This study aims to determine the prevalence of problematic smartphone use (PSU) among secondary school adolescents and to examine its relationship with psychological problems (depression, anxiety, and stress [Model 1], or the number of psychological problems [Model 2]). This cross-sectional study has utilised a self-administered questionnaire assessing the participants’ sociodemographic and clinical characteristics, pattern and purpose of usage, presence of PSU (via the Malay-version smartphone addiction scale-short version [SAS-SV]), and presence of psychological problems (via the depression-anxiety-stress scale-21 [DASS-21]). Four hundred and fourteen students aged 15–16 from five national secondary schools in Seremban and smartphone users have been recruited via cluster sampling. Students in remedial or special education classes, previously diagnosed with depression, anxiety or stress and absent on the day of data collection were excluded. The prevalence of PSU, probable depression, anxiety and stress were 43.5%, 31.6%, 48.3% and 26.8%, respectively. Most respondents reported mild to moderate severity for each psychological problem. However, three in ten respondents had multiple psychological problems. In both multiple logistic regression models, Malay students had higher daily usage, and the higher monthly costs were significantly associated with PSU when other confounding factors were controlled. A higher number of psychological problems was associated with PSU (adjusted odds ratio: 1.28, 95% confidence interval: 1.06–1.54; p=0.011) but not purpose of usage or individual psychological problem. PSU and psychological problems were prevalent among secondary school adolescents. These findings highlight the complex relationship between PSU and psychological problems that warrant further detailed studies.

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596

• Buctot, D. B., Kim, N., & Kim, J. J. (2020). Factors associated with smartphone addiction prevalence and its predictive capacity for health-related quality of life among Filipino adolescents. Children and Youth Services Review, 110, Article 104758. https://doi.org/10.1016/j.childyouth.2020.104758

• Cha, S. S., & Seo, B. K. (2018). Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use. Health Psychology Open, 5(1). https://doi.org/10.1177/2055102918755046

• Choi, S. W., Kim, D. J., Choi, J. S., Ahn, H., Choi, E. J., Song, W. Y., Kim, S., & Youn, H. (2015). Comparison of risk and protective factors associated with smartphone addiction and Internet addiction. Journal of Behavioral Addictions, 4(4), 308-314. https://doi.org/10.1556/2006.4.2015.043

• Coco, G. L., Salerno, L., Franchina, V., La Tona, A., Di Blasi, M., & Giordano, C. (2020). Examining bi-directionality between fear of missing out and problematic smartphone use. A two-wave panel study among adolescents. Addictive Behaviors, 106, Article 106360. https://doi.org/10.1016/j.addbeh.2020.106360

• Coyne, S. M., Rogers, A. A., Zurcher, J. D., Stockdale, L., & McCall, B. (2020). Does time spent using social media impact mental health?: An eight year longitudinal study. Computers in Human Behavior, 104, Article 106160. https://doi.org/10.1016/j.chb.2019.106160

• Coyne, S. M., Stockdale, L., & Summers, K. (2019). Problematic cell phone use, depression, anxiety, and self-regulation: Evidence from a three year longitudinal study from adolescence to emerging adulthood. Computers in Human Behavior, 96, 78-84. https://doi.org/10.1016/J.CHB.2019.02.014

• Elhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017). Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders, 207, 251-259. https://doi.org/10.1016/j.jad.2016.08.030

• Elhai, J. D., Levine, J. C., Dvorak, R. D., & Hall, B. J. (2016). Fear of missing out, need for touch, anxiety and depression are related to problematic smartphone use. Computers in Human Behavior, 63, 509-516. https://doi.org/10.1016/j.chb.2016.05.079

• Elhai, J. D., Vasquez, J. K., Lustgarten, S. D., Levine, J. C., & Hall, B. J. (2018). Proneness to boredom mediates relationships between problematic smartphone use with depression and anxiety severity. Social Science Computer Review, 36(6), 707-720. https://doi.org/10.1177/0894439317741087

• Fischer-Grote, L., Kothgassner, O. D., & Felnhofer, A. (2019). Risk factors for problematic smartphone use in children and adolescents: A review of existing literature. Neuropsychiatrie, 33(4), 179-190. https://doi.org/10.1007/s40211-019-00319-8

