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BMC Public Health
Digital self-presentation andadolescent
mental health: Cross-sectional andlongitudinal
insights fromthe“LifeOnSoMe”-study
Gunnhild Johnsen Hjetland1,2*, Turi Reiten Finserås1, Børge Sivertsen1,3, Ian Colman4,5, Randi Træland Hella6,
Amanda Iselin Olesen Andersen1 and Jens Christoffer Skogen1,2,7
Abstract
Background The intensive use of social media among adolescents has caused concern about its impact on their
mental health, but studies show that social media use is linked to both better and worse mental health. These seem-
ingly contradictory findings may result from the diverse motivations, interactions, and experiences related to social
media use, and studies investigating specific facets of social media use in relation to mental health and well-being,
beyond general usage metrics, have been called for. Aspects of self-presentation on social media, such as feedback-
seeking and upwards social comparison have been linked to worse mental health, however, there is a need for more
studies exploring the relationship between self-presentation on social media and adolescent mental health over time.
Aim The aim of this study was to explore the cross-sectional and longitudinal relationship between aspects of self-
presentation and depression, anxiety, and well-being among adolescents.
Methods This study utilised both cross-sectional and longitudinal datasets from the LifeOnSoMe-study, compris-
ing 3,424 and 439 participants, respectively (OSF preregistration https:// doi. org/ 10. 17605/ OSF. IO/ BVPS8). Latent
Class Analysis (LCA) was used to identify similar response patterns within the Self-Presentation and Upwards Social
Comparison Inclination Scale (SPAUSCIS). Regression models and first differencing methods were applied to evaluate
the cross-sectional and longitudinal associations between focus on self-presentation and mental health and well-
being among adolescents.
Results A strong emphasis on self-presentation was linked to increased levels of depression and anxiety
in both males and females, and reduced well-being in females when compared to those with lower or intermediate
self-presentation focus. The effect sizes ranged from small to medium. Furthermore, an escalation in self-presentation
focus over time was associated with a slight increase in symptoms of anxiety and depression; however, the associa-
tion with well-being did not reach statistical significance.
Conclusion The results of the present study suggest that a heightened focus on self-presentation, which includes
behaviours such as seeking feedback, employing strategic self-presentation tactics, and engaging in upward social
comparisons, is associated with an elevated risk of reduced mental health.
Keywords Social media, Adolescent, Mental health, Self-presentation, Upward social comparison
*Correspondence:
Gunnhild Johnsen Hjetland
Gunnhildjohnsen.Hjetland@fhi.no
Full list of author information is available at the end of the article
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Hjetlandetal. BMC Public Health (2024) 24:2635
Introduction
e intensive use of social media among adolescents
has caused concerns about its impact on their men-
tal health and well-being, and a host of scientific papers
have addressed this issue [1]. A recent umbrella review
showed that the amount of time spent on social media
use is weakly associated with both higher levels of mental
health problems and with higher well-being among ado-
lescents [2]. ese seemingly contradictory findings may
be attributed to heterogeneity of social media use and
to person-specific effects [3], meaning that social media
use can entail widely different motivations, interactions,
experiences, and behaviours, and that any effects of social
media use are likely to vary depending on how, why, and
by whom they are used. erefore, investigating how par-
ticular facets of social media use influence mental health
and well-being, beyond general metrics of frequency
and duration of use, has been called for [2]. In addition,
research should focus on key attributes spanning a range
of different social media platforms, in line with an affor-
dance approach [4], to stay relevant in the ever evolving
social media landscape. In the context of social media,
affordances refer to “the perception of action possibilities
users have when engaging with social media and its fea-
tures” ([5], pp. 408–409).
One aspect of social media use that has been stud-
ied in relation to mental health and well-being is self-
presentation [6, 7]. Social approval is seen as one of the
main goals of self-presentation on social media [8], and
some adolescents place great emphasis on their online
personas [9–11]. In line with Goffman’s theory of
self-presentation and social interaction [12], all social
encounters entail some form of performance to manage
how one is perceived by others (i.e., self-presentation).
To present the best possible version of themselves,
people downplay certain characteristics and enhance
others; a process called impression management [12].
Compared to traditional face-to-face interactions,
social media affordances facilitate impression manage-
ment and idealized self-presentation by allowing users
to manipulate their text and image based communica-
tion [13]. Furthermore, the number of likes and num-
ber or content of comments can easily be compared to
others’ to quantify one’s social success [14]. Some peo-
ple make great efforts to receive the desired feedback,
referred to as feedback-seeking or digital status seek-
ing [15]. Arguably, as self-presentation on social media
is often idealized and is mainly positive, upward social
comparison, i.e., comparing oneself to someone who is
viewed as better than oneself [16], may be particularly
likely [14, 17]. Social media use also increases the num-
ber of available comparison targets to include not only
peers in one’s immediate surroundings, but also a wider
network of acquaintances, ‘influencers’, and celebrities,
thereby expanding the opportunities for engaging in
upward social comparison.
