Mindful Attention as a Mediator Between Smartphone Overuse and Depressive Symptoms for Up to 6 Months Among Young People: Findings from Two Separate Epidemiological and Longitudinal Community Studies

Abi-Jaoude, E., Naylor, K. T., & Pignatiello, A. (2020). Smartphones, social media use and youth mental health. Canadian Medical Association Journal, 192(6), E136–E141. https://doi.org/10.1503/cmaj.190434

Alonso, J., Petukhova, M., Vilagut, G., Chatterji, S., Heeringa, S., Üstün, T. B., Alhamzawi, A. O., Viana, M. C., Angermeyer, M., Bromet, E., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Hinkov, H., Hu, C.-Y., Karam, E. G., Kovess, V., ... Kessler, R. C. (2011). Days out of role due to common physical and mental conditions: Results from the WHO World Mental Health surveys. Molecular Psychiatry, 16(12), 1234–1246. https://doi.org/10.1038/mp.2010.101

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Ames, C. S., Richardson, J., Payne, S., Smith, P., & Leigh, E. (2014). Mindfulness-based cognitive therapy for depression in adolescents. Child and Adolescent Mental Health, 19(1), 74–78. https://doi.org/10.1111/camh.12034

Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. https://doi.org/10.1037/0022-3514.84.4.822

Campbell, S., & Macqueen, G. (2004). The role of the hippocampus in the pathophysiology of major depression. Journal of Psychiatry & Neuroscience, 29(6), 417–426.

Catling, J. C., Bayley, A., Begum, Z., Wardzinski, C., & Wood, A. (2022). Effects of the COVID-19 lockdown on mental health in a UK student sample. BMC Psychology, 10(1), 118. https://doi.org/10.1186/s40359-022-00732-9

Census and Statistics Department. (2017). Usage of information technology and the internet by Hong Kong residents, 2000 to 2016. Census and Statistics Department. Retrieved from https://www.statistics.gov.hk/pub/B71711FB2017XXXXB0100.pdf

Chen, J., Liang, Y., Mai, C., Zhong, X., & Qu, C. (2016). General deficit in inhibitory control of excessive smartphone users: Evidence from an event-related potential study. Frontiers in Psychology, 7, 511. https://doi.org/10.3389/fpsyg.2016.00511

Chen, S. H., Weng, L. J., Su, Y. J., Wu, H. M., & Yang, P. F. (2003). Development of Chinese Internet Addiction Scale and its psychometric study. Chinese Journal of Psychology, 45(3), 279–294.

Cheung, M.-C., Lai, J. S. K., & Yip, J. (2022). Influences of smartphone and computer use on health-related quality of life of early Adolescents. International Journal of Environmental Research and Public Health, 19(4). https://doi.org/10.3390/ijerph19042100

Choi, J., Cho, H., Choi, J.-S., Choi, I. Y., Chun, J.-W., & Kim, D.-J. (2021). The neural basis underlying impaired attentional control in problematic smartphone users. Translational Psychiatry, 11(1), 129. https://doi.org/10.1038/s41398-021-01246-5

Chun, J.-W., Choi, J., Cho, H., Choi, M.-R., Ahn, K.-J., Choi, J.-S., & Kim, D.-J. (2018). Role of frontostriatal connectivity in adolescents with excessive smartphone use. Frontiers in Psychiatry, 9, 437. https://doi.org/10.3389/fpsyt.2018.00437

Deng, Y. Q., Li, S., Tang, Y. Y., Zhu, L. H., Ryan, R., & Brown, K. (2012). Psychometric properties of the Chinese translation of the mindful attention awareness scale (MAAS). Mindfulness, 3(1), 10–14. https://doi.org/10.1007/s12671-011-0074-1

Elhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017). Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders, 207, 251–259. https://doi.org/10.1016/j.jad.2016.08.030

GovHK (2022). Class suspension continued. GovHK. https://www.news.gov.hk/eng/2022/02/20220214/20220214_174151_936.html

Haug, S., Castro, R. P., Kwon, M., Filler, A., Kowatsch, T., & Schaub, M. P. (2015). Smartphone use and smartphone addiction among young people in Switzerland. Journal of Behavioral Addictions, 4(4), 299–307. https://doi.org/10.1556/2006.4.2015.037

Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: a Regression-based Approach. Guilford Press.

