Nomophobia and Stress among Vietnamese high school students in Covid-19 Pandemic.docx

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Nomophobia and Stress among Vietnamese high school students in Covid-19 Pandemic:
A Moderated Mediation Model of Self-Control and Loneliness
Abstract
INTRODUCTION: Nomophobia is a specific form of phobia defined as a feeling of
discomfort or anxiety caused by the absence of a phone, personal computer, or any other virtual
communication device. Nomophobia is rising among high school students, especially in light
of the Covid-19 pandemic, such as social distancing, long-term online learning, and lack of
social support. Many studies have also shown that students with high levels of nomophobia
have a higher risk of stress. However, very few researchers are interested in studying self-
control as a moderate factor for the indirect relationship between nomophobia and stress.
OBJECTIVES: This study investigated whether self-control factors moderate the indirect
effect of nomophobia on the stress in Vietnamese high school students.
METHODS: Participants include 556 Vietnamese high school students. Participants
completed the Nomophobia Scale, Depression Anxiety Stress Scales 21, The UCLA loneliness
scale version 3 and The Brief Self-Control Scale. Moderated mediation analyses were
conducted using the PROCESS macro 32 to investigate the relationship among variables.
RESULTS: In the relationship between nomophobia and stress in Vietnamese high school
students, loneliness is partly mediated; Self-control significantly moderated the indirect effect
of nomophobia on stress.
CONCLUSION: This study suggests that interventions to prevent and reduce nomophobia
should reduce loneliness and enhance self-control.
Introduction
The coronavirus disease 2019 (COVID-19) outbreak has created a global health crisis,
exposing everyone to a traumatic and unexpected situation. The experience of social distancing

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has changed human behavior and profoundly impacted an individual's emotions, daily habits,
and relationships. Increasing pandemics and uncertainty about pandemic duration have
reinforced mortal fear and stress người (Davico et al., 2021; Fauci et al., 2020; Jiao et al., 2020;
Lu et al., 2020). The Covid -19 pandemic has resulted in a loss of daily routines and reduced
social interaction, which can cause boredom, frustration, and feelings of isolation, which can
create high levels of distress in people. Individuals increase the risk of mental disorders, such
as anxiety and addiction (Augner & Hacker, 2012; Anna Lucia Spear King et al., 2014; C.
Wang, Pan, Wan, Tan, Xu, Ho, et al., 2020). Recent studies have confirmed the negative impact
of the COVID-19 pandemic, especially on stress, anxiety, and depression (Cao et al., 2020;
Hao et al., 2020; Rajkumar, 2020). According to recent reports, it has been found that curfews
and social distancing have an impact on mental health decline (C. Wang, Pan, Wan, Tan, Xu,
Ho, et al., 2020; C. Wang, Pan, Wan, Tan, Xu, McIntyre, et al., 2020). Stress negatively affects
function; prolonged exposure to stress causes physical and mental health problems, affects
everyday behavior, and reduces the quality of life (Taylor & Dorn, 2006). In addition to the
stress-related mental health effects of the COVID-19 pandemic, in-person educational
disruptions and mandatory social distancing have increased students' perception of stress.
Computers and smartphones have dramatically changed the learning and teaching environment.
In recent times, while phone usage has increased thanks to advances in technology, it
is believed that amid the Covid-19 pandemic, time spent on mobile phones has increased due
to social isolation, and this is substituted for face-to-face interactions. Some scholars have
emphasized that smartphone use can lead to solid psychological attachment, leading to
addiction (Lee et al., 2015; Wu et al., 2013). Nomophobia is considered a manifestation of
excessive phone use (Billieux et al., 2008, 2015; A. L.S. King et al., 2013), seen as equivalent
to smartphone addiction (Bragazzi & Del Puente, 2014). According to existing studies,
smartphone applications such as social networks, mobile games, and entertainment will induce

