Social Networking Sites, Depression, and Anxiety: A Systematic Review

Social Media Use and Deliberate Self-Harm Among Youth: A Systematized Narrative Review

BACKGROUND

Suicide is now the 2^nd leading cause of death among adolescents and young adults. Social media's influence on youth suicidal risk or attenuation of risk is a novel and rapidly expanding topic of research that requires attention from a broad range of mental health services professionals. We aimed to provide an updated review of social media-related risk and protective factors to youth deliberate-self harm (DSH) to guide mental health services professionals in offering care and support to youth vulnerable to suicide.

METHODS

Studies on which primary research was conducted that evaluated young people's use of social media platforms related to DSH were systematically searched via Scopus and identified through expert recommendation and the Association for Computing Machinery's digital library of conference materials. The search focused on the timeframe June 2014 to September 2019, to offer an update since the time the most recent systematic reviews on this topic concluded their literatures searches. Quality was reviewed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

A total of 38 articles were eligible, and 24 articles rated as high quality were included in a narrative review. Of the included articles, 19 explored DSH risk and 8 explored DSH protection. Most articles reported on cross-sectional quantitative or qualitative studies. Opportunities for both risks and benefits were explored, and potential influences of social media use were considered for subgroups of youth who may be especially vulnerable to suicide.

CONCLUSIONS

In the relatively short period of review, the association between social media use and youth DSH was tested in population-based studies, offering preliminary evidence for suicide prevention and treatment efforts. Further research is needed to understand the contribution of social media use to youth DSH, particularly among youth most vulnerable to suicidal risk.

Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review

BACKGROUND

Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect.

OBJECTIVE

The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents.

METHODS

An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out.

RESULTS

The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results.

CONCLUSIONS

Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence.

Social Media Use and Depressive Symptoms-A Longitudinal Study from Early to Late Adolescence

An increasing number of studies have addressed how adolescents’ social media use is associated with depressive symptoms. However, few studies have examined whether these links occur longitudinally across adolescence when examined at the individual level of development. This study investigated the within-person effects between active social media use and depressive symptoms using a five-wave longitudinal dataset gathered from 2891 Finnish adolescents (42.7% male, age range 13–19 years). Sensitivity analysis was conducted, adjusting for gender and family financial status. The results indicate that depressive symptoms predicted small increases in active social media use during both early and late adolescence, whereas no evidence of the reverse relationship was found. Yet, the associations were very small, statistically weak, and somewhat inconsistent over time. The results provide support for the growing notion that the previously reported direct links between social media use and depressive symptoms might be exaggerated. Based on these findings, we suggest that the impact of social media on adolescents’ well-being should be approached through methodological assumptions that focus on individual-level development.

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

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.

Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users: A psychometric evaluation and cross-sectional study

Research on the association between social anxiety and social media usage remains inconclusive: despite the preference for computer-mediated communication there is currently no clear empirical support for social anxiety being associated with longer duration of social media use. Self-report measures for social anxiety that are adapted for the context of social media could facilitate further research. The current study aimed to develop a Swedish version of the recently developed Social Anxiety Scale for Social Media Users (SAS-SMU), evaluate its psychometric properties, and explore associations between different uses of social media and social anxiety. Three factors were retained for SAS-SMU with excellent internal consistency. SAS-SMU evidenced convergent validity with measures of social anxiety, negative convergent validity with satisfaction with life, and divergent validity with measures of obsessive-compulsive disorder, depression and generalized anxiety disorder. Results indicated that higher levels of social anxiety were associated with passive and active use as well as longer duration of social media use in general, which is at odds with a previous study where passive use remained the only significant predictor for social anxiety.

Twitter as a promising microblogging application for psychiatric consultation - Understanding the predictors of use, satisfaction and e-health literacy

BACKGROUND

The use of social media is widespread globally. It provides a quicker and faster means of efficient exchange of communications. The use of Twitter Applications to seek mental health advice is becoming popular.

OBJECTIVES

This study aims to identify the determinants associated with Twitter use in psychiatric consultations and to assess the level of satisfaction in using the microblogging platform. In addition, the level of e-health literacy is also assessed among users.

