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Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

• Published: 20 April 2020
• Volume 5 , pages 245–257, ( 2020 )

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• John A. Naslund 1 ,
• Ameya Bondre 2 ,
• John Torous 3 &
• Kelly A. Aschbrenner 4  

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Introduction

Social media has become a prominent fixture in the lives of many individuals facing the challenges of mental illness. Social media refers broadly to web and mobile platforms that allow individuals to connect with others within a virtual network (such as Facebook, Twitter, Instagram, Snapchat, or LinkedIn), where they can share, co-create, or exchange various forms of digital content, including information, messages, photos, or videos (Ahmed et al. 2019 ). Studies have reported that individuals living with a range of mental disorders, including depression, psychotic disorders, or other severe mental illnesses, use social media platforms at comparable rates as the general population, with use ranging from about 70% among middle-age and older individuals to upwards of 97% among younger individuals (Aschbrenner et al. 2018b ; Birnbaum et al. 2017b ; Brunette et al. 2019 ; Naslund et al. 2016 ). Other exploratory studies have found that many of these individuals with mental illness appear to turn to social media to share their personal experiences, seek information about their mental health and treatment options, and give and receive support from others facing similar mental health challenges (Bucci et al. 2019 ; Naslund et al. 2016b ).

Across the USA and globally, very few people living with mental illness have access to adequate mental health services (Patel et al. 2018 ). The wide reach and near ubiquitous use of social media platforms may afford novel opportunities to address these shortfalls in existing mental health care, by enhancing the quality, availability, and reach of services. Recent studies have explored patterns of social media use, impact of social media use on mental health and wellbeing, and the potential to leverage the popularity and interactive features of social media to enhance the delivery of interventions. However, there remains uncertainty regarding the risks and potential harms of social media for mental health (Orben and Przybylski 2019 ) and how best to weigh these concerns against potential benefits.

In this commentary, we summarized current research on the use of social media among individuals with mental illness, with consideration of the impact of social media on mental wellbeing, as well as early efforts using social media for delivery of evidence-based programs for addressing mental health problems. We searched for recent peer reviewed publications in Medline and Google Scholar using the search terms “mental health” or “mental illness” and “social media,” and searched the reference lists of recent reviews and other relevant studies. We reviewed the risks, potential harms, and necessary safety precautions with using social media for mental health. Overall, our goal was to consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services, while balancing the need for safety. Given this broad objective, we did not perform a systematic search of the literature and we did not apply specific inclusion criteria based on study design or type of mental disorder.

Social Media Use and Mental Health

In 2020, there are an estimated 3.8 billion social media users worldwide, representing half the global population (We Are Social 2020 ). Recent studies have shown that individuals with mental disorders are increasingly gaining access to and using mobile devices, such as smartphones (Firth et al. 2015 ; Glick et al. 2016 ; Torous et al. 2014a , b ). Similarly, there is mounting evidence showing high rates of social media use among individuals with mental disorders, including studies looking at engagement with these popular platforms across diverse settings and disorder types. Initial studies from 2015 found that nearly half of a sample of psychiatric patients were social media users, with greater use among younger individuals (Trefflich et al. 2015 ), while 47% of inpatients and outpatients with schizophrenia reported using social media, of which 79% reported at least once-a-week usage of social media websites (Miller et al. 2015 ). Rates of social media use among psychiatric populations have increased in recent years, as reflected in a study with data from 2017 showing comparable rates of social media use (approximately 70%) among individuals with serious mental illness in treatment as compared with low-income groups from the general population (Brunette et al. 2019 ).

Similarly, among individuals with serious mental illness receiving community-based mental health services, a recent study found equivalent rates of social media use as the general population, even exceeding 70% of participants (Naslund et al. 2016 ). Comparable findings were demonstrated among middle-age and older individuals with mental illness accessing services at peer support agencies, where 72% of respondents reported using social media (Aschbrenner et al. 2018b ). Similar results, with 68% of those with first episode psychosis using social media daily were reported in another study (Abdel-Baki et al. 2017 ).

Individuals who self-identified as having a schizophrenia spectrum disorder responded to a survey shared through the National Alliance of Mental Illness (NAMI) and reported that visiting social media sites was one of their most common activities when using digital devices, taking up roughly 2 h each day (Gay et al. 2016 ). For adolescents and young adults ages 12 to 21 with psychotic disorders and mood disorders, over 97% reported using social media, with average use exceeding 2.5 h per day (Birnbaum et al. 2017b ). Similarly, in a sample of adolescents ages 13–18 recruited from community mental health centers, 98% reported using social media, with YouTube as the most popular platform, followed by Instagram and Snapchat (Aschbrenner et al. 2019 ).

Research has also explored the motivations for using social media as well as the perceived benefits of interacting on these platforms among individuals with mental illness. In the sections that follow (see Table 1 for a summary), we consider three potentially unique features of interacting and connecting with others on social media that may offer benefits for individuals living with mental illness. These include: (1) Facilitate social interaction; (2) Access to a peer support network; and (3) Promote engagement and retention in services.

Facilitate Social Interaction

Social media platforms offer near continuous opportunities to connect and interact with others, regardless of time of day or geographic location. This on demand ease of communication may be especially important for facilitating social interaction among individuals with mental disorders experiencing difficulties interacting in face-to-face settings. For example, impaired social functioning is a common deficit in schizophrenia spectrum disorders, and social media may facilitate communication and interacting with others for these individuals (Torous and Keshavan 2016 ). This was suggested in one study where participants with schizophrenia indicated that social media helped them to interact and socialize more easily (Miller et al. 2015 ). Like other online communication, the ability to connect with others anonymously may be an important feature of social media, especially for individuals living with highly stigmatizing health conditions (Berger et al. 2005 ), such as serious mental disorders (Highton-Williamson et al. 2015 ).

Studies have found that individuals with serious mental disorders (Spinzy et al. 2012 ) as well as young adults with mental illness (Gowen et al. 2012 ) appear to form online relationships and connect with others on social media as often as social media users from the general population. This is an important observation because individuals living with serious mental disorders typically have few social contacts in the offline world and also experience high rates of loneliness (Badcock et al. 2015 ; Giacco et al. 2016 ). Among individuals receiving publicly funded mental health services who use social media, nearly half (47%) reported using these platforms at least weekly to feel less alone (Brusilovskiy et al. 2016 ). In another study of young adults with serious mental illness, most indicated that they used social media to help feel less isolated (Gowen et al. 2012 ). Interestingly, more frequent use of social media among a sample of individuals with serious mental illness was associated with greater community participation, measured as participation in shopping, work, religious activities, or visiting friends and family, as well as greater civic engagement, reflected as voting in local elections (Brusilovskiy et al. 2016 ).

Emerging research also shows that young people with moderate to severe depressive symptoms appear to prefer communicating on social media rather than in-person (Rideout and Fox 2018 ), while other studies have found that some individuals may prefer to seek help for mental health concerns online rather than through in-person encounters (Batterham and Calear 2017 ). In a qualitative study, participants with schizophrenia described greater anonymity, the ability to discover that other people have experienced similar health challenges and reducing fears through greater access to information as important motivations for using the Internet to seek mental health information (Schrank et al. 2010 ). Because social media does not require the immediate responses necessary in face-to-face communication, it may overcome deficits with social interaction due to psychotic symptoms that typically adversely affect face-to-face conversations (Docherty et al. 1996 ). Online social interactions may not require the use of non-verbal cues, particularly in the initial stages of interaction (Kiesler et al. 1984 ), with interactions being more fluid and within the control of users, thereby overcoming possible social anxieties linked to in-person interaction (Indian and Grieve 2014 ). Furthermore, many individuals with serious mental disorders can experience symptoms including passive social withdrawal, blunted affect, and attentional impairment, as well as active social avoidance due to hallucinations or other concerns (Hansen et al. 2009 ), thus potentially reinforcing the relative advantage, as perceived by users, of using social media over in person conversations.

Access to a Peer Support Network

There is growing recognition about the role that social media channels could play in enabling peer support (Bucci et al. 2019 ; Naslund et al. 2016b ), referred to as a system of mutual giving and receiving where individuals who have endured the difficulties of mental illness can offer hope, friendship, and support to others facing similar challenges (Davidson et al. 2006 ; Mead et al. 2001 ). Initial studies exploring use of online self-help forums among individuals with serious mental illnesses have found that individuals with schizophrenia appeared to use these forums for self-disclosure and sharing personal experiences, in addition to providing or requesting information, describing symptoms, or discussing medication (Haker et al. 2005 ), while users with bipolar disorder reported using these forums to ask for help from others about their illness (Vayreda and Antaki 2009 ). More recently, in a review of online social networking in people with psychosis, Highton-Williamson et al. ( 2015 ) highlight that an important purpose of such online connections was to establish new friendships, pursue romantic relationships, maintain existing relationships or reconnect with people, and seek online peer support from others with lived experience (Highton-Williamson et al. 2015 ).

Online peer support among individuals with mental illness has been further elaborated in various studies. In a content analysis of comments posted to YouTube by individuals who self-identified as having a serious mental illness, there appeared to be opportunities to feel less alone, provide hope, find support and learn through mutual reciprocity, and share coping strategies for day-to-day challenges of living with a mental illness (Naslund et al. 2014 ). In another study, Chang ( 2009 ) delineated various communication patterns in an online psychosis peer-support group (Chang 2009 ). Specifically, different forms of support emerged, including “informational support” about medication use or contacting mental health providers, “esteem support” involving positive comments for encouragement, “network support” for sharing similar experiences, and “emotional support” to express understanding of a peer’s situation and offer hope or confidence (Chang 2009 ). Bauer et al. ( 2013 ) reported that the main interest in online self-help forums for patients with bipolar disorder was to share emotions with others, allow exchange of information, and benefit by being part of an online social group (Bauer et al. 2013 ).

For individuals who openly discuss mental health problems on Twitter, a study by Berry et al. ( 2017 ) found that this served as an important opportunity to seek support and to hear about the experiences of others (Berry et al. 2017 ). In a survey of social media users with mental illness, respondents reported that sharing personal experiences about living with mental illness and opportunities to learn about strategies for coping with mental illness from others were important reasons for using social media (Naslund et al. 2017 ). A computational study of mental health awareness campaigns on Twitter provides further support with inspirational posts and tips being the most shared (Saha et al. 2019 ). Taken together, these studies offer insights about the potential for social media to facilitate access to an informal peer support network, though more research is necessary to examine how these online interactions may impact intentions to seek care, illness self-management, and clinically meaningful outcomes in offline contexts.

Promote Engagement and Retention in Services

Many individuals living with mental disorders have expressed interest in using social media platforms for seeking mental health information (Lal et al. 2018 ), connecting with mental health providers (Birnbaum et al. 2017b ), and accessing evidence-based mental health services delivered over social media specifically for coping with mental health symptoms or for promoting overall health and wellbeing (Naslund et al. 2017 ). With the widespread use of social media among individuals living with mental illness combined with the potential to facilitate social interaction and connect with supportive peers, as summarized above, it may be possible to leverage the popular features of social media to enhance existing mental health programs and services. A recent review by Biagianti et al. ( 2018 ) found that peer-to-peer support appeared to offer feasible and acceptable ways to augment digital mental health interventions for individuals with psychotic disorders by specifically improving engagement, compliance, and adherence to the interventions and may also improve perceived social support (Biagianti et al. 2018 ).

Among digital programs that have incorporated peer-to-peer social networking consistent with popular features on social media platforms, a pilot study of the HORYZONS online psychosocial intervention demonstrated significant reductions in depression among patients with first episode psychosis (Alvarez-Jimenez et al. 2013 ). Importantly, the majority of participants (95%) in this study engaged with the peer-to-peer networking feature of the program, with many reporting increases in perceived social connectedness and empowerment in their recovery process (Alvarez-Jimenez et al. 2013 ). This moderated online social therapy program is now being evaluated as part of a large randomized controlled trial for maintaining treatment effects from first episode psychosis services (Alvarez-Jimenez et al. 2019 ).

Other early efforts have demonstrated that use of digital environments with the interactive peer-to-peer features of social media can enhance social functioning and wellbeing in young people at high risk of psychosis (Alvarez-Jimenez et al. 2018 ). There has also been a recent emergence of several mobile apps to support symptom monitoring and relapse prevention in psychotic disorders. Among these apps, the development of PRIME (Personalized Real-time Intervention for Motivational Enhancement) has involved working closely with young people with schizophrenia to ensure that the design of the app has the look and feel of mainstream social media platforms, as opposed to existing clinical tools (Schlosser et al. 2016 ). This unique approach to the design of the app is aimed at promoting engagement and ensuring that the app can effectively improve motivation and functioning through goal setting and promoting better quality of life of users with schizophrenia (Schlosser et al. 2018 ).

Social media platforms could also be used to promote engagement and participation in in-person services delivered through community mental health settings. For example, the peer-based lifestyle intervention called PeerFIT targets weight loss and improved fitness among individuals living with serious mental illness through a combination of in-person lifestyle classes, exercise groups, and use of digital technologies (Aschbrenner et al. 2016b , c ). The intervention holds tremendous promise as lack of support is one of the largest barriers towards exercise in patients with serious mental illness (Firth et al. 2016 ), and it is now possible to use social media to counter such. Specifically, in PeerFIT, a private Facebook group is closely integrated into the program to offer a closed platform where participants can connect with the lifestyle coaches, access intervention content, and support or encourage each other as they work towards their lifestyle goals (Aschbrenner et al. 2016a ; Naslund et al. 2016a ). To date, this program has demonstrated preliminary effectiveness for meaningfully reducing cardiovascular risk factors that contribute to early mortality in this patient group (Aschbrenner, Naslund, Shevenell, Kinney, et al., 2016), while the Facebook component appears to have increased engagement in the program, while allowing participants who were unable to attend in-person sessions due to other health concerns or competing demands to remain connected with the program (Naslund et al. 2018 ). This lifestyle intervention is currently being evaluated in a randomized controlled trial enrolling young adults with serious mental illness from real world community mental health services settings (Aschbrenner et al. 2018a ).

