Perceived stress and mobile phone addiction among China Nursing Students: The chain-mediating role of anxiety and flow experience

Perceived stress and mobile phone addiction among China Nursing Students: The chain-mediating role of anxiety and flow experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceived stress and mobile phone addiction among China Nursing Students: The chain-mediating role of anxiety and flow experience Shuiqing Rong, Zhaonan Yang, Lida Yang, Yuanbo Li, Jiawei Zhou, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4373381/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The relationship between perceived stress and mobile phone addiction among nursing students requires elucidation, alongside the clarification of potential explanatory pathways for associated risks. Methods : 4179 freshmen and sophomore students participated in this investigation. Several assessment tools were employed, including the Chinese Perceived Stress Scale, Generalized Anxiety Disorder-7 scale, Flow State Scale, and Mobile Phone Addiction Tendency Scale. Data analysis encompassed descriptive statistics, independent sample T-tests, Pearson correlation analysis, and Hayes' PROCESS 3.5 for chain-mediated modeling. Results : Pearson correlation analysis unveiled positive associations between perceived stress and anxiety (r=0.507, p<0.01), flow experience (r=0.657, p<0.01), and mobile phone addiction (r=0.578, p<0.01). Anxiety exhibited positive correlations with flow experience (r=0.490, p<0.01) and mobile phone addiction (r=0.564, p<0.01). Additionally, flow experience showed a positive relationship with mobile phone addiction (r=0.579, p<0.01). Chain mediation analysis revealed that anxiety [mediated effect: 26.62%, SE=0.014, 95% CI= (0.182,0.237)] and flow experience [mediated effect: 25.05%, SE=0.014, 95% CI= (0.169,0.225)] partially mediated the link between perceived stress and mobile phone addiction, respectively. Perceived stress exerted its influence on mobile phone addiction through the chain-mediated effects of anxiety and flow experience [mediating effect: 4.98%, SE=0.039, 95% CI= (0.031, 0.047)]. Conclusion : Perceived stress not only directly impacts the mobile phone addiction tendencies of nursing students but also exerts indirect effects via the independent mediation of anxiety and flow experience. Moreover, perceived stress affects mobile phone addiction through the chain-mediated pathway involving both anxiety and flow experience. perceived stress mobile phone addiction anxiety flow experience nursing students Figures Figure 1 Figure 2 1 Introduction With the evolution of technology and the advancement of society, the Internet assumes an increasingly integral role in our daily lives. As of December 2022, China boasted a robust Internet penetration rate of 75.6%, with over 90% of the populace accessing it through mobile phones [ 1 ] . Mobile phones have profoundly altered societal dynamics, becoming indispensable components of our existence. Nonetheless, recent years have seen mounting concerns over the pervasive issue of excessive mobile phone usage [ 2 ] . Termed mobile phone overuse, dependence, or addiction, this phenomenon constitutes a behavioral addiction [ 3 ] , characterized by an individual's compulsive engagement in mobile phone-mediated activities, resulting in substantial impairment of social and psychological well-being [ 4 ] . Individuals may develop an irresistible urge to utilize their mobile phones, diverting their focus from daily responsibilities. Statistics reveal that mobile phone ownership among Chinese college students surpasses 99% [ 5 ] . Compared to the working population, college students exhibit lower levels of psychological maturity and self-regulation capacity [ 6 ] , rendering them particularly susceptible to mobile phone addiction [ 7 ] . This addiction intertwines intricately with students' physical and mental health [ 8 ] , engenders feelings of insecurity [ 9 ] , promotes nocturnal habits [ 10 ] , compromises sleep quality [ 11 ] , exacerbates feelings of low self-esteem and depression [ 12 ] , and detrimentally impacts academic performance [ 13 ] . Nursing students, serving as vital reserves in the nursing profession, contend with heightened pressures compared to their peers and are inclined to resort to mobile phones as a coping mechanism for stress relief [ 14 ] . Consequently, mobile phone addiction emerges as a prominent behavioral concern among nursing students [ 14 ] . Thus, delving into the determinants of mobile phone addiction among nursing students holds promise for enhancing their overall well-being and aiding in the mitigation of addictive behaviors. Drawing from general stress theory [ 15 ] , stress can precipitate maladaptive behaviors. Nursing students, bereft of immediate parental oversight and support, grapple with a myriad of stressors including acclimatizing to their new environment, fulfilling academic obligations, and navigating interpersonal dynamics. This confluence of stressors imposes a significant burden on nursing students, particularly freshmen and sophomores, leading some to seek solace in virtual realms as a means of stress mitigation. Notably, nursing students contend with elevated levels of educational stress compared to their counterparts in other disciplines [ 16 ] . Such stressors emanate from two primary domains: academic and clinical. Academic stressors encompass arduous coursework demands [ 17 ] , rigorous examinations [ 18 ] , among others. Conversely, clinical stressors revolve around apprehensions stemming from unfamiliar clinical environments [ 19 ] , patient care responsibilities [ 20 ] , and perceived inadequacy in nursing competencies [ 21 ] . Perceived stress, within this context, denotes the psychological disarray or threat induced by various life stressors, manifesting as physiological and psychological tension and discomfort [ 22 ] . Several studies, including research by Gao et al. [ 23 ] , have provided evidence underscoring the pivotal role of perceived stress as a key determinant in precipitating mobile phone addiction among college students. Obviously, individuals experiencing heightened levels of stress are predisposed to mobile phone addiction, suggesting a notable positive correlation between perceived stress and mobile phone addiction. However, despite these findings elucidating the association between stress and mobile phone addiction, the precise mechanisms through which stress engenders mobile phone addiction remain elusive. 1.1 The mediating role of anxiety Empirical investigations, as reported by Herbison et al. [ 24 ] , have underscored that perceived stress serves as a reliable predictor of anxiety, with heightened levels of perceived stress correlating positively with increased anxiety levels. Stress, recognized as a primary contributor to psychological distress, inclines individuals towards negative emotional states such as anxiety [ 25 ] . Individuals perceiving elevated stress levels may turn to mobile phones as a means of escapism from the harsh realities of stress-induced negative emotions [ 26 ] . Anxiety, characterized by apprehension regarding future uncertainties or adversities, accompanied by tense emotional and physical responses [ 27 ] , exerts significant impacts on the physical and mental well-being of college students, with prolonged anxiety potentially culminating in suicidal tendencies [ 28 ] . Indeed, Kim and Koh [ 29 ] proposed that anxiety positively predicts mobile phone addiction, a sentiment echoed by Matar Boumosleh and Jaalouk [ 30 ] , who identified anxiety as an independent positive predictor of mobile phone addiction. Aligned with the compensatory Internet use model [ 31 ] , individuals may resort to the Internet, including mobile phones, as a coping mechanism to assuage anxiety. Moreover, some studies suggest that individuals may adopt maladaptive coping strategies, such as substance dependence, to alleviate emotional distress [ 32 ] , with mobile phone addiction often serving as a conduit for anxiety dissipation. In summation, the perception of stress may influence the extent of mobile phone addiction among nursing students through the mediating pathway of anxiety. Hence, we posit Hypothesis 1: Anxiety mediates the relationship between perceived stress and mobile phone addiction. 1.2 The mediating role of flow experience According to the flow state model [ 33 ] , this study defines flow experience as a student's high level of concentration while using a mobile phone, feeling that time flies, and enjoying the use of the phone very much. Stressed students tend to choose negative means (e.g., using mobile phones) to relieve stress, and as the frequency of mobile phone use increases, they eventually develop to use mobile phones when they are stressed and immerse themselves in the online world [ 15 ] , resulting in mobile phone addiction. The immersion experience from mobile phone addiction relieves stress, and perceived stress is positively correlated with immersion [ 34 ] . Immersion is similar to flow experience, which refers to an overall feeling when an individual is fully immersed in something or a situation [ 35 ] . Flow experience can significantly predict mobile phone addiction [ 36 ] . The integrative theory of playfulness in computer interactions suggests that the flow experience leads to repetition of behavior [ 29 ] ; Julia B [ 37 ] suggests that Facebook flow is highly correlated with the addictive use of Facebook and even helps to maintain its addictive use. Based on the above kinds of literature, we propose hypothesis 2: Flow experience mediates the role between perceived stress and mobile phone addiction. 1.3 The chain-mediating role of anxiety and flow experience between perceived stress and mobile phone addiction According to flow theory, the flow experience is a state of being immersed in using a mobile phone [ 33 ] . High flow experience is associated with mobile phone addiction [ 38 ] . Mobile phone addiction plays a crucial role in the development of flow experience [ 39 ] , and immersion is also associated with anxiety [ 15 ] . All the above evidence indicates that anxiety and flow experience may play a chain mediating role between perceived stress and mobile phone addictions, but limited previous study has been conducted to confirm the link between them. Therefore, based on the general aggression model, a chain mediating model is proposed in this study (Fig. 1 ). 