METHODS

The target population included Twitter users seeking psychiatric consultation. A leading psychiatrist's twitter account with 4.5 million followers was selected and consent obtained. A validated Patient Satisfaction Questionnaire was adopted to assess the level of satisfaction in Twitter use and e-health literacy. The questionnaire was tagged to the chosen Twitter account and reminders were sent until the sample size was reached. Data was analysed using SPSS version 22.0. The analysis included descriptive statistics tabulation, multi-response analysis, and cross-tabulation for satisfaction variables and the chi-square test was used to measure association between different variables.

RESULTS

The study obtained 155 completed response sheets, of which 52 were Twitter users seeking psychiatric advice while the rest sought general health advice. Most of the study participants were females (71.6 %). Women, single status and income range between 4000-9000 Saudi riyal were found to be significantly associated with Twitter use for psychiatric consultation. Generally, most of the participants were satisfied with Twitter in seeking psychiatric consultation that reduced financial disbursement. Furthermore, concerns were expressed regarding the waiting period, word limitations and issues of privacy. The e-health literacy was higher among the participants.

CONCLUSION

Psychiatric consultations via Twitter is more popular among women. By addressing privacy issues and reducing response time, Twitter may be used as a major platform to deliver mental health services to the population.

Unique associations of social media use and online appearance preoccupation with depression, anxiety, and appearance rejection sensitivity

Social media (SM) can create a climate of social comparison and preoccupation with appearance, which can pose risks for emotional problems, such as depression and social anxiety. In this study, 763 adolescents and young adults reported time spent and intensity of social media use and preoccupation with both general and appearance-related (AR) social media activities and content. Associations were investigated with markers of depression and social anxiety symptoms and appearance sensitivities - appearance anxiety and appearance rejection sensitivity (appearance-RS). Social media use was positively associated with symptoms of depression, social anxiety, appearance anxiety, and appearance-RS. General and AR preoccupation had unique and positive associations with depression and social anxiety symptoms and with appearance sensitivities. AR preoccupation was also found to strengthen the relationship between time spent on social media and appearance-RS. Although there were gender differences on all measures, with young women scoring higher on all measures, there was no evidence that gender moderated the effects of AR social media preoccupation. Findings support emerging evidence that social media engagement and behavior, particularly activities involving appearance comparisons and judgements, may be more of a risk to depression and social anxiety symptoms and appearance sensitivities than simply the frequency of social media use.

General and Alcohol-Related Social Media Use and Mental Health: a Large-Sample Longitudinal Study

The current study aimed to investigate if general and alcohol-related social media use predicts symptoms of depression and anxiety. Students in Bergen, Norway, participated in a Web-based survey during fall 2015 (T1) and a follow-up survey during fall 2016 (T2). A total of 5217 participated in both surveys. Crude and adjusted linear regression analyses were conducted to investigate if social media use at T1 predicted depression and anxiety at T2. Several social media use variables (e.g., using Instagram) were positively associated with depression and anxiety over time, but these associations became non-significant when covariates were controlled for. Number of online friends was inversely related to depression whereas using Twitter was positively related to anxiety at T2, when covariates were controlled for. The effect sizes of the observed associations were all very small. The current study found little support for a relationship between social media use and mental health.

Leveraging the social network for treatment of social anxiety: Pilot study of a youth-specific digital intervention with a focus on engagement of young men

OBJECTIVE

The primary objective was to determine the acceptability, feasibility and safety of a novel digital intervention (Entourage) for young people with prominent social anxiety symptoms, with a particular focus on the engagement of young men. The secondary aim was to explore whether the intervention was associated with clinically significant improvements to clinical and social variables known to co-occur with social anxiety.

METHOD

A multidisciplinary team comprising of mental health clinicians, researchers, young adult fiction writers, a comic artist and young people with a lived experience of social anxiety developed the Entourage platform in collaboration. Entourage combines evidence-based therapeutic techniques for social anxiety with an engaging, social-media-based interface that allows users to build social connections, while also receiving expert clinical moderation and support from peer workers. Acceptability, feasibility and safety outcomes of Entourage were tested in a 12-week pilot study with 89 young people (48.3% male; age M = 19.8 years, SD = 3.3 years). Eligible participants were recruited via liaison with four headspace early-intervention centres in north-western Melbourne.

