Smartphone Addiction in Youth: A Narrative Review of Systematic Evidence and Emerging Strategies

Abstract

Smartphone addiction has emerged as a significant public health concern, particularly among adolescents and young adults. This narrative review, conducted in line with the ANDJ checklist, synthesizes evidence from 25 systematic reviews and meta-analyses, complemented by randomized controlled trials and clinical studies, to provide a structured overview of the field. The study selection flow and publication trends reveal a rapidly expanding research landscape, with most evidence produced in the last decade, reflecting both the ubiquity of smartphones and increasing awareness of their health impacts. The synthesis highlights converging findings across reviews: excessive smartphone use is consistently associated with psychosocial, behavioral, and academic challenges, alongside sleep disturbances and mental health symptoms. Common messages include the recognition of smartphone addiction as a multidimensional phenomenon, while emerging themes point to heterogeneity in definitions, tools, and methodological approaches. Comparative analysis of reviews underscores both shared risk factors—such as emotional dysregulation and social isolation—and differences in study designs and target populations. Importantly, this review identifies critical gaps, including the lack of standardized definitions, limited longitudinal evidence, and scarce cross-cultural validation. At the same time, promising opportunities are noted, from lifestyle-based interventions (e.g., physical activity) to educational and policy-level strategies fostering digital literacy and self-regulation. The post-pandemic context further emphasizes the need for sustained monitoring and adaptive responses. Overall, this review calls for youth-centered, multi-sector interventions aligned with WHO recommendations, supporting coordinated, evidence-based action across health, education, and policy domains.

1. Introduction

1.1. From Early Mobile Phones to Today’s Smartphones: A Brief History

The smartphone as we know it today is the result of decades of technological innovation, evolving from early mobile communication devices of the 1990s. Early models like the IBM Simon Personal Communicator (1993), often credited as the first true smartphone, integrated basic telephony with features such as email, fax, calendar, and a rudimentary touchscreen interface [1,2]. Shortly after, the Nokia 9000 Communicator (1996) and the Palm Treo series (early 2000s) expanded on these functions, providing mobile professionals with more versatile tools for communication and organization [3].

Despite these advances, these early smartphones were niche devices aimed primarily at business users and faced significant limitations. The user interfaces were often cumbersome and unintuitive by today’s standards. For example, text input was slow and required multiple presses on numeric keypad buttons to select individual letters—a system known as multi-tap input—making writing messages time-consuming and inefficient [2]. Physical keyboards were typically small and bulky, screens were limited in size and resolution, and connectivity technologies (such as 2G and early 3G) constrained internet speeds and data access. As a result, widespread consumer adoption was limited.

A pivotal shift occurred with the introduction of the Apple iPhone in 2007, which revolutionized the smartphone landscape by introducing a capacitive touchscreen interface, an intuitive operating system (iOS), and a powerful mobile web browser [3,4]. The iPhone’s success was soon followed by the release of the first Android smartphone, the HTC Dream (T-Mobile G1) in 2008, which helped establish a more open ecosystem for mobile applications [5]. These innovations lowered barriers to entry for users, dramatically improved user experience, and accelerated smartphone adoption worldwide.

This transformation ushered in an era where smartphones became not only communication tools but also central hubs for social interaction, entertainment, information, and commerce. The ease of use, constant connectivity, and the explosion of app ecosystems have led to their ubiquitous presence in everyday life [6,7]. However, this pervasive integration also introduced new challenges, such as increased screen time and behavioral patterns akin to addictive use, which have become subjects of growing psychological and social concern [8].

1.2. Smartphone Use Among Youth: Rising Trends and Health Implications

Smartphones have rapidly transitioned from mere communication devices to indispensable tools embedded in daily life, particularly among younger generations. Recent studies indicate that average daily smartphone usage has increased markedly over the past decade. For example, in many countries, young adults spend on average between 3 and 5 h per day actively using their smartphones, with some reports suggesting even higher usage among teenagers [9].

This increase in usage is linked not only to communication but also to social media, entertainment, education, and health-related applications. Consequently, smartphones have become central to how youth interact with the world, socialize, and manage their well-being [10].

However, this pervasive use has raised concerns about potential adverse effects. Prolonged screen time has been associated with musculoskeletal symptoms, such as neck and shoulder pain, often referred to as “text neck” syndrome, resulting from sustained head flexion during smartphone use [11,12,13,14]. Research has documented muscle fatigue and postural strain associated with typical smartphone postures [15], with long-term effects potentially impacting spinal health [16].

Beyond physical consequences, problematic smartphone use has been linked to psychological and behavioral concerns, including increased feelings of loneliness, anxiety, and depression, as well as patterns of excessive and compulsive smartphone engagement resembling behavioral addiction [17,18,19].

Often described as “smartphone addiction,” this phenomenon is characterized by compulsive use that interferes with daily functioning and mental well-being. Although it is not currently recognized as a formal clinical disorder in diagnostic manuals such as the DSM-5 or ICD-11, a growing body of empirical research supports conceptualizing it as a behavioral addiction, due to similarities with other compulsive behaviors, including altered reward processing and impaired self-control [19,20].

To better identify at-risk individuals, several psychometrically validated instruments have been developed, such as the Smartphone Addiction Scale (SAS) and its shortened versions, which are widely applied in adolescent and young adult populations. Prevalence estimates of problematic smartphone use vary, with some studies reporting rates between 10% and 30%, highlighting the public health relevance of this issue [20,21,22].

In response, educational initiatives have been designed to raise awareness among young people about the risks of excessive smartphone use and to promote balanced, mindful engagement with technology. These programs also emphasize the potential of mobile health (mHealth) and telemedicine solutions to support health, self-care, and well-being [9].

Building on this practical perspective, it is equally important to consider the theoretical foundations that help explain smartphone use and addiction. Understanding these mechanisms provides a framework for interpreting behaviors, identifying risk factors, and designing interventions that are grounded in evidence.

1.3. Theoretical Framework for Understanding Smartphone Addiction

The rapid integration of smartphones into daily life has transformed them from mere communication devices into powerful gateways for information, work, leisure, and social interaction. While these affordances have brought unprecedented convenience, they have also raised concerns about excessive use and its potential to become addictive. Yet, the very term “smartphone addiction” remains contested. Some scholars argue that the label “addiction” may be misleading, preferring instead the term problematic smartphone use (PSU) [23] to capture the idea of functional impairment without necessarily implying a psychiatric disorder. Others, however, contend that smartphone overuse shares defining characteristics with established behavioral addictions, such as loss of control, craving, and persistence despite negative consequences, and should therefore be conceptualized within the spectrum of addictive behaviors [24]. This conceptual tension underscores the need for a robust theoretical framework that can accommodate the complexity of the phenomenon, integrating cognitive, affective, and social dimensions.

One of the most influential models in this regard is the Interaction of Person–Affect–Cognition–Execution (I-PACE) model [25], which has become a cornerstone in addiction research. The model posits that addictive behaviors arise from the interaction of individual predispositions (such as personality traits, impulsivity, or genetic factors), affective states (including stress, anxiety, or boredom), cognitive biases (like attention drawn toward rewarding stimuli), and executive functioning deficits (such as impaired self-regulation and inhibitory control) [25]. Empirical research applying the I-PACE model to smartphone use supports its explanatory power across cultural and age groups [26], showing how different vulnerabilities converge to sustain compulsive digital engagement. These findings suggest that interventions must be multifaceted, targeting not only behaviors but also underlying cognitive and emotional processes.

At a neurobiological level, parallels with substance-related disorders are striking. Studies have demonstrated that excessive smartphone use activates dopaminergic reward pathways, reinforcing cycles of craving and gratification similar to those seen in other addictions [27]. Neuroimaging evidence further reveals structural and functional alterations in the prefrontal cortex and striatum [28], brain regions implicated in decision-making, impulse control, and reward sensitivity. These neural patterns provide a biological substrate for compulsive checking, continuous scrolling, and habitual engagement often reported by users [28]. Understanding these mechanisms is crucial for developing targeted interventions that can mitigate compulsive behaviors and enhance self-regulation.

Yet, the phenomenon cannot be reduced to brain processes alone. Psychosocial mechanisms are equally critical. The desire for social connectedness, amplified by the immediacy of notifications, often fuels compulsive checking behaviors. Constructs such as the Fear of Missing Out (FoMO) illustrate how anxiety about being excluded from online interactions intensifies dependence on smartphones [29]. Similarly, maladaptive coping strategies, such as using smartphones to escape stress, boredom, or negative emotions, can entrench problematic use. Social and cultural contexts further shape vulnerability and resilience: for instance, adults embedded in supportive family environments or in peer cultures with healthier norms around device use tend to exhibit greater resilience, whereas populations exposed to high social comparison pressures or culturally normalized overuse may show heightened susceptibility [30]. These findings emphasize the need for culturally sensitive approaches when designing prevention and intervention strategies.

A further challenge lies in measurement. Various instruments, including the Smartphone Addiction Scale (SAS), Smartphone Application-Based Addiction Scale (SABAS), and the Smartphone Addiction Inventory (SPAI), have been developed to quantify problematic use [31,32]. These scales differ in theoretical underpinnings, constructs assessed, and cut-off thresholds, leading to inconsistent prevalence estimates across studies and cultures [31,32]. The absence of universally standardized tools hinders reproducibility and comparability, highlighting a pressing need for methodological harmonization. Moreover, longitudinal studies are limited, making it difficult to distinguish temporary overuse from persistent patterns indicative of true behavioral addiction.

Finally, it is important to situate smartphone addiction within a broader societal and ethical context. Smartphones are not inherently harmful; indeed, they are indispensable tools for education, healthcare, and maintaining social ties. The challenge lies in balancing their benefits with the risks of overuse. With the rise in AI-driven personalization and persuasive design, concerns about the intentional engineering of addictive features have become more prominent. This raises questions about the responsibility of technology developers, ethical marketing, and the role of policy in protecting vulnerable populations, particularly children and adolescents. It also highlights the need for digital literacy programs that equip users with strategies for mindful engagement and self-regulation.

Smartphone addiction is a multifaceted phenomenon that cannot be understood through a single lens. It requires an integrated perspective bridging psychological models, neurobiological evidence, social determinants, and ethical considerations. By moving beyond fragmented explanations, researchers and policymakers can establish a stronger theoretical basis for identifying risk and protective factors, designing effective interventions, and ultimately guiding both scientific inquiry and public health strategies in an increasingly digital society [23,24,25,26,27,28,29,30,31,32].

