Youth today have a relatively nuanced and mixed experience with social media. How can you best navigate this relationship as a mental health clinician?
SPECIAL REPORT: CHILD AND ADOLESCENT PSYCHIATRY
Social media has become ubiquitous in the daily lives of most youth and as use increases so do concerns about the impact of social media on mental health. While positive impacts of social media do exist, they tend to be less emphasized than the growing body of research describing the potential negative effects of social media on mental health.
The relationships between social media and youth mental health are complex and challenging to understand in the context of the COVID-19 pandemic, which itself has impacted mental health. Recent surveys report that youth today have a relatively nuanced and mixed experience with social media.1 Indeed, with regard to their developmental stage, youth may not be able to fully recognize or appreciate the impact of social media on their mental health and well-being. While for some, social media may be a source of connectedness, support, and creativity, for others, social media may contribute to depression, loneliness, and more. Given that social media is here to stay, clinicians need to assess youth experiences of social media and work effectively with children, parents, and guardians in order to support and address variable experiences with these platforms.
Understanding All Experiences
There is no universally agreed upon definition of social media, which can make understanding trends and potential impacts challenging. The 2021 Common Sense Media report separated “social media” (Snapchat, Instagram, Discord, Reddit, Pinterest, and Facebook) from “online video sites” (YouTube, TikTok, and Twitch), reporting that 84% of teens and 38% of tweens use social media while 77% of teens and 64% of tweens use online video sites.2 Youth from low-income households reported greater time spent using social media and online video sites compared to youth from high-income households.2 In a survey by the Pew Research Center, most teens reported neither good nor bad experiences with social media (59%) and more teens reported positive experiences with social media (32%) than negative (9%).1 When asked about the likely impact on their peers, 32% reported they think other teens have a mostly negative experience.1
For those teens who reported positive experiences with social media, a greater sense of social connectedness topped the list.1 Black or Hispanic teens were more likely than white teens to say that content viewed on social media makes them feel they have more support and acceptance.1 Black teens were also more likely than other groups to report that social media gives them a creative outlet.1 Online spaces can feel safer than real life spaces to explore identity and sexuality and to find ‘likeness’ and community, particularly for marginalized groups, such as LGBTQ+ youth and racial or ethnic minority youth. Adaptive technologies on social media platforms can allow access for youth with disabilities. Some youth engage with social media-driven social justice movements and advocacy efforts. Given the variety of social media platforms and the different reasons and potential outcomes related to use, it is as important to understand the positive experiences as the negative ones, in the context of a particular youth.
Depression and Social Media
If teens today largely report social media as a neutral or positive experience, why worry about the potential negative effects? Developmentally, it is normative for teens to have a sense of infallibility in the world. The fact that teens predict a more negative experience for others compared to themselves reveals that adolescents may not recognize the more insidious effects on their own lives.
Many research studies have pointed to relationships between social media use and mental health conditions as well as risky behaviors. Relationships between social media use and mental health are multifactorial, with studies generally showing correlational (and not causal) relationships, due to the impracticality and thus absence of double-blinded, randomized controlled studies. Multiple studies have found that social media use correlates with depressive symptoms, anxiety, and loneliness as well as increased emergency department visits for mental health complaints.3 The directionality of this relationship is unclear, as studies have also found that adolescents suffering from depression and mental illness report more social media use.3-5 Thus, the following question remains difficult to answer: does more social media use cause depression or does depression cause more social media use?
The association of social media use and cyberbullying has been well-established and cyberbullying itself has been linked to higher rates of depression, anxiety, and suicide compared with “traditional” bullying.6,7 There are also concerns for exposure to pornographic material and engagement in risky sexual behaviors, including sexting.8 Sexting and viewing online pornography can be normative experiences for adolescents, who have a desire to explore sexuality and connection, but there may be significant risks for youth who develop overly trusting relationships with strangers online or if privacy is threatened or breached.
