Influence Smartphones addiction on mental health and sleep quality  among medical students in Sudan amids armed conflict :A cross sectional study.

doi:10.21203/rs.3.rs-4469377/v1

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Influence Smartphones addiction on mental health and sleep quality among medical students in Sudan amids armed conflict :A cross sectional study.

https://doi.org/10.21203/rs.3.rs-4469377/v1

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Background:

Smartphone use has rapidly increased worldwide. It was estimated that worldwide use of smartphones surpassed 1 billion in 2012, which means that 1 out of 7 people use smartphones. Mobile phones have become an unavoidable part of the youth's lives and are attractive and very handy technological appliances, competent to disseminate a lot of information at their fingertips. They also include features like internet access, multimedia, and GPS navigation, in addition to their use for communication. We aimed to assess the influence of smartphone addiction on mental health and sleep quality among medical students in Sudan.

Methods:

This cross-sectional survey focused on Sudanese medical students, living inside or outside the country, who tend to be addicted to smartphones during the conflict period. The questionnaire covered various domains, including sociodemographic data, the Suboptimal Health Status questionnaire, the sleep condition indicator, the smartphone addiction scale, and depression, anxiety, and stress scales during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26.

Results:

A total of 1704 questionnaires were collected. Of all participants, 1176 (69.0%) were female and 528 (31.0%) were male. The mean age of the participants was 491. Age was classified: as less than 18 (40, 2.3%), 19–21 years (368, 21.6%), and more than 21 years (1296, 76.1%). More than half of the respondents (1048, 61.5%) had a low suboptimal health status questionnaire prevalence, while 656 (38.5%) had a high prevalence. 336 (31.5%) of the participants had a low rate of sleep condition indicator prevalence, while 1168 (68.5%) had a high rate according to the prevalence rate.

Conclusion:

In conclusion, our study sheds light on the significant prevalence of smartphone addiction among medical students in Sudan, with 67.6% of participants exhibiting high levels of addiction. This addiction has profound health implications, particularly in terms of negatively impacting sleep patterns. The findings underscore the need for tailored interventions and awareness programs targeting smartphone addiction, considering demographic factors such as age, gender, and marital status. Additionally, our study emphasizes the importance of further research to explore contextual factors contributing to smartphone addiction among medical students and to develop effective strategies for intervention and prevention.

Bioinformatics

smartphone addiction

mental health

sleep quality

medical students

Sudan

armed conflict

In recent years, the prevalence of smartphone addiction has become a growing concern, particularly among young adults and students. Medical students, in particular, are not immune to the allure of constant connectivity and the instant gratification that smartphones provide. In Sudan, where armed conflict has created a high-stress environment for many individuals, the impact of smartphone addiction on mental health and sleep quality among medical students is a topic that warrants further investigation.

Smartphone use has rapidly increased worldwide, with over 1 billion users estimated in 2012, meaning that 1 in 7 people use smartphone (1),s. Mobile phones have become an integral part of the youth's life, offering convenience and access to a wealth of information. Smartphones stand out from ordinary mobiles due to their easy access to the web and other applications, which can be downloaded and stored. The increased usage of smartphones among young people has led to smartphone addiction becoming a significant social issue, resulting in physical health problems such as musculoskeletal disorders, ocular manifestations, and an elevated risk of psychological disorders. These social problems resemble the features of behavioral addiction(2). The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), classifies behavioral addiction as having cognitive and behavioral symptoms similar to substance-related addiction, including loss of control and withdrawal symptoms. It also acknowledges internet gaming disorder as a condition for further study( 3).

This cross-sectional study aims to explore the influence of smartphone addiction on mental health and sleep quality among medical students in Sudan amidst ongoing armed conflict. By examining the relationship between smartphone use patterns, psychological well-being, and sleep disturbances, this research seeks to shed light on the potential negative consequences of excessive smartphone usage in this vulnerable population. Understanding how smartphones impact mental health and sleep quality among medical students in Sudan can inform interventions and strategies to promote healthier technology habits and improve overall well-being in this context

In Korea, Seo et al. (4) reporte. A study conducted in Korea found that smartphone addiction in teenagers was strongly correlated with physical symptoms, depression, anxiety, delinquency, and aggressiveness. In this study, we aim to assess the impact of smartphone addiction on the mental health and sleep quality of medical students in Sudan.

