The effects of phone addiction on nursing students’ health

Abstract

Background

Technological progress and the multifunctionality of smartphones have contributed to their excessive use, particularly among young people. Smartphone addiction (phonoholism) and nomophobia are growing social issues, often linked to psychological problems such as stress, anxiety, depression, insomnia, and reduced academic performance. This study aimed to assess the prevalence of smartphone addiction among nursing students and identify influencing factors.

Methods

This study employed a cross-sectional design using a diagnostic survey method. The research was conducted among 303 nursing students at Pomeranian Medical University in Szczecin. Data were collected using an author-designed questionnaire and standardized instruments, including the NMP-Q (Nomophobia Questionnaire), MPPUSA (Mobile Phone Problem Use Scale for Adolescents), AIS (Athens Insomnia Scale), and DASS-21 (Depression, Anxiety, and Stress Scale).

Results

Over half (51.16%) of participants reported smartphone dependency; 22.44% felt addicted to the Internet. Sleep problems affected 66.34% of respondents. While 38.28% reported no depressive symptoms, anxiety and stress levels were normal in 38.61% and 37.62%, respectively. Higher addiction rates were observed among singles, those in informal relationships, and younger students. Problematic phone use correlated significantly with depression, anxiety, stress, and insomnia (p < 0.001).

Conclusions

Most nursing students use smartphones appropriately without signs of nomophobia. Age and relationship status significantly influenced addiction levels, while gender and place of residence did not. Strong links were found between phonoholism, nomophobia, and psychological issues.

Introduction

Data from the Global System for Mobile Communications (GSM) Association reveals that global smartphone ownership reached 75% in 2021 [1]. While the widespread availability of smartphones and the Internet offers numerous benefits, it has also led to problematic smartphone and Internet use, resulting in negative outcomes such as decreased academic performance, psychological distress, and disrupted sleep patterns [2]. A review of the literature reveals that phone addiction is a growing global concern. In addition, terms such as phonoholism, nomophobia (the fear of losing connection or being unable to access the network), FOMO syndrome (fear of missing out on information or social connections), ringxiety and textaphrenia (the sensation of receiving calls or messages when no one is actually trying to contact you), and phubbing (ignoring someone in a social context by focusing on one’s phone) are commonly used to describe related behaviors [3, 4].

Smartphone addiction, similar to other behavioral addictions, arises from a complex interplay of social, psychological, and biological factors. Although it is not formally recognized as a distinct diagnostic category, excessive smartphone use shares many characteristics with established behavioral addictions, including compulsive engagement, impaired control, and continuation despite negative consequences. Phonoholism can be conceptualized within this framework, referring to a strong compulsion to engage in smartphone use as a habitual yet maladaptive behavior. Due to its widespread prevalence, problematic smartphone use has become an important social concern, shaped by interacting psychological, personality, social, and economic determinants [5].

Nomophobia (i.e., “no mobile phone phobia”) represents a related but distinct phenomenon, defined as the anxiety or discomfort experienced when individuals are unable to access or use their smartphone as a means of communication. This distress is typically triggered by physical separation from the device, such as when it is out of reach or unavailable [6]. In adults, problematic smartphone use is closely associated with everyday activities, including work, social interaction, information seeking, travel, and consumer behavior. The literature also highlights the occurrence of cross-addiction, whereby individuals develop dependencies on multiple behaviors simultaneously. The increasing availability of smartphones with constant internet access, combined with highly personalized digital content (e.g., advertisements, social media, and streaming platforms), has further intensified engagement and reinforced habitual use patterns [7]. Individual vulnerability to problematic smartphone use is influenced by various personality and psychosocial factors, such as low self-esteem, fear of loneliness, social anxiety, shyness, and difficulties in forming interpersonal relationships. For some individuals, smartphones may serve as a means of emotional regulation, identity formation, or escape from everyday stressors [8].

Among students, smartphones play a dual role. On one hand, they are essential tools supporting academic activities, providing rapid access to educational resources, databases, and communication with peers and faculty. On the other hand, excessive use may lead to problematic patterns such as phonoholism and nomophobia, which can negatively affect overall well-being [9]. Empirical evidence indicates that compulsive smartphone use may impair social functioning, reduce empathy, weaken interpersonal relationships, and contribute to neglect of daily responsibilities. Additionally, physical consequences have been documented, including sleep disturbances, fatigue, and musculoskeletal strain affecting the upper limbs, spine, and visual system [10].

