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Right Now | Instagram and Grampa

Social Media Use and Adult Depression

March-April 2022

Illustration by James Steinberg

Covid States Project website

Parenting teenagers in 2022 generally entails worrying about their use of platforms such as Instagram, Snapchat, and TikTok; multiple studies point to links between social-media use and anxiety and depression among children and adolescents. Yet a new study reveals similar associations between depression and social-media use for their parents and grandparents too.

The findings come out of the COVID States Project, a series of surveys of adults in all 50 states, which began in spring 2020, soon after the pandemic began. It’s led by a multidisciplinary team of researchers from four universities, including Roy Perlis, the Dozoretz Professor of Psychiatry at Massachusetts General Hospital and Harvard Medical School, and John Della Volpe, director of polling at the Harvard Kennedy School’s Institute of Politics. For this study, they identified more than 5,000 people, with an average age of 56, who showed no signs of depression as measured by a standard screening. Participants initially were asked if they use social media. When surveyed again later, those who used Snapchat, Facebook, and TikTok were more likely to report symptoms of depression.

“Most of the prior literature focused on kids or young adults,” Perlis explains. “But in 2022 older adults also use social media, and we know almost nothing about the relationship between social media and anxiety and depression in older adults.” Such questions feel particularly pressing given the mental-health impact of the pandemic. “Rates of depression and anxiety were very high early in the pandemic,” he says, “and they’ve remained about three times greater than they would be normally.”

Findings about mental health and social-media use can be tricky to interpret. Most studies can’t prove that using Facebook or Instagram causes depression, Perlis cautions. These studies often capture a single moment in time and show that people who use social media report more symptoms of anxiety and depression. This may mean that being anxious or depressed makes a person more likely to engage with social media. Or, “maybe people who use social media are more prone to depression because the same sort of traits or personality, characteristics or feelings, the same things that make them more apt to use social media also make them more apt to become depressed,” he suggests. Perhaps social-media users get their news in a format that offers less balanced coverage or promotes “doomscrolling,” dampening mood in the process. Maybe “they are using social media instead of seeing other people,” Perlis offers, “or they’re using social media because they don’t have social supports in the real world.”

This latest study still can’t explain what triggers depression among social-media users, he acknowledges, but it “lets us start to cross off alternative explanations for the relationship that we’ve seen.” The researchers knew the study participants were not depressed when the study began, and since it was conducted over time, it enabled them to see the depression symptoms appear. Their analysis also showed that the participants’ news sources, number of social supports, and face-to-face time with others did not meaningfully affect their levels of depression.

In an intriguing set of findings, the researchers identified links between particular social-media platforms and depression in certain age groups. For example, Facebook use was associated with depression among people younger than 35, but not for those over 35. In the over-35 group, TikTok and Snapchat were connected to depression symptoms. “I think we have more work to do to understand why the associations are so different across different age groups of adults,” Perlis says. “I would say that was the thing that made me the most eager to do follow-up studies and try to understand what’s going on.”

Although the study can’t confirm why social media might be linked to depression, Perlis speculates that “what seems to be the case in kids is probably true in adults: constantly looking at images of people who appear to be happier than you, and more successful than you, who generally seem to have a better life than you, certainly doesn’t make most people feel better.” A barrage of negative images isn’t likely to help either. Social media is like “drinking from a firehose,” he says, in contrast with older forms of media, which offer smaller doses of potentially harmful images.

 As a neurobiologist, Perlis says this work falls outside his typical research areas. “I spend a lot of my time in the wet lab making stem-cell models of brain diseases,” he explains. But when the Kennedy School’s Della Volpe asked him to join the COVID States project to consider issues such as mental health and social-media use, he felt compelled to say yes. “I come at this as a psychiatrist, an epidemiologist, and a parent,” he says. “I wonder every day when I see my kids on their phones: What’s this doing exactly? How much is okay? As with so many other things, there probably are levels of use that are perfectly okay, and a point where maybe it becomes less healthy.” Answering all the unknowns about social media and mental health, including the question of “how much,” Perlis adds, requires future research.

He’s hoping to motivate “others who have been working closer in this area” to dive into such questions. If social media are being used by people who are vulnerable to mental-health problems, perhaps these platforms can be used creatively to reach them and provide help when needed, Perlis suggests. “How do we use social media to encourage healthy behaviors, so it potentially contributes to public health? That’s the sort of work that I’d like to see done.” 

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• Open access
• Published: 06 July 2023

Pros & cons: impacts of social media on mental health

• Ágnes Zsila 1 , 2 &
• Marc Eric S. Reyes   ORCID: orcid.org/0000-0002-5280-1315 3  

BMC Psychology volume  11 , Article number:  201 ( 2023 ) Cite this article

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The use of social media significantly impacts mental health. It can enhance connection, increase self-esteem, and improve a sense of belonging. But it can also lead to tremendous stress, pressure to compare oneself to others, and increased sadness and isolation. Mindful use is essential to social media consumption.

Social media has become integral to our daily routines: we interact with family members and friends, accept invitations to public events, and join online communities to meet people who share similar preferences using these platforms. Social media has opened a new avenue for social experiences since the early 2000s, extending the possibilities for communication. According to recent research [ 1 ], people spend 2.3 h daily on social media. YouTube, TikTok, Instagram, and Snapchat have become increasingly popular among youth in 2022, and one-third think they spend too much time on these platforms [ 2 ]. The considerable time people spend on social media worldwide has directed researchers’ attention toward the potential benefits and risks. Research shows excessive use is mainly associated with lower psychological well-being [ 3 ]. However, findings also suggest that the quality rather than the quantity of social media use can determine whether the experience will enhance or deteriorate the user’s mental health [ 4 ]. In this collection, we will explore the impact of social media use on mental health by providing comprehensive research perspectives on positive and negative effects.

Social media can provide opportunities to enhance the mental health of users by facilitating social connections and peer support [ 5 ]. Indeed, online communities can provide a space for discussions regarding health conditions, adverse life events, or everyday challenges, which may decrease the sense of stigmatization and increase belongingness and perceived emotional support. Mutual friendships, rewarding social interactions, and humor on social media also reduced stress during the COVID-19 pandemic [ 4 ].

On the other hand, several studies have pointed out the potentially detrimental effects of social media use on mental health. Concerns have been raised that social media may lead to body image dissatisfaction [ 6 ], increase the risk of addiction and cyberbullying involvement [ 5 ], contribute to phubbing behaviors [ 7 ], and negatively affects mood [ 8 ]. Excessive use has increased loneliness, fear of missing out, and decreased subjective well-being and life satisfaction [ 8 ]. Users at risk of social media addiction often report depressive symptoms and lower self-esteem [ 9 ].

Overall, findings regarding the impact of social media on mental health pointed out some essential resources for psychological well-being through rewarding online social interactions. However, there is a need to raise awareness about the possible risks associated with excessive use, which can negatively affect mental health and everyday functioning [ 9 ]. There is neither a negative nor positive consensus regarding the effects of social media on people. However, by teaching people social media literacy, we can maximize their chances of having balanced, safe, and meaningful experiences on these platforms [ 10 ].

We encourage researchers to submit their research articles and contribute to a more differentiated overview of the impact of social media on mental health. BMC Psychology welcomes submissions to its new collection, which promises to present the latest findings in the emerging field of social media research. We seek research papers using qualitative and quantitative methods, focusing on social media users’ positive and negative aspects. We believe this collection will provide a more comprehensive picture of social media’s positive and negative effects on users’ mental health.

Data Availability

Not applicable.

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Acknowledgements

Ágnes Zsila was supported by the ÚNKP-22-4 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.

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Ágnes Zsila

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Department of Psychology, College of Science, University of Santo Tomas, Manila, 1008, Philippines

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AZ conceived and drafted the Editorial. MESR wrote the abstract and revised the Editorial. All authors read and approved the final manuscript.

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Zsila, Á., Reyes, M.E.S. Pros & cons: impacts of social media on mental health. BMC Psychol 11 , 201 (2023). https://doi.org/10.1186/s40359-023-01243-x

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Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

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Introduction

Social media has become a prominent fixture in the lives of many individuals facing the challenges of mental illness. Social media refers broadly to web and mobile platforms that allow individuals to connect with others within a virtual network (such as Facebook, Twitter, Instagram, Snapchat, or LinkedIn), where they can share, co-create, or exchange various forms of digital content, including information, messages, photos, or videos (Ahmed et al. 2019 ). Studies have reported that individuals living with a range of mental disorders, including depression, psychotic disorders, or other severe mental illnesses, use social media platforms at comparable rates as the general population, with use ranging from about 70% among middle-age and older individuals to upwards of 97% among younger individuals (Aschbrenner et al. 2018b ; Birnbaum et al. 2017b ; Brunette et al. 2019 ; Naslund et al. 2016 ). Other exploratory studies have found that many of these individuals with mental illness appear to turn to social media to share their personal experiences, seek information about their mental health and treatment options, and give and receive support from others facing similar mental health challenges (Bucci et al. 2019 ; Naslund et al. 2016b ).

Across the USA and globally, very few people living with mental illness have access to adequate mental health services (Patel et al. 2018 ). The wide reach and near ubiquitous use of social media platforms may afford novel opportunities to address these shortfalls in existing mental health care, by enhancing the quality, availability, and reach of services. Recent studies have explored patterns of social media use, impact of social media use on mental health and wellbeing, and the potential to leverage the popularity and interactive features of social media to enhance the delivery of interventions. However, there remains uncertainty regarding the risks and potential harms of social media for mental health (Orben and Przybylski 2019 ) and how best to weigh these concerns against potential benefits.

In this commentary, we summarized current research on the use of social media among individuals with mental illness, with consideration of the impact of social media on mental wellbeing, as well as early efforts using social media for delivery of evidence-based programs for addressing mental health problems. We searched for recent peer reviewed publications in Medline and Google Scholar using the search terms “mental health” or “mental illness” and “social media,” and searched the reference lists of recent reviews and other relevant studies. We reviewed the risks, potential harms, and necessary safety precautions with using social media for mental health. Overall, our goal was to consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services, while balancing the need for safety. Given this broad objective, we did not perform a systematic search of the literature and we did not apply specific inclusion criteria based on study design or type of mental disorder.

Social Media Use and Mental Health

In 2020, there are an estimated 3.8 billion social media users worldwide, representing half the global population (We Are Social 2020 ). Recent studies have shown that individuals with mental disorders are increasingly gaining access to and using mobile devices, such as smartphones (Firth et al. 2015 ; Glick et al. 2016 ; Torous et al. 2014a , b ). Similarly, there is mounting evidence showing high rates of social media use among individuals with mental disorders, including studies looking at engagement with these popular platforms across diverse settings and disorder types. Initial studies from 2015 found that nearly half of a sample of psychiatric patients were social media users, with greater use among younger individuals (Trefflich et al. 2015 ), while 47% of inpatients and outpatients with schizophrenia reported using social media, of which 79% reported at least once-a-week usage of social media websites (Miller et al. 2015 ). Rates of social media use among psychiatric populations have increased in recent years, as reflected in a study with data from 2017 showing comparable rates of social media use (approximately 70%) among individuals with serious mental illness in treatment as compared with low-income groups from the general population (Brunette et al. 2019 ).

Similarly, among individuals with serious mental illness receiving community-based mental health services, a recent study found equivalent rates of social media use as the general population, even exceeding 70% of participants (Naslund et al. 2016 ). Comparable findings were demonstrated among middle-age and older individuals with mental illness accessing services at peer support agencies, where 72% of respondents reported using social media (Aschbrenner et al. 2018b ). Similar results, with 68% of those with first episode psychosis using social media daily were reported in another study (Abdel-Baki et al. 2017 ).

Individuals who self-identified as having a schizophrenia spectrum disorder responded to a survey shared through the National Alliance of Mental Illness (NAMI) and reported that visiting social media sites was one of their most common activities when using digital devices, taking up roughly 2 h each day (Gay et al. 2016 ). For adolescents and young adults ages 12 to 21 with psychotic disorders and mood disorders, over 97% reported using social media, with average use exceeding 2.5 h per day (Birnbaum et al. 2017b ). Similarly, in a sample of adolescents ages 13–18 recruited from community mental health centers, 98% reported using social media, with YouTube as the most popular platform, followed by Instagram and Snapchat (Aschbrenner et al. 2019 ).

Research has also explored the motivations for using social media as well as the perceived benefits of interacting on these platforms among individuals with mental illness. In the sections that follow (see Table 1 for a summary), we consider three potentially unique features of interacting and connecting with others on social media that may offer benefits for individuals living with mental illness. These include: (1) Facilitate social interaction; (2) Access to a peer support network; and (3) Promote engagement and retention in services.

Facilitate Social Interaction

Social media platforms offer near continuous opportunities to connect and interact with others, regardless of time of day or geographic location. This on demand ease of communication may be especially important for facilitating social interaction among individuals with mental disorders experiencing difficulties interacting in face-to-face settings. For example, impaired social functioning is a common deficit in schizophrenia spectrum disorders, and social media may facilitate communication and interacting with others for these individuals (Torous and Keshavan 2016 ). This was suggested in one study where participants with schizophrenia indicated that social media helped them to interact and socialize more easily (Miller et al. 2015 ). Like other online communication, the ability to connect with others anonymously may be an important feature of social media, especially for individuals living with highly stigmatizing health conditions (Berger et al. 2005 ), such as serious mental disorders (Highton-Williamson et al. 2015 ).

Studies have found that individuals with serious mental disorders (Spinzy et al. 2012 ) as well as young adults with mental illness (Gowen et al. 2012 ) appear to form online relationships and connect with others on social media as often as social media users from the general population. This is an important observation because individuals living with serious mental disorders typically have few social contacts in the offline world and also experience high rates of loneliness (Badcock et al. 2015 ; Giacco et al. 2016 ). Among individuals receiving publicly funded mental health services who use social media, nearly half (47%) reported using these platforms at least weekly to feel less alone (Brusilovskiy et al. 2016 ). In another study of young adults with serious mental illness, most indicated that they used social media to help feel less isolated (Gowen et al. 2012 ). Interestingly, more frequent use of social media among a sample of individuals with serious mental illness was associated with greater community participation, measured as participation in shopping, work, religious activities, or visiting friends and family, as well as greater civic engagement, reflected as voting in local elections (Brusilovskiy et al. 2016 ).

Emerging research also shows that young people with moderate to severe depressive symptoms appear to prefer communicating on social media rather than in-person (Rideout and Fox 2018 ), while other studies have found that some individuals may prefer to seek help for mental health concerns online rather than through in-person encounters (Batterham and Calear 2017 ). In a qualitative study, participants with schizophrenia described greater anonymity, the ability to discover that other people have experienced similar health challenges and reducing fears through greater access to information as important motivations for using the Internet to seek mental health information (Schrank et al. 2010 ). Because social media does not require the immediate responses necessary in face-to-face communication, it may overcome deficits with social interaction due to psychotic symptoms that typically adversely affect face-to-face conversations (Docherty et al. 1996 ). Online social interactions may not require the use of non-verbal cues, particularly in the initial stages of interaction (Kiesler et al. 1984 ), with interactions being more fluid and within the control of users, thereby overcoming possible social anxieties linked to in-person interaction (Indian and Grieve 2014 ). Furthermore, many individuals with serious mental disorders can experience symptoms including passive social withdrawal, blunted affect, and attentional impairment, as well as active social avoidance due to hallucinations or other concerns (Hansen et al. 2009 ), thus potentially reinforcing the relative advantage, as perceived by users, of using social media over in person conversations.

Access to a Peer Support Network

There is growing recognition about the role that social media channels could play in enabling peer support (Bucci et al. 2019 ; Naslund et al. 2016b ), referred to as a system of mutual giving and receiving where individuals who have endured the difficulties of mental illness can offer hope, friendship, and support to others facing similar challenges (Davidson et al. 2006 ; Mead et al. 2001 ). Initial studies exploring use of online self-help forums among individuals with serious mental illnesses have found that individuals with schizophrenia appeared to use these forums for self-disclosure and sharing personal experiences, in addition to providing or requesting information, describing symptoms, or discussing medication (Haker et al. 2005 ), while users with bipolar disorder reported using these forums to ask for help from others about their illness (Vayreda and Antaki 2009 ). More recently, in a review of online social networking in people with psychosis, Highton-Williamson et al. ( 2015 ) highlight that an important purpose of such online connections was to establish new friendships, pursue romantic relationships, maintain existing relationships or reconnect with people, and seek online peer support from others with lived experience (Highton-Williamson et al. 2015 ).

Online peer support among individuals with mental illness has been further elaborated in various studies. In a content analysis of comments posted to YouTube by individuals who self-identified as having a serious mental illness, there appeared to be opportunities to feel less alone, provide hope, find support and learn through mutual reciprocity, and share coping strategies for day-to-day challenges of living with a mental illness (Naslund et al. 2014 ). In another study, Chang ( 2009 ) delineated various communication patterns in an online psychosis peer-support group (Chang 2009 ). Specifically, different forms of support emerged, including “informational support” about medication use or contacting mental health providers, “esteem support” involving positive comments for encouragement, “network support” for sharing similar experiences, and “emotional support” to express understanding of a peer’s situation and offer hope or confidence (Chang 2009 ). Bauer et al. ( 2013 ) reported that the main interest in online self-help forums for patients with bipolar disorder was to share emotions with others, allow exchange of information, and benefit by being part of an online social group (Bauer et al. 2013 ).

For individuals who openly discuss mental health problems on Twitter, a study by Berry et al. ( 2017 ) found that this served as an important opportunity to seek support and to hear about the experiences of others (Berry et al. 2017 ). In a survey of social media users with mental illness, respondents reported that sharing personal experiences about living with mental illness and opportunities to learn about strategies for coping with mental illness from others were important reasons for using social media (Naslund et al. 2017 ). A computational study of mental health awareness campaigns on Twitter provides further support with inspirational posts and tips being the most shared (Saha et al. 2019 ). Taken together, these studies offer insights about the potential for social media to facilitate access to an informal peer support network, though more research is necessary to examine how these online interactions may impact intentions to seek care, illness self-management, and clinically meaningful outcomes in offline contexts.

Promote Engagement and Retention in Services

Many individuals living with mental disorders have expressed interest in using social media platforms for seeking mental health information (Lal et al. 2018 ), connecting with mental health providers (Birnbaum et al. 2017b ), and accessing evidence-based mental health services delivered over social media specifically for coping with mental health symptoms or for promoting overall health and wellbeing (Naslund et al. 2017 ). With the widespread use of social media among individuals living with mental illness combined with the potential to facilitate social interaction and connect with supportive peers, as summarized above, it may be possible to leverage the popular features of social media to enhance existing mental health programs and services. A recent review by Biagianti et al. ( 2018 ) found that peer-to-peer support appeared to offer feasible and acceptable ways to augment digital mental health interventions for individuals with psychotic disorders by specifically improving engagement, compliance, and adherence to the interventions and may also improve perceived social support (Biagianti et al. 2018 ).

Among digital programs that have incorporated peer-to-peer social networking consistent with popular features on social media platforms, a pilot study of the HORYZONS online psychosocial intervention demonstrated significant reductions in depression among patients with first episode psychosis (Alvarez-Jimenez et al. 2013 ). Importantly, the majority of participants (95%) in this study engaged with the peer-to-peer networking feature of the program, with many reporting increases in perceived social connectedness and empowerment in their recovery process (Alvarez-Jimenez et al. 2013 ). This moderated online social therapy program is now being evaluated as part of a large randomized controlled trial for maintaining treatment effects from first episode psychosis services (Alvarez-Jimenez et al. 2019 ).

Other early efforts have demonstrated that use of digital environments with the interactive peer-to-peer features of social media can enhance social functioning and wellbeing in young people at high risk of psychosis (Alvarez-Jimenez et al. 2018 ). There has also been a recent emergence of several mobile apps to support symptom monitoring and relapse prevention in psychotic disorders. Among these apps, the development of PRIME (Personalized Real-time Intervention for Motivational Enhancement) has involved working closely with young people with schizophrenia to ensure that the design of the app has the look and feel of mainstream social media platforms, as opposed to existing clinical tools (Schlosser et al. 2016 ). This unique approach to the design of the app is aimed at promoting engagement and ensuring that the app can effectively improve motivation and functioning through goal setting and promoting better quality of life of users with schizophrenia (Schlosser et al. 2018 ).

