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C
URRENT
O
PINION
Influence of social media on mental health:
a systematic review
Manoj Kumar Sharma
a
, Nisha John
a
, and Maya Sahu
b
Purpose of review
Social media’s role in a user’s life has increased dramatically over the past decade. It is used increasingly
as a leisure activity amongst young adults. The types of social media have also diversified with time and
the ease of access is worrying. Aim of the current review is to find the effect of social media use on mental
health.
Recent findings
Systematic search of articles was carried out from different database from 1991 to February 2020 across
five databases. The PICO guidelines, PRISMA flow diagram and Rayyan software was used in identifying
relevant studies which were assessed using the risk of bias. Cross-referencing was done with the co-authors.
A total of 16 studies was finally included in the review. Social media role is far reaching both in terms of
an individual’s self-perception and mood but also on their social relationships. It is interesting to find its
effect also in politics, organizations and even psychiatric illnesses. The 16 studies were divided into the
positive, negative and neutral effects of social media.
Summary
Debate over social media’s role mental health will continue till a greater number of RCTs are conducted.
Various variables amongst different age groups should be measured. It would also be beneficial if
longitudinal research can be done.
Keywords
mental health, social media, well being
INTRODUCTION
Over the past decade, social media use has become
increasingly popular leisure activities among the
people [1,2]. Social media provides a common plat-
form where individuals having their own account/
profile can connect with people all over the world
[3,4]. They visit sites of social media by logging into
their account from anywhere and anytime using
smart phone, laptop or desktop and engage in dif-
ferent types of entertainment and social activity
through posts or blogs [1,5]. Further social media
gives the opportunity of meeting friends based on
shared interest, chatting, mailing, playing games
and gambling [6,7].
Types of social media
Preferences to the types of social media use have
changed over time. Use of WhatsApp, Facebook,
Twitter, Instagram, Snapchat, E-mail or YouTube
has increased dramatically [8]. According to Pew
Research Centre, YouTube and Facebook are the
most-widely used online platforms, and its user base
is most broadly representative of the population as a
whole. Some of them also use sites such as Twitter,
Pinterest, Instagram and LinkedIn [9].
Factors affecting use of social media
The use of social media varies because of some demo-
graphic factors such as age, sex education and marital
status [10,11]. Young adults are among the earliest
and highest social media adopters, although usage by
older adults has increased in recent years [12]. Other
studies have also found higher usage among younger
a
Department of Clinical Psychology and
b
Department of Nursing,
National Institute of Mental Health & Neurosciences, Bengaluru, Karna-
taka, India
Correspondence to Manoj Kumar Sharma, Department of Clinical
Psychology, SHUT clinic (Service for Healthy Use of Technology),
National Institute of Mental Health & Neurosciences, Bengaluru,
Karnataka, India. Tel: +91 08026995197; fax: +91 08026562121.
E-mail: shutclinic@gmail.com
Curr Opin Psychiatry 2020, 33:000– 000
DOI:10.1097/YCO.0000000000000631
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REVIEW
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YCO 330505
people [13,14], and in males [15]. Some studies
reported more usage among females and older users
[2,16]. Research also suggests that individuals who
are not in relationship are more likely to use social
media than who are into it [17].
Social media use and mental health
Social media is a wonderful platform of being praised
or getting opinions from hundreds of real-life or
virtual friends which can either boost the morale
or down it as well [18]. Additionally, social media
may develop their identities and culture without
interruption from parents or those in a position of
authority [2]. Furthermore, social media may pro-
mote social interaction or social connectedness being
the base for meeting potential people of same inter-
est, thoughts, feelings or belongingness [8].
Although routine use of social media is associ-
ated with positive health outcomes, emotional
attachment to social media use is associated with
negative health outcomes [19
&&
]. Studies reported
that excessive use of social media has found to be
correlated with depressive symptoms, self-esteem,
general and physical appearance anxiety and body
dissatisfaction [20
&
,21].
Social media addiction
Although social media use has been a modern behav-
iour, studies also have reported that time spent on
social media is rapidly increasing [18]. Studies focus-
ing on the behavioural addictions are ever increasing.
The most common researched areas are the internet,
videogames and mobile phones [22
&
]. Similarly,
excessive use of social media which is indicative of
addictive use is characterized by being preoccupied
by social media [salience], using social media in order
to reduce negative feelings [mood modification],
gradually using social media more and more in order
to get the same pleasure from it (tolerance/craving),
suffering distress if prohibited from using social
media ([withdrawal), causing harm to other impor-
tant life areas because of the social media use
(conflict/functional impairment) and desiring or
attempting to control the use of social media without
success (relapse/loss of control) [8].
