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International Journal of Health Sciences & Research (www.ijhsr.org) 163
Vol.8; Issue: 1; January 2018
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article
Relationship between Smartphone Addiction with Anxiety and Depression
among Undergraduate Students in Malaysia
Norbaidurah Ithnain1, Shazli Ezzat Ghazali2, Norrafizah Jaafar1
1Health Education Officer, Institute for Health Behavioural Research, Ministry of Health Malaysia, Jalan
Rumah Sakit, 50590 Bangsar, Kuala Lumpur, MALAYSIA
2Lecturer of Health Psychology Programme. Faculty of Health Sciences, The National University of Malaysia,
Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, MALAYSIA
Corresponding Author: Norbaidurah Ithnain
ABSTRACT
Recently, smartphone addiction has become a public health concern because it leads to poor mental
health; anxiety and depression among university students around the world. Therefore, the objective
of the study was to identify the relationship between smartphone addiction with anxiety and
depression among undergraduate students in one of a local university in Malaysia on September 2016.
Smartphone Addiction Scale (SAS-M), Beck Anxiety Inventory (BAI-M) and Beck Depression
Inventory (BDI-M) were used as a data collection tool. Analysis of the data was done using IBM
SPSS software version 21.0. A total of 369 students (299 female and 70 male; mean age=19.3±0.98)
participated in this study. Descriptive analysis results showed scores of smartphone addiction, anxiety
and depression students were 102.52±7.21, 10.15±8.08 and 7.96±6.21. The inferential analysis found
a statistically significant positive relationship between smartphone addiction with anxiety and
depression (p<0.001). Smartphone addiction was found as predictor to anxiety (B=0.052, t=4.469,
p<0.001) and depression (B=0.091, t=6.067, p<0.001) respectively. The findings of this study showed
university students in Malaysia were inclined towards becoming addicted to smartphone and were
exposed to anxiety and depression. Implementation of health education programs and interventions
that are appropriate to deal with addiction and improve mental well-being can empower students to
practice healthy behaviors.
Keywords: Smartphone addiction, anxiety, depression, undergraduate students, Malaysia
INTRODUCTION
Smartphone technology is rapidly
expanding worldwide including Malaysia.
The rapid development of the technology
has a positive impact on users that can
utilize smartphones not to just make calls
and messaging, but the applications in
smartphone covering various fields that
complemented the life of the people. In
2016, the number of smartphone users in the
world is estimated to reach 2.1 billion and
expected to grow to 2.8 billion in 2020. [1]
Malaysia recorded 18.46 million number of
smartphone users in 2016 and this number is
projected to increase to more than 20
million in 2020. [2]
According to Smartphone User
Persona Report from Vserv on 2015,
smartphone users in Malaysia spent more
time each day at 187 minutes each day, or 3
hours 7 minutes with their devices
compared to their neighbouring countries
such as Indonesia, Philippines and Thailand.
During this period, the most smartphone
usage were social networks and chat
applications. [3] Convenience, social needs
and social influences were among the
factors influencing smartphone usage
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 164
Vol.8; Issue: 1; January 2018
among users. [4-7] Therefore, smartphones
today have played an important part in our
community technoculture especially among
young generation.
Despite the advantages and needs of
smartphone, excessive use can lead to
smartphone addiction. Smartphone
addiction refers to dependency, excessive
and uncontrolled use of the smartphone. [8, 9]
The phenomenon of smartphone addiction
has been a global concern as it can
contribute to poor mental health especially
among university students. [10-16] Based on
previous studies, smartphone addiction has
also been categorized as behavioural
addiction due to the inability of users to
control their use. [11,17]
According to Choliz, [18] the problem
of using smartphones is related to
behavioural addiction due to clinical
features such as psychological effects on
emotions, personality and cognitive in
which the younger generation is more
vulnerable to excessive usage and
dependency towards smartphones. Alavi et
al. [19] stated that individuals suffering from
behavioural addiction have symptoms such
as craving, excessive behaviour,
psychological and physical withdrawal
symptoms. This behavioural addiction
usually feature a very strong desire that
encourages someone to do something
repeatedly without the ability to control, to
reduce or to stop. [20]
According to Chiu, [21] smartphone
addiction can cause mental health problems
such as anxiety and depression that will
cause critical barriers in relationships,
activities, physical and mental well-being.