These examples highlight the promise of incorporating the features of popular social media into existing programs, which may offer opportunities to safely promote engagement and program retention, while achieving improved clinical outcomes. This is an emerging area of research, as evidenced by several important effectiveness trials underway (Alvarez-Jimenez et al. 2019 ; Aschbrenner et al. 2018a ), including efforts to leverage online social networking to support family caregivers of individuals receiving first episode psychosis services (Gleeson et al. 2017 ).

Challenges with Social Media for Mental Health

The science on the role of social media for engaging persons with mental disorders needs a cautionary note on the effects of social media usage on mental health and wellbeing, particularly in adolescents and young adults. While the risks and harms of social media are frequently covered in the popular press and mainstream news reports, careful consideration of the research in this area is necessary. In a review of 43 studies in young people, many benefits of social media were cited, including increased self-esteem and opportunities for self-disclosure (Best et al. 2014 ). Yet, reported negative effects were an increased exposure to harm, social isolation, depressive symptoms, and bullying (Best et al. 2014 ). In the sections that follow (see Table 1 for a summary), we consider three major categories of risk related to use of social media and mental health. These include: (1) Impact on symptoms; (2) Facing hostile interactions; and (3) Consequences for daily life.

Impact on Symptoms

Studies consistently highlight that use of social media, especially heavy use and prolonged time spent on social media platforms, appears to contribute to increased risk for a variety of mental health symptoms and poor wellbeing, especially among young people (Andreassen et al. 2016 ; Kross et al. 2013 ; Woods and Scott 2016 ). This may partly be driven by the detrimental effects of screen time on mental health, including increased severity of anxiety and depressive symptoms, which have been well documented (Stiglic and Viner 2019 ). Recent studies have reported negative effects of social media use on mental health of young people, including social comparison pressure with others and greater feeling of social isolation after being rejected by others on social media (Rideout and Fox 2018 ). In a study of young adults, it was found that negative comparisons with others on Facebook contributed to risk of rumination and subsequent increases in depression symptoms (Feinstein et al. 2013 ). Still, the cross-sectional nature of many screen time and mental health studies makes it challenging to reach causal inferences (Orben and Przybylski 2019 ).

Quantity of social media use is also an important factor, as highlighted in a survey of young adults ages 19 to 32, where more frequent visits to social media platforms each week were correlated with greater depressive symptoms (Lin et al. 2016 ). More time spent using social media is also associated with greater symptoms of anxiety (Vannucci et al. 2017 ). The actual number of platforms accessed also appears to contribute to risk as reflected in another national survey of young adults where use of a large number of social media platforms was associated with negative impact on mental health (Primack et al. 2017 ). Among survey respondents using between 7 and 11 different social media platforms compared with respondents using only 2 or fewer platforms, there were 3 times greater odds of having high levels of depressive symptoms and a 3.2 times greater odds of having high levels of anxiety symptoms (Primack et al. 2017 ).

Many researchers have postulated that worsening mental health attributed to social media use may be because social media replaces face-to-face interactions for young people (Twenge and Campbell 2018 ) and may contribute to greater loneliness (Bucci et al. 2019 ) and negative effects on other aspects of health and wellbeing (Woods and Scott 2016 ). One nationally representative survey of US adolescents found that among respondents who reported more time accessing media such as social media platforms or smartphone devices, there were significantly greater depressive symptoms and increased risk of suicide when compared with adolescents who reported spending more time on non-screen activities, such as in-person social interaction or sports and recreation activities (Twenge et al. 2018 ). For individuals living with more severe mental illnesses, the effects of social media on psychiatric symptoms have received less attention. One study found that participation in chat rooms may contribute to worsening symptoms in young people with psychotic disorders (Mittal et al. 2007 ), while another study of patients with psychosis found that social media use appeared to predict low mood (Berry et al. 2018 ). These studies highlight a clear relationship between social media use and mental health that may not be present in general population studies (Orben and Przybylski 2019 ) and emphasize the need to explore how social media may contribute to symptom severity and whether protective factors may be identified to mitigate these risks.

Facing Hostile Interactions

Popular social media platforms can create potential situations where individuals may be victimized by negative comments or posts. Cyberbullying represents a form of online aggression directed towards specific individuals, such as peers or acquaintances, which is perceived to be most harmful when compared with random hostile comments posted online (Hamm et al. 2015 ). Importantly, cyberbullying on social media consistently shows harmful impact on mental health in the form of increased depressive symptoms as well as worsening of anxiety symptoms, as evidenced in a review of 36 studies among children and young people (Hamm et al. 2015 ). Furthermore, cyberbullying disproportionately impacts females as reflected in a national survey of adolescents in the USA, where females were twice as likely to be victims of cyberbullying compared with males (Alhajji et al. 2019 ). Most studies report cross-sectional associations between cyberbullying and symptoms of depression or anxiety (Hamm et al. 2015 ), though one longitudinal study in Switzerland found that cyberbullying contributed to significantly greater depression over time (Machmutow et al. 2012 ).

For youth ages 10 to 17 who reported major depressive symptomatology, there were over 3 times greater odds of facing online harassment in the last year compared with youth who reported mild or no depressive symptoms (Ybarra 2004 ). Similarly, in a 2018 national survey of young people, respondents ages 14 to 22 with moderate to severe depressive symptoms were more likely to have had negative experiences when using social media and, in particular, were more likely to report having faced hostile comments or being “trolled” from others when compared with respondents without depressive symptoms (31% vs. 14%) (Rideout and Fox 2018 ). As these studies depict risks for victimization on social media and the correlation with poor mental health, it is possible that individuals living with mental illness may also experience greater hostility online compared to individuals without mental illness. This would be consistent with research showing greater risk of hostility, including increased violence and discrimination, directed towards individuals living with mental illness in in-person contexts, especially targeted at those with severe mental illnesses (Goodman et al. 1999 ).

A computational study of mental health awareness campaigns on Twitter reported that while stigmatizing content was rare, it was actually the most spread (re-tweeted) demonstrating that harmful content can travel quickly on social media (Saha et al. 2019 ). Another study was able to map the spread of social media posts about the Blue Whale Challenge, an alleged game promoting suicide, over Twitter, YouTube, Reddit, Tumblr, and other forums across 127 countries (Sumner et al. 2019 ). These findings show that it is critical to monitor the actual content of social media posts, such as determining whether content is hostile or promotes harm to self or others. This is pertinent because existing research looking at duration of exposure cannot account for the impact of specific types of content on mental health and is insufficient to fully understand the effects of using these platforms on mental health.

Consequences for Daily Life

The ways in which individuals use social media can also impact their offline relationships and everyday activities. To date, reports have described risks of social media use pertaining to privacy, confidentiality, and unintended consequences of disclosing personal health information online (Torous and Keshavan 2016 ). Additionally, concerns have been raised about poor quality or misleading health information shared on social media and that social media users may not be aware of misleading information or conflicts of interest especially when the platforms promote popular content regardless of whether it is from a trustworthy source (Moorhead et al. 2013 ; Ventola 2014 ). For persons living with mental illness, there may be additional risks from using social media. A recent study that specifically explored the perspectives of social media users with serious mental illnesses, including participants with schizophrenia spectrum disorders, bipolar disorder, or major depression, found that over one third of participants expressed concerns about privacy when using social media (Naslund and Aschbrenner 2019 ). The reported risks of social media use were directly related to many aspects of everyday life, including concerns about threats to employment, fear of stigma and being judged, impact on personal relationships, and facing hostility or being hurt (Naslund and Aschbrenner 2019 ). While few studies have specifically explored the dangers of social media use from the perspectives of individuals living with mental illness, it is important to recognize that use of these platforms may contribute to risks that extend beyond worsening symptoms and that can affect different aspects of daily life.

In this commentary, we considered ways in which social media may yield benefits for individuals living with mental illness, while contrasting these with the possible harms. Studies reporting on the threats of social media for individuals with mental illness are mostly cross-sectional, making it difficult to draw conclusions about direction of causation. However, the risks are potentially serious. These risks should be carefully considered in discussions pertaining to use of social media and the broader use of digital mental health technologies, as avenues for mental health promotion or for supporting access to evidence-based programs or mental health services. At this point, it would be premature to view the benefits of social media as outweighing the possible harms, when it is clear from the studies summarized here that social media use can have negative effects on mental health symptoms, can potentially expose individuals to hurtful content and hostile interactions, and can result in serious consequences for daily life, including threats to employment and personal relationships. Despite these risks, it is also necessary to recognize that individuals with mental illness will continue to use social media given the ease of accessing these platforms and the immense popularity of online social networking. With this in mind, it may be ideal to raise awareness about these possible risks so that individuals can implement necessary safeguards, while highlighting that there could also be benefits. Being aware of the risks is an essential first step, before then recognizing that use of these popular platforms could contribute to some benefits like finding meaningful interactions with others, engaging with peer support networks, and accessing information and services.

To capitalize on the widespread use of social media and to achieve the promise that these platforms may hold for supporting the delivery of targeted mental health interventions, there is need for continued research to better understand how individuals living with mental illness use social media. Such efforts could inform safety measures and also encourage use of social media in ways that maximize potential benefits while minimizing risk of harm. It will be important to recognize how gender and race contribute to differences in use of social media for seeking mental health information or accessing interventions, as well as differences in how social media might impact mental wellbeing. For example, a national survey of 14- to 22-year olds in the USA found that female respondents were more likely to search online for information about depression or anxiety and to try to connect with other people online who share similar mental health concerns when compared with male respondents (Rideout and Fox 2018 ). In the same survey, there did not appear to be any differences between racial or ethnic groups in social media use for seeking mental health information (Rideout and Fox 2018 ). Social media use also appears to have a differential impact on mental health and emotional wellbeing between females and males (Booker et al. 2018 ), highlighting the need to explore unique experiences between gender groups to inform tailored programs and services. Research shows that lesbian, gay, bisexual, or transgender individuals frequently use social media for searching for health information and may be more likely compared with heterosexual individuals to share their own personal health experiences with others online (Rideout and Fox 2018 ). Less is known about use of social media for seeking support for mental health concerns among gender minorities, though this is an important area for further investigation as these individuals are more likely to experience mental health problems and online victimization when compared with heterosexual individuals (Mereish et al. 2019 ).

Similarly, efforts are needed to explore the relationship between social media use and mental health among ethnic and racial minorities. A recent study found that exposure to traumatic online content on social media showing violence or hateful posts directed at racial minorities contributed to increases in psychological distress, PTSD symptoms, and depression among African American and Latinx adolescents in the USA (Tynes et al. 2019 ). These concerns are contrasted by growing interest in the potential for new technologies including social media to expand the reach of services to underrepresented minority groups (Schueller et al. 2019 ). Therefore, greater attention is needed to understanding the perspectives of ethnic and racial minorities to inform effective and safe use of social media for mental health promotion efforts.

Research has found that individuals living with mental illness have expressed interest in accessing mental health services through social media platforms. A survey of social media users with mental illness found that most respondents were interested in accessing programs for mental health on social media targeting symptom management, health promotion, and support for communicating with health care providers and interacting with the health system (Naslund et al. 2017 ). Importantly, individuals with serious mental illness have also emphasized that any mental health intervention on social media would need to be moderated by someone with adequate training and credentials, would need to have ground rules and ways to promote safety and minimize risks, and importantly, would need to be free and easy to access.

An important strength with this commentary is that it combines a range of studies broadly covering the topic of social media and mental health. We have provided a summary of recent evidence in a rapidly advancing field with the goal of presenting unique ways that social media could offer benefits for individuals with mental illness, while also acknowledging the potentially serious risks and the need for further investigation. There are also several limitations with this commentary that warrant consideration. Importantly, as we aimed to address this broad objective, we did not conduct a systematic review of the literature. Therefore, the studies reported here are not exhaustive, and there may be additional relevant studies that were not included. Additionally, we only summarized published studies, and as a result, any reports from the private sector or websites from different organizations using social media or other apps containing social media–like features would have been omitted. Although, it is difficult to rigorously summarize work from the private sector, sometimes referred to as “gray literature,” because many of these projects are unpublished and are likely selective in their reporting of findings given the target audience may be shareholders or consumers.

Another notable limitation is that we did not assess risk of bias in the studies summarized in this commentary. We found many studies that highlighted risks associated with social media use for individuals living with mental illness; however, few studies of programs or interventions reported negative findings, suggesting the possibility that negative findings may go unpublished. This concern highlights the need for a future more rigorous review of the literature with careful consideration of bias and an accompanying quality assessment. Most of the studies that we described were from the USA, as well as from other higher income settings such as Australia or the UK. Despite the global reach of social media platforms, there is a dearth of research on the impact of these platforms on the mental health of individuals in diverse settings, as well as the ways in which social media could support mental health services in lower income countries where there is virtually no access to mental health providers. Future research is necessary to explore the opportunities and risks for social media to support mental health promotion in low-income and middle-income countries, especially as these countries face a disproportionate share of the global burden of mental disorders, yet account for the majority of social media users worldwide (Naslund et al. 2019 ).

Future Directions for Social Media and Mental Health

As we consider future research directions, the near ubiquitous social media use also yields new opportunities to study the onset and manifestation of mental health symptoms and illness severity earlier than traditional clinical assessments. There is an emerging field of research referred to as “digital phenotyping” aimed at capturing how individuals interact with their digital devices, including social media platforms, in order to study patterns of illness and identify optimal time points for intervention (Jain et al. 2015 ; Onnela and Rauch 2016 ). Given that most people access social media via mobile devices, digital phenotyping and social media are closely related (Torous et al. 2019 ). To date, the emergence of machine learning, a powerful computational method involving statistical and mathematical algorithms (Shatte et al. 2019 ), has made it possible to study large quantities of data captured from popular social media platforms such as Twitter or Instagram to illuminate various features of mental health (Manikonda and De Choudhury 2017 ; Reece et al. 2017 ). Specifically, conversations on Twitter have been analyzed to characterize the onset of depression (De Choudhury et al. 2013 ) as well as detecting users’ mood and affective states (De Choudhury et al. 2012 ), while photos posted to Instagram can yield insights for predicting depression (Reece and Danforth 2017 ). The intersection of social media and digital phenotyping will likely add new levels of context to social media use in the near future.

