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ANALYSIS OF THE ASSOCIATION
BETWEEN NOMOPHOBIA AND ANXIETY IN
EIGHTH SEMESTER MEDICAL STUDENTS
OF THE UNIVERSIDAD REGIONAL DEL
SURESTE
ANÁLISIS DE LA ASOCIACIÓN ENTRE NOMOFOBIA Y
ANSIEDAD EN ESTUDIANTES DE OCTAVO SEMESTRE DE
MEDICINA DE LA UNIVERSIDAD REGIONAL DEL
SURESTE
Iván Antonio García Montalvo
Facultad de Medicina y Cirugía, URSE, Oaxaca, México
pág. 2826
DOI: https://doi.org/10.37811/cl_rcm.v9i4.18916
Analysis of the Association between Nomophobia and Anxiety in Eighth
Semester Medical Students of the Universidad Regional del Sureste
ABSTRACT
The technological transformation of recent decades has radically changed how people access and
process information, especially by integrating smartphones into everyday life. This phenomenon has
brought with it both benefits and challenges, among which the emergence of nomophobia, as well as
associated anxiety symptoms, stand out. The study was conducted with eighth semester medical students
at the Universidad Regional del Sureste. The target population included all the students of that academic
cycle, applying inclusion and exclusion criteria to guarantee its homogeneity. Two validated instruments
were used for data collection: the Nomophobia Questionnaire (NMP-Q) and the Generalized Anxiety
Disorder Scale (GAD-7). Data processing was carried out by descriptive and correlational statistical
analysis, respecting the ethical principles of confidentiality. The results showed that 94.4% of the
students evaluated presented some degree of nomophobia, manifesting behaviors such as compulsive
telephone checking. It was identified that 66.5% of the participants reported clinically significant levels
of anxiety. Statistical analysis showed a positive and significant relationship between levels of
nomophobia and anxiety. There is a high prevalence of nomophobia and anxiety in medical students; it
should be considered necessary to implement strategies for the prevention and management of excessive
use of mobile devices, as well as to strengthen psychoemotional support in medical training.
Keywords: anxiety, nomophobia, medical students, smartphones
1
Autor principal
Correspondencia:
Iván Antonio García Montalvo1
c.invest.medicina@urse.edu.mx
https://orcid.org/0000-0003-4993-9249
Facultad de Medicina y Cirugía, URSE, Oaxaca
México
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Análisis de la Asociación entre Nomofobia y Ansiedad en Estudiantes de
Octavo Semestre de Medicina de la Universidad Regional del Sureste
RESUMEN
La transformación tecnológica de las últimas décadas ha cambiado radicalmente la manera en que las
personas acceden y procesan información, especialmente con la integración de los teléfonos inteligentes
en la vida cotidiana. Este fenómeno ha traído consigo tanto beneficios como retos, entre los cuales
destaca la aparición de la nomofobia así como de síntomas de ansiedad asociados. El estudio se realizó
con estudiantes de octavo semestre de medicina de la Universidad Regional del Sureste. La población
objetivo incluyó a todos los estudiantes de ese ciclo académico, aplicando criterios de inclusión y
exclusión para garantizar la homogeneidad de la misma. Para la recolección de datos se utilizaron dos
instrumentos validados: el Cuestionario de Nomofobia (NMP-Q) y la Escala para el Trastorno de
Ansiedad Generalizada (GAD-7). El procesamiento de los datos se llevó a cabo mediante análisis
estadístico descriptivo y correlacional, respetando los principios éticos de confidencialidad. Los
resultados mostraron que el 94.4% de los estudiantes evaluados presentaron algún grado de nomofobia,
manifestando conductas como la verificación compulsiva del teléfono. Se identificó que el 66.5% de los
participantes reportaron niveles clínicamente significativos de ansiedad. El análisis estadístico evidenció
una relación positiva y significativa entre los niveles de nomofobia y ansiedad. Existe una alta
prevalencia de nomofobia y ansiedad en estudiantes de medicina, se debe de considerar necesaria la
implementación de estrategias de prevención y manejo del uso excesivo de dispositivos móviles, así
como de fortalecer el apoyo psicoemocional en la formación médica.
