The internet generation (iGen) is the first cohort to have lived their entire adolescence in the age of the smart phone (those born between 1995-2012).
This generation is experiencing ever higher rates of loneliness, depression, anxiety and mental health issues in general (even before Covid), leading to questions about the potential contributory impact of smart phone and social media use.
The first version of Facebook (FaceMash) was started by Mark Zuckerberg in 2004 at Harvard University. Today there are 2.8 billion FB users worldwide, over 1.8 billion daily users.
According to the Pew Research Center, more than 70% of Americans use social media (SM) (up from 5% in 2005 and 50% in 2011). Most are daily users. Adolescents and young adults are the highest users.
SM plays a substantial role in the social and emotional lives and development of adolescents and young adults, with unknown implications. While there is an explosion of interest and research in this area, the data are, as yet, unclear. Conclusions are often contradictory. And influences on mental health outcomes are numerous, making it difficult to separate out aspects of SM use from other factors.
Science does tell us that social connection is one of the strongest contributors to overall health, including physical health, emotional health and longevity. This association seems to by mediated by a number of interconnected factors, such as hormone release (oxytocin and others), effects on inflammation and the immune system, and the “buffering” of stress. Chronic stress, involving stress hormones such as cortisol and adrenaline, can be toxic for the brain and body. According to the “buffering hypothesis,” social support can reduce the negative effects of stress on health and wellbeing. Having fewer human connections is associated with higher risk of heart attack, stroke, sleep disturbance, altered immune system, higher inflammation and stress hormones, and even cancer. Studies also show that perceived social support protects against stress-induced depression and anxiety.
In-person human-to-human social contact, eye contact and touch have many beneficial physiologic effects. Touch can reduce the experience of physical pain, lower stress hormone levels, and boost the immune system. In one study, people who received hugs tended to develop fewer illness symptoms when exposed to the common cold virus.
We don’t know if there is a difference in the magnitude or quality of health benefits depending upon whether the social connection is virtual vs. in-person.
Here are some examples of the conflicting research results regarding SM use and adolescent mental health (pre-Covid). We do know that exposure to the blue light of screens before bedtime can interfere with sleep. One 8-year study of adolescents (from age 13 to age 20) showed no relationship between time spent on SM and anxiety or depression. Multiple other studies of teens, however, have shown a relationship between exposure to media and low self-esteem, substance use, depression, loneliness, eating disorders, self-harm, and suicidal thoughts and behaviors. Directionality is unclear; maybe people who are anxious or depressed are more likely to use SM (for avoidance, to escape pressures, to connect to others, as a diversion, etc.).
There are many possible benefits of SM, depending on how it is used, how often, and what it might be replacing. In general, active use of SM (engaging with others) tends to be healthier than passive use (just scrolling through other people’s feeds). Some studies point to the benefits that can be derived from playing video games with others, including problem-solving and social connection. Online social networking and accessing communities of support (such as for LGBTQ youth) can play vital roles in gaining sense of belonging, learning information, connecting to resources, alleviating loneliness, and exploring identities.
Some of the negative aspects of extensive SM use (and overall time spent on-line) are well-described. Even before Covid, adolescent in-person communication has declined, while online communication has increased. Young people, in general, are more likely to experience discomfort making eye contact, making a phone call, maintaining an in-person conversation, and approaching an adult such as a teacher or advisor.
Adolescents may find themselves targets of harassing or abusive on-line behavior, including stalking, being overly monitored by a significant other, or being pressured to send sexual photos. Cyberbullying (both as victim and perpetrator) may be more psychologically damaging than in-person bullying, and can be a risk factor for suicidality. These days, bullying extends beyond the school day and into one’s home and bedroom; there is no escape or downtime on social media. Studies suggest that the more time spent online, the higher the risk of becoming a victim and/or perpetrator of cyberbullying.
Other SM risks include exposure to content that is harmful or inappropriate to age. This can include porn, pro-anorexia (“pro-ana”) sites, seeing disturbing content, and violence. “Copy behaviors” can follow, including anorexia, bulimia, and other forms of self-harm, such as cutting. Repeated exposure to graphic depictions of disturbing news events, such as videos of police violence or natural disasters, can be traumatizing.