Despite the growing body of research on smartphone addiction, nomophobia, and associated mental health outcomes, their conceptual boundaries remain insufficiently defined. Smartphone addiction is commonly used as an umbrella term describing excessive and uncontrolled use; however, due to its lack of formal recognition in major diagnostic systems, the term “problematic smartphone use” is often preferred as a more precise and neutral descriptor. Nomophobia, in contrast, specifically refers to the emotional distress associated with loss of access to a mobile device or communication. While closely related, these constructs capture different dimensions of digital behavior and psychological response. Importantly, both phenomena are strongly associated with mental health variables, including stress, anxiety, and depressive symptoms. However, they should not be treated as interchangeable constructs. Clarifying these distinctions is essential for accurate interpretation of research findings and for situating empirical results within a broader theoretical framework of behavioral addictions and mental health. It is important to highlight that many students tend to excessively use smartphones, particularly before bedtime, which can significantly impair sleep quality and contribute to increased daytime sleepiness [10]. Nursing students constitute a particularly relevant population for examining problematic smartphone use due to the unique combination of academic, clinical, and emotional demands they experience during their training. Unlike many other student groups, they are regularly exposed to high-stakes clinical environments, including direct patient care, suffering, and death, which contribute to elevated levels of psychological stress and emotional burden. In addition, the anticipation of future professional responsibilities, such as shift work and long working hours, may further intensify stress and disrupt coping resources. These conditions may increase susceptibility to maladaptive coping strategies, including excessive smartphone use as a means of distraction, emotional regulation, or avoidance. Therefore, focusing on nursing students allows for a more nuanced understanding of how occupationally relevant stressors may contribute to problematic patterns of smartphone use [11–13].

Importantly, problematic smartphone use in this population represents not only a behavioral concern but also a potential threat to future professional practice. While existing research often emphasizes prevalence, the functional consequences of this phenomenon warrant greater attention. Excessive smartphone use has been linked to sleep disturbances, fatigue, and heightened anxiety, all of which may impair cognitive functioning, attention, and emotional regulation. In a clinical context, such impairments may translate into reduced clinical judgment, decreased situational awareness, and compromised decision-making abilities. Consequently, these deficits may increase the risk of medical errors and negatively affect patient safety. Addressing phonoholism during professional training is therefore critical, as maladaptive patterns established at this stage may persist into clinical practice and ultimately influence the quality and safety of patient care. In response to growing concerns about phonoholism and its potential impact on both well-being and professional functioning, this study aimed to assess the prevalence of problematic smartphone use among nursing students and to identify its key psychological and contextual determinants. Furthermore, the study sought to examine the relationship between smartphone addiction and factors such as perceived stress, sleep disturbances, and anxiety, which may be particularly salient in the context of nursing education and may have implications for future clinical performance [14, 15].

Methods

Setting and design

The research process was carried out based on the diagnostic survey method using the survey technique. The study was conducted in accordance with the Declaration of Helsinki after obtaining a positive opinion from the Bioethics Committee of PUM (Resolution No. KB-0012/518/12/16). The study was conducted among nursing students who studied Pomeranian Medical University in Szczecin in November/December 2023. The criteria for inclusion in the research process were: status as a nursing student at Pomeranian Medical University in Szczecin, obtaining informed consent to participate in the study. On the other hand, the criteria for exclusion from the research process included: lack of consent to participate in the study and incorrectly completed questionnaires.

All respondents were briefed on the topic and purpose of the study, and were informed of the voluntary nature and anonymity of the research, which will be used only for the purposes of the scientific study. In addition, each respondent was given the opportunity to withdraw their consent to participate in the study without giving a reason. In case of any doubts, respondents were given the necessary explanations and all questions were answered. The return of the completed questionnaires was tantamount to consent to the execution of the study.

The sample size was estimated based on data from the Polish Chamber of Nurses and Midwives, indicating a target population of approximately N = 30,200 nursing students in Poland. Assuming a 95% confidence level (Z = 1.96), a margin of error of 6% (e = 0.06), and a conservative population proportion of p = 0.5, the required sample size was calculated using the standard formula for proportions with finite population correction. The calculation was performed using an online statistical tool (R version 4.3.2), yielding a minimum sample size of 264 participants.

Research instrument

This study used the diagnostic survey method and the survey technique appropriate for it. In the course of the study, a survey questionnaire and standardized research instruments such as the Nomophobia Questionnaire (NMP-Q), the Scale of Problematic Mobile Phone Use by Adolescents (MPPUSA scale), the Athens Insomnia Scale (AIS), and the Depression, Anxiety and Stress Scale version 21 (DASS-21) were used.