• Hadi, A. A., Nawawi, H. M. M., Shamsuri, N., Rahim, N. N., & Pasi, N. (2019). Smartphone addiction and its relationship with psychological health among students of a medical school in East Coast Malaysia. Asian Journal of Pharmaceutical and Clinical Research, 12(8), 257-260. https://doi.org/10.22159/ajpcr.2019.v12i18.34396

• Haug, S., Castro, R. P., Kwon, M., Filler, A., Kowatsch, T., & Schaub, M. P. (2015). Smartphone use and smartphone addiction among young people in Switzerland. Journal of Behavioral Addictions, 4(4), 299-307. https://doi.org/10.1556/2006.4.2015.037

• Ho, R. C., Zhang, M. W., Tsang, T. Y., Toh, A. H., Pan, F., Lu, Y., Cheng, C., Yip, P. S., Lam, L. T., Lai, C. M., Watanabe, H., & Mak, K. K. (2014). The association between Internet addiction and psychiatric co-morbidity: A meta-analysis. BMC Psychiatry, 14, Article 183. https://doi.org/10.1186/1471-244X-14-183

• Ikeda, K., & Nakamura, K. (2014). Association between mobile phone use and depressed mood in Japanese adolescents: A cross-sectional study. Environmental Health and Preventive Medicine, 19(3), 187-193. https://doi.org/10.1007%2Fs12199-013-0373-3

• Institute for Public Health. (2017). National health and morbidity survey 2017 (NHMS 2017): Adolescent mental health (DASS-21). Ministry of Health Malaysia.

• Ismail, W. S., Sim, S. T., Tan, K. A., Bahar, N., Ibrahim, N., Mahadevan, R., Jaafar, N. R. N., Baharudin, A., & Aziz, M. A. (2020). The relations of Internet and smartphone addictions to depression, anxiety, stress, and suicidality among public university students in Klang Valley, Malaysia. Perspectives in Psychiatric Care, 56(4), 949-955. https://doi.org/10.1111/ppc.12517

• Ithnain, N., Ghazali, S. E., & Jaafar, N. (2018). Relationship between smartphone addiction with anxiety and depression among undergraduate students in Malaysia. International Journal of Health Sciences and Research, 8(1), 163-171.

• Jo, Y. S., Bhang, S. Y., Choi, J. S., Lee, H. K., Lee, S. Y., & Kweon, Y. S. (2020). Internet, gaming, and smartphone usage patterns of children and adolescents in Korea: A c-CURE clinical cohort study. Journal of Behavioral Addictions, 9(2), 420-432. https://doi.org/10.1556/2006.2020.00022

• Jun, S. (2016). The reciprocal longitudinal relationships between mobile phone addiction and depressive symptoms among Korean adolescents. Computers in Human Behavior, 58, 179-186. https://doi.org/10.1016/j.chb.2015.12.061

• Jun, S. (2019). Longitudinal influences of depressive moods on problematic mobile phone use and negative school outcomes among Korean adolescents. School Psychology International, 40(3), 294-308. https://doi.org/10.1177/0143034319830452

• Kim, H., Cho, M. K., Ko, H., Yoo, J. E., & Song, Y. M. (2020). Association between smartphone usage and mental health in South Korean adolescents: The 2017 Korea youth risk behavior web-based survey. Korean Journal of Family Medicine, 41, 98-104. https://doi.org/10.4082/kjfm.18.0108

• Kwon, M., Lee, J. Y., Won, W. Y., Park, J. W., Min, J. A., Hahn, C., Gu, X., Choi, J. H., & Kim, D. J. (2013). Development and validation of a smartphone addiction scale (SAS). Plos One, 8(2), Article e56936. https://doi.org/10.1371/journal.pone.0056936

• Lapierre, M. A., Zhao, P., & Custer, B. E. (2019). Short-term longitudinal relationships between smartphone use/dependency and psychological well-being among late adolescents. Journal of Adolescent Health, 65(5), 607-612. https://doi.org/10.1016/j.jadohealth.2019.06.001

• Lee, C., & Lee, S. K. (2017). Prevalence and predictors of smartphone addiction proneness among Korean adolescents. Children and Youth Services Review, 77, 10-17. https://doi.org/10.1016/j.childyouth.2017.04.002

