Research Article

Pattern of mobile phone usage and its effects on

psychological health, sleep, and academic performance in
students of a medical university
Naveenta Gupta1, Sonia Garg1, Khushdeep Arora2
1
Department of Physiology, Guru Gobind Singh Medical College, Faridkot, Punjab, India.
2
Department of Physiology, Dashmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India.

Correspondence to: Naveenta Gupta, E-mail: [email protected]

Received November 3, 2015. Accepted December 17, 2015

||ABSTRACT
Background: Mobile phones have become increasingly popular in recent years, especially in young generation. Although these are
convenient and useful, teenagers are becoming more and more dependent on them. Aims and Objective: This study was designed
to assess the mobile phone usage pattern and its negative effects on psychological health, sleep, and academic performance in
students of a medical university. Materials and Methods: A descriptive study was conducted on a total of 1,000 medical students
aged between 17 and 24 years who were using mobile phone for at least 1 year. They were requested to fill a specially designed,
self-administrated, pretested, questionnaire that comprised details of their frequency and pattern of using mobile phone and its
effects on their psychological health, sleep-related behavioral issues, and academic performance. The data collected were statistically
analyzed. Result: Among the total 1,000 students, all of them possessed their own mobile phone, with about 76.4% students having
smart phones. Major purpose of using the phone was for communication, coordination of activities, and in emergency situations,
while others were also using it for downloading games, music, videos, and for style. Nighttime usage of mobile phone was highly
significantly (p o 0.0001) associated with difficulty in waking up, waking time tiredness, decline in study habits, difficulty in
concentration, increase in missed classes, and going late for classes. Total time spent on mobile phones was significantly (p o 0.05)
associated with waking time tiredness and difficulty in waking up and highly significantly (p o 0.001) with decline in study habits,
increase in missed classes, and going late for classes. Conclusion: Besides the positive role of mobile phones in our daily lives, its
overuse presents negative impact on psychological health, sleep, and academic performance of students. Hence, it is important to
guide the students regarding efficient, safe, purposeful usage, and negative effects of mobile phones on health and environment.

KEY WORDS: Mobile Phone; Psychological Health; Sleep; Academic Performance

||INTRODUCTION but, these days, mobile phones function as mobile computers that
serve us with music player, games, internet, video camera,
Mobile phones have become a ubiquitous part of our daily lives. calculator, alarm clock, and many more other perceived benefits
Initially, mobile phones were used only as a communication tool; as increased accessibility and social connectivity, reduced lone-
liness, and security in emergency situations.[1]
Owing to these countless perks, mobile phones are increasingly
Access this article online adopted and used by teenagers. Moreover, usage of mobile phones
Quick Response Code: has increased dramatically owing to their more affordability and
Website: http://www.njppp.com
availability all over the world. Fixed telephone lines reached one
DOI: 10.5455/njppp.2016.6.0311201599 billion users in 128 years, while mobile networks attained this
milestone in simply over two decades. Worldwide, mobile phone
subscriptions have reached six billion.[2] In India, people living in
both rural and urban areas, literate or illiterate, and belonging to
almost all age groups are now dependent on a mobile phone.

National Journal of Physiology, Pharmacy and Pharmacology Online 2016. © 2016 Naveenta Gupta. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon
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132 2016 | Vol 6 | Issue 2 National Journal of Physiology, Pharmacy and Pharmacology
Effect of mobile phones on medical students Gupta et al.