RESULTS

56.8% of the sample reported social anxiety symptoms in the severe or very severe range at baseline. Results demonstrated the Entourage intervention was feasible, safe, and potentially acceptable, with 98.6% of participants reporting they would recommend Entourage to another young person experiencing social anxiety. Usage results were also comparable across male and non-male participants. Results showed that young people reliably and significantly improved on clinical and social variables. In particular, young males showed a clinically significant improvement on social anxiety symptoms (d = 0.79, p < .001), depression (d = 0.71, p < .001), belongingness (d = 0.58, p = .001), increased feelings of social connectedness (d = 0.46, p = .004) and decreased loneliness (d = 0.46, p = .006). Non-male participants also experienced a significant increase in social connectedness (d = 0.76, p < .001), alongside reduced social anxiety (d = 0.78, p < .001) and experiential avoidance (d = 0.81, p < .001).

CONCLUSIONS

Entourage is a highly engaging and potentially effective intervention that represents a novel combination of features designed both to reduce social anxiety symptoms and improve social connection among young people. Entourage demonstrated some acceptability, feasibility and safety, with encouraging benefits to clinical and social variables. Entourage also showed favorable results for the engagement and support of young men with social anxiety symptoms.

Technology Use for Adolescent Health and Wellness

As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research.

Rethinking Social Interaction: Empirical Model Development

Background

Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions.

Objective

To develop a theoretically based empirical model of current social interfaces to inform relevant measures.

Methods

A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique.

Results

We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges.

Conclusions

We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures.

Associations between positive and negative social media experiences and sleep disturbance among young adults

OBJECTIVES

We sought to examine the association of positive and negative experiences using social media (SM) and sleep disturbance in a national survey of U.S. young adults.

METHODS

Experiences using SM were assessed with 2 items asking participants about the percentage of time using SM that involved a negative/positive experience that they were personally involved in. Sleep disturbance was assessed using the validated PROMIS 4-item short form. Ordinal logistic regression was used to examine associations between positive and negative SM experiences and high sleep disturbance, while controlling for relevant covariates.

RESULTS

Although reporting high levels of negative experiences was significantly associated with greater odds of high sleep disturbance (AOR = 1.49, 95%CI = 1.18-1.89), reporting high levels of positive experiences was not associated with sleep disturbance.

CONCLUSIONS

These findings suggest that more robust examinations of negative SM experiences-especially as they relate to sleep disturbance-may be warranted.

Multimodal mental health analysis in social media

Depression is a major public health concern in the U.S. and globally. While successful early identification and treatment can lead to many positive health and behavioral outcomes, depression, remains undiagnosed, untreated or undertreated due to several reasons, including denial of the illness as well as cultural and social stigma. With the ubiquity of social media platforms, millions of people are now sharing their online persona by expressing their thoughts, moods, emotions, and even their daily struggles with mental health on social media. Unlike traditional observational cohort studies conducted through questionnaires and self-reported surveys, we explore the reliable detection of depressive symptoms from tweets obtained, unobtrusively. Particularly, we examine and exploit multimodal big (social) data to discern depressive behaviors using a wide variety of features including individual-level demographics. By developing a multimodal framework and employing statistical techniques to fuse heterogeneous sets of features obtained through the processing of visual, textual, and user interaction data, we significantly enhance the current state-of-the-art approaches for identifying depressed individuals on Twitter (improving the average F1-Score by 5 percent) as well as facilitate demographic inferences from social media. Besides providing insights into the relationship between demographics and mental health, our research assists in the design of a new breed of demographic-aware health interventions.

Digital depression: a new disease of the millennium?

OBJECTIVE

In the past decade, since the innovation of the smartphone, there has been an increase in depression, anxiety, and suicidality among teenagers and young adults. The objective of this article was to review the current evidence for these associations and to provide initial clinical guidance.

METHODS

A narrative review of the available literature on digital technology, social media, and psychiatric outcomes in adolescents.

