In our final blog for Children’s Mental Health Week, Professor Neil Humphrey and Dr Margarita Panayiotou discuss mental health and social media.

• A causal link between young people’s use of digital technologies and their subsequent experience of mental health difficulties has not been proven.
• Social media can have both positive and negative effects on mental health.
• There are four steps we can take to learn more and empower young people to benefit from social media use.

We are in the midst of a societal moral panic. Concerns about the negative impact of so-called ‘screen time’ (including, but not limited to social media usage) on young people’s mental health and wellbeing abound. The Health Secretary, Matt Hancock, has called for new laws to ban under-13s from social media and instructed the Chief Medical Officer to draw up guidelines on daily time limits. Meanwhile, preventive action is already being taken, with a recent ‘digital detox’ campaign at DeMontfort University, and a Royal Society for Public Health ‘Scroll Free September’ campaign last year. Such actions assume a causal link between young people’s use of digital technologies and their subsequent experience of mental health difficulties. Indeed, Simon Stevens, the Head of the NHS, is quoted as saying that the health service has been left to pick up the pieces of a youth mental health crisis ‘fuelled’ by social media. However, this causal link is not proven. Far from it, in fact.

Media attention

There is an unhelpful conflation and confusion of ‘screen time’ and ‘social media usage’. Screen time includes social media usage, but also (for example) watching television, playing video games, browsing the internet, calling a friend via FaceTime or Skype, and so on. However, a recent ‘review of reviews’ found that the evidence base on the relationship between screen time and health outcomes is dominated by studies focusing on time spent watching television, of moderate or low quality, and in which screen time is largely self-reported. The latter issue is important because other research tells us that we are not good at estimating the amount of time spent engaging with our devices.

There are many social media platforms, each of which provides distinct user experiences and features that may have differential downstream consequences for mental health. Indeed, a recent study by the Royal Society for Public Health found differences in the perceived net impact of some of the most popular platforms on young people’s health and wellbeing. There is also a critical distinction between passive (eg simply scrolling through others’ posts) and active (eg communicating with other users and/or creating content) use of a given platform. Time well spent on social media may actually be beneficial for young people.

Much of the very recent media focus on this issue was sparked by the publication of a study where the authors found a significant association between hours spent using social media and symptoms of depression in a large sample of teenagers. As the study was cross-sectional, it is not clear whether young people using social media for longer were more likely to report depressive symptoms, or the other way around. Subsequent media coverage largely ignored this important limitation. It is also noteworthy that other evidence that calls this claimed link into question has received nowhere near as much media coverage. One study of more than 350,000 young people concluded that digital technology use accounted for just 0.4% of the variation in adolescents’ wellbeing. This association is of a similar magnitude to that of levels of potato consumption and mental health.

In addition to asking if use of social media impacts negatively on young people’s mental health, we also need to ask how and why this may be the case. There are a variety of possible mechanisms:

• Time spent on social media represents sedentary behaviour, which we already know is associated with a range of unfavourable health outcomes.
• Social media may expose young people to victimisation (so-called cyberbullying), which has been shown to have detrimental consequences for mental health.
• It may interfere with sleep hygiene, which is associated with mental health problems, including depression.
• Social media may promote ‘compare and despair’ behaviour.

Youth panic

This is the latest in a series of youth panics that stretches back over many generations. Before social media, the folk devil was violent video games, which we were told led to increased aggression in real life. Despite the evidence being equivocal, the video game controversy splutters on. Going back even further to the mid 1980s, it was so-called ‘video nasties’. It is no coincidence that most, if not all, moral panics that centre on young people involve the emergence of new media or technology. Young people are far more proficient at adapting to innovation. This can create a perception among older adults that they are losing control of the culture they helped shape.

It can be easy to overlook the benefits of social media. It has revolutionised the way in which young people form, maintain, and grow their social connections. Research shows that social media has also created new means through which they can become more involved in their communities (eg charitable or political activism), share new creative projects (eg online videos, podcasts and blogs), develop their identity, and collaborate on educational projects (eg a homework WhatsApp group). With specific reference to mental health, it has transformed how young people access information and support.

So, where do we go from here?

Social media is here to stay. What do we need to do in order to optimise its benefits and minimise the risk of potential negative effects?

1. More research is needed: Longitudinal and experimental studies that can help us to unpick what is undoubtedly a complex relationship between social media usage and mental health are desperately needed.
2. Increase digital awareness and resilience: We agree with the Children’s Commissioner and with 84% of young people that the development of a compulsory digital citizenship curriculum will help young people develop their digital literacy skills and help them become more “savvy” users. Instead of banning or censoring, we can increase young people’s awareness of the impact unrealistic comparisons can have on their mood. For instance, 68% of young people support social media highlighting when a photo has been manipulated.
3. Encourage self-regulation: Rather than imposing arbitrary time limits on social media usage (and screen time more generally), young people should be encouraged and enabled to regulate their own behaviour as part of a broader strategy to promote balance in terms of how they spend their time.
4. Capitalise on the potential of social media to support and promote young people’s mental health: For example, the same algorithmic technology that is used to push particular advertisements based on our search histories could be used to discretely signpost young people to sources of support when they search for particular content (eg suicide, self-harm).

“We need to teach children how to cope with all aspects of social media – good and bad – to prepare them for an increasingly digitised world. There is real danger in blaming the medium for the message.” Professor Simon Wessely, former President of the Royal College of Psychiatrists.