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Jahrami H, Fekih Romdhane F, Pandi-Perumal SR, BaHammam AS, Vitiello MV. Global research evidence on nomophobia during 2008-2022: a bibliometric analysis and review. PSYCHOL HEALTH MED 2024; 29:889-904. [PMID: 37846044 DOI: 10.1080/13548506.2023.2268888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
Nomophobia, often known as a 21st-century disorder, is a recent condition that has received considerable attention, with numerous studies conducted to better understand it since it was first introduced in 2008. To better understand the present research status and prospects to assist practitioners, policymakers, and funding agencies in protecting the population from nomophobia-related harm, a bibliometric study of nomophobia-related publications was conducted. We used Scopus and dimensions.ai to perform a search between 2008 and 2022. The HistCite, R software, and VOSviewer were used to analyze the data and extract relevant keywords indexed in medical databases using mesh heading phrases. Between January 2008 and April 2022, 1,781 papers, 30 datasets, two grants, six patents, four clinical trials, and five policy documents were identified. The bulk of the articles included in this review were published after 2017 with the majority written in English. Most of the research focuses on determining the prevalence of nomophobia in various populational groups, such as students, clinical samples, and the general adult population. Several studies examined the possible association between nomophobia symptoms and other psychiatric or physical health issues, such as changes in sleep, learning and attention, academic performance, coping strategies, etc. The current body of research knowledge of nomophobia in the main includes epidemiologic and diagnostic effort that has provided mixed results regarding its assessment and prevalence rates, and appreciable data on its treatment and prevention are lacking.
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Affiliation(s)
- Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Government Hospitals, Manama, Bahrain
| | - Feten Fekih Romdhane
- Faculty of Medicine of Tunis, Tunis, Tunisia, Razi Hospital, rue des orangers, Manouba, Tunisia
| | - Seithikurippu R Pandi-Perumal
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Division of Research and Development, Lovely Professional University, Phagwara, Punjab, India
| | - Ahmed S BaHammam
- Department of Medicine, University Sleep Disorders Center and Pulmonary Service, King Saud University, Riyadh, Saudi Arabia
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
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Zhai S, Li T, Zhang D, Qu Y, Xie Y, Wu X, Zou L, Tao F, Tao S. Insomnia trajectories predict chronic inflammation over 2 years at the transition to adulthood. J Sleep Res 2023; 32:e13906. [PMID: 37062708 DOI: 10.1111/jsr.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Insomnia in adolescents is an important public health concern, as its impacts on both their current and future physical and mental health has been discussed. However, few longitudinal studies have examined insomnia and chronic inflammation at the transition from adolescence to adulthood. This study aimed to examine the predictive effects of insomnia and insomnia trajectories on inflammation in college students by using a prospective design. Using data from the College Student Behaviour and Health Cohort Study, which was conducted between April 2019 and April 2021, with an interval of 6 months. We investigated the associations between insomnia trajectories from Year 1 to Year 3 and five inflammatory biomarkers (C-reactive protein [CRP], tumour necrosis factor [TNF]-α, interleukin [IL]-6, IL-1β, IL-10) at Year 3. The association of insomnia symptoms at baseline, Wave 1 or Wave 2 with inflammatory biomarkers at Wave 4 were also assessed. A total of 312 college students (males: 51.6%) aged 16-26 years (mean [SD] 18.82 [1.22] years) were analysed. We identified two insomnia trajectory classes: increasing insomnia (n = 63 [20.2%]) and decreasing insomnia (n = 249 [79.8%]). Generalised linear model analysis revealed that insomnia symptoms at Wave 1 were associated with significantly elevated CRP and TNF-α levels at Wave 4. Increasing insomnia trajectories predicted consistently higher levels of CRP, TNF-α and IL-10. However, after adjusting for potential confounders, these associations were significantly attenuated. Overall, the findings suggest that insomnia symptoms affect chronic inflammation at the transition to adulthood. Our study needs to be replicated in larger cohorts to further explore how inflammation interacts with insomnia to increase the susceptibility to adverse health conditions.
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Affiliation(s)
- Shuang Zhai
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Tingting Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Dan Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yang Qu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yang Xie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, People's Republic of China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Liwei Zou
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, People's Republic of China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, People's Republic of China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, People's Republic of China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Shuman Tao
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, Anhui, People's Republic of China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, People's Republic of China
- Department of Ophthalmology, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Nadar MS, Fekih-Romdhane F, Helmy M, Hattab S, Alhaj OA, AlRasheed MM, Trabelsi K, Jahrami H, Saad HB. Impact of Nomophobia on Musculoskeletal Problems in the Upper Extremity among Adults: Implications for Occupational Therapy. Occup Ther Health Care 2023:1-16. [PMID: 37747410 DOI: 10.1080/07380577.2023.2243629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/29/2023] [Indexed: 09/26/2023]
Abstract
Nomophobia (NO MObile PHone Phobia) is a psychological condition in which people are anxious of being cut off from their mobile phones and been associated with adverse consequences to physical and psychosocial health. The objective of this study was to measure the impact of nomophobia on musculoskeletal problems in the upper extremity among adults. The Nomophobia scale (NMP-Q) was used to measure addiction to smartphone use among 5,087 Middle Eastern adults. A snowball sampling approach was used to recruit the participants between March and June 2021. Results showed that nomophobia was evident in 1,119 participants (22%) with a mean NMP-Q score of 114.1 (SD 11.1). A total of 3,396 upper extremity symptoms were reported among our participants. The binomial logistic regression showed that NMP-Q score is a significant predictor of symptoms to the thumb only (β = 0.01, p = .026). This study has provided evidence of the negative physical consequences of addiction to smartphone use. Participants with thumb-related symptoms were more prone to sustain other concurrent upper extremity symptoms, probably due to their maladaptive habits of using the phone. Thus, it is important to increase awareness about the risks associated with the use of smartphones. Implications for occupational therapy are presented.