The issue has reached a significant public
health concern and in 2015, WHO issued a
report on Public Health Implications of
Excessive Use of the Internet, Computers,
Smartphones and Similar Electronic
Devices. This report summarizes the
problems associated with excessive use of
smartphone with mental health such as
anxiety, depression and stress. [20]
In addition, recent studies have
found there was a relationship between
smartphone addiction with anxiety and
depression. [12,21,22] Kwon et al. [23] and
Demirci et al. [12] explained the higher the
person addicted to smartphone, their anxiety
and depression is higher. An addictive
individual will loss of self-control, lack of
desire and ability to communicate with
others. As a result, the individual will start
isolating himself or herself and continue to
depend on smartphones. Indirectly, this also
causes the individual to be worried when
cannot use smartphone. [24]
Study done by Kumar [25] showed
majority of private university students in
Malaysia agreed that smartphones can cause
headache, mental loss and sleep disorders.
In 2009, a study conducted by Zulkefly and
Baharudin [26] among university students in
Malaysia found that students who spent
more time with phone were more
susceptible to psychological disorders
caused by unhealthy and uncontrolled
smartphone use.
A study by Ching et al. [27] reported
46.9% of Malaysian students were addictive
to smartphone. This figure showed that they
are moving towards dependence on
smartphone in their daily lives. However,
there is limited study done in Malaysia on
the relationship of excessive use of
smartphone or smartphone addiction on
anxiety and, depression. Since it has been a
global concern recently, there is a need to
identify the relationship between
smartphone addiction with anxiety and
depression among undergraduate students in
Malaysia.
MATERIALS AND METHODS
Design and sample: This is a cross-
sectional study using purposive sampling
among newly intake of undergraduate
students in one of a local university in
Malaysia in September 2016. Those who
were absent and, withdraw during data
collection as well as uncompleted
questionnaire were excluded in the study.
Data collection procedure and ethics: A
pilot study was administered to 30
undergraduate students who were not
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 165
Vol.8; Issue: 1; January 2018
participating in the study. Result showed
that the students did not have difficulty in
understanding and completing the
questionnaire. Then, actual study was
carried out. A brief introduction on the
purpose of the study was given to the
students. Those who agreed to participate
were required to fill in the consent form
before answering a set of questionnaire. The
students took approximately 30 minutes to
answer and once complete, they returned the
questionnaire. Ethics approval was obtained
from the university and Malaysia National
Medical Research Register prior to the
initiation of the study.
Instrument: A self-administered
questionnaire was distributed to 435
participants. The questionnaire consists of
five different sections: a) demography
characteristics; information on age, race,
gender, family income, b) the pattern of
smartphone usage; information on duration
of smartphone usage daily (hours), monthly
expenses on smartphone and, main use of
smartphone, c)smartphone addiction; using
an adapted Malay Version of Smartphone
Addiction Scale (SAS-M), d) anxiety; using
Beck Anxiety Inventory (BAI)-Malay
Version and, e) depression; using Beck
Depression Inventory (BDI) -Malay
Version.
Smartphone Addiction Scale
The original version scale has been
developed by Kwon et al. [23] and has been
adapted translated to Malay language by
Ching et al. [27] among university students
with Cronbach Alpha 0.94. The Cronbach
Alpha for this study was 0.87. SAS-M
includes 33 items and divided into 6
subscales (cyber-space-oriented
relationship, daily life disturbance, primacy,
overuse, positive anticipation and
withdrawal). Each question has a response
scale from 1 to 6 (1=strongly disagree to
6=strongly agree), reflecting the frequency
of the symptoms and the score range is from
33-198, with higher scores indicating the
higher risk of smartphone addiction.
Beck Anxiety Inventory (BAI)
To measure anxiety, Beck Anxiety
Inventory-Malay Version by Mukhtar and
Zulkefly [28] was used. The BAI-Malay
consists of 21 items with a four-point scale
(zero to three) with Cronbach Alpha 0.91. In
the present study, Cronbach's alpha
coefficient was 0.82. This inventory has
widely used to measure the severity of
anxiety. Anxiety was divided into 4
categories, which are mild (score 0-13),
moderate (score 14-19), severe (score 20-
28) and extremely severe (score 29-63).
