Phantom Vibration Syndrome and Problematic Smartphone Use: A Cross-Sectional Study on Sleep Disturbances, Mental Health, and Academic Stress Among University Students

Phantom Vibration Syndrome and Problematic Smartphone Use: A Cross-Sectional Study on Sleep Disturbances, Mental Health, and Academic Stress Among University Students | 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 Phantom Vibration Syndrome and Problematic Smartphone Use: A Cross-Sectional Study on Sleep Disturbances, Mental Health, and Academic Stress Among University Students Maherin Khan¹, Meyren Mansour, Ashish Ashish, Priyanshu Dixit, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8028025/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 In a world where the mind vibrates even when the phone does not, digital habits are quietly reshaping how we rest, focus, and feel. Phantom vibration syndrome (PVS), the false sensation of a phone vibrating, and problematic smartphone use (PSU) have become increasingly common among university students. These behaviors may reflect deeper psychological conditioning linked to anxiety, poor sleep, and stress, yet remain underexplored from a public health perspective. METHODS A cross-sectional online survey was conducted among 553 university students to examine the prevalence and correlates of PVS and PSU. Standardized scales measured sleep disturbance, anxiety symptoms, and academic stress. Descriptive and inferential analyses were performed using SPSS. An open-ended question invited students to share strategies for managing smartphone use, and responses were analyzed thematically to identify recurring digital well-being themes. RESULTS Phantom vibrations were reported by 41.4% of participants, with 22% experiencing them occasionally and 5.4% frequently. More than half (54.8%) reported fatigue and poor sleep. Higher PSU scores were significantly associated with anxiety (p < 0.01) and sleep disturbance (p < 0.05). Qualitative insights revealed three consistent coping patterns: digital detox routines, environmental changes, and structured daily activities that limited device use. CONCLUSIONS The findings suggest that the modern student's constant connectivity has subtle but measurable effects on mental and physical well-being. By treating digital balance as an essential health behavior, similar to sleep hygiene or nutrition, universities can help protect students from the psychological fatigue of always being online. Addressing PVS and PSU through awareness and behavioral interventions should be considered a public health priority for the digital age. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction A silent expectation that never materialized but has a strong mental resonance. This brief feeling has become a commonplace aspect of digital life for the younger generation, serving as a subtly potent reminder of how deeply technology has permeated human behavior. Reaching for a phone that never vibrated or checking a screen that remained dark, which was once an occasional distraction, has become an almost universal reflex. Excessive smartphone use has rapidly evolved into a modern behavioral epidemic, affecting not just productivity but the very rhythms of sleep, mood, and mental focus among young adults [ 1 , 2 ]. Beyond mere screen exposure, specific behaviors such as phantom vibration syndrome (PVS) and problematic smartphone use (PSU) reflect psychological dependency created by constant digital connectivity [ 3 – 5 ]. While recent research has explored the consequences of excessive smartphone exposure, much of it focuses narrowly on screen time or social media addiction, overlooking subtler phenomena such as PVS [ 6 , 7 ]. Similarly, although PSU has been linked to heightened anxiety, poor sleep, and academic strain, studies often rely on small or homogeneous samples [ 8 , 9 ]. A substantial knowledge gap persists in understanding how these interconnected digital behaviors jointly affect mental and physical well-being across culturally diverse academic populations [ 10 – 12 ]. University students represent a particularly vulnerable demographic, caught between academic demands, social pressures, and the constant pull of technology [ 13 , 14 ]. The convergence of these stressors fosters an environment where compulsive smartphone engagement becomes normalized and its health implications overlooked. This study therefore investigates the combined impact of PVS and PSU on sleep disturbance, anxiety, and academic stress among university students. By examining these emerging digital behaviours together, this research seeks to illuminate their collective contribution to the growing public-health crisis of digital fatigue. Addressing this silent epidemic is crucial: just as diet, sleep, and physical activity define wellness, digital well-being must now be recognised as a core determinant of health in the 21st century. Methods Study Design This study employed a cross-sectional design to examine the associations between phantom vibration syndrome (PVS),problematic smartphone use (PSU),sleep disturbance, mental health status among university students. Data were collected through a self-administered questionnaire distributed between April to May 2025. The survey included both structured and open ended questions aimed at evaluating smartphone-related behaviours, emotional reliance, and psychological symptoms over the previous two weeks. Study Population The target population consisted of undergraduate and postgraduate students enrolled in various academic program at Jilin University. Participants were eligible if they were currently enrolled, aged 17 years or older, and provided informed consent. A non-probability convenience sampling was used, and survey posters containing QR codes were circulated physically and electronically to maximise outreach within the student community. Approximately 700 students were reached through these platforms, 600 initiated the survey, and 553 provided completed and valid responses, which were included in the final analysis. Responses with missing or inconsistent data were excluded. A flow diagram illustrating participant recruitment and inclusion is provided in Figure 1. Data Collection and Measure The questionnaire included both closed- and open-ended items across five domains: sociodemographic characteristics, phantom vibration syndrome (PVS), smartphone use behaviors, sleep quality, and recent mental health symptoms. Mental health-related items were adapted from commonly used screening tools such as the PHQ-9 and GAD-7 to reflect symptoms like fatigue [15, low mood, and anxiety, though full scales were not applied [15, 16]. PVS was assessed by experience, frequency, and context of occurrence, while smartphone behaviours included screen time, emotional attachment, and use during pre-sleep or night-time hours [17]. Sleep quality was self-rated, and the impact of smartphone use on academics, sleep, or social life was recorded. A final open-ended question asked participants to suggest one change to improve their well-being. Responses were reviewed and grouped thematically. The English-language questionnaire was informally pretested for clarity, with an estimated completion time of 7–10 minutes. No personal identifiers were collected. Statistical Analysis All data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 29.0. Descriptive statistics were calculated for all variables. Categorical variables were summarized using frequencies and percentages, while continuous variables were reported as means and standard deviations. Bivariate associations between phantom vibration syndrome (PVS) and categorical variables such as daily screen time, nighttime phone checking, sleep quality, and anxiety-related symptoms were examined using chi-square (χ²) tests. A p-value of <0.05 was considered statistically significant. In addition to chi-square tests, binary logistic regression models were conducted to further assess the relationship between PVS and key health outcomes. Separate models were constructed with: Model 1: Anxiety symptoms (present vs. absent) Model 2: Poor sleep quality (poor/very poor vs. good/very good) as dependent variables. PVS status (yes vs. no) was entered as the primary independent variable. Each model was adjusted for potential co-founders, including age group, gender, and daily screen time (>6 hours vs. ≤6 hours). Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values. All statistical tests were two-tailed, and a significance level of p < 0.05 was considered statistically significant. Ethical Approval This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki [19]. Ethical approval was obtained from Institutional Review Board of Jilin university (AF-BMSIRB-01-07). Prior to participation, all respondents were informed of the study’s purpose, assured of anonymity and confidentiality of their response. Open-ended response and qualitative summary In addition to structured items, the survey included an optional open-ended question inviting participants to describe their personal strategies or opinions regarding smartphone use, digital well-being, and experiences of phantom vibration sensations. This qualitative component was designed to capture individual perspectives that might not be reflected in quantitative scales, thereby enriching the behavioural interpretation of findings. Data handling and analysis All open-text responses were screened to remove any identifying information and were analysed inductively using a thematic content analysis approach[18]. Responses were reviewed independently by two researchers, who identified recurring patterns and conceptual categories through iterative reading and coding. Codes were grouped into broader themes that reflected common coping strategies and attitudes toward digital behaviour. The analytic process followed standard qualitative rigor principles, including data familiarisation, coding, theme development, and refinement. Discrepancies in coding were discussed until consensus was reached. Manual coding in spreadsheet format was used to organise excerpts under thematic headings. Results Participants Characteristics A total of 553 students participated in the study. The majority were aged 17–23 years (78.7%) and identified as East Asian (79.4%). Gender distribution was balanced, and over half studied ≥4 hours per day with attendance rates above 90% (Table 1). Table 1. Sociodemographic and Study Characteristics of Participants (N = 553) Characteristic Category n(%) Age Group 17- 23 years 435 (78.7%) 24 – 27 years 81 (14.6%) 28+ years 37 (6.7%) Gender Male 291 (52.6%) Female 262 (47.4%) Ethnicity East Asian 244 (44.1%) Middle Eastern 109 (19.71%) South Asian 106 (19.17%) African 56 (10.13%) European 38(6.87%) Year of Study 1 st year 167(30.2%) 2 nd year 119(21.5%) 3 rd year 163(29.5%) 4 th year 74(13.4%) 5 th year 30(5.4%) Daily Study Hours 6 hours 166(30.0%) Attendance Rate >90% 386(69.8%) 80-89% 92 (16.6%) 60-79% 38 (6.9%) <60% 37 (6.7%) Daily Screen Time 8 hours 120 (21.7%) Prevalence and Characteristics of Phantom Vibration Syndrome (PVS) Overall, 41.4% (n=229) of respondents reported experiencing phantom vibrations. Among these, most reported rare episodes (62.6%), while 32.0% experienced them occasionally and 5.4% frequently. PVS episodes occurred most often while studying (48.1%) and during class (33.8%), followed by while communicating (27.5%) or before sleep (22.8%). Emotional responses to PVS were largely neutral (57.7%), but 25.9% reported relief, 10.5% frustration, and 6.0% anxiety (Figure 2). Smartphone Use Behaviours Most participants reported using their smartphones within 30 minutes before bedtime, and over half spent more than four hours daily on their devices. Academic performance and sleep schedules were the most commonly affected domains, while social interaction was less frequently reported. Emotional attachment to smartphones was widespread, with many participants describing affective dependence on their devices (Figure 3). Sleep Quality and Mental Health Symptoms Overall, 22.4% of students reported poor or very poor sleep quality. Fatigue and low energy were the most commonly reported symptoms (54.8%), followed by anxiety-related symptoms such as trouble relaxing (42.9%) and excessive worry (40.7%). Table 2 summarises the prevalence of sleep and mental health indicators in the study population. Table 2. Sleep quality and mental health symptoms among university students (n = 553) Variable n % Sleep Quality Good / Very good 429 77.6 Bad / Very bad 124 22.4 Mental Health Symptoms Fatigue / low energy 303 54.8 Sleep troubles 192 34.7 Loss of interest 200 36.2 Depression/ hopelessness 159 28.8 Concentration issues 163 29.5 Trouble relaxing (GAD) 237 42.9 Nervous / anxious feelings 225 40.7 Excessive worry 225 40.7 Irritability 132 23.9 PHQ-9 = Patient Health Questionnaire-9; GAD-7 = Generalised Anxiety Disorder-7. PHQ-9 and GAD-7 items were adapted but not administered in full. Associations between PVS, smartphone use, and well-being Chi-square analyses revealed significant associations between PVS experience and several behavioural and mental health factors. Students who experienced PVS were more likely to report high daily screen time (>6 hours; χ²(1) = 12.4, p = 0.002) and nighttime phone checking (χ²(1) = 9.1, p = 0.01) compared to those without PVS. PVS was also significantly associated with anxiety symptoms (χ²(1) = 15.6, p < 0.001). No significant associations were found with gender or academic year. Qualitative Responses Thematic analysis of 112 open-ended responses identified three dominant strategies proposed by students to reduce stress and improve well-being: (1) digital detox and screen-time boundaries, such as using blocking apps or scheduling phone-free periods; (2) environmental modifications, including designated relaxation spaces at university; and (3) structured routines, particularly integrating regular physical activity and mindfulness practices. A thematic map (Figure 4) was developed based on the themes identified through this analysis[18]. Discussion This study examined the relationship between phantom vibration syndrome (PVS) and problematic smartphone use (PSU) among university students and their associations with sleep quality, mental health, and academic stress. Our findings reveal that both PVS and PSU are highly prevalent within this population, reflecting the growing behavioural entanglement between psychological arousal, emotional dependence, and digital stimuli. Behavioural and Psychological Interpretations The high prevalence of PVS indicates that the mind may be adapting to constant connectivity — anticipating notifications even in their absence. This aligns with conditioning theory, where repeated cues (such as vibrations or alerts) reinforce anticipatory responses. Over time, this forms a dopamine reward loop: every real or imagined vibration triggers a small burst of expectation, compelling users to check their