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research, 191(1), 36–43. https://doi.org/10.1016/j.pscychresns.2010.08.006

Horvath, J., Mundinger, C., Schmitgen, M. M., Wolf, N. D., Sambataro, F., Hirjak, D., Kubera, K. M., Koenig, J., & Christian Wolf, R. (2020). Structural and functional correlates of smartphone addiction. Addictive Behaviors, 105, 106334. https://doi.org/10.1016/j.addbeh.2020.106334

Huang, V., Yu, M., Carleton, R. N., & Beshai, S. (2019). Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies. PLoS ONE, 14(11), e0224865. https://doi.org/10.1371/journal.pone.0224865

Hui, C. L.-M., Suen, Y.-N., Lam, B. Y.-H., Wong, S. M.-Y., Wong, C. S.-M., Lui, S. S.-Y., Chan, K.-T., Wong, M. T.-H., Chan, S. K.-W., Lee, E. H.-M., Chang, W.-C., Wong, G. H.-Y., & Chen, E. Y.-H. (2022). LevelMind@JC: Development and evaluation of a community early intervention program for young people in Hong Kong. Early Intervention in Psychiatry, 16(8), 920–925. https://doi.org/10.1111/eip.13261

Ives-Deliperi, V. L., Solms, M., & Meintjes, E. M. (2011). The neural substrates of mindfulness: an fMRI investigation. Social Neuroscience, 6(3), 231–242. https://doi.org/10.1080/17470919.2010.513495

Jimenez, S. S., Niles, B. L., & Park, C. L. (2010). A mindfulness model of affect regulation and depressive symptoms: Positive emotions, mood regulation expectancies, and self-acceptance as regulatory mechanisms. Personality and Individual Differences, 49(6), 645–650. https://doi.org/10.1016/j.paid.2010.05.041

Jones, P. B. (2013). Adult mental health disorders and their age at onset. The British Journal of Psychiatry, 202(s54), S5–S10. https://doi.org/10.1192/bjp.bp.112.119164

Jun, S. (2016). The reciprocal longitudinal relationships between mobile phone addiction and depressive symptoms among Korean adolescents. Computers in Human Behavior, 58, 179–186. https://doi.org/10.1016/j.chb.2015.12.061

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016

Kang, Y.-K., Guo, W.-J., Xu, H., Chen, Y.-H., Li, X.-J., Tan, Z.-P., Li, N., Gesang, Z.-R., Wang, Y.-M., Liu, C.-B., Luo, Y., Feng, J., Xu, Q.-J., Lee, S., & Li, T. (2015). The 6-item Kessler psychological distress scale to survey serious mental illness among Chinese undergraduates: Psychometric properties and prevalence estimate. Comprehensive Psychiatry, 63, 105–112. https://doi.org/10.1016/j.comppsych.2015.08.011

Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L. T., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593

Kessler, R. C., & Frank, R. G. (1997). The impact of psychiatric disorders on work loss days. Psychological Medicine, 27(4), 861–873. https://doi.org/10.1017/s0033291797004807

Kroenke, K. (2021). PHQ-9: Global uptake of a depression scale. World Psychiatry, 20(1), 135–136. https://doi.org/10.1002/wps.20821

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Lee, S.-Y., Lee, H. K., Choi, J.-S., Bang, S.-Y., Park, M.-H., Jung, K.-I., & Kweon, Y.-S. (2020). The Matthew Effect in recovery from smartphone addiction in a 6-month longitudinal study of children and adolescents. International Journal of Environmental Research and Public Health, 17(13), 4751. https://doi.org/10.3390/ijerph17134751

Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ, 365, l1476. https://doi.org/10.1136/bmj.l1476

Ma, Y., & Siu, A. F. Y. (2020). Dispositional mindfulness and mental health in Hong Kong college students: The mediating roles of decentering and self-acceptance. Australian Journal of Psychology, 72(2), 156–164. https://doi.org/10.1111/ajpy.12269

MacKillop, J., & Anderson, E. J. (2007). Further psychometric validation of the Mindful Attention Awareness Scale (MAAS). Journal of Psychopathology and Behavioral Assessment, 29(4), 289–293. https://doi.org/10.1007/s10862-007-9045-1

Mak, K.-K., Lai, C.-M., Ko, C.-H., Chou, C., Kim, D.-I., Watanabe, H., & Ho, R. C. M. (2014). Psychometric properties of the Revised Chen Internet Addiction Scale (CIAS-R) in Chinese adolescents. Journal of Abnormal Child Psychology, 42(7), 1237–1245. https://doi.org/10.1007/s10802-014-9851-3