Several studies have also demonstrated that when compared with a control group, Twitter users with a self-disclosed diagnosis of schizophrenia show unique online communication patterns (Birnbaum et al. 2017a ), including more frequent discussion of tobacco use (Hswen et al. 2017 ), symptoms of depression and anxiety (Hswen et al. 2018b ), and suicide (Hswen et al. 2018a ). Another study found that online disclosures about mental illness appeared beneficial as reflected by fewer posts about symptoms following self-disclosure (Ernala et al. 2017 ). Each of these examples offers early insights into the potential to leverage widely available online data for better understanding the onset and course of mental illness. It is possible that social media data could be used to supplement additional digital data, such as continuous monitoring using smartphone apps or smart watches, to generate a more comprehensive “digital phenotype” to predict relapse and identify high-risk health behaviors among individuals living with mental illness (Torous et al. 2019 ).

With research increasingly showing the valuable insights that social media data can yield about mental health states, greater attention to the ethical concerns with using individual data in this way is necessary (Chancellor et al. 2019 ). For instance, data is typically captured from social media platforms without the consent or awareness of users (Bidargaddi et al. 2017 ), which is especially crucial when the data relates to a socially stigmatizing health condition such as mental illness (Guntuku et al. 2017 ). Precautions are needed to ensure that data is not made identifiable in ways that were not originally intended by the user who posted the content as this could place an individual at risk of harm or divulge sensitive health information (Webb et al. 2017 ; Williams et al. 2017 ). Promising approaches for minimizing these risks include supporting the participation of individuals with expertise in privacy, clinicians, and the target individuals with mental illness throughout the collection of data, development of predictive algorithms, and interpretation of findings (Chancellor et al. 2019 ).

In recognizing that many individuals living with mental illness use social media to search for information about their mental health, it is possible that they may also want to ask their clinicians about what they find online to check if the information is reliable and trustworthy. Alternatively, many individuals may feel embarrassed or reluctant to talk to their clinicians about using social media to find mental health information out of concerns of being judged or dismissed. Therefore, mental health clinicians may be ideally positioned to talk with their patients about using social media and offer recommendations to promote safe use of these sites while also respecting their patients’ autonomy and personal motivations for using these popular platforms. Given the gap in clinical knowledge about the impact of social media on mental health, clinicians should be aware of the many potential risks so that they can inform their patients while remaining open to the possibility that their patients may also experience benefits through use of these platforms. As awareness of these risks grows, it may be possible that new protections will be put in place by industry or through new policies that will make the social media environment safer. It is hard to estimate a number needed to treat or harm today given the nascent state of research, which means the patient and clinician need to weigh the choice on a personal level. Thus, offering education and information is an important first step in that process. As patients increasingly show interest in accessing mental health information or services through social media, it will be necessary for health systems to recognize social media as a potential avenue for reaching or offering support to patients. This aligns with growing emphasis on the need for greater integration of digital psychiatry, including apps, smartphones, or wearable devices, into patient care and clinical services through institution-wide initiatives and training clinical providers (Hilty et al. 2019 ). Within a learning healthcare environment where research and care are tightly intertwined and feedback between both is rapid, the integration of digital technologies into services may create new opportunities for advancing use of social media for mental health.

As highlighted in this commentary, social media has become an important part of the lives of many individuals living with mental disorders. Many of these individuals use social media to share their lived experiences with mental illness, to seek support from others, and to search for information about treatment recommendations, accessing mental health services and coping with symptoms (Bucci et al. 2019 ; Highton-Williamson et al. 2015 ; Naslund et al. 2016b ). As the field of digital mental health advances, the wide reach, ease of access, and popularity of social media platforms could be used to allow individuals in need of mental health services or facing challenges of mental illness to access evidence-based treatment and support. To achieve this end and to explore whether social media platforms can advance efforts to close the gap in available mental health services in the USA and globally, it will be essential for researchers to work closely with clinicians and with those affected by mental illness to ensure that possible benefits of using social media are carefully weighed against anticipated risks.

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Dr. Naslund is supported by a grant from the National Institute of Mental Health (U19MH113211). Dr. Aschbrenner is supported by a grant from the National Institute of Mental Health (1R01MH110965-01).

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Naslund, J.A., Bondre, A., Torous, J. et al. Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice. J. technol. behav. sci. 5 , 245–257 (2020). https://doi.org/10.1007/s41347-020-00134-x

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Pros & cons: impacts of social media on mental health

• Ágnes Zsila 1 , 2 &
• Marc Eric S. Reyes   ORCID: orcid.org/0000-0002-5280-1315 3  

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The use of social media significantly impacts mental health. It can enhance connection, increase self-esteem, and improve a sense of belonging. But it can also lead to tremendous stress, pressure to compare oneself to others, and increased sadness and isolation. Mindful use is essential to social media consumption.

Social media has become integral to our daily routines: we interact with family members and friends, accept invitations to public events, and join online communities to meet people who share similar preferences using these platforms. Social media has opened a new avenue for social experiences since the early 2000s, extending the possibilities for communication. According to recent research [ 1 ], people spend 2.3 h daily on social media. YouTube, TikTok, Instagram, and Snapchat have become increasingly popular among youth in 2022, and one-third think they spend too much time on these platforms [ 2 ]. The considerable time people spend on social media worldwide has directed researchers’ attention toward the potential benefits and risks. Research shows excessive use is mainly associated with lower psychological well-being [ 3 ]. However, findings also suggest that the quality rather than the quantity of social media use can determine whether the experience will enhance or deteriorate the user’s mental health [ 4 ]. In this collection, we will explore the impact of social media use on mental health by providing comprehensive research perspectives on positive and negative effects.

Social media can provide opportunities to enhance the mental health of users by facilitating social connections and peer support [ 5 ]. Indeed, online communities can provide a space for discussions regarding health conditions, adverse life events, or everyday challenges, which may decrease the sense of stigmatization and increase belongingness and perceived emotional support. Mutual friendships, rewarding social interactions, and humor on social media also reduced stress during the COVID-19 pandemic [ 4 ].

On the other hand, several studies have pointed out the potentially detrimental effects of social media use on mental health. Concerns have been raised that social media may lead to body image dissatisfaction [ 6 ], increase the risk of addiction and cyberbullying involvement [ 5 ], contribute to phubbing behaviors [ 7 ], and negatively affects mood [ 8 ]. Excessive use has increased loneliness, fear of missing out, and decreased subjective well-being and life satisfaction [ 8 ]. Users at risk of social media addiction often report depressive symptoms and lower self-esteem [ 9 ].

Overall, findings regarding the impact of social media on mental health pointed out some essential resources for psychological well-being through rewarding online social interactions. However, there is a need to raise awareness about the possible risks associated with excessive use, which can negatively affect mental health and everyday functioning [ 9 ]. There is neither a negative nor positive consensus regarding the effects of social media on people. However, by teaching people social media literacy, we can maximize their chances of having balanced, safe, and meaningful experiences on these platforms [ 10 ].

We encourage researchers to submit their research articles and contribute to a more differentiated overview of the impact of social media on mental health. BMC Psychology welcomes submissions to its new collection, which promises to present the latest findings in the emerging field of social media research. We seek research papers using qualitative and quantitative methods, focusing on social media users’ positive and negative aspects. We believe this collection will provide a more comprehensive picture of social media’s positive and negative effects on users’ mental health.

Data Availability

Not applicable.

Statista. (2022). Time spent on social media [Chart]. Accessed June 14, 2023, from https://www.statista.com/chart/18983/time-spent-on-social-media/ .

Pew Research Center. (2023). Teens and social media: Key findings from Pew Research Center surveys. Retrieved June 14, 2023, from https://www.pewresearch.org/short-reads/2023/04/24/teens-and-social-media-key-findings-from-pew-research-center-surveys/ .

Boer, M., Van Den Eijnden, R. J., Boniel-Nissim, M., Wong, S. L., Inchley, J. C.,Badura, P.,… Stevens, G. W. (2020). Adolescents’ intense and problematic social media use and their well-being in 29 countries. Journal of Adolescent Health , 66(6), S89-S99. https://doi.org/10.1016/j.jadohealth.2020.02.011.

Marciano L, Ostroumova M, Schulz PJ, Camerini AL. Digital media use and adolescents’ mental health during the COVID-19 pandemic: a systematic review and meta-analysis. Front Public Health. 2022;9:2208. https://doi.org/10.3389/fpubh.2021.641831 .

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Naslund JA, Bondre A, Torous J, Aschbrenner KA. Social media and mental health: benefits, risks, and opportunities for research and practice. J Technol Behav Sci. 2020;5:245–57. https://doi.org/10.1007/s41347-020-00094-8 .

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Harriger JA, Thompson JK, Tiggemann M. TikTok, TikTok, the time is now: future directions in social media and body image. Body Image. 2023;44:222–6. https://doi.org/10.1016/j.bodyim.2021.12.005 .

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Chi LC, Tang TC, Tang E. The phubbing phenomenon: a cross-sectional study on the relationships among social media addiction, fear of missing out, personality traits, and phubbing behavior. Curr Psychol. 2022;41(2):1112–23. https://doi.org/10.1007/s12144-022-0135-4 .

Valkenburg PM. Social media use and well-being: what we know and what we need to know. Curr Opin Psychol. 2022;45:101294. https://doi.org/10.1016/j.copsyc.2020.101294 .

Bányai F, Zsila Á, Király O, Maraz A, Elekes Z, Griffiths MD, Urbán R, Farkas J, Rigó P Jr, Demetrovics Z. Problematic social media use: results from a large-scale nationally representative adolescent sample. PLoS ONE. 2017;12(1):e0169839. https://doi.org/10.1371/journal.pone.0169839 .

American Psychological Association. (2023). APA panel issues recommendations for adolescent social media use. Retrieved from https://apa-panel-issues-recommendations-for-adolescent-social-media-use-774560.html .

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Acknowledgements

Ágnes Zsila was supported by the ÚNKP-22-4 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.

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Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary

Ágnes Zsila

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AZ conceived and drafted the Editorial. MESR wrote the abstract and revised the Editorial. All authors read and approved the final manuscript.

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Zsila, Á., Reyes, M.E.S. Pros & cons: impacts of social media on mental health. BMC Psychol 11 , 201 (2023). https://doi.org/10.1186/s40359-023-01243-x

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Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

Affiliations.

• 1 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.
• 2 CareNX Innovations, Mumbai, India.
• 3 Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA.
• 4 Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH.
• PMID: 33415185
• PMCID: PMC7785056
• DOI: 10.1007/s41347-020-00134-x

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

Keywords: digital health; mHealth; mental health; psychiatry; safety; social media.

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Conflict of interest statement

Conflict of Interest The authors have nothing to disclose.

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The dashed lines represent potential confounding. The solid line represents the main association of interest. BMI indicates body mass index.

Error bars indicate 95% CIs.

eFigure. Participant selection from the complete PATH sample into the analytic sample.

eTable 1. Items from the GAIN-SS scale used to assess internalizing and externalizing problems.

eTable 2. Unadjusted and adjusted relative risk ratios for each category of social media use in relation to internalizing and externalizing problems among U.S. youth in the PATH Study, 2013-2016, after multiple imputation with chained equations (n=7,234).

eMethods. Calculating population attributable fractions from adjusted models.

• Social Media and the Youth Mental Health Crisis JAMA Medical News & Perspectives July 3, 2023 This Medical News article discusses potential harms and benefits of social media use and what primary care physicians can do to protect children and adolescents and support families. Jennifer Abbasi
• US Surgeon General Calls for Social Media Warning Labels JAMA Medical News & Perspectives September 3, 2024 This Medical News article is an interview with US Surgeon General Vivek Murthy, MD, MBA, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about his call for a warning label on social media platforms. Jennifer Abbasi; Yulin Hswen, ScD, MPH
• Is There an Association Between Social Media Use and Mental Health? The Timing of Confounding Measurement Matters JAMA Psychiatry Comment & Response April 1, 2020 Katherine M. Keyes, PhD; Noah Kreski, MPH
• Is There an Association Between Social Media Use and Mental Health? The Timing of Confounding Measurement Matters—Reply JAMA Psychiatry Comment & Response April 1, 2020 Kenneth A. Feder, PhD; Kira E. Riehm, MSc; Ramin Mojtabai, MD

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Riehm KE , Feder KA , Tormohlen KN, et al. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019;76(12):1266–1273. doi:10.1001/jamapsychiatry.2019.2325

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Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth

• 1 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
• 2 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
• 3 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
• 4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
• 5 Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland
• 6 Department of Behavioral and Community Health, University of Maryland, College Park, College Park
• 7 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
• 8 Washington State Department of Health, Olympia
• Medical News & Perspectives Social Media and the Youth Mental Health Crisis Jennifer Abbasi JAMA
• Medical News & Perspectives US Surgeon General Calls for Social Media Warning Labels Jennifer Abbasi; Yulin Hswen, ScD, MPH JAMA
• Comment & Response Is There an Association Between Social Media Use and Mental Health? The Timing of Confounding Measurement Matters Katherine M. Keyes, PhD; Noah Kreski, MPH JAMA Psychiatry
• Comment & Response Is There an Association Between Social Media Use and Mental Health? The Timing of Confounding Measurement Matters—Reply Kenneth A. Feder, PhD; Kira E. Riehm, MSc; Ramin Mojtabai, MD JAMA Psychiatry

Question   Is time spent using social media associated with mental health problems among adolescents?

Findings   In this cohort study of 6595 US adolescents, increased time spent using social media per day was prospectively associated with increased odds of reporting high levels of internalizing and comorbid internalizing and externalizing problems, even after adjusting for history of mental health problems.

Meaning   Adolescents who spend more than 3 hours per day on social media may be at heightened risk for mental health problems, particularly internalizing problems.

