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Indian J Psychiatry
Indian J Psychiatry
IJPsy
Indian J Psychiatry
Indian Journal of Psychiatry
0019-5545
1998-3794
Wolters Kluwer - Medknow India

IJPsy-66-591
10.4103/indianjpsychiatry.indianjpsychiatry_244_24
Review Article
Exploring risk factors and determinants: A scoping review of factors associated with nomophobia
Rajguru Akanksha J.
Mishra Ashwani K.
Bhargava Rachna
Sarkar Siddharth
Balhara Yatan Pal Singh
National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
Address for correspondence: Dr. Yatan Pal Singh Balhara, Room 4080, Teaching Block, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: ypsbalhara@gmail.com
7 2024
17 7 2024
66 7 591602
19 3 2024
20 6 2024
23 6 2024
Copyright: © 2024 Indian Journal of Psychiatry
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Background:

Nomophobia or no-mobile-phone phobia, defined as the fear of being unable to use or being unreachable via one’s mobile phone. The pervasive concern has varied bio-psychosocial and clinical implications in an individual’s life. Nomophobia is currently in an exploratory phase.

Methods:

A scoping review was conducted to systematically map the relevant evidence and literature on nomophobia. The review of scholarly literature spanning from January 2010 to May 2023 employed a narrative synthesis methodology to succinctly encapsulate the research findings. Additionally, it encompassed a meticulous examination and visual representation of studies, detailing both the frequency of investigation into specific variables and the instances in which said variables exhibited a statistically significant association with nomophobia.

Results:

A thorough examination of 92 studies revealed a total of 133 variables spanning demographic, lifestyle-related, academic, smartphone-related, psychosocial, and clinical domains. Notably, 42.86% of these variables have only been investigated in a single research study, underscoring the imperative for replication to enhance the generalizability, validity, and applicability of research findings. Moreover, the review identifies Nomophobia Questionnaire (NMP-Q) by Yildirim and Correia as the most widely used tool for measuring the severity of nomophobia.

Conclusion:

There is a crucial need for homogeneity and consistency in reporting nomophobia scores and establishing corresponding gradations indicative of functional ramifications or clinical severity of nomophobia. The findings elucidate significant research gaps in existing literature on nomophobia, hold implications for further synthesis of data, and contribute to a comprehensive understanding of nomophobia; ensuring superior diagnostic accuracy and precision, and facilitating successful delivery of targeted interventions.

Narrative synthesis
nomophobia
scoping review
systematic mapping
==== Body
pmcINTRODUCTION

Nomophobia is often associated with problematic use of mobile technologies and addiction problems. Nomophobia or “no-mobile-phone phobia” is defined as the fear of being unable to use or being unreachable via one’s mobile phone.[12] The clinical characteristics and its psychosocial implications include impulsive use of technological devices, regular and excessive smartphone use, nervousness and/or anxiety at the thought of losing, misplacing, battery draining/failure, lack of access to internet and/or network services, avoidance of situations or places where smartphones are not permitted, frequently checking the phone, spending a considerable amount of time on the phone to exclusion of face-to-face communication, and associated financial issues.[3] The inability to use mobile phones may cause anxiousness, nervousness, frustration, distress, persistence, obsessive thoughts and compulsions, and suicidal ideation.[45]

Excessive smartphone use and nomophobia significantly impact an individual’s physical, psychological, and social health. Physiological symptoms associated with nomophobia may include dizziness, difficulty in breathing, elevated blood pressure levels, stomach cramps, trembling, sweating, headache, lethargy, respiratory distress, heartthrob, tachycardia, and even cancer (as a long-term consequence).[1678] There is literature to suggest that the degree of smartphone use or dependence is significantly related to musculoskeletal discomfort,[9] fatigue,[10] eye strain,[11] and headaches.[10] Negative impact on sleep[11] and circadian rhythm[1012] have also been reported.

