Kamal S, Malik M, Blumenshine P. Recognizing social media-related depression and anxiety. Harvard Public Health Review. 2021; 28. 

Depression and anxiety in adolescents and young adults is reaching epidemic proportions. From 2005 to 2014, the overall prevalence of depression in adolescents aged 12 to 17 increased from 8.7% to 11.3% and from 2011 to 2018, rates of depression and anxiety in college students increased from 31.5% to 42.2% and 51.5% to 63.6% respectively.1,2 Psychological well-being, a closely related construct, decreased suddenly for adolescents around 2012 and has remained low since that time.3 These trends have been mirrored by a simultaneous increase since 2012 in smartphone adoption and screen-time, particularly social media usage, among American adolescents. The COVID-19 pandemic accelerated these trends: adults in April and May of 2020 were three times as likely to screen positive for depressive and anxiety disorders compared to the year prior.4 Today, social media is omnipresent in the lives of adolescents and adults. The Pew Research Center found that 84% of Americans aged 18-29 adults use at least one social media site and Piper Sandler Investment Research found that the average teen spends 12 hours per week on social media.5,6 Social media usage is a new and important consideration when dealing with and organizing efforts to combat rising depression and anxiety.

There is a growing body of literature investigating the relationship between mental health and social media usage. Social media usage is linked with higher levels of anxiety and depression in adolescents, and there are positive, significant correlations between use of social media and symptoms of anxiety and depression.7–10 There has also been research published specifically quantifying the relationship between social media usage and depression and anxiety among young adults.11–13 Time spent on social media was strongly and positively correlated with an increased risk of depression: Compared to a baseline of spending 0-30 minutes on social media, spending more than 30 minutes was associated with a 26% (31 to 60 minutes) and 84% (61 to 120 minutes) increase in risk of depression.12 Adults aged 19-32 who were using more than 60 minutes per day of social media were also found to have a 100%-268% increased risk of having anxiety.14

Although there had been some concern within the literature that these associations should not be linked to causation, new research has been published establishing temporality of social media usage and depression as well as improvement in symptoms when social media usage is decreased. A recent study found that subjects with high baseline usage of social media had increased risk of developing depression but that subjects with baseline depression did not develop increased social media usage, establishing a temporal association of social media and depression, strengthening the argument for causation.15 Some proposed explanations for social media usage causing depression and anxiety include usage leading to upward social comparison, decrease in activities that are beneficial for mental health (such as exercise, face-to-face interactions, etc.), and decreased quality sleep.10 Of particular significance, new research has shown that limiting social media usage to just 30 minutes per day led to significant reductions in depression and anxiety.16,17

Within professional health organizations, there has been research and introduction of policy to combat these mental health impacts of social media. The American Academy of Pediatricians recognizes “Facebook Depression” as a phenomenon and advises parents to talk to their children and adolescents about online use.18 In November of 2017, the American Medical Association took a step towards addressing the topic by adopting a policy addressing social media usage and its negative health impacts on mental health. The policy stated that: “Our AMA: (1) will collaborate with relevant professional organizations to: (a) support the development of continuing education programs to enhance physicians’ knowledge of the health impacts of social media usage; and (b) support the development of effective clinical tools and protocols for the identification, treatment, and referral of children, adolescents, and adults at risk for and experiencing health sequelae of social media usage; and (2) advocates for schools to provide safe and effective educational programs by which students can learn to identify and mitigate the onset of mental health sequelae of social media usage”.19

Although this topic has begun to be addressed via such policy, as it stands today, there is no term in the literature for the mental health sequelae of social media usage discussed herein, nor are there any published clinical guidelines for safe social media usage. Giving the phenomenon a name allows professionals to directly address it, research it, treat it, and allows for specific discussions of it with patients. We propose the term Social Media Related Depression and Anxiety (SMRDA) to describe the phenomenon of negative mental health sequelae of social media usage.