In summary, understanding smartphone addiction requires an integrated approach that connects psychological, neurobiological, social, and ethical evidence. This theoretical perspective not only clarifies the mechanisms underlying compulsive behaviors but also provides an essential context for formulating relevant research questions and designing targeted interventions.

1.4. Smartphone Addiction: Aim and Scope of the Study

1.4.1. Emerging Questions

Building on the theoretical foundation, the next step is to define the key aims and guiding questions of the present study. Situating the research within a robust conceptual framework allows for a focused analysis, identification of gaps, and development of concrete recommendations for the prevention and management of problematic smartphone use.

The ubiquity of smartphones has profoundly reshaped how individuals connect, communicate, and structure their daily routines. These devices offer undeniable benefits, ranging from improved access to information to enhanced social engagement. At the same time, however, growing concern surrounds their potential to foster maladaptive patterns of use that resemble behavioral addictions. This dual nature—between indispensable tool and possible source of dysfunction—has attracted increasing attention in the scientific community and generated a host of pressing research questions that remain unresolved.

Some key illustrative questions include the following:

• Definition and Measurement: How can smartphone addiction be clearly defined and reliably measured across diverse populations, considering the heterogeneity of available diagnostic criteria and assessment tools?
• Underlying Mechanisms: What neurobiological and psychological processes contribute to the onset and persistence of compulsive smartphone use, and how do these mechanisms interact?
• Vulnerability and Resilience: Which individual traits, social dynamics, and cultural contexts increase susceptibility to problematic use, and conversely, which protective factors foster resilience?
• Technological Innovation: How can emerging technologies—such as artificial intelligence, machine learning, and digital phenotyping—be applied to enhance prevention, real-time monitoring, and personalized interventions?
• Ethical and Societal Challenges: What ethical, legal, and public health concerns arise as smartphones become increasingly embedded in everyday life, and how should these challenges be addressed?

These questions underscore the need for a targeted and integrative approach capable of clarifying conceptual ambiguities, identifying converging evidence, and orienting future research and policy efforts.

1.4.2. Aim of the Review

Given the rapidly expanding volume of literature on smartphone addiction, a comprehensive synthesis is necessary to better understand the state of the art. This work undertakes a narrative review of systematic reviews and meta-analyses, with the goal of consolidating high-quality evidence while maintaining flexibility in scope.

The focus on systematic reviews is intentional: such studies represent rigorous syntheses of primary findings, conducted with transparent and reproducible methods. However, neither systematic nor scoping reviews alone appear fully adequate to capture the complexity of this research domain. Systematic reviews, by design, often rely on narrowly defined research questions and strict inclusion criteria, which may be too restrictive in a field characterized by heterogeneous definitions, diverse assessment instruments, and varied intervention strategies. Conversely, scoping reviews—while broader in scope—tend to emphasize mapping the landscape without critically addressing conceptual coherence or methodological quality.

A narrative review therefore offers an appropriate balance. By leveraging the rigor of systematic reviews and meta-analyses while allowing for contextual integration and interdisciplinary insight, this approach avoids the fragmentation inherent in isolated primary studies. It also provides the flexibility to highlight patterns, divergences, and emerging directions across domains.

Specifically, the review aims to

• Map scientific publication trends over recent years, documenting the evolution of research output and identifying emerging subfields.
• Identify and synthesize key themes, such as definitions and measurement approaches, neurobiological and psychological correlates, risk and protective factors, and intervention strategies.
• Highlight opportunities to apply current knowledge in clinical and public health settings, while pinpointing gaps requiring further investigation.

By adopting this integrative perspective, the review seeks to clarify the current state of knowledge, anticipate future research needs, and propose actionable recommendations for interventions and policy. In doing so, it aims to contribute to a more coherent and forward-looking understanding of smartphone addiction in an era where digital technologies increasingly shape human behavior and social life.

2. Materials and Methods

Given the multidisciplinary complexity and evolving nature of this topic—characterized by diverse methodologies, terminological inconsistencies, and emerging intervention research—the narrative review methodology was selected for its flexibility. This approach allowed us to integrate, in the comparative analysis in the discussion, insights from (1) randomized controlled trials (RCTs) and clinical trials. (2) Following relevant clinical guidelines, it allowed us to incorporate local pilot initiatives with a focus, for example, on the Italian context. (3) Moreover, it enabled discussion of economic growth models related to digital health interventions, which would be difficult to capture comprehensively within more rigid systematic or scoping review frameworks.

This narrative review focuses specifically on systematic reviews and meta-analyses related to smartphone addiction, aiming to provide a well-rounded synthesis of the current state of knowledge in this field. For this narrative review, PubMed and Scopus were selected due to their complementary strengths in biomedical, psychological, and digital health research. PubMed, managed by the U.S. National Library of Medicine, provides authoritative coverage of biomedical and clinical studies, ensuring access to high-quality peer-reviewed literature on behavioral addictions, including smartphone-related health effects. Scopus, a European-based multidisciplinary database, offers broader coverage of social sciences, psychology, and technology-related research, allowing identification of studies on psychosocial, cultural, and technological determinants of smartphone use. Using both databases ensures comprehensive coverage across medical, psychological, and digital health domains, which is particularly important for a narrative review aiming to integrate interdisciplinary perspectives.

The primary rationale for focusing on systematic reviews and meta-analyses is that these study types synthesize and critically appraise large bodies of individual primary research, providing consolidated, evidence-based overviews of key findings, methodologies, and research trends. This approach ensures a stable and comprehensive perspective on the field, avoiding fragmentation caused by isolated or contradictory single studies.

Priority was given to recent systematic reviews and meta-analyses, as these often include and build upon earlier foundational research. This ensures that the review reflects the most current scientific advances and consensus, while also acknowledging the historical development of concepts and methods. This strategy reduces redundancy and increases the relevance of conclusions for current research and clinical practice.

Inclusion criteria were established to select systematic reviews and meta-analyses specifically focused on smartphone addiction or problematic smartphone use. Reviews addressing broader categories of digital or behavioral addictions without explicit emphasis on smartphones were excluded to maintain focus and clarity. Similarly, studies lacking methodological rigor or transparency in the review process were omitted.

The literature search aimed to capture a comprehensive and clinically relevant picture of smartphone addiction, focusing exclusively on systematic reviews. These studies were selected to ensure that the evidence synthesized was robust, reproducible, and representative of high-quality research. Particular attention was given to reviews that examined behavioral, psychological, and neurobiological correlates of problematic smartphone use. The selection also emphasized contributions addressing young populations, as they are most affected by intensive smartphone engagement. Both recent publications and reviews building upon foundational work were considered, enabling an overview of emerging trends, assessment methods, and intervention strategies.

The literature search was conducted using the composite search key reported in Box 1, which was designed to comprehensively capture relevant studies across multiple domains related to smartphone addiction. This search strategy ensured broad yet targeted coverage, encompassing psychological, neurobiological, and technological perspectives., We placed particular emphasis on studies involving young people sometimes referred to with a variety of terms, such as ‘youth,’ ‘adolescents,’ ‘teen,’ ‘immature,’ and ‘junior,’ to capture the most relevant populations. This narrative review methodology allows for a flexible and nuanced exploration of the topic, combining the methodological rigor of systematic syntheses with the ability to discuss conceptual developments, emerging challenges, and research gaps. Although narrative reviews do not follow the strict protocols of systematic reviews, this work adhered to established guidelines such as the ANDJ checklist for transparency and comprehensive reporting.

Box 1. Used composite key.

((smartphone[Title/Abstract]) OR (mobile phone[Title/Abstract]) OR (cell phone[Title/Abstract]) O(mobile device[Title/Abstract]) OR (digital media use [Title/Abstract]))

AND

((addiction[Title/Abstract]) OR (dependence[Title/Abstract]) OR (problematic use[Title/Abstract]) OR (compulsive use[Title/Abstract]) OR (overuse[Title/Abstract]))

By integrating findings from recent high-quality evidence syntheses, this review aims to identify core themes such as assessment challenges, neurobiological and psychosocial mechanisms, vulnerability and resilience factors, and intervention strategies. This comprehensive perspective supports future research and clinical practice responsive to the complex and evolving nature of smartphone addiction.

3. Results

The results of this review are organized into seven Section 3.1, Section 3.2, Section 3.3, Section 3.4, Section 3.5, Section 3.6 and Section 3.7, each providing a structured overview of the current evidence on smartphone addiction, with a particular focus on youth.

Section 3.1, Study Selection Flow: outlines the narrative review process, inspired by PRISMA guidelines, detailing how 25 systematic reviews were identified, screened, and included.

Section 3.2, Publication Trends: Search, Analysis, and Interpretation: examines the growth and characteristics of research in this field, highlighting recent trends and the increasing scientific interest in smartphone addiction.

Section 3.3, Themes and Common Message: synthesizes the main patterns emerging across the selected reviews, presenting key recurring insights while remaining broadly applicable to diverse populations and study designs.

Section 3.4, Interpretation of Results: provides a considered discussion of the multidimensional nature of smartphone addiction, encompassing behavioral, psychological, and social aspects.

Section 3.5, Comparison of Systematic Reviews on Smartphone Addiction: contrasts methodologies, populations, and outcomes across studies to highlight commonalities and differences in the literature.

Section 3.6, Gaps in the Literature on Smartphone Addiction in Youth: identifies areas where evidence remains limited, inconsistent, or underexplored, such as longitudinal research, standardized measurement, and cross-cultural perspectives.

Finally, Section 3.7, Emerging Opportunities and Recommendations: outlines directions for future research, clinical practice, and public health initiatives, emphasizing the potential for interventions, prevention strategies, and integrated approaches to address smartphone addiction in young populations.

3.1. Study Selection Flow (Narrative Review, PRISMA-Inspired Description)

A targeted literature search was conducted in PubMed (96 systematic reviews) and Scopus (130 systematic reviews), chosen for their comprehensive coverage of biomedical, psychological, and digital health research relevant to behavioral addictions. This initial search yielded 226 records. After removing 35 duplicates, 191 unique records remained for further consideration.

These records underwent a screening process focusing on both relevance to smartphone addiction and methodological rigor. The aim was not merely to include all available studies, but to prioritize reviews that could meaningfully contribute to understanding the evolution, mechanisms, and interventions related to smartphone addiction. During this phase, 120 records were excluded due to problems with focus. For example, some studies addressed general internet or digital device use without specific reference to smartphones, while others examined behavioral addictions unrelated to digital technology, making their inclusion less relevant for the objectives of this review. This screening left 71 articles for a more detailed assessment.

