独
0.44
0.05
11.84***
Dependent variable Independent variable R^(2) beta SE t
Model 1
Problematic internet use Loneliness 0.14 0.38 0.04 10.13***
Model 2
Bedtime procrastination Problematic internet use 0.28 0.39 0.15 10.27***
Loneliness 0.24 0.14 6.79***
Model 3
Interpersonal sensitivity Bedtime procrastination 0.43 0.11 0.01 3.17**
Problematic internet use 0.26 0.05 6.57***
Loneliness 0.44 0.05 11.84***| Dependent variable | Independent variable | $R^{2}$ | $\boldsymbol{\beta}$ | SE | $t$ |
| :--- | :--- | :--- | :--- | :--- | :--- |
| Model 1 | | | | | |
| Problematic internet use | Loneliness | 0.14 | 0.38 | 0.04 | 10.13*** |
| Model 2 | | | | | |
| Bedtime procrastination | Problematic internet use | 0.28 | 0.39 | 0.15 | 10.27*** |
| | Loneliness | | 0.24 | 0.14 | 6.79*** |
| Model 3 | | | | | |
| Interpersonal sensitivity | Bedtime procrastination | 0.43 | 0.11 | 0.01 | 3.17** |
| | Problematic internet use | | 0.26 | 0.05 | 6.57*** |
| | Loneliness | | 0.44 | 0.05 | 11.84*** |
Loneliness rarr\rightarrow Problematic internet use rarr\rightarrow Bedtime procrastination rarr\rightarrow Interpersonal sensitivity 孤独感 rarr\rightarrow 有问题地使用互联网 rarr\rightarrow 睡前拖延症 rarr\rightarrow 人际关系敏感性
0.02
0.01
0.01 to 0.03 0.01 至 0.03
Effect types Paths Effect Bootstrap SE Bootstrap 95% CI
Total effect Loneliness rarr Interpersonal sensitivity 0.58 0.03 0.52 to 0.64
Direct effect Loneliness rarr Interpersonal sensitivity 0.44 0.04 0.36 to 0.50
Indirect effects Total indirect effect 0.14 0.02 0.10 to 0.19
Loneliness rarr Problematic internet use rarr Interpersonal sensitivity 0.10 0.02 0.06 to 0.15
Loneliness rarr Bedtime procrastination rarr Interpersonal sensitivity 0.03 0.01 0.01 to 0.05
Loneliness rarr Problematic internet use rarr Bedtime procrastination rarr Interpersonal sensitivity 0.02 0.01 0.01 to 0.03| Effect types | Paths | Effect | Bootstrap SE | Bootstrap 95% CI |
| :--- | :--- | :--- | :--- | :--- |
| Total effect | Loneliness $\rightarrow$ Interpersonal sensitivity | 0.58 | 0.03 | 0.52 to 0.64 |
| Direct effect | Loneliness $\rightarrow$ Interpersonal sensitivity | 0.44 | 0.04 | 0.36 to 0.50 |
| Indirect effects | Total indirect effect | 0.14 | 0.02 | 0.10 to 0.19 |
| | Loneliness $\rightarrow$ Problematic internet use $\rightarrow$ Interpersonal sensitivity | 0.10 | 0.02 | 0.06 to 0.15 |
| | Loneliness $\rightarrow$ Bedtime procrastination $\rightarrow$ Interpersonal sensitivity | 0.03 | 0.01 | 0.01 to 0.05 |
| | Loneliness $\rightarrow$ Problematic internet use $\rightarrow$ Bedtime procrastination $\rightarrow$ Interpersonal sensitivity | 0.02 | 0.01 | 0.01 to 0.03 |
adaptable healthcare professionals. Offering a supportive social environment, regular psychological counseling, and fostering teamwork among peers may aid in the early identification and mitigation of loneliness experienced by nursing undergraduates, thus improving their interpersonal sensitivity and preventing subsequent cascading psychological issues. 适应能力强的医护人员。为护理专业本科生提供支持性的社交环境、定期进行心理辅导、培养同学间的团队合作精神，可以帮助他们及早发现和缓解孤独感，从而提高他们的人际敏感度，防止随后出现一连串的心理问题。
The problematic internet use played a mediating role in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Loneliness may make them more prone to have problematic internet use problems, further increasing interpersonal sensitivity and thus confirming the H2 hypothesis. This was consistent with previous studies that underscored 问题性网络使用在护理本科生的孤独感与人际敏感度之间的关系中起着中介作用。孤独感可能使他们更容易出现问题性网络使用问题，从而进一步提高人际敏感度，从而证实了 H2 假设。这与以往研究强调的
the relationship between problematic internet use and mental health issues [52]. Meanwhile, consistent with the Compensatory Internet Use theory [14], individuals experiencing loneliness may turn to the internet as a means of alleviating their negative emotions, thereby resulting in problematic internet use. A study of 559 Turkish university students indicated that loneliness was the most important predictor of problematic internet use [53]. Nursing undergraduates may experience loneliness and resort to the Internet as a coping mechanism [54]. Individuals with problematic internet use tendencies are more likely to rely on feedback from others in virtual social interactions, displaying higher levels of interpersonal sensitivity and destroying their social relationships [55]. Furthermore, problematic internet use may lead nursing undergraduates to experience more negative emotions in virtual socialization, such as criticism or indifferent feedback on social media [56]. These negative experiences may contribute to nursing undergraduates developing more complex and sensitive attitudes toward social relationships, manifesting as higher levels of interpersonal sensitivity [39]. These findings highlight the importance of addressing both loneliness and problematic internet use within nursing education and mental health interventions. Promoting awareness of healthy internet use, fostering resilience against the adverse effects of digital dependency, and advocating for a balanced approach to virtual and face-to-face social interactions are critical for improving the interpersonal sensitivity of nursing undergraduates. By integrating psychological support and education on healthy online behaviors into nursing curricula, educators and healthcare professionals can empower students to cultivate robust interpersonal skills essential for their professional development and overall well-being. 