RESULTS

Psychiatric outcomes have worsened in adolescents in the past decade, correlating with the invention of the smartphone and the rise of social media. Depressive symptoms among American teenagers rose rapidly around 2012 and now are reported in 22% of adolescents, which is at least double the rate in adults. Suicide rates have risen, especially among teenage girls in the United States, in whom there has been a doubling of completed suicide in the past decade. A causal relationship between social media use and these harmful psychiatric outcomes is supported by emerging randomized data showing reduced depressive symptoms associated with a decrease in social media use in college students.

CONCLUSIONS

Social media and digital technology correlate with harmful psychiatric outcomes in adolescents and young adults. Clinical recommendations should include limitations in social media use.

Methods in predictive techniques for mental health status on social media: a critical review

Social media is now being used to model mental well-being, and for understanding health outcomes. Computer scientists are now using quantitative techniques to predict the presence of specific mental disorders and symptomatology, such as depression, suicidality, and anxiety. This research promises great benefits to monitoring efforts, diagnostics, and intervention design for these mental health statuses. Yet, there is no standardized process for evaluating the validity of this research and the methods adopted in the design of these studies. We conduct a systematic literature review of the state-of-the-art in predicting mental health status using social media data, focusing on characteristics of the study design, methods, and research design. We find 75 studies in this area published between 2013 and 2018. Our results outline the methods of data annotation for mental health status, data collection and quality management, pre-processing and feature selection, and model selection and verification. Despite growing interest in this field, we identify concerning trends around construct validity, and a lack of reflection in the methods used to operationalize and identify mental health status. We provide some recommendations to address these challenges, including a list of proposed reporting standards for publications and collaboration opportunities in this interdisciplinary space.

Identification of nonclinical interventions for spontaneous recovery of depression using mathematical modeling

BACKGROUND

In order to make a risk or vulnerability assessment of major depressive disorder (MDD) in adolescents and suggest nonclinical interventions for spontaneous recovery for low-vulnerable adolescents a novel network mathematical model has been proposed.

METHODS

In the existing network theory, the theoretical model consists of a symptom network surrounded by the triggering factors as external field which are the cause for adolescents being diagnosed with MDD. But in our network model, the triggering external field is replaced by nonclinical interventions, easily implementable in schools and colleges with teachers as facilitators.

RESULTS

The four variables of subjective well-being (SWB), emotional quotient-Attention (EQ-A), emotional quotient-Clarity (EQ-C) and emotional quotient-Reparation (EQ-R) were the symptoms considered for stratification of the vulnerability. The mathematical model was created using the four symptoms and the four nonclinical interventions of technology use, physical exercise, peer pressure positive and peer pressure negative, and their inter-relationship.

CONCLUSION

A balance of tech use and physical exercise and of the peer pressure help maintain the adolescents in the low-vulnerability group in our study with 227 adolescents in Bangalore. Furthermore, we predict that positive peer pressure and physical exercise could increase the EQ thus suggesting a preventive model for the onset of major depressive disorder (MDD).

Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions

Adolescents are spending an increasing amount of their time online and connected to each other via digital technologies. Mobile device ownership and social media usage have reached unprecedented levels, and concerns have been raised that this constant connectivity is harming adolescents' mental health. This review synthesized data from three sources: (a) narrative reviews and meta-analyses conducted between 2014 and 2019, (b) large-scale preregistered cohort studies and (c) intensive longitudinal and ecological momentary assessment studies, to summarize what is known about linkages between digital technology usage and adolescent mental health, with a specific focus on depression and anxiety. The review highlights that most research to date has been correlational, focused on adults versus adolescents, and has generated a mix of often conflicting small positive, negative and null associations. The most recent and rigorous large-scale preregistered studies report small associations between the amount of daily digital technology usage and adolescents' well-being that do not offer a way of distinguishing cause from effect and, as estimated, are unlikely to be of clinical or practical significance. Implications for improving future research and for supporting adolescents' mental health in the digital age are discussed.