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Affiliation(s)
- Mohammed Sh Nadar
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | - Feten Fekih-Romdhane
- Department of psychiatry, "Ibn Omrane", Razi hospital, Manouba, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunism Tunisia
| | - Mai Helmy
- Psychology Department, College of Education, Sultan Qaboos University, Muscat, Oman
- Psychology Department, Faculty of Arts, Menoufia University, Al Minufiyah, Egypt
| | - Suhaib Hattab
- Division of Physiology, Pharmacology and Toxicology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Omar Amin Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Petra, Jordan
| | - Maha M AlRasheed
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
- Education, Motricity, Sport, and Health, University of Sfax, Sfax, Tunisia
| | - Haitham Jahrami
- Ministry of Health, Manama, Kingdom of Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Helmi Ben Saad
- Heart Failure Research Laboratory, Farhat Hached Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine, University of Sousse, Sousse, Tunisia
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Naser AY, Alwafi H, Itani R, Alzayani S, Qadus S, Al-Rousan R, Abdelwahab GM, Dahmash E, AlQatawneh A, Khojah HMJ, Kautsar AP, Alabbasi R, Alsahaf N, Qutub R, Alrawashdeh HM, Abukhalaf AHI, Bahlol M. Nomophobia among university students in five Arab countries in the Middle East: prevalence and risk factors. BMC Psychiatry 2023; 23:541. [PMID: 37496010 PMCID: PMC10369834 DOI: 10.1186/s12888-023-05049-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/24/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Excessive use of mobile phones leading to development of symptoms suggestive of dependence syndrome with teenagers are far more likely to become dependent on mobile phones as compared to adults. COVID-19 pandemic has had an impact on the mental health of several groups in society, especially university students. This study aimed to explore the prevalence of mobile phone dependence among university students and its associated factors. METHODS Between September 2021 and January 2022, a cross-sectional study was conducted at universities in Jordan, Lebanon, Egypt, Bahrain, and Saudi Arabia utilizing an online and paper-based self-administered questionnaire. We employed a previously developed questionnaire by Aggarwal et al. RESULTS: A total of 5,720 university students were involved in this study (Egypt = 2813, Saudi Arabia = 1509, Jordan = 766, Lebanon = 432, and Bahrain = 200). The mean estimated daily time spent on using mobile phone was 186.4 (94.4) minutes. The highest mobile dependence score was observed for the university students from Egypt and the lowest mobile dependence score was observed for the university students from Lebanon. The most common dependence criteria across the study sample was impaired control (55.6%) and the least common one was harmful use (25.1%). Females and those reported having anxiety problem or using a treatment for anxiety were at higher risk of developing mobile phone dependence by 15% and 75%, respectively. CONCLUSION Mobile phone dependence is common among university students in Arab countries in the Middle East region. Future studies exploring useful interventions to decrease mobile phone dependence are warranted.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, Beirut, Lebanon
| | - Salman Alzayani
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - Sami Qadus
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Rabaa Al-Rousan
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Ghada Mohammad Abdelwahab
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Eman Dahmash
- Department of Chemical and Pharmaceutical Sciences, School of Life Sciences, Pharmacy and Chemistry, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Ahmad AlQatawneh
- ACDIMA Center for Bioequivalence and Pharmaceutical Studies, Department of Clinical Research, Amman, Jordan
| | - Hani M J Khojah
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Angga Prawira Kautsar
- Unit of Global Health, Department of Health Sciences, University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Renan Alabbasi
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Nouf Alsahaf
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Razan Qutub
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | | | - Amer Hamad Issa Abukhalaf
- Florida Institute for Built Environment Resilience, M.E. Rinker, Sr. School of Construction Management, College of design construction and planning, University of Florida, Gainesville, FL, USA
| | - Mohamed Bahlol
- Specialty of Pharmaceutical Management and Economics, Department of Pharmacy Practice and Clinical Pharmacy, Egyptian Russian University, Cairo, Egypt
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Daraj LR, AlGhareeb M, Almutawa YM, Trabelsi K, Jahrami H. Systematic Review and Meta-Analysis of the Correlation Coefficients between Nomophobia and Anxiety, Smartphone Addiction, and Insomnia Symptoms. Healthcare (Basel) 2023; 11:2066. [PMID: 37510507 PMCID: PMC10380081 DOI: 10.3390/healthcare11142066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Nomophobia is an emerging phenomenon in the 21st century. Consequently, it results in various health problems, both physical and psychological. The following systematic review and meta-analysis aimed to establish the relationship between nomophobia with anxiety, smartphone addiction, and insomnia. To identify the relevant studies, we searched through several databases. Out of the 1523 studies identified, 16 studies met the inclusion criteria. After conducting the statistical analysis, the results revealed that anxiety r = 0.31 (95% CI: 0.25 to 0.38), smartphone addiction r = 0.39 (95% CI: 0.04 to 0.75), and insomnia r = 0.56 (95% CI: 0.38 to 0.75) are positively associated with nomophobia. Mobile phone usage has become inevitable, even for individuals who use it to a lesser degree than others, to perform simple tasks, such as communicating with others or for educational purposes. It is crucial to raise awareness about the consequences of overusing these devices, including the physical and psychological complications in both the short and long terms.
