Smartphone and Facebook addictions share common risk and prognostic factors in a sample of undergraduate students

Introdução: Para melhorar a compreensão da interface entre dependência de smartphone (DS) e a dependência de Facebook (DF), avaliamos a hipótese de que a ocorrência simultânea de ambas as dependências corelaciona-se com o número de consequências negativas por elas produzidas. Além disso, avaliamos se a DS está associada a níveis mais baixos de satisfação com o suporte social. Método: Recrutamos uma amostra de conveniência de estudantes de graduação da Universidade Federal de Minas Gerais, na faixa de 18 e 35 anos. Todos os sujeitos preencheram o questionário avaliando dados sociodemográficos e contendo a versão brasileira do Smartphone Addiction Inventory, a Escala de Bergen para DF, a Escala de Impulsividade de Barrat 11 (BIS-11), a Escala de Satisfação com o Suporte Social (SSSS) e a Escala Breve de Busca de Sensações (BSSS-8). Após o preenchimento do questionário, os entrevistadores realizaram a Mini-International Neuropsychiatric Interview. Resultados: Na análise univariada, a DS associou-se ao sexo feminino, pessoas na faixa de idade entre 18 e 25 anos, rastreio para DF, transtornos por uso de substâncias, transtorno depressivo maior, transtornos de ansiedade, baixos escores na SSSS, altos escores na BSSS-8 e altos escores na BIS. O grupo rastreado positivamente para DS e DF apresentou maior prevalência de transtornos por uso de substâncias, depressão e transtornos de ansiedade quando comparado ao grupo rastreado apenas para DS. Conclusão: Na amostra avaliada, a comorbidade de DS e DF se correlacionou a níveis mais altos de consequências negativas e níveis mais baixos de satisfação com o suporte social. Esses resultados sugerem que DS e DF compartilham fatores de vulnerabilidade. Estudos adicionais são necessários para esclarecer a direção dessas associações. Descritores: Dependência de smartphone, dependência de Facebook, dependência de redes sociais, suporte social, busca por sensações, impulsividade. Abstract


Introduction
Smartphone technologies are central for today's wellbeing. They provide portability, real-time connection, and a broad range of solutions that have transformed their use into an everyday need. [1][2][3] Smartphone users are exposed, on average, to 2.5 hours of screen time per day, according to a recent study. 4 Despite the significant benefits that may be provided by smartphones, several researchers alert to the potential adverse effects of abusing their use.
A growing body of evidence strongly suggests that some subjects develop a compulsion related to smartphone use that results in adverse outcomes.
Among those outcomes we find: a decrease in academic and work performance; the impairment of interpersonal relationships; an increased prevalence of traffic accidents; and sleep disorders. [5][6][7][8][9][10] More recently, in a study using self-report data assessing private, workplace-related smartphone use, and selfrated productivity, Duke & Montag reported a moderate association between smartphone addiction and a selfreported decrease in productivity due to spending time on the smartphone at the workplace. 11 In the last decade, several studies reinforced the hypothesis that this compulsion may be considered a behavioral addiction by assessing profiles of subjects at risk to develop a compulsive use of smartphones.
As evidence regarding technological addiction grows, nosological classifications recognize some patterns of excessive use of technology as pathological.
Recently, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) included Internet gaming disorder in Section III, 38