[Mediators of Problematic Social Media Use in Adolescence as Possible Mechanisms of Change in Psychotherapy]

Mediators of Problematic Social Media Use in Adolescence as Possible Mechanisms of Change in Psychotherapy Social media are omnipresent in the lives of adolescents. Problematic use of social media has been linked to adverse mental health outcomes including depression, anxiety, suicidality, self-harm, body dissatisfaction and eating pathology. Preliminary evidence suggests that interventions aiming at reducing the amount of time spent in social media and changing dysfunctional beliefs about social media use are promising. However, the mechanisms of change of these interventions with regard to mental health remain unclear. Therefore, this review first provides an overview of the association between social media and mental health and then identifies mediators of this relationship as potential mechanisms of change of interventions targeting problematic media use in adolescents. The identified mediators encompass social comparison, decreased self-esteem, fear of missing out, sleep problems and increased rumination. Future studies should apply a longitudinal design, should investigate additional confounding variables (e. g. age, level of psychopathology) and should also focus on positive effects of social media use on mental health. Thereby, this line of research has the potential to improve our understanding how social media use exerts its effects and based thereupon to develop new or optimize current interventions on problematic social media use to improve mental health in adolescents by targeting the identified mediators.

Social media use and risky behaviors in adolescents: A meta-analysis

INTRODUCTION

This systematic review and meta-analysis examined the associations between social media use and risky behaviors during adolescence, and evaluated study characteristics (e.g., sample age, type of social media platform assessed) that may moderate these relationships.

METHODS

A comprehensive search strategy identified relevant studies from PsycInfo, PubMed, Google Scholar, and Proquest Dissertations and Theses Global.

RESULTS

The final sample included 27 independent cross-sectional studies with a total of 67,407 adolescents (M_age = 15.5, range: 12.6-18.0 years; 51.7% girls; 57.2% White). Results from random effects models indicated that there were positive, small-to-medium correlations between social media use and engagement in risky behaviors generally (r = 0.21, 95% CI = 0.16-0.25), substance use (r = 0.19, 95% CI = 0.12-0.26), and risky sexual behaviors (r = 0.21, 95% CI = 0.15-0.28). There were an insufficient number of independent samples available to conduct a random effect models for violence-related behaviors (k = 3). Moderator analyses suggested that studies assessing solely early social media platforms (e.g., Facebook/MySpace only) in relation to substance use had smaller effect sizes than substance use studies assessing a broader range of contemporary social media platforms. In addition, younger samples had larger effect sizes for studies focused on social media use and risky sexual behaviors.

CONCLUSIONS

The positive links identified between social media and risky behaviors during adolescence in this meta-analysis suggest that developmental theories of risk taking would benefit from incorporating the social media context. Longitudinal studies are needed to clarify directionality and make more specific practice and policy recommendations so that social media is a safe place in which adolescents can thrive.

Depression and anxiety symptoms are related to problematic smartphone use severity in Chinese young adults: Fear of missing out as a mediator

INTRODUCTION

Recently studies examined mediating psychological constructs accounting for relations between both depression and anxiety with problematic smartphone use (PSU) severity. The aim of the current study was to analyze the fear of missing out (FOMO) as a possible mediator in these relationships.

METHOD

We recruited 1034 Chinese undergraduate students via a web-based survey that measured smartphone use frequency, PSU, depression, anxiety and FOMO.

RESULTS

Structural equation modeling demonstrated that FOMO was significantly related to smartphone use frequency and PSU severity. FOMO significantly mediated relations between anxiety and both smartphone use frequency and PSU severity. FOMO did not account for relations between depression and smartphone use/PSU.

CONCLUSION

This is one of the first studies testing FOMO in relation to PSU severity among Asian participants. FOMO may be an important variable accounting for why some types of psychopathology (e.g., anxiety) are associated with PSU.

The use of social media by Australian preadolescents and its links with mental health

OBJECTIVES

Preadolescent social media use is normative and could influence mental health. This study investigated: (a) Differences between preadolescent users and non-users of various social media platforms on mental health, (b) unique links between time spent on those platforms, appearance-based activities on social media, and mental health, and (c) the moderating role of biological sex on those relationships.

METHOD

Preadolescent youth (N = 528; 50.9% male) completed online surveys.

RESULTS

Users of YouTube, Instagram, and Snapchat reported more body image concerns and eating pathology than non-users, but did not differ on depressive symptoms or social anxiety. Appearance investment uniquely predicted depressive symptoms. Appearance comparisons uniquely predicted all aspects of mental health, with some associations stronger for females than males.

