1. Introduction
long with other advanced technologies, smartphones are also widely used in medical communities due to their numerous applications.
Smartphones play an essential role in promoting learning among medical students and physicians to find the most appropriate treatment solution and improve learning. However, unreasonable and excessive use of mobile phones has led to the emergence of a phenomenon called mobile phone addiction. In recent years, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) respecting non-drug addiction (internet game disorder), has also concerned smartphone addiction. Smartphone addiction is associated with sleep disorders, stress, anxiety, risk aspects, various biopsychological health, decreased academic performance, and life satisfaction. As it can have devastating effects on students’ personal and social well-being, smartphone addiction has been on the rise in recent years due to over-reliance on technology; thus, thorough research is required on smartphone addiction and its effects on academic performance and personal life.
Therefore, due to the high prevalence of smartphone use among medical students, this study aimed to determine the relationship between smartphone addiction and stress and life satisfaction in students of Guilan University of Medical Sciences.
2. Methods
This descriptive-analytical study used a cross-sectional design. This research was conducted on 331 medical students in the intern and trainee of the Faculty of Medicine of the University of Guilan Province, Iran, in 2020 who were selected by convenience sampling method. To determine the sample size [16], considering the statistical power of 95%, the error level of 0.05, and the correlation obtained from previous studies [17] equal to 0.20, the minimum sample size of 327 was obtained. Considering the possible samples dropout and to increase the accuracy of the study, 355 individuals were determined. The inclusion criteria were studying at Guilan Medical School. The exclusion criteria were presenting any psychological problems, such as depression.
A four-part questionnaire was used to collect the necessary data. The first part of personal and social information (age, gender, academic performance; grade point average, the place of residence, marital status, & educational level) and Smartphone Addiction Scale (SAS), Perceived Stress Scale (PSS; Cohen et al, 1983), and the Satisfaction With Life Scale (SWLS)were completed by the study volunteers. The time to complete each questionnaire was 15-20 minutes.The collected data were analyzed in SPSS using descriptive statistics and inferential statistics (Pearson correlation coefficient, Independent Samples t-test, & multiple linear regression analysis).
3. Results
The present study results revealed that the Mean±SD age of the explored students equaled 23.90±1.58 years and their Mean±SD grade point average was 16.24±1.10. Most of the research participants were interns (55.3%), male (54.1%), single (90.9%), and lived in a private home (40.2%). Table 1 indicates the distribution of smartphone addiction variables, stress and life satisfaction, and Pearson correlation coefficients. 


Smartphone addiction has a positive correlation with stress (P=0.01, r=0.65) and negatively with life satisfaction (P=0.01, r=-0.58) (P<0.01). There was also a significant negative correlation between stress and life satisfaction (P=0.01, r=-0.53) (P<0.01). The results of the Pearson correlation coefficient indicated that grade point average had a significant relationship with smartphone addiction (P=0.01, r=-0.68), stress (P=0.01, r=-0.71), and life satisfaction (P=0.01, r=0.60).  The Independent Samples t-test results revealed that females scored higher in life satisfaction (P=0.01, t=-0.44). Single subjects had higher scores on smartphone addiction (P=0.03, t=2.15) and stress (P=0.01, t=2.64) and lower scores on life satisfaction (P=0.02), t=-2.30).
The regression model indicated that stress and life satisfaction based on the adjusted R2 coefficient together explained 57% of the variance of the smartphone addiction in the examined students (P=0.001, F=215.84). The value of β for these two variables suggested that if other conditions were constant, with an increase of one unit in these two variables by 0.52 and -0.34 units, respectively; an increase occurred in the score of smartphone addiction.
4. Discussion and Conclusion
The present study aimed to determine the relationship between smartphone addiction and stress, academic performance, and life satisfaction in medical students. The obtained results revealed a significant and direct relationship between smartphone addiction and stress and a significant and inverse relationship between smartphone addiction and life satisfaction. Additionally, a significant and inverse relationship was observed between smartphone addiction and grade point average. In the study of Ching et al. in a medical school, the rate of smartphone addiction was reported to be 46.9%. In the e-Silva study, approximately 96.8% of students used their mobile phones during classrooms and conferences. Only 43.7% of students used their smartphones for >10 minutes for educational purposes; this amount was more common among intern students. Medical students are under extensive stress during their studies; as a result, their self-control power decreases, which makes them more prone to smartphone addiction. The present study findings can provide useful insights for policymakers to establish intervention programs to reduce the psychological effects of smartphone addiction on students.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1399.423).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflicts of interest.
 

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