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INVITED COMMENTARY
116 NCMJ vol. 81, no. 2
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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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120
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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