Social media use and its increase have created a
new research platform and effect of excessive use on
individual’s mental health are areas of concern [23].
Studies reported the theoretical background of
innate psychological needs for self-competence,
determination, realization, autonomy, recognition,
relatedness and entertainment to be the major
intrinsic driving forces of engaging individuals in
various activities. Of these, enjoyment is inherent in
such activities and the positive experiences associ-
ated with them [13]. There is need to further exam-
ine how social media can influence various aspects
of life. Hence the aim of the current review is to find
the effect of social media use on mental health.
METHOD
Quantitative studies were included in the review.
The review was carried out by using different search
strategies and various databases. The collected
articles were checked for clarity and content and
then used for the review. PICO guidelines were used
for the systematic review.
P Population/patient General population
I Intervention/indicator Social media use
C Comparator/control Other social media/solutions
O Outcome Mental health
Search strategies
The literature search was done from the year 1991 to
February 2020 through the electronic databases
such as PubMed, Proquest, APA PsycNET, OVID
and EBSCO host. The key words/phrases used to
identify related studies were: ‘social media’ or ‘social
networking sites’ and ‘mental health’ and ‘adoles-
cents’ or ‘youth’ or ‘young adults’ and ‘randomized
controlled trial’ or ‘clinical trial’. References from
the retrieved studies were also cross-checked for
additional literature.
Selection criteria for inclusion of papers
To narrow down the papers selected for the review,
the following inclusion and exclusion criteria
were used.
Inclusion criteria
(1) Studies that looked for the effect of social media
on mental health.
KEY POINTS
Several forms of social media use have become
increasingly popular among people.
The effects of mental health are seen in mood, self-
perception and in social relations.
Social media’s influence can be positive, negative
or neutral.
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(2) Studies focusing on social media and
mental health.
(3) Studies that included primary data.
(4) Studies published in peer reviewed and indexed
journal available online.
(5) Literature published in English.
Exclusion criteria
(1) Studies using social media as a direct interven-
tion for medical illnesses.
(2) Studies with inadequate information on the
research methodology.
(3) Unpublished studies
(4) Any study using a purely qualitative methodol-
ogy or mixed method approach.
Technology assisted search and screening
Rayyan software was used to assist in the database
screening for inclusion criteria [24]. All the articles
were reviewed and those articles that did not meet
the inclusion criteria were excluded. Cross-referenc-
ing of the excluded and selected studies was done
with agreement of the co-authors.
Data extraction and quality assessment
Selection of reviewed articles were done using
PRISMA Flow diagram [25], seen in Fig. 1. The rele-
vant articles were studied and the data were
extracted. The extraction of the data was completed
by one researcher and another researcher checked
the studies to see if they were consistent with the
FIGURE 1. PRISMA Flow diagram showing the selection of review articles [26].
Influence of social media on mental health Sharma et al.
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aim and inclusion criteria. Quality assessment of
the selected studies was done using Cochrane’s
criteria.
RESULTS
From the electronic database an initial 884 studies
were identified which involve the use of social
media. After applying the inclusion criteria and
the PRISMA guidelines the total number of studies
included for the review was 16.
Study characteristics
Majority of the participants were from United States
of America. The sample size varied from 16 to 4935.
The participants were mainly university students
with the maximum mean age detailed at 23.78
[26]. The range of social media used was diverse
and Facebook was the most prominent medium
used as seen in Table 1.
The sampling details were categorized in
Table 2, as the positive, negative and the neutral
effects of social media. From the overall studies, five
studies reported positive effects of social media use.
Positive influences are seen in psychiatric illness
[27], consumer markets [28], the users’ emotional
state [26], organizations [29] and in reducing sexual
references for at risk adolescents [30]. Eight studies
measured the negative effects. They are seen in the
user’s mood [31
&&
], decreased offline interaction
[32], political evaluations [33], self-esteem of the
individual [34], decreased prosocial behaviour
[35], increased positive perception towards alcohol
intake [36], the ability to disconnect from social
media [37] and disengaged moral codes [38]. Three
studies could not be classified either into either
effects and thus are placed in the neutral category.
Popularity of a video is dependent on specific facial
expressions [39]. Other areas affected are political
self-efficacy [40] and social feedback [41].
