The Somatic Triad: Influence of Screen
Time, Postural Load, and Breathing Pattern Dysfunction on Psychological
Distress in University Students- A cross-sectional Study.
Avani
Pal1*
Professor & HOD
(Activities), Jayantrao College of Physiotherapy, Tilak Maharashtra Vidhyapeeth
University (TMV), Maharashtra, India
avanipal90@gmail.com
Abstract
Background:Psychological
distress among university students has increased significantly and is commonly
addressed through cognitive or pharmacological approaches. However, the modern
academic environment involves prolonged screen use, which contributes to
increased postural load and breathing pattern dysfunction. These physiological
changes may influence psychological distress but remain underexplored within
student mental health frameworks.
Objective: Psychological
distress among university students has increased significantly and is commonly
addressed through cognitive or pharmacological approaches. However, the modern
academic environment involves prolonged screen use, which contributes to
increased postural load and breathing pattern dysfunction. These physiological
changes may influence psychological distress but remain underexplored within
student mental health frameworks.
Methods:A total of 150
university students aged 18–30 years were included in this cross-sectional
correlational study. Screen time was assessed using self-reported daily
duration. Postural load was evaluated using the Rapid Upper Limb Assessment
(RULA). Breathing pattern dysfunction was assessed using the Nijmegen
Questionnaire. Psychological distress was measured using the Depression Anxiety
Stress Scale (DASS-21). Data were analyzed using correlation and multiple
regression analysis.
Outcome Measures: Screen
time (hours/day), postural load (RULA score), breathing pattern dysfunction
(Nijmegen score), and psychological distress (DASS-21 scores) were assessed
using standardized tools.
Results:The study
demonstrated that increased screen time was significantly associated with
higher postural load and breathing dysfunction. Postural load and Nijmegen
scores showed stronger positive correlations with depression, anxiety, and
stress compared to screen time. Regression analysis revealed that somatic
variables significantly predicted psychological distress and accounted for a
substantial proportion of variance.
Conclusion:The findings suggest
that screen time influences psychological distress through its impact on
posture and breathing. Addressing these somatic factors through ergonomic
correction and breathing interventions may enhance current approaches to
student mental health.
Keywords:Screen time, Postural
load, Breathing pattern dysfunction, psychological distress, University
students
Psychological
distress among university students has emerged as a significant public health
concern, with increasing prevalence of anxiety, depression, and stress reported
across higher education settings¹, ². Academic demands, competitive
environments, and uncertainties regarding future careers contribute substantially
to this burden. While institutional responses have largely focused on
counselling services and pharmacological management, these approaches
predominantly address cognitive and emotional domains, often overlooking the
physiological and somatic factors that may contribute to psychological
distress³.
The rapid
digitization of education has fundamentally altered student lifestyles.
Learning management systems, digital assignments, online resources, and
prolonged device usage have resulted in sustained screen exposure as an
integral part of academic functioning. This shift has inadvertently increased
sedentary behaviour and imposed continuous biomechanical stress on the
body⁴. Prolonged screen time is commonly associated with forward head posture,
rounded shoulders, and increased postural load, collectively referred to as
maladaptive digital posture⁵. These biomechanical alterations are not
merely musculoskeletal concerns but may also influence neurological and
psychological processes.
Emerging evidence
suggests that posture is closely linked to emotional and cognitive states
through the concept of embodied cognition⁶. Slouched or constrained
postures have been associated with reduced energy levels, increased fatigue,
and negative affective states. In addition, sustained postural load can lead to
musculoskeletal discomfort, which acts as a persistent physical stressor,
potentially exacerbating psychological distress³. Despite this, postural
factors are rarely considered within conventional mental health frameworks in
higher education.
Another critical yet
underrecognized component is breathing pattern dysfunction. Prolonged screen
engagement often leads to shallow, thoracic breathing patterns, sometimes
referred to as dysfunctional breathing⁷. This pattern is characterized by
reduced diaphragmatic activity and increased reliance on accessory respiratory
muscles. Breathing pattern dysfunction has been associated with symptoms such
as anxiety, dizziness, fatigue, and reduced concentration⁸. Physiologically,
altered breathing patterns can disrupt carbon dioxide balance, influence
cerebral blood flow, and contribute to autonomic nervous system imbalance,
particularly increased sympathetic activation⁹,¹⁰.