Unfortunately, communication technology has some nega- their awareness about effects of mobile phone. The question-
tive effects also. Constant usage and addiction to cell phones has naire was pretested by a pilot study among 30 students, and
affected the people physically, psychologically, and socially. appropriate modifications were done according to the experi-
Excessive mobile phone use has been found to be associated ences of pilot study.
with health problems such as impaired concentration, head- Demographic details included age, sex, education, and
ache, dizziness, fatigue, thermal sensations in and around ear, socioeconomic status. Frequency of mobile phone usage
facial dermatitis, stress, sleep disturbances owing to nighttime included average time spent on various features of mobile
use, and frustration.[3] Inappropriate use of mobile phone by phones such as calls and text messages. Pattern of mobile phone
students presents many deleterious effects, for example, usage usage comprised number of persons calling/day; mode,
of phones during lectures causes disturbances in classrooms purpose, and timing of mobile phone usage; usage at
affecting students’ academic performances,[4] accidents while inappropriate or prohibited places; where they kept their
driving,[5] damaged relationships owing to preference to phone phone during sleep; and whether they switched it off during
calls by ignoring other members,[6] and increased freedom from sleep or not.
parents[7] along with decreased social freedom.[8] Psychologi- Questions related to psychological health included their
cally, people get addicted to mobile phones that has led to accessibility stress, ringxiety, or whether they have ever thrown
emotional stress. Students may also show cognitive/behavioral their phone because of angry conversation. Regarding sleep,
salience in which they constantly think about their phones they were asked whether they felt waking time tiredness and
when they are not using it or keep on checking their mobile difficulty in waking up, which may be related to nighttime usage
phones for missed calls or messages.[4] or total time spent on mobile phone.
Mobile phone addiction can be explained by the fact that Regarding academic performance, they were asked whether
students find the use of mobile phone to be exciting. Any they have felt decline in study habits and grades, difficulty in
behavior that gives satisfaction or helps to get rid of a negative concentration, increase in missed classes, and were late for
behavior such as tension or boredom leads to intensification of classes.
that behavior for taking pleasure or getting rid of a negative The study was approved by Institutional Ethical Committee.
situation as is the case with mobile phone.[9] Only the volunteer students willing to participate in the study
In spite of some knowledge on unfavorable health effects, were selected, and their informed consent was taken. Privacy of
mobile phones are gaining popularity, especially in young students was protected as they were told not to write their
generation. The aim of this study, therefore, was to examine names on the questionnaire.
self-reported pattern of mobile phone usage among students of
a medical university and to assess effects of mobile phones use
on their psychological health in the form of their perceived Statistical Analysis
stress, sleep quality, and academic performance. The data were compiled and expressed as frequency and
percentages. The data were analyzed statistically using w2-test
to observe the relationship between late night usage of mobile
||MATERIALS AND METHODS phone and total time spent on mobile phone with their sleep-
related issues and academic activities. Value of p o0.05 was
A descriptive cross sectional study was conducted on a total of taken as significant.
1,000 students of a medical university for a period of 5 months
from May 2015 to September 2015. Both male and female
students of age between 17 and 24 years were included. ||RESULT
Inclusion Criteria In this study, the mean age of subjects was 20.90 ± 1.81 years,
Students who were using mobile phones on a regular basis for and their mean age of first usage of mobile phone was 15.8
±1.29 years. Their average monthly expenditure on mobile
more than 1 year were included in the study.
phone was Rs. 323 ± 151.
Table 1 shows demographic characteristics of the study
Exclusion Criteria population. Table 2 shows pattern of mobile phone use among
Subjects with history of alcohol or substance abuse and any medical students. Figure 1 shows purpose of mobile phone use
psychiatric or sleep disorder were excluded from the study. by students, and Figure 2 shows the average time spent on
various features of mobile phones. Tables 3 and 4 show the
Study Design problems related to sleep and academic activities observed in
Students were requested to fill a specially designed, self- students, which were further correlated with late night mobile
administrated, questionnaire which comprised their socio- phone usage and total time spent on mobile phones, respec-
demographic characteristics, frequency and pattern of mobile tively. Table 5 shows the psychological health-related issues
phone usage, questions related to their psychological health, owing to the use of mobile phone among medical students.
sleep-related behavioral issues, academic performance, and On statistical analysis, it was observed that late night usage of

National Journal of Physiology, Pharmacy and Pharmacology 2016 | Vol 6 | Issue 2 133
Gupta et al. Effect of mobile phones on medical students

Table 1: Demographic characteristics of the study population Table 2: Pattern of use of mobile phone among medical students
Characteristics Number of students, Number of students,
N = 1,000 (% age) N = 1,000 (% age)

