Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Participants
2.2. Study Instrument
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Considerations
3. Results
3.1. Participant Characteristics
3.2. SAS-SV
3.3. PHQ-9 and PSS-4
3.4. Correlation between SAS-SV and Other Measures
3.5. Likelihood of Smartphone Addiction
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Merriam-Webster. Smartphone. 2021. Available online: https://www.merriam-webster.com/dictionary/smartphone (accessed on 22 June 2021).
- Statista. Smartphone Subscriptions Worldwide 2027. 2022. Available online: https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/ (accessed on 7 February 2023).
- Kwon, M.; Lee, J.Y.; Won, W.Y.; Park, J.W.; Min, J.A.; Hahn, C.; Gu, X.; Choi, J.H.; Kim, D.J. Development and Validation of a Smartphone Addiction Scale (SAS). PLoS ONE 2013, 8, e56936. [Google Scholar] [CrossRef] [PubMed]
- Billieux, J.; Maurage, P.; Lopez-Fernandez, O.; Kuss, D.J.; Griffiths, M.D. Can Disordered Mobile Phone Use Be Considered a Behavioral Addiction? An Update on Current Evidence and a Comprehensive Model for Future Research. Curr. Addict. Rep. 2015, 2, 156–162. [Google Scholar] [CrossRef]
- Elhai, J.D.; Dvorak, R.D.; Levine, J.C.; Hall, B.J. Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. J. Affect. Disord. 2017, 207, 251–259. [Google Scholar] [CrossRef] [PubMed]
- Kardefelt-Winther, D.; Heeren, A.; Schimmenti, A.; van Rooij, A.; Maurage, P.; Carras, M.; Edman, J.; Blaszczynski, A.; Khazaal, Y.; Billieux, J. How can we conceptualize behavioural addiction without pathologizing common behaviours? Addiction 2017, 112, 1709–1715. [Google Scholar] [CrossRef] [PubMed]
- Zhong, Y.; Ma, H.; Liang, Y.F.; Liao, C.J.; Zhang, C.C.; Jiang, W.J. Prevalence of smartphone addiction among Asian medical students: A meta-analysis of multinational observational studies. Int. J. Soc. Psychiatry 2022, 68, 1171–1183. [Google Scholar] [CrossRef]
- Amez, S.; Baert, S. Smartphone use and academic performance: A literature review. Int. J. Educ. Res. 2020, 103, 101618. [Google Scholar] [CrossRef]
- Junco, R.; Cotten, S.R. No A 4 U: The relationship between multitasking and academic performance. Comput. Educ. 2012, 59, 505–514. [Google Scholar] [CrossRef]
- Chen, Q.; Yan, Z. Does multitasking with mobile phones affect learning? A review. Comput. Hum. Behav. 2016, 54, 34–42. [Google Scholar] [CrossRef]
- First, M. Multitasking or continuous partial attention: A critical bottleneck for digital natives. Turk. Online J. Distance Educ. 2013, 14, 266–272. [Google Scholar]
- Hawi, N.S.; Samaha, M. To excel or not to excel: Strong evidence on the adverse effect of smartphone addiction on academic performance. Comput. Educ. 2016, 98, 81–89. [Google Scholar] [CrossRef]
- Beland, L.P.; Murphy, R. Ill Communication: Technology, distraction & student performance. Labour Econ. 2016, 41, 61–76. [Google Scholar] [CrossRef]
- Sohn, S.; Rees, P.; Wildridge, B.; Kalk, N.J.; Carter, B. 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 2019, 19, 356. [Google Scholar] [CrossRef]
