The smartphone addiction scale: development and validation of a short version for adolescents

Likes and impulsivity: Investigating the relationship between actual smartphone use and delay discounting

The omnipresence of smartphones among adolescents and adults gives rise to the questions about excessive use and personality factors which are associated with heavier engagement with these devices. Previous studies have found behavioral similarities between smartphone use and maladaptive behaviors (e.g. drinking, gambling, drug abuse) in the context of intertemporal choice but mostly relied on participants’ self-reports regarding engagement with their phone. In this study, we collected actual usage data by smartphone application from 101 participants and assessed their tendency to discount future rewards, their reward responsiveness, self-control and consideration of future consequences. We found that smartphone screen time was correlated with choosing smaller immediate over larger delayed rewards and that usage of social media and gaming apps predicted delay discounting. Additionally, smartphone use was negatively correlated with self-control but not correlated with consideration of future consequences. Neither psychological variable could mediate the relationship between smartphone usage and delay discounting. Our findings provide further evidence that smartphone use and impulsive decision-making go hand in hand and that engagement with these devices needs to be critically examined by researchers to guide prudent behavior.

Fear of Missing Out (FoMO) and social media's impact on daily-life and productivity at work: Do WhatsApp, Facebook, Instagram, and Snapchat Use Disorders mediate that association?

Fear of Missing Out (FoMO) is the tendency to experience anxiety over missing out on rewarding experiences of others. It has been associated with daily-life disruptions, such as distractions during driving. FoMO has also consistently been a predictor of Internet, smartphone, and social networks use disorders. In the current work, we investigated the association between FoMO and social media use's impact on daily-life and productivity at work. In addition, we aimed to determine whether WhatsApp, Facebook, Instagram, and Snapchat Use Disorders mediate that relationship. The effective sample comprised 748 German-speaking study participants from the general population (age M = 38.63, SD = 12.10; 336 men, 412 women) who took part in an online survey study. Bivariate analyses showed that severity of all social networks use disorders were positively correlated with FoMO and social media's negative impact on daily-life and productivity at work. Furthermore, controlling for age and gender, mediation analyses showed that out of all platforms, only Snapchat Use Disorder did not mediate the association between FoMO and social media's negative impact on daily-life and productivity at work. These results provide further evidence about FoMO's central role in digital technology use-related disorders.

Validation of smartphone addiction scale - Short version (SAS-SV) in Brazilian adolescents

The objectives of this study were to analyze the psychometric properties of the Smartphone Addiction Scale - Short Version (SAS-SV) as follows: (i) the factor structure of the SAS-SV using different statistical methods; (ii) the evidence of convergence; (iii) the temporal stability of the SAS-SV; and (iv) predictive SAS-SV validity. A total of 451 adolescents participated in this study (age M = 13.1; SD = 1.22) by completing a sociodemographic questionnaire (including items evaluating the perception of smartphone use), the Internet Addiction Test (IAT), and the SAS-SV. It was found that 53.2% demonstrated problematic smartphone use. The SAS-SV showed good reliability (α = 0.81; ω = 0.78), and all of its items were kept. The network analysis indicated that the items evaluating the withdrawal and preoccupation symptoms had the greatest influence on the network. The intraclass correlation coefficient was 0.846 and indicated good temporal stability of the SAS-SV 20-30 days after the first application. The receiver operating characteristic (ROC) curve analysis indicated 33 points as the best cutoff for the SAS-SV (AUC = 0.739; sensitivity = 65.37%; specificity = 72.26). The instrument also showed a moderate correlation with the variables related to smartphone use (time spent on smartphones, number of messages sent and received, and number of times the smartphone is checked). These data indicate that the SAS-SV may be a reliable instrument for use with Brazilian adolescents.

Assessing Nomophobia: Validation Study of the European Portuguese Version of the Nomophobia Questionnaire

Nomophobia (no mobile phone phobia) can be defined as a situational phobia described by the fear of not having a smartphone available or being incapable of accessing the Internet. Based on these characteristics, the Nomophobia Questionnaire (NMP-Q) was designed, showing a four-factor structure and good psychometric characteristics. The current study intended to adapt the NMP-Q to European Portuguese (NMP-Q-PT) and test its factor structure and psychometric properties. Five hundred participants from the general population (convenience sampling) filled in the NMP-Q-PT, the Smartphone Addiction Scale-Short Version (SAS-SV) and the Depression, Anxiety, and Stress Scales (DASS-21). Three models were tested through confirmatory factor analysis. One higher order factor (global nomophobia) with four lower order factors revealed a good fit to the data. The NMP-Q-PT presented excellent consistency, construct and discriminant validity, as well as good concurrent and divergent validities. Overall, the NMP-Q-PT showed to be a reliable and valid instrument for measuring nomophobia.

Does a smartphone on the desk drain our brain? No evidence of cognitive costs due to smartphone presence in a short-term and prospective memory task

It has recently been shown that the mere presence of one's own smartphone on the desk impairs working memory performance. The aim of this study was to follow up on this important finding by assessing the effect of smartphone presence (present on the desk vs. absent from the desk) on different memory functions (short-term memory and prospective memory), and by further examining the moderating role of individual differences in smartphone dependency and impulsiveness. We found no overall effect of smartphone presence on short-term and prospective memory performance. There was a moderating effect for prospective memory: Performance was better when the smartphone was absent versus present for participants with low smartphone dependency. In light of the absence of an overall effect of smartphone presence on memory functions, our results show that previous findings of impairments in working memory due to smartphone presence do not generalize to other domains of memory capacity.

Smartphone usage duration is not associated with increased pain or proprioception deficit in young adults with chronic mechanical low back pain: a cross-sectional study

Background

Smartphone use has been associated with pain in the upper quadrant; however, the relationship between usage duration and low back pain is still unclear. This study investigated the association between continuous smartphone use up to 30-min and back pain severity and proprioception acuity in patients with chronic low back pain. Fifty-eight patients with chronic mechanical LBP played a game for 10- and 30-min. In each session, pain and back repositioning errors were measured at baseline and immediately after task completion.

Results

Pain significantly but slightly increased following smartphone use, regardless to the duration (after 10 min: mean increase = 0.75 ± 1.17, P value < 0.001, 95% CI 0.44–1.06; after 30 min: mean increase = 0.96 ± 1.93, P value < 0.001, 95% CI 0.44–1.46). However, changes in perceived pain scores were not significantly different between the two tested durations (P value = 0.42). Proprioception repositioning error was not significantly different within the same testing session (mean change = 0.08 ± 1.83, 0.13 ± 1.77, P value = 0.73, 0.58, 95% CI − 0.40–0.56, − 0.60–0.33, for the 10 and 30 min, respectively). The changes in proprioception were not significant between the two-tested durations (P value = 0.56). Further, smartphone addiction did not significantly affect changes in pain and proprioception after game playing, regardless of the duration (P > 0.05).

Conclusions

These findings show that smartphone use slightly increases back pain immediately after continuous use; with no effect on back proprioception within the duration tested in this study. Changes in pain and proprioception were not influenced by smartphone addiction.

