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SYNOPSIS: These investigators noted a correlation between adolescent social media use and depressive symptoms, online harassment, poor sleep, low self-esteem, and poor body image. However, causality could not be determined.
SOURCE: Kelly Y, Zilanawala A, Booker C, Sacker A. Social media use and adolescent mental health: Findings from the UK Millennium Cohort Study. EClinicalMedicine 2018;6:59-68. doi:10.1016/j.eclinm.2018.12.005.
With information surfacing about worrisome content spliced into online videos intended for children,1 there has been increased public focus on examining the effect of social media on child mental health. Researchers also have been studying this topic for several years.
According to results published by the Pew Research Center in November 2018, 45% of U.S. teens reported they are online “almost constantly.”2 They reported using the platforms Snapchat, Instagram, and YouTube most often. Forty-five percent of teens 13 to 17 years of age reported that the effect of social media has been neither positive nor negative, while 31% reported mostly positive and 24% reported mostly negative experiences. For teens who recounted a positive effect from social media, the main reasons included connecting with friends and family (40%), ease of finding information (16%), and meeting others with the same interest (15%). Of those who reported that social media has had a mostly negative effect, the top concern was that social media leads to more bullying.2
In this U.K. report on social media use and adolescent mental health, Kelly et al focused specifically on depressive symptoms. They hypothesized that numerous potential explanatory pathways connect mental health and social media use. Although previous researchers have evaluated several potential pathways, Kelly et al evaluated several potential pathways simultaneously, including online harassment, poor sleep, poor self-esteem, and poor body image. The idea was that the association between depressive symptoms, social media, and any of the previously mentioned pathways could be influenced by other pathways. For example, an adolescent’s relationship with poor body image and depressive symptoms could be mediated partially by poor self-esteem. Overall, there is also a concern that young people with poor mental health may be more apt to use social media for prolonged periods.
Data for this study were pulled from the Millennium Cohort Study of U.K. children born between September 2000 and January 2002. The cohort included 19,244 families and was stratified to represent all U.K. countries, including disadvantaged and ethnically diverse areas. Cohort data were collected at nine months, three years, five years, seven years, and 14 years. Caregivers were asked about socioeconomic circumstances and social and emotional difficulties when the children were 11 years of age. At age 14 years, cohort members completed computer-assisted questionnaires about social media use, mental health, online harassment, sleep, self-esteem, and body image. The questionnaires included the Mood and Feelings Questionnaire — short version (SMFQ); a questionnaire on online harassment, sleep, self-esteem, and body image; and information about average hours of weekday social media use.
The SMFQ consists of 13 items that assess symptoms arising from depression that occurred over the previous two weeks. Information on average hours of social media use was reported as less than one hour, one to less than three hours, three to less than five hours, or more than five hours. One to three hours was the most prevalent. The Millennium Cohort Study team created the questionnaire on harassment, sleep, self-esteem, and body image, and it was similar to those used in other large surveys. It also included a self-esteem assessment based on the Rosenberg scale, which is widely used in social science research.
The researchers controlled for family income, family structure (i.e., one- vs. two-parent households), and cohort age in years. Using information from when the cohort participants were 11 years of age, researchers attempted to control for internalizing disorder symptoms. Internalizing disorders include depression, anxiety, and dissociative and obsessive-compulsive disorders.
The average age of participants was 14 years. More girls reported greater than three hours of social media use than boys (43.1% vs. 31.29%, respectively). The association between depressive symptoms and social media was more pronounced for girls (test for interaction, P < 0.001). Those living in lower-income homes and one-parent households were more likely to use social media for five or more hours daily.
None of the evaluated potential pathways showed specific gender differences. Since this study was based on cross-sectional data, causality and the direction of association of the pathways cannot be inferred. For example, the investigators were unable to determine if online harassment led to poor body image and depression. Using multivariable linear regression models, researchers determined the most pronounced routes between depressive symptoms and social media were found to be via poor sleep and online harassment. The researchers noted that the association between online harassment and depression also included pathways through body image issues, self-esteem, and poor sleep. The research showed that all the proposed pathways seemed to be interconnected.
Although the study was not completed in the United States, a similarly diverse population lives in the United Kingdom. An interesting finding is that both greater than five hours of social media use and no social media use were associated with low self-esteem. More research is ongoing regarding the role of social media culturally for teens.2 However, there are studies that show a correlation between active social media use with positive outcomes and passive social media use with negative outcomes.3
Although the authors admitted that social media use can be beneficial, they chose to focus on the potential negative effects on adolescent mental health. It would be interesting and beneficial to see what potential pathways exist between social media and good mental health, as a large percentage of teens in the Pew survey reported positive effects and the study findings showed an association between low self-esteem and lack of social media use.
Since this study was based on cross-sectional data, there were several limitations. The researchers were not able to evaluate the role of different types of social media use, the time of day of social media use, or the “fear of missing out.” Further research in this field could assess the role of the fear of missing out and whether it leads to prolonged social media usage or increased emotional investment.
Based on these results, it would appear prudent for primary care physicians and mental health professionals to include counseling and discussion about social media use at well-child visits and mental health appointments for both users and nonusers of social media. If social media seems to be associated with negative effects, consider discussing potential effects on sleep, bullying, body image, and self-esteem, as these may be high-yield areas based on this study. Interventions may include limiting overnight use, encouraging active participation, and focusing on positive social connection.
Financial Disclosure: Integrative Medicine Alert’s Executive Editor David Kiefer, MD; Peer Reviewer Suhani Bora, MD; Relias Media Executive Editor Leslie Coplin; Editor Jonathan Springston; Editorial Group Manager Terrey L. Hatcher; and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no financial relationships relevant to this field of study.