Social media platforms could also be used to promote engagement and participation in in-person services delivered through community mental health settings. For example, the peer-based lifestyle intervention called PeerFIT targets weight loss and improved fitness among individuals living with serious mental illness through a combination of in-person lifestyle classes, exercise groups, and use of digital technologies (Aschbrenner et al. 2016b , c ). The intervention holds tremendous promise as lack of support is one of the largest barriers towards exercise in patients with serious mental illness (Firth et al. 2016 ), and it is now possible to use social media to counter such. Specifically, in PeerFIT, a private Facebook group is closely integrated into the program to offer a closed platform where participants can connect with the lifestyle coaches, access intervention content, and support or encourage each other as they work towards their lifestyle goals (Aschbrenner et al. 2016a ; Naslund et al. 2016a ). To date, this program has demonstrated preliminary effectiveness for meaningfully reducing cardiovascular risk factors that contribute to early mortality in this patient group (Aschbrenner, Naslund, Shevenell, Kinney, et al., 2016), while the Facebook component appears to have increased engagement in the program, while allowing participants who were unable to attend in-person sessions due to other health concerns or competing demands to remain connected with the program (Naslund et al. 2018 ). This lifestyle intervention is currently being evaluated in a randomized controlled trial enrolling young adults with serious mental illness from real world community mental health services settings (Aschbrenner et al. 2018a ).

These examples highlight the promise of incorporating the features of popular social media into existing programs, which may offer opportunities to safely promote engagement and program retention, while achieving improved clinical outcomes. This is an emerging area of research, as evidenced by several important effectiveness trials underway (Alvarez-Jimenez et al. 2019 ; Aschbrenner et al. 2018a ), including efforts to leverage online social networking to support family caregivers of individuals receiving first episode psychosis services (Gleeson et al. 2017 ).

Challenges with Social Media for Mental Health

The science on the role of social media for engaging persons with mental disorders needs a cautionary note on the effects of social media usage on mental health and wellbeing, particularly in adolescents and young adults. While the risks and harms of social media are frequently covered in the popular press and mainstream news reports, careful consideration of the research in this area is necessary. In a review of 43 studies in young people, many benefits of social media were cited, including increased self-esteem and opportunities for self-disclosure (Best et al. 2014 ). Yet, reported negative effects were an increased exposure to harm, social isolation, depressive symptoms, and bullying (Best et al. 2014 ). In the sections that follow (see Table 1 for a summary), we consider three major categories of risk related to use of social media and mental health. These include: (1) Impact on symptoms; (2) Facing hostile interactions; and (3) Consequences for daily life.

Impact on Symptoms

Studies consistently highlight that use of social media, especially heavy use and prolonged time spent on social media platforms, appears to contribute to increased risk for a variety of mental health symptoms and poor wellbeing, especially among young people (Andreassen et al. 2016 ; Kross et al. 2013 ; Woods and Scott 2016 ). This may partly be driven by the detrimental effects of screen time on mental health, including increased severity of anxiety and depressive symptoms, which have been well documented (Stiglic and Viner 2019 ). Recent studies have reported negative effects of social media use on mental health of young people, including social comparison pressure with others and greater feeling of social isolation after being rejected by others on social media (Rideout and Fox 2018 ). In a study of young adults, it was found that negative comparisons with others on Facebook contributed to risk of rumination and subsequent increases in depression symptoms (Feinstein et al. 2013 ). Still, the cross-sectional nature of many screen time and mental health studies makes it challenging to reach causal inferences (Orben and Przybylski 2019 ).

Quantity of social media use is also an important factor, as highlighted in a survey of young adults ages 19 to 32, where more frequent visits to social media platforms each week were correlated with greater depressive symptoms (Lin et al. 2016 ). More time spent using social media is also associated with greater symptoms of anxiety (Vannucci et al. 2017 ). The actual number of platforms accessed also appears to contribute to risk as reflected in another national survey of young adults where use of a large number of social media platforms was associated with negative impact on mental health (Primack et al. 2017 ). Among survey respondents using between 7 and 11 different social media platforms compared with respondents using only 2 or fewer platforms, there were 3 times greater odds of having high levels of depressive symptoms and a 3.2 times greater odds of having high levels of anxiety symptoms (Primack et al. 2017 ).

Many researchers have postulated that worsening mental health attributed to social media use may be because social media replaces face-to-face interactions for young people (Twenge and Campbell 2018 ) and may contribute to greater loneliness (Bucci et al. 2019 ) and negative effects on other aspects of health and wellbeing (Woods and Scott 2016 ). One nationally representative survey of US adolescents found that among respondents who reported more time accessing media such as social media platforms or smartphone devices, there were significantly greater depressive symptoms and increased risk of suicide when compared with adolescents who reported spending more time on non-screen activities, such as in-person social interaction or sports and recreation activities (Twenge et al. 2018 ). For individuals living with more severe mental illnesses, the effects of social media on psychiatric symptoms have received less attention. One study found that participation in chat rooms may contribute to worsening symptoms in young people with psychotic disorders (Mittal et al. 2007 ), while another study of patients with psychosis found that social media use appeared to predict low mood (Berry et al. 2018 ). These studies highlight a clear relationship between social media use and mental health that may not be present in general population studies (Orben and Przybylski 2019 ) and emphasize the need to explore how social media may contribute to symptom severity and whether protective factors may be identified to mitigate these risks.

Facing Hostile Interactions

Popular social media platforms can create potential situations where individuals may be victimized by negative comments or posts. Cyberbullying represents a form of online aggression directed towards specific individuals, such as peers or acquaintances, which is perceived to be most harmful when compared with random hostile comments posted online (Hamm et al. 2015 ). Importantly, cyberbullying on social media consistently shows harmful impact on mental health in the form of increased depressive symptoms as well as worsening of anxiety symptoms, as evidenced in a review of 36 studies among children and young people (Hamm et al. 2015 ). Furthermore, cyberbullying disproportionately impacts females as reflected in a national survey of adolescents in the USA, where females were twice as likely to be victims of cyberbullying compared with males (Alhajji et al. 2019 ). Most studies report cross-sectional associations between cyberbullying and symptoms of depression or anxiety (Hamm et al. 2015 ), though one longitudinal study in Switzerland found that cyberbullying contributed to significantly greater depression over time (Machmutow et al. 2012 ).

For youth ages 10 to 17 who reported major depressive symptomatology, there were over 3 times greater odds of facing online harassment in the last year compared with youth who reported mild or no depressive symptoms (Ybarra 2004 ). Similarly, in a 2018 national survey of young people, respondents ages 14 to 22 with moderate to severe depressive symptoms were more likely to have had negative experiences when using social media and, in particular, were more likely to report having faced hostile comments or being “trolled” from others when compared with respondents without depressive symptoms (31% vs. 14%) (Rideout and Fox 2018 ). As these studies depict risks for victimization on social media and the correlation with poor mental health, it is possible that individuals living with mental illness may also experience greater hostility online compared to individuals without mental illness. This would be consistent with research showing greater risk of hostility, including increased violence and discrimination, directed towards individuals living with mental illness in in-person contexts, especially targeted at those with severe mental illnesses (Goodman et al. 1999 ).

A computational study of mental health awareness campaigns on Twitter reported that while stigmatizing content was rare, it was actually the most spread (re-tweeted) demonstrating that harmful content can travel quickly on social media (Saha et al. 2019 ). Another study was able to map the spread of social media posts about the Blue Whale Challenge, an alleged game promoting suicide, over Twitter, YouTube, Reddit, Tumblr, and other forums across 127 countries (Sumner et al. 2019 ). These findings show that it is critical to monitor the actual content of social media posts, such as determining whether content is hostile or promotes harm to self or others. This is pertinent because existing research looking at duration of exposure cannot account for the impact of specific types of content on mental health and is insufficient to fully understand the effects of using these platforms on mental health.

Consequences for Daily Life

The ways in which individuals use social media can also impact their offline relationships and everyday activities. To date, reports have described risks of social media use pertaining to privacy, confidentiality, and unintended consequences of disclosing personal health information online (Torous and Keshavan 2016 ). Additionally, concerns have been raised about poor quality or misleading health information shared on social media and that social media users may not be aware of misleading information or conflicts of interest especially when the platforms promote popular content regardless of whether it is from a trustworthy source (Moorhead et al. 2013 ; Ventola 2014 ). For persons living with mental illness, there may be additional risks from using social media. A recent study that specifically explored the perspectives of social media users with serious mental illnesses, including participants with schizophrenia spectrum disorders, bipolar disorder, or major depression, found that over one third of participants expressed concerns about privacy when using social media (Naslund and Aschbrenner 2019 ). The reported risks of social media use were directly related to many aspects of everyday life, including concerns about threats to employment, fear of stigma and being judged, impact on personal relationships, and facing hostility or being hurt (Naslund and Aschbrenner 2019 ). While few studies have specifically explored the dangers of social media use from the perspectives of individuals living with mental illness, it is important to recognize that use of these platforms may contribute to risks that extend beyond worsening symptoms and that can affect different aspects of daily life.

In this commentary, we considered ways in which social media may yield benefits for individuals living with mental illness, while contrasting these with the possible harms. Studies reporting on the threats of social media for individuals with mental illness are mostly cross-sectional, making it difficult to draw conclusions about direction of causation. However, the risks are potentially serious. These risks should be carefully considered in discussions pertaining to use of social media and the broader use of digital mental health technologies, as avenues for mental health promotion or for supporting access to evidence-based programs or mental health services. At this point, it would be premature to view the benefits of social media as outweighing the possible harms, when it is clear from the studies summarized here that social media use can have negative effects on mental health symptoms, can potentially expose individuals to hurtful content and hostile interactions, and can result in serious consequences for daily life, including threats to employment and personal relationships. Despite these risks, it is also necessary to recognize that individuals with mental illness will continue to use social media given the ease of accessing these platforms and the immense popularity of online social networking. With this in mind, it may be ideal to raise awareness about these possible risks so that individuals can implement necessary safeguards, while highlighting that there could also be benefits. Being aware of the risks is an essential first step, before then recognizing that use of these popular platforms could contribute to some benefits like finding meaningful interactions with others, engaging with peer support networks, and accessing information and services.

To capitalize on the widespread use of social media and to achieve the promise that these platforms may hold for supporting the delivery of targeted mental health interventions, there is need for continued research to better understand how individuals living with mental illness use social media. Such efforts could inform safety measures and also encourage use of social media in ways that maximize potential benefits while minimizing risk of harm. It will be important to recognize how gender and race contribute to differences in use of social media for seeking mental health information or accessing interventions, as well as differences in how social media might impact mental wellbeing. For example, a national survey of 14- to 22-year olds in the USA found that female respondents were more likely to search online for information about depression or anxiety and to try to connect with other people online who share similar mental health concerns when compared with male respondents (Rideout and Fox 2018 ). In the same survey, there did not appear to be any differences between racial or ethnic groups in social media use for seeking mental health information (Rideout and Fox 2018 ). Social media use also appears to have a differential impact on mental health and emotional wellbeing between females and males (Booker et al. 2018 ), highlighting the need to explore unique experiences between gender groups to inform tailored programs and services. Research shows that lesbian, gay, bisexual, or transgender individuals frequently use social media for searching for health information and may be more likely compared with heterosexual individuals to share their own personal health experiences with others online (Rideout and Fox 2018 ). Less is known about use of social media for seeking support for mental health concerns among gender minorities, though this is an important area for further investigation as these individuals are more likely to experience mental health problems and online victimization when compared with heterosexual individuals (Mereish et al. 2019 ).

Similarly, efforts are needed to explore the relationship between social media use and mental health among ethnic and racial minorities. A recent study found that exposure to traumatic online content on social media showing violence or hateful posts directed at racial minorities contributed to increases in psychological distress, PTSD symptoms, and depression among African American and Latinx adolescents in the USA (Tynes et al. 2019 ). These concerns are contrasted by growing interest in the potential for new technologies including social media to expand the reach of services to underrepresented minority groups (Schueller et al. 2019 ). Therefore, greater attention is needed to understanding the perspectives of ethnic and racial minorities to inform effective and safe use of social media for mental health promotion efforts.

Research has found that individuals living with mental illness have expressed interest in accessing mental health services through social media platforms. A survey of social media users with mental illness found that most respondents were interested in accessing programs for mental health on social media targeting symptom management, health promotion, and support for communicating with health care providers and interacting with the health system (Naslund et al. 2017 ). Importantly, individuals with serious mental illness have also emphasized that any mental health intervention on social media would need to be moderated by someone with adequate training and credentials, would need to have ground rules and ways to promote safety and minimize risks, and importantly, would need to be free and easy to access.

An important strength with this commentary is that it combines a range of studies broadly covering the topic of social media and mental health. We have provided a summary of recent evidence in a rapidly advancing field with the goal of presenting unique ways that social media could offer benefits for individuals with mental illness, while also acknowledging the potentially serious risks and the need for further investigation. There are also several limitations with this commentary that warrant consideration. Importantly, as we aimed to address this broad objective, we did not conduct a systematic review of the literature. Therefore, the studies reported here are not exhaustive, and there may be additional relevant studies that were not included. Additionally, we only summarized published studies, and as a result, any reports from the private sector or websites from different organizations using social media or other apps containing social media–like features would have been omitted. Although, it is difficult to rigorously summarize work from the private sector, sometimes referred to as “gray literature,” because many of these projects are unpublished and are likely selective in their reporting of findings given the target audience may be shareholders or consumers.

Another notable limitation is that we did not assess risk of bias in the studies summarized in this commentary. We found many studies that highlighted risks associated with social media use for individuals living with mental illness; however, few studies of programs or interventions reported negative findings, suggesting the possibility that negative findings may go unpublished. This concern highlights the need for a future more rigorous review of the literature with careful consideration of bias and an accompanying quality assessment. Most of the studies that we described were from the USA, as well as from other higher income settings such as Australia or the UK. Despite the global reach of social media platforms, there is a dearth of research on the impact of these platforms on the mental health of individuals in diverse settings, as well as the ways in which social media could support mental health services in lower income countries where there is virtually no access to mental health providers. Future research is necessary to explore the opportunities and risks for social media to support mental health promotion in low-income and middle-income countries, especially as these countries face a disproportionate share of the global burden of mental disorders, yet account for the majority of social media users worldwide (Naslund et al. 2019 ).

Future Directions for Social Media and Mental Health

As we consider future research directions, the near ubiquitous social media use also yields new opportunities to study the onset and manifestation of mental health symptoms and illness severity earlier than traditional clinical assessments. There is an emerging field of research referred to as “digital phenotyping” aimed at capturing how individuals interact with their digital devices, including social media platforms, in order to study patterns of illness and identify optimal time points for intervention (Jain et al. 2015 ; Onnela and Rauch 2016 ). Given that most people access social media via mobile devices, digital phenotyping and social media are closely related (Torous et al. 2019 ). To date, the emergence of machine learning, a powerful computational method involving statistical and mathematical algorithms (Shatte et al. 2019 ), has made it possible to study large quantities of data captured from popular social media platforms such as Twitter or Instagram to illuminate various features of mental health (Manikonda and De Choudhury 2017 ; Reece et al. 2017 ). Specifically, conversations on Twitter have been analyzed to characterize the onset of depression (De Choudhury et al. 2013 ) as well as detecting users’ mood and affective states (De Choudhury et al. 2012 ), while photos posted to Instagram can yield insights for predicting depression (Reece and Danforth 2017 ). The intersection of social media and digital phenotyping will likely add new levels of context to social media use in the near future.

Several studies have also demonstrated that when compared with a control group, Twitter users with a self-disclosed diagnosis of schizophrenia show unique online communication patterns (Birnbaum et al. 2017a ), including more frequent discussion of tobacco use (Hswen et al. 2017 ), symptoms of depression and anxiety (Hswen et al. 2018b ), and suicide (Hswen et al. 2018a ). Another study found that online disclosures about mental illness appeared beneficial as reflected by fewer posts about symptoms following self-disclosure (Ernala et al. 2017 ). Each of these examples offers early insights into the potential to leverage widely available online data for better understanding the onset and course of mental illness. It is possible that social media data could be used to supplement additional digital data, such as continuous monitoring using smartphone apps or smart watches, to generate a more comprehensive “digital phenotype” to predict relapse and identify high-risk health behaviors among individuals living with mental illness (Torous et al. 2019 ).

With research increasingly showing the valuable insights that social media data can yield about mental health states, greater attention to the ethical concerns with using individual data in this way is necessary (Chancellor et al. 2019 ). For instance, data is typically captured from social media platforms without the consent or awareness of users (Bidargaddi et al. 2017 ), which is especially crucial when the data relates to a socially stigmatizing health condition such as mental illness (Guntuku et al. 2017 ). Precautions are needed to ensure that data is not made identifiable in ways that were not originally intended by the user who posted the content as this could place an individual at risk of harm or divulge sensitive health information (Webb et al. 2017 ; Williams et al. 2017 ). Promising approaches for minimizing these risks include supporting the participation of individuals with expertise in privacy, clinicians, and the target individuals with mental illness throughout the collection of data, development of predictive algorithms, and interpretation of findings (Chancellor et al. 2019 ).

In recognizing that many individuals living with mental illness use social media to search for information about their mental health, it is possible that they may also want to ask their clinicians about what they find online to check if the information is reliable and trustworthy. Alternatively, many individuals may feel embarrassed or reluctant to talk to their clinicians about using social media to find mental health information out of concerns of being judged or dismissed. Therefore, mental health clinicians may be ideally positioned to talk with their patients about using social media and offer recommendations to promote safe use of these sites while also respecting their patients’ autonomy and personal motivations for using these popular platforms. Given the gap in clinical knowledge about the impact of social media on mental health, clinicians should be aware of the many potential risks so that they can inform their patients while remaining open to the possibility that their patients may also experience benefits through use of these platforms. As awareness of these risks grows, it may be possible that new protections will be put in place by industry or through new policies that will make the social media environment safer. It is hard to estimate a number needed to treat or harm today given the nascent state of research, which means the patient and clinician need to weigh the choice on a personal level. Thus, offering education and information is an important first step in that process. As patients increasingly show interest in accessing mental health information or services through social media, it will be necessary for health systems to recognize social media as a potential avenue for reaching or offering support to patients. This aligns with growing emphasis on the need for greater integration of digital psychiatry, including apps, smartphones, or wearable devices, into patient care and clinical services through institution-wide initiatives and training clinical providers (Hilty et al. 2019 ). Within a learning healthcare environment where research and care are tightly intertwined and feedback between both is rapid, the integration of digital technologies into services may create new opportunities for advancing use of social media for mental health.

As highlighted in this commentary, social media has become an important part of the lives of many individuals living with mental disorders. Many of these individuals use social media to share their lived experiences with mental illness, to seek support from others, and to search for information about treatment recommendations, accessing mental health services and coping with symptoms (Bucci et al. 2019 ; Highton-Williamson et al. 2015 ; Naslund et al. 2016b ). As the field of digital mental health advances, the wide reach, ease of access, and popularity of social media platforms could be used to allow individuals in need of mental health services or facing challenges of mental illness to access evidence-based treatment and support. To achieve this end and to explore whether social media platforms can advance efforts to close the gap in available mental health services in the USA and globally, it will be essential for researchers to work closely with clinicians and with those affected by mental illness to ensure that possible benefits of using social media are carefully weighed against anticipated risks.

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Dr. Naslund is supported by a grant from the National Institute of Mental Health (U19MH113211). Dr. Aschbrenner is supported by a grant from the National Institute of Mental Health (1R01MH110965-01).

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Naslund, J.A., Bondre, A., Torous, J. et al. Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice. J. technol. behav. sci. 5 , 245–257 (2020). https://doi.org/10.1007/s41347-020-00134-x

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Gen Z mental health: The impact of tech and social media

Much like many relationships a person might have between ages 18 and 24, the relationship a young person has with social media  can be complicated. No matter where they live, respondents in a new global survey said social media usage can lead to a fear of missing out (FOMO) or poor body image, but it also can help with social connections and self-expression.

McKinsey Health Institute’s (MHI’s) 2022 Global Gen Z Survey asked more than 42,000 respondents in 26 countries across continents questions based on the four dimensions of health: mental, physical, social, and spiritual. 1 Participants were surveyed on the following nine key topics: overall health and well-being, mental health in the workplace, spiritual health and religion, social determinants of health, social media and digital health services, mental health service utilization, mental health among students, attitudes toward mental health, and global current events. As with all surveys, these data reflect a moment in time and MHI makes no long-term approximations about how these results will trend over time. MHI then analyzed differences and similarities across generations and countries, with a hope of informing the broader dialogue around Gen Z mental health.

