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      Depression, anxiety, and smartphone addiction in university students- A cross sectional study

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          Abstract

          Objectives

          The study aims to assess prevalence of smartphone addiction symptoms, and to ascertain whether depression or anxiety, independently, contributes to smartphone addiction level among a sample of Lebanese university students, while adjusting simultaneously for important sociodemographic, academic, lifestyle, personality trait, and smartphone-related variables.

          Methods

          A random sample of 688 undergraduate university students (mean age = 20.64 ±1.88 years; 53% men) completed a survey composed of a) questions about socio-demographics, academics, lifestyle behaviors, personality type, and smartphone use-related variables; b) 26-item Smartphone Addiction Inventory (SPAI) Scale; and c) brief screeners of depression and anxiety (PHQ-2 and GAD-2), which constitute the two core DSM-IV items for major depressive disorder and generalized anxiety disorder, respectively.

          Results

          Prevalence rates of smartphone-related compulsive behavior, functional impairment, tolerance and withdrawal symptoms were substantial. 35.9% felt tired during daytime due to late-night smartphone use, 38.1% acknowledged decreased sleep quality, and 35.8% slept less than four hours due to smartphone use more than once. Whereas gender, residence, work hours per week, faculty, academic performance (GPA), lifestyle habits (smoking and alcohol drinking), and religious practice did not associate with smartphone addiction score; personality type A, class (year 2 vs. year 3), younger age at first smartphone use, excessive use during a weekday, using it for entertainment and not using it to call family members, and having depression or anxiety, showed statistically significant associations with smartphone addiction. Depression and anxiety scores emerged as independent positive predictors of smartphone addiction, after adjustment for confounders.

          Conclusion

          Several independent positive predictors of smartphone addiction emerged including depression and anxiety. It could be that young adults with personality type A experiencing high stress level and low mood may lack positive stress coping mechanisms and mood management techniques and are thus highly susceptible to smartphone addiction.

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          Most cited references16

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          The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

          Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization. Copyright 2010. Published by Elsevier Inc.
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            Relationship of Smartphone Use Severity with Sleep Quality, Depression, and Anxiety in University Students

            Background and Aims The usage of smartphones has increased rapidly in recent years, and this has brought about addiction. The aim of the current study was to investigate the relationship between smartphone use severity and sleep quality, depression, and anxiety in university students. Methods In total, 319 university students (203 females and 116 males; mean age = 20.5 ± 2.45) were included in the study. Participants were divided into the following three groups: a smartphone non-user group (n = 71, 22.3%), a low smartphone use group (n = 121, 37.9%), and a high smartphone use group (n = 127, 39.8%). All participants were evaluated using the Pittsburgh Sleep Quality Index, Beck Depression Inventory, Beck Anxiety Inventory; moreover, participants other than those in the smartphone non-user group were also assessed with the Smartphone Addiction Scale. Results The findings revealed that the Smartphone Addiction Scale scores of females were significantly higher than those of males. Depression, anxiety, and daytime dysfunction scores were higher in the high smartphone use group than in the low smartphone use group. Positive correlations were found between the Smartphone Addiction Scale scores and depression levels, anxiety levels, and some sleep quality scores. Conclusion The results indicate that depression, anxiety, and sleep quality may be associated with smartphone overuse. Such overuse may lead to depression and/or anxiety, which can in turn result in sleep problems. University students with high depression and anxiety scores should be carefully monitored for smartphone addiction.
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              Development and Validation of a Smartphone Addiction Scale (SAS)

              Objective The aim of this study was to develop a self-diagnostic scale that could distinguish smartphone addicts based on the Korean self-diagnostic program for Internet addiction (K-scale) and the smartphone's own features. In addition, the reliability and validity of the smartphone addiction scale (SAS) was demonstrated. Methods A total of 197 participants were selected from Nov. 2011 to Jan. 2012 to accomplish a set of questionnaires, including SAS, K-scale, modified Kimberly Young Internet addiction test (Y-scale), visual analogue scale (VAS), and substance dependence and abuse diagnosis of DSM-IV. There were 64 males and 133 females, with ages ranging from 18 to 53 years (M = 26.06; SD = 5.96). Factor analysis, internal-consistency test, t-test, ANOVA, and correlation analysis were conducted to verify the reliability and validity of SAS. Results Based on the factor analysis results, the subscale “disturbance of reality testing” was removed, and six factors were left. The internal consistency and concurrent validity of SAS were verified (Cronbach's alpha = 0.967). SAS and its subscales were significantly correlated with K-scale and Y-scale. The VAS of each factor also showed a significant correlation with each subscale. In addition, differences were found in the job (p<0.05), education (p<0.05), and self-reported smartphone addiction scores (p<0.001) in SAS. Conclusions This study developed the first scale of the smartphone addiction aspect of the diagnostic manual. This scale was proven to be relatively reliable and valid.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 August 2017
                2017
                : 12
                : 8
                : e0182239
                Affiliations
                [001]Department of Nursing and Health Sciences, Notre Dame University-Louaize, Zouk Mosbeh, Lebanon
                Tokyo Institute of Technology, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-5461-8920
                Article
                PONE-D-16-41014
                10.1371/journal.pone.0182239
                5544206
                28777828
                5be722ed-027e-4ba2-a8bc-fc26ead82d19
                © 2017 Matar Boumosleh, Jaalouk

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 October 2016
                : 14 July 2017
                Page count
                Figures: 0, Tables: 5, Pages: 14
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Engineering and Technology
                Equipment
                Communication Equipment
                Cell Phones
                Biology and Life Sciences
                Psychology
                Addiction
                Social Sciences
                Psychology
                Addiction
                Biology and Life Sciences
                Psychology
                Personality
                Social Sciences
                Psychology
                Personality
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Biology and Life Sciences
                Psychology
                Addiction
                Behavioral Addiction
                Social Sciences
                Psychology
                Addiction
                Behavioral Addiction
                Biology and Life Sciences
                Psychology
                Emotions
                Anxiety
                Social Sciences
                Psychology
                Emotions
                Anxiety
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Addiction
                Gambling Addiction
                Social Sciences
                Psychology
                Addiction
                Gambling Addiction
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Gambling Addiction
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