In the next phase, full-text evaluation, the remaining articles were assessed for their quality, recency, and contribution to the field. 46 articles were excluded at this stage. Among these, 15 were considered outdated, meaning their findings had been largely integrated or superseded by more recent studies, limiting their added value to the current synthesis. Additionally, 31 reviews had been superseded by more recent evidence, such as newer systematic reviews or meta-analyses offering more comprehensive, methodologically robust, or updated findings. These exclusions ensured that the final synthesis was both current and methodologically sound.

Ultimately, 25 systematic reviews [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57] were included in the narrative synthesis. These studies were selected to provide breadth and depth, covering validated assessment tools, behavioral and psychological risk factors, neurobiological correlates, and evidence-based intervention strategies. By integrating historical and contemporary insights, this selection allows the narrative review to highlight emerging trends, consolidate findings across diverse populations, and inform future research, clinical practice, and public health strategies.

3.2. Publication Trends

This investigation is based on a targeted literature search performed exclusively in the PubMed database. The objective was to investigate the volume and characteristics of scientific publications on smartphone addiction and related digital device use in healthcare. To ensure broad yet specific coverage, three composite search keys were applied (see Box 2) to capture relevant studies.

Box 2. Used composite keys.

((smartphone[Title/Abstract]) OR (mobile phone[Title/Abstract]) OR (cell phone[Title/Abstract]) OR (mobile device[Title/Abstract]) OR (digital media use [Title/Abstract]))

AND

((addiction[Title/Abstract]) OR (dependence[Title/Abstract]) OR (problematic use[Title/Abstract]) OR (compulsive use[Title/Abstract]) OR (overuse[Title/Abstract]))

(smartphone[Title/Abstract]) AND (addiction[Title/Abstract])

(smartphone[Title/Abstract]) OR (mobile phone[Title/Abstract]) OR (cell phone[Title/Abstract]) OR (mobile device[Title/Abstract]) OR (digital media use [Title/Abstract])

Using Key 1, which broadly includes terms related to smartphones, mobile devices, and addiction-related keywords, a total of 2518 publications were retrieved dating back to 2001. The majority of these studies (2375; 94.3%) were published in the last 10 years, and 1778 (70.6%) appeared in the last 5 years, demonstrating a strong recent growth in scientific interest.

Focusing more narrowly on smartphone addiction, Key 2 retrieved 1466 publications from 2011 onwards. Of these, nearly all (1431; 97.6%) were published in the last 10 years, and a substantial share (1089; 74.3%) appeared in the last 5 years, confirming the rapidly expanding nature of this research field.

The third search, Key 3, which encompasses mobile and digital devices in healthcare more broadly, yielded 44,070 publications dating back to 1969. Although the time span is considerably longer, 38,317 (86.9%) of these publications were released in the last ten years, and 25,429 (57.7%) in the last five years, highlighting not only sustained but also accelerating growth in research activity within this domain.

Table 1. Comparative summary.

Search Key	Total Publications	Last 10 Years	% of Total	Last 5 Years	% of Total
Key 1—Smartphone/Mobile + Addiction Terms	2518	2375	94.3%	1778	70.6%
Key 2—“Smartphone Addiction” Only	1466	1431	97.6%	1089	74.3%
Key 3—Mobile/Digital Devices in Healthcare	44,070	38,317	86.9%	25,429	57.7%

reports a comparative summary.

In-Depth Interpretation

The PubMed data reveal a rapidly expanding and highly dynamic research landscape for smartphone addiction, reflecting both the increasing societal penetration of smartphones and the rising awareness of their behavioral health impacts.

• Key 1, which captures a broad spectrum of smartphone- and mobile-related addiction studies, shows that 94.3% of publications appeared in the last ten years, with 70.6% published in the last five years. This suggests a recent acceleration of scientific interest, likely driven by technological advancements, wider smartphone adoption, and growing recognition of potential risks associated with prolonged device use.
• Key 2, focused specifically on “smartphone addiction,” demonstrates an even sharper concentration of recent research: 97.6% of studies in the last ten years and 74.3% in the last five. This indicates that smartphone addiction has emerged as a distinct research domain only in the past decade, underscoring the urgency of developing standardized definitions, reliable assessment tools, and evidence-based interventions.
• Key 3, encompassing mobile and digital device applications in healthcare, reflects a larger and more mature field, yet it too shows strong recent growth (86.9% in the last ten years, 57.7% in the last five). This highlights the interconnectedness of smartphone addiction research with broader digital health technologies, including mobile health (mHealth), telemedicine, and health behavior monitoring.

Taken together, these findings illustrate that smartphone addiction research is both emergent and embedded within a wider technological and clinical context. The temporal concentration of publications suggests that scientific understanding is evolving rapidly, but also points to potential gaps in longitudinal studies, cross-cultural validation, and interdisciplinary integration.

Importantly, the data support the choice of a narrative review approach, which allows for synthesis of high-quality evidence while integrating insights across psychological, neurological, social, and technological domains. By situating smartphone addiction research within this broader context, it becomes possible to identify emerging trends, highlight unresolved questions, and inform future directions for both research and clinical interventions.

3.3. Themes and Common Message

3.3.1. Common Message

Recent evidence underscores the growing concern surrounding behavioral addictions related to digital technology and smartphone use, particularly among adolescents and young adults. Systematic reviews consistently indicate that problematic engagement with online platforms, internet use, and smartphones is associated with a range of psychosocial and cognitive consequences [33,34,35]. Nomophobia, defined as the fear of being without a mobile phone, has emerged as a prevalent phenomenon linked to anxiety, sleep disturbances, and social withdrawal [36,52]. Loneliness and boredom are frequently identified as both correlates and potential mediators of excessive digital device use [37,41,54].

High levels of smartphone or internet engagement appear to negatively impact academic performance, with sedentary behavior and reduced physical activity serving as contributing factors [38,39,45,46]. Additionally, early maladaptive schemas and parental affective disorders have been implicated in increasing vulnerability to digital addiction among younger populations [40,49]. Neurocognitive evidence, particularly from fMRI studies, suggests that excessive internet and smartphone use may impair cognitive control and executive functioning in adolescents and young adults [48].

The COVID-19 pandemic has further amplified these trends, with systematic reviews documenting increased smartphone and internet addiction alongside heightened mental health challenges, including anxiety, depression, and insomnia [41,43,51]. Among medical and nursing students, these associations are particularly pronounced, reflecting the combined pressures of academic demands and social isolation [42,50]. Notably, interventions such as physical activity programs and structured digital tools for behavior modification show promise in mitigating addiction-related outcomes, although evidence remains preliminary [45,47].

Overall, the literature converges on the understanding that digital addictions are multidimensional, encompassing psychological, social, and neurocognitive factors. These findings highlight the urgent need for targeted interventions, early identification strategies, and longitudinal research to elucidate causal pathways and inform evidence-based prevention policies.

3.3.2. Emerging Themes

By applying the procedure, 25 systematic reviews [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57] were selected.

Table 2. Sketch of the overviewed studies.

