
==== Front
BMC Nurs
BMC Nurs
BMC Nursing
1472-6955
BioMed Central London

39256718
2321
10.1186/s12912-024-02321-0
Research
The effect of loneliness on interpersonal sensitivity among nursing undergraduates: a chain mediation role of problematic internet use and bedtime procrastination
http://orcid.org/0000-0002-4910-8026
Shi Xinji 1
http://orcid.org/0000-0001-9607-313X
Wu Yibo 2
Cao Fukai 3
http://orcid.org/0000-0002-0371-4004
Wang Xue 1
http://orcid.org/0009-0005-4259-3697
Du Kunshuo 1
http://orcid.org/0000-0001-7814-8011
Zang Shuang zangshuang@cmu.edu.cn

1
1 https://ror.org/032d4f246 grid.412449.e 0000 0000 9678 1884 Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122 Liaoning Province China
2 https://ror.org/02v51f717 grid.11135.37 0000 0001 2256 9319 School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191 China
3 grid.440734.0 0000 0001 0707 0296 Jitang College of North China University of Science and Technology, No.21 Bohai Avenue, Caofeidian District, Tangshan City, 063210 Hebei Province China
11 9 2024
11 9 2024
2024
23 64230 1 2024
3 9 2024
© The Author(s) 2024
2024
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Background

Loneliness was associated with interpersonal sensitivity, but the factors contributing to this relationship in nursing students remain unclear. This study investigated the relationship between loneliness and interpersonal sensitivity among nursing undergraduates, with a specific focus on the mediating roles played by problematic internet use and bedtime procrastination.

Method

This study was conducted as a cross-sectional survey at a university in China between November and December 2022. Data were collected using a self-administered online questionnaire that included demographic characteristics, the Three-Item Loneliness Scale (T-ILS), the Chinese Version of Short Form of Interpersonal Sensitivity Measure (IPSM-CS), the 6-item short form of the Problematic Internet Use Questionnaire (PIUQ-SF-6), and the Bedtime Procrastination Scale (BPS). Pearson correlation analysis was employed to explore the relationships among loneliness, interpersonal sensitivity, problematic internet use, and bedtime procrastination. Structural equation modeling (SEM) was conducted using AMOS software to examine the mediating role of problematic internet use and bedtime procrastination between loneliness and interpersonal sensitivity.

Results

Loneliness was positively related to interpersonal sensitivity among nursing undergraduates (β = 0.44, P < 0.001). There was a significant chain mediation role of problematic internet use and bedtime procrastination in the relationship between loneliness and interpersonal sensitivity.

Conclusions

The study contributed to deepening the understanding of the relationship between loneliness and interpersonal sensitivity and provided valuable insights into the improvement of interpersonal sensitivity in nursing undergraduates.

Keywords

Nursing undergraduates
Loneliness
Interpersonal sensitivity
Problematic internet use
Bedtime procrastination
Liaoning province general higher education undergraduate teaching reform research project, 2022No. 0480 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcBackground

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.

Fig. 1 Hypothesized model of the interrelationships of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity

Method

Study design and procedures

Between November and December 2022, a cross-sectional study was conducted at Jitang College of North China University of Science and Technology (Tangshan, Hebei, China) using a single-centered cluster sampling approach. The study aimed to investigate the mental and physical health status of all students. All undergraduate students enrolled at this college were included in this study. The inclusion criteria were (a) undergraduates presently studying at the university; (b) voluntary participation in this study; and (c) not participating in other similar studies.

The survey questionnaire was distributed to all students anonymously through the college’s official channels. Data collection was conducted through the distribution of a self-administered online questionnaire, utilizing WeChat (a widely employed social platform in China with over one billion users) and Questionnaire Star (a free online survey program). Students were informed about the study and fully understood its purpose. Informed consent was obtained from all participants.

In compliance with the Declaration of Helsinki and the Measures for Ethical Review of Biomedical Research Involving Human Beings [41], this study obtained ethical approval from the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002).

Sample size and sampling

According to the sample size estimation formula of structural equation modeling (SEM), the sample size should ideally be 10 to 15 times the number of dimensions [42]. In this study, the sample size was calculated 15 times with 10 dimensions. The minimum sample size was 150. Meanwhile, to ensure stable estimation in SEM, a minimum of 200 participants is required [43]. Considering a potential 20% rate of invalid questionnaires, a total sample size of 240 participants was deemed necessary.

The original study included 5475 participants. In this study, we exclusively selected nursing undergraduates as the study population, initially enrolling 864 participants. Then, 127 participants were excluded due to the obvious regularity of their answers. Finally, this study included a total of 737 participants.

Measures

Demographic characteristics

Demographic characteristics of participants included age (years), gender (female, male), academic year (first, second, third, fourth), ethnicity (Han, minority), hukou (agricultural, non-agricultural), and place of residence (rural, urban).