Gender Pattern of mobile phone use

Males 428 (42.8) Have own mobile phone 1000 (100)
Females 572 (57.2) Two phones 90 (9)
Mode of residence Dual sim phone 478 (47.8)
Hostel 830 (83) Smart phone 764 (76.4)
Family 170 (17) Internet on phone 704 (70.4)
Socioeconomic status Number of persons calling/day
High 64 (6.4) 1–2 174 (17.4)
Middle 904 (90.4) 3–4 248 (24.8)
Low 32 (3.2) 45 578 (57.8)
Mode of use
Ringing 730 (73)
mobile phone was highly significantly (p o 0.0001) associated Vibration 155 (15.5)
with difficulty in waking up, waking time tiredness, decline in Silent 115 (11.5)
study habits, difficulty in concentration, increase in missed Use at places
classes, and going late for classes. Home 960 (96)
Moreover, total time spent on usage of mobile phone was Public places 710 (71)
significantly (p o 0.05) associated with difficulty in waking up Class 180 (18)
and waking time tiredness and highly significantly (p o 0.0001) Eating 54 (5.4)
associated with decline in study habits, increase in missed Driving 94 (9.4)
classes, and going late for classes. Time of maximum use
Morning 36 (3.6)
Afternoon 70 (7)
||DISCUSSION Evening 624 (62.4)
Night 270 (27)
Mobile phones are now indispensable in daily life. Owing to Where do you keep your mobile phone
improved standard of living in India, mobile phone ownership is during sleep?
highly prevalent among teens and young adults. The findings of At bed 906 (90.6)
this study suggest specific mobile usage patterns, various At table near bed 94 (9.4)
compulsions caused by mobile use, and a number of important Do you switch off your phone during sleep? 62 (6.2)
relationships between mobile phone usage, health-related
behaviors, and academic activities among college students.
In our study, we observed that mobile phone use was very
high among medical students of both the sexes, and all the they frequently used it for taking pictures, recording videos,
students had their own mobile phone, similar to findings in playing games, listening to music, and Internet surfing as was
other studies.[10] Moreover, the students from low socio- also found in another study.[13]
economic status families possessed their own mobile phones. In our study, majority of the students used their phones for
The mobile phones that were earlier used by only high-income social interaction and sharing of thoughts with their parents
society are nowadays used by most people as they have got and friends.[14] Besides calling, the second most common usage
cheaper over time. of mobile phone was as instrument for coordination of day-to-
Average monthly phone bill of students under our study day activities such as alarm clock or reminder, for safety
was limited to Rs 300–500. This amount was found to be much purposes, and emergency situations. These multifunction
less than that spent by Malaysian students in another study.[11] features of mobile phones cause an increase in mobile phone
However, this difference in expenditure may be owing to the value, leading the users to perceive it as a must-have tool.[4,14]
disparity in purchasing power of parents or may be that Indian The disadvantage of having so many features on a single device
students try to keep check on their expenditure. is that if students lose their phone they would lose most of their
We observed that some students possessed another spare contact numbers, recorded media, schedulers, and important
mobile phone, and many students were using dual sim phones, personal data.
which suggest improper usage of mobile phones as they may be Some students think that mobile phone belongs to their
hiding their contacts, information or data from others, style, and others admitted that they cannot imagine life without
especially their family members.[12] Majority of the students a mobile phone, which indicates their dependent behavior. This
were possessing smart phones along with Internet facility, and suggests that adolescents are more eager to adopt new

134 2016 | Vol 6 | Issue 2 National Journal of Physiology, Pharmacy and Pharmacology
Effect of mobile phones on medical students Gupta et al.

934
1000
900

700
800
Number of students

626
700

514
600
500 417

338

326
400

184
300

136
200

68
100
0

Figure 1: Purpose of mobile phone usage by students.

technologies and some consequent behavioral characteristics as This shows that, sometimes, students use the peripheral features
they are more susceptible to fashion trends and styles.[7,14] In a of phone more than using it as a communication tool only.[16]
study conducted on Australians adolescents, some of the As far as number of persons called per day is concerned, we
participants were found to have very strong attachment to observed that many students were calling more than five
their cell phones and reported it to be an integral part of their persons per day. Total cumulative time spent on all features of
life.[14,15] phone such as calling, messages, games, music, videos, Internet,
Another common feature used on mobile phone was WhatsApp, and other features was more than 1 h for 76.4% of
‘‘WhatsAppTM,’’ an application which enables users to send and students, with 17.8% of students using the mobile phone
receive images, videos, audios, and text messages instanta- heavily (i.e., they were spending more than 3 h on their mobile
neously to individuals and groups of friends. At present, phone).[17] In one study, it was interpreted that individuals with
WhatsApp is one of the most popular applications as it helps low self-esteem overuse their mobile phone as they have more
in easier social interactions among individuals leading to higher propensity to seek reassurance. Moreover, the extraverts, who
frequencies of chatting, planning, and group communications.[15] are essentially social in nature, tend to overuse their mobile

800

700
610

600
Number of students

482

456

438

500
346

400
308
306

278
260

300
206

180

178
154
122

200
112

106

98

96
84

84

54

100
30

12
0

0
<30 min 30-60min 60-120min 120-180min >180min

Calling Games Music and videos Whats app Total time spent

Figure 2: Average time spent on different features of mobile phone by students.