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Affiliation(s)
- Lateefa Rashed Daraj
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain
| | - Muneera AlGhareeb
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain
| | - Yaser Mansoor Almutawa
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain
- Government Hospitals, Manama 329, Bahrain
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Jahrami H. The Relationship between Nomophobia, Insomnia, Chronotype, Phone in Proximity, Screen Time, and Sleep Duration in Adults: A Mobile Phone App-Assisted Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11101503. [PMID: 37239789 DOI: 10.3390/healthcare11101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Earlier studies that have investigated the association between nomophobia and insomnia revealed that a strong relationship exists between both variables. This study aimed to explore possible associations between these variables and their impact on physical and mental health outcomes using a cross-sectional study design and mobile phone apps to collect data. Using a survey approach, data were collected from 444 participants (52% female, mean age 34 ± 12) using the Nomophobia Questionnaire (NMP-Q), the Insomnia Severity Index (ISI), the Morningness-Eveningness Questionnaire (MEQ) and three Android mobile phone apps. The Plees Tracker, screen time, and pedometer apps aided in collecting data on sleep duration, time spent on screen per day, and how close the phone was to the person. A statistically significant association was noted between nomophobia and insomnia, nomophobia and the eveningness chronotype, and nomophobia and screen time. The eveningness chronotype was also associated with an increased screen time use. The results show that NMP-Q, ISI, and screen time increase according to the chronotype. No statistically significant differences were noted in daily steps or sleep duration according to chronotype. The findings suggest that interventions targeting nomophobia may be beneficial in addressing insomnia among adults, particularly those with an evening chronotype. Future studies should consider exploring the causal relationship between them.
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Affiliation(s)
- Haitham Jahrami
- Government Hospitals, Manama P.O. Box 12, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
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Al-Mamun F, Mamun MA, Prodhan MS, Muktarul M, Griffiths MD, Muhit M, Sikder MT. Nomophobia among university students: Prevalence, correlates, and the mediating role of smartphone use between Facebook addiction and nomophobia. Heliyon 2023; 9:e14284. [PMID: 36942222 PMCID: PMC10023918 DOI: 10.1016/j.heliyon.2023.e14284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Nomophobia ('no mobile phone phobia') has been growing issue worldwide in recent years and has been associated with a number of psychological and behavioral health-related problems. However, few studies have examined nomophobia in Bangladesh. Therefore, the severity and correlates of nomophobia, and the mediating role of smartphone use between Facebook addiction and nomophobia was investigated. A cross-sectional study utilizing 585 university students was conducted employing a convenience sampling method. Data were collected using a survey in March 2022. The survey comprised questions related to socio-demographics, behavioral health, academic performance, nomophobia, smartphone addiction, Facebook addiction, insomnia, and depression. The mean score of nomophobia was 88.55 out of 140 (±21.71). The prevalence was 9.4% for mild nomophobia, 56.1% for moderate nomophobia, and 34.5% for severe nomophobia. First-year students had higher levels of nomophobia than other years. Significant predictors for nomophobia included daily duration of smartphone time, psychoactive substance use, and being in a relationship. Nomophobia was significantly associated with smartphone addiction, Facebook addiction, insomnia, and depression. Moreover, smartphone addiction significantly mediated the relationship between Facebook addiction and nomophobia. Strategies that help reduce daily smartphone time, and reduce psychoactive substance use might help reduce nomophobia prevalence among university students.
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Affiliation(s)
- Firoj Al-Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Department of Public Health, University of South Asia, Dhaka, Bangladesh
- Corresponding author. CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh.
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | | | - Md. Muktarul
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, United Kingdom
| | - Mohammad Muhit
- Department of Public Health, University of South Asia, Dhaka, Bangladesh
| | - Md. Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
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Wattick RA, Olfert MD, Claydon E, Hagedorn-Hatfield RL, Barr ML, Brode C. Early life influences on the development of food addiction in college attending young adults. Eat Weight Disord 2023; 28:14. [PMID: 36807705 PMCID: PMC9940052 DOI: 10.1007/s40519-023-01546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE There is little investigation into the causes of food addiction. The aim of this study was to determine the impact of early life influences on the development of food addiction in college-attending young adults aged 18-29. METHODS This study utilized a sequential explanatory mixed-methods research design. College-attending young adults were invited to complete an online survey measuring Adverse Childhood Experiences (ACEs), food addiction, depression, anxiety, stress, and demographic information. Correlations between food addiction and the other variables were analyzed and significant variables were placed into a nominal logistic regression model to predict the development of food addiction. Participants who met the criteria for food addiction were invited to participate in interviews to examine their childhood eating environment and when their symptoms emerged. Interviews were transcribed and thematically analyzed. Quantitative analysis was conducted using JMP Pro Version 16.0 and qualitative analysis was conducted using NVIVO Software Version 12.0. RESULTS Survey respondents (n = 1645) had an overall 21.9% prevalence of food addiction. Significant correlations were observed between food addiction and ACEs, depression, anxiety, stress, and sex (p < .01 for all). Depression was the only significant predictor of the development of food addiction (OR = 3.33 95% CI 2.19, 5.05). The most common eating environment described by interview participants (n = 36) was an emphasis on diet culture, ideal body image, and restrictive environments. Symptoms frequently emerged after transitioning into college and having the ability to make their own food choices. CONCLUSION These results show the impact of early life eating environments and young adulthood mental health on the development of food addiction. These findings contribute to the understanding of underlying causes of food addiction. LEVEL OF EVIDENCE Level V, Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Rachel A Wattick
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G25 4100 Agricultural Sciences Building, 1194 Evansdale Dr., P.O. Box 6108, Morgantown, WV, 26505-6108, USA
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, G25 4100 Agricultural Sciences Building, 1194 Evansdale Dr., P.O. Box 6108, Morgantown, WV, 26505-6108, USA.
