Sansone_Art_Jan_2013by Randy A. Sansone, MD, and Lori A. Sansone, MD

R. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, OH, and Director of Psychiatry Education at Kettering Medical Center in Kettering, OH. L. Sansone is a civilian family medicine physician and Medical Director of the Family Health Clinic at Wright-Patterson Air Force Base Medical Center in WPAFB, OH. The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of the United States Air Force, Department of Defense, or United States Government.

Innov Clin Neurosci. 2013;10(1):33–37

Funding: There was no funding for the development and writing of this article.

Financial Disclosures: The authors have no conflicts of interest relevant to the content of this article.

Key Words: Addiction, cell phones, cyberbullying, mobile phones, sleep, stress

Abstract: Cell phones are a relatively novel and evolving technology. While the potential benefits of this technology continue to emerge, so do the potential psychosocial risks. For example, one psychosocial risk is user stress, which appears to be related to feeling compelled to promptly respond to cell-phone activity in order to maintain spontaneity and access with others. Other potential psychosocial risks include disruptions in sleep; the user’s risk of exposure to cyberbullying, particularly the unwanted exposure of photographs and/or videos of the victim; and overuse, particularly among adolescents. With regard to the latter phenomenon, the boundaries among overuse, misuse, dependence, and addiction are not scientifically clear. Therefore, while cell phones are a convenient and expedient technology, they are not without their potential psychosocial hazards.


According to a 2007 to 2008 community survey conducted by Harris Interactive, of the 9,132 adults surveyed, 89 percent of the participants reported owning a cell phone, whereas only 79 percent reported having a traditional telephone landline.[1] Among the participants with cell phones, 14 percent exclusively used a cell phone. In addition to the patent popularity of cell phones with the public, this technology is gaining popularity in the healthcare field as a medium for clinical assessment and intervention. For example, cell phone technology has been used to manage commuter stress; reduce examination anxiety; counter battlefield stress; enhance emotional self-awareness; promote socially supportive behavior; assess alcohol use, mood status, stress, and coping behaviors; monitor mood states; and coordinate the activities of surgical wards.[2–9] Cell phones have also been advocated in the healthcare environment to facilitate patient reminders about appointments, enable disease monitoring and management, and provide patient education.[10] Again, the preceding findings affirm that cell phones are quite popular with the public and have significant potential for therapeutic use in the healthcare field. However, in this edition of The Interface, we examine the potential psychosocial risks associated with this type of novel technology.

Cell phones and personal stress

According to limited data, cell phones may momentarily increase personal stress. As an empirical example, in a study of more than 100 individuals in the United Kingdom, Balding et al[11] reported that cell phone technology was associated with increased personal stress. The emergence of stress was attributed to participants getting caught up in compulsively checking for new messages, alerts, and updates. In contrast, the investigators did not find linkages between cell phone use and personal stress related to work endeavors.

In a study of 1,367 participants in upstate New York communities, Chesley[12] undertook hour-long telephone interviews that focused on the use of technology, including cell phones, and the potential boundary effects between work and home. She found that persistent communication by cell phone was associated with increased personal distress, decreased family satisfaction, and negative spillover between work and family environments.

Using a self-report questionnaire methodology, Imamura et al[13] examined cell phone use among 10,709 Japanese students in grades 7 through 9. In this 2009 study, 49.9 percent of the students possessed a cell phone and 5.5 percent reported three or more stressful incidents in the past week related to cell phone usage. The authors concluded that, “…e-mail-related stress [is] associated with poor mental health status.”

Finally, Angster et al[14] examined 128 undergraduate students in the United States regarding their cell-phone experiences. Participants indicated that a high frequency of texting with others was associated with finding those relationships less fulfilling.

The previous findings indicate that cell-phone use may do the following: 1) potentially increase personal stress levels through the need to monitor and respond to text messages and alerts; 2) blur the boundaries between work and home in a unsatisfactory manner; (3) precipitate stress in adolescents; and (4) at high levels, be associated with less emotionally satisfying relationships with others.

Cell phones and sleep disturbance

Do cell phones contribute to sleep disturbance? Van den Bulck[15] has suggested that cell phones may lead to overexcitement and interfere with or shorten sleep time. In support of this impression, a number of studies using self-report methodologies indicate that cell phone usage in adolescents may impair sleep. For example, in a Japanese study of 220 high school students, Ogata et al[16] concluded that e-mailing by cell phone was possibly associated with sleep loss at night. Kamibeppu and Sugiura[17] examined 578 Japanese eighth-grade students and found that nearly half owned a cell phone; as a group, they stayed up at night engaging in e-mail exchanges. In a Swedish study of 4,156 young adults between the ages of 20 and 24 years, Thomee et al[18] found that compared to low cell phone use, high cell phone use by participants was associated with sleep disturbances. In a study of 1,656 Belgium school children, Van den Bulck[19] reported that participants who used a cell phone more than once a week were 5.1 times more likely to be tired; overall, being tired (35% of participants) was attributable to such use, and cell-phone use after lights out increased the odds of being very tired by 2.2 (95% confidence interval=2.5–10.4).