2 Materials and methods 2.1 Participants In this study, a convenience sampling method was employed to collect data from students enrolled in a nursing college situated in Heilongjiang province during December 2021. A total of 4179 students were surveyed, resulting in 3050 valid questionnaires after the removal of invalid responses, yielding a commendable valid recovery rate of 72.98%. Among the respondents, 921 (30.2%) were male students, while 2129 (69.8%) were female students. Regarding residential backgrounds, 1580 (51.8%) hailed from urban areas, whereas 1470 (48.2%) originated from rural locales. The average age of the participants was 19.10 years (SD = 1.046). Notably, 714 students exhibited tendencies towards mobile phone addiction, constituting 23.41% of the valid questionnaires. Prior to data collection, ethical approval was obtained from the Ethics Committee of Harbin Medical University, and informed consent was secured from all participants, adhering to ethical research practices.The purpose and content of the study were communicated prior to the survey, consent was obtained from the school teachers and the subjects themselves, and the subjects participated in the survey voluntarily and anonymously. The content of the study and the research process complied with the ethical provisions of the Declaration of Helsinki. 2.2 Measures 2.2.1 Chinese perceived stress scale (CPSS) The Chinese Perceived Stress Scale (CPSS) was utilized to assess the perceived stress levels among the study participants. Originally developed by Cohen et al. [ 22 ] and introduced to China by Yang et al. [ 40 ] , the scale comprises 14 items and is structured into two dimensions: tension and loss of control. Responses are rated on a Likert 5-point scale, ranging from 0 to 4, with higher scores indicative of heightened levels of perceived stress. In this investigation, the Cronbach's α coefficient for the CPSS was calculated to be 0.963, demonstrating high internal consistency reliability. 2.2.2 Generalized Anxiety Disorder-7 (GAD-7) Anxiety levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, developed by Spitzer et al. [ 41 ] . Comprising 7 items, each item is scored on a scale of 0 to 3, with 0 indicating the absence of symptoms, 1 for occasional symptoms, 2 for frequent symptoms, and 3 for persistent symptoms. Total scores are computed by summing all item-level scores, with higher scores indicative of elevated anxiety levels. In this study, the Cronbach's α coefficient for the GAD-7 was calculated to be 0.966, indicating robust internal consistency reliability. 2.2.3 Flow State Scale (FSS) The scale utilized in this study was adapted by Zhang et al. [ 42 ] to suit the context of mobile phone addiction. It comprises four items designed to assess the level of flow experience during mobile phone usage. Responses are provided on a 5-point Likert scale, ranging from 1 (Completely out of line) to 5 (Fully compliant). The total score ranges from 5 to 20, with higher scores indicative of heightened flow experiences during mobile phone usage. In this investigation, the total Cronbach’s α coefficient for the scale was calculated to be 0.933, indicating strong internal consistency reliability. 2.2.4 Mobile Phone Addiction Tendency Scale (MPATS) The Mobile Phone Addiction Tendency Scale (MPATS), developed by Xiong Jie et al. [ 43 ] , was employed in this study. This scale comprises 16 items categorized into four dimensions: withdrawal symptoms, emergent behaviors, social soothing, and mood changes. Respondents rate each item on a 5-point Likert scale, ranging from 1 (Completely out of line) to 5 (Fully compliant). The total score ranges from 16 to 80, with higher scores indicating a greater tendency towards smartphone addiction, with scores exceeding 48 indicative of mobile phone addiction. In this investigation, the Cronbach's α coefficient for the MPATS was calculated to be 0.945, denoting high internal consistency reliability. 2.3 Statistical Analysis Statistical analyses were conducted using SPSS 26.0 statistical software. Initially, descriptive statistical analyses were performed on the variables, followed by the calculation of correlations between these variables using Pearson correlation analysis. Subsequently, the data underwent tests for differences and common method deviation. Independent samples t-tests were employed to compare scores on the Mobile Phone Addiction Scale among nursing college students with varying demographic characteristics. For mediating effects analysis, Hayes' Process [ 44 ] model 6, along with the Bootstrap method, was utilized. The Bootstrap method facilitated the testing of the significance of mediating effects, with 95% confidence intervals that did not encompass 0 indicative of a significant effect. Furthermore, in accordance with existing literature, demographic variables such as gender [ 45 ] , grade [ 46 ] , and age [ 47 ] of college students were incorporated as control variables in this study to mitigate potential confounding factors. 3 Result 3.1 Common Method Biases Test To ensure the scientific rigor of the findings, Harman’s single-factor test was conducted to assess potential common methodological biases before commencing data analysis [ 48 ] . All items from the questionnaire were amalgamated for exploratory factor analysis. The results revealed 14 factors with characteristic roots exceeding 1, and the proportion of variance explained by the first common factor was 34.10%, significantly below the threshold of 40%. Consequently, no significant common methodological biases were detected in this study [ 49 ] . 3.2 Descriptive statistics and correlation analysis After screening out questionnaires with irregular responses, missing items, and inadequate completion periods, a total of 3050 nursing students participated in the study, with 23.44% exhibiting tendencies towards mobile phone addiction. The demographic characteristics of the participants are presented in Table 1 . Male students comprised 30.2% of the total survey population, whereas female students accounted for 69.8%. To investigate whether demographic variables exerted an influence on mobile phone addiction, independent sample t-tests were conducted on variables such as gender and grade. The findings indicated that mobile phone addiction scores were significantly higher among female students compared to male students, and sophomores exhibited higher levels of mobile phone addiction than freshmen. Table 1 Differential analysis of mobile phone addiction in terms of gender and grade(n = 3050) Variable Gender(M ± SD) t Grade(M ± SD) t Male(921) Female(2129) First grade(1896) Second grade(1154) Mobile phone addiction 41.08 ± 13.84 43.00 ± 12.65 -3.61 * 41.10 ± 12.53 44.60 ± 13.58 -7.24 * * P < 0.001 The comprehensive results for all correlations are detailed in Table 2 . Perceived stress, anxiety, flow experience, and mobile phone addiction demonstrate positive correlations with each other. Table 2 Means, standard deviations, and correlation analysis between variables(n = 3050) 1 2 3 4 1. Mobile phone addiction 1 2. Anxiety 0.564 * 1 3. Flow experience 0.579 * 0.490 * 1 4. Perceived stress 0.578 * 0.507 * 0.657 * 1 M 42.420 6.590 12.000 27.310 SD 13.049 5.482 3.400 9.556 * P < 0.01 3.3 Testing of the mediating effect of anxiety and flow experience The bootstrap method was employed to draw 5000 samples, and Hayes' Process v3.5 macro program model 6 [ 44 ] was utilized to examine the mediating effects of anxiety and flow experience, while controlling for three variables: gender, grade, and place of birth. The results of the regression analysis (see Table 3 ) indicated that perceived stress emerged as a significant positive predictor of anxiety (β = 0.504, t = 32.468, p < 0.001), flow experience (β = 0.547, t = 35.660, p < 0.001), and mobile phone addiction (β = 0.248, t = 13.745, p < 0.001). Furthermore, anxiety positively predicted both flow experience (β = 0.215, t = 13.916, p < 0.001) and mobile phone addiction (β = 0.303, t = 19.303, p < 0.001), whereas flow experience was found to be a positive predictor of mobile phone addiction (β = 0.262, t = 14.664, p < 0.001). Table 3 Regression analysis of the relationship between the variables in the chain mediation model Regression equation (n = 3050) Overall fit index Significance of regression coefficients Result variables Predictive variables R R² F β t Anxiety Gender 0.517 0.267 277.674 ** -0.307 -2.380 Age 0.006 0.322 Grade 0.09 4.789 Perceived stress 0.504 32.468 ** Flow experience Gender 0.685 0.469 537.206 ** 0.035 2.666 * Age -0.056 -3.502 ** Grade 0.012 0.085 Perceived stress 0.547 35.660 ** Anxiety 0.215 13.916 ** Mobile phone addiction Gender 0.694 0.482 472.442 ** 0.066 5.052 ** Age -0.019 -1.229 Grade 0.091 5.775 ** Perceived stress 0.248 13.745 ** Anxiety 0.303 19.303 ** Flow experience 0.262 14.664 ** ** P < 0.001, * P < 0.01 The results of the mediation effect, as indicated by the Bootstrap 95% confidence interval in Table 4 , revealed significant indirect effects for three pathways: Table 4 Standardized indirect effects from stress and rumination β BootSE Bootstrap95%CI Proportion of Relative Effect% BootLLCI BootULCI Via anxiety 0.209 0.014 0.182 0.237 0.266 26.62% Via anxiety and flow experience 0.039 0.004 0.031 0.047 0.050 4.98% Via flow experience 0.196 0.014 0.169 0.225 0.250 25.05% Total indirect effect 0.444 0.020 0.404 0.485 0.567 56.65% Direct effect 0.339 0.025 0.290 0.387 0.434 43.35% Total effect 0.782 0.020 0.743 0.822 1.000 100% 1. Perceived stress → anxiety → flow experience → mobile phone addiction, with an indirect effect value of 0.039. This suggests that the chain mediating effect between perceived stress and mobile phone addiction among nursing students is significant. 2. Perceived stress → anxiety → mobile phone addiction, with an indirect effect value of 0.209. This indicates that anxiety partially mediated the relationship between perceived stress and mobile phone addiction. 3. Perceived stress → flow experience → mobile phone addiction, with an indirect effect value of 0.196. This highlights the significant role of flow experience in mediating the relationship between perceived stress and mobile phone addiction. The mediation effects of anxiety and flow experience on mobile phone addiction are visually depicted in Fig. 2 . 