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The Impact of Social Media on Youth Mental Health: Challenges and Opportunities

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The technology landscape has rapidly evolved in recent years, with social media now playing a central role in the lives of youth. Social media has created both significant new challenges and exciting opportunities. Research is beginning to uncover how specific social media experiences may influence youth mental health.
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The technology landscape has rapidly evolved in recent
years, with social media now playing a central role in the
lives of youth. Social media has created both significant new
challenges and exciting opportunities. Research is beginning
to uncover how specific social media experiences may influ-
ence youth mental health.
Digital technologies have become a universal feature of
young people’s lives. Exposure to screens begins early
in life for many youth, with US children under age two spend-
ing an average of 42 minutes per day with screen media
[1]. By the time youth reach adolescence, most are fully
immersed in a world of smartphones, computers, and social
media. Recent nationally representative statistics suggest
that 95% of adolescents aged 13-18 have access to a smart-
phone and 88% have access to a desktop or laptop at home
[2]. In 2018, 45% of US adolescents reported that they were
online “almost constantly,” up from 24% only three years
prior [2]. The pervasiveness of new media has created an
increasingly complex environment for youth, parents, health
care providers, and policymakers to navigate. Indeed, while
this media environment has introduced numerous new chal-
lenges and risks for youth mental health, so too has it pre-
sented considerable benefits and opportunities.
Adolescence and the Media Landscape
Today’s media landscape is larger and more diverse than
ever before, with youth having access to an unprecedented
volume of digital content across numerous devices, includ-
ing smartphones, tablets, computers, laptops, and gaming
consoles. Social media represents a central component of
this landscape. Broadly, social media is defined as any digi-
tal tools or applications that allow users to interact socially
[3], and can be distinguished from traditional media (eg,
television) by the fact that users can both consume and cre-
ate content. Under this broad definition, “social media” may
include social networking sites (eg, Instagram, Snapchat,
Facebook, TikTok), text messaging and messaging apps,
social gaming tools, YouTube, and more. Any comprehensive
understanding of contemporary adolescents’ mental health
requires a consideration of the role of social media.
Adolescence represents a period of heightened risk for
the onset of mental illness, with nearly 1 in 5 adolescents
suffering from a diagnosable mental disorder [4]. Notably,
the incidence of certain mental health concerns, such as
depression [5] and suicide [6], have increased significantly
among adolescents in recent years, with rates of suicide
among youth aged 10-24 increasing 56% from 2007 to 2017
[6]. Given that this increase has coincided with the wide-
spread adoption of social media, this has led to concerns
regarding a potential link. In addition, technology use tends
to increase over the course of childhood, with adolescents
using new media, and social media in particular, at higher
rates and with greater frequency than younger children
[7]. Nearly all adolescents aged 13-17 use some form of
social media, with the most popular sites currently being
YouTube (85%), Instagram (72%), Snapchat (69%), and
Facebook (51%) [2]; however, new platforms are frequently
introduced, with some (ie, TikTok), quickly gaining traction
among young people.
Furthermore, social media may uniquely appeal to ado-
lescents given the characteristics of this developmental
period, making teens particularly susceptible to both the
opportunities and risks of new technologies. During ado-
lescence, rapid development of the brain’s socioaffective
circuitry may heighten sensitivity to social information,
increasing the drive for social rewards and concern over
peer evaluation [8]. Important developmental tasks of ado-
lescence include the establishment of intimate peer rela-
tionships, increasing independence from adults, and the
exploration of identity [9]. Social media offers a prime con-
text for navigating these tasks in new, increasingly complex
ways: peers are constantly available, personal information
is displayed publicly and permanently, and quantifiable peer
feedback is instantaneously provided in the form of “likes”
and “views” [10].
The Impact of Social Media on Youth Mental
Health:
Challenges and Opportunities
Jacqueline Nesi
Electronically published March 2, 2020.
Address correspondence to Jacqueline Nesi, Coro West, Ste 204,
1 Hoppin St, Providence, RI 02903 (jacqueline_nesi@brown.edu).
N C Med J. 2020;81(2):116-121. ©2020 by the North Carolina Institute
of Medicine and The Duke Endowment. All rights reserved.