In an Egyptian study, Salama et al[20] studied 300 individuals and found that 29.5 percent reported sleep disturbance, which correlated with longer total use per day of cell phones. In a study population of 437 Saudi adults, Al-Khlaiwi and Meo[21] reported that four percent of participants experienced sleep disturbances that were presumably related to the use of cell phones. In a Finnish study, Punamaki et al[22] found that intense cell phone usage among 7,292 adolescents was associated with negative sleep effects and increased daytime fatigue. Finally, in a Japanese study of 94,777 adolescents, Munezawa et al[23] found that calling and/or text-messaging after lights out was associated with shorter sleep duration, poorer subjective sleep quality, insomnia, and excessive daytime sleepiness. On a side note, a study by Santini et al[24] suggested that there may be gender differences in the sleep disturbances associated with cell phones, with women reporting more symptoms than men.

Note that the preceding studies all entail self-report methodologies, which have potentially inherent limitations. Are there any objective findings that cell-phone use impairs sleep in humans? While Danker-Hopfe et al[25] found no evidence that two cell-phone frequencies disturbed the macrostructure of sleep as assessed in a laboratory setting, other such studies have reported more concerning findings. For example, in a study from the United Kingdom, Hung et al[26] examined electroencephalograms (EEG) in 10 young healthy adults and reported possible cell-phone effects on sleep onset. Loughran et al[27] examined 50 Australian participants and found that cell-phone exposure prior to sleep could promote rapid eye movement sleep and modify the sleep EEG. Huber et al[28] reported that pulse-modulated electromagnetic fields, such as those from cell phones, affected regional cerebral blood flow during a waking state and caused changes in the EEG architecture during presleep (enhanced alpha frequency waves) and during Stage 2 of sleep (increased spindle frequency).

Overall, the preceding findings indicate that both subjective and objective disturbances in sleep can develop with cell phone use. As a caveat, subjective findings are limited by the lack of objective corroboration as well as the possibility of multiple confounds. Likewise, the objective data are difficult to fully interpret (i.e., abnormal findings are present, but do they fully account for meaningful sleep disturbances reported by participants?).

Cell phones and cyberbullying

While cell phones are not attributable causes of cyberbullying, they certainly function as a contemporary and expeditious means of victimizing others. According to the available literature, the prevalence of cyberbullying among adolescents who possess cell phones ranges from 5.9 to 24.6 percent.[29–31] According to two other groups, the use of pictures and/or videos of the victim is the most negative form of cyberbullying.[32,33] While less frequent than traditional bullying, students who engage in traditional bullying are oftentimes the perpetrators of cyberbullying, with few gender differences observed.[32–34]

Cell phones and dependency/addiction

Is there such a phenomenon as technological addiction? According to Takao et al,[35] problematic cell phone use can be considered addiction-like. In keeping with this proposal, Walsh et al[36] held focus groups with 32 Australians, ages 16 to 24 years, and found that some participants were extremely attached to their cell phones and reported symptoms suggestive of addictive behavior. In a Korean sample, Lee et al[37] reported that 16 percent of middle school students were “addicted” to their cell phones. In an Italian study of 1,011 students ages 9 to 18 years, Dimonte and Ricchuito[38] indicated that most participants suffered from a sort of addiction to the cell phone. In a Tunisian population, Halayem et al[39] reported that 26 percent of participants suffered from excessive cell-phone use, which they described as “addiction.”

According to Choliz,[40] addictive cell phone use may meet several criteria for dependence, including excessive use, problems with parents associated with excessive use, interference with school and other personal activities, gradual increase in use to obtain the same previous level of gratification, and the need to avoid emotional alterations when cell phone use is impeded. In a Taiwanese study, Yen et al[41] examined 10,191 adolescents and their cell phone use, and reported that 30 percent evidenced tolerance, 36 percent withdrawal, 27 percent heavier use than intended, 18 percent unsuccessful attempts to reduce use, and 10 percent functional impairment in terms of secondary poor relationships with friends or classmates.[41] From an opposing perspective, Sanchez-Carbonell et al[42] argue that the maladaptive use of cell phones is best characterized as “abuse,” but not genuine addiction, due to the lack of rapid emotional changes that would be expected during use versus nonuse.