问题性网络使用与心理健康问题之间的关系[52]。同时，与补偿性网络使用理论[14]一致，经历孤独的人可能会将网络作为缓解负面情绪的一种手段，从而导致问题性网络使用。一项针对 559 名土耳其大学生的研究表明，孤独感是预测问题性网络使用的最重要因素[53]。护理专业的本科生可能会感到孤独，并将互联网作为一种应对机制[54]。有问题性网络使用倾向的人更有可能在虚拟社交互动中依赖他人的反馈，表现出更高的人际敏感性，并破坏他们的社会关系[55]。此外，问题性网络使用可能导致护理专业本科生在虚拟社交中体验到更多负面情绪，如社交媒体上的批评或冷漠反馈[56]。这些负面体验可能会促使护理专业本科生对社会关系形成更复杂、更敏感的态度，表现为更高水平的人际敏感性[39]。这些发现强调了在护理教育和心理健康干预中解决孤独感和有问题的网络使用的重要性。提高对健康使用互联网的认识，培养抵御数字依赖不良影响的能力，倡导平衡对待虚拟和面对面社交互动的方法，对于提高护理专业本科生的人际敏感度至关重要。 通过将心理支持和健康上网行为教育纳入护理课程，教育工作者和医疗保健专业人员可以增强学生的能力，培养对其专业发展和整体健康至关重要的强大人际交往技能。
The bedtime procrastination played a mediating role in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Loneliness may increase the likelihood of them engaging in bedtime procrastination, further amplifying interpersonal sensitivity. Thus, the H3 hypothesis was supported. Additionally, these findings are consistent with previous research indicating the significant mediating role of sleep in the relationship between loneliness and psychological wellbeing [57]. Loneliness, as a negative emotional state, may disrupt regulatory processes associated with self-regulation and impulse control, making individuals more prone to engaging in behaviors that offer immediate gratification but compromise long-term well-being, ultimately leading to bedtime procrastination [19, 58]. A study investigating 1,550 Chinese undergraduates showed that, in addition to sleep duration, bedtime procrastination was also strongly associated with other dimensions of sleep quality (e.g., daytime functioning) [59]. Studies 睡前拖延症在护理专业本科生的孤独感与人际敏感度之间的关系中起着中介作用。孤独感可能会增加他们睡前拖延的可能性，从而进一步放大人际敏感性。因此，H3 假设得到了支持。此外，这些发现与之前的研究一致，表明睡眠在孤独感与心理健康的关系中起着重要的中介作用[57]。孤独作为一种消极的情绪状态，可能会扰乱与自我调节和冲动控制相关的调节过程，使人更容易参与那些能带来即时满足感但却有损长期幸福感的行为，最终导致睡前拖延症[19, 58]。一项对 1,550 名中国大学生进行的研究表明，除了睡眠时间外，睡前拖延症还与睡眠质量的其他方面（如日间功能）密切相关[59]。研究
have found an association between bedtime procrastination and individuals’ emotional self-regulation abilities, suggesting that those who engage in bedtime procrastination may encounter heightened negative emotions [60]. The poor sleep quality, fatigue, and negative emotions resulting from bedtime procrastination may render nursing undergraduates more susceptible to the influence of others’ emotions, potentially leading to exaggerated reactions to others’ emotional expressions and consequently exacerbating interpersonal sensitivity [20,21,60]. These findings hold important implications for interventions aimed at improving the interpersonal sensitivity of nursing undergraduates. Given the observed mediation of bedtime procrastination in the relationship between loneliness and interpersonal sensitivity, targeted strategies focusing on sleep management and healthy sleep habits are warranted. Offering health education, recommending sound sleep habits, and providing coping strategies for regulating psychological discomfort may all contribute to improving the sleep behavior of nursing undergraduates, thereby enhancing overall mental well-being. 有研究发现，睡前拖延与个人的情绪自我调节能力有关，这表明睡前拖延的人可能会遇到更强的负面情绪[60]。睡前拖延导致的睡眠质量差、疲劳和负面情绪可能会使护理专业大学生更容易受到他人情绪的影响，从而可能导致对他人情绪表达的夸张反应，进而加剧人际敏感性[20,21,60]。这些发现对旨在改善护理专业本科生人际敏感性的干预措施具有重要意义。鉴于所观察到的睡前拖延在孤独感与人际关系敏感度之间的中介作用，有必要采取有针对性的策略，重点关注睡眠管理和健康的睡眠习惯。提供健康教育、推荐良好的睡眠习惯、提供调节心理不适的应对策略，这些都有助于改善护理专业本科生的睡眠行为，从而提高整体心理健康水平。
We found that loneliness indirectly affected nursing undergraduates’ interpersonal sensitivity through the chain mediation of problematic internet use and bedtime procrastination. Therefore, the H4 hypothesis was supported. This study provides empirical evidence for the Temporal Motivation Theory [26]. During the pandemic, as feelings of loneliness intensified, nursing undergraduates may have been inclined to alleviate negative emotions and loneliness through the use of the internet to attain momentary emotional satisfaction [61]. However, excessive use of the internet may also deepen their reliance on virtual social interactions and lead to problematic internet use [15]. Studies indicated that the light emitted by smartphones may hinder the production of melatonin, consequently