CONCLUSIONS

Preadolescents could be encouraged to reduce their opportunities to make appearance comparisons and to invest less in their appearance on social media. Preadolescents may benefit from social media intervention programs.

Exploring the Knowledge, Attitudes, and Behavioural Responses of Healthcare Students towards Mental Illnesses-A Qualitative Study

Background: The stigma of mental illness causes delays in seeking help, and often compromises victims’ therapeutic relationships with healthcare providers. The knowledge, attitudes, and behavioural responses of future healthcare professionals toward individuals with mental illnesses are explored here to suggest steps that will reduce mental illness stigma in healthcare providers. Methods: A generic qualitative approach—Qualitative Description—was used. Eighteen students from nine healthcare programs at a Canadian University participated in individual semi-structured interviews. Participants answered questions regarding their knowledge, attitudes, and behavioural responses towards individuals with mental illnesses. Thematic content analysis guided the data analysis. Results: Four main themes were constructed from the data: positive and negative general perceptions toward mental illness; contact experiences with mental illnesses; mental illness in a healthcare setting; and learning about mental illness in healthcare academia. Conclusions: Students showed well-rounded mental health knowledge and mostly positive behaviours toward individuals with mental illnesses. However, some students hold stigmatizing attitudes and do not feel prepared through their academic experiences to work with individuals with mental illnesses. Mental health education can reduce the stigma toward mental illness and improve the care delivered by healthcare professionals.

Social Media Use Is (Weakly) Related to Psychological Distress

Although the growing prevalence of social media usage raises concerns about its potentially negative impact on mental health and distress, research has found mixed results. This study resolves these inconsistencies by examining the association between hours of time spent on social media use and psychological distress in a sample of New Zealand adults (N = 19,075). After adjusting for demographics and time spent on various other activities (e.g., exercise, sleep, and housework), social media use correlated positively with psychological distress. Although social media use had one of the largest per-hour unit associations with psychological distress compared with time spent engaging in other habitual activities, the association was very weak. Thus, only excessive amounts of social media usage would result in practical changes in distress. These findings provide robust data from a large-scale national probability sample of adults, demonstrating that social media use is typically not a serious risk factor for psychological distress.

The Associations between Problematic Social Networking Site Use and Sleep Quality, Attention-Deficit Hyperactivity Disorder, Depression, Anxiety and Stress

Social networking sites (SNSs) are now used by billions of users worldwide and can help facilitate communication and the sharing of information. However, there is evidence that problematic SNS use (PSNSU) can have negative effects on health. The present study examined the associations between PSNSU, sleep quality, attention-deficit/hyperactivity disorder (ADHD), depression, anxiety and stress among SNS users. A total of 638 SNS users (mean age = 32.03 years, SD = 10.08) completed an online survey comprising instruments assessing SNS addiction, sleep quality, ADHD, depression, anxiety and stress. Regression analysis indicated that the factors of age (β = − .24, p < .01), relationship status (i.e., being in a relationship) (β = − .09, p < .05), ADHD (β = .43, p < .01) and anxiety (β = .12, p < .01) explained 23.9% of the variance in problematic SNS use. Bivariate correlations identified moderate positive correlations between PSNSU, poor sleep quality (r = .24, p < .01, R2 = .06), ADHD (r = .47, p < .01, R2 = .22), depression (r = .32, p < .01, R2 = .10), anxiety (r = .38, p < .01, R2 = .14) and stress (r = .34, p < .01, R2 = .12). The study demonstrated that PSNSU was associated with psychopathological and psychiatric disorders symptoms, the findings will help inform future interventions for reducing and tackling PSNSU.

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

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.