0029-2559/2020/81209
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Understanding the Impact of Social Media on
Youth Mental Health
Research on social media and adolescent mental health
has proliferated in recent years, with many studies explor-
ing whether more frequent use of social media is associated
with various mental health concerns, including depression
[11], body image concerns and disordered eating [12], and
externalizing problems [13]. In general, findings from these
studies have been mixed, with many revealing a small but
significant negative effect of social media use on mental
health. A growing body of work now seeks to build on these
studies with more nuanced investigations of how, why, and
for whom social media use may have positive or negative
effects on youth development. Social media comprises a
vast array of digital tools, and thus characterizing its overall
effect on youth remains challenging. First, it is important to
understand individual strengths and vulnerabilities that may
predispose certain adolescents to engage with and respond
to social media in adaptive or maladaptive ways. In addition,
it is critical to identify how specific social media behaviors or
experiences may put adolescents at risk.
Potential Risks of Social Media for Adolescent
Mental Health
Adolescents’ peer experiences play a critical role in
the onset and maintenance of psychopathology. Within
the social media environment, peer interactions can occur
with increased frequency, immediacy, and intensity [10].
Specific online peer experiences have been identified in
prior work as potential risk factors for mental health con-
cerns. Cybervictimization, or the experience of being a vic-
tim of bullying by peers online, has been consistently found
to be associated with higher rates of self-harm and suicidal
behavior [14], as well as internalizing and externalizing prob-
lems [15]. Other types of social media peer experiences,
such as social exclusion and online conflict or drama [16],
also may put youth at risk. Peer influence processes may
also be heightened online, where youth may access a wide
range of their peers in addition to potentially risky content.
Youth who are exposed to social media content depicting
risky behaviors (ie, alcohol and other substance use) may
be more likely to engage in these behaviors themselves [17].
Content related to suicide and self-injury may also be read-
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118
ily available online, potentially increasing suicide risk among
youth who are already vulnerable. In a recent study of over
400 youth who were psychiatrically hospitalized due to risk
of harm to self or others, a small but meaningful proportion
of youth reported viewing online content that promoted sui-
cide (14.8%) or self-injury (16.6%) during the two weeks
prior to their admission [18].
Social comparison may be another risk associated with
adolescents’ social media use. Individuals frequently engage
in selective self-presentation on social media, resulting in a
stream of posts and images that are often carefully crafted
to portray users in a positive light. This may lead some youth
to engage in negative social comparisons regarding their
own accomplishments, abilities, or appearance. Studies
have shown that higher levels of online social comparison
are associated with depressive symptoms in youth [19], and
that appearance-specific comparisons on social media may
heighten risk for disordered eating and body image concerns
[20].
Finally, a critical consideration in examining the effects
of technology use on youth mental health is the issue of
displacement: what other important activities are being
replaced by time spent on social media? It is well-estab-
lished that sleep hygiene is essential to youth mental health
and development. However, prior work has reliably demon-
strated a link between mobile screen time before bed and
a range of poorer sleep outcomes, including shorter sleep
duration, poor sleep quality, and daytime sleepiness [21].
Notably, 40% of adolescents report that they use a mobile
device within five minutes before going to sleep, and 36%
report waking up to check their device at least once during
the night [22]. Thus, the impact of social media on sleep
quality remains a primary risk for subsequent mental health
concerns among youth, and is an important area for future
study.
Potential Benefits of Social Media for Adolescent
Mental Health
While much of the narrative surrounding new media
use among adolescents has emphasized potential risks, the
unique features of the social media environment have also
created new opportunities for promoting adolescents’ mental
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Youngstrom sidebar continued
health. In general, there is a range of potential benefits
associated with social media use, including possibilities for
humor and entertainment, identity exploration, and creative
expression [2, 16, 23]. One of the most clearly established
benefits of social media use is that of social connection, with
81% of teens reporting that social media allows them to feel
more connected to their friends [16]. In a recent nationally
representative survey, 77% of adolescents reported that
social media was at least “somewhat” important for keeping
up with friends on a day-to-day basis, and 69% reported it to
be at least somewhat important for having meaningful con-
versations with close friends [23]. Adolescents frequently
cite connecting with friends and family as a primary positive
aspect of social media [2], and prior work generally shows
that social media use promotes individuals’ well-being when
it is used to advance a sense of acceptance or belonging [24].