Methodological quality of the studies
Disagreement over articles were resolved through
consensus meeting and discussing with the co-
author. The methodological quality for the studies
were evaluated using the risk of bias in the Review
Manager software [42], represented as a graph in
Fig. 2 and summary in Fig. 3. Given the nature of
studies included, most of the studies were generally
unclear in most domains measured except for the
reporting of the study findings.
Self and well being
Effect of social media are both positive [30] and nega-
tive [38]. Even a single message through e-mail inter-
vention was enough to create a positive impact for at-
risk adolescents. Reduced sexual references on their
online profiles were noticed on social networking sites
[29]. The negative aspect of sending messages through
online milieus builds on the moral disengagement of
users. People are more willing and justified to lie when
communicating via e-mail than via pen and paper [38].
The overall well being and trait self-esteem of
social media users were undesirably impacted with
frequent use [31
&&
,34]. This effect is seen even with
just 20 min of exposure to Facebook. Mediating
factors were how meaningful the users’ perceived
the online activity to be [31
&&
] and if they were
exposed to more upward social comparisons, such
as high activity social network or indulged in healthy
habits [34]. An interesting factor noted was even
passively browsing the internet had more effects than
just internet browsing, over the same duration. A
downward comparison information (e.g., a low activ-
ity social network, unhealthy habits) have a lower
effect on an individual’s self-esteem.
Social relationships and its influence
Social media can be used beneficially to build social
relationships of people. Within just 10 min of use
Table 1. Different mediums used to connect social media
Medium Studies
Facebook (n¼9) Fournier et al. (2013), Neubaum and Kra
¨mer (2015), Sheldon et al. (2011),
Yuen et al. (2019), Vogel et al. (2014), Heiss and Matthes (2016), Lee (2014),
Chiou et al. (2014)
Twitter (n¼2) Park and Lee (2013), Kim and Jeong (2016)
YouTube (n¼2) Lam et al. (2017), Lewinski (2015)
MySpace (n¼1) Moreno et al. (2009)
E-mail (n¼1) Naquin et al. (2010)
Online Music (n¼1) Egermann et al. (2013)
Unspecified social networking site (n¼1) Li et al. (2017)
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Table 2. Details of the included studies in the systematic review
S No. Reference Sample
size (N)
Study design Males/females
n (%)
Age range, M
(SD)
Education level Medium Result
Positive effect
1 Lam et al., 2017
USA
4935 Clinical trial Male: 2472 (50.1%)
Female: 2463
(49.9%)
<34 Not reported YouTube YouTube is useful to deliver schizophrenia education to
Chinese-speaking individuals in the USA. YouTube
could also help in alleviating the negative stigma
towards mental health.
2 Kim and Jeong,
2016
Republic of Korea
259 Clinical trial Not reported Not reported University Twitter For social networking site promotions, similarity or social
connections between a message sender and recipient is
more influential than celebrities to attract consumers.
3 Neubaum and
Kra
¨mer, 2015
Germany
60 Quasi-experimental Male: 30
Female: 30
18– 30, 23.78
(2.57)
University Facebook Interacting on Facebook predicted users’ positive
emotional state.
4 Park and Lee,
2013
USA
40 Clinical trial Male: 9
Female: 31
20– 22, 20.55 University Twitter Having a human presence through the use of social media
managers’ avatars seemed to promote favourable
organization public relationships and positive word of
mouth communication. Although dialogic
communication intentions did not show significant
difference between organizations incorporating a
human presence versus an organizational presence.
5 Moreno et al.,
2009
USA
190 RCT Male: 58.4% 18–20 Not reported MySpace Brief E-mail intervention that use social networking sites
show promise in reducing sexual references in online
profiles for at-risk adolescents.
Negative effect
6 Yuen et al., 2019
USA
312 Quasi-experimental Female: (79%) 18– 25, 18.8 University Facebook Particularly when passively browsed, using Facebook led
to significantly worsened mood compared with
browsing the Internet. Perceptions of meaningfulness,
not envy, mediated the relationship between online
activity and mood.