National Journal of Physiology, Pharmacy and Pharmacology 2016 | Vol 6 | Issue 2 135
Gupta et al. Effect of mobile phones on medical students

Table 3: Correlation of sleep-related issues and academic performance with late night usage of mobile phone
Sleep and academic performance Late night mobile phone use (number of students = 1,000) (% age)

Daily, Weekly, Monthly, Occasionally, Not at all, w2 p

N = 270 (27) N = 106 (10.6) N = 108 (10.8) N = 388 (38.8) N = 128 (12.8)

Waking time tiredness, 94 (9.4) 78 (7.8) 50 (5) 76 (7.6) 32 (3.2) 123.28 0.0001*
(N = 330)
Difficulty in waking up 98 (9.8) 80 (8) 56 (5.6) 64 (6.4%) 36 (3.6) 153 0.0001*
(N = 334)
Decline in study habits and grades (N = 150 (15) 56 (5.6) 36 (3.6) 32 (3.2) 34 (3.4) 196 0.0001*
308)
Decrease in concentration 122 (12.2) 56 (5.6) 32 (3.2) 22 (2.2) 14 (1.4) 197 0.0001*
(N = 246)
Increase in missed classes, 68 (6.8) 40 (4) 62 (6.2) 48 (4.8) 26 (2.6) 106 0.0001*
(N = 244)
Being late for classes, 86 (8.6) 56 (5.6) 66 (6.6) 50 (5) 16 (1.6) 154 0.0001*
(N = 274)

More than one sleep- and academic performance-related issues present in the same student.
*p o 0.001 = highly significant.

phone.[18] The preferred mode of using the mobile phone in our difficult to shut off their phones even at night time during
study was in ringing mode rather than in silent or vibration sleeping.
modes, which signifies that students do not want to miss any Students were also found to use their phones during late
incoming call or text message at any time. night hours. According to a study, there is no safe amount or
The use of mobile phones is prohibited in a growing number safe time to use a cell phone after lights out; even moderate use
of public places such as banks, hospitals, and public transits as doubles the risk of long-term tiredness.[20] Mobile phones may
it is thought to disturb the social activities of people. In our also potentially affect students’ academic performance. A highly
study, mobile phones were used by 71% of students at public significant correlation was found between nighttime use of
places, which may be because of their portability and mobile phone and difficulty in waking up, waking time
requirement for constant communication. Mobile phones are tiredness, decline in study habits and grades, decrease in
thought to be a distressing element in educational institutes, concentration, increased frequency of missed classes, and being
and 18% of students in this study were using mobile phones in late for classes. One possible explanation for this may be
classrooms where they exchange text messages rather than development of a hypervigilant attitude of individuals toward
voice calls. Sending messages during lectures affects the their mobile phones even in the late night hours. Our results are
learning abilities of the students in a negative way for not consistent with another study conducted in Japan in which 68%
being able to concentrate properly.[1] Mobile phones were also of the students, who received poor grades, owned a mobile
used by some students during driving, which is risky and may phone.[21] In another study, talking on a cell phone, using
lead to accidents, even if they are using it with hands-free e-mail, messaging services, and browsing the Internet were
device as calling on phone reduces driver’s attentiveness.[5] found to be the reasons for a significant amount of class
Some of the students were also using the phone while eating, tardiness and sleep deprivation.[22] This may be a disturbing
which is thought to be inappropriate. This usage pattern shows factor as studies have shown that sleep disturbances and poor
their dependence on mobile phones as they cannot resist the sleep quality show negative impact on general health and
attraction of using it even at places where it is prohibited, risky, feeling of well-being along with impaired cognitive function and
or while doing other important works such as eating or poor academic performance.[23]
studying. Most of the students were using their phones in In our study, a highly significant correlation was found
evening or at night, which may be owing to their busy schedule between total time spent by the students on mobile phones and
of classes in morning or afternoon. difficulty in waking up, waking time tiredness, decline in their
While sleeping, students used to keep their phone on bed or study habits, increase in missed classes, and being late for
table near bed as is also found in other studies.[19] Only few classes. It can be interpreted that many college students may be
students switched off their phones during sleeping. These sacrificing their academic position, emotional and physical
observations suggest that people who are habitual mobile health, and other aspects of life only to ensure that they do not
phone users get so much involved with it that they find it miss a call, text message, or social networking post.[24]

136 2016 | Vol 6 | Issue 2 National Journal of Physiology, Pharmacy and Pharmacology
Effect of mobile phones on medical students Gupta et al.

