Introduction
In recent years, with the rapid development of social media, it has become an indispensable part of people’s daily lives [1]. Especially among younger populations, social media serves not only as a primary channel for obtaining information and communication, but also provides emotional support and a means for stress relief [2]. For nursing students, social media plays a vital role in learning, exchanging ideas, acquiring professional knowledge, and maintaining social support networks [3]. However, with the increased frequency of social media use, problematic social media use (PSMU) has gradually emerged as a growing concern for mental health. PSMU is characterized by excessive dependence on and uncontrollable use of social media, which surpasses normal social needs and negatively impacts individuals’ daily lives [4, 5]. Research indicates that PSMU not only consumes significant amounts of time and energy but can also lead to a range of mental health issues, including mood disorders such as depression and anxiety [6, 7].
Nursing students, as a unique student group, face complex academic pressures and emotional stressors during clinical internships. Particularly in the context of an increasingly complex healthcare environment, their sources of stress differ from those of students in other disciplines. The uncertainty of clinical work, high-intensity learning tasks, and anxiety about professional competence are among the many factors that make nursing students more susceptible to mental health issues [8, 9]. Depression, as the most common mental health issue among nursing students, not only severely affects their academic performance and clinical skills but can also have long-lasting negative effects on their future career development [10]. Studies have shown that the prevalence of depression among nursing students is as high as 34% [11]. According to the stress-coping theory, individuals assess external stressors and adopt coping strategies in response. When nursing students face multiple pressures, such as academic and internship-related stress, they may turn to social media as a coping mechanism to temporarily alleviate anxiety and stress. However, when problematic social media use occurs, it may exacerbate their mental health issues [12]. Multiple meta-analyses have provided evidence of a significant correlation between problematic social media use and depression among nursing students [13, 14]. Excessive reliance on social media can lead to issues such as social comparison, cyberbullying, and a lack of face-to-face social interactions, all of which may worsen depressive symptoms.
Anzeige
Mental Health Literacy (MHL) has emerged as a key factor influencing individuals’ mental health and has gained increasing attention in recent research. MHL refers to an individual’s understanding of mental health knowledge and their ability to address mental health issues, including the recognition of conditions such as depression, seeking professional help, and understanding treatment options [15]. Studies have shown that individuals with higher MHL are more likely to adopt effective coping strategies for managing negative emotions and seek professional help, thereby reducing the occurrence of depression. In contrast, individuals with lower MHL may struggle to identify their emotional issues accurately or fail to recognize their severity, leading to a lack of timely intervention for depressive symptoms [16]. Research by Wan et al. has indicated a significant negative correlation between nursing students’ MHL and depression [17].
Although existing studies have separately explored the impact of Problematic Social Media Use (PSMU) and MHL on depression, the interactive effects of both on depression remain unclear. For nursing students, PSMU and MHL may not act independently to influence depression, but rather interact to jointly affect the onset and development of depressive symptoms. Understanding the interaction between PSMU and MHL is crucial not only for explaining the complex causes of depression among nursing students but also for developing effective psychological intervention strategies. Therefore, this study aims to investigate the impact of problematic social media use, mental health literacy, and their interaction on depression among nursing students. The findings of this study will provide valuable guidance for enhancing nursing students’ mental health literacy and regulating social media use, ultimately helping them better cope with stress, alleviate depressive symptoms, and promote their mental well-being.
Methods
Study participants
This study was conducted between May and June 2024 using convenient sample, selecting nursing undergraduates from a university as the study participants. A total of 628 participants were recruited for the study. The study was approved by the university’s ethics committee(HMUDQ202404110012).
Instruments
Demographic data sheet
This sheet was designed by the researchers and collected general demographic data, including age, gender, grade level, family residence location, whether the participant was an only child, whether they held a class leader position, self-reported family economic status, and the educational level of their parents.
Patient health questionnaire-9 (PHQ-9)
The PHQ-9 consists of 9 items that assess symptoms related to depression, including anhedonia, low mood, sleep disturbances, low energy, changes in appetite, self-worth issues, concentration difficulties, psychomotor agitation or retardation, and thoughts of suicide or self-harm. Responses are scored on a 4-point Likert scale (0–3), with the total score ranging from 0 to 27. This scale is widely used across various populations and has demonstrated good internal consistency [18]. In this study, the Cronbach’s a coefficient for the PHQ-9 was 0.86. Following the results from Kroenke et al., a score of < 5 was used to define no depression, while scores ≥ 5 were used as the cut-off for depression detection [19].