Palabras clave: ansiedad, nomofobia, estudiantes de medicina, teléfonos inteligentes
Artículo recibido 05 julio 2025
Aceptado para publicación: 09 agosto 2025
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INTRODUCTION
The word addiction is often associated with harmful substances such as alcohol or drugs, but its scope
is broader. Anyone can become addicted to objects or activities that meet specific characteristics if they
have conditions that make them vulnerable. One of the most important is the lack of self-control, which
can transform initially harmless behaviors into addictive habits. Thus, addiction involves not only
chemical dependence but also behavioral dependence, reflecting a complexity that goes beyond what is
commonly understood (Köpetz et al., 2013). The popularity of smartphones has grown enormously,
raising concerns about their addictive potential. Although psychology initially focused addiction on non-
substance gambling, excessive smartphone use has been the subject of increasing study (Wacks &
Weinstein, 2021). However, addiction to these devices is not officially recognized in manuals such as
the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) or the International Classification
of Diseases (ICD-11) (Paschke et al., 2021). Recent research shows that compulsive phone use can cause
symptoms similar to other addictions, such as anxiety, irritability, and concentration problems, as well
as being linked to mental disorders such as depression and stress (Ratan et al., 2021; Hartogsohn et al.,
2023).
The dependence on and attraction to cell phones has given rise to several phases and terms that describe
different aspects of addiction. Prominent among these are conditions such as nomophobia, textibility,
ringxiety, textaphrenia, the “phantom ringing/vibration syndrome”, and commufaking. These terms
reflect problematic states that arise from excessive and compulsive use of mobile devices and the
adverse social outcomes that can result from this behavior (Lee et al., 2018). Nomophobia, in particular,
focuses on smartphone dependence but with a specific focus on the constant availability of
communication. This involves access to tools and applications that provide information and, above all,
communication. Nomophobia offers a unique perspective on smartphone use, which is of particular
interest from a coping perspective. While other terms focus on the adverse effects of excessive use,
nomophobia highlights the importance of constant availability and the impact this has on human
behavior (Rodríguez-García et al., 2020; Garcia-Portocarrero et al., 2025).
Some of these terms, such as ringing/phantom vibration syndrome, reflect the intensity of the
psychological dependence that can develop. Others, such as textaphrenia, describe anxiety or fear of not
pág. 2829
receiving messages or calls. Taken together, these terms illustrate the complexity of cell phone addiction
and the need to approach it from multiple perspectives to better understand its causes and consequences
(Mangot et al., 2018). Cell phone addiction manifests itself in various forms: impulsive use, use as an
escape or to avoid direct interaction, and dependence marked by long periods of use (De-Sola Gutiérrez
et al., 2016). Those affected tend always to have chargers and experience anxiety about losing access to
the device (Bhattacharya et al., 2019). The phenomenon of “ringxiety” (compulsion to check
notifications), keeping the phone on day and night, and sleeping near it is observed. Direct social
interaction decreases, which increases isolation, anxiety, and stress. Financial problems may also arise
due to excessive spending on cell phone use (Subba et al., 2013).
Nomophobia and anxiety represent two emerging psychosocial phenomena that have gained prominence
in the last decade, particularly in high-demanding academic settings such as medical schools. Global
studies, such as those conducted in Saudi Arabia (Alkalash et al., 2023) and India (Sharma et al., 2019),
reveal that between 85% and 99% of medical students present some degree of nomophobia, with up to
40% at severe levels. In parallel, anxiety affects 82.19% of this population (Bano et al., 2021),
configuring a scenario where both conditions coexist and feedback on each other. This bidirectional
cycle is aggravated in medical contexts, where the need to consult clinical protocols, communicate with
multidisciplinary teams, and access digital educational platforms normalizes the constant use of the
device, increasing dependence.
Nomophobia not only affects mental health but also compromises essential clinical competencies.
Students with severe nomophobia report a 30% decrease in concentration during hospital internships16
and a greater propensity for error in diagnostic simulations, according to Abukhanova et al. (2024). In
the case eighth semester students at the Universidad Regional del Sureste (URSE), this pairing takes on
a critical dimension due to the unique demands of their training: transition to clinical rotations, pressure
to perform on standardized exams, and prolonged exposure to digital technologies as pedagogical tools.
This study analyzed the association between nomophobia and anxiety in eighth semester medical
students at the URSE.
pág. 2830
METHODS
The study was observational since the researcher did not intervene in the variables, allowing the data to
reflect the natural evolution of the phenomena. The scope was analytical, as comparisons between
groups were analyzed, and associations between variables were sought to establish possible
relationships. The design was cross-sectional, measuring variables at a single point in time and providing
a snapshot of the data. The universe and study population were the eighth semester students enrolled in
the Faculty of Medicine and Surgery, URSE, from August 2024 to June 2025. The study was conducted
following the guidelines established in the Declaration of Helsinki and evaluated by the Research
Committee of the Faculty of Medicine and Surgery of the URSE; since it is a cross-sectional study and
a questionnaire was applied, informed consent will be tacit, as will the safeguarding of the information
following the protection of personal data.