Temporal association between objectively measured smartphone usage, sleep quality and physical activity among Chinese adolescents and young adults

We studied the association between objectively measured smartphone usage and objectively measured sleep quality and physical activity for seven consecutive days among Hong Kong adolescents and young adults aged 11-25 years (n = 357, 67% female). We installed an app that tracked the subjects' smartphone usage and had them wear an ActiGraph GT3X accelerometer on their wrist to measure their sleep quality and physical activity level. Smartphone usage data were successfully obtained from 187 participants (52.4%). The participants on average spent 2 h 46 min per day on their smartphone. Multilevel regression showed that 1 min of daytime smartphone usage was associated with 0.07 min decrease in total sleeping time that night (p = .043, 95% confidence interval [CI]: -0.14, -0.003). Broken down for different usage purposes, 1 min of daytime social network usage and games and comics was associated with a 0.28 (p = .02, 95% CI: -0.52, -0.04) min and 0.18 min (p = .01, 95% CI: -0.32, -0.04) decrease in total sleeping time that night, respectively. One minute of daytime smartphone usage was associated with an increase of 4.55 steps in the number of steps (p = .001, 95% CI: 1.77, 7.34) on the next day. To conclude, time spent on a smartphone in the daytime was associated with total sleeping time that night and number of steps the next day, but was not associated with sleep efficiency, wake after sleep onset and moderate-to-vigorous-intensity activity (MVPA) among Hong Kong adolescents and young adults.

Neural Correlates of Smartphone Dependence in Adolescents

Increases in depressive and suicide-related symptoms among United States adolescents have been recently linked to increased use of smartphones. Understanding of the brain mechanisms that underlie the potential smartphone dependence may help develop interventions to address this important problem. In this exploratory study, we investigated the neural mechanisms underlying potential smartphone dependence in a sample of 19 adolescent volunteers who completed self-assessments of their smartphone dependence, depressive symptoms, and sleep problems. All 19 adolescents underwent diffusion MRI that allowed for assessment of white matter structural connectivity within the framework of connectomics. Based on previous literature on the neurobiology of addiction, we hypothesized a disruption of network centrality of three nodes in the mesolimbic network: Nucleus Accumbens, anterior cingulate cortex, and amygdala. Our results showed positive correlations between the node centrality of the right amygdala and self-reported smartphone dependence, between smartphone dependence and sleep problems, and between sleep problems and depressive symptoms. A higher phone dependence was observed in females compared to males. Supported by these results, we propose a model of how smartphone dependence can be linked to aberrations in brain networks, sex, sleep disturbances, and depression in adolescents.

A brief intervention to reduce burnout and improve sleep quality in medical students

BACKGROUND

Perceived stress, burnout, and poor sleep quality are high among medical students. Interventions designed to target these issues are necessary to promote the health and well-being of medical students. The purpose of this study was twofold: 1) to assess the feasibility of implementing a sunrise alarm clock intervention with medical students and 2) to evaluate the impact of the intervention on perceived stress, burnout scores, and sleep quality.

METHODS

We conducted a feasibility study to evaluate the efficacy of a two-week, sunrise alarm clock intervention in combination with electronic device removal at bedtime. We assessed first- and second-year medical students' perceived stress, burnout scores, including Emotional Exhaustion, Depersonalization, and Low Sense of Personal Achievement, and sleep quality before and after the intervention. In addition, we measured smartphone addiction prior to the intervention.

RESULTS

A total of 57 students consented to participate, of which 55 completed both the pre- and post-assessments (3.5% attrition). The mean age of the participants was 24.8 ± 1.9 years, 50.9% (n = 29) identified as women, and 68.4% (n = 39) identified as white. Pre-intervention, 42.1% (n = 24) of students met criteria for smartphone addiction and 77.2% (n = 44) met criteria for poor sleep quality. In addition, 22.8% (n = 13) of participants had high emotional exhaustion, 64.9% (n = 31) high depersonalization, and 42.1% (n = 24) low sense of personal accomplishment prior to the intervention. Following the two-week intervention, participants showed improvements in emotional exhaustion (p = 0.001, Cohen's d = 0.353), depersonalization (p = 0.001, Cohen's d = 0.411) low sense of personal accomplishment (p = 0.023, Cohen's d = 0.275), perceived stress (p < .001, Cohen's d = .334), and sleep quality (p < 0.001, Cohen's d = 0.925). The number of participants who reported poor sleep quality decreased to 41.8% (n = 23), demonstrating a significant decline (p = 0.026). Participants also improved subjective sleep quality (p < 0.001, Cohen's d = 1.033), sleep duration (p = 0.001, Cohen's d = 0.431), sleep latency (p < 0.001, Cohen's d = 0.433), and sleep efficiency (p = 0.021, Cohen's d = 0.673).

CONCLUSIONS

These findings suggest that the two-week sunrise alarm clock protocol with electronic device removal was effective in improving sleep quality and reducing burnout scores, and perceived stress. However, additional research comparing this intervention to a proper control group is needed to draw meaningful conclusions about the effectiveness of this intervention.

The association between the Big Five personality traits and smartphone use disorder: A meta-analysis

BACKGROUND AND AIMS

Personality is one of the most frequently investigated variables to shed light on the putatively addictive use of the smartphone. By investigating associations between personality and individual differences in addictive smartphone use, researchers aim to understand if some personality traits predispose technology users to develop addictive behaviors. Here, based on existing empirical literature, we aimed at determining the strength of associations between Big Five personality traits and smartphone use disorder (SmUD) by a meta-analytic approach.

METHOD

For each Big Five personality trait, we performed a meta-analysis of correlations representing their association with SmUD. We also investigated possible publication bias and the moderating effects of age, gender, nationality, length of personality assessments, and time of publication.

RESULTS

We found n = 26 eligible studies. In line with both the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the framework on problematic mobile-phone use by Billieux, we observed a positive association between Neuroticism and SmUD (r = 0.25), while the association between Extraversion and SmUD was not significant. Partially in line with the aforementioned theoretical frameworks, Conscientiousness was negatively associated with SmUD (r = -0.16). Remaining traits showed smaller associations. No significant publication bias emerged. Moderator analyses showed that time of publication moderated the link between Conscientiousness and SmUD. Moreover, Agreeableness and Conscientiousness showed a heightened inverse association with SmUD among older samples.

CONCLUSIONS

The present meta-analysis provides robust empirical evidence that Big Five personality traits can help to understand individual differences in SmUD, supporting the usefulness of their assessment when planning and targeting interventions aimed at at-risk individuals.

Psychometric properties and measurement invariance of the 7-item game addiction scale (GAS) among Chinese college students

BACKGROUND

The 7-item Gaming Addiction Scale (GAS) has been used as a screening tool for addictive game use worldwide, and this study aimed to examine its psychometric properties and measurement invariance among college students in China.

METHODS

Full-time students from multiple colleges in China were recruited. A total of 1040 completed questionnaires were used in the final analysis. Reliability of the GAS was assessed by internal consistency and split-half reliability. Validity of the GAS was assessed by structural validity, convergent validity, discriminant validity, and concurrent validity. A series of Multigroup Confirmatory Factor Analysis (MG-CFA) were conducted to test and establish measurement invariance across gender, class standing, family income and parental educational level.