Studies on adolescents have shown that different
aspects of self-presentation, such as feedback-seeking,
strategic self-presentation such as editing photos, and
upward social comparison, are associated with worse
mental health in terms of more symptoms of anxiety and
depression, and reduced body satisfaction and well-being
[11, 18–21]. ese findings can be linked to the broader
concept of ‘approval anxiety’, i.e., the degree of psycho-
logical arousal about others’ reactions to one’s messages
and posts on social media, which has been proposed
as one component of digital stress [22]. Digital stress,
in turn, has been shown to increase the risk of negative
mental health outcomes as a result of social media use.
Self-presentation on social media may therefore be one
aspect of social media use that can have negative con-
sequences for adolescent mental health. Most previous
studies are, however, based on cross-sectional data, and
more longitudinal studies are needed to establish the rel-
evance of aspects of self-presentation on social media
to adolescent mental health. e few longitudinal stud-
ies that exist have shown that posting a lot of content
on social media, being preoccupied with one’s physical
attractiveness in social media photos, feedback-seeking,
and upward social comparison are linked to symptoms of
anxiety and depression, and reduced well-being [18, 23,
24].
Adolescence is a period when peer approval becomes
increasingly relevant, and seeking approval alongside
a heightened sensitivity to social rewards may be a an
important motivator for using social media during this
developmental phase [5]. Adolescents seem to vary a
great deal in their preoccupation with self-presentation
on social media. In a previous study, we investigated
how adolescents differed in their preoccupation with
likes, comments, and followers, in deleting posts with
too few likes and manipulating images to look better, and
in upward social comparison, collectively referred to as
“focus on self-presentation” [25]. e results showed that
females and adolescents with low emotional stability and
high scores on extraversion, were more likely to be highly
focused on self-presentation. Similarly, adolescent girls
have been found to report higher levels of feedback-seek-
ing and social comparison [11, 18], post more ‘selfies’, be
more focused on their physical appearance, and be more
concerned about peer feedback, compared to adolescent
boys [26]. While some research has found that the asso-
ciations between aspects of self-presentation on social
media and mental health problems are similar for boys
and girls [24], some findings indicate that the association
is stronger for girls [11, 18].
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Hjetlandetal. BMC Public Health (2024) 24:2635
e aim of the present study was to further explore
the relationship between focus on self-presentation
and depression, anxiety, and well-being. Firstly, a latent
class analysis was used to map out response patterns on
a seven-item scale assessing focus on self-presentation
among adolescents. Secondly, the association between
these response patterns and mental health was assessed
separately for males and females using a cross-sectional
dataset. Lastly, the longitudinal association between
focus on self-presentation and mental health was
assessed over two time-points.
Methods
e present study (OSF preregistration https:// doi.
org/ 10. 17605/ OSF. IO/ BVPS8) was based on data from
an online survey conducted in two rounds in 2020 and
2021, in Bergen, Norway, called the LifeOnSoMe-study.
Bergen is the second-largest city in Norway and has
a population of about 300,000. All senior high school
pupils of 16years or older were invited to participate
in the survey via their teachers and information screens
on their school. e pupils received a link to a website
and logged in using their electronic ID. Before starting
the survey, they received information about the study
and provided their informed consent. In addition,
those that had participated in the 2020 data collection
received an email with a link to the survey. e par-
ticipation rate was 53% in 2020 and 35% in 2021. e
broader aim of the LifeOnSoMe-study was to explore
the relationship between adolescents’ motivations,
experiences, and behaviours related to social media use
and sociodemographic variables, lifestyle and social
factors, and mental health.
e present study was based on two separate datasets.
e cross-sectional dataset comprised responses from
the two rounds of the survey. For those who completed
the survey both in 2020 and 2021 (n = 461), we only used
their 2020 responses. e total number of participants
in the cross-sectional dataset was 3,771. Of these, par-
ticipants missing information about gender (n = 5) or
age (n = 158) were excluded. Furthermore, only 40 par-
ticipants ticked the option “non-binary” for gender. is
number is too low to perform meaningful analyses, and
these participants were excluded from the study. ose
with 100% missing values on the independent variable
(n = 144) were excluded from the analyses, resulting in
a total sample size of n = 3,424. e longitudinal dataset
was based on the responses of those who completed the
survey both in 2020 and 2021 (N = 461, 59% females).
Of these, 22 participants missing 100% of the items of
the independent variable were excluded (n = 4 at T1 and
n = 18 at T2), resulting in a total sample of n = 439.
Variables
Focus onself‑presentation
To assess focus on self-presentation on social media,
we used the Self-Presentation and Upward Social
Comparison Inclination Scale (SPAUSCIS), which
was developed based on qualitative focus group inter-
views with adolescents. e development of the scale
is described in detail elsewhere [11, 25]. In a previ-
ous study, we showed that the SPAUSCIS had one
latent factor and high internal consistency in a sample
of adolescents [25]. e scale consists of 7 statements
regarding focus on self-presentation on social media,
covering feedback-seeking, strategic self-presentation,
and upward social comparison (see supplementary
TableS1). e participants were asked how much each
statement pertained to them, and the response options
were “not at all”, “very little”, “sometimes/partly true”,
“a lot”, and “very much”, coded 1–5. e total score was
computed by averaging the sum score on the total num-
ber of items, resulting in a total score ranging from 1–5.
