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Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem.
The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use.
Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed.
Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94;
Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder.
In the era of the internet and with fast-growing mobile technology availability, smartphones have become an essential part of people’s daily lives because of their mobility and various functions. Without bringing a laptop everywhere, people can easily send emails, have a video conference, share files and photos, and have access to entertainment (eg, playing games, etc) by using smartphones. According to a 2015 Pew Research Center report [
Growing evidence suggests that excessive or problematic smartphone use can adversely affect individual physical health (eg, headaches, neck, and wrist pain; obscured vision) [
To explore the relationship of self-esteem with extent of excessive smartphone use, the Bowlby attachment theory [
Although prior research has explored relationships between excessive or problematic smartphone use and mental health or psychological attributes among general populations, much less is known about effects on self-esteem among people with mental health disorders such as internet gaming disorder [
This study included individuals recruited from various parts of South Korea (Metropolitan area, Chungcheong-do, Gyeongsang-do, Jeolla-do, and Gangwon-do/Jeju-do) from October 2018 to February 2019 through the smartphone overdependence management system. The smartphone overdependence management system is a mobile app–based system, developed in a prior study [
The Korean version of the Rosenberg self-esteem scale [
The Korean Smartphone Addiction Proneness Scale (K-SAPS), developed by the National Information Agency of Korea in 2011, was used to assess
We included the K-SAPS as the primary independent variable in the model and also examined it as a categorical variable to assess the degree of excessive smartphone use (high, moderate, and low) based on prior research [
Guided by the Bowlby attachment theory [
The dependent variable in this study was self-esteem, measured with the Rosenberg self-esteem scale. The independent variables were K-SAPS score and degree of excessive smartphone use (high, moderate, or low). Using descriptive statistics, we first examined the characteristics of the Korean cohort of young and middle-aged adults with internet gaming disorder and differences by gender. Specifically, we compared the extent to which men and women were different concerning individual characteristics using two-tailed independent
Furthermore, we utilized a generalized linear regression model to examine the association between K-SAPS and self-esteem and between the degree of excessive smartphone use and self-esteem, among adults with internet gaming disorder. The Rosenberg self-esteem scale was not normally distributed (Shapiro-Wilk normality test:
Characteristics of the study participants.
Characteristic | All (N=189) | Men (n=120) | Women (n=69) | ||
K-SAPSb, mean (SD) | 39.16 (6.91) | 37.94 (7.06) | 41.30 (6.13) | .001 | |
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.02 | |
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High (K-SAPS≥44) | 46 (24.3) | 25 (20.8) | 21 (30.4) |
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Moderate (40≤K-SAPS≤43) | 52 (27.5) | 28 (23.3) | 24 (34.8) |
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Low (K-SAPS≤39) | 91 (48.2) | 67 (55.8) | 24 (34.8) |
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Social and demographic |
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Age (in years), mean (SD) | 34.39 (7.9) | 34.45 (8.11) | 34.30 (7.61) | .90 | |
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.28 | |
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Never been married | 102 (54.0) | 69 (57.5) | 33 (47.8) |
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Married | 84 (44.4) | 50 (41.7) | 34 (49.3) |
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Separated/widowed | 3 (1.6) | 1 (0.8) | 2 (2.9) |
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.29 | |
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Less than high school | 1 (0.5) | 1 (0.8) | 0 (0.0) |
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High school graduate | 39 (20.6) | 21 (17.5) | 18 (26.1) |
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College graduate or above | 149 (78.8) | 98 (81.7) | 51 (73.9) |
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.28 | |
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X<2,000,000 | 33 (17.5) | 23 (19.2) | 10 (14.5) |
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2,000,000≤X<4,000,000 | 77 (40.7) | 53 (44.2) | 24 (34.8) |
