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| Nomophobia among medical students before and after COVID-19 – A propensity score-matched study |
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Pavan Kumar Kadiyala1, P Prasanth Dayala2, Naga Chaitanya Duggirala3, Sukeerthi Busi4
1 Associate Professor, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
2 Assistant Professor, Department of Psychiatry, MNR Medical College, Sangareddy, Telangana, India
3 Assistant Professor, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
4 Post Graduate, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
Click here for correspondence address and email
| Date of Submission | 26-Jul-2022 |
| Date of Acceptance | 23-Sep-2022 |
| Date of Web Publication | 05-Dec-2022 |
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Introduction: NOMObile PHone PhOBIA (NOMOPHOBIA) is a psychological condition where people fear of being detached from mobile phone connectivity or use. Mobile phones became the main source of entertainment and academics during the lockdown enforced to contain COVID-19. The present study aims to find the change in the prevalence, severity, and characteristics of nomophobia among medical students.
Materials and Methods: A cross-sectional study was conducted among medical students during September 2019 and after the second wave of COVID-19 in September 2021, using Google Forms. The form included sociodemographic data, clinical details, characteristics of mobile phone usage, and the Nomophobia Questionnaire (NMP-Q). The two groups (2019 and 2021) were matched using propensity score matching (PSM) analysis.
Results: There were significant differences between the groups in terms of age, time spent and purpose of mobile phone usage, and frequently used mobile applications. Among the 2019 and 2021 groups, 99.50% and 99.54% had nomophobia, respectively. No significant differences were found between the groups in terms of severity, and dimensions of NMP-Q, except the dimension of "losing connectedness." After PSM, similar results of nil significant differences, except the increase in severity of the dimension of "losing connectedness" in the 2021 group were found.
Conclusion: The COVID-19 infection and lockdown, which happened during the era of technological advancement, have not changed the characteristics of nomophobia among medical students. However, post-COVID-19, there is a significant increase in the feelings of losing ubiquitous connectivity provided by mobile phones. If you find yourself always alert for phone notifications or reaching out to get your phone at frequent intervals, it's time for a digital detox.
Keywords: COVID-19, mobile phone addiction, nomophobia, nomophobia questionnaire, propensity score matching
How to cite this URL:
Kadiyala PK, Dayala P P, Duggirala NC, Busi S. Nomophobia among medical students before and after COVID-19 – A propensity score-matched study. Arch Ment Health [Epub ahead of print] [cited 2023 Mar 24]. Available from: https://www.amhonline.org/preprintarticle.asp?id=362702 |
| Introduction | |  |
Mobile phones and social networking have become part and parcel of our lifestyle, providing a new sense of speed and connectivity to social life. With significant technological improvements and decreasing cost of smartphones, mobile phone dependence is increasing worldwide. Mobile phones are "possibly the biggest nondrug addiction of the 21st century." The usage of mobile phones has both the property of freeing and enslaving, a paradox of technology.[1] The smartphone gives a sense of virtual connection with people at the cost of decreasing face-to-face social interactions. Frequent use of the smartphone leads to social isolation, lack of concentration, and distress due to running out of battery or network data.[2]
The word "NOMOPHOBIA-NOMOBILE PHONE PHOBIA" originated from a research organization in England.[1],[3] It is defined as a psychological condition where individuals fear being detached from mobile phone connectivity (a type of situational phobia).[3] New research has shown excessive use of mobile phones leads to the development of symptoms meeting the criteria of dependence. This diagnostic condition has been proposed but not included in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition.[2]
Mobile phones are fascinating for younger generations, as it gives them a feeling of autonomy and identity. The students of this tech-savvy generation, particularly, are at high risk for nomophobia.[4] Especially during COVID-19, the usage of smartphone increased very much as it became the main source of entertainment and academics, because of restrictions to contain the spread of COVID-19.[5] Few studies have been done regarding the fear of being away from mobile phones or their usage among medical students in India, comparing it before and after COVID-19 (second wave).