Loneliness

The Three-Item Loneliness Scale (T-ILS) developed by Hughes et al. [4] was used to measure loneliness. This study used the version translated into Chinese by Liu et al. [44] An example item was “How often do you feel that you lack companionship?” Responses ranged from 1 (hardly ever) to 3 (often). The overall score was calculated as the sum of all three items (range: 3–9). Higher scores reflected a higher level of loneliness. The Cronbach’s α of the original scale was 0.72 [4] and the translated version of the scale was 0.87 in Chinese samples [44]. In this study, Cronbach’s α for the T-ILS was 0.87.

Interpersonal sensitivity

Interpersonal sensitivity was measured with the Chinese Version of the Short Form of Interpersonal Sensitivity Measure (IPSM-CS), which was developed by You et al. [1] The IPSM-CS was a 15-item scale with five dimensions: interpersonal awareness (e.g., “I worry about what others think of me”), fragile inner-self (e.g., “If others knew the real me, they would not like me”), separation anxiety (e.g., “I feel insecure when I say goodbye to people”), need for approval (e.g., “I feel happy when someone compliments me”), and timidity (e.g., “I find it hard to get angry with people”). Responses to each item were rated on a 5-point Likert scale ranging from 1 (very unlike me) to 5 (very like me). The range of possible scores is between 15 and 75, with a higher score indicating a higher interpersonal sensitivity degree. The Cronbach’s α of the original scale was 0.74 [1]. In this study, Cronbach’s α for the IPSM-CS was 0.90.

Problematic internet use

Problematic Internet use was measured using the 6-item short form of the Problematic Internet Use Questionnaire (PIUQ-SF-6) [45]. The original version was developed by Demetrovics et al. and has demonstrated appropriate validity and reliability [45]. The Chinese version of the scale was translated by Koronczai et al. [46], with a Cronbach’s α of 0.84. PIUQ-SF-6 was divided into three dimensions: obsession (e.g., “How often does it happen to you that you feel depressed, moody, or nervous when you are not on the Internet and these feelings stop once you are back online?”), neglect (e.g., “How often do people in your life complain about spending too much time online?”), and control disorder (e.g., “How often does it happen to you that you wish to decrease the amount of time spent online but you do not succeed?”). Responses to each item were assessed on a 5-point Likert scale ranging from 1 (never) to 5 (almost). The range of possible scores is between 6 and 30, with a higher score indicating increased problematic internet use. In this study, Cronbach’s α for the PIUQ-SF-6 was 0.92.

Bedtime procrastination

The 9-item Bedtime Procrastination Scale (BPS) developed by Kroese et al. [17] was used to assess bedtime procrastination. The Chinese version of the scale was translated by Ma et al. [28] An example item was “I go to bed later than I had intended.” Items were scored on a 5-point Likert scale ranging from 1 (never) to 5 (always). The second, third, seventh, and ninth items were scored in reverse (e.g., “I can easily stop with my activities when it is time to go to bed”). The range of possible scores is between 9 and 45. Higher scores reflected a higher bedtime procrastination degree. The Cronbach’s α of the original scale was 0.92 [17] and the Chinese version of the scale was 0.91 [28]. In this study, Cronbach’s α for the BPS was 0.77.

Statistical analysis

All statistical analyses were conducted by IBM SPSS 25.0 and Amos 28.0 (IBM Corp., Armonk, NY, USA). Two-sided p < 0.05 was considered statistically significant.

First, a Harman single-factor test was performed to diagnose the common method bias [47]. Second, the normal distribution was tested by the Kolmogorov-Smirnov test and QQ-plot. All continuous variables followed an approximately normal distribution. Descriptive statistics were calculated using means, standard deviations (SD), frequencies, and percentages. Third, Pearson correlation analysis was used to evaluate the correlation between four variables: loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity. Finally, we used AMOS software for SEM analyses to examine the mediating role of problematic internet use and bedtime procrastination between loneliness and interpersonal sensitivity. The model was adjusted and fitted using the maximum likelihood ratio method. Bootstrap tests (sampling was repeated 5,000 times) were conducted to assess the significance of the mediating effect with a 95% confidence interval (CI) not including 0. The models’ goodness of fit was evaluated using the following criteria: minimum discrepancy function based on Chi-squared divided by degrees of freedom (CMIN/DF) (< 3 good, < 5 acceptable), comparative fit index (CFI) ⩾0.90, Tucker-Lewis index (TLI) ⩾0.90, goodness of fit index (GFI) ⩾0.90 and root mean square error of approximation (RMSEA) ⩽0.08, standardized root mean square residual (SRMR): ⩽0.06 [48, 49].