The interrelationship
between posture and breathing further strengthens the need for an integrated
perspective. Forward head posture and thoracic stiffness can mechanically
restrict diaphragmatic movement, promoting inefficient breathing patterns. In
turn, dysfunctional breathing increases muscular tension in the neck and upper
chest, reinforcing postural strain⁵. This creates a self-perpetuating
physiological loop, where biomechanical and respiratory dysfunctions interact
to amplify stress responses within the body³.
Within this context,
the concept of the “Somatic Triad” is proposed, integrating screen time,
postural load, and breathing pattern dysfunction as interconnected contributors
to psychological distress³. Rather than viewing these factors in isolation,
this framework considers their combined and potentially synergistic effects on
mental health. Understanding this triad provides a more comprehensive model
that bridges behavioural, physical, and physiological domains.
This study
investigates the influence of the Somatic Triad on psychological distress among
university students. By examining the relationships between screen time,
postural load, breathing pattern dysfunction, and mental health outcomes, the
study aims to provide empirical evidence supporting a multidimensional approach
to student wellbeing. Such an approach may inform physiotherapy-led
interventions that extend beyond traditional musculoskeletal management to
include breathing retraining and ergonomic correction, thereby contributing to
more holistic mental health strategies within higher education settings.
Psychological distress among university students continues
to rise despite existing mental health interventions, indicating limitations in
current approaches that primarily focus on cognitive and emotional factors. The
increasing reliance on digital learning has led to prolonged screen exposure,
resulting in sustained sedentary behaviour and associated physiological
changes.
Prolonged screen use contributes to increased postural load
and altered breathing patterns, both of which are known to influence physiological
stress responses. However, these factors are often examined independently and
are rarely integrated within mental health research. The combined effect of
screen time, postural load, and breathing pattern dysfunction remains
insufficiently explored, particularly in the context of student populations.
There is a need to investigate these interconnected factors
within a unified framework to better understand their contribution to
psychological distress. This may provide a more comprehensive perspective and
support the development of physiotherapy-based interventions targeting both
physical and psychological wellbeing.
To examine the influence of screen time, postural load, and
breathing pattern dysfunction on psychological distress among university
students.
1.
To assess screen time, postural load (RULA), breathing
pattern dysfunction (Nijmegen Questionnaire), and psychological distress
(DASS-21) among university students.
2.
To determine the relationship between screen time and
psychological distress.
3.
To analyse the association of postural load and breathing
pattern dysfunction with psychological distress.
4.
To evaluate the combined contribution of screen time,
postural load, and breathing pattern dysfunction in predicting psychological
distress.
5.
To determine whether somatic variables predict psychological
distress after controlling for perceived stress.
Current university mental health approaches primarily focus
on cognitive and social factors, while the physiological effects of prolonged
screen use—such as postural load and breathing pattern dysfunction—remain
underexplored in relation to psychological distress.
1.
Is screen time associated with psychological distress among
university students?
2.
Are postural load and breathing pattern dysfunction related
to psychological distress?
3.
Do somatic factors contribute to psychological distress
beyond perceived stress?
HYPOTHESES
H0: There is no relationship between screen time, postural
load, breathing pattern dysfunction, and psychological distress among
university students, and these variables do not significantly predict
psychological distress after controlling for perceived stress.
H1: There is a relationship between screen time, postural load,
breathing pattern dysfunction, and psychological distress among university
students, and these variables significantly predict psychological distress
after controlling for perceived stress.
Sample Size &
Study Design & Method:
A cross-sectional analytical study was conducted among 150
undergraduate and postgraduate students aged 18–30 years in Pune city over a
period of 6 months. Participants who met the inclusion criteria were recruited
using a convenience sampling method, and allocation was carried out using
simple randomization. After obtaining informed consent, they were assessed
using self-reported average daily screen time (in hours)
·
Students aged 18–30 years
·
Both male and female participants
·
Individuals using digital devices regularly for academic
purposes
·
Willing to participate and provide informed consent
·
Students with diagnosed psychiatric disorders under active
treatment
·
Individuals with known respiratory disorders (e.g., asthma,
COPD)
·
Recent musculoskeletal injuries affecting posture
·
Any neurological or systemic condition influencing breathing
or posture
Materials: 1. Pen, 2. Assessment sheet, 3. Consent Form, 4. Patient
evaluation sheet, 5. Data collection forms / demographic sheet, 6. Digital
devices (smartphones/laptops) for screen time recording
1.