4 Discussion This study delves into the interplay between perceived stress and mobile phone addiction among Chinese nursing students, while also examining the mediating roles of anxiety and flow experience. The findings underscore that perceived stress not only serves as a direct predictor of mobile phone addiction but also exerts an indirect influence through the pathways of anxiety and flow experience. Moreover, anxiety and flow experience collectively exhibit a chain mediation effect in elucidating the relationship between perceived stress and mobile phone addiction. 4.1 The mediating role of anxiety Consistent with prior research findings, our study revealed a positive correlation between perceived stress and mobile phone addiction among nursing students. This alignment supports the framework provided by general strain theory [ 50 ] , a widely recognized framework utilized to elucidate perceived stress as a predictor of mobile phone addiction [ 6 ] . According to this theory, negative experiences stemming from various stressors can precipitate problematic behaviors. Previous investigations have similarly highlighted perceived stress as a prominent trigger of mobile phone addiction [ 51 ] . Furthermore, Mai et al. [ 52 ] observed a positive association between stress and adolescent Internet addiction, underscoring the significant role of stress in shaping addictive behaviors. Of particular relevance is the context of the COVID-19 pandemic, during which mobile phones have emerged as ubiquitous tools for alleviating boredom and mitigating negative emotions [ 53 ] . This heightened reliance on mobile phones during the pandemic may further exacerbate tendencies towards mobile phone addiction. We have confirmed that anxiety acts as an independent mediator between perceived stress and mobile phone addiction. Specifically, our findings demonstrate that perceived stress heightens the risk of anxiety, subsequently elevating the likelihood of mobile phone addiction. This result aligns with the observations made by Wang et al. [ 54 ] , who reported an escalation in anxiety levels in response to perceived stress. Chronic stress arising from daily life challenges can compromise individuals' immune function and deplete their energy reserves, rendering them more susceptible to anxiety [ 55 ] . According to stress and coping theory [ 56 ] , heightened perceived stress is strongly associated with increased anxiety levels. Moreover, Spada et al. [ 57 ] identified perceived stress as a significant predictor of anxiety, emphasizing a positive correlation between perceived stress and anxiety as well as depression. In the context of China, students opting for nursing majors in vocational universities often confront academic underperformance or unfavorable family circumstances. Consequently, they may experience initial psychological distress and feelings of inferiority, making it challenging to establish clear learning objectives [ 58 ] . Additionally, nursing students exhibit a limited understanding of the nursing profession, leading to uncertainty about their future career paths. Moreover, mastering multiple disciplines such as biology, physics, psychology, and sociology imposes significant academic demands and learning difficulties, further exacerbating stress levels [ 59 ] . These stressors collectively contribute to the manifestation of anxiety among nursing students. The direct link between anxiety and mobile phone addiction has been substantiated in our research, aligning with the compensatory Internet use model proposed by Elhai et al. [ 8 ] . This model posits that individuals’ resort to mobile phone usage as a means of alleviating negative emotions, potentially fostering mobile phone addiction through excessive usage. Numerous studies have corroborated the association between anxiety and mobile phone addiction [ 60 – 62 ] . For instance, Matar Boumosleh and Jaalouk underscored the predictive and explanatory role of anxiety in mobile phone addiction among nursing students [ 30 ] . Additionally, Zhang et al. identified anxiety as a mediating factor in the relationship between stress and addiction [ 63 ] . Our study extends these findings by demonstrating that heightened levels of stress correspond to elevated anxiety levels, thereby increasing the likelihood of mobile phone addiction among students. 4.2 The mediating role of flow experience The findings of this study indicate that flow experience serves as a partial mediator in the relationship between perceived stress and mobile phone addiction. Perceived stress enhances flow experience, subsequently heightening the risk of mobile phone addiction. It has been established that perceived stress significantly predicts flow experience among nursing students, consistent with the conclusions drawn by Huang et al. [ 64 ] , who observed an escalation in flow experience in response to perceived stress. The immersion theory, advanced by Barnett [ 65 ] , posits that individuals are motivated to engage in activities that provide pleasure and engross their attention. According to this theory, students who immerse themselves in mobile phone use as a stress-relief mechanism are more likely to habitually use mobile phones, potentially culminating in addiction. Moreover, Lu and Yeo [ 66 ] highlighted the resemblance between flow experience and immersion, both of which denote an enjoyable engagement in activities. Additionally, Xu et al. [ 67 ] reported that perceived stress positively predicts immersion or flow experience, further supporting our findings. The immersion theory posits that flow experience can engross individuals when using mobile phones, with higher levels of flow experience increasing the likelihood of mobile phone addiction. Repetition serves as the foundation of addictive behavior, and flow experience acts as a catalyst for activating addiction [ 1 ] . Our study demonstrated a direct association between flow experience and mobile phone addiction, consistent with Csikszentmihalyi's flow theory [ 68 ] . When individuals experience flow, it generates positive experiences that may contribute to potential issues such as addictive behaviors. Prior research has also substantiated the link between flow experiences and mobile phone addiction [ 35 , 69 , 70 ] . For instance, Lu et al. provided evidence that flow experience predicted and elucidated mobile phone addiction among college students [ 70 ] . Similarly, Gong et al. identified flow experience as a mediating factor in the relationship between perceived stress and Internet addiction, corroborating our findings [ 35 ] . 4.3 The chain-mediating role of anxiety and flow experience The results of our study indicate that anxiety and flow experience act as chain mediators in the theoretical model, thus providing further validation for the playfulness theory of computer interaction [ 36 ] . According to this theory, individuals experiencing high levels of stress are prone to developing anxiety, which, in turn, drives them to seek solace in the online world, leading to immersion and eventual addiction. Moreover, our findings align with the compensatory Internet use theory [ 31 ] , which posits that individuals under significant stress or pressure may experience negative emotions such as anxiety and subsequently turn to the online realm as a means of alleviating stress and anxiety, ultimately resulting in mobile phone addiction. These findings carry significant implications for the prevention of mobile phone addiction among nursing students. Early intervention aimed at mitigating stress levels can halt the progression towards anxiety and, consequently, prevent the onset of mobile phone addiction. It is imperative for healthcare professionals and educators to not only address mobile phone addiction among nursing students but also prioritize the identification and management of stress and anxiety within this population. By addressing stress and anxiety proactively, healthcare providers and educators can effectively mitigate the risk of mobile phone addiction among nursing students. 5 Limitations This study delves into the factors influencing mobile phone addiction among nursing students through the lens of perceived stress, offering a comprehensive analysis of the pathways and circumstances that impact this phenomenon. It furnishes empirical evidence and practical insights aimed at ameliorating mobile phone addiction among college students. However, several limitations warrant acknowledgment. Firstly, the study design is cross-sectional, precluding the establishment of causal relationships between variables. We sampled only one school, which is generally representative, and the limits to the findings can be generalized. Future research endeavors could benefit from longitudinal or experimental methodologies to validate the causal hypotheses posited in this study. Secondly, reliance on questionnaire scales as research instruments, self-reported by participants, may have introduced response biases. Some respondents might have completed the questionnaires hastily, prioritizing speed over accuracy. To address this limitation, future studies could implement control measures such as scheduling specific appointment times to enhance the authenticity of questionnaire responses. Lastly, while this study considers the mediating effects of anxiety and flow experience between perceived stress and mobile phone addiction, other potential mediating variables warrant further investigation. Future research could explore additional mediators to gain a more comprehensive understanding of the mechanisms underlying mobile phone addiction among nursing students. 