Smartphone overuse tied to adverse mental health outcomes, SG survey says

A health and lifestyle survey conducted among Singapore residents aged 15–65 years has identified a link between problematic smartphone use (PSU) and adverse mental health outcomes.

“In Singapore, the prevalence of PSU was 30.2 percent, translating to about one in three people in the general population having PSU,” the investigators said. While the number appears high, Hong Kong beats this – with its weighted PSU prevalence of 38.5 percent – according to a population-based survey among adults aged ≥18 years. [J Behav Addict 2018;7;1157-1165]

When looking at the link between PSU and adverse mental outcomes, individuals with PSU were more prone to experience symptoms of moderate or severe depression (odds ratio [OR], 3.2), anxiety (OR, 3.4), insomnia (OR, 3.4), and poorer positive mental health (β, –0.3; p<0.001 for all). [Asian J Psychiatr 2024:98:104124]

“The association between PSU and anxiety, depression, and insomnia is concerning,” they stressed.

According to the Compensatory Internet Use Theory, excessive internet use may be attributed to an attempt to cut negative sentiments. [Comput Hum Behav 2014;31:351-354] “As the smartphone is constantly accessible and available for use, those in distress may turn to using it to feel better,” the researchers said.

The sleep disturbance or displacement may be due to the delayed onset of melatonin production due to the electromagnetic radiation from the phones, as well as the cognitive arousal that could trigger insomnia. [Behav Sci (Basel) 2023;13:839; Int J Radiat Biol 2006;82:69-76; Pers Ubiquitous Comput 2023;27:447-466]

The odds of experiencing PSU were lower among older individuals (adjusted ORs [aORs], 0.6 and 0.3 for the respective 35–49- and 50–65-year age groups; p<0.001 for both), suggesting that the younger ones (15–34-year age group) were more predisposed to smartphone overuse. This is supported by the higher odds of PSU in the pre-tertiary education subgroup (aOR, 1.3; p=0.033), which comprised mostly younger participants (ie, those in vocational institute, pre-university, junior college, and diploma) at the time of analysis.

“The dependence of younger respondents on smartphones for socialization purposes, coupled with lower self-control and higher social stress and anxiety, may predispose them to PSU,” the researchers explained. The COVID-19 pandemic may have upped the dependency as the study was conducted during this time, they added.

Valuable insights into mental health comorbidities

The investigators used data from the Health and Lifestyle Survey. A total of 6,509 participants completed the survey (response rate 73.2 percent), and 5,536 (50.7 percent women) were included in the analysis. About 40 percent of the participants were in the 15–34-year age group. The Smartphone Addiction Scale – Short Version was used to evaluate PSU. Although this is a widely used assessment tool to identify PSU, diagnosis could not be confirmed by clinical assessment, the researchers noted.

The study may have also been limited by the small R-square value and weak effect size found in the association between PSU and positive mental health, they added. “However, as positive mental health is an emerging field in Singapore, this finding can still inform relevant organizations on strategies to promote positive mental health in the country.”

The high response rate ensures generalizability of the findings to the Singapore population, while the translation of questionnaires into all four major languages spoken in Singapore ensures inclusivity. The self-administered survey approach and data confidentiality assurance also dialled down the risk of social desirability bias.

“The study is the first to examine PSU in a national sample of Singaporeans across a wide age range. It provides valuable insights into mental health comorbidities among those with PSU, which is useful for practitioners,” the researchers concluded.

Other noteworthy consequences of smartphone overuse include loss of productivity due to constant interruptions and detachment difficulties, compromised quality time with family and during occasions, and increased risk of vehicular accidents. [Addict Behav Rep 2017;6:90-95; J Occup Health Psychol 2014;19:74-84; Int J Manag Rev 2018;20:825-846; Accid Anal Prev 2018;119:149-154; J Med Internet Res 2022;24:e21313]

Longitudinal studies are thus warranted to further elucidate the association between PSU and adverse health outcomes.