The Nomophobia Questionnaire (NMP-Q), developed in 2014 by Yildirim during his doctoral dissertation at Iowa State University and later adapted into Polish by W.M. Czerski [6], assesses nomophobia with 20 questions on a 7-point Likert scale. It covers four dimensions:

• lack of communication (Q10-15): Feelings of losing direct communication and phone usage.

• loss of communication (Q16-20): Emotions related to losing social media and online presence.

• lack of access to information (Q1-4): Simulated loss of smartphone access to information.

• giving up comfort (Q5-9): Loss of comfort and peace from smartphone use, including coverage and Wi-Fi.

Scores range from 20 to 140, with higher scores indicating higher nomophobia. Cronbach’s alpha coefficients range from 0.80 to 0.94.

The Mobile Phone Problem Use Scale for Adolescents (MPPUSA), developed by E. Krzyzak-Szymańska, is a Polish adaptation of the original tool by Lopez-Fernandez et al. [16]. It includes three subscales:

• Dominance: Measures how much the phone dominates other aspects of life.

• Involvement: Assesses the intensity of phone use.

• Entrapment-Dependence: Evaluates dependence on the smartphone.

The 21-question questionnaire uses a 10-point Likert scale, with scores ranging from 26 to 260. The categories are: occasional use (26–29 points), proper use (30–130 points), risk of problematic use (131–166 points) and pathological use (167–260 points). The Cronbach’s alpha coefficient is 0.96.

The Athens Insomnia Scale (AIS) is an 8-item questionnaire used to assess insomnia symptoms based on ICD-10 criteria. Respondents rate each statement on a 4-point Likert scale (0 = no symptom, 3 = severe symptom). Scores range from 0 to 24, with 8 or more points indicating a high probability of inorganic insomnia. The Cronbach’s alpha coefficient is 0.90 [17].

The Depression, Anxiety, and Stress Scales (DASS-21) is a tool for assessing mental health, originally developed by the Psychology Foundation of Australia and later adapted into Polish by Makara-Studzińska, Petkowicz, Urbańska, and Petkowicz. The DASS-21 includes three self-report scales—depression, anxiety, and stress—each with 7 items, totaling 21 statements. Respondents rate each statement on a 4-point Likert scale: 0 (“did not apply to me”), 1 (“applied to me to some extent”), 2 (“applied to me to a large extent”), and 3 (“applied to me most of the time”). Scores are calculated by summing the responses for each scale and multiplying by 2. The scales correspond to specific questions: depression (3, 5, 10, 13, 16, 17, 21), anxiety (2, 4, 7, 9, 15, 19, 20), and stress (1, 6, 8, 11, 12, 14, 18). The Cronbach’s alpha for the overall scale was 0.93, with subscale values: stress 0.85, anxiety 0.80, and depression 0.86 [18].

The questionnaire included questions on sociodemographic factors (e.g., gender, age, marital status) and personal beliefs about smartphone use, including feelings of addiction. The final question aimed to explore the relationship between motivation and frequency of smartphone use.

Statistical analysis

Data was collected in a Microsoft Excel spreadsheet and analyzed using R (version 4.3.2). Quantitative variables were analyzed using descriptive statistics (mean, standard deviation, median, quartiles, and min/max), while qualitative variables were analyzed by calculating absolute frequencies and percentages. To compare standardized questionnaire results between two groups, the Mann-Whitney test was used; for three or more groups, the Kruskal-Wallis test was applied, followed by Dunn’s post-hoc test if significant differences were found. Spearman’s correlation coefficient was used to assess correlations between questionnaire results and quantitative variables. A significance level of 0.05 was applied, with p-values below 0.05 considered significant.

Results

Analysis of the results of the self-administered survey questionnaire

The study included 303 nursing students studying at the Pomeranian Medical University in Szczecin. The mean age in the study group was 27.69 years (SD = 10.7). During the course of the study, 350 questionnaires were made available, 303 were finally included in the analysis, which is 86.6%. The predominant group among the respondents was female (91.75), aged 21–30 (45.21%), in an informal relationship (42.24%), living in a city of more than 100,000 residents, economically active (72.94%), studying for their first year of undergraduate studies (36.98%). The analysis revealed that 51.16% of respondents felt addicted to their phone, while 55.45% reported internet addiction. Regarding phone usage frequency, 57.43% used their phone several times a day, and 23.43% used it almost all day (Table 1).