Moisala, M., Salmela, V., Hietajärvi, L., Salo, E., Carlson, S., Salonen, O., Lonka, K., Hakkarainen, K., Salmela-Aro, K., & Alho, K. (2016). Media multitasking is associated with distractibility and increased prefrontal activity in adolescents and young adults. NeuroImage, 134, 113–121. https://doi.org/10.1016/j.neuroimage.2016.04.011

Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W., & Reininghaus, U. (2018). Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry, 17(2), 123–132. https://doi.org/10.1002/wps.20513

Posner, M. I., Rothbart, M. K., Sheese, B. E., & Tang, Y. (2007). The anterior cingulate gyrus and the mechanism of self-regulation. Cognitive, Affective & Behavioral Neuroscience, 7(4), 391–395. https://doi.org/10.3758/cabn.7.4.391

Ralph, B. C. W., Thomson, D. R., Cheyne, J. A., & Smilek, D. (2014). Media multitasking and failures of attention in everyday life. Psychological Research, 78(5), 661–669. https://doi.org/10.1007/s00426-013-0523-7

Santomauro, D. F., Herrera, A. M. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., et al. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7

Serra, G., Lo Scalzo, L., Giuffrè, M., Ferrara, P., & Corsello, G. (2021). Smartphone use and addiction during the coronavirus disease 2019 (COVID-19) pandemic: Cohort study on 184 Italian children and adolescents. Italian Journal of Pediatrics, 47(1), 150. https://doi.org/10.1186/s13052-021-01102-8

Shapiro, S. L., & Carlson, L. E. (2009). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. American Psychological Association.

Sheline, Y. I. (2003). Neuroimaging studies of mood disorder effects on the brain. Biological Psychiatry, 54(3), 338–352. https://doi.org/10.1016/s0006-3223(03)00347-0

Sipe, W. E. B., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: Theory and practice. The Canadian Journal of Psychiatry, 57(2), 63–69. https://doi.org/10.1177/070674371205700202

Sohn, S. Y., Rees, P., Wildridge, B., Kalk, N. J., & Carter, B. (2019). Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: A systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry, 19(1), 356. https://doi.org/10.1186/s12888-019-2350-x

Solem, S., Hagen, R., Wang, C. E., Hjemdal, O., Waterloo, K., Eisemann, M., & Halvorsen, M. (2017). Metacognitions and mindful attention awareness in depression: A comparison of currently depressed, previously depressed and never depressed individuals. Clinical Psychology & Psychotherapy, 24(1), 94–102. https://doi.org/10.1002/cpp.1983

Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., et al. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Soysa, C. K., & Wilcomb, C. J. (2015). Mindfulness, self-compassion, self-efficacy, and gender as predictors of depression, anxiety, stress, and well-being. Mindfulness, 6(2), 217–226. https://doi.org/10.1007/s12671-013-0247-1

Sun, Y., Fu, Z., Bo, Q., Mao, Z., Ma, X., & Wang, C. (2020). The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry, 20, 474. https://doi.org/10.1186/s12888-020-02885-6

Tang, Y.-Y., Askari, P., & Choi, C. (2020). Brief mindfulness training increased glutamate metabolism in the anterior cingulate cortex. Neuroreport, 31(16), 1142–1145. https://doi.org/10.1097/WNR.0000000000001527

Tanil, C. T., & Yong, M. H. (2020). Mobile phones: The effect of its presence on learning and memory. PloS One, 15(8), e0219233. https://doi.org/10.1371/journal.pone.0219233

van Emmerik, A. A. P., Berings, F., & Lancee, J. (2018). Efficacy of a mindfulness-based mobile application: A randomized waiting-list controlled trial. Mindfulness, 9(1), 187–198. https://doi.org/10.1007/s12671-017-0761-7

Wacks, Y., & Weinstein, A. M. (2021). Excessive smartphone use is associated with health problems in adolescents and young adults. Frontiers in Psychiatry, 12, 669042. https://doi.org/10.3389/fpsyt.2021.669042

Warsaw, R. E., Jones, A., Rose, A. K., Newton-Fenner, A., Alshukri, S., & Gage, S. H. (2021). Mobile technology use and its association with executive functioning in healthy young adults: A systematic review. Frontiers in Psychology, 12, 643542. https://doi.org/10.3389/fpsyg.2021.643542