delaying the onset of sleep [62, 63]. Simultaneously, smartphones offer various applications, facilitating easy immersion and a loss of temporal awareness [64]. Engaging in frequent nighttime internet browsing and similar activities may prolong the wakefulness time of nursing undergraduates who are immersed in internet surfing, thereby impacting their regular sleep patterns [65]. Furthermore, bedtime procrastination exacerbates the physical fatigue and anxiety levels of nursing undergraduates, potentially rendering them more susceptible to the influence of others and exhibiting heightened levels of interpersonal sensitivity [64]. The findings of this chained mediation model underscore the importance of not only independently addressing the impact of loneliness in the development of psychological health interventions but also considering the integrated effects of mediating factors. Educational and practical interventions should prioritize guidance on healthy 我们发现，孤独感通过问题性网络使用和就寝拖延的连锁中介间接影响了护理本科生的人际敏感性。因此，H4 假设得到支持。本研究为时间动机理论[26]提供了实证证据。在大流行病期间，由于孤独感加剧，护理本科生可能倾向于通过使用互联网来缓解负面情绪和孤独感，以获得一时的情感满足[61]。然而，过度使用网络也可能加深他们对虚拟社交互动的依赖，导致网络使用问题[15]。研究表明，智能手机发出的光线可能会阻碍褪黑激素的分泌，从而推迟睡眠的开始 [62, 63]。同时，智能手机提供了各种应用，便于人们沉浸其中，失去时间意识[64]。频繁的夜间上网和类似活动可能会延长沉浸于上网的护理专业大学生的觉醒时间，从而影响他们的正常睡眠模式[65]。此外，睡前拖延会加剧护理本科生的身体疲劳和焦虑水平，可能使他们更容易受到他人的影响，表现出更高的人际敏感性[64]。这一连锁中介模型的研究结果强调，在制定心理健康干预措施时，不仅要独立解决孤独的影响，还要考虑中介因素的综合影响。教育和实际干预措施应优先指导健康的
internet usage and promote beneficial sleep behaviors to effectively mitigate the impact of loneliness on interpersonal sensitivity among nursing undergraduates. By addressing these interconnected factors, institutions can better support students’ mental health and overall well-being. 使用互联网和促进有益的睡眠行为，以有效减轻孤独感对护理专业本科生人际敏感度的影响。通过解决这些相互关联的因素，院校可以更好地支持学生的心理健康和整体福祉。
Also, inspired by the findings in this study, nursing education institutions should prioritize early identification and intervention for loneliness in clinical practice. Developing tailored interventions that integrate education on healthy internet use and sleep hygiene into the curriculum can effectively alleviate loneliness among nursing undergraduates and improve their interpersonal sensitivity. Future research should continue to investigate targeted intervention measures and their efficacy in addressing these issues within nursing education. By prioritizing these initiatives, institutions can proactively support the mental well-being of nursing undergraduates and enhance their overall educational experience. 同时，受本研究结果的启发，护理教育机构应在临床实践中优先考虑孤独感的早期识别和干预。制定有针对性的干预措施，将健康上网和睡眠卫生教育纳入课程，可以有效缓解护理本科生的孤独感，提高他们的人际敏感度。未来的研究应继续调查有针对性的干预措施及其在护理教育中解决这些问题的效果。通过优先考虑这些措施，院校可以积极主动地支持护理本科生的心理健康，提高他们的整体教育体验。
Limitations 局限性
There were several limitations in this study. First, the study was confined to nursing undergraduates from one university in China, potentially restricting the generalizability of our findings to other regions, cultures, and educational contexts. To enhance the external validity of the study, future research could consider expanding the sample to encompass participants from diverse geographical and cultural backgrounds. Second, our study relied on self-reported data, introducing the possibility of social desirability and recall biases. Future research might incorporate objective measurement tools to validate the accuracy of self-reported data. Third, due to the cross-sectional design of our study, the causation between variables cannot be determined. To gain a more comprehensive understanding of the relationships between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity, future research could employ a longitudinal design, tracking participants over time to provide clearer insights into the causal relationships among these variables. Finally, while our study focused on the effect of loneliness on interpersonal sensitivity, we recognize the possibility that other relationships between these variables may exist. Future research could further explore their relationships to provide a more nuanced understanding of the complex interplay between these factors. 本研究存在一些局限性。首先，研究对象仅限于中国一所大学的护理专业本科生，这可能会限制我们的研究结果在其他地区、文化和教育背景下的推广性。为了提高研究的外部有效性，未来的研究可以考虑扩大样本范围，以涵盖来自不同地域和文化背景的参与者。其次，我们的研究依赖于自我报告的数据，因此可能存在社会期望和回忆偏差。未来的研究可能会采用客观的测量工具来验证自我报告数据的准确性。第三，由于我们的研究是横断面设计，因此无法确定变量之间的因果关系。为了更全面地了解孤独感、有问题的网络使用、睡前拖延症和人际关系敏感度之间的关系，未来的研究可以采用纵向设计，对参与者进行长期跟踪，以便更清楚地了解这些变量之间的因果关系。最后，虽然我们的研究侧重于孤独感对人际敏感度的影响，但我们认识到这些变量之间可能还存在其他关系。未来的研究可以进一步探讨它们之间的关系，以便更细致地了解这些因素之间复杂的相互作用。
Conclusion 结论
In conclusion, our study found a significant chain mediation role of problematic internet use and bedtime procrastination in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Strategies such as fostering healthy internet use 总之，我们的研究发现，在护理专业本科生的孤独感与人际关系敏感性之间的关系中，有问题的网络使用和睡前拖延具有重要的连锁中介作用。促进健康使用互联网等策略