Reference	Focus	Aim	Emerging Themes	Key Results
Thomas, M.F. et al. [33]	Problematic online dating	To synthesize existing literature on problematic online dating and identify research gaps	Variability in definitions; psychological and behavioral correlates; methodological heterogeneity	Highlighted inconsistent definitions; associations with impulsivity, anxiety, and social difficulties; need for standardized assessment tools
Crowhurst, S., Hosseinzadeh, H. [34]	Smartphone addiction	To identify longitudinal predictors and risk factors for smartphone addiction	Individual, social, and environmental risk factors; longitudinal evidence	Risk factors include baseline anxiety, low self-control, high social media use; social support may mitigate risk
Andrade, L.I., Viñán-Ludeña, M.S. [35]	ICT addiction	To map research trends and commonalities across ICT addictions	Cross-domain similarities; neurocognitive correlates; comorbidity with mental health disorders	Internet and smartphone addictions share psychological mechanisms; gaming addiction often linked with impulsivity; rising trend in social media addiction research
Al-Mamun, F. et al. [36]	Nomophobia	To quantify prevalence and understand population-level patterns of nomophobia	Age and gender differences; regional variations; relationship with anxiety	Pooled prevalence around 20–30%; higher in young adults and students; significant association with anxiety and sleep disturbances
Mestre-Bach, G. et al. [37]	Internet use disorder & loneliness	To evaluate whether internet use disorders are associated with loneliness	Bidirectional relationship; categorical severity approach; mental health correlates	Strong positive association between internet use disorder severity and loneliness; effect sizes higher in severe cases
Kuş, M. [38]	Technology and academic performance	To quantify effect of digital tools and device use on learning performance	Device use, social media, digital distraction	Excessive technology use negatively impacts academic performance; moderate educational technology use can enhance learning outcomes
Nambirajan, M.K. et al. [39]	Smartphone addiction & sedentary behavior	To examine association between smartphone addiction and sedentary lifestyle	Screen time, physical inactivity, age differences	Smartphone addiction positively associated with sedentary behavior; strongest effects in adolescents
Li, Q. et al. [40]	Parental affective disorders & digital addiction	To determine whether parental affective disorders increase risk of digital addiction in offspring	Intergenerational influence; emotional regulation; parenting style	Children of parents with affective disorders show higher risk of digital addiction; parental guidance and emotional support are protective factors
Hu, J., Zhao, C., Yu, T. [41]	Boredom and smartphone addiction	To investigate how boredom relates to smartphone addiction pre- and post-pandemic	Behavioral shifts due to pandemic, boredom as a predictor	Increased smartphone addiction post-pandemic; boredom consistently associated with higher addiction levels
Efstathiou, M., et al. [42]	Mental health in nursing students	To synthesize prevalence data on mental health issues among nursing students	High stress, anxiety, depression in health students	Significant prevalence of anxiety and depression; consistent across multiple studies
Pham, P.T.T., et al. [43]	Smartphone/internet addiction and mental health during COVID-19	To examine the association between digital addiction and mental health during the pandemic	COVID-19 impact on digital behaviors, stress, anxiety	Strong correlations between addiction and poor mental health outcomes
Yuan, G., et al. [44]	Screen time and Autism Spectrum Disorder	To assess risk and usage patterns of screen time in ASD populations	Excessive screen exposure, potential addiction, developmental impact	High screen time associated with social and behavioral challenges in ASD
Pirwani, N., Szabo, A. [45]	Physical activity and smartphone addiction	To explore whether physical activity mitigates smartphone addiction in university students	Intervention strategies, lifestyle modifications	Physical activity linked to reduced addiction symptoms and improved wellbeing
Paterna, A., et al. [46]	Problematic smartphone use and academic achievement	To examine the relationship between smartphone use and academic performance	Academic impact of addiction, cognitive interference	Higher problematic use associated with lower academic achievement
Goh, K.W., et al. [47]	Digital tools for smoking cessation	To evaluate effectiveness of digital interventions in Asian populations	eHealth interventions, adherence factors	Digital tools moderately effective; engagement and cultural adaptation critical
León Méndez M, et al. [48]	Cognitive control and digital addiction	To assess neural correlates of internet and smartphone addiction in adolescents and young adults	Neurocognitive impacts, fMRI evidence	Impaired cognitive control and altered brain activation patterns in addicted individuals
Vieira, C., Kuss, D.J., Griffiths, M.D. [49]	Early maladaptive schemas and behavioral addictions	To investigate links between early maladaptive schemas and behavioral addictions	Psychological vulnerability factors, schema theory	Certain maladaptive schemas consistently associated with higher addiction risk
Leow, M.Q.H., Chiang, J., Chua, T.J.X., Wang, S., Tan, N.C. [50]	Smartphone addiction and sleep	To examine the relationship between smartphone addiction and sleep quality	Sleep disturbance, academic stress, excessive screen time	Smartphone addiction significantly associated with poorer sleep quality among medical students
Nour MO, Alharbi KK, Hafiz TA, et al. [51]	Depression prevalence	To determine prevalence and associated factors of depression among adults	Gender, age, socio-economic status, chronic illness	High prevalence of depression; several demographic and health-related factors associated
Daraj, L.R., AlGhareeb, M., Almutawa, Y.M., et al. [52]	Nomophobia and mental health	To explore correlations between nomophobia, anxiety, smartphone addiction, and insomnia	Anxiety, sleep disturbance, excessive phone use	Strong positive correlations between nomophobia and anxiety, smartphone addiction, and insomnia symptoms
Cilligol Karabey, S., Palanci, A., Turan, Z. [53]	Social and academic impact	To investigate how smartphone addiction affects social life and academic performance	Peer relationships, academic distraction, screen time	Smartphone addiction negatively affects social interactions and academic performance in adolescents
Ge, M.W., Hu, F.H., Jia, Y.J., et al. [54]	Loneliness and digital addiction	To examine the relationship between loneliness and internet/smartphone addiction	Social isolation, mental health, screen exposure	Loneliness is a significant predictor of higher internet and smartphone addiction levels
Rahmillah, F.I., Tariq, A., King, M., Oviedo-Trespalacios, O. [55]	Road distraction	To assess whether mobile phone-related distraction is linked to unsafe driving	Road safety, attention, phone usage	Maladaptive mobile phone use is associated with increased risk of distraction and traffic accidents
Chu, Y., Oh, Y., Gwon, M., et al. [56]	Smartphone use and sleep quality	To perform dose–response analysis between smartphone usage and self-reported sleep quality	Usage intensity, sleep disturbance, behavioral patterns	Higher smartphone use linked to poorer self-reported sleep quality in a dose-dependent manner
Akhtar, F., Patel, P.K., Heyat, M.B.B., et al. [57]	Smartphone addiction and health outcomes	To examine harmful effects of smartphone addiction on mental health, oxidative stress, and neurodegeneration	Mental health, oxidative stress, neurodegeneration, interventions	Smartphone addiction adversely affects mental health, increases oxidative stress, and may contribute to neurodegenerative changes; potential for targeted anti-addiction strategies

provides an organized overview structured into several key columns: No. (number), Reference (citation of the study), Focus (main topic or area of investigation), Description (brief summary of the study), Aim (objectives the study sought to achieve), Emerging Themes (new or recurring concepts identified across studies), and Key Results (main findings and conclusions). This layout offers a clear and concise framework to compare and contrast the contributions of each study, highlighting the evolving themes and significant outcomes within the field.

Thomas MF et al. reviewed problematic online dating, emphasizing the heterogeneity in definitions, associated factors, and study designs [33]. Their findings underscore the need for standardized criteria to advance research and intervention strategies. Crowhurst and Hosseinzadeh focused on longitudinal studies of smartphone addiction, identifying key risk factors such as stress, anxiety, poor emotional regulation, and excessive social media use, which can predispose individuals to compulsive digital behaviours [34].

Andrade and Viñán-Ludeña provided a comprehensive mapping of research on ICT addiction, encompassing Internet, smartphone, social media, and gaming addictions [35]. Their review highlights the growing volume of literature while stressing the importance of distinguishing between different types of digital addictions to tailor prevention and treatment approaches effectively. Similarly, Al-Mamun et al. quantified the prevalence of nomophobia through meta-analysis, revealing significant rates across populations, with variations according to age, gender, and cultural context [36].

Mestre-Bach et al. examined the link between internet use disorder symptoms and loneliness, reporting a consistent positive association and underlining the psychosocial impact of excessive internet use [37]. Kuş conducted a meta-analysis on technology-related factors and students’ academic performance, showing that excessive device use can impair learning outcomes, whereas mindful technology management may mitigate negative effects [38]. Nambirajan et al. analyzed the relationship between smartphone addiction and sedentary behavior in children, adolescents, and young adults, confirming that higher dependence correlates with more sedentary lifestyles, raising concerns for physical and mental health [39]. Finally, Li et al. explored how parental affective disorders influence digital addiction in children and adolescents, suggesting that parental emotional difficulties can increase the vulnerability of youth to problematic digital behaviors [40].

Hu et al. examined the relationship between boredom and smartphone addiction, comparing patterns before and after the COVID-19 pandemic [41]. Their meta-analysis highlighted how heightened boredom during lockdowns exacerbated compulsive smartphone use, emphasizing the pandemic’s impact on digital behavior. Similarly, Efstathiou et al. synthesized meta-analytic evidence on mental health issues among nursing students, revealing high prevalence rates of anxiety, depression, and stress, which may interact with problematic technology use [42].

Pham et al. focused specifically on the pandemic context, analyzing the association between smartphone and internet addiction and mental health outcomes [43]. Their findings indicate that increased digital engagement during COVID-19 was linked to higher risks of depression and anxiety, underscoring the need for integrated mental health interventions. Yuan et al. provided a comprehensive review of screen time and autism spectrum disorder, addressing patterns of usage, risk factors, and potential for digital addiction in this population [44].

Pirwani and Szabo investigated whether physical activity could mitigate smartphone addiction in university students, finding evidence that structured exercise may reduce compulsive device use and support mental well-being [45]. Paterna et al. examined the relationship between problematic smartphone use and academic performance, concluding that excessive use negatively affects learning outcomes and emphasizing the importance of behavioral monitoring [46]. Goh et al. assessed the effectiveness of digital tools for smoking cessation in Asian countries, illustrating how technology-based interventions can positively influence health behavior when properly designed [47].

León Méndez et al. explored the effects of internet and smartphone addiction on cognitive control in adolescents and young adults through fMRI studies, demonstrating altered neural patterns in executive function and self-regulation [48]. Finally, Vieira et al. reviewed early maladaptive schemas in relation to behavioral addictions, highlighting how entrenched cognitive patterns may predispose individuals to compulsive engagement with digital technologies [49].

Further studies have reinforced the complex links between smartphone use, mental health, and physiological outcomes. Leow et al. conducted a systematic review and meta-analysis examining the relationship between smartphone addiction and sleep quality among medical students [50]. Their findings consistently indicate that excessive smartphone use correlates with poorer sleep, reduced sleep duration, and increased sleep disturbances, highlighting a critical area for student well-being interventions.

Nour et al. analyzed the prevalence of depression among adults in Saudi Arabia, identifying multiple sociodemographic and behavioral risk factors that intersect with technology use [51]. Daraj et al. specifically addressed “nomophobia” (fear of being without a mobile phone), showing strong correlations with anxiety, smartphone addiction, and insomnia symptoms [52]. These findings suggest that nomophobia may serve as both a symptom and a reinforcing factor in broader behavioral addiction patterns.

Cilligol Karabey et al. reviewed the social and academic consequences of smartphone addiction in adolescents, showing impairments in attention, academic performance, and interpersonal relationships [53]. Similarly, Ge et al. explored the association between loneliness and internet or smartphone addiction in adolescents, reporting a bidirectional relationship where social isolation both contributes to and results from excessive digital engagement [54].

Rahmillah et al. investigated the implications of maladaptive mobile phone use for road safety, emphasizing that distracted driving is strongly associated with compulsive smartphone behavior, raising significant public health concerns [55]. Chu et al. conducted a dose–response meta-analysis of smartphone use and sleep quality, confirming that higher durations of device use are linked to poorer subjective sleep outcomes [56].

Finally, Akhtar et al. provided a comprehensive survey integrating systematic review, research questions, and network visualization techniques to map the impact of smartphone addiction on mental health, oxidative stress, and neurodegenerative processes [57]. Their work highlights potential biological mechanisms and points toward future anti-addiction interventions that could combine behavioral and pharmacological strategies.

Collectively, these studies underscore the multifaceted consequences of smartphone addiction across cognitive, emotional, social, and physiological domains, highlighting the urgent need for multi-level interventions and targeted strategies for vulnerable populations, especially adolescents and university students.

3.4. Interpretation of Results

The systematic reviews and meta-analyses examined highlight that smartphone addiction is a multifactorial phenomenon with wide-ranging behavioral, cognitive, and psychosocial consequences. Across the literature, definitions of problematic smartphone use remain heterogeneous, which complicates comparisons and synthesis of findings. Variability in conceptualization is not unique to smartphones; similar challenges are observed in broader online behavioral addictions, with studies highlighting inconsistencies in how behaviors are defined and measured [33]. ICT-related addictions, including smartphones, social media, and gaming, often overlap conceptually, reflecting ambiguities in the frameworks used to assess digital engagement and addiction [35].