Study Design

We conducted an online survey of Sudanese medical students using convenience sampling. The survey was available on various social media platforms from January 2nd to February 25th, 2024 and could be accessed by anyone with the link. We shared information about the study with a group of collaborators to help collect data. We did not contact respondents prior to starting the study. We invited individuals to participate in a study that examined the impact of smartphone addiction on mental health and sleep quality among medical students in Sudan. This included a Participant Information Sheet (PIS) and the survey link. The PIS provided details about the study's goals, protection of personal data, survey length, and the right to withdraw from the study at any time. We emphasized that participation in the survey was voluntary and there were no financial incentives. The target population was Sudanese medical students, regardless of their location.

Data Collection

We developed an online questionnaire based on recent literature and input from faculty members at the University of Alzaiem Alazhari. The questionnaire covered various topics, such as sociodemographic data, Suboptimal Health Status questionnaire, sleep condition indicator, Smartphone addiction scale, and depression, anxiety, and stress scale. The questions were randomized to reduce response bias, and respondents were required to complete all mandatory items. They had the option to review and change their answers using a 'back' button. To ensure clarity and relevance, we piloted the survey with 30 medical students. We received feedback that helped improve the wording of the questions, although most respondents found the questions clear, relevant, and specific. We used Google Forms for data collection, which was distributed by 26 collaborators through personal and professional groups, as well as social media platforms like Facebook, WhatsApp, Twitter, and LinkedIn. We also posted study information on Sudanese social media groups for medical students and sent reminders on days 3 and 7 of the data collection period. We did not collect respondents' IP addresses to maintain anonymity and confidentiality, although Google Forms only allowed one submission per IP address.

Data Management and Statistical Analysis:

Responses were securely stored in Google Sheets, accessible only to the study team. The data was thoroughly cleaned and analyzed using IBM's Statistical Package for Social Sciences (SPSS) software, specifically version 26 (https://www.ibm.com/docs/en/spss-statistics/26.0.0).Continuous data was presented as mean ± SD, while categorical data was presented as numbers (percentage). To assess the normality of the data, we used the Kolmogorov-Smirnov test. For normally distributed data, we used an independent t-test to determine significant differences between groups. In cases where the null hypothesis of the Kolmogorov-Smirnov test was rejected, we used the Mann-Whitney U test. To determine significant differences between groups for categorical data, we used either the Chi-square test or Fisher's exact test. A p-value of less than 0.05 was considered significant.

Ethical Approval:

The study received approval from the Research and Ethics Committee at the University of Alzaiem Alazhari, Sudan. The study adhered to the ethical standards outlined in the 1964 Helsinki Declaration and its subsequent amendments, as well as other approved ethical guidelines. Informed consent was obtained from all participants, as indicated in the data collection tool. To ensure comprehensive and accurate reporting of the study findings, we followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES)20. We confirm that all methods were conducted in accordance with relevant research ethics guidelines and regulations. Participants provided informed consent at the start of the online survey before completing the questionnaire.

A total of 1704 questionnaires were collected. Of all the participants, 1176 (69.0%) were female and 528 (31.0%) were male. The mean age of the participants was 491. Age was classified into categories as follows: less than 18 years, 40 (2.3%); 19-21 years, 368 (21.6%); and more than 21 years, 1296 (76.1%). Among these, approximately 56 (3.3%) were in the first level of university, followed distantly by 152 (8.9%) in the second level, 432 (25.4%) in the third level, 528 (31.0%) in the fourth level, 360 (21.1%) in the fifth level, 128 (7.4%) in the sixth level, and 48 (2.8%) had graduated from the university.

The study revealed that 136 (8.0%) were single, while the majority, 1568 (92%), were married. Moreover, only 792 (46.55%) of the participants lived inside Sudan, while 912 (53.5%) lived outside Sudan. Additionally, more than half of the respondents, 1048 (61.5%), had a low SHSQ prevalence, while 656 (38.5%) had a high prevalence. 336 (31.5%) of the participants had a low rate of SCI prevalence, while 1168 (68.5%) had a high rate according to the SSI prevalence rate.