Data collection techniques
We used the technical survey in its virtual modality to collect the data, which allowed us to obtain
primary source information. Three strategies were applied to ensure that our target sample completed
the instrument. First stage: Through the institutional emails provided, the link to the Google Forms form
was sent to the selected individuals. Second stage: We coordinated with the teachers and coordinator of
the eighth semester of study to share the link to the form with the selected individuals. Third stage: This
stage focused on approaching those individuals with whom it was impossible to establish contact in the
previous stages. It consisted of interacting with students through social networks and cell phone
numbers, offering the exact retribution as in the second stage.
Data collection instruments
A self-applied instrument in virtual format was used, lasting approximately 10 to 15 minutes, structured
in the following parts: Sociodemographic data: age and sex.
Nomophobia was measured using the NMP-Q, which consists of 20 questions with scores measured on
a Likert scale from 1 to 7. The total scores will vary from 20 points (20x1) to 140 points (20x7). This
scale will be interpreted as no nomophobia with a score of 20, mild between 21-59, moderate between
60-99, and severe between 100-140 points. The instrument has been validated in Spanish, showing a
Cronbach's alpha of 0.95, and has also been validated in Mexican students.
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Anxiety: it was measured using the GAD-7, which consists of 7 items with Likert-type responses, with
a minimum value of 0 and a maximum of 3. This will allow categorizing anxiety as without anxiety (0-
4) and with anxiety (5-21). In addition, anxiety can be categorized in degrees: mild (5-9), moderate (10-
14), and severe (15-21). The instrument has been validated in Spanish, showing a Cronbach's alpha of
0.92, and has also been validated in Mexican students.
The information collected through the Google Form will be exported to Microsoft Excel 2017 for coding
and cleaning. The data will be double and independently typed, ensuring quality and consistency.
Duplicate records, inconsistent, incomplete, or double responses will be excluded. Subsequently, the
data will be transferred to the SPSS version 22 statistical package for analysis. Initially, the presence of
missing or duplicate data will be rechecked. The descriptive analysis will be performed according to the
type of variable: quantitative variables will be expressed by arithmetic mean and standard deviation,
provided they present normal distribution, verified by visual methods and normality tests such as
Shapiro-Wilk, considering normality when p ≥ 0.05. The Chi-square test and the odds ratio (OR) were
used to analyze the relationship between nomophobia and anxiety, considering statistical significance
with p < 0.05.
RESULTS
The study sample consisted of 155 subjects out of 160 subjects. They were demographically distributed
as follows: 56.1% were female while 43.2% were male, with a mean age of 22.1 ±1.2 years. Of the total
number of medical students, 94.4% of the participants presented some degree of nomophobia, while
only 5.6% were free of this condition. This data is particularly relevant, as it indicates that the vast
majority of these future health professionals experience, to a greater or lesser extent, anxiety or
discomfort related to the absence or limited use of their mobile devices. Women predominate within the
small group without nomophobia, accounting for 77.8%, compared with 22.2% of men. This distribution
suggests that the absence of nomophobia is more frequent in women.
When analyzing the population with nomophobia, a slight female predominance is observed, with 54.4%
of women compared to 45.6% of men. Although not very marked, this difference could be related to
sociocultural and psychological factors that influence the use of and dependence on technology. Women
tend to maintain more active social networks and may experience greater pressure to be available and
pág. 2832
connected, which could explain this trend.
The severity of nomophobia was classified as mild, moderate, and severe. Of the students with
nomophobia, 57.1% reported a mild level, with a female majority of 58.3%. As for moderate
nomophobia, 35.4% of the participants reported it. In this group, the gender distribution is slightly
inverted, with 48% of females and 52% of males. A severe degree of nomophobia was reported by 7.5%
of the students, with a female predominance of 54.5%.
Only 33.5% of the students evaluated did not present symptoms of anxiety. This group was composed
of 40.1% women and 59.9% men. In contrast, 66.5% of the students manifested some degree of anxiety,
which means that two out of three medical students experience anxiety at some level. Within this group,
the proportion of females is notably higher, representing 65% compared to 35% of males.
A breakdown of the anxiety levels shows that most cases correspond to mild anxiety, with 66% of the
students affected. Of these, 63.2% are female and 36.8% male. Moderate anxiety affects 23.3% of the
students, of whom 62.5% are female and 37.5% male. Severe anxiety, although less frequent, affects
10.7% of the sample, with a marked female predominance: 81.8% of the cases are female, and only
18.2% are male.