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nomophobia (Jeong et al., 2016). According to (A. L.S. King et al., 2013), nomophobia is a
specific form of phobia defined as a feeling of discomfort or anxiety caused by the absence of
a phone, personal computer, or any other communication device virtual. The results of
nomophobia can cause problems with concentration, insomnia, decreased performance, and
stress (Augner & Hacker, 2012). Smartphone use has increased the trend of nomophobia during
the pandemic. Smartphones have become a significant connection for communication over the
internet, online courses, online games, and shopping. It is considered a way to deal with stress.
Recent research has shown a significant positive relationship between increased stress levels
and nomophobia (Bano et al., 2021; Farchakh et al., 2021).
In the study on the relationship between nomophobia and depression, anxiety, and stress
by cross-sectional study method, Bano et al. (2021) reported higher anxiety and stress scores
in students with severe nomadism. Statistically significant differences in anxiety and stress
levels related to residency pattern and degree of nomophobia. Farchakh et al. (2021) also
showed a positive correlation between nomophobia and anxiety, depression, stress, insomnia,
and impulsivity. The tendency to become addicted to smartphones increases with stress and
anxiety. A study of medical students found smartphones addiction tends to increase with stress
and anxiety. A survey of medical students found that those with higher Internet addiction scores
were more anxious than students with lower scores (Yücens & Üzer, 2018). Many medical
studies have identified a positive correlation (Demirci, 2019; Elhai et al., 2018; Lin et al., 2017).
Those who scored high for gaming addiction, compulsive internet use, and social media use
also reported high scores for depression, loneliness, avoidance, poor sleep quality, and
depression-related anxiety (Fernandes et al., 2020). Thomée et al. (2011) also reported that
people who use or check their smartphones a lot during the day might experience sleep
disturbances, stress, anxiety, and reduced academic performance. In another study done by
Kalaskar (2015), 90% of students participating in the survey said they had used smartphones

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for more than two years. Those who spend between five and six hours on smartphones every
day are prone to psychological problems like anxiety, trouble sleeping, stress, loss of
motivation and interest in classes, etc.
In recent years, studies have investigated the relationship between agoraphobia and
loneliness, stress, anxiety, depression, and other mental health problems (Augner & Hacker,
2012; Bano et al., 2021; Farchakh et al., 2021; Li et al., 2021; Zeliha, 2019). However, in the
world and Vietnam, we have not found any research that simultaneously explores the role of
loneliness and self-control in life in the relationship between nomophobia and stress in high
school students. Therefore, our study aims to test a complex theoretical model in which
loneliness is considered a mediator and self-control is seen as a moderator of the association
between nomophobia and stress.
The Mediating Effect of Loneliness on Nomophobia and Stress
Nomophobia and Loneliness
Loneliness is a negative emotional state that arises when a perceived difference between
desired and actual social relationships (Peplau & Perlman, 1982; Farchakh et al., 2021; )).
Available evidence suggests that different age groups experience loneliness differently. Young
people feel lonely and isolated more than twice as often as adults (Child & Lawton, 2019).
Loneliness is a feeling of exclusion, disconnection from others, and unhappiness with
relationships (Snape & Manclossi, 2018). Previous studies have shown that there is a positive
correlation between nomophobia and loneliness, with higher levels of loneliness increasing the
risk of developing nomophobia (Bian & Leung, 2015; Li et al., 2021; Zeliha, 2019). Ozdemir
et al. (2018) research on university students has also shown a positive correlation between
nomophobia and self-esteem and loneliness, whereas subjective happiness and nomophobia are
negatively correlated. Kara et al. (2021) reported that adolescents who use smartphones for
long periods of the day are at increased risk of developing nomophobia, in which loneliness

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plays a solid mediating role. Besides, the daily use of smartphones increases, adolescents feel
more lonely and anxious, thus increasing nomophobia. Some authors have also found that the
higher a person's loneliness score, the more likely they are addicted (Bian & Leung, 2015; Li
et al., 2021; Zeliha, 2019). Loneliness and mobile phone addiction are significantly positively
correlated (Liu et al., 2019; Yayan et al., 2019). A bidirectional relationship between loneliness
and excessive Internet use has been demonstrated (Bozoglan et al., 2013; Huan et al., 2014;
Kim et al., 2009; Shi et al., 2017; Yao & Zhong, 2014), especially the relationship between
loneliness and problematic use of social networking sites in adolescents and adults). In
addition, Sum et al. (2008) reported that high levels of loneliness were associated with greater
Internet use for social connections. Feeling lonely during the COVID-19 pandemic is positive
correlates, both directly and indirectly, with anxiety. Furthermore, increased feelings of
loneliness and isolation predicted high levels of stress and excessive social media use. In
addition, the predictive effect of loneliness on anxiety increased (Boursier et al., 2020).
According to the compensatory Internet use theory (Kardefelt-Winther, 2014), when
individuals are misaligned in the real world, they can use mobile phones (virtual networks) to
get rid of negative feelings extreme (lonely). Kardefelt-Winther discovered that lonely
adolescents could meet their social needs through social connections on the Internet (Kardefelt-
Winther, 2014). Loneliness can influence one's decision to use the Internet for entertainment,
exacerbating cell phone addiction (Brand et al., 2016, 2019). People who feel lonely often use
smartphones as a tool to combat loneliness (Jiang et al., 2018). As individuals spend more time
at home during the COVID-19 pandemic, smartphone use may increase to pass the time. Rising
smartphone use to neglect everything else in an individual's life is an essential component of
addiction (Elhai et al., 2017; Griffiths, 2005). As a result, both loneliness and fear of Covide-
19 can increase smartphone use, leading to problematic and possibly addictive smartphone use.
Loneliness and Stress

