The effect of loneliness on interpersonal sensitivity among nursing undergraduates: a chain mediation role of problematic internet use and bedtime procrastination

Interpersonal sensitivity, considered inappropriate or excessive awareness and responsiveness to the behaviors and emotions of others, is a widely researched personality trait often associated with a “depressive-prone personality” [1]. Interpersonal sensitivity was one of the most prominent psychological symptoms among medical students, with negative impacts on both individual psychological well-being and social adaptation functions [2]. Meanwhile, interpersonal sensitivity was a susceptibility factor for many mental disorders, such as anxiety and depression [3]. Individuals possessing this personality trait tend to experience discomfort and feelings of inadequacy in interpersonal communication, leading to a frequent avoidance of social interactions [2].

Loneliness refers to a subjective state of feeling isolated or disconnected from others [4]. Research has shown that loneliness is associated with interpersonal sensitivity [5]. According to the social needs approach, the emergence of loneliness is attributed to the absence of a social need for relationships or a set of relationships [6]. When individuals are unable to satisfy their social and/or intimacy needs within relationships, feelings of loneliness arise. Research has indicated that lonely individuals are more prone to social withdrawal [7]. On the other hand, the Choking Under Social Pressure theory [8] offers another perspective, suggesting that individuals with high levels of loneliness experience excessive anxiety in social interactions as they strive to establish positive interpersonal relationships. This heightened anxiety restricts their interpersonal abilities, resulting in adverse social consequences, and making them more cautious and sensitive in social interactions. Additionally, loneliness has been shown to impair executive functioning, increase sensitivity to negative social stimuli, and undermine interpersonal trust [9]. Although the impact of loneliness on interpersonal sensitivity has not been extensively studied, this study, integrating the theoretical frameworks and existing research findings, hypothesizes a significant positive correlation between loneliness and interpersonal sensitivity.

Problematic internet use is defined as persistent and compulsive internet use that disrupts daily life [10]. The increased reliance on digital devices and online resources for entertainment or education has led to students’ difficulties in regulating internet use, potentially resulting in discomfort, hindrance in daily activities, and the emergence of problematic internet use [11, 12]. A previous systematic review reported a prevalence range of 0.8–26.7% for problematic internet use in adolescents and adults [13]. According to the Compensatory Internet Use theory [14], individuals experiencing unfavorable circumstances may choose to mitigate negative emotions by engaging in virtual online activities, showing a tendency to compensate for interpersonal deficiencies in real-life communication through internet engagement. Additionally, previous research has shown that loneliness was a significant predictor of problematic internet use, with higher levels of loneliness associated with increased social interaction online [15]. Meanwhile, research has also indicated that individuals who engage in problematic internet use often neglect real-life interpersonal interactions, leading to negative relational outcomes [16]. Therefore, we hypothesize that loneliness may drive individuals to seek emotional support online, and this compensatory behavior could further enhance interpersonal sensitivity.

Bedtime procrastination refers to the phenomenon where individuals, without external impediments, are unable to retire to bed at the scheduled time, representing an unhealthy behavior associated with sleep habits [17]. According to the annual sleep report of China 2022, a mere 6.41% of college students reported never encountering bedtime procrastination [18]. Previous studies have suggested that individuals experiencing loneliness were more likely to ruminate on their feelings of isolation, particularly at night, thereby delaying the onset of sleep [19]. Bedtime procrastination may lead to poor sleep quality, negative emotions, and adverse impacts on interpersonal relationships [20‐22].

During the COVID-19 pandemic, students faced increased academic pressure and social restrictions, contributing to heightened feelings of loneliness [23]. This may prompt them to seek social satisfaction through the internet, potentially leading to problematic internet use [15]. A study involving 1000 medical students revealed that 17.8% of participants use their smartphones for more than 3 h daily, often engaging with them late into the night, making it difficult for them to disengage even when attempting to sleep [24]. When individuals are susceptible to problematic internet use, they tend to reduce their bedtime to allocate additional time for mobile phone usage [25]. The Temporal Motivation Theory suggests that individuals when faced with tasks or behavioral choices, weigh the importance of achieving long-term objectives against the allure of immediate gratification [26]. Individuals with problematic internet use exhibit higher psychological cravings for internet use [27]. According to this theory, as the health benefits of sleep manifest at a later time point, this diminishes their motivation to go to bed at a reasonable hour, leading to bedtime procrastination. In addition, bedtime procrastination was strongly associated with poorer sleep quality and sleep insufficiency [17, 28]. The negative impacts of bedtime procrastination may further affect interpersonal relationships and potentially affect interpersonal sensitivity [21, 22].

