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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
1
Health Education Officer, Institute for Health Behavioural Research, Ministry of Health Malaysia, Jalan
Rumah Sakit, 50590 Bangsar, Kuala Lumpur, MALAYSIA
2
Lecturer 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 (pNorbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
among users. [4-7] Therefore, smartphones smartphone addiction with anxiety and
today have played an important part in our depression. [12,21,22] Kwon et al. [23] and
community technoculture especially among Demirci et al. [12] explained the higher the
young generation. person addicted to smartphone, their anxiety
Despite the advantages and needs of and depression is higher. An addictive
smartphone, excessive use can lead to individual will loss of self-control, lack of
smartphone addiction. Smartphone desire and ability to communicate with
addiction refers to dependency, excessive others. As a result, the individual will start
and uncontrolled use of the smartphone. [8, 9] isolating himself or herself and continue to
The phenomenon of smartphone addiction depend on smartphones. Indirectly, this also
has been a global concern as it can causes the individual to be worried when
contribute to poor mental health especially cannot use smartphone. [24]
among university students. [10-16] Based on Study done by Kumar [25] showed
previous studies, smartphone addiction has majority of private university students in
also been categorized as behavioural Malaysia agreed that smartphones can cause
addiction due to the inability of users to headache, mental loss and sleep disorders.
control their use. [11,17] In 2009, a study conducted by Zulkefly and
According to Choliz, [18] the problem Baharudin [26] among university students in
of using smartphones is related to Malaysia found that students who spent
behavioural addiction due to clinical more time with phone were more
features such as psychological effects on susceptible to psychological disorders
emotions, personality and cognitive in caused by unhealthy and uncontrolled
which the younger generation is more smartphone use.
vulnerable to excessive usage and A study by Ching et al. [27] reported
dependency towards smartphones. Alavi et 46.9% of Malaysian students were addictive
al. [19] stated that individuals suffering from to smartphone. This figure showed that they
behavioural addiction have symptoms such are moving towards dependence on
as craving, excessive behaviour, smartphone in their daily lives. However,
psychological and physical withdrawal there is limited study done in Malaysia on
symptoms. This behavioural addiction the relationship of excessive use of
usually feature a very strong desire that smartphone or smartphone addiction on
encourages someone to do something anxiety and, depression. Since it has been a
repeatedly without the ability to control, to global concern recently, there is a need to
reduce or to stop. [20] identify the relationship between
According to Chiu, [21] smartphone smartphone addiction with anxiety and
addiction can cause mental health problems depression among undergraduate students in
such as anxiety and depression that will Malaysia.
cause critical barriers in relationships,
activities, physical and mental well-being. MATERIALS AND METHODS
The issue has reached a significant public Design and sample: This is a cross-
health concern and in 2015, WHO issued a sectional study using purposive sampling
report on Public Health Implications of among newly intake of undergraduate
Excessive Use of the Internet, Computers, students in one of a local university in
Smartphones and Similar Electronic Malaysia in September 2016. Those who
Devices. This report summarizes the were absent and, withdraw during data
problems associated with excessive use of collection as well as uncompleted
smartphone with mental health such as questionnaire were excluded in the study.
anxiety, depression and stress. [20] Data collection procedure and ethics: A
In addition, recent studies have pilot study was administered to 30
found there was a relationship between undergraduate students who were not
International Journal of Health Sciences & Research (www.ijhsr.org) 164
Vol.8; Issue: 1; January 2018Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
participating in the study. Result showed Beck Anxiety Inventory (BAI)
that the students did not have difficulty in To measure anxiety, Beck Anxiety
understanding and completing the Inventory-Malay Version by Mukhtar and
questionnaire. Then, actual study was Zulkefly [28] was used. The BAI-Malay
carried out. A brief introduction on the consists of 21 items with a four-point scale
purpose of the study was given to the (zero to three) with Cronbach Alpha 0.91. In
students. Those who agreed to participate the present study, Cronbach's alpha
were required to fill in the consent form coefficient was 0.82. This inventory has
before answering a set of questionnaire. The widely used to measure the severity of
students took approximately 30 minutes to anxiety. Anxiety was divided into 4
answer and once complete, they returned the categories, which are mild (score 0-13),
questionnaire. Ethics approval was obtained moderate (score 14-19), severe (score 20-
from the university and Malaysia National 28) and extremely severe (score 29-63).