As for the psychological characteristics of heavy cell phone users, Thomee et al[43] found that such levels of cell phone use were associated with personal dependency, demands for achievement, and persistent needs for connections with others. Ha et al[44] found that excessive users of cell phones were more depressed, exhibited more anxiety, and had lower self-esteem.

On a side note, there are several available scales for cell phone overuse. These include the Mobile Phone Problem Use Scale by Bianchi and Phillips, the Cell Phone Addiction Scale by Koo (in Korean), and the Cellular Phone Dependence Questionnaire by Toda et al (in Japanese).[45–47]

In summary, most authorities acknowledge that there is a risk of overuse of cell phones. Whether this phenomenon is misuse, dependency, or addiction remains scientifically unclear and will likely be open to debate over the years to come.


Cell phones offer historically unique opportunities for maintaining unrestricted and spontaneous contact with others. However, like any other phenomenon, there appear to be some potential psychosocial risks with cell phones. These risks include the personal stress of responding to and maintaining unrestricted and immediate contact with others; possible sleep disturbances related to the anticipation of use after lights out, feeling keyed up after cell-phone conversations, and/or biologically mediated changes in sleep structure related to the electromagnetic fields generated by cell phones; the facilitation of cyberbullying; and overuse/misuse. Understanding the potential psychosocial benefits and limitations of this novel technology and their relationships to overall physical and mental health is important in both psychiatric and primary care settings.


1. Harris Interactive. Cell phone usage continues to increase. Located at: vault/Harris-Interactive-Poll-Research-Cell-Phone-Usage-Continues-to-Increase-2008-04.pdf. Accessed on 1/23/12.

2. Grassi A, Gaggioli A, Riva G. The green valley: the use of mobile narratives for reducing stress in commuters. Cyberpsychol Behav. 2009;12:155–161.

3. Grassi A, Gaggioli A, Riva G. New technologies to manage exam anxiety. Stud Health Technol Inform. 2011;167:57–62.

4. Riva G, Grassi A, Villani D, Preziosa A. Cellular phones for reducing battlefield stress: rationale and a preliminary research. Stud Health Technol Inform. 2007;125:400–405.

5. Morris ME, Kathawala Q, Leen TK, et al. Mobile therapy: case study evaluations of a cell phone application for emotional self-awareness. J Med Internet Res. 2010;12:e10.

6. Gay G, Pollak J, Adams P, Leonard JP. Pilot study of Aurora, a social, mobile-phone-based emotion sharing and recording system. J Diabetes Sci Technol. 2011;5:325–332.

7. Kauer SE, Reid SC, Sanci L, Patton GC. Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: lessons and recommendations. Drug Alcohol Rev. 2009;28:25–30.

8. Reid DC, Kauer SD, Dudgeon P, et al. A mobile phone program to track young people’s experiences of mood, stress and coping. Development and testing of the mobiletype program. Soc Psychiatry Psychiatr Epidemiol. 2009;44:501–507.

9. Hansen TR, Bardram JE. Applying mobile and pervasive computer technology to enhance coordination of work in a surgical ward. Stud Health Technol Inform. 2007;129:107–111.

10. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15:231–240.

11. Psypost. People with smart phones fall victim to social networking stress. Accessed on January 24, 2012.

12. Chesley N. Blurring boundaries? Linking technology use, spillover, individual distress, and family satisfaction. J Marriage Fam. 2005;67:1237–1248.

13. Imamura A, Nishida A, Nakazawa N, et al. Effects of cellular phone email use on the mental health of junior high school students in Japan. Psychiatry Clin Neurosci. 2009;63:701–703.

14. Angster A, Frank M, Lester D. An exploratory study of students’ use of cell phones, texting, and social networking sites. Psychol Rep. 2010;107:402–404.

15. Van den Bulck J. The effects of media on sleep. Adolesc Med State Art Rev. 2010;21:418–429.

16. Ogata Y, Izumi Y, Kitaike T. Mobile-phone e-mail use, social networks, and loneliness among Japanese high school students. Nihon Koshu Eisei Zasshi. 2006;53:480–492.

17. Kamibeppu K, Sugiura H. Impact of the mobile phone on junior high-school students’ friendships in the Tokyo metropolitan area. Cyberpsychol Behav. 2005;8:121–130.

18. Thomee S, Harenstam A, Hagberg M. Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults—a prospective cohort study. BMC Public Health. 2011;11:66.

19. Van den Bulck J. Adolescent use of mobile phones for calling and for sending text messages after lights out: results from a prospective cohort study with a one-year follow-up. Sleep. 2007;30:1220–1223.

20. Salama OE, Abou El Naga RM. Cellular phones: are they detrimental? J Egypt Public Health Assoc. 2004;79:197–223.

21. Al-Khlaiwi T, Meo SA. Association of mobile phone radiation with fatigue, headache, dizziness, tension and sleep disturbance in Saudi population. Saudi Med J. 2004;25:732–736.