#StateOfMind: Family Meal Frequency Moderates the Association Between Time on Social Networking Sites and Well-Being Among U.K. Young Adults

Family belonging may influence relationships between the amount of time spent on social networking sites (SNS) and well-being. We examined the SNS and well-being association among young adults and investigated whether different markers of family belonging moderated this association. SNS, well-being, and family data (n = 2,229) were collected from adults aged 16-21 years living with their parent(s) in the United Kingdom. Participants were classed as nonusers (0 hours/weekday spent chatting or interacting with friends through social Web sites), moderate (nonzero to 4 hours/weekday), or heavy users (4+ hours/weekday). Multivariable linear regressions examined the SNS use and well-being associations; interaction terms tested whether these varied by family belonging (family meal frequency, strength of family support, and importance of family to personal identity). Well-being scores were lower for heavy users of SNS compared with moderate users (p = 0.044), and for those sharing few or no family meals (p < 0.001). The SNS use and well-being association was significantly moderated by family meal frequency (p = 0.009). Among those reporting no family meals, well-being scores were lower for heavy users versus nonusers (22.4 vs. 25.3). Well-being scores were similar across the SNS use categories among those having more family meals. Among heavy users of SNS, young adults having no family meals may be particularly vulnerable to the harms of being online. Our findings highlight the importance of minimizing the harms of heavy SNS use, including support for families to enable them to develop and build young adults' resilience to the stresses and anxieties that potentially accompany online social networking.

Young Adolescents' Digital Technology Use and Mental Health Symptoms: Little Evidence of Longitudinal or Daily Linkages

This study examines whether adolescents' digital technology use is associated with mental health symptoms (N=388) during early to mid-adolescence. Adolescents completed an initial Time 1 (T1) assessment in 2015, followed by a 14-day ecological momentary assessment (EMA) via mobile phone in 2016-2017 which yielded 13,017 total observations over 5270 study days. Adolescents' T1 technology use did not predict later mental health symptoms. Adolescents' reported mental health was also not worse on days when they reported spending more versus less time on technology. Little was found to support daily quadratic associations (whereby adolescent mental health was worse on days with little or excessive use). Adolescents at higher risk for mental health problems also exhibited no signs of increased risk for mental health problems on higher technology use days. Findings from this EMA study do not support the narrative that young adolescents' digital technology usage is associated with elevated mental health symptoms.

Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey

Background

Depression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online.

Objective

The objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties.

Methods

The study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation.

Results

In study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety.

Conclusions

People with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web.

International Registered Report Identifier (IRRID)

RR2-10.1007/978-3-319-21006-3_3

A narrative Overview About Psychosocial Characteristics as Risk Factors of a Problematic Social Networks Use

Purpose of Review

Social networks use disorder describes the problematic use of social networking sites and online-communication applications. Social characteristic of social networks use emphasizes the special relevance of psychosocial factors and social cognitions in this context. The current review aims at summarizing findings on individual psychosocial characteristics to analyze the relevance of social processes as potential mechanisms of a social networks use disorder.

Recent Findings

The empirical overview illustrates that, aside from psychopathological factors, individual psychosocial characteristics and social cognitions as well as their interactions appear to be relevant risk factors for a problematic use of social networks. However, empirical findings are mixed.

Summary

We propose two hypotheses on the development of a potential social networks use disorder that might account for mixed results: the fear-driven/compensation-seeking hypothesis including compensatory use expectancies and the reward-driven hypothesis including positive use expectancies as key elements, both of which could lead to symptoms of social networks use disorder depending on interindividual differences in predisposing and reinforcing factors.

Road Traffic Noise Exposure and Depression/Anxiety: An Updated Systematic Review and Meta-Analysis

Unlike other World Health Organization evidence reviews, the systematic review on mental disorders could not provide a quantitative estimate of the effect of environmental noise. With that in mind, we aimed to update it with additional studies published through to 18 August 2019 in order to allow for a formal meta-analysis of the association of residential road traffic noise with anxiety and depression. The quality effects and random effects estimators were used for meta-analysis and the robustness of findings was tested in several sensitivity analyses. Ten studies were included in the qualitative synthesis, from which we extracted 15 estimates for depression (n = 1,201,168) and five for anxiety (n = 372,079). Almost all studies were cross-sectional and the risk of bias in them was generally high. We found 4% (95% CI: -3%, 11%) higher odds of depression and 12% (95% CI: -4%, 30%) of anxiety associated with a 10 dB(A) increase in day-evening-night noise level (Lden). Both models suffered from moderate heterogeneity (55% and 54%), but there was evidence of publication bias only in the depression model. These findings were robust with no evidence of study-level moderators. A sensitivity analysis on an alternative set of categorically-reported estimates supported a linear relationship between Lden and depression. Taking into account an overall quality assessment for the included studies, we conclude that there is evidence of "very low" quality that increasing exposure to road traffic noise may be associated with depression and anxiety.