| | - Elizabeth Claydon
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Dr., Morgantown, WV, 26505-9190, USA
| | - Rebecca L Hagedorn-Hatfield
- Department of Nutrition, Health and Human Performance, School of Education Health and Human Sciences, Meredith College, 3800 Hillsborough Street, Raleigh, NC, 27607-5298, USA
| | - Makenzie L Barr
- Department of Dietetics and Human Nutrition, University of Kentucky, 212 Funkhouser Building, Lexington, KY, 40514, USA
| | - Cassie Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
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Wattick RA, Olfert MD, Hagedorn-Hatfield RL, Barr ML, Claydon E, Brode C. Diet quality and eating behaviors of college-attending young adults with food addiction. Eat Behav 2023. [PMID: 36863205 DOI: 10.1016/j.eatbeh.2023.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND College students are heavily influenced by their food environment and are an important population in which to study food addiction. This mixed-methods study aimed to examine diet quality and eating behaviors of college students with food addiction. METHODS Students attending a large university in November 2021 were invited to complete an online survey that measured food addiction, eating styles, eating disorder symptoms, diet quality, and anticipated feelings after eating. Kruskal-Wallis H determined differences between those with and without food addiction in mean scores of quantitative variables. Participants who met the symptom threshold for the presence of food addiction were invited to participate in an interview that elicited more information. Quantitative data was analyzed using JMP Pro Version 16.0 and qualitative data was thematically analyzed using NVIVO Pro Software Version 12.0. RESULTS Respondents (n = 1645) had a 21.9 % prevalence of food addiction. Individuals with mild food addiction had the highest scores in cognitive restraint. Those with severe food addiction had the highest scores in uncontrolled eating, emotional eating, and eating disorder symptoms. Individuals with food addiction showed significantly higher negative expectancies for healthy and junk food, lower intake of vegetables, higher intakes of added sugars and saturated fat. Interview participants had problems with sweets and carbohydrates most often and described eating until physically ill, eating in response to negative emotions, dissociation while eating, and strong negative feelings after eating. CONCLUSION Findings contribute to the understanding of the behaviors, emotions, and perceptions surrounding food by this population, providing potential behaviors and cognitions to target for treatment.
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Affiliation(s)
- Rachel A Wattick
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences; 4100 Agricultural Sciences Building, PO Box 6108, Morgantown, WV 26505-6108, United States of America.
| | - Melissa D Olfert
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences; 4100 Agricultural Sciences Building, PO Box 6108, Morgantown, WV 26505-6108, United States of America.
| | - Rebecca L Hagedorn-Hatfield
- Meredith College, School of Education Health & Human Sciences, Department of Nutrition, Health and Human Performance; 3800 Hillsborough Street, Raleigh, NC 27607-5298, United States of America.
| | - Makenzie L Barr
- University of Kentucky, Department of Dietetics and Human Nutrition, 212 Funkhouser Building, Lexington, KY 40514, United States of America.
| | - Elizabeth Claydon
- West Virginia University, School of Public Health, Department of Social & Behavioral Sciences, 64 Medical Center Dr., Morgantown, WV 26505-9190, United States of America.
| | - Cassie Brode
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, United States of America.
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Vagka E, Gnardellis C, Lagiou A, Notara V. Nomophobia and Self-Esteem: A Cross Sectional Study in Greek University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2929. [PMID: 36833624 PMCID: PMC9957397 DOI: 10.3390/ijerph20042929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
Nomophobia is a relatively new term describing someone's fear, discomfort, or anxiety when his/her smartphone is not available. It is reported that low self-esteem may contribute to an individual's tendency for nomophobia. The aim of this particular study was to investigate the association between nomophobia and self-esteem among Greek university students. The study sample consisted of 1060 male and female university students aged 18 to 25 years, participating on a voluntary basis with an online anonymous questionnaire. Data were collected through "Nomophobia Questionnaire (NMP-Q)" and "Rosenberg's self-esteem scale (RSES)". All participants exhibited some level of nomophobia, with the moderate level prevailing (59.6%). Regarding self-esteem categories, 18.7% of the participants showed low self-esteem, while the rest showed normal/high levels. Students with low self-esteem were twice as likely to exhibit a higher level of nomophobia compared to those with normal/high (adj Cum OR = 1.99, p value < 0.001). Additionally, women and students having fathers without a university education had a higher risk of exhibiting a greater level of nomophobia (adj Cum OR = 1.56 and 1.44, respectively, p values ≤ 0.008). It was observed that low self-esteem and nomophobia are closely connected. Further investigation into this particular issue is needed to explore potential causality between them.