Cronbach’s alpha was 0.87 in the cross-sectional sample
and 0.86 in the longitudinal sample (at T1).
Social media use
e participants’ frequency of social media use was
measured by the following question: “How often do
you use social media?” e response alternatives were
“almost never”, “several times a month, but less than
once a week”, “1–2 times per week”, “3–4 times per
week”, “5–6 times per week”, “every day”, “several times
each day”, and “almost constantly”. In the present study,
we created a tripartite variable which differentiated
between “daily or less”, “many times each day”, and
“almost constantly”. e participants’ duration of social
media use was assessed by the following question: “On
the days that you use social media, approximately how
much time do you spend on social media?” e seven
response options ranged from “less than 30 min” to
“more than 5h”. e response options were categorized
into “less than 2h”, “2–4h”, “4–5h”, and “more than 5h”.
Symptoms ofanxiety
Symptoms of anxiety were measured using the General
Anxiety Disorder 7 (GAD-7; [27]). e GAD-7 consists
of 7 questions related to symptoms of general anxiety.
e response options ranges from 0 (not at all) to 3
(almost every day). e measure was used as a continu-
ous variable with the total score ranging from 0 to 21.
Cronbach’s alpha was 0.90 in the cross-sectional sample
and 0.89 in the longitudinal sample (at T1).
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Hjetlandetal. BMC Public Health (2024) 24:2635
Symptoms ofdepression
Symptoms of depression were measured using the
Short Mood and Feelings Questionnaire (SMFQ; [28]).
e SMFQ consists of 13 statements related to symp-
toms of depression. e response options are 0 (not
true), 1 (sometimes true), and 2 (true). e scores on
each item are summed to a total score ranging from 0
to 26. e measure was used as a continuous variable.
Cronbach’s alpha was 0.91 in the cross-sectional sample
and 0.88 in the longitudinal sample (at T1).
Well‑being
e Warwick-Edinburgh Mental Well-Being Scale
(WEMWBS) was used to assess the participants’ level
of mental well-being [29]. e WEMWBS focuses solely
on positive aspects of mental health, covering positive
affect, satisfying personal relationships, and positive
functioning. e scale has 14 positively scored items
and responses are given on a 5-point Likert scale rang-
ing from “none of the time” (1) to “all of the time” (5).
e minimum score is 14 and the maximum score is 70,
with a higher score indicating better mental well-being.
e responses are based on the previous two weeks.
e Norwegian version of the WEMWBS was used in
the present study, which has shown good validity and
reliability for Norwegian adolescents [30]. Cronbach’s
alpha was 0.93 in the cross-sectional sample and 0.92 in
the longitudinal sample (at T1).
Background variables
Participants provided their age, gender, and which year
in senior high school (first, second, or third) and which
program they attended college (preparatory or vocational
education). Subjective socioeconomic status (SES) was
assessed by the question “How well off do you consider
you own family to be compared to others?” e response
options ranged from 0 (“very poor”) to 10 (“very well
off”). In the current study, SES was recoded into a tripar-
tite variable of low SES (scores 0–4; 6.4%), medium SES
(5–7, 52%), and high SES (8–10, 42%). Personality was
measured using the Ten-Item Personality Inventory [31],
consisting of ten items measuring two opposing traits of
each personality dimension (Extraversion, agreeableness,
conscientiousness, emotional stability, and openness to
new experiences). e items are preceded by “I see myself
as”, followed by trait adjectives. e response categories
range from 1 (strongly disagree) to 7 (strongly agree). e
total score on each trait is calculated by taking the aver-
age of the two items after recoding the reverse-scored
item, resulting in a total score ranging from 2 to 14.
Statistical analyses
All analyses were performed using R version 4.1.3 [32]
and RStudio version 2023.06.1 + 524 [33]. To assess the
structural validity of the SPAUSCIS, a confirmatory fac-
tor analysis was performed using the cross-sectional
dataset. Internal validity was assessed with Cronbach’s
alpha, using the ‘psych’ package [34] and the confirma-
tory factor analysis was performed using the ‘lavaan’
package [35] and DWLS estimator suitable for ordinal
variables [36]. Groups with similar response patterns on
the items of the SPAUSCIS were identified using latent
class analysis (LCA), using the ‘poLCA’ package [37].
e most appropriate number of latent classes was cho-
sen based on several statistical criteria: Aikake infor-
mation criterion (AIC), Bayesian information criterion
(BIC), relative entropy, and the Lo-Mendell-Rubin ad hoc
adjusted likelihood ratio test (LMR-LR), as well as inter-
pretability of the model.
Cross‑sectional associations
Linear regression was used to assess the associations
between latent class membership and depressive symp-
toms, symptoms of anxiety, and well-being. e associa-
tions were estimated for the full sample and separately
for males and females, and expressed as coefficients with
corresponding standard errors, in addition to Cohen’s ds.
