One in four children and young people could have problematic smartphone use, according to research that also suggests such behaviour is associated with poorer mental health.

The amount of time children and teens spend using their devices has become an issue of growing concern, but experts say there is still little evidence as to whether spending time on screens is harmful in itself.

The experts behind the latest study said they wanted to look beyond the time young people were spending on smartphones and instead explore the type of relationship they had with such devices.

The results suggest more than 23% of young people have a dysfunctional relationship with their smartphones, and that this appears to be associated with poorer mental health – although the research cannot say whether phone use is driving such problems.

“It seems like a substantial minority of teenagers and young people from various different countries are self-reporting a pattern of behaviour that … we recognise from other addictions,” said Dr Nicola Kalk of King’s College London, co-author of the study. “The quality of the evidence is poor, but it is enough to warrant further investigation.”

Writing in the journal BMC Psychiatry, the team reported how they looked at data from 41 studies involving a total of almost 42,000 participants across Europe, Asia and America, predominately in their teens or early 20s.

These studies used questionnaires to probe the prevalence of problematic smartphone use – behaviours such as being anxious when the device is not available or neglecting other activities to spend time on the smartphone.

Taken together, the team said on average these studies suggested as many as one in four children and young people had problematic smartphone use, with girls in their late teens the most likely to report such behaviour.

Subsets of the studies showed problematic smartphone use appears to be more common in wealthier individuals, something the team said might be driven by early adopters of new technology, as well as in those with low self-esteem and greater levels of loneliness. It was also found to be more common among those with internet addiction, addiction to Facebook, compulsive shopping and higher levels of drinking and cigarette smoking.

Among the studies that probed mental health, the results suggested people with problematic smartphone use were also more likely to have depression – for which the odds were more than three times worse – anxiety, feelings of stress and poor sleep as well as poorer educational attainment.

While the team said it was too soon to call problematic smartphone usage an addiction, they noted that it appeared to be linked to similar patterns of behaviour and emotion.

Kalk said further studies were needed to explore if these behaviours were hard to break, or cause harm – other key features of an addiction.

The authors argued that the availability and pervasiveness of smartphones in everyday life meant problematic use of the devices posed a different and “arguably much bigger public health problem” than substances of abuse or internet gaming.

Kalk said the team were now looking at whether smartphones were just delivering addictive content, or whether there was something inherently addictive about using such devices.

She added that tracking use, a common feature on phones, was helpful. “Once you start monitoring your use, you are engaging with its impact and how much time it is taking and what you are not doing because you are spending time on your phone,” she said.

However the research has limitations, including that the studies relied on self-report rather than diagnoses of mental health problems, while more than half of them were deemed to be of poor quality.

Dr Amy Orben, an expert in screen time at the University of Cambridge, raised concerns, noting that the definition of problematic internet use varied considerably across studies, and the measures used were contested.

She said studies finding little signs of problematic internet use might have been overlooked, while the research could not say whether problematic smartphone use caused poorer mental health.

“It has been shown previously that smartphone effects are not a one-way street, but that mood can impact the amount of smartphone use as well, making these correlations bidirectional in nature,” she said.

Prof Russell Viner, President of Royal College of Paediatrics and Child Health, said that parents were navigating unchartered water when it came to technology.

“One of the most critical things for parents to consider is whether screen time is having a detrimental impact on other activities like school, relationships or other interests. This study suggests that this is the case for a significant minority of children and young people,” he said.

Viner said in these cases parents should calmly install age-appropriate boundaries on smartphone use, and ask questions about whether their children were experiencing other problems.

“While screen time is a new problem, part of the solution is tried and tested – open and regular conversations based on respect and trust,” he said.