Psychological manifestations of nomophobia may include persistent anxiety, depression, low self-esteem, panic, self-inflicted isolation, nervousness, irritation, agitation, anger, paranoia, insecurity, confusion, loneliness, dependency, identity-related issues, etc.[1314] It may also lead to deficits in empathy and attention.[15] Furthermore, it provides a potential escape from conflicts in social lives, loneliness, and emotive problems of the real world.[1617] Excessive use of smartphones and extreme attachment can become problematic and may lead to dependence and behavioral addiction.[18192021] These may include internet addiction, gaming disorder, sex addiction, pornography addiction, pathological gambling, and hyper-personal communication in online chats and games which has the potential to become a personal threat for the individual in question.[22]

Systematic reviews have shown that nomophobia is currently in an exploratory phase.[2324] Growing number of studies have explored the relationship between nomophobia and associated psychological and clinical variables. However, researchers have pointed out the need to holistically and comprehensively examine factors associated with and predictors of nomophobia.[252627282930] The current review aims to encompass a meticulous examination and visual representation of studies, detailing both the frequency of investigation into specific variables and the instances in which said variables exhibited a statistically significant association with nomophobia. It will serve to elucidate the salience of variables consistently linked with nomophobia while also highlighting areas where potential research gaps exist or where findings need replication, indicating opportunities for further investigation or validation.

The present review is an attempt to synthesize and consolidate the different factors associated with nomophobia by mapping the literature. This can serve as a starting point for more detailed empirical studies and meta-analysis. No such systematic mapping of literature has been found.

METHODS

Aim

The scoping review was aimed at systematically mapping and synthesizing the literature on factors associated with nomophobia.

Design

The study is guided by a multistage framework for conducting scoping reviews by the Arksey and O’Malley framework.[31]

Identifying the research questions

The scoping review was aimed at addressing the following research questions

What are the various demographic, behavioral, psychosocial, and clinical factors associated with nomophobia?

Identifying relevant studies

We conducted an online search using PubMed, Cochrane, and Web of Science to identify relevant articles published between January 2010 and May 2023. No studies prior to 2010 could be found. The search was conducted using keywords related to the research questions and Medical Subject Headings (MeSH) terms. The search string for key terms on PubMed was ((((Nomophobia) AND (associated variable)) OR (factors)) OR (correlates)) OR (predictors). Hand searches were conducted at the National Medical Library, New Delhi, and BB Dixit Library, AIIMS, New Delhi, to identify any additional researches.

Snowballing of references in relevant articles was done in an attempt to identify relevant literature and be exhaustive. We also made a concerted effort to include grey literature. This was achieved by undertaking searches on Google Scholar and/or Google search engine. They included unpublished thesis, preprints, and non-peer-reviewed journal articles. Corresponding authors of studies with paid access were contacted via email for full-text articles.

Selection of studies that were included

The following inclusion criteria were applied for the selection of the studies: (a) Journal articles, thesis, and preprints published in the English language. Other forms of publication like websites, magazines, newsletters, etc., were not included, (b) Population of interest/investigation were adults (18 years or more), (c) Studies that used appropriate, standardized measures of nomophobia. Studies that used nomophobia interchangeably with smartphone addiction and/dependence, internet addiction/dependence were excluded, (d) Studies that focused on identification of factors associated with, and predictors of nomophobia (e) included observational studies, systematic reviews, descriptive, comparison and association-based studies, regression or modeling studies, experimental, and mixed methods study designs. In the case of mixed method studies, only the quantitative parts of the study were considered for the review. (f) Published between January 2010 and May 2023 [Figure 1].