As SES, frequency and duration of social media use, and
the personality traits of extraversion and emotional sta-
bility has been linked to both focus on self-presentation
[25] and to mental health outcomes in previous studies
[2, 38, 39], all regressions were adjusted for these varia-
bles in multiple linear models. For the full sample, adjust-
ments were also made for gender. Adjusted Cohen’s d
values were calculated following the procedure included
in the ESIZEREG module for Stata [40]. Likelihood ratio
tests were used to examine a potential gender modera-
tion in the associations between class membership and
the dependent variables, comparing models with the
interaction gender × class membership and models with
gender included as a covariate. In all analyses, a p-value
of < 0.05 indicated statistically significant associations. A
post-hoc analysis assessing the correlation between the
total score of the SPAUSCIS as a continuous variable
with symptoms of depression and anxiety, and well-being
using Spearman rank correlation.
Longitudinal associations
e ‘plm’ package [41] was used to estimate first dif-
ference models to assess the longitudinal associations
between focus on self-presentation and mental health
and well-being. First difference models difference out
fixed effects such as gender, socioeconomic status and
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Hjetlandetal. BMC Public Health (2024) 24:2635
other variables that are assumed to be fixed over time
[42]. us, the model avoids bias due to unobserved
time-invariant variables. To ease interpretation of the
results, we report both the “raw” coefficients and coef-
ficients based on z-scored dependent variables. When
using standardized dependent variables, the coefficients
are interpreted as standard deviations: For every one-unit
increase in the independent variable, the dependent vari-
able increases by a given number of standard deviations.
Missing data
ere were some missing data. After excluding those
that were missing 100% of the SPAUSCIS items from the
dataset, there were 0.8 to 3.9% missing on the items of
the SPAUSCIS in the cross-sectional dataset, 0.2 to 1.1%
missing in the longitudinal dataset at T1 and 1.1 to 4.3%
at T2. e SPAUSCIS total score is calculated as the
mean of the item scores and those missing one or more
items received a mean based on the completed items.
e total scores of SMFQ, GAD-7 and WEMWBS were
calculated by dividing the sum score of completed items
on the number of completed items, multiplied by the
total number of items of the relevant scale. Pairwise dele-
tion was used throughout the analyses to retain as much
information as possible.
Results
Table1 shows descriptive information for the cross-sec-
tional data. e mean age of the sample was 17.28years
(SD 1.01), and 56% were girls. ere were significant dif-
ferences between girls and boys in all variables except
age,school year and birth country. Females had higher
scores on the duration and frequency of social media use
and on focus on self-presentation, as well as on symp-
toms of depression and anxiety, and lower scores on
well-being.
e CFA of the items of the SPAUSCIS resulted in a
Comparative Fit Index (CFI) of 0.999, a Tucker-Lewis
Index (TLI) of 0.998, a root mean square error of approx-
imation (RMSEA) of 0.051 (95%CI 0.043–0.060, p = .398),
and a standardized root mean square residual (SRMR) of
0.021, all signalling god fit [43]. Items 2 and 3 and items
6 and 7 had highly correlated error terms, which were
allowed for in the model.
e LCA yielded three classes corresponding to a low
(class 1), intermediate (class 2), and high (class 3) focus
on self-presentation, in line with the previous findings
[25]. Predicted class membership was 44% in class 1, 33%
in class 2, and 23% in class 3. Class 3 and2 was domi-
nated by females, while class 1 was dominated by males.
Class 3 also had a lower proportion of adolescents with
high SES, and a higher proportion of adolescents using
social media ‘almost constantly’ compared to class 1 and
2. See supplementary figure S1 and tableS2 for a more
detailed description of the LCA results. See also supple-
mentary table S3 for descriptives across class member-
ship and S4 for an overview of SPAUSCIS scores across
class membership.
Table2 shows the results of the linear models. Being in
class 3 was associated with higher symptoms of anxiety
and depression compared to class 1 and 2 in both crude
and fully adjusted cross-sectional analyses for the sam-
ple as a whole and for males and females when analysed
separately (all p’s < .01). e effect sizes were small-to-
medium in crude models (Cohen’s ds from 0.34–0.66 for
anxiety and 0.43-0.74 for depression) and small in fully
adjusted models (Cohen’s ds from 0.16–0.32 for anxiety
and 0.25–0.33 for depression). For well-being, being in
class 3 was associated with lower well-being compared
to class 1 and 2 for males, females, and the sample as a
whole in the crude models (all p’s < .05), with small effect
sizes (Cohen’s d from -0.20- -0.46). In the fully adjusted
models, the lower well-being associated with class 3
membership was no longer significant for males. Class
2membership was not associated with any difference in
symptoms of anxiety, depression or well-being compared
to class 1 membership in adjusted models, but was asso-
ciated with lower well-being for the sample as a whole
in the crude model (Cohen’s d -0.13, p < .001). e like-
lihood ratio tests comparing models with and without
the interaction term class membership × gender were not
significant, meaning that the associations between class
membership and anxiety, depression, and well-being
were not significantly different for males and females
(results provided in the Appendix, all p’s > .05).
e post-hoc analysis showed that the correlation coef-
ficient was 0.38 (p < .001) for the SPAUSCIS and symp-
toms of depression, 0.36 (p < .001) for SPAUSCIS and
symptoms of anxiety, and -0.27 (p < .001) for well-being .