- Rotenstein, L.S.; Ramos, M.A.; Torre, M.; Segal, J.B.; Peluso, M.J.; Guille, C.; Sen, S.; Mata, D.A. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016, 316, 2214–2236. [Google Scholar] [CrossRef] [PubMed]
- Borjalilu, S.; Mohammadi, A.; Mojtahedzadeh, R. Sources and Severity of Perceived Stress Among Iranian Medical Students. Iran. Red Crescent Med. J. 2015, 17, e17767. [Google Scholar] [CrossRef] [PubMed]
- Qamar, K.; Khan, N.S.; Kiani, M.R.B. Factors associated with stress among medical students. J. Pak. Med. Assoc. 2015, 65, 753–755. [Google Scholar]
- Saeed, A.; Bahnassy, A.; Al-Hamdan, N.; Almudhaibery, F.S.; Alyahya, A.Z. Perceived stress and associated factors among medical students. J. Fam. Community Med. 2016, 23, 166–171. [Google Scholar] [CrossRef]
- Iorga, M.; Dondas, C.; Zugun-Eloae, C. Depressed as Freshmen, Stressed as Seniors: The Relationship between Depression, Perceived Stress and Academic Results among Medical Students. Behav. Sci. 2018, 8, 70. [Google Scholar] [CrossRef]
- Ciotti, M.; Ciccozzi, M.; Terrinoni, A.; Jiang, W.C.; Wang, C.B.; Bernardini, S. The COVID-19 pandemic. Crit. Rev. Clin. Lab. Sci. 2020, 57, 365–388. [Google Scholar] [CrossRef]
- Kaul, V.; de Moraes, A.G.; Khateeb, D.; Greenstein, Y.; Winter, G.; Chae, J.; Stewart, N.H.; Qadir, N.; Dangayach, N.S. Medical Education During the COVID-19 Pandemic. Chest 2021, 159, 1949–1960. [Google Scholar] [CrossRef]
- Han, T.S.; Cho, H.; Sung, D.; Park, M.-H. A systematic review of the impact of COVID-19 on the game addiction of children and adolescents. Front. Psychiatry 2022, 13, 976601. [Google Scholar] [CrossRef]
- Popescu, A.M.; Balica, R.Ș.; Lazăr, E.; Bușu, V.O.; Vașcu, J.-E. Smartphone addiction risk, technology-related behaviors and attitudes, and psychological well-being during the COVID-19 pandemic. Front. Psychol. 2022, 13, 997253. [Google Scholar] [CrossRef]
- Alhazmi, A.A.; Alzahrani, S.H.; Baig, M.; Salawati, E.M.; Alkatheri, A. Prevalence and factors associated with smartphone addiction among medical students at King Abdulaziz University, Jeddah. Pak. J. Med. Sci. 2018, 34, 984–988. [Google Scholar] [CrossRef] [PubMed]
- Alsalameh, A.M.; Harisi, M.J.; Alduayji, M.A.; Almutham, A.A.; Mahmood, F.M. Evaluating the relationship between smartphone addiction/overuse and musculoskeletal pain among medical students at Qassim University. J. Fam. Med. Prim. Care 2019, 8, 2953–2959. [Google Scholar] [CrossRef]
- Alosaimi, F.D.; Alyahya, H.; Alshahwan, H.; Al Mahyijari, N.; Shaik, S.A. Smartphone addiction among university students in Riyadh, Saudi Arabia. Saudi Med. J. 2016, 37, 675–683. [Google Scholar] [CrossRef] [PubMed]
- Harris, B.; McCredie, M.; Fields, S. Examining the psychometric properties of the Smartphone Addiction Scale and its short version for use with emerging adults in the U.S. Comput. Hum. Behav. Rep. 2020, 1, 100011. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001, 16, 606–613. [Google Scholar] [CrossRef]
- Al-Hadi, A.N.; Al-Ateeq, D.A.; Al-Sharif, E.; Bawazeer, H.M.; Alanazi, H.; Al-Shomrani, A.T.; Shuqdar, R.M.; Al-Owaybil, R. An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample. Ann. Gen. Psychiatry 2017, 16, 32. [Google Scholar] [CrossRef] [PubMed]