Results

Common method bias test

The results of the Harman single-factor test showed that there were six factors with eigenvalues exceeding 1. The first factor accounted for 27.11% of the total variance, falling below the critical standard of 40%, indicating that there is no serious common method bias in this study [47].

Demographic characteristics of participants

Of the 737 participants, the mean age was 20.05 years old (SD = 1.38). Most of the participants were female (80.87%), third-year level (28.90%), Han ethnicity (95.93%), agricultural hukou (71.91%), and lived in rural (53.32%) (Table 1).

Table 1 Demographic characteristics of the participants (N = 737)

Variables	N	Percentage (%)	
Age (years)	20.05 ± 1.38

(Mean ± SD)

		
Gender			
 female	596	80.87	
 male	141	19.13	
Academic year			
 forth	191	25.92	
 third	213	28.90	
 second	160	21.71	
 first	173	23.47	
Ethnicity			
 Han	707	95.93	
 minority	30	4.07	
Hukou			
 agricultural	530	71.91	
 non-agricultural	207	28.09	
Place of residence			
 rural	393	53.32	
 urban	344	46.68	
Note: SD means standard deviation

Descriptive statistics and Pearson’s correlation analysis

The descriptive statistics of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity were displayed in Table 2. The nursing undergraduates’ interpersonal sensitivity scores were 43.99 ± 8.54. Among these dimensions of interpersonal sensitivity, the score of the need for approval dimension was the highest (10.38 ± 2.14), while the score of the fragile inner-self dimension was the lowest (7.31 ± 2.32). Additionally, the average scores of loneliness, problematic internet use, and bedtime procrastination were 5.22 ± 1.54, 14.78 ± 4.57, and 27.31 ± 6.12, respectively. These results denoted that most nursing undergraduates had moderate interpersonal sensitivity, loneliness, problematic internet use, and bedtime procrastination (scores close to the intermediate value of their respective scales).

Table 2 Descriptive statistics of loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity among the participants (N = 737)

Study variables	Mean	SD	Items	
Interpersonal sensitivity	43.99	8.54	15	
 Interpersonal sensitivity: interpersonal awareness	9.30	2.46	3	
 Interpersonal sensitivity: fragile inner-self	7.31	2.32	3	
 Interpersonal sensitivity: separation anxiety	8.24	2.36	3	
 Interpersonal sensitivity: need for approval	10.38	2.14	3	
 Interpersonal sensitivity: timidity	8.75	2.00	3	
Loneliness	5.22	1.54	3	
Problematic internet use	14.78	4.57	6	
 Problematic internet use: obsession	4.85	1.80	2	
 Problematic internet use: neglect	5.17	1.65	2	
 Problematic internet use: control disorder	4.75	1.69	2	
Bedtime procrastination	27.31	6.12	9	
Note: SD means standard deviation

The correlation analysis showed that interpersonal sensitivity was positively correlated with loneliness (r = 0.45, P < 0.01), problematic internet use (r = 0.35, P < 0.01), and bedtime procrastination (r = 0.35, P < 0.01). This suggested that individuals with higher levels of interpersonal sensitivity were more likely to experience increased loneliness, engage in problematic internet use, and exhibit bedtime procrastination. Loneliness was positively correlated with problematic internet use (r = 0.36, P < 0.01) and bedtime procrastination (r = 0.38, P < 0.01). This indicated that individuals experiencing higher levels of loneliness were more likely to engage in problematic internet use and delay their bedtime. Problematic internet use was positively correlated with bedtime procrastination (r = 0.45, P < 0.01), suggesting that those who exhibited problematic internet use were also more prone to delaying their bedtime (Table 3).

Table 3 The correlation between loneliness, problematic internet use, bedtime procrastination, and interpersonal sensitivity (N = 737)

Variables	1	2	3	4	5	6	7	8	9	10	11	12	
1. Interpersonal sensitivity	—												
2. Interpersonal sensitivity: interpersonal awareness	0.84**	—											
3. Interpersonal sensitivity: fragile inner-self	0.71**	0.53**	—										
4. Interpersonal sensitivity: separation anxiety	0.82**	0.59**	0.59**	—									
5. Interpersonal sensitivity: need for approval	0.63**	0.49**	0.10**	0.36**	—								
6. Interpersonal sensitivity: timidity	0.77**	0.54**	0.41**	0.52**	0.50**	—							
7. Loneliness	0.45**	0.45**	0.48**	0.42**	0.05	0.29**	—						
8. Problematic internet use	0.35**	0.30**	0.43**	0.35**	0.03	0.20**	0.36**	—					
9. Problematic internet use: obsession	0.34**	0.27**	0.40**	0.34**	0.04	0.20**	0.33**	0.91**	—				
10. Problematic internet use: neglect	0.31**	0.29**	0.34**	0.28**	0.05	0.17**	0.32**	0.88**	0.71**	—			
11. Problematic internet use: control disorder	0.30**	0.24**	0.41**	0.29**	-0.001	0.16**	0.31**	0.88**	0.71**	0.64**	—		
12. Bedtime procrastination	0.35**	0.39**	0.29**	0.31**	0.12**	0.16**	0.38**	0.45**	0.38**	0.50**	0.33**	—	
Note: **P < 0.01 (two-tailed)

