Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender

  • Eun Jung Bae
    College of Nursing, Seoul National University, Seoul, Republic of Korea
    Search for articles by this author
  • Da Eun Kim
    College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
    Search for articles by this author
  • Hae Sagong
    Auburn University School of Nursing, Auburn, AL, USA
    Search for articles by this author
  • Ju Young Yoon
    Corresponding author at: Seoul National University, College of Nursing, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
    College of Nursing, Seoul National University, Seoul, Republic of Korea

    Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea

    Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Republic of Korea
    Search for articles by this author
Published:April 23, 2022DOI:


      • Depressive symptoms were a mediator between problematic smartphone use (PSU) and FSS.
      • Peer relationships (PR) were a mediator between PSU and FSS only for males.
      • Depressive symptoms and PR were serial mediators between PSU use and FSS only for males.


      This study explored the relationship between problematic smartphone use and depressive symptoms, peer relationships, and functional somatic symptoms with a representative sample of Korean male and female adolescents using serial multiple mediation models. The results identified the mediating effect of depressive symptoms and peer relationships for males in the association between problematic smartphone use and FSS. The serial mediating effect of the two mediators was also verified in the model for males. However, in the model for females, only depressive symptoms mediated the relationship between problematic smartphone use and FSS. The findings suggest that parents and professionals should assess adolescents with problematic smartphone use for the risk of FSS when depressive symptoms develop. Schools should also provide programs to build positive peer relationships to reduce FSS.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Almquist Y.B.
        • Modin B.
        • Augustine L.
        Peer acceptance in the school class and subjective health complaints: A multilevel approach.
        Journal of School Health. 2013; 83: 690-696
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders: DSM-5.
        5th ed. American Psychiatric Publishing, Washington, D.C2013
        • Bae S.M.
        • Hong J.Y.
        • Hyun M.H.
        A validation study of the peer relationship quality scale for adolescents.
        Korean Journal of Youth Studies. 2015; 22: 325-344
        • Baek H.W.
        • Shin Y.M.
        • Shin K.M.
        Emotional and behavioral problems related to smartphone overuse in elementary school children.
        Journal of Korean Neuropsychiatric Association. 2014; 53: 320-326
        • Berchtold A.
        • Surís J.C.
        • Meyer T.
        • Taushanov Z.
        Development of somatic complaints among adolescents and young adults in Switzerland.
        Swiss Journal of Sociology. 2018; 44: 239-258
        • Bierman K.L.
        • Powers C.J.
        Social skills training to improve peer relations.
        in: Rubin K.H. Bukowski W.M. Laursen B. Handbook of peer interactions, relationships, and groups. The Guilford Press, 2009: 603-621
        • Brown B.B.
        • Larson J.
        Peer relationships in adolescence.
        in: Lerner R.M. Steinberg L. Handbook of adolescent psychology: Contextual influences on adolescent development. John Wiley & Sons Inc, 2009: 74-103
        • Campo J.V.
        Annual research review: Functional somatic symptoms and associated anxiety and depression - developmental psychopathology in pediatric practice: Functional somatic symptoms, anxiety, and depression.
        Journal of Child Psychology and Psychiatry. 2012; 53: 575-592
        • Cha S.S.
        • Seo B.K.
        Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use.
        Health Psychology Open. 2018; 5
        • Chae S.H.
        • Kim J.S.
        A meta-analysis on the correlation between attachment to parents, teachers, peers, and school adjustment.
        Korean Journal of Counseling. 2015; 16: 339-358
        • Cho B.H.
        • Lim K.H.
        Development and validation of emotional or behavioral problems scale.
        The Korean Journal of Counseling Psychotherapy. 2003; 15: 729-746
        • Choi E.S.
        • Kim W.
        The mediating effect of emotional stability in the relationship between smartphone addiction and interpersonal satisfaction of middle school students.
        Korea Youth Research Association. 2017; 24: 259-279
        • Chun J.
        Conceptualizing effective interventions for smartphone addiction among korean female adolescents.
        Children and Youth Services Review. 2018; 84: 35-39
        • Council on Communications and Media
        Media use in school-aged children and adolescents.
        Pediatrics. 2016; 138e20162592
        • Coyne S.M.
        • Stockdale L.
        • Summers K.