Medical Research Register prior to the Beck Depression Inventory (BDI)
initiation of the study. The last section in the questionnaire was
Instrument: A self-administered used Beck Depression Inventory (BDI) -
questionnaire was distributed to 435 Malay Version by Mukhtar and Oei. [29] The
participants. The questionnaire consists of BDI-Malay consist 20 items with a four-
five different sections: a) demography point scale (zero to three) with 0.91 of
characteristics; information on age, race, Cronbach alpha. The Cronbach's alpha
gender, family income, b) the pattern of coefficient in this present study was 0.82.
smartphone usage; information on duration This inventory requires participants to
of smartphone usage daily (hours), monthly answer the questions in relation to how they
expenses on smartphone and, main use of felt over the past week, with higher scores
smartphone, c)smartphone addiction; using indicating more severe depression. There
an adapted Malay Version of Smartphone are 4 categories under depression, which are
Addiction Scale (SAS-M), d) anxiety; using mild (score 0-13), moderate (score 14-19),
Beck Anxiety Inventory (BAI)-Malay severe (score 20-28) and extremely severe
Version and, e) depression; using Beck (score 29-63).
Depression Inventory (BDI) -Malay
Version. Statistical Analysis: All data was entered
Smartphone Addiction Scale and analysed using SPSS software version
The original version scale has been 21. The descriptive statistical analysis of
developed by Kwon et al. [23] and has been data was performed to determine the mean,
adapted translated to Malay language by standard deviation, frequency, and
Ching et al. [27] among university students percentage. Pearson’s correlation was used
with Cronbach Alpha 0.94. The Cronbach to determine the strength of the relationship
Alpha for this study was 0.87. SAS-M between the variables and, Simple Linear
includes 33 items and divided into 6 Regression was performed to determine the
subscales (cyber-space-oriented effect of smartphone addiction to anxiety
relationship, daily life disturbance, primacy, and depression.
overuse, positive anticipation and
withdrawal). Each question has a response RESULTS
scale from 1 to 6 (1=strongly disagree to Out of 435 questionnaires distributed
6=strongly agree), reflecting the frequency out, only 369 students returned the
of the symptoms and the score range is from questionnaire with response rate 85.0%.
33-198, with higher scores indicating the There are 5.3% were absent during data
higher risk of smartphone addiction. collection, 3.7% refused to participate in the
study, 4.2% did not complete the
questionnaire and 1.8% were outliers. Table
International Journal of Health Sciences & Research (www.ijhsr.org) 165
Vol.8; Issue: 1; January 2018Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
1 presented the demographic characteristics divided into two categories which are low
of the sample. Majority participants were smartphone addiction (SAS-M score<
among female 299 (81.0 %). Their ages median value 103) and high smartphone
range from 19 to 30 years with a mean age addiction (SAS-M score > median value
of 19.32 ± 0.98 years. Malay participants 103). Results showed nearly half of the
were dominant in the study 57.5%, followed students (47.7%) experienced high
by Chinese 29.5%, Indian 11.1% and others smartphone addiction.
1.9%. Besides that, 42.0% participants have For anxiety, results showed that
family income above RM 4000. 54.2% of the respondents experienced mild,
while 14.6%, 11.1%, 6.3% and 3.8% of the
Table 1: Distribution of students according to sex, race and respondents have moderate, severe and
monthly family income (n=369)
extremely severe anxiety respectively. Mean
Variable n (%)
Gender ± Standard Deviation for anxiety score was
Male 70 (19.0%) 10.15±8.08. In depression, 80.5% of the
Female 299 (81.0%)
Race students were mild, 14.1% moderate, 5.1%
Malay 212 (57.5%) severe and only 0.3% experienced
Chinese 109 (29.5%)
Indian 41 (11.1%)
extremely severe. Mean ± Standard
Others 7 (1.9%) Deviation for anxiety score was 7.96±6.21.
Monthly family income (n=345)
Less than RM1000 43 (12.5%) Table 3: Level, mean and standard deviation: smartphone
RM1000-1999 40 (11.6%) addiction, anxiety and depression (n=369)
RM2000-2999 55 (15.9%) Variable n (%) Mean and standard
RM3000-3999 52 (15.1%) deviation
More than RM4000 155 (44.9%) Smartphone addiction
Low smartphone addiction 193 (52.3%)
High smartphone addiction 176 (47.7%) 102.52±21.07
The pattern of smartphone usage Anxiety
Table 2 shows 70.0% used smartphone Mild 260 (70.5%)
Moderate 54 (14.6%)
more than four hours per day. Half of them Severe 41 (11.1%) 10.15±8.08
(57.2%) used smartphone for social Extremely Severe 14 (3.8)
networking sites and spent less than RM50 Depression
Mild 297 (80.5%)
for smartphone monthly expenses. Moderate 52 (14.1%)
Severe 19 (5.1%) 7.96±6.21
Table 2: Pattern of smartphone usage (n=369) Extremely Severe 1 (0.3)
Variable n (%)
Duration of smartphone used(daily)
Less than 1 hour 9 (2.4%) Relationship between smartphone
1-3 hour 98 (26.6%) addiction with anxiety and depression
4-6 hours 166 (45.0%)
7-9 hours 54 (14.6%)
Table 4 presented the correlation
More than 9 hours 42 (11.4%) between smartphone addiction with anxiety
Main use of smartphone (n=315) and depression. Results showed that there is
Call/SMS 75 (23.8%)
Social networking sites 211 (67.0%) a significant positive correlation between
Application/Games 14 (4.4%) smartphone addiction with anxiety (r=0.227;
News/information 11 (3.5%)
Others 4 (1.3%) pNorbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among Undergraduate Students in Malaysia p
Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
smartphone usage experiencing phone conducted after treatment. The follow-up
ringing (ringxiety) problems and tend to use period was carried out for four weeks. The
smartphones in prohibited areas (classes and results of the study showed the level of
libraries) and during meals. In 2008, smartphone addiction and level of anxiety
Avvannavar et al., [45] reported that this were decreased after the program and it
condition occurs when an individual hears proved that the program could be used as
the sound of the phone while it does not one of treatment methods for smartphone
ring. Besides that, "Nomophobia" is addiction.
