Purpose The surge in adolescent smartphone use has coincided with the rise in the adolescent mental health crisis, raising public health concerns. While studies have focused on screen time, the perceived importance of smartphones in adolescents’ lives has been overlooked. This analysis examined the association between attachment to smartphones and mental health among adolescents, considering related health factors such as sleep quality and overall well-being.

Methods Data from a cohort of 138 community-dwelling adolescents (aged 16-19 years) recruited through the Children’s Hospital of Philadelphia electronic health record system were analyzed. The self-reported Mobile Phone Involvement Questionnaire (MPIQ) measured behavioral and cognitive attachment to smartphones through 8 items rated on a 1-7 Likert scale, with sum score ranging from 8 to 56. Like previous studies, we used a sum score ≥ 32 as the threshold for moderate-severe attachment. Mental health outcomes, including anxiety and depression, as well as health related factors like sleep disturbance and global well-being, were derived from the PROMIS pediatric short forms. PROMIS scores were converted to t-scores and stratified into clinical categories based on validated cut-points: within normal limits (t-score ≤ 50) and above normal limits (t-score > 50). Summary statistics were generated. T-tests compared mean anxiety and depression t-scores for groups above and below the MPIQ cut-point (≥ 32). ANOVA assessed differences in MPIQ scores across clinical categories of anxiety and depression. Sex differences in smartphone attachment and mental health outcomes were also analyzed. Multivariable regressions estimated the association between smartphone attachment and mental health outcomes, controlling for demographics and the other health factors.

Results Respondents had a mean age of 17.7±0.6 years; 51.5% female, 87% white, 96.4% non-Hispanic, and 79.7% in high school.

The mean MPIQ score was 28.8±8.9, with females scoring higher than males (30.3 vs. 27.2, p = 0.04).

 Mean depression t-score was 47.9±9.32, with 58.7% within normal limits and 41.3% above normal limits.

Mean anxiety t-score was 48.5±10.11, with 60.9% within normal limits and 39.1% above normal limits.

Females scored significantly higher than males on anxiety, but not on depression.

Compared to those below, those above the MPIQ cut-point (≥ 32) had significantly higher anxiety (52.9 vs. 46.3, p < 0.001) and depression (51.4 vs. 46.3, p = 0.002) scores. Multivariable regression indicated that higher MPIQ scores were significantly associated with increased anxiety (ß = 0.25, p < 0.01) and depression (ß = 0.13, p < 0.05), adjusting for age, sex, race, sleep disturbance, and global well-being.

Conclusions Increased smartphone attachment was associated with worse mental health among adolescents, even after controlling for sleep disturbance and global well-being.

Adolescents with MPIQ scores ≥ 32 had clinically significant anxiety and depression.

Females showed higher smartphone attachment and anxiety than males, suggesting increased vulnerability.

Understanding these outcomes has key clinical implications, enabling targeted interventions and early identification of at-risk adolescents to prevent the aggravation of mental health issues related to phone attachment.

Full: https://www.jahonline.org/article/S1054-139X(24)00599-8/fulltext00599-8/fulltext)