Brian Primack, MD, PhD

According to the World Health Organization, depression is now the leading cause of disability worldwide.

 This issue is particularly timely because of the massive proliferation of social media. About 90% of young adults in the US use social media, and the majority of these users visit social media sites at least once a day. This begs the question as to the relationship between social media use and depression. Some researchers have suggested that using more social media can help improve social capital, which may lead to alleviation and/or prevention of depression.

But some research suggests that spending considerable time poring through others’ idealized photo collections and achievements can lead to negative self-comparisons that might increase depression.

Because of the controversy in this area, and the fact that earlier studies have been limited by small or localized samples, in 2014 we surveyed a nationally representative sample of 1787 US young adults ages 19 to 32 on their social media use and depression. A large and prestigious research company called GfK (“Growth from Knowledge”) assisted in the recruitment of this sample using sampling frames, which represented 97% of the US population. We measured social media use in terms of time and frequency of use with items adapted from the Pew Internet questionnaire. We measured depression using the validated Patient-Reported Outcomes Measurement Information System (PROMIS) scale, and we also measured and controlled for 7 socio-demographic covariates.

We were surprised by what we found. We had expected a U-shaped curve, with a higher risk of depression correlating with no social media use at all or excessive use. But instead what we found was a straight line. More social media use was associated with more depression in a linear fashion.

 For example, compared with those who checked social media least frequently throughout the week, participants who reported most frequently checking social media had 2.74 times the odds of increased depression (95% confidence interval [CI] = 1.86-4.04). Similarly, compared with peers who spent less time on social media throughout the day, participants who spent the most total time on social media had 1.66 times the odds of increased depression (95% CI = 1.14-2.42).

In these analyses, we controlled for 7 factors that may contribute to depression, including age, sex, race, ethnicity, relationship status, living situation, household income, and education level. We also conducted many sensitivity analyses, such as changing the way variables were operationalized. Results were consistent regardless of methodological details. All of the final results were also adjusted to account for survey weights.

It should of course be emphasized that because this was a cross-sectional study, it does not disentangle cause and effect. It may be that people who already are depressed are turning to social media to fill a void. Alternatively, exposure to social media also may cause depression, which could then in turn fuel more use of social media. For example, exposure to highly idealized representations of peers on social media may elicit feelings of envy and the distorted belief that others lead happier, more successful lives. Another possibility is that engaging in activities of little meaning on social media may give a feeling of “time wasted” that negatively influences mood. Yet another possibility is that spending more time on social media may increase the risk of exposure to cyber-bullying or other similar negative interactions, which can cause feelings of depression.

Our findings suggest that clinicians need to ask about social media use by people who are depressed. Our findings could also be used as a basis for public health interventions leveraging social media. Some social media platforms already have made forays into such preventative measures. For example, when a person searches the blog site Tumblr for tags indicative of a mental health crisis-such as “depressed,” “suicidal,” or “hopeless”-they are redirected to a message that begins with “Everything OK?” and are provided with links to resources. Similarly, a year ago Facebook tested a feature that allows friends to anonymously report worrisome posts. The posters then receive pop-up messages that voice concern and encourage them to speak with a friend or helpline.

It is important to remember that all social media exposures are not the same. Future studies should examine if there are different risks for depression depending on whether the social media interactions people have tend to be more active versus passive or whether they tend to be more confrontational versus supportive. This would help us develop more fine-grained recommendations around social media use. Similarly, personality could mediate how individuals may be affected by social media use. For example, someone with lower self-esteem or self-worth could interpret others’ celebratory social media posts as confirmations of their own inadequacy, while people with high self-esteem could find these photos exciting or motivating. Qualitative research delving into social media experiences of people suffering from depression may be particularly valuable in illuminating some of these issues.

We do not advocate forgoing social media altogether. Social media, like many other technologies, represents a double-edged sword, with many potential positive uses. Instead, we hope that this work stands as a reminder for individuals to pay attention to how they’re using social media and to make sure that they are using the medium for improving life and not inadvertently detracting from it.

Dr Primack is Professor of Medicine at the University of Pittsburgh School of Medicine and Assistant Vice Chancellor for Health and Society in the University’s Schools of the Health Sciences in Pittsburgh, PA. He also directs the University’s Center for Research on Media, Technology, and Health.

 World Health Organization. Depression Fact Sheet. Geneva, Switzerland: World Health Organization. 

http://www.who.int/mediacentre/factsheets/fs369/en/

 Ellison NB, Steinfield C, Lampe C. The benefits of Facebook “friends:” social capital and college students’ use of online social network sites. 

 Chou HTG, Edge N. “They are happier and having better lives than I am”: The impact of using Facebook on perceptions of others’ lives. 

 Lin LY, Sidani JE, Shensa A, et al. Association between social media use and depression among US young adults. 

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More social media use was associated with more depression in this study. Findings suggest that clinicians need to ask about social media use by people who are depressed.

Author | Brian Primack, MD, PhD

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Social Media and Depression