Smartphone Use and Anxiety in University Students:
A Systematic Review of its Correlation and Contributing Variables
by Frankie Prologo, Pre-Med Biology
The rise in smartphone use among university students has raised concerns about its potential impact on mental health, particularly anxiety. Over the past decade, a growing body of cross-sectional studies investigated the relationship between smartphone use, anxiety, and associated factors in university students. Despite this increasing research interest, no systematic reviews have been published analyzing smartphone use, anxiety, and contributing variables in this population. This systematic review aims to provide an overview of the available research done on the correlation between smartphone use and anxiety in university students. Additionally, we examine how mediating factors such as depression, sleep quality, avoidant attachment, and self-control help to explain the correlation. A literature search was conducted through PubMed, Web of Science, and PsychINFO, focusing on studies published from 2014 to 2024. We included 12 cross-sectional studies. We observed a large amount of heterogeneity between studies’ outcome measurements. Not having a consistent scoring method of smartphone use and anxiety across studies made it difficult to draw generalizable conclusions. Nevertheless, our analysis revealed a positive correlation between smartphone use and anxiety. Stronger correlations were observed when these variables were occurring in the presence of poor sleep quality and/or depression. Our findings suggest that smartphone-related anxiety is not likely to exist in isolation. Rather, factors such as poor sleep quality and depression exacerbate the relationship. This review has potential clinical implications and can support future longitudinal studies done with university students to better understand the causation of this relationship over time.
smartphone use, anxiety, university students, mental health, screen time, psychological distress
Introduction
Smartphones are becoming increasingly common in a wide range of populations throughout the world (1). For instance, in 2021, the global number of smartphone users was estimated to be greater than 3.8 billion (2). This widespread use of smartphones has been associated with increased access to potentially negative influences such as gambling, internet gaming, and pornography (3). Additionally, prolonged smartphone use has been associated with poor physical fitness and worsening academic performance (4). In recent years, there have been growing concerns about how smartphones negatively impact mental health. Multiple studies investigating mental health have shown that smartphone use, especially in the form of addiction, is positively correlated with anxiety (1).
A systematic review in adults published by Ratan et al. in 2021 analyzed available research on how smartphone addiction relates to mental health (3). This review found that 14 of the 27 reviewed studies linked smartphone addiction to poor mental health outcomes, particularly depression and anxiety. The studies included in their review relied on self-reported data from questionnaires such as the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Smartphone Addiction Scale Short Version (SAS-SV). The review also indicated that smartphone use was associated with an array of neurological and physical problems. Neurologically, excessive smartphone use was associated with decreased grey and white brain matter in a pattern similar to substance abuse. Physically, smartphone use can lead to arthritis, neck pain, and hand flexion issues depending on the level of addiction. Although this review provides a quality overview of the research done on smartphone use and its negative outcomes in adults, to our knowledge, no systematic reviews have been published on the correlation between smartphone use and anxiety specifically in university students.
University students appear to be especially vulnerable to experiencing the negative effects of smartphones due to academic pressures, social expectations, and increased accessibility of smartphones (1). Students with mental health problems often have poor relationships with other students and faculty members, lower levels of student involvement, lower grades, and lower graduation rates compared to students without mental health issues (3). Some studies have shown smartphone related mental health issues leading to more serious consequences such as suicidal behavior (3, 5).
Because of these concerning trends, there has been a growing body of cross-sectional studies exploring the impacts of smartphone use on mental health in college students across the world. For example, research conducted in Jordan showed that more than half of the university students surveyed were addicted to smartphones and had heightened anxiety levels (1). Similar findings were reported in Egypt where 44% of the surveyed students had smartphone addiction that was positively correlated with anxiety and poor sleep quality (5). Another similar study conducted in Lebanon found that students with high stress and anxiety levels were more likely to be addicted to smartphones (6).
While these studies focus on the direct relationship between smartphone use and anxiety, evidence suggests that there are also mediating factors. For instance, poor self-regulation and procrastination behaviors, suboptimal sleep quality, and low self-esteem might increase anxiety and cause smartphone addiction (6-8). Thus, the correlation between smartphone use and anxiety does not exist in isolation, and these mediating factors may explain the strength of the relationship. Regardless of the nature of the relationship, these studies highlight a global trend linking smartphone addiction with increased anxiety in university students.
Despite the growing body of research involving university students, knowledge gaps still exist on this topic. For instance, lack of causation from cross-sectional studies, socioeconomic concerns, mediating variables, and research primarily taking place with adults make it difficult to draw conclusions on how smartphones are affecting university students’ anxiety levels from one study alone. Socioeconomic factors are a concern because they can influence the outcomes of studies but are not always noted. For example, a geographical region may have high mental health awareness and thus naturally record lower anxiety scores—skewing the data. In addition, mediating variables can affect the strength of correlation between smartphone use and anxiety, so the correlation can vary between studies. Further research is needed to address these knowledge gaps in the university student population.