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Long-term or severe loneliness can cause several emotional disturbances and impair
mental health (Spitzer et al., 2019). Adolescence is particularly vulnerable to experiencing
feelings of loneliness, which is an essential factor in adolescent health and quality of life
(Danneel et al., 2019). Many studies indicate that stress is causally related to loneliness (Brown
et al., 2018; Campagne, 2019). This mechanism is active not only in the elderly but across
many age groups (Drake et al., 2016). It has been found to have multiple sources, some related
to aging, but all related to loss of appropriate capacity. Feeling lonely is a risk factor for anxiety
and chronic stress (McHugh & Lawlor, 2013; Wilson et al., 2007; Zammuner, 2009) and high
involvement in maladaptive behaviors (Loades et al., 2020; Segrin & Passalacqua, 2010). In
addition, loneliness is positively correlated with anxiety in both older adults and young adults
(Ebesutani et al., 2015) and negatively associated with happiness, health, and life satisfaction
(Moore & Schultz, 1983; Salimi, 2011). Glaser et al. (1985) in the publication of research on
stress, loneliness, and herpesviruses, found that people with high levels of loneliness had higher
stress levels in the student group. Which significantly affected their immune systems, which
provided evidence of a causal relationship between stress, loneliness, and health. Recent studies
have also found a strong, positive association between stress and loneliness (Jaremka et al.,
2014), thus also a causal pathway through the abnormal activity of the HPA axis such as a
significant component of the endocrine system (Edwards et al., 2010; Hawkley et al., 2006,
2012; Steptoe et al., 2004). A British study indicates that stress is a condition for loneliness
(Stone et al., 2013). Social isolation and loneliness increased the risk of depression and anxiety
when measuring loneliness and from 0.25 years to 9 years later. Duration of loneliness was
significantly more positively correlated with mental health symptoms than loneliness intensity
(Loades et al., 2020).
The Moderating Effect of Self-control on Loneliness and Stress

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Previous studies have highlighted that people with high levels of loneliness have a higher
risk of stress (Brown et al., 2018; Campagne, 2019; Jaremka et al., 2014; Stone et al., 2013).
In addition, loneliness was found to be negatively correlated with self-control (Stavrova et al.,
2021; (Liu et al., 2019; W. C. Wang, 2019). Self-control is the ability to regulate one's thoughts,
feelings, behaviors, and desires, especially in difficult situations, to help individuals conform
to their surroundings' demands and minimize or reject unwanted negative behaviors (Gailliot
et al., 2007; Tangney et al., 2004). Even so, self-control is only a limited source of energy and
will be depleted (Baumeister et al., 2007). When we use self-control, we consume it, at least at
some point (Muraven et al., 1998). Each individual is born with different levels of self-control
(Tangney et al., 2004). But the degree of self-control is not fixed over time and can be improved
through practice (Denson et al., 2011). According to Muraven & Baumeister (2000), Negative
emotions can undermine the power of self-control. Lower self-control was associated with
higher loneliness at trait and status levels (Stavrova et al., 2021). Loneliness is associated with
personality disorders, psychosis, and suicide, impairing control and increasing depressive
symptoms (Cacioppo et al., 2006; Mushtaq et al., 2014). Failures in self-control negatively
impact others, leading to a higher risk of being ostracized by others, which predicts an increased
sense of loneliness over time. Participants reported feeling excluded by others for failure to
control themselves; conversely, only failures in self-control leading to negative consequences
for others impact loneliness. Loneliness is a negative emotion. When individuals feel lonely,
they tend to focus more on their emotional state, managing their feelings, controlling their
thoughts, and making choices, which can cause disabling situations self-control (Liu et al.,
2019; W. C. Wang, 2019). When lonely people feel bored, they are more likely to engage in
novel experiences and feelings, seeking to maintain psychological agitation, impairs self-
control. Meanwhile, Self-control was significantly negatively correlated with the development
of stress symptoms (Boals et al., 2011; Bowlin & Baer, 2012; Tangney et al., 2004). Tangney