Social media sites are platforms for carefully curated (and photoshopped and filtered) images. Even though people, on one level, are aware that these are not realistic (“FakeBook”), time spent on SM has been linked to low self-esteem and feelings of insecurity, as well as the development of disordered eating. Physical attractiveness (and thinness) is overvalued. FaceMash, the first version of Facebook, was a “hot-or-not” rating site of Harvard female students. If self-worth is highly linked to appearance, self-esteem and mood can be unstable and externally mediated, changing quickly based on the number of “likes” or positive comments one receives from photos posted to SM. Adolescents are especially sensitive to peer influences and are therefore more susceptible to these negative feelings.
The FOMO (fear of missing out) phenomenon is amplified by SM, as people post photos of all the fabulous parties they are attending, the people they are with, and vacation spots. “Social media envy” leads to feelings of sadness, self-doubt and anxiety as people compare their lives with what they are seeing on SM (“Facebook depression”).
“Addiction” (used colloquially here) to SM is another area of increasing concern. Addiction can be generally described as a repetitive behavior that some people may have difficulty controlling or stopping. It involves a compulsive quality, unsuccessful attempts to cut back, and ongoing use despite negative consequences. SM use can, in some cases, reach this level. It may replace other important activities, such as sleep or schoolwork. Smart phones and SM platforms are designed to be “addictive,” with frequent notifications and the speed of interactions, instilling fear of missing something if not checked frequently. A “like” or positive comment can trigger a dopamine release, and a craving for more of the same. The “rewards” of SM are unpredictable, as one is never sure which post will receive positive feedback; such “variable reward systems” (gambling is a good example) are especially likely to result in compulsive repetitive behavior. (Internet Gaming Disorder was added as a “condition for further study” to the most recent edition of the psychiatric diagnostic manual (DSM-5) in 2013.)
The “displacement hypothesis” describes another concern. Time spent on SM is time not spent doing other things, such as being physically active, sleeping a full night, being outdoors, socializing in-person, engaging in hobbies, and daydreaming. For optimal brain development, children and adolescents need to engage in a full range of activities (including substantial off-line time).
SM is a significant platform for disinformation, where one can’t tell real from fake (inaccurate statements, as well as doctored photos and videos). Inflammatory and false information often gets amplified because our brains are wired to react more strongly (and therefore read, share and “like”) to posts eliciting powerful emotions (such as anger) as opposed to measured and nuanced information. Because we are highly responsive to favorable social responses, such as “likes,” this becomes a positive feedback cycle, further distorting reality, intensifying negative emotions and increasing societal divisions. The basic human drive for belonging to an in-group of like-minded people is especially strong in adolescents; when certain opinions are shared repeatedly by one’s online community, it’s harder to maintain objective judgment.
For parents, you can engage your children in ongoing discussions about some of the benefits and pitfalls of their SM use. Familiarize yourself with what sites they are visiting and platforms they are using. Here are some signs to look out for, suggesting that their SM use might be of concern:
- SM use interferes with other aspects of life such as time spent with others, school, work etc.
- Difficulty reducing use. Finding it very difficult to put away their phone in order to fully engage in another activity for a period of time.
- Worsening depression or anxiety related to use. Comparing self unfavorably to others and feeling worse about self.
- Risky use (such as texting or checking phone while driving, sexting etc.).
We are in the midst of a SM wave that we do not fully understand. And the stakes are high for the health of our younger generations. It is reassuring to know that research on this topic is ongoing. In the meantime, while there is much we still do not fully understand about SM and mental health, the following recommendations are based on strong evidence:
- Move your body! Go outdoors.
- Limit screen time before bed, as it can interfere with sleep.
- SM is not an accurate source for news; seek out a variety of reputable news sources.
- Monitor for signs that SM use is having negative effects on mood or functioning.
- Parents: stay aware of children’s types and patterns of use (which sites). Intervene if needed.
- Engage in a variety of “off-line” activities and hobbies.
- Interact regularly with people in-person.
- Put away phones when driving!