22. Punamaki RL, Wallenius M, Nygard CH, et al. Use of information and communication technology (ICT) and perceived health in adolescence: the role of sleeping habits and waking-time tiredness. J Adolesc. 2007;30:569–585.

23. Munezawa T, Kaneita Y, Osaki Y, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep. 2011;34:1013–1020.

24. Santini R, Seigne M, Bonhomme-Faivre L, et al. Symptoms reported by mobile cellular telephone users. Pathol Biol (Paris). 2001;49:222–226.

25. Danker-Hopfe H, Dorn H, Bahr A, et al. Effects of electromagnetic fields emitted by mobile phones (GSM 900 and WCDMA/UMTS) on the macrostructure of sleep. J Sleep Res. 2011;20:73–81.

26. Hung CS, Anderson C, Horne JA, McEvoy P. Mobile phone “talk-mode” signal delays EEG-determined sleep onset. Neurosci Lett. 2007;421:82–86.

27. Loughran SP, Wood AW, Barton JM, et al. The effect of electromagnetic fields emitted by mobile phones on human sleep. Neuroreport. 2005;16:1973–1976.

28. Huber R, Treyer V, Borbely AA, et al. Electromagnetic fields, such as those from mobile phones, alter regional cerebral blood flow and sleep and waking EEG. J Sleep Res. 2002;11:289–295.

29. Aricak T, Siyahhan S, Uzunhasanoglu A, et al. Cyberbullying among Turkish adolescents. Cyberpsychol Behav. 2008;11:253–261.

30. Wang J, Iannotti RJ, Luk JW, Nansel TR. Co-occurrence of victimization from five subtypes of bullying: physical, verbal, social exclusion, spreading rumors, and cyber. J Pediatr Psychol. 2010;35:1103–1112.

31. Buelga S, Cava MJ, Musitu G. Cyberbullying: adolescent victimization through mobile phone and internet. Psicothema. 2010;22:784–789.

32. Smith PK, Mahdavi J, Carvalho M, et al. Cyberbullying: its nature and impact in secondary school pupils. J Child Psychol Psychiatry. 2008;49:376–385.

33. Slonje R, Smith PK. Cyberbullying: another main type of bullying? Scand J Psychol. 2008;49:147–154.

34. Raskauskas J, Stoltz AD. Involvement in traditional and electronic bullying among adolescents. Dev Psychol. 2007;43:564–575.

35. Takao M, Takahashi S, Kitamura M. Addictive personality and problematic mobile phone use. Cyberpsychol Behav. 2009;12:501–517.

36. Walsh SP, White KM, Young RM. Over-connected? A qualitative exploration of the relationship between Australian youth and their mobile phones. J Adolesc. 2008;31:77–92.

37. Lee H, Kim MS, Son HK, et al. Discriminating power of socio-demographic and psychological variables on addictive use of cellular phones among middle school students. Taehan Kanho Hakhoe Chi. 2007;37:957–965.

38. Dimonte M, Ricchiuto G. Mobile phone and young people. A survey pilot study to explore the controversial aspects of a new social phenomenon. Minerva Pediatr. 2006;58:357–363.

39. Halayem S, Nouira O, Bourgou S, et al. The mobile: a new addiction upon adolescents. Tunis Med. 2010;88:593–596.

40. Choliz M. Mobile phone addiction: a point of issue. Addiction. 2010;105:373–374.

41. Yen CF, Tang TC, Yen JY, et al. Symptoms of problematic cellular phone use, functional impairment and its association with depression among adolescents in Southern Taiwan. J Adolesc. 2009;32:863–873.

42. Sanchez-Carbonell X, Beranuy M, Castellana M, et al. Internet and cell phone addiction: passing fad or disorder? Adicciones. 2008;20:149–159.

43. Thomee S, Dellve L, Harenstam A, Hagberg M. Perceived connections between information and communication technology use and mental symptoms among young adults—a qualitative study. BMC Public Health. 2010;10:66.

44. Ha JH, Chin B, Park DH, et al. Characteristics of excessive cellular phone use in Korean adolescents. Cyberpsychol Behav. 2008;11:783–784.

45. Bianchi A, Phillips JG. Psychological predictors of problem mobile phone use. Cyberpsychol Behav. 2005;8:39–51.

46. Koo HY. Development of a cell phone addiction scale for Korean adolescents. J Korean Acad Nurs. 2009;39:818–828.

47. Toda M, Monden K, Kubo K, Morimoto K. Cellular phone dependence tendency of female university students. Nihon Eiseigaku Zasshi. 2004;59:383–386.