Gen Zers, on average, are more likely than other generations to cite negative feelings about social media. 2 Social media is defined here as apps to connect, potentially broadly, with other users. It does not include direct messaging apps. They are also more likely to report having poor mental health. But correlation is not causation, and our data indicates that the relationship between social media use and mental health is complex. One surprise: Older generations’ engagement with these platforms is on par with Gen Zers. For example, baby boomers in eight of the 26 countries surveyed report spending as much time on social media as Gen Zers, with millennials being the most likely to post. And while negative impacts of social media were reported across cohorts, positive effects were even more common—more than 50 percent of all groups cited self-expression and social connectivity as positives from social media.

More than 50 percent of all groups cited self-expression and social connectivity as positives from social media.

There are also signs that technology provides access to supportive mental health resources for younger people. Gen Z respondents are more likely than other generations to use digital wellness apps and digital mental health programs. 3 Digital wellness apps are defined as consumer-driven digital applications that aim to reduce stress, improve well-being and productivity, and address nonclinical conditions for consumers, focusing on topics such as meditation, sleep tracking, cognitive behavioral therapy, and fitness. Digital mental health programs are telehealth programs that offer remote appointments with a healthcare provider (for example, physician, therapist), either over video or phone. Additionally, respondents indicate that certain aspects of social media use can benefit their mental health, such as using social media for self-expression. Young refugees and asylum seekers are among those most likely to cite social media as a tool to stay connected and decrease loneliness.

Methodology

To gain a better understanding of Gen Z in comparison with other generations, the McKinsey Health Institute conducted an internet-based survey in May 2022 in ten European countries (France, Germany, Italy, the Netherlands, Poland, Spain, Sweden, Switzerland, Türkiye, and United Kingdom), with approximately 1,000 completes per country (including around 600 Gen Z). In August 2022, an additional 1,600 completes per country (including 600 Gen Z) were collected from 16 mostly non-European countries (Argentina, Australia, Brazil, China, Egypt, India, Indonesia, Ireland, Japan, Mexico, Nigeria, Saudi Arabia, South Africa, United Arab Emirates, United States, Vietnam). In total, the survey collected responses from 42,083 people, including 16,824 Gen Z individuals (mostly 18–24-year-olds and including a negligible minority of 13–17-year-old non-European respondents), 13,080 millennials (25–40 years old), 6,937 Gen Xers (41–56 years old), 5,119 baby boomers (57–75 years old), and 123 from the Silent Generation (76–93 years old).

Within each country, the survey applied weights to match the distribution of age cohorts, gender, and share of population with tertiary education in the sample to the country’s national census. The sample was drawn from populations with access to the internet, which made the samples more representative of Gen Z respondents, in which nearly all individuals with access to the internet are active technology users; however, for other generations, this is less likely to be the case. This analysis reflects self-reported results in 2022.

Considerations for cross-generational surveys

The survey focused on how respondents—mainly Gen Z—were feeling at the time they were surveyed. Therefore, we cannot determine whether differences in answers between age cohorts are caused by an intrinsic change in attitudes and behaviors or are merely induced by age differences: it is possible that Gen Z will eventually think and behave like millennials, Gen X, or baby boomers, when they reach those ages.

Considerations for surveys conducted online

The survey was conducted online. Therefore, it may not accurately reflect the behaviors or attitudes of individuals who do not have reliable online access. This can be particularly significant in various aspects of life, given that the internet can have a profound impact on the information we access and how we process it.

Considerations for cross-country surveys

Cross-country, sociocultural differences can impact perceptions, scale usage, and affect other factors that may influence responses. However, we cannot automatically conclude that these differences are objective. For instance, the variations in answers on an agreement scale may be due to the respondent’s inclination to agree or disagree and their propensity to choose extreme answers such as “strongly disagree” or “strongly agree.”

Although we relied on cultural experts and youth reviewers to ensure equivalence of meanings across languages during translations, some observed differences across countries may still be induced by the translations.

To measure country differences, we computed country averages and used them to calculate simple averages across countries. By doing so, we treated each country equally, regardless of its population size.

In the six insights below, MHI delves deeper into the ways in which mental health, technology, and social media intersect for our respondents (see sidebar “Methodology” for further detail). This survey covered additional topics such as climate change and spiritual health (for selected insights, see sidebars “Climate change is a concern for many respondents” and “Gen Z and spiritual health: Insights”).

Gen Z respondents report challenges with health across most dimensions

Although many individuals around the world are struggling with their health, there are meaningful differences within groups.

Globally, one in seven baby boomers say their mental health has declined over the past three years, compared with one in four Gen Z respondents. Female Gen Zers were almost twice as likely to report poor mental health when compared with their male counterparts (21 percent versus 13 percent, respectively).

In most surveyed countries, a higher proportion of Gen Z respondents said their mental health was poor or very poor when compared with other dimensions of health (16 percent in Gen Z and 7 percent for baby boomers). However, in China, Egypt, Nigeria, Saudi Arabia, United Arab Emirates, and Vietnam, Gen Z respondents reported that they struggled most with their social health. Overall, mental health experiences varied by region, with Gen Z participants in Saudi Arabia, Egypt, and Nigeria rating their mental health as “very good” with the highest frequencies.

While Gen Z tends to report worse mental health, the underlying cause is not clear. There are several age-specific factors that may impact Gen Z’s mental health independent of their generational cohort, including developmental stage, level of engagement with healthcare, and familial or societal attitudes.

Almost everyone is using social media, but in different ways

More than 75 percent of respondents in all age groups said they use and check social media sites at least ten minutes a day.

Younger generations tend to engage with social media regularly, in both active and passive ways. Almost half of both millennial and Gen Z respondents check social media multiple times a day. Over one-third of Gen Z respondents say they spend more than two hours each day on social media sites; however, millennials are the most active social media users, with 32 percent stating they post either daily or multiple times a day.

Whether less active social media use by Gen Z respondents could be related to greater caution and self-awareness among youth, reluctance to commit, or more comfort with passive social media use remains up for debate. Studies have shown that passive social media use (for example, scrolling) could be linked to declines in subjective well-being over time. 1 Philippe Verduyn et al., “Passive Facebook usage undermines affective well-being: Experimental and longitudinal evidence,” Journal of Experimental Psychology: General , 2015, Volume 144, Number 2.

Gen Zers and millennials are more likely than other generations to say social media affects their mental health

Studies of young adults and their social media use have shown an inverse relationship between screen time and psychological well-being, 1 Jean Twenge et al., “Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study,” Preventive Medicine Reports , 2018, Volume 12. with higher utilization associated with poorer well-being. Other research indicates the nature of the relationship individuals have with social media can have a greater impact on their mental health than time spent. 2 Mesfin A. Bekalu, Rachel F. McCloud, and K. Viswanath, “Association of social media use with social well-being, positive mental health, and self-rated health: Disentangling routine use from emotional connection to use,” Health Education & Behavior , 2019, Volume 46, Number 2.

Our findings show a nuanced relationship between social media use and mental health. While around one-third of respondents across cohorts report positive impacts of social media on mental health, generations differ in reported negative impacts.

Negative effects seem to be greatest for younger generations, with particularly pronounced impacts for Gen Zers who spend more than two hours a day on social media and Gen Zers with poor mental health. Gen Z respondents from Europe and Oceania were most likely to report negative impacts from social media, and respondents from Asia were least likely (32 percent and 19 percent, respectively). 3 Participants were requested to rank 13 factors, including technology and social media, on how they perceive their impact on mental health. There is the possibility for varying interpretation of what classifies as negative or positive effects. Differences across generations and regions could be influenced in part by social media algorithms.

While the positive impact stays comparable, older generations report fewer negative effects

All generational cohorts in the survey said that social media use had the most positive impact on self-expression and social connectivity. Self-reported refugees and asylum seekers cite higher levels of positive impact than others across all aspects.

Across generations, there are more positive than negative impacts reported by respondents; however, the reported negative impact is higher for Gen Z. Respondents from high-income countries (as defined by World Bank) were twice as likely to report a negative impact of social media on their lives than respondents from lower-middle-income countries (13 percent compared with 7 percent).

When compared with their male counterparts, a higher proportion of female Gen Zers said social media had a negative impact on FOMO (32 percent versus 22 percent), body image (32 percent versus 16 percent), and self-confidence (24 percent versus 13 percent).

Positive aspects of technology may include increased access to health resources

Across generations, more than one in four respondents report using digital wellness apps as compared with one out of five using digital mental health programs (28 percent compared with 19 percent, respectively). Fifty percent more Gen Z respondents reported using digital mental health programs than Gen X or baby boomers (22 percent for Gen Z versus 15 percent for Gen X and baby boomers).

Among those respondents who report using digital mental health programs, most Gen Zers say they would likely keep using them (65 percent); other generations are even more committed, with 74 percent reporting that they would likely continue to use the programs. Four out of five respondents across all generations report that these programs benefit their mental health.

While evaluation of outcomes and effectiveness requires continued study, digital health resources may play an important role in supporting mental health globally, especially when in-person resources are limited or geographically inaccessible. For certain populations, digital health resources could be the preferred method of obtaining support.

Most find help on their own or by referral

Thirty-four percent of Gen Z respondents who use digital mental health programs and apps say they found them on their own. This proportion increases to approximately 50 percent in Brazil, Indonesia, Mexico, and South Africa. In other countries, primary care physicians and healthcare payers (insurance plans) were listed as primary access points to digital mental health programs.

No matter the geography, employers have growing  opportunities to promote workplace well-being and ensure employees have access to the evidence-based mental health resources they need.

At least a third of respondents in most countries and generational cohorts said physical, mental, social, and spiritual health resources were important or very important in choosing an employer, and Gen Z gave particular weight to mental health resources. Given that Gen Z is a growing percentage of the workforce, and that few Gen Z respondents cited employers as a primary access point for help, there may be room for employers to further  engage around mental health in the future.

Technology and social media can be a part of the solution

Climate change is a concern for many respondents.

Climate change appears to be a major concern across generations: in the McKinsey Health Institute 2022 Global Gen Z Survey, more than half of respondents across all age groups reported feeling highly distressed when asked about climate change, with females reporting a higher percentage compared with males. Many Gen Z respondents reported experiencing stress, sadness, anger, and frustration due to climate change and its related disasters. More than 50 percent of total respondents expressed fear and anxiety about the future, with Gen Z demonstrating greater concern than other generations. More than 50 percent of all respondents agree or strongly agree that “government leaders and companies have failed to take care of the planet.”

This fear is not purely existential about the fate of the world or “eco-anxiety,” but instead is often rooted in specific environmental risks that may impact their direct day-to-day livelihoods. When asked about which statements related to climate change resonated with them, 33 percent agree or strongly agree that climate change poses a threat to their family’s physical or financial security. Individuals with self-reported poor mental health are more likely to feel affected by climate change, with 67 percent of Gen Z in this group stating that the future is “frightening” when looking at climate change, compared with 47 percent of Gen Z with neutral or good mental health.

Given the complex and multifaceted nature of mental health and climate change threats and related disruptions, there are no simple answers to the challenges they pose. There is an opportunity for further understanding of how experiences and attitudes around climate change may be influenced by political and ecological factors. However, in order to help young people navigate these issues, healthcare providers, educators, and parents can take a proactive approach by exploring these topics through targeted questioning and solution-oriented discussions. By encouraging young people to think critically about mental health and climate change, the focus can become empowerment and active role-playing to promote personal well-being, climate resilience, and the health of the planet.

Social media and technology, while part of the broader dialogue around youth mental health, can be powerful tools in promoting well-being and offering scaled mental health support. For example, developers might consider embedding algorithms that make it easier for youth expressing psychological distress to find support groups, crisis hotlines, or emergency mental health services. Additionally, digital mental health companies could consider partnering with virtual and community-based providers to connect people with high-acuity needs to timely and culturally-appropriate crisis services.

Gen Z and spiritual health: Insights

According to the McKinsey Health Institute 2022 Global Gen Z survey, those between the ages of 18 and 24 report poorer spiritual health than older generations, with Gen Z respondents almost three times more likely than baby boomers to report poor or very poor spiritual health.

Spiritual health enables people to integrate meaning in their lives. Spiritually healthy people have a strong sense of purpose. While people who are experiencing poor mental health could have good spiritual health, or vice versa, Gen Z individuals who experienced poor mental health were five times more likely to report poor spiritual health than those with neutral or good mental health.

Responses varied widely by country, both in terms of overall ratings of spiritual health and in respondents’ perceived importance of spiritual health. For example, there was a 48-point range across countries in respondents indicating that spiritual health was “extremely important” to them. While 8 percent of total respondents in the Netherlands said spiritual health was “extremely important” to them, 56 percent of total respondents in Brazil said the same. Respondents in higher-income countries were half as likely to indicate spiritual health is “extremely important” to them versus lower-middle-income countries (23 percent versus 43 percent).

Respondents in Africa and South America were most likely to report that spiritual health was extremely important to them (46 percent and 41 percent, respectively); respondents in Europe were least likely (18 percent).

Given these data, it’s clear that spiritual health matters to young people around the world, and there may be important links to overall well-being. People seeking to support the mental health and psychological resilience of young people may want to inquire about how they are finding purpose in their homes, families, and at work.

Around the world, communities are struggling to provide young people with someone to call, someone to respond, or a safe place to get help during mental health, substance use, and/or suicidal crises . The availability of crisis supports globally is varied, with the majority of countries having no national suicide or mental health crisis line. In addition, communities in every geography lack adequate community mental health services infrastructure to respond to the volume of crises young people experience each year, instead relying on schools, emergency rooms, hospitals, law enforcement, or families to bridge a gap that could save lives and livelihoods. Dispatching specially trained mobile teams or providing a safe place to go in crisis is even more rare—a gap that technology could bridge.

Collaboration between technology companies, mental health professionals, educators, employers, policy makers, and the wider community is necessary. By prioritizing mental health and utilizing technology in a positive way, young people are more likely to achieve and sustain better health. Other strategies that could be considered include using social media to build supportive online communities for affinity groups and promoting youth leaders to create and disseminate content that promotes mental health. 4 Mizuko Ito, Candice Odgers, and Stephen Schueller, Social media and youth wellbeing: What we know and where we could go , Connected Learning Alliance, June 2020. Researchers and companies can explore evidence-based strategies such as mental health promotion and mindfulness programs to mitigate the negative effects of social media and to help young people use social media as a platform for authentic self-expression. 5 Julia Brailovskaia and Jürgen Margraf, “Positive mental health and mindfulness as protective factors against addictive social media use during the COVID-19 outbreak,” PLOS One , 2022, Volume 17, Number 11.

A “precision prevention” approach to talking with young people about the role of technology in their lives may help create a more informed, supportive, and healthful environment. By providing parents, educators, and healthcare professionals with these tools, they can become actively engaged in promoting the health of Gen Z and beyond. While addressing these issues may seem overwhelming, it is essential that stakeholders work together to help improve the mental health of young people.

MHI is an enduring, non-profit-generating global entity within McKinsey. MHI strives to catalyze actions across continents, sectors, and communities to achieve material improvements in health, empowering people to lead their best possible lives. MHI sees supporting youth mental health as essential to adding years to life and life to years.

If you would like to learn more about the McKinsey Health Institute (MHI) 2022 Global Gen Z survey and the additional data and insights the McKinsey Health Institute has from the survey, please submit an inquiry via the MHI “contact us” form . The McKinsey Health Institute, as a non-profit-generating entity of McKinsey, is creating avenues for further research that can catalyze action.

Erica Coe is a coleader at the McKinsey Health Institute and a partner in McKinsey’s Atlanta office. Kana Enomoto is a coleader at the McKinsey Health Institute and an associate partner in the Washington, DC, office, where Andrew Doy is a consultant and Cheryl Healy is an associate partner.

The authors wish to thank Nicolas Abi-Chacra, Lea Arora, Victoria Bennett, Abby Bloomfield, Ulrike Deetjen, Alexandru Degeratu, Martin Dewhurst, Joseph Jung, Abhishek Mahajan, Roxanne Sabbag, Emma Summerton, Pooja Tatwawadi, and Oliver Walker for their contributions to this article. They also wish to thank MHI geographical leaders Alistair Carmichael, Andira Putri, and Shriya Sethi. They also wish to thank the European Society for Child and Adolescent Psychiatry (ESCAP) affiliates and Orygen for providing their local expertise and helping shape the MHI Global Gen Z Survey (2022). They also wish to thank Megan Jones Bell, Murali Doraiswamy, Sharon Hoover, Roberta Katz, Shekhar Saxena, and Anil Thapliyal for their contributions.

This article was edited by Elizabeth Newman, an executive editor in the Chicago office.

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Living Better

The truth about teens, social media and the mental health crisis.

Michaeleen Doucleff

For years, the research picture on how social media affects teen mental health has been murky. That is changing as scientists find new tools to answer the question. Olivier Douliery/AFP via Getty Images hide caption

For years, the research picture on how social media affects teen mental health has been murky. That is changing as scientists find new tools to answer the question.

Back in 2017, psychologist Jean Twenge set off a firestorm in the field of psychology.

Twenge studies generational trends at San Diego State University. When she looked at mental health metrics for teenagers around 2012, what she saw shocked her. "In all my analyses of generational data — some reaching back to the 1930s — I had never seen anything like it," Twenge wrote in the Atlantic in 2017.

Twenge warned of a mental health crisis on the horizon. Rates of depression, anxiety and loneliness were rising. And she had a hypothesis for the cause: smartphones and all the social media that comes along with them. "Smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases. That's very suspicious," Twenge told NPR in 2017.

But many of her colleagues were skeptical. Some even accused her of inciting a panic with too little — and too weak — data to back her claims.

Now, six years later, Twenge is back. She has a new book out this week, called Generations , with much more data backing her hypothesis. At the same time, several high-quality studies have begun to answer critical questions, such as does social media cause teens to become depressed and is it a key contributor to a rise in depression?

In particular, studies from three different types of experiments, altogether, point in the same direction. "Indeed, I think the picture is getting more and more consistent," says economist Alexey Makarin , at the Massachusetts Institute of Technology.

Shots - Health News

How to help young people limit screen time — and feel better about how they look, a seismic change in how teens spend their time.

In Generations , Twenge analyzes mental health trends for five age groups, from the Silent Generation, who were born between 1925 and 1945, to Gen Z, who were born between 1995 and 2012. She shows definitively that "the way teens spend their time outside of school fundamentally changed in 2012," as Twenge writes in the book.

Take for instance, hanging out with friends, in person. Since 1976, the number of times per week teens go out with friends — and without their parents — held basically steady for nearly 30 years. In 2004, it slid a bit. Then in 2010, it nosedived.

"It was just like a Black Diamond ski slope straight down," Twenge tells NPR. "So these really big changes occur."

At the same time, around 2012, time on social media began to soar. In 2009, only about half of teens used social media every day, Twenge reports. In 2017, 85% used it daily. By 2022, 95% of teens said they use some social media, and about a third say they use it constantly, a poll from Pew Research Center found .

"Now, in the most recent data, 22% of 10th grade girls spend seven or more hours a day on social media," Twenge says, which means many teenage girls are doing little else than sleeping, going to school and engaging with social media.

Not surprisingly, all this screen time has cut into many kids' sleep time. Between 2010 and 2021, the percentage of 10th and 12th graders who slept seven or fewer hours each night rose from a third to nearly one-half. "That's a big jump," Twenge says. "Kids in that age group are supposed to sleep nine hours a night. So less than seven hours is a really serious problem."

Teen girls and LGBTQ+ youth plagued by violence and trauma, survey says

On its own, sleep deprivation can cause mental health issues. "Sleep is absolutely crucial for physical health and for mental health. Not getting enough sleep is a major risk factor for anxiety and depression and self-harm," she explains. Unfortunately, all of those mental health problems have continued to rise since Twenge first sounded the alarm six years ago.

"Nuclear bomb" on teen social life

"Every indicator of mental health and psychological well-being has become more negative among teens and young adults since 2012," Twenge writes in Generations . "The trends are stunning in their consistency, breadth and size."

Across the board, since 2010, anxiety, depression and loneliness have all increased . "And it's not just symptoms that rose, but also behaviors," she says, "including emergency room visits for self-harm, for suicide attempts and completed suicides." The data goes up through 2019, so it doesn't include changes due to COVID-19.

