on October 01, 2026
The smartphone has become a living environment
The smartphone is no longer just a tool for making phone calls or communicating. For many adolescents, it is simultaneously a means of communication, entertainment, information, study, socialization, and identity formation.
The distinction between online and offline life has therefore become increasingly blurred.
This transformation presents important opportunities, but also new risk factors. Technology can facilitate access to information, maintain long-distance relationships, and offer educational opportunities; at the same time, problematic use can be associated with sleep disorders, reduced physical activity, exposure to harmful content, cyberbullying, isolation, and mental health problems.
The World Health Organization highlights precisely this ambivalence: the impact of digital technologies on young people's mental health is not unidirectional and depends on the type of use, the context, individual characteristics, and environmental conditions. The relationship can also be bidirectional: psychological distress can encourage greater use of technology, while certain patterns of use can in turn aggravate the distress.
For this reason, simply talking about "smartphones yes" or "smartphones no" is reductive. The health issue concerns above all how, how much, when, and why it is used.
How problematic is digital use among adolescents?
The starting material reports a picture characterized by the widespread use of smartphones and very prolonged usage times, with a significant proportion of young people who continue to use devices even at night.
The most robust international data confirms that the phenomenon of problematic use is significant.
The WHO HBSC European report, based on nearly 280,000 young people aged 11, 13, and 15 from 44 countries and geographical areas, found that the proportion of adolescents with signs of problematic social media use increased from 7% in 2018 to 11% in 2022. The phenomenon was more frequent in girls than in boys, at 13% and 9%, respectively.
The concept of problematic use is important because it does not simply coincide with many hours spent in front of a screen.
It includes difficulty controlling behavior, interference with daily activities, and negative consequences for personal, academic, or social life.
An adolescent can therefore use their phone a lot without necessarily developing problematic behavior, while another may exhibit a dysfunctional relationship even with less overall time.
The problem is not just time in front of a screen
Screen time is a useful parameter, but it is not sufficient to describe digital health.
There are at least four elements to consider:
- duration of exposure;
- time of day, especially evening and nighttime use;
- content and activities, such as social networks, video games, communication, study, or potentially harmful content;
- functional consequences, that is, what digital use takes away from sleep, study, physical activity, and relationships.
The WHO document dedicated to the digital determinants of young people's mental health highlights precisely the complexity of the phenomenon: some online activities can simultaneously have positive and negative effects, and the consequences are influenced by individual and environmental characteristics. The most vulnerable young people may be disproportionately exposed to the negative effects.
The clinically most useful question is therefore not just "how many hours do they use their smartphone?", but also:
What is the young person doing during those hours, and what are they gradually stopping doing?
Sleep: one of the first indicators to observe
Sleep is probably one of the areas where digital use can have the most immediate consequences.
Smartphone use in the evening can delay bedtime, increase cognitive arousal, and keep the young person connected when they should be starting their rest period.
The problem can become even more evident when the phone remains physically close to the bed, allowing notifications, messages, and repeated access during the night.
A large umbrella review published in 2025, comprising seven systematic reviews for a total of 127 primary studies and approximately 867,000 participants, found associations between digital device use and several sleep parameters in adolescents, including shorter sleep duration, greater bedtime procrastination, and worsening sleep quality; the associations appeared particularly evident for smartphones, social media, and problematic use.
However, a more recent study based on daily within-person associations showed a more nuanced picture: the daily increase in screen time was associated mainly with a slight delay in falling asleep, while no significant associations emerged with all other sleep parameters. The association was more evident when use occurred after the planned bedtime.
These results indicate that the timing of use can be as important as the total amount of time spent in front of a screen.
When the phone enters the bedroom
Nighttime use therefore deserves particular attention.
An adolescent who stays connected until late at night can establish a behavioral cycle:
notifications → checking the phone → delayed sleep → tiredness → reduced attention → greater search for digital stimuli.
Sleep deprivation can also affect emotional regulation, memory, attention, and academic performance.
Sleep should therefore become one of the first variables to assess when a parent observes excessive digital use.
A simple practical indicator is to ask whether the smartphone:
- regularly delays bedtime;
- is used in bed;
- interrupts sleep;
- is checked immediately upon waking;
- interferes with the regularity of the sleep-wake rhythm.
Smartphones, social media, and mental health
The relationship between social media use and adolescents' mental health is one of the most studied topics in recent years.
The literature shows associations with depressive and anxious symptoms, but does not allow for the claim that social media use is always and directly the cause of these disorders.
A systematic review and meta-analysis published in 2024 examined studies on adolescents from both the general population and clinical populations, assessing the relationship between social media use and internalizing symptoms, such as anxiety and depression. The overall result confirms a relationship, but the nature of the available studies requires caution in causal interpretation.
