Pediatric Pearls: Effects of Social Media Use on Mental Wellbeing
Your patient is a 13-year-old girl who recently began undergoing treatment for generalized anxiety disorder. At a recent check-up, her parents expressed concern about the amount of time she spent on social media, and asked if that could have an impact on the severity of her anxiety.
How would you advise your patient?
(Answer and discussion on next page)
Jessica L Tomaszewski, MD, is a pediatrician in the Division of General Pediatrics/Primary Care in the Department of Pediatrics at Nemours duPont Pediatrics, Jessup Street, in Wilmington, DE.
Answer: Very frequent use of social media could be a predictor of poor mental health and well-being in adolescents.
A growing body of literature has been exploring the relationship between social media use and mental health in adolescents. Russell M. Viner, PhD, investigated the associations between frequency of use and subsequent mental health and wellness throughout adolescence, and whether there were existing ameliorating factors.
The Research
Using data from the Our Futures Study—a publicly available longitudinal study of 12,866 adolescents in England—social media frequency was collected, along with validated questionnaires on mental health and well-being. This data set includes young adults aged 13 to 16 years. Frequency of social media use was measured as “weekly or less” to “multiple times daily” via waves, starting with wave 1 (participants aged 13-14) to wave 3 (participants aged 15-16 years). Mental health was examined with a 12-item General Health Questionnaire (GHQ12) at wave 2 and well-being at wave 3. Analysis was adjusted for confounders and separated by gender. Mediating factors included cyberbullying, sleep adequacy, and physical activity.
The Results
Social media use increased significantly from wave 1 to wave 3: respondents checking social media “multiple times a day” increased from 34.4% to 61.9% in boys and from 51.4% to 75.4% in girls. “Very frequent” social media use during wave 1 predicted a high GHQ12 score at wave 2 among girls (adjusted odds ratio [OR] 1.31 [95% CI, 1.06-1.63], p=0.014; n=4429) and boys (1.67 [1.24-2.26], p=0.0009; n=4379). Persistent “very frequent” social media use across waves 1 and 2 predicted lower well-being scores among girls, particularly with respect to anxiety (adjusted OR, 1.28 [1.11-1.48], p=0.0007, n=3745).
When mediating factors were taken into account with respect to these results, adjustment for cyberbullying, sleep, and physical activity attenuated the associations of social media use with GHQ12 high score (proportion mediated, 58.2%), life satisfaction (80.1%), happiness (47.7%), and anxiety (32.4%) in girls, such that these associations (except for anxiety) were no longer significant. These mediating factors did not have the same effect for the boys in this study; association with GHQ12 high score among boys remained significant, being mediated only 12.1% by these factors.
There are several takeaway points from these results. Very frequent use of social media was a predictor of poor mental health and well-being in adolescents. Including factors such as inadequate sleep and cyberbullying in the analysis attenuated the associations between frequent daily social media use and later psychological distress, life satisfaction, and happiness scores among girls, suggesting the harmful effects of social media may be primarily found in cyberbullying and the displacement of sleep. These mediating factors did not seem to have nearly the same degree of effect on boys, suggesting that other mechanisms are at play. It was also of note that the overall use of social media was higher among girls, along with a higher baseline level of anxiety.
Bottom Line—Thoughtful use of social media is an important area of advocacy and education for parents and adolescent patients. Helping patients and families establish healthier sleep practices and promote physical activity, particularly with girls and women, may ameliorate some of the potential harmful effects of frequent social media use.
Reference:
Viner RM, Aswathikutty-Gireesh A, Stiglic N, et al. Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data. Lancet Child Adolesc Health. 2019;3(10):685-696. https://doi.org/10.1016/S2352-4642(19)30186-5.