and promoting effective sleep management can improve interpersonal sensitivity among nursing undergraduates. The findings contribute to the theoretical understanding of these associations and offer practical implications for educational institutions and healthcare providers, which can develop targeted interventions to enhance the overall well-being and professional development of nursing students. 和促进有效的睡眠管理可以提高护理专业本科生的人际敏感度。研究结果有助于从理论上理解这些关联，并为教育机构和医疗保健提供者提供了实际意义，他们可以制定有针对性的干预措施，以提高护理专业学生的整体福祉和专业发展。
Acknowledgements 致谢
The authors would like to thank all the participants of the study. 作者在此向所有参与研究的人员表示感谢。
Author contributions 作者供稿
XJS and SZ contributed to the conception and designed study. XJS analyzed, interpreted the data, and drafted the manuscript. YBW and FKC contributed to data collection. SZ acquired resources. XJS, YBW, XW, and KSD contributed to the critical revision of the report. All authors read and approved the final manuscript. XJS 和 SZ 参与了研究的构思和设计。XJS 分析、解释了数据并起草了手稿。YBW 和 FKC 参与了数据收集。SZ 获得了资源。XJS、YBW、XW 和 KSD 对报告进行了重要修改。所有作者阅读并批准了最终手稿。
Funding 资金筹措
This research was supported by grants from the Liaoning province general higher education undergraduate teaching reform research project, 2022 (No. 0480). 本研究得到 2022 年辽宁省普通高等教育本科教学改革研究项目（编号：0480）的资助。
Data availability 数据可用性
The data in this study can be obtained from the corresponding author on reasonable request. 本研究的数据可向通讯作者索取。
Declarations 声明
Ethics approval and consent to participate 伦理批准和参与同意书
This study obtained ethical approval from the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002). Informed consent was obtained from all participants. 本研究获得了华北科技学院冀唐学院伦理审查委员会的伦理批准（JTXY-2022-002）。所有参与者均已知情同意。
Consent for publication 同意出版
Not Applicable. 不适用。
Competing interests 竞争利益
The authors declare no competing interests. 作者声明不存在利益冲突。
Received: 30 January 2024 / Accepted: 3 September 2024 收到：收到：2024 年 1 月 30 日 / 接受：2024 年 9 月 3 日 2024 年 9 月 3 日
Published online: 11 September 2024 在线出版：2024 年 9 月 11 日
References 参考资料
You Z, Liu Y, Tan Q, Xu Y, Zhang L, Andrasik F. Development and validation of the Chinese version of short-form of interpersonal sensitivity measure (IPSM). Commun Ment Health J. 2021;57(2):277-84. You Z，Liu Y，Tan Q，Xu Y，Zhang L，Andrasik F.人际敏感性测量简表（IPSM）中文版的开发与验证.2021;57(2):277-84.
Guo J, Huang X, Zheng A, Chen W, Lei Z, Tang C, et al. The influence of selfesteem and Psychological Flexibility on Medical College Students’ Mental Health: a cross-sectional study. Front Psychiatry. 2022;13:836956. Guo J, Huang X, Zheng A, Chen W, Lei Z, Tang C, et al. 自尊和心理弹性对医学生心理健康的影响：一项横断面研究。Front Psychiatry.2022;13:836956.
Wilhelm K, Boyce P, Brownhill S. The relationship between interpersonal sensitivity, anxiety disorders and major depression. J Affect Disord. 2004;79(1-3):33-41. Wilhelm K、Boyce P、Brownhill S.人际关系敏感性、焦虑症和重度抑郁症之间的关系。J Affect Disord.2004;79(1-3):33-41.
Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: results from two Population-Based studies. Res Aging. 2004;26(6):655-72. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT.在大型调查中测量孤独感的简易量表：两项基于人口的研究结果。Res Aging.2004;26(6):655-72.
Jiang D, Hou Y, Chen X, Wang R, Fu C, Li B, et al. Interpersonal sensitivity and loneliness among Chinese gay men: a cross-sectional survey. Int J Environ Res Public Health. 2019;16(11):2039. Jiang D, Hou Y, Chen X, Wang R, Fu C, Li B, et al. 中国男同性恋者的人际敏感性与孤独感：一项横断面调查。Int J Environ Res Public Health.2019;16(11):2039.
Gallardo LO, Martín-Albo J, Barrasa A. What leads to loneliness? An Integrative Model of Social, Motivational, and emotional approaches in adolescents. J Res Adolescence: Official J Soc Res Adolescence. 2018;28(4):839-57. Gallardo LO, Martín-Albo J, Barrasa A. What leads to loneliness?青少年社交、动机和情感方法的综合模型。J Res Adolescence：Official J Soc Res Adolescence.2018;28(4):839-57.
Zhang BG, Qian XF. Weight self-stigma and engagement among obese students in a physical education class. Front Psychol. 2022;13:1035827. Zhang BG, Qian XF.肥胖学生在体育课上的体重自我污名和参与度。Front Psychol.2022;13:1035827.
Knowles ML, Lucas GM, Baumeister RF, Gardner WL. Choking under social pressure: social monitoring among the lonely. Personal Soc Psychol Bull. 2015:41(6):805-21. Knowles ML, Lucas GM, Baumeister RF, Gardner WL.社会压力下的窒息：孤独者的社会监督。Personal Soc Psychol Bull.2015:41(6):805-21.
Benjamin DG, Gummanur P. Loneliness - Cancer of the mind. Indian J Palliat Care. 2023;29(2):212-6. Benjamin DG, Gummanur P. 孤独--心灵的癌症。Indian J Palliat Care.2023;29(2):212-6.
Aboujaoude E. Problematic internet use: an overview. World Psychiatry: Official J World Psychiatric Association (WPA). 2010;9(2):85-90. Aboujaoude E. 有问题的互联网使用：概述。世界精神病学》：世界精神病学协会官方期刊（WPA）。2010;9(2):85-90.