devices habitually. This mechanism mirrors addictive behavioural cycles observed in other compulsive activities, including gambling or social media use. Similarly, the association between PSU and anxiety symptoms suggests that excessive smartphone engagement fosters hyper arousal, impairing emotional regulation and rest. Continuous exposure to social updates, notifications, and online comparisons reinforces fear of missing out (FOMO) — a psychological phenomenon linked to stress, low self-esteem, and disrupted sleep. These processes collectively erode mental focus, self-control, and restfulness, explaining the high rates of fatigue and poor sleep quality observed in our participants. Cross-Cultural Relevance and Comparison The patterns identified in this study align with international evidence. Studies in China, Norway, and Turkey have likewise reported associations between prolonged smartphone use and symptoms of anxiety and sleep disturbance [2,7,9]. However, our findings extend these observations to a culturally diverse academic cohort, demonstrating that digital dependency transcends geographic boundaries. The emotional attachment and pre-sleep usage habits seen here mirror global behavioural trends, reinforcing that digital overuse is an emerging public health concern with universal reach. Public Health Implications From a public-health perspective, universities play a crucial role in mitigating the adverse effects of digital overuse. As higher education increasingly integrates technology into every aspect of learning, digital well-being must be treated as a core health determinant — akin to nutrition, exercise, or sleep hygiene. Institutions can promote healthy digital habits through awareness campaigns, structured “digital detox” workshops, and phone-free study environments. Integrating digital behaviour assessment into mental health services could enable early identification of students at risk for anxiety or insomnia related to PSU. The findings underscore the need for institutional and policy-level action to promote digital well-being among young adults. Universities could incorporate structured digital hygiene modules within student orientation programs and provide access to digital detox or mindfulness workshops through campus health centers. At a broader level, national public health agencies could recognize digital behavior management as a preventive mental health measure, integrating it alongside nutrition, physical activity, and sleep promotion within existing wellness frameworks. Establishing such evidence-based policies could mitigate the behavioral risks of smartphone dependency and enhance student mental resilience across educational settings. Broader Behavioural Insights The coexistence of PVS and PSU illustrates the subtle psychological cost of perpetual connectivity. The human brain — conditioned to respond to intermittent rewards — remains in a state of heightened vigilance, anticipating digital stimuli even in silence. This persistent cognitive engagement blurs boundaries between rest and alertness, explaining the overlap between digital use, stress, and reduced sleep quality. Understanding these processes through a behavioural-science lens underscores that this is not simply a matter of willpower, but of environmental conditioning that reshapes perception and attention. Future Directions Longitudinal research is needed to establish temporal links between digital behaviours and psychological outcomes, while integrating objective indicators such as screen-time logs, physiological stress markers, or actigraphy could enhance data accuracy. Intervention-based studies — including mindfulness training, behavioural nudges, or screen-time regulation programs — should be explored as preventive strategies. Conclusion of Discussion Ultimately, this study underscores the urgent need for public-health frameworks that acknowledge digital exposure as a determinant of mental well-being. Addressing this emerging behavioural epidemic requires not only individual awareness but also institutional commitment to fostering healthier digital environment. By framing digital balance as a core component of holistic health—alongside sleep, nutrition, and exercise—universities can support students’ well-being in an environment where the mind remains alert to digital stimuli, even in the absence of actual notifications. Limitations This study has several limitations. First, its cross-sectional design prevents inference of causal relationships between smartphone use, mental health, and sleep outcomes. Second, all variables were based on self-reported measures, which may be influenced by recall or social desirability bias. Third, the sample was drawn from a single academic population through online distribution, which may limit generalizability to broader student or non-student populations. Finally, the study did not include objective measures such as screen-time tracking or physiological indicators of stress, which could provide additional insight into behavioural mechanisms. Despite these limitations, the findings contribute valuable evidence on an emerging behavioural health issue and underscore the need for longitudinal and intervention-based research. The interrelationships identified in this study are summarised in Figure 5, which presents a conceptual model of the hypothesised pathways linking phantom vibration syndrome (PVS), problematic smartphone use (PSU), and psychological outcomes. The model highlights the potential buffering role of digital-well-being strategies and the influence of confounders such as age, gender, and screen-time exposure. Conclusion This study highlights that phantom vibration syndrome and problematic smartphone use are prevalent and interconnected behaviours among university students, with measurable associations with anxiety symptoms, poor sleep quality, and academic stress. These patterns illustrate how constant digital engagement can heighten psychological arousal, disrupt rest, and undermine overall well-being. Beyond identifying risk factors, the qualitative findings revealed that students themselves recognise the importance of behavioural change. Many proposed simple, self-directed strategies such as digital detox periods, structured daily routines, physical exercise, and designated relaxation spaces on campus. These student-driven suggestions reflect a growing awareness of the psychological costs of excessive connectivity and point toward practical, low-cost solutions that can be implemented within academic settings. At a broader level, the findings underscore the need for universities and public health stakeholders to adopt integrated digital-well-being strategies that promote balanced smartphone use, sleep hygiene, and mental-health awareness. Introducing supportive environments such as phone-free study zones, wellness workshops, and spaces for relaxation could help students manage stress and enhance focus. By combining behavioural education, environmental design, and mental-health promotion, institutions can create healthier digital cultures that protect student well-being and academic performance in an increasingly connected world. Abbreviations PVS: Phantom Vibration Syndrome PSU: Problematic Smartphone Use PHQ-9: Patient Health Questionnaire-9 GAD-7: Generalized Anxiety Disorder-7 Declarations Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Consent to participate Participation was voluntary, and informed consent was obtained electronically prior to completing the questionnaire. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethics approval and consent to participate The study protocol was approved by the Institutional Review Board of Jilin University (Approval No. AF-BMSIRB-01-07). All participants provided electronic informed consent before completing the survey. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions MK conceptualized the study, designed the questionnaire, conducted statistical analysis, and drafted the manuscript. MM, AA,PD, VO, and SA contributed to data collection and validation. HA, AA, and PK assisted with data analysis and manuscript review. The supervising professor H.Z, provided oversight, methodological guidance, and final review of the manuscript. All authors read and approved the final manuscript. 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World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. https://doi.org/10.1001/jama.2013.281053 Additional Declarations No competing interests reported. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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15:33:30","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77488,"visible":true,"origin":"","legend":"","description":"","filename":"9c3f347a3b374b77bccde83a708e86cb1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/e7e3be86b3ecc62b31d88263.xml"},{"id":97895804,"identity":"9f424584-c43a-4a38-b6ca-6089dad01e7a","added_by":"auto","created_at":"2025-12-10 15:35:01","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":89118,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/e5d46c690da235e0d84b1b5f.html"},{"id":97895775,"identity":"4c27aa18-6a04-4f96-be5f-6bb72fd3a127","added_by":"auto","created_at":"2025-12-10 15:34:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":173947,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant recruitment and inclusion flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/a73897d203940adbd81f5bd4.png"},{"id":97719942,"identity":"b19d6e86-1e40-44d3-98fe-8d0ffec41ee9","added_by":"auto","created_at":"2025-12-08 15:33:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20773,"visible":true,"origin":"","legend":"\u003cp\u003eEmotional responses to phantom vibration experiences among students reporting PVS (n = 229).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/e3079d514fb13e9458b40c68.png"},{"id":97895466,"identity":"a30150b0-d2ff-4d45-9e40-552d78392a3f","added_by":"auto","created_at":"2025-12-10 15:34:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":22277,"visible":true,"origin":"","legend":"\u003cp\u003eEmotional and social patterns of smartphone use among university students.(n = 553).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/63c7989bdd098b11f0be7ec4.png"},{"id":97894559,"identity":"99293068-36b5-4953-8d23-f5b5ea328d57","added_by":"auto","created_at":"2025-12-10 15:32:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":230773,"visible":true,"origin":"","legend":"\u003cp\u003eThematic map summarising digital well-being strategies identified by students. Key approaches included structured digital detox periods, mindful environmental design, and routine-based behavioural regulation.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/d463069000f8896d7866a876.png"},{"id":97719952,"identity":"0b5f4844-0d6c-406f-b8fe-06dd91f0a074","added_by":"auto","created_at":"2025-12-08 15:33:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":264426,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual model illustrating hypothesised pathways between phantom vibration syndrome (PVS), problematic smartphone use (PSU), and mental-health outcomes. PVS and PSU are proposed to influence sleep disturbance, anxiety symptoms, and academic stress. Digital-well-being strategies may buffer these effects, while age, gender, and daily screen time (\u0026gt; 6 h) are considered potential confounders.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/c3e597bf8d4748b7c4937104.png"},{"id":99679651,"identity":"f9c00f30-0c6e-47db-b54b-f4735b27537d","added_by":"auto","created_at":"2026-01-07 08:40:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1143728,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8028025/v1/cf92f962-e903-4238-a89f-a2a47f7b7c31.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Phantom Vibration Syndrome and Problematic Smartphone Use: A Cross-Sectional Study on Sleep Disturbances, Mental Health, and Academic Stress Among University Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA silent expectation that never materialized but has a strong mental resonance. This brief feeling has become a commonplace aspect of digital life for the younger generation, serving as a subtly potent reminder of how deeply technology has permeated human behavior. Reaching for a phone that never vibrated or checking a screen that remained dark, which was once an occasional distraction, has become an almost universal reflex.\u003c/p\u003e\u003cp\u003eExcessive smartphone use has rapidly evolved into a modern behavioral epidemic, affecting not just productivity but the very rhythms of sleep, mood, and mental focus among young adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Beyond mere screen exposure, specific behaviors such as phantom vibration syndrome (PVS) and problematic smartphone use (PSU) reflect psychological dependency created by constant digital connectivity [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile recent research has explored the consequences of excessive smartphone exposure, much of it focuses narrowly on screen time or social media addiction, overlooking subtler phenomena such as PVS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, although PSU has been linked to heightened anxiety, poor sleep, and academic strain, studies often rely on small or homogeneous samples [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A substantial knowledge gap persists in understanding how these interconnected digital behaviors jointly affect mental and physical well-being across culturally diverse academic populations [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUniversity students represent a particularly vulnerable demographic, caught between academic demands, social pressures, and the constant pull of technology [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The convergence of these stressors fosters an environment where compulsive smartphone engagement becomes normalized and its health implications overlooked.\u003c/p\u003e\u003cp\u003eThis study therefore investigates the combined impact of PVS and PSU on sleep disturbance, anxiety, and academic stress among university students. By examining these emerging digital behaviours together, this research seeks to illuminate their collective contribution to the growing public-health crisis of digital fatigue. Addressing this silent epidemic is crucial: just as diet, sleep, and physical activity define wellness, digital well-being must now be recognised as a core determinant of health in the 21st century.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eThis study employed a cross-sectional design to examine the associations between phantom vibration syndrome (PVS),problematic smartphone use (PSU),sleep disturbance, mental health status among university students. Data were collected through a self-administered questionnaire distributed between April to May 2025. The survey included both structured and open ended questions aimed at evaluating smartphone-related behaviours, emotional reliance, and psychological symptoms over the previous two weeks.