About 552 (32.4%) had a low SAS prevalence, while 792 (46.5%) had a moderate level, and 360 (21.1%) had a high level. According to the analysis, the mean of depression was 1.5, while the standard deviation was 0.662. Approximately 1016 (59.6%) had mild depression, 528 (31.0%) had a moderate level, and 160 (9.4%) had severe depression. The mean of anxiety was 1.56, with a standard deviation of 0.622. Of all the students, 864 (50.7%) had a mild anxiety level, 720 (42.3%) had a moderate level, and 120 (7.0%) had a severe anxiety level. The mean value of stress was 1.37, with a standard deviation of 0.634. 1216 (71.4%) of all the students suffered from mild stress, 344 (20.2%) had a moderate stress level, and 144 (8.5%) had a severe level of stress.

To our knowledge, this study is the first investigation into smartphone addiction among medical students in Sudan. The results are significant: 67.6% of participants showed a high level of smartphone addiction, surpassing rates found in previous research on medical students [5], [6]. Another study examined smartphone addiction among university students in Sudan, Jordan, Saudi Arabia, and Yemen and found that Sudanese students had a higher tendency towards smartphone addiction compared to Yemeni students. Jordanian and Saudi students had a higher prevalence of smartphone addiction than Sudanese students [7]. The increase in smartphone use among these students is likely due to their reliance on online medical references.

Interestingly, our study revealed significant findings regarding smartphone addiction (SHSQ) based on age. Students under the age of 18 and those over 21 showed high SHSQ rates of 40% and 40.7%, respectively. For students aged 19–21, the prevalence of high SHSQ was 30.4%. These findings suggest that late teens and early twenties may be a susceptible period for increased smartphone use, which aligns with the higher education phase. These findings are consistent with another study that reported a 37% smartphone addiction rate among adolescent students [8]. However, another study found a higher likelihood of addiction among those who started using mobile phones at a younger age [9]. Our study found that females have a higher level of smartphone addiction compared to males in terms of gender differences. Specifically, 40.8% of females reported high SHSQ, compared to 33.3% of males. This finding is consistent with another study that also observed a higher prevalence of smartphone addiction among females [7]. However, contrasting results emerged from another study, indicating that males tend to be more addicted to smartphones than females [10].

There are several factors that may contribute to the observation that Sudanese female medical students use mobile phones more than male students. One possible explanation is the multiple roles and responsibilities that Sudanese female students often have to manage, including academics, social interactions, and potentially family obligations. Mobile phones may serve as essential tools for managing these roles, leading to increased usage. Additionally, social and communication patterns may differ between genders, influencing the frequency and purpose of mobile phone use. Sudanese females may be more inclined to use their mobile phones for communication, social networking, or academic activities, which could contribute to the higher reported usage.When analyzing class years, we discovered interesting disparities in smartphone addiction. Specifically, 42.2% of fifth-year students exhibited high SHSQ scores. This suggests a potential correlation between academic phase and smartphone usage. The elevated prevalence among fifth-year medical students may be attributed to the unique challenges they face, as they are either in their last year of medical school or one year before graduation. These students likely use smartphones extensively for educational purposes such as exploring clinical demonstration videos and researching future medical pathways. Additionally, the stress associated with final exams during the clinical year might contribute to increased smartphone addiction among medical students. This reflects the multifaceted nature of their smartphone usage patterns during this critical academic phase.

In a prior study involving fifth-year students, it was found that 97.2% of medical students experienced anxiety during the OSCE exam [11]. When examining marital status, the results indicate that only 11.8% of married students exhibited high Smartphone and Internet Addiction Scale (SIS) scores, compared to 40.8% of single students. The higher prevalence of smartphone addiction among single medical students compared to their married counterparts could be influenced by several factors. Single individuals often have different social dynamics and potentially more free time, which may lead to increased smartphone usage for entertainment, social interaction, or other non-academic purposes. Married medical students may experience a different set of responsibilities and time constraints, potentially reducing their leisure time for smartphone-related activities. The presence of a spouse and family obligations might also contribute to a more balanced approach to technology use among married students. Furthermore, social support within a marital relationship could offer alternative sources of companionship and entertainment, reducing the reliance on smartphones for these needs. However, a prior study indicated that in the clinical years, 41–59% of medical students utilized smartphones for lecture notes, medical videos, electronic textbooks, and medical research [12].The prevalence of suboptimal health status (SHSQ) is 38.5%, which aligns with previous findings [13]. SHSQ refers to a state where individuals have not been diagnosed but are at risk of developing diseases like depression and anxiety [14]. A Jordanian study supports this, showing a significant positive correlation between smartphone addiction, depression, and anxiety among medical students [15]. In Iran, a study involving university students found that smartphone addiction can negatively impact both the physical and mental aspects of students' quality of life [16]. The high levels of SHSQ observed in Sudanese medical students in this study may be due to the ongoing armed conflict in Sudan since April 2023. Previous research conducted in Ukraine during wartime also found a high prevalence of severe anxiety and manifestations among university students in war-affected regions [17].