Longitudinal associations
First difference modelling was used to assess how
changes in focus on self-presentation, measured by the
SPAUSCIS, from T1 to T2 was related to changes in
symptoms of anxiety and depression, and well-being. e
first difference model yielded a coefficient of 0.85 (SD
0.36, p = .037) for symptoms of anxiety, 1.53 (SD 0.39,
p < .001) for symptoms of depression, and a non-signifi-
cant coefficient for well-being (-1.24, SD 0.68, p = .069).
us, for each increase of 1 on the SPAUSCIS (total score
ranging from 1 to 5) from T1 to T2, symptoms of anxiety
increased by 0.85 and symptoms of depression increased
by 1.53. e decrease in well-being for each increase of
1 on the SPAUSCIS scale did not reach statistical signifi-
cance. Using standardized coefficients, each increase of
1 on the SPAUSCIS from T1 to T2 was associated with
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Hjetlandetal. BMC Public Health (2024) 24:2635
an increase of 0.17 standard deviations in symptoms of
anxiety (SD 0.07, p < .05) and 0.25 standard deviations in
symptoms of depression (SD 0.06, p < .001), both corre-
sponding to small effect sizes [44], and a non-significant
decrease of -0.13 (SD 0.07, p = .069) in well-being.
Discussion
In this study, we used both cross-sectional and longitu-
dinal data to investigate the relationship between focus
on self-presentation on social media and experiences of
symptoms of depression, anxiety, and overall well-being
among adolescents. e results of a latent class analy-
sis revealed, in line with a previous study [25], that the
participants’ response patterns could be best charac-
terized by a three-class solution, representing varying
degrees of focus on self-presentation: low, intermediate,
and high. A high focus on self-presentation was associ-
ated with higher scores on symptoms of depression and
anxiety for both males and females, and lower scores on
well-being among females, compared to a low or inter-
mediate focus on self-presentation. Effect sizes ranged
from small to medium. Additionally, we found that an
Table 1 Descriptives for the cross-sectional data
GAD-7 General Anxiety Disorder 7, SMFQ Short Mood and Feelings Questionnaire, SPAUSCIS Self-presentation and Upward Social Comparison Inclination Scale,
WEMWBS Warwick-Edinburgh Mental Well-Being Scale
a Linear model ANOVA
b Pearson’s Chi-squared test
Male (N = 1508) Female (N = 1916) Total (N = 3424) P value
Age 0.738a
Mean (SD) 17.27 (0.98) 17.28 (1.00) 17.28 (0.99)
Year of high school 0.035b
1 292 (19.5%) 402 (21.0%) 694 (20.4%)
2 728 (48.5%) 842 (44.1%) 1570 (46.0%)
3 480 (32.0%) 666 (34.9%) 1146 (33.6%)
Study program < 0.001b
College preparatory 1025 (68.4%) 1529 (79.8%) 2554 (74.8%)
Vocational education 473 (31.6%) 386 (20.2%) 859 (25.2%)
Country of birth 0.084b
Norway 1383 (91.9%) 1728 (90.2%) 3111 (90.9%)
Other country 122 (8.1%) 188 (9.8%) 310 (9.1%)
Subjective socioeconomic status < 0.001b
Low (0–4) 65 (4.4%) 147 (7.7%) 212 (6.3%)
Medium (5–7) 700 (47.1%) 1063 (56.0%) 1763 (52.1%)
High (8–10) 721 (48.5%) 689 (36.3%) 1410 (41.7%)
Social media frequency < 0.001b
Daily or less 460 (30.5%) 364 (19.0%) 824 (24.1%)
Many times each day 716 (47.5%) 984 (51.4%) 1700 (49.7%)
Almost constantly 330 (21.9%) 568 (29.6%) 898 (26.2%)
Social media duration < 0.001b
< 2 h 565 (37.7%) 448 (23.5%) 1013 (29.7%)
2–4 h 559 (37.3%) 736 (38.6%) 1295 (38.0%)
4–5 h 200 (13.3%) 414 (21.7%) 614 (18.0%)
> 5 h 176 (11.7%) 311 (16.3%) 487 (14.3%)
Anxiety, GAD-7
Mean (SD) 4.10 (4.39) 7.10 (4.98) 5.78 (4.96) < 0.001a
Depression, SMFQ
Mean (SD) 5.02 (5.03) 8.99 (6.36) 7.24 (6.14) < 0.001a
Well-being, WEMWBS
Mean (SD) 51.53 (9.70) 46.04 (9.62) 48.46 (10.03) < 0.001a
Focus on self-presentation, SPAUSCIS
Mean (SD) 1.54 (0.64) 2.21 (0.80) 1.91 (0.81) < 0.001a
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Hjetlandetal. BMC Public Health (2024) 24:2635
increasing emphasis on self-presentation over time was
associated with an increase in symptoms of anxiety and
depression, although these effects were relatively small.
Conversely, the association between an increased focus
on self-presentation and well-being did not reach sta-
tistical significance. Hence, our findings suggest that a
heightened focus on self-presentation, which includes
behaviours like seeking feedback, employing strategic
self-presentation tactics, and engaging in upward social
comparisons, is associated with a small increase in risk of
negative mental health outcomes.