Importance   Social media use may be a risk factor for mental health problems in adolescents. However, few longitudinal studies have investigated this association, and none have quantified the proportion of mental health problems among adolescents attributable to social media use.

Objective   To assess whether time spent using social media per day is prospectively associated with internalizing and externalizing problems among adolescents.

Design, Setting, and Participants   This longitudinal cohort study of 6595 participants from waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October 30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the Population Assessment of Tobacco and Health study, a nationally representative cohort study of US adolescents, assessed US adolescents via household interviews using audio computer-assisted self-interviewing. Data analysis was performed from January 14, 2019, to May 22, 2019.

Exposures   Self-reported time spent on social media during a typical day (none, ≤30 minutes, >30 minutes to ≤3 hours, >3 hours to ≤6 hours, and >6 hours) during wave 2.

Main Outcomes and Measure   Self-reported past-year internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems during wave 3 using the Global Appraisal of Individual Needs–Short Screener.

Results   A total of 6595 adolescents (aged 12-15 years during wave 1; 3400 [51.3%] male) were studied. In unadjusted analyses, spending more than 30 minutes of time on social media, compared with no use, was associated with increased risk of internalizing problems alone (≤30 minutes: relative risk ratio [RRR], 1.30; 95% CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours: RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82; >30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15; 95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73); associations with externalizing problems were inconsistent. In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78; 95% CI, 1.15-2.77) and comorbid internalizing and externalizing problems (>3 to ≤6 hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43) but not externalizing problems alone.

Conclusions and Relevance   Adolescents who spend more than 3 hours per day using social media may be at heightened risk for mental health problems, particularly internalizing problems. Future research should determine whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.

For adolescents in the United States, social media use is ubiquitous. A 2018 Pew Research Center poll found that 97% of adolescents report using at least 1 of the 7 most popular social media platforms (YouTube, Instagram, Snapchat, Facebook, Twitter, Tumblr, and Reddit). Moreover, digital media use by adolescents is common: 95% report owning or having access to a smartphone, and almost 90% report they are online at least several times a day. 1

Social media offers numerous potential benefits to users, including exposure to current events, interpersonal connection, and enhancement of social support networks. 2 However, concerns are increasingly raised about potential harms of social media use. 2 One-quarter of adolescents think social media has a mostly negative influence on people their age, pointing to reasons like rumor spreading, lack of in-person contact, unrealistic views of others’ lives, peer pressure, and mental health issues. 1

An increasing body of literature suggests that social media use is associated with mental health problems in adolescence. Numerous cross-sectional studies and a limited number of longitudinal studies suggest that high levels of social media use are associated with internalizing problems, including depressive and anxiety symptoms, 3 - 6 although results are not entirely consistent. 7 Some studies also suggest an association between social media use and externalizing problems, such as bullying and attention problems. 8 , 9 Furthermore, a previous study 4 produced mixed results regarding the possible moderating effect of sex.

The prevalence of major depressive disorder and depressive symptoms has increased among adolescents in the United States, 10 , 11 and adolescent suicide death and attempt rates have increased sharply during the past 2 decades. 12 , 13 Some authors 14 have postulated that increases in depression may be attributable to rapid increases in social media use. However, evidence of this association in nationally representative samples is scarce, and little is known about whether reducing time spent on social media might influence the prevalence of mental health problems at a national level.

In this article, we build on existing literature by examining the prospective association of time spent on social media with internalizing and externalizing problems in a representative sample of US adolescents. We used data from the Population Assessment of Tobacco and Health (PATH) study, which is a nationally representative, longitudinal cohort of adolescents. 15 Unlike a prior study, 16 we adjusted for mental health problems measured before the exposure, which is critical for reducing the influence of reverse causality. We hypothesized that greater time spent on social media would prospectively be associated with internalizing and externalizing problems alone, as well as comorbid problems at 1-year follow-up. On the basis of past research, 5 we also examined whether these associations differed between males and females.

In this longitudinal cohort study, participants were drawn from the public-use data files of waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October 30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the PATH study. 15 The methods of the PATH study have been previously described. 15 In brief, the target population for this survey was the civilian household population in the United States. Data were collected in 1-year intervals, starting with wave 1 from September 12, 2013, to December 14, 2014. Multistage-stratified sampling was used to obtain a sample of households from which up to 2 individuals aged 12 to 17 years were randomly selected to be interviewed. Data analysis was performed from January 14, 2019, to May 22, 2019. After oral parent permission and adolescent assent were obtained, adolescents were interviewed using audio computer-assisted self-interviewing. The current analyses were considered exempt from human subjects research according to Johns Hopkins institutional review board policy because the data were publicly available and deidentified.

The weighted response rate for adolescents during wave 1 was 78.4%, and the weighted retention rate during wave 3 was 83.3%. 17 A total of 7595 adolescents (aged 12-15 years during wave 1, aged 13-16 years during wave 2, and aged 14-17 years during wave 3) completed all 3 PATH survey waves. Of these, 1000 adolescents (13.2%) were excluded because they were missing data on at least 1 variable required for this analysis; the remaining 6595 adolescents comprised the analytic sample (eFigure in the Supplement ).

Past-year mental health problems, the outcome of interest, were assessed during wave 3 using the Global Appraisal of Individual Needs–Short Screener (GAIN-SS). 18 The GAIN-SS is a screening measure intended to identify a probable mental health disorder and assess symptom severity; it has been validated in adolescents 19 and includes internalizing and externalizing subscales (eTable 1 in the Supplement ). Each item measures 1 symptom; for this study, symptoms were considered to be present if the respondent selected in the past month or 2 to 12 months from the response options that indicated the last time they had experienced that symptom. Symptom counts were generated for each subscale. Adolescents were classified as reporting low to moderate (0-3 symptoms) or high (≥4 symptoms) internalizing and externalizing problems. These cut points have been validated for use when making treatment decisions 18 and have previously been used with the PATH sample. 20 , 21 We combined these subscales to create a single outcome variable with 4 mutually exclusive categories: no or low internalizing and externalizing problems, internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems. Comorbid problems were defined as having all 4 internalizing and 4 or more externalizing symptoms.

The exposure of interest was time spent using social media per day during wave 2. Adolescents who reported that they ever went online were asked, “Sometimes people use the internet to connect with other people online through social networks like Facebook, Google Plus, YouTube, MySpace, Linkedin, Twitter, Tumblr, Instagram, Pinterest, or Snapchat. This is often called ‘social media.’ Do you have a social media account?” Adolescents who reported that they had a social media account that they visited were asked, “On a typical day, about how much total time do you spend on social media sites?” The response options were up to 30 minutes; more than 30 minutes, up to 3 hours; more than 3 hours, up to 6 hours; and more than 6 hours. We retained these categories for our exposure variable, with an additional category of none for adolescents who reported not going online, not having a social media account, or never visiting their social media account.

Potential confounders, including demographic characteristics (ie, sex, age, race, and parental educational level), body mass index (based on parent-reported weight and height), self-reported lifetime marijuana use and alcohol use, and scale scores for lifetime internalizing and externalizing problems, were adjusted for in the analyses. To ensure that we did not improperly adjust for mediating variables, 22 we used covariates measured at wave 1 instead of wave 2. The full study design is displayed in Figure 1 .

Multinomial logistic regression was used to estimate the associations between time spent on social media per day with internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems (reference group: no or low internalizing and externalizing problems). Both unadjusted and adjusted analyses were conducted. Regression coefficients were exponentiated for interpretation as relative risk ratios (RRRs). In addition, we used the adjusted model to generate and plot predicted probabilities of high internalizing and externalizing problems for each level of social media use for an otherwise average study participant.

We tested for the presence of a linear trend in the coefficients for social media use in their relation to each category of mental health problems by converting the social media use variable to an ordinal variable and reestimating the adjusted model (ie, a Mantel test for trend 23 ). A linear trend would suggest that more time spent on social media is associated with a proportionally greater likelihood of reporting mental health problems.

We tested whether any observed association of social media use with mental health problems differed between males and females by testing an interaction term between social media use and sex in our adjusted model.

In addition, we estimated the respective proportions of high internalizing and high externalizing problem cases that would be potentially prevented if adolescents spent less time using social media (ie, the population-attributable fraction [PAF] for social media use). We did this for 4 counterfactual scenarios that represented increasingly greater population reductions in social media use. In scenario 1, adolescents who actually used social media more than 6 hours per day would instead use social media more than 3 hours to 6 hours or less per day; in scenario 2, adolescents who actually used social media more than 3 hours per day would instead use social media more than 30 minutes to 3 hours or less per day; in scenario 3, adolescents who actually used social media more than 30 minutes per day would instead use social media 30 minutes or less per day; and in scenario 4, adolescents who actually spent any amount of time on social media per day would instead not spend any time on social media.

We estimated each scenario by generating a counterfactual population from our adjusted model using the approach to calculate PAFs described by Greenland and Drescher 24 and Rückinger et al. 25 See the eMethods in the Supplement for a detailed description.

To test whether our results were sensitive to missing data, we repeated analyses using multiply imputed data. We performed multiple imputation using chained equations and recomputed the unadjusted, adjusted, and sex-interaction models. We stratified by sex and generated 10 imputed data sets to account for the hypothesized interaction between sex and social media use. 26

Data for analyses were weighted to be representative of 12- to 15-year-old adolescents living in the United States in 2013 to 2014. Standard errors were estimated using the wave 3 all-waves replicate weights constructed using balanced repeated replication (the Fay method) provided in the PATH data set. Statistical significance was assessed at a 2-sided P  < .05 level. All analyses were conducted using Stata, version 14 (StataCorp).

A total of 6595 adolescents (aged 12-15 years during wave 1; 3400 [51.3%] male) were included in the analysis. During wave 3, of the sample of 6595 adolescents, 611 (9.1%) reported internalizing problems alone, 885 (14.0%) reported externalizing problems alone, 1169 (17.7%) reported comorbid internalizing and externalizing problems, and the remaining 3930 (59.3%) reported no or low problems. During wave 2, a total of 1125 adolescents (16.8%) reported no social media use, 2082 (31.8%) reported 30 minutes or less, 2000 (30.7%) reported more than 30 minutes to 3 hours or more, 817 (12.3%) reported more than 3 hours to 6 hours or less, and 571 (8.4%) reported more than 6 hours of use per day. Sample characteristics are given in Table 1 .

Compared with adolescents who did not use social media, the use of social media for more than 30 minutes per day was associated with greater risk of internalizing problems alone (≤30 minutes: RRR, 1.30; 95% CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours: RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82; >30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15; 95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73) ( Table 2 ). In the adjusted model, the associations for the 2 highest categories of social media use persisted for internalizing problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78; 95% CI, 1.15-2.77), and the associations for the 3 highest categories of social media use persisted for comorbid internalizing and externalizing problems (>30 minutes to ≤3 hours: RRR, 1.59; 95% CI, 1.23-2.05; >3 to ≤6 hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43). In contrast, in unadjusted analyses, the association of social media use with externalizing problems was inconsistent (≤30 minutes: RRR, 1.28; 95% CI, 0.98-1.67; >30 minutes to ≤3 hours: RRR, 1.60; 95% CI, 1.16-2.21; >3 to ≤6 hours: RRR, 1.36; 95% CI, 0.97-1.90; >6 hours: RRR, 1.59; 95% CI, 1.07-2.37) and not significant in the adjusted analysis (≤30 minutes: RRR, 1.18; 95% CI, 0.89-1.56; >30 minutes to ≤3 hours: RRR, 1.37; 95% CI, 0.98-1.92; >3 to ≤6 hours: RRR, 1.22; 95% CI, 0.86-1.72; >6 hours: RRR, 1.40; 95% CI, 0.90-2.19) ( Table 2 ). The predicted probabilities of high internalizing, externalizing, and comorbid problems for each level of social media use, with all other covariates set to their mean, are displayed in Figure 2 .

We observed a significant linear trend in the coefficients for both internalizing ( F 1,99  = 8.86, P  = .004) and comorbid problems ( F 1,99  = 35.16, P  < .001); as time on social media increased, the odds of these outcomes increased proportionately. In contrast, we observed no association for externalizing problems ( F 1,99  = 2.25, P  = .14).

We observed no statistically significant interaction between social media use and sex for internalizing ( F 4,96  = 0.84, P  = .50), externalizing ( F 4,96  = 0.32, P  = .86), or comorbid problems ( F 4,96  = 0.73, P  = .57).

All PAF estimates are given in Table 3 . On the basis of our adjusted model assuming no confounding, 0.8% to 18.9% of internalizing problems and 0.8% to 15.3% of externalizing problems could be prevented if participants had instead used less social media.

Results of analyses using multiple imputation methods did not differ appreciably from the main analyses (eTable 2 in the Supplement ).

Consistent with a prior study, 4 we found that adolescent social media use was prospectively associated with increased risk of comorbid internalizing and externalizing problems as well as internalizing problems alone. This association remained significant after adjusting for demographics, past alcohol and marijuana use, and, most importantly, a history of mental health problems, which mitigates the possibility that reverse causality explains these findings. In contrast, we did not find an association of social media use with externalizing problems alone. This finding suggests that the association of social media use with comorbid problems occurs primarily because of the association of social media with internalizing problems and the high comorbidity of internalizing and externalizing problems. Unlike a prior study, 4 we found no evidence of moderation by sex, perhaps because of the simplicity of our social media use variable, which could not capture the nature of interactions on social media that may differ by sex.