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et al. (2004) found that self-control was significantly negatively correlated with indicators of
poor psychological regulation such as depression and anxiety. Subsequent studies have further
clarified the negative relationships between self-control and stress, anxiety and depression
(Baldwin et al., 2019; Boals et al., 2011; Bowlin & Baer, 2012; Hofmann et al., 2012).. Self-
control can affect stress in several ways. For example, people with self-control often improve
in stressful situations using effective regulatory strategies (Hennecke et al., 2019; Hofmann et
al., 2012) and seek more social support (Nielsen et al., 2020; vanDellen et al., 2015).
Furthermore, people with poor self-control may experience more significant and frequent
problems regulating thoughts and behavior (de Ridder et al., 2018). Greater self-control in
childhood and adolescence may lead to better overall living conditions, reduced frequency and
intensity of stressors (Mischel et al., 1989; Moffitt et al., 2011). People with greater self-control
may also experience lower stress because they structure and plan their lives in ways that limit
exposure to potential stressors (Hofmann et al., 2012; Webb et al., 2018). Research by Nielsen
et al. (2020) shows that self-control negatively predicts daily stress and variability. This means
that people with good self-control have lower stress levels. From the above analysis, we
would expect that people with high levels of loneliness and low self-controlhave higher
stress levels than those with low levels of loneliness and self-control. High controls
have lower stress levels. In other words, self-control will modulate the relationship
between loneliness and stress (hypothesis 2).
Figure 1
Hypothetical model
Loneliness
Nomophobia Stress

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Methods
Participants
The study surveyed 602 students from two high schools in Huong Thuy town, Thua
Thien Hue province, using a stratified random sampling method. According to Sloven's
formula, with an error rate of 5% and the total number of students for the 2020-2021 school
year of the two schools is 2916, the sample size needed for this study is 352 or more. Our study
had informed consent of the high school principals, and all participants consented to participate
in the study. Before answering the questionnaire, we have committed to keeping the personal
information provided by students confidential. In the end, there were 556 valid votes with a
rate of 92.35%, exceeding the 30% response rate that most researchers require for analysis [20].
In the sample, the age group ranges from 16 to 18 (Mean = 16.99, SD = 0.840); 40.3% male
students, 59.7% female students (see Table 1). After completing the questionnaire, each
participant received a gift worth 20,000 VND.
Table 1
An overview of survey participants
n %
Gender Male 224 40.3
Female 332 59.7
Grade 10th grade 203 36.5
11th grade 182 32.7
12th grade 171 30.8
Age 16 199 35.8
17 164 29.5
18 193 34.7
Family structure Two-parent family 512 92.1
Divorced or separated parents 16 2.9

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Deceased father/mother 21 3.8
Another situation 7 1.3
Live with Birth mother 519 93.3
Stepmother 6 1.1
Foster mother 1 0.2
Other case 30 5.4
Live with Birth Father 531 95.5
Stepfather 3 0.5
Foster father 1 0.2
Other case 21 3.8
Academic performance
(Grade point average,
GPA)
Poor 5 0.9
Below average 167 30.0
Average 265 47.7
Good 99 17.8
Excellent 20 3.6
Note: n: Number of participants; %: Percentage
Instruments
Nomophobia Scale (NMP-Q): In this study, the Nomophobia Questionnaire (NMP-Q)
of Yildirim (2014), including 20 items, is designed in the form of a 7-point Likert scale, from
1 = “Strongly disagree” to 7 = “Strongly agree.” The total score was calculated by summing
the responses for each question, ranging from 20 to 140, with higher scores corresponding to a
more severe fear of lack of phones. The score from the NMP-Q questionnaire is interpreted as
follows: the NMP-Q score of 20 indicates that there is no fear of missing a phone; NMP-Q
scores greater than 20 and less than 60 correspond to a slight fear of lack of phones; NMP-Q
scores greater than or equal to 60 and less than 100 correspond to the average fear of missing
phones, and NMP-Q score greater than or equal to 100 corresponds to a severe fear of lack of
phones (Yildirim & Correia, 2015). Reliability test results show that the reliability of the scale
in our study is quite high with α = 0.898, with the component sentences all satisfying the
condition with weight greater than 0.3, the results KMO index results meet the standard, Barlett