Table 1.

Sociodemographic characteristics and selected descriptive variables of the study group

Variable	Category	n	%
Gender	Female	278	91.75
	Male	25	8.25
Age (years)	≤ 20	89	29.37
	21–30	137	45.21
	31–40	28	9.24
	41–50	33	10.89
	51–60	15	4.95
	> 60	1	0.33
Year of study	1st year, Bachelor’s	112	36.98
	2nd year, Bachelor’s	28	9.24
	3rd year, Bachelor’s	17	5.61
	1st year, Master’s	59	19.47
	2nd year, Master’s	87	28.71
Mode of study	Full-time	184	60.73
	Part-time	119	39.27
Place of residence	City > 100,000 inhabitants	161	53.14
	City 10,000–100,000 inhabitants	55	18.15
	City < 10,000 inhabitants	27	8.91
	Rural area	60	19.80
Marital status	Single	100	33.00
	Informal relationship	128	42.24
	Formal relationship	75	24.75
Occupational status	Student only (unemployed)	82	27.06
	Working student	221	72.94
Self-perceived mobile phone addiction	Yes	155	51.16
	No	148	48.84
Self-perceived Internet addiction	Yes	168	55.45
	No	135	44.55
Frequency of mobile phone use	Several times a day	58	19.14
	Several times per day	174	57.43
	Almost all day	71	23.43

Analysis of phone addiction, nomophobia, sleepiness, and severity of depression, anxiety and stress among nursing students

The NMP-Q Questionnaire results indicate that respondents expressed moderate concern about the inability to communicate (M = 27.54 points), minimal concern about the loss of communication (M = 14.47 points), a neutral stance on the inability to access information (M = 16.5 points), and a lower level of concern regarding the loss of convenience (M = 15.71 points). An analysis of the respondents’ cell phone use according to the MPPUSA showed that the mean score for this scale was 94.3 points (SD = 43.75). It was observed that 78.22% of nursing students used the phone correctly, 42 respondents (13.86%) were concerned with problematic phone use, 16 respondents (5.28%) used the phone problematically, and 8 respondents (2.64%) occasionally used the telephone. Interpreting the results obtained with the Athens Insomnia Scale, it was shown that the mean score for this scale was 7.85 points (SD = 4.44). It was observed that 66.34% of respondents suffered from insomnia, while 33.66% of respondents had no sleep problems. The DASS-21 results indicate that the majority of nursing students reported normal levels of depression (38.28%), with the remaining participants showing mild (10.56%), moderate (23.43%), severe (11.22%), or very severe (16.50%) depression. Regarding anxiety, 38.61% exhibited normal levels, while 2.97% had mild, 20.79% moderate, 10.89% severe, and 26.73% very severe anxiety. For stress, 37.62% reported normal levels, with others experiencing mild (14.52%), moderate (19.47%), severe (16.50%), or very severe (11.88%) stress (Table 2).

Table 2.

Mental health indicators and technology-related behaviors among nursing students

Measure		Category	n	%
Athens Insomnia Scale		Insomnia	201	66.34
		No insomnia	102	33.66
DASS-21	Depression	Normal	116	38.28
		Mild	32	10.56
		Moderate	71	23.43
		Severe	34	11.22
		Extremely severe	50	16.50
	Anxiety	Normal	117	38.61
		Mild	9	2.97
		Moderate	63	20.79
		Severe	33	10.89
		Extremely severe	81	26.73
	Stress	Normal	114	37.62
		Mild	44	14.52
		Moderate	59	19.47
		Severe	50	16.50
		Extremely severe	36	11.88
MPPUSA		Occasional mobile phone use	8	2.64
		Normal mobile phone use	237	78.22
		At risk of problematic mobile phone use	42	13.86
		Problematic mobile phone use	16	5.28

Relationship between phone addiction, nomophobia, and other studied variables

The study revealed a statistically significant negative correlation between mobile phone addiction, as measured by MMPUSA, and age (p < 0.001), indicating that higher age was associated with lower levels of problematic phone use. Statistically significant differences in problematic mobile phone use were also observed in relation to marital status (p < 0.001). Individuals who were single or in informal relationships reported higher levels of problematic use compared to those in formal relationships. While this finding may suggest a potential association between relationship status and patterns of smartphone use, it should be interpreted with caution, as unmeasured factors (e.g., social support, lifestyle differences) may contribute to this relationship. No statistically significant differences were found in problematic mobile phone use with respect to gender or place of residence (p > 0.05; Table 3). However, the interpretation of gender-related findings is limited by the substantial gender imbalance in the study sample, which reduces the reliability of comparisons between groups.