RESULTS

Exploratory factor analysis revealed a unidimensional structure of the GAS. The GAS exhibited excellent internal consistency (Cronbach's α = 0.951, theta coefficient = 0.953, omega coefficient = 0.959) and structural validity (χ² /df = 0.877 (p < 0.05), CFI = 0.999, TIL = 0.996, RMSEA =0.000). Concurrent validity of the GAS was confirmed by its correlation with problematic internet use, sleep quality, nine dimensions of psychiatric symptoms, and substance use. The GAS also demonstrated measurement invariance across father's educational level (Δχ2 (df) = 19.128 (12), ΔCFI = - 0.009, ΔRMSEA = 0.010 for weak factorial model; Δχ2 (df) = 50.109 (42), ΔCFI = - 0.010, ΔRMSEA = 0.007 for strict factorial model.) and mother's educational level (Δχ2 (df) = 6.679 (12), ΔCFI = 0.007, ΔRMSEA = - 0.010 for weak factorial model; Δχ2 (df) =49.131 (42), ΔCFI = - 0.009, ΔRMSEA = - 0.004 for strict factorial model), as well as partial measurement invariance across gender (except for item 2), class standing (except for item 7) and family income (except for item 5).

CONCLUSIONS

The Chinese version of the 7-item GAS can be an adequate assessment tool to assess internet gaming disorder among the college student population in China.

Development and validation of a Smartphone Impact Scale among healthcare professionals

Objectives

Smartphone overuse is prevalent among healthcare professionals. There is no standard scale that can measure the impact of smartphone usage on healthcare professionals. This study aimed to develop and validate a tool, the Smartphone Impact Scale (SIS), that can effectively measure the use of smartphone among healthcare professionals.

Methods

We developed a generic instrument to study the impact of smartphone usage among healthcare professionals. A total of 1436 healthcare professionals from various regions of KSA participated in this study through an online questionnaire-based survey. The psychometric properties of the SIS were developed using content validity index (CVI), factor analysis, internal consistency, and test-retest reliability analysis.

Results

A 23-item scale was selected for reliability and validity analysis. The average CVI was found to be 0.824. The internal consistency with Cronbach's alpha value was 0.91, and test-retest reliability was 0.85. The Cronbach's alpha values for Factors 1 and 2 were 0.875 and 0.803, respectively. The confirmatory factor analysis indices were as follows: root mean square of approximation = 0.0710, comparative fit index = 0.861, Tucker–Lewis index = 0.845, and the coefficient of determination = 0.969. The correlation between two factors was 0.66. After factor analysis, we developed a final questionnaire with 23 items.

Conclusions

Our SIS showed a three-factor structure and appropriate psychometric characteristics. Due to its adequate reliability and validity, SIS can be conveniently used to evaluate the impact of smartphone usage on healthcare professionals.

An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19

OBJECTIVE

The sudden outbreak of Coronavirus Disease 2019 (COVID-19) has had a dramatic effect on the mental health of the public. In the present study, we demonstrated the psychological effects on children and adolescents associated with the epidemic .

METHODS

By using convenience sampling method, questionnaires, such as Spence Child Anxiety Scale, Child Depression Inventory and Coping style Scale, were distributed to participating 359 children and 3254 adolescents online.

RESULTS

The anxiety levels of children and adolescents were (23.87 ± 15.79) and (29.27 ± 19.79), respectively. 22.28% respondents were suffering from depressive symptoms. Seven significant factors associated with increased levels of anxiety, including female, resident in urban regions, emotion-focused coping style. Nine factors associated with increased levels of depression, such as smartphone addiction (OR 1.411, 95% CI 1.099-1.180), Internet addiction (OR 1.844, 95% CI 1.209-2.811), and resident in Hubei province (OR 3.107, 95% CI 1.252-7.708). Two additional factors associated with decreased levels of depressive symptoms: hours spend on Internet per day before the epidemic (OR 0.652, 95% CI 0.609-0.697) and tendency to apply problem-focused coping style (OR 0.937, 95% CI 0.923-0.951).

CONCLUSION

Our findings indicate that the COVID-19 outbreak has had a significant psychosocial impact on children and adolescents. Findings of current levels of anxiety and depression not only highlight the need to address emotional distress for children and adolescents during the epidemic but also provide researchers with scientific fundamentals to formulate targeted interventions based on the significant influencing factors.

The relationship of smartphone addiction with psychological distress and neuroticism among university medical students

Background

Smartphone plays a vital role in higher education as it serves as a device with multiple functions. Smartphone addiction was reported on the rise among college and university students. The addiction may result in unwanted consequences on their academic performance and psychological health. One factor that consistently relates to psychological distress and smartphone addiction is the neurotic personality trait. This study explored the relationship of smartphone addiction with psychological health and neuroticism among USM medical students.

Methods

A cross-sectional study was carried out on medical students in a public medical school. DASS-21, the neuroticism-subscale of USMaP-i and SAS-SV were administered to measure psychological distress, neuroticism, and smartphone addiction of the medical students. Spearman correlation was performed to examine the correlation between smartphone addiction with psychological distress and neuroticism. Simple linear regression was performed to investigate relationship factors of smartphone addiction.

Results

A total of 574 medical students participated in this study. The prevalence of smartphone addiction was 40.6%. It was higher among male (49.2%) compared to female (36.6%) medical students. The result showed a fair positive correlation between smartphone addiction and psychological health (rdepression = 0.277, p-value < 0.001; ranxiety = 0.312, p-value < 0.001; rstress = 0.329, p-value < 0.001). However, there was a poor positive correlation between smartphone addiction and neuroticism (r = 0.173, p-value < 0.001). The simple linear regression showed a significant increase in the levels of depression, anxiety, stress and neuroticism upon one unit increase in smartphone addiction (bdepression = 0.101, p-value < 0.001; banxiety = 0.120, p-value < 0.001; bstress = 0.132, p-value < 0.001; bneuroticism = 0.404, p-value < 0.05). These results indicated significant relationships between smartphone addiction, psychological health and neuroticism.

Conclusion

This study suggested a high prevalence of smartphone addiction among medical students, particularly in male medical students. The smartphone addiction might lead to psychological problems and the most vulnerable group is the medical student with the neurotic personality trait.

Correlations between mobile phone addiction and anxiety, depression, impulsivity, and poor sleep quality among college students: A systematic review and meta-analysis

BACKGROUND AND AIMS

Mobile phone addiction (MPA) is frequently reported to be correlated with anxiety, depression, stress, impulsivity, and sleep quality among college students. However, to date, there is no consensus on the extent to which those factors are correlated with MPA among college students. We thus performed a meta-analysis to quantitatively synthesize the previous findings.

METHODS

A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane Library, Wanfang, Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Chinese Biological Medicine (CBM) databases from inception to August 1, 2020. Pooled Pearson's correlation coefficients between MPA and anxiety, depression, impulsivity, and sleep quality were calculated by R software using random effects model.

RESULTS

Forty studies involving a total of 33, 650 college students were identified. Weak-to-moderate positive correlations were found between MPA and anxiety, depression, impulsivity and sleep quality (anxiety: summary r = 0.39, 95% CI = 0.34-0.45, P < 0.001, I2 = 84.9%; depression: summary r = 0.36, 95% CI = 0.32-0.40, P < 0.001, I2 = 84.2%; impulsivity: summary r = 0.38, 95% CI = 0.28-0.47, P < 0.001, I2 = 94.7%; sleep quality: summary r = 0.28, 95% CI = 0.22-0.33, P < 0.001, I2 = 85.6%). The pooled correlations revealed some discrepancies when stratified by some moderators. The robustness of our findings was further confirmed by sensitivity analyses.