Figure 1 PRISMA flow diagram of articles through the scoping review process

In the context of the current study, nomophobia is defined as the fear of not being able to use a smartphone or a cellular phone and/or its services. It encompasses not being able to communicate, not being able to access information via smartphone, losing connectedness, and giving up convenience.[2]

Data extraction

We extracted data from selected studies using an extraction table in Microsoft Excel. The following information was extracted: author, publication year, country, sample, study design, tools used to measure nomophobia, and findings in terms of demographic, smartphone-related, psychosocial, and clinical variables that are associated with nomophobia. While extracting data from systematic reviews, each article included in the study was reviewed using the inclusion and exclusion criteria, and relevant studies were included in the present study

Data synthesis

A meta-analysis of the included studies was deemed unfeasible owing to the heterogeneity of populations, multitude of variables, study designs, scales used, outcomes of the study, and insufficiency of data for statistical pooling. A narrative synthesis[32] was performed to consolidate the findings of different studies. Pictorial representations have been integrated to depict the frequency of studies examining each variable (categorized as demographic, psychosocial, smartphone use related, academic, lifestyle, and clinical), alongside the count of studies wherein a significant association with nomophobia was discerned. In any study, a variable was considered significant if any measure of relationship (such as correlation, regression, association, or comparison) yielded statistically significant results. The pictorial representations were created using Microsoft Excel.

GitMind was utilized for the creation of a comprehensive mind map, systematically delineating and cataloging all pertinent factors investigated within the scope of the reviewed studies.[33] The review was not preregistered. We followed PRISMA reporting guidelines (PRISMA-ScR) for the final report.[34]

Ethical approval

Ethical approval was not applicable for this review article as it does not involve original research with human participants, animals, or sensitive data.

RESULTS

Search and selection of studies

An initial database search identified 195 studies related to nomophobia and associated factors, correlates, and predictors. One hundred and eleven studies were assessed for eligibility upon exclusion of articles that were duplicate (n = 84), not full texts (n = 4), and not in English (n = 3). Forty-four of these studies were excluded based on the prespecified inclusion and exclusion criteria. Additionally, studies found from alternate sources, namely, hand searches, snowballing of references from relevant studies, and studies from systematic reviews were also assessed for eligibility based on inclusion and exclusion criteria. A total of 92 studies were included in the review.

Study characteristics

The studies were categorized based on the WHO country groupings. Highest number of studies were from the European region (n = 45),[142729353637383940414243444546474849505152535455565758596061626364656667686970717273747576] followed by Eastern Mediterranean regions (n = 18),[304677787980818283848586878889909192] South East Asia (n = 14),[93949596979899100101102103104105106] Western Pacific (n = 7),[107108109110111112113] Region of Americas (n = 4),[28114115116] and African region (n = 3).[117118119] One study was conducted in Pakistan and Turkey.[120]

Thirty-four were multivariable studies, i.e. used various types of regression models and/or structural equational modeling techniques, mediational or moderation analysis.[27293035383940424647535455586067687173768081828690939798106108109112119120] Rest of the studies involved univariate or bivariate analysis techniques such as correlation, comparison, and associations [Supplementary Table 1].

Scales used

The majority of the studies either used English or contextually relevant translations or versions of the Nomophobia questionnaire (NMP-Q) by Yildirim and Correia (2015).[2] Other scales for nomophobia include the Nomophobia Scale,[66] Questionnaire to assess nomophobia (QANIP),[29] Anxiety/Dependence on Technology subscale of the Media and Technology Usage and Attitudes Scale (MTUAS),[115] and Azadmanesh’s nomophobia questionnaire.[80]

Factors associated with nomophobia

Various factors associated with nomophobia were classified under six headings, namely, demographic, smartphone-related, lifestyle, academic, psychosocial, and clinical variables.

Demographic variables

The demographic variable that has received the most scholarly attention is gender,[143035373940414243444950515456596063656667686971747677798182838486888993959698102103104105106107113115116117118] closely pursued by age.[303537394142434449515260636667717479808184868789939598103105106107116118] Some other variables include working status,[384966] number of siblings,[49] socioeconomic status,[4993100106] subjective economic status,[117] place and region of residence,[373949] living status,[38545577102117] religious affiliations,[117118] relationship status,[597793117] and years of professional experience.[4142] Parental educational,[363755] living status,[8284] and level of “advanced” or “expert” use of information and communication technologies[39] were also studied.