Indicators of sleep conditions show a high rate of 68.5%, possibly due to disrupted sleep patterns caused by excessive screen time, especially before bed. Smartphone activities can stimulate the mind and make it difficult to fall asleep and maintain restful sleep. This supports earlier findings that suggest smartphone addiction disrupts sleep [18]. A study in South India found poor sleep quality in 77 medical students who used smartphones [19]. Another study suggests a link between sleep quality and academic performance, with better grades achieved by those who go to bed between 10:00 and 11:00 PM [20]. Research has also shown that undergraduate students at risk of smartphone addiction are less likely to achieve high cumulative GPAs [21]. The unexpectedly high prevalence of smartphone addiction and its various associations warrant further investigation into contextual factors. This research supports existing theories on smartphone addiction and mental health concerning medical students [13].

This study enhances our comprehension and emphasizes the necessity for personalized interventions that take into account age, gender, and marital status in the examination of smartphone usage patterns. The findings underscore the significance of awareness and counseling programs for medical students. However, it is crucial to recognize the limitations of the study, such as potential biases and the cross-sectional design, and to exercise caution when making definitive conclusions.

In conclusion, our study sheds light on the significant prevalence of smartphone addiction among medical students in Sudan, with 67.6% of participants exhibiting high levels of addiction. This addiction has profound implications for health, particularly in terms of negatively impacting sleep patterns. The findings underscore the need for tailored interventions and awareness programs targeting smartphone addiction, considering demographic factors such as age, gender, and marital status. Additionally, our study emphasizes the importance of further research to explore contextual factors contributing to smartphone addiction among medical students and to develop effective strategies for intervention and prevention.

While this online survey provided valuable insights into the perceptions and concerns of Sudanese medical students regarding smartphone addiction during the conflict, several limitations should be acknowledged. The study’s reliance on online data collection and non-probability sampling procedures may have introduced selection bias, as participation was contingent on internet access and familiarity with online surveys, potentially excluding those without internet access. The self-report nature of the survey further widens the possibility of response bias, where participants may provide socially desirable answers or misrepresent their actual experiences. As the survey was conducted amidst conflict, participants’ responses could have also been influenced by heightened stress and unique contextual factors. Furthermore, the reliance on quantitative data limits the depth of qualitative insights.

One of the most simple and smart techniques to avoid phone addiction is using apps that restrict daily usage and placing the charging station outside bedrooms to reduce late-night phone use. Also, one should consider engaging in consistent activities to cope with psychological stress, seek support from family, friends, and additional therapy or counselling to manage mental health, especially symptoms of depression.

Ethical approval and consent to participate

Ethical approval of the study was obtained from the IRB of Alzaiem Alazhari University.

Informed written consent from each participant was guaranteed before partaking in the study and confidentiality of the participants was secured.

The study was carried out according to the relevant ethical guidelines and regulations.

Consent for publication

Not applicable

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Competing interest

The authors declare that they have no competing interests.

Funding

The authors received no funding for this work

Authors’ contribution

All authors contributed equally to the study

All authors revised the manuscript and approved it for publication.