Numerous mechanisms could account for the association between social media use and internalizing problems. Adolescents who engage in high levels of social media use may experience poorer quality sleep, which may be a mediator on the pathway to internalizing problems. 27 Time spent on social media may increase the risk of experiencing cyberbullying, which has a strong association with depressive symptoms. 28 Social media may also expose adolescents to idealized self-presentations that negatively influence body image and encourage social comparisons. 4 Poor emotion regulation and lack of social interaction may also be associated with social media use and contribute to symptoms of anxiety and depression. 29

These mechanisms are potentially consistent with the notion that spending less time on social media may contribute to mental health. In fact, the PAFs obtained in our study suggest that if adolescents using social media for more than 30 minutes per day had instead used it for 30 minutes or less, there would have been 9.4% fewer high internalizing problem cases and 7.3% fewer high externalizing problem cases. Of importance, this is not meant to imply that reductions in mental health problems would definitively happen if social media use were reduced or that all social media use is harmful. Instead, these PAFs suggest the potential influence of our findings on the population at a national level assuming a causal effect of social media use and no confounding—both strong assumptions. Future research could improve on our PAF estimates by using data from randomized clinical trials (RCTs).

Our findings must be balanced with the potential benefits of social media use, which include exposure to current events, communication over geographic barriers, and social inclusion for those who may be otherwise excluded in their day-to-day lives (eg, lesbian, bisexual, transgender, queer, and questioning youth). 2 A limitation of our study is that we measured overall time spent on social media; prior studies 30 - 32 have found that social media use may be positively or negatively associated with mental health depending on which platforms are used and how. Nevertheless, a number of interventions could lead to a reduction in time spent on social media by adolescents, while still allowing for the benefits of such use. The American Academy of Pediatrics has developed a Family Media Use Plan, which can be tailored to specific developmental phases and help parents set reasonable rules for digital media use. 2 Pediatricians and teachers are essential for promoting these plans, as well as helping parents identify problematic social media use in their children. 33 There is also evidence that interventions that promote media literacy, defined as “specific knowledge and skills that can help critical understanding and usage of the media,” 34 (p 455) counteract the harmful association of media use with behavioral health. 34 Also, there is an increasing movement to improve the design of social media platforms; a notable recent example is not displaying the number of “likes” that an Instagram post receives. 35 We believe that technology companies and regulators responsible for social media platforms should consider how these platforms can be designed to minimize risk of mental health problems.

Some researchers have raised concerns that studies on technology use and well-being are limited by publication bias. 36 We believe that this is a legitimate concern given that many studies on this topic, including the present study, are secondary analyses of data not collected for the purpose of studying social media. 36 There appears to be an urgent need for experimental research, specifically a priori registered RCTs that examine interventions designed to reduce social media use. Our study findings suggest a population-level association between social media use and mental health problems, and evidence from RCTs could build on this by examining changes in mental health as a result of changes in social media use. The existing observational study findings and at least 1 RCT in college students 37 appear to be sufficient to justify investment in these trials. In addition, RCTs may be valuable for developing clinical guidelines and informing regulatory policy for social media design.

Some limitations of this study should be noted. First, adolescents self-reported the exposure and outcome, which may inflate the observed associations. Second, we measured mental health problems with a self-report questionnaire rather than a diagnostic interview. Third, the validity of self-reported time spent on social media in the PATH study is unknown. Some research suggests that self-reported time on social media may exceed actual use 38 ; future studies should consider the use of digital trace data to capture actual time spent using social media. 39 Fourth, social media use continues to change rapidly over time; although our data were collected relatively recently, they may not reflect current trends. Fifth, although our study design mitigates the possibility of reverse causality, some residual confounding from imprecise measurement of prior mental health problems may have been present. Sixth, it remains possible that mental health problems are prospectively associated with social media use, but we could not examine this in the present study because of data limitations. Seventh, it is possible that the observed associations were an artifact of unmeasured confounding. Although we controlled for a number of potential confounders, there may be others, such as physical activity, that we were unable to include because of data limitations.

This study suggests that increased time spent on social media may be a risk factor for internalizing problems in adolescents. Future research should determine whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.

Accepted for Publication: June 14, 2019.

Corresponding Author: Kira E. Riehm, MS, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205 ( [email protected] ).

Published Online: September 11, 2019. doi:10.1001/jamapsychiatry.2019.2325

Author Contributions: Ms Riehm had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Riehm, Feder, Crum, Green, La Flair, Mojtabai.

Acquisition, analysis, or interpretation of data: Riehm, Feder, Tormohlen, Young, Green, Pacek, La Flair.

Drafting of the manuscript: Riehm, Feder, Pacek.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Riehm, Feder, Green, Pacek.

Administrative, technical, or material support: Green.

Supervision: Crum, Green, Mojtabai.

Conflict of Interest Disclosures: Dr Young reported receiving grants from the National Institute on Drug Abuse and the Brain and Behavior Research Foundation during the conduct of the study, receiving grants from Supernus Pharmaceuticals and Psychnostics LLC outside the submitted work, and receiving personal fees from University of Montana's American Indian/Alaska Native Clinical Translational Program. Dr Pacek reported receiving grants from the National Institute on Drug Abuse during the conduct of the study. No other disclosures were reported.

Funding/Support: Ms Riehm was supported by grant 5T32MH014592-39 from the National Institute of Mental Health Psychiatric Epidemiology Training Program (Peter Zandi, principal investigator) and by a doctoral foreign study award from the Canadian Institutes of Health Research. Dr Feder was supported by National Research and Service Award F31DA044699 from the National Institute on Drug Abuse. Ms Tormohlen was supported by grant T32DA007292 (Renee M. Johnson, principal investigator), Dr Young was supported by grant K23DA044288, and Dr Pacek was supported by grant K01DA043413 from the National Institute on Drug Abuse.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Social Media Use and Mental Health and Well-Being Among Adolescents – A Scoping Review

Viktor schønning.

1 Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway

Gunnhild Johnsen Hjetland

Leif edvard aarø, jens christoffer skogen.

2 Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway

3 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway

Associated Data

Introduction: Social media has become an integrated part of daily life, with an estimated 3 billion social media users worldwide. Adolescents and young adults are the most active users of social media. Research on social media has grown rapidly, with the potential association of social media use and mental health and well-being becoming a polarized and much-studied subject. The current body of knowledge on this theme is complex and difficult-to-follow. The current paper presents a scoping review of the published literature in the research field of social media use and its association with mental health and well-being among adolescents.

Methods and Analysis: First, relevant databases were searched for eligible studies with a vast range of relevant search terms for social media use and mental health and well-being over the past five years. Identified studies were screened thoroughly and included or excluded based on prior established criteria. Data from the included studies were extracted and summarized according to the previously published study protocol.

Results: Among the 79 studies that met our inclusion criteria, the vast majority (94%) were quantitative, with a cross-sectional design (57%) being the most common study design. Several studies focused on different aspects of mental health, with depression (29%) being the most studied aspect. Almost half of the included studies focused on use of non-specified social network sites (43%). Of specified social media, Facebook (39%) was the most studied social network site. The most used approach to measuring social media use was frequency and duration (56%). Participants of both genders were included in most studies (92%) but seldom examined as an explanatory variable. 77% of the included studies had social media use as the independent variable.

Conclusion: The findings from the current scoping review revealed that about 3/4 of the included studies focused on social media and some aspect of pathology. Focus on the potential association between social media use and positive outcomes seems to be rarer in the current literature. Amongst the included studies, few separated between different forms of (inter)actions on social media, which are likely to be differentially associated with mental health and well-being outcomes.

In just a few decades, the use of social media have permeated most areas of our society. For adolescents, social media play a particularly large part in their lives as indicated by their extensive use of several different social media platforms ( Ofcom, 2018 ). Furthermore, the use of social media and types of platforms offered have increased at such a speed that there is reason to believe that scientific knowledge about social media in relation to adolescents’ health and well-being is scattered and incomplete ( Orben, 2020 ). Nevertheless, research findings indicating the potential negative effects of social media on mental health and well-being are frequently reported in traditional media (newspapers, radio, TV) ( Bell et al., 2015 ). Within the scientific community, however, there are ongoing debates regarding the impact and relevance of social media in relation to mental health and well-being. For instance, Twenge and Campbell (2019) stated that use of digital technology and social media have a negative impact on well-being, while Orben and Przybylski (2019) argued that the association between digital technology use and adolescent well-being is so small that it is more or less inconsequential. Research on social media use is a new focus area, and it is therefore important to get an overview of the studies performed to date, and describe the subject matter studies have investigated in relation to the effect of social media use on adolescents mental health and well-being. Also, research gaps in this emerging research field is important to highlight as it may guide future research in new and meritorious directions. A scoping review is therefore deemed necessary to provide a foundation for further research, which in time will provide a knowledge base for policymaking and service delivery.

This scoping review will help provide an overall understanding of the main foci of research within the field of social media and mental health and well-being among adolescents, as well as the type of data sources and research instruments used so far. Furthermore, we aim to highlight potential gaps in the research literature ( Arksey and O’Malley, 2005 ). Even though a large number of studies on social media use and mental health with different vantage points has been conducted over the last decade, we are not aware of any broad-sweeping scoping review covering this area.

This scoping review aims to give an overview of the main research questions that have been focused on with regard to use of social media among adolescents in relation to mental health and well-being. Both quantitative and qualitative studies are of interest. Three specific secondary research questions will be addressed and together with the main research question serve as a template for organizing the results:

• • Which aspects of mental health and well-being have been the focus or foci of research so far?
• • Has the research focused on different research aims across gender, ethnicity, socio-economic status, geographic location? What kind of findings are reported across these groups?
• • Organize and describe the main sources of evidence related to social media that have been used in the studies identified.

Defining Adolescence and Social Media

In the present review, adolescents are defined as those between 13 and 19 years of age. We chose the mean age of 13 as our lower limit as nearly all social media services require users to be at least 13 years of age to access and use their services ( Childnet International, 2018 ). All pertinent studies which present results relevant for this age range is within the scope of this review. For social media we used the following definition by Kietzmann et al. (2011 , p. 1): “Social media employ mobile and web-based technologies to create highly interactive platforms via which individuals and communities share, co-create, discuss, and modify user-generated content.” We also employed the typology described by Kaplan and Haenlein’s classification scheme across two axes: level of self-presentation and social presence/media richness ( Kaplan and Haenlein, 2010 ). The current scoping review adheres to guidelines and recommendations stated by Tricco et al. (2018) .

See protocol for further details about the definitions used ( Schønning et al., 2020 ).

Data Sources and Search Strategy

A literature search was performed in OVID Medline, OVID Embase, OVID PsycINFO, Sociological Abstracts (proquest), Social Services Abstracts (proquest), ERIC (proquest), and CINAHL. The search strategy combined search terms for adolescents, social media and mental health or wellbeing. The database-controlled vocabulary was used for searching subject headings, and a large spectrum of synonyms with appropriate truncations was used for searching title, abstract, and author keywords. A filter for observational studies was applied to limit the results. The search was also limited to publications from 2014 to current. The search strategy was translated between each database. An example of full strategy for Embase is attached as Supplementary Material .

Study Selection: Exclusion and Inclusion Criteria

The exclusion and inclusion criteria are detailed in the protocol ( Schønning et al., 2020 ). Briefly, we included English language peer-reviewed quantitative- or qualitative papers or systematic reviews published within the last 5 years with an explicit focus on mental health/well-being and social media. Non-empirical studies, intervention studies, clinical studies and publications not peer-reviewed were excluded. Intervention studies and clinical studies were excluded as we sought to not introduce too much heterogeneity in design and our focus was on observational studies. The criteria used for study selection was part of an iterative process which was described in detail in the protocol ( Schønning et al., 2020 ). As per the study protocol ( Schønning et al., 2020 ), and in line with scoping review guidelines ( Peters et al., 2015 , 2017 ; Tricco et al., 2018 ), we did not assess methodological quality or risk of bias of the included studies.

The selection process is illustrated by a flow-chart indicating the stages from unsorted search results to the number of included studies (see Figure 1 ). Study selection was accomplished and organized using the Rayyan QCRI software 1 . The inclusion and exclusion process was performed independently by VS and JCS. The interrater agreement was κ = 0.87, indicating satisfactory agreement.

Flowchart of exclusion process from unsorted results to included studies.

Data Extraction and Organization

Details of the data extracted is described in the protocol. Three types of information were extracted, bibliographic information, information about study design and subject matter information. Subject matter information included aim of study, how social media and mental health/well-being was measured, and main findings of the study.

Visualization of Words From the Titles of the Included Studies

The most frequently occurring words and bigrams in the titles of the included studies are presented in Figures 2 , ​ ,3. 3 . The following procedure was used to generate Figure 1 : First, a text file containing all titles were imported into R as a data frame ( R Core Team, 2014 ). The data frame was processed using the “tidy text”-package with required additional packages ( Silge and Robinson, 2016 ). Second, numbers and commonly used words with little inherent meaning (so called “stop words,” such as “and,” “of,” and “in”), were removed from the data frame using the three available lexicons in the “tidy-text”-package ( Silge and Robinson, 2016 ). Furthermore, variations of “adolescents” (e.g., “adolescent,” “adolescence,” and “adolescents”) and “social media” (e.g., “social media,” “social networking,” “online social networks”) were removed from the data frame. Third, the resulting data frame was sorted based on frequency of unique words, and words occurring only once were removed. The final data frame is presented as a word cloud in Figure 1 ( N = 113). The same procedure as described above was employed to generate commonly occurring bigrams (two words occurring adjacent to each other), but without removing bigrams occurring only once ( N = 231). The word clouds were generated using the “wordcloud2”-package in R ( Lang and Chien, 2018 ). For Figure 1 , shades of blue indicate word frequencies >2 and green a frequency of 2. For Figure 2 , shades of blue indicate bigram frequencies of >1 and green a frequency of 1.

Word cloud from the titles of the included studies. Most frequent words, excluding variations of “adolescence” and “social media.” N = 113. Shades of blue indicate word frequencies >2 and green a frequency of 2. The size of each word is indicative of its relative frequency of occurrence.

Word cloud from the titles of the included studies. Bigrams from the titles of the included studies, excluding variations of “adolescence” and “social media.” N = 231. Shades of blue indicate bigram frequencies of >1 and green a frequency of 1. The size of each bigram is indicative of its relative frequency of occurrence.