7Liet al., 2017
Taiwan
Study 1: 84
Experiment 2: 96
Clinical trial Experiment 1: Male:
40
Female: 44
Experiment 2: Male:
56
Female: 40
20.4
20.6
University
Social
Networking
Site
Experiment 1- Priming with SNSs was linked with
decreased desirability for offline social activities and an
increased disposition to work alone
Experiment 2-Reduced desirability of offline socializing
and offline pleasurable experiences
8 Heiss and
Matthes, 2016
Austria
125 Clinical trial Male: 37% 15– 20, 16.66
(1.08)
High school Facebook A politicians’ participatory Facebook posts has an affect
on young people’s political efficacy and no affect for
non-participatory posts. There is a negative effect of
participatory posts for individuals with high levels of
cynicism and negative trait evaluations. There is a
significant positive effect on external and collective
efficacy for those low in political cynicism and for those
who evaluated the politician positively.
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Table 2 (Continued )
S No. Reference Sample
size (N)
Study design Males/females
n (%)
Age range, M
(SD)
Education level Medium Result
9 Vogel et al.,
2014
USA
Experiment 1:
145
Experiment 2:
128
Clinical trial Experiment 1: Male:
39
Female: 106
Experiment 2: Male:
34
Female: 94
19.64 (2.87)
19.08 (1.63)
University Facebook Experiment 1: Individuals who used Facebook most often
had poorer trait self-esteem which was mediated
because of the greater exposure to upward social
comparisons seen on social media
Experiment 2: An individual’s state self-esteem and self-
evaluations were lower when their profile contained an
upward
comparison information (e.g. a high activity social
network, healthy habits) than a downward comparison
information (e.g. low activity social network, unhealthy
habits).
10 Chiou et al.,
2014
Republic of China
Experiment 1: 78
Experiment 2:
114
Clinical trial Experiment 1: Male:
35
Female: 43
Experiment 2: Male:
55
Female: 59
18– 41, 28.64
(7.38)
/ 21.73 (1.37)
University Facebook Experiment 1: Participants who were induced to after
public communication consequently allocated less
money to anonymous strangers in the dictator game.
Experiment 2: Participants directing a post about
participation had volunteered to help code fewer data
sheets.
11 Fournier et al.,
2013
USA
57 Clinical trial Male: 18
Female: 39
18–33, 20 University Facebook Viewing alcohol-related content on Facebook over
estimates a higher drinking norm amongst college
students than those who did not view.
12 Sheldon et al.,
2011
USA
Experiment 4: 94 Quasi-experimental Male: 35
Female: 59
Not reported Not reported Facebook Facebook reduction goal is affected by an individual’s
initial relationship disconnect. It also predicted worse
performance for the individual to reach the goal
13 Naquin et al.,
2010
USA
Experiment 1: 48
Experiment 2: 56
Experiment 3:
177
Clinical tTrial Not reported Not reported University E-mail Experiment 1: Electronic media permits more
disengagement with moral codes than writing on
paper.
Experiment 2- Justification plays a mediating role between
media and the decision to be deceptive in those people
who were already more likely to entertain thoughts of
misrepresentation.
Experiment 3- E-mail seems to promotes a greater
likelihood to lie for the sake of self-interest.
Neutral effect
14 Lewinski, 2015
Netherlands
16 Observational Not reported Not reported Not reported YouTube A video’s popularity is determined by the lack of facial
emotions and presence of facial nonemotions. Fewer
the affiliative emotions (happiness and sadness), the
more popular the video was, whereas, disaffiliative
facial emotions of speakers (anger, fear, and disgust)
was not an indicator of future performance of a social
media content.
15 Lee, 2014
USA
251 Clinical trial Female: 52.19% 20.94 (1.99) University Facebook There is a significant three-way interaction among internal
political self-efficacy, need for cognition, and other
poeples’ opinion cues
16 Egermann et al.,
2013
Germany
5730 Quasi-experimental Male: 53.4%
Female: 46.6%
30.7 (12.4) Not reported Online music Social feedback was more influential than informational
feedback.
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Facebook users felt closer to others by commentat-
ing on others updates [26].
Experiments are carried out by looking at the
adverse effect of social media [32,35]. Prevalence of
monologue communication may encourage an
egocentric tendency which could undermine the
likelihood of prosocial behaviour. Social media
was linked with a weakened desirability for offline
social pleasurable activities and an increased incli-
nation to work alone. This result occurs more for the
heavy social media users. The mediating factor here
are the experience of felt relatedness. Looking
at nonverbal communication in social media
advertising campaigns on YouTube, less incidence
of affiliative facial emotions and more nonemo-
tional expressions was an indicator for the popular-
ity of different videos [39]. Dis-affiliative facial
emotions of the online speakers (anger, fear and
disgust) do not contribute as an indicator for a
video’s popularity.