Compared to other undergraduates, nursing students encounter unique psychological and emotional pressures [29]. They undergo emotional challenges from patients and families and the psychological burdens of professional responsibility [30]. Nursing students have played a critical role in healthcare settings, serving as volunteers and even engaging as frontline healthcare workers amid the COVID-19 pandemic [31, 32]. As the pandemic gradually came under control, the learning and living environments of nursing undergraduates began to return to normal. However, psychological shadows and behavioral patterns left by the pandemic may persist [33]. The uncertainty, fear, and isolation brought about by the COVID-19 pandemic may aggravate the loneliness of nursing students and profoundly affect their social interaction and psychological well-being [29, 33]. As an essential reserve force in the healthcare field, nursing students’ psychological well-being significantly affects not only their academic achievements and personal lives but also plays a crucial role in shaping their future career decisions, personal development, and the quality of their prospective clinical nursing work [34]. Meanwhile, nursing roles typically demand effective collaboration within teams, necessitating communication with other healthcare professionals, nursing colleagues, and medical management [35]. For nursing undergraduates, cultivating positive interpersonal relationships contributes to a supportive and collaborative learning environment, fostering personal growth and adaptability [36], and ultimately preparing them for the intricate demands of their future clinical roles. However, nursing students with high interpersonal sensitivity may experience social anxiety and feelings of inferiority, which not only affect their psychological well-being but also potentially hinder their performance in the workplace, academic settings, and daily life [2, 3]. Therefore, it is crucial to identify effective interventions to mitigate the negative impacts of interpersonal sensitivity for nursing students.

Currently, existing studies have primarily focused on exploring relationships between pairs of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity. For instance, Jiang et al. [5] identified a positive correlation between loneliness and interpersonal sensitivity. Boursier et al. [15] found that loneliness is one of the most significant predictors of problematic internet use, with higher levels of loneliness associated with increased online social interactions. Xu et al. [37] confirmed a positive correlation between loneliness and bedtime procrastination among college students. Additionally, a longitudinal study on Chinese college students revealed a significant bidirectional relationship between problematic internet use and bedtime procrastination [38]. Numerous studies have also explored the relationship between problematic internet use and interpersonal sensitivity [39, 40]. Despite these important findings, there remains a significant gap in understanding how these variables interact collectively rather than merely in pairs. This gap hinders the ability to develop targeted interventions. Moreover, research specifically targeting nursing undergraduates is scarce. Given the unique challenges faced by this population, understanding the interactions between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity is crucial for promoting their mental health and professional development. To address these gaps and extend previous studies, this research comprehensively investigates the interrelationships among loneliness, problematic internet use, bedtime procrastination, and their combined effects on interpersonal sensitivity among nursing undergraduates. By exploring how these variables interact with one another, we aim to gain a better understanding of the needs and challenges faced by nursing students, provide insights into improving their interpersonal sensitivity, and offer targeted recommendations and guidance for future educational practices to help them adapt to the post-pandemic new normal.

Considering the existing studies, this study’s particular research hypotheses are as follows (Fig. 1):

H1: Loneliness is positively related to interpersonal sensitivity.

H2: Problematic internet use serves as a mediating role between loneliness and interpersonal sensitivity.

H3: Bedtime procrastination serves as a mediating role between loneliness and interpersonal sensitivity.

H4: Problematic internet use is positively related to bedtime procrastination, which plays a chain mediating role between loneliness and interpersonal sensitivity.

This study explored the relationship between loneliness and interpersonal sensitivity among nursing undergraduates, with a focus on the mediating roles of problematic internet use and bedtime procrastination. The study revealed three important findings. First, loneliness was significantly positively related to interpersonal sensitivity. Second, problematic internet use and bedtime procrastination emerged as pivotal mediating factors between loneliness and interpersonal sensitivity. Finally, loneliness, through the chain mediation of problematic internet use and bedtime procrastination, indirectly affected the interpersonal sensitivity of nursing undergraduates.