Adolescent mental health literacy assessment questionnaire (AMHLAQ)
The AMHLAQ was developed by Li et al. in 2021 and assesses mental health literacy across four dimensions: knowledge, recognition, attitude, and behavior, with a total of 22 items [20]. The scale uses a 5-point Likert scale where “strongly disagree” is scored 1 point and “strongly agree” is scored 5 points. Six items in the attitude dimension are reverse-scored. The higher the total score, the greater the individual’s level of mental health literacy. Previous research has demonstrated good validity and reliability for this scale, with a Cronbach’s a coefficient of 0.87 in this study. Scores < 90 are considered indicative of insufficient mental health literacy [21].
Adolescent problematic mobile social media use scale
The scale, developed by Jiang et al. In 2018, assesses problematic mobile social media use in adolescents and includes 20 items categorized into five dimensions: increased attachment, physical harm, fear of missing out, cognitive failure, and guilt [22]. The scale uses a 5-point Likert scale, where “completely disagree” is scored 1 point and “completely agree” is scored 5 points. Higher scores indicate more severe problematic use of mobile social media. The scale has shown good reliability and validity, with a Cronbach’s a of 0.91 in this study. In this research, a total scored ≥ 67 was defined as indicative of problematic mobile social media use. Scores ≥ the 75th percentile (P75) were categorized as problematic, while scores < P75 were categorized as non-problematic.
Data collection
Data was collected through an on-site questionnaire survey. After coordinating with the class instructors, the researcher arranged a suitable time with the students. Questionnaires were distributed in the classroom, with the researcher providing a unified explanation of the study’s purpose, the questionnaire’s completion process, and related precautions. Participants were asked to read the instructions thoroughly and indicate their consent before proceeding with the questionnaire. After completing the surveys, the researcher reviewed the responses to ensure completeness and accuracy.
Anzeige
Statistical analysis
Data was processed and analyzed using SPSS 26.0 software. The chi-square test was used to compare differences in depressive symptoms based on various demographic characteristics. A logistic regression model was constructed, incorporating mental health literacy, problematic social media use, and their interaction terms, while adjusting for variables such as gender, grade level, household registration, and self-reported family economic status. The multiplicative interaction was assessed using the product term approach, with a p-value < 0.05 indicating the presence of a multiplicative interaction. When the odds ratio (OR) > 1 and the 95% confidence interval (CI) does not include 1, it indicates a positive multiplicative interaction between mental health literacy and problematic social media use on depression. For the additive interaction model, the interaction term between mental health literacy and problematic social media use was included in the logistic regression, and the relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (SI) were calculated using the Excel table developed by Andersson et al. [23]. If the 95% CI for RERI and AP does not contain 0 and the CI for SI does not contain 1, it suggests the presence of an additive interaction. A significance level of a = 0.05 was set for all analyses.
Results
Demographic data
The average age of participants in this study was 20.53 ± 1.49 years, with 103 males (16.1%) and 537 females (83.9%). The grade distribution was as follows: 184 first-year students (28.7%), 179 s-year students (28.0%), 168 third-year students (26.3%), and 109 fourth-year students (17.0%). Of the participants, 307 (48.0%) were only children, 376 (58.8%) were from urban areas, and 205 (32.3%) were class leaders. The educational levels of their parents were as follows: 71.9% of fathers and 71.4% of mothers had education levels of high school or lower. Family economic status was rated as poor for 119 participants (18.6%), average for 404 participants (63.1%), and good for 117 participants (18.3%).
Problematic social media use, mental health literacy, and depression scores
The average score for problematic social media use was 56.29 ± 16.22, with 24.84% (159 participants) showing problematic social media use behaviors. The average depression score was 5.19 ± 5.32, with 46.25% (296 participants) exhibiting depressive symptoms. The average total score for mental health literacy was 82.46 ± 13.24, with 29.84% (191 participants) demonstrating adequate mental health literacy.
Comparison of depression and problematic social media use by demographic characteristics
The depression symptom detection rate among nursing students was 46.25% (296/640). Students from rural areas showed a higher depression detection rate than those from urban areas. Non-only children had a higher depression detection rate than only children, and depression was more prevalent among students whose mothers had lower levels of education. Additionally, nursing students from families with poorer economic conditions had a higher depression detection rate. As for problematic social media use, only family economic status showed a statistically significant difference in detection rates (P > 0.05) (see Table 1).