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test with p < 0.05 and extracted variance > 50%. This result proves that the scale has high
reliability, meeting research requirements. CFA confirms the 4-factor structure derived from
EFA because all the regression weights show positive, highly significant (above 0.4) relevant
indices: Chi-Square = 543,365, CMIN/ DF =3.354, P < 0.001, CFI = 0.911, GFI = 0.914 and
RMSEA = 0.065 (≤ 0.08) Based on revised indices, several covariance paths between entries
2 and 4, entries 3 and 7 was added, which improved the model fit.
Depression Anxiety Stress Scales 21 (DASS 21): DASS 21 is a shortened version of
DASS (consisting of 42 items). The stress component (7 questions) of the 21-item Depression,
Anxiety and Stress Scale (DASS-21) was used to evaluate the stress status. The score on the
stress sub-scale will need to be multiplied by 2 to calculate the final score. Scores were
dichotomized into everyday stress (with scores between 0 and 14) and increased stress (with
scores greater than 14). Increased stress was further classified into mild (with scores between
15 and 18), moderate (with scores between 19 and 25), severe (with scores between 26 and 33),
and highly extreme stress (with scores greater than 33). In our study, this scale has good internal
reliability (α = 0.761).
The UCLA loneliness scale version 3 (UCLA III): The UCLA III Scale (Russell,
1996) was used to evaluate the loneliness of Vietnamese high school students who have
nomophobia. The UCLA III Scale is a self-reporting scale consisting of 20 items (e.g., sample
items such as “how often do you feel that you lack companionship”) to measure a participant’s
subjective feelings of social isolation and loneliness. The UCLA III scale includes 11 sentences
in the negative direction (lonely) and nine in the positive order (not lonely). For each item,
participants needed to provide answers on a 4-point Likert scale ranging from 1 to 4 (“never”
to “often”). The total loneliness score ranges from 1 to 80, with higher scores indicating higher
levels of loneliness. In Vietnam, Ho et al. (2021) reported that the internal reliability of the
UCLA III Scale was 0.85. In our study, this scale has good internal reliability (α = 0.792).

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The Brief Self-Control Scale (BSCS): To evaluate loneliness of Vietnamese high
school students have nomophobia, the BSCS Scale (Tangney, Baumeister, and Boone, 2004)
was applied. The isashortself-report measure of general self-control. The BSCS was created
from the original Self-Control Scale (SCS; Tangney, Baumeister, and Boone 2004), a 36-item
step, composed of five dimensions: Self-Discipline (11 items), Deliberate/Non-impulsive
action (10 items), Healthy Habits (7 items), Work Ethic (5 items), and Reliability (5 items).
Tangney, Baumeister, and Boone (2004) subsequently developed the BSCS as a 13-item
unidimensional measure of self-control, tapping the same range of content as the SCS (it
includes items from the five dimensions reported above). The BSCS can be scored, after
reverse scoring the appropriate items (see Table 2), by adding the items rated on a 5-point scale,
anchored from 1 = Not at all like me to 5 = Very much like me. In our study, this scale has
good internal reliability (α = 0.769).
Data Analysis
In this study, SPSS software version 25.0 was selected to perform descriptive statistics
and correlation analysis among Pearson's variables. The Process macro for SPSS (Model 4)
was selected to analyze the mediating role of loneliness in the association between nomophobia
and stress. The Process macro for SPSS (Model 14) was selected to determine whether the
indirect path is moderated by self-control. In model 14, nomophobia was the independent
variable, loneliness was the mediator variable, stress was the predictor variable, and age was
the control variable.
Results
Correlations among Study Variables
This study indicated that nomophobia was positively correlated with stress (r = 0.150,
p <0.01) and loneliness (r = 0.097, p <0.05), negatively correlated with self-control (r = -0.192,
p<0.01) (Table 2). Loneliness was positively correlated with stress (r = 0.475, p<0.01) and