In this study, we discovered a significant positive relationship between loneliness and interpersonal sensitivity among nursing undergraduates. When they have higher feelings of loneliness, they may have higher interpersonal sensitivity. Therefore, the H1 hypothesis was supported. This result was consistent with a previous study on Chinese gay men [5], which similarly found an association between loneliness and interpersonal sensitivity. The stability of the positive relationship between loneliness and interpersonal sensitivity may be attributed to their inherent nature. Individuals with heightened interpersonal sensitivity often tend to over-interpret others’ attitudes and reactions [1]. Meanwhile, individuals experiencing high levels of loneliness may develop a tendency towards negative interpretations of social interactions, leading to increased sensitivity and vigilance towards others’ evaluations and behaviors [50, 51]. In this study, the relationship between loneliness and interpersonal sensitivity observed in nursing undergraduates can be elucidated through the Choking Under Social Pressure theory [8], which suggests that heightened loneliness in social contexts may restrict interpersonal abilities and lead to adverse social consequences. Nursing undergraduates may engage in clinical practice, academic tasks, and teamwork in their professional training, necessitating the establishment of close relationships with peers, teachers, and patients [35]. However, the changes caused by the COVID-19 pandemic have led to social restrictions, increased interpersonal distance in clinical practice, and apprehension regarding future career uncertainties, which increases the loneliness of nursing undergraduates [33]. Individuals experiencing loneliness manifest a hypervigilant response to negative social stimuli and may be more inclined to interpret ambiguous social cues in a pessimistic manner, which may increase interpersonal sensitivity [50, 51]. Our study emphasizes the importance of addressing loneliness within the context of nursing education. Educational institutions and clinical mentors should not only focus on cultivating professional skills but also address the issue of loneliness among nursing undergraduates, thereby fostering more adaptable healthcare professionals. Offering a supportive social environment, regular psychological counseling, and fostering teamwork among peers may aid in the early identification and mitigation of loneliness experienced by nursing undergraduates, thus improving their interpersonal sensitivity and preventing subsequent cascading psychological issues.

The problematic internet use played a mediating role in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Loneliness may make them more prone to have problematic internet use problems, further increasing interpersonal sensitivity and thus confirming the H2 hypothesis. This was consistent with previous studies that underscored the relationship between problematic internet use and mental health issues [52]. Meanwhile, consistent with the Compensatory Internet Use theory [14], individuals experiencing loneliness may turn to the internet as a means of alleviating their negative emotions, thereby resulting in problematic internet use. A study of 559 Turkish university students indicated that loneliness was the most important predictor of problematic internet use [53]. Nursing undergraduates may experience loneliness and resort to the Internet as a coping mechanism [54]. Individuals with problematic internet use tendencies are more likely to rely on feedback from others in virtual social interactions, displaying higher levels of interpersonal sensitivity and destroying their social relationships [55]. Furthermore, problematic internet use may lead nursing undergraduates to experience more negative emotions in virtual socialization, such as criticism or indifferent feedback on social media [56]. These negative experiences may contribute to nursing undergraduates developing more complex and sensitive attitudes toward social relationships, manifesting as higher levels of interpersonal sensitivity [39]. These findings highlight the importance of addressing both loneliness and problematic internet use within nursing education and mental health interventions. Promoting awareness of healthy internet use, fostering resilience against the adverse effects of digital dependency, and advocating for a balanced approach to virtual and face-to-face social interactions are critical for improving the interpersonal sensitivity of nursing undergraduates. By integrating psychological support and education on healthy online behaviors into nursing curricula, educators and healthcare professionals can empower students to cultivate robust interpersonal skills essential for their professional development and overall well-being.