Huang CL, Wu C, Yang SC. How students view online knowledge: epistemic beliefs, self-regulated learning and academic misconduct. Comput Educ. 2023;200:104796. Huang CL, Wu C, Yang SC.学生如何看待网络知识：认识论信念、自我调节学习与学术不端行为.Comput Educ. 2023;200:104796.
Islam MR, Tushar MI, Tultul PS, Akter R, Sohan M, Anjum R, et al. Problematic internet use and depressive symptoms among the school-going adolescents in Bangladesh during the COVID-19 pandemic: a cross-sectional study findings. Health Sci Rep. 2023;6(1):e1008. Islam MR, Tushar MI, Tultul PS, Akter R, Sohan M, Anjum R, et al. COVID-19 大流行期间孟加拉国在校青少年的问题性互联网使用和抑郁症状：横断面研究结果。Health Sci Rep. 2023;6(1):e1008.
Kuss DJ, Griffiths MD, Karila L, Billieux J. Internet addiction: a systematic review of epidemiological research for the last decade. Curr Pharm Design. 2014;20(25):4026-52. Kuss DJ、Griffiths MD、Karila L、Billieux J. 《网络成瘾：过去十年流行病学研究的系统回顾》。Curr Pharm Design.2014;20(25):4026-52.
Kardefelt-Winther D. A conceptual and methodological critique of internet addiction research: towards a model of compensatory internet use. Comput Hum Behav. 2014;31:351-4. Kardefelt-Winther D. 网络成瘾研究的概念和方法论批判：走向补偿性网络使用模型。Comput Hum Behav.2014;31:351-4.
Boursier V, Gioia F, Musetti A, Schimmenti A. Facing loneliness and anxiety during the COVID-19 isolation: the role of Excessive Social Media Use in a sample of Italian adults. Front Psychiatry. 2020;11:586222. Boursier V, Gioia F, Musetti A, Schimmenti A.在 COVID-19 隔离期间面对孤独和焦虑：意大利成年人样本中过度使用社交媒体的作用。Front Psychiatry.2020;11:586222.
Chen L, Yan Z, Tang W, Yang F, Xie X, He J. Mobile phone addiction levels and negative emotions among Chinese young adults: the mediating role of interpersonal problems. Comput Hum Behav. 2016;55:856-66. Chen L, Yan Z, Tang W, Yang F, Xie X, He J. 中国年轻人的手机成瘾水平与负面情绪：人际关系问题的中介作用。Comput Hum Behav.2016;55:856-66.
Kroese FM, De Ridder DT, Evers C, Adriaanse MA. Bedtime procrastination: introducing a new area of procrastination. Front Psychol. 2014;5:611. Kroese FM, De Ridder DT, Evers C, Adriaanse MA.睡前拖延：引入拖延的新领域。Front Psychol.2014;5:611.
Wang J, Zhang Y, Liu Y. The Annual Sleep Report of China 2022. Beijing, China: Social Science Academic; 2022. Wang J, Zhang Y, Liu Y.中国 2022 年度睡眠报告》。中国北京：社会科学文献出版社；2022.
Feneberg AC, Forbes PAG, Piperno G, Pronizius E, Stijovic A, Skoluda N et al. Diurnal dynamics of stress and mood during COVID-19 lockdown: a large multinational ecological momentary assessment study. Proceedings Biological sciences. 2022;289(1975):20212480. Feneberg AC, Forbes PAG, Piperno G, Pronizius E, Stijovic A, Skoluda N et al. COVID-19 封锁期间压力和情绪的昼夜动态：大型多国生态瞬间评估研究。生物科学论文集》。2022;289(1975):20212480.
Chen D, Zhang Y, Lin J, Pang D, Cheng D, Si D. Factors influencing bedtime procrastination in junior college nursing students: a cross-sectional study. BMC Nurs. 2022;21(1):97. Chen D，Zhang Y，Lin J，Pang D，Cheng D，Si D. 影响大专护生就寝拖延的因素：一项横断面研究。BMC Nurs.2022;21(1):97.
Roberts RE, Roberts CR, Chen IG. Functioning of adolescents with symptoms of disturbed sleep. J Youth Adolescence. 2001;30(1):1-18. Roberts RE, Roberts CR, Chen IG.有睡眠障碍症状的青少年的功能。J Youth Adolescence.2001;30(1):1-18.
Chester DS, Dzierzewski JM. Sour sleep, sweet revenge? Aggressive pleasure as a potential mechanism underlying poor sleep quality’s link to aggression. Emotion. 2020;20(5):842-53. Chester DS, Dzierzewski JM.酸涩的睡眠，甜蜜的报复？攻击性快感作为睡眠质量差与攻击性联系的潜在机制。Emotion.2020;20(5):842-53.
Elmer T, Mepham K, Stadtfeld C. Students under lockdown: comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS ONE. 2020;15(7):e0236337. Elmer T, Mepham K, Stadtfeld C. 《封锁下的学生：瑞士 COVID-19 危机前后学生社交网络与心理健康的比较》。PLoS ONE.2020;15(7):e0236337.
Gupta N, Garg S, Arora K. Pattern of mobile phone usage and its effects on psychological health, sleep, and academic performance in students of a medical university. Natl J Physiol Pharm Pharmacol. 2016;6(2):132-9. Gupta N, Garg S, Arora K. 医科大学学生使用手机的模式及其对心理健康、睡眠和学习成绩的影响。Natl J Physiol Pharm Pharmacol.2016;6(2):132-9.
Wang PY, Chen KL, Yang SY, Lin PH. Relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students. PLOS ONE. 2019;14(4):e0214769. Wang PY, Chen KL, Yang SY, Lin PH.大三女生睡眠质量、智能手机依赖和健康相关行为的关系。PLOS ONE.2019;14(4):e0214769.