Structural model and mediating effect analysis

The structural equation model was initially tested, and the correlations between error terms for the dimensions of interpersonal sensitivity were added according to modification indices. The corrected model demonstrated acceptable goodness-of-fit indices: CMIN = 112.382, DF = 24, CMIN/DF = 4.68, CFI = 0.97, TLI = 0.95, GFI = 0.97, RMSEA = 0.07, and SRMR = 0.03. The standardized path coefficients of the final model are shown in Fig. 2.

Fig. 2 Final model for the effects of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity. Note: **P < 0.01, ***P < 0.001 (two-tailed)

Table 4 showed the results of the mediation effect analysis. First, loneliness could be significantly and positively related to the problematic internet use of nursing undergraduates (β = 0.38, P < 0.001, Model 1). Second, loneliness (β = 0.24, P < 0.001) and problematic internet use (β = 0.39, P < 0.001) could be significantly and positively related to the bedtime procrastination of nursing undergraduates (Model 2). Third, loneliness (β = 0.44, P < 0.001), problematic internet use (β = 0.26, P < 0.001), and bedtime procrastination (β = 0.11, P < 0.01) could be significantly and positively related to the interpersonal sensitivity of nursing undergraduates (Model 3).

Table 4 Regression analysis of the relationship between variables in the mediation effect model

Dependent variable	Independent variable	R 2	β	SE	t	
Model 1						
Problematic internet use	Loneliness	0.14	0.38	0.04	10.13***	
Model 2						
Bedtime procrastination	Problematic internet use	0.28	0.39	0.15	10.27***	
	Loneliness		0.24	0.14	6.79***	
Model 3						
Interpersonal sensitivity	Bedtime procrastination	0.43	0.11	0.01	3.17**	
	Problematic internet use		0.26	0.05	6.57***	
	Loneliness		0.44	0.05	11.84***	
Note: **P < 0.01, ***P < 0.001 (two-tailed)

Table 5 showed the total, direct, and indirect effects of loneliness, problematic internet use, and bedtime procrastination on interpersonal sensitivity. The mediating effect of problematic internet use and bedtime procrastination was significant, and the total indirect effect value was 0.14, accounting for 24.14% of the total effect (0.58). Specifically, the mediating effect was composed of indirect effects generated through three pathways. First, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through problematic internet use was 0.10 (Bootstrap 95% CI: 0.06 to 0.15). Second, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through bedtime procrastination was 0.03 (Bootstrap 95% CI: 0.01 to 0.05). Third, the path coefficient for the indirect effect of loneliness on interpersonal sensitivity through problematic internet use and bedtime procrastination was 0.02 (Bootstrap 95% CI: 0.01 to 0.03).

Table 5 Total, direct, and indirect effects of loneliness on interpersonal sensitivity

Effect types	Paths	Effect	Bootstrap SE	Bootstrap 95% CI	
Total effect	Loneliness → Interpersonal sensitivity	0.58	0.03	0.52 to 0.64	
Direct effect	Loneliness → Interpersonal sensitivity	0.44	0.04	0.36 to 0.50	
Indirect effects	Total indirect effect	0.14	0.02	0.10 to 0.19	
	Loneliness → Problematic internet use → Interpersonal sensitivity	0.10	0.02	0.06 to 0.15	
	Loneliness → Bedtime procrastination → Interpersonal sensitivity	0.03	0.01	0.01 to 0.05	
	Loneliness → Problematic internet use → Bedtime procrastination → Interpersonal sensitivity	0.02	0.01	0.01 to 0.03	

Discussion

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.

Limitations

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.

Conclusion

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.

Acknowledgements

The authors would like to thank all the participants of the study.

Author contributions

XJS and SZ contributed to the conception and designed study. XJS analyzed, interpreted the data, and drafted the manuscript. YBW and FKC contributed to data collection. SZ acquired resources. XJS, YBW, XW, and KSD contributed to the critical revision of the report. All authors read and approved the final manuscript.

Funding

This research was supported by grants from the Liaoning province general higher education undergraduate teaching reform research project, 2022 (No. 0480).

Data availability

The data in this study can be obtained from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study obtained ethical approval from the Ethics Review Committee of Jitang College of North China University of Science and Technology (JTXY-2022-002). Informed consent was obtained from all participants.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Xinji Shi and Yibo Wu are share the first authorship on this work.
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