Screen Time
Assessed using self-reported average daily screen time (in
hours), including academic and non-academic usage. they were categorized into
three groups based on their self-reported daily screen time.
·
Low screen time: ≤ 3 hours/day
·
Moderate screen time: 4–6 hours/day
·
High screen time: ≥ 7 hours/day
2.
Postural Load
Rapid Upper Limb Assessment (RULA) is a widely used observational tool for assessing postural
load and ergonomic risk. It has demonstrated good validity in identifying
musculoskeletal risk factors associated with upper limb and neck postures. RULA
has demonstrated good validity for assessing postural risk in occupational and
clinical settings. It shows high inter-rater reliability (ICC = 0.86–0.91) and
intra-rater reliability (ICC = 0.88–0.93), indicating strong consistency in
scoring.
3.
Breathing Pattern Dysfunction
Nijmegen Questionnaire
is a validated tool for assessing breathing pattern dysfunction and
hyperventilation syndrome. It demonstrates good validity with sensitivity of
91% and specificity of 95%. The tool also shows high internal consistency
(Cronbach’s α ≈ 0.87–0.90) and good test–retest reliability (ICC
≈ 0.85–0.90).
4.
Psychological Distress
Measured using the Depression Anxiety Stress Scale
(DASS-21), which evaluates levels of depression, anxiety, and stress.It shows high internal consistency with Cronbach’s α of
0.88 for Depression, 0.82 for Anxiety, and 0.90 for Stress. The scale also
demonstrates good construct validity and test–retest reliability (ICC ≈
0.71–0.81).
5.
Perceived Stress (Control Variable)
Assessed using the Perceived Stress Scale (PSS). The Perceived Stress Scale is a validated tool for measuring
perceived stress levels. It demonstrates good internal consistency with
Cronbach’s α ranging from 0.78 to 0.91. The scale also shows acceptable
test–retest reliability (ICC ≈ 0.70–0.85) and good construct validity
across different populations.
Ethical approval was obtained from the institutional review
committee. Participation was voluntary, and confidentiality of data was
ensured. Participants had the right to withdraw from the study at any time
without any consequences. Participants were informed about the purpose of the
study and written consent was obtained prior to data collection. Data were
collected using standardized questionnaires administered in a controlled
setting.
Participants first completed a demographic data sheet
followed by assessment of screen time, Nijmegen Questionnaire, DASS-21, and
PSS. Postural assessment using RULA was conducted by the investigator based on
observation of the participant’s usual sitting posture during device use.
All data were recorded systematically and maintained
confidentially.
Data analysis was performed using SPSS (v.26). Data were analysed
using appropriate statistical methods. Descriptive statistics (mean and
standard deviation) were used to summarize the data.
Pearson correlation analysis was performed to examine
relationships between variables. Multiple regression analysis was used to
determine the combined predictive effect of screen time, postural load, and
breathing pattern dysfunction on psychological distress.
Statistical significance was set at p < 0.05.
|
Variable |
Mean |
Standard
Deviation (SD) |
|
Screen
Time (hours/day) |
6.8 |
2.1 |
|
Postural
Load (RULA Score) |
5.6 |
1.3 |
|
Nijmegen
Score (BPD) |
24.2 |
8.5 |
|
DASS-21
Total Score |
32.5 |
10.2 |
|
Perceived
Stress (PSS) |
21.4 |
6.7 |
Interpretation:
The findings indicate that students reported relatively high screen time along
with moderate postural load. Nijmegen scores suggest the presence of breathing
pattern dysfunction in a considerable proportion of participants. The DASS-21
scores reflect moderate levels of psychological distress, indicating that both
physiological and psychological factors are present within the study
population.
|
Variables |
Screen Time |
RULA Score |
Nijmegen Score |
DASS-21 |
|
Screen Time |
1 |
0.48** |
0.42** |
0.32* |
|
RULA Score |
0.48** |
1 |
0.52** |
0.54** |
|
Nijmegen Score |
0.42** |
0.52** |
1 |
0.61** |
|
DASS-21 |
0.32* |
0.54** |
0.61** |
1 |
* p < 0.05
** p < 0.001
Interpretation:
Screen time showed a weak to moderate relationship with psychological distress.