We are conducting this systematic review to provide an overview of relevant research that has been done on the correlation between smartphone use and anxiety in university students. The review will focus on studies that examine the relationship between smartphone use and anxiety as well as other mediating variables such as location, methods, and other variables researchers may have explored. Thorough analysis of these studies will show the potential correlations between smartphone use and anxiety in the university student population.
The findings of this review may benefit university workers, students, and healthcare professionals. By understanding more about the correlation and potential causation link between smartphone use and anxiety, future research can focus on interventions to decrease smartphone related anxiety in college students. For instance, universities might implement programs to promote healthier smartphone use habits, while mental health professionals could provide more effective support for students struggling with anxiety related to smartphone use. Overall, targeted interventions can improve the quality of life for university students across the world.
Methods
Search Strategy
We conducted a literature search using the databases PubMed, Web of Science, and PsychINFO in September 2024. The search was restricted to studies published between 2014 and 2024. We further reviewed reference lists in relevant articles for additional eligible studies.
Eligibility Criteria
From the resulting search, we selected primary, peer-reviewed research published between 2014 and 2024. All included manuscripts performed randomized, cross-sectional studies investigating anxiety and smart phone use in university students. We restricted the review to one type of study to allow consistent comparison between papers. No specific age range was required as university student age varies worldwide. Studies from all countries were eligible, as were single or multi-site studies. Studies that examined variables other than smartphone use and anxiety were still eligible for review provided that the primary association between smartphone use and anxiety was analyzed. We excluded studies that did not measure smartphone use or anxiety, non-primary research articles, and articles not written in English.
Data Extraction
Data tables were constructed in Microsoft Excel. From each article, we extracted the authors’ names, year of publication, study location, sample size, study design, and scoring methods and scores for both smartphone use/addiction and anxiety. We also extracted the statistical methods used to analyze the strength of the correlation between smartphone use and anxiety. Additionally, we extracted mediating variables, such as sleep quality, that were measured alongside smartphone use and anxiety to better understand their effect on the correlation.
Results
Characteristics of The Studies
As seen in Table 1, this review included 12 studies that investigated the correlation between smartphone use and anxiety in university students. All studies were cross-sectional. The sample sizes ranged from 226-2,337 participants. Studies took place at universities in a wide range of countries including China, Lebanon, South Korea, Turkey, Jordan, and Oman. Most studies listed their population as “university students.” However, two studies took place with graduate healthcare students (9, 10). All studies that reported their gender distribution included a majority of females. Geng et al. had the largest gender gap, including 83.1% females (7).
Methodologies of Included Studies
Table 2 illustrates the scoring methods utilized by each study for smartphone use and anxiety and the statistical analysis methods used for evaluation of the potential correlations. Nine of the studies used the Smartphone Addiction Scale or Smartphone Addiction Scale Short Version (SAS/SAS-SV) to score smartphone use (1, 5, 7-9, 11-14). Other methods used to measure smartphone use included the Young Internet Addiction Test (YIAT), Internet Addiction Test (IAT), and Smartphone Addiction Inventory (SAI) (6, 10, 15). The most common method to score anxiety was the Depression Anxiety and Stress Scale (DASS) with seven studies using this tactic (5, 7, 9, 10, 12-14). Other methods used to measure anxiety included the Spielberger Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Kessler Psychological Distress Scale (KPDS), and General Anxiety Disorder Scale – 7th edition (GAD-7) (1, 6, 8, 11, 15). Five of the studies used Pearson correlation analysis to statistically analyze the relationship between smartphone use and anxiety (7, 9, 10, 13-15). Other common methods used to analyze this relationship included Spearman correlation and linear regression.
Outcomes of Smartphone Use and Anxiety
Smartphone use was positively correlated with anxiety in all studies (Table 3). Correlations between smartphone use and anxiety were significant in all studies with p values consistently below .05. Six of the studies reported very strong correlations with p values less than .0001 (5, 6, 9, 10, 12, 13).
Although the studies exhibit different correlation strengths, all 12 studies showed that smartphone use and anxiety are closely related. For example, Peng et al. found it likely that smartphone addiction directly contributes to anxiety, citing that 71.03% of smartphone-addicted students also had anxiety (15). Conversely, Boumosleh & Jaalouk found that anxiety is a positive predictor of smartphone addiction, suggesting students use smartphones as a coping mechanism (6). Further, Abuhamdah et al. found that 59.1% of participant’s psychological distress can be attributed to smartphone addiction (1). These mixed findings highlight the complex relationship between smartphone use and anxiety.