CONCLUSIONS

The current meta-analysis provided solid evidence that MPA was positively correlated with anxiety, depression, impulsivity, and sleep quality. This indicated that college students with MPA were more likely to develop high levels of anxiety, depression, and impulsivity and suffer from poor sleep quality. More studies, especially large prospective studies, are warranted to verify our findings.

Factors associated with smartphone addiction: A comparative study between Japanese and Thai high school students

BACKGROUND

Smartphone addiction is a growing social problem with adverse health outcomes. There are few comparative studies in Asia that examine factors associated with smartphone addiction. The current study aimed to address this research gap by presenting a comparative analysis of factors associated with smartphone addiction in Japan and Thailand, two countries heterogeneous in both their level of economic development and culture.

METHODS

Participant data were collected using two population-based surveys. Participants were high school students in grade 11, aged 16-17 years old, and were selected using quota sampling in Japan in 2014 and random sampling in Thailand in 2016. The outcome of interest was smartphone addiction, measured using a modified version of the Young Diagnostic Questionnaire for Internet Addiction. Multiple logistic regression analysis was performed to determine factors associated with smartphone addiction (gender; nationality; family connectedness; and average time spent on smartphone per day).

RESULTS

This study included a total of 7694 students, 6585 students from Japan and 1109 students from Thailand. The prevalence of smartphone addiction was 35.9% among Thai students and 12% among Japanese students. Thai students were more likely to have smartphone addiction than Japanese students (AOR 2.76; 95% CI: 2.37-3.30). Being female was associated with increased odds of smartphone addiction in both Japanese (AOR 1.53; 95% CI: 1.32-1.78) and Thai students (AOR 1.34; 95% CI: 1.01-1.78). The parental connectedness variables "my parents noticed when I was unhappy" (AOR 0.77; 95% CI: 0.62-0.96) and "my parents noticed when I did something good" (AOR 0.78, 95% CI: 0.61-0.99) were associated with lower odds of smartphone addiction among Japanese students.

CONCLUSION

Smartphone addiction was more prevalent among Thai adolescents than Japanese adolescents, and more prevalent among females than males in both countries. Interventions for reducing smartphone addiction should take into account both context and gender, and should leverage the protective effect of parental connectedness.

COVID-19 anxiety symptoms associated with problematic smartphone use severity in Chinese adults

BACKGROUND

COVID-19 is fast-spreading and potentially fatal, introducing home quarantine, social distancing, and increased internet usage globally. We investigated COVID-19 anxiety, general anxiety and depression symptoms, and their impact on problematic smartphone use (PSU) severity METHODS: Participants were 908 residents of a large Eastern Chinese city, surveyed from late-February to mid-March, 2020. We administered online measures including the Depression Anxiety Stress Scale-21, Smartphone Addiction Scale-Short Version, and items querying COVID-19-related news exposure and threat of death. Additionally, participants rated anxiety using the Generalized Anxiety Disorder Scale-7 with reference to COVID-19.

RESULTS

COVID-19 anxiety correlated with severity of PSU, depression and anxiety. Using established cut-off scores, 12% of participants were identified with at least moderate depression, and 24% with moderate anxiety. Using structural equation modeling, COVID-19 anxiety related to PSU severity, mediating relations between general anxiety and PSU severity. However, controlling PSU for general anxiety and depression severity, COVID-19 anxiety no longer predicted PSU severity.

LIMITATIONS

Limitations include the cross-sectional research design and reliance on data from only one country.

CONCLUSIONS

Results are discussed in context of the I-PACE model of excessive internet use. While COVID-19 anxiety is likely a global anxiety-provoking event, other everyday worries and anxiety are additionally clinically important in driving excessive internet use.

Neural correlates of cue reactivity in individuals with smartphone addiction

Popularity of smartphones has dramatically increased in the past years, accompanied by increased concerns regarding potentially adverse effects on physical and mental health. Addictive behavior associated with excessive smartphone use, frequently referred to as "smartphone addiction" (SPA), has attracted increased scientific interest. However the neural correlates of SPA are unknown. We used functional magnetic resonance imaging at 3T to investigate the neural correlates of cue reactivity (CR) in individuals with SPA (n = 21) compared to controls (n = 21). SPA was assessed using the Smartphone Addiction Inventory (SPAI), and neural activity was measured by a modified CR task. Contrasts of images of smartphones vs. neutral stimuli and stimuli including active vs. inactive smartphones (p < 0.001, uncorrected for height, followed by correction for spatial extent) were analyzed. In the first contrast, group differences in medial prefrontal (MPFC), occipital, temporal, and anterior cingulate (ACC) cortices, in temporoparietal regions, and cerebellum were found. For active vs. inactive smartphones, group differences were found in frontal operculum/anterior insula and precentral gyrus. Negative correlations were found between MPFC, ACC, precuneus, and precentral gyrus and specific SPAI subscores, i.e. compulsive behavior, functional impairment and withdrawal. This study suggests spatial similarities of CR-related brain activation between addictive smartphone use and other well-known addictive disorders.

Impact of smartphone addiction on depression and self-esteem among nursing students

Aim

To assess the impact of smartphone addiction on depression and self-esteem among nursing students.

Setting

Faculty of Nursing.

Design

Cross-sectional, survey-based research design used in this study. Sample: Stratified random sample consists of 320 nursing students. Tools: Four tools used for data collection: personal data sheet, Hamilton rating scale of depression, smartphone addiction scale and Self-esteem Inventory.

Results

About 95.8% of nursing students reported smartphone addiction, while 32.5% were pseudonormal of depression. Twenty-eight percent of them had low self-esteem. The study also revealed a statistically significant positive correlation between smartphone addiction and levels of depression. There was a statistically significant negative correlation between levels of depression and self-esteem.

Effect of the mobile phone-related background on inhibitory control of problematic mobile phone use: An event-related potentials study

The present study aims to provide electrophysiological evidence for deficient inhibitory control in problematic mobile phone use and to investigate whether reduced inhibition is more pronounced during exposure to a mobile phone related background cue. A screen scale of smartphone addiction was completed by 227 college students, and finally an experimental group and a control group consisting of 20 problematic mobile phone users and 19 controls were included in the study. Event-related potentials were recorded during a backgrounded Go/NoGo task performed by those two groups, in which either a frequent Go signal (letter "M") or a rare NoGo signal (letter "W") was superimposed on three different background cues: neutral, mobile phone application-related and mobile phone using-related pictures. Results showed that problematic mobile phone users performed more commission errors than controls following mobile phone application background. Furthermore, problematic mobile phone users displayed a weaker NoGo P3 amplitude than controls on the mobile phone application background. The result might suggest that there is no general impairment of inhibitory control in problematic mobile phone use. The deficient inhibitory control on behavioral and psychophysiological level appeared merely in the mobile phone-related background. Such deficient stimuli-specific inhibitory control appears at the late stage of inhibitory control. Prevention programs should be designed to curtail exposure to the mobile phone-related stimulus and enhance cognitive control of potential problematic mobile phone users.