6 Conclusion The findings of this study offer valuable insights into the mechanisms through which perceived stress contributes to the likelihood of mobile phone addiction. Additionally, the study underscores the significance of mitigating stress levels and addressing anxiety as essential components of preventing mobile phone addiction among college students. Furthermore, the role of flow experience emerges as pivotal in averting mobile phone addiction. Therefore, efforts aimed at preventing and intervening in college students' mobile phone addiction should not only focus on reducing stress and anxiety but also on minimizing the immersive flow experience associated with mobile phone usage. Declarations Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This work is supported by the Heilongjiang Province Philosophy and Social Science Research Planning Project [grant number 18SHB076]. Author Contribution Shuiqing Rong, Zhaonan Yang, and Lida Yang conducted the initial analyses, drafted the manuscript, and reviewed and revised it.Yuanbo Li, Jiawei Zhou, Xiaomeng Hu, Siyuan Ke, Qiongyi Wang, Qinghe Fan, Wei Duan, Yizhi Wang, and Junling Liu collected data and conducted initial analyses. Xiuxian Yang and Yanjie Yang conceptualized and designed the study, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. All authors contributed to and have approved the final manuscript. Acknowledgments We express our sincere gratitude to all participants who completed our questionnaires. Ethics Statement This research project has been approved by the relevant ethics committees or organizations and was conducted in strict accordance with ethical guidelines. In this study, we respected and protected the rights and privacy of the participants and ensured the confidentiality of their personal information. 1. Participants' informed consent: We explained the purpose, process, risks, and benefits of the study to all individuals participating in the study either orally or in writing, and obtained their informed consent. Participants had the right to know that their participation was voluntary and that they could withdraw from the study at any time. 2. Data confidentiality and privacy protection: We have taken appropriate measures to protect the privacy of participants' personal information. We will not publicize or disclose any personal information that could lead to participants being identified. We will anonymize participants' information in the study. 3. Assessment and management of potential risks: We have assessed the potential risks that may be involved in the study during the project design phase and have taken appropriate measures to minimize or manage these risks. We guarantee that participants will not suffer any physical or psychological harm as a result of participating in the study. 4. Use of research data: We will strictly adhere to the principles of legality and transparency in the use of data to ensure proper use and interpretation of research data. We will avoid misinterpretation and misuse of the data as much as possible and will only use the data for research purposes. 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CAPLAN SE. Relations among loneliness, social anxiety, and problematic Internet use [J]. Cyberpsychology & behavior: the impact of the Internet, multimedia and virtual reality on behavior and society, 2007, 10(2): 234 – 42. WANG W, MEHMOOD A, LI P et al. Perceived Stress and Smartphone Addiction in Medical College Students: The Mediating Role of Negative Emotions and the Moderating Role of Psychological Capital [J]. Frontiers in psychology, 2021, 12(660234. RAMóN-ARBUéS E, GEA-CABALLERO V, GRANADA-LóPEZ JM et al. The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students [J]. Int J Environ Res Public Health, 2020, 17(19). FOLKMAN S. Stress, coping, and hope [J]. Psycho-oncology, 2010, 19(9): 901–8. SPADA MM, NIKEVI A V, MONETA G B, et al. Metacognition, perceived stress, and negative emotion [J]. Personality Individual Differences. 2008;44(5):1172–81. KEENER TA, HALL K, WANG K, et al. Quality of Life, Resilience, and Related Factors of Nursing Students During the COVID-19 Pandemic [J]. Nurse Educ. 2021;46(3):143–8. DUBE MB, MLOTSHWA PR. Factors influencing enrolled nursing students' academic performance at a selected private nursing education institution in KwaZulu-Natal [J]. Curationis. 2018;41(1):e1–7. EL-SAYED DESOUKY D, ABU-ZAID H. Mobile phone use pattern and addiction in relation to depression and anxiety [J]. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 2020, 26(6): 692–9. SCHOU ANDREASSEN C, BILLIEUX J, GRIFFITHS MD, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study [J]. Psychol Addict behaviors: J Soc Psychologists Addict Behav. 2016;30(2):252–62. XIAO Z. HUANG J. The Relation Between College Students' Social Anxiety and Mobile Phone Addiction: The Mediating Role of Regulatory Emotional Self-Efficacy and Subjective Well-Being [J]. Frontiers in psychology, 2022, 13(861527. ZHANG A, XIONG S, PENG Y et al. Perceived stress and mobile phone addiction among college students: The roles of self-control and security [J]. Frontiers in psychiatry, 2022, 13(1005062. HUANG Q, HU M. CHEN H. Exploring Stress and Problematic Use of Short-Form Video Applications among Middle-Aged Chinese Adults: The Mediating Roles of Duration of Use and Flow Experience [J]. Int J Environ Res Public Health, 2021, 19(1). BARNETT L A. The playful child: Measurement of a disposition to play [J]. Play Cult. 1991;4(1):51–74. LU X, YEO K J. Pathological Internet use among Malaysia University Students: Risk factors and the role of cognitive distortion [J]. Comput Hum Behav, 2015, 45(235 – 42. XU W, LIANG H N, BAGHAEI N, et al. Effects of an Immersive Virtual Reality Exergame on University Students' Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study [J]. JMIR serious games. 2021;9(4):e29330. CSIKSZENTMIHALYI M. The flow experience and its significance for human psychology [M]. 1988. LARCHE C J, DIXON M J. The relationship between the skill-challenge balance, game expertise, flow and the urge to keep playing complex mobile games [J]. J Behav addictions. 2020;9(3):606–16. LU L, LIU M, GE B et al. Adolescent Addiction to Short Video Applications in the Mobile Internet Era [J]. Frontiers in psychology, 2022, 13(893599. Additional Declarations No competing interests reported. Supplementary Files shujv.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:22:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31893,"visible":true,"origin":"","legend":"\u003cp\u003eTheoretical model.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4373381/v1/fb42240a7855a23bbf085422.jpg"},{"id":58130105,"identity":"06ed63fe-cc60-411d-b51c-22b4eae47004","added_by":"auto","created_at":"2024-06-11 14:22:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22878,"visible":true,"origin":"","legend":"\u003cp\u003eModel of the chain mediating effects of anxiety and flow experience on the relationship between perceived stress and mobile phone addiction.\u003c/p\u003e\n\u003cp\u003e* P\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003eThe dataset(s) supporting the conclusions of this article is(are) included within the article (and its additional file(s)).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4373381/v1/a23f0d716d919022d22af4c4.jpg"},{"id":77000138,"identity":"9488a49a-3464-476a-85c0-6623895e908b","added_by":"auto","created_at":"2025-02-24 07:32:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1186640,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4373381/v1/a39ab592-1165-45bc-a044-38b94ee5b47c.pdf"},{"id":58130106,"identity":"7ee3fed2-8aea-4742-8e94-360b69749da8","added_by":"auto","created_at":"2024-06-11 14:22:02","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1467830,"visible":true,"origin":"","legend":"","description":"","filename":"shujv.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4373381/v1/859e1c9795327e8fa6864752.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceived stress and mobile phone addiction among China Nursing Students: The chain-mediating role of anxiety and flow experience","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eWith the evolution of technology and the advancement of society, the Internet assumes an increasingly integral role in our daily lives. As of December 2022, China boasted a robust Internet penetration rate of 75.6%, with over 90% of the populace accessing it through mobile phones \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Mobile phones have profoundly altered societal dynamics, becoming indispensable components of our existence. Nonetheless, recent years have seen mounting concerns over the pervasive issue of excessive mobile phone usage\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Termed mobile phone overuse, dependence, or addiction, this phenomenon constitutes a behavioral addiction \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, characterized by an individual's compulsive engagement in mobile phone-mediated activities, resulting in substantial impairment of social and psychological well-being \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Individuals may develop an irresistible urge to utilize their mobile phones, diverting their focus from daily responsibilities. Statistics reveal that mobile phone ownership among Chinese college students surpasses 99% \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Compared to the working population, college students exhibit lower levels of psychological maturity and self-regulation capacity \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e, rendering them particularly susceptible to mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This addiction intertwines intricately with students' physical and mental health \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, engenders feelings of insecurity \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, promotes nocturnal habits \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, compromises sleep quality \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, exacerbates feelings of low self-esteem and depression \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, and detrimentally impacts academic performance \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Nursing students, serving as vital reserves in the nursing profession, contend with heightened pressures compared to their peers and are inclined to resort to mobile phones as a coping mechanism for stress relief \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Consequently, mobile phone addiction emerges as a prominent behavioral concern among nursing students \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Thus, delving into the determinants of mobile phone addiction among nursing students holds promise for enhancing their overall well-being and aiding in the mitigation of addictive behaviors.