Lirong Zhang,1 Shuangyin Zhao,1 Shaocong Zhao,1 Yizhen Ke,1 Weichen Yang,1 Mingxing Lei2,3 

1Department of Physical Education, Xiamen University of Technology, Xiamen, Fujian, People’s Republic of China; 2Department of Orthopaedics, Hainan Hospital of Chinse PLA General Hospital, Sanya, Hainan, People’s Republic of China; 3Nursing Department, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China

Correspondence: Lirong Zhang, Department of Physical Education, Xiamen University of Technology, No. 600, Ligong Road, Jimei District, Xiamen, Fujian, 361024, People’s Republic of China, Tel +8613806063882, Email 22674481@qq.com Mingxing Lei, Department of Orthopedic Surgery, Hainan Hospital of Chinse PLA General Hospital, No. 80 Jianglin Road, Haitang District, Sanya, Hainan, 572013, People’s Republic of China, Tel +8618811772189, Email leimingxing2@sina.com

Background: The use of electronic screens has become ubiquitous in modern society, but the specific relationship between hours of electronic screen exposure and mental health outcomes needs to be further investigated. Hence, this study aims to examine the detailed relationship between electronic screen exposure time and mental health status.
Methods: A sample of 2896 university students were recruited and their baseline characteristics, including demographics, lifestyle habits, and mental health status, were collected. The association between electronic screen exposure time and mental health status was investigated using linear regression analysis. The predictive performance of electronic screen exposure time for predicting mental health status, including severe anxiety and depression was, also analyzed using the area under the curve (AUC) analysis.
Results: The time of exposure to electronic screen was significantly associated with anxiety (p < 0.001) and depression (p < 0.001). The AUC value was 0.641 (95% CI: 0.571– 0.712) for severe anxiety and 0.665 (95% CI: 0.613– 0.716) for severe depression. The optimal cut-off value for predicting anxiety and depression based on electronic screen exposure time was found to be both 6.5 hours. A subgroup analysis confirmed that participants with higher exposure time to electronic screens had significantly higher anxiety (p < 0.001) and depression scores (p < 0.001). The association between the hours of exposure to electronic screen and severe anxiety (p = 0.042) and severe depression (p < 0.001) remained significant after controlling for demographics, exercises, and other lifestyle factors.
Conclusion: The findings suggest that excessive electronic screen exposure time is associated with increased risk of anxiety and depression among university students. These findings highlight the need for interventions targeting electronic screen use to improve mental health outcomes, and less than 6.5 hours per day of exposure to electronic screen are recommended among university students.

Keywords: university students, exposure to electronic screen, mental health, anxiety, depression