Beck Depression Inventory (BDI)
The last section in the questionnaire was
used Beck Depression Inventory (BDI) -
Malay Version by Mukhtar and Oei. [29] The
BDI-Malay consist 20 items with a four-
point scale (zero to three) with 0.91 of
Cronbach alpha. The Cronbach's alpha
coefficient in this present study was 0.82.
This inventory requires participants to
answer the questions in relation to how they
felt over the past week, with higher scores
indicating more severe depression. There
are 4 categories under depression, which are
mild (score 0-13), moderate (score 14-19),
severe (score 20-28) and extremely severe
(score 29-63).
Statistical Analysis: All data was entered
and analysed using SPSS software version
21. The descriptive statistical analysis of
data was performed to determine the mean,
standard deviation, frequency, and
percentage. Pearson’s correlation was used
to determine the strength of the relationship
between the variables and, Simple Linear
Regression was performed to determine the
effect of smartphone addiction to anxiety
and depression.
RESULTS
Out of 435 questionnaires distributed
out, only 369 students returned the
questionnaire with response rate 85.0%.
There are 5.3% were absent during data
collection, 3.7% refused to participate in the
study, 4.2% did not complete the
questionnaire and 1.8% were outliers. Table
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 166
Vol.8; Issue: 1; January 2018
1 presented the demographic characteristics
of the sample. Majority participants were
among female 299 (81.0 %). Their ages
range from 19 to 30 years with a mean age
of 19.32 ± 0.98 years. Malay participants
were dominant in the study 57.5%, followed
by Chinese 29.5%, Indian 11.1% and others
1.9%. Besides that, 42.0% participants have
family income above RM 4000.
Table 1: Distribution of students according to sex, race and
monthly family income (n=369)
The pattern of smartphone usage
Table 2 shows 70.0% used smartphone
more than four hours per day. Half of them
(57.2%) used smartphone for social
networking sites and spent less than RM50
for smartphone monthly expenses.
Table 2: Pattern of smartphone usage (n=369)
Variable
n (%)
Duration of smartphone used(daily)
Less than 1 hour
9 (2.4%)
1-3 hour
98 (26.6%)
4-6 hours
166 (45.0%)
7-9 hours
54 (14.6%)
More than 9 hours
42 (11.4%)
Main use of smartphone (n=315)
Call/SMS
75 (23.8%)
Social networking sites
211 (67.0%)
Application/Games
14 (4.4%)
News/information
11 (3.5%)
Others
4 (1.3%)
Smartphone monthly expenses (RM)
Less than RM 50
291 (78.9%)
RM 51 and above
78 (21.1%)
Level of smartphone addiction, anxiety
and depression
Results from Table 3 shows the mean score
for smartphone addiction in this study was
102.52 ± 21.07. The median value in this
study has been used to categorize the score.
[30] Therefore, smartphone addiction was
divided into two categories which are low
smartphone addiction (SAS-M score<
median value 103) and high smartphone
addiction (SAS-M score > median value
103). Results showed nearly half of the
students (47.7%) experienced high
smartphone addiction.
For anxiety, results showed that
54.2% of the respondents experienced mild,
while 14.6%, 11.1%, 6.3% and 3.8% of the
respondents have moderate, severe and
extremely severe anxiety respectively. Mean
± Standard Deviation for anxiety score was
10.15±8.08. In depression, 80.5% of the
students were mild, 14.1% moderate, 5.1%
severe and only 0.3% experienced
extremely severe. Mean ± Standard
Deviation for anxiety score was 7.96±6.21.
Table 3: Level, mean and standard deviation: smartphone
addiction, anxiety and depression (n=369)
Variable
n (%)
Mean and standard
deviation
Smartphone addiction
Low smartphone addiction
193 (52.3%)
102.52±21.07
High smartphone addiction
176 (47.7%)
Anxiety
Mild
260 (70.5%)
10.15±8.08
Moderate
54 (14.6%)
Severe
41 (11.1%)
Extremely Severe
14 (3.8)
Depression
Mild
297 (80.5%)
7.96±6.21
Moderate
52 (14.1%)
Severe
19 (5.1%)
Extremely Severe
1 (0.3)
Relationship between smartphone
addiction with anxiety and depression
Table 4 presented the correlation
between smartphone addiction with anxiety
and depression. Results showed that there is
a significant positive correlation between
smartphone addiction with anxiety (r=0.227;
p<0.001) and depression (r=-0.302;
p<0.001) respectively.