\u003c/p\u003e \u003cp\u003eDrawing from general stress theory \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, stress can precipitate maladaptive behaviors. Nursing students, bereft of immediate parental oversight and support, grapple with a myriad of stressors including acclimatizing to their new environment, fulfilling academic obligations, and navigating interpersonal dynamics. This confluence of stressors imposes a significant burden on nursing students, particularly freshmen and sophomores, leading some to seek solace in virtual realms as a means of stress mitigation. Notably, nursing students contend with elevated levels of educational stress compared to their counterparts in other disciplines \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Such stressors emanate from two primary domains: academic and clinical. Academic stressors encompass arduous coursework demands \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, rigorous examinations \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, among others. Conversely, clinical stressors revolve around apprehensions stemming from unfamiliar clinical environments \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, patient care responsibilities \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, and perceived inadequacy in nursing competencies \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePerceived stress, within this context, denotes the psychological disarray or threat induced by various life stressors, manifesting as physiological and psychological tension and discomfort \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Several studies, including research by Gao et al. \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, have provided evidence underscoring the pivotal role of perceived stress as a key determinant in precipitating mobile phone addiction among college students. Obviously, individuals experiencing heightened levels of stress are predisposed to mobile phone addiction, suggesting a notable positive correlation between perceived stress and mobile phone addiction. However, despite these findings elucidating the association between stress and mobile phone addiction, the precise mechanisms through which stress engenders mobile phone addiction remain elusive.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 The mediating role of anxiety\u003c/h2\u003e \u003cp\u003eEmpirical investigations, as reported by Herbison et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, have underscored that perceived stress serves as a reliable predictor of anxiety, with heightened levels of perceived stress correlating positively with increased anxiety levels. Stress, recognized as a primary contributor to psychological distress, inclines individuals towards negative emotional states such as anxiety \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Individuals perceiving elevated stress levels may turn to mobile phones as a means of escapism from the harsh realities of stress-induced negative emotions \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Anxiety, characterized by apprehension regarding future uncertainties or adversities, accompanied by tense emotional and physical responses \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, exerts significant impacts on the physical and mental well-being of college students, with prolonged anxiety potentially culminating in suicidal tendencies \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Indeed, Kim and Koh \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e proposed that anxiety positively predicts mobile phone addiction, a sentiment echoed by Matar Boumosleh and Jaalouk \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e, who identified anxiety as an independent positive predictor of mobile phone addiction.\u003c/p\u003e \u003cp\u003eAligned with the compensatory Internet use model \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, individuals may resort to the Internet, including mobile phones, as a coping mechanism to assuage anxiety. Moreover, some studies suggest that individuals may adopt maladaptive coping strategies, such as substance dependence, to alleviate emotional distress \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, with mobile phone addiction often serving as a conduit for anxiety dissipation.\u003c/p\u003e \u003cp\u003eIn summation, the perception of stress may influence the extent of mobile phone addiction among nursing students through the mediating pathway of anxiety. Hence, we posit Hypothesis 1: Anxiety mediates the relationship between perceived stress and mobile phone addiction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 The mediating role of flow experience\u003c/h2\u003e \u003cp\u003eAccording to the flow state model \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e, this study defines flow experience as a student's high level of concentration while using a mobile phone, feeling that time flies, and enjoying the use of the phone very much. Stressed students tend to choose negative means (e.g., using mobile phones) to relieve stress, and as the frequency of mobile phone use increases, they eventually develop to use mobile phones when they are stressed and immerse themselves in the online world \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, resulting in mobile phone addiction. The immersion experience from mobile phone addiction relieves stress, and perceived stress is positively correlated with immersion \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Immersion is similar to flow experience, which refers to an overall feeling when an individual is fully immersed in something or a situation \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Flow experience can significantly predict mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. The integrative theory of playfulness in computer interactions suggests that the flow experience leads to repetition of behavior\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e; Julia B \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e suggests that Facebook flow is highly correlated with the addictive use of Facebook and even helps to maintain its addictive use. Based on the above kinds of literature, we propose hypothesis 2: Flow experience mediates the role between perceived stress and mobile phone addiction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 The chain-mediating role of anxiety and flow experience between perceived stress and mobile phone addiction\u003c/h2\u003e \u003cp\u003eAccording to flow theory, the flow experience is a state of being immersed in using a mobile phone \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. High flow experience is associated with mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Mobile phone addiction plays a crucial role in the development of flow experience \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e, and immersion is also associated with anxiety \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. All the above evidence indicates that anxiety and flow experience may play a chain mediating role between perceived stress and mobile phone addictions, but limited previous study has been conducted to confirm the link between them. Therefore, based on the general aggression model, a chain mediating model is proposed in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2 Materials and methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eIn this study, a convenience sampling method was employed to collect data from students enrolled in a nursing college situated in Heilongjiang province during December 2021. A total of 4179 students were surveyed, resulting in 3050 valid questionnaires after the removal of invalid responses, yielding a commendable valid recovery rate of 72.98%. Among the respondents, 921 (30.2%) were male students, while 2129 (69.8%) were female students. Regarding residential backgrounds, 1580 (51.8%) hailed from urban areas, whereas 1470 (48.2%) originated from rural locales. The average age of the participants was 19.10 years (SD\u0026thinsp;=\u0026thinsp;1.046). Notably, 714 students exhibited tendencies towards mobile phone addiction, constituting 23.41% of the valid questionnaires. Prior to data collection, ethical approval was obtained from the Ethics Committee of Harbin Medical University, and informed consent was secured from all participants, adhering to ethical research practices.The purpose and content of the study were communicated prior to the survey, consent was obtained from the school teachers and the subjects themselves, and the subjects participated in the survey voluntarily and anonymously. The content of the study and the research process complied with the ethical provisions of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measures\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Chinese perceived stress scale (CPSS)\u003c/h2\u003e \u003cp\u003eThe Chinese Perceived Stress Scale (CPSS) was utilized to assess the perceived stress levels among the study participants. Originally developed by Cohen et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e and introduced to China by Yang et al. \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e, the scale comprises 14 items and is structured into two dimensions: tension and loss of control. Responses are rated on a Likert 5-point scale, ranging from 0 to 4, with higher scores indicative of heightened levels of perceived stress. In this investigation, the Cronbach's α coefficient for the CPSS was calculated to be 0.963, demonstrating high internal consistency reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Generalized Anxiety Disorder-7 (GAD-7)\u003c/h2\u003e \u003cp\u003eAnxiety levels were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, developed by Spitzer et al. \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Comprising 7 items, each item is scored on a scale of 0 to 3, with 0 indicating the absence of symptoms, 1 for occasional symptoms, 2 for frequent symptoms, and 3 for persistent symptoms. Total scores are computed by summing all item-level scores, with higher scores indicative of elevated anxiety levels. In this study, the Cronbach's α coefficient for the GAD-7 was calculated to be 0.966, indicating robust internal consistency reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Flow State Scale (FSS)\u003c/h2\u003e \u003cp\u003eThe scale utilized in this study was adapted by Zhang et al. \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e to suit the context of mobile phone addiction. It comprises four items designed to assess the level of flow experience during mobile phone usage. Responses are provided on a 5-point Likert scale, ranging from 1 (Completely out of line) to 5 (Fully compliant). The total score ranges from 5 to 20, with higher scores indicative of heightened flow experiences during mobile phone usage. In this investigation, the total Cronbach\u0026rsquo;s α coefficient for the scale was calculated to be 0.933, indicating strong internal consistency reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Mobile Phone Addiction Tendency Scale (MPATS)\u003c/h2\u003e \u003cp\u003eThe Mobile Phone Addiction Tendency Scale (MPATS), developed by Xiong Jie et al.