There is also concern for negative impacts on self-esteem and disordered eating. There is no shortage of social media accounts promoting “body goals,” including “pro-ana” (pro-anorexia) accounts, “thinspiration” accounts, “fitspiration” accounts, and more.9 Social media and obesity is another complicated relationship. Studies have examined the impacts of targeted ads for ultra-processed high-calorie snack foods on social media and how excessive media use contributes to sedentary behavior and displaced sleep, all of which may contribute to weight gain and obesity in childhood.3
Social media platform algorithms quickly learn to suggest content related to what has been previously viewed and can contribute to contagion-effects and increases in self-identification with psychopathology. With the increase in TikTok videos posted by those with self-described tics or Tourette Syndrome during the COVID-19 pandemic, there was a corresponding increase in visits to mental health providers with what are now known as functional tic-like behaviors.10
Social media can expose children to graphic acts of self-injury, with research showing there has been a tremendous increase in Instagram posts related to self-injurious behaviors.11 As more personal disclosures and posts related to disorders such as dissociative identity disorder, borderline personality disorder, bipolar disorder, anxiety, depression, and autism are posted online, social media platforms have enabled self-evaluation and self-diagnosis among youth.12 While it can be empowering, destigmatizing, and educational to learn about mental health conditions online, the importance of working with a mental health professional is often not promoted as much as self-assessment and self-diagnosis. Self-identified mental illness and related social media content can romanticize, glamourize, and even sexualize mental health conditions.12 If having a mental illness garners support or social capital within a network, there is little impetus to work with a mental health professional on treatment.
Creating Safer Experiences
Mental health professionals, parents, guardians, and teachers can all help our youth have safer and healthier experiences with social media. A curious and nonjudgmental stance as we explore social media use with youth is important, and a social media history is now a critical part of a psychiatric evaluation. Assessment of risky behavior in online spaces is as essential as assessment of risky behaviors in real life. Adults can help youth understand some of the potential pitfalls of social media and teach youth about staying safe online with privacy settings, turning off location-enabled services, and understanding that anything posted online may be permanent.
It is important to help kids learn the difference between an ‘influencer’ and an ‘expert’ so that youth can learn to identify more trustworthy accounts and sources of information. Adults can help challenge dangerous stereotypes or communities that promote unhealthy behaviors and empower youth to make healthy decisions in online spaces. Parents and guardians can model good digital citizenship by following the family rules about device use at home and while together as a family.13 For most youth, the goal is to develop healthy relationships with social media and there are many resources available through the AAP and Common Sense Media to help families navigate media plans.
Social media continues to rapidly evolve, and it is important to help our youth develop healthy relationships with this technology as they work toward independence and autonomy. Studies on individual platforms (TikTok, Instagram, Snapchat, etc) will likely be more helpful in guiding best practices around use of specific platforms, rather than studies on social media as a broad category. As we have noted, for most youth, social media use is neither all good nor all bad and the experiences of youth differ widely based on their own lived experiences, areas of strength, and vulnerability. While data suggest correlational relationships between social media use and mental health diagnoses or risk-taking behavior, these relationships are complex. It is likely that youth with underlying vulnerabilities may find themselves having more difficulties or negative sequelae of social media use.
In an assessment, clinicians should explore a youth’s online experiences in a curious and nonjudgmental way and then work with them to counter the more insidious and addictive elements of this technology, as well as prevent or mitigate risky or dangerous experiences they may encounter in online spaces. Clinicians can also advise parents around family media plans, first cell phone purchases, and parental monitoring.13,14
Dr Burley is a Child & Adolescent Psychiatry Fellow at Maine Medical Center in Portland, Maine. Dr Belfort is the Child & Adolescent Psychiatry Fellowship Training Director at Maine Medical Center in Portland, Maine and the co-chair of the Media Committee at AACAP.
1. Anderson M, Vogels EA, Perrin A, Rainie L. Connection, creativity and drama: teen life on social media in 2022. Pew Research Center. November 16, 2022. Accessed March 21, 2023. https://www.pewresearch.org/internet/2022/11/16/connection-creativity-and-drama-teen-life-on-social-media-in-2022/
2. Rideout V, Peebles A, Mann S, Robb M. The Common Sense Census: Media Use by Tweens and Teens, 2021. Common Sense Media. March 9, 2022. Accessed March 21, 2023. https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens-2021
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