- Cohen, S. Perceived stress in a probability sample of the United States. In The Social Psychology of Health. The Claremont Symposium on Applied Social Psychology; Sage Publications, Inc.: Thousand Oaks, CA, USA, 1988; pp. 31–67. [Google Scholar]
- Warttig, S.L.; Forshaw, M.J.; South, J.; White, A.K. New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4). J. Health Psychol. 2013, 18, 1617–1628. [Google Scholar] [CrossRef]
- Cho, H.-Y.; Kim, D.J.; Park, J.W. Stress and adult smartphone addiction: Mediation by self-control, neuroticism, and extraversion. Stress Health J. Int. Soc. Investig. Stress 2017, 33, 624–630. [Google Scholar] [CrossRef]
- Kardefelt-Winther, D. Problematizing excessive online gaming and its psychological predictors. Comput. Hum. Behav. 2014, 31, 118–122. [Google Scholar] [CrossRef]
- Vujić, A.; Szabo, A. Hedonic use, stress, and life satisfaction as predictors of smartphone addiction. Addict. Behav. Rep. 2022, 15, 100411. [Google Scholar] [CrossRef] [PubMed]
- Yang, H.; Liu, B.; Fang, J. Stress and Problematic Smartphone Use Severity: Smartphone Use Frequency and Fear of Missing Out as Mediators. Front. Psychiatry 2021, 12, 659288. [Google Scholar] [CrossRef]
- Sánchez-Fernández, M.; Borda-Mas, M. Problematic smartphone use and specific problematic Internet uses among university students and associated predictive factors: A systematic review. Educ. Inf. Technol. 2022, 28, 7111–7204. [Google Scholar] [CrossRef] [PubMed]
- Choi, S.-W.; Kim, D.-J.; Choi, J.-S.; Ahn, H.; Choi, E.-J.; Song, W.-Y.; Kim, S.; Youn, H. Comparison of risk and protective factors associated with smartphone addiction and Internet addiction. J. Behav. Addict. 2015, 4, 308–314. [Google Scholar] [CrossRef] [PubMed]
- Haug, S.; Castro, R.P.; Kwon, M.; Filler, A.; Kowatsch, T.; Schaub, M.P. Smartphone use and smartphone addiction among young people in Switzerland. J. Behav. Addict. 2015, 4, 299–307. [Google Scholar] [CrossRef]
- Boumosleh, J.M.; Jaalouk, D. Depression, anxiety, and smartphone addiction in university students—A cross sectional study. PLoS ONE 2017, 12, e0182239. [Google Scholar] [CrossRef] [PubMed]
- Seki, T.; Hamazaki, K.; Natori, T.; Inadera, H. Relationship between internet addiction and depression among Japanese university students. J. Affect. Disord. 2019, 256, 668–672. [Google Scholar] [CrossRef]
- Işcan, G.; Baş, F.Y.; Özcan, Y.; Özdoğanci, C. Relationship between “nomophobia” and material addiction “cigarette” and factors affecting them. Int. J. Clin. Pract. 2021, 75, e13816. [Google Scholar] [CrossRef]
- Dey, M.; Studer, J.; Schaub, M.P.; Gmel, G.; Ebert, D.D.; Lee, J.Y.-C.; Haug, S. Problematic smartphone use in young Swiss men: Its association with problematic substance use and risk factors derived from the pathway model. J. Behav. Addict. 2019, 8, 326–334. [Google Scholar] [CrossRef]
- Liu, H.; Zhou, Z.; Huang, L.; Zhu, E.; Yu, L.; Zhang, M. Prevalence of smartphone addiction and its effects on subhealth and insomnia: A cross-sectional study among medical students. BMC Psychiatry 2022, 22, 305. [Google Scholar] [CrossRef]