Other Variables Influencing the Correlation between Smartphone Use and Anxiety
Table 4 lists the reported mediating factors and their effect on the correlation between smartphone use and anxiety. A clear trend is that depression was closely linked to smartphone use and anxiety. Seven of the twelve studies showed depression co-occurring with anxiety and/or smartphone use (5, 6, 9, 10, 12, 13). For example, Okasha et al. found that high smartphone usage was associated with both heightened anxiety and depression (5). Geng et al. found that depression can amplify anxiety levels and indirectly increase the strength of the correlation between smartphone addiction and anxiety (7). Peng et al. cited that the presence of depression can increase the correlation between smartphone addiction and anxiety as well as decrease learning engagement (15). Additionally, Bomosleh and Jaalouk found that depression can serve as a positive predictor of smartphone addiction (6). The co-occurrence of depression had great influence on the correlation between smartphone use and anxiety.
Four studies investigated sleep quality and identified it as a key mediating factor in the relationship between smartphone use and anxiety (5, 11-13). Across all four studies, sleep quality was diminished by anxiety, depression, smartphone addiction, or a combination of these factors. For instance, Demirci et al. found smartphone addiction can cause anxiety and depression which can in turn predict poor sleep quality (11). In addition, Nikolic et al. found that students who used smartphones for more than four hours per day had poorer sleep quality and more anxiety (12). Poor sleep quality is closely linked to smartphone-related anxiety.
Some studies also found that sociodemographic and lifestyle factors were mediators to the relationship between smartphone use and anxiety. Abuhamdeh et al. noted that female students, divorced individuals, and those experiencing sleep disturbances were more prone to smartphone-related anxiety (1). However, they also found that higher-income students were less likely to experience anxiety (1). Al Battashi et al. found that male students who live off campus reported higher levels of smartphone-related anxiety (9). In contrast, Boumosleh & Jaalouk found that gender, residence, work hours per week, GPA, lifestyle habits, and religious practice were unrelated to students’ smartphone addiction scores (6). These findings highlight the varied influence of sociodemographic and lifestyle factors on the relationship between smartphone use and anxiety.
Other mediating factors were identified by individual studies. For example, Geng et al. suggested that students who delay their bedtime to use smartphones will be more prone to anxiety, suggesting bedtime procrastination is a mediating factor (7). The relationship between smartphone addiction and anxiety was also mediated by self-control (14). For example, students with greater self-control might have lower anxiety levels even when combined with increased smartphone use (14). Kim et al. found that self-esteem and avoidant attachment are mediating factors (8). For instance, students with avoidant attachment issues were more likely to use smartphones to cope with uncomfortable social situations, thereby increasing anxiety (8).
Discussion
Main Results
This review of 12 studies conducted in various geographical contexts revealed that smartphone use and anxiety have a strong, positive correlation in university students. In addition, our analysis found that mediating variables can have significant effects on the correlation between smartphone use and anxiety. For example, sleep quality was a significant mediating variable. All studies that investigated sleep quality as a mediating variable showed that participants had decreased sleep quality when combined with smartphone use, anxiety, or both (9-11, 13).
Depression also acted as a mediating variable. Studies that investigated depression tended to show significantly stronger correlations between smartphone use and anxiety (5, 6, 9, 10, 12, 13). These studies also found that depression was commonly associated with anxiety, indicating that anxiety is not likely to occur in isolation (5, 6, 9, 10, 12, 13). For instance, Okasha et al. observed a very strong correlation between smartphone use and anxiety while more than half of the smartphone-addicted participants had a co-occurrence of depression (5). This pattern indicates that depression may compound the negative effects of anxiety and/or smartphone addiction. The influence of depression on the correlation between smartphone use and anxiety is important to consider when developing interventions to lower smartphone-related anxiety.
Sociodemographic factors may also play a role in mediating the relationship between smartphone use and anxiety. A trend across the studies was that females had stronger correlations between smartphone use and anxiety (1, 10-12). Additionally, Abuhamdah et al. and Okasha et al. suggested that socioeconomic status influences the correlation between smartphone use and anxiety (1, 5). They found that students with lower income backgrounds had proportionally more smartphone-related anxiety than students from higher income backgrounds (1, 5). While these sociodemographic factors are not universally predictive, they provide insight into how lifestyle, socioeconomic status, and gender factor into the complexity of the relationship between smartphone use and anxiety.
Current Research
Our review is consistent with available research that states smartphone use and anxiety are positively correlated and influenced by mediating variables. For example, our results are in accordance with the research done by Ratan et al. who found a strong association between smartphone addiction and mental health issues, particularly anxiety and depression (3). Additionally, they found that smartphone addiction was associated with poor sleep quality and reduced sleep duration (3). Ratan et al. also found smartphone-related anxiety to be associated with various negative physical and neurological outcomes such as reduced white matter integrity (3). Our review did not investigate the physical and neurological impacts of smartphone-related anxiety.
