Study examines links between problematic smartphone apply and anxiety, sleep and depression

In a recent study published in BMJ Mental HealthScientists have found a link between problematic smartphone apply (PSU) and anxiety, depression and insomnia among UK teenagers.

Background

Mental illness is the leading cause of disability in the UK, with depression and anxiety particularly common among teenagers. Smartphone apply has increased, and there is conflicting information about the link between screen time and anxiety and depression. Some argue that mobile phone apply is common among children and teenagers, while others believe it is maladaptive.

Most previous studies are cross-sectional, which raises doubts about causality. Some longitudinal studies in Southeast Asia have shown a elaborate relationship between PSU and depression, with psychiatric problems increasing PSU. However, previous studies have shown that psychosocial adjustments influence the rehabilitation or durability of PSU.

About the study

In this mixed, prospective cohort and longitudinal study, researchers investigated whether smartphone apply was associated with indigent mental health outcomes. They also explored adolescents’ understanding of smartphone apply, related advantages and disadvantages, and steps taken to reduce smartphone apply.

Researchers recruited 69 students aged 13 to 16 from two secondary schools to assess their mobile device apply, sleep, and mood using semi-structured questionnaires at baseline and after four weeks. They used the miniature version of the Smartphone Addiction Scale (SAS-SV) to assess exposure to PSU and followed participants from March 28 to June 3, 2022.

The primary outcome measure was anxiety, as measured by the Generalized Anxiety Disorder Questionnaire (GAD-7). GAD-7 scores of less than 5.0 indicated no anxiety, 5.0 to 9.0 indicated subtle anxiety, 10 to 14 moderate anxiety, and ≥15 severe anxiety. Secondary outcomes included changes in depressive symptoms based on the nine-item Patient Health Questionnaire (PHQ9) and insomnia severity, as measured by the Insomnia Severity Index (ISI).

PHQ9 scores below 5.0 indicated no depression, 5.0 to 9.0 indicated subtle depression, 10 to 14 moderate depression, and ≥15 severe depression. ISI scores below 7 indicated negligible insomnia, 8.0 to 14 subclinical insomnia, 15 to 21 moderate clinical insomnia, and 22 to 28 severe clinical insomnia. The researchers used linear regressions for analysis, adjusting for age and biological sex. They used Cronbach’s alpha values ​​to assess the internal reliability between study scores and conducted thematic analysis of free-text responses.

Results

The median age of participants was 15 years; 44% were female, and 59% were white. The overall prevalence of PSU was 15%, which was higher among women (17%) than men (11%). The PSU group was most likely to apply TikTok, Snapchat, and music-related apps, while the non-PSU group was more likely to apply YouTube, music apps, and TikTok.

Among PSU participants, 44% developed moderate to severe anxiety compared to 26% of those without PSU exposure. Among those exposed to PSU, 56% experienced depressive symptoms compared to 36% of those without PSU exposure, and 22% of those exposed to PSU and 23% of those without PSU reported sleep difficulties. The team found linear associations between PSU and changes in anxiety, depression, and insomnia, with increases of 10 PSU over four weeks increasing anxiety, depression, and sleep difficulties by 2.2, 1.4, and 2.1, respectively. There was good reliability between the results of the primary and secondary studies.

Of the participants, 90% tried to limit their smartphone apply, with 83% of the non-PSU group finding silencing their smartphones effective and 100% of the PSU group finding it somewhat effective. Seventy-two percent of the non-PSU group found turning off notifications effective, while 78% of the PSU group found it somewhat effective. Some found it complex to control their apply because they apply apps to set time limits, and some felt it should be an individual initiative.

The themes indicated mixed effects of smartphone apply on relationships and mood, negative effects on school performance and productivity, and a desire to reduce smartphone time. While smartphone apply facilitates communication with friends and family, especially those outside their local area, it can distance users from family, enhance irritability, and affect social interactions.

Smartphones can distract students, reducing productivity and time spent on homework. However, online educational resources can be beneficial. The impact of smartphone apply on school performance varies depending on the time spent using the device and the prioritization of other tasks, such as exams. Smartphone apply can improve mood by providing entertainment and reducing stress; however, negative effects have included self-comparison, cyberbullying, exposure to scary content, and suicidal thoughts. Long-term smartphone apply can enhance stress, suggesting that self-control and effective time management are key.

Application

In summary, based on the findings, increased mobile device apply may enhance anxiety, depression and sleep problems among UK teenagers. While most recognise the consequences of excessive smartphone apply and manage them effectively, some need support in using reduction techniques to control their apply.