The results of the analysis showed a statistically significant association between the presence of
nomophobia and anxiety in medical students (χ² = 6.501, p = 0.005) (see Table 1). Furthermore, the
calculated odds ratio was 6.587, indicating that students with nomophobia are approximately 6.6 times
more likely to have anxiety compared to those without nomophobia. These findings suggest a strong
relationship between the two conditions, highlighting the importance of addressing nomophobia as a
relevant factor in the mental health of this population.
DISCUSSION
Of the study subjects, 94.4% presented some degree of nomophobia. Nomophobia, defined as the
irrational fear of being without a cell phone or without access to the connectivity it provides, has become
an increasingly frequent phenomenon, especially among young university students. This disorder,
although not yet officially recognized in diagnostic manuals such as the DSM-V, has been the subject
of growing interest due to its impact on mental health and academic performance. In particular, medical
students are a vulnerable group, given the high demands and stress they face during their training, which
pág. 2833
may enhance dependence on cell phones as a coping or escape mechanism (Kaviani et al., 2020).
When analyzing the population with nomophobia, 54.4% were women, and 45.6% were men. This
difference may be related to sociocultural and psychological factors that influence the use of and
dependence on technology. Women tend to maintain more active social networks and may experience
greater pressure to be available and connected, which could explain this tendency.
This level implies that those affected experience some discomfort or anxiety when they do not have
immediate access to their phone, but it does not significantly interfere with their daily activities.
However, the high prevalence of this grade indicates that cell phone dependence is widespread and
normalized among medical students
35.4% of the participants manifested moderate nomophobia. This indicates that, as the severity
increases, the proportion of affected males increases, approaching and even slightly surpassing that of
females. Moderate nomophobia is characterized by more intense anxiety, which can affect
concentration, academic performance, and interpersonal relationships. In medical students, this
condition may interfere with maintaining attention in class, performing clinical practice, or managing
the stress associated with their training.
Severe nomophobia involves a significant level of anxiety and discomfort, which can manifest itself in
physical symptoms such as tachycardia, sweating, tremors, and panic attacks in the absence of a cell
phone. This level of dependence can severely affect mental health and general well-being, as well as
compromising academic and social performance. The fact that more than half of the severe cases are
women is consistent with other studies suggesting a greater female vulnerability to anxiety-related
disorders and technology dependence.
These results reflect a complex and multifaceted problem. The high prevalence of nomophobia in
medical students may be linked to several factors. On the one hand, the cell phone is an indispensable
tool for accessing medical information, communicating with classmates and professors, and managing
schedules and activities. On the other hand, excessive or compulsive use can generate a dependency that
affects mental health and quality of life. The academic pressure, stress, and anxiety inherent to a medical
career can increase this dependence, turning the cell phone into a refuge from the demands of the
environment (Charry-Jiménez et al., 2024).
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Nomophobia may be associated with other psychological disorders, such as social anxiety and
depression, which are common in college students. Previous studies have found a significant correlation
between nomophobia and social anxiety, suggesting that cell phone dependence may be both a cause
and a consequence of difficulties in relating to others and managing stress. In this sense, nomophobia is
a technological problem and an indicator of emotional and social vulnerabilities that require integrated
attentionl (Mohani et al., 2024).
The gender distribution found in the study also indicates differences in the use of and relationship with
technology between men and women. Women, presenting a higher prevalence in mild and severe
degrees, could be more exposed to the adverse effects of this dependence, possibly due to social factors
that promote greater connectivity and availability. Males, on the other hand, show a higher proportion
of moderate nomophobia, which could reflect different patterns of use or coping strategies.
Faced with this reality, educational and health institutions must implement strategies to prevent and
manage nomophobia in medical students. This implies promoting responsible and balanced use of
technology and offering psychological support and spaces for developing emotional and social skills.
Education about the risks of technology dependence, together with stress and anxiety management
programs, can contribute to reducing the prevalence and severity of nomophobia (Daei et al., 2019).
Promoting activities that encourage disconnection and direct contact between people is necessary,
strengthening interpersonal relationships and autonomy. The promotion of healthy habits, such as setting
limits on cell phone use and practicing relaxation techniques, can be beneficial to improve the overall
well-being of students.
Anxiety is an increasingly frequent phenomenon among university students, and in particular, among
medical students, who face a considerably high academic and emotional burden. The results obtained in
this study provide a clear and worrying insight into the prevalence and degrees of anxiety in this
population, as well as the gender differences that exist in the manifestation of this disorder. The anxiety
results obtained in the study subjects highlight several issues of great relevance. First, the high
prevalence of anxiety among medical students is alarming. The fact that two-thirds of the students
present some degree of anxiety indicates that this problem is systemic and not an exception. This could
be related to high academic demands, performance pressure, internal competition, and constant exposure
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to emotionally intense situations, such as contact with patients and the management of serious diseases.