Steel P, König CJ. Integrating theories of motivation. Acad Manage Rev. 2006;31(4):889-913. Steel P, König CJ.激励理论的整合。Acad Manage Rev. 2006;31(4):889-913.
Niu GF, Sun XJ, Subrahmanyam K, Kong FC, Tian Y, Zhou ZK. Cue-induced craving for internet among internet addicts. Addict Behav. 2016;62:1-5. Niu GF, Sun XJ, Subrahmanyam K, Kong FC, Tian Y, Zhou ZK.诱因诱发的网络成瘾者对网络的渴求。Addict Behav.2016;62:1-5.
Xiaohan M, Liwei Z, Jing G, Ying Z, Yiming F. Reliability and validity of the Bedtime Procrastination Scale in Chinese College Students. Chin J Clin Psychol. 2021;29(04):717-20. Xiaohan M, Liwei Z, Jing G, Ying Z, Yiming F. 《中国大学生睡前拖延量表的信度和效度》。Chin J Clin Psychol.2021;29(04):717-20.
Bot, CMAd. Vos AJBMd. Three-questions-method for coping with the emotional burden of nurses and nursing students during COVID-19. Int J Environ Res Public Health. 2022;19(11):6538. Bot, CMAd.Vos AJBMd.在 COVID-19 期间应对护士和护理学生情绪负担的三问法。Int J Environ Res Public Health.2022;19(11):6538.
Kim JY, Choi EH. Predictors of end-of-life care stress, calling, and resilience on end-of-life care performance: a descriptive correlational study. BMC Palliat care. 2022;21(1):77. Kim JY, Choi EH.临终关怀压力、呼唤和复原力对临终关怀绩效的预测因素：一项描述性相关研究。BMC Palliat care.2022;21(1):77.
Buchan J, Catton H. Recover to rebuild: investing in the nursing workforce for health system effectiveness. Geneva: International Council of Nurses; 2023. Buchan J, Catton H. Recover to rebuild: Investing in the nursing workforce for the health system effectiveness.Geneva：国际护士理事会；2023 年。
Foo C, Verma M, Tan SM, Haldane V, Reyes KA, Garcia F, et al. COVID-19 public health and social measures: a comprehensive picture of six Asian countries. BMJ Global Health. 2022;7(11):e009863. Foo C、Verma M、Tan SM、Haldane V、Reyes KA、Garcia F 等。 COVID-19 公共卫生和社会措施：六个亚洲国家的综合情况。BMJ Global Health.2022;7(11):e009863.
Rohde G, Johannessen B, Maaseide M, Flateland S, Skisland AV, Moi EB, et al. Being a nursing student during the coronavirus pandemic: a mixed methods study. BMC Nurs. 2023;22(1):60. Rohde G, Johannessen B, Maaseide M, Flateland S, Skisland AV, Moi EB, et al. 冠状病毒大流行期间的护理学生：一项混合方法研究。BMC Nurs.2023;22(1):60.
Wan XX, Huang HH, Zhang YY, Peng QQ, Guo XX, Wu SS, et al. The effect of prosocial behaviours on Chinese undergraduate nursing students’ subjective wellbeing: the mediating role of psychological resilience and coping styles. Int J Ment Health Nurs. 2023;32(1):277-89. Wan XX , Huang HH , Zhang YY , Peng QQ , Guo XX , Wu SS , et al. 亲社会行为对中国护理本科生主观幸福感的影响：心理弹性和应对方式的中介作用。Int J Ment Health Nurs.2023;32(1):277-89.
Moore J, Prentice D, McQuestion M. Social Interaction and collaboration among Oncology nurses. Nurs Res Pract. 2015;2015:248067. Moore J, Prentice D, McQuestion M. 肿瘤科护士之间的社会互动与合作。Nurs Res Pract.2015;2015:248067.
Phillips KF, Mathew L, Aktan N, Catano B. Clinical education and student satisfaction: an integrative literature review. Int J Nurs Sci. 2017;4(2):205-13. Phillips KF, Mathew L, Aktan N, Catano B. Clinical education and student satisfaction: an integrative literature review.Int J Nurs Sci. 2017;4(2):205-13.
Xu C, Lin N, Shen Z, Xie Z, Xu D, Fu J, et al. Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model. BMC Public Health. 2024;24(1):491. Xu C，Lin N，Shen Z，Xie Z，Xu D，Fu J，et al.睡前拖延与大流行后中国大学生的孤独感相关：一个调节链中介模型。BMC Public Health.2024;24(1):491.
Cui G, Yin Y, Li S, Chen L, Liu X, Tang K, et al. Longitudinal relationships among problematic mobile phone use, bedtime procrastination, sleep quality and depressive symptoms in Chinese college students: a cross-lagged panel analysis. BMC Psychiatry. 2021;21(1):449. Cui G, Yin Y, Li S, Chen L, Liu X, Tang K, et al. 中国大学生问题手机使用、睡前拖延症、睡眠质量和抑郁症状之间的纵向关系：跨滞后面板分析。BMC Psychiatry.2021;21(1):449.
Lin L, Wang X, Li Q, Xia B, Chen P, Wang W. The influence of interpersonal sensitivity on Smartphone Addiction: a Moderated Mediation Model. Front Psychol. 2021;12:670223. Lin L, Wang X, Li Q, Xia B, Chen P, Wang W.人际敏感性对智能手机成瘾的影响：调节中介模型。Front Psychol.2021;12:670223.
Ko CH, Yen JY, Yen CF, Lin HC, Yang MJ. Factors predictive for incidence and remission of internet addiction in young adolescents: a prospective study. Cyberpsychology Behavior: Impact Internet Multimedia Virtual Real Behav Soc. 2007;10(4):545-51. Ko CH, Yen JY, Yen CF, Lin HC, Yang MJ.青少年网络成瘾发生和缓解的预测因素：一项前瞻性研究。网络心理学行为：2007; 10(4):545-51.