Associations between symptoms of problematic smartphone, Facebook, WhatsApp, and Instagram use: An item-level exploratory graph analysis perspective

BACKGROUND AND AIMS

Studies have demonstrated associations between both problematic smartphone and social networks use with everyday life adversities. However, examination of associations between problematic smartphone use (PSU) and problematic use of specific social networking platforms, especially on item-level data, has received relatively little attention. Therefore, the aim of the current study was to explore how items of problematic smartphone, Facebook, WhatsApp, and Instagram use are associated.

METHODS

949 German-speaking adults participated in a web survey study. The participants were queried about their socio-demographics as well as levels of problematic smartphone, Facebook, WhatsApp, and Instagram use. In addition to bivariate correlation analysis, exploratory graph analysis (EGA), a type of network analysis, was conducted.

RESULTS

The results showed that while problematic Facebook and Instagram use seem to be distinct phenomena, problematic smartphone and WhatsApp use were heavily intertwined. Furthermore, the only cross-platform symptom observed was the extent of reported pain in wrists and neck due to digital technology use. The EGA network models showed very good stability in bootstrap analyses.

DISCUSSION AND CONCLUSIONS

In general, the results of this study suggest that while Instagram and Facebook use may potentially constitute distinct problematic behaviors, problematic smartphone/WhatsApp use scales may be measuring highly similar or even the same construct.

Investigation of Correlated Internet and Smartphone Addiction in Adolescents: Copula Regression Analysis

Internet and smartphone addiction have become important social issues. Various studies have demonstrated their association with clinical and psychological factors, including depression, anxiety, aggression, anger expression, and behavioral inhibition, and behavioral activation systems. However, these two addictions are also highly correlated with each other, so the consideration of the relationship between internet and smartphone addiction can enhance the analysis. In this study, we considered the copula regression model to regress the bivariate addictions on clinical and psychological factors. Real data analysis with 555 students (age range: 14-15 years; males, N = 295; females, N = 265) from South Korean public middle schools is illustrated. By fitting the copula regression model, we investigated the dependency between internet and smartphone addiction and determined the risk factors associated with the two addictions. Furthermore, by comparing the model fits of the copula model with linear regression and generalized linear models, the best copula model was proposed in terms of goodness of fit. Our findings revealed that internet and smartphone addiction are not separate problems, and that associations between them should be considered. Psychological factors, such as anxiety, the behavioral inhibition system, and aggression were also significantly associated with both addictions, while ADHD symptoms were related to internet addiction only. We emphasize the need to establish policies on the prevention, management, and education of addiction.

Insecure Attachment and Technology Addiction Among Young Adults: The Mediating Role of Impulsivity, Alexithymia, and General Psychological Distress

Previous studies have emphasized the effect of insecurity attachment on youth's Internet and smartphone addiction. In this study, we examine the mediating role of alexithymia, impulsivity, and general psychological distress in the relationship between insecure attachment dimensions and technology addiction. Data were collected from 539 adolescents and young adults, mostly women (N = 378; 70.1 percent), aged 19.76 ± 1.99 years. Participants completed self-report measures of attachment insecurity, psychological risk factors (i.e., impulsivity, psychological distress, and alexithymia), and technology addiction (i.e., problematic Internet use, smartphone, and Internet addiction). The gender-related (i.e., multi-group) mediation model was tested through a path analysis with both observed and latent variables. Attachment anxiety had no direct effect on technology addiction, whereas attachment avoidance had a small negative direct effect, but only among women. Insecure attachment dimensions were significantly associated with psychological risk factors, whereas the latter had a significant, direct association with technology addiction. Psychological risk factors significantly mediated the association between insecure attachment dimensions and technology addiction. Finally, the tested model was gender-invariant. Findings suggest that insecure attachment dimensions have an indirect effect on the development of technology addiction mediated almost entirely by higher levels of psychological risk factors. Such findings might have relevant implications to inform any treatment plan for young adults who are overinvolved with technology activities and so to deliver patient-tailored interventions.

Smartphone use and the quality of life of medical students in the Kumaun Region, Uttarakhand

Background:

Once a device for telecommunication, now a powerful device bringing the whole world in one's palm, smartphones are increasingly becoming a common commodity among the medical students. Smartphones foster social interaction and facilitate multitasking and learning, but they also have some adverse effects. Young people, especially students, who are always inquisitive towards new technology, are likely to be affected by both these positive and negative impacts.

Objective:

To assess smartphone use and its association with the quality of life (QOL) of medical students.

Materials and Method:

A cross-sectional study was conducted among the undergraduate medical students of Government Medical College (GMC), Haldwani. All the students enrolled in MBBS course in GMC, Haldwani, who gave consent for participation and were present on the day of questionnaire administration, were included in the study. Smartphone addiction scale (SAS-SV), and WHO-BREF questionnaires for QOL were used for assessing smartphone use, and QOL of the medical students, respectively.

Results:

A total of 395 medical students were included in the study; out of them, 42% considered themselves addicted to the smartphone. According to SAS-SV, smartphone addiction was found among 43.8% medical students. It was seen that the junior-most and senior-most batches were significantly less addicted to the smartphone (p-value < 0.001). Male students were more addicted (OR = 1.45, CI = 0.962–2.174) to the smartphone as compared to females. The QOL of the students was significantly affected by smartphone use in all domains assessed (p-value ranging from < 0.001 to 0.002).

Conclusions:

Smartphone addiction is high among medical students and it has a significant negative impact on their QOL.

Changes of Neurotransmitters in Youth with Internet and Smartphone Addiction: A Comparison with Healthy Controls and Changes after Cognitive Behavioral Therapy

BACKGROUND AND PURPOSE

Neurotransmitter changes in youth addicted to the Internet and smartphone were compared with normal controls and in subjects after cognitive behavioral therapy. In addition, the correlations between neurotransmitters and affective factors were investigated.

MATERIALS AND METHODS

Nineteen young people with Internet and smartphone addiction and 19 sex- and age-matched healthy controls (male/female ratio, 9:10; mean age, 15.47 ± 3.06 years) were included. Twelve teenagers with Internet and smartphone addiction (male/female ratio, 8:4; mean age, 14.99 ± 1.95 years) participated in 9 weeks of cognitive behavioral therapy. Meshcher-Garwood point-resolved spectroscopy was used to measure γ-aminobutyric acid and Glx levels in the anterior cingulate cortex. The γ-aminobutyric acid and Glx levels in the addicted group were compared with those in controls and after cognitive behavioral therapy. The γ-aminobutyric acid and Glx levels correlated with clinical scales of Internet and smartphone addiction, impulsiveness, depression, anxiety, insomnia, and sleep quality.

RESULTS

Brain parenchymal and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios were higher in subjects with Internet and smartphone addiction (P = .028 and .016). After therapy, brain parenchymal- and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios were decreased (P = .034 and .026). The Glx level was not statistically significant in subjects with Internet and smartphone addiction compared with controls and posttherapy status. Brain parenchymal- and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios correlated with clinical scales of Internet and smartphone addictions, depression, and anxiety. Glx/Cr was negatively correlated with insomnia and sleep quality scales.