Our findings are in line with previous studies [11, 18–
21], and they add to the literature by showing these rela-
tionships by also using a longitudinal approach. Although
this study is unable to establish a causal link between
focus on self-presentation and mental health, there are
some candidate mechanisms that could explain such a
link. Firstly, placing importance on likes and comments
may reflect a sense of self-worth that relies on online vali-
dation, making the individual vulnerable to fluctuations
in likes and comments. Secondly, focus on self-pres-
entation can be related to what Steele etal. [22] termed
‘approval anxiety’, which can contribute to an overall
stress reaction (‘digital stress’) and consequently lead to
symptoms of anxiety and depression, and lower mental
well-being. irdly, a high focus on self-presentation may
reflect a higher level of self-objectifications, i.e., an inter-
nalization of the observers’ gaze and viewing oneself as
an object [45], which is regarded a risk factor for men-
tal health problems [46–48]. Conversely, it is also pos-
sible that mental health problems lead to a higher focus
on self-presentation. Studies have shown that underlying
risk factors for poor mental health, such as shyness, lone-
liness, and neuroticism, predict heavier social media use
and problematic social media use [49, 50], and may also
predict a higher focus on self-presentation. To disentan-
gle the causal relationship between focus on self-presen-
tation and mental health, large multi-wave longitudinal
studies are needed. e current finding that focus on self-
presentation and mental health problems change concur-
rently indicate a crucial avenue for further investigation.
e current results showed that the group with a high
focus on self-presentation was dominated by girls, but
that the associations between focus on self-presentation
Table 2 Linear models for GAD-7, SMFQ, and WEMWBS separate for males and females and for males and females combined
* p < .05, **p < .01, ***p < .001
a Models adjusted for socioeconomic status, frequency and duration of social media use, extraversion, and emotional stability. Models including both genders also
adjusted for gender
Class 2 vs class 1, β (SE) Cohen’s d Class 3 vs class 1, β (SE) Cohen’s d Class 3 vs class 2, β (SE) Cohen’s d
GAD-7 crude
Males 0.37 (0.25) 0.09 2.62(0.40)*** 0.59 2.25 (0.42)*** 0.52
Females 0.20 (0.27) 0.04 1.87 (0.29)*** 0.37 1.67 (0.27)*** 0.34
All 1.00 (0.18)*** 0.21 3.21 (0.22)*** 0.66 2.20 (0.23)*** 0.45
GAD-7 adj.a
Males -0.03 (0.24) -0.01 1.42 (0.39)*** 0.31 1.40 (0.41)*** 0.32
Females 0.16 (0.23) 0.03 1.06 (0.26)*** 0.21 0.77 (0.22)*** 0.16
All 0.03 (0.17) 0.01 1.09 (0.22)*** 0.21 0.91 (0.20)*** 0.18
SMFQ crude
Males 0.74 (0.28)** 0.15 3.01 (0.44)*** 0.60 2.27 (0.51)*** 0.43
Females -0.12 (0.34) -0.02 2.81 (0.38)*** 0.43 2.93 (0.33)*** 0.48
All 1.19 (0.22)*** 0.21 4.45 (0.27)*** 0.74 3.27 (0.28)*** 0.54
SMFQ adj. a
Males 0.09 (0.25) 0.02 1.39 (0.40)*** 0.28 1.30 (0.44)** 0.25
Females -0.05 (0.30) -0.01 2.15 (0.35)*** 0.33 1.96 (0.29)*** 0.31
All -0.01 (0.19) 0.00 1.83 (0.26)*** 0.29 1.74 (0.24)*** 0.28
WEMWBS crude
Males -0.74 (0.57) -0.08 -2.53 (0.89)** -0.25 -1.78 (0.89)* -0.20
Females 0.77 (0.53) 0.08 -2.13 (0.58)*** -0.21 -2.89 (0.51)*** -0.31
All -1.32 (0.39)*** -0.13 -4.69 (0.45)*** -0.46 -3.38 (0.44)*** -0.36
WEMWBS adj. a
Males -0.46 (0.48) -0.05 -0.78 (0.77) -0.08 -0.62 (0.74) -0.07
Females 0.14 (0.45) 0.02 -1.81 (0.51)*** -0.18 -1.82 (0.42)*** -0.19
All -0.19 (0.33) -0.02 -1.45 (0.42)*** -0.14 -1.40 (0.36)*** -0.15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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Hjetlandetal. BMC Public Health (2024) 24:2635
and depression, anxiety, and well-being were not statisti-
cally different for males and females, as indicated by the
interaction analysis. Similarly, Maheux etal. [24] found
that while girls reported a higher level of preoccupation
with their physical attractiveness in social media pho-
tos, the longitudinal association with depressive symp-
toms were similar for boys and girls. In the fully adjusted
models of the present study, however, well-being was
only associated with class membership for the sample
as a whole and for girls, but not for boys. is may be
related to the overrepresentation of girls in the dataset
or to unobserved variables that are affecting the associa-
tion differently for each gender. In the present study, we
had no information about the content of the participants’
self-presentation. Studies have shown that girls’ self-
presentation differs from boys. For example, girls have
been shown to post more selfies and be more invested in
physical appearance [26], which may impact the associa-
tion between focus on self-presentation and well-being.