        Problematic cell phone use, depression, anxiety, and self-regulation: Evidence from a three year longitudinal study from adolescence to emerging adulthood.
        Computers in Human Behavior. 2019; 96: 78-84
        • De-Sola Gutiérrez J.
        • Rodríguez de Fonseca F.
        • Rubio G.
        Cell-phone addiction: A review.
        Frontiers in Psychiatry. 2016; 7: 175
        • Edwards T.M.
        • Wiersma M.
        • Cisneros A.
        • Huth A.
        Children and adolescents with medically unexplained symptoms: A systematic review of the literature.
        The American Journal of Family Therapy. 2019; 47: 183-197
        • Eikelboom E.M.
        • Tak L.M.
        • Roest A.M.
        • Rosmalen J.G.M.
        A systematic review and meta-analysis of the percentage of revised diagnoses in functional somatic symptoms.
        Journal of Psychosomatic Research. 2016; 88: 60-67
        • Elhai J.D.
        • Dvorak R.D.
        • Levine J.C.
        • Hall B.J.
        Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology.
        Journal of Affective Disorders. 2017; 207: 251-259
        • Fırat S.
        • Gül H.
        • Sertçelik M.
        • Gül A.
        • Gürel Y.
        • Kılıç B.G.
        The relationship between problematic smartphone use and psychiatric symptoms among adolescents who applied to psychiatry clinics.
        Psychiatry Research. 2018; 270: 97-103
        • Ha H.S.
        • Lee J.W.
        • Jung E.J.
        • Kim S.E.
        • Han J.Y.
        • Gu B.H.
        The Korea child youth panel survey IX (research report no. 18-R13).
        (Retrieved from National Youth Policy Institute website:)
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.
        The Guilford Press, New York2013
        • Hoare E.
        • Skouteris H.
        • Fuller-Tyszkiewicz M.
        • Millar L.
        • Allender S.
        Associations between obesogenic risk factors and depression among adolescents: A systematic review.
        Obesity Reviews. 2014; 15: 40-51
        • Hoftun G.B.
        • Romundstad P.R.
        • Zwart J.A.
        • Rygg M.
        Chronic idiopathic pain in adolescence – high prevalence and disability: The young HUNT study 2008.
        Pain. 2011; 152: 2259-2266
        • Horst S.
        • Shelby G.
        • Anderson J.
        • Acra S.
        • Polk D.B.
        • Saville B.R.
        • Garber J.
        • Walker L.S.
        Predicting persistence of functional abdominal pain from childhood into young adulthood.
        Clinical Gastroenterology and Hepatology. 2014; 12: 2026-2032
        • Horwood S.
        • Anglim J.
        Personality and problematic smartphone use: A facet-level analysis using the five factor model and HEXACO frameworks.
        Computers in Human Behavior. 2018; 85: 349-359
        • Ihm J.
        Social implications of children’s smartphone addiction: The role of support networks and social engagement.
        Journal of Behavioral Addictions. 2018; 7: 473-481
        • Janssens K.A.
        • Klis S.
        • Kingma E.M.
        • Oldehinkel A.J.
        • Rosmalen J.G.
        Predictors for persistence of functional somatic symptoms in adolescents.
        The Journal of Pediatrics. 2014; 164: 900-905
        • Janssens K.A.
        • Rosmalen J.G.
        • Ormel J.
        • van Oort F.V.
        • Oldehinkel A.J.
        Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: The TRAILS study.
        Journal of Child Psychology and Psychiatry. 2010; 51: 304-312
        • Jaycox L.H.
        • Stein B.D.
        • Paddock S.
        • Miles J.N.
        • Chandra A.
        • Meredith L.S.
        • Tanielian T.
        • Hickey S.
        • Burnam M.A.
        Impact of teen depression on academic, social, and physical functioning.
        Pediatrics. 2009; 124 (e596-605)
        • Kenney E.L.
        • Gortmaker S.L.
        United States Adolescents' Television, computer, videogame, smartphone, and tablet use: Associations with sugary drinks, sleep, physical activity, and obesity.
        The Journal of Pediatrics. 2017; 182: 144-149
        • Kim B.N.
        Effect of smartphone addiction on youths sociality development.
        The Journal of the Korea Contents Association. 2013; 13: 208-217
        • Kim D.I.
        • Chung Y.J.
        • Lee J.Y.
        • Kim M.C.
        • Lee Y.H.
        • Kang E.B.
        • Keum C.M.
        • Nam J.
        Development of smartphone addiction proneness scale for adults: Self-report.
        The Korean Journal of Counseling. 2012; 13: 629-644
        • Kim K.I.
        • Kim J.H.
        • Won H.T.
        Korean manual of symptom checklist-90-revision. Jung Ang Juk Sung Publisher, Seoul1984: 8-10
        • Kim Y.
        • Lee N.
        • Lim Y.
        Gender differences in the association of smartphone addiction with food group consumption among korean adolescents.
        Public Health. 2017; 145: 132-135
        • Kim Y.H.
        Analysis of mobile phone ownership and usage behavior of children and adolescents.
        KISDI STAT Report. 2018; 18: 1-7
        • Kochel K.P.