Table 3.

The impact of sociodemographic variables on problematic mobile phone use according to the MPPUSA

Variables		MMPUSA [points]
		M	SD	p
Marital status	Formal relationship	79.99	52.03	< 0.001 C, B > A
	Informal relationship	99.14	40.40
	Single	98.85	38.94
Gender	Women	92.68	40.96	0.244
	Men	112.40	66.01
Place of residence	Village	87.77	36.40	0.267
	City with up to 10.000 residents	98.41	37.27
	City with 10.000–100.000 residents	89.56	50.96
	City more than 100 000 population	97.67	44.55

M mean, SD standard deviation, r Pearsona, NMP-Q The Nomophobia Questionnaire, MPPUSA the Scale of Problematic Mobile Phone Use by Adolescents

The study demonstrated a relationship between problematic mobile phone use according to MMPUSA, nomophobia according to NMP-Q, as well as the severity of depression, anxiety, stress according to DASS-21, and insomnia according to AIS.

Analysis revealed significant positive correlations between phonoholism according to MMPUSA and nomophobia according to NMP-Q. including all its subscales. Higher levels of problematic phone use were associated with greater fear of losing communication (r = 0.531, p < 0.001), fear of losing connection (r = 0.600, p < 0.001), fear of lack of access to information (r = 0.682, p < 0.001), and fear of giving up convenience (r = 0.640, p < 0.001). These findings indicate that individuals reporting more problematic smartphone use also tend to report higher levels of nomophobia across its dimensions (Table 4). Additionally, statistically significant positive correlations were found between phonoholism according to MMPUSA and the severity of depressive symptoms (r = 0.324, p < 0.001), anxiety (r = 0.333, p < 0.001), and stress (r = 0.404, p < 0.001). A similar positive association was observed between problematic smartphone use and insomnia according to AIS (r = 0.317, p < 0.001). Thus, higher levels of problematic phone use were associated with higher levels of psychological distress and sleep difficulties. However, given the cross-sectional design of the study, these relationships should be interpreted as correlational rather than causal. It cannot be determined whether problematic smartphone use contributes to increased psychological distress and insomnia, or whether individuals experiencing higher levels of these symptoms are more likely to engage in excessive phone use. Moreover, although statistically significant, the observed correlations are of small to moderate magnitude, which suggests that other factors not assessed in this study may also play an important role in explaining these relationships (Table 4).

Table 4.

The relationship between phonoholism and nomophobia, the severity of depressive symptoms, anxiety, stress, and sleep quality among nursing students

Variable		MMPUSA [points]
		r	p
NMP-Q	Inability to communicate	0.53	< 0.001
	Loss of connectivity	0.6	< 0.001
	Lack of access to information	0.68	< 0.001
	Giving up convenience	0.64	< 0.001
DASS-21	Depression level	0.32	< 0.001
	Anxiety level	0.33	< 0.001
	Stress level	0.40	< 0.001
AIS		0.32	< 0.001

r Pearson correlation coefficient, MPPUSA the Scale of Problematic Mobile Phone Use by Adolescents, NMP-Q The Nomophobia Questionnaire, AIS the Athens Insomnia Scale, DASS-21 the Depression, Anxiety and Stress Scale

The study assessed the correlation between nomophobia, as measured by NMP-Q, and symptoms of depression, anxiety, and stress according to DASS-21 among nursing students. The analysis revealed statistically significant positive correlations between nomophobia and all examined dimensions of psychological distress (p < 0.001). Higher levels of depressive symptoms, anxiety, and stress were associated with higher scores across all NMP-Q subscales, including fear of lack of communication, loss of connection, lack of access to information, and giving up convenience. These findings indicate that greater psychological distress co-occurs with higher levels of nomophobia. The relationship between nomophobia and sleep disturbances was also examined. Statistically significant positive correlations were found between insomnia severity (AIS) and all dimensions of nomophobia: lack of communication (r = 0.231, p < 0.001), loss of connection (r = 0.232, p < 0.001), lack of access to information (r = 0.262, p < 0.001), and giving up convenience (r = 0.302, p < 0.001). This suggests that higher levels of nomophobia are associated with more severe insomnia symptoms (Table 5). However, due to the cross-sectional design, these relationships should be interpreted as correlational rather than causal. It remains unclear whether nomophobia contributes to increased psychological distress and sleep problems, or whether individuals with higher levels of distress and insomnia are more likely to report stronger nomophobia. Additionally, the observed correlations are relatively small to moderate in magnitude, indicating that other factors may also influence these associations.