National Health and Family Planning Commission of the People’s Republic of China. Measures for Ethical Review of Biomedical Research Involving Human Beings. [ln Chinese]. 2016 [http://www.gov.cn/gongbao/content/2017/content_5227817.htm 《中华人民共和国国家卫生和计划生育委员会。涉及人的生物医学研究伦理审查办法》。[ln Chinese].2016 [ http://www.gov.cn/gongbao/content/2017/content_5227817.htm
Minglong W. Structural equation model: operation and application of AMOS. 2nd ed. Chongqing, China: Chongqing People’s Publishing House; 2010. [in Chinese]. Minglong W. 《结构方程模型：AMOS 的操作与应用》。第 2 版。中国重庆：重庆：重庆人民出版社；2010.[中文].
Bagozzi RP, Yi Y. Specification, evaluation, and interpretation of structural equation models. J Acad Mark Sci. 2012;40:8-34. Bagozzi RP, Yi Y.结构方程模型的规范、评估和解释。J Acad Mark Sci.
LiuT, Wong GHY, Tang JYM, Lu S, Leung D, Sze L, et al. Detection of depression using the UCLA three-item loneliness scale in older Chinese. Innov Aging. 2019;3(Suppl 1):S530-1. LiuT, Wong GHY, Tang JYM, Lu S, Leung D, Sze L, et al. 使用加州大学洛杉矶分校孤独感三项目量表检测中国老年人的抑郁状况。Innov Aging.2019;3(Suppl 1):S530-1.
Demetrovics Z, Király O, Koronczai B, Griffiths MD, Nagygyörgy K, Elekes Z, et al. Psychometric properties of the problematic internet use Questionnaire Short-Form (PIUQ-SF-6) in a nationally Representative Sample of adolescents. PLoS ONE. 2016;11(8):e0159409. Demetrovics Z、Király O、Koronczai B、Griffiths MD、Nagygyörgy K、Elekes Z 等. 全国青少年代表性样本中互联网使用问题问卷简表（PIUQ-SF-6）的心理测量特性。PLoS ONE.2016;11(8):e0159409.
Koronczai B, Kökönyei G, Urbán R, Király O, Nagygyörgy K, Felvinczi K, et al. Confirmation of the Chinese Version of the problematic internet use Questionnaire Short Form (PIUQ-SF). Int J Mental Health Addict. 2017;15(1):191-7. Koronczai B、Kökönyei G、Urbán R、Király O、Nagygyörgy K、Felvinczi K 等. 问题性网络使用问卷简表（PIUQ-SF）中文版的确认。Int J Mental Health Addict.2017;15(1):191-7.
Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879-903. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP.行为研究中常见的方法偏差：文献综述与建议补救措施》（Common method biases in behavioral research: a critical review of the literature and recommended remedies.J Appl Psychol.2003;88(5):879-903.
West SG , Taylor AB , Wu W. Model fit and model selection in structural equation modeling. Handb Struct Equation Model. 2012;1:209-31. West SG , Taylor AB , Wu W. 《结构方程建模中的模型拟合与模型选择》。Handb Struct Equation Model.2012;1:209-31.
Matthews GA, Tye KM. Neural mechanisms of social homeostasis. Ann NY Acad Sci. 2019;1457(1):5-25. Matthews GA, Tye KM.社会平衡的神经机制。Ann NY Acad Sci.
Abdellaoui A, Chen HY, Willemsen G, Ehli EA, Davies GE, Verweij KJH, et al. Associations between loneliness and personality are mostly driven by a genetic association with Neuroticism. J Pers. 2019;87(2):386-97. Abdellaoui A, Chen HY, Willemsen G, Ehli EA, Davies GE, Verweij KJH, et al.孤独与人格之间的关联主要是由神经质的遗传关联驱动的。J Pers.2019;87(2):386-97.
Gavurova B, Ivankova V, Rigelsky M, Mudarri T. Internet addiction in SocioDemographic, Academic, and Psychological Profile of College Students during the COVID-19 pandemic in the Czech Republic and Slovakia. Front Public Health. 2022;10:944085. Gavurova B, Ivankova V, Rigelsky M, Mudarri T. COVID-19 大流行期间捷克共和国和斯洛伐克大学生社会人口、学业和心理概况中的网络成瘾问题。Front Public Health.2022;10:944085.
Ceyhan AA, Ceyhan E. Loneliness, depression, and computer self-efficacy as predictors of problematic internet use. Cyberpsychology Behavior: Impact Internet Multimedia Virtual Real Behav Soc. 2008;11(6):699-701. Ceyhan AA, Ceyhan E. 孤独、抑郁和计算机自我效能感是问题性网络使用的预测因素。网络心理学行为：2008；11（6）：699-701.
Kao PC. The interrelationship of Ioneliness, Smartphone Addiction, Sleep Quality, and students’ attention in English as a Foreign Language Class. Int J Environ Res Public Health. 2023;20(4):3460. Kao PC.电离度、智能手机成瘾、睡眠质量与学生英语课注意力的相互关系。Int J Environ Res Public Health.2023;20(4):3460.
Lv S, Wang H. Cross-lagged analysis of problematic social media use and phubbing among college students. BMC Psychol. 2023;11(1):39. Lv S, Wang H. 大学生问题社交媒体使用与嗜睡的交叉滞后分析。BMC Psychol.2023;11(1):39.
Liang L , Zhu M , Dai J, Li M , Zheng Y . The mediating roles of emotional regulation on negative emotion and internet addiction among Chinese adolescents from a development perspective. Front Psychiatry. 2021;12:608317. Liang L , Zhu M , Dai J, Li M , Zheng Y .从发展的角度看情绪调节对中国青少年负性情绪和网络成瘾的中介作用。Front Psychiatry.2021;12:608317.