The public and highly accessible nature of social media
also creates the possibility for establishing new connections
online. This may provide opportunities to receive online
social support for certain youth, particularly those who may
not readily have access to communities of similar peers. For
example, youth identifying as LGBTQ have been shown to be
more likely than non-LGBTQ youth to have online friends and
to identify these friends as an important source of emotional
support [25]. The receipt of online social support may also
play a protective role for youth with mental illness, including
depression and suicidality. Indeed, one study suggests that
more than half (57.0%) of psychiatrically hospitalized youth
report receiving social support or encouragement on social
media during the two weeks prior to their admission [18].
The promise of new media for promoting adolescent
mental health goes beyond its day-to-day use among youth
to include novel health care applications in screening, treat-
ment, and prevention. In regard to screening, prior work has
demonstrated the potential feasibility of reviewing social
media pages for signs of depression or substance abuse
[17, 26]. On a larger scale, increasingly sophisticated
machine learning algorithms have been developed to detect
social media-based signals of mental illness, including
depression, post-traumatic stress disorder, and suicidality
[27]. Social networking sites like Facebook and Instagram
have already implemented screening and intervention
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procedures when users exhibit signs of emotional distress
or suicide risk. Social media also presents unprecedented
opportunities for increasing mental health awareness, and
social media-based health promotion efforts have been
tested for a variety of mental and behavioral health con-
cerns [28]. The immediate accessibility and potential scale
of social media offers exciting possibilities for youth mental
health treatment, including the potential to serve hard-to-
reach populations. While a large number of mental health
mobile apps have recently been developed for youth, and ini-
tial evidence supports their acceptability, further research is
needed to establish efficacy and effectiveness.
Conclusions and Future Directions
Over the past two decades, new media have established
an increasingly central presence in the lives of youth, pre-
senting both new challenges and new opportunities. An
emerging body of research has begun to identify social
media experiences that may contribute to adolescents’
mental health. However, more research is needed as the
digital media landscape continues to rapidly evolve. Much
of the existing research has relied on self-report measures
of adolescent media use, and has been conducted at a single
time point, preventing any definitive conclusions regarding
whether media use precedes and predicts mental health
outcomes or vice versa. Future experimental and longitu-
dinal studies are needed, including those that incorporate
objective measures, such as direct observation of adoles-
cents’ social media pages. In addition, future investigations
must continue to move beyond previous notions of “screen
time” as a primary contributor to mental health, and instead
consider the specific social media experiences and indi-
vidual characteristics that may make certain adolescents
particularly vulnerable to social media’s positive or negative
effects. Finally, the translation of basic social media research
findings into clinical and policy application remains an area
of critical need in the field. As the presence of new media
only continues to grow, it will be essential to develop evi-
dence-based approaches for encouraging healthy social
media use in youth, and to effectively utilize these tools for
mental health screening and intervention.
Jacqueline Nesi, PhD postdoctoral fellow, Department of Psychiatry &
Human Behavior, Division of Clinical Psychology, Brown University and
Bradley Hasbro Research Center, Rhode Island Hospital, Providence,
Rhode Island.
Acknowledgments
Jacqueline Nesi is supported, in part, by funds provide by the
American Foundation for Suicide Prevention (PDF-010517). Any opin-
ions, findings, and conclusions or recommendations expressed in this
material are solely the responsibility of the author and do not necessar-
ily reflect the views of AFSP.
Potential conflicts of interest. The author has no relevant conflicts
of interest.
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Adolescents’ use of social media (SM) has increased drastically in recent years, with more than 80% of teens now belonging to sites such as Instagram, Snapchat, and Facebook. ¹ This has critical implications for youths’ psychosocial development. Research increasingly supports a differential susceptibility model of media effects, ² whereby certain adolescents show increased risk for negative effects of SM use. Emerging research with community samples of youth suggest that mental health concerns may be one factor that heightens vulnerability to adverse SM experiences. In particular, youth with internalizing symptoms are more likely to report negative emotional responses to SM activity. ³ In addition, youth with suicidal thoughts or behaviors are more likely to experience cybervictimization, and may be at risk for exposure to suicide-related SM content. ⁴ Despite this preliminary evidence, almost no research to date has examined SM use among youth with clinically severe psychiatric presentations. This has significantly limited our understanding of a central feature in the lives of youth with mental illness. To address this limitation, we examined SM experiences among a large sample of psychiatrically hospitalized adolescents. We sought to determine the prevalence of positive and negative SM experiences in this population, and to explore differences in SM use based on diagnostic presentation.