The emotional effects of music experienced by
an individual is influenced by social feedback [41].
Social feedback was found to have a more influential
role than informational. This was attributed to the
motivation to socially conform. Relatedness dissat-
isfaction or social disconnect in users have worse
performances to reach their goal of Facebook reduc-
tion [37].
Organizations and politics
Social media influence extends not just to individ-
ual users but also in marketing. Social media pro-
motions through Twitter influenced consumers
more if there was a similarity or social connect
between the message sender and recipient, than
using celebrities. The celebrities positive effect for
a product were seen more in poster advertisements
[28]. Twitter pages of organizations which had a
human presence helped to promote a favourable
image for the organization, by improving the per-
ceived public relationship and word of mouth com-
munication [29].
In the political sector, a politician’s participa-
tory post on Facebook influenced an individual’s
political efficacy [33]. Internal political self-efficacy
(IPSE) were moderating factors for a person’’s
FIGURE 2. Risk of bias graph presented as percentages across all included studies.
FIGURE 3. Risk of bias summary for each included study.
Influence of social media on mental health Sharma et al.
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opinion of comments on politicians Facebook pro-
file. Higher IPSE individuals were less likely to be
influenced by the comments of others [40].
Psychiatric illness
Social media can be used to benefit psychiatric ill-
nesses by disseminating information. YouTube psy-
choeducation videos in a different language was
used to bridge the gap between healthcare and
the ethnic minorities [27]. Influence is also noted
in alcohol intake norms with college students over-
estimate drinking norms based on online posts [36].
DISCUSSION
The number of studies published in this field has
shown a substantial increase from the start of the
millennium. This is consistent with the advance-
ments of different forms of social media being used.
This systematic review aimed to assess the effect of
social media on mental health. Facebook, Twitter,
Instagram, Snapchat, E-mail or YouTube being the
popular forms of social media which has increased
dramatically in use with time [8]. This study showed
that Facebook was the most commonly assessed
form of social media. University students, young
adults are the commonly targeted population which
is found to be consistent with literature [13,14].
The variables measured by the studies were
diverse. Majority of the 16 studies were carried
out either by clinical trials or quasi-experimental
studies and only one study used an RCT design.
Because of this, it is difficult to accurately ascertain
the overall effect of social media indisputably. It is
evidenced by the studies quality assessment where
unclear bias is mainly seen for the selection, perfor-
mance, detection and attrition bias. This area of
enquiry is still developing and yet it is still encour-
aging to see such clinical studies already emerged.
Is this sudden epidemic of social media creating
a change in the biopsychosocial factors and well
being of the user? Time spent on social media is
rapidly increasing [18]. The influence social media
over a user is definitely fast. Ten to twenty minutes
of use is enough to have either a positive or negative
influence [26,31
&&
]. An E-mail which is generally
used to serve people for professional responsibilities
can also be used as a portal to lie [38]. Studies are
divided regarding effects on their overall well being
having a limited positive influence [26]. The detri-
mental effects noticed in a user’s feeling of well
being are feelings of meaninglessness and a lower
state of state and trait self- esteem and self-evalua-
tion [31
&&
,32,34]. These findings are consistent with
finding across literature [20
&
,21].
Finally, an important variable generally mea-
sured is the social relationships. Individuals without
social networks are more likely to use social media
[17] and that is an important factor determining if
they would quit social media [37]. Social media can
also be used to build relationships [8]. This is sup-
ported from our findings with users’ being more
influenced by the feedback they received [41] and
would rather stay online and socialize than partake
in offline activities [32].
Strength and limitation
The strengths of this review lie in the comprehen-
sive and systematic approach taken, along with the
deliberate and detailed approach to review each full-
text article. Nevertheless, the main limitations were
the research designs of the studies included. Fur-
thermore, possible studies pertinent to this review
CONCLUSION
Over time social media has transitioned and diver-
sified over various platforms. The present review
demonstrates that the effects are also far reaching.
Although there are benefits in using social media,
one cannot ignore the advancements in technology
helping to increase access to social media and caus-
ing a greater number of negative effects.
The debate over the effects of social media will
continue until a greater number of RCTs are con-
ducted measuring various variables amongst differ-
ent age groups. It would also be beneficial if
longitudinal researches were done.
Acknowledgements
None.
Financial support and sponsorship
The researchers did not receive any specific grant from
any funding agencies.
Conflicts of interest
There is no conflicts of interest with regard to this
publication.
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