All these rapid changes coincide with what, Twenge says, may be the most rapid uptake in a new technology in human history: the incorporation of smartphones into our lives, which has allowed nearly nonstop engagement with social media apps. Apple introduced the first iPhones in 2007, and by 2012, about 50% of American adults owned a smartphone, the Pew Research Center found .

The timing is hard to ignore, says data scientist Chris Said , who has a Ph.D. in psychology from Princeton University and has worked at Facebook and Twitter. "Social media was like a nuclear bomb on teen social life," he says. "I don't think there's anything in recent memory, or even distant history, that has changed the way teens socialize as much as social media."

Murky picture becomes clearer on causes of teen depression

But the timing doesn't tell you whether social media actually causes depression in teens.

In the past decade, scientists have published a whole slew of studies trying to answer this question, and those studies sparked intense debate among scientists and in the media. But, Said says, what many people don't realize is scientists weren't using — or didn't even have — the proper tools to answer the question. "This is a very hard problem to study," he says. "The data they were analyzing couldn't really solve the problem."

Mental Health

The mental health of teen girls and lgbtq+ teens has worsened since 2011.

So the findings have been all over the place. They've been murky, noisy, inconclusive and confusing. "When you use tools that can't fully answer the question, you're going to get weak answers," he says. "So I think that's one reason why really strong evidence didn't show up in the data, at least early on."

On top of it, psychology has a bad track record in this field, Said points out. For nearly a century, psychologists have repeatedly blamed new technologies for mental and physical health problems of children, even when they've had little — or shady — data to back up their claims.

For example, in the 1940s, psychologists worried that children were becoming addicted to radio crime dramas, psychologist Amy Orben at the University of Cambridge explains in her doctoral thesis. After that, they raised concerns about comic books, television and — eventually — video games. Thus, many researchers worried that social media may simply be the newest scapegoat for children's mental health issues.

A handful of scientists, including MIT's Alexey Makarin, noticed this problem with the data, the tools and the field's past failures, and so they took the matter into their own hands. They went out and found better tools.

Hundreds of thousands of more college students depressed

Over the past few years, several high-quality studies have come that can directly test whether social media causes depression. Instead of being murky and mixed, they support each other and show clear effects of social media. "The body of literature seems to suggest that indeed, social media has negative effects on mental health, especially on young adults' mental health," says Makarin, who led what many scientists say is the best study on the topic to date.

In that study, Makarin and his team took advantage of a once-in-a-lifetime opportunity: the staggered introduction of Facebook across U.S. colleges from 2004 to 2006. Facebook rolled out into society first on college campuses, but not all campuses introduced Facebook at the same time.

For Makarin and his colleagues, this staggered rollout is experimental gold.

"It allowed us to compare students' mental health between colleges where Facebook just arrived to colleges where Facebook had not yet arrived," he says. They could also measure how students' mental health shifted on a particular campus when people started to spend a bunch of their time on social media.

Luckily, his team could track mental health at the time because college administrators were also conducting a national survey that asked students an array of questions about their mental health, including diagnoses, therapies and medications for depression, anxiety and eating disorders. "These are not just people's feelings," Makarin says. "These are actual conditions that people have to report."

They had data on a large number of students. "The data comes from more than 350,000 student responses across more than 300 colleges," Makarin says.

This type of study is called a quasi-experiment, and it allows scientists to estimate how much social media actually changes teens' mental health, or as Makarin says, "We can get causal estimates of the impact of Facebook on mental health."

So what happened? "Almost immediately after Facebook arrives on campus, we see an uptick in mental health issues that students report," Makarin says. "We especially find an impact on depression rates, anxiety disorders and other questions associated with depression in general."

And the effect isn't small, he says. Across the population, the rollout of Facebook caused about 2% of college students to become clinically depressed. That may sound modest, but with more than 17 million college students in the U.S. at the time, that means Facebook caused more than 300,000 young adults to suffer from depression.

For an individual, on average, engaging with Facebook decreases their mental health by roughly 22% of the effect of losing one's job, as reported by a previous meta-analysis, Makarin and his team found.

Facebook's rollout had a larger effect on women's mental health than on men's mental health, the study showed. But the difference was small, Makarin says.

He and his colleagues published their findings last November in the American Economic Review . "I love that paper," says economist Matthew Gentzkow at Stanford University, who was not involved in the research. "It's probably the most convincing study I've seen. I think it shows a clear effect, and it's really credible. They did a good job of isolating the effect of Facebook, which isn't easy."

Of course, the study has limitations, Gentzkow says. First off, it's Facebook, which teens are using less and less. And the version of Facebook is barebones. In 2006, the platform didn't have a "like" button" or a "newsfeed." This older version probably wasn't as "potent" as social media now, says data scientist Chris Said. Furthermore, students used the platform only on a computer because smartphones weren't available yet. And the study only examined mental health impacts over a six-month period.

Nevertheless, the findings in this study bolster other recent studies, including one that Gentzkow led.

Social media is "like the ocean" for kids

Back in 2018, Gentzkow and his team recruited about 2,700 Facebook users ages 18 or over. They paid about half of them to deactivate their Facebook accounts for four weeks. Then Gentzkow and his team looked to see how a Facebook break shifted their mental health. They reported their findings in March 2020 in the American Economic Review.

This type of study is called a randomized experiment, and it's thought of as the best way to estimate whether a variable in life causes a particular problem. But with social media, these randomized experiments have big limitations. For one, the experiments are short-term — here only four weeks. Also, people use social media in clusters, not as individuals. So having individuals quit Facebook won't capture the effect of having an entire social group quit together. Both of these limitations could underestimate the impact of social media on an individual and community.

Nevertheless, Gentzkow could see how deactivating Facebook made people, on average, feel better. "Being off Facebook was positive across well-being outcomes," he says. "You see higher happiness, life satisfaction, and also lower depression, lower anxiety, and maybe a little bit lower loneliness."

Gentzkow and his team measured participants' well-being by giving them a survey at the end of the experiment but also asking questions, via text message, through the experiment. "For example, we sent people text messages that say, 'Right now, would you say you're feeling happy or not happy,'" he explains.

Again, as with Makarin's experiment, the effect was moderate. Gentzkow and his colleagues estimate that temporarily quitting Facebook improves a person's mental health by about 30% of the positive effect seen by going to therapy. "You could view that meaning these effects are pretty big," he explains, "or you could also see that as meaning that the effects of therapy are somewhat small. And I think both of those things are true to an extent."

Scientists still don't know to what extent social media is behind the rising mental health issues among teenagers and whether it is the primary cause. "It seems to be the case — like it's a big factor," says MIT's Alexey Makarin, "but that's still up for debate."

Still, though, other specifics are beginning to crystallize. Scientists are narrowing in on what aspects of social media are most problematic. And they can see that social media won't hurt every teen — or hurt them by the same amount. The data suggests that the more hours a child devotes to social media, the higher their risk for mental health problems.

Finally, some adolescents are likely more vulnerable to social media, and children may be more vulnerable at particular ages. A study published in February 2022 looked to see how time spent on social media varies with life satisfaction during different times in a child's life (see the graphic).

The researchers also looked to see if a child's present use of social media predicted a decrease of life satisfaction one year later. That data suggests two windows of time when children are most sensitive to detrimental effects of social media, especially heavy use of it. For girls, one window occurs at ages 11 through 13. And for boys, one window occurs at ages 14 and 15. For both genders, there's a window of sensitivity around age 19 — or near the time teenagers enter college. Amy Orben and her team at the University of Cambridge reported the findings in Nature Communications .

This type of evidence is known as a correlative. "It's hard to draw conclusions from these studies," Gentzkow says, because many factors contribute to life satisfaction, such as environmental factors and family backgrounds. Plus, people may use social media because they're depressed (and so depression could be the cause, not the outcome of social media use).

"Nevertheless, these correlative studies, together with the evidence from the causal experiments, paint a picture that suggests we should take social media seriously and be concerned," Gentzkow adds.

Psychologist Orben once heard a metaphor that may help parents understand how to approach this new technology. Social media for children is a bit like the ocean, she says, noting that it can be an extremely dangerous place for children. Before parents let children swim in any open water, they make sure the child is well-prepared and equipped to handle problems that arise. They provide safety vests, swimming lessons, often in less dangerous waters, and even then parents provide a huge amount of supervision.

Alyson Hurt created the graphic. Jane Greenhalgh and Diane Webber edited the story.

• mental health
• smartphones
• social media

• Open access
• Published: 22 June 2023

Social media and mental health in students: a cross-sectional study during the Covid-19 pandemic

• Abouzar Nazari   ORCID: orcid.org/0000-0003-2155-5438 1 ,
• Maede Hosseinnia   ORCID: orcid.org/0000-0002-2248-7011 2 ,
• Samaneh Torkian 3 &
• Gholamreza Garmaroudi   ORCID: orcid.org/0000-0001-7449-227X 4  

BMC Psychiatry volume  23 , Article number:  458 ( 2023 ) Cite this article

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Social media causes increased use and problems due to their attractions. Hence, it can affect mental health, especially in students. The present study was conducted with the aim of determining the relationship between the use of social media and the mental health of students.

Materials and methods

The current cross-sectional study was conducted in 2021 on 781 university students in Lorestan province, who were selected by the Convenience Sampling method. The data was collected using a questionnaire on demographic characteristics, social media, problematic use of social media, and mental health (DASS-21). Data were analyzed in SPSS-26 software.

Shows that marital status, major, and household income are significantly associated with lower DASS21 scores (a lower DASS21 score means better mental health status). Also, problematic use of social media (β = 3.54, 95% CI: (3.23, 3.85)) was significantly associated with higher mental health scores (a higher DASS21 score means worse mental health status). Income and social media use (β = 1.02, 95% CI: 0.78, 1.25) were significantly associated with higher DASS21 scores (a higher DASS21 score means worse mental health status). Major was significantly associated with lower DASS21 scores (a lower DASS21 score means better mental health status).

This study indicated that social media had a direct relationship with mental health. Despite the large amount of evidence suggesting that social media harms mental health, more research is still necessary to determine the cause and how social media can be used without harmful effects.

Peer Review reports

• Social media

Social media is one of the newest and most popular internet services, which has caused significant progress in the social systems of different countries in recent years [ 1 , 2 ]. The use of the Internet has become popular among people in such a way that its use has become inevitable and has made life difficult for those who use it excessively [ 3 ]. Social media has attracted the attention of millions of users around the world owing to the possibility of fast communication, access to a large amount of information, and its widespread dissemination [ 4 ]. Facebook, WhatsApp, Instagram, and Twitter are the most popular media that have attractive and diverse spaces for online communication among users, especially the young generation [ 5 , 6 ].

According to studies, at least 55% of the world’s population used social media in 2022 [ 7 ]. Iranian statistics also indicate that 78.5% of people use at least one social media. WhatsApp, with 71.1% of users, Instagram, with 49.4%, and Telegram, with 31.6% are the most popular social media among Iranians [ 8 , 9 ].

The use of social media has increased significantly in all age groups due to the origin of the COVID-19 pandemic [ 10 ] .It affected younger people, especially students, due to educational and other purposes [ 11 , 12 ]. Because of the sudden onset of the COVID-19 pandemic, educational institutions and learners had to accept e-learning as the only sustainable education option [ 13 ]. The rapid migration to E-learning has brought several challenges that can have both positive and negative consequences [ 14 ].

Unlike traditional media, where users are passive, social media enables people to create and share content; hence, they have become popular tools for social interaction [ 15 ].The freedom to choose to participate in the company of friends, anonymity, moderation, encouragement, the free exchange of feelings, and network interactions without physical presence and the constraints of the real world are some of the most significant factors that influence users’ continued activity in social media [ 16 ]. In social media, people can interact, maintain relationships, make new friends, and find out more about the people they know offline [ 17 ]. However, this popularity has resulted in significant lifestyle changes, as well as intentional or unintentional changes in various aspects of human social life [ 18 ]. Despite many advantages, the high use of social media brings negative physical, psychological, and social problems and consequences [ 19 ], but despite the use and access of more people to the Internet, its consequences and crises have been ignored [ 20 ].

Use of social media and mental health

Spending too much time on social media can easily become problematic [ 21 ]. Excessive use of social media, called problematic use, has symptoms similar to addiction [ 22 , 23 ]. Problematic use of social media represents a non-drug-related disorder in which harmful effects emerge due to preoccupation and compulsion to over-participate in social media platforms despite its highly negative consequences [ 24 , 25 , 26 ], which leads to adverse consequences of mental health, including anxiety, depression, lower well-being, and lower self-esteem [ 27 , 28 , 29 ].

Mental health & use of social media

Mental health is the main pillar of healthy human societies, which plays a vital role in ensuring the dynamism and efficiency of any society in such a way that other parts of health cannot be achieved without mental health [ 30 ]. According to World Health Organization’s (WHO) definition, mental health refers to a person’s ability to communicate with others [ 31 ]. Some researchers believe that social relationships can significantly affect mental health and improve quality of life by creating a sense of belonging and social identity [ 32 ]. It is also reported that people with higher social interactions have higher physical and mental health [ 33 ].

Scientific evidence also shows that social media affect people’s mental health [ 34 ]. Social studies and critiques often emphasize the investigation of the negative effects of Internet use [ 35 ]. For example, Kim et al. studied 1573 participants aged 18–64 years and reported that Internet addiction and social media use were associated with higher levels of depression and suicidal thoughts [ 36 ]. Zadar also studied adults and reported that excessive use of social media and the Internet was correlated with stress, sleep disturbances, and personality disorders [ 37 ]. Richards et al. reported the negative effects of the Internet and social media on the health and quality of life of adolescents [ 38 ]. There have been numerous studies that examine Internet addiction and its associated problems in young people [ 39 , 40 ], as well as reports of the effects of social media use on young people’s mental health [ 41 , 42 ].

A study on Iranian students showed that social media leads to depression, anxiety, and mental health decline [ 25 ]. A study on Iranian students showed that social media leads to depression, anxiety, and mental health decline [ 25 ]. But no study has investigated the effects of social media on the mental health of students from a more traditional province with lower individualism and higher levels of social support (where they were thought to have lower social media use and better mental health) during the COVID-19 pandemic. As social media became more and more vital to university students’ social lives during the lockdowns, students were likely at increased risk of social media addiction, which could harm their mental health. University students depended more on social media due to the limitations of face-to-face interactions. In addition, previous studies were conducted exclusively on students in specific fields. However, in our study, all fields, including medical and non-medical science fields were investigated.

The present study was conducted to determine the relationship between the use of social media and mental health in students in Lorestan Province during the COVID-19 pandemic.

Study design and participants

The current study was descriptive-analytical, cross-sectional, and conducted from February to March 2022 with a statistical population made up of students in all academic grades at universities in Lorestan Province (19 scientific and academic centers, including centers under the supervision of the Ministry of Health and the Ministry of Science).

Sample size

According to the convenience sampling method, 781 people were chosen as participants in the present study. During the sampling, a questionnaire was created and uploaded virtually on Porsline’s website, and then the questionnaire link was shared in educational and academic groups on social media for students to complete the questionnaire under inclusion criteria (being a student at the University of Lorestan and consenting to participate in the study).

The research tools included the demographic information questionnaire, the standard social media use questionnaire, and the mental health questionnaire.

Demographic information

The demographic information age, gender, ethnicity, province of residence, urban or rural, place of residence, semester, and the field of study, marital status, household income, education level, and employment status were recorded.

Psychological assessment

The students were subjected to the Persian version of the Depression Anxiety Stress Scale (DASS21). It consists of three self-report scales designed to measure different emotional states. DASS21 questions were adjusted according to their importance and the culture of Iranian students. The DASS21 scale was scored on a four-point scale to assess the extent to which participants experienced each condition over the past few weeks. The scoring method was such that each question was scored from 0 (never) to 3 (very high). Samani (2008) found that the questionnaire has a validity of 0.77 and a Cronbach’s alpha of 0.82 [ 43 ].

Use of social media questionnaire

Among the 13 questions on social media use in the questionnaire, seven were asked on a Likert scale (never, sometimes, often, almost, and always) that examined the problematic use of social media, and six were asked about how much time users spend on social media. Because some items were related to the type of social media platform, which is not available today, and users now use newer social media platforms such as WhatsApp and Instagram, the questionnaires were modified by experts and fundamentally changed, and a 22-item questionnaire was obtained that covered the frequency of using social media. Cronbach’s alpha was equal to 0.705 for the first part, 0.794 for the second part, and 0.830 for all questions [ 44 ]. Considering the importance of the problematic use of the social media, six questions about the problematic use were measured separately.

To confirm the validity of the questionnaire, a panel of experts with CVR 0.49 and CVI 0.70 was used. Its reliability was also obtained (0.784) using Cronbach’s alpha coefficient. Finally, the questionnaire was tested in a class with 30 students to check the level of difficulty and comprehension of the questionnaire. Finally, a 22-item questionnaire was obtained, of which six items were about the problematic use of social media and the remaining 16 questions were about the rate and frequency of using social media. Cronbach’s alpha was 0.705 for the first part, including questions about the problematic use of the social media, and 0.794 for the second part, including questions about the rate and frequency of using the social media. The total Cronbach’s alpha for all questions was 0.830. Six questions about the problematic use of social media were measured separately due to the importance of the problematic use of social media. Also, a separate score was considered for each question. The scores of these six questions on the problematic use of the social media were summed, and a single score was obtained for analysis.

Statistical analysis

Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL, USA). The normal distribution of continuous variables was analyzed using the Kolmogorov-Smirnov test, histogram, and P-P diagram, which showed that they are not normally distributed. Descriptive statistics were calculated for all variables. Comparison between groups was done using Mann-Whitney and Kruskal-Wallis non-parametric tests. Multiple linear regression analysis was used to investigate the relationship between mental health, problematic use of social media, and social media use (The result of merging the Frequency of using social media and Time to use social media). Generalized Linear Models (GLM) were used to assess the association between mental health with the use of social media and problematic use of social media. Due to the high correlation (r = 0.585, p = < 0.001) between the use of social media and problematic use of social media, collinearity, we run two separate GLM models. Regression coefficients (β) and adjusted β (β*) with 95% CI and P-value were reported.

A total of 781 participants completed the questionnaires, of which 64.4% were women and 71.3% were single. The minimum age of the participants was 17 years, the maximum age was 45 years, and about half of them (48.9%) were between 21 and 25 years old. A total of 53.4% of the participants had bachelor’s degrees. The income level of 23.2% of participants was less than five million Tomans (the currency of Iran), and 69.7% of the participants were unemployed. 88.1% were living with their families and 70.8% were studying in non-medical fields. 86% of the participants lived in the city, and 58.9% were in their fourth semester or higher. Considering that the research was conducted in a Lorish Province, 43.8% of participants were from the Lorish ethnicity.

The mean total score of mental health was 12.30 with a standard deviation of 30.38, and the mean total score of social media was 14.5557 with a standard deviation of 7.74140.

Table  1 presents a comparison of the mean problematic use of social media and mental health with demographic variables. Considering the non-normality of the hypothesis H0, to compare the means of the independent variables, Mann-Whitney non-parametric tests (for the variables of gender, the field of study, academic semester, employment status, province of residence, and whether it is rural or urban) and Kruskal Wallis (for the variables age, ethnicity, level of education, household income and marital status). According to the obtained results, it was found that the score of problematic use of social media is significantly higher in women, the age group less than 20 years, unemployed, non-native students, dormitory students, and students living with friends or alone, Fars students, students with a household income level of fewer than 7 million Tomans(Iranian currency), and single, divorced, and widowed students were higher than the other groups(P < 0.05).

By comparing the mean score of mental health with demographic variables using non-parametric Mann-Whitney and Kruskal Wallis tests, it was found that there is a significant difference between the variable of poor mental health and all demographic variables (except for the semester variable), residence status (rural or urban) and education level. (There was a significant relationship (P < 0.05). In such a way that the mental health condition was worse in women, age group less than 20 years old, non-medical science, unemployed, non-native, and dormitory students. Also, Fars students, divorced, widowed, and students with a household income of fewer than 5 million Tomans (Iranian currency) showed poorer mental health status. (Table  1 ).