Using the data from the aforementioned studies, we also present clinical guidelines to limit mental health sequelae of social media usage: No more than 30 minutes of social media usage per day.  Although these guidelines are based on a number of studies, further research is needed to determine the most successful interventions to prevent SMRDA. The term SMRDA gives a label to the issue and helps raise awareness of it. The guidelines for social media presented are intended to serve as a first line, easily implementable, research-supported  intervention for individuals suffering from depression and/or anxiety related to social media usage. Other potential interventions at the school- and community-level include sending home information on SMRDA and the proposed social media usage guidelines, holding educational sessions on SMRDA during school, or asking students to reflect on their social media usage during health class. At the physician level, asking about their social media usage could help patients reflect on the role of social media usage in their mood and anxiety states  and increase openness to altering usage if it appears to be linked with low mood or heightened anxiety. With the ubiquity of social media usage, the challenge of dealing with SMRDA is of importance for physicians and healthcare providers, especially since children and adolescents are a vulnerable population. The proposed guidelines are easily implementable, likely cost-effective and could have significant, positive impacts on the overall health of children and adolescents.

Conflicts of  Interest

Mr. Kamal and Mr. Malik have no conflicts of interest. Dr. Blumenshine owns common stock in Facebook.

References 

1. Mojtabai R, Olfson M, Han B. National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults. Pediatrics. 2016;138(6). doi:10.1542/peds.2016-1878

2. Duffy ME, Twenge JM, Joiner TE. Trends in Mood and Anxiety Symptoms and Suicide-Related Outcomes Among U.S. Undergraduates, 2007–2018: Evidence From Two National Surveys. J Adolesc Health Care. 2019;65(5):590-598.

3. Twenge JM, Martin GN, Campbell WK. Decreases in psychological well-being among American adolescents after 2012 and links to screen time during the rise of smartphone technology. Emotion. 2018;18(6):765-780.

4. Twenge JM, Joiner TE. U.S. Census Bureau-assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID-19 pandemic. Depress Anxiety. 2020;37(10):954-956.

5. Social Media Fact Sheet. Pew Research Center. Published April 7, 2021. https://www.pewresearch.org/internet/fact-sheet/social-media/

6. Taking Stock with Teens Fall 2020. Piper Sandler Investment Research. Published October 2020. http://www.pipersandler.com/private/pdf/TSWTs_Fall_2020_Full_Report.pdf

7. Vannucci A, Flannery KM, Ohannessian CM. Social media use and anxiety in emerging adults. J Affect Disord. 2017;207:163-166.

8. Woods HC, Scott H. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence. 2016;51:41-49. doi:10.1016/j.adolescence.2016.05.008

9. Andreassen CS, Billieux J, Griffiths MD, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychology of Addictive Behaviors. 2016;30(2):252-262. doi:10.1037/adb0000160

10. Twenge JM. More Time on Technology, Less Happiness? Associations Between Digital-Media Use and Psychological Well-Being. Curr Dir Psychol Sci. 2019;28(4):372-379.

11. Primack BA, Shensa A, Escobar-Viera CG, et al. Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Comput Human Behav. 2017;69:1-9.

12. Lin LY, Sidani JE, Shensa A, et al. Association between social media use and depression among u.S. Young adults: Research article: Social media and depression. Depress Anxiety. 2016;33(4):323-331.

13. Twenge JM, Campbell WK. Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep. 2018;12:271-283.
14. Shensa A, Sidani JE, Dew MA, Escobar-Viera CG, Primack BA. Social Media Use and Depression and Anxiety Symptoms: A Cluster Analysis. Am J Health Behav. 2018;42(2):116-128.

15. Primack BA, Shensa A, Sidani JE, Escobar-Viera CG, Fine MJ. Temporal Associations Between Social Media Use and Depression. Am J Prev Med. 2021;60(2):179-188.

16. Hunt MG, Marx R, Lipson C, Young J. No More FOMO: Limiting Social Media Decreases Loneliness and Depression. J Soc Clin Psychol. 2018;37(10):751-768.

17. Hunt M, All K, Burns B, Li K. Too Much of a Good Thing: Who We Follow, What We Do, And How Much Time We Spend on Social Media Affects Well-Being. J Soc Clin Psychol. 2021;40(1):46-68.

18. O’Keeffe GS, Clarke-Pearson K, Council on Communications and Media. The impact of social media on children, adolescents, and families. Pediatrics. 2011;127(4):800-804.

19. American Medical Association House of Delegates. Addressing Social Media Usage and its Negative Impacts on Mental Health. (D-478.965). Published online November 16, 2017. https://policysearch.ama-assn.org/policyfinder/detail/%20?uri=%2FAMADoc%2Fdirectives.xml-D-478.965.xml

Subscribe to Our Newsletter

HPHR

© 2021 HARVARD PUBLIC HEALTH REVIEW: A PEER-REVIEWED JOURNAL
PRIVACY POLICY