Nomophobia in the digital age: prevalence, psychological and behavioral determinants and public health implications: a narrative review

INTRODUCTION

The exponential growth of smartphone adoption has altered everyday life, making these devices essential for communication, education, entertainment and social interaction. The uninterrupted availability of internet access has progressively embedded smartphones as an integral component of daily life. However, this ubiquity has contributed to emerging patterns of problematic smartphone use and behavioural dependency, raising concerns regarding their detrimental psychological implications.^1–3

Nomophobia (no mobile phone phobia), defined as stress or anxiety experienced when individuals are unable to access their mobile phones due to the unavailability of a network signal, low battery power, or disruption of internet connectivity.⁴ It is characteristics such as fear of losing communication, inability to access information, prolonged smartphone use, inability to refrain from smartphone use, persistent carrying a smartphone charger, diminished social interaction, compulsive calls or messages checking and escalating financial expenditure trends with the use of a smartphone. In contrast to traditional phobias, which are triggered by external stimuli or situations, nomophobia arises from the disruption of digital access that has become integral to everyday functioning.^5–7

Problematic smartphone use is associated with adverse psychological outcomes, including anxiety, depression, social phobia, fear of missing out (FoMO), sleep disturbances, low self-esteem and reduced well-being.^8–11 These patterns often involve excessive screen time, poor self-regulation, constantly checking behaviours, emotional reliance on devices and difficulty limiting use despite negative consequences, resembles features of behavioral addiction.^2,12–14 Nomophobia disproportion-nately affects certain population groups, particularly adolescents and young adults, who are vulnerable due to early and prolonged exposure to digital environments, as well as heightened social connectivity needs.^6,7,15-17

Despite its growing recognition, Nomophobia is not clinically classified in any psychiatric or medical diagnostic frameworks such as DSM (Diagnostical and Statistical Manual of Mental Disorders) or ICD (International Classification of Diseases).⁷ Although previous reviews have examined prevalence and associated factors, most focus on isolated dimensions without integrating psychological, behavioral and demographic determinants within a unified conceptual framework.^18,19 Therefore, this narrative review aims to synthesize existing evidence on the prevalence, conceptual understanding and correlates of nomophobia while exploring its broader public health relevance.

METHODS

This narrative review synthesised literature on the prevalence, conceptual understanding and psychological, behavioural and demographic correlates of nomophobia. A systematic search of the literature was conducted in electronic databases, including PubMed, PubMed Central and Google Scholar. Studies published between January 2008 and February 2026 were considered. The final search was conducted in February 2026.

The key terms included: “nomophobia,” “no mobile phone phobia,” “smartphone addiction,” “mobile phone dependence,” and “behavioural addiction.” Studies were identified in PubMed and the following search strategy was applied: (‘nomophobia’ OR ‘no mobile phone phobia’ OR (‘smartphone addiction’ OR ‘mobile phone dependence’) AND (‘anxiety’ OR ‘depression’ OR ‘behavioural addiction’). Similar search strategies, with appropriate modifications to match the syntax and indexing conventions of each platform, were adapted for the other databases searched. Studies were included if they were peer-reviewed, published in English-language observational study designs including cohort, longitudinal, ecological, case-control and cross-sectional studies conducted among human participants. Research articles examining the prevalence, psychological correlates and behavioural determinants of nomophobia were included. The studies focusing on technical or non-psychological aspects of mobile phone use and COVID-19 specific studies were excluded.

Three independent reviewers (S, NC and SD) screened titles and abstracts using the Rayyan software for study selection. Full texts of eligible studies were assessed according to predefined inclusion and exclusion criteria and disagreements were resolved through consensus. Data was extracted from the included studies by three independent reviewers (S, NC and SD) and further refined following the recommended modifications from RKS. For each study, the following information was extracted, including the first author, year, study design, sample size, country, study population, instrument, prevalence of nomophobia, associated factors and key findings.

RESULTS

The initial search yielded a total of 324 records across databases, including 72 from PubMed, 54 from Google Scholar and 198 from PubMed Central. After removing 37 duplicates, 287 records were screened based on titles and abstracts. Subsequently, 36 studies met the inclusion criteria and were included in the final synthesis. The prevalence of nomophobia and its determinants are presented in Table 1.