A systematic literature review of 40 articles published between April 2015 and August 2020 on nomophobia in young adults using the Nomophobia Questionnaire (NMP-Q) questionnaire found the prevalence ranging between 15.2% and 99.7%.[6] Another systematic review found younger individuals and women were affected more by nomophobia, with prevalence ranging between 6% and 73%, being the total score in the range of 45.5 and 93.82 on NMP-Q.[7]
An online survey of 3139 Peruvian medical students between June 2020 and March 2021 found 4% with no nomophobia, 63% with mild, 25.7% with moderate, and 7.3% with severe nomophobia, assessed using NMP-Q.[8] Sethia et al., in 2018, studied 473 medical students using the questionnaire (NMP-Q). About 62% (n = 291) were having moderate, 6% having severe nomophobia, 32% having mild nomophobia, and only 1 participant had no nomophobia.[9] A study conducted at a rural tertiary health-care center in Maharashtra state of India on 412 health science students during COVID lockdown in May 2020, found 97.6% of them had nomophobia. Based on NMP-Q scores, 18.7% had mild, 61.4% had moderate, and 17.5% had severe nomophobia. The mean score ± standard deviation (SD) (range) of NMP-Q was 77.58 ± 24.59 (20–140).[10] A cross-sectional study of 307 medical students of a tertiary care medical college in Chennai from April to June 2020 using NMP-Q, found the presence of nomophobia in 100% of students. About 31.3% had mild, 49.5% had moderate, and 19.2% had severe nomophobia. The severity of nomophobia was correlated with the daily duration of usage of mobile phones, the amount spent on recharging mobile, and self-perception of having mobile phone addiction.[11]
Aims and objectives
This study aimed to compare the prevalence and severity of nomophobia among medical students before and after COVID-19 (second wave).
| Materials and Methods | | |
A cross-sectional study was conducted among medical students from a tertiary medical college during September 2019 and after the second wave of COVID-19 in September 2021 after obtaining ethical approval. A Google Form was developed which included demographic details, NMP-Q, and details about the characteristics of mobile phone usage (average number of hours spent on the phone per day, mobile phones most commonly used for, most frequently checked/viewed social media apps), along with the description for the study objectives, consent of participation. Undergraduate and postgraduate medical students using smartphones, who gave consent and completely filled out the online questionnaire, were included in the study.
NMP-Q is a 20-item questionnaire, developed by Yildirim and Correia in 2015. It is a 7-point Likert scale, covering four dimensions: not being able to communicate, losing connectedness, not being able to access information, and giving up convenience. Total score ≤20 means "no nomophobia," while scores between 21 and 60, 61 and 100, and 100 and 140 meant "mild," "moderate," and "severe" nomophobia, respectively.[12]
Propensity score matching analysis
Propensity score matching (PSM) analysis was performed in this study with the matching package in R software (4.2.1, R core team, Vienna, Austria). It was conducted with the 1:1 nearest neighbor (greedy) matching method without replacement and caliper width equal to 0.2 of the SD of the logit of the propensity score.[13] PSM analysis was considered the participants in the two study groups (2019 and 2021) maybe different. The covariates included age, gender, year of study, locality, marital status, residence, medical and psychiatric comorbidity, hours of daily usage of mobile phones, the purpose of usage, and frequently checked mobile applications based on observations from the previous studies.[6]
The effectiveness of PSM analysis was concluded by the degree of balance in all the measured baseline covariates between the two groups after matching. Hypothesis testing and P values are not advised to check the balance as failure to reject the null hypothesis (i.e. P > 0.05) does not ensure the successful balance of covariates between the two groups.[14] Instead, phi coefficient (Φ) and Cramér's V were used for calculating the effect size as the baseline covariates were categorical (or binary) variables.[15]
Statistical analysis
Data were analyzed using Microsoft Office and IBM Statistical Package for Social Sciences (SPSS, Version 25, IBM Inc, Armonk, NY). The "psmatching" was performed through the SPSS R-Plugin, which programs all analyses in R. It estimated propensity scores for a binary variable from a set of specified covariates and subsequently performed matching. Categorical variables were converted to binary (dichotomous) or dummy variables and taken as continuous variables for PSM analysis. The categorical data were represented in the form of frequencies and percentages. The continuous data were represented in the form of mean, mean rank, or median, depending on the shapes of the distribution of variables. Kolmogorov–Smirnov test was used to test the normality of data distribution. Chi-square test and t-test or Mann–Whitney U-test were done to find the differences between the two groups. A P < 0.05 was considered significant. Reporting of the study followed the recommendations from the STROBE statement.[16]
| Results | | |
A total of 200 students in 2019 and 216 students in 2021 responded to the sent questionnaire. There were significant differences between the groups in terms of age (Φ =0.149; P = 0.002), time spent (Cramér's V = 0.232; P = 0.00), purpose of use of mobile phones (Cramér's V = 0.155; P = 0.018), and frequently used mobile applications (Cramér's V = 0.190; 0.002). Among students surveyed in 2019 and 2021, only 0.5% and 0.46% had no nomophobia, 26% and 25.9% had mild, 61.5% and 60.2% had moderate, and 12% and 13.4% had severe nomophobia, respectively. No significant differences were found between the groups in terms of total score (P = 0.171), severity (P = 0.978), and dimensions of NMP-Q, except the dimension of "losing connectedness" (U = 21,510.5; Z = 2.061; P = 0.039).