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negatively correlated with self-control (r = -0.305, p<0.01). Self-control was negatively
correlated with stress (r = -0.304, p <0.01).
Table 2
Pearson correlations, mean, and standard deviations among study variables
M SD Stress Nomophobia Loneliness Self-Control
Stress 27.24 8.891 __
Nomophobia 82.70 21.175 0.150** __
Loneliness 44.78 8.212 0.475** 0.097* __
Self-Control 39.4371 4.80293 -0.304** -0.192** -0.305**
Note: **. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
Mediation Analyses
For hypothesis 1, we expected loneliness to mediate the relationship between
nomophobia and stress level. As shown in table 3 and Figure 2, the direct paths from
nomophobia to loneliness (B= 0.0628, SE = 0.0154, 95% CI [0.0326, 0.0930] were significant.
The mediators paths from loneliness to stress (B= 0.4716, SE =0.0397, 95% CI [0.5496, 0.2366]
were significant. The direct path from nomophobia to stress were (B= 0.0628, SE=0.0154, 95%
CI= [0.0326, 0.0930]). Table 3 indicated that the unstandardized regression coefficients of the
indirect effect were significant (B= 0.0178, SE=0.0081, 95% CI= [0.0021, 0.0335]. These
results indicated that lonliness partially mediated effect on the relationship between
nomophobia and stress (see Fig. 2), supporting the hypothesis 1.
Table 3
Bias-corrected bootstrap test on mediating effects
Paths β SE 95% CI
Low High
Nomophobia - Stress 0.0628*** 0.0154 0.0326 0.0930
Nomophobia – Loneliness 0.0378*** 0.0164 0.0055 0.0700

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Loneliness – Stress 0.4716*** 0.0397 0.3937 0.5496
Nomophobi – Loneliness – Stress 0.0178 0.0081 0.0021 0.0335
Age - Loneliness 0.0179 0.4136 -0.7945 0.8303
Age - Stress 0.0679 0.3860 -0.6903 0.8261
Note: * p < 0.05, *** p < 0.001.
Figure 2
Mediation model of the indirect effect of Nomophobia on the Stress
Moderated Mediation Analyses
According to hypothesis 2, we expected that self-control would moderate both
nomophobia's direct and indirect effect on stress. A moderated mediation model was used to
investigate whether loneliness mediated the association between nomophobia and stress while
simultaneously investigating whether this mediation was moderated by self-control. According
to Table 4, nomophobia positively predicts stress level were significantly (B = 0.0581, SE
=0.0154, p< 0.001, 95% CI = [0.0279, 0.0884]) and positively predicts loneliness were
significantly (B=0.0378, SE=0.0164, p <0.05, 95% CI = [0.0055, 0.0700]. Loneliness
positively predict stress level were significantly (B=1.2843, SE=0.2749, p<0.001, 95% CI =
[0.7444, 1.8242]).
Table 4 also indicated that the interaction between loneliness and self-control were
significant (B= 0.0103, SE = 0.0037, p <0.01, 95% CI = [0.0030, 0.0176]), suggesting self -
Loneliness
0.4716***
0.0378***
Nomophobia Stress
0.0628***

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control moderated the effects of loneliness on stress. The simple slopes indicated that at low
self -control, the positively correlation between loneliness and stress was stronger (B=0.5247,
SE = 0.0506, p<0.01, 95% CI = [0.0506, 0.0506]) and at high self-control, the positively
correlation between loneliness and stress was weak (B= 0.3140, SE =0.0551, p<0.01, 95% CI
= [0.2057, 0.4223] (see Fig 3).
Conditional indirect effect analysis indicated that the overall indirect effect was
stronger for high school students who have low self-control (B= 0.0198, SE = 0.0092, p <0.01,
95% CI = [0.0024, 0.0379]) than for those who have high self-control (B= 0.0119, SE =0.0057,
p <0.01, 95% CI = [0.0014, 0.0241]. The index of moderated mediation was significant B= -
0.0008, SE = 0.0005, 95% CI = [-0.0020, -0.0001], indicating that self-control significantly
moderated the indirect effect of nomophobia and stress level (see Fig 4).
Table 4
Moderated mediation analysis
Paths β SE 95%CI
Low High
Nomophobia– Loneliness 0.0378* 0.0164 0.0055 0.0700
Nomophobia– Stress 0.0581*** 0.0154 0.0279 0.0884
Loneliness – Stresss 1.2843*** 0.2749 0.7444 1.8242
Self Control– Stress 0.7575* 0.3265 0.1162 1.3988
Loneliness * Self-Control -0.0219** 0.0070 -0.0356 -0.0082
Age - Loneliness 0.0179 0.4136 -0.7945 0.8303
Age – Stress 0.0298 0.3796 -0.7158 0.7754
Conditional effects of the focal predictor at values of the moderator
− 1 SD below mean Self-Control 0.5247 0.0506 0.0506 0.0506
+ 1 SD below mean Self-Control 0.3140 0.0551 0.2057 0.4223