A systematic narrative review published at the same time analyzed 67 studies on children and adolescents aged 5 to 18, finding that the literature includes heterogeneous results and different ways of measuring exposure to social media.
A more recent meta-analysis, comprising 24 studies and 68 effects, found a positive correlation between some risk factors related to social networks and several mental disorders in adolescents and young adults, but with extremely high heterogeneity among the studies. This finding reinforces the need to avoid simplistic interpretations.
The most cautious conclusion is therefore that certain patterns of digital use can represent a risk factor or an amplifier of psychological distress, especially in vulnerable individuals, but the relationship is complex and bidirectional.
Emotional dysregulation
The starting material uses the concept of "dysregulation" to describe very different manifestations, both externalizing and internalizing. Among these, anger, aggressive behaviors, isolation, anxiety, depression, social withdrawal, and difficulty managing emotions are mentioned.
From a clinical point of view, it is important not to turn this description into a new diagnosis.
Emotional dysregulation is rather a cross-cutting phenomenon that can appear in different conditions and in response to multiple factors.
Adolescence is also a phase characterized by important neurobiological, psychological, and social changes. The capacity for self-regulation develops progressively and is influenced by the family, school, and relational environment.
When a digital environment becomes particularly intense, continuous, and unpredictable, it can increase the number of stimuli to which the young person must respond.
Notifications, messages, social approval, comparison with peers, emotionally intense content, and immediate rewards can create an environment characterized by high stimulation.
This does not mean that the smartphone automatically "causes" dysregulation. It means that, in some people and under certain conditions, it can become an element that contributes to maintaining or amplifying it.
Digital sociality and real-life sociality
One of the most delicate aspects concerns the possible replacement of face-to-face relationships with a predominantly digital connection.
The problem is not online communication itself. For many adolescents, social media are in fact a real part of relationships with peers.
The criticality arises when digital communication progressively reduces other fundamental experiences:
playing, moving, talking face to face, practicing sports, sharing family activities, studying, sleeping, and participating in community life.
The WHO highlights that technologies can promote connection and learning, but they can also increase exposure to cyberbullying, harmful content, isolation, and other risks.
For this reason, prevention should not be built exclusively on prohibition.
It is necessary to create alternatives.
An adolescent who has access to sports activities, friendships, cultural experiences, music, learning opportunities, and meaningful family relationships is more likely to develop a balanced relationship with technology.
Physical activity against digital sedentary behavior
One of the indirect effects of excessive device use can be the reduction of time dedicated to movement.
Replacing physical activity, outdoor play, and sports with hours of sedentary behavior in front of a smartphone or computer can contribute to worsening the overall quality of lifestyle.
Physical activity, on the other hand, represents an important protective factor for physical and mental health during adolescence.
Sport also offers something that a smartphone cannot replace: the body as a means of experience, connection, and self-regulation.
Running, jumping, coordinating, playing on a team, interacting with others, and learning to deal with victory and defeat are fundamental experiences for development.
The starting material highlights precisely the need to reclaim a dimension of sport that is more focused on physical development, group interaction, and well-being, preventing performance from prematurely becoming the sole measure of value.
Cyberbullying and harmful content
Digital health is not just about the amount of time spent online.
A teenager may spend a relatively limited amount of time online but still be exposed to particularly problematic content.
Cyberbullying, digital violence, content promoting self-harm, sexualized images, misinformation, and unrealistic body images are specific risks of the digital environment.
WHO Europe identifies cyberbullying, self-harm-related content, unrealistic body ideals, and other forms of potentially harmful exposure as major online dangers for children and adolescents.
This explains why an effective digital education program must teach not only how much technology to use, but also how to interpret what is encountered online.
Family: the example matters more than a simple ban
The regulation of digital use cannot be entirely delegated to the teenager.
The family is the first environment in which habits, rules, and behavioral models are formed.
If a parent constantly uses their smartphone during meals, while talking to their child, or during other moments of interaction, it becomes difficult to ask the child to behave completely differently.
Digital health must therefore become a family practice.
Some rules can be simple:
- no smartphones during meals;
- avoid using devices during family conversations;
- establish an evening routine without devices;
- do not leave the phone in the bedroom overnight;
- set aside daily time for physical activity;
- plan non-digital social and family activities;
- talk with the child about the content they encounter online;
- use parental controls as an educational tool, not exclusively for monitoring.
The goal is not to create a war between parents and smartphones.
It is to create predictable and shared boundaries.
The school as a prevention environment
The school can also play an important role.
Not only through lessons on the proper use of devices, but through an education that develops real skills: critical thinking, collaboration, emotional management, communication, autonomy, and the ability to recognize online risks.
WHO emphasizes the need to integrate digital literacy, child protection, and mental health support within broader strategies.
The school can also be a space to reclaim what the digital environment sometimes tends to reduce: physical activity, direct interaction, cooperation, and belonging to a group.
