Relationship between smartphone use time, neck disability, headache intensity, and anxiety in university students.
DOI:
https://doi.org/10.64478/44wrxc92Keywords:
Comprehensive health care, Cervical Pain, Problematic Smartphone Use, Headache Intensity, Generalized Anxiety, University StudentsAbstract
Introduction: Neck pain (NP) is one of the leading causes of disability worldwide and shows a high prevalence among young adults. In parallel, smartphone use has increased steadily, and prolonged exposure has been associated with musculoskeletal and psychological symptoms. Although NP has traditionally been attributed to sustained cervical flexion during smartphone use (text neck), recent evidence supports a multifactorial model in which biomechanical, behavioral, and psychosocial factors, such as anxiety, play a relevant role. In Argentina, evidence examining these variables jointly in university populations remains scarce. Objective: To investigate the association between smartphone use time and neck disability, headache pain intensity, and anxiety levels in university students. Methods: A cross-sectional study was conducted in a convenience sample of university students. Data were collected through an anonymous online survey including sociodemographic information, smartphone use time, and musculoskeletal symptoms. Neck disability was assessed using the Neck Disability Index (NDI), headache pain intensity using the Numeric Pain Rating Scale (NPRS), and anxiety symptoms using the Generalized Anxiety Disorder scale (GAD-7). Spearman correlation coefficients and Kruskal–Wallis tests with post-hoc comparisons were applied. Statistical significance was set at p < 0.05. Results: The sample comprised 1,178 university students (61.2% men and 38.8% women), with a mean age of 25.9 ± 7.9 years. Overall, 81.6% of participants reported at least one musculoskeletal symptom associated with smartphone use, with neck pain (63.5%) and headache (52.4%) being the most prevalent. Smartphone use time showed positive correlations with neck disability (ρ = 0.279; p < 0.001), headache pain intensity (ρ = 0.062; p = 0.035), and anxiety symptoms (ρ = 0.153; p < 0.001). Significant differences were observed across smartphone use levels in neck disability (H = 97.11; p < 0.001; ε² = 0.08) and anxiety (H = 27.58; p < 0.001; ε² = 0.02), with a progressive increase as exposure time increased. No significant differences were found in headache pain intensity across usage groups (H = 6.35; p = 0.096; ε² = 0.003). Conclusion: In university students, longer smartphone use was associated with greater cervical disability and higher anxiety levels, supporting the need to address the musculoskeletal impact of smartphone use from a multifactorial perspective.
References
Andrade Ortega J. A.; Delgado Martínez A. D. y Almécija Ruiz, S. (2008). Validación de una versión española del Índice de Discapacidad Cervical. Medicina Clínica, 130(2), 85-89. DOI: 10.1157/13115352
Correia, I. M. T.; Ferreira, A. S.; Gomes, J. F. M.; Reis, F. J. J.; Nogueira, L. A. C. y Meziat-Filho, N. (2025). Cervical flexion posture during smartphone use was not a risk factor for neck pain, but low sleep quality and insufficient levels of physical activity were. A longitudinal investigation. Brazilian Journal of Physical Therapy, 29(6), 101258. https://doi.org/10.1016/j.bjpt.2025.101258
Correia, I. M. T.; Sá Ferreira, A.; Fernandez, J.; Reis, F. J. J.; Nogueira, L. A. C. y Meziat-Filho, N. (2021). Association between text neck and neck pain in adults. Spine, 46(5), 571-578. https://doi.org/10.1097/BRS.0000000000003854