Table 1
General demographic data on the detection rates of depressive symptoms and problematic social media use among nursing students
Variables | N (%) | Depression | Problematic social media use | |||||
|---|---|---|---|---|---|---|---|---|
n (%) | χ 2 | P | n (%) | χ 2 | P | |||
Gender | 0.324 | 0.569 | 0.902 | 0.342 | ||||
Male | 103(16.1) | 45(43.7) | 23(22.3) | |||||
Female | 537(83.9) | 251(46.7) | 144(26.8) | |||||
Grade | 4.863 | 0.182 | 6.885 | 0.076 | ||||
Freshmen | 184(28.7) | 95(51.6) | 61(33.2) | |||||
sophomore | 179(28.0) | 72(40.2) | 41(22.9) | |||||
Junior | 168(26.3) | 77(45.8) | 41(24.4) | |||||
Senior | 109(17.0) | 52(47.7) | 24(22.0) | |||||
Signal Child | 10.06 | 0.002 | 2.693 | 0.101 | ||||
Yes | 307(48.0 ) | 122(39.7) | 71(23.1) | |||||
No | 333(52.0) | 174(52.3) | 96(28.8) | |||||
Class Leader | 0.975 | 0.323 | 0.085 | 0.771 | ||||
Yes | 205(32.3) | 89(43.4) | 55(26.8) | |||||
No | 435(67.7) | 207(47.6) | 112(25.7) | |||||
Residents | 11.329 | < 0.001 | 2.200 | 0.138 | ||||
Urban | 376(58.8) | 153(40.7) | 90(23.9) | |||||
Rural | 264(41.2) | 143(54.2) | 77(29.2) | |||||
Education Level-Father | 0.049 | 0.826 | 0.631 | 0.427 | ||||
Above high school | 180(28.1) | 82(45.6) | 43(31.4) | |||||
High school and below | 460(71.9) | 214(42.2) | 124(27.0) | |||||
Education Level-Mother | 6.596 | 0.010 | 0.022 | 0.881 | ||||
Above high school | 183(28.6) | 70(38.3) | 47(25.7) | |||||
High school and below | 457(71.4) | 226(49.5) | 120(26.3) | |||||
Family economic status | 29.945 | < 0.001 | 9.083 | 0.011 | ||||
Poor | 119(18.7) | 79(66.4) | 44(37.0) | |||||
General | 404(63.0) | 180(44.6) | 94(23.3) | |||||
Good | 117(18.3) | 37(31.6) | 29(24.7) | |||||
Independent effects of problematic social media use and mental health literacy on depression symptoms
A multivariate logistic regression model was established with depression symptoms as the dependent variable (1 = present, 0 = absent), and mental health literacy (1 = inadequate, 0 = adequate) and problematic social media use (1 = present, 0 = absent) as independent variables. After controlling for factors such as family location, being an only child, maternal education level, and family economic status, the results showed that both problematic social media use and lack of mental health literacy were positively associated with depression symptoms, with odds ratios (OR) of 3.313 (95% CI: 2.255–4.868) and 1.626 (95% CI: 1.137–2.324), respectively. Both associations were statistically significant (P < 0.001) (see Table 2).
Table 2
Regression Analysis of Problematic Social Media Use, Mental Health literacy and depression
Variables | Depression Rate | χ² | B | S.E. | Wald χ² | OR(95%CI)¥ | P |
|---|---|---|---|---|---|---|---|
n (%) | |||||||
Problematic Social Media Use | 74.605*** | ||||||
No | 182(38.5) | - | - | - | 1.000 | - | |
Yes | 114(68.3) | 1.198 | 0.196 | 37.231 | 3.313(2.255–4.868) | < 0.001 | |
Mental Health Literacy | 42.331** | ||||||
Adequate | 71(37.2) | - | - | - | 1.000 | - | |
Inadequate | 225(50.1) | 0.486 | 0.182 | 7.099 | 1.626(1.137–2.324) | 0.008 |
Interaction between problematic social media use and mental health literacy on depression symptoms
A logistic regression model (Model 1) including the interaction term between problematic social media use and mental health literacy was established. After adjusting for key confounding factors, the results revealed a significant multiplicative interaction between problematic social media use and lack of mental health literacy on depression symptoms (OR = 2.449; 95% CI: 1.061–5.651, P = 0.036). Additionally, Model 2, which analyzed the additive interaction between problematic social media use and mental health literacy, found that the two factors had a significant additive interaction on depression symptoms. The relative excess risk of interaction (RERI) was 4.169 (95% CI: 0.834–7.503), the attributable proportion (AP) was 0.645 (95% CI: 0.401–0.889), and the synergy index (SI) was 4.222 (95% CI: 1.360-13.112). The highest depression symptom detection rate (77.2%, 88/114) was observed among nursing students who both exhibited problematic social media use and lacked mental health literacy. The OR (95% CI) for this group was 6.464 (3.630–11.510) (see Table 3).
