Problematic smartphone use (PSU) has substantially increased in the last seven years, negatively impacting children’s overall quality of life, although the proportion of children with clinical-level PSU remains low.

Study: Smartphone use, wellbeing, and their association in children. Image Credit: Javier Bermudez Zayas / Shutterstock

A recent study in the journal Pediatric Research investigated the changes in the duration of smartphone use and PSU, and how these have impacted the quality of life in children and adolescents in the last seven years.

How does mental health impact the healthy development of children and adolescents?

The healthy development of children and adolescents is robustly dependent on physical and mental health. The coronavirus disease 2019 (COVID-19) pandemic, which started in the spring of 2020, has led to significant social, environmental, and economic crises worldwide. In addition, several studies have shown how pandemic-related restrictions changed the daily lives of children and adolescents, which considerably strained their mental health.

In recent years, a substantial increase in the use of electronic media, especially smartphones, has been documented. A recent survey conducted in Germany revealed that the number of children between 12 and 18 years of age with smartphones increased from 62% to 94% between 2012 and 2021. Subsequently, the time spent using smartphones has significantly risen in the last few years.

Interestingly, one study indicated that during the COVID-19 pandemic, the use of screen-based media by children and adolescents was associated with frustration, anger, depression, and anxiety. In addition to the positive use of smartphones, such as communication with others and searching for information, many PSUs have also been recorded. Scientists have defined PSU as excessive smartphone use that causes daily dysfunction and symptoms of behavioral addiction, including compulsivity or loss of control.

The prevalence of PSU in children and adolescents in 2019 was estimated to be 23%, which increased to 30% during the pandemic. However, in the current study, the prevalence of clinically relevant PSU was 3%, which is lower than these earlier estimates, though the average PSU score did increase over time. This means that while more children are showing higher average symptoms associated with problematic smartphone use, only a small percentage meet the threshold for clinical concern. Pre-COVID-19 studies had associated PSU with enhanced behavioral difficulties and poorer academic performance, peer and family relations, and overall quality of life.

It must be noted that most studies investigating PSU’s impact on children have used self-reported data, which is susceptible to errors and biases. Furthermore, these studies did not assess whether behavioral changes regarding smartphone use during the pandemic persisted or attenuated over time.

About the study

The current study assessed the change in smartphone usage duration, symptoms of PSU, and quality of life in children and adolescents between 2018 and 2024. Considering the expected increase in smartphone use, this study hypothesized that smartphones’ negative impact has been more substantial in recent years.

All relevant data were collected between March 2018 and July 2024 within the LIFE Child study, which is a German-based cohort study. All participants were invited for a follow-up visit once a year. The mean age of children considered in this study was 14 years. The study cohort contained 49% female and 51% male participants.

PSU was assessed using a German-translated scale originally developed in South Korea. A total of fifteen questions regarding various PSU symptoms were asked, and the respondents’ responses were recorded using a 4-point Likert scale ranging from 1 to 4. Each item score was added to obtain the PSU total score (ranging from 15 to 60), where higher values represented more problematic use. The duration of smartphone use varied between a typical school day and a weekend day.

Study findings

The average quality of life of the participants, based on the t-score, was 52.4, a marginally higher value than the expected mean of 50. Furthermore, the education levels of the mothers of the participating children were relatively high.

Children who were not allowed to have smartphones were excluded from this study. These children were significantly younger, with a mean age of 11.6 years, more frequently male, had mothers with a higher education, and had a higher quality of life than those who owned smartphones.

Children who owned smartphones revealed increasing PSU total scores, which significantly increased after 2018, particularly in 2021, 2022, 2023, and 2024, with an estimated mean score of 28.5, 29.2, 30.0, and 29.9, respectively. The increase in PSU total scores from 2018 to 2021, 2022, and 2023 became significantly weaker with increasing child age.

Compared to boys, girls experienced a significantly higher increase in PSU between 2018 and 2024. Notably, 11-year-olds experienced a significant decrease in PSU total scores between 2023 and 2024, and were the only age group to show such a trend. It must be noted that higher PSU total scores were significantly associated with lower quality of life. However, the study authors emphasize that these findings do not allow for conclusions about causality, meaning it is unclear whether increased smartphone use leads to lower quality of life or whether children with lower quality of life are more likely to use smartphones excessively.

The frequency of children using smartphones for more than three hours per weekend day (defined in the study as “prolonged smartphone use”) was significantly higher between 2021 and 2024 compared to 2018, rising from 37% to 73%. Unlike PSU-related observations, changes in smartphone use duration were not linked with age or sex. However, compared to 2018, the changes in quality of life were significantly stronger in girls between 2022 and 2024.

While the study focused primarily on the effects of the COVID-19 pandemic, the authors also note that other societal events, such as the climate and energy crisis and the war in Ukraine, may also be affecting the quality of life of children and adolescents.

It is also important to mention that the study has some limitations. The sample under-represented children from families with lower education, and the reliance on self-reported data may introduce inaccuracies or bias. Furthermore, the questionnaire used to assess smartphone use duration changed during the survey period, which could have influenced how children reported their usage. The authors also highlight that the study’s cross-sectional design means that, while associations can be identified, no direct cause-and-effect relationship can be established.

Conclusions

The current study highlighted that smartphone use has become increasingly problematic in the last seven years, significantly decreasing the overall quality of life of children and adolescents. However, the study design does not allow for conclusions about whether smartphone use causes lower quality of life or vice versa. Therefore, it is important to limit the time spent using smartphones by offering alternative activities. Furthermore, schools could provide proper health literacy, highlighting the adverse effects of excessive smartphone use.