Wong, C. S. M., Hui, C. L. M., Suen, Y. N., Wong, S. M. Y., Chang, W. C., Chan, S. K. W., et al. (2023a). The Hong Kong youth epidemiological study of mental health (HK-YES)—A population-based psychiatric epidemiology study of youth mental health in Hong Kong: A study protocol. Early Intervention in Psychiatry. https://doi.org/10.1111/eip.13364

Wong, S. M. Y., Hui, C. L. M., Cheung, V. K., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., et al. (2023b). Prevalence of frequent nightmares and their prospective associations with 1-year psychiatric symptoms and disorders and functioning in young adults: a large-scale epidemiological study in Hong Kong. Sleep, 46(4), zsac296. https://doi.org/10.1093/sleep/zsac296

Wong, S. M. Y., Hui, C. L. M., Suen, Y. N., Wong, C. S. M., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2021a). The impact of social unrest and pandemic on mental health of young people in Hong Kong: The transdiagnostic role of event-based rumination. The Australian and New Zealand Journal of Psychiatry. https://doi.org/10.1177/00048674211025710

Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2021d). Prospective prediction of PTSD and depressive symptoms during social unrest and COVID-19 using a brief online tool. Psychiatry Research, 298, 113773. https://doi.org/10.1016/j.psychres.2021.113773

Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2021e). Mental health risks after repeated exposure to multiple stressful events during ongoing social unrest and pandemic in Hong Kong: The Role of Rumination: Risques pour la santé mentale après une exposition répétée à de multiples événements stressants d’agitation sociale durable et de pandémie à Hong Kong: le rôle de la rumination. The Canadian Journal of Psychiatry, 66(6), 577–585. https://doi.org/10.1177/0706743720979920

Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W. C., Wong, G. H. Y., & Chen, E. Y. H. (2021b). Induced ideas of reference during social unrest and pandemic in Hong Kong. Schizophrenia Research, 229, 46–52. https://doi.org/10.1016/j.schres.2021.01.027

Wong, S. M. Y., Ip, C. H., Hui, C. L. M., Suen, Y. N., Wong, C. S. M., Chang, W. C., Chan, S. K. W., Lee, E. H. M., Lui, S. S. Y., Chan, K. T., Wong, M. T. H., & Chen, E. Y. H. (2022a). Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: The significance of suicide-related rumination, family functioning, and ongoing population-level stressors. Psychological Medicine. https://doi.org/10.1017/S0033291722001519

Wong, S. M. Y., Lam, B. Y. H., Wong, C. S. M., Lee, H. P. Y., Wong, G. H. Y., Lui, S. S. Y., Chan, K. T., Wong, M. T. H., Chan, S. K. W., Chang, W. C., Lee, E. H. M., Suen, Y. N., Hui, C. L. M., & Chen, E. Y. H. (2021c). Measuring subjective stress among young people in Hong Kong: Validation and predictive utility of the single-item subjective level of stress (SLS-1) in epidemiological and longitudinal community samples. Epidemiology and Psychiatric Sciences, 30, e61. https://doi.org/10.1017/S2045796021000445

Wong, S. M., Chen, E. Y., Wong, C. S., Suen, Y. N., Chan, D. L., Tsang, S. H., et al. (2022b). Impact of smartphone overuse on 1-year severe depressive symptoms and momentary negative affect: Longitudinal and experience sampling findings from a representative epidemiological youth sample in Hong Kong. Psychiatry Research, 318, 114939. https://doi.org/10.1016/j.psychres.2022.114939

Yu, X., Tam, W. W. S., Wong, P. T. K., Lam, T. H., & Stewart, S. M. (2012). The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Comprehensive Psychiatry, 53(1), 95–102. https://doi.org/10.1016/j.comppsych.2010.11.002

Zhang, G., Yang, X., Tu, X., Ding, N., & Lau, J. T. F. (2020). Prospective relationships between mobile phone dependence and mental health status among Chinese undergraduate students with college adjustment as a mediator. Journal of Affective Disorders, 260, 498–505. https://doi.org/10.1016/j.jad.2019.09.047

Zhou, D., Kang, Y., Cosme, D., Jovanova, M., He, X., Mahadevan, A., et al. (2023). Mindful attention promotes control of brain network dynamics for self-regulation and discontinues the past from the present. Proceedings of the National Academy of Sciences, 120(2), e2201074119. https://doi.org/10.1073/pnas.2201074119