Anzeige
Table 3
Association of the Interaction between Problematic Social Media Use and Mental Health Literacy with Depression
Model | Variables | Depression Rate | B | S.E. | Wald χ² | OR(95%CI) ¥ | P | |
|---|---|---|---|---|---|---|---|---|
n (%) | ||||||||
Model 1 | Problematic Social Media Use×Mental Health Literacy | |||||||
No×Adequate | - | - | - | 1.000 | - | |||
Yes× Inadequate | 0.896 | 0.427 | 4.405 | 2.449(1.061–5.651) | 0.036 | |||
Model 2 | Problematic Social Media Use | Mental Health Literacy | ||||||
No | Adequate | 45 (32.6) | - | - | - | 1.000 | - | |
Inadequate | 137 (40.9) | 0.318 | 0.218 | 2.216 | 1.375(0.896–2.110) | 0.145 | ||
Yes | Adequate | 26 (49.1) | 0.652 | 0.340 | 3.680 | 1.920(0.986–3.738) | 0.055 | |
Inadequate | 88 (77.2) | 1.866 | 0.294 | 40.183 | 6.464(3.630–11.510) | < 0.001 | ||
Discussion
This study explores the impact of problematic social media use (PSMU) and mental health literacy (MHL) on depression symptoms among nursing students, highlighting the interactive effects between these factors. The results demonstrate a significant positive association between PSMU and depression, with lower MHL exacerbating this relationship. Specifically, nursing students with low MHL are more susceptible to the negative impacts of excessive social media use, which further increases their risk of depression.
Comparison of depression symptoms across demographic characteristics
The study found significant differences in depression symptom detection rates based on factors such as family location, whether students are only children, maternal education level, and family economic status. Specifically, students from rural areas and those with lower family economic status had higher depression detection rates, aligning with existing research that suggests socio-economic status and educational background are important determinants of mental health [24, 25]. Economic hardship limits access to resources that can alleviate stress and promote emotional regulation, such as social interactions and extracurricular activities. Additionally, the relative scarcity of educational and mental health resources in rural areas may hinder students’ ability to cope effectively with academic pressures, social adaptation challenges, and identity-related anxieties.
The finding that non-only children had a higher depression detection rate than only children is consistent with the “resource dilution” theory, which posits that family resources, both emotional and material, are diluted as the number of children increases [26]. Only children tend to receive more focused support, while non-only children may experience reduced attention due to resource distribution among siblings.
Anzeige
Parental education level also emerged as a significant factor in depression among nursing students [27, 28]. Specifically, lower maternal education was linked to a higher risk of depression, which may reflect the mother’s greater emotional and caregiving role in the family. Mothers with lower education levels may lack the knowledge or resources to provide adequate emotional support and mental health guidance, leaving students more vulnerable to stress. In contrast, paternal education level did not show a significant impact, possibly due to the traditional economic support role typically associated with fathers, which may not directly influence emotional well-being.
Independent effects of problematic social media use and mental health literacy on depression
The study found a significant positive association between PSMU and depression symptoms, which is consistent with previous research [29, 30]. Problematic social media use, characterized by excessive and uncontrollable engagement that negatively impacts daily life, has been linked to poor emotional regulation and low self-esteem. Students who excessively engage with social media may become more sensitive to negative information, heightening feelings of anxiety and loneliness [31]. Furthermore, the “substitution satisfaction theory” suggests that excessive use of social media can displace face-to-face social interactions, physical activity, and the development of other interests, limiting opportunities for emotional support and stress relief in real life [32].