\u003c/p\u003e\n\u003cp\u003eStudy Population\u003c/p\u003e\n\u003cp\u003eThe target population consisted of undergraduate and postgraduate students enrolled in various academic program at Jilin University. Participants were eligible if they were currently enrolled, aged 17 years or older, and provided informed consent. A non-probability convenience sampling was used, and survey posters containing QR codes were circulated physically and electronically to maximise outreach within the student community.\u003c/p\u003e\n\u003cp\u003eApproximately 700 students were reached through these platforms, 600 initiated the survey, and 553 provided completed and valid responses, which were included in the final analysis. Responses with missing or inconsistent data were excluded. A flow diagram illustrating participant recruitment and inclusion is provided in Figure 1.\u003c/p\u003e\n\u003cp\u003eData Collection and Measure\u003c/p\u003e\n\u003cp\u003eThe questionnaire included both closed- and open-ended items across five domains: sociodemographic characteristics, phantom vibration syndrome (PVS), smartphone use behaviors, sleep quality, and recent mental health symptoms. Mental health-related items were adapted from commonly used screening tools such as the PHQ-9 and GAD-7 to reflect symptoms like fatigue [15, low mood, and anxiety, though full scales were not applied [15, 16]. PVS was assessed by experience, frequency, and context of occurrence, while smartphone behaviours included screen time, emotional attachment, and use during pre-sleep or night-time hours [17]. Sleep quality was self-rated, and the impact of smartphone use on academics, sleep, or social life was recorded.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;A final open-ended question asked participants to suggest one change to improve their well-being. Responses were reviewed and grouped thematically. The English-language questionnaire was informally pretested for clarity, with an estimated completion time of 7\u0026ndash;10 minutes. No personal identifiers were collected.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eAll data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 29.0. Descriptive statistics were calculated for all variables. Categorical variables were summarized using frequencies and percentages, while continuous variables were reported as means and standard deviations.\u003c/p\u003e\n\u003cp\u003eBivariate associations between phantom vibration syndrome (PVS) and categorical variables such as daily screen time, nighttime phone checking, sleep quality, and anxiety-related symptoms were examined using chi-square (\u0026chi;\u0026sup2;) tests. A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eIn addition to chi-square tests, binary logistic regression models were conducted to further assess the relationship between PVS and key health outcomes. Separate models were constructed with:\u003c/p\u003e\n\u003cp\u003eModel 1: Anxiety symptoms (present vs. absent)\u003c/p\u003e\n\u003cp\u003eModel 2: Poor sleep quality (poor/very poor vs. good/very good)\u003c/p\u003e\n\u003cp\u003eas dependent variables. PVS status (yes vs. no) was entered as the primary independent variable. Each model was adjusted for potential co-founders, including age group, gender, and daily screen time (\u0026gt;6 hours vs. \u0026le;6 hours). Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values. All statistical tests were two-tailed, and a significance level of p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki [19]. Ethical approval was obtained from Institutional Review Board of Jilin university (AF-BMSIRB-01-07). Prior to participation, all respondents were informed of the study\u0026rsquo;s purpose, assured of anonymity and confidentiality of their response.\u003c/p\u003e\n\u003cp\u003eOpen-ended response and qualitative summary\u003c/p\u003e\n\u003cp\u003eIn addition to structured items, the survey included an optional open-ended question inviting participants to describe their personal strategies or opinions regarding smartphone use, digital well-being, and experiences of phantom vibration sensations. This qualitative component was designed to capture individual perspectives that might not be reflected in quantitative scales, thereby enriching the behavioural interpretation of findings.\u003c/p\u003e\n\u003cp\u003eData handling and analysis\u003c/p\u003e\n\u003cp\u003eAll open-text responses were screened to remove any identifying information and were analysed inductively using a thematic content analysis approach[18]. Responses were reviewed independently by two researchers, who identified recurring patterns and conceptual categories through iterative reading and coding. Codes were grouped into broader themes that reflected common coping strategies and attitudes toward digital behaviour.\u003c/p\u003e\n\u003cp\u003eThe analytic process followed standard qualitative rigor principles, including data familiarisation, coding, theme development, and refinement. Discrepancies in coding were discussed until consensus was reached. Manual coding in spreadsheet format was used to organise excerpts under thematic headings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants Characteristics\u003c/p\u003e\n\u003cp\u003eA total of 553 students participated in the study. The majority were aged 17\u0026ndash;23 years (78.7%) and identified as East Asian (79.4%). Gender distribution was balanced, and over half studied \u0026ge;4 hours per day with attendance rates above 90% (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. Sociodemographic and Study Characteristics of Participants (N = 553)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Age Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;17- 23 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 435 (78.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;24 \u0026ndash; 27 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 81 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;28+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 37 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;291 (52.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;262 (47.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ethnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;East Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 244 (44.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Middle Eastern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 109 (19.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;South Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 106 (19.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;56 (10.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;European\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;38(6.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Year of Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003csup\u003est\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;167(30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2\u003csup\u003end\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;119(21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003csup\u003erd\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;163(29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;74(13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;30(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Daily Study Hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;60(10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2-4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;149(26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4-6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;178(32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;166(30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Attendance Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;386(69.