Characteristics of the Included Studies

Of 7927 unique studies, 79 (1%) met our inclusion criteria ( Aboujaoude et al., 2015 ; Banjanin et al., 2015 ; Banyai et al., 2017 ; Barry et al., 2017 ; Best et al., 2014 , 2015 ; Booker et al., 2018 ; Bourgeois et al., 2014 ; Boyle et al., 2016 ; Brunborg et al., 2017 ; Burnette et al., 2017 ; Colder Carras et al., 2017 ; Critchlow et al., 2019 ; Cross et al., 2015 ; Curtis et al., 2018 ; de Lenne et al., 2018 ; de Vries et al., 2016 ; Erfani and Abedin, 2018 ; Erreygers et al., 2018 ; Fahy et al., 2016 ; Ferguson et al., 2014 ; Fisher et al., 2016 ; Foerster and Roosli, 2017 ; Foody et al., 2017 ; Fredrick and Demaray, 2018 ; Frison and Eggermont, 2016 , 2017 ; Geusens and Beullens, 2017 , 2018 ; Hamm et al., 2015 ; Hanprathet et al., 2015 ; Harbard et al., 2016 ; Hase et al., 2015 ; Holfeld and Mishna, 2019 ; Houghton et al., 2018 ; Jafarpour et al., 2017 ; John et al., 2018 ; Kim et al., 2019 ; Kim, 2017 ; Koo et al., 2015 ; Lai et al., 2018 ; Larm et al., 2017 , 2019 ; Marchant et al., 2017 ; Marengo et al., 2018 ; Marques et al., 2018 ; Meier and Gray, 2014 ; Memon et al., 2018 ; Merelle et al., 2017 ; Neira and Barber, 2014 ; Nesi et al., 2017a , b ; Niu et al., 2018 ; Nursalam et al., 2018 ; Oberst et al., 2017 ; O’Connor et al., 2014 ; O’Reilly et al., 2018 ; Przybylski and Bowes, 2017 ; Przybylski and Weinstein, 2017 ; Richards et al., 2015 ; Rousseau et al., 2017 ; Salmela-Aro et al., 2017 ; Sampasa-Kanyinga and Chaput, 2016 ; Sampasa-Kanyinga and Lewis, 2015 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Settanni et al., 2018 ; Spears et al., 2015 ; Throuvala et al., 2019 ; Tiggemann and Slater, 2017 ; Tseng and Yang, 2015 ; Twenge and Campbell, 2019 ; Twenge et al., 2018 ; van den Eijnden et al., 2018 ; Wang et al., 2018 ; Wartberg et al., 2018 ; Wolke et al., 2017 ; Woods and Scott, 2016 ; Yan et al., 2017 ). Among the included studies, 74 (94%) are quantitative ( Aboujaoude et al., 2015 ; Banjanin et al., 2015 ; Banyai et al., 2017 ; Barry et al., 2017 ; Best et al., 2014 ; Booker et al., 2018 ; Bourgeois et al., 2014 ; Boyle et al., 2016 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Critchlow et al., 2019 ; Cross et al., 2015 ; Curtis et al., 2018 ; de Lenne et al., 2018 ; de Vries et al., 2016 ; Erfani and Abedin, 2018 ; Erreygers et al., 2018 ; Fahy et al., 2016 ; Ferguson et al., 2014 ; Fisher et al., 2016 ; Foerster and Roosli, 2017 ; Foody et al., 2017 ; Fredrick and Demaray, 2018 ; Frison and Eggermont, 2016 , 2017 ; Geusens and Beullens, 2017 , 2018 ; Hamm et al., 2015 ; Hanprathet et al., 2015 ; Harbard et al., 2016 ; Hase et al., 2015 ; Houghton et al., 2018 ; Jafarpour et al., 2017 ; John et al., 2018 ; Kim et al., 2019 ; Kim, 2017 ; Koo et al., 2015 ; Lai et al., 2018 ; Larm et al., 2017 , 2019 ; Marchant et al., 2017 ; Marengo et al., 2018 ; Marques et al., 2018 ; Meier and Gray, 2014 ; Memon et al., 2018 ; Merelle et al., 2017 ; Neira and Barber, 2014 ; Nesi et al., 2017a , b ; Niu et al., 2018 ; Nursalam et al., 2018 ; Oberst et al., 2017 ; O’Connor et al., 2014 ; Przybylski and Bowes, 2017 ; Przybylski and Weinstein, 2017 ; Richards et al., 2015 ; Rousseau et al., 2017 ; Salmela-Aro et al., 2017 ; Sampasa-Kanyinga and Chaput, 2016 ; Sampasa-Kanyinga and Lewis, 2015 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Settanni et al., 2018 ; Spears et al., 2015 ; Tiggemann and Slater, 2017 ; Tseng and Yang, 2015 ; Twenge and Campbell, 2019 ; Twenge et al., 2018 ; van den Eijnden et al., 2018 ; Wang et al., 2018 ; Wartberg et al., 2018 ; Wolke et al., 2017 ; Woods and Scott, 2016 ; Yan et al., 2017 ), three are qualitative ( O’Reilly et al., 2018 ; Burnette et al., 2017 ; Throuvala et al., 2019 ), and two use mixed methods ( Best et al., 2015 ; Holfeld and Mishna, 2019 ) (see Supplementary Tables 1 , 2 in the Supplementary Material for additional details extracted from all included studies). In relation to study design, 45 (57%) used a cross-sectional design ( Bourgeois et al., 2014 ; Ferguson et al., 2014 ; Meier and Gray, 2014 ; Neira and Barber, 2014 ; O’Connor et al., 2014 ; Banjanin et al., 2015 ; Hanprathet et al., 2015 ; Hase et al., 2015 ; Koo et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Spears et al., 2015 ; Tseng and Yang, 2015 ; Frison and Eggermont, 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Woods and Scott, 2016 ; Banyai et al., 2017 ; Barry et al., 2017 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Larm et al., 2017 , 2019 ; Merelle et al., 2017 ; Oberst et al., 2017 ; Przybylski and Bowes, 2017 ; Przybylski and Weinstein, 2017 ; Tiggemann and Slater, 2017 ; Wolke et al., 2017 ; Yan et al., 2017 ; de Lenne et al., 2018 ; Erreygers et al., 2018 ; Fredrick and Demaray, 2018 ; Geusens and Beullens, 2018 ; Lai et al., 2018 ; Marengo et al., 2018 ; Marques et al., 2018 ; Niu et al., 2018 ; Nursalam et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Settanni et al., 2018 ; Wang et al., 2018 ; Wartberg et al., 2018 ; Critchlow et al., 2019 ; Kim et al., 2019 ; Twenge and Campbell, 2019 ), 17 used a longitudinal design ( Cross et al., 2015 ; Boyle et al., 2016 ; de Vries et al., 2016 ; Fahy et al., 2016 ; Frison and Eggermont, 2016 ; Harbard et al., 2016 ; Foerster and Roosli, 2017 ; Geusens and Beullens, 2017 ; Kim, 2017 ; Nesi et al., 2017a , b ; Rousseau et al., 2017 ; Salmela-Aro et al., 2017 ; Booker et al., 2018 ; Houghton et al., 2018 ; van den Eijnden et al., 2018 ; Holfeld and Mishna, 2019 ), seven were systematic reviews ( Aboujaoude et al., 2015 ; Best et al., 2015 ; Fisher et al., 2016 ; Marchant et al., 2017 ; Erfani and Abedin, 2018 ; John et al., 2018 ; Memon et al., 2018 ), two were meta-analyses ( Foody et al., 2017 : Curtis et al., 2018 ), one was a causal-comparative study ( Jafarpour et al., 2017 ), one was a review article ( Richards et al., 2015 ), one used a time-lag design ( Twenge et al., 2018 ), one was a scoping review ( Hamm et al., 2015 ), three used a focus-group interview design ( Burnette et al., 2017 ; O’Reilly et al., 2018 ; Throuvala et al., 2019 ), and one study used a combined survey and focus-group design ( Best et al., 2014 ).

The most common study settings were schools [ N = 42 (54%)] ( Best et al., 2014 ; Bourgeois et al., 2014 ; Meier and Gray, 2014 ; Neira and Barber, 2014 ; O’Connor et al., 2014 ; Banjanin et al., 2015 ; Hanprathet et al., 2015 ; Hase et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Frison and Eggermont, 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Woods and Scott, 2016 ; Banyai et al., 2017 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Foerster and Roosli, 2017 ; Geusens and Beullens, 2017 , 2018 ; Kim, 2017 ; Larm et al., 2017 , 2019 ; Merelle et al., 2017 ; Nesi et al., 2017a , b ; Przybylski and Bowes, 2017 ; Rousseau et al., 2017 ; Salmela-Aro et al., 2017 ; Tiggemann and Slater, 2017 ; de Lenne et al., 2018 ; Fredrick and Demaray, 2018 ; Houghton et al., 2018 ; Lai et al., 2018 ; Marengo et al., 2018 ; Niu et al., 2018 ; Nursalam et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Settanni et al., 2018 ; van den Eijnden et al., 2018 ; Wang et al., 2018 ; Holfeld and Mishna, 2019 ; Kim et al., 2019 ). Fourteen of the included studies were based on data from a home setting ( Cross et al., 2015 ; Koo et al., 2015 ; Spears et al., 2015 ; Boyle et al., 2016 ; de Vries et al., 2016 ; Harbard et al., 2016 ; Barry et al., 2017 ; Frison and Eggermont, 2017 ; Oberst et al., 2017 ; Yan et al., 2017 ; Booker et al., 2018 ; Marques et al., 2018 ; Wartberg et al., 2018 ; Critchlow et al., 2019 ). Eleven publications were reviews or meta-analyses and included primary studies from different settings ( Aboujaoude et al., 2015 ; Best et al., 2015 ; Hamm et al., 2015 ; Richards et al., 2015 ; Fisher et al., 2016 ; Foody et al., 2017 ; Marchant et al., 2017 ; Curtis et al., 2018 ; Erfani and Abedin, 2018 ; John et al., 2018 ; Memon et al., 2018 ). One study used both a home and school setting ( Erreygers et al., 2018 ), and 11 (14%) of the included studies did not mention the study setting for data collection ( Ferguson et al., 2014 ; Tseng and Yang, 2015 ; Fahy et al., 2016 ; Burnette et al., 2017 ; Jafarpour et al., 2017 ; Przybylski and Weinstein, 2017 ; Wolke et al., 2017 ; O’Reilly et al., 2018 ; Twenge et al., 2018 ; Throuvala et al., 2019 ; Twenge and Campbell, 2019 ).

Mental Health Foci of Included Studies

For a visual overview of the mental health foci of the included studies see Figures 2 , ​ ,3. 3 . Most studies had a focus on different negative aspects of mental health, as evident from the frequently used terms in Figures 2 , ​ ,3. 3 . The most studied aspect was depression, with 23 (29%) studies examining the relationship between social media use and depressive symptoms ( Ferguson et al., 2014 ; Neira and Barber, 2014 ; O’Connor et al., 2014 ; Banjanin et al., 2015 ; Richards et al., 2015 ; Spears et al., 2015 ; Tseng and Yang, 2015 ; Fahy et al., 2016 ; Frison and Eggermont, 2016 , 2017 ; Woods and Scott, 2016 ; Banyai et al., 2017 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Larm et al., 2017 ; Nesi et al., 2017a ; Salmela-Aro et al., 2017 ; Fredrick and Demaray, 2018 ; Houghton et al., 2018 ; Niu et al., 2018 ; Twenge et al., 2018 ; Wang et al., 2018 ; Wartberg et al., 2018 ). Twenty of the included studies focused on different aspects of good mental health, such as well-being, happiness, or quality of life ( Best et al., 2014 , 2015 ; Bourgeois et al., 2014 ; Ferguson et al., 2014 ; Cross et al., 2015 ; Koo et al., 2015 ; Richards et al., 2015 ; Spears et al., 2015 ; Fahy et al., 2016 ; Foerster and Roosli, 2017 ; Przybylski and Bowes, 2017 ; Przybylski and Weinstein, 2017 ; Yan et al., 2017 ; Booker et al., 2018 ; de Lenne et al., 2018 ; Erfani and Abedin, 2018 ; Erreygers et al., 2018 ; Lai et al., 2018 ; van den Eijnden et al., 2018 ; Twenge and Campbell, 2019 ). Nineteen studies had a more broad-stroke approach, and covered general mental health or psychiatric problems ( Aboujaoude et al., 2015 ; Hanprathet et al., 2015 ; Hase et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Spears et al., 2015 ; Fisher et al., 2016 ; Barry et al., 2017 ; Jafarpour et al., 2017 ; Kim, 2017 ; Merelle et al., 2017 ; Oberst et al., 2017 ; Wolke et al., 2017 ; Marengo et al., 2018 ; Marques et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Holfeld and Mishna, 2019 ; Kim et al., 2019 ; Larm et al., 2019 ). Eight studies examined the link between social media use and body dissatisfaction and eating disorder symptoms ( Ferguson et al., 2014 ; Meier and Gray, 2014 ; de Vries et al., 2016 ; Burnette et al., 2017 ; Rousseau et al., 2017 ; Tiggemann and Slater, 2017 ; Marengo et al., 2018 ; Wartberg et al., 2018 ). Anxiety was the focus of seven studies ( O’Connor et al., 2014 ; Koo et al., 2015 ; Spears et al., 2015 ; Fahy et al., 2016 ; Woods and Scott, 2016 ; Colder Carras et al., 2017 ; Yan et al., 2017 ), and 13 studies included a focus on the relationship between alcohol use and social media use ( O’Connor et al., 2014 ; Boyle et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Brunborg et al., 2017 ; Geusens and Beullens, 2017 , 2018 ; Larm et al., 2017 ; Merelle et al., 2017 ; Nesi et al., 2017b ; Curtis et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Critchlow et al., 2019 ; Kim et al., 2019 ). Seven studies examined the effect of social media use on sleep ( Harbard et al., 2016 ; Woods and Scott, 2016 ; Yan et al., 2017 ; Nursalam et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Larm et al., 2019 ). Five studies saw how drug use and social media use affected each other ( O’Connor et al., 2014 ; Merelle et al., 2017 ; Sampasa-Kanyinga et al., 2018 ; Kim et al., 2019 ; Larm et al., 2019 ). Self-harm and suicidal behavior was the focus of eleven studies ( O’Connor et al., 2014 ; Sampasa-Kanyinga and Lewis, 2015 ; Tseng and Yang, 2015 ; Kim, 2017 ; Marchant et al., 2017 ; Merelle et al., 2017 ; Fredrick and Demaray, 2018 ; John et al., 2018 ; Memon et al., 2018 ; Twenge et al., 2018 ; Kim et al., 2019 ). Other areas of focus other than the aforementioned are loneliness, self-esteem, fear of missing out and other non-pathological measures ( Neira and Barber, 2014 ; Banyai et al., 2017 ; Barry et al., 2017 ; Colder Carras et al., 2017 ).