After 1:1 PSM, 147 students from each group (2019 and 2021) were included in the analysis. There was no significant disturbance or effect size >0.2 between the groups in terms of age (Φ =0.014; P = 0.807), time spent (Cramér's V = 0.079; P = 0.402), purpose of use of mobile phones (Cramér's V = 0.029; P = 0.970), and frequently used mobile applications (Cramér's V = 0.015; 0.996) [Table 1] and [Table 2]. After matching also, no significant differences were found between the groups in terms of total score (P = 0.361), severity (P = 0.755), and dimensions of NMP-Q [Table 3], except the dimension of "losing connectedness" (U = 12,255.0; Z = 1.994; P = 0.046) [Figure 1] [Table 4]. | Figure 1: Flow diagram of included and excluded participants and the statistical analysis performed. PSM: Propensity score matching
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 | Table 1: Matching of sociodemographic variables through propensity score matching analysis
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 | Table 2: Matching of clinical variables through propensity score matching analysis
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 | Table 3: Severity of Nomophobia Questionnaire between the groups before and after propensity score matching analysis
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 | Table 4: Total score and dimensions of Nomophobia Questionnaire between the groups before and after propensity score matching analysis
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| Discussion | | |
In this era of technological advancement, the dependence on the mobile phone has increased to such an extent that a day without a mobile phone cannot be imagined. "Nomophobia" is one such example. Further, the lockdown due to COVID-19 contributed to the increased exposure to smartphones for entertainment as well as academics among the students. Our study aimed to detect nomophobia among undergraduate and postgraduate medical students before and after COVID-19 (second wave).
In our study, among students surveyed in 2019 and 2021, only 0.5% and 0.46% had no nomophobia, 26% and 25.9% had mild, 61.5% and 60.2% had moderate, and 12% and 13.4% had severe nomophobia, respectively. The total prevalence is in the higher range of that reported by the systematic review of previous studies done between April 2015 and August 2020.[6] The prevalence of nomophobia before COVID-19 is similar to the studies done on Indian medical students by Farooqui et al. in 2015 and 2016, Sethia et al. in 2016, Madhusudan et al. in 2016 and 2017, Bartwal and Nath in 2017, and Khilnani et al. in 2018.[9],[17],[18],[19],[20] The prevalence of nomophobia after COVID-19 (second wave) is similar to other studies done during COVID-19 such as Sasidharan et al. from April to June 2020, Ghogare et al. in May 2020, and Copaja-Corzo et al. on Peruvian medical students from June 2020 to March 2021.[8],[10],[11] The high severity of nomophobia found might be due to the comparative availability of leisure time, curiosity of exploring technology, and extensive usage for educational or research purposes.[21] In the study by Sui et al. that surveyed university students in September 2019–January 2020 (before COVID-19) and May–June 2020 (during COVID-19), the authors found that students "using some type of app more, using their smartphone a little more, and about the same perceived smartphone reliance during COVID-19." They reported COVID-19 has not increased the prevalence of nomophobia or smartphone addiction.[22]
In our study, no significant differences were found between the groups (before and after COVID-19) in terms of the total score, severity, and dimensions of NMP-Q, except the dimension of "losing connectedness" even after controlling for confounding by independent covariates through PSM analysis. The study showed that COVID-19 infection and lockdown, which happened during the era of technological advancement, have not changed the characteristics of nomophobia among medical students, except a significant increase in the feelings of losing the ubiquitous connectivity, which mobile phones provide. However, Bhatnagar et al. reported increased use, time, and severity of usage of mobile phones during the lockdown by medical students.[5]
Limitations
Data were collected from the medical students of only one medical college of the state, and therefore, the findings cannot be generalized. Being a nonrandomized observational study, it is challenging to compare the severity and dimensions of nomophobia between the groups, however, post hoc PSM analysis adjusted for confounders, facilitating comparability between the groups.