One of the most striking observations is the significant difference between females and males in the
prevalence as well as the severity of anxiety. In all degrees of anxiety, women are overrepresented, and
this difference is accentuated as the severity of the disorder increases. In severe anxiety, for example,
more than 80% of cases are women.
This finding is consistent with previous studies that have shown that women tend to report higher levels
of anxiety than men, both in the general population and in college and medical students. There may be
multiple reasons for this difference (Farhane-Medina et al., 2022). On the one hand, there are biological
and hormonal factors that predispose women to experience anxiety more frequently. On the other hand,
social and cultural factors also play an essential role: women tend to face higher social expectations and
often have fewer coping resources available or less social support in competitive environments (McLean
et al., 2011).
Gender socialization may influence how men and women perceive and report their symptoms. Men may
tend to minimize or underreport their anxiety symptoms because of cultural stigmas that associate
emotional vulnerability with weakness (Farhane-Medina et al., 2022).
The presence of anxiety in medical students is not a minor issue, as it can have serious consequences
both academically and personally. Academically, anxiety can negatively affect concentration, memory,
and performance on exams, which in turn can perpetuate a cycle of stress and underachievement. On a
personal level, anxiety can impair quality of life, affect interpersonal relationships, and increase the risk
of developing other psychological disorders such as depression (McCurdy et al., 2022).
Severe anxiety, although less common, is especially worrisome because of its debilitating impact.
Students experiencing this level of anxiety may become overwhelmed, unable to cope with the demands
of the program, and, in extreme cases, may consider dropping out or developing risky behaviors
(England et al., 2019).
CONCLUSIONS
The study provides updated evidence on the relationship between nomophobia and anxiety in eighth
semester medical students at the Universidad Regional del Sureste. In an environment where mobile
technology is essential for academic and personal life, it is key to understand its psychological
pág. 2836
repercussions, especially in populations subjected to high stress, such as medical students. The results
show a high prevalence of both conditions. Chi-square statistical analysis confirmed a significant
association (χ² = 6.501, p = 0.005), and the odds ratio (OR = 6.587) indicated that students with
nomophobia are more than six times more likely to have anxiety than those without nomophobia.
Nomophobia, defined as the irrational fear of being without access to a cell phone, has ceased to be
anecdotal and has become a relevant mental health problem among young university students. In
medical students, technological dependence is enhanced by the need for constant access to academic
information and social networks. However, when device use becomes a source of anxiety, it affects
emotional well-being and academic performance. The high percentage of anxiety and its strong
association with nomophobia suggest that the medical and educational environment, due to its demands
and competitiveness, may be an additional risk factor for addictive behavior toward technology.
The relationship between the two variables appears to be bidirectional: anxiety can lead to compulsive
use of the cell phone as a coping mechanism, while the inability to access the device can trigger or
aggravate anxious symptoms, creating a vicious circle. This phenomenon is especially relevant in the
era of hyperconnectivity, where immediacy has transformed social and academic dynamics. From a
clinical and educational perspective, the results underscore the need for prevention and mental health
promotion strategies in the university setting. Institutions must recognize nomophobia and anxiety as
emerging problems that require priority attention. Integrating responsible digital education programs,
stress management workshops, and psychological support spaces can help reduce the incidence and
impact of these disorders. In addition, it is essential to promote emotional and technological self-
regulation and train teachers and staff in the early detection of warning signs.
This study opens new lines of research on individual, social, and contextual factors that mediate the
relationship between nomophobia and anxiety. Future longitudinal studies allow us to analyze these
phenomena' evolution and evaluate the effectiveness of preventive and therapeutic interventions.
Among the limitations is that the cross-sectional design prevents us from establishing causal
relationships, and using self-reports may introduce biases. Despite this, the robustness and consistency
of the results support the validity of the conclusions. The digital revolution brings benefits but also
unprecedented challenges for mental health, and this study lays the groundwork for future actions aimed
pág. 2837
at building healthier and more resilient educational environments.
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ANNEX
Table 1. Results of the Chi-square test of association and measure of strength (OR) between nomophobia
and anxiety in the study subjects
Anxiety (YES)
Anxiety (NO)
Total
Nomophobia (YES)
101
46
147
Nomophobia (NO)
2
6
8
Total
103
52
155
Statistic
Value
Chi-square (X2)
6.501
Value p
0.005389
Odds Ratio (OR)
6.587