The final model shows that marital status, field, and household income were significantly associated with lower DASS21 scores (a lower DASS21 score means better mental health status). Being single (β* = -23.03, 95% CI: (-33.10, -12.96), being married (β* = -38.78, 95% CI: -51.23, -26.33), was in Medical sciences fields (β* = -8.15, 95% CI: -11.37, -4.94), and have income 7–10 million (β* = -5.66, 95% CI: -9.62, -1.71) were significantly associated with lower DASS21 scores (a lower DASS21 score means better mental health status). Problematic use of social media (β* = 3.54, 95% CI: (3.23, 3.85) was significantly associated with higher mental health scores (a higher DASS21 score means worse mental health status). (Table  2 )

Age, income, and use of social media (β* = 1.02, 95% CI: 0.78, 1.25) were significantly associated with higher DASS21 scores (a higher DASS21 score means worse mental health status). Marital status and field were significantly associated with lower DASS21 scores (a lower DASS21 score means better mental health status). Age groups < 20 years (β* = 6.36, 95% CI: 0.78, 11.95) and income group < 5 million (β* = 6.58, 95% CI: 1.47, 11.70) increased mental health scores. Being single (β* = -34.72, 95% CI: -47.06, -38.78), being married (β* = -38.78, 95% CI: -51.23, -26.33) and in medical sciences fields (β* = -8.17, 95% CI: -12.09, -4.24) decreased DASS21 scores. (Table  3 )

The main purpose of this study was to determine the relationship between social media use and mental health among students during the COVID-19 pandemic.

University students are more reliant on social media because of the limitations of in-person interactions [ 45 ]. Since social media has become more and more vital to the social lives of university students during the pandemic, students may be at increased risk of social media addiction, which may be harmful to their mental health [ 14 ].

During non-adulthood, peer relations and approval are critical and social media seems to meet these needs. For example, connection and communication with friends make them feel better and happier, especially during the COVID-19 pandemic and national lockdowns where face-to-face communication was restricted [ 46 ]. Kele’s study showed that the COVID-19 pandemic has increased the time spent on social media, and the frequency of online activities [ 47 ].

Because of the COVID-19 pandemic, e-learning became the only sustainable option for students [ 13 ]. This abrupt transition can lead to depression, stress, or anxiety for some students due to insufficient time to adjust to the new learning environment. The role of social media is also important to some university students [ 48 ].

Staying at home, having nothing else to do, and being unable to go out and meet with friends due to the lockdown measures increased the time spent on social media and the frequency of online activities, which influenced their mental health negatively [ 49 ]. These reasons may explain the findings of previous studies that found an increase in depression and anxiety among adolescents who were healthy before the COVID-19 pandemic [ 50 ].

According to the results, there was a statistically significant relationship between social media use and mental health in students, in such a way that one Unit increase in the score of social media use enhanced the score of mental health. These two variables were directly correlated. Consistent with the current study, many studies have shown a significant relationship between higher use of social media and lower mental health in students [ 45 , 51 , 52 , 53 , 54 ].

Inconsistent with the findings of the present study, some previous studies reported the positive effect of social media use on mental health [ 55 , 56 , 57 ]. The differences in findings could be attributed to the time and location of the studies. Anderson’s study in France in 2018 found no significant relationship between social media use and mental health. This may be because of the differences between the tools for measuring the ability to detect fake news and health literacy and the scales of the research [ 4 ].

The present study showed that the impact of using social media on the mental health of students was higher than Lebni’s study, which was conducted in 2020 [ 25 ]. Also, in Dost Mohammad’s study in 2018, the effect of using social media on the mental health of students was reported to be lower than in the present study [ 58 ]. Entezari’s study in 2021, was also lower than the present study [ 59 ]. It seems that the excessive use of social media during the COVID-19 pandemic was the reason for the greater effects of social media on students’ mental health.

The use of social media has positive and negative characteristics. Social media is most useful for rapidly disseminating timely information via widely accessible platforms [ 4 ]. Among the types of studies, at least one shows an inverse relationship between the use of social media and mental health [ 53 ]. While social media can serve as a tool for fostering connection during periods of physical isolation, the mental health implications of social media being used as a news source are tenuous [ 45 ].

The results of the GLM analysis indicated that there was a statistically significant relationship between the problematic use of social media and mental health in students in such a way that one-unit increase in the score of problematic use of social media enhanced the mental health score, and it was found that the two variables had a direct relationship. Consistent with our study, Boer’s study showed that problematic use of social media may highlight the potential risk to adolescent mental health [ 60 ]. Malaeb also reported that the problematic use of social media had a positive relationship with mental health [ 61 ], but that study was conducted on adults and had a smaller sample size before the COVID-19 pandemic.

Saputri’s study found that excessive social media use likely harms the mental health of university students since students with higher social media addiction scores had a greater risk of experiencing mild depression [ 62 ]. A systematic literature review before the COVID-19 pandemic (2019) found that the time spent by adolescents on social media was associated with depression, anxiety, and psychological distress [ 63 ]. Marino’s study (2018) reported a significant correlation between the problematic use of social media by students and psychological distress [ 64 ].

Social media has become more vital for students’ social lives owing to online education during the COVID-19 pandemic. Therefore, this group is more at risk of addiction to social media and may experience more mental health problems than other groups. Lebni also indicated that students’ higher use of the Internet led to anxiety, depression, and adverse mental health, but the main purpose of the study was to investigate the effects of such factors on student’s academic performance [ 25 ]. Previous studies indicated that individuals who spent more time on social media had lower self-esteem and higher levels of anxiety and depression [ 65 , 66 ]. In the present study, students with higher social media addiction scores were at higher mental health risk. Such a finding was consistent with research by Gao et al., who found that the excessive use of social media during the pandemic had adverse effects on social health [ 14 ]. Cheng et al. indicated that using the Internet, especially for communication with people, can harm mental health by changing the quality of social relationships, face-to-face communication, and changes in social support [ 24 ].

A reason for the significant relationship between social media use and mental health in students during the COVID-19 pandemic in the present study was probably the students’ intentional or unintentional use of online communication. Unfortunately, social media published information, which might be incorrect, in this pandemic that caused public fear and threatened mental health.

During the pandemic, social media played essential roles in learning and leisure activities. Due to electronic education, staying at home, and long leisure time, students had more time, frequency, and opportunities to use social media in this pandemic. Such a high reliance on social media may threaten student’s mental health. Lee et al. conducted a study during the COVID-19 pandemic and confirmed that young people who used social media had higher symptoms of depression and loneliness than before the COVID-19 pandemic [ 67 ].

The present study showed that there was a significant positive relationship between problematic use of social media and gender, so that women were more willing to use social media, probably because they had more opportunities to use social media as they stayed at home more than men; hence, they were more exposed to problematic use of social media. Consistent with our study, Andreassen reported that being a woman was an important factor in social media addiction [ 68 ]. In contrast to our study, Azizi’s study in Iran showed that male students use social media significantly more than female students, possibly due to differences in demographic variables in each population [ 69 ].

Moreover, there was a significant relationship between age and problematic use of social media in that people younger than 20 were more willing to use social media in a problematic way. Consistent with the present study, Perrin also indicated that younger people further used social media [ 70 ].

According to the findings, unemployed students used social media more than employed ones, probably because they had more time to spend in virtual space, leading to higher use and the possibility of problematic use of social media [ 71 ].

Moreover, non-native students were more willing to use the social media probably because students who lived far away from their families used social media problematically due to the lack of family control over hours of use and higher opportunities [ 72 ] .

The results showed that rural students have a greater tendency to use social Medias than urban students. Inconsistent with this finding, Perrin reported that urban people were more willing to use the social media. The difference was probably due to different research times and places or different target groups [ 70 ].

According to the current study, people with low household income were more likely to use social media, most likely because low-income people seek free information and services due to a lack of access to facilities and equipment in the real world or because they seek assimilation with people around them. Inconsistent with our findings, Hruska et al. reported that people with high household income levels made much use of social media [ 73 ], probably because of cultural, economic, and social differences or different information measurement tools.

Furthermore, single, divorced, and widowed students used social media more than married students. This is because they spend more time on social media due to the need for more emotional attention, the search for a life partner, or a feeling of loneliness. This also led to the problematic use of social media [ 74 ].

According to the results, Fars people used social media more than other ethnic groups, but this difference was insignificant. This finding was consistent with Perrin’s study, but the population consisted of people aged 18 to 65 [ 70 ].

In the current study, there was a significant relationship between gender and mental health, so that women had lower mental health than men. The difference was in health sociology. Consistent with the present study, Ghasemi et al. indicated that it appeared necessary to pay more attention to women’s health and create an opportunity for them to use health services [ 75 ].

The findings revealed that unemployed students had lower mental health than employed students, most likely because unemployed individuals have lower mental health due to not having a job and being economically dependent on others, as well as feeling incompetent at times. Consistent with the present study, Bialowolski reported that unemployment and low income caused mental disorders and threatened mental health [ 76 ].

According to this study, non-native students have lower mental health than native students because they live far from their families. The family plays an imperative role in improving the mental health of their children, and mental health requires their support. Also, the economic, social, and support problems caused by being away from the family have endangered their mental health [ 77 ].

Another important factor of the current study was that married people had higher mental health than single people. In addition, divorced and widowed students had lower mental health [ 78 ]. Possibly due to the social pressure they suffer in Iranian society. Furthermore, they received lower emotional support than married people. Therefore, their lower mental health seemed logical [ 79 , 80 , 81 ]. A large study in a European population also reported differences in the likelihood of mood, anxiety, and personality disorders between separated/divorced and married mothers [ 82 ].

A key point confirmed in other studies is the relationship between low incomes with mental health. A meta-analysis by Lorant indicated that economic and social inequalities caused mental disorders [ 83 ]. Safran also reported that the probability of developing mental disorders in people with low socioeconomic status is up to three times higher than that of people with the highest socioeconomic status [ 84 ]. Bialowolski’s study was consistent with the current study but Bialowolski’s study examined employees [ 76 ].

The present study was conducted during the COVID-19 pandemic and therefore had limitations in accessing students. Another limitation was the use of self-reporting tools. Participants may show positive self-presentation by over- or under-reporting their social media-related behaviors and some mental health-related items, which may directly or indirectly lead to social desirability bias, information bias, and reporting bias. Small sample sizes and convenience sampling limit student population representativeness and generalizability. This study was based on cross-sectional data. Therefore, the estimation results should be seen as associative rather than causative. Future studies would need to investigate causal effects using a longitudinal or cohort design, or another causal effect research design.

The findings of this study indicated that the high use of social media affected students’ mental health. Furthermore, the problematic use of the social media had a direct relationship with mental health. Variables such as age, gender, income level, marital status, and unemployment of non-native students had significant relationships with social media use and mental health. Despite the large amount of evidence suggesting that social media harms mental health, more research is still necessary to determine the cause and how social media can be used without harmful effects. It is imperative to better understand the relationship between social media use and mental health symptoms among young people to prevent such a negative outcome.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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The authors would like to express their gratitude to all academic officials of Lorestan universities and Mr. Mohsen Amani for their cooperation in data collection.

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Abouzar Nazari

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Maede Hosseinnia

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Samaneh Torkian

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Abouzar Nazari and Maedeh Hossennia designed the study, collected the data and drafted the manuscript. Samaneh Torkian performed the statistical analysis and prepared the tables. Gholamreza Garmaroudi, as the responsible author, supervised the entire study. All authors reviewed and edited the draft manuscript and approved the final version.

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Nazari, A., Hosseinnia, M., Torkian, S. et al. Social media and mental health in students: a cross-sectional study during the Covid-19 pandemic. BMC Psychiatry 23 , 458 (2023). https://doi.org/10.1186/s12888-023-04859-w

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Received : 31 January 2023

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DOI : https://doi.org/10.1186/s12888-023-04859-w

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• 14 February 2023

How social media affects teen mental health: a missing link

• Amy Orben 0 &
• Sarah-Jayne Blakemore 1

Amy Orben is a programme leader track scientist at the MRC Cognition and Brain Sciences Unit, University of Cambridge, UK.

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Sarah-Jayne Blakemore is professor of psychology and cognitive neuroscience at the Department of Psychology, University of Cambridge, UK.

Depression, anxiety and suicidality have all sharply increased in adolescents over the past decade 1 . So, too, has the amount of time that young people spend online (see ‘Troubling trends’). Partly because of fears that there’s a link between these trends, governments around the world are under pressure to do more to regulate technology companies.

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Competing Interests

A.O. is an unpaid member of governmental and non-governmental organizations (including the UK Department for Culture, Media and Sport, and The British Academy). She has also provided unpaid and paid talks and consultancy work to organizations that will not gain or lose financially from this publication. S.-J.B. currently receives funding from Wellcome, the MRC, the Jacobs Foundation, the Wellspring Foundation and the University of Cambridge. In the past five years, S.-J.B. engaged in a paid consultancy with Cognita International Schools Group and has provided paid expert witness work for UK charities, legal organisations in the UK and USA and the UK government. S.-J.B. is the author of two books related to the brain, education and learning, for which she received an advance and royalties. S.-J.B. gives talks in schools, in the state and private sector, as well as at education conferences and for education organizations, and other public, private and third sector organizations (some talks are remunerated). S.-J.B. is a member of the Rethinking Assessment group, the Steering Committee of the Cambridge Centre of Science Policy, the Technical Advisory Group for the UK Government Department of Education 'Education and Outcomes Panel-C Study' and the Singapore Government National Research Foundation Scientific Advisory Board. She was a member of the Times Education Commission in 2021-22.

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Social media harms teens’ mental health, mounting evidence shows. what now.

Understanding what is going on in teens’ minds is necessary for targeted policy suggestions

Most teens use social media, often for hours on end. Some social scientists are confident that such use is harming their mental health. Now they want to pinpoint what explains the link.

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By Sujata Gupta

February 20, 2024 at 7:30 am

In January, Mark Zuckerberg, CEO of Facebook’s parent company Meta, appeared at a congressional hearing to answer questions about how social media potentially harms children. Zuckerberg opened by saying: “The existing body of scientific work has not shown a causal link between using social media and young people having worse mental health.”

But many social scientists would disagree with that statement. In recent years, studies have started to show a causal link between teen social media use and reduced well-being or mood disorders, chiefly depression and anxiety.

Ironically, one of the most cited studies into this link focused on Facebook.

Researchers delved into whether the platform’s introduction across college campuses in the mid 2000s increased symptoms associated with depression and anxiety. The answer was a clear yes , says MIT economist Alexey Makarin, a coauthor of the study, which appeared in the November 2022 American Economic Review . “There is still a lot to be explored,” Makarin says, but “[to say] there is no causal evidence that social media causes mental health issues, to that I definitely object.”

The concern, and the studies, come from statistics showing that social media use in teens ages 13 to 17 is now almost ubiquitous. Two-thirds of teens report using TikTok, and some 60 percent of teens report using Instagram or Snapchat, a 2022 survey found. (Only 30 percent said they used Facebook.) Another survey showed that girls, on average, allot roughly 3.4 hours per day to TikTok, Instagram and Facebook, compared with roughly 2.1 hours among boys. At the same time, more teens are showing signs of depression than ever, especially girls ( SN: 6/30/23 ).

As more studies show a strong link between these phenomena, some researchers are starting to shift their attention to possible mechanisms. Why does social media use seem to trigger mental health problems? Why are those effects unevenly distributed among different groups, such as girls or young adults? And can the positives of social media be teased out from the negatives to provide more targeted guidance to teens, their caregivers and policymakers?

“You can’t design good public policy if you don’t know why things are happening,” says Scott Cunningham, an economist at Baylor University in Waco, Texas.

Increasing rigor

Concerns over the effects of social media use in children have been circulating for years, resulting in a massive body of scientific literature. But those mostly correlational studies could not show if teen social media use was harming mental health or if teens with mental health problems were using more social media.

Moreover, the findings from such studies were often inconclusive, or the effects on mental health so small as to be inconsequential. In one study that received considerable media attention, psychologists Amy Orben and Andrew Przybylski combined data from three surveys to see if they could find a link between technology use, including social media, and reduced well-being. The duo gauged the well-being of over 355,000 teenagers by focusing on questions around depression, suicidal thinking and self-esteem.

Digital technology use was associated with a slight decrease in adolescent well-being , Orben, now of the University of Cambridge, and Przybylski, of the University of Oxford, reported in 2019 in Nature Human Behaviour . But the duo downplayed that finding, noting that researchers have observed similar drops in adolescent well-being associated with drinking milk, going to the movies or eating potatoes.

Holes have begun to appear in that narrative thanks to newer, more rigorous studies.

In one longitudinal study, researchers — including Orben and Przybylski — used survey data on social media use and well-being from over 17,400 teens and young adults to look at how individuals’ responses to a question gauging life satisfaction changed between 2011 and 2018. And they dug into how the responses varied by gender, age and time spent on social media.

Social media use was associated with a drop in well-being among teens during certain developmental periods, chiefly puberty and young adulthood, the team reported in 2022 in Nature Communications . That translated to lower well-being scores around ages 11 to 13 for girls and ages 14 to 15 for boys. Both groups also reported a drop in well-being around age 19. Moreover, among the older teens, the team found evidence for the Goldilocks Hypothesis: the idea that both too much and too little time spent on social media can harm mental health.

“There’s hardly any effect if you look over everybody. But if you look at specific age groups, at particularly what [Orben] calls ‘windows of sensitivity’ … you see these clear effects,” says L.J. Shrum, a consumer psychologist at HEC Paris who was not involved with this research. His review of studies related to teen social media use and mental health is forthcoming in the Journal of the Association for Consumer Research.

Cause and effect

That longitudinal study hints at causation, researchers say. But one of the clearest ways to pin down cause and effect is through natural or quasi-experiments. For these in-the-wild experiments, researchers must identify situations where the rollout of a societal “treatment” is staggered across space and time. They can then compare outcomes among members of the group who received the treatment to those still in the queue — the control group.

That was the approach Makarin and his team used in their study of Facebook. The researchers homed in on the staggered rollout of Facebook across 775 college campuses from 2004 to 2006. They combined that rollout data with student responses to the National College Health Assessment, a widely used survey of college students’ mental and physical health.

The team then sought to understand if those survey questions captured diagnosable mental health problems. Specifically, they had roughly 500 undergraduate students respond to questions both in the National College Health Assessment and in validated screening tools for depression and anxiety. They found that mental health scores on the assessment predicted scores on the screenings. That suggested that a drop in well-being on the college survey was a good proxy for a corresponding increase in diagnosable mental health disorders. 

Compared with campuses that had not yet gained access to Facebook, college campuses with Facebook experienced a 2 percentage point increase in the number of students who met the diagnostic criteria for anxiety or depression, the team found.

When it comes to showing a causal link between social media use in teens and worse mental health, “that study really is the crown jewel right now,” says Cunningham, who was not involved in that research.

A need for nuance

The social media landscape today is vastly different than the landscape of 20 years ago. Facebook is now optimized for maximum addiction, Shrum says, and other newer platforms, such as Snapchat, Instagram and TikTok, have since copied and built on those features. Paired with the ubiquity of social media in general, the negative effects on mental health may well be larger now.

Moreover, social media research tends to focus on young adults — an easier cohort to study than minors. That needs to change, Cunningham says. “Most of us are worried about our high school kids and younger.” 

And so, researchers must pivot accordingly. Crucially, simple comparisons of social media users and nonusers no longer make sense. As Orben and Przybylski’s 2022 work suggested, a teen not on social media might well feel worse than one who briefly logs on. 

Researchers must also dig into why, and under what circumstances, social media use can harm mental health, Cunningham says. Explanations for this link abound. For instance, social media is thought to crowd out other activities or increase people’s likelihood of comparing themselves unfavorably with others. But big data studies, with their reliance on existing surveys and statistical analyses, cannot address those deeper questions. “These kinds of papers, there’s nothing you can really ask … to find these plausible mechanisms,” Cunningham says.

One ongoing effort to understand social media use from this more nuanced vantage point is the SMART Schools project out of the University of Birmingham in England. Pedagogical expert Victoria Goodyear and her team are comparing mental and physical health outcomes among children who attend schools that have restricted cell phone use to those attending schools without such a policy. The researchers described the protocol of that study of 30 schools and over 1,000 students in the July BMJ Open.

Goodyear and colleagues are also combining that natural experiment with qualitative research. They met with 36 five-person focus groups each consisting of all students, all parents or all educators at six of those schools. The team hopes to learn how students use their phones during the day, how usage practices make students feel, and what the various parties think of restrictions on cell phone use during the school day.

Talking to teens and those in their orbit is the best way to get at the mechanisms by which social media influences well-being — for better or worse, Goodyear says. Moving beyond big data to this more personal approach, however, takes considerable time and effort. “Social media has increased in pace and momentum very, very quickly,” she says. “And research takes a long time to catch up with that process.”