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Conditional indirect effect at different values of Self-Control
− 1 SD below mean Self-Control 0.0198 0.0092 0.0024 0.0379
+ 1 SD below mean Self-Control 0.0119 0.0057 0.0014 0.0241
Index of moderated mediation
-0.0008 0.0005 -0.0020 -0.0001
Note: * p < 0.05 ** p< 0.01 *** p < 0.001.
Figure 3
Self-Control as moderator of the relationship between Loneliness and Stress
Figure 4
The final moderated mediation model
1
1.5
2
2.5
3
3.5
4
4.5
5
Low Lonelines High Lonelines
STRESS
Low Self-
Control
High Self-
Control
Loneliness
Stress
Nomophobia
0.0378*
0.7575*
1.2843***
0.0581***

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Discussion
This study analyzes the impact of nomophobia, loneliness, and self-control on stress
symptoms in Vietnamese high school students. Specifically, this study examined a moderated
mediation model, in which loneliness is considered a mediator and self-control is presented as
a moderator in the pathway from nomophobia to stress.
First, we found that nomophobia positively predicted stress symptoms. This finding is
consistent with previous findings (Bano et al., 2021; Farchakh et al., 2021; Fernandes et al.,
2020; Kalaskar, 2015; Yücens & Üzer, 2018). Recent literature has reported that increased
stress levels and nomophobia have a significant positive relationship (Bano et al., 2021;
Farchakh et al., 2021). Bano et al., (2021) reported higher anxiety and stress scores in students
with severe nomophobia. There was a significant positive correlation between nomophobia and
anxiety, depression, stress, and impulsivity (Farchakh et al., 2021). On the other hand, the
tendency to be addicted to phones increases with stress and anxiety. Those with higher Internet
addiction scores were more anxious than students with lower (Yücens & Üzer, 2018). Those
who scored high for gaming addiction, compulsive internet use, and social media use also
reported high scores for depression, loneliness, avoidance, poor sleep quality, and depression-
related anxiety translation (Fernandes et al., 2020). People who use or check smartphones a lot
during the day may experience sleep disturbances, stress, anxiety, and reduced academic
performance, as well as reduced physical well-being (Thomée et al., 2011). Spending five to
six hours on smartphones every day is prone to psychological problems like anxiety, trouble
sleeping, stress, loss of motivation and interest in classes, etc. (Kalaskar, 2015). Therefore,

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high school students with high levels of nomophobia tend to report higher stress levels than
students with low levels of nomophobia.
Second, we found that loneliness is a partial mediator in the relationship between
nomophobia and stress, supporting hypothesis 1. These results mean that nomophobia
positively predicts loneliness, and then loneliness positively predicts stress. Ozdemir et al.,
(2018) research on university students has also shown a positive correlation between
nomophobia and self-esteem and loneliness, whereas subjective happiness and nomophobia are
negatively correlated. The study by Kara et al. (2021) reported that adolescents who use
smartphones for long periods of the day are at increased risk of developing nomophobia, in
which loneliness plays a solid mediating role. People who feel lonely often use smartphones as
a tool to combat loneliness (Jiang et al., 2018). As individuals spend more time at home during
the COVID-19 pandemic, smartphone use may increase as a way to pass the time, and rising
smartphone use to neglect everything else in an individual's life, this is an essential component
of addiction (Elhai et al., 2017; Griffiths, 2005). People with high levels of loneliness have a
higher risk of stress (Brown et al., 2018; Campagne, 2019; Jaremka et al., 2014; Stone et al.,
2013). Feeling lonely has been reported to be a specific risk factor for anxiety and chronic
stress (McHugh & Lawlor, 2013; Wilson et al., 2007; Zammuner, 2009), as well as being
heavily involved in maladaptive behaviors (Loades et al., 2020; Segrin & Passalacqua, 2010).
Boursier et al. (2020) suggested that feeling of loneliness during the COVID-19 pandemic is
positively associated, both directly and indirectly, with anxiety. Furthermore, feelings of
loneliness predicted high levels of both anxiety and excessive social media use. In addition,
loneliness positively correlates with anxiety in both older adults and young adults (Ebesutani
et al., 2015) and positively correlates with happiness, health, and life satisfaction sống (Moore
& Schultz, 1983; Salimi, 2011). Recent studies have also found a strong, positive correlation
between stress and loneliness (Jaremka et al., 2014); A British study indicates that stress is a