Table 4: Pearson correlation analysis of smartphone addiction
with anxiety and depression (n=369)
Anxiety
Depression
R
p value
R
p value
Smartphone Addiction
0.227
<0.001
0.302
<0.001
Smartphone addiction had a
significant effect on anxiety, with
smartphone addiction as predictor accounted
5.2% variance in anxiety (B=0.052, t=4.469,
Variable
n (%)
Gender
Male
70 (19.0%)
Female
299 (81.0%)
Race
Malay
212 (57.5%)
Chinese
109 (29.5%)
Indian
41 (11.1%)
Others
7 (1.9%)
Monthly family income (n=345)
Less than RM1000
43 (12.5%)
RM1000-1999
40 (11.6%)
RM2000-2999
55 (15.9%)
RM3000-3999
52 (15.1%)
More than RM4000
155 (44.9%)
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 167
Vol.8; Issue: 1; January 2018
p<0.001). Results also stated that
smartphone addiction explains 9.1%
variance of depression (B=0.091, t=6.067,
p<0.001) (refer to Table 5).
Table 5: Simple linear regression analysis of smartphone
addiction with anxiety and depression (n=369)
Model
B
SE
β
t
p
Anxiety
Constant
-1.045
0.224
Smartphone
Addiction
0.010
0.002
0.052
4.469
<0.001
R:0.227 , R2:0.052, F:19.97, p<0.001
Depression
Constant
-1.404
0.226
Smartphone
Addiction
0.013
0.002
0.091
6.067
<0.001
R:0.302 , R2:0.091, F:36.80, p<0.001
DISCUSSION
University students tend to adapt
early on electronic devices and, they can be
categorized as early adopters. [31] For them,
smartphone is something interesting,
entertainment objects, can connect with
friends and giving them a sense of
autonomy, identity and credibility. [32]
Result from this study found 45.0% of
students spent 4-6 hours a day to use the
smartphone. The findings of this study
supported by Hatice et al. [33] who found
40.1% of students spend 4 to 6 hours a day.
Meanwhile, 30% of the students spend more
than seven hours on and this figure is quite
worrying. This is because time allocation
for smartphones more than 5 hours is
inappropriate for a student who should
prioritize academic issues and concentrate
on learning rather than social issues as it
will affect the academic achievement. [34]
Amidtaher et al. [35] stated that an increase
in smartphone dependency will decrease the
academic achievement. Besides that, a cross
sectional study in India found some of the
students had experienced certain side effects
of long term mobile use like headache,
backache, eye strain. [36]
The finding of this study showed
that most of the students used smartphones
to browse social networking sites. The
finding is similar with previous study,
which showed that smartphone users are
now using their gadgets for social
relationships It is also supported by another
studies which reported that one of the key
factors of smartphone use among university
students are social relationships. [37,38]
Besides that, a study conducted by Nee and
Fan [39] showed that Malaysia university
students were an active social networking
sites users and it becomes part of their daily
activities and, they found that as the use of
social networking sites increased, their
psychological well-being become decreased.
Roberts, Yaya and Manolis [40] and, Salehan
and Negahban [41] stated that the excessive
use of social networking sites can lead to
smartphone addiction.
Findings of this study also found that
majority of students allocate less than RM50
per month for smartphone expenses. The
findings were in line with a study by
Zulkefly and Baharudin [26] who found
students spending the modest amount of
money on smartphone usage. In Malaysia,
numerous telecommunications companies
such as Maxis, Celcom, Digi and U-Mobile
offer affordable plans which enable users to
choose a plan that fits in their financial
capability. For smartphone addiction, the
mean score for this study was higher than
the previous study [12,33] and nearly half of
the students in this study experienced high
score of smartphone addiction.
This study highlight that there was a
relationship between smartphone addiction
with anxiety and depression. The students
who reported high scores of smartphone
addiction tended to report high scores of
anxiety and depression. The results of this
study were in line with previous studies [12,
21,42-43] that there is a relationship between
smartphone addiction with anxiety and
depression among university student. A
study by Demirci et al. [12] found that
smartphone overuse may lead to anxiety
and/or depression which can lead to sleep
problems. Based on several studies, they
also found that excessive use of smartphone
lead to anxiety and create several disorders
such as ringxiety, Nomophobia and fear of
missing out (FoMo).