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;80-89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92 (16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;60-79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 38 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt;60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 37 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Daily Screen Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt;2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;23 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2-4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 102 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4-6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 187 (33.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 6-8 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 121 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;8 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 120 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePrevalence and Characteristics of Phantom Vibration Syndrome (PVS)\u003c/p\u003e\n\u003cp\u003eOverall, 41.4% (n=229) of respondents reported experiencing phantom vibrations. Among these, most reported rare episodes (62.6%), while 32.0% experienced them occasionally and 5.4% frequently. PVS episodes occurred most often while studying (48.1%) and during class (33.8%), followed by while communicating (27.5%) or before sleep (22.8%). Emotional responses to PVS were largely neutral (57.7%), but 25.9% reported relief, 10.5% frustration, and 6.0% anxiety (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSmartphone Use Behaviours\u003c/p\u003e\n\u003cp\u003eMost participants reported using their smartphones within 30 minutes before bedtime, and over half spent more than four hours daily on their devices. Academic performance and sleep schedules were the most commonly affected domains, while social interaction was less frequently reported. Emotional attachment to smartphones was widespread, with many participants describing affective dependence on their devices (Figure 3).\u003c/p\u003e\n\u003cp\u003eSleep Quality and Mental Health Symptoms\u003c/p\u003e\n\u003cp\u003eOverall, 22.4% of students reported poor or very poor sleep quality. Fatigue and low energy were the most commonly reported symptoms (54.8%), followed by anxiety-related symptoms such as trouble relaxing (42.9%) and excessive worry (40.7%). Table 2 summarises the prevalence of sleep and mental health indicators in the study population.\u003c/p\u003e\n\u003cp\u003eTable 2. Sleep quality and mental health symptoms among university students (n = 553)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"646\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; % \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 646px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sleep Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Good / Very good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Bad / Very bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 646px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Mental Health Symptoms \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Fatigue / low energy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;54.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sleep troubles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Loss of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Depression/ hopelessness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 159\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Concentration issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Trouble relaxing (GAD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Nervous / anxious feelings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Excessive worry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Irritability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; PHQ-9 = Patient Health Questionnaire-9; GAD-7 = Generalised Anxiety Disorder-7. PHQ-9 and GAD-7 items were adapted but not administered in full. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssociations between PVS, smartphone use, and well-being\u003c/p\u003e\n\u003cp\u003eChi-square analyses revealed significant associations between PVS experience and several behavioural and mental health factors. Students who experienced PVS were more likely to report high daily screen time (\u0026gt;6 hours; \u0026chi;\u0026sup2;(1) = 12.4, p = 0.002) and nighttime phone checking (\u0026chi;\u0026sup2;(1) = 9.1, p = 0.01) compared to those without PVS. PVS was also significantly associated with anxiety symptoms (\u0026chi;\u0026sup2;(1) = 15.6, p \u0026lt; 0.001). No significant associations were found with gender or academic year.\u003c/p\u003e\n\u003cp\u003eQualitative Responses\u003c/p\u003e\n\u003cp\u003eThematic analysis of 112 open-ended responses identified three dominant strategies proposed by students to reduce stress and improve well-being: (1) digital detox and screen-time boundaries, such as using blocking apps or scheduling phone-free periods; (2) environmental modifications, including designated relaxation spaces at university; and (3) structured routines, particularly integrating regular physical activity and mindfulness practices. A thematic map (Figure 4) was developed based on the themes identified through this analysis[18].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the relationship between phantom vibration syndrome (PVS) and problematic smartphone use (PSU) among university students and their associations with sleep quality, mental health, and academic stress. Our findings reveal that both PVS and PSU are highly prevalent within this population, reflecting the growing behavioural entanglement between psychological arousal, emotional dependence, and digital stimuli.\u003c/p\u003e\n\u003cp\u003eBehavioural and Psychological Interpretations\u003c/p\u003e\n\u003cp\u003eThe high prevalence of PVS indicates that the mind may be adapting to constant connectivity \u0026mdash; anticipating notifications even in their absence. This aligns with conditioning theory, where repeated cues (such as vibrations or alerts) reinforce anticipatory responses. Over time, this forms a dopamine reward loop: every real or imagined vibration triggers a small burst of expectation, compelling users to check their devices habitually. This mechanism mirrors addictive behavioural cycles observed in other compulsive activities, including gambling or social media use.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, the association between PSU and anxiety symptoms suggests that excessive smartphone engagement fosters hyper arousal, impairing emotional regulation and rest. Continuous exposure to social updates, notifications, and online comparisons reinforces fear of missing out (FOMO) \u0026mdash; a psychological phenomenon linked to stress, low self-esteem, and disrupted sleep. These processes collectively erode mental focus, self-control, and restfulness, explaining the high rates of fatigue and poor sleep quality observed in our participants.