National Library of Medicine: Social media use and emerging mental health issues

By Antonio Ventriglio, Fabiana Ricci, Julio Torales, João Mauricio Castaldelli-Maia, Abdulbari Bener, Alexander Smith, and Michael Liebrenz

Since its inception, social media has brought about numerous benefits, including higher levels of social connectedness, potential positive interactions, and greater access to information. Nonetheless, the excessive use of social media can lead to negative health outcomes, such as social anxiety, depression, low self-esteem, reduced sleep quality, and higher perceived stress. It has been argued that boredom and loneliness may be mediating factors between social media misuse and negative mental health effects, above all among youth and adolescents. Likewise, exposure to graphic imagery or misinformation on social media may also have deleterious implications for mental health. Taken together, this suggests a need for targeted studies on the relationship between social media and mental health, as well as the development of educational interventions for adolescents to share knowledge about the safe use of such tools. Mental health professionals should be adequately trained in identifying risk factors and treating the negative health outcomes that may result from social media. Specific strategies and guidelines should be adopted by social media companies aligned with international evidence from health agencies and experts in e-mental health.

While it has entailed certain benefits like increased connectedness and information sharing, the widespread uptake of social media has also reduced face-to-face connections and engendered social isolation, especially among adolescents.[1] In 2014, researchers assessed n = 1,787 individuals aged between 19 and 32 years in the United States, finding a significant association between time spent using social media and reported perceived social isolation.[1] Notably, perceived social isolation has established links to substantial morbidity and mortality, as well as negative health outcomes such as sleep disorders, loneliness, depression, and anxiety.[1] Depression in adolescents may be difficult to estimate and can subtly contribute to impaired school performance or social functioning, alcohol and substance use, poor self-esteem, and increased suicidality.[2] In fact, major depression can be a significant risk factor for suicide; almost 90% of adolescents and youths who die from suicide report a personal history of mood disorders.[2,3] Additionally, suicide is the second leading cause of self-inflicted death in individuals aged 15–29 years old.[3]

SOCIAL MEDIA USE AND MENTAL HEALTH

The relationship between social media use and mental health may be injurious and mediated by several factors, that is, the displacement of in-person social interactions (at individual and generational levels); interference with in-person social interactions (through excessive time spent on digital media and reduced quality of sleep); cyberbullying and other consequences (e.g., online behavioral disinhibition, online aggressive behaviors, comparisons with social models depicted in the media, etc.); the proliferation of misinformation or graphic content (e.g., mental health misinformation and war-related imagery); and self-harm behaviors and related information available online.[4]

A recent investigation underlined the importance of early identification for adolescents exhibiting problematic usage of technological devices and the internet, in particular those reporting significant levels of boredom and loneliness as predictors and mediators of psychopathological issues, specifically depressive and anxiety symptoms.[5] The problematic comparison with social models, as depicted by the media, is also a key associative factor between loneliness and social media.[6] Recurrently, adolescents may consider people on their social networks to be happier than themselves with more thrilling lifestyles. This could be due to a lack of authenticity in online identity profiles and may lead to a number of unrealistic expectations and friendships, together with unfavorable comparisons for adolescents.[6] The impact on personal health may be detrimental, specifically for body image, psychological well-being, and social interactions.[5,6]

Studies have found that “posting” personal images or status updates on social media leads to an increased sense of social support, as a number of virtual “friends” may “like” the posts and comment on them.[5,6] Although these responses could reflect the feedback from a supposed strong social support network, the absence of responses or reactions to the posts may also be misinterpreted as a lack of social approval with potentially negative effects on self-esteem.[7]

There is a general consensus that social networks provide a strong element of social connectedness and perceived support, even if these may be superficial or unrealistic—an old saying says “the more connected we are, the more lonely we can be.”[7] Equally, social media may provide a feeling of belonging to social virtual groups and enable adolescents to influence others or to be influenced by them; this could have a sizeable impact in terms of shared group behaviors or individual behaviors.[5,7] For example, in 2017, an alarming “suicide game” appeared on social media like Facebook, Twitter, and Instagram, called “Blue Whale Challenge.”[8] This game occurs over a period of 50 days and players are engaged and instructed step-by-step in order to perform increasingly risky self-harm behaviors until the point of death by suicide.[8] This was influenced by the behavior observed among whales, highly social animals that typically travel in herds, but may beach themselves, leaving the herd, until the point of death. Ultimately, this resulted in 157 online suicides among young players from different countries.[9]

Instagram has been classified as the most harmful social media application for youth mental health. In this regard, a survey involving more than 1,500 young adults showed that Instagram use was associated with subjective reports of anxiety and depression.[10] In particular, the number of “likes” received on a personal post, as well as the number of “views” of the “live stories” posted (i.e. the ratio between viewers and followers) may impact the self-esteem of youths and adolescents, alongside their perceived status and body-image.[11] Analogously, “Fear of Missing Out” (better known as FOMO) is becoming a prominent phenomenon, where individuals may feel guilty with others showing positive experiences online from which they are excluded. FOMO can impinge upon self-esteem and may increase personal levels of anxiety and depression among social media users.[12]

There is often greater exposure to misinformation on social media than individuals would otherwise experience. As has been previously highlighted during the CoronaVIrus Disease 19 (COVID-19) pandemic, misinformation, and so-called infodemics heightened mental distress.[13] Likewise, this has also been evident during ongoing geopolitical conflicts, where exposure to war-related imagery had correlations with mental distress and symptoms of posttraumatic stress disorder in a cohort of adolescents.[14] Recently, certain types of social media, especially TikTok, have emerged as vehicles for mental health dialogues, with “influencers” sharing their diagnoses (or self-diagnoses) and experiences with psychiatric conditions.[15] While this has improved openness toward mental health issues and awareness of symptoms, it has simultaneously caused a rise in misinformation, creating “copy-cat” effects and leading to the possible pathologization of otherwise normal behaviors.[16] Notably, research into the accuracy of autism information in 133 TikTok videos with over 198 million views found that 32% were overgeneralized and 41% contained inaccurate information.[17]

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