Until that catch-up occurs, though, researchers cannot dole out much advice. “What guidance could we provide to young people, parents and schools to help maintain the positives of social media use?” Goodyear asks. “There’s not concrete evidence yet.”

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Social Media

Study: Social media use linked to decline in mental health

Dylan Walsh

Sep 14, 2022

Mark Zuckerberg launched TheFacebook at Harvard University in February 2004. Days later, 650 students had made accounts. Today, there are roughly two billion daily active users.

Concurrent with Facebook’s meteoric expansion has been growing concern over the mental well-being of adolescents and young adults. According to data from the Centers for Disease Control , the suicide rate among 10- to 24-year-olds was stable from 2000 to 2007; it then increased 57% between 2007 and 2017.

Given these parallel trends, it’s important to understand the relationship between mental health and technology use, especially how youths use social media. But there have been few causal studies.

“There may be hundreds of papers that present correlations between social media and well-being, and many of them are great and highly informative, but we still know little about which way the effect runs,” said Alexey Makarin,  an assistant professor at MIT Sloan. People who use more social media may become more depressed, or, conversely, people who are more depressed may be more active on social media. “There is a lack of true causal evidence.”

Makarin and colleagues Luca Braghieri of Bocconi University and Ro’ee Levy of Tel Aviv University aim to fill this gap with a new paper , forthcoming in the American Economic Review . The researchers paired the staggered rollout of Facebook in colleges with 430,000 responses from the National College Health Assessment , a semi-annual survey of mental health and well-being on campuses across the U.S. (The survey looks at other dimensions of student health, as well, like substance use and exercise habits.) The researchers found a significant link between the presence of Facebook and a deterioration in mental health among college students.

Facebook access leads to more anxiety and depression

When Facebook began, access was restricted to people with a Harvard email address. Less than a month later, the website had expanded to Columbia, Stanford, and Yale. This progressive opening continued until September of 2006, when anybody over 13 years old was able to create an account.

College-wide Facebook access led to a 7% increase in severe depression among students, researchers found.

“We were able to use the fact that Facebook rolled out at different universities at different times, together with the fact that we have this huge survey already conducted at universities, to understand the causal impact of Facebook on student mental health,” Makarin said.

Most broadly, the researchers found a sizable increase in the number of students who reported mental distress at some time in the preceding year. College-wide access to Facebook led to an increase in severe depression by 7% and anxiety disorder by 20%. Beyond these results, a greater percentage of the most susceptible students also treated symptoms with either psychotherapy or antidepressants. In total, the negative effect of Facebook on mental health appeared to be roughly 20% the magnitude of what is experienced by those who lose their job.

The researchers posit that social comparison with peers is behind those results, and it is an effect that appears to grow stronger as people are exposed to Facebook for greater lengths. “The effects seem to increase with time,” Makarin said. “If, in late fall 2004, a freshman at Harvard had Facebook available to him for one semester and a sophomore for two semesters, it appears as though the effect is stronger with the sophomore, who had greater exposure.”

Trying to solve a “truly bad” situation

Given Makarin and his coauthors are looking at Facebook in its earliest form, they’ve faced questions about the salience of these findings. “People wonder how much this tells us about Facebook, or Instagram, right now,” Makarin said. “And that’s a fair criticism — but there are a few things in our defense.”

Related Articles

First, to the degree that social comparison drives these results, Makarin notes there is reason to believe the effect has not diminished; looking at and interpreting the curated posts of others remains a fundamental operating principle on Facebook and other, similar forms of social media. (Makarin also suspects that the ubiquity of smartphones could make this channel of influence stronger.)

Second, even if the study pertains to a particular period, the paucity of experimental data on how social media affects its users means any contribution should be considered worthwhile. “Whatever causal evidence we are able to provide is, by its nature, useful,” he said.

Makarin and his coauthors also take care to delimit the scope of their study. The mental health of Facebook’s users is only one dimension on which to measure the overall effect of social media. People may derive benefits, like connection with old friends or access to likeminded groups or good deals on products, that, in total, outweigh the costs.

But even if this is the case, Makarin believes that social media companies and policymakers should still work to alleviate the potentially harmful effects on mental well-being. As of 2021, 4.5 billion people — more than half of the global population — had a social media account.

“When I came to this work, I knew that mental health was an important issue, but to be honest, I thought of it as just one more outcome to study in our social media agenda,” he said. “When I started to really look into the trends of deteriorating mental health among the young adults, though, I came to realize how truly bad the situation is, and that stuck with me. Any insights that this paper, or others, can offer into what’s behind this trend will be very valuable to society.”

Read next: 5 social media trends experts are watching

Teens are spending nearly 5 hours daily on social media. Here are the mental health outcomes

Forty-one percent of teens with the highest social media use rate their overall mental health as poor or very poor

Vol. 55 No. 3 Print version: page 80

• Social Media and Internet
• Technology and Design

Percentage of teens with the highest social media use who rate their overall mental health as poor or very poor , compared with 23% of those with the lowest use. For example, 10% of the highest use group expressed suicidal intent or self-harm in the past 12 months compared with 5% of the lowest use group, and 17% of the highest users expressed poor body image compared with 6% of the lowest users.

Average number of hours a day that U.S. teens spend using seven popular social media apps, with YouTube , TikTok , and Instagram accounting for 87% of their social media time. Specifically, 37% of teens say they spend 5 or more hours a day, 14% spend 4 to less than 5 hours a day, 26% spend 2 to less than 4 hours a day, and 23% spend less than 2 hours a day on these three apps.

[ Related: Potential risks of content, features, and functions: The science of how social media affects youth ]

Percentage of the highest frequency social media users who report low parental monitoring and weak parental relationships who said they had poor or very poor mental health , compared with 25% of the highest frequency users who report high parental monitoring and strong parental relationships . Similarly, 22% of the highest users with poor parental relationships and monitoring expressed thoughts of suicide or self-harm compared with 2% of high users with strong parental relationships and monitoring.

Strong parental relationships and monitoring significantly cut the risk of mental health problems among teen social media users, even among those with significant screen time stats.

Rothwell, J. (October 27, 2023). Parenting mitigates social media-linked mental health issues . Gallup. Survey conducted between June 26–July 17, 2023, with responses by 6,643 parents living with children between ages 3 and 19, and 1,591 teens living with those parents. https://news.gallup.com/poll/513248/parenting-mitigates-social-media-linked-mental-health-issues.aspx .

Rothwell, J. (2023). How parenting and self-control mediate the link between social media use and mental health . https://ifstudies.org/ifs-admin/resources/briefs/ifs-gallup-parentingsocialmediascreentime-october2023-1.pdf .

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• Open access
• Published: 13 September 2024

Psychological distress, social media use, and academic performance of medical students: the mediating role of coping style

• Ramin Shiraly 1 , 5 ,
• Ashrafalsadat Roshanfekr 2 ,
• Abdolrahim Asadollahi 3 &
• Mark D. Griffiths 4  

BMC Medical Education volume  24 , Article number:  999 ( 2024 ) Cite this article

Metrics details

Given that social media use (SMU) is an increasingly widespread activity among university students, more information is needed to evaluate its relationship with students’ mental health, particularly medical students.

The present study assessed the relationships between SMU and coping style with psychological distress and academic performance of medical students.

An offline cross-sectional survey conducted with 398 undergraduate medical students. The survey collected data on demographics, psychological distress (DASS-21), coping strategies (Brief COPE Scale), academic performance (grade point average) and estimated average time spent on social media per day. Structural equation modeling was used to clarify relationships between the main study variables. The study also examined the mediating effect of maladaptive coping between SMU and psychological distress.

Students with higher levels of psychological distress were more likely to be engaged in frequent social media use. Spending more than two hours a day on social media use had a positive association with maladaptive coping ( p  < 0.001), particularly with substance use and behavioral disengagement both of which could negatively affect academic performance. Maladaptive coping mediated the relationship between students’ SMU and psychological distress.

The findings suggest that medical students commonly use social media as a maladaptive coping tool to deal with psychological distress. Empowering students to adopt and foster appropriate coping strategies could help them to enhance resilience against life stresses and ameliorate potential long-term mental health consequences associated with maladaptive behaviors.

Peer Review reports

Introduction

University students are considered as a high risk group for developing depressive and anxiety disorders [ 1 ]. There is substantial evidence from studies conducted across different developed and developing countries showing that the rate of psychological distress among university students is higher than general population [ 2 ]. Transitioning to university can be a stressful life experience because students commonly face a wide range of stresses such as living away from the family, augmented responsibilities, extensive course loads, altered sleep/wake patterns, and inadequate time for self-care [ 3 , 4 , 5 ]. Education in medicine is particularly accompanied by numerous stresses. It is well known that the prevalence of psychological distress including depression, anxiety and other related mental health problems among medical students is consistently higher than their non-medical peers [ 6 ]. Globally, it is estimated that on average, 27% of medical students are affected by depression and 34% suffer from anxiety [ 7 , 8 ]. Uncontrolled psychological distress among university students can negatively impact their quality of life and academic performance and increase the risk of interpersonal relationship instability, lack of self-confidence, alcohol and substance use, and suicidal ideations and behaviors [ 2 ].

An understanding of factors associated with psychological distress and academic performance among medical students is needed to tailor appropriate strategies and to support those individuals who are predisposed to experience greater mental distress. Given that social media use (SMU) is an increasingly widespread activity among university students, there has been a growing interest in investigating the potential links between students’ social media activity and mental well-being. Problematic social media use has been associated with mental health problems such as depression, anxiety, and stress [ 9 ]. A majority of the related literature has investigated adolescents and young adults and has reported negative SMU-related mental health consequences. For example, a large cohort study reported that US adolescents who spent more than three hours per day on social media were particularly at risk of developing internalizing problems [ 10 ].

There is also some evidence that an increase in prevalence of depression among young adolescents may be related to a rapid increase in social media use among this age group [ 11 ]. Moreover, a systematic review of 13 studies found a general correlation between social media use and adolescents’ mental health problems. However, the authors emphasized the relationships were complex, and few studies were designed to explore the effect of mediating factors [ 12 ]. It has been postulated that spending a lot of time on social media promotes a sedentary lifestyle and less face-to-face social interactions, both of which are risk factors for mental health disorders [ 9 ]. However, current evidence is inconsistent because some studies have reported uncertainty regarding the potential risks and benefits of SMU on mental well-being [ 13 , 14 ].

Similarly, research on the effect of social media use on students’ academic performance has shown contradictory results [ 15 , 16 ]. Several studies have reported negative impacts of social media use on students’ academic performance [ 17 , 18 ]. However, many of these studies assessed time spent on smartphones and included data on SMSs, calls, games and non-social networking apps that may not actually represent social media use [ 19 ]. On the other hand, some authors believe that social media use has the potential for improving students’ academic performance through collaborative and interactive learning [ 20 ].

Individuals with stress-related unpleasant emotions may use specific behavioral approaches to reduce, moderate or manage life stress that collectively comprise coping strategies. Previous research has emphasized the importance of coping strategies in psychological adjustment against mental distress [ 21 ]. Coping strategies might focus on regulation of emotions to better tolerate stressful conditions (i.e., emotion-focused coping) or seek ways to resolve the problem that have caused psychological distress (i.e., problem-focused coping) [ 22 ]. Accordingly, coping styles can be categorized into adaptive and maladaptive approaches.

Adaptive coping is described as actively trying to confront the problems, by seeking stressor-related information and social support, and planning strategies to resolve the problems [ 23 ]. In contrast, maladaptive (avoidant) coping is described as a strategy in which an individual tries to disengage from a stressor through arousal-reduction strategies such as distraction, relaxation or escape from the stressor by moving away from it [ 24 , 25 ]. Both adaptive and maladaptive coping strategies are likely to reduce mental distress in the short-term. However, unhealthy coping strategies could lead to adverse mental health outcomes in the long-term [ 26 ].

Currently, the available empirical evidence is insufficient to draw firm conclusions on the relationships between student social media use, distress, and academic performance. One key question is whether social media use has a direct role in inducing or relieving mental distress or whether it is mediated by other related factors such as coping strategies. Given that medical students often have greater mental health problems that other students [ 6 ], this cohort was the focus in the present study. It was hypothesized that: (i) the estimated average time spent on social media would significantly predict medical students’ levels of psychological distress (H 1 ), (ii) the estimated average time spent on social media and psychological distress would significantly predict medical students’ academic performance (H 2 ) and (iii) the association between social media use and psychological distress among medical students would be mediated by other factors such as students’ coping style (H 3 ). To the best of the present authors’ knowledge, this is the first study to evaluate the interaction between social media use and coping styles on mental health among medical students.

Participants and procedure

A cross-sectional survey study was conducted between July and August 2022 at Shiraz Medical University. Eligible students included those who had spent at least six months of clinical training in hospital settings during the 5th to 7th years of their medical curriculum. The sample size was determined using PASS 15.0.5 software (NCSS, LLC. Kaysville, Utah, USA). It was based on total population of students ( N  = 3200), the prevalence of psychological distress among Iranian university students in a previously conducted study [ 27 ]: 0.41, 5% significance level, effect design = 0.177 and 4% margin of error. A convenience sample of 400 students was recruited from four main teaching hospitals of the university. The surveys were conducted face-to-face by ‘paper-and-pencil’ administration and the enrollment process was continued until the required sample size was attained.

Data collection

Data collection was carried out by two experienced researchers after receiving ethical approval. Before administering the surveys, participants were given a verbal explanation about the objectives of the study and they provided written informed consent. The surveys were anonymous. However, students were asked to write their student number, so that their grade point averages (GPAs) could be retrieved from the Department of Education in the School of Medicine. To avoid any potential bias in completion of forms (such as unreal answers or completing forms twice by one individual), the research team assured participants about anonymity and confidentiality of the collected information. The students completed the questionnaires in hospital wards and the surveys were collected immediately after completion. All the psychometric scales included in the survey were the validated Persian versions (see next section for details). The present study was reviewed and approved by Research Ethics Committee of Shiraz University of Medical Sciences (ref: IR.SUMS.MED.REC.1401.228).

Basic demographic information: This included age, gender, marital status (single/married), and clinical educational level (pre-internship/internship). In most Iranian medical universities, the clinical curriculum of undergraduate students includes 24 months pre-internship and 18 months internship.

Self-reported history of anxiety or depression: This was simply assessed by asking participants if they had been diagnosed with anxiety and/or depression by a physician in the past 12 months.

Social media use: This was assessed by asking participants how much time they spent on social networking sites for personal purposes on a typical day. Four response categories included: (i) 0 to 30 min, (ii) 31 to 60 min, (iii) 61 to 120 min, and (iv) > 120 min. To estimate the frequency of use of the most popular social media platforms among Iranian young adults, participants were asked to indicate how frequently they visited the most popular social media used by Iranian young adults (i.e., WhatsApp, Instagram, Facebook, Twitter, YouTube and LinkedIn ). The responses were classified as (i) never, (ii) less than once per week, (iii) 1–2 times per week, (iv) 3–6 times per week, (v) almost daily, (vi) 2–4 times per day, and (vii) ≥ 5 times per day. Additionally, students were asked to indicate their main motivation for using social media from three possible options: (i) general information seeking, (ii) entertainment, and (iii) academic and educational purposes.

Psychological distress: This was assessed using the 21-item Depression, Anxiety and Stress Scale (DASS-21). The DASS-21 is used to assess the extent to which individuals experience negative emotional states over the previous week. The scale comprises three subscales: depression (Items 3, 5, 10, 13, 16, 17, 21), anxiety (Items 2, 4, 7, 9, 15, 19, 20), and stress (Items 1, 6, 8, 11, 12, 14, 18). Participants use a four-point Likert scale ranging from 0 ( did not apply to me at all ) to 3 ( applied to me very much, or most of the time ). In addition to a total score for the whole scale, subscales scores were calculated to estimate the level of depression, anxiety, and stress among participants [ 28 ]. Moreover, the severity of psychological distress was categorized into normal (0–4 for depression, 0–3 for anxiety, and 0–7 for stress), mild (5–6 for depression, 4–5 for anxiety, and 8–9 for stress), moderate (7–10 for depression, 6–7 for anxiety, and 10–12 for stress), severe (11–13 for depression, 8–9 for anxiety, and 13–16 for stress), and extremely severe (≥ 14 for depression, ≥ 10 for anxiety, ≥ 17 for stress). As a previous study showed that DASS-21 can be used as a general score of distress [ 29 ], in the present study’s analyses, the total scale score was used as an overall measure of psychological distress. The validity and reliability of the Persian version of the DASS-21 have been confirmed in both clinical and non-clinical populations [ 30 , 31 ]. Cronbach’s alpha in the present study was 0.926.

Coping styles: These were evaluated using the 28-item Persian version of the Brief COPE Inventory [ 32 ]. The scale assesses an individual’s response to stressful situations and events during the past month. Each item is rated on a four-point Likert scale ranging from 1 ( I haven ’ t been doing this at all ) to 4 ( I ’ ve been doing this a lot ). Stress responses include emotions, cognitions and behaviors provoked by stressful stimuli. This scale is assumed to assess different methods individuals might use to deal with environmental stresses. The Brief COPE includes 14 subscales: active coping (Items 2 and 7), planning (Items 14 and 25), positive reframing (Items 12 and 17), acceptance (Items 20 and 24), humor (Items 18 and 28), turning to religion (Items 22 and 27), using emotional support (Items 5 and 15), using instrumental support (Items 10 and 23), self-distraction (Items 1 and 19), denial (Items 3 and 8), venting (Items 9 and 21), substance use (Items 4 and 11), behavioral disengagement (Items 6 and 16), and self-blame (Items 13 and 26). It has been indicated that different coping responses reflect two principal coping styles: adaptive (approach) coping (including active coping, acceptance, use of emotional and instrumental support, positive reframing, planning, humor and religion) and maladaptive (avoidant) coping (including self-distraction, denial, substance use, behavioral disengagement, venting, and self-blaming) [ 25 , 33 ]. Total scores for adaptive and maladaptive coping were calculated separately by summing up their related components scores representing each coping style. The validity and reliability of the Persian version of the scale has been reported to be satisfactory [ 32 ]. Cronbach’s alpha for total, adaptive and maladaptive items scores in the present study were 0.793, 0.813 and 0.690, respectively.

Academic performance: This was assessed using the students’ overall grade point average (GPA). GPAs were classified into three categories: good (GPA ≥ 17), moderate (GPA = 14–16.99) and poor (GPA < 14). Students’ GPAs were obtained from the medical school’s Department of Education.

Statistical analysis

Data including demographic characteristics were analyzed as frequencies and percentages for categorical variables and means and standard deviations for numerical variables. Mann–Whitney U test and Kruskal–Wallis test were used to assess significant differences between DASS-21 scores based on the study variables. Spearman’s rank correlation test was used to calculate the correlations between the main study variables.

A structural equation model with latent variables was tested. Since it was hypothesized that SMU may predict students’ academic performance and psychological distress, and the latter could also be influenced by coping strategies, a model with three predictive variables (SMU, adaptive coping and maladaptive coping) and two outcome variables (psychological distress and GPA) were designed using AMOS (v.23).

To examine the mediating effect of coping strategies in the relationship between SMU and psychological distress, Hayes Macro Process was used, which is a well-documented bootstrapping statistical technique to test the mediation effects between variables [ 34 ]. The mediating effect of both adaptive and maladaptive coping scores were assessed through simple mediation relationships. In first step, psychological distress was considered as the dependent variable (Y), SMU as independent variable (X) and adaptive coping as the mediating variable (M). In the next step, psychological distress was considered as the dependent variable (Y), SMU as independent variable (X), and maladaptive coping as the mediating variable (M). Following Hayes Macro Process procedure, Model 4 multivariable regression analysis was conducted using 5000 boot-strapped samples. According to Preacher and Hayes [ 35 ], a mediating effect is present when (i) there is a total effect that can be mediated (c ≠ 0), and (ii) the indirect effect (a*b) is statistically significant in the direction predicted by the mediation hypothesis. SPSS version 26 (IBM, United States) was used for all statistical analysis and the significance level was set at 5%.