\u003c/p\u003e\n\u003cp\u003eCross-Cultural Relevance and Comparison\u003c/p\u003e\n\u003cp\u003eThe patterns identified in this study align with international evidence. Studies in China, Norway, and Turkey have likewise reported associations between prolonged smartphone use and symptoms of anxiety and sleep disturbance [2,7,9]. However, our findings extend these observations to a culturally diverse academic cohort, demonstrating that digital dependency transcends geographic boundaries. The emotional attachment and pre-sleep usage habits seen here mirror global behavioural trends, reinforcing that digital overuse is an emerging public health concern with universal reach.\u003c/p\u003e\n\u003cp\u003ePublic Health Implications\u003c/p\u003e\n\u003cp\u003eFrom a public-health perspective, universities play a crucial role in mitigating the adverse effects of digital overuse. As higher education increasingly integrates technology into every aspect of learning, digital well-being must be treated as a core health determinant \u0026mdash; akin to nutrition, exercise, or sleep hygiene. Institutions can promote healthy digital habits through awareness campaigns, structured \u0026ldquo;digital detox\u0026rdquo; workshops, and phone-free study environments. Integrating digital behaviour assessment into mental health services could enable early identification of students at risk for anxiety or insomnia related to PSU. The findings underscore the need for institutional and policy-level action to promote digital well-being among young adults. Universities could incorporate structured digital hygiene modules within student orientation programs and provide access to digital detox or mindfulness workshops through campus health centers. At a broader level, national public health agencies could recognize digital behavior management as a preventive mental health measure, integrating it alongside nutrition, physical activity, and sleep promotion within existing wellness frameworks. Establishing such evidence-based policies could mitigate the behavioral risks of smartphone dependency and enhance student mental resilience across educational settings.\u003c/p\u003e\n\u003cp\u003eBroader Behavioural Insights\u003c/p\u003e\n\u003cp\u003eThe coexistence of PVS and PSU illustrates the subtle psychological cost of perpetual connectivity. The human brain \u0026mdash; conditioned to respond to intermittent rewards \u0026mdash; remains in a state of heightened vigilance, anticipating digital stimuli even in silence. This persistent cognitive engagement blurs boundaries between rest and alertness, explaining the overlap between digital use, stress, and reduced sleep quality. Understanding these processes through a behavioural-science lens underscores that this is not simply a matter of willpower, but of environmental conditioning that reshapes perception and attention.\u003c/p\u003e\n\u003cp\u003eFuture Directions\u003c/p\u003e\n\u003cp\u003eLongitudinal research is needed to establish temporal links between digital behaviours and psychological outcomes, while integrating objective indicators such as screen-time logs, physiological stress markers, or actigraphy could enhance data accuracy. Intervention-based studies \u0026mdash; including mindfulness training, behavioural nudges, or screen-time regulation programs \u0026mdash; should be explored as preventive strategies.\u003c/p\u003e\n\u003cp\u003eConclusion of Discussion\u003c/p\u003e\n\u003cp\u003eUltimately, this study underscores the urgent need for public-health frameworks that acknowledge digital exposure as a determinant of mental well-being. Addressing this emerging behavioural epidemic requires not only individual awareness but also institutional commitment to fostering healthier digital environment. By framing digital balance as a core component of holistic health\u0026mdash;alongside sleep, nutrition, and exercise\u0026mdash;universities can support students\u0026rsquo; well-being in an environment where the mind remains alert to digital stimuli, even in the absence of actual notifications.\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, its cross-sectional design prevents inference of causal relationships between smartphone use, mental health, and sleep outcomes. Second, all variables were based on self-reported measures, which may be influenced by recall or social desirability bias. Third, the sample was drawn from a single academic population through online distribution, which may limit generalizability to broader student or non-student populations. Finally, the study did not include objective measures such as screen-time tracking or physiological indicators of stress, which could provide additional insight into behavioural mechanisms. Despite these limitations, the findings contribute valuable evidence on an emerging behavioural health issue and underscore the need for longitudinal and intervention-based research.\u003c/p\u003e\n\u003cp\u003eThe interrelationships identified in this study are summarised in Figure 5, which presents a conceptual model of the hypothesised pathways linking phantom vibration syndrome (PVS), problematic smartphone use (PSU), and psychological outcomes. The model highlights the potential buffering role of digital-well-being strategies and the influence of confounders such as age, gender, and screen-time exposure.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights that phantom vibration syndrome and problematic smartphone use are prevalent and interconnected behaviours among university students, with measurable associations with anxiety symptoms, poor sleep quality, and academic stress. These patterns illustrate how constant digital engagement can heighten psychological arousal, disrupt rest, and undermine overall well-being.\u003c/p\u003e\n\u003cp\u003eBeyond identifying risk factors, the qualitative findings revealed that students themselves recognise the importance of behavioural change. Many proposed simple, self-directed strategies such as digital detox periods, structured daily routines, physical exercise, and designated relaxation spaces on campus. These student-driven suggestions reflect a growing awareness of the psychological costs of excessive connectivity and point toward practical, low-cost solutions that can be implemented within academic settings.\u003c/p\u003e\n\u003cp\u003eAt a broader level, the findings underscore the need for universities and public health stakeholders to adopt integrated digital-well-being strategies that promote balanced smartphone use, sleep hygiene, and mental-health awareness. Introducing supportive environments such as phone-free study zones, wellness workshops, and spaces for relaxation could help students manage stress and enhance focus.\u003c/p\u003e\n\u003cp\u003eBy combining behavioural education, environmental design, and mental-health promotion, institutions can create healthier digital cultures that protect student well-being and academic performance in an increasingly connected world.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePVS: Phantom Vibration Syndrome\u003c/p\u003e\n\u003cp\u003ePSU: Problematic Smartphone Use\u003c/p\u003e\n\u003cp\u003ePHQ-9: Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003eGAD-7: Generalized Anxiety Disorder-7\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eParticipation was voluntary, and informed consent was obtained electronically prior to completing the questionnaire.