Several risk factors for smartphone addiction consistently emerge. Individual vulnerabilities, including personality traits, emotional dysregulation, and pre-existing psychological conditions, appear to predispose youth to higher risk [34]. Environmental and behavioral factors further modulate this risk. Sedentary behavior, for instance, shows a strong association with smartphone addiction in children, adolescents, and young adults, suggesting that prolonged inactivity may reinforce excessive device use [39]. Familial influences are also notable; parental affective disorders are associated with a greater likelihood of digital addiction in offspring, indicating intergenerational and environmental contributions to vulnerability [40]. Situational factors, such as boredom or social isolation during events like the COVID-19 pandemic, have similarly been linked to increased smartphone use, highlighting the role of contextual stressors in exacerbating addictive behaviors [41].

The consequences of smartphone addiction are broad and multidimensional. Mental health outcomes are consistently reported, with elevated levels of anxiety, depression, and insomnia documented across multiple populations [43,52]. Sleep disturbances are particularly well characterized among medical and university students, with meta-analytic evidence suggesting dose–response relationships between smartphone usage and impaired sleep quality [50,56]. Cognitive impacts, including deficits in attention, executive function, and cognitive control, are increasingly identified in adolescents and young adults with high smartphone engagement, with neuroimaging studies providing preliminary mechanistic insights [48]. Academic performance is also negatively affected, with higher smartphone usage correlating with reduced learning outcomes, lower grades, and impaired task completion [38,46].

Psychosocial implications are equally significant. Adolescents with higher levels of smartphone addiction report increased loneliness, social isolation, and difficulties in peer relationships, underscoring the interplay between excessive device use and social functioning [37,54]. Negative academic and social outcomes are reinforced by maladaptive engagement patterns, as excessive smartphone use can displace in-person interactions and structured activities [53]. Protective factors, including physical activity, appear to mitigate some of these effects, suggesting that interventions targeting lifestyle behaviors may offer practical avenues to reduce addiction risk and its associated harms [45].

Emerging evidence also points to neurobiological and physiological consequences. Excessive smartphone use has been linked to oxidative stress and early indicators of neurodegeneration, highlighting potential long-term health risks that extend beyond immediate behavioral or psychosocial outcomes [57].

In summary, the interpretation of current literature indicates that smartphone addiction is a complex, multidimensional phenomenon influenced by individual traits, familial context, environmental factors, and situational stressors. It is strongly associated with mental health difficulties, cognitive impairments, sleep disturbances, social isolation, and diminished academic performance in youth. Despite this robust evidence base, methodological heterogeneity, variable definitions of addiction, and a predominance of cross-sectional designs limit causal inferences. These limitations underscore the need for standardized assessment tools, longitudinal studies, and cross-cultural research to fully understand the mechanisms, trajectories, and potential interventions for smartphone addiction among young populations.

3.5. Comparison of Systematic Reviews on Smartphone Addiction

The systematic reviews and meta-analyses on smartphone addiction reveal both convergence and divergence in terms of methodology, focus, and outcomes, highlighting the complexity of this emerging public health concern. Across the literature, there is broad agreement that smartphone addiction poses risks to the mental, cognitive, and social well-being of youth, yet the depth and scope of investigation differ considerably. Several reviews examine conceptual definitions and measurement approaches, noting inconsistencies in how problematic smartphone use is defined and assessed. For instance, some studies emphasize the overlap of smartphone addiction with broader ICT-related behaviors, including internet use, gaming, and social media engagement [35], while others focus more narrowly on specific behaviors such as problematic online dating [33]. These definitional variations reflect a broader challenge in synthesizing findings and complicate comparisons across studies, particularly when considering adolescents whose usage patterns and developmental needs differ from those of adults.

Population focus emerges as another critical dimension. Some reviews specifically target adolescents and young adults, emphasizing social, academic, and emotional consequences [39,53,54], while others include children [40] or adult populations [51]. The age range and developmental stage of participants shape both the risk factors identified and the outcomes reported. Adolescents, for example, are particularly vulnerable to social influences, peer pressure, and identity formation issues, which intersect with smartphone usage and may amplify addiction risk. In contrast, studies in young adults often highlight academic performance, cognitive load, and lifestyle consequences. This variability in focus underscores the need for age-stratified analyses that can capture developmental nuances in vulnerability and resilience.

Methodological approaches also vary across reviews. Some studies quantify prevalence, effect sizes, and dose–response relationships, providing statistical rigor and allowing the assessment of risk magnitude for outcomes such as sleep disturbances, sedentary behavior, or academic impairment [36,46,56]. Other ones, on the other hand, integrate conceptual frameworks, psychological correlates, and behavioral patterns, offering a richer understanding of underlying mechanisms and potential mediators [33,49]. The combination of both approaches offers complementary insights, yet the lack of standardized measurement instruments limits comparability and may contribute to heterogeneity in reported prevalence and risk estimates.

The outcomes assessed further illustrate both overlap and divergence. Mental health consequences, including anxiety, depression, and insomnia, are consistently reported, emphasizing the psychosocial burden of smartphone addiction [43,52,57]. Sleep quality is a particularly robust finding, with multiple meta-analyses demonstrating dose–response associations between smartphone use and sleep disruption [50,56]. Cognitive effects, especially attention, executive function, and cognitive control deficits, are predominantly explored through neuroimaging studies [48], although these remain limited in sample size and developmental breadth. Behavioral outcomes such as sedentary lifestyle, screen time patterns, and engagement in physical activity are also examined [39,45], providing insight into modifiable risk factors that could be targeted in interventions. Social outcomes, including loneliness, maladaptive interactions, and reduced social cohesion, are especially salient in adolescent populations [37,54], reflecting the interplay between online engagement and real-world social functioning.

Geographical and cultural contexts also shape the findings. Several reviews highlight regional differences in prevalence and behavioral patterns, suggesting that cultural norms, academic pressures, and digital infrastructure influence both smartphone usage and susceptibility to addiction [36,47,51]. Interventions, therefore, may require cultural adaptation, as strategies effective in one setting may not translate directly to others.

Finally, the literature diverges in its emphasis on mechanistic versus applied outcomes. Some studies focus on long-term physiological and neurobiological consequences, including oxidative stress and potential neurodegeneration [57], while others prioritize immediate functional impacts on cognition, academic achievement, and lifestyle behaviors [38,46]. This spectrum, ranging from conceptual and mechanistic insights to applied behavioral outcomes, indicates that a holistic understanding of smartphone addiction in youth requires integration across multiple levels of analysis, encompassing neurobiological, psychological, and social domains.

In sum, the comparison of systematic reviews underscores a robust evidence base on risk factors, mental health outcomes, and behavioral consequences of smartphone addiction in youth. At the same time, differences in populations studied, definitions, methodologies, and outcomes highlight the need for standardized conceptual frameworks, harmonized measurement tools, and cross-population investigations. Addressing these divergences will be essential for synthesizing evidence, informing targeted interventions, and guiding public health strategies to mitigate the impact of smartphone addiction on young populations.

3.6. Gaps in the Literature on Smartphone Addiction in Youth

Despite the substantial growth of research on smartphone addiction among children, adolescents, and young adults, important gaps remain that limit our understanding of its prevalence, mechanisms, and consequences. One of the primary challenges is the lack of standardized definitions and assessment tools. Studies use diverse terms such as “problematic smartphone use” [34,35,46], “nomophobia” [36,52], or “internet use disorder symptoms” [37,54], often relying on self-report scales that were originally developed for adult populations. This inconsistency hampers the comparability of findings and may fail to capture age-specific behaviors, motivations, and contextual factors unique to youth, including school-related demands, peer interactions, and parental monitoring [39,41]. Moreover, the threshold for defining problematic use often varies, leaving uncertainty about what constitutes clinically meaningful smartphone addiction in younger populations.

Another major gap is the limited longitudinal evidence. Most studies adopt cross-sectional designs, which identify associations between smartphone addiction and outcomes such as sedentary behavior [39], poor academic performance [38,46], disrupted sleep [50,56], and mental health problems including depression and anxiety [43,50,51]. While these findings underscore the potential harms of excessive smartphone use, the lack of longitudinal data prevents clear conclusions about causality. For example, it remains unclear whether smartphone addiction drives depressive symptoms and social withdrawal, or whether pre-existing emotional vulnerabilities make youth more prone to problematic use [40,41,43,54]. Similarly, boredom has been linked to increased smartphone engagement before and after the COVID-19 pandemic [41], yet the dynamics of this relationship over time and its interaction with other psychosocial factors are not fully understood.

Protective and moderating factors are also underexplored. Limited evidence suggests that physical activity may mitigate smartphone addiction among university students [45], while parental affective disorders appear to increase vulnerability in children and adolescents [40]. However, research is scarce on other potentially important moderators such as family cohesion, peer support, digital literacy, self-regulation skills, or personality traits [34,35,57]. Understanding these factors is critical for designing effective prevention programs tailored to developmental stages and social contexts.

Another significant gap concerns the neurocognitive consequences of smartphone addiction. Emerging studies suggest that excessive smartphone use may impair cognitive control, attention, and executive function in adolescents and young adults [48]. Neuroimaging evidence, though promising, is limited in scope and sample size, leaving unanswered questions about the long-term effects on the developing brain. Adolescence is a critical period for the maturation of cognitive and emotional regulation processes, and understanding how smartphone addiction intersects with these developmental trajectories is essential for both clinical and educational interventions.

Social and emotional aspects of smartphone addiction also require more attention. Several reviews highlight associations between excessive smartphone use and loneliness, social withdrawal, and maladaptive coping strategies [37,54]. However, most studies focus on isolated outcomes, rather than integrated models that consider how social, emotional, cognitive, and behavioral factors interact to exacerbate or mitigate addiction. Furthermore, the role of online social pressures, peer influence, and identity formation in smartphone addiction has received limited empirical investigation, despite their recognized importance in adolescent development.

Cultural and contextual variability represents another notable gap. Research conducted in Asian populations often emphasizes academic pressure and competitive educational environments as drivers of smartphone addiction [47], whereas studies in Western contexts highlight social interaction, entertainment, and leisure use [34,35]. Cross-cultural investigations are scarce, making it difficult to distinguish universal risk factors from those that are context-specific. Moreover, few studies examine socio-economic influences, urban-rural differences, or access to digital technologies, all of which may shape patterns of smartphone use and vulnerability to addiction.

Finally, intervention research targeting youth remains underdeveloped. While some studies report promising effects of behavioral strategies, physical activity, or digital tools in mitigating smartphone addiction [45,47], high-quality randomized trials with adequate sample sizes are rare. Long-term follow-up and implementation studies are particularly scarce, leaving uncertainty about the sustainability and generalizability of intervention effects. Without rigorous evidence, preventive and therapeutic programs cannot be optimally designed or widely recommended.