increasing among young generations. [17] In addition to determining a
According to King et al., [46] this syndrome relationship between smartphone addiction
occurs when an individual feels anxious or and anxiety, findings of this study also
uncomfortable when parted from reported significant relationship between
smartphone, computers or virtual smartphone addiction and depression. It was
communication devices. supported by previous studies that found
According to Przybylski et al. [47] individuals with smartphone addiction
anxiety was also identified as a component problems tend to have depression problems.
[42,51,52]
of Fear of Missing Out (FoMO); it is In 2015, Park et al. [52] has
defined as fears, anxiety, and concerns if conducted a study to compare depression
unable to find out the latest information and, problems among 20 students which had
experiencing social interaction. The study been divided into two groups namely Heavy
reported university students with higher Smartphone User Groups and Control
scores of FoMO will be more likely to Groups; results showed that heavy users
check Facebook pages on smartphones who use excessive smartphones tend to
during class compared to lower FoMO suffer depression. In addition, the finding of
scores. A study by Skierkowski and Wood, this study was supported by Thomee et al.
[48] [53]
found students who restricted the usage which conduct a year-long follow-up
of short messages on their smartphones analysis reported that excessive use of
experienced anger, worry and anxiety. In smartphone may be a risk factor for
another study, 50.0% of young people has depression symptoms. Therefore, it can be
experienced anxiety when they cannot concluded that this study supports other
check their smartphones, compared to only studies concerning the relationship between
25.0% Gen X and 15.0% Baby Boomers. [49] smartphone addiction with anxiety and
In addition, Ganganahalli et al. [36] reported depression among university students and
during examination days, nearly 90.0% of shows that this phenomenon also happen
student responded that they felt very bad or among university students in Malaysia.
had a feeling of lost or disconnected from
the world if cannot using mobile for hours. CONCLUSION
In order to overcome the issue of The present study showed university
smartphone addiction and anxiety, Yu and students in Malaysia were inclined towards
Son [50] conducted a study on Acceptance becoming addicted to smartphone and were
Commitment Therapy involving 18 exposed to anxiety and depression.
participants and divided them into two Therefore, there is a need to create possible
groups namely the Program Group and the health education programs and interventions
Control Group. Acceptance Commitment that are appropriate to deal with the
Therapy is a psychological intervention that addiction to the university students and
uses acceptance and awareness strategies improve their mental well-being.
along with commitments and behavioural
change strategies to enhance psychological ACKNOWLEDGMENT
flexibility. The program was supervised for We would like to thank the Director-
eight sessions and a follow-up study was General of Health and Deputy Director-General
International Journal of Health Sciences & Research (www.ijhsr.org) 168
Vol.8; Issue: 1; January 2018Norbaidurah Ithnain et al. Relationship between Smartphone Addiction with Anxiety and Depression among
Undergraduate Students in Malaysia
of Health (Research and Technical Support), Applied Cognitive Psychology
Ministry of Health Malaysia for permission to 2007;21:527-37.
publish this paper. We would also like to 9. Lin YH, Chang LR, Lee YH, et al.
express thanks to the University for the Development and Validation of the
permission to collect the data and to all students Smartphone Addiction Inventory
who participated in this research. A very special (SPAI). PLoS One 2014; 9(6).
thanks dedicated to Ms Teresa Yong Sui Mien, 10. Emad AS & Eman H. The Influence of
for the valuable comments and suggestion to Smart Phones on Human Health and
improve the manuscript. Lastly, we would also Behavior: Jordanians’ Perceptions.
like to express appreciation for all the support International Journal of Computer
from all parties that have contributed directly or Networks and Applications. 2015;
indirectly to complete this study. 2(2):52-6.
11. Akhouri D & Kehksha A. A
Funding: No funding sources comparative study of addiction of
Conflict of interest: None declared simple phone and smart phone and its
effect on mental health: the dark side of
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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.
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