• Lee, J., Sung, M. J., Song, S. H., Lee, Y. M., Lee, J. J., Cho, S. M., Park, M. K., & Shin, Y. M. (2018). Psychological factors associated with smartphone addiction in South Korean adolescents. The Journal of Early Adolescence, 38(3), 288-302. https://doi.org/10.1177/0272431616670751

• Liu, S., Wing, Y. K., Hao, Y., Li, W., Zhang, J., & Zhang, B. (2019). The associations of long-time mobile phone use with sleep disturbances and mental distress in technical college students: A prospective cohort study. Sleep, 42(2), Article zsy213. https://doi.org/10.1093/sleep/zsy213

• Mak, K. K., Lai, C. M., Watanabe, H., Kim, D. I., Bahar, N., Ramos, M., Young, K. S., Ho, R. C., Aum, N. R., & Cheng, C. (2014). Epidemiology of internet behaviors and addiction among adolescents in six Asian countries. Cyberpsychology, Behavior and Social Networking, 17(11), 720-728. https://doi.org/10.1089/cyber.2014.0139

• Nor, H. A. M., Bashir, N. F. J. M., & Mokhtar, D. M. M. (2020). Relation between smartphone addiction, sleep quality and psychological health among adolescents in Malaysia. International Journal of Psychosocial Rehabilitation, 24(4), 4288-4298. https://doi.org/10.37200/IJPR/V24I4/PR201535

• Musa, R., Fadzil, M. A., & Zain, Z. (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression, Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry, 8(2), 82-89.

• Nasser, N. S., Loh, J. L., Rashid, A. A., Sharifat, H., Ahmad, U., Ibrahim, B., Mustafa, S., Hoo, F. K., Ching, S. M., & Suppiah, S. S. (2020). A survey on smartphone dependence and psychological effects among undergraduate students in a Malaysian University. Medical Journal of Malaysia, 75(4), 356-362. https://doi.org/10.1186/s12888-016-1083-3

• Panova, T., & Carbonell, X. (2018). Is smartphone addiction really an addiction? Journal of Behavioral Addictions, 7(2), 252-259. https://doi.org/10.1556/2006.7.2018.49

• Park, S. Y., Yang, S., Shin, C. S., Jang, H., & Park, S. Y. (2019). Long-term symptoms of mobile phone use on mobile phone addiction and depression among Korean adolescents. International Journal of Environmental Research and Public Health, 16(19), Article 3584. https://doi.org/10.3390/ijerph16193584

• Sánchez-Martínez, M., & Otero, A. (2009). Factors associated with cell phone use in adolescents in the community of Madrid (Spain). Cyberpsychology, Behavior and Social Networking, 12(2), 131-137. https://doi.org/10.1089/cpb.2008.0164

• Sohn, S., Rees, P., Wildridge, B., Kalk, N. J., & Carter, B. (2019). Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: A systematic review, meta-analysis and GRADE of the evidence. BioMed Central Psychiatry, 19, Article 356. https://doi.org/10.1186/s12888-019-2350-x

• Thomée, S. (2018). Mobile phone use and mental health. A review of the research that takes a psychological perspective on exposure. International Journal of Environmental Research and Public Health, 15(12), Article 2692. https://doi.org/10.3390/ijerph15122692

• Thomée, S., Härenstam, A., & Hagberg, M. (2011). Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults - a prospective cohort study. BioMed Central Public Health, 11, Article 66. https://doi.org/10.1186/1471-2458-11-66

• Vahedi, Z., & Saiphoo, A. (2018). The association between smartphone use, stress, and anxiety: A meta-analytic review. Stress Health, 34(3), 347-358. https://doi.org/10.1002/smi.2805

• Yu, S., & Sussman, S. (2020). Does smartphone addiction fall on a continuum of addictive behaviors? International Journal of Environmental Research and Public Health, 17(2), Article 422. https://doi.org/10.3390/ijerph17020422

• Zhang, M., Tran, B. X., Huong, L. T., Hinh, N. D., Nguyen, H., Tho, T. D., Latkin, C., & Ho, R. (2017). Internet addiction and sleep quality among Vietnamese youths. Asian Journal of Psychiatry, 28, 15-20. https://doi.org/10.1016/j.ajp.2017.03.025