In summary, advancing research on smartphone addiction in youth will require the development of age-appropriate and standardized assessment tools, longitudinal and mechanistic studies to clarify causality, exploration of protective and moderating factors, detailed investigation of neurocognitive outcomes, culturally informed research, and robust intervention trials. Addressing these gaps is critical for understanding the full impact of smartphone addiction on the developmental, cognitive, social, and emotional well-being of children, adolescents, and young adults.

3.7. Opportunities and Recommendations for Advancing Research and Practice on Digital Addiction

Despite the growing body of literature on digital addiction, significant gaps remain in how the phenomenon is conceptualized, assessed, and addressed across different contexts. Based on recent systematic reviews and meta-analyses, several key opportunities emerge for advancing the field, alongside concrete recommendations to guide research and policy development.

3.7.1. Opportunities

These are the emerging opportunities:

Clarification and Standardization

A major opportunity lies in clarifying and harmonizing definitions related to smartphone addiction, as emphasized by Thomas et al. [33]. Terminological inconsistencies and methodological variability limit the comparability of findings across studies. Establishing standardized diagnostic criteria and measurement tools would help create a more coherent research landscape and support the development of robust meta-analyses.

Interdisciplinary Approaches

As shown by Crowhurst and Hosseinzadeh [34] and Andrade and Viñán-Ludeña [35], digital addiction is a multifaceted phenomenon that includes smartphone overuse, problematic gaming, compulsive social media engagement, and excessive ICT use more broadly. This complexity calls for interdisciplinary research strategies that bridge psychology, sociology, education, and information technology, enabling more comprehensive insights and effective solutions.

Mental Health Integration

Multiple reviews—including those by Al-Mamun et al. [36] and Mestre-Bach et al. [37]—highlight the strong associations between digital addiction and mental health challenges such as anxiety, depression, and loneliness. This overlap creates an opportunity to better integrate digital addiction screening and treatment into broader mental health care frameworks.

Targeted Youth and Educational Interventions

Emerging evidence from studies such as Kuş [38] and Nambirajan et al. [39] points to the detrimental effects of digital overuse on academic performance, sleep quality, and physical activity among young people. These findings suggest that schools and universities can serve as key settings for early prevention and skill-building, equipping students with the tools to manage digital use healthily.

Pandemic-Driven Research Frontiers

The COVID-19 pandemic dramatically altered digital behaviors worldwide. Studies by Hu et al. [41] and Pham et al. [43] show that factors like social isolation, boredom, and disrupted routines intensified digital overuse. This context creates a new frontier for research into behavioral vulnerability during crises and the long-term implications of digital reliance.

3.7.2. Recommendations

Harmonize Definitions and Measures

The need for standardized definitions and validated assessment tools is strongly reinforced by several systematic reviews. For instance, Thomas et al. [33] and Crowhurst & Hosseinzadeh [34] reported wide variability in operational definitions of problematic smartphone or online behaviors, which undermines comparability and the accumulation of robust evidence. Similarly, Andrade & Viñán-Ludeña [35] highlighted the overlap and blurred boundaries between different ICT-related addictions, further underscoring the importance of unified taxonomies and validated instruments. Such findings converge on the necessity of harmonizing definitions and measures to enable reproducibility, cross-study comparisons, and cumulative learning.

Holistic Mental Health Support

The comorbidity between problematic smartphone use and mental health outcomes is consistently documented across multiple reviews. Al-Mamun et al. [36] and Daraj et al. [52] demonstrated strong associations between nomophobia, anxiety, and insomnia, while Mestre-Bach et al. [37] and Ge et al. [54] confirmed that loneliness is both a predictor and a consequence of excessive digital use. Likewise, Pham et al. [43] found robust links between smartphone/internet addiction and adverse mental health outcomes during the COVID-19 pandemic. These results collectively support the integration of mental health services—targeting anxiety, loneliness, and depression—within prevention and intervention strategies. Cognitive-behavioral interventions, as suggested in several reviews, should be combined with broader psychological and social support to foster resilience and sustainable recovery.

Youth-Centered Preventive Strategies

Given that adolescents and young adults are disproportionately affected, several studies (e.g., Nambirajan et al. [39]; Cilligol Karabey et al. [53]) highlighted the academic and social consequences of excessive smartphone use in these populations. Preventive strategies should therefore target schools and universities, integrating digital literacy, awareness campaigns, and lifestyle interventions such as physical activity, which Pirwani & Szabo [45] found to reduce addiction symptoms and improve wellbeing. Such youth-centered approaches address both behavioral risks and protective factors, supporting healthier digital engagement.

Integration with Physical and Neurobiological Perspectives

Emerging evidence also calls for incorporating physical and neurobiological correlates into prevention and treatment. Kuş [38] and Paterna et al. [46] showed that problematic smartphone use negatively impacts academic performance, while León Méndez et al. [48] documented altered brain activation patterns associated with impaired cognitive control in adolescents and young adults. Moreover, Akhtar et al. [57] highlighted biological pathways such as oxidative stress and neurodegeneration linked to smartphone addiction. Together, these findings emphasize the importance of a multidisciplinary, biopsychosocial approach to intervention.

4. Discussion

Building on the integrated synthesis of the 25 overviewed systematic reviews, empirical studies, and local initiatives, this discussion contextualizes the current state of knowledge on smartphone addiction among youth while highlighting avenues for future research and practice. Across psychological, behavioral, social, and educational domains, excessive smartphone use emerges as a pressing concern, associated with anxiety, depression, disrupted sleep, academic difficulties, and sedentary lifestyles.

Through this synthesis, key gaps and actionable recommendations naturally emerged. These include inconsistencies in definitions and assessment tools, underexplored contextual and psychosocial factors, limited longitudinal and mechanistic evidence, and the need for empirically validated interventions. These insights provide the foundation for structuring the discussion in a way that connects evidence, mechanisms, and practical strategies.

The discussion is grounded both in the evidence-based gaps identified in the literature and in the corresponding recommendations, and is organized into seven interconnected subsections. This approach allows for a differentiated integration of global knowledge, empirical findings, and locally adapted interventions.

Section 4.1 (Summary and Contribution of the Review) specifically highlights the contribution of this overview of 25 systematic reviews. It consolidates fragmented literature and pinpoints key gaps, providing actionable guidance for standardizing assessment tools, integrating digital addiction frameworks into mental health support, and promoting youth-centered preventive programs.

Section 4.2 (Growth in Smartphone Use and Digital Behaviour Trends) situates the discussion within the global proliferation of smartphones among Generation Z. Patterns of daily engagement, gender-specific vulnerabilities, and school-day digital behavior underscore the gaps in longitudinal evidence, moderating factors, and socio-cultural variability, while pointing to recommendations for youth-centered preventive strategies, digital literacy programs, and balanced device use.

Section 4.3 (Beyond Diagnosis: Addressing Smartphone Addiction Through Global Guidelines) examines the diagnostic gap, noting the absence of formal recognition in DSM-5-TR and ICD-11. The section links global guidance from WHO, AAP, RCPCH, and the European Commission to the gaps identified in standardized assessment and policy frameworks, emphasizing prevention-focused strategies and interdisciplinary, evidence-informed policy development.

Section 4.4 (RCTs and Clinical Trials Informing Prevention and Treatment Strategies) presents empirical evidence supporting intervention effectiveness. By testing cognitive-behavioral, mindfulness, physical, and digital approaches, RCTs address gaps in intervention validation, short-term follow-up, and heterogeneity, providing actionable recommendations for multi-modal, empirically grounded prevention and treatment strategies.

Section 4.5 (Psychological Mechanisms Underlying Problematic Digital Use) explores individual-level vulnerabilities—personality traits, emotional regulation, attachment styles, and FoMO—that the reviews identified as underexplored. Integrating these mechanisms with empirical studies informs recommendations to tailor interventions using mindfulness, attachment-informed, and personality-sensitive approaches.

Section 4.6 (Importance of Local Initiatives: An Italian Example from the Istituto Superiore di Sanità) illustrates the translation of global guidance into context-sensitive, youth-centered actions. Local initiatives, including educational campaigns, CAWI surveys, and school-to-work programs, exemplify practical implementation strategies that address gaps in cultural adaptation, youth engagement, and real-world applicability.

Section 4.7 (Limitations) acknowledges methodological constraints of the narrative synthesis while emphasizing the mitigations applied, including systematic inclusion of RCTs, transparent criteria, and a translational focus. These limitations highlight areas for future research—standardized, longitudinal, and mechanistically informed studies—to strengthen evidence-based practice.

Collectively, these subsections illustrate a coherent framework for understanding smartphone addiction in youth, showing how the gaps and recommendations, derived directly from the 25 systematic reviews, guide the integration of research, policy, and practice. The following discussion elaborates on these areas, emphasizing actionable strategies that bridge global, empirical, and local knowledge to inform prevention, intervention, and health promotion initiatives.

4.1. Summary and Contribution of the Review

This narrative review of systematic reviews addresses the pressing issue of smartphone addiction by examining 25 studies that collectively reflect the current state of scientific knowledge. The analysis confirms growing concern about psychological and behavioral risks linked to excessive smartphone use—particularly among adolescents and young adults. Frequently reported issues include anxiety, depression, poor sleep, academic difficulties, and sedentary lifestyles.

While numerous systematic reviews have explored aspects of smartphone addiction, a broader, integrative perspective was needed. Many reviews focus on single dimensions (e.g., sleep, mental health, or academic performance), leaving the field fragmented. By synthesizing multiple systematic reviews, this work

• Highlights convergent findings across diverse domains.
• Identifies gaps in conceptual frameworks, definitions, and methodologies that limit cumulative knowledge.
• Offers actionable recommendations directly informed by multiple lines of evidence.

Beyond documenting risks, the review outlines directions for advancing research and guiding interventions [38,40,41,45,46,54]. Key priorities include the standardization of definitions and assessment tools, integration of digital addiction frameworks within mental health support, promotion of educational programs for prevention, counterbalancing sedentary behaviors through physical activity, and monitoring post-pandemic shifts in digital habits. Moreover, family and social contexts emerge as critical factors for designing sustainable, long-term interventions.