        • Ladd G.W.
        • Rudolph K.D.
        Longitudinal associations among youth depressive symptoms, peer victimization, and low peer acceptance: An interpersonal process perspective.
        Child Development. 2012; 83: 637-650
        • Lapierre M.A.
        • Zhao P.
        • Custer B.E.
        Short-term longitudinal relationships between smartphone use/dependency and psychological well-being among late adolescents.
        Journal of Adolescent Health. 2019; 65: 607-612
        • Lee S.Y.
        • Lee D.
        • Nam C.R.
        • Kim D.Y.
        • Park S.
        • Kwon J.G.
        • Kweon Y.S.
        • Lee Y.
        • Kim D.J.
        • Choi J.S.
        Distinct patterns of internet and smartphone-related problems among adolescents by gender: Latent class analysis.
        Journal of Behavioral Addictions. 2018; 7: 454-465
        • Lim S.A.
        Longitudinal effect of social withdrawal on negative peer relations mediated by smartphone dependence among Korean early adolescents.
        International Journal of Mental Health and Addiction. 2022; 1–15
        • Mahapatra S.
        Smartphone addiction and associated consequences: Role of loneliness and self-regulation.
        Behaviour & Information Technology. 2019; 38: 833-844
        • Ministry of Science and ICT
        • National Information Society Agency
        The survey on smartphone overdependence.
        Korean Ministry of Science and ICT, Sejong, Korea2019
        • Nummi T.
        • Virtanen P.
        • Leino-Arjas P.
        • Hammarström A.
        Trajectories of a set of ten functional somatic symptoms from adolescence to middle age.
        Archives of Public Health. 2017; 75: 11
        • OECD
        Self-rated health.
        in: Health at a glance 2019: OECD indicators. OECD Publishing, Paris2019
        • Panova T.
        • Carbonell X.
        Is smartphone addiction really an addiction?.
        Journal of Behavioral Addictions. 2018; 7: 252-259
        • Park Y.J.
        • Im Y.J.
        Influence of perceived attachment security and social support on somatic symptoms in late school-aged children using a school health clinic.
        Child Health Nursing Research. 2016; 22: 370-378
        • Roh H.S.
        • Shin J.U.
        • Lee J.W.
        • Lee Y.W.
        • Kim T.W.
        • Kim J.Y.
        • Park M.R.
        • Song G.S.
        • Seo S.S.
        Effect of school-based social skills training program on peer relationships: Preliminary study.
        Journal of the Korean Academy of Child and Adolescent Psychiatry. 2018; 29: 14-25
        • Seo D.G.
        • Park Y.
        • Kim M.K.
        • Park J.
        Mobile phone dependency and its impacts on adolescents’ social and academic behaviors.
        Computers in Human Behavior. 2016; 63: 282-292
        • Shannon R.A.
        • Bergren M.D.
        • Matthews A.
        Frequent visitors: Somatization in school-age children and implications for school nurses.
        The Journal of School Nursing. 2010; 26: 169-182
        • Sohn S.
        • Rees P.
        • Wildridge B.
        • Kalk N.J.
        • Carter B.
        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. 2019; 19: 356
        • Song J.W.
        • Lee J.L.
        The effects of early adolescents smart phone addiction on peer attachment: The mediating effects of ego-identity according to gender.
        The Korean Home Management Association. 2018; 36: 45-57
        • Statistic Korea
        • Ministry of Gender Equality and family
        2020 statistics on the youth.
        (Retrieved from)
        • Taylor K.
        • Silver L.
        Smartphone ownership is growing rapidly around the world, but not always equally.
        Pew Research Center. 2019; 5
        • Vaiciunas T.
        • Smigelskas K.
        The role of school-related well-being for adolescent subjective health complaints.
        International Journal of Environmental Research and Public Health. 2019; 16: 1577
        • Van Dale K.G.
        • Somers C.L.
        • Gregg D.H.
        • Yoon J.S.
        • Hillman S.B.
        • Bartoi M.G.
        The roles of teasing and social support in adolescent internalizing and externalizing behavioral outcomes.
        The Official Journal of the International Society for Child Indicators. 2014; 7: 537-552
        • van Geelen S.M.
        • Hagquist C.
        Are the time trends in adolescent psychosomatic problems related to functional impairment in daily life? A 23-year study among 20, 000 15–16-year-olds in Sweden.
        Journal of Psychosomatic Research. 2016; 87: 50
        • Yang J.
        • Fu X.
        • Liao X.
        • Li Y.
        Association of problematic smartphone use with poor sleep quality, depression, and anxiety: A systematic review and meta-analysis.
        Psychiatry Research. 2020; 284112686
        • Yu M.O.
        • Ju S.J.
        • Kim J.H.
        A study on smartphone addiction, mental health, and impulsiveness for high school students at Korea.
        Journal of Digital Convergence. 2014; 12: 409-418