Figure 2 illustrates the frequency of studies examining each demographic variable and the number of studies where a significant association with nomophobia was observed.

Figure 2 Comparison of frequency of investigation into demographic variables with frequency of statistically significant associations with nomophobia

Academic variables

A few studies examined the link between nomophobia and academic variables such as department,[145155636779818893100117118] year of school,[143639555659666777818788939599102103104105117] number of credits,[30] number of hours spent on studying per week,[77] academic achievements,[496977798893] number of warnings,[77] and participation in extra-/cocurricular activities.[117]

Figure 3 pictorially represents the frequency of studies examining each academic variable and the number of studies where a significant association with nomophobia was observed.

Figure 3 Comparison of frequency of investigation into academic variables with frequency of statistically significant associations with nomophobia

Lifestyle variables

Academic investigations have examined the interrelationships between nomophobic behaviors and lifestyle factors such as physical activity,[42607892] body mass index,[428486] eating habits/patterns,[117] and sleep.[608892117118] Studies have also examined the relationship between nomophobia and behaviors such as smoking status,[51556077828893] use of psychoactive substances,[608293] and consumption of alcohol.[55608893]

Figure 4 illustrates the frequency of studies examining each lifestyle variable and the number of studies where a significant association with nomophobia was observed.

Figure 4 Comparison of frequency of investigation into lifestyle variables with frequency of statistically significant associations with nomophobia

Smartphone use-related behaviors

In an attempt to gauge smartphone usage patterns, studies explored the role of smartphones in shaping daily routines and potentially influencing sleep patterns by enquiring about smartphone use immediately upon waking,[144150596298] just before going to sleep[144143596269] and, whether they kept their smartphones near their bedside while going to sleep[6269] and carry chargers/power banks.[14414969] Some studies also examined the purposes for which individuals use their smartphones[35383943729899] and the contexts in which they were used.[143793]

Usage metrics such as duration of smartphone use[3943499599103105] and ownership,[404354606787100118] duration of daily smartphone use,[14303839404143444950545759606269798593959899100104105106107112] access to internet on device,[3839799599103118] duration of daily internet use,[144150546287118] frequency of checking smartphones,[14303740414344495054626981959899105] screen time,[92] social media usage duration,[1473] calls per day,[3795105] messages per day,[374395105] emails per day,[37] number of applications[9599103105]; and device metrics such as number of devices or activations,[38118] cost of phone,[38] type of phone,[116] and screen size[86] were also studied. The quantity of online social interactions was measured by enquiring about the number of friends made online[3787] and a number of followers.[37]

Figure 5 illustrates the frequency of studies examining each smartphone use-related variable and the number of studies where a significant association with nomophobia was observed.

Figure 5 Comparison of frequency of investigation into smartphone use-related variables with frequency of statistically significant associations with nomophobia

Psychosocial variables

Multiple studies have explored the associations between nomophobia and self-esteem,[38597580849799109120] attachment styles,[7685] fear of missing out,[44484952] mindfulness,[687685] impulsivity,[84115] life satisfaction,[4044] self-happiness,[99120] emotion management skills[2743] and emotion dysregulation,[54] boredom proneness,[54115] and state boredom.[101] Some studies also examined the relationships between various coping strategies and nomophobia[7094]

Less than two studies investigated the relationship between nomophobia and intolerance to uncertainty,[27] differentiation of self,[27] locus of control,[46] affect,[54] sensation seeking,[72] chronotype,[92] perceived work overload,[52] future expectation,[55] mobile phone attachment,[46] and work satisfaction.[60]

Studies have explored the relationship between nomophobia and Big Five personality traits.[14353641444562678082119] Other personality traits include negative affect, detachment, disinhibition, and antagonism.[82] Researchers have also examined the connections between nomophobia and temperaments.[2990]

In the social realm, associations between nomophobia and perceived social support,[4045108] loneliness[435899101120] and solitude,[109] perception of the relationship with the family[5560] have also been explored.