\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e, was employed in this study. This scale comprises 16 items categorized into four dimensions: withdrawal symptoms, emergent behaviors, social soothing, and mood changes. Respondents rate each item on a 5-point Likert scale, ranging from 1 (Completely out of line) to 5 (Fully compliant). The total score ranges from 16 to 80, with higher scores indicating a greater tendency towards smartphone addiction, with scores exceeding 48 indicative of mobile phone addiction. In this investigation, the Cronbach's α coefficient for the MPATS was calculated to be 0.945, denoting high internal consistency reliability.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using SPSS 26.0 statistical software. Initially, descriptive statistical analyses were performed on the variables, followed by the calculation of correlations between these variables using Pearson correlation analysis. Subsequently, the data underwent tests for differences and common method deviation. Independent samples t-tests were employed to compare scores on the Mobile Phone Addiction Scale among nursing college students with varying demographic characteristics. For mediating effects analysis, Hayes' Process \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e model 6, along with the Bootstrap method, was utilized. The Bootstrap method facilitated the testing of the significance of mediating effects, with 95% confidence intervals that did not encompass 0 indicative of a significant effect.\u003c/p\u003e \u003cp\u003eFurthermore, in accordance with existing literature, demographic variables such as gender \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e, grade\u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e, and age \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e of college students were incorporated as control variables in this study to mitigate potential confounding factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Result","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Common Method Biases Test\u003c/h2\u003e \u003cp\u003eTo ensure the scientific rigor of the findings, Harman\u0026rsquo;s single-factor test was conducted to assess potential common methodological biases before commencing data analysis \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. All items from the questionnaire were amalgamated for exploratory factor analysis. The results revealed 14 factors with characteristic roots exceeding 1, and the proportion of variance explained by the first common factor was 34.10%, significantly below the threshold of 40%. Consequently, no significant common methodological biases were detected in this study \u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Descriptive statistics and correlation analysis\u003c/h2\u003e \u003cp\u003eAfter screening out questionnaires with irregular responses, missing items, and inadequate completion periods, a total of 3050 nursing students participated in the study, with 23.44% exhibiting tendencies towards mobile phone addiction. The demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Male students comprised 30.2% of the total survey population, whereas female students accounted for 69.8%. To investigate whether demographic variables exerted an influence on mobile phone addiction, independent sample t-tests were conducted on variables such as gender and grade. The findings indicated that mobile phone addiction scores were significantly higher among female students compared to male students, and sophomores exhibited higher levels of mobile phone addiction than freshmen.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferential analysis of mobile phone addiction in terms of gender and grade(n\u0026thinsp;=\u0026thinsp;3050)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGender(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eGrade(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale(921)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale(2129)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFirst grade(1896)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSecond grade(1154)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobile phone addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e41.08\u0026thinsp;\u0026plusmn;\u0026thinsp;13.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.61\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e44.60\u0026thinsp;\u0026plusmn;\u0026thinsp;13.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-7.24\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comprehensive results for all correlations are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Perceived stress, anxiety, flow experience, and mobile phone addiction demonstrate positive correlations with each other.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans, standard deviations, and correlation analysis between variables(n\u0026thinsp;=\u0026thinsp;3050)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Mobile phone addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.564\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Flow experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.579\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.490\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Perceived stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.578\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.507\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.657\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Testing of the mediating effect of anxiety and flow experience\u003c/h2\u003e \u003cp\u003eThe bootstrap method was employed to draw 5000 samples, and Hayes' Process v3.5 macro program model 6 \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e was utilized to examine the mediating effects of anxiety and flow experience, while controlling for three variables: gender, grade, and place of birth. The results of the regression analysis (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) indicated that perceived stress emerged as a significant positive predictor of anxiety (β\u0026thinsp;=\u0026thinsp;0.504, t\u0026thinsp;=\u0026thinsp;32.468, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), flow experience (β\u0026thinsp;=\u0026thinsp;0.547, t\u0026thinsp;=\u0026thinsp;35.660, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mobile phone addiction (β\u0026thinsp;=\u0026thinsp;0.248, t\u0026thinsp;=\u0026thinsp;13.745, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, anxiety positively predicted both flow experience (β\u0026thinsp;=\u0026thinsp;0.215, t\u0026thinsp;=\u0026thinsp;13.916, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and mobile phone addiction (β\u0026thinsp;=\u0026thinsp;0.303, t\u0026thinsp;=\u0026thinsp;19.303, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas flow experience was found to be a positive predictor of mobile phone addiction (β\u0026thinsp;=\u0026thinsp;0.262, t\u0026thinsp;=\u0026thinsp;14.664, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis of the relationship between the variables in the chain mediation model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegression equation\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3050)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eOverall fit index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSignificance of regression coefficients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResult variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredictive variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e277.674\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.468\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlow experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e537.206\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.666\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.502\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e35.660\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.916\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobile phone addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e472.442\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.052\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.775\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13.745\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19.303\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlow experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.664\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e** P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, * P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the mediation effect, as indicated by the Bootstrap 95% confidence interval in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, revealed significant indirect effects for three pathways:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized indirect effects from stress and rumination\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBootSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBootstrap95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003eProportion of Relative Effect%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBootLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBootULCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVia anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.62%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVia anxiety and\u003c/p\u003e \u003cp\u003eflow experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.98%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVia flow experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal indirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e56.65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e1. Perceived stress \u0026rarr; anxiety \u0026rarr; flow experience \u0026rarr; mobile phone addiction, with an indirect effect value of 0.039. This suggests that the chain mediating effect between perceived stress and mobile phone addiction among nursing students is significant.