A study by Svensson, Johnson, & Olsson [51] also showed
gender differences, finding that self-presentation was
associated with internalizing symptoms for girls only.
Future research should explore these gender differences
in the interactions between aspects of social media use
and well-being.
In our study, no longitudinal association was observed
between focus on self-presentation and well-being. is
suggests that while an increase in focus on self-presen-
tation over time may be related to more symptoms of
anxiety and depression, it does not appear to impact well-
being. e small effect sizes found for symptoms of anxi-
ety and depression support this notion. At the same time,
our longitudinal sample size was relatively limited, which
may have contributed to the nonsignificant association
due to issues of statistical power. Furthermore, it is pos-
sible that focus on self-presentation does not change very
much from one year to the next, and that a longer time
span would yield larger differences between focus on self-
presentation at baseline and follow-up and a clearer rela-
tionship between focus on self-presentation and mental
health and well-being. It is also possible that the rela-
tionship between focus on self-presentation and mental
health differs between younger and older adolescent, in
line with a study showing that the strength of the rela-
tionship between social media use and life satisfaction
changed depending on the adolescents’ age [52]. Spe-
cifically, higher social media use predicted decreases in
life satisfaction one year later among girls at ages 11–13
and 19, and among boys at 13–15 and 19. Exploring how
focus on self-presentation is related to well-being among
younger adolescents than those included in our study
(16 +), would be of interest.
Our findings are in line with the results of a recent
study by Winstone and colleagues [23], who employed
latent class analysis to identify different user types on
social media among 13-year-olds and how these types
were related to mental health outcomes. In their study,
adolescents characterized by high levels of content shar-
ing (‘Broadcasters’) had a higher risk of poor mental
health one year later, compared to those with moderate
content sharing. In the present study, we did not meas-
ure self-presentation activity such as frequency of post-
ing content, but rather how preoccupied the participants
were with the feedback they received, strategic self-pres-
entation, and their degree of upward social comparison.
It may be that adolescents who post a lot on social media
are also highly preoccupied with their online self-presen-
tation, and that it is their preoccupation with self-presen-
tation that increases their risk of mental health problems
and not posting per se. In fact, some research indicates
that self-presenting on social media even can have some
benefits. For example, studies have shown that people
can experience an increase in self-esteem after viewing
one’s own social media profile [53, 54], and social media
can facilitate authentic self-presentation of aspects of the
self that are perceived as unwanted in offline social set-
ting [55]. Furthermore, positive self-presentation (i.e.,
showing positive sides of the self) has been shown to
increase subjective well-being, perhaps by supporting
self-affirmation [56] and a positive self-image [57]. Future
studies should explore these dynamics of posting on
social media, different aspects of focus on self-presenta-
tion, and mental health in order to inform interventions
to reduce mental health problems among adolescents.
Implications
Only a high focus on self-presentation was associated
with a higher risk of symptoms of depression and anxi-
ety in fully adjusted analyses; an intermediate focus did
not show this relationship. is finding aligns with other
research showing that moderate use of social media is
not linked to negative outcomes, and that only high use
or high investment is [58–60]. For example, one study
found that using visual social media such as Instagram
and Snapchat for more than two hours each day posi-
tively predicted internalizing symptoms, while less than
two hours of use each day did not [59]. is implies that
the common notion that all social media use is negative
for mental health is unwarranted and can lead to unnec-
essary worrying among adolescents about their social
media use. However, the results of the present study sug-
gest that a high focus on self-presentation may increase
the risk of mental health problems, and helping adoles-
cents balance their preoccupation with self-presentation,
for example using school-based programs, should be a
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 11
Hjetlandetal. BMC Public Health (2024) 24:2635
priority. School-based programs that encourages adoles-
cents to reflect and think critically about their own and
others’ use of social media, may facilitate higher levels
of social media literacy and build their resilience and
ability to leverage the potential positive effects of social
media, while negating negative effects [61]. Furthermore,
in a clinical context, dimensions of social media use such
as feedback-seeking and strategic self-presentation are
important topics to consider, as there is a possibility that
they contribute to a worsening of mental health. How-
ever, as social media also give opportunities for social
support and friendship formation, particularly for mar-
ginalized groups (e.g., [62]), an open-minded approach
is warranted. Furthermore, tech producers could help
minimize any negative effects of social media use by for
instance limiting affordances that trigger upward social
comparison and feedback-seeking, such as beauty filters
and likes, thus redesigning their social media platforms
to support, rather than harm, mental health.