- Saadeh, H.; Al Fayez, R.Q.; Al Refaei, A.; Shewaikani, N.; Khawaldah, H.; Abu-Shanab, S.; Al-Hussaini, M. Smartphone Use Among University Students During COVID-19 Quarantine: An Ethical Trigger. Front. Public Health 2021, 9, 600134. [Google Scholar] [CrossRef] [PubMed]
- Mamun, M.A.; Rayhan, I.; Akter, K.; Griffiths, M.D. Prevalence and Predisposing Factors of Suicidal Ideation Among the University Students in Bangladesh: A Single-Site Survey. Int. J. Ment. Health Addict. 2022, 20, 1958–1971. [Google Scholar] [CrossRef]
- Hosen, I.; Al Mamun, F.; Sikder, T.; Abbasi, A.Z.; Zou, L.; Guo, T.; Mamun, M.A. Prevalence and Associated Factors of Problematic Smartphone Use During the COVID-19 Pandemic: A Bangladeshi Study. Risk Manag. Healthc. Policy 2021, 14, 3797–3805. [Google Scholar] [CrossRef] [PubMed]
Sociodemographic Characteristic | Number of Students (%) | Mean SAS-SV Scores ± SD, p-Value | Mean PHQ-9 Scores ± SD, p-Value | Mean PSS-4 Scores ± SD, p-Value | |
---|---|---|---|---|---|
Type of college | Private | 163 (51.7) | 32.01 ± 12.58 | 10.49 ± 6.54 | 7.12 ± 3.41 |
Public | 152 (48.3) | 32.63 ± 11.39 | 9.80 ± 7.31 | 6.93 ± 3.20 | |
p = 0.645 | p = 0.379 | p = 0.615 | |||
Sex | Male | 140 (44.4) | 30.80 ± 12.30 | 9.22 ± 6.69 | 7.00 ± 3.13 |
Female | 175 (55.6) | 33.52 ± 11.6 | 10.90 ± 7.03 | 7.05 ± 3.46 | |
p = 0.046 | p = 0.033 | p = 0.906 | |||
Marital status | Single | 292 (92.7) | 32.67 ± 11.92 | 10.24 ± 6.85 | 7.07 ± 3.29 |
Married | 19 (6) | 23.89 ± 9.43 | 6.78 ± 6.16 | 6.15 ± 3.86 | |
Divorced, separated, or widowed | 4 (1.3) | 46.25 ± 6.65 | 19.75 ± 6.34 | 8.25 ± 0.50 | |
p < 0.001 | p = 0.002 | p = 0.387 | |||
Study year | First | 89 (28.3) | 34.73 ± 12.87 | 10.98 ± 7.18 | 6.86 ± 3.82 |
Second | 54 (17.1) | 32.35 ± 12.23 | 10.64 ± 5.73 | 7.29 ± 3.49 | |
Third | 43 (13.7) | 31.13 ± 11.97 | 10.27 ± 7.72 | 5.62 ± 2.96 | |
Fourth | 42 (13.3) | 30.14 ± 10.93 | 8.71 ± 6.75 | 7.12 ± 2.56 | |
Fifth | 87 (27.6) | 31.44 ± 11.31 | 9.64 ± 6.99 | 7.68 ± 2.95 | |
p = 0.212 | p = 0.425 | p = 0.018 | |||
GPA | Excellent | 121 (38.4) | 33.29 ± 12.29 | 9.56 ± 6.34 | 7.04 ± 3.47 |
Very good | 141 (44.8) | 30.92 ± 11.51 | 10.13 ± 7.13 | 6.90 ± 3.19 | |
Good | 47 (14.9) | 34.67 ± 12.37 | 11.42 ± 7.17 | 7.40 ± 3.41 | |
Pass | 6 (1.9) | 26.00 ± 11.41 | 13.00 ± 10.77 | 7.00 ± 2.68 | |
p = 0.096 | p = 0.324 | p = 0.847 | |||
Diagnosed with a psychiatric disorder prior to medical school admission | Yes | 35 (11.1) | 27.22 ± 13.69 | 11.85 ± 5.88 | 6.25 ± 3.39 |
No | 280 (88.9) | 32.95 ± 11.65 | 9.94 ± 7.02 | 7.12 ± 3.29 | |
p = 0.008 | p = 0.124 | p = 0.143 | |||
Family history of psychiatric disorders | Yes | 66 (21) | 30.87 ± 11.41 | 10.21 ± 6.97 | 7.34 ± 2.85 |
No | 249 (79) | 32.69 ± 12.15 | 10.14 ± 6.92 | 6.94 ± 3.42 | |
p = 0.275 | p = 0.944 | p = 0.383 | |||
Number of smartphone devices owned | 1 | 156 (49.5) | 32.86 ± 11.06 | 10.70 ± 7.34 | 8.03 ± 2.74 |
2 | 99 (31.4) | 31.81 ± 12.29 | 9.69 ± 6.35 | 6.16 ± 3.37 | |
3 or more | 60 (19.1) | 31.70 ± 13.90 | 9.50 ± 9.69 | 5.85 ± 3.79 | |
p = 0.722 | p = 0.377 | p < 0.001 | |||