According to Subba et al., [44] those
who are suffering problems with
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 168
Vol.8; Issue: 1; January 2018
smartphone usage experiencing phone
ringing (ringxiety) problems and tend to use
smartphones in prohibited areas (classes and
libraries) and during meals. In 2008,
Avvannavar et al., [45] reported that this
condition occurs when an individual hears
the sound of the phone while it does not
ring. Besides that, "Nomophobia" is
increasing among young generations. [17]
According to King et al., [46] this syndrome
occurs when an individual feels anxious or
uncomfortable when parted from
smartphone, computers or virtual
communication devices.
According to Przybylski et al. [47]
anxiety was also identified as a component
of Fear of Missing Out (FoMO); it is
defined as fears, anxiety, and concerns if
unable to find out the latest information and,
experiencing social interaction. The study
reported university students with higher
scores of FoMO will be more likely to
check Facebook pages on smartphones
during class compared to lower FoMO
scores. A study by Skierkowski and Wood,
[48] found students who restricted the usage
of short messages on their smartphones
experienced anger, worry and anxiety. In
another study, 50.0% of young people has
experienced anxiety when they cannot
check their smartphones, compared to only
25.0% Gen X and 15.0% Baby Boomers. [49]
In addition, Ganganahalli et al. [36] reported
during examination days, nearly 90.0% of
student responded that they felt very bad or
had a feeling of lost or disconnected from
the world if cannot using mobile for hours.
In order to overcome the issue of
smartphone addiction and anxiety, Yu and
Son [50] conducted a study on Acceptance
Commitment Therapy involving 18
participants and divided them into two
groups namely the Program Group and the
Control Group. Acceptance Commitment
Therapy is a psychological intervention that
uses acceptance and awareness strategies
along with commitments and behavioural
change strategies to enhance psychological
flexibility. The program was supervised for
eight sessions and a follow-up study was
conducted after treatment. The follow-up
period was carried out for four weeks. The
results of the study showed the level of
smartphone addiction and level of anxiety
were decreased after the program and it
proved that the program could be used as
one of treatment methods for smartphone
addiction.
In addition to determining a
relationship between smartphone addiction
and anxiety, findings of this study also
reported significant relationship between
smartphone addiction and depression. It was
supported by previous studies that found
individuals with smartphone addiction
problems tend to have depression problems.
[42,51,52] In 2015, Park et al. [52] has
conducted a study to compare depression
problems among 20 students which had
been divided into two groups namely Heavy
Smartphone User Groups and Control
Groups; results showed that heavy users
who use excessive smartphones tend to
suffer depression. In addition, the finding of
this study was supported by Thomee et al.
[53] which conduct a year-long follow-up
analysis reported that excessive use of
smartphone may be a risk factor for
depression symptoms. Therefore, it can be
concluded that this study supports other
studies concerning the relationship between
smartphone addiction with anxiety and
depression among university students and
shows that this phenomenon also happen
among university students in Malaysia.
CONCLUSION
The present study showed university
students in Malaysia were inclined towards
becoming addicted to smartphone and were
exposed to anxiety and depression.
Therefore, there is a need to create possible
health education programs and interventions
that are appropriate to deal with the
addiction to the university students and
improve their mental well-being.
ACKNOWLEDGMENT
We would like to thank the Director-
General of Health and Deputy Director-General
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
International Journal of Health Sciences & Research (www.ijhsr.org) 169
Vol.8; Issue: 1; January 2018
of Health (Research and Technical Support),
Ministry of Health Malaysia for permission to
publish this paper. We would also like to
express thanks to the University for the
permission to collect the data and to all students
who participated in this research. A very special
thanks dedicated to Ms Teresa Yong Sui Mien,
for the valuable comments and suggestion to
improve the manuscript. Lastly, we would also
like to express appreciation for all the support
from all parties that have contributed directly or
indirectly to complete this study.
Funding: No funding sources
Conflict of interest: None declared
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How to cite this article: Ithnain N, Ghazali SE, Jaafar N. Relationship between smartphone
addiction with anxiety and depression among undergraduate students in Malaysia. Int J Health Sci
Res. 2018; 8(1):163-171.