Table 5.

The relationship between nomophobia and the severity of depression, anxiety, and stress symptoms, as well as sleep quality among nursing students

NMP-Q	DASS-21						AIS
	Depression level		Anxiety level		Stress level
	r	p	r	p	r	p	r	p
Inability to communicate	0.143	0.013	0.117	0.041	0.255	< 0.001	0.231	< 0.001
Loss of connectivity	0.248	< 0.001	0.269	< 0.001	0.288	< 0.001	0.232	< 0.001
Lack of access to information	0.212	< 0.001	0.226	< 0.001	0.345	< 0.001	0.262	< 0.001
Giving up convenience	0.258	< 0.001	0.253	< 0.001	0.346	< 0.001	0.302	< 0.001

r Pearson correlation coefficient, MPPUSA the Scale of Problematic Mobile Phone Use by Adolescents, AIS the Athens Insomnia Scale, DASS-21 the Depression, Anxiety and Stress Scale

Discussion

The present study demonstrated that the majority of nursing students used mobile phones appropriately. Although participants reported a moderate level of nomophobia particularly related to concerns about losing communication they were not excessively worried about losing access to information, connectivity, or general comfort when deprived of their smartphones. These findings are consistent with previous research. For instance, Adamczewska-Chmiel et al. [19] reported that 16.6% of respondents exhibited problematic mobile phone use, while Ramjan et al. [20] identified concerning levels of nomophobia and smartphone addiction among nursing students, accompanied by increased stress, anxiety, sleep disturbances, and poorer academic performance. Similarly, Frassini et al. [21] found moderate levels of nomophobia among Italian nursing students and nurses, and Moreno-Guerrero et al. [22] highlighted nomophobia as an emerging public health concern. Comparable results were also observed by Nowak et al. [23], where only a small proportion of respondents demonstrated problematic phone use, despite generally appropriate usage patterns.

The current study revealed a statistically significant positive correlation between phone addiction and nomophobia. Furthermore, it was observed that the higher the level of phone addiction, the more pronounced the symptoms of nomophobia, which affected various aspects of smartphone use. Statistically significant positive correlations were also noted between phone addiction and the severity of depression, anxiety, and stress, as well as insomnia. Our findings are consistent with other studies confirming that mobile phone addiction leads to various consequences, including mental health issues such as increased symptoms of depression, mental disorders, social anxiety, and sleep problems [24]. In the study by Çobanoğlu A. et al. [25] conducted among 215 nursing students at a university in northeastern Turkey, a positive and moderate correlation was found between the level of nomophobia and smartphone addiction, as well as digital addiction. Moreover, regression coefficient analysis showed that smartphone addiction had a significant positive impact on nomophobia. Therefore, it is important to provide students with professional psychological support to develop health and life behaviors in order to reduce the risk of developing nomophobia.

A literature review conducted by Pera [26] indicates that Problematic Smartphone Use (PSU) creates potential risks for the development of adverse effects and negative consequences for both physical health (e.g., impacting neck muscle performance) and mental health, such as sleep problems, heightened anxiety symptoms, psychological distress, and depressive symptoms. This study also highlights the relationship between depression and anxiety symptoms and the intensity of mobile phone use, which can lead to emotional dysregulation, psychological stress, sleep disorders, and deterioration of academic performance. Elhai et al. [27] also confirm that problematic and general smartphone use often co-occurs with mental health disorders, such as depression, anxiety, and stress. Their research showed that the severity of depression symptoms was associated with problematic smartphone use, showing at least a moderate effect on each other. The relationship between anxiety and problematic use was also consistent but had a minor impact. Stress was somewhat linked to problematic use, and its effects were either minor or moderate. Similarly, the study by Li et al. [28] conducted among 967 students at a Chinese university confirmed that anxiety symptoms were positively correlated with problematic smartphone use. Therefore, considering the growing prevalence of PSU among university students, it is necessary to undertake multi-component interventions that reduce the frequency of smartphone use and increase self-efficacy in order to promote students’ mental health.