The bedtime procrastination played a mediating role in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Loneliness may increase the likelihood of them engaging in bedtime procrastination, further amplifying interpersonal sensitivity. Thus, the H3 hypothesis was supported. Additionally, these findings are consistent with previous research indicating the significant mediating role of sleep in the relationship between loneliness and psychological well-being [57]. Loneliness, as a negative emotional state, may disrupt regulatory processes associated with self-regulation and impulse control, making individuals more prone to engaging in behaviors that offer immediate gratification but compromise long-term well-being, ultimately leading to bedtime procrastination [19, 58]. A study investigating 1,550 Chinese undergraduates showed that, in addition to sleep duration, bedtime procrastination was also strongly associated with other dimensions of sleep quality (e.g., daytime functioning) [59]. Studies have found an association between bedtime procrastination and individuals’ emotional self-regulation abilities, suggesting that those who engage in bedtime procrastination may encounter heightened negative emotions [60]. The poor sleep quality, fatigue, and negative emotions resulting from bedtime procrastination may render nursing undergraduates more susceptible to the influence of others’ emotions, potentially leading to exaggerated reactions to others’ emotional expressions and consequently exacerbating interpersonal sensitivity [20, 21, 60]. These findings hold important implications for interventions aimed at improving the interpersonal sensitivity of nursing undergraduates. Given the observed mediation of bedtime procrastination in the relationship between loneliness and interpersonal sensitivity, targeted strategies focusing on sleep management and healthy sleep habits are warranted. Offering health education, recommending sound sleep habits, and providing coping strategies for regulating psychological discomfort may all contribute to improving the sleep behavior of nursing undergraduates, thereby enhancing overall mental well-being.

We found that loneliness indirectly affected nursing undergraduates’ interpersonal sensitivity through the chain mediation of problematic internet use and bedtime procrastination. Therefore, the H4 hypothesis was supported. This study provides empirical evidence for the Temporal Motivation Theory [26]. During the pandemic, as feelings of loneliness intensified, nursing undergraduates may have been inclined to alleviate negative emotions and loneliness through the use of the internet to attain momentary emotional satisfaction [61]. However, excessive use of the internet may also deepen their reliance on virtual social interactions and lead to problematic internet use [15]. Studies indicated that the light emitted by smartphones may hinder the production of melatonin, consequently delaying the onset of sleep [62, 63]. Simultaneously, smartphones offer various applications, facilitating easy immersion and a loss of temporal awareness [64]. Engaging in frequent nighttime internet browsing and similar activities may prolong the wakefulness time of nursing undergraduates who are immersed in internet surfing, thereby impacting their regular sleep patterns [65]. Furthermore, bedtime procrastination exacerbates the physical fatigue and anxiety levels of nursing undergraduates, potentially rendering them more susceptible to the influence of others and exhibiting heightened levels of interpersonal sensitivity [64]. The findings of this chained mediation model underscore the importance of not only independently addressing the impact of loneliness in the development of psychological health interventions but also considering the integrated effects of mediating factors. Educational and practical interventions should prioritize guidance on healthy internet usage and promote beneficial sleep behaviors to effectively mitigate the impact of loneliness on interpersonal sensitivity among nursing undergraduates. By addressing these interconnected factors, institutions can better support students’ mental health and overall well-being.

Also, inspired by the findings in this study, nursing education institutions should prioritize early identification and intervention for loneliness in clinical practice. Developing tailored interventions that integrate education on healthy internet use and sleep hygiene into the curriculum can effectively alleviate loneliness among nursing undergraduates and improve their interpersonal sensitivity. Future research should continue to investigate targeted intervention measures and their efficacy in addressing these issues within nursing education. By prioritizing these initiatives, institutions can proactively support the mental well-being of nursing undergraduates and enhance their overall educational experience.

There were several limitations in this study. First, the study was confined to nursing undergraduates from one university in China, potentially restricting the generalizability of our findings to other regions, cultures, and educational contexts. To enhance the external validity of the study, future research could consider expanding the sample to encompass participants from diverse geographical and cultural backgrounds. Second, our study relied on self-reported data, introducing the possibility of social desirability and recall biases. Future research might incorporate objective measurement tools to validate the accuracy of self-reported data. Third, due to the cross-sectional design of our study, the causation between variables cannot be determined. To gain a more comprehensive understanding of the relationships between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity, future research could employ a longitudinal design, tracking participants over time to provide clearer insights into the causal relationships among these variables. Finally, while our study focused on the effect of loneliness on interpersonal sensitivity, we recognize the possibility that other relationships between these variables may exist. Future research could further explore their relationships to provide a more nuanced understanding of the complex interplay between these factors.

In conclusion, our study found a significant chain mediation role of problematic internet use and bedtime procrastination in the relationship between loneliness and interpersonal sensitivity among nursing undergraduates. Strategies such as fostering healthy internet use and promoting effective sleep management can improve interpersonal sensitivity among nursing undergraduates. The findings contribute to the theoretical understanding of these associations and offer practical implications for educational institutions and healthcare providers, which can develop targeted interventions to enhance the overall well-being and professional development of nursing students.