CONCLUSIONS

The high γ-aminobutyric acid levels and disrupted balance of γ-aminobutyric acid-to-Glx including glutamate in the anterior cingulate cortex may contribute to understanding the pathophysiology and treatment of Internet and smartphone addiction and associated comorbidities.

The Matthew Effect in Recovery from Smartphone Addiction in a 6-Month Longitudinal Study of Children and Adolescents

The clinical course of problematic smartphone use (PSU) remains largely unknown due to a lack of longitudinal studies. We recruited 193 subjects with smartphone addiction problems for the present study. After providing informed consent, the subjects completed surveys and underwent comprehensive interviews regarding smartphone usage. A total of 56 subjects among the 193 initially recruited subjects were followed up for six months. We compared baseline characteristics between persistent addicted users and recovered users at the end of the 6-month follow-up. Persistent problematic smartphone users displayed higher baseline smartphone addiction severity and were more prone to develop mental health problems at the follow-up. However, baseline depressive or anxiety status did not significantly influence the course of PSU. PSU behaved more like an addictive disorder rather than a secondary psychiatric disorder. Harm avoidance, impulsivity, higher Internet use, and less conversation time with mothers were identified as poor prognostic factors in PSU. Lower quality of life, low perceived happiness, and goal instability also contributed to persistent PSU, while recovery increased these scores as well as measures of self-esteem. These findings suggest that the Matthew effect is found in the recovery of PSU with better premorbid psychosocial adjustment leading to a more successful recovery. Greater clinical resources are required for interventions in vulnerable populations to modify the course of this increasingly prevalent problematic behavior worldwide.

Relationship between smartphone addiction and meaning and purpose of life in students of health sciences

PURPOSE

In this study was aimed to examine the relationship between smartphone addiction (SA) and meaning and purpose of life (MPL) of university students.

DESIGN AND METHODS

A cross-sectional study consisted of 677 students studying in students of Health Sciences. The data were collected by a questionnaire included the smartphone addiction scale-short form and the meaning and purpose in life scale.

FINDINGS

A significant and negative correlation was found between SA and the MPL levels.

PRACTICE IMPLACITIONS

Individual coping programs with SA should be handle within the scope of school health nursing. Also these programs should include activities to help students find meaning and purpose in their lives.

Examining bi-directionality between Fear of Missing Out and problematic smartphone use. A two-wave panel study among adolescents

BACKGROUND

In recent years, the Fear of Missing Out (FoMO) construct has been the object of growing attention in digital technology research with previous studies finding support for the relationship between FoMO and problematic smartphone use (PSU) among adolescents and young adults. However, no previous studies clarified the causal link between FoMO and PSU using a longitudinal design.

METHODS

An auto-regressive, cross-lagged panel design was tested by using a longitudinal dataset with two waves of data collection (T0 and T1, one year apart). Participants included two hundred and forty-two adolescents (109 males and 133 females), with a mean age of 14.16 years, who filled out the Fear of Missing Out scale (FoMOs) and the Smartphone Addiction Scale (SAS). Moreover, participants filled out the Difficulties in Emotion Regulation Scale (DERS), at the first time-point of data collection.

RESULTS

The findings of the study show that FoMO (both FoMO-Fear and FoMO-Control subscales) and PSU are positively related at both time-points (i.e. at a cross-sectional level). However no cross-lagged associations between them were longitudinally supported. Females and older adolescents show higher FoMO-Fear at T1.

CONCLUSIONS

The findings of the present study suggest caution when causal links between FoMO and PSU are inferred.

Smartphone-Based Answering to School Subject Questions Alters Gait in Young Digital Natives

Smartphone texting while walking is a very common activity among people of different ages, with the so-called "digital natives" being the category most used to interacting with an electronic device during daily activities, mostly for texting purposes. Previous studies have shown how the concurrency of a smartphone-related task and walking can result in a worsening of stability and an increased risk of injuries for adults; an investigation of whether this effect can be identified also in people of a younger age can improve our understanding of the risks associated with this common activity. In this study, we recruited 29 young adolescents (12 ± 1 years) to test whether walking with a smartphone increases fall and injuries risk, and to quantify this effect. To do so, participants were asked to walk along a walkway, with and without the concurrent writing task on a smartphone; several different parameters linked to stability and risk of fall measures were then calculated from an inertial measurement unit and compared between conditions. Smartphone use determined a reduction of spatio-temporal parameters, including step length (from 0.64 ± 0.08 to 0.55 ± 0.06 m) and gait speed (1.23 ± 0.16 to 0.90 ± 0.16 m/s), and a general worsening of selected indicators of gait stability. This was found to be mostly independent from experience or frequency of use, suggesting that the presence of smartphone activities while walking may determine an increased risk of injury or falls also for a population that grew up being used to this concurrency.

Hypnotised by Your Phone? Smartphone Addiction Correlates With Hypnotisability

Hypnosis and heavy smartphone use are both characterised by absorbed states in which one loses track of time and responds automatically to stimuli. In this pre-registered study, we tested whether there was a relationship between smartphone addiction and hypnotisability: one's tendency to follow suggestions under hypnosis. Over 11 public lectures, we hypnotised 641 student-aged participants; after the hypnosis session, participants completed the Smartphone Addiction Scale (Short Version). There was a positive correlation between hypnotisability and smartphone addiction (r = .17, 95% CI [.09, .24], p < .001) with a magnitude similar to standard predictors of hypnotisability. This correlation was small but unlikely spurious: it was positive in 10 of the 11 samples (including two from psychology courses) and persisted in a follow-up several months later. The addiction scores in this Canadian sample were unexpectedly high (M = 31.41) compared to other countries. We hypothesise that targeting the absorbed, time-distorted, and automatic use of smartphones may promote healthier phone habits.

The frequency of impairments in everyday activities due to the overuse of the internet, gaming, or smartphone, and its relationship to health-related quality of life in Korea

BACKGROUND

This study aimed to investigate the relationships between the frequency of impairments in daily activities due to the overuse of the Internet, gaming, or smartphones (IGS) and sociodemographic characteristics, social relationships (including family) & activities, psychosocial characteristics, health status, and health-related quality of life (HRQoL) of Korean adults.

METHODS

Secondary data from the 2017 Community Health Survey, a large-scale sample survey conducted yearly in South Korea, were analyzed for 190,066 adults over 19 years of age. Three categories were created for impairment groups due to IGS overuse: No Impairment, Mild Impairment, and Moderate-to-Severe groups. And between-group differences were examined using a one-way ANOVA for health status measured with the EQ-5D-3 L and chi-square tests for all categorical dependent variables, which included sociodemographic characteristics, social relationships & activities, and psychosocial factors. The association between frequencies of daily activity impairments due to IGS overuse and the dependent variables were examined using a multivariate logistic regression analysis and a linear regression model.

RESULTS

Approximately 21,345 (11.23%) of the 190,066 participants reported experiencing impairments in daily activities due to IGS overuse at least once in the previous year and the impairments were more severe in males than females. Participants experiencing impairments in daily activities contacted their friends a significantly higher number of times (4 times or more per month) and engaged in leisure activities more frequently (more than once per month) than those without impairments. There was also a significant positive relationship between IGS overuse and stress, depression, suicidal ideation, and suicide attempts. Among participants aged 19-64, impairments in daily activities due to IGS overuse were associated with a lower HRQoL. Conversely, for those aged 65 and over, mild and moderate-to-severe impairments due to IGS overuse were associated with a significantly higher HRQoL.

