The mediation effects of smartphone addiction, negative emotion and psychological resilience in the relationship between social support and sleep quality among medical students

Purpose: Poor sleep quality and its serious consequences have become an urgent public health issue, but there is a lack of evidence in medical students. This study aimed to examine the multiple associations between sleep quality, social support, psychological resilience, smartphone addiction, and negative emotions among medical students, in order to provide a basis for targeted intervention measures. Methods: A cross-sectional study involving 716 medical students was conducted using a self-report questionnaire that assessed demographic characteristics, Perceived Social Support Scale, Connor-Davidson Resilience Scale-10, Mobile Phone Addiction Index, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Pearson correlation analysis and structural equation modeling (SEM) were performed to examine the association between social support, smartphone addiction, negative emotion, psychological resilience and sleep quality. Results: < 0.01) were positively correlated with poor sleep quality. The SEM results indicated that social support exerts a direct positive effect on sleep quality and also an indirect effect on sleep quality via smartphone addiction and negative emotion, which serve as both separate and chain mediators. In contrast, psychological resilience has no direct impact on sleep quality, but it exerts an indirect effect on sleep quality through the same dual mediating pathways of smartphone addiction and negative emotion. Conclusion: This study clarifies the differential pathways through which social support and psychological resilience influence sleep quality via SEM analysis. These findings supplement the theoretical framework of sleep quality influencing factors, highlight the core mediating role of smartphone addiction and negative emotion, and provide targeted insights for formulating interventions to improve individuals' sleep health.