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Affiliation(s)
- Elissavet Vagka
- Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, 11521 Athens, Greece
| | - Charalambos Gnardellis
- Department of Fisheries and Aquaculture, University of Patras, 30200 Messolonghi, Greece
| | - Areti Lagiou
- Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, 11521 Athens, Greece
| | - Venetia Notara
- Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, 11521 Athens, Greece
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11
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Jahrami H, Trabelsi K, Vitiello MV, BaHammam AS. The Tale of Orthosomnia: I Am so Good at Sleeping that I Can Do It with My Eyes Closed and My Fitness Tracker on Me. Nat Sci Sleep 2023; 15:13-15. [PMID: 36713639 PMCID: PMC9875581 DOI: 10.2147/nss.s402694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Kingdom of Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia.,Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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12
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Aldhahir AM, Bintalib HM, Siraj RA, Alqahtani JS, Alqarni OA, Alqarni AA, Alghamdi HS, Alyami MM, Naser AY, Fatani AI, Alwafi H. Prevalence of Nomophobia and Its Impact on Academic Performance Among Respiratory Therapy Students in Saudi Arabia. Psychol Res Behav Manag 2023; 16:877-884. [PMID: 36960416 PMCID: PMC10029368 DOI: 10.2147/prbm.s404898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Background Nomophobia has been highly prevalent among health discipline students. However, there is no available data on the prevalence of nomophobia among respiratory therapy (RT) students in Saudi Arabia. Methods A cross-sectional survey using the nomophobia questionnaire (NMP-Q) was conducted and distributed using a convenience sample of RT students through an online platform (Survey Monkey) between September and November 2022. Results Overall, 1428 RT students, with males accounting for 773 (54%), responded to the online survey. The prevalence of nomophobia among RT students was 97.3% (1390). The mean (±SD) of the total NMP-Q items scores was 62 (±22), indicating a moderate level of nomophobia among the RT students. Female RT students had significantly higher nomophobia scores than male RT students (63 (47-80) vs 59 (43-75); p <0.001)). Single RT students had significantly higher nomophobia scores than married RT students (62 (46-78) vs 46 (37-64); p <0.001)). RT students who were living outside the family home had significantly higher nomophobia scores than RT students who were living with their family (66 (54-78) vs 60 (44-77); p = 0.001)). RT students with a GPA of 4.50 to 5.00 had the highest nomophobia score (63 (46-79); p = 0.005)). RT students who were in their third year had the highest nomophobia score (66 (48-80); p <0.001)). RT students who reported no academic warnings had the highest nomophobia score (63 (48-80); p <0.001)). RT students who spent ≥ five hours studying per week had the highest nomophobia score (64 (51-80); p <0.001)). Conclusion Nomophobia is common among RT students, with the majority experiencing a moderate level. Being female, single, living outside the family home, and having a higher academic performance were risk factors associated with higher nomophobia levels.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- Correspondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Saudi Arabia, Tel +966557775561, Email
| | - Heba M Bintalib
- Department of Respiratory Care, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Rayan A Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Omar A Alqarni
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanin S Alghamdi
- Department of Respiratory Therapy, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Mohammed M Alyami
- Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Alaa I Fatani
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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The Prevalence of Mild, Moderate, and Severe Nomophobia Symptoms: A Systematic Review, Meta-Analysis, and Meta-Regression. Behav Sci (Basel) 2022; 13:bs13010035. [PMID: 36661607 PMCID: PMC9854858 DOI: 10.3390/bs13010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
NOMOPHOBIA, or NO MObile PHone Phobia, refers to a psychological condition in which people fear being disconnected from their mobile phones. The purpose of this review was to establish the prevalence of nomophobia symptoms in youth and young adults according to severity, country, culture, population, measurement tool, and year of data collection. An electronic search of fourteen databases, two digital preservation services, and three content aggregator services was conducted from the inception of each database until 15 September 2021. A total of 52 studies involving 47,399 participants from 20 countries were included in the analyses. The prevalence of nomophobia was defined as the proportion of individuals scoring at or above established cut-offs on validated measures. Based on a random-effects meta-analysis, approximately 20% of individuals showed mild symptoms of nomophobia, 50% showed moderate symptoms, and 20% showed severe symptoms. Our results showed that university students from non-Western cultures are the most likely to suffer severe symptoms. In the year 2021, the prevalence rate of nomophobia increased. The instrument that was best able to detect nomophobia was the nomophobia questionnaire. Most individuals who own mobile phones experience mild or moderate symptoms of nomophobia. Severe symptoms deserve attention from clinicians and research scientists. A valid method of identifying individuals with a severe addiction to their mobile phones will help with timely and effective therapeutic management.
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14
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Li T, Zhang D, Qu Y, Zhai S, Xie Y, Tao S, Zou L, Tao F, Wu X. Association between trajectories of problematic mobile phone use and chronotype among Chinese college students. Addict Behav 2022; 134:107398. [PMID: 35752086 DOI: 10.1016/j.addbeh.2022.107398] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
AIMS This study aimed to describe the prevalence of problematic mobile phone use (PMPU) and chronotype among Chinese college students, estimate PMPU development trajectories, and further examine the effect of PMPU trajectories on chronotype. DESIGN In a stratified cluster sampling design, PMPU and chronotype were evaluated in 999 college students from two universities in a 2-year prospective investigation from April 2019 to April 2021, and an investigation was conducted every six months (time 1 ∼ time 5, T1 ∼ T5). PARTICIPANTS N = 999 college students (mean age at T1: 18.8 years (SD = 1.2), 37.7% male) took part in the study. MEASUREMENTS The Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess the PMPU and sleep quality of college students at each time point. The Morning and Evening Questionnaire (MEQ) was adopted to investigate the chronotype of college students at T5. FINDINGS The prevalence of PMPU at T1 ∼ T5 was 24.3%, 27.3%, 35.1%, 31.2% and 31.9%, respectively. The prevalence rates of morning types (M-types), neutral types (N-types), and evening types (E-types) were 19.1%, 70.8%, and 10.1%, respectively. Using latent growth mixture modelling, we identified three trajectories of PMPU: low-level (49.5%), moderate-level (38.6%), and high-level score trajectories (11.9%). Multivariate logistic regression analysis results showed that a trajectory with a high score was positively associated with E-types (P < 0.05). After stratification by gender, a high-level score trajectory was positively associated with E-types only among female college students (P < 0.05). There were sex differences in the association between trajectories of PMPU and chronotype. CONCLUSION Long-term symptoms of PMPU may be a potential risk factor for circadian rhythm disturbance among college students, and this effect was significantly different between genders.