The study by Nikolic et al. [29] conducted among medical students, showed a positive correlation between smartphone addiction and the severity of stress, anxiety, and depression. Additionally, statistically significant relationships were observed between Problematic Smartphone Use (PSU) and sleep quality, as well as general mental and physical health. The study indicates that excessive phone use may lead to a deterioration in sleep quality, manifested by daytime fatigue, difficulty falling asleep, and shorter sleep duration. Consequently, this phenomenon may have potential negative effects on the health and well-being of an individual.Similarly, research focused on the neuropsychiatric effects of excessive smartphone use, conducted by Adamczewska-Chmiel K. et al. [19], confirms that individuals suffering from phone addiction often show higher levels of anxiety and experience symptoms characteristic of anxiety and depression disorders. This means that people addicted to mobile phones are more likely to experience symptoms typical of depression and anxiety disorders. Furthermore, it was shown that smartphone addicts tend to experience more sleep disturbances, manifesting in shorter sleep duration and more frequent sleep deprivation compared to other participants in the study.

The study by Li Y. et al. [30], conducted among 33,650 students, confirmed the significant impact of pathological mobile phone use on mental health. It was observed that students addicted to mobile phones had a higher risk of developing high levels of anxiety, depression, and impulsivity, as well as reported poorer sleep quality. A cross-sectional study conducted by Liu H. and collaborators [31], among medical students, focused on the prevalence of smartphone addiction and its impact on health and insomnia. The authors showed a strong relationship between mobile phone addiction and insomnia, which may be explained by several factors, such as excessive smartphone use before bedtime disrupting sleep processes, overuse of smartphones generally leading to increased psychological stress, which negatively impacts sleep and physical recovery, and the blue light emitted by screens potentially affecting melatonin levels, which in turn influences sleep and wake cycles. It is also worth noting that Feng Z. and collaborators [32] who conducted research among 450 medical students from China, concluded that poor sleep quality may partially mediate the relationship between mobile phone addiction and the severity of depression symptoms.

The results of the present study indicated that sociodemographic factors such as gender and place of residence were not significantly associated with the level of nomophobia among nursing students. In contrast, age and marital status were significantly associated with problematic mobile phone use. Higher age was correlated with lower levels of problematic use, and individuals in formal relationships reported less problematic smartphone use compared to those who were single or in informal relationships. However, these findings should be interpreted cautiously, as the cross-sectional design does not allow for causal conclusions, and other unmeasured factors (e.g., lifestyle, social support) may contribute to these associations.

Similar findings were reported by Frassini S. et al. [21], who observed that gender and year of study were not associated with nomophobia levels among nursing students. However, the literature remains inconsistent. For example, Demirci K. et al. [33], in a study of 319 university students, found significantly higher levels of smartphone addiction among women compared to men. Their results also suggested associations between excessive smartphone use and depressive symptoms, anxiety, and poor sleep quality. Importantly, these relationships should be interpreted as correlational rather than causal.

Other studies provide additional context. Acikgoz A. et al. [34] reported that excessive internet and smartphone use is particularly prevalent among adolescents and young adults. Similarly, Kheradmand A. et al. [35] demonstrated that age was negatively associated with smartphone addiction, with younger individuals showing a greater tendency toward problematic use. They also found that single individuals were more likely to exhibit signs of smartphone addiction compared to those in formal relationships. In contrast, Elamin et al. [36] did not observe a significant relationship between marital status and smartphone addiction, suggesting that these associations may vary depending on the study population and cultural context.

To better understand the observed patterns of problematic smartphone use, it is important to consider potential underlying psychological mechanisms. One such factor is the fear of missing out (FoMO). Individuals with higher levels of FoMO may be more prone to frequent checking behaviors and difficulty disengaging from digital devices. Additionally, the need for social validation reinforced through social media interactions such as likes, comments, and messages may further strengthen habitual smartphone use and contribute to behavioral dependency [14, 15, 37].

In the context of nursing students, these mechanisms may be intensified by high levels of academic and clinical stress. Smartphones may serve as a readily available means of short-term emotional regulation, distraction, or avoidance. However, while such strategies may provide temporary relief, they may also reinforce maladaptive coping patterns and interfere with restorative processes, including sleep. Over time, this may contribute to a bidirectional relationship, in which psychological distress is associated with increased smartphone use, which in turn co-occurs with greater levels of anxiety, depressive symptoms, and insomnia [38, 39].

Strengths and limitations

The main strength of this study lies in the use of well-established and widely applied research instruments, which have been employed in the majority of comparable studies. This enables meaningful comparison of the present findings with existing literature. The analysis encompassed multiple dimensions of mental health and technology-related behaviors, including mobile phone use, sleep disturbances, depression, anxiety, and stress, providing a comprehensive assessment of the study population. Furthermore, the inclusion of both undergraduate and graduate students, as well as full-time and part-time study modes, increased the internal diversity of the sample. The study also addresses a timely and relevant public health issue related to problematic technology use and mental health among nursing students.