NMP-Q = Nomophobia Questionnaire; FoMO / FoMOS = Fear of Missing Out Scale; DASS / DASS-21 / DASS-42 = Depression Anxiety Stress Scale; UCLA-LS = UCLA Loneliness Scale; PSQI = Pittsburgh Sleep Quality Index; HSCL-25 = Hopkins Symptom Checklist-25; CPAS = Cell Phone Addiction Scale; TMD Brief = Test of Mobile Phone Dependence Brief; ISI = Insomnia Severity Index; ICD-10 – International Classification of Diseases, 10th Revision; GAD7 = Generalized Anxiety Disorder; GPA = Grade point average

Study characteristics

Table 1 summarises the characteristics of the selected studies. The included studies were conducted across India, Saudi Arabia, Iran, Egypt, Peru, Türkiye, Spain, Pakistan, Nepal, Bangladesh, Tunisia and Italy. Most studies used cross-sectional designs among undergraduate students, medical and nursing students, healthcare workers, adolescent and community populations. Sample sizes ranged from 157 to 5191 participants.

The nomophobia questionnaire (NMP-Q) was the most commonly used assessment tool, alongside instruments assessing anxiety, depression, sleep quality, FoMO, loneliness, psychological distress and smartphone dependence. Moderate to severe nomophobia was highly prevalent across studies. Common predictors included younger age, female gender, prolonged smartphone use, excessive social media engagement, poor sleep quality, anxiety, depression, stress, FoMO, loneliness and problematic smartphone behaviors. Nomophobia was consistently associated with adverse psychological, behavioural, academic and sleep-related outcomes.

Conceptual framework of nomophobia

Nomophobia develops through the interaction of technological exposure, psychological reinforcement and behavioural conditioning. Increased smartphone accessibility promotes frequent use and immediate gratification through communication and information access. Repeated reinforcement strengthens emotional dependence and anxiety during digital disconnection.^2,12 Psychological factors such as FoMO, loneliness and stress further reinforce excessive smartphone use.^2,3

As this cycle progresses, behavioral consequences including excessive screen time, sleep disturbances and impaired concentration emerge.^8,15 Overall, nomophobia represents a multidimensional phenomenon shaped by psychological vulnerabilities and digitally connected social environments as illustrated in Figure 1 (Pathways and Determinants in the Development of Nomophobia).^2,3

Prevalence of nomophobia

The reviewed studies consistently demonstrated high prevalence of nomophobia across adolescents, university students, healthcare trainees and community populations. Moderate nomophobia was the most common category, although severe nomophobia was also frequently reported.

Among adolescent populations, Jamshidifar et al documented an overall prevalence of 98.6% among Iranian adolescent female students.²⁰ Similarly, Devi et al and George et al reported prevalence exceeding 99% among Indian undergraduate and medical students.^21,22 Comparable findings were observed among Pakistani medical students by Saleem et al.²³

High levels of moderate-to-severe nomophobia were reported among healthcare students by Alkalash et al, Mohani et al, Aslani et al and Ferchichi et al across Saudi Arabia, India, Iran and Tunisia.^24–27 Thomas et al similarly identified moderate nomophobia as the predominant category among Indian undergraduate students.²⁸ Community-based studies also demonstrated substantial smartphone dependence. Alwafi et al identified mobile phone dependence among over half of participants from Saudi Arabia and Jordan.²⁹ Balamurugan et al, Arumuganathan et al and Sheikh et al reported a high prevalence.^30–32 Similar findings were observed among Nepalese healthcare workers by Banjade et al.³³

Nomophobia and its determinants

Studies reported that nomophobia is associated with anxiety, emotional regulation, FoMO, loneliness, self-esteem, excessive screen time, digital engagement, sleep disturbance, academic dysfunction, psychological traits, personality factors, individual vulnerability, behavioural dependence, demographic and social determinants. Summary of key determinants and their roles presented in Table 2.