CONCLUSIONS

Increased impairments in daily activities due to IGS overuse may negatively affect mental health. However, among older adults, the frequency of such impairments was positively associated with HRQoL. This finding could be considered to apply interventions with Internet usage or ICT devices for older adults to enhance their quality of life.

Impact of Problematic Smartphone Use and Instagram Use Intensity on Self-Esteem with University Students from Physical Education

Mobile devices are a revolutionary element that offer many possibilities, although they can also cause problems for users. This is the case with the development of addictive behaviors that can affect personal well-being. The purpose of this paper has been to analyze the influence of smartphone addiction and Instagram use intensity on the self-esteem of Physical Education students. A cross-sectional research design was adopted by applying an online survey to a sample of undergraduate students (n = 385). The results showed that gender and age were factors that influenced the problematic use of the smartphone. In turn, there was a significant positive correlation between smartphone addiction and Instagram use intensity. The influence of smartphone addiction on students' self-esteem was also highlighted. In contrast, Instagram use intensity did not affect self-esteem. Finally, the findings are discussed, and the main implications of the study are established, where physical education students take on a special role in order to avoid the improper use of smartphones and Instagram through sport.

Associations of Electronic Device Use Before and After Sleep With Psychological Distress Among Chinese Adults in Hong Kong: Cross-Sectional Study

BACKGROUND

Hong Kong has a high rate of electronic device (e-device; computer, smartphone, and tablet) use. However, little is known about the associations of the duration of e-device use before and after sleep with psychological symptoms.

OBJECTIVE

This study aimed to investigate the associations of the duration of e-device use before and after sleep with psychological distress.

METHODS

A probability-based telephone survey was conducted on 3162 Hong Kong adults (54.6% female; mean age 47.4 years, SD 18.3 years) in 2016. Multivariate linear and Poisson regressions were used to calculate adjusted regression coefficients (aBs) and prevalence ratios (aPRs) of anxiety and depressive symptoms (measured by Patient Health Questionnaire-4) for the duration from waking to the first e-device use (≥61, 31-60, 6-30, and ≤5 minutes) and the duration of e-device use before sleeping (≤5, 6-30, 31-60, and ≥61 minutes).

RESULTS

The first e-device use in ≤5 (vs ≥61) minutes after waking was associated with anxiety (aB 0.35, 95% CI 0.24-0.46; aPR 1.74, 95% CI 1.34-2.25) and depressive symptoms (aB 0.27, 95% CI 0.18-0.37; aPR 1.84, 95% CI 1.33-2.54). Using e-devices for ≥61 (vs ≤5) minutes before sleeping was also associated with anxiety (aB 0.17, 95% CI 0.04-0.31; aPR 1.32, 95% CI 1.01-1.73) and depressive symptoms (aB 0.17, 95% CI 0.05-0.28; aPR 1.47, 95% CI 1.07-2.02). E-device use both ≤5 minutes after waking and for ≥61 minutes before sleeping was strongly associated with anxiety (aB 0.68, 95% CI 0.47-0.90; aPR 2.64, 95% CI 1.90-3.67) and depressive symptoms (aB 0.55, 95% CI 0.36-0.74; aPR 2.56, 95% CI 1.69-3.88).

CONCLUSIONS

E-device use immediately (≤5 minutes) after waking and use for a long duration (≥61 minutes) before sleeping were associated with anxiety and depressive symptoms among Chinese adults in Hong Kong.

Use of Instagram by Pre-Service Teacher Education: Smartphone Habits and Dependency Factors

It is increasingly common to upload photographs on the Internet of sports practices carried out. However, this behavior can be related to smartphone addiction, which has become a global problem. In turn, the intensive use of the Instagram social network has begun to be linked to addictive behaviors on mobile devices. The purposes of this paper were to analyze the Instagram usage habits of future primary school teachers, to determine the influence of sociodemographic factors on intensive Instagram use and smartphone addiction, and to determine the influence of intensive Instagram use on smartphone addiction. For this purpose, a transversal design was adopted where two standardized scales were applied to a sample of university students of the Primary Education Degree of the University of Granada, Spain (n = 385). The results showed that the type of image most uploaded to this social network was the selfie, well above sport. Furthermore, the structural equation model highlighted the significant influence of the intensive use of Instagram and smartphone addiction. Finally, the implications and findings of this study are discussed, highlighting the importance of generating healthy habits regarding the use of technology.

Depression, anxiety and fear of missing out as correlates of social, non-social and problematic smartphone use

Few studies have examined mental health variables in relation to social vs. non-social smartphone use, and how such types of use relate to problematic smartphone use (PSU). We conducted a web survey of 316 American undergraduate students about severity of depression, anxiety, fear of missing out (FOMO), social and non-social smartphone use, and PSU. Using structural equation modeling, we found that compared to social smartphone use, non-social use was more strongly linked with severity of PSU (β = 0.18, p < .05) and FOMO (β = 0.24, p < .05). FOMO mediated relations between depression severity and non-social smartphone use (β = 0.09, p = .04). Furthermore, FOMO mediated relations between both depression (β = 0.23, p < .001) and anxiety (β = 0.16, p = .04) with PSU severity. We discuss non-social smartphone use as a possible avoidance strategy among anxious individuals, and the role of FOMO in individuals desiring social connectedness but also feeling socially anxious. Results are discussed in the context of a comprehensive theoretical model on pathways toward excessive internet use.

Internet, gaming, and smartphone usage patterns of children and adolescents in Korea: A c-CURE clinical cohort study

BACKGROUND AND AIM

Whereas many studies on Internet gaming disorder (IGD) have used self-report questionnaires, only a few have adopted clinical interviews and samples. The current study aimed at using data from face-to-face diagnostic interviews, based on the criteria for IGD in the DSM-5, to determine the Internet, gaming, and smartphone usage patterns of children and adolescents.

METHODS

A latent class analysis was conducted using data collected through diagnostic interviews for Internet, gaming, and smartphone addiction with 190 participants (M = 13.14 years, SD = 2.46; 143 boys, 47 girls) who were part of a multicenter clinical cohort study.

RESULTS

Participants were classified into four groups: pleasure-seeking (Class 1), internal-use (Class 2), problematic-use (Class 3), and pathological-use (Class 4). The pleasure-seeking group (8.11%) showed low tendencies in general and proper control. The internal-use group (17.63%) showed significant increases in "cognitive salience" and "craving," with strong internal desires. The problematic-use group (37.28%) had no "interference with role performance"; however, they displayed "difficulty regulating use" and "persistent use despite negative consequences," with a slight functional impairment. The pathological-use group (36.98%) scored the highest on all these items, revealing a severe functional impairment. Compared to the other groups, the pathological-use group had the highest depression and daily stress levels and displayed the lowest levels of happiness.

CONCLUSIONS

This study provides basic data to elucidate Internet, gaming, and smartphone overuse patterns among children and adolescents, which could be used to develop differentiated intervention strategies for each group.