\u003c/p\u003e \u003cp\u003e2. Perceived stress \u0026rarr; anxiety \u0026rarr; mobile phone addiction, with an indirect effect value of 0.209. This indicates that anxiety partially mediated the relationship between perceived stress and mobile phone addiction.\u003c/p\u003e \u003cp\u003e3. Perceived stress \u0026rarr; flow experience \u0026rarr; mobile phone addiction, with an indirect effect value of 0.196. This highlights the significant role of flow experience in mediating the relationship between perceived stress and mobile phone addiction.\u003c/p\u003e \u003cp\u003eThe mediation effects of anxiety and flow experience on mobile phone addiction are visually depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study delves into the interplay between perceived stress and mobile phone addiction among Chinese nursing students, while also examining the mediating roles of anxiety and flow experience. The findings underscore that perceived stress not only serves as a direct predictor of mobile phone addiction but also exerts an indirect influence through the pathways of anxiety and flow experience. Moreover, anxiety and flow experience collectively exhibit a chain mediation effect in elucidating the relationship between perceived stress and mobile phone addiction.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1 The mediating role of anxiety\u003c/h2\u003e \u003cp\u003eConsistent with prior research findings, our study revealed a positive correlation between perceived stress and mobile phone addiction among nursing students. This alignment supports the framework provided by general strain theory \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e, a widely recognized framework utilized to elucidate perceived stress as a predictor of mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. According to this theory, negative experiences stemming from various stressors can precipitate problematic behaviors. Previous investigations have similarly highlighted perceived stress as a prominent trigger of mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e. Furthermore, Mai et al. \u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e observed a positive association between stress and adolescent Internet addiction, underscoring the significant role of stress in shaping addictive behaviors. Of particular relevance is the context of the COVID-19 pandemic, during which mobile phones have emerged as ubiquitous tools for alleviating boredom and mitigating negative emotions \u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e. This heightened reliance on mobile phones during the pandemic may further exacerbate tendencies towards mobile phone addiction.\u003c/p\u003e \u003cp\u003eWe have confirmed that anxiety acts as an independent mediator between perceived stress and mobile phone addiction. Specifically, our findings demonstrate that perceived stress heightens the risk of anxiety, subsequently elevating the likelihood of mobile phone addiction. This result aligns with the observations made by Wang et al. \u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e, who reported an escalation in anxiety levels in response to perceived stress. Chronic stress arising from daily life challenges can compromise individuals' immune function and deplete their energy reserves, rendering them more susceptible to anxiety \u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e. According to stress and coping theory\u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e, heightened perceived stress is strongly associated with increased anxiety levels. Moreover, Spada et al. \u003csup\u003e[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e identified perceived stress as a significant predictor of anxiety, emphasizing a positive correlation between perceived stress and anxiety as well as depression. In the context of China, students opting for nursing majors in vocational universities often confront academic underperformance or unfavorable family circumstances. Consequently, they may experience initial psychological distress and feelings of inferiority, making it challenging to establish clear learning objectives \u003csup\u003e[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/sup\u003e. Additionally, nursing students exhibit a limited understanding of the nursing profession, leading to uncertainty about their future career paths. Moreover, mastering multiple disciplines such as biology, physics, psychology, and sociology imposes significant academic demands and learning difficulties, further exacerbating stress levels \u003csup\u003e[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e. These stressors collectively contribute to the manifestation of anxiety among nursing students.\u003c/p\u003e \u003cp\u003eThe direct link between anxiety and mobile phone addiction has been substantiated in our research, aligning with the compensatory Internet use model proposed by Elhai et al.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. This model posits that individuals\u0026rsquo; resort to mobile phone usage as a means of alleviating negative emotions, potentially fostering mobile phone addiction through excessive usage. Numerous studies have corroborated the association between anxiety and mobile phone addiction \u003csup\u003e[\u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e. For instance, Matar Boumosleh and Jaalouk underscored the predictive and explanatory role of anxiety in mobile phone addiction among nursing students \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Additionally, Zhang et al. identified anxiety as a mediating factor in the relationship between stress and addiction \u003csup\u003e[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e. Our study extends these findings by demonstrating that heightened levels of stress correspond to elevated anxiety levels, thereby increasing the likelihood of mobile phone addiction among students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 The mediating role of flow experience\u003c/h2\u003e \u003cp\u003eThe findings of this study indicate that flow experience serves as a partial mediator in the relationship between perceived stress and mobile phone addiction. Perceived stress enhances flow experience, subsequently heightening the risk of mobile phone addiction. It has been established that perceived stress significantly predicts flow experience among nursing students, consistent with the conclusions drawn by Huang et al. \u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/sup\u003e, who observed an escalation in flow experience in response to perceived stress. The immersion theory, advanced by Barnett\u003csup\u003e[\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e, posits that individuals are motivated to engage in activities that provide pleasure and engross their attention. According to this theory, students who immerse themselves in mobile phone use as a stress-relief mechanism are more likely to habitually use mobile phones, potentially culminating in addiction. Moreover, Lu and Yeo \u003csup\u003e[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e highlighted the resemblance between flow experience and immersion, both of which denote an enjoyable engagement in activities. Additionally, Xu et al. \u003csup\u003e[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e reported that perceived stress positively predicts immersion or flow experience, further supporting our findings.\u003c/p\u003e \u003cp\u003eThe immersion theory posits that flow experience can engross individuals when using mobile phones, with higher levels of flow experience increasing the likelihood of mobile phone addiction. Repetition serves as the foundation of addictive behavior, and flow experience acts as a catalyst for activating addiction\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Our study demonstrated a direct association between flow experience and mobile phone addiction, consistent with Csikszentmihalyi's flow theory \u003csup\u003e[\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e. When individuals experience flow, it generates positive experiences that may contribute to potential issues such as addictive behaviors.\u003c/p\u003e \u003cp\u003ePrior research has also substantiated the link between flow experiences and mobile phone addiction \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e. For instance, Lu et al. provided evidence that flow experience predicted and elucidated mobile phone addiction among college students \u003csup\u003e[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e. Similarly, Gong et al. identified flow experience as a mediating factor in the relationship between perceived stress and Internet addiction, corroborating our findings \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3 The chain-mediating role of anxiety and flow experience\u003c/h2\u003e \u003cp\u003eThe results of our study indicate that anxiety and flow experience act as chain mediators in the theoretical model, thus providing further validation for the playfulness theory of computer interaction \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. According to this theory, individuals experiencing high levels of stress are prone to developing anxiety, which, in turn, drives them to seek solace in the online world, leading to immersion and eventual addiction. Moreover, our findings align with the compensatory Internet use theory \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, which posits that individuals under significant stress or pressure may experience negative emotions such as anxiety and subsequently turn to the online realm as a means of alleviating stress and anxiety, ultimately resulting in mobile phone addiction.