Figure 6 pictorially represents the frequency of studies examining each psychosocial variable and the number of studies where a significant association with nomophobia was observed.

Figure 6 Comparison of frequency of investigation into psychosocial variables with frequency of statistically significant associations with nomophobia

Clinical variables

Numerous investigations have scrutinized the associations between clinical psychopathologies and nomophobia. Among the clinical variables, depression[39424344475054606572849193110111] and anxiety[39424344475054606578848591104111] have garnered the most attention, as evidenced by the exploration in 15 studies, followed closely by stress.[434450658491108110111]

Social anxiety was also the foci of interest in multiple studies, variables included Social Interaction Anxiety,[100] Social Appearance Anxiety,[73] and Social Phobia.[71] Other clinical psychopathologies examined include obsessive thoughts[35114]; obsession–compulsions, paranoid ideation, phobic anxiety, psychoticism, phobic anxiety, and interpersonal sensitivity[4760]; somatization and hostility.[475460] Insomnia was yet another pertinent clinical variable studied frequently.[7884869293]

Studies also examined the relationship between nomophobia and addictive behaviors: Substance use addictions such as smoking addiction,[51] alcohol risk addiction[63]; and behavioral addictions, namely, internet addiction[78112] or problematic internet use,[7387] smartphone/mobile phone addiction[284453636572468393112] or problematic smartphone/mobile phone use,[110] netlessphobia,[48] social media addiction,[40] Facebook addiction,[93] digital addiction,[53] gaming addiction,[40] food addiction.[79] Perceiving oneself as addicted was yet another variable examined for its associations with nomophobia.[41]

Figure 7 illustrates the frequency of studies examining each clinical variable and the number of studies where a significant association with nomophobia was observed.

Figure 7 Comparison of frequency of investigation into clinical variables with frequency of statistically significant associations with nomophobia

Figure 8 summarizes and maps the findings of the study. The size of variables is proportional to the number of studies that examine their relationship with nomophobia.

Figure 8 Systematic mapping of factors associated with nomophobia

DISCUSSION

The aim of the study was to systematically map literature with respect to nomophobia and the factors associated with it. We identified variables under six domains, namely, demographic, lifestyle-related, academic, smartphone-related, psychosocial, and clinical variables. Approximately 47.8% of the studies were conducted in the European region with a large chunk of research conducted in Turkey (n = 31). Most of the studies were descriptive, nonexperimental designs, similar to the findings of other systematic reviews.[24]

Ninety-nine variables out of the total 133 examined demonstrated significance in at least half of the studies where they were assessed. A limited number of variables that were examined in more than one study demonstrated consistent significance throughout the academic literature. These variables include years of professional experience, use as soon as waking up, use just before going to bed, leave smartphone near bedside, number of friends made online, social media usage duration, fear of missing out, impulsivity, mindfulness, boredom, negative affect, family support and connectedness, stress, interpersonal sensitivity, phobic anxiety, hostility, obsession–compulsions, psychoticism, paranoid ideation, problematic internet use, and insomnia.

Among demographic variables, gender was the most extensively investigated. Within lifestyle and academic parameters, smoking status and year of study, respectively, garnered the highest frequency of examination. Among psychosocial factors, the correlation between nomophobia and personality traits received the greatest attention. In terms of clinical variables associated with nomophobia, depression and anxiety emerged as the most extensively researched variables.

Addiction and nomophobia

During the process of data extraction, we observed that terms such as smartphone/internet/mobile phone addictions, problematic use of smartphones/mobile phones/internet, and nomophobia have been frequently used interchangeably with nomophobia. Nomophobia and smartphone addiction are interrelated and share commonalities, namely, a sense of comfort and relief stemming from smartphone use.[121] Moreover, nomophobic behaviors are analogous to substance dependence/addiction in their production of short-term rewards, a sense of relief and/or comfort,[121] persistence despite negative consequences and deteriorated functioning,[29] and coinciding symptoms with the withdrawal of nonsubstance abuse disorders (gambling, internet, smartphone) to include anxiety, irritability, and sadness.[3122123]

The fear of losing, being away, not being able to use smartphones and associated anxiety, and nervousness may be seen as a withdrawal symptom of smartphone addiction[124] but is not the same as smartphone addiction or dependence. Researchers and clinicians need to be cognizant of the differences between the terms and need to operationalize them to ensure correct use and improved conceptual understanding of the phenomenon.