In comparison, postural load and breathing pattern dysfunction demonstrated
stronger correlations with DASS-21 scores. This suggests that somatic factors
are more closely associated with psychological distress than screen exposure
alone.
|
Predictor Variable |
B |
β |
p-value |
|
Screen Time |
1.12 |
0.18 |
<0.05 |
|
Postural Load (RULA) |
2.85 |
0.34 |
<0.001 |
|
Nijmegen Score |
0.76 |
0.41 |
<0.001 |
|
Perceived Stress (PSS) |
0.91 |
0.29 |
<0.01 |
Model Summary: R² = 0.52
Interpretation:
Regression analysis showed that all
variables significantly contributed to psychological distress. Breathing
pattern dysfunction emerged as the strongest predictor, followed by postural
load. Screen time had a smaller but significant effect. The model explained a
substantial portion of variance, indicating the importance of somatic factors
in predicting distress.
DISCUSSION
The findings of the present study highlight the significant
role of physiological factors in psychological distress among university
students. While screen time demonstrated a moderate association with distress,
postural load and breathing pattern dysfunction showed stronger relationships,
indicating that the body may act as a critical yet often overlooked link in
student mental health. These results suggest that prolonged screen exposure may
not directly cause distress but rather contributes through its impact on
posture and breathing. This supports the idea that when the body remains in a
state of mechanical strain and altered respiratory patterns, it may promote
sustained physiological stress responses.
These findings also provide insight into the limitations of
purely cognitive approaches to mental health. Interventions that focus only on
thought processes may be less effective if the individual remains in a state of
physiological arousal due to dysfunctional breathing and postural strain. Poor
breathing mechanics, particularly shallow or thoracic breathing, may contribute
to sympathetic dominance, thereby maintaining or amplifying anxiety and stress
responses despite cognitive intervention.
From a theoretical perspective, the study expands the
traditional biopsychosocial model by incorporating somatic and physiological
dimensions, particularly those related to modern digital lifestyles. It also
provides support for the concept of embodied cognition, suggesting that
physical states such as posture can influence emotional and psychological
outcomes. The integration of biomechanical and respiratory factors offers a
more comprehensive understanding of mental health in young adults.
The findings have important practical implications for
universities. Ergonomic modifications, such as the use of laptop stands and
external keyboards, may help reduce postural strain during prolonged screen
use. Incorporating structured micro-breaks that include postural correction and
simple breathing exercises may assist in reducing physiological stress during
academic activities. Additionally, there is a need for a clinical shift where
early signs of breathing pattern dysfunction are identified, and appropriate
physiotherapy-based interventions are integrated alongside conventional mental
health support.
Despite these contributions, certain limitations must be
acknowledged. The cross-sectional design limits the ability to establish
causality between variables. It remains unclear whether psychological distress
leads to poor posture and breathing changes or whether these factors contribute
to distress. Furthermore, reliance on self-reported measures may introduce
reporting bias.
Future research should focus on longitudinal designs to
better understand the temporal relationship between these variables.
Experimental studies, particularly randomized controlled trials, are needed to
evaluate the effectiveness of interventions targeting posture and breathing in
reducing psychological distress. Such research may further strengthen the role
of somatic approaches in student mental health management.
CONCLUSION
The present study highlights that psychological distress in
university students is closely linked to the physiological demands of prolonged
screen use. Increased postural load and breathing pattern dysfunction were
found to play a significant role, suggesting that mental health cannot be
viewed independently of the body.
The Somatic Triad provides a more integrated understanding
of student wellbeing, where screen time influences posture and breathing, which
in turn contribute to psychological distress. Addressing these interconnected
factors may help in developing more effective and holistic approaches to
student mental health management.
The study adopts a multidimensional approach by integrating
behavioral, biomechanical, and physiological factors, providing a comprehensive
understanding of psychological distress. The use of standardized and validated
tools such as DASS-21, RULA, and the Nijmegen Questionnaire enhances the reliability
of the findings. Additionally, the concept of the Somatic Triad offers a novel
and clinically relevant perspective within physiotherapy practice.
The cross-sectional design limits the ability to establish
causality between variables. The study relies partly on self-reported measures,
which may introduce reporting bias. Furthermore, the sample is restricted to a
specific student population, which may limit the generalizability of the
findings.
Future research should focus on longitudinal studies to
understand the direction of relationships over time. Randomized controlled
trials are needed to evaluate the effectiveness of posture and breathing
interventions in reducing psychological distress. Expanding the study to
diverse populations and incorporating objective measurements may further
strengthen the findings.
The author declares that there are no conflicts of interest
related to this study.
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