The Digital Health Record
In Italy, pediatric experiences have been developed to assess the relationship between children and technology.
The Digital Health Record was initially piloted in Sardinia and subsequently used in other regional contexts. Its goal is to assess different dimensions of the relationship between the child and the digital environment, including exposure time, content, devices, physical activity, study, socialization, and the presence of digital parenting models.
In the Emilia-Romagna region, the project was integrated into the practice of family pediatricians as part of digital health promotion initiatives. Regional documentation describes the Digital Health Record as a screening tool aimed at the early identification of risk factors and subsequent pediatric assessment.
It is an interesting approach because it shifts the focus from the generic concept of "smartphone addiction" to a broader assessment.
It observes:
time, content, replaced activities, family context, physical activity, study, socialization, and usage patterns.
This perspective is consistent with international guidelines that consider the digital environment as one of the determinants of health, rather than an isolated variable.
What to observe at home
A parent should pay particular attention when smartphone use begins to significantly alter daily functioning.
Some signs warrant a discussion with a pediatrician or mental health professional:
- significant reduction in sleep;
- abandonment or significant reduction in sports activities;
- isolation from family relationships;
- gradual abandonment of real-life friendships;
- academic decline;
- inability to stop using the device;
- intense irritability when the device is restricted;
- hidden or nighttime use;
- loss of interest in previously enjoyable activities;
- exposure to cyberbullying or self-harm content;
- emergence or worsening of anxiety, depression, social withdrawal, or other psychological symptoms.
The presence of any one of these signs does not allow for a diagnosis of addiction or mental disorder on its own.
However, it indicates that further investigation is appropriate.
Do not demonize technology: teach how to use it
Technology will inevitably be part of the lives of new generations.
The realistic goal, therefore, is not to eliminate the smartphone, but to build conscious digital competence.
This means learning to recognize when technology is useful and when it is beginning to replace fundamental needs.
The child should be helped to understand the difference between:
using a smartphone because it is needed and using it automatically because they cannot do anything else.
The latter situation is the one that deserves greater attention.
Prevention must also be proportionate to age. A young child does not have the same self-regulation skills as a teenager, and a teenager cannot be treated like an adult.
WHO and UNICEF emphasize that mental health services for children and adolescents must be adapted to the different stages of development and that early intervention is important, considering that a significant portion of mental disorders emerge during childhood and adolescence.
Rebuilding a balance between the digital and the real
Digital health prevention therefore does not consist merely in reducing hours in front of the screen.
It means making room for the experiences that the screen can replace.
More physical activity.
More sleep.
More face-to-face relationships.
More creative activities.
More sports.
More time outdoors.
More active learning.
More family dialogue.
More critical thinking.
And, above all, greater awareness of what happens when the digital ceases to be a tool and becomes the primary environment in which the child experiences their emotions, relationships, and gratifications.
A new idea of digital health
Digital health should fully enter pediatric and adolescent prevention.
The Digital Health Record model represents, in this sense, a concrete example of how the relationship with technology can be observed together with the other dimensions of the child's and adolescent's development. The Italian experiences described in the available sources show an orientation toward an integrated assessment of screen time, content, physical activity, study, socialization, and family context.
The most important message is not that the smartphone is an enemy.
It is that a developing brain needs many different experiences.
It needs to sleep, move, learn, play, communicate, build relationships, face difficulties, develop autonomy, and experience the real world.
Technology can accompany this journey, but it should not replace it.
True prevention therefore consists in building a balance in which the digital remains a tool and does not become the exclusive environment of growth.
Bibliographic references
- World Health Organization Regional Office for Europe. Teens, screens and mental health. WHO Europe, 2024.
- World Health Organization Regional Office for Europe. Addressing the digital determinants of youth mental health and well-being: policy brief. WHO Europe, 2025.
- World Health Organization Regional Office for Europe. Making the WHO European Region the healthiest online environment for children: position statement. 2024.
- World Health Organization. Mental health of children and young people: service guidance. 2024.
- World Health Organization. Digital environments and mental health. WHO.
- Systematic review and meta-analysis on social media use and internalizing symptoms in clinical and community adolescent samples. JAMA Network Open, 2024.
- Systematic narrative review of social media use and symptoms of depression and anxiety among children and adolescents. 2024.
- Systematic review and meta-analysis of associations between social media use and mental disorders in adolescents and young adults. 2025.
- Umbrella review of digital device use and sleep in adolescents. International Journal of Environmental Research and Public Health. 2025.
- Within-person systematic review and meta-analysis of daily screen use and sleep in youth. 2026.
- Italian Federation of Pediatricians. The Digital Health Report: pediatric assessment of exposure to new technologies. Il Medico Pediatra. doi:10.36179/2611-5212-2022-11.
- Emilia-Romagna Region. Documentation on the digital health project and the Digital Health Report in pediatric prevention. 2025.