The response rate of those approached to participate was 100%. However, two participants were excluded from final analysis because their GPA scores could not be verified. Participants included 398 medical students who were in the clinical stage of medical training (5th to 7th years of education) where their degree course was spent in teaching hospitals. Overall, 217 students were in pre-internship stage (54.5%) and 181 were in the internship stage (45.5%). Most participants were aged 22–26 years (92.5%), with a mean age of 24 years (SD ± 1.6). There were 218 male students (55%) and 180 female students (45%) including 346 who were single (87%) and 52 who were married (13%). Approximately 23% of the participants had a self-reported history of depression/anxiety within the past year. Over half of the participants reported using social media more than two hours per day (52%). The most common social media platforms used by Iranian medical students at least once per day were WhatsApp (96.7%), Instagram (84.7%), YouTube (24.6%), Twitter (19.1%), LinkedIn (2.7%) and Facebook (0.8%). The motivations of students to visit social media networks were mostly for information and entertainment purposes, and just over 12% of the students reported using social media platforms for academic and educational purposes.

Table 1 shows distribution of DASS-21 scores according to the study variables. The resultant DASS-21 scores ranged from 0–51 (mean = 14.5 SD ± 10.7). There was no statistically significant difference between participants' DASS-21 scores and the three levels of academic performance ( p  = 0.232). However, DASS-scores were statistically different based on the history of depression/anxiety ( p  < 0.001), frequency of social media use per day ( p  = 0.021), and frequency of using adaptive and maladaptive coping strategies ( p  < 0.001). More specifically, students with higher DASS-21 scores were more likely to be engaged in frequent use of social media and maladaptive coping and less likely to use adaptive coping strategies.

Table 2 shows the prevalence of depression, anxiety, and stress symptoms and their severity categories in the sample. Using the DASS-21 subscales, depression was the most prevalent emotional state (44.4%), followed by anxiety (37.7%), and stress (37.4%). The prevalence of medium to high use of different coping strategies and more than two hours per day use of social media use is shown in Table  3 . Overall, irrespective of the students’ emotional state, using adaptive strategies was more common than using maladaptive strategies. The most common adaptive strategies used were planning (79%), active coping (77%) and acceptance (75%), and the most common maladaptive coping strategies were self-distraction (59%), venting (56%), and self-blaming (44%). With respect to emotional states, students with greater anxiety, stress or depression were more likely to use maladaptive than adaptive coping strategies. This difference was especially prominent for self-blaming, substance use, and behavioral disengagement. Also, students who used social media more than two hours per day were more likely to have a depressed mood than those who used social media less often ( p  = 0.007). Additionally, there was no statistically significant difference between students’ academic performance and time spent using social media ( p  = 0.330).

Results of Rho Spearman correlations between the main study variables showed that SMU was positively and significantly correlated with psychological distress ( p  = 0.005) and maladaptive coping ( p  < 0.001). However, there was no significant correlation between SMU and adaptive coping ( p  = 0.876) (Table  4 ). Moreover, GPA, as a measure of academic performance, had no significant correlations with SMU, adaptive coping, maladaptive coping or psychological distress.

Structural equation modeling showed good to excellent fit indices = CMIN/DF = 2.67 (acceptable range = 1–3), GFI = 0.990 (acceptable > 0.90), CFI = 0.972 (acceptable > 0.95), SRMR = 0.058 (acceptable < 0.08), RMSEA = 0.054 (acceptable < 0.06) and PCLOSE = 0.203 (acceptable > 0.05). The model showed that the direct relationship between SMU and psychological distress was not significant (path coefficient = 0.068, p  = 0.114). However, the indirect relationship between SMU and psychological distress via maladaptive coping score was significant (path coefficient = 0.546, p  = 0.001). The indirect relationship between SMU and psychological distress via adaptive coping score was non-significant (path coefficient = 0.08, p  = 0.165). Moreover, the direct relationship between SMU and GPA scores was not significant (path coefficient = 0.068, p  = 0.114) and the relationship between psychological distress and GPA was borderline non-significant (path coefficient =—0.102, p  = 0.07) (Fig.  1 ).

Structural equation modeling of associations between average daily times spent on social media use (SMU), adaptive and maladaptive coping scores, psychological distress (measured by DASS-21 scores) and academic performance (measured by grade point average [GPA]). Numbers between boxes are standardized path coefficients

Figure  2 shows the results of simple mediation analysis using Hayes Macro Process in assessing the mediating effects of coping strategies in the relationship between SMU and psychological distress. In the case where psychological distress was the dependent variable (Y), SMU as the independent variable (X), and adaptive coping score as mediating variable (M), the total effect of X on Y was significant (unstandardized coefficient = 1.9078, SE = 0.7617, p  = 0.0128). However, the indirect effect of X on Y was not statistically significant (unstandardized coefficient = -0.3388, SE = 0.2649, p  = 0.1774) and the 95%CI for coefficient included zero (LLCI = -0.8675, ULCI = 0.0135), showing that adaptive coping strategies had no mediating effect on the relationship between SMU and psychological distress.

Mediating effects of coping strategies (adaptive and maladaptive coping) on the relationship between social media use (SMU) and psychological distress among the participants ( N  = 398). *: statistically significant. a: (Unstandardized coefficient and standard error of the association between the independent variable [X] and the mediator variable[M]). b: Unstandardized coefficient and standard error of the association between the mediator variable [M] and the dependent variable [Y]. c: Unstandardized coefficient and standard error of total effect of the independent variable [X] on dependent variable [Y]. IF [Indirect effect]: Unstandardized coefficient and standard error of indirect effect [IF] of the independent variable [X] on dependent variable [Y]

Conversely, when psychological distress was the dependent variable (Y), SMU was the independent variable (X) and maladaptive coping was the mediating variable (M), both the total effect of X on Y (unstandardized coefficient = 1.9078, SE = 0.7617, p  = 0.0128), and the indirect effect of X on Y (unstandardized coefficient = 1.2346, SE = 0.4024, p  = 0.0019) were statistically significant and the 95%CI for coefficient did not include zero (LLCI = 0.4707, ULCI = 2.0370), showing that maladaptive coping strategies had a substantial (65%) mediating effect on the relationship between SMU and psychological distress.

The present study investigated the relationship between SMU and medical students’ psychological distress (assessed using the DASS-21) and academic performance (assessed using GPA), and explored whether these were directly related to the magnitude of time spent on social media or were mediated by a third variable. It was hypothesized that greater social media use would predict greater psychological distress and a worse academic performance. The findings showed that there was a significant positive association between high SMU and higher psychological distress among medical students. However, structural equation modeling and mediation analysis showed that this relationship was indirectly mediated by students’ maladaptive coping style.

These findings supported both H 1 and H 3 and suggest that social media use may act as a maladaptive coping strategy to deal with psychological distress among medical students. Previous studies have reported equivocal findings concerning the impact of social media on mental well-being of youth. The majority of studies in the literature suggest that problematic SMU may negatively impact young individuals’ mental health [ 9 , 36 , 37 ]. Based on the present study’s findings, the relationship between SMU and psychological distress depended on the students’ coping style and it appears that those students with high psychological distress use social media as a maladaptive tool to cope with their stresses.

It has been previously suggested that social networking sites are used for different reasons by university students. Although they may be used for maintaining social connectedness and increasing personal knowledge, they may also be used as a coping mechanism [ 38 ]. Based on the extant literature, social media use has been labeled as being a ‘dual effect phenomenon because there is much debate and polarization regarding the potential benefits and harms of social media use by young individuals [ 39 , 40 ].

There are still significant gaps in the existing evidence regarding the exact function of social media as a coping strategy. Current perspectives on using social media suggest that it can be used for various types of coping strategy. For example, a specific social media platform can be used for distraction from unpleasant thoughts or can be used to get social support. Social media use depends on the coping goal an individual sets to be achieved. Overall, it appears that the effect of SMU on an individual’s psychological state varies based on the general tendency to handle stressors with a set of coping strategies, more specifically, the person’s ‘dominant coping style’ [ 41 ].

In the present study, participants reported using adaptive coping more frequently than maladaptive coping strategies. However, medical students with greater depression, anxiety and stress (represented by higher DASS-21 scores) were more likely to use maladaptive coping strategies (than adaptive ones) and spent more time using social media. This difference in using coping strategies and frequency of SMU suggests different applications of social media for normal and psychologically distressed medical students. The most common adaptive coping strategies used by participants were planning, active coping, and acceptance, while the most common maladaptive strategies used were self-distraction, venting, and self-blaming.

Consistent with the present study’s findings, it has been reported that while using adaptive coping is more common than maladaptive coping strategies, maladaptive coping behaviors more strongly predict psychological distress among medical students [ 42 , 43 , 44 ]. Findings of the study by Neufeld and Malin [ 43 ] among a sample of Canadian medical students were similar with respect to the most common maladaptive strategies among medical students. However, the most common adaptive strategies used by Canadian medical students were active coping, emotional support, and positive reframing, respecively [ 43 ].

The present study found no significant association between average daily time spent on social media and academic performance (assessed using GPA scores) and found a borderline non-significant association between psychological distress and academic performance. Nevertheless, the results showed high prevalence of maladaptive behaviors including self-distraction, substance use, behavioral disengagement among those students with higher SMU, all of which can negatively impact academic performance. Some studies have demonstrated decreased academic achievements and increased psychological distress with increasing use of social media by university students [ 15 , 16 , 17 , 18 ]. An Indian study also found a negative association between using social media and academic performance of medical students [ 45 ]. However, findings are not consistent across studies. For example, a study conducted in Saudi Arabia found no relationship between social media use and medical students’ academic performance [ 46 ]. It has been suggested that problematic use of social media may act as a time-consuming activity that interferes with normal academic functioning [ 47 ]. According to some previous studies, SMU is not inherently deleterious to academic advancement. However, if it involves simultaneous participation in multiple activities (multitasking behavior), this can negatively affect students’ academic performance [ 47 , 48 ].

The present study found that just over 12% of medical students used social media for educational purposes. This percentage of academic use is less than that reported from Western countries. According to a meta-analysis, almost 20% of medical students use social media for academic purposes, but most of the included studies were from Western countries [ 49 ].

As expected, depression, anxiety and stress emotional states were common among Iranian medical students. More than 40% of the sample of clinical medical students reported depression and more than one-third reported stress and/or anxiety. Several previous studies have reported high levels of psychological distress during clinical rotations where students have to adapt to stringent demands of hospitals [ 6 ]. It has been shown that high rates of anxiety and depression can affect medical students’ empathy, professional behaviors, and performance as a physician [ 50 ].

The potentially dual relationship between SMU and students’ psychological state has a variety of implications. First, these findings suggest that proper and beneficial use of social media by medical students requires learning to adopt appropriate problem-focused coping strategies during emotional crises and distressing conditions. If not, social media could be used as a maladaptive coping tool that may reduce stress in the short-term but cause adverse mental health consequences in the long-term. Therefore, education of university students in practicing adaptive coping skills may help to prevent potential adverse mental health consequences associated with maladaptive coping strategies.

Another interesting observation in the present study data was that high SMU was particularly associated with increased substance use and behavioral disengagement, both of which are emotion-focused coping strategies. Use of such strategies could lead students to not engaging properly with their academic studies (e.g., poor class attendance) and decreased motivation to reach set goals which negatively impact academic performance [ 51 ]. Therefore, it is recommended that university educational systems monitor students with poor academic performance with regard to aforementioned maladaptive strategies through periodic mental health counselling.

One interesting field for future research is to examine which specific social media platforms are more commonly used by students who are facing stressful life conditions and are using social media as a maladaptive coping tool. Moreover, it is worth investigating whether highly visited social media platforms by students differ during normal conditions and during emotional disturbances.

There are some limitations to the present study. The research was carried out at a single university with a relatively small sample, and the target population may not be representative of all Iranian medical students. Also, the study design was cross-sectional, relying on the self-report data with a single assessment of perceived distress one week before the survey. Participants were not evaluated for problematic social media use and only data on the average daily time spent on social networking sites was collected. Moreover, the present study did not assess the passive or proactive nature of SMU among participants. It should also be noted that the study was conducted during 2022, which can be considered as a post COVID-19 pandemic period. It has been shown that assessment of academic performance of university students was affected by the pandemic during recent years [ 52 ], therefore, there is a possibility that the GPAs of the present study participants may have been affected by the pandemic. While mediation analysis provides supporting evidence on the effect of social media use on students’ psychological distress, causality can only be confirmed by appropriate longitudinal study designs.

The present study provides more support on the potential coping role of SMU in its relationship with psychological distress among medical students. The findings suggest empowering students to adopt and foster appropriate active coping strategies which could help them to enhance resilience against life stressors and ameliorate potential long-term mental health consequences associated with maladaptive approaches. Further studies focusing on the patterns of social media use are needed to achieve greater clarity with regard to implications of social media use on medical students’ mental health.

Availability of data and materials

The datasets generated and/or analyzed during the present study are not publicly available due to due to institutional regulations and privacy restrictions but are available from the corresponding author upon reasonable request.

Abbreviations

Goodness of fit index

Comparative fit index

Minimum discrepancy function divided by degrees of freedom

Standardized root mean square residual

Root mean square error of approximation

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Acknowledgements

The authors very much appreciate the cooperation offered by the deputy head of education in Shiraz Faculty of medicine.

This article is based on the thesis (Grant No. 25957) prepared by AR in fulfillment of the requirements for the medical doctor degree. There was no financial support for this work that could have influenced its outcome or presentation.

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RS conceived the presented idea, reviewed the literature and prepared the primary manuscript. AR contributed in the study design, data gathering and analysis. AA contributed in SEM analysis and visualization of the results. MDG contributed in reviewing and writing drafts and critically appraising the manuscript. All the authors read and approved the final manuscript.

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Shiraly, R., Roshanfekr, A., Asadollahi, A. et al. Psychological distress, social media use, and academic performance of medical students: the mediating role of coping style. BMC Med Educ 24 , 999 (2024). https://doi.org/10.1186/s12909-024-05988-w

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How Social Media and Screen Time Can Affect Children's Mental Health

Psychiatrist dr. asha patton-smith of kaiser permanente offers guidance for parents, by erika gonzalez and patricia fantis • published february 21, 2023.

New research shows sites like TikTok may have a negative impact on children's mental health. The algorithm is designed to keep users engaged longer, and studies show the more kids and teens spend on social media, the more likely they’ll be depressed.

Psychiatrist Dr. Asha Patton-Smith of Kaiser Permanente offered guidance for parents.

How Much Screen Time Should Kids Get Per Day?

24/7 New York news stream: Watch NBC 4 free wherever you are

Children 6 and older should be limited to two hours of screen time maximum, Patton-Smith said.

Ages 2-5 should be limited to one hour or less.

And children 2 and younger should not get any screen time.

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“And this is from the American Academy of Pediatrics,” Patton-Smith said.

How Can Parents Reduce Children’s Screen Time Habits?

“Parents and caregivers, what I always tell them is that you can show them better than you can tell them,” Patton-Smith said.

She said the first thing parents should do is reduce their own screen time.

“Obviously, the older the kid, the more challenging it is in this process, but setting limits and having times when screens need to be off – dinner time, family time outside, certain times on weekends, time during study,” she said.

‘They Are in Crisis': American Teen Girls Facing Record Levels of Hopelessness, Sadness and Trauma, CDC Data Shows

TikTok Boosts Posts About Eating Disorders and Suicide to Vulnerable Teens, New Research Shows

How is social media harmful.

A 2019 study in The Journal of the American Medical Association looked at different types of social media and screens and found the amount of time on screens can be detrimental, Patton-Smith said.

“However, social media is what seems to be the biggest culprit with regard to challenges increasing depression and anxiety,” she said.

By reinforcing the algorithm, users can get sucked in and continue to stay.

“So, if you’re searching something and other things come up that are very similar, you look up and you’ve been on for hours and it seems like it’s only been a few minutes,” Patton-Smith said.

Another thing that is particularly difficult with teenagers are “upward social comparisons,” she said.

“So, comparing social experiences that you’re seeing in social media as more favorable than your experience,” she said.

Body image is one. What activities people are doing is another.

“I hear a lot of teens say, ‘Everybody’s having a lot of fun but me,’” Patton-Smith said. “How do you know? Is it because of social media? Because that’s not always accurate.”  

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Screen Time, Social Media Use Linked to Eating Disorder Symptoms

MONDAY, Sept. 16, 2024 (HealthDay News) -- Greater total screen time, social media use, and problematic screen use are associated with eating disorder symptoms in early adolescence, according to a study published online Sept. 4 in Eating and Weight Disorders .

Jonathan Chu, from the University of California in San Francisco, and colleagues analyzed prospective cohort data for 10,246 participants aged 9 to 14 years from the Adolescent Brain Cognitive Development Study to examine the prospective associations between screen use and eating disorder symptoms. The longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year 2 were examined. In addition, cross-sectional associations between problematic screen use in year 2 and eating disorder symptoms in year 2 were estimated.

The researchers found an association for each additional hour of total screen time and social media use with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratios, 1.05 to 1.55). Higher odds of all eating disorder symptoms were seen in association with both problematic social media and mobile phone use (odds ratios, 1.26 to 1.82).

"Clinicians are encouraged to regularly assess screen time in youth, given the accumulating support for its association with a range of poor mental health outcomes," the authors write. "Moreover, clinicians should consider screening for disordered eating in youth who report high or problematic screen use, given the benefits of early identification for prognosis."

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The Impact of Social Media on the Mental Health of Adolescents and Young Adults: A Systematic Review

Abderrahman m khalaf.

1 Psychiatry Department, Saudi Commission for Health Specialties, Ministry of Health, Riyadh, SAU

Abdullah A Alubied

Ahmed m khalaf.

2 College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU

Abdallah A Rifaey

3 College of Medicine, Almaarefa University, Riyadh, SAU

Adolescents increasingly find it difficult to picture their lives without social media. Practitioners need to be able to assess risk, and social media may be a new component to consider. Although there is limited empirical evidence to support the claim, the perception of the link between social media and mental health is heavily influenced by teenage and professional perspectives. Privacy concerns, cyberbullying, and bad effects on schooling and mental health are all risks associated with this population's usage of social media. However, ethical social media use can expand opportunities for connection and conversation, as well as boost self-esteem, promote health, and gain access to critical medical information. Despite mounting evidence of social media's negative effects on adolescent mental health, there is still a scarcity of empirical research on how teens comprehend social media, particularly as a body of wisdom, or how they might employ wider modern media discourses to express themselves. Youth use cell phones and other forms of media in large numbers, resulting in chronic sleep loss, which has a negative influence on cognitive ability, school performance, and socio-emotional functioning. According to data from several cross-sectional, longitudinal, and empirical research, smartphone and social media use among teenagers relates to an increase in mental distress, self-harming behaviors, and suicidality. Clinicians can work with young people and their families to reduce the hazards of social media and smartphone usage by using open, nonjudgmental, and developmentally appropriate tactics, including education and practical problem-solving.

Introduction and background

Humans are naturally social species that depend on the companionship of others to thrive in life. Thus, while being socially linked with others helps alleviate stress, worry, and melancholy, a lack of social connection can pose major threats to one's mental health [ 1 ]. Over the past 10 years, the rapid emergence of social networking sites like Facebook, Twitter, Instagram, and others has led to some significant changes in how people connect and communicate (Table 1 ). Over one billion people are currently active users of Facebook, the largest social networking website, and it is anticipated that this number will grow significantly over time, especially in developing countries. Facebook is used for both personal and professional interaction, and its deployment has had a number of positive effects on connectivity, idea sharing, and online learning [ 2 ]. Furthermore, the number of social media users globally in 2019 was 3.484 billion, a 9% increase year on year [ 3 ].

Mental health is represented as a state of well-being in which individuals recognize their potential, successfully navigate daily challenges, perform effectively at work, and make a substantial difference in the lives of others [ 4 ]. There is currently debate over the benefits and drawbacks of social media on mental health [ 5 ]. Social networking is an important part of safeguarding our mental health. Mental health, health behavior, physical health, and mortality risk are all affected by the quantity and quality of social contacts [ 5 ].