19
condition for loneliness (Stone et al., 2013). The above analysis demonstrated that nomophobia
indirectly affects stress through loneliness. Therefore, reducing loneliness may prevent
adolescents with high levels of nomophobia from being at risk of stress.
Finally, we found that self-control significantly modulated the indirect effects of
nomophobia on stress. The results indicated that the impact of nomophobia and loneliness on
stress was increased in high school students with low self-control and decreased in students
with high self-control. In other words, for adolescents with low levels of self-control, the
stronger the positive effect of loneliness on stress; meanwhile, the positive impact of loneliness
on stress decreased for adolescents with high self-control. Previous studies have highlighted
that people with high levels of loneliness have a higher risk of stress (Brown et al., 2018;
Campagne, 2019; Jaremka et al., 2014; Stone et al., 2013). In addition, loneliness was found to
be negatively correlated with self-control (Stavrova et al., 2021; Liu et al., 2019; W. C. Wang,
2019). Lower self-control was associated with higher loneliness at trait and status levels
(Stavrova et al., 2021). When individuals feel lonely, they tend to focus more on their emotional
state, managing their emotions, controlling their thoughts, and making choices, which can
cause disabling situations self-control (Liu et al., 2019; W. C. Wang, 2019). When Lonely
people feel bored, they are more likely to engage in new experiences and sensations, seek to
maintain psychological agitation, which impairs self-control.
In line with previous findings, we found that low self-control and high levels of
loneliness increase stress levels. Previous literature has reported that self-control is
significantly negatively correlated with stress, anxiety, and depression (Boals et al., 2011;
Bowlin & Baer, 2012; Tangney et al., 2004 ). Research by Nielsen et al. (2020) shows that self-
control negatively predicts daily stress and stress variability. People with self-control are often
more proficient at improving stressful situations using effective regulatory strategies
(Hennecke et al., 2019; Hofmann et al., 2012) and seeking more social support (Nielsen et al.,

20
2020; van Dellen et al., 2015). Furthermore, people with poor self-control may experience more
significant and frequent problems regulating thoughts and behavior (de Ridder et al., 2018).
People with greater self-control may also experience lower stress because they limit their
exposure to potential stressors (Hofmann et al., 2012; Webb et al., 2018). As a result, students
with high loneliness and low self-control tended to report higher stress levels. The above
analysis shows that high school students with low levels of loneliness and high self-control
have a low risk of stress; in contrast, adolescents with high levels of loneliness and low self-
control were at increased risk of stress (see Figure 3).
Conclusion
This study has extended insights into the complex relationship between
nomophobia, loneliness, self-control, and stress among high school students. The
mediating role of loneliness and the moderator role of self-control have identified the
internal mechanism between nomophobia and stress. The present study results may
provide valuable guidelines in implementing psychological interventions to improve
nomophobia and stress in high school students. The results of the present study may
provide valuable guidelines in implementing psychological interventions to improve
claustrophobia and stressin high school students. Preventing and minimizing cell phone
phobia can be used as a preventive therapy to help reduce symptoms of stress.
Accordingly, interventions to prevent cell phone deprivation should focus on measures
to reduce loneliness and enhance self-control. However, this study still has the
limitations of a cross-sectional study. Therefore, a longitudinal study design to
determine the cause-and-effect relationship between research variables is necessary.
Conflicts of Interest: The authors declare no conflict of interest.
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