Perceived feeling of increased smartphone usage time during the COVID-19 pandemic | Yes | 211 (67) | 34.72 ± 11.85 | 11.35 ± 7.08 | 7.82 ± 3.08 |
No | 104 (33) | 27.43 ± 10.85 | 7.74 ± 5.90 | 5.41 ± 3.17 | |
p < 0.001 | p < 0.001 | p < 0.001 | |||
Have you ever used a substance with addictive potential? | Yes | 66 (21) | 29.62 ± 12.35 | 12.12 ± 7.14 | 7.65 ± 3.23 |
No | 249 (79) | 33.02 ± 11.84 | 9.63 ± 6.78 | 6.86 ± 3.32 | |
p = 0.040 | p = 0.009 | p = 0.087 | |||
Total | 315 | 32.31 ± 12.01 | 10.16 ± 6.92 | 7.03 ± 3.31 |
Frequency (%) | Total | ||
---|---|---|---|
Male | Female | p Value * = 0.48 | |
Addicted | 64 (45.7) | 87 (49.7) | 151 (47.9) |
Not addicted | 76 (54.3) | 88 (50.3) | 164 (52.1) |
Total | 140 | 175 | 315 |
SAS-SV Question | Mean ± SD |
---|---|
| 3.36 ± 1.6 |
| 3.62 ± 1.75 |
| 3.01 ± 1.72 |
| 3.51 ± 1.72 |
| 2.92 ± 1.59 |
| 2.89 ± 1.61 |
| 3 ± 1.65 |
| 3.29 ± 1.64 |
| 3.79 ± 1.68 |
| 2.87 ± 1.64 |
Variable | Smartphone Addiction Scale—Short Version (SAS-SV) | Current Cumulative GPA Category * | Depressive Symptoms (PHQ-9) ** | Perceived Stress (PSS-4) ** | ||||
---|---|---|---|---|---|---|---|---|
Correlation Coefficient (r) | p-Value (p) | r | p | r | p | r | p | |
SAS-SV | 1 | 0 | −0.027 | 0.639 | 0.216 | <0.001 | 0.247 | <0.001 |
GPA | −0.027 | 0.639 | 1 | 0 | −0.107 | 0.057 | −0.061 | 0.283 |
PHQ-9 | 0.216 | <0.001 | −0.107 | 0.057 | 1 | 0 | 0.273 | <0.001 |
PSS-4 | 0.247 | <0.001 | −0.061 | 0.283 | 0.273 | <0.001 | 1 | 0 |
B | S.E. | Wald | p-Value | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Constant | −2.136 | 0.670 | 10.152 | 0.001 | 0.118 | ||
Sex | −0.110 | 0.258 | 0.183 | 0.669 | 0.896 | 0.540 | 1.485 |
Marital status | 0.062 | 0.389 | 0.026 | 0.873 | 1.064 | 0.496 | 2.283 |
Diagnosed with a psychiatric disorder prior to medical school admission | −0.818 | 0.427 | 3.672 | 0.055 | 0.441 | 0.191 | 1.019 |
Perceived feeling of increased smartphone usage time during the COVID-19 pandemic | 1.223 | 0.292 | 17.517 | <0.001 | 3.398 | 1.916 | 6.026 |
Have you ever used a substance with addictive potential? | −0.790 | 0.331 | 5.701 | 0.017 | 0.454 | 0.237 | 0.868 |
PHQ-9 | 0.022 | 0.020 | 1.145 | 0.285 | 1.022 | 0.982 | 1.064 |
PSS-4 | 0.187 | 0.047 | 16.188 | <0.001 | 1.206 | 1.101 | 1.321 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
AlSaif, H.I.; Alhozaimi, Z.A.; Alrashed, A.S.; Alanazi, K.S.; Alshibani, M.G.; Almigbal, T.H.; Alsaad, S.M.; Alrasheed, A.A.; Alosaimi, F.D. Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic. Medicina 2023, 59, 1501. https://doi.org/10.3390/medicina59081501
AlSaif HI, Alhozaimi ZA, Alrashed AS, Alanazi KS, Alshibani MG, Almigbal TH, Alsaad SM, Alrasheed AA, Alosaimi FD. Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic. Medicina. 2023; 59(8):1501. https://doi.org/10.3390/medicina59081501
Chicago/Turabian StyleAlSaif, Haytham I., Zeyad A. Alhozaimi, Alhanouf S. Alrashed, Kholoud S. Alanazi, Mohammed G. Alshibani, Turky H. Almigbal, Saad M. Alsaad, Abdullah A. Alrasheed, and Fahad D. Alosaimi. 2023. "Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic" Medicina 59, no. 8: 1501. https://doi.org/10.3390/medicina59081501