Another systematic review by Elhai et al. examined 23 studies on problematic smartphone use and psychopathology (4). Although both anxiety and depression exhibited positive correlations to smartphone use, their review found that depression had a stronger link (4). In our review, depression and anxiety were equally likely to be correlated to smartphone use. This supports the need for future research into the potential role that depression might play in the correlation between smartphone use and anxiety. In addition, Elhai et al. found little association between decreased self-esteem and problematic smartphone use (4). In contrast, two studies in our review found a significant association between low self-esteem and smartphone use (8, 10).
This review increases awareness of the adverse effects that smartphone use can have on aspects of daily life, well-being, and mental health. Our review contributes congruent results to a body of research that suggests smartphone use is tightly linked to anxiety and other mental health conditions. Given the large quantity of smartphone use in student life, it is crucial for universities and other institutions to acknowledge these risks.
Study Limitations
The studies included in this review exhibit considerable heterogeneity. Primary sources of heterogeneity include geographic and cultural differences between studies. These cultural differences can affect both the extent of smartphone use and how mental health issues are perceived and reported. In addition, the studies varied in their methods for assessing smartphone use and anxiety. The Smartphone Addiction Scale (SAS or SAS-SV) was a common measurement of smartphone use. However, other studies employed tools such as the Internet Addiction Test (IAT) and the Young Internet Addiction Test (YIAT). This makes it difficult to evaluate results from direct comparison between studies. Similarly, anxiety was measured using various scales including the Beck Anxiety Inventory (BAI), Depression Anxiety Stress Scale (DASS), and Generalized Anxiety Disorder Scale (GAD-7). Each of these scales has different scoring criteria and sensitivity to the symptoms of anxiety—furthering the difficulty of direct comparison.
Study populations also contributed to heterogeneity. For example, medical students reported higher baseline levels of anxiety and stress compared to the university students in other studies (10). Further, gender imbalances in sample composition (majority females) might influence the findings. For instance, one study showed that females had higher levels of smartphone-related anxiety due to a previously elevated baseline level of anxiety (1). If females are more likely to display a certain trait, it becomes difficult to generalize the results to a broader, split-gender population. Future studies should aim to standardize the measurement tools and control sociodemographic factors to enhance comparability.
Additional limitations include the reliance on self-reported data and all studies being cross-sectional. Self-reported data can introduce bias into the results due to under/over reporting of data. For example, students might underreport their anxiety levels out of embarrassment. Cross-sectional studies do not allow for determination of causation. However, these compiled findings of cross-sectional studies showed a positive trend of the correlation between smartphone use, anxiety, and its influences in university students.
Future Research Directions
The findings of this review can assist mental health professionals in identifying individuals who are at risk of depression or anxiety. Patients exhibiting any of the correlations mentioned in this review should be considered for potentially serious mental health concerns.
In addition, data outlined in this review shows that longitudinal studies are needed to better understand the causal relationship between smartphone use and anxiety among university students over time. Tracking smartphone use and anxiety over time can aid researchers in determining whether excessive smartphone use leads to increased anxiety or if anxiety predisposes individuals to greater levels of smartphone use.
Further, this review can be used to guide research into mediating factors that affect the correlation between smartphone use and anxiety. We found that depression and poor sleep quality played a significant role in the correlation between smartphone use and anxiety in university students. Exploring how these factors interact could help establish interventions for university students and other high-risk groups. Researchers may also examine how specific smartphone activities (i.e. social media use, academic-related use, or gaming) relate to anxiety, sleep quality, and depression.
In addition to investigating these mediating factors, it is also important to address inconsistencies in measurement across studies. We show that studies vary greatly in their methodology of assessing smartphone use and anxiety. Future studies should consider standardizing the scoring methods of smartphone use and anxiety to allow for enhanced comparability in future reviews. Developing a universally accepted scale for measuring smartphone dependence and anxiety symptoms would help unify available research.
Conclusion
Overall, the studies examined in this review demonstrate a consistent, positive correlation between smartphone use and anxiety in university students. In addition, depression and low sleep quality were consistently linked to the correlation. This review can serve as a foundation for developing longitudinal studies that examine the correlation between smartphone use and anxiety in university students. Understanding the correlation between smartphone use, anxiety, and its mediating variables longitudinally can validate our results and further support interventions to improve mental health. Future research into the reduction of the correlation between smartphone use and anxiety may improve sleep quality, reduce anxiety and/or smartphone use, and reduce depression—improving quality of life for university students.
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