Demographic and social determinants

Younger age emerged as one of the strongest predictors of nomophobia. Alwafi et al, Copaja-Corzo et al, Arumuganathan et al and Banjade et al reported significantly higher nomophobia among adolescents and young adults.^29,30,33,34 Gender-related findings were inconsistent. Hamzaa et al, Thomas et al, Leon-Mejia et al and Saleem et al reported higher nomophobia among females, whereas other studies observed no significant gender differences.^18,23,28,35

Mengi et al, Aslani et al and Jamshidifar et al reported higher prevalence among students.^20,25,36 Jamshidifar et al identified household income, father’s education and internet access as significant contributors.²⁰ Balamurugan et al reported higher nomophobia among individuals from middle socioeconomic backgrounds.³¹ Güveli et al found that having more smartphone users within the family significantly increased nomophobia risk. Similarly, social network access and internet availability were repeatedly linked with higher nomophobia severity among adolescents and university students.³⁷

Anxiety and emotional regulation

Anxiety, depression, stress and emotional dysregulation emerged as major psychological correlates of nomophobia. Sharma et al reported that higher nomophobia scores among Indian medical students were significantly associated with increased levels of depression, anxiety and stress.³⁸ Similarly, Güveli et al, Leon-Mejia et al and Kumar et al observed identified significant associations between nomophobia, anxiety, stress and problematic smartphone use among Spanish university students.^18,37,39 Elhai et al further demonstrated that nomophobia mediated the relationship between FoMO and psychological distress.⁴⁰ Withdrawal symptoms, anxiety and emotional discomfort during smartphone separation were also reported by Mohani et al and Alwafi et al.^24,29

Fear of missing out (FoMO)

FoMO emerged as one of the strongest predictors of nomophobia. Elhai et al and Hamzaa et al reported a strong positive correlation between FoMO and nomophobia among Egyptian nursing students, with psychological alienation acting as a mediating factor.^35,40 Mohapatra et al and Chowdhury et al additionally reported that fear of missing communication, excessive social media use and repetitive phone-checking behaviours significantly contributed to nomophobia severity.^41,42

Loneliness and self-esteem

Loneliness, psychological alienation and low self-esteem were important psychosocial correlates of nomophobia. Setia et al and Hamzaa et al reported a positive association between loneliness and nomophobia and an inverse relationship with self-esteem among students.^35,43 However, Guveli et al found no significant association between loneliness and nomophobia among Turkish adults.³⁷

Excessive screen time and digital engagement

Excessive smartphone use and prolonged screen exposure were among the most consistent behavioural predictors of nomophobia. Mengi et al, Copaja-Corzo et al and Chowdhury et al reported significantly higher nomophobia among individuals with prolonged daily smartphone use.^34,36,42

Frequent smartphone checking behavior was also repeatedly associated with greater nomophobia severity. Aslani et al and Mahajan et al identified notification checking frequency and repetitive smartphone engagement as major determinants.²⁵ Hamzaa et al and Hussein et al further linked prolonged smartphone uses, bedtime phone checking with insomnia and severe nomophobia.^35,45

Problematic digital engagement, including excessive social media use, gaming and prolonged internet use, was strongly associated with nomophobia. Mohani et al, Marthandappa et al, Hamzaa et al, Copaja-Corzo et al, Aslani et al, Mahajan et al and Chowdhury et al all identified social networking and compulsive digital engagement as significant predictors.^{24,25,34,35,42,45}

Gaming and sedentary digital lifestyles also contributed substantially. Balamurugan et al and AlMarzooqi et al identified gaming and internet dependency behaviours as important correlates of nomophobia.^31,46

Sleep disturbance and academic dysfunction

Sleep disturbances including insomnia, poor sleep quality, daytime sleepiness and bedtime smartphone uses were consistently associated with higher nomophobia levels. Mengi et al, Hussein et al, AlMarzooqi et al and Sheikh et al demonstrated significant associations between nomophobia and poor sleep quality among medical students.^32,36,44,46 Academic dysfunction including poor concentration, lower productivity, declining academic performance and daytime sleepiness was also commonly reported by Saleem et al, Thomas et al, Alkalash et al and Aslani et al.^23,25,26,28

Psychological traits and personality-related factors

Psychological vulnerability factors including FoMO, anxiety, depression, stress, loneliness, low self-esteem and emotional instability showed strong associations with nomophobia. Hamzaa et al and Elhai et al identified FoMO and psychological alienation as major contributors to nomophobia and psychological distress.^35,40 Sharma et al, Kumar et al, Guveli et al and Leon-Mejia et al consistently demonstrated significant associations between nomophobia, depression, anxiety and stress.^18,37–39 Setia et al additionally reported an inverse relationship between self-esteem and nomophobia.⁴³