Structural and functional correlates of smartphone addiction

Popularity and availability of smartphones have dramatically increased in the past years. This trend is accompanied by increased concerns regarding potentially adverse effects of excessive smartphone use, particularly with respect to physical and mental health. Recently, the term "smartphone addiction" (SPA) has been introduced to describe smartphone-related addictive behavior and associated physical and psychosocial impairment. Here, we used structural and functional magnetic resonance imaging (MRI) at 3 T to investigate gray matter volume (GMV) and intrinsic neural activity in individuals with SPA (n = 22) compared to a control group (n = 26). SPA was assessed using the Smartphone Addiction Inventory (SPAI), GMV was investigated by means of voxel-based morphometry, and intrinsic neural activity was measured by the amplitude of low frequency fluctuations (ALFF). Compared to controls, individuals with SPA showed lower GMV in left anterior insula, inferior temporal and parahippocampal cortex (p < 0.001, uncorrected for height, followed by correction for spatial extent). Lower intrinsic activity in SPA was found in the right anterior cingulate cortex (ACC). A significant negative association was found between SPAI and both ACC volume and activity. In addition, a significant negative association between SPAI scores and left orbitofrontal GMV was found. This study provides first evidence for distinct structural and functional correlates of behavioral addiction in individuals meeting psychometric criteria for SPA. Given their widespread use and increasing popularity, the present study questions the harmlessness of smartphones, at least in individuals that may be at increased risk for developing smartphone-related addictive behaviors.

[Validity and reliability of the Chinese version of Mobile Phone Involvement Questionnaire in college students]

OBJECTIVE

To test the validity and reliability of the Chinese version of Mobile Phone Involvement Questionnaire (MPIQ) in college students.

METHODS

We assessed the degree of phone dependence using the MPIQ among 2122 college students. One month later, 60 students were randomly selected for assessment with the MPIQ, and the ROC curve was generated to evaluate the true positive rate (sensitivity) and false positive rate at different cutoff values to determine the optimal cutoff score of the MPIQ.

RESULTS

Among 98.9% of the participants who finished all the items, their MPIQ scores show a positive skew distribution and a one-factor structure. The load scores of the items ranged from 0.54 to 0.77. The Cronbach's α coefficient and the Spearman Brown split reliability were 0.84 and 0.83, respectively, the correlation coefficients between the items and total score ranged from 0.54 to 0.76, and the test-retest reliability was 0.48 (P &lt; 0.001). At the optimal cut-off score of 32, the sensitivity and the specificity of the MPIQ were 0.634 and 0.652, respectively.

CONCLUSIONS

At the optimal cut-off score of 32, the MPIQ has good validity and reliability for assessing phone dependence among college students.

Confirmatory Factor Analysis of the Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia

BACKGROUND

At present, the validity and reliability evidence of the Malay version of the Smartphone Addiction Scale (SAS-M) is only available by exploratory factor analysis (EFA). The aim of this study is to validate and determine the psychometric properties of the SAS-M by confirmatory factor analysis (CFA).

METHODS

A cross-sectional study was conducted among 323 medical students in Universiti Sains Malaysia. The students were given questionnaire forms consisting of socio-demographic information, the SAS-M and the Malay version of the Internet Addiction Test (MVIAT). The CFA was conducted using robust maximum likelihood estimator. The internal consistency reliability was determined by Raykov's rho coefficient. The concurrent validity was assessed by the Pearson's correlations between the factor scores of the SAS-M and the MVIAT.

RESULTS

The analysis showed the five-factor model of the SAS-M has an acceptable model fit after the inclusion of 12 correlated errors (SRMR = 0.067, RMSEA 0.059 (90% CI: 0.054, 0.065), CFI = 0.895, TLI = 0.882). The factor loadings ranged from 0.320 to 0.875. The internal consistency reliability was good (Raykov's rho = 0.713 to 0.858) and it showed good concurrent validity with the MVIAT.

CONCLUSIONS

The CFA showed that the SAS-M is a valid and reliable self-administered questionnaire to measure the level of smartphone addiction among medical students.

Predictors of problematic smartphone use among university students

Predictors of problematic smartphone use have been found mainly in studies on elementary and high school students. Few studies have focused on predictors related to social network and messaging apps or smartphone model. Thus, the objective of our study was to identify predictors of problematic smartphone use related to demographic characteristics, loneliness, social app use, and smartphone model among university students. This cross-sectional study involved 257 Brazilian university students who answered a smartphone addiction scale, a questionnaire about smartphone usage patterns, and the Brazilian version of the UCLA-R loneliness scale. Women, iPhone owners, and users of Instagram and Snapchat had significantly higher smartphone addiction scores. We found correlations between scores for the Brazilian version of smartphone addiction scale and the importance attributed to WhatsApp, Facebook, Instagram, and Snapchat, and the Brazilian version of the UCLA-R loneliness scale. Our hierarchical regression model predicted 32.2% of the scores of the Brazilian version of the smartphone addiction scale, with the greatest increase in predictive capability by the step that added smartphone social app importance, followed by the step that added loneliness. Adding the smartphone model produced the smallest increase in predictive capability. The theoretical and practical implications of these results are discussed.

Data-driven analysis using multiple self-report questionnaires to identify college students at high risk of depressive disorder

Depression diagnosis is one of the most important issues in psychiatry. Depression is a complicated mental illness that varies in symptoms and requires patient cooperation. In the present study, we demonstrated a novel data-driven attempt to diagnose depressive disorder based on clinical questionnaires. It includes deep learning, multi-modal representation, and interpretability to overcome the limitations of the data-driven approach in clinical application. We implemented a shared representation model between three different questionnaire forms to represent questionnaire responses in the same latent space. Based on this, we proposed two data-driven diagnostic methods; unsupervised and semi-supervised. We compared them with a cut-off screening method, which is a traditional diagnostic method for depression. The unsupervised method considered more items, relative to the screening method, but showed lower performance because it maximized the difference between groups. In contrast, the semi-supervised method adjusted for bias using information from the screening method and showed higher performance. In addition, we provided the interpretation of diagnosis and statistical analysis of information using local interpretable model-agnostic explanations and ordinal logistic regression. The proposed data-driven framework demonstrated the feasibility of analyzing depressed patients with items directly or indirectly related to depression.

Problematic Mobile Phone and Smartphone Use Scales: A Systematic Review

The popularity of smartphones is undeniable in nearly all facets of society. Despite the many benefits attributed to the technology, concern has grown over the potential for excessive smartphone use to become problematic in nature. Due to the growing concerns surrounding the recognized and unrecognized implications of smartphone use, great efforts have been made through research to evaluate, label and identify problematic smartphone use mostly through the development and administration of scales assessing the behavior. This study examines 78 existing validated scales that have been developed over the past 13 years to measure, identify or characterize excessive or problematic smartphone use by evaluating their theoretical foundations and their psychometric properties. Our review determined that, despite an abundance of self-report scales examining the construct, many published scales lack sufficient internal consistency and test-retest reliability. Additionally, there is a lack of research supporting the theoretical foundation of many of the scales evaluated. Future research is needed to better characterize problematic smartphone use so that assessment tools can be more efficiently developed to evaluate the behavior in order to avoid the excessive publication of seemingly redundant assessment tools.