Social Media Metrics of Included Studies

The studies included in the current scoping review often focus on specific, widely used, social media and social networking services, such as 31 (39%) studies focusing on Facebook ( Bourgeois et al., 2014 ; Meier and Gray, 2014 ; Banjanin et al., 2015 ; Cross et al., 2015 ; Hanprathet et al., 2015 ; Richards et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Spears et al., 2015 ; Boyle et al., 2016 ; de Vries et al., 2016 ; Frison and Eggermont, 2016 ; Harbard et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Banyai et al., 2017 ; Barry et al., 2017 ; Brunborg et al., 2017 ; Larm et al., 2017 ; Merelle et al., 2017 ; Nesi et al., 2017a , b ; Rousseau et al., 2017 ; Tiggemann and Slater, 2017 ; Booker et al., 2018 ; de Lenne et al., 2018 ; Lai et al., 2018 ; Marengo et al., 2018 ; Marques et al., 2018 ; Memon et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Settanni et al., 2018 ; Twenge et al., 2018 ), 11 on Instagram ( Sampasa-Kanyinga and Lewis, 2015 ; Boyle et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Barry et al., 2017 ; Brunborg et al., 2017 ; Frison and Eggermont, 2017 ; Nesi et al., 2017a ; Marengo et al., 2018 ; Memon et al., 2018 ; Sampasa-Kanyinga et al., 2018 ), 11 including Twitter ( Richards et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Spears et al., 2015 ; Harbard et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Barry et al., 2017 ; Brunborg et al., 2017 ; Merelle et al., 2017 ; Nesi et al., 2017a ; Memon et al., 2018 ; Sampasa-Kanyinga et al., 2018 ), and five studies asking about Snapchat ( Boyle et al., 2016 ; Barry et al., 2017 ; Brunborg et al., 2017 ; Nesi et al., 2017a ; Marengo et al., 2018 ). Eight studies mentioned Myspace ( Richards et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; de Vries et al., 2016 ; Harbard et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Larm et al., 2017 ; Booker et al., 2018 ; Sampasa-Kanyinga et al., 2018 ) and two asked about Tumblr ( Barry et al., 2017 ; Nesi et al., 2017a ). Other media such as Skype ( Merelle et al., 2017 ), Youtube ( Richards et al., 2015 ), WhatsApp ( Brunborg et al., 2017 ), Ping ( Merelle et al., 2017 ), Bebo ( Booker et al., 2018 ), Hyves ( de Vries et al., 2016 ), Kik ( Brunborg et al., 2017 ), Ask ( Brunborg et al., 2017 ), and Qzone ( Niu et al., 2018 ) were only included in one study each.

Almost half ( n = 34, 43%) of the included studies focus on use of social network sites or online communication in general, without specifying particular social media sites, leaving this up to the study participants to decide ( Best et al., 2014 , 2015 ; Ferguson et al., 2014 ; Neira and Barber, 2014 ; O’Connor et al., 2014 ; Koo et al., 2015 ; Tseng and Yang, 2015 ; Fahy et al., 2016 ; Woods and Scott, 2016 ; Burnette et al., 2017 ; Colder Carras et al., 2017 ; Foerster and Roosli, 2017 ; Foody et al., 2017 ; Geusens and Beullens, 2017 , 2018 ; Jafarpour et al., 2017 ; Kim, 2017 ; Marchant et al., 2017 ; Oberst et al., 2017 ; Przybylski and Weinstein, 2017 ; Salmela-Aro et al., 2017 ; Yan et al., 2017 ; Curtis et al., 2018 ; Erfani and Abedin, 2018 ; Erreygers et al., 2018 ; Nursalam et al., 2018 ; Scott and Woods, 2018 ; van den Eijnden et al., 2018 ; Wartberg et al., 2018 ; Critchlow et al., 2019 ; Holfeld and Mishna, 2019 ; Larm et al., 2019 ; Throuvala et al., 2019 ; Twenge and Campbell, 2019 ). Seven of the included studies examined the relationship between virtual game worlds or socially oriented video games and mental health ( Ferguson et al., 2014 ; Best et al., 2015 ; Spears et al., 2015 ; Yan et al., 2017 ; van den Eijnden et al., 2018 ; Larm et al., 2019 ; Twenge and Campbell, 2019 ).

In the 79 studies included in this scoping review, several approaches to measuring social media use are utilized. The combination of frequency and duration of social media use is by far the most used measurement of social media use, and 44 (56%) of the included studies collected data on these parameters ( Ferguson et al., 2014 ; Meier and Gray, 2014 ; Neira and Barber, 2014 ; Banjanin et al., 2015 ; Best et al., 2015 ; Hanprathet et al., 2015 ; Sampasa-Kanyinga and Lewis, 2015 ; Tseng and Yang, 2015 ; Boyle et al., 2016 ; de Vries et al., 2016 ; Frison and Eggermont, 2016 , 2017 ; Harbard et al., 2016 ; Sampasa-Kanyinga and Chaput, 2016 ; Woods and Scott, 2016 ; Banyai et al., 2017 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Foerster and Roosli, 2017 ; Jafarpour et al., 2017 ; Kim, 2017 ; Larm et al., 2017 , 2019 ; Merelle et al., 2017 ; Nesi et al., 2017b ; Oberst et al., 2017 ; Rousseau et al., 2017 ; Tiggemann and Slater, 2017 ; Yan et al., 2017 ; Booker et al., 2018 ; de Lenne et al., 2018 ; Erreygers et al., 2018 ; Houghton et al., 2018 ; Lai et al., 2018 ; Marengo et al., 2018 ; Marques et al., 2018 ; Niu et al., 2018 ; Nursalam et al., 2018 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Settanni et al., 2018 ; Twenge et al., 2018 ; van den Eijnden et al., 2018 ; Twenge and Campbell, 2019 ). Eight studies focused on the relationship between social media addiction or excessive use and mental health ( Banjanin et al., 2015 ; Tseng and Yang, 2015 ; Banyai et al., 2017 ; Merelle et al., 2017 ; Nursalam et al., 2018 ; Settanni et al., 2018 ; Wang et al., 2018 ). Bergen Social Media Addiction Scale is a commonly used questionnaire amongst the included studies ( Hanprathet et al., 2015 ; Banyai et al., 2017 ; Settanni et al., 2018 ). Seven studies asked about various specific actions on social media, such as liking or commenting on photos, posting something or participating in a discussion ( Meier and Gray, 2014 ; Koo et al., 2015 ; Nesi et al., 2017b ; Geusens and Beullens, 2018 ; Marques et al., 2018 ; van den Eijnden et al., 2018 ; Critchlow et al., 2019 ).

Five studies had a specific and sole focus on the link between social media use and alcohol, and examined how various alcohol-related social media use affected alcohol intake ( Boyle et al., 2016 ; Geusens and Beullens, 2017 , 2018 ; Nesi et al., 2017b ; Critchlow et al., 2019 ). Some studies had a more theory-based focus and investigated themes such as peer comparison, social media intrusion or pro-social behavior on social media and its effect on mental health ( Bourgeois et al., 2014 ; Rousseau et al., 2017 ; de Lenne et al., 2018 ). One of the included studies looked into night-time specific social media use ( Scott and Woods, 2018 ) and one looked into pre-bedtime social media behavior ( Harbard et al., 2016 ) to study the link between this use and sleep.

Amongst the 79 included studies, only six (8%) studies had participants of one gender ( Ferguson et al., 2014 ; Meier and Gray, 2014 ; Best et al., 2015 ; Burnette et al., 2017 ; Jafarpour et al., 2017 ; Tiggemann and Slater, 2017 ). Sixteen studies (20%) did not mention the gender distribution of the participants ( Aboujaoude et al., 2015 ; Best et al., 2015 ; Hamm et al., 2015 ; Richards et al., 2015 ; Fisher et al., 2016 ; Woods and Scott, 2016 ; Foody et al., 2017 ; Marchant et al., 2017 ; Przybylski and Weinstein, 2017 ; Curtis et al., 2018 ; Erfani and Abedin, 2018 ; John et al., 2018 ; Memon et al., 2018 ; O’Reilly et al., 2018 ; Twenge et al., 2018 ; Twenge and Campbell, 2019 ). Several of these were meta-analyses or reviews ( Aboujaoude et al., 2015 ; Best et al., 2014 ; Curtis et al., 2018 ; Foody et al., 2017 ; John et al., 2018 ; Erfani and Abedin, 2018 ; Wallaroo, 2020 ). The studies that included both genders as participants generally had a well-balanced gender distribution with no gender below 40% of the participants. Eight of the studies did not report gender-specific results ( Harbard et al., 2016 ; Nesi et al., 2017b ; Curtis et al., 2018 ; de Lenne et al., 2018 ; Niu et al., 2018 ; Nursalam et al., 2018 ; Wang et al., 2018 ; Twenge and Campbell, 2019 ). Of the included studies, gender was seldom examined as an explanatory variable, and other sociodemographic variables (e.g., ethnicity, socioeconomic status) were not included at all.

Implicit Causation Based on Direction of Association

Sixty-one (77%) of the included studies has social media use as the independent variable and some of the mentioned measurements of mental health as the dependent variable ( Aboujaoude et al., 2015 ; Banjanin et al., 2015 ; Banyai et al., 2017 ; Barry et al., 2017 ; Best et al., 2014 ; Booker et al., 2018 ; Bourgeois et al., 2014 ; Boyle et al., 2016 ; Brunborg et al., 2017 ; Colder Carras et al., 2017 ; Critchlow et al., 2019 ; Cross et al., 2015 ; Curtis et al., 2018 ; de Lenne et al., 2018 ; de Vries et al., 2016 ; Erfani and Abedin, 2018 ; Fahy et al., 2016 ; Fisher et al., 2016 ; Foerster and Roosli, 2017 ; Fredrick and Demaray, 2018 ; Frison and Eggermont, 2016 ; Geusens and Beullens, 2018 ; Hamm et al., 2015 ; Hanprathet et al., 2015 ; Harbard et al., 2016 ; Hase et al., 2015 ; Holfeld and Mishna, 2019 ; Jafarpour et al., 2017 ; John et al., 2018 ; Kim et al., 2019 ; Kim, 2017 ; Lai et al., 2018 ; Larm et al., 2017 , 2019 ; Marengo et al., 2018 ; Marques et al., 2018 ; Meier and Gray, 2014 ; Memon et al., 2018 ; Neira and Barber, 2014 ; Nesi et al., 2017b ; Niu et al., 2018 ; Nursalam et al., 2018 ; O’Connor et al., 2014 ; O’Reilly et al., 2018 ; Przybylski and Bowes, 2017 ; Przybylski and Weinstein, 2017 ; Richards et al., 2015 ; Sampasa-Kanyinga and Chaput, 2016 ; Sampasa-Kanyinga and Lewis, 2015 ; Sampasa-Kanyinga et al., 2018 ; Scott and Woods, 2018 ; Spears et al., 2015 ; Tseng and Yang, 2015 ; Twenge and Campbell, 2019 ; Twenge et al., 2018 ; van den Eijnden et al., 2018 ; Wang et al., 2018 ; Wartberg et al., 2018 ; Wolke et al., 2017 ; Woods and Scott, 2016 ; Yan et al., 2017 ). Most of the included studies hypothesize social media use pattern will affect youth mental health in certain ways. The majority of the included studies tend to find a correlation between more frequent social media use and poor well-being and/or mental health (see Supplementary Table 2 ). The strength of this correlation is however heterogeneous as social media use is measured substantially different across studies. Four (5%) of the included studies focus explicitly on how mental health can affect social media use ( Merelle et al., 2017 ; Nesi et al., 2017a ; Erreygers et al., 2018 ; Settanni et al., 2018 ). Fourteen studies included a mediating factor or focus on reciprocal relationships between social media use and mental health ( Ferguson et al., 2014 ; Koo et al., 2015 ; Tseng and Yang, 2015 ; Frison and Eggermont, 2017 ; Geusens and Beullens, 2017 ; Marchant et al., 2017 ; Oberst et al., 2017 ; Rousseau et al., 2017 ; Salmela-Aro et al., 2017 ; Tiggemann and Slater, 2017 ; Houghton et al., 2018 ; Marques et al., 2018 ; Niu et al., 2018 ; Wang et al., 2018 ). An example is a cross-sectional study by Ferguson et al. (2014) suggesting that exposure to social media contribute to later peer competition which was found to be a predictor of negative mental health outcomes such as eating disorder symptoms.

Cyberbullying as a Nexus

Thirteen of the 79 (17%) included studies investigated cyberbullying as the measurement of social media use ( Aboujaoude et al., 2015 ; Cross et al., 2015 ; Hamm et al., 2015 ; Hase et al., 2015 ; Spears et al., 2015 ; Fahy et al., 2016 ; Fisher et al., 2016 ; Foody et al., 2017 ; Przybylski and Bowes, 2017 ; Wolke et al., 2017 ; Fredrick and Demaray, 2018 ; John et al., 2018 ; Holfeld and Mishna, 2019 ). Most of the systematic reviews and meta-analyses included focused on cyberbullying. A cross-sectional study from 2017 suggests that cyberbullying has similar negative effects as direct or relational bullying, and that cyberbullying is “mainly a new tool to harm victims already bullied by traditional means” ( Wolke et al., 2017 ). A meta-analysis from 2016 concludes that “peer cybervictimization is indeed associated with a variety of internalizing and externalizing problems among adolescents” ( Fisher et al., 2016 ). A systematic review from 2018 concludes that both victims and perpetrators of cyberbullying are at greater risk of suicidal behavior compared with non-victims and non-perpetrators ( John et al., 2018 ).