Table 4: Correlation of sleep-related issues and academic performance with total time spent on mobile phone
Sleep and academic performance Total time spent on mobile phone use (number of students = 1,000) (% age)

o 30 min, 30–60 min, 60–120, min, 120–180 min, 4 180 min, w2 p

N = 30 (3) N = 206 (20.6) N = 308 (30.8) N = 278 (27.8) N = 178 (17.8)

Waking time tiredness 16 (1.6) 78 (7.8) 92 (9.2) 88 (8.8) 56 (5.6) 9.6 0.04*
(N = 330)
Difficulty in waking up 8 (0.8) 52 (5.2) 108 (10.8) 88 (8.8) 78 (7.8) 16.2 0.003*
(N = 334)
Decline in study habits and grades 10 (1) 70 (7) 70 (7) 76 (7.6) 82 (8.2) 31.5 0.0001**
(N = 308)
Decrease in concentration 12 (1.2) 48 (4.8) 64 (6.4) 74 (7.4) 48 (4.8) 7.6 0.108
(N = 246)
Increase in missed classes 8 (0.8) 50 (5) 78 (7.8) 46 (4.6) 62 (6.2) 20 0.0001**
(N = 244)
Being late for classes 4 (0.4) 50 (5) 66 (6.6) 108 (10.8) 46 (4.6) 28.1 0.0001**
(N = 274)

More than one sleep- and academic performance-related issues present in the same student.
*p o 0.05 = significant; o0.001 = highly significant.

Some students admitted that they cannot live without a Other factors contributing to mobile phone-related stress
phone and will buy a new phone immediately if their phone could be interruptions of work, disturbance by ring signals,
breaks down, which indicates that mobile usage is unavoidable feeling of never being free, feelings of guilt for not answering all
and has become an integral part of their life.[25] the calls or messages, forgetting the phone at home, running out
On a stressful day, most of the students like to talk to their of batteries or calling range, and keeping the battery charged all
family members in person for getting an emotional and psychic the times.[29]
support, which shows that mobile phone has not resulted in In our study, students frequently checked their phone owing
social anxiety and has not reduced face-to-face relationships. to ringxiety or phantom ring, which is considered to be an
One possible explanation is that intimate contact with family indicator of mobile phone addiction.[30] With increase in
and friends in person may be more stress-buffering than the number of individuals reporting mobile phone-related behavior
less intimate contact while using communication technology to problems, phantom ring may become a cause of concern for
obtain social support. However, technology appears to be an health professionals in coming years.[31] About one-third of
excellent substitute for communication when in-person contact students were aware of the fact that mobile phone is
with family and friends is not practicable. responsible for ecosystem disturbances and health ailments.
Students are expected to be always accessible by phone in But, this fact did not reduce the usage of mobile phones by
every time and place by their family members and friends, students.
which is a stressor of mobile phone use compared with actual The findings of this study can be discussed by using
frequency of use. Otherwise, they have to give reasons or make stimulation-habituation assumption. Mobile phone usage sti-
excuses for not being available. Moreover, they get poor sleep as mulates adolescents by providing recent advances and inter-
they are stressed owing to possibility of being called during late esting information desired by them. They develop a habit to
night. Expectation of permanent availability and students’ spend much more time with their phone, which goes on
disability in controlling calls along with their secret relation- increasing with time, and they become habitual of their phone.
ships with peers out of family supervision and panic for This habituation leads to health and behavioral problems in
transpiring these relationships may lead to apprehension, adolescents causing many difficulties in their daily activities and
anxiety, and frustration.[26] Moreover, the constant accessibility adjustment with family members.
of students via communication technology to other individuals The strength of the study was that it was done on a large
who are in need of social support may lead to significant number of subjects, and it represents people from variable
disruptions of their daily schedule regardless of their own regions of Punjab from different backgrounds. Moreover, the
actual frequency of technology use.[27] Some students believe a pro forma was validated beforehand in similar population. The
positive impact of mobile phones on their routine life, it to be an study has certain limitations also as it is representing only one
easy communication tool, and accessibility at all times as a great segment of society (i.e., medical students) but not the whole
convenience. Young people also develop emotional attachments community, and the results depend upon the honesty of
to their phones. These factors encourage increasing mobile students in answering the questionnaire. A further study
phone use by the students, which can lead to dependence.[28] including general population is suggested.

National Journal of Physiology, Pharmacy and Pharmacology 2016 | Vol 6 | Issue 2 137
Gupta et al. Effect of mobile phones on medical students

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