指導教授：黃俊豪臺灣大學：健康政策與管理研究所蘇庭睿Su, Ting-RueiTing-RueiSu2014-11-282018-06-292014-11-282018-06-292014http://ntur.lib.ntu.edu.tw//handle/246246/262714背景：智慧型手機除具備傳統手機的功能外，更增添上網功能，讓智慧型手機的使用更加普及。但過去研究顯示，在大學生族群中，過度使用網路及手機與睡眠相關問題有所關聯。然而，鮮少研究關注智慧型手機對睡眠品質的影響。因此，本研究旨在探討問題性智慧型手機使用及睡前使用行為與睡眠品質之關係。 方法：本橫斷式研究於2014年3月進行，共納入974名有使用智慧型手機之大學生為研究對象（回收率為81.0%）。問卷的量表包含：參考中文網路成癮量表（CIAS）所編修之問題性智慧型手機使用量表（PSUS）、匹茲堡睡眠品質量表（PSQI）及病患健康問卷（PHQ-9）。並使用探索性因素分析評估PSUS的適用性，及多變項邏輯斯迴歸分析智慧型手機的問題使用與睡眠品質之關聯。 結果：本研究中共有47.9％之大學生有睡眠品質不良的問題。在控制背景變項後發現，憂鬱傾向（AOR=3.85，95％CI=2.63-5.65）、PSUS分數（AOR=1.02，95％CI=1.01-1.03）與睡前智慧型手機使用（1-3天/週：AOR=2.19，95％CI =1.33-3.60;4-7天/週：AOR=1.82，95％CI =1.05-3.16）具顯著相關。此外，本研究也發現憂鬱傾向與睡前使用1-3天/週有顯著交互作用（AOR=0.31，95％CI=0.16-0.60）。當PSUS分別以其四個行為表徵分析時，「人際關係和健康問題」與「時間管理問題」，在不同憂鬱傾向下會有不同的顯著影響。 結論：隨著大學生問題性智慧型手機使用之嚴重程度增加，睡眠品質不良的風險也隨之提高。值得注意的是，即便在沒有憂鬱傾向的大學生族群中，每週睡前使用1-3天仍與睡眠品質不良具有顯著關聯。本研究結果顯示，針對問題性智慧型手機使用所進行之適性介入有迫切需要，以減輕其造成之衝擊。Background: Smartphones have gained widespread popularity as they allow users to access the Internet while providing the functions of regular cell phones. Prior research among college students has also found excessive use of the Internet and cell phones to be associated with sleep problems. However, little is known about the effects of smartphone use on sleep quality. Hence, this study aimed to examine the relationship between problematic smartphone use, including smartphone use before sleep, and sleep quality. Methods: A total of 974 smartphone-using college students in northern Taiwan were recruited in this cross-sectional study during March of 2014 (response rate=81.0%). Problematic Smartphone Use Scale (PSUS), which is modified from Chen Internet Addiction Scale (CIAS), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire (PHQ-9) were used in this survey. Exploratory factor analysis was also performed to evaluate the psychometric properties of PSUS. Finally, multivariate logistic regression was employed to assess the associations between problematic smartphone use and sleep quality. Results: This study identified 47.9% of college students as poor sleepers. Depressive tendency (AOR=3.85, 95% CI=2.63-5.65) and the following variables related to smartphone use were found significantly associated with poor sleep quality: higher PSUS scores (AOR=1.02, 95% CI=1.01-1.03) and smartphone use before sleep (1-3 days/week: AOR=2.19, 95% CI=1.33-3.60; 4-7days/week: AOR=1.82, 95% CI=1.05-3.16), after controlling for background characteristics. In addition, smartphone use before sleep 1-3 days/week had a significant interaction effect with depressive tendency (AOR=0.31, 95% CI=0.16-0.60) on sleep quality. Alternatively, when problematic smartphone use was assessed by its four behavioral manifestations, instead of PSUS scores, “interpersonal and health problems” and “time management problems” were also found to interact significantly with depressive tendency. Conclusions: Elevated problematic smartphone use may increase the risk of having poor sleep quality among college students. Notably, smartphone use before sleep 1-3 days/week significantly affected sleep quality even among students without depressive tendency. These findings suggest that tailored interventions are urgently needed to ameliorate the impact of problematic smartphone use.誌謝 i 中文摘要 ii ABSTRACT iii CONTENTS v LIST OF TABLES vii Chapter 1 Introduction 1 1.1 Risk factors and consequences of poor sleep quality among college students 1 1.2 Problematic smartphone use 2 1.3 The impact of smartphone use on sleep quality 3 1.3.1 Problematic smartphone use and sleep quality 3 1.3.2 Smartphone use before sleep and sleep quality 4 1.4 The current study 5 Chapter 2 Methods 7 2.1 Participants 7 2.2 Measures 7 2.2.1 Pittsburgh Sleep Quality Index (PSQI) 7 2.2.2 Problematic Smartphone Use Scale (PSUS) 8 2.2.3 Patient Health Questionnaire (PHQ-9) 9 2.2.4 Smartphone use before sleep and the history of smartphone use 9 2.2.5 Background characteristics 10 2.3 Procedure 10 Chapter 3 Results 12 3.1 Background characteristics, depressive tendency, and their associations with PSQI. 12 3.2 Factor analysis of PSUS 14 3.3 Smartphone use characteristics, problematic smartphone use, and their associations with PSQI 16 3.4 Multivariate logistic regression models for factors associated with poor sleep quality 18 Chapter 4 Discussion 22 4.1 The role of depressive tendency as an effect modifier 22 4.2 Interaction effects of behavioral manifestations of problematic smartphone use and depressive tendency on sleep quality 23 4.2.1 Effects of interpersonal and health problems among students without depressive tendency 24 4.2.2 Effects of time management problems among students with depressive tendency 24 4.3 Effects of smartphone use before sleep on sleep quality among students without depressive tendency 25 4.4 The role of background characteristics 26 4.5 Limitations and future directions 27 Chapter 5 Conclusions 29 References 30 附錄 36 壹、文獻回顧 36 貳、研究方法 41 參、參考文獻 45851916 bytesapplication/pdf論文使用權限：同意有償授權(權利金給回饋學校)問題性智慧型手機使用睡前使用智慧型手機睡眠品質憂鬱傾向大學生台灣thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/262714/1/ntu-103-R01848002-1.pdf