Individual vulnerability and behavioural dependence

Several studies highlighted behavioural dependency patterns associated with nomophobia. Jamshidifar et al and Alwafi et al reported significant associations between mobile phone dependence, withdrawal symptoms and impaired behavioural control.^20,29

Behavioural indicators including phantom vibrations, compulsive connectivity, bedtime phone checking and disturbances in daily routine were identified by Saleem et al and Mohapatra et al.^23,41 Physical discomfort including eye strain, neck pain and sedentary behavior were additionally reported by Ferchichi et al and Gallè et al.^27,47

DISCUSSION

The reviewed studies consistently demonstrated high prevalence of nomophobia across adolescents, university students and adults, although prevalence estimates varied across populations and settings. Extremely high prevalence was particularly reported among medical and university students. George et al, Devi et al and Saleem et al reported prevalence rates exceeding 99%, while Jamshidifar et al observed very high prevalence among adolescent female students.^20–23 In contrast, Mohapatra et al reported comparatively lower prevalence, suggesting that differences in sociocultural context, assessment tools and smartphone usage patterns may influence prevalence estimates.⁴¹ Despite variability, moderate nomophobia was the most commonly reported category, consistent with findings from systematic reviews by Notara et al and Jahramiet al.^19,48

A strong association between nomophobia and psychological distress was consistently observed. Studies by Sharma et al, Kumar et al, Guveli et al and Ferreira IS et al demonstrated significant positive relationships between nomophobia, anxiety, depression and stress. These findings support earlier evidence suggesting that smartphones function as tools for emotional reassurance, coping and social validation. Although smartphone use may provide temporary emotional relief, repeated reliance appears to reinforce emotional dysregulation and dependency behaviours.^37–39,49 Similar observations were reported by Elhai et al, Rozgonjuk and Elhaiet al who highlighted the bidirectional relationship between problematic smartphone uses and emotional distress.^2,8,40

FoMO emerged as important psychological mechanism underlying nomophobia. Hamzaa et al and Alhaj H et al demonstrated that individuals with higher FoMO were more likely to exhibit severe nomophobia and problematic smartphone behaviours.^35,50 These findings align with earlier conceptual frameworks proposed by Przybylski et al and Elhai et al where repetitive smartphone checking and constant online connectivity were viewed as manifestations of social reassurance seeking.^43,51 Hamzaa et al additionally identified psychological alienation as a mediating factor, suggesting that emotional disconnection may intensify dependence on digital communication.³⁵

The relationship between loneliness, self-esteem and nomophobia showed inconsistent findings. Baby N et al reported that loneliness and low self-esteem increased vulnerability to nomophobia, while Wang et al similarly linked poor self-esteem with problematic smartphone uses.^13,52 However, Güveli et al found no significant association between loneliness and nomophobia among Turkish adults.³⁷ Such inconsistencies may reflect differences in cultural expectations, coping styles and age-related smartphone use patterns.

Behavioural determinants, particularly excessive screen time and repetitive smartphone checking, emerged as some of the strongest predictors of nomophobia. Studies by Copaja-Corzo et al, Marthandappa et al, Aslani et al and Chowdhury et al consistently demonstrated that prolonged smartphone use increased nomophobia severity.^25,34,42,45 These findings parallel behavioural addiction frameworks proposed by Billieux et al and Montag et al where repetitive digital engagement becomes reinforced through notifications, social interaction and instant gratification mechanisms.¹²

Social media engagement was also strongly associated with nomophobia. Lin CY et al and Ferreira IS et al reported significant associations between social networking addiction and problematic smartphone dependence, while AlMarzooqi et al identified gaming and esports participation as additional behavioural contributors.^46,49,53 These findings support earlier literature suggesting that algorithm-driven digital platforms reinforce dependency through continuous social and reward-based reinforcement processes Busch and McCarthyet al.³

Sleep disturbance emerged as another important consequence of nomophobia. Studies by Hussein et al, Mengi et al and AlMarzooqi et al reported significant associations between nomophobia, insomnia and poor sleep quality.^36,4,46 Similar findings were previously reported by Demirci et al and Exelmans and Van den Bulcket al where nighttime smartphone uses and emotional stimulation disrupted sleep patterns and circadian rhythms.^54,55 This relationship may be bidirectional, as poor sleep can further contribute to emotional dysregulation and increased smartphone dependence.