The Original Contribution of the Review

This review contributes uniquely in several ways, going beyond risk documentation to provide a structured, critical synthesis of a fragmented yet rapidly growing field. Compared to previous systematic reviews, its added value lies in:

• Consolidation of evidence: integrates findings from 25 systematic reviews into a single, coherent overview, overcoming fragmentation.
• Identification of gaps: exposes inconsistent definitions, heterogeneous tools, and underexplored domains that hinder progress.
• Actionable guidance: translates evidence into practical recommendations for interventions and research priorities, with a focus on youth populations.
• Forward-looking perspective: situates current knowledge within emerging challenges, including post-pandemic digital behaviors, new technologies, and evolving social contexts.
• Bridging disciplines: combines insights from psychology, behavioral science, education, and public health to inform holistic prevention and intervention strategies.

In a context of rapidly evolving youth digital behaviors, this review provides both a map of existing knowledge and a roadmap for future research and practice, supporting coordinated strategies for prevention, education, and mental health promotion.

4.2. Growth in Smartphone Use Among Young People and Digital Behaviour Trends

Recent global statistics reveal a rapid surge in smartphone adoption among youth, reflecting a broader worldwide proliferation of these devices. As of early 2025, approximately 4.69 billion people globally own a smartphone, marking an increase of around 440 million users from 2024, with projections estimating nearly 5.8 billion users by 2028 [58]. Among Generation Z, smartphone ownership exceeds 95–98%, with many young individuals relying on their phones as their primary means of digital access [59]. According to the Pew Research Center’s “Teens, Social Media and Technology 2024” report, nearly all U.S. teens (96%) use the internet daily, with 46% reporting being online “almost constantly” [60]. Smartphone ownership among teens is nearly universal, with 95% of 13- to 17-year-olds owning a smartphone. The most popular platforms among teens are YouTube (90%), TikTok (63%), Instagram (60%), and Snapchat (55%). Facebook usage has declined to 32%, and X (formerly Twitter) usage has decreased to 17%. WhatsApp usage has increased to 23%, while Reddit remains stable at 14%.

According to the U.S. National Center for Health Statistics, 50.4% of adolescents aged 12–17 spend four or more hours per day on screens, excluding time spent on schoolwork [61]. A detailed school-day study by the Seattle Children’s Research Institute tracked 117 teens and found that they spent nearly 25% of class time on their smartphones, mostly engaging in messaging, Instagram, video streaming, or email. This behavior raises concerns about potential learning displacement and cognitive disruption during critical educational periods [62].

Complementing these growth figures, European Union data show that nearly 97% of teenagers aged 16–29 report daily internet use in 2024, compared to 88% of the general population [63]. In the United States, 95% of teens aged 13–17 have smartphone access, with many online daily or near-constantly [64].

Mental Health and Usage Patterns

According to PISA 2022 data from 22 EU countries, 96% of 15 year olds reported daily engagement with social media, and 37% spent more than three hours per day on these platforms [65]. These high usage patterns correlate with elevated rates of anxiety and depression, especially among adolescent girls—reflecting gender-specific vulnerability commonly reported in broader digital well-being research [66]. The World Health Organization’s European report similarly highlights a rise in problematic social media use from 7% in 2018 to 11% in 2022, alongside 12% at risk for problematic gaming; girls appear more vulnerable [67].

Longitudinal studies from 2021 to 2023 show a continuing increase in smartphone use over 3 h daily and more frequent symptoms of problematic smartphone use (PSU), especially among girls and younger children. These trends are associated with declines in overall quality of life [68].

From all of the above emerges that smartphone ownership and daily internet use among youth have become nearly universal, embedding digital connectivity deeply into their social and educational lives. However, excessive use—particularly beyond three hours per day—is associated with increased anxiety, depression, and reduced well-being, with girls and younger children being especially vulnerable. The rising prevalence of problematic and addictive smartphone behaviors underscores the need for targeted interventions.

Frequent smartphone use during school hours risks disrupting attention and learning, potentially impacting academic performance. The COVID-19 pandemic has further amplified these trends, emphasizing the necessity for ongoing monitoring and updated strategies to support youth mental health and digital habits.

Overall, these findings highlight the complex challenges posed by smartphone use among young people and stress the importance of focused research and policy measures.

4.3. Beyond Diagnosis: Addressing Smartphone Addiction Through Global Guidelines and Preventive Frameworks

Despite the growing prevalence of problematic smartphone use, smartphone addiction is not currently recognized as a formal clinical diagnosis in the leading psychiatric classification systems—the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the International Classification of Diseases, 11th Revision (ICD-11). Specifically:

• The DSM-5-TR [69] includes Internet Gaming Disorder as a condition warranting further research but does not list smartphone or social media addiction as standalone disorders [69,70].
• The ICD-11 [71] recognizes Gaming Disorder under the section on behavioral addictions, but again, general smartphone addiction is excluded [70].

This diagnostic gap has led to significant debate in both academic and clinical communities. While some researchers argue for the inclusion of smartphone addiction based on behavioral and neurobiological similarities with substance use disorders—such as compulsive use, withdrawal symptoms, and functional impairment—others caution against over-pathologizing normative behaviors, especially among adolescents.

Nevertheless, a wide body of empirical research consistently documents negative outcomes associated with excessive smartphone use. These include increased risk for anxiety, depression, sleep disturbances, and academic underperformance, particularly among adolescents and young adults. Calls for diagnostic consensus are intensifying, especially in light of the growing prevalence of digital dependency globally.

The study reported in [70] highlights that problematic smartphone use displays several features of behavioral addictions; however, the absence of standardized diagnostic criteria hinders consistent assessment, comparability across studies, and the development of effective interventions.

While smartphone addiction is not yet officially recognized as a clinical disorder in major diagnostic manuals like the DSM-5-TR or ICD-11, growing clinical and public health attention has prompted several international institutions to publish guidelines, frameworks, and policy recommendations. These documents stop short of labeling the behavior as a formal mental illness, but they clearly frame excessive or problematic digital use as a modifiable health risk, particularly among children and adolescents. The emphasis is on prevention—through digital literacy, lifestyle balance, and self-regulation—rather than clinical diagnosis.

For instance, the World Health Organization (WHO) highlights the importance of balanced digital engagement and psychosocial well-being [72]. The European Commission, through the DigComp 2.2 Digital Competence Framework for Citizens, encourages the development of responsible and reflective digital habits [73]. In the U.S., the American Academy of Pediatrics (AAP) recommends that families create a Family Media Plan to manage screen time and ensure key activities like sleep, physical activity, or face-to-face interaction are not displaced [74]. The Royal College of Paediatrics and Child Health (RCPCH) in the UK similarly stresses that screen time should not interfere with essential behaviors and advocates for school-based interventions to develop resilience and digital literacy among youth [75].

Although not directly targeting smartphone use, the U.S. Food and Drug Administration (FDA) plays a role in regulating digital mental health tools and is developing frameworks for AI-powered interventions that could potentially be used for smartphone-related behavioral problems [76].

Overall, the emerging key insights are

• Smartphone addiction is not yet recognized as a formal diagnosis in DSM-5-TR or ICD-11.
• No standardized clinical criteria currently exist, making evidence across studies difficult to compare.
• Growing concern from health institutions has prompted guidance focused on prevention, regulation, and education—particularly for youth.
• Institutions such as the WHO, AAP, RCPCH, European Commission, and the FDA emphasize the importance of balanced use, family support, school-based programs, and digital literacy.
• The field calls for interdisciplinary, evidence-informed policy frameworks to guide future regulation and potentially inform diagnostic models.

4.4. RCTs and Clinical Trials Informing Prevention and Treatment Strategies

While systematic reviews have identified individual, social, and environmental risk factors underlying problematic digital use, as well as key psychological mechanisms such as emotional regulation, personality traits, and cognitive vulnerabilities [34,35,48,49], empirical intervention studies are necessary to evaluate whether strategies targeting these mechanisms are effective. Randomized controlled trials (RCTs) and clinical studies provide this critical evidence, testing the impact of cognitive-behavioral, mindfulness-based, physical, and digital interventions on reducing problematic smartphone and social media use. In this way, the insights from systematic reviews inform the design and rationale of interventions assessed in clinical settings, bridging the gap between epidemiological knowledge and actionable prevention or treatment strategies.

In the absence of formal diagnostic recognition for smartphone or digital addiction in major classification systems like the DSM-5-TR or ICD-11, randomized controlled trials (RCTs) and clinical studies offer critical empirical support for the growing body of policy recommendations. Guidelines from institutions such as the WHO, AAP, or the European Commission often suggest preventive strategies—like family media plans, screen time limits, or school-based interventions—but RCTs provide the scientific foundation to assess whether these interventions are actually effective in improving mental health outcomes or reducing problematic use.

Moreover, these trials help bridge the gap between clinical debate and public health action. Interventions such as cognitive behavioral therapy (CBT), digital detox programs, or regulatory smartphone apps have been tested in controlled settings, showing measurable improvements in behavior and well-being. These findings lend clinical legitimacy to what is otherwise a still-contested disorder.

Finally, RCTs inform future policy-making. As international agencies move toward developing frameworks for digital mental health, especially for youth, evidence from clinical trials ensures that policies are grounded in robust data—not just precautionary logic. In this sense, RCTs play a pivotal role in shaping both the scientific and regulatory landscape of digital behavior management.

Using the same search strategy described in Section 2, a selection of recent randomized controlled trials (RCTs) and clinical studies was identified, with a specific focus on problematic smartphone use and related behavioral interventions. These studies were included based on their direct contribution to evidence-based strategies that may inform public health guidelines, clinical recommendations, and preventive policies. The selected works address diverse intervention modalities—ranging from psychotherapeutic approaches and app-based coaching to neurostimulation, physical activity, and mindfulness techniques—all aimed at reducing digital overuse or modifying associated cognitive-behavioral patterns. Moreover, several of these trials explore broader digital behavior challenges in youth populations, providing actionable insights that can bridge the current diagnostic gaps and strengthen the foundation for future inclusion in international classification systems.

The selected articles contribute valuable evidence toward shaping future clinical and public health recommendations on problematic smartphone use and related behavioral dependencies. Collectively, they underscore both the feasibility of intervention strategies and the emerging consensus on the need for prevention and self-regulation frameworks. Smartphone addiction has become a pressing concern, particularly among young adults and university students, prompting researchers to explore both its psychological underpinnings and potential interventions. Chen et al. [77] investigated the rehabilitative effects of transcranial direct current stimulation (tDCS) and exergames on smartphone addiction, showing that both interventions could modulate brain activity as measured by EEG, offering promising clinical insights for reducing compulsive smartphone use.