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Affiliation(s)
- Tingting Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Dan Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yang Qu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shuang Zhai
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yang Xie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Shuman Tao
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, China
| | - Liwei Zou
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, China.
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15
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Bragazzi NL, Garbarino S, Puce L, Trompetto C, Marinelli L, Currà A, Jahrami H, Trabelsi K, Mellado B, Asgary A, Wu J, Kong JD. Planetary sleep medicine: Studying sleep at the individual, population, and planetary level. Front Public Health 2022; 10:1005100. [PMID: 36330122 PMCID: PMC9624384 DOI: 10.3389/fpubh.2022.1005100] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the "circadian landscape," with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada,*Correspondence: Nicola Luigi Bragazzi
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, Academic Neurology Unit, Ospedale A. Fiorini, Terracina, Italy,Sapienza University of Rome, Rome, Italy
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain,College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia,Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, Tunisia
| | - Bruce Mellado
- School of Physics and Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa,Subatomic Physics, iThemba Laboratory for Accelerator Based Sciences, Somerset West, South Africa
| | - Ali Asgary
- Disaster and Emergency Management Area and Advanced Disaster, Emergency and Rapid-Response Simulation (ADERSIM), School of Administrative Studies, York University, Toronto, ON, Canada
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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16
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Jahrami H, Fekih-Romdhane F, Saif Z, Bragazzi NL, Pandi-Perumal SR, BaHammam AS, Vitiello MV. A Social Media Outage Was Associated with a Surge in Nomophobia, and the Magnitude of Change in Nomophobia during the Outage Was Associated with Baseline Insomnia. Clocks Sleep 2022; 4:508-519. [PMID: 36278533 PMCID: PMC9589948 DOI: 10.3390/clockssleep4040040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
We examined the immediate impact of a social media outage on nomophobia and associated symptoms using a longitudinal cohort design. Data were collected at two timepoints, baseline (T1) and during the social media outage of 4 October 2021 (T2). T1 was collected in August–September 2021 as part of the baseline of an ongoing study. The nomophobia questionnaire (NMP-Q), Generalized Anxiety Disorder-7 scale (GAD-7), and Athens insomnia scale (AIS) were administered to 2706 healthy participants from the general Bahraini population (56% females, mean age 33.57 ± 11.65 years). Approximately one month later, during the social media outage, 306 of the study participants were opportunistically assessed using the NMP-Q. At baseline, we found that nomophobia levels strongly correlated positively with both insomnia (p = 0.001) and anxiety symptoms (p = 0.001). This is the first report to examine the impact of a social media outage on nomophobia. Our findings indicate that symptoms of nomophobia increased significantly during a social media outage. Baseline insomnia scores predicted a surge in the global scores of nomophobia symptoms during a social media outage.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, Manama 410, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
- Correspondence: ; Tel.: +973-1728-7334
| | - Feten Fekih-Romdhane
- Department of Psychiatry “Ibn Omrane”, Razi Hospital, Manouba 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis 1068, Tunisia
| | | | - Nicola Luigi Bragazzi
- Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Seithikurippu R. Pandi-Perumal
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602117, India
| | - Ahmed S. BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, P.O. Box 225503, Riyadh 11324, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, P.O. Box 2454, Riyadh 11324, Saudi Arabia
| | - Michael V. Vitiello
- Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, WA 98195-6560, USA
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17
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Alwafi H, Naser AY, Aldhahir AM, Fatani AI, Alharbi RA, Alharbi KG, Almutwakkil BA, Salawati E, Ekram R, Samannodi M, Almatrafi MA, Rammal W, Assaggaf H, Qedair JT, Al Qurashi AA, Alqurashi A. Prevalence and predictors of nomophobia among the general population in two middle eastern countries. BMC Psychiatry 2022; 22:520. [PMID: 35918684 PMCID: PMC9344455 DOI: 10.1186/s12888-022-04168-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Nomophobia is a psychological condition caused by a fear of disconnecting from others through mobile phones. AIM This study aims to determine the prevalence of and predictors of nomophobia and anxiety symptoms among the general population in Saudi Arabia and Jordan. METHODS This study was an observational cross-sectional study using a web-based online survey distributed in two middle eastern countries (Saudi Arabia and Jordan) between Jun 24 and Jul 20, 2021. A convenience sample was used to recruit the study participants. Categorical variables were identified as frequencies and percentages. In addition, a binary logistic regression analysis was used to determine the factors associated with nomophobia symptoms. The Statistical Package for Social Science (SPSS) software, version 27 (IBM Corp, Armonk, NY, USA), analyzed the data. RESULTS A total of 5,191 responded to the online survey. Around (26.5%) reported that they suffer from an anxiety problem or use a treatment for anxiety. The median daily time spent using a mobile phone (IQR) (minutes) was around 210 min per day. About half of the study sample (51.2%) are diagnosed with dependence syndrome. The binary logistic regression analysis revealed that those within the age group of 30-49 years and 50 years and above) are less likely to have mobile phone dependence compared to those less than 30 years old. Females were 16% at lower risk of developing mobile phone dependence compared to males Married participants were less likely to have mobile phone dependence compared to single participants (OR: 0.62 (95% CI 0.56-0.70)), while divorced participants were at a 46% higher risk of developing mobile phone dependence. CONCLUSION Nomophobia prevalence among Saudi Arabia and Jordon's population is 51.2%. Several factors may predict mobile phone dependence including age, gender, marital status, and previous history of anxiety.
