Impact of smartphone addiction on health status, mental well-being, and sleep quality among medical students in Sudan | BMC Psychiatry

General

To our knowledge, this study is the first investigation into smartphone addiction among medical students in Sudan.

Age

Our study revealed no significant correlation between problematic smartphone use and year of study ( p = 0.269). It is likely that the reason for this is a similar occupation (student) for all the participants.

A study previously conducted in India reported a 37% smartphone addiction rate among adolescents, more than that of medical students in a similar study [17]. A study also found a higher likelihood of addiction among those who started using mobile phones at a younger age [18]. Our results suggest that neither age nor academic stage necessarily correlate with problematic smartphone use. Rather, smartphones have become an integral part of students’ lives. This is likely due to their reliance on online medical references in our digital age [19].

Gender

Our study also found no significant differences in smartphone addiction by gender. This sample challenges some existing literature that typically finds higher addiction levels among females for example study that also observed a higher prevalence of smartphone addiction among females [20]. The results reported in our study might be attributed to changing societal norms and the increasing prevalence of smartphones among all demographics. Recent studies suggest that as smartphone usage becomes more universal, the gap between genders in terms of addiction may diminish [21].

Moreover, the types of activities engaged in on smartphones may differ by gender, with males often gravitating towards gaming and females towards social media [22, 23]. This divergence in usage patterns may impact overall addiction levels, suggesting that future research should explore the specific applications and activities that contribute to addiction, rather than focusing solely on device usage.

DAS

Our study showed a significant correlation between DAS and SAS-SV scales (p < 0.001). Furthermore, SHSQ-25 and DAS were strongly correlated (p < 0.001) highlighting the well researched fact that physical health affects mental health scores (Table 3).

A Jordanian study supports this, showing a significant positive correlation between smartphone addiction, depression, and anxiety among medical students [24]. In Iran, a study involving university students found that smartphone addiction can negatively impact both the physical and mental aspects of students’ quality of life [25]. In a prior study involving fifth-year students, it was found that 97.2% of medical students experienced anxiety during the OSCE exam [26]. As smartphones serve as multifunctional tools for studying, socializing, and entertainment, their pervasive presence may blur the lines between healthy use and problematic use [10].

SCI

Our study showed a significant correlation of SCI with SAS-SV (p < 0.001), possibly due to disrupted sleep patterns caused by excessive screen time, especially before bed. Smartphone activities can stimulate the mind and make it difficult to fall asleep and maintain restful sleep. This supports earlier findings that suggest smartphone addiction disrupts sleep [27]. A study in South India found poor sleep quality in 77 medical students who used smartphones [28]. Another study suggests a link between sleep quality and academic performance, with better grades achieved by those who go to bed between 10:00 and 11:00 PM [29]. Research has also shown that undergraduate students at risk of smartphone addiction are less likely to achieve high cumulative GPAs [30, 31].

Residence

Medical students in Sudan showed a relatively high level of smartphone addiction, surpassing similar studies from other countries [32, 33]. A study examined smartphone addiction among university students in Sudan, Jordan, Saudi Arabia, and Yemen and found that Sudanese students had a higher tendency towards smartphone addiction compared to Yemeni students. Jordanian and Saudi students had a higher prevalence of smartphone addiction than Sudanese students [20]. This aligns with a global analysis performed in 24 countries which reports a higher prevalence of smartphone addiction in countries like Saudi Arabia and China while less use is reported in countries like France and Germany [34]. Notably Saudi Arabia and Gulf countries are a major destination for Sudanese expatriates and their families due to work opportunities. This resulted in many students who left Sudan due to the war after April 2023 to join their families and relatives in the Gulf region and thus we notice higher levels of smartphone addiction among students outside Sudan than those in Sudan, even if this difference is not significant. This finding aligns with the concept of digital divide, where disparities in access to technology can lead to varying levels of engagement and addiction [35].

The significant difference in SHSQ-25 scores between students living in Sudan and those residing outside the country highlights the influence of residence on health status and smartphone usage (Table 4 and Fig. 2). It is possible high levels of SHSQ-25 observed in Sudanese medical students in this study may be due to the ongoing armed conflict in Sudan since April 2023. Previous research conducted in Ukraine during wartime also found a high prevalence of severe anxiety and manifestations among university students in war-affected regions [36]. Interestingly this difference in SHSQ-25 did not affect the DAS scales.

Represent association between smartphone addiction scale and marital status

Martial status

Our study showed that married couples are less likely to have problematic sleep usage, sleep disturbance, suboptimal health status and mental illness. The significant association between marital status and smartphone addiction (p < 0.001), sleep condition (p < 0.001), health status (p < 0.001), depression, anxiety and stress (p = 0.006) raises important questions about the psychosocial dynamics influencing technology use among young adults.

Single individuals may utilize smartphones as a primary means of social connection, particularly in environments where face-to-face interaction is limited. This reliance on digital communication could serve as a coping mechanism for loneliness or social anxiety, a phenomenon documented in previous research [37].

Furthermore, the developmental stage of young adulthood is characterized by exploration and identity formation. For single students, smartphones may represent not only a tool for social interaction but also a platform for self-presentation and validation. Studies indicate that social media engagement is linked with self-esteem and peer acceptance [38]. Consequently, students may feel compelled to maintain an active online presence, leading to excessive smartphone usage and potential addiction.

The higher prevalence of smartphone addiction among single medical students compared to their married counterparts could be influenced by several factors. Single individuals often have different social dynamics and potentially more free time, which may lead to increased smartphone usage for entertainment, social interaction, or other non-academic purposes. Married medical students may experience a different set of responsibilities and time constraints, potentially reducing their leisure time for smartphone-related activities. The presence of a spouse and family obligations might also contribute to a more balanced approach to technology use among married students. Furthermore, social support within a marital relationship could offer alternative sources of companionship and entertainment, reducing the reliance on smartphones for these needs. However, a prior study indicated that in the clinical years, 41% to 59% of medical students utilized smartphones for lecture notes, medical videos, electronic textbooks, and medical research [19]. Therefore, the strong association of smartphone addiction with a wide variety of influences warrant further investigation into contextual factors. This research supports existing theories on smartphone addiction and mental health concerning medical students [39].