Strengths andlimitations
In line with an affordances approach [4], this study
focused on key attributes of social media platforms rather
than specific social media platforms. us, the find-
ings can be applicable to a wide range of platforms now
and in the future. Furthermore, the measure of focus on
self-presentation on social media was developed based
on qualitative interviews with adolescents and adapted
based on adolescent feedback, thus increasing the likeli-
hood that the measure covered aspects of social media
use that are relevant for adolescents and moving beyond
quantity or frequency of self-presentation.
e present study also had some important limita-
tions. Firstly, the validity of the observed longitudinal
association rests on the assumption that there were no
unobserved time-variant factors impacting the measured
variables across the study period. e first difference
model accounts for time-invariant factors such as gen-
der, personality, and socioeconomic status, but factors
that change over time are not accounted for. For example,
given that the data were collected during the COVID-19
pandemic, it is possible that periods of lockdowns have
led both to an increase in focus on self-presentation and
in symptoms of depression and anxiety, and residual
confounding cannot be ruled out. Secondly, the study
included only two time points and is therefore limited
in terms of determining cause and effect. irdly, assess-
ing the relationship between focus on self-presentation
and mental health and well-being over a longer time
span could possibly have yielded a stronger relation-
ship. To fully disentangle these causal relationships, fur-
ther research employing large, multi-wave longitudinal
studies is warranted. Furthermore, it is possible that
the relationship between focus on self-presentation and
mental health differs across different developmental peri-
ods, and studies should include a wider age range.
Conclusion
is study employed both cross-sectional and longitudi-
nal data to investigate the link between adolescents’ focus
on self-presentation on social media and their symptoms
of depression, anxiety, and overall well-being. Analysing
the data using LCA, we identified three distinct groups
characterized by varying degrees of self-presentation
focus: low, intermediate, and high. A high focus on self-
presentation was associated with more symptoms of
anxiety and depression for boys and girls, and with lower
well-being for girls in fully adjusted models. Further-
more, an increase in self-presentation focus over time
was associated with small increases in depressive and
anxiety symptoms, while the effect on well-being was
not statistically significant. ese findings suggest that a
high focus on self-presentation, including behaviours like
seeking feedback, strategic self-presentation, and upward
social comparisons, is associated with an elevated risk of
poor mental health. e observed covariance between
that focus on self-presentation and mental health prob-
lems underscores a significant relationship warranting
further investigation.
Abbreviations
SPAUSCIS Self-Presentation and Upwards Social Comparison Inclination
Scale
GAD-7 General Anxiety Disorder 7
SMFQ Short Mood and Feelings Questionnaire
WEMWBS Warwick-Edinburgh Mental Well-Being Scale
SES Socioeconomic status
LCA Latent class analysis
CFA Confirmatory factor analysis
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12889- 024- 20052-4.
Supplementary Material 1.
Acknowledgements
We extend our gratitude to the pupils who took part in the survey, and we
appreciate the collaboration and support provided by Bergen municipality
and Vestland County Council for this study. Special thanks go to the resource
group for their valuable contributions and discussions pertaining to the devel-
opment of focus group interviews and the questionnaire.
Authors’ contributions
Conceptualization, GJH and JCS; methodology, GJH and JCS; formal analysis,
GJH and JCS; investigation, GJH, RTH, and JCS; writing—original draft prepara-
tion, GJH and JCS; writing—review and editing, GJH, TRF, BS, IC, RTH, AIOA,
and JCS; project administration, JCS. All authors have read and agreed to the
published version of the manuscript.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 11
Hjetlandetal. BMC Public Health (2024) 24:2635
Funding
Open access funding provided by Norwegian Institute of Public Health (FHI)
The work of GJH was supported by the Dam Foundation [grant number
2021/FO347287], while the work of TRF, AIOA and JCS was supported by The
Research Council of Norway [grant number 319845]. The work of IC was partly
supported by the Research Council of Norway through its Centers of Excel-
lence funding scheme, project number 262700. The funding sources were not
involved in the study design, in the collection, analysis, or interpretation of the
data, or in the writing of the manuscript.
Availability of data and materials
The datasets analysed during the current study are not publicly available, as
they contain sensitive information, and the ethical approval of the study does
not include this option. Requests to access these datasets should be directed
to GJH, Gunnhildjohnsen.Hjetland@fhi.no.
Declarations
Ethics approval and consent to participate
The data collection was approved by the Regional Ethics Committee (REK) in
Norway (reference number REK #65611) and was conducted in compliance
with the principles outlined in the Helsinki Declaration. All participants were
provided with information about the study’s overall objectives, both digitally
and through communication with their teacher, and they provided electronic
informed consent when participating. It was also made clear that participants
had the option to withdraw from the study at any time. Additionally, all
individuals invited to participate were at least 16 years old, granting them the
legal capacity to independently provide consent; however, parents or guard-
ians were also informed about the study.
Consent for publication
Not applicable.
Competing interests
Dr. Colman has received consulting fees from Meta Inc.
Author details
1 Department of Health Promotion, Norwegian Institute of Public Health,
Bergen, Norway. 2 Centre for Evaluation of Public Health Measures, Norwegian
Institute of Public Health, Oslo, Norway. 3 Department of Research and Inno-
vation, Helse Fonna HF, Haugesund, Norway. 4 School of Epidemiology
and Public Health, University of Ottawa, Ottawa, Canada. 5 Centre for Fertility
and Health, Norwegian Institute of Public Health, Oslo, Norway. 6 Regional
Centre for Child and Youth Mental Health and Child Welfare, NORCE Research,
Bergen, Norway. 7 Alcohol and Drug Research Western Norway, Stavanger
University Hospital, Stavanger, Norway.
Received: 21 November 2023 Accepted: 11 September 2024
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