The reviewed studies also highlighted the role of personality-related vulnerabilities in nomophobia susceptibility. Emotional instability, impulsivity, psychological alienation and low self-esteem were repeatedly associated with problematic smartphone dependence. Findings from Hamzaa et al and Baby N et al suggest that psychosocial vulnerability and emotional insecurity may predispose individuals to excessive smartphone uses.^35,52 Similar observations were reported by Billieux et al and Rozgonjuk and Elhaiet al linking poor emotional regulation and impulsivity with behavioural addiction tendencies.^8,40,56

Demographic findings consistently identified younger age as one of the strongest predictors of nomophobia. Studies by Alwafi et al, Copaja-Corzo et al and Arumuganathan et al reported significantly higher nomophobia among adolescents and young adults.^29,30,34 These findings align with previous literature suggesting that smartphones are deeply integrated into the educational, social and developmental experiences of younger populations.⁵⁷

Gender-related findings, however, remained inconsistent, with some studies reporting higher nomophobia among females and others finding no significant differences. Environmental and social influences including peer pressure, family smartphone culture, academic demands and constant internet connectivity were also repeatedly identified as contributing factors reinforcing smartphone dependency and psychological distress during disconnection.

Strengths and limitations

This review synthesizes evidence from recent international studies and provides a comprehensive overview of the psychological, behavioural and socio-environmental determinants of nomophobia. Inclusion of current literature enhances the relevance of the findings.

However, most included studies were cross-sectional and relied on self-reported measures, increasing the risk of response and recall bias. Variability in assessment tools and lack of standardized diagnostic criteria further limit comparability across studies. In addition, many intervention recommendations are extrapolated from broader smartphone addiction literature rather than nomophobia-specific evidence. The predominance of university student samples from middle- and high-income countries also limits generalizability to other populations.

A limitation in nomophobia research is the lack of standardized measurement. Although the NMP-Q is the most widely used tool, variations in scoring systems and cut-off thresholds reduce comparability across studies. Differences in classification of mild, moderate and severe nomophobia contribute to inconsistent prevalence estimates.

Cultural differences in smartphone use patterns and social norms may further influence reporting and interpretation. In addition, nomophobia is not formally recognized as a clinical disorder despite its frequent association with behavioural addiction frameworks, resulting in variability in definitions and assessment approaches.

Implications for research and practice

Longitudinal and intervention-based studies are needed to clarify causal relationships and evaluate targeted strategies for nomophobia. Future research should focus on interventions such as cognitive behavioural therapy (CBT), digital detox programs and digital literacy interventions specifically designed for nomophobia. Greater emphasis should also be placed on culturally adaptable and cost-effective interventions, particularly in low- and middle-income settings.^58,59

Public health implications and interventions

Nomophobia is an emerging public health concern associated with anxiety, sleep disturbances, impaired academic performance and reduced well-being, especially among adolescents and young adults. Potential interventions include CBT, structured digital detox approaches, screen-time regulation, sleep hygiene education and digital literacy programs. Educational institutions may also promote phone-free classrooms and awareness campaigns targeting students, parents and teachers. However, evidence for nomophobia-specific interventions remains limited and requires further evaluation, particularly in resource-constrained settings.

CONCLUSION

Nomophobia is a growing behavioural concern driven by psychological dependence on constant digital connectivity. It is influenced by psychological, behavioural, demographic, and socio-environmental factors and is associated with anxiety, sleep disturbances, reduced academic performance, and impaired well-being. Given its increasing prevalence, nomophobia should be recognized as an emerging public health issue. Strengthening awareness, early screening, and context-sensitive interventions may help reduce the long-term impact of excessive smartphone dependence, particularly among young populations and in resource-limited settings.

ACKNOWLEDGEMENTS

The authors acknowledge the Indian Council of Medical Research, New Delhi, for funding this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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