Several limitations should be acknowledged. First, the study employed a cross-sectional design, which precludes causal inference between mobile phone use and mental health outcomes. Second, data were collected using self-report questionnaires, which rely on participants’ self-assessment and may be affected by reporting bias, social desirability bias, or conscious and unconscious response distortion. This risk may increase with greater awareness of the study topic. Third, although the sample size was sufficient for statistical analysis, it does not constitute a fully representative sample of the broader population of individuals within the studied age group, as participants were recruited from a single academic institution, limiting the generalizability of the findings. Additionally, the gender distribution was highly imbalanced, with a predominance of female participants, reflecting the demographic structure of the nursing profession but limiting gender-based comparisons. Although this reflects the demographic structure of nursing programs, it limits the validity of gender-based comparisons and may influence prevalence estimates. Previous research suggests that women tend to report higher levels of anxiety, depressive symptoms, and smartphone use. Therefore, the results observed in this study may not be fully generalizable to more gender-balanced populations and should be interpreted with caution when compared to broader student samples. Another limitation concerns the assessment of problematic smartphone use. The MPPUSA scale, although widely used, was originally developed for adolescent populations. Its application in an adult sample may affect measurement accuracy and sensitivity. This issue reflects a broader gap in the literature, as research on problematic smartphone use has predominantly focused on children and adolescents, and there is still a lack of well-validated tools specifically designed for adult populations. Consequently, caution is warranted when interpreting and comparing findings across studies involving different age groups. Finally, the study did not include screening tools for neurodevelopmental conditions such as ADHD or autism spectrum disorders, which could potentially influence technology use patterns and mental health outcomes. Despite these limitations, the study provides valuable insights into the associations between smartphone use and mental health, and its methodology remains consistent with approaches commonly adopted in comparable research, allowing for valid comparison with existing research.

Implication

The findings of this study also have important practical implications. Given the potential impact of problematic smartphone use on mental well-being and future clinical performance, there is a need for targeted, multi-component interventions. These may include integrating digital hygiene and responsible smartphone use education into nursing curricula, with a focus on self-regulation strategies and awareness of maladaptive patterns. Additionally, university health services could implement screening programs to identify students at risk of phonoholism and offer psychological support, including stress management and coping skills training. Peer-support initiatives and workshops addressing issues such as sleep hygiene, anxiety reduction, and digital balance may further enhance intervention effectiveness. Implementing such measures at the educational stage may help prevent the persistence of maladaptive behaviors and promote healthier coping strategies among future healthcare professionals.

Conclusions

The findings indicate that although most nursing students don’t exhibit problematic patterns of smartphone use, a meaningful subgroup may be at risk of phonoholism and its associated consequences. Age and relationship status emerged as significant sociodemographic correlates, suggesting that specific subgroups of students may be particularly vulnerable, whereas no significant associations were observed for gender or place of residence. Importantly, problematic smartphone use was significantly associated with higher levels of nomophobia, depressive symptoms, and insomnia, while nomophobia itself was linked to increased psychological distress, including stress and anxiety. These results suggest that excessive smartphone use is not merely a behavioral concern but may be embedded in a broader network of psychological difficulties, with potential implications for students’ well-being and future professional functioning. Given the cognitive and emotional demands of nursing practice, these findings underscore the importance of early identification and targeted preventive strategies within nursing education.

Abbreviations

AIS

Athens Insomnia Scale

DASS-21

Depression, Anxiety and Stress Scale – 21 items

FOMO

Fear of Missing Out

GSM

Global System for Mobile Communications

MPPUSA

Mobile Phone Problem Use Scale for Adolescents

NMP-Q

Nomophobia Questionnaire

Authors’ contributions

Conceptualization, A.M.C., Methodology, A.M.C. , S.M., Formal Analysis, A.M.C., S.M.; Investigation, A.M.C., S.M. ; Writing—Original Draft Preparation A.M.C. ; Writing—Review and Editing: A.M.C.; Visualization, A.M.C., G.W., A.K.; Supervision, E.G.; G.W., L.M. ; Project Administration A.M.C., K.R. All authors have read and agreed to the published version of the manuscript.

Funding

No funding was received for this research.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki, and approved by Bioethics Committee of the Pomeranian Medical University in Szczecin was obtained (KB-0012/518/12/16).

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.