Gu S, He Z, Sun L, Jiang Y, Xu M, Feng G, et al. Effects of Coronavirus-19 Induced Ioneliness on Mental Health: Sleep Quality and Intolerance for uncertainty as mediators. Front Psychiatry. 2021;12:738003. Gu S, He Z, Sun L, Jiang Y, Xu M, Feng G, et al. Coronavirus-19 诱导的孤独感对心理健康的影响：睡眠质量和对不确定性的不容忍度是中介。Front Psychiatry.2021;12:738003.
Herzog-Krzywoszanska R, Krzywoszanski L, Bedtime, Procrastination. Sleeprelated behaviors, and demographic factors in an online survey on a Polish sample. Front NeuroSci. 2019;13:963. Herzog-Krzywoszanska R, Krzywoszanski L, Bedtime, Procrastination.波兰样本在线调查中与睡眠相关的行为和人口统计因素。Front NeuroSci.
Ma X, Meng D, Zhu L, Xu H, Guo J, Yang L, et al. Bedtime procrastination predicts the prevalence and severity of poor sleep quality of Chinese undergraduate students. J Am Coll Health: JACH. 2022;70(4):1104-11. Ma X, Meng D, Zhu L, Xu H, Guo J, Yang L, et al. 睡前拖延症预测了中国大学生睡眠质量差的发生率和严重程度。J Am Coll Health：JACH.2022;70(4):1104-11.
Sirois FM, Nauts S, Molnar DS. Self-compassion and bedtime procrastination: an emotion regulation perspective. Mindfulness. 2019;10:434-45. Sirois FM, Nauts S, Molnar DS.自我同情与睡前拖延症：情绪调节的视角》（Self-compassion and bedtime procrastination: an emotion regulation perspective.正念》。2019;10:434-45.
Nauts S, Kamphorst BA, Stut W, De Ridder DTD, Anderson JH. The explanations people give for going to Bed Late: a qualitative study of the varieties of Bedtime Procrastination. Behav Sleep Med. 2019;17(6):753-62. Nauts S, Kamphorst BA, Stut W, De Ridder DTD, Anderson JH.人们对晚睡的解释：睡前拖延症种类的定性研究》。行为睡眠医学》。2019;17(6):753-62.
Phillips AJK, Vidafar P, Burns AC, McGlashan EM, Anderson C, Rajaratnam SMW, et al. High sensitivity and interindividual variability in the response of the human circadian system to evening light. Proc Natl Acad Sci USA. 2019;116(24):12019-24. Phillips AJK, Vidafar P, Burns AC, McGlashan EM, Anderson C, Rajaratnam SMW, et al.人类昼夜节律系统对晚间光线的高敏感性和个体间差异性。Proc Natl Acad Sci USA.2019;116(24):12019-24.
Song Y, Sznajder K, Cui C, Yang Y, Li Y, Yang X. Anxiety and its relationship with sleep disturbance and problematic smartphone use among Chinese medical Song Y，Sznajder K，Cui C，Yang Y，Li Y，Yang X.中国医务人员的焦虑及其与睡眠障碍和问题智能手机使用的关系
students during COVID-19 home confinement - A structural equation model analysis. J Affect Disord. 2022;296:315-21. COVID-19 家庭禁闭期间学生的结构方程模型分析。J Affect Disord.2022;296:315-21.
Geng Y, Gu J, Wang J, Zhang R. Smartphone addiction and depression, anxiety: the role of bedtime procrastination and self-control. J Affect Disord. 2021;293:415-21. Geng Y, Gu J, Wang J, Zhang R. 《智能手机成瘾与抑郁、焦虑：睡前拖延和自我控制的作用》。J Affect Disord.2021;293:415-21.
Yu L, Wu Y, Guo C, Qiao Q, Wang X, Zang S. Latent profile analysis for healthrelated quality of life, sleep quality, morning and evening type, and internet addiction among medical students. Sci Rep. 2023;13(1):11247. Yu L, Wu Y, Guo C, Qiao Q, Wang X, Zang S. 医学生健康相关生活质量、睡眠质量、早晚型和网络成瘾的潜在特征分析。科学报告，2023；13（1）：11247.
Publisher's note 出版商说明
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 《施普林格-自然》对出版地图和机构隶属关系中的管辖权主张保持中立。
^(†){ }^{\dagger} Xinji Shi and Yibo Wu are share the first authorship on this work. ^(†){ }^{\dagger} 史新骥和吴一波是这项工作的共同第一作者。
*Correspondence: *通信：
Shuang Zang zangshuang@cmu.edu.cn 双藏 zangshuang@cmu.edu.cn
¹Department of Community Nursing, School of Nursing, China Medical University, No. 77 Puhe Road, Shenyang North New Area, ¹ 沈阳市北部新区蒲河路 77 号中国医科大学护理学院社区护理系、
Shenyang 110122, Liaoning Province, China 中国辽宁省沈阳市 110122 ^(2){ }^{2} School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China ^(2){ }^{2} 北京大学公共卫生学院，北京市海淀区学苑路 38 号，邮编 100191 ^(3){ }^{3} Jitang College of North China University of Science and Technology, No. 21 Bohai Avenue, Caofeidian District, Tangshan City 063210, Hebei Province, China ^(3){ }^{3} 河北省唐山市曹妃甸区渤海大街 21 号华北科技学院冀唐学院 邮编：063210
导出提示
谨慎下载超过 300 页以上 PDF，容易内存溢出。
PDF Pro 下载需借用浏览器的打印功能，出现打印界面后，在【打印机】处选择【另存为 PDF】，最后点击【保存】即可。