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Affiliation(s)
- Hassan Alwafi
- grid.412832.e0000 0000 9137 6644Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdallah Y. Naser
- grid.460941.e0000 0004 0367 5513Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Abdulelah M. Aldhahir
- grid.411831.e0000 0004 0398 1027Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Alaa Idrees Fatani
- grid.412832.e0000 0000 9137 6644Department of Medicine and Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rahaf Awaili Alharbi
- grid.412832.e0000 0000 9137 6644Department of Medicine and Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khawlah Ghazi Alharbi
- grid.412832.e0000 0000 9137 6644Department of Medicine and Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Braah Ali Almutwakkil
- grid.412832.e0000 0000 9137 6644Department of Medicine and Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Emad Salawati
- grid.412125.10000 0001 0619 1117Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan Ekram
- grid.412832.e0000 0000 9137 6644School of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohammed Samannodi
- grid.412832.e0000 0000 9137 6644Department of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed A. Almatrafi
- grid.412832.e0000 0000 9137 6644Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Wael Rammal
- grid.415254.30000 0004 1790 7311Department of Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hamza Assaggaf
- grid.412832.e0000 0000 9137 6644Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jumanah T. Qedair
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A. Al Qurashi
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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18
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Jahrami HA, Fekih-Romdhane F, Saif ZQ, Alhaj OA, AlRasheed MM, Pandi-Perumal SR, BaHammam AS, Vitiello MV. Sleep dissatisfaction is a potential marker for nomophobia in adults. Sleep Med 2022; 98:152-157. [PMID: 35868112 DOI: 10.1016/j.sleep.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION NOMOPHOBIA is a term used to describe an anxiety disorder in which people fear being disconnected from their mobile phones. Strong associations between nomophobia and insomnia have previously been documented. However, there is no clear explanation for this relationship between the two disorders. The present study was designed to first determine the diagnostic precision of the Insomnia Severity Index (ISI) various components in detecting or classifying nomophobia; and second, examine the diagnostic performance of the identified ISI components in classifying nomophobia. METHODS From a previous study 549 participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), and the ISI. The sample was divided into two parts so that each part represented the original sample, using a 40% (n = 209) allocation for sample 1 and 60% (n = 340) for sample 2. To determine common components between nomophobia and insomnia, an exploratory factor analysis was performed using sample 1 to determine the diagnostic precision of the ISI's various components in detecting or classifying nomophobia. A test of the ISI and a cut-off value (ISI-4 ≥2) was then conducted on Sample 2 to determine whether they would accurately identify significant nomophobia. RESULTS Sleep dissatisfaction was a common component of insomnia and nomophobia. Sleep dissatisfaction had excellent diagnostic accuracy in detecting individuals with nomophobia (sensitivity 75.13%, specificity 100%, Youden' index 0.75, area under curve 0.88). CONCLUSION Questioning patients sleep dissatisfaction may serve as a marker for both nomophobia and insomnia, both of which may demand more comprehensive evaluation.
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Affiliation(s)
- Haitham A Jahrami
- Ministry of Health, Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain.
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Psychiatry Department "Ibn Omrane", Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | | | - Omar A Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Science, University of Petra, Amman, Jordan
| | - Maha M AlRasheed
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Princess Nora bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Seithikurippu R Pandi-Perumal
- Somnogen Canada Inc., College Street, Toronto, Canada; Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Michael V Vitiello
- Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, WA, 98195-6560, United States
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19
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AlMarzooqi MA, Alhaj OA, Alrasheed MM, Helmy M, Trabelsi K, Ebrahim A, Hattab S, Jahrami HA, Ben Saad H. Symptoms of Nomophobia, Psychological Aspects, Insomnia and Physical Activity: A Cross-Sectional Study of ESports Players in Saudi Arabia. Healthcare (Basel) 2022; 10:healthcare10020257. [PMID: 35206871 PMCID: PMC8872081 DOI: 10.3390/healthcare10020257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/18/2022] Open
Abstract
(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.
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Affiliation(s)
- Mezna A. AlMarzooqi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence:
| | - Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman 961343, Jordan;
| | - Maha M. Alrasheed
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mai Helmy
- Psychology Department, College of Education, Sultan Qaboos University, Muscat 123, Oman;
- Psychology Department, Faculty of Arts, Menoufia University, Shebin El-Kom 32511, Egypt
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
- Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Ahmed Ebrahim
- Ministry of Health, Manama 410, Bahrain; (A.E.); (H.A.J.)
| | - Suhaib Hattab
- Division of Physiology, Pharmacology & Toxicology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, AnNajah National University, Nablus 4000, Palestine;
| | - Haitham A. Jahrami
- Ministry of Health, Manama 410, Bahrain; (A.E.); (H.A.J.)