In addition, the study revealed a significant independent effect of MHL on depression. Students with low MHL are more likely to experience depressive symptoms, supporting existing literature on the role of mental health literacy in preventing and alleviating psychological issues [33]. MHL encompasses the knowledge of mental health, coping strategies, and the ability to seek professional help. Students with higher MHL are more likely to recognize and manage negative emotions effectively, using techniques like cognitive restructuring or emotional redirection to alleviate depression [34]. Conversely, students with lower MHL may lack these skills, and in the face of academic or interpersonal pressure, they may internalize stress, viewing it as personal inadequacy and thereby increasing the risk of depression.
Interactive effects of problematic social media use and mental health literacy on depression symptoms
The results suggest that PSMU and low MHL have a significant additive interaction in contributing to depression symptoms. This indicates a synergistic effect, where the combination of problematic social media use and low MHL significantly exacerbates depression symptoms. Specifically, students with both PSMU and low MHL showed a higher depression detection rate than those influenced by only one of these factors. This suggests that the lack of MHL amplifies the negative effects of PSMU on depression.
Anzeige
Students with low MHL are less able to recognize and manage negative emotions, making them more susceptible to the emotional turmoil generated by negative or distorted content on social media. Without coping strategies to deal with these emotions, they are likely to ruminate on the negative information, which in turn magnifies anxiety, self-doubt, and other negative feelings. In contrast, students with higher MHL tend to have better discernment skills and can critically assess information, reducing the emotional impact of social media. Furthermore, students with low MHL are more likely to use social media as an emotional outlet, which may provide short-term relief but can lead to a dependency cycle, exacerbating feelings of loneliness and depression over time [35, 36].
Limitation
To the best of our knowledge, this is the first study to explore the relationship between problematic social media use, mental health literacy, and depressive symptoms among nursing students. It also provides valuable insights into how these factors interact and influence students’ mental health. This research contributes to a deeper understanding of the role social media plays in shaping mental health literacy and depressive symptoms, offering a theoretical basis for the development of targeted interventions to improve mental health literacy and mitigate the negative effects of social media use on mental well-being in this population.
However, this study still has several limitations. First, the sample was drawn from a specific group of nursing students from selected regions or schools, which may limit the generalizability of the findings to other populations. Future research could include a broader sample to enhance external validity. Second, this study employed a cross-sectional design, which only identifies associations between problematic social media use, mental health literacy, and depressive symptoms, without being able to draw causal conclusions. Longitudinal studies would be valuable to explore the causal relationships among these variables. Finally, the reliance on self-reported data introduces the possibility of social desirability bias and recall bias, which may affect the accuracy of the results. Future studies could incorporate observational data or third-party assessments to increase the objectivity of the findings.
Conclusions
This study examines the independent and interactive impacts of problematic social media use and mental health literacy on depression symptoms among nursing students. Both factors were found to have significant positive associations with depression, with their interaction further increasing the risk of depression. The findings suggest that enhancing mental health literacy and promoting healthy social media use habits among nursing students are essential for preventing and reducing depression symptoms. Future interventions should focus on improving emotional regulation skills, fostering critical thinking regarding social media, and providing support for building real-life social connections. By addressing these factors, nursing students can better manage stress, improve mental health, and reduce the risk of depression.
Relevance for clinical practice
This study suggests that improving MHL may help mitigate the negative effects of PSMU on depression. Nursing schools and educational institutions should integrate mental health literacy education into their curricula, focusing on developing emotional regulation skills and promoting healthy coping strategies. Additionally, digital literacy programs should be implemented to help students critically engage with social media content and recognize its potential emotional impact. Encouraging face-to-face interactions, peer support, and participation in physical activities can provide alternative avenues for emotional expression and stress relief, thereby reducing reliance on social media as a coping mechanism.
Moreover, interventions should focus on promoting a balanced approach to social media use, helping students understand its potential risks while encouraging healthy online engagement. This could include workshops, counseling services, and peer support groups that provide a space for students to discuss their experiences with social media and mental health.
Acknowledgements
We thank all the participants for their corporation.
Declarations
Ethics approval and consent to participant
This study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Harbin Medical University- Daqing campus. Informed consent was obtained from all individual participants included in the study. Participants were provided with detailed information regarding the study’s purpose, procedures, potential risks and benefits, and confidentiality measures. Written consent forms were signed by all participants prior to their involvement in the research.
Consent for publication
Not applicable. No identifying images or other personal or clinical details of participants that compromise anonymity are presented in this manuscript.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