Elhai, J. D.; Levine, J. C.; Dvorak, R. D. y Hall, B. J. (2016). Fear of missing out, need for touch, anxiety and depression are related to problematic smartphone use. Computers in Human Behavior, 63, 509-516. https://doi.org/10.1016/j.chb.2016.05.079
García-Campayo, J.; Zamorano, E.; Ruiz, M. A.; Pardo, A.; Pérez-Páramo, M.; López-Gómez, V.; Freire, O. y Rejas, J. (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8, 8. https://doi.org/10.1186/1477-7525-8-8
Grasser, T.; Borges Dario, A.; Carmo Silva Parreira, P.; Macedo Tavares Correia, I. y Meziat-Filho, N. (2023). Defining text neck: A scoping review. European Spine Journal, 32, 3463-3484. https://doi.org/10.1007/s00586-023-07821-2
Kazeminasab, S., Nejadghaderi, S. A.; Amiri, P.; Pourfathi, H.; Araj-Khodaei, M.; Sullman, M. J. M.; Kolahi, A. A. y Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskeletal Disorders, 23(1), 26. https://doi.org/10.1186/s12891-021-04957-4
Mashabi, A.; Ragab, W.; Alrayes, G.; Amoudi, J.; Tokhta, S.; Bashawri, G.; Alqaznili, R.; Ghaith, J.; Almadani, L.; Aljohani, M. M. A. y Al-Shenqiti, A. (2025). Prevalence of Text Neck Between Different Female Students at Taibah University, Saudi Arabia; Cross Section Design. Healthcare, 13(6), 651. https://doi.org/10.3390/healthcare1306065
Nawaz, S.; Bhowmik, J.; Linden, T. y Mitchell, M. (2024). Validation of a modified problematic use of mobile phones scale to examine problematic smartphone use and dependence. Heliyon, 10(2), e24832. https://doi.org/10.1016/j.heliyon.2024.e24832
Przybylski, A. K.; Murayama, K.; DeHaan, C. R. y Gladwell, V. (2013). Motivational, emotional, and behavioral correlates of fear of missing out. Computers in Human Behavior, 29(4), 1841-1848. https://doi.org/10.1016/j.chb.2013.02.014
Sohn, S. Y.; Rees, P.; Wildridge, B.; Kalk, N. J. y Carter, B. (2021). Correction to: Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry, 21(1), 52. https://doi.org/10.1186/s12888-020-02986-2
Cerutti R.; Presaghi, F.; Spensieri, V.; Valastro, C. y Guidetti, V. (2016). The Potential Impact of Internet and Mobile Use on Headache and Other Somatic Symptoms in Adolescence. A Population-Based Cross-Sectional Study. Headache, 56(7), 1161-70. DOI: 10.1111/head.12840
Vicente-Herrero, M. T.; Delgado-Bueno, S.; Bandrés-Moyá, F.; Ramírez Iñiguez de la Torre, M. V. y Capdevila-García, L. (2018). Valoración del dolor: Revisión comparativa de escalas y cuestionarios. Revista de la Sociedad Española del Dolor, 25(4), 228-236. https://doi.org/10.20986/resed.2018.3630/2018
Vos, T.; Flaxman, A. D.; Naghavi, M.; Lozano, R.; Michaud, C.; Ezzati, M.; Shibuya, K.; Salomon, J. A.; Abdalla, S.; Aboyans, V.; Abraham, J.; Ackerman, I.; Aggarwal, R.; Ahn, S. Y.; Ali, M. K.; Alvarado, M.; Anderson, H. R.; Anderson, L. M.; Andrews, K. G.; Murray, C. J. L. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2163-2196. https://doi.org/10.1016/S0140-6736(12)61729-2
Wang, J.; Su, H.; Xie, W. y Yu, S. (2017). Mobile Phone Use and The Risk of Headache: A Systematic Review and Meta-analysis of Cross-sectional Studies. Scientific Reports, 7(1), 12595. https://doi.org/10.1038/s41598-017-12802-9
Yang, H.; Liu, B. y Fang, J. (2021). Stress and Problematic Smartphone Use Severity: Smartphone Use Frequency and Fear of Missing Out as Mediators. Frontiers in Psychiatry, 12, 659288. https://doi.org/10.3389/fpsyt.2021.659288
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