and the International
Classification of Diseases (ICD) included gaming disorder as a specific diagnostic category. 8 Despite the growing evidence demonstrating the existence of compulsive use of smartphones, the inclusion of this disorder in an official nosologic classification has not yet occurred. 39,40 Due to the lack of a consensual definition, a clear pattern of symptoms, and a diagnostic category, several terms have emerged to describe the pathological use of smartphones. Some authors have named this behavior as problematic smartphone use, 27 smartphone use disorder, 41 or smartphone addiction (SA). 25 The addictive disorder is not related to the smartphone itself, but rather to the applications and functions provided by it. Some authors formulated hypotheses to explain the cognitive mechanisms underpinning smartphone use disorder. The dual system theory, proposed by Soror et al., 42 suggests that a conflict between the reflexive/automatic system (e.g., responding to a message when we hear our phone ring) and the reflective/control system (monitoring if the situation is appropriate, i.e., not answering the phone while driving) influences mobile phone use and may explain the negative consequences associated with their use. 43 Another theoretical framework, proposed by Billieux et al., associates three pathways to mobile phone use. 44 The first is the excessive reassurance pathway, where subjects present high anxiety, low self-esteem experience and a need for reassurance that is met with the excessive use of smartphones.
The second is the impulsive pathway, corresponding to low self-control that can result in excessive use of the smartphone, accompanied by symptoms of addiction, an antisocial pattern of smartphone use and/or risky mobile phone use behavior. Third, there is the extraversion pathway, i.e., when the addictive outcomes are expressed in subjects who have the constant need to socialize with others.
Moreover, Elhai et al. 45 have proposed that mood changes resulting from smartphone use act as positive reinforcement in seeking excessive reassurance or the unwillingness to miss relevant information, corresponding to negative reinforcement in the smartphone use habituation process. 46 Because the source of the compulsive behavior is not the smartphone itself, but rather the Internet content accessed through it, it is essential to focus on social media applications in order to better understand the smartphone abuse behavior. Social networks, especially WhatsApp ® and Facebook ® , are predominantly used through smartphones. 16,47,48 The accessibility and portability of these devices improve access to the Internet, favoring the abuse of and dependency on social networks. In a study by Montag et al., in a large sample assessed for a period of four weeks, WhatsApp ® accounted for near 20% of all smartphone use. 28 In this regard, some authors have been studying the overlap of SA with social network addiction, in particular Facebook addiction (FA). 25,37,[49][50][51][52][53][54][55] The estimated prevalence of FA ranges from 1.6 to 41.8% 56 of users. Facebook dependents tend to have a lower self-esteem and lower levels of life satisfaction, using Facebook as a way to regulate their emotions 57 when compared to healthy social network users. 58 Montag et al. reported that extroversion and low conscientiousness are associated with social network addiction through the smartphone. 28 Low social support satisfaction may be one of the The authors reported that, in the sample assessed, the subjects used social networks with the goal of achieving approval and social support. 16,48 To improve the comprehension of the interface

Measures
To assess SA likelihood, we used the Brazilian looking for excitement and adventure; 2) disinhibition; 3) search for experience; and 4) susceptibility to boredom. 78 Scores range from 8 to 40, with higher scores indicating an increased tendency for sensation seeking.

Procedures
After signing the informed consent, the interviewers requested subjects to perform a paper-and-pencil questionnaire assessing demographic information (i.e., biological gender, race, date of birth, marital status, and family income), the SPAI-BR, the Bergen Scale, the BIS-11, the SSSS, and the BSSS-8. After completion of the questionnaires, the interviewers conducted a MINI structured interview.
In our study, subjects dependent on Facebook and smartphones concomitantly presented higher impulsivity and lower social support satisfaction.
We can suppose that low impulse control induces reward searching behavior, such as the ritual of regularly checking Facebook through smartphones for hedonistic purposes. This hypothesis is compatible to Billieux's model of impulsive pathway for problematic smartphone use. 87 The authors of that model propose that one of the pathways that lead to problematic smartphone use is driven by poor impulse control, resulting in uncontrollable urges and excessive use.
In parallel, decreased social support satisfaction can favor Facebook abuse as a form of searching for social peers, social reinforcement and reassurance, which agrees with the excessive reassurance pathway, also present in Billieux's model. 87   Several studies have reported that the type of content most frequently accessed by smartphone dependents is social networks. 16,25,37,[49][50][51][52][53] The association between SA and dependence on social networks can be explained by a few reasons. Smartphones' portability and accessibility favor excessive and quick access to social networks. 16,52,96,97 As a result, when compared to computer-based social network access, smartphones could be associated with an increased risk for addiction, 98 MRI. 104 The nucleus accumbens is considered the reward center of the brain, 104 which may lead to the conclusion that Facebook users perceive likes as a reinforcing stimulus. Montag et al. 103 reported that students who regularly checked Facebook more frequently had lower volumes of nucleus accumbens.
Moreover, the reduction of nucleus accumbens volume was less associated with total time of Facebook use than with the amount of regular checking. The authors concluded that frequent Facebook checking through smartphones is a reward-seeking behavior, and that reward-seeking behaviors may be a risk factor for developing dependence on Facebook through the smartphone, considering that the device favors regular checking of social networks.

Conclusions
In our sample, the co-occurrence of SA and FA correlated with higher levels of negative consequences and lower levels of social support satisfaction. These results strongly suggest that SA and FA share some elements of vulnerability. Further studies are warranted to clarify the directions of the associations identified.