Challenges with synthesis of data

A vast majority of the studies included in the current review used NMP-Q and its translations or culturally adapted versions. However, we found heterogeneity and inconsistency in the assessment and interpretation of NMP-Q scores. Studies have used NMP-Q scores as a continuous variable wherein higher scores represent greater severity of nomophobia. Other studies have classified NMP-Q scores in different categories: two (present and absent),[103] three (mild, moderate, and severe), and four (absent, mild, moderate, and severe). Some studies explicitly state the categories and associated cutoffs, whereas others do not. There is no evidence of the scale’s cutoff points and associated levels reflecting functional impact or clinical severity of nomophobia. Hence, the high prevalence of nomophobia studies is merely indicative of the presence of symptoms of the disorder and should not be mistaken as clinically diagnosable entities. Dib and colleagues (2022) point out that a score in the “severe” category on NMP-Q can be classified as a full diagnosis of nomophobia, whereas mild and moderate scores are open to interpretation by researchers and clinicians.[82] However, research studies must specify clear cutoff points and should aim to ensure that the cutoff points they select align with those used in a larger number of studies, thereby ensuring consistency and coherence across the academic landscape which can facilitate future synthesis efforts.

Nomophobia is still in an exploratory phase.[2324] The present review has highlighted areas where a significant research gap persists, as evidenced by the graphical analyses comparing the investigation of frequencies and statistically significant associations of variables. Furthermore, the consolidation of data into a mind map has underscored these lacunae, delineating the extent of investigation of each variable. This provides a comprehensive landscape of the existing research and indicates area that warrants further scrutiny. Out of the 133 variables identified in the current review, 42.86% of the variables have only been investigated in a single research study. Replicating these findings is imperative for two primary reasons. Firstly, replication studies play a crucial role in validating research outcomes, ensuring their reliability and reproducibility, and contributing to the generalizability of the findings.[125] Secondly, replication facilitates the utilization of quantitative methods, enabling the synthesis of data to construct holistic models. This approach grants researchers the capacity to identify gaps, patterns, trends, and associations among variables which can aid in prioritizing variables for further investigation and intervention development. In addition, the knowledge can help garner a deeper understanding of nomophobia, its underlying mechanisms, and its impacts on an individual’s behavior and well-being. Comprehensive understanding can inform intervention and prevention strategies aimed at reducing nomophobic behaviors.

Limitations

Our study posed a few limitations. We only included articles published in English. Some relevant articles in Farsi and Spanish were identified during snowballing research but could not be included in the review. The study had a broad focus; however, the authors made an attempt to be as exhaustive and comprehensive as possible. The selection of studies and data extraction was primarily done by one author, to prevent this from leading to bias in study selection and data extraction, iterative consultations were frequently held with all the coauthors. No quantitative synthesis of data was undertaken to quantitively determine the relative importance of various factors associated with nomophobia. Additionally, the review did not include a quality assessment of individual studies.

CONCLUSION

Nomophobia is a relatively novel manifestation of problematic/excessive use of technology. The present review aimed to capture the demographic, lifestyle, academic, smartphone-related, psychosocial, and clinical factors associated with nomophobia. Delineating factors associated with nomophobia will facilitate the identification of research gaps and vulnerable groups; and establish targeted preventive strategies and/or treatment protocols. Identifying factors will facilitate a better understanding of the etiopathogenesis, clinical presentation, and management of nomophobia. The present review can serve as a guide for future research on nomophobia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Supplementary Table 1 Summary of the studies included in the review
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