Social Media and Mental Health

Social media divides opinion. For some it is the scourge of modern life, destroying our children’s attention, their ability to socialise, and their mental health, and yet for others it is a lifeline, connecting young people, teaching them new skills and allowing them to celebrate each other across miles and years.

Just as it divides public opinion it divides researchers. Some find that it is a negative influence, especially on young people. Other researchers find that it has positive effects, with others highlighting that both can be simultaneously true. The risk of researchers being split in their opinion is that it can lead to poor science. The field is beset with causal conclusions being drawn from correlational studies, claims of cherry picking results (p-hacking), and invalid or unreliable methods for assessing aspects of social media use.

The need for good research has never been more pressing. Our children are digital natives, having grown up with social media, smartphones, and smart devices, but we adults seem to be struggling to catch up with how to talk about and manage cyber-bullying, online algorithms for content, and addiction. We see this in the tragic stories of young people like Molly Russell and Nicole Fox. Both Molly and Nicole died by self-harm and suicide. The coroner in the case of Molly Russell concluded that social media, and in particular that the algorithms that social media platforms use resulted in Molly being bombarded with content about self-harm and suicide at a time when she was already vulnerable due to depression. He concluded that this contributed “more than minimally” to her death and that the social media sites need to take action so this cannot happen. In Ireland, Coco’s law was enacted in 2021 following the death of Nicole ‘Coco’ Fox following online bullying. Following a long campaign by her mother, Jackie, sharing of intimate images became a form of sexual abuse with prosecutions following the enactment of the law.

These examples remind us why we need to truly understand the social media world, but the positive aspects of social media are never going to make it into news stories. The time is ripe for balanced conversations about the influence of social media on young people, in the general public, amongst researchers and perhaps most importantly for policy and law makers. We have to own our biases and look to the best science to help us better understand the nuances of how social media is influencing our young people today. Only by doing this can we mitigate the risks and enhance the benefits. Social media is here to stay, now we need to know truly what impact it has on us.

By bringing together this special issue we hope to highlight some of the key clinical questions about social media that practitioners working with children may be thinking about and dealing with. The special issue starts with a large review of the negative impact of ICTS on young people, concluding that there are two major concerns in the literature; addiction and negative online behaviours/content. There are two papers on addiction and two on these negative online behaviours and content. We follow with six papers on key issues for clinicians working with young people, before concluding with the adolescent perspective including a review and a large focus group qualitative study.

The diversity of methods allow us to triangulate our understanding of the role of social media and to highlight a research agenda going forward.

Our first paper in this special edition is a scoping review. Messena and Everri have synthesised 129 studies of children’s use of digital technologies. Their focus is on negative use as they acknowledge that even the definitions of this are lacking. The fact that they found this number of papers within a 3 year period speaks to the proliferation of this research in recent years. Two areas appear to be crucial in this literature; addiction or excessive use, and negative online behaviours or experiences. Therefore the next sections are papers on these topics. Zhou and colleagues focus on adolescent psychiatric inpatients to study internet addiction in China. They find high levels of excessive internet use consistent with addiction, with up to 25% meeting criteria for medium to severe internet addiction. However, although the presentations of young people with and without addiction were largely similar, there were some notable differences that warrant further exploration. In a large three-wave study in Brazil, Tavares and colleagues explore screen time and gaming during the Covid-19 pandemic. As well as time-related increases in screen time and gaming, as reported by parents, the authors find very interesting correlations between these that are perhaps surprising.

Two papers directly explore negative online behaviours and experiences. Relational victimization is described as exposure to behaviours aimed at damaging relationships or one’s social reputation, such as exclusion, manipulation, and rumour spreading and can be a particularly prevalent form of cyberbullying. In the paper by McField, Lawrence and Okoli, path analysis is used on one wave of data from the longitudinal Illinois Study of Bullying and Sexual Violence to look at whether relational victimization, cyberbullying and family support are associated with depressive symptoms and substance use among adolescents. A different risk is studied by Moroney and colleagues. Adolescents in high achieving schools have been found to exhibit elevated mental health problems relative to national norms and this reflects risk factors such as achievement and social pressure. Given the association between digital media use and mental health issues in adolescents, Moroney and colleagues considered the role of digital media use in mental health problems among adolescents in high achieving schools. They examined the concurrent association of digital media use with self-reported negative mental health symptoms among a large sample (n = 2,952) of adolescents from three high achieving U.S. schools, its mediation through specific online behaviours, and potential gender differences. In particular, they looked at frequency of digital media use as a mediator of internalising problems, externalising problems and substance abuse with interesting results.

The next set of papers focus on clinical issues in the online world. Awareness of possible digital risks is crucial in order for clinicians to provide full assessments for young people. Lau-Zhu, Anderson and Lister’s explore this by combining a survey with focus groups to explore what digital risks clinicians are aware of. Fifty-three clinicians ranked their concerns as well as their perception of what young people and their parents were concerned by, and then 12 of these took part in focus groups to fully understand the concerns. This paper highlights some key factors in the assessment of these digital risks in clinical practice. The next paper by xxx also looks at the assessment of digital risks in clinical practice and offers a series of questions clinicians can use to explore technology use among children and young people. The authors also argue the need for greater longitudinal research and the need for a standardised tool which assimilates young people’s use of technology with their vulnerabilities and resilience to online risk. The next two papers highlight positive and negative aspects of the same social media platform – namely TikTok. Giedinghagen discusses the role of TikTok in Mass Psychogenic Illness, proposing an overarching construct that does not require distinguishing between factitious symptoms and functional symptoms. McCashin and Murphy take an alternative approach combining a literature search for health-related TikTok research with a search of TikTok itself, focusing on an Irish context to find out who the creators of content are and how it is being used to promote health. Much of the current research focusing on TikTok appears to take a content analysis approach and the authors argue that currently the platform is being under-utilised by health-promoting institutions. The final two papers in this section highlight intervention. Mahon and Hevey present a randomised controlled trial focusing on addressing body concerns related to social media use. Body dissatisfaction is prevalent among adolescents and is associated with social media use, particularly with regard to engaging in appearance-related behaviours, such as viewing or posting appearance-related content. Mahon and Hevey evaluate a self-compassion intervention adapted to address social media-related body image concerns in adolescents using a mixed methods design. 80 adolescents were quantitatively assessed at pre-intervention, post-intervention and 3-month follow-up on measures of self-compassion, self-criticism, social media comparisons and body image perceptions, while postintervention focus groups explored adolescents’ responses to the intervention.

What apps are out for children of parents with mental illness – to include if included in the special issue

We finish this special issue with perhaps the most important perspectives – those of the young people themselves. Popat and Tarrant synthesise the existing qualitative literature on adolescents’ perspectives on social media. Papers published between 2014 and 2020, excluding those collecting data during the Covid-19 pandemic were found and synthesised. Twenty-four papers met the inclusion criteria and the authors find both positive and negative perspectives on social media in their development of themes. The negative themes largely reflect those covered in the special issue, including appearance comparisons and body ideals, exposure to bullying and harmful content and pressure to stay connected. The positive themes however, present the complementary perspective. This positive perspective is then demonstrated by O’Reilly and colleagues who interview 54 adolescents in six focus groups on their perspectives on the links between social media and mental health. For this paper they choose to focus on positive aspects of these links and illustrate how clearly young people can highlight these positive roles of social media in protecting and promoting good mental health.