\u003c/p\u003e \u003cp\u003eThese findings carry significant implications for the prevention of mobile phone addiction among nursing students. Early intervention aimed at mitigating stress levels can halt the progression towards anxiety and, consequently, prevent the onset of mobile phone addiction. It is imperative for healthcare professionals and educators to not only address mobile phone addiction among nursing students but also prioritize the identification and management of stress and anxiety within this population. By addressing stress and anxiety proactively, healthcare providers and educators can effectively mitigate the risk of mobile phone addiction among nursing students.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Limitations","content":"\u003cp\u003eThis study delves into the factors influencing mobile phone addiction among nursing students through the lens of perceived stress, offering a comprehensive analysis of the pathways and circumstances that impact this phenomenon. It furnishes empirical evidence and practical insights aimed at ameliorating mobile phone addiction among college students. However, several limitations warrant acknowledgment.\u003c/p\u003e \u003cp\u003eFirstly, the study design is cross-sectional, precluding the establishment of causal relationships between variables. We sampled only one school, which is generally representative, and the limits to the findings can be generalized. Future research endeavors could benefit from longitudinal or experimental methodologies to validate the causal hypotheses posited in this study.\u003c/p\u003e \u003cp\u003eSecondly, reliance on questionnaire scales as research instruments, self-reported by participants, may have introduced response biases. Some respondents might have completed the questionnaires hastily, prioritizing speed over accuracy. To address this limitation, future studies could implement control measures such as scheduling specific appointment times to enhance the authenticity of questionnaire responses.\u003c/p\u003e \u003cp\u003eLastly, while this study considers the mediating effects of anxiety and flow experience between perceived stress and mobile phone addiction, other potential mediating variables warrant further investigation. Future research could explore additional mediators to gain a more comprehensive understanding of the mechanisms underlying mobile phone addiction among nursing students.\u003c/p\u003e"},{"header":"6 Conclusion","content":"\u003cp\u003eThe findings of this study offer valuable insights into the mechanisms through which perceived stress contributes to the likelihood of mobile phone addiction. Additionally, the study underscores the significance of mitigating stress levels and addressing anxiety as essential components of preventing mobile phone addiction among college students. Furthermore, the role of flow experience emerges as pivotal in averting mobile phone addiction. Therefore, efforts aimed at preventing and intervening in college students' mobile phone addiction should not only focus on reducing stress and anxiety but also on minimizing the immersive flow experience associated with mobile phone usage.\u003c/p\u003e"},{"header":"Declarations","content":"\n\u003ch2\u003eDeclaration of Competing Interest\u003c/h2\u003e \u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work is supported by the Heilongjiang Province Philosophy and Social Science Research Planning Project [grant number 18SHB076].\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eShuiqing Rong, Zhaonan Yang, and Lida Yang conducted the initial analyses, drafted the manuscript, and reviewed and revised it.Yuanbo Li, Jiawei Zhou, Xiaomeng Hu, Siyuan Ke, Qiongyi Wang, Qinghe Fan, Wei Duan, Yizhi Wang, and Junling Liu collected data and conducted initial analyses. Xiuxian Yang and Yanjie Yang conceptualized and designed the study, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. All authors contributed to and have approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe express our sincere gratitude to all participants who completed our questionnaires.\u003c/p\u003e\n\u003ch2\u003eEthics Statement\u003c/h2\u003e\n\u003cp\u003eThis research project has been approved by the relevant ethics committees or organizations and was conducted in strict accordance with ethical guidelines. In this study, we respected and protected the rights and privacy of the participants and ensured the confidentiality of their personal information.\u003c/p\u003e\n\u003cp\u003e1. Participants\u0026apos; informed consent: We explained the purpose, process, risks, and benefits of the study to all individuals participating in the study either orally or in writing, and obtained their informed consent. Participants had the right to know that their participation was voluntary and that they could withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e2. Data confidentiality and privacy protection: We have taken appropriate measures to protect the privacy of participants\u0026apos; personal information. We will not publicize or disclose any personal information that could lead to participants being identified. We will anonymize participants\u0026apos; information in the study.\u003c/p\u003e\n\u003cp\u003e3. Assessment and management of potential risks: We have assessed the potential risks that may be involved in the study during the project design phase and have taken appropriate measures to minimize or manage these risks. We guarantee that participants will not suffer any physical or psychological harm as a result of participating in the study.\u003c/p\u003e\n\u003cp\u003e4. Use of research data: We will strictly adhere to the principles of legality and transparency in the use of data to ensure proper use and interpretation of research data. We will avoid misinterpretation and misuse of the data as much as possible and will only use the data for research purposes.\u003c/p\u003e\n\u003cp\u003eThis statement is intended to safeguard the ethical compliance of the research project and to protect the rights and privacy of the participants. If you have any further questions or concerns, please do not hesitate to contact us.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZHANG Y, DING Y, HUANG H et al. Relationship between insecure attachment and mobile phone addiction: A meta-analysis [J]. 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Effects of an Immersive Virtual Reality Exergame on University Students' Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study [J]. JMIR serious games. 2021;9(4):e29330.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCSIKSZENTMIHALYI M. The flow experience and its significance for human psychology [M]. 1988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLARCHE C J, DIXON M J. The relationship between the skill-challenge balance, game expertise, flow and the urge to keep playing complex mobile games [J]. J Behav addictions. 2020;9(3):606\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLU L, LIU M, GE B et al. Adolescent Addiction to Short Video Applications in the Mobile Internet Era [J]. Frontiers in psychology, 2022, 13(893599.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"perceived stress, mobile phone addiction, anxiety, flow experience, nursing students","lastPublishedDoi":"10.21203/rs.3.rs-4373381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4373381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The relationship between perceived stress and mobile phone addiction among nursing students requires elucidation, alongside the clarification of potential explanatory pathways for associated risks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: 4179 freshmen and sophomore students participated in this investigation. Several assessment tools were employed, including the Chinese Perceived Stress Scale, Generalized Anxiety Disorder-7 scale, Flow State Scale, and Mobile Phone Addiction Tendency Scale. Data analysis encompassed descriptive statistics, independent sample T-tests, Pearson correlation analysis, and Hayes' PROCESS 3.5 for chain-mediated modeling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Pearson correlation analysis unveiled positive associations between perceived stress and anxiety (r=0.507, p\u0026lt;0.01), flow experience (r=0.657, p\u0026lt;0.01), and mobile phone addiction (r=0.578, p\u0026lt;0.01). Anxiety exhibited positive correlations with flow experience (r=0.490, p\u0026lt;0.01) and mobile phone addiction (r=0.564, p\u0026lt;0.01). Additionally, flow experience showed a positive relationship with mobile phone addiction (r=0.579, p\u0026lt;0.01). Chain mediation analysis revealed that anxiety [mediated effect: 26.62%, SE=0.014, 95% CI= (0.182,0.237)] and flow experience [mediated effect: 25.05%, SE=0.014, 95% CI= (0.169,0.225)] partially mediated the link between perceived stress and mobile phone addiction, respectively. Perceived stress exerted its influence on mobile phone addiction through the chain-mediated effects of anxiety and flow experience [mediating effect: 4.98%, SE=0.039, 95% CI= (0.031, 0.047)].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Perceived stress not only directly impacts the mobile phone addiction tendencies of nursing students but also exerts indirect effects via the independent mediation of anxiety and flow experience. Moreover, perceived stress affects mobile phone addiction through the chain-mediated pathway involving both anxiety and flow experience.\u003c/p\u003e","manuscriptTitle":"Perceived stress and mobile phone addiction among China Nursing Students: The chain-mediating role of anxiety and flow experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 14:21:57","doi":"10.21203/rs.3.rs-4373381/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3e77fd17-ed81-4ce4-b9c6-6c3507a01e82","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T07:24:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 14:21:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4373381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4373381","identity":"rs-4373381","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}