By Mark Gold, MD
In August, the Substance Abuse and Mental Health Services Administration (SAMHSA) released results from the 2018 National Survey on Drug Use and Health. The release revealed that 14.4 percent of adolescents between the ages of 12 and 17 had a major depressive episode in the past year.1 Major depressive episodes are mental disorders characterized by two-week or longer periods of depressed mood or decreased enjoyment of usual activities, and associated behavioral problems. According to these released figures, 3.5 million, or one-in-seven adolescents had a major depressive episode in the past year. The numbers rose from 2017 when 13.3 percent of adolescents had experienced such an event and were up from 2004 when only 9 percent did. Added to rising suicide rates,2 these numbers raise the alarm of worsening mental health trends among adolescents. The internet and social media appear to play critical roles in spreading suicidal behavior: the effect of suicide clusters, for example, implicates social media.3
While many young Americans face a dizzying array of challenges in their lives—from substance misuse to academic pressures to general fears about societal stability—adolescents in the past have also dealt with these concerns and did not experience a similar rate of depressive episodes. This leads journalists, educators, experts, and politicians looking for a root cause to understand these recent changes, and one major change stands apart from the rest: access to social media. In a recent study, researchers tried to determine whether frequent social media use contributes to negative mental health outcomes among adolescents.
What did this study find about social media use and adolescent mental health?
This study found that “very frequent” social media use was associated with negative mental health outcomes among girls and boys. Researchers in this study used data from the “Our Futures” study, which tracks 12,866 individuals between the ages of 13 and 16 in England. This study measured participants in three “waves,” beginning with wave 1, with participants between 13 and 14 years of age, and ending in wave 3, with participants between 15 and 16 years of age. Participants answered questions from the General Health Questionnaire, or GHQ12, about their mental health and wellbeing. They rated anxiety, happiness, and sense of life satisfaction on a scale of 1 to 10. The researchers also measured boys and girls in the study separately, and gauged participants’ experiences with exercise, sleep quality, and cyberbullying. The study measured social media use on the basis of how frequently participants checked different sites or applications. “Very frequent” use meant checking social media multiple times every day, in contrast to checking it every week or even less frequently.
Very frequent social media use in wave 1, when participants were, again, between the ages of 13 and 14, predicted poor mental health evaluation in wave 2. This result held for both boys and girls. The number of participants checking their social media accounts multiple times every day rose from wave 1 to wave 3: the figure for boys increased from 34.4 percent to 61.9 percent, and the figure for girls increased from 51.4 percent to 75.4 percent. These findings may be explained by girls having more exposure to cyberbullying, which had the most significant effect in explaining social media-related mental health difficulties. It could also be the case that because girls use social media more frequently than boys in general, they experience more cyberbullying and get less sleep and exercise than boys do. At the same time, boys may engage in more gaming, and experience more gaming-related social isolation and other problems. Boys and girls have been shown to have smartphone and internet addictions that cause deleterious effects on mental health.4
Why is this important?
Yale’s Dr. Marc Potenza and colleagues have raised concerns for many years about teen use of social media and smartphones and reported on both internet addictions and their many unhelpful effects on mental health.5 This study suggests that there are important mental health contributions gained from exercise and sleep. Dasha Nicholls, a coauthor of the study from Imperial College London, told Time, “The key messages to young people are: Get enough sleep; don’t lose contact with your friends in real life; and physical activity is important for mental health and well-being.”6 While this is sound advice in general, what about those causal links between mental health and social media use? Is it the answer to the question of rising mental health challenges among adolescents? The study’s authors say that social media in and of itself is not the problem—the problem is what social media use can lead to, especially cyberbullying, sleep deficits, and lack of exercise. The authors recommend mental health interventions that emphasize sleep, exercise, and resilience to cyberbullying. Other experts might disagree with these findings, especially given the role of social media in suicide, suicide clusters and suicide contagion. Research on suicide clusters among the young suggests that they can develop in part through the spread of beliefs and person-to-person communication, which can seem to “normalize” suicide, and that social media and internet use may contribute.
This study is limited by the self-reporting technique used to measure mental health and wellbeing, and by asking how often participants check social media accounts and platforms, instead of direct assessments of how much actual time they spend when they do check them. It’s possible that this research underestimates the extent to which adolescents use social media, and that future studies could demonstrate that much larger amounts of time are spent on it, with worse consequences for mental health. But it’s also possible that social media use is not contributing that much to poor mental health for younger people, or at least not to major depressive episodes or rising suicide rates. As with other relatively recent trends among the young, such as vaping, we expose large numbers of teens to something and do the testing and discoveries afterwards. Sadly, we’ll learn more about this topic over time. We should also consider differences for adolescent sexual minorities, who have consistently higher rates of depression.7
Meanwhile, a certain amount of intuitive reasoning can be applied to the question, as this study shows: would anyone expect a teenager spending hours and hours a day on social media platforms, largely isolated from in-person interaction, potentially exposed to cyberbullying and other social pressures and not engaging in behaviors we know promote wellbeing to have a decidedly positive sense of satisfaction and fulfillment in life? Proxies for social media activity, like the number of accounts adolescents have and their self-reported frequency of checking accounts, appears to be related to loneliness. impulsivity, anxiety, and depression.8 This may be due to sleep or bullying, but most importantly, it is not helpful or healthy. Monica Lewinsky has a cyberbullying PSA that is worth looking at, since it may allow us to actually experience what cyberbullying is like.
Clearly, there is evidence that greater electronic media use is associated with depressive symptoms, though telemedicine, telepsychiatry, artificial intelligence, and other opportunities suggest that digital communication may be harnessed to improve health, mood and early intervention strategies, too. There are positive effects of social media and positive ways to use social media—we just don’t yet know exactly how it all works. Healthier approaches may develop over time, such as a Pinterest incorporating therapeutic techniques in its search results. Social media also helps new communities form, though here again nuance is key on the question of how healthy these communities are. One study found, for example, that many “thinspiration” sites actively promote eating disorders.9 On the other hand, some celebrities use their platforms to promote having a healthy body image.
Much more research is needed to explore these possibilities. At the moment, when it comes to social media, public health will likely benefit from more real life interactions and sensible choices inclined towards moderation.
Substance Abuse and Mental Health Services Administration. (2019) Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf#page=45
Hedegaard, H., Curtin, S.C., Warner, M. (2018) Suicide mortality in the United States, 1999–2017. NCHS Data Brief, no 330. Hyattsville, MD: National Center for Health Statistics
Hawton, K., Hill, N.T.M., Gould, M., John, A., Lascelles, K., Robinson, J. (2019) Clustering of suicides in children and adolescents. Lancet Child Adolesc Health.
Roh, D., Bhang, S.Y., Choi, J.S., Kweon, Y.S., Lee, S.K., Potenza, M.N. (2018) The validation of Implicit Association Test measures for smartphone and Internet addiction in at-risk children and adolescents. J Behav Addict.
Yau, Y.H., Pilver, C.E., Steinberg, M.A., Rugle, L.J., Hoff, R.A., Krishnan-Sarin, S., Potenza, M.N. (2014) Relationships between problematic internet use and problem-gambling severity: findings from a high-school survey. Addict Behav.
Ducharme, J. (August 13, 2019) Social Media Hurts Girls More Than Boys. Time
Bettis, A.H., Liu, R.T. (2019) Population-Based Analysis of Temporal Trends in the Prevalence of Depressed