| Conclusion | | |
Nomophobia is an emerging health-related deleterious effect of excess usage of mobile phones, which needs attention. Despite the infinite perks of smartphone usage, it will lead to negative consequences (especially a decline in academic performance). If you find yourself always alert for phone notifications or reaching out to get your phone at frequent intervals, it's time for a digital detox.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Bhattacharya S, Bashar MA, Srivastava A, Singh A. Nomophobia: NO mobile phone phobia. J Family Med Prim Care 2019;8:1297-300.  [ PUBMED] [Full text] |
| 2. | Bragazzi NL, Del Puente G. A proposal for including nomophobia in the new DSM-V. Psychol Res Behav Manag 2014;7:155-60. |
| 3. | King AL, Valença AM, Silva AC, Sancassiani F, Machado S, Nardi AE. "Nomophobia": Impact of cell phone use interfering with symptoms and emotions of individuals with panic disorder compared with a control group. Clin Pract Epidemiol Ment Health 2014;10:28-35. |
| 4. | Nikhita CS, Jadhav PR, Ajinkya SA. Prevalence of mobile phone dependence in secondary school adolescents. J Clin Diagn Res 2015;9:C06-9. |
| 5. | Bhatnagar P, Tarachandra S, Undaru S. A study on patterns of use of mobile phone and nomophobia in medical undergraduate students during a COVID-19 pandemic lockdown. Eur Psychiatry 2021;64 Suppl 1:S671. |
| 6. | Notara V, Vagka E, Gnardellis C, Lagiou A. The emerging phenomenon of nomophobia in young adults: A systematic review study. Addict Health 2021;13:120-36. |
| 7. | León-Mejía AC, Gutiérrez-Ortega M, Serrano-Pintado I, González-Cabrera J. A systematic review on nomophobia prevalence: Surfacing results and standard guidelines for future research. PLoS One 2021;16:e0250509. |
| 8. | Copaja-Corzo C, Aragón-Ayala CJ, Taype-Rondan A, Nomotest-Group. Nomophobia and its associated factors in Peruvian medical students. Int J Environ Res Public Health 2022;19:5006. |
| 9. | Sethia S, Melwani V, Melwani S, Priya A, Gupta M, Khan A. A study to assess the degree of nomophobia among the undergraduate students of a medical college in Bhopal. Int J Commun Med Public Health 2018;5:2442-5. |
| 10. | Ghogare AS, Aloney SA, Vankar GK, Bele AW, Patil PS, Ambad RS. A cross-sectional online survey of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among undergraduate health sciences students of a rural tertiary health-care center from Maharashtra, India. Ann Indian Psychiatry 2022;6:27-37. [Full text] |
| 11. | Sasidharan A, Selvamani I, Venkataraman I, Dinesh BS, Nesan GS, Kavitha P. Severity of nomophobia and its association with anxiety, stress and depression among medical students during the Covid-19 pandemic. J Posit Sch Psychol 2022;6:2241-53. |
| 12. | Yildirim C, Correia AP. Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire. Comput Human Behav 2015;49:130-7. |
| 13. | Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011;10:150-61. |
| 14. | Baek S, Park SH, Won E, Park YR, Kim HJ. Propensity score matching: A conceptual review for radiology researchers. Korean J Radiol 2015;16:286-96. |
| 15. | Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 2009;38:1228-3422. |
| 16. | von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Ann Intern Med 2007;147:573-7. |
| 17. | Farooqui IA, Pore P, Gothankar J. Nomophobia: An emerging issue in medical institutions? J Ment Health 2018;27:438-41. |
| 18. | Madhusudan M, Sudarshan BP, Sanjay TV, Gopi A, Fernandes SD. Nomophobia and its determinants among the students of a medical college in Kerala. Int J Med Sci Public Health 2017;6:1046-50. |
| 19. | Bartwal J, Nath B. Evaluation of nomophobia among medical students using smartphone in North India. Med J Armed Forces India 2020;76:451-5. |
| 20. | Khilnani AK, Thaddanee R, Khilnani G. Prevalence of nomophobia and factors associated with it: A cross-sectional study. Int J Res Med Sci 2019;7:468-72. |
| 21. | Kanmani A, Bhavani U, Maragatham RS. Nomophobia – An insight into its psychological aspects in India. Int J Indian Psychol 2017;4:5-15. |
| 22. | Sui W, Sui A, Munn J, Irwin JD. Comparing the prevalence of nomophobia and smartphone addiction among university students pre-COVID-19 and during COVID-19. J Am Coll Health 2022:1-4. |
Correspondence Address:
Pavan Kumar Kadiyala,
H.No. 6-150, Nidamanuru, Vijayawada - 521 104, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/amh.amh_115_22
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4] |
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