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4,000,000≤X<6,000,000 | 45 (23.8) | 24 (20.0) | 21 (30.4) |
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X≥6,000,000 | 34 (18.0) | 20 (16.7) | 14 (20.3) |
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.84 | |
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Not at all | 25 (13.2) | 17 (14.2) | 8 (11.6) |
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Some | 123 (65.1) | 78 (65.0) | 45 (65.2) |
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A lot | 41 (21.7) | 25 (20.8) | 16 (23.2) |
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.74 | |
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Less satisfied/dissatisfied | 21 (11.1) | 13 (10.8) | 8 (11.6) |
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Satisfied | 68 (36.0) | 41 (34.2) | 27 (39.1) |
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Very/completely satisfied | 100 (52.9) | 66 (55.0) | 34 (49.3) |
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.13 | |
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Yes | 51 (27.0) | 28 (23.3) | 23 (33.3) |
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No | 138 (73.0) | 92 (76.7) | 46 (66.7) |
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.10 | |
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Yes | 68 (36.0) | 38 (31.7) | 30 (43.5) |
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No | 121 (64.0) | 82 (68.3) | 39 (56.5) |
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Rosenberg Self-Esteem Scale, mean (SD) | 24.13 (4.82) | 24.17 (4.79) | 24.07 (4.92) | .88 |
aSignificance assessment of the Rao-Scott chi-square test for categorical variables and
bK-SAPS: Korean Smartphone Addiction Proneness Scale.
cKRW: Korean won (an approximate exchange rate of 2,000,000 KRW=US $1713 was applicable at the time of publication).
Generalized linear models of self-esteem concerning smartphone overuse among adults with internet gaming disorder.
Variables | Self-esteema | ||||||||
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Model 1 | Model 2 | Model 3 | Model 4 | |||||
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Bb | B | B | B | |||||
K-SAPSc | –0.18 | .001 | N/Ad | N/A | N/A | N/A | N/A | N/A | |
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Moderate | N/A | N/A | –0.13 | .87 | N/A | N/A | N/A | N/A |
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High | N/A | N/A | –3.42 | <.001 | N/A | N/A | N/A | N/A |
Social and demographic |
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Age (in years) | 0.03 | .52 | 0.03 | .48 | 0.04 | .40 | 0.04 | .48 | |
Gender (reference: men) | –0.66 | .66 | –0.51 | .47 | N/A | N/A | N/A | N/A | |
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Never been married | -6.94 | .05 | –5.78 | .11 | –6.78 | .06 | –5.76 | .11 |
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Married | -6.81 | .05 | –5.96 | .08 | –6.76 | .05 | –5.93 | .09 |
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Less than high school | –4.90 | .13 | –4.53 | .15 | –4.69 | .14 | –4.52 | .15 |
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High school graduate | –0.94 | .94 | –1.18 | .15 | –0.58 | .48 | –1.14 | .17 |
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X<2,000,000 | 1.49 | .24 | 1.97 | .12 | 1.46 | .24 | 1.99 | .12 |
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2,000,000 ≤X<4,000,000 | 1.09 | .28 | 1.49 | .14 | 1.06 | .29 | 1.56 | .13 |
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4,000,000 ≤X<6,000,000 | 2.37 | .02 | 2.87 | .01 | 2.28 | .03 | 2.90 | .01 |
Family-related |
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Not at all | –0.37 | .76 | –0.55 | .65 | –0.59 | .64 | –0.55 | .65 |
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Some | –0.45 | .61 | –0.65 | .45 | –0.47 | .60 | –0.63 | .47 |
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Less satisfied/dissatisfied | –5.21 | <.001 | –5.55 | <.001 | –5.43 | <.001 | –5.63 | <.001 |
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Satisfied | –1.47 | .06 | –1.50 | .05 | –1.58 | .04 | –1.50 | .05 |
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Perceived abuse experience | –0.93 | .27 | –1.05 | .20 | –1.04 | .21 | –1.09 | .18 |
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Experience of being bullied | –0.11 | .88 | –0.02 | .97 | –0.15 | .84 | 0.03 | .96 |
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Gender×K-SAPSg | N/A | N/A | N/A | N/A | –0.19 | .004 | N/A | N/A |
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Gender×degree of excessive smartphone use: high | N/A | N/A | N/A | N/A | N/A | N/A | –3.73 | <.001 |
aThe Korean version of the Rosenberg self-esteem scale was used for the outcome assessment.