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Review Board of Jilin University (Approval No. AF-BMSIRB-01-07). All participants provided electronic informed consent before completing the survey.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eMK conceptualized the study, designed the questionnaire, conducted statistical analysis, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eMM, AA,PD, VO, and SA contributed to data collection and validation.\u003c/p\u003e\n\u003cp\u003eHA, AA, and PK assisted with data analysis and manuscript review.\u003c/p\u003e\n\u003cp\u003eThe supervising professor H.Z, provided oversight, methodological guidance, and final review of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the students who participated in this study for their time and responses. We also extend our gratitude to the Ethics Committee of Basic Medical Sciences, Jilin University, for providing ethical approval and valuable guidance throughout the research process.\u003c/p\u003e\u003c!--EndFragment--\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVagka E, Gnardellis C, Lagiou A, Notara V. Smartphone use and social media involvement in young adults: association with nomophobia, Depression Anxiety Stress Scales (DASS) and self-esteem. Int J Environ Res Public Health. 2024;21(7):920. https://doi.org/10.3390/ijerph21070920\u003c/li\u003e\n\u003cli\u003eYağcı Ş, Ceylan A, Okur E. The effects of smartphone addiction on the body in young adults in Turkey. Ethn Health. 2024;29(7):745\u0026ndash;755. https://doi.org/10.1080/13557858.2024.2376040\u003c/li\u003e\n\u003cli\u003eSohn SY, Rees P, Wildridge B, et al. 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Eur Psychiatry. 2023;66(Suppl 1):S381\u0026ndash;S382. https://doi.org/10.1192/j.eurpsy.2023.826\u003c/li\u003e\n\u003cli\u003eWiklund E, Wiklund M, Vikman J, Hedenborg S. \u0026quot;A constant battle against sedentary lifestyle and screen time\u0026quot;: Swedish school nurses\u0026apos; views on school children\u0026apos;s physical activity and its promotion \u0026ndash; a grounded theory study. Front Sports Act Living. 2024;6:1393336. https://doi.org/10.3389/fspor.2024.1393336\u003c/li\u003e\n\u003cli\u003eMangot AG, Murthy VS, Kshirsagar SV, Deshmukh AH, Tembe DV. Prevalence and pattern of phantom ringing and phantom vibration among medical interns and their relationship with smartphone use and perceived stress. Indian J Psychol Med. 2018;40(5):440\u0026ndash;445. https://doi.org/10.4103/IJPSYM.IJPSYM_141_18\u003c/li\u003e\n\u003cli\u003eWilmer HH, Sherman LE, Chein JM. Smartphones and cognition: a review of research exploring the links between mobile technology habits and cognitive functioning. Front Psychol. 2017;8:605. https://doi.org/10.3389/fpsyg.2017.00605\u003c/li\u003e\n\u003cli\u003eMengistu N, Habtamu E, Kassaw C, Madoro D, Molla W, Wudneh A, Abebe L, Duko B. Problematic smartphone and social media use among undergraduate students during the COVID-19 pandemic: the case of southern Ethiopia universities. PLoS One. 2023;18(1):e0280724. https://doi.org/10.1371/journal.pone.0280724\u003c/li\u003e\n\u003cli\u003eMar\u0026iacute;n-D\u0026iacute;az V, Mu\u0026ntilde;oz-Gonz\u0026aacute;lez JM, Sampedro-Requena BE. Problematic relationships with smartphones of Spanish and Colombian university students. Int J Environ Res Public Health. 2020;17(15):5370. https://doi.org/10.3390/ijerph17155370\u003c/li\u003e\n\u003cli\u003eKroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606\u0026ndash;613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x\u003c/li\u003e\n\u003cli\u003eSpitzer RL, Kroenke K, Williams JBW, L\u0026ouml;we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092\u0026ndash;1097.\u003c/li\u003e\n\u003cli\u003eRamasubramani P, Vengadessin N, Saya GK. Prevalence of phantom vibrations and ringing syndrome, and its association with smartphone addiction among medical students of a teaching hospital in South India. Psychiatry. 2023;86(2):157\u0026ndash;163. https://doi.org/10.1080/00332747.2022.2143143\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101. https://doi.org/10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eWorld Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u0026ndash;2194. https://doi.org/10.1001/jama.2013.281053 \u003c/li\u003e\n\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":"","lastPublishedDoi":"10.21203/rs.3.rs-8028025/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8028025/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e\u003cp\u003eIn a world where the mind vibrates even when the phone does not, digital habits are quietly reshaping how we rest, focus, and feel. Phantom vibration syndrome (PVS), the false sensation of a phone vibrating, and problematic smartphone use (PSU) have become increasingly common among university students. These behaviors may reflect deeper psychological conditioning linked to anxiety, poor sleep, and stress, yet remain underexplored from a public health perspective.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e\u003cp\u003eA cross-sectional online survey was conducted among 553 university students to examine the prevalence and correlates of PVS and PSU. Standardized scales measured sleep disturbance, anxiety symptoms, and academic stress. Descriptive and inferential analyses were performed using SPSS. An open-ended question invited students to share strategies for managing smartphone use, and responses were analyzed thematically to identify recurring digital well-being themes.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e\u003cp\u003ePhantom vibrations were reported by 41.4% of participants, with 22% experiencing them occasionally and 5.4% frequently. More than half (54.8%) reported fatigue and poor sleep. Higher PSU scores were significantly associated with anxiety (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and sleep disturbance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Qualitative insights revealed three consistent coping patterns: digital detox routines, environmental changes, and structured daily activities that limited device use.\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e\u003cp\u003eThe findings suggest that the modern student's constant connectivity has subtle but measurable effects on mental and physical well-being. By treating digital balance as an essential health behavior, similar to sleep hygiene or nutrition, universities can help protect students from the psychological fatigue of always being online. Addressing PVS and PSU through awareness and behavioral interventions should be considered a public health priority for the digital age.\u003c/p\u003e","manuscriptTitle":"Phantom Vibration Syndrome and Problematic Smartphone Use: A Cross-Sectional Study on Sleep Disturbances, Mental Health, and Academic Stress Among University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 15:33:25","doi":"10.21203/rs.3.rs-8028025/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":"715edbfd-95f1-4feb-86b8-5ee97d877ba7","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T08:40:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 15:33:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8028025","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8028025","identity":"rs-8028025","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}