Social media use and mental health may be related, and the displaced behavior theory could assist in clarifying why. The displaced behavior hypothesis is a psychology theory that suggests people have limited self-control and, when confronted with a challenging or stressful situation, may engage in behaviors that bring instant gratification but are not in accordance with their long-term objectives [ 6 ]. In addition, when people are unable to deal with stress in a healthy way, they may act out in ways that temporarily make them feel better but ultimately harm their long-term goals and wellness [ 7 , 8 ]. In the 1990s, social psychologist Roy Baumeister initially suggested the displaced behavior theory [ 9 ]. Baumeister suggested that self-control is a limited resource that can be drained over time and that when self-control resources are low, people are more likely to engage in impulsive or self-destructive conduct [ 9 ]. This can lead to a cycle of bad behaviors and outcomes, as individuals may engage in behaviors that bring short respite but eventually add to their stress and difficulties [ 9 ]. According to the hypothetical terms, those who participate in sedentary behaviors, including social media, engage in fewer opportunities for in-person social interaction, both of which have been demonstrated to be protective against mental illnesses [ 10 ]. Social theories, on the other hand, discovered that social media use influences mental health by affecting how people interpret, maintain, and interact with their social network [ 4 ].

Numerous studies on social media's effects have been conducted, and it has been proposed that prolonged use of social media sites like Facebook may be linked to negative manifestations and symptoms of depression, anxiety, and stress [ 11 ]. A distinct and important time in a person's life is adolescence. Additionally, risk factors such as family issues, bullying, and social isolation are readily available at this period, and it is crucial to preserve social and emotional growth. The growth of digital technology has affected numerous areas of adolescent lives. Nowadays, teenagers' use of social media is one of their most apparent characteristics. Being socially connected with other people is a typical phenomenon, whether at home, school, or a social gathering, and adolescents are constantly in touch with their classmates via social media accounts. Adolescents are drawn to social networking sites because they allow them to publish pictures, images, and videos on their platforms. It also allows teens to establish friends, discuss ideas, discover new interests, and try out new kinds of self-expression. Users of these platforms can freely like and comment on posts as well as share them without any restrictions. Teenagers now frequently post insulting remarks on social media platforms. Adolescents frequently engage in trolling for amusement without recognizing the potentially harmful consequences. Trolling on these platforms focuses on body shaming, individual abilities, language, and lifestyle, among other things. The effects that result from trolling might cause anxiety, depressive symptoms, stress, feelings of isolation, and suicidal thoughts. The authors explain the influence of social media on teenage well-being through a review of existing literature and provide intervention and preventative measures at the individual, family, and community levels [ 12 ].

Although there is a "generally correlated" link between teen social media use and depression, certain outcomes have been inconsistent (such as the association between time spent on social media and mental health issues), and the data quality is frequently poor [ 13 ]. Browsing social media could increase your risk of self-harm, loneliness, and empathy loss, according to a number of research studies. Other studies either concluded that there is no harm or that some people, such as those who are socially isolated or marginalized, may benefit from using social media [ 10 ]. Because of the rapid expansion of the technological landscape in recent years, social media has become increasingly important in the lives of young people. Social networking has created both enormous new challenges and interesting new opportunities. Research is beginning to indicate how specific social media interactions may impair young people's mental health [ 14 ]. Teenagers could communicate with one another on social media platforms, as well as produce, like, and share content. In most cases, these individuals are categorized as active users. On the other hand, teens can also use social media in a passive manner by "lurking" and focusing entirely on the content that is posted by others. The difference between active and passive social media usage is sometimes criticized as a false dichotomy because it does not necessarily reveal whether a certain activity is goal-oriented or indicative of procrastination [ 15 ]. However, the text provides no justification for why this distinction is wrong [ 16 ]. For instance, one definition of procrastination is engaging in conversation with other people to put off working on a task that is more important. The goal of seeing the information created by other people, as opposed to participating with those same individuals, may be to keep up with the lives of friends. One of the most important distinctions that can be made between the various sorts is whether the usage is social. When it comes to understanding and evaluating all these different applications of digital technology, there are a lot of obstacles to overcome. Combining all digital acts into a single predictor of pleasure would, from both a philosophical and an empirical one, invariably results in a reduction in accuracy [ 17 ].

Methodology

This systematic review was carried out and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and standard practices in the field. The purpose of this study was to identify studies on the influence of technology, primarily social media, on the psychosocial functioning, health, and well-being of adolescents and young adults.

The MEDLINE bibliographical database, PubMed, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Scopus were searched between 1 January 2000 and 30 May 2023. Social media AND mental health AND adolescents AND young adults were included in the search strategy (impact or relation or effect or influence).

Two researchers (AK and AR) separately conducted a literature search utilizing the search method and evaluated the inclusion eligibility of the discovered papers based on their titles and abstracts. Then, the full texts of possibly admissible publications were retrieved and evaluated for inclusion. Disagreements among the researchers were resolved by debate and consensus.

The researchers included studies that examined the impact of technology, primarily social media, on the psychosocial functioning, health, and well-being of adolescents and young adults. We only considered English publications, reviews, longitudinal surveys, and cross-sectional studies. We excluded studies that were not written in English, were not comparative, were case reports, did not report the results of interest, or did not list the authors' names. We also found additional articles by looking at the reference lists of the retrieved articles.

Using a uniform form, the two researchers (AK and AA) extracted the data individually and independently. The extracted data include the author, publication year, study design, sample size and age range, outcome measures, and the most important findings or conclusions.

A narrative synthesis of the findings was used to analyze the data, which required summarizing and presenting the results of the included research in a logical and intelligible manner. Each study's key findings or conclusions were summarized in a table.

Study Selection

A thorough search of electronic databases, including PubMed, Embase, and Cochrane Library, was done from 1 January 2000 to 20 May 2023. Initial research revealed 326 potentially relevant studies. After deleting duplicates and screening titles and abstracts, the eligibility of 34 full-text publications was evaluated. A total of 23 papers were removed for a variety of reasons, including non-comparative studies, case reports, and studies that did not report results of interest (Figure ​ (Figure1 1 ).

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

This systematic review identified 11 studies that examined the connection between social media use and depression symptoms in children and adolescents. The research demonstrated a modest but statistically significant association between social media use and depression symptoms. However, this relationship's causality is unclear, and additional study is required to construct explanatory models and hypotheses for inferential studies [ 18 ].

Additional research studied the effects of technology on the psychosocial functioning, health, and well-being of adolescents and young adults. Higher levels of social media usage were connected with worse mental health outcomes [ 19 ], and higher levels of social media use were associated with an increased risk of internalizing and externalizing difficulties among adolescents, especially females [ 20 ]. The use of social media was also connected with body image problems and disordered eating, especially among young women [ 21 ], and social media may be a risk factor for alcohol consumption and associated consequences among adolescents and young adults [ 22 ].

It was discovered that cyberbullying victimization is connected with poorer mental health outcomes in teenagers, including an increased risk of sadness and anxiety [ 23 ]. The use of social media was also connected with more depressive symptoms and excessive reassurance-seeking, but also with greater popularity and perceived social support [ 24 ], as well as appearance comparisons and body image worries, especially among young women [ 25 ]. Children and adolescents' bedtime media device use was substantially related to inadequate sleep quantity, poor sleep quality, and excessive daytime drowsiness [ 26 ].

Online friends can be a significant source of social support, but in-person social support appears to provide greater protection against persecution [ 27 ]. Digital and social media use offers both benefits and risks to the health of children and adolescents, and an individualized family media use plan can help strike a balance between screen time/online time and other activities, set boundaries for accessing content, promote digital literacy, and support open family communication and consistent media use rules (Tables ​ (Tables2, 2 , ​ ,3) 3 ) [ 28 ].

Does Social Media Have a Positive or Negative Impact on Adolescents and Young Adults?

Adults frequently blame the media for the problems that younger generations face, conceptually bundling different behaviors and patterns of use under a single term when it comes to using media to increase acceptance or a feeling of community [ 29 , 30 ]. The effects of social media on mental health are complex, as different goals are served by different behaviors and different outcomes are produced by distinct patterns of use [ 31 ]. The numerous ways that people use digital technology are often disregarded by policymakers and the general public, as they are seen as "generic activities" that do not have any specific impact [ 32 ]. Given this, it is crucial to acknowledge the complex nature of the effects that digital technology has on adolescents' mental health [ 19 ]. This empirical uncertainty is made worse by the fact that there are not many documented metrics of how technology is used. Self-reports are the most commonly used method for measuring technology use, but they can be prone to inaccuracy. This is because self-reports are based on people's own perceptions of their behavior, and these perceptions can be inaccurate [ 33 ]. At best, there is simply a weak correlation between self-reported smartphone usage patterns and levels that have been objectively verified [ 34 , 35 ].

When all different kinds of technological use are lumped together into a single behavioral category, not only does the measurement of that category contribute to a loss of precision, but the category also contributes to a loss of precision. To obtain precision, we need to investigate the repercussions of a wide variety of applications, ideally guided by the findings of scientific research [ 36 ]. The findings of this research have frequently been difficult to interpret, with many of them suggesting that using social media may have a somewhat negative but significantly damaging impact on one's mental health [ 36 ]. There is a growing corpus of research that is attempting to provide a more in-depth understanding of the elements that influence the development of mental health, social interaction, and emotional growth in adolescents [ 20 ].

It is challenging to provide a succinct explanation of the effects that social media has on young people because it makes use of a range of different digital approaches [ 37 , 38 ]. To utilize and respond to social media in either an adaptive or maladaptive manner, it is crucial to first have a solid understanding of personal qualities that some children may be more likely to exhibit than others [ 39 ]. In addition to this, the specific behaviors or experiences on social media that put teenagers in danger need to be recognized.

When a previous study particularly questioned teenagers in the United States, the authors found that 31% of them believe the consequences are predominantly good, 45% believe they are neither positive nor harmful, and 24% believe they are unfavorable [ 21 ]. Teens who considered social media beneficial reported that they were able to interact with friends, learn new things, and meet individuals who shared similar interests because of it. Social media is said to enhance the possibility of (i) bullying, (ii) ignoring face-to-face contact, and (iii) obtaining incorrect beliefs about the lives of other people, according to those who believe the ramifications are serious [ 21 ]. In addition, there is the possibility of avoiding depression and suicide by recognizing the warning signs and making use of the information [ 40 ]. A common topic that comes up in this area of research is the connection that should be made between traditional risks and those that can be encountered online. The concept that the digital age and its effects are too sophisticated, rapidly shifting, or nuanced for us to fully comprehend or properly shepherd young people through is being questioned, which challenges the traditional narrative that is sent to parents [ 41 ]. The last thing that needs to be looked at is potential mediators of the link between social factors and teenage depression and suicidality (for example, gender, age, and the participation of parents) [ 22 ].

The Dangers That Come With Young Adults Utilizing Social Media

The experiences that adolescents have with their peers have a substantial impact on the onset and maintenance of psychopathology in those teenagers. Peer relationships in the world of social media can be more frequent, intense, and rapid than in real life [ 42 ]. Previous research [ 22 ] has identified a few distinct types of peer interactions that can take place online as potential risk factors for mental health. Being the target of cyberbullying, also known as cyber victimization, has been shown to relate to greater rates of self-inflicted damage, suicidal ideation, and a variety of other internalizing and externalizing issues [ 43 ]. Additionally, young people may be put in danger by the peer pressure that can be found on social networking platforms [ 44 ]. This can take the form of being rejected by peers, engaging in online fights, or being involved in drama or conflict [ 45 ]. Peer influence processes may also be amplified among teenagers who spend time online, where they have access to a wider diversity of their peers as well as content that could be damaging to them [ 46 ]. If young people are exposed to information on social media that depicts risky behavior, their likelihood of engaging in such behavior themselves (such as drinking or using other drugs) may increase [ 22 ]. It may be simple to gain access to online materials that deal with self-harm and suicide, which may result in an increase in the risk of self-harm among adolescents who are already at risk [ 22 ]. A recent study found that 14.8% of young people who were admitted to mental hospitals because they posed a risk to others or themselves had viewed internet sites that encouraged suicide in the two weeks leading up to their admission [ 24 ]. The research was conducted on young people who were referred to mental hospitals because they constituted a risk to others or themselves [ 24 ]. They prefer to publish pictures of themselves on social networking sites, which results in a steady flow of messages and pictures that are often and painstakingly modified to present people in a favorable light [ 24 ]. This influences certain young individuals, leading them to begin making unfavorable comparisons between themselves and others, whether about their achievements, their abilities, or their appearance [ 47 , 48 ].

There is a correlation between higher levels of social networking in comparison and depressed symptoms in adolescents, according to studies [ 25 ]. When determining how the use of technology impacts the mental health of adolescents, it is essential to consider the issue of displacement. This refers to the question of what other important activities are being replaced by time spent on social media [ 49 ]. It is a well-established fact that the circadian rhythms of children and adolescents have a substantial bearing on both their physical and mental development.

However, past studies have shown a consistent connection between using a mobile device before bed and poorer sleep quality results [ 50 ]. These results include shorter sleep lengths, decreased sleep quality, and daytime tiredness [ 50 ]. Notably, 36% of adolescents claim they wake up at least once over the course of the night to check their electronic devices, and 40% of adolescents say they use a mobile device within five minutes of going to bed [ 25 ]. Because of this, the impact of social media on the quality of sleep continues to be a substantial risk factor for subsequent mental health disorders in young people, making it an essential topic for the continuation of research in this area [ 44 ].

Most studies that have been conducted to investigate the link between using social media and experiencing depression symptoms have concentrated on how frequently and problematically people use social media [ 4 ]. Most of the research that was taken into consideration for this study found a positive and reciprocal link between the use of social media and feelings of depression and, on occasion, suicidal ideation [ 51 , 52 ]. Additionally, it is unknown to what extent the vulnerability of teenagers and the characteristics of substance use affect this connection [ 52 ]. It is also unknown whether other aspects of the environment, such as differences in cultural norms or the advice and support provided by parents, have any bearing on this connection [ 25 ]. Even if it is probable that moderate use relates to improved self-regulation, it is not apparent whether this is the result of intermediate users having naturally greater self-regulation [ 25 ].

Gains From Social Media

Even though most of the debate on young people and new media has centered on potential issues, the unique features of the social media ecosystem have made it feasible to support adolescent mental health in more ways than ever before [ 39 ]. Among other benefits, using social media may present opportunities for humor and entertainment, identity formation, and creative expression [ 53 ]. More mobile devices than ever before are in the hands of teenagers, and they are using social media at never-before-seen levels [ 27 ]. This may not come as a surprise given how strongly young people are drawn to digital devices and the affordances they offer, as well as their heightened craving for novelty, social acceptance, and affinity [ 27 ]. Teenagers are interacting with digital technology for longer periods of time, so it is critical to comprehend the effects of this usage and use new technologies to promote teens' mental health and well-being rather than hurt it [ 53 ]. Considering the ongoing public discussion, we should instead emphasize that digital technology is neither good nor bad in and of itself [ 27 ].

One of the most well-known benefits of social media is social connection; 81% of students say it boosts their sense of connectedness to others. Connecting with friends and family is usually cited by teenagers as the main benefit of social media, and prior research typically supports the notion that doing so improves people's well-being. Social media can be used to increase acceptance or a feeling of community by providing adolescents with opportunities to connect with others who share their interests, beliefs, and experiences [ 29 ]. Digital media has the potential to improve adolescent mental health in a variety of ways, including cutting-edge applications in medical screening, treatment, and prevention [ 28 ]. In terms of screening, past research has suggested that perusing social media pages for signs of melancholy or drug abuse may be viable. More advanced machine-learning approaches have been created to identify mental disease signs on social media, such as depression, post-traumatic stress disorder, and suicidality. Self-report measures are used in most studies currently conducted on adolescent media intake. It is impossible to draw firm conclusions on whether media use precedes and predicts negative effects on mental health because research has only been conducted once. Adults frequently blame the media for the problems that younger generations face [ 30 ]. Because they are cyclical, media panics should not just be attributed to the novel and the unknown. Teenagers' time management, worldview, and social interactions have quickly and dramatically changed as a result of technology. Social media offers a previously unheard-of opportunity to spread awareness of mental health difficulties, and social media-based health promotion programs have been tested for a range of cognitive and behavioral health conditions. Thanks to social media's instant accessibility, extensive possibilities, and ability to reach remote areas, young people with mental health issues have exciting therapy options [ 54 ]. Preliminary data indicate that youth-focused mental health mobile applications are acceptable, but further research is needed to assess their usefulness and effectiveness. Youth now face new opportunities and problems as a result of the growing significance of digital media in their life. An expanding corpus of research suggests that teenagers' use of social media may have an impact on their mental health. But more research is needed [ 18 ] considering how swiftly the digital media landscape is changing.

Conclusions

In the digital era, people efficiently employ technology; it does not "happen" to them. Studies show that the average kid will not be harmed by using digital technology, but that does not mean there are no situations where it could. In this study, we discovered a connection between social media use and adolescent depression. Since cross-sectional research represents the majority, longitudinal studies are required. The social and personal life of young people is heavily influenced by social media. Based on incomplete and contradictory knowledge on young people and digital technology, professional organizations provide guidance to parents, educators, and institutions. If new technologies are necessary to promote social interaction or develop digital and relational (digitally mediated) skills for growing economies, policies restricting teen access to them may be ineffective. The research on the impact of social media on mental health is still in its early stages, and more research is needed before we can make definitive recommendations for parents, educators, or institutions. Reaching young people during times of need and when assistance is required is crucial for their health. The availability of various friendships and services may improve the well-being of teenagers.

The authors have declared that no competing interests exist.

More From Forbes

Social media and how it could affect developing brains.

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BATH, UNITED KINGDOM - APRIL 19: A 12-year-old boy looks at a iPad screen on April 19, 2023 in Bath, ... [+] England. (Photo by Matt Cardy/Getty Images)

Canadian school boards are suing social media giants for nearly $3 billion, claiming such platforms have rewired the way children think, behave and learn.

There continues to be much debate about whether or not social media truly harms the mental health of teens and adolescents, and whether or not it conclusively causes physical changes to the brain. Although there have been studies that have examined the effect of social media and the mental health and well-being of adolescents, most reviews have found them to be inconclusive according to The New York Times that cited an article in Current Opinion in Psychology.

This of course, does not mean that social media does not or will not have a detrimental effect on the physical and mental health of our youth. 90% of teens aged 13-17 have used social media, and teens are online on average nine hours a day, not including time spent on homework, according to The American Academy of Child and Adolescent Psychiatry .

The sheer amount of time American youth are spending on social media platforms should be concerning for all parents and educators given how much the adolescent brain is developing during the teen years.

During adolescence, the brain undergoes major changes in the way neurons, or nerve cells that send messages throughout the body, connect to other parts of the body. Areas of the brain that regulate emotions, impulses and cognitive control are particularly susceptible to external influences, including that of social media.

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Surgeon General Dr. Vivek Murthy, in his U.S. Surgeon General’s Advisory on Social Media and Youth Mental Health , writes, “Frequent social media use may be associated with distinct changes in the developing brain in the amygdala (important for emotional learning and behavior) and the prefrontal cortex (important for impulse control, emotional regulation, and moderating social behavior), and could increase sensitivity to social rewards and punishments.”

Many social media platforms use likes, comments and notifications in their algorithms, and this can invariably lead to compulsive and addictive behaviors in youth constantly checking social media and potentially seeking validation from peers and friends. In addition, teens are constantly exposed to highly curated, often idealized representations of others’ lives that can translate into feelings of low self-worth when comparing themselves with others.

It is not surprising that the 2019 UK Millennium Cohort Study published in Journal of eClinical Medicine found greater social media use to be associated with online harassment, poor sleep, body weight dissatisfaction, low self-esteem and higher depressive symptoms. How this affects the physical development of the brain in adolescents needs to be studied further. This will help public health experts, parents and educators understand what physiologic changes are occurring in the brain as a result of the mental health ramifications of social media.

Although a causal effect between social media use and teen mental health has not been demonstrated, public health officials and parents particularly should not shy away from addressing social media use in our youth. Adolescents are using these platforms for large amounts of time throughout the day, and we are only beginning to understand how this use affects the development of the brain and how it is impacting their mental health.

There is no doubt that social media has allowed youth to express themselves in creative ways, and can connect people instantaneously even across continents. This can absolutely result in the emergence of meaningful relationships that can provide positive value for teens. Despite its benefits; parents, educators, public health experts and policy makers should also understand that there could be serious harm from the use of social media, particularly with respect to how it is shaping the developing brain and its effect on the mental health of adolescents.

Teens being online on average nine hours a day means that less time is spent interacting with others in person. There can be no substitute for engaging with real people, learning from them, developing social mannerisms and forming social bonds in real-time.

American youth should consider taking social media breaks, negotiating their time with social media and taking advantage of the present moment to develop lifelong relationships away from screens. Adolescence only occurs once, but neurological and mental effects from its time may last much longer.

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