bB is the unstandardized coefficient.
cK-SAPS: Korean Smartphone Addiction Proneness Scale.
dN/A: not applicable.
eDegree of excessive smartphone use was assessed by the K-SAPS: high (K-SAPS≥44), moderate (40≤K-SAPS≤43), and low (K-SAPS≤39).
fKRW: Korean won (an approximate exchange rate of 2,000,000 KRW=US $1713 was applicable at the time of publication).
gGrand mean centering and scaling (dividing by SD) was applied to the continuous K-SAPS variable.
To the extent of our knowledge, this study is the first, based on a Korean cohort of young and middle-aged adults with internet gaming disorder, to examine the association between excessive smartphone use and self-esteem and detect gender differences. Although several studies have investigated the relationship between problematic or excessive smartphone use and mental health [
Another finding of this study was that men were found to be more negatively influenced from excessive smartphone use concerning self-esteem than women were; notably, men with a high degree of smartphone overuse were more likely to have low self-esteem compared with women with a high degree of smartphone overuse. This finding may be explained with the circumstance that men may use their smartphones, specifically for gaming, or their gaming behavior may be carried out via their smartphone. In contrast, women may game on other internet-connected devices and use their smartphones for different functions, including social networking or information searching [
Interestingly, among adults with internet gaming disorder, those who perceived less satisfaction or dissatisfaction about their relationships with their family seemed to have lower self-esteem than those who were very/completely satisfied with their relationships with their family. Indeed, prior research identified family-related factors as predictors of self-esteem among young individuals, including family functioning and environment [
This study had some limitations. First, this study mainly examined the estimated effects of excessive smartphone use on self-esteem, and gender differences, among young and middle-aged adults with internet gaming disorder. However, evidence indicates a bidirectional relationship between addictive behaviors and psychological factors [
Despite the limitations, there were several strengths. First, this study was conducted based on unique data, including a wide range of information about smartphone usage, internet gaming disorder, self-esteem, family-related factors, adverse experiences among young and middle-aged adults in South Korea. This allowed us to adjust for various related factors in associations between excessive smartphone use and self-esteem, which resulted in meaningful results, such as family-related factors. Second, this study, is the first (of which we are aware) to examine the relationship between excessive smartphone use and self-esteem among adults with internet gaming disorder, a population that was less explored in prior research. Finally, we further investigated gender differences in the association between smartphone overuse and self-esteem in this population, about which little is known.
Although smartphones, with their advantageous features, have become an essential part of people’s daily lives, smartphone overuse could harm individual health and well-being. It is of particular concern for those more susceptible or vulnerable such as individuals with mental health disorders, including internet gaming disorder. Our finding of the negative association between excessive smartphone use and self-esteem among adults with internet gaming disorder suggests that more efforts or endeavors should be made by considering developing public health interventions or programs to reduce excessive or problematic smartphone use, particularly among those with mental health disorders such as internet gaming disorder. Furthermore, our finding of gender differences in the association between smartphone overuse and self-esteem could suggest merit in developing gender-specific interventions targeting men with internet gaming disorder.
Korean won
Korean smartphone addiction proneness scale
Many thanks to In Hye Yook for providing some resources and assistance for manuscript preparation and Dr. Hyun Cho and Dr. Ji-Won Chun for their involvement in data collection and management. This work was supported by the National Research Foundation of Korea (NRF) (grant nos. 2014M3C7A1062893 and NRF-2019R1A5A2027588).
HK was involved in conceptualization, conducted data analyses, and wrote the paper. IC and DK supervised the initial project of this study and critically reviewed the manuscript.
None declared.