Physical activity has also emerged as a potential strategy. Zhang et al. [78] conducted a randomized controlled trial comparing aerobic exercise and Tai Chi Chuan, finding that structured physical interventions not only reduced problematic smartphone behaviors. but might also influence gut microbiota, suggesting a fascinating gut–brain–behavior link Complementing this, Liu et al. [79] demonstrated that even a brief single-session mindfulness intervention could improve self-control and state mindfulness in students, mediating reductions in smartphone addiction.

Digital and online strategies have likewise shown promise. Throuvala et al. [80] tested a ten-day online program combining mindfulness exercises, self-monitoring, and mood tracking, and found measurable decreases in smartphone-related distraction, highlighting the feasibility of short-term, app-based interventions. Extending this line of research, Guertler et al. [81] evaluated an app-based coaching program for vocational school students, showing small but significant reductions in problematic internet use, stress, and addictive behaviors, alongside improvements in social competence. This study underscores the potential of scalable digital interventions to support mental health and reduce technology-related compulsions among young adults.

Underlying psychological factors remain critical in understanding why some individuals are more vulnerable. Matar Boumosleh and Jaalouk [82] conducted an observational study among Lebanese university students, revealing that both depression and anxiety were independently associated with higher levels of smartphone addiction, emphasizing the need to consider mental health in prevention and treatment strategies.

Taken together, these studies underscore a multi-faceted approach to addressing smartphone addiction: interventions can range from neurostimulation and physical activity to mindfulness practices and app-based digital tools, while accounting for underlying emotional and psychological vulnerabilities. Further research is needed to refine these strategies and explore their long-term effectiveness.

4.5. Psychological Mechanisms Underlying Problematic Digital Use: Linking Review Evidence to Empirical Studies

Systematic reviews on smartphone and social media addiction have consistently highlighted a set of individual, social, and environmental risk factors. Longitudinal and meta-analytic studies show that baseline anxiety, low self-control, high social media use, and sedentary behaviors increase susceptibility to problematic use, particularly in adolescents and young adults [34,39,43]. Reviews also underscore negative outcomes, including disrupted sleep, academic difficulties, mental health problems, and social isolation [46,50,54]. Importantly, several reviews emphasize gaps in understanding the underlying psychological mechanisms—such as personality traits, emotional regulation, and cognitive vulnerabilities—that may drive compulsive engagement with digital technologies [35,48,49]. These insights suggest that interventions targeting behavior alone may be insufficient without considering individual predispositions and moderating factors.

Building on these findings, recent empirical studies provide a deeper understanding of such mechanisms. Giancola et al. [83] demonstrated that both grandiose and vulnerable narcissism predict problematic social media use (PSMU) through the mediating role of fear of missing out (FoMO) in young adults. Importantly, trait mindfulness moderated this pathway, attenuating the effect of FoMO on PSMU. Similarly, Perazzini et al. [84] showed that adult attachment styles influence FoMO, and mindful attitudes buffer this effect, suggesting that mindfulness can protect against excessive engagement driven by social and emotional vulnerabilities.

Additional empirical studies reinforce these findings. Casale et al. [85] conducted a systematic review confirming the association between narcissism and problematic social media use, highlighting FoMO as a key mediating mechanism. Liu et al. [86] found that adult attachment orientations predict social networking site addiction through FoMO and online social support. Santoro et al. [87] showed that mentalization mediates the relationship between attachment styles and PSMU, emphasizing the role of social-cognitive processes. Chang et al. [88] demonstrated in a randomized controlled trial that mindfulness interventions significantly reduce social media addiction among university students, suggesting that enhancing present-focused attention and emotional regulation can mitigate compulsive engagement.

These findings complement the evidence from systematic reviews by linking broad epidemiological patterns to individual-level psychological processes, highlighting specific mediators and moderators that can inform targeted prevention and intervention strategies. Together, these empirical contributions reinforce and extend review-based recommendations, suggesting that effective interventions for smartphone addiction may benefit from incorporating mindfulness training, personality-informed approaches, attachment-sensitive frameworks, and cognitive-behavioral strategies targeting maladaptive attention and emotion regulation patterns. By integrating these mechanisms into preventive programs, researchers and practitioners can design interventions that are more precise, theoretically grounded, and likely to reduce vulnerability to problematic smartphone and social media use.

4.6. Importance of Local Initiatives: An Italian Example from the Istituto Superiore di Sanità

In light of the growing concerns highlighted throughout this review—ranging from excessive smartphone use to its potential impact on mental health and quality of life, particularly in adolescents—strengthening local awareness and prevention initiatives emerges as a crucial strategy. These initiatives allow institutions to translate research evidence into accessible, culturally sensitive, and engaging interventions at community level. The Italian experience, particularly through the work of the Istituto Superiore di Sanità (ISS), offers a compelling model of how national public health entities can operate locally with strategic precision.

Over the past decade, the ISS has developed a multifaceted approach to the issue of smartphone overuse, which includes scientific publications, educational campaigns, digital tools, and public engagement activities. One of the most impactful outputs has been the publication of several ISTISAN Reports aimed at healthcare professionals, educators, and policy-makers. For example, ISTISAN Report 19/15 [89] and ISTISAN Report 18/21 [90] present comprehensive chapters exploring digital risk behaviors, psychological impacts, and methodological frameworks such as CAWI (Computer-Assisted Web Interviewing). It also introduces validated instruments to assess digital dependence and offers guidelines for data-driven public health responses.

An innovative component of ISS’s work has been its investment in youth engagement, exemplified by a school-to-work learning project (Alternanza Scuola-Lavoro). The so-called ‘alternanza scuola-lavoro’ programmes (ASLP)—school-to-work transition initiatives implemented in Italy—offered students hands-on learning opportunities developed in cooperation with experts from industry, public and private bodies, and the third sector, fostering early engagement with societal challenges such as digital well-being. ISS participated and is participating in ASLPS (Salinetti et al., 2018) [91]. This initiative at the ISS, in particular involved high school students in structured educational paths co-designed with public health experts of the ISS, focusing on the social and psychological implications of smartphone use [92,93,94]. By involving students directly in data collection, reflection, and communication, the initiative promoted critical digital literacy and empowered young people as both participants and multipliers of prevention messages.

Furthermore, ISS newsletters (such as the Notiziario dell’Istituto Superiore di Sanità) have showcased the potential of using CAWI instruments among adolescents, underlining the advantages of rapid, anonymous, and user-friendly tools that allow for immediate feedback loops and wider population engagement [92]. These digital surveys, distributed through schools and public events, have proven to be not only efficient for data collection but also highly educational.

Another dimension of ISS’s local engagement is its involvement in European and national science communication events, particularly the European Researchers’ Night. Through multiple editions, the ISS has hosted interactive exhibitions, workshops, and science games focused also on digital health, social behavior, and prevention (see the workshop “lo smartphone un amico ma non troppo” in [95]). These events are designed to resonate with adolescents and families, bridging the gap between research and lived experience.

What makes these initiatives particularly valuable is their ability to speak the language of the target audience—especially youth—while remaining grounded in scientific rigor. They also demonstrate the importance of integrating formal education, public health, and civic participation in promoting healthy digital behavior.

Taken together, these examples suggest that local-level action, when led by national public health authorities and grounded in interdisciplinary collaboration, can serve as a practical and effective component of broader strategies for digital health promotion. These insights can also guide the implementation of international recommendations at country level; the emerging key messages are the following ones:

• Local initiatives rooted in national institutions can play a transformative role in addressing smartphone overuse, particularly among young people.
• The ISS has developed a replicable model that combines scientific dissemination, educational outreach, and public participation.
• Tools such as CAWI surveys and school-based co-design activities show promise in both monitoring risk and building awareness.
• Embedding digital health issues in public events (e.g., Researchers’ Night) facilitates community-wide engagement.
• Countries aiming to implement WHO or EU-level recommendations should consider locally adapted, youth-centered actions as part of their strategic response.

4.7. Limitations

This narrative review was primarily designed to synthesize findings from recent systematic reviews and meta-analyses on smartphone addiction, aiming to provide a comprehensive and conceptually integrated overview of the field. To address common limitations associated with narrative syntheses, several mitigating strategies were applied.

First, all available empirical studies specifically focused on smartphone addiction or problematic smartphone use—including RCTs, clinical trials, and observational studies—were systematically retrieved and included. These studies complement the broader evidence syntheses, offering insights into emerging intervention strategies ranging from mindfulness-based therapies and neuromodulation to app-based coaching, educational programs, and structured physical activity.

Second, the review’s focus on smartphone-specific studies may have excluded broader behavioral addiction research that could provide transferable insights. However, this targeted scope enhances thematic clarity and ensures that conclusions are directly applicable to smartphone overuse and addiction.

Third, although the review does not include a formal risk-of-bias assessment or quantitative meta-synthesis, transparency was ensured through explicit inclusion criteria, adherence to established methodological guidelines (e.g., ANDJ checklist), and the selection of peer-reviewed studies with rigorous design and clearly defined methods.

Fourth, the review integrates a translational dimension, highlighting the relevance of evidence for real-world application. In particular, it considers international policy documents on digital health and youth well-being, alongside local initiatives—such as school-based co-design projects, youth-centered surveys, and public engagement campaigns like the European Researchers’ Night. These examples illustrate how high-level evidence can inform context-sensitive interventions.

Collectively, these strategies enhance the robustness of the review, bridging systematic evidence, diverse empirical studies, international frameworks, and local practices to support actionable, evidence-informed approaches for promoting digital well-being.

5. Conclusions

This narrative review synthesizes evidence from 25 systematic reviews and meta-analyses, complemented by empirical studies—including RCTs and clinical trials—while also considering relevant international documents on digital health and youth well-being, as well as local initiatives. Together, these sources confirm growing concerns regarding the psychological, behavioral, and social risks of excessive smartphone use, particularly among youth, while exposing persistent gaps in definitions, measurement tools, and long-term evidence.

Although no dedicated international guidelines exist for smartphone addiction, broader documents issued by organizations such as the WHO and the European Union provide useful frameworks on digital well-being, prevention of behavioral addictions, and youth health promotion. These frameworks, combined with local initiatives (e.g., school-based co-design projects, national surveys, and community outreach programs), offer operational models for translating evidence into practice and tailoring interventions to specific populations.

By bridging systematic evidence, empirical studies, international policy documents, and locally grounded practices, this review underscores both the urgency and the opportunity to develop integrated strategies that foster healthier digital habits and strengthen digital well-being.