Strengths and Limitations of Present Study

The main strength of this scoping review lies in the effort to give a broad overview of published research related to use of social media, and mental health and well-being among adolescents. Although a range of reviews on screen-based activities in general and mental health and well-being exist ( Dickson et al., 2018 ; Orben, 2020 ), they do not necessarily discern between social media use and other types of technology-based media. Also, some previous reviews tend to be more particular regarding mental health outcome ( Best et al., 2014 ; Seabrook et al., 2016 ; Orben, 2020 ), or do not focus on adolescents per se ( Seabrook et al., 2016 ). The main limitation is that, despite efforts to make the search strategy as comprehensive and inclusive as possible, we probably have not been able to identify all relevant studies – this is perhaps especially true when studies do include relevant information about social media and mental health/well-being, but this information is part of sub-group analyses or otherwise not the main aim of the studies. In a similar manner, related to qualitative studies, we do not know if our search strategy were as efficient in identifying studies of relevance if this was not the main theme or focus of the study. Despite this, we believe that we were able to strike a balance between specificity and sensitivity in our search strategy.

Description of Central Themes and Core Concepts

The findings from the present scoping review on social media use and mental health and well-being among adolescents revealed that the majority (about 3/4) of the included studies focused on social media and pathology. The core concepts identified are social media use and its statistical association with symptoms of depression, general psychiatric symptoms and other symptoms of psychopathology. Similar findings were made by Keles et al. (2020) in a systematic review from 2019. Focus on the potential association between social media use and positive outcomes seems to be rarer in the current literature, even though some studies focused on well-being which also includes positive aspects of mental health. Studies focusing on screen-based media in general and well-being is more prevalent than studies linking social media specifically with well-being ( Orben, 2020 ). The notion that excessive social media use is associated with poor mental health is well established within mainstream media. Our observation that this preconception seems to be the starting point for much research is not conducive to increased knowledge, but also alluded to elsewhere ( Coyne et al., 2020 ).

Why the Focus on Poor Mental Health/Pathology?

The relationship between social media and mental health is likely to be complex, and social media use can be beneficial for maintaining friendships and enriching social life ( Seabrook et al., 2016 ; Birkjær and Kaats, 2019 ; Coyne et al., 2020 ; Orben, 2020 ). This scoping review reveals that the majority of studies focusing on effects of social media use has a clearly stated focus on pathology and detrimental results of social media use. Mainstream media and the public discourse has contributed in creating a culture of fear around social media, with a focus on its negative elements ( Ahn, 2012 ; O’Reilly et al., 2018 ). It is difficult to pin-point why the one-sided focus on the negative effects of social media has been established within the research literature. But likely reasons are elements of “moral panic,” and reports of increases in mental health problems among adolescents in the same period that social media were introduced and became wide-spread ( Birkjær and Kaats, 2019 ). The phenomenon of moral panic typically resurges with the introduction and increasing use of new technologies, as happened with video games, TV, and radio ( Mueller, 2019 ).

The Metrics of Social Media

Social media trends change rapidly, and it is challenging for the research field to keep up. The included studies covered some of the most frequently used social media, but the amount of studies focusing on each social media did not accurately reflect the contemporary distribution of users. Even though sites such as Instagram and Snapchat were covered in some studies, the coverage did not do justice to the amount of users these sites had. Newer social media sites such as TikTok were not mentioned in the included studies even though it has several hundred million daily users ( Mediakix, 2019 ; Wallaroo, 2020 ).

Across the included studies there was some variation in how social media were gauged, but the majority of studies focused on the mere frequency and duration of use. There were little focus on separating between different forms of (inter)actions on social media, as these can vary between being a victim of cyberbullying to participating in healthy community work. Also, few studies differentiated between types of actions (i.e., posting, scrolling, reading), active and passive modes of social media use (i.e., production versus consumption, and level of interactivity), a finding similar to other reports ( Seabrook et al., 2016 ; Verduyn et al., 2017 ; Orben, 2020 ). There is reason to believe that different modes of use on social media platforms are differentially associated with mental health, and a recent narrative review highlight the need to address this in future research ( Orben, 2020 ). One of the included studies found for instance that it is not the total time spent on Facebook or the internet, but the specific amount of time allocated to photo-related activities that is associated with greater symptoms of eating disorders such as thin ideal internalization, self-objectification, weight dissatisfaction, and drive for thinness ( Meier and Gray, 2014 ). This observation can possibly be explained by social comparison mechanisms ( Appel et al., 2016 ) and passive use of social media ( Verduyn et al., 2017 ). The lack of research differentiating social media use and its association with mental health is an important finding of this scoping review and will hopefully contribute to this being included in future studies.

Few studies examined the motivation behind choosing to use social media, or the mental health status of the users when beginning a social media session. It has been reported that young people sometimes choose to enter sites such as Facebook and Twitter as an escape from threats to their mental health such as experiencing overwhelming pressure in daily life ( Boyd, 2014 ). This kind of escapism can be explained through uses and gratifications theory [see for instance ( Coyne et al., 2020 )]. On the other hand, more recent research suggest that additional motivational factors may include the need to control relationships, content, presentation, and impressions ( Throuvala et al., 2019 ), and it is possible that social media use can act as an reinforcement of adolescents’ current moods and motivations ( Birkjær and Kaats, 2019 ). Regardless, it seems obvious that the interplay between online and offline use and underlying motivational mechanisms needs to be better understood.

There has also been some questions about the accuracy when it comes to deciding the amount and frequency of one’s personal social media use. Without measuring duration and frequency of use directly and objectively it is unlikely that subjective self-report of general use is reliable ( Kobayashi and Boase, 2012 ; Scharkow, 2016 , 2019 ; Naab et al., 2019 ). Especially since the potential for social media use is almost omnipresent and the use itself is diverse in nature. Also, due to processes such as social desirability, it is likely that some participants report lower amounts of social media use as excessive use is seen largely undesirable ( Krumpal, 2013 ). Inaccurate reporting of prior social media use could also be a threat to the validity of the reported numbers and thus bias the results reported. Real-time tracking of actual use and modes of use is therefore recommended in future studies to ensure higher accuracy of these aspects of social media use ( Coyne et al., 2020 ; Orben, 2020 ), despite obvious legal and ethical challenges. Another aspect of social media use which does not seem to be addressed is potential spill-over effects, where use of social media leads to potential interest in or thinking about use of – and events or contents on – social media when the individual is offline. When this aspect has been addressed, it seems to be in relation to preoccupations and with a focus on excessive use or addictive behaviors ( Griffiths et al., 2014 ). Conversely, given the ubiquitous and important role of social media, experiences on social media – for better or for worse – are likely to be interconnected with the rest of an individual’s lived experience ( Birkjær and Kaats, 2019 ).

The Studies Seem to Implicitly Think That the Use of Social Media “Causes”/“Affects” Mental Health (Problems)

Most of the included studies establish an implicit causation between social media and mental health. It is assumed that social media use has an impact on mental health. The majority of studies included establish some correlation between more frequent use of social media and poor well-being/mental health, as evident from Supplementary Table 2 . As formerly mentioned, most of the included studies are cross-sectional and cannot shed light into temporality or cause-and-effect. In total, only 16 studies had a longitudinal design, using different types of regression models, latent growth curve models and cross-lagged models. Yet there seems to be an unspoken expectation that the direction of the association is social media use affecting mental health. The reason for this supposition is unclear, but again it is likely that the mainstream media discourse dominated by mostly negative stories and reports of social media use has some impact together with the observed moral panic.

With the increased popularity of social media and internet arrived a reduction of face-to-face contact and supposed increased social isolation ( Kraut et al., 1998 ; Espinoza and Juvonen, 2011 ). This view is described as the displacement hypothesis [see for instance ( Coyne et al., 2020 )]. Having a thriving social life and community with meaningful relations are for many considered vital for well-being and good mental health, and the supposed reduction of sociality were undoubtedly met with skepticism by some. Social media use has increased rapidly among young people over the last two decades along with reports that mental health problems are increasing. Several studies report that there is a rising prevalence of symptom of anxiety and depression among our adolescents ( Bor et al., 2014 ; Olfson et al., 2015 ). The observation that increases in social media use and mental health issues happened in more or less the same time period can have contributed to focus on how use of social media affects mental health problems.

The existence of an implicit causation is supported by the study variables chosen and the lack of positively worded outcomes. Depression, anxiety, alcohol use, psychiatric problems, suicidal behavior and eating disorders are amongst the most studied outcome-variables. On the other side of the spectrum we have well-being, which can oscillate from positive to negative, whilst the measures of pathology only vary from “ill” to “not ill” with positive outcomes not possible.

What Is the Gap in the Literature?

The current literature on social media and mental health among youth is still developing and has several gaps and shortcomings, as evident from this scoping review and other publications ( Seabrook et al., 2016 ; Coyne et al., 2020 ; Keles et al., 2020 ; Orben, 2020 ). Some of the gaps and shortcomings in the field we propose solutions for has been identified in a systematic review from 2019 by Keles et al. (2020) . The majority of the included studies in the current scoping review were cross-sectional, were limited in their inclusion of potential confounders and 3rd variables such as sociodemographics and personality, preventing knowledge about possible cause-and-effect between social media and mental health. There is a lack of longitudinal studies examining the effects of social media over extended periods of time, as well as investigations longitudinally of how mental health impacts social media use. However, since the formal search was ended for this scoping review, some innovative studies have emerged using longitudinal data ( Brunborg and Andreas, 2019 ; Orben et al., 2019 ; Coyne et al., 2020 ). More high quality longitudinal studies of social media use and mental health could help us identify the patterns over time and help us learn about possible cause-and-effect relationships, as well as disentangling between- and within-person associations ( Coyne et al., 2020 ; Orben, 2020 ). Furthermore, both social media use and mental health are complex phenomena in themselves, and future studies need to consider which aspects they want to investigate when trying to understand their relationship. Mechanisms linking social media use and eating disorders are for instance likely to be different than mechanisms linking social media use and symptoms of ADHD.

Our literature search also revealed a paucity of qualitative studies exploring the why’s and how’s of social media use in relation to mental health among adolescents. Few studies examine how youth themselves experience and perceive the relationship between social media and mental health, and the reasons for their continued and frequent use. Qualitatively oriented studies would contribute to a deeper understanding of adolescent’s social media sphere, and their thoughts about the relationship between social media use and mental health [see for instance ( Burnette et al., 2017 )]. For instance, O’Reilly et al. (2018) found that adolescents viewed social media as a threat to mental well-being, and concluded that they buy into the idea that “inherently social media has negative effects on mental wellbeing” and seem to “reify the moral panic that has become endemic to contemporary discourses.” On the other hand, Weinstein found using both quantitative and qualitative data that adolescents’ perceptions of the relationship between social media use and well-being probably is more nuanced, and mostly positive. Another clear gap in the research literature is the lack of focus on potentially positive aspects of social media use. It is obvious that there are some positive sides of the use of social media, and these also need to be investigated further ( Weinstein, 2018 ; Birkjær and Kaats, 2019 ). Gender-specific analyses are also lacking in the research literature, and there is reason to believe that social media use have different characteristics between the genders with different relationships to mental health. In fact, recent findings indicate that not only gender should be considered an important factor when investigating the role of social media in adolescents’ lives, but individual characteristics in general ( Orben et al., 2019 ; Orben, 2020 ). Analyses of socioeconomic status and geographic location are also lacking and it is likely that these factors might play a role the potential association between social media use and mental health. And finally, several studies point to the fact that social media potentially could be a fruitful arena for promoting mental well-being among youth, and developing mental health literacy to better equip our adolescents for the challenges that will surely arise ( O’Reilly et al., 2018 ; Teesson et al., 2020 ).

Research into the association between social media use and mental health and well-being among adolescents is rapidly emerging. The field is characterized by a focus on the association between social media use and negative aspects of mental health and well-being, and where studies focusing on the potentially positive aspects of social media use are lacking. Presently, the majority of studies in the field are quantitatively oriented, with most utilizing a cross-sectional design. An increase in qualitatively oriented studies would add to the field of research by increasing the understanding of adolescents’ social-media life and their own experiences of its association with mental health and well-being. More studies using a longitudinal design would contribute to examining the effects of social media over extended periods of time and help us learn about possible cause-and-effect relationships. Few studies look into individual factors, which may be important for our understanding of the association. Social media use and mental health and well-being are complex phenomena, and future studies could benefit from specifying the type of social media use they focus on when trying to understand its link to mental health. In conclusion, studies including more specific aspects of social media, individual differences and potential intermediate variables, and more studies using a longitudinal design are needed as the research field matures.

Author Contributions

JS conceptualized the review approach and provided general guidance to the research team. VS and JS drafted the first version of this manuscript. JS, GH, and LA developed the draft further based on feedback from the author group. All authors reviewed and approved the final version of the manuscript and have made substantive intellectual contributions to the development of this manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Bergen municipality, Hordaland County Council and Western Norway University of Applied Sciences for their collaboration and help with the review. We would also like to thank Senior Librarian Marita Heinz at the Norwegian Institute for Public Health for vital help conducting the literature search.

Funding. This review was partly funded by Regional Research Funds in Norway, funding #RFF297031. No other specific funding was received for the present project. The present project is associated with a larger innovation-project lead by Bergen municipality in Western Norway related to the use of social media and mental health and well-being. The innovation-project is funded by a program initiated by the Norwegian Directorate of Health, and in Vestland county coordinated by the County Council (County Authority). The project aims to explore social media as platform for health-promotion among adolescents.

1 https://rayyan.qcri.org/welcome

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01949/full#supplementary-material

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