Are 1 in 4 young people ‘addicted’ to smartphones?

A study by researchers at King’s College London has estimated that one in four children and young people use their smartphones in a way that is consistent with a behavioural addiction. The research was published in BMC Psychiatry.

By analysing literature that has been published since 2011 when smartphones first became widespread, the range of studies showed that 10-30% of children and young people used their smartphones in a dysfunctional way, which means an average of 23% were showing problematic smartphone usage (PSU).

PSU was defined as any behaviour linked to smartphones that has the features of an addiction, such as feeling panicky or upset when the phone is unavailable, finding it difficult to control the amount of time spent on the phone and using the phone to the detriment of other enjoyable activities.

The study is the first to investigate the prevalence of PSU in children and young people at this scale, summarising findings from 41 studies that have researched a total of 41,871 teenagers and young people. The 41 studies included 30 from Asia, nine from Europe and two America. 55% of the participants were female, and young women in the 17 to 19-year-old age group were most likely to have PSU.

The researchers also investigated the links of this type of smartphone usage and mental health and found a consistent association between PSU and poor measures of mental health in terms of depressed mood, anxiety, stress, poor sleep quality and educational attainment.

Co-senior author, Dr Ben Carter from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s, said: ‘There is currently a lot of public discourse around the possible negative effects of smartphone use, and previous research has tended to only examine the quantity and frequency of time spent on any technology or screen.

‘Our review assesses the effects not just of heavy use, but of dysfunctional smartphone use, and by looking at an ‘addicted’ pattern of behaviour towards smartphones we have established correlations between this type of dysfunctional behaviour and poorer mental health outcomes.’

Over the past decade there has been an increase in smartphone use among children and young people and this has occurred at the same time as a rise in common mental disorders in the same age group. To help clarify the possible association between smartphone use and mental health in children and young people the researchers investigated patterns of smartphone-related behaviour, rather than smartphone use per se.

Co-senior author Dr Nicola Kalk from the IoPPN said: ‘Smartphones are here to stay and there is a need to understand the prevalence of problematic smartphone usage. We don’t know whether it is the smartphone itself that can be addictive or the apps that people use. Nevertheless, there is a need for public awareness around smartphone use in children and young people, and parents should be aware of how much time their children spend on their phones.’

First author Samantha Sohn the IoPPN said: ‘Behavioural addictions can have serious consequences on mental health and day-to-day functioning, so there is a need for further investigation into problematic smartphone usage in the UK.

‘In order to determine whether PSU should be classified as a behavioural addiction we need longitudinal data looking at PSU in relation to more objective health outcomes, as well as evidence that people with PSU struggle to moderate their use.’

Dr Amy Orben, College Research Fellow at Emmanuel College and Research Fellow, MRC Cognition and Brain Sciences Unit, University of Cambridge, offered a more skeptical view.

“The review published in BMC Psychiatry systematically collected studies on the topic of problematic smartphone behaviour to examine both the prevalence and effects of these behaviours in the teenage population.

“While the study press release states that the study provides an estimate that 1 in 4 children and young people are affected by problematic smartphone usage, I myself am cautious to draw these conclusions on the basis of the evidence provided. This is due to multiple concerns about the review’s methodology and inference I set out below.

“Firstly, the review included data from 41 studies, only 7% of which were longitudinal. The review itself highlights that all studies were of poor or moderate quality, with a high risk of bias, meaning that they are not a robust basis for wide-reaching conclusions. Meta-analyses and systematic reviews operate on a ‘Garbage In, Garbage Out’ principle: if the studies forming the basis of the review are low in quality the review itself will also be of low quality.

“As a colleague once put it – bad ingredients make bad soup. Furthermore, the review only included studies up to October 15th 2017 which is over 2 years ago. This means that the review is most probably missing many crucial studies published since then, making results out of date.

Secondly, and of equal importance, is the lack of a consistent definition of problematic smartphone use in the review. In the 41 studies included, there were over 24 different and diverse definitions of problematic smartphone use. The authors averaged the prevalence of problematic smartphone use across all these 41 studies, without trying to take into account or match their many different definitions.

“By doing so they are likely to be comparing apples to oranges, especially as many measures of problematic smartphone use are poorly psychometrically validated and contested. This makes the conclusion that 1 in 4 children are affected by an undefined measure of problematic smartphone use very problematic in itself.

“Thirdly, a detailed outline of the search terms used when collecting the constituent studies included in this review was not available at time of writing this reaction. However, the overview of search terms in the main study seemed to show that the review included “behaviour, addictive” as a search term.

“This means that the review looked for studies that included the terms “behaviour” or “addictive” in their Medical Subject Headings. This should engender caution, as it makes it more likely that the review collected a biased sample of the literature. Studies that find addictive or problematic smartphone behaviour are more likely to state that in their title, abstract or text.

“Those studies that don’t find problematic smartphone behaviour, however, might fail to add such terminology into their study, as it is not important for their conclusions. This could lead to them not having “behaviour” or “addictive” in their Medical Subject Headings.

“As the review only collected those with these terms, it might be overlooking studies that did not find problematic smartphone use. This means that the study might be overestimating the prevalence of problematic smartphone usage.

“Lastly, it is important to note again that the vast majority of studies in this review (93%) where cross-sectional. This means that no causal statements can be made linking problematic smartphone use to outcomes like depression or suicide. It has been shown previously that smartphone effects are not a one-way street, but that mood can impact the amount of smartphone use as well, making these correlations bidirectional in nature.

“Overall, this study is a welcome addition to the literature which has been rapidly increasing in volume and is in need of careful synthesis. However, limits in its methodology means that the conclusions reached and relayed in the press release are uncertain and should be considered and replicated in other reviews before such results are taken as fact.””