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Investigators have long recognized that adolescents’ peer experiences provide a crucial context for the acquisition of developmental competencies, as well as potential risks for a range of adjustment difficulties. However, recent years have seen an exponential increase in adolescents’ adoption of social media tools, fundamentally reshaping the landscape of adolescent peer interactions. Although research has begun to examine social media use among adolescents, researchers have lacked a unifying framework for understanding the impact of social media on adolescents’ peer experiences. This paper represents Part 1 of a two-part theoretical review, in which we offer a transformation framework to integrate interdisciplinary social media scholarship and guide future work on social media use and peer relations from a theory-driven perspective. We draw on prior conceptualizations of social media as a distinct interpersonal context and apply this understanding to adolescents’ peer experiences, outlining features of social media with particular relevance to adolescent peer relations. We argue that social media transforms adolescent peer relationships in five key ways: by changing the frequency or immediacy of experiences, amplifying experiences and demands, altering the qualitative nature of interactions, facilitating new opportunities for compensatory behaviors, and creating entirely novel behaviors. We offer an illustration of the transformation framework applied to adolescents’ dyadic friendship processes (i.e., experiences typically occurring between two individuals), reviewing existing evidence and offering theoretical implications. Overall, the transformation framework represents a departure from the prevailing approaches of prior peer relations work and a new model for understanding peer relations in the social media context.
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Concerns are increasingly raised in academic and lay literature about the impact of the internet on young people’s well-being. This systematic review examined empirical research on the relationship between social media use and depressive symptoms in the child and adolescent population. A systematic search of Medline, PsycInfo and Embase databases yielded eleven eligible studies. Relevant results were extracted from each study, with a total sample of 12,646. Analysis revealed a small but statistically significant correlation between social media use and depressive symptoms in young people. However, studies varied widely in methods, sample size and results, making the clinical significance of these findings nuanced. Over half of the studies were cross-sectional, while those of longitudinal design were of limited duration. This review justifies further investigation of this phenomenon, with a need for consensus on variables and measurement.
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Importance: Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality. Objective: To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes. Data sources: A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied. Study selection: The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation. Data extraction and synthesis: Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data. Main outcomes and measures: The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol. Results: Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%). Conclusions and relevance: To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.
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Importance Social media use may be a risk factor for mental health problems in adolescents. However, few longitudinal studies have investigated this association, and none have quantified the proportion of mental health problems among adolescents attributable to social media use. Objective To assess whether time spent using social media per day is prospectively associated with internalizing and externalizing problems among adolescents. Design, Setting, and Participants This longitudinal cohort study of 6595 participants from waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October 30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the Population Assessment of Tobacco and Health study, a nationally representative cohort study of US adolescents, assessed US adolescents via household interviews using audio computer-assisted self-interviewing. Data analysis was performed from January 14, 2019, to May 22, 2019. Exposures Self-reported time spent on social media during a typical day (none, ≤30 minutes, >30 minutes to ≤3 hours, >3 hours to ≤6 hours, and >6 hours) during wave 2. Main Outcomes and Measure Self-reported past-year internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems during wave 3 using the Global Appraisal of Individual Needs–Short Screener. Results A total of 6595 adolescents (aged 12-15 years during wave 1; 3400 [51.3%] male) were studied. In unadjusted analyses, spending more than 30 minutes of time on social media, compared with no use, was associated with increased risk of internalizing problems alone (≤30 minutes: relative risk ratio [RRR], 1.30; 95% CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours: RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82; >30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15; 95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73); associations with externalizing problems were inconsistent. In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78; 95% CI, 1.15-2.77) and comorbid internalizing and externalizing problems (>3 to ≤6 hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43) but not externalizing problems alone. Conclusions and Relevance Adolescents who spend more than 3 hours per day using social media may be at heightened risk for mental health problems, particularly internalizing problems. Future research should determine whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.
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Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators. Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.
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In the early days of the Internet, both conventional wisdom and scholarship deemed online communication a threat to well-being. Later research has complicated this picture, offering mixed evidence about how technology-mediated communication affects users. With the dawn of social network sites, this issue is more important than ever. A close examination of the extensive body of research on social network sites suggests that conflicting results can be reconciled by a single theoretical approach: the interpersonal-connection-behaviors framework. Specifically, we suggest that social network sites benefit their users when they are used to make meaningful social connections and harm their users through pitfalls such as isolation and social comparison when they are not. The benefits and drawbacks of using social network sites shown in existing research can largely be explained by this approach, which also posits the need for studying specific online behaviors in future research.