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain
| | - Helmi Ben Saad
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse 4000, Tunisia;
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia
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20
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Longitudinal Relationships between Nomophobia, Addictive Use of Social Media, and Insomnia in Adolescents. Healthcare (Basel) 2021; 9:healthcare9091201. [PMID: 34574975 PMCID: PMC8471181 DOI: 10.3390/healthcare9091201] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Temporal relationships between nomophobia (anxiety related to ‘no mobile phone phobia’), addictive use of social media, and insomnia are understudied. The present study aimed to use a longitudinal design to investigate temporal relationships between nomophobia, addictive use of social media, and insomnia among Iranian adolescents; (2) Methods: A total of 1098 adolescents (600 males; 54.6%; age range = 13 to 19) were recruited from 40 randomly selected classes in Qazvin, Iran. They completed baseline assessments. The same cohort was invited to complete three follow-up assessments one month apart. Among the 1098 adolescents, 812 (400 males; 49.3%; age range = 13 to 18) completed the baseline and three follow-up assessments. In each assessment, the participants completed three questionnaires, including the Nomophobia Questionnaire (NMP-Q), Bergen Social Media Addiction Scale (BSMAS), and Insomnia Severity Index (ISI); (3) Results: Multilevel linear mixed-effects regression analyses showed that participants demonstrated increased insomnia longitudinally over 3 months (B = 0.12 and 0.19; p = 0.003 and <0.001). Insomnia was associated with nomophobia (B = 0.20; p < 0.001) and addictive use of social media (B = 0.49; p < 0.001). Nomophobia and addictive use of social media interacted with time in associations with insomnia as demonstrated by significant interaction terms (B = 0.05; p < 0.001 for nomophobia; B = 0.13; p < 0.001 for addictive use of social media); (4) Conclusions: Both nomophobia and addictive use of social media are potential risk factors for adolescent insomnia. The temporal relationship between the three factors suggests that parents, policymakers, and healthcare providers may target reducing nomophobia and addictive use of social media to improve adolescents’ sleep.
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21
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The Prevalence of Nomophobia by Population and by Research Tool: A Systematic Review, Meta-Analysis, and Meta-Regression. PSYCH 2021. [DOI: 10.3390/psych3020019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: No systematic review or meta-analysis has yet been performed to examine the global prevalence of nomophobia by population, by instrument. Thus, this review was performed to estimate the prevalence of nomophobia by severity. Methods: American Psychological Association PsycINFO, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, EMBASE, MEDLINE, ProQuest Medical, ScienceDirect, Scopus, and Web of Science from inception of each respective database to second week of January 2021 were used. There was no language restriction. The random-effect meta-analysis model was used with the DerSimonian and Laird methodology was used for computation. Results: Twenty papers, involving 12,462 participants from ten countries, were evaluated for meta-analysis. The prevalence of moderate to severe nomophobia is 70.76% [95% CI 62.62%; 77.75%]. The prevalence of severe nomophobia is 20.81% [95% CI 15.45%; 27.43%]. University students appeared to be the highest group affected with a prevalence of severe nomophobia 25.46% [95% CI 18.49%; 33.98%]. Meta-regressions of severe nomophobia showed that age and sex were not a successful predictor of severe nomophobia β = −0.9732, p = 0.2672 and β = −0.9732, p = 0.4986. Conclusions: The prevalence of severe nomophobia is approximately 21% in the general adult population. University students appeared to be the most impacted by the disorder.
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22
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Jahrami H, Rashed M, AlRasheed MM, Bragazzi NL, Saif Z, Alhaj O, BaHammam AS, Vitiello MV. Nomophobia is Associated with Insomnia but Not with Age, Sex, BMI, or Mobile Phone Screen Size in Young Adults. Nat Sci Sleep 2021; 13:1931-1941. [PMID: 34737661 PMCID: PMC8560167 DOI: 10.2147/nss.s335462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE NOMOPHOBIA (NO MObile PHone PhoBIA) or problematic smartphone use is a psychological disorder in which people are afraid of being cut off from their mobile phones. Currently, there has been no direct assessment of mobile phone screen size in the home setting and its effect on nomophobia and related symptoms, such as insomnia. Thus, we investigated the association between nomophobia, insomnia, and mobile phone screen size in a young adult population in Bahrain. PATIENTS AND METHODS Using a descriptive, cross-sectional design, we surveyed participants aged 18 to 35 between August and September 2020 using an online questionnaire. Participants completed demographic questions and questions about personal mobile phones, the Nomophobia Questionnaire (NMP-Q), and the Insomnia Severity Index (ISI). The mobile phone screen size was determined using an open-source online database. Crude and adjusted regression analyses were fitted to examine the associations between the study variables. RESULTS A total of 549 individuals, 54% females, were included in the final analyses. One hundred and fourteen participants (21%) had severe nomophobia, and 81 (14%) had clinical insomnia. A strong positive pair-wise linear association was observed between NMP-Q and ISI β 0.15, P = 0.001. Age, sex, BMI, and mobile phone screen size showed no association with the NMP-Q. CONCLUSION Nomophobia is very prevalent in young adult men and women, and it is closely associated with insomnia, regardless of mobile phone screen size, suggesting that mobile phone screen size should not be used as a proxy for hazardous usage.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, Manama, Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mona Rashed
- Ministry of Health, Manama, Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Maha M AlRasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada
| | | | - Omar Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, 11324, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Michael V Vitiello
- Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, WA, 98195-6560, USA
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