Park MJ, Park GD, Lee YY, Oh JA. Smartphone use actual condition for research. Seoul: Kyung Hee Cyber University;2012.
Ajay Raj Sethuraman, Shivani Rao*, Lena Charlette, Pandurang Vithal Thatkar, Vivin Vincent. Smartphone addiction among medical college students in the Andaman and Nicobar Islands. International Journal of Community Medicine and Public Health. 2018 p4273
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.: American Psychiatric Association;2013.
Seo CM, Lee JH, Choi TY, Kim J, Shin I, Woo J. Study for relations between smart-phone addiction level and Korea youth self report. J Korean Soc Biol Ther Psychiatry. 2012; 18:223–230.
Liu H, Zhou Z, Huang L, Zhu E, Yu L, Zhang M. Prevalence of smartphone addiction and its effects on subhealth and insomnia: a cross-sectional study among medical students. BMC psychiatry. 2022 Dec;22(1):1-7.
Alhazmi AA, Alzahrani SH, Baig M, Salawati EM. Prevalence and factors associated with smartphone addiction among medical students at King Abdulaziz University, Jeddah. Pakistan journal of medical sciences. 2018 Jul;34(4):984.
Albursan IS, Al Qudah MF, Dutton E, Hassan EM, Bakhiet SF, Alfnan AA, Aljomaa SS, Hammad HI. National, sex and academic discipline difference in smartphone addiction: A study of students in Jordan, Saudi Arabia, Yemen and Sudan. Community Mental Health Journal. 2019 Jul 1;55:825-30.
Bhanderi DJ, Pandya YP, Sharma DB. Smartphone use and its addiction among adolescents in the age group of 16–19 years. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2021 Jan;46(1):88.
Sahin S, Ozdemir K, Unsal A, Temiz N. Evaluation of mobile phone addiction level and sleep quality in university students. Pakistan journal of medical sciences. 2013 Jul;29(4):913.
Chatterjee S, Kar SK. Smartphone addiction and quality of sleep among Indian medical students. Psychiatry. 2021 Apr 3;84(2):182-91.
Jaber MH. Assessment Of Anxiety Related To Osce Exam Among Alzaeim Al-Azahari University Medical Students 2022.
Ibrahim NA, Salisu M, Popoola AA, Ibrahim TI. Use of smartphones among medical students in the clinical years at a medical school in Sub-Sahara Africa: A pilot study. Journal of Mobile Technology in Medicine. 2014 Jul 28;3(2):28-34.
Lei LY, Ismail MA, Mohammad JA, Yusoff MS. The relationship of smartphone addiction with psychological distress and neuroticism among university medical students. BMC psychology. 2020 Dec;8:1-9.
Kung YY, Kuo TB, Lai CT, Shen YC, Su YC, Yang CC. Disclosure of suboptimal health status through traditional Chinese medicine-based body constitution and pulse patterns. Complementary therapies in medicine. 2021 Jan 1;56:102607.
Alabdallat Y, Albakri KA, Al-Hanaqtah BM, Al-Dajani MH, Saleh OM, Harvey H. The Association between Smartphone Addiction, Depression and Anxiety among Medical Students in Jordan. Jordan Medical Journal. 2023 Apr 5;57(1).
Shahrestanaki E, Maajani K, Safarpour M, Ghahremanlou HH, Tiyuri A, Sahebkar M. The relationship between smartphone addiction and quality of life among students at Tehran University of medical sciences. Addicta: The Turkish Journal on Addictions. 2020 Jan 1;7(1):23-32.
Stadnik A, Melnyk Y, Babak S, Vashchenko I, Krut P. Psychological distress among students and cadets of universities in the war conditions.
Zhong Y, Ma H, Liang YF, Liao CJ, Zhang CC, Jiang WJ. Prevalence of smartphone addiction among Asian medical students: A meta-analysis of multinational observational studies. International Journal of Social Psychiatry. 2022 Sep;68(6):1171-83.
Kumar VA, Chandrasekaran V, Brahadeeswari H. Prevalence of smartphone addiction and its effects on sleep quality: A cross-sectional study among medical students. Industrial psychiatry journal. 2019 Jan;28(1):82.
Hysing M, Harvey AG, Linton SJ, Askeland KG, Sivertsen B. Sleep and academic performance in later adolescence: Results from a large population‐based study. Journal of sleep research. 2016 Jun;25(3):318-24.
Hawi NS, Samaha M. To excel or not to excel: Strong evidence on the adverse effect of smartphone addiction on academic performance. Computers & Education. 2016 Jul 1;98:81-9.

The authors declare no competing interests.

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Influence Smartphones addiction on mental health and sleep quality among medical students in Sudan amids armed conflict :A cross sectional study.

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