Distress, Suicidality, and Affective Disorders at the Time of Social Networks

PURPOSE OF REVIEW

We reviewed how scholars recently addressed the complex relationship that binds distress, affective disorders, and suicidal behaviors on the one hand and social networking on the other. We considered the latest machine learning performances in detecting affective-related outcomes from social media data, and reviewed understandings of how, why, and with what consequences distressed individuals use social network sites. Finally, we examined how these insights may concretely instantiate on the individual level with a qualitative case series.

RECENT FINDINGS

Machine learning classifiers are progressively stabilizing with moderate to high performances in detecting affective-related diagnosis, symptoms, and risks from social media linguistic markers. Qualitatively, such markers appear to translate ambivalent and socially constrained motivations such as self-disclosure, passive support seeking, and connectedness reinforcement. Binding data science and psychosocial research appears as the unique condition to ground a translational web-clinic for treating and preventing affective-related issues on social media.

Active and Passive Social Media Use and Symptoms of Anxiety and Depressed Mood Among Icelandic Adolescents

Adolescent use of social media platforms such as Facebook, Instagram, and Snapchat has increased dramatically over the last decade and now pervades their everyday social lives. Active and passive social media use may impact emotional health differently, but little is known about whether and to what extent either type of social media use influences emotional distress among young people. We analyzed population survey data collected from Icelandic adolescents (N = 10,563) to document the prevalence of social media use and investigate the relationship of both active and passive social media use with self-reported symptoms of anxiety and depressed mood. A hierarchical linear regression model revealed that passive social media use was related to greater symptoms of anxiety and depressed mood among adolescents and active social media use was related to decreased symptoms of anxiety and depressed mood, even after controlling for time spent on social media. When adding known risk and protective factors, self-esteem, offline peer support, poor body image, and social comparison to the model, active use was not related to emotional distress; however, passive use was still related to adolescent symptoms of anxiety and depressed mood. The effect of social media on emotional distress differed by gender as time spent on social media had a stronger relationship with emotional distress among girls. In addition, passive use was more strongly related to symptoms of depressed mood among girls. Future research should include risk and protective factors as mediators of different types of social media use and adolescent emotional distress.

Desire to Belong Affects Instagram Behavior and Perceived Social Support

Social networking site (SNS) use has been shown to predict both positive and negative well-being. These discrepant findings may be explained by people's motivations for and frequency of using SNSs. This study aimed to explore how frequency of online interactions can be affected by users' motives, specifically, being motivated by a sense of belonging, and possible perceived social support derived from the popular image-based SNS, Instagram. A total of 313 Instagram users (84.4% female, median age = 22 years) completed an online survey between March and September 2017 asking about their motives for using Instagram, perceived social support, and frequency of Instagram use. Multiple regression mediation analyses examined the relationship between being motivated by a desire to belong, mediator variables (frequency of posting, liking, and viewing posts), and perceived social support. A greater desire to belong significantly positively predicted frequency of Instagram use, total perceived social support, and perceived social support from friends and significant others. However, frequency of Instagram use did not predict perceived social support. As such, frequency of Instagram use did not mediate the relationship between motivation and social support. Future research could explore how other user motives and peer feedback affect Instagram use and other well-being outcomes.

Smartphone, Social Media, and Mental Health App Use in an Acute Transdiagnostic Psychiatric Sample

Background

Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health.

Objective

This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use.

Methods

The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale).

Results

Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type.

Conclusions

The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health–specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life.

Media Use Is Linked to Lower Psychological Well-Being: Evidence from Three Datasets

Adolescents spend a substantial and increasing amount of time using digital media (smartphones, computers, social media, gaming, Internet), but existing studies do not agree on whether time spent on digital media is associated with lower psychological well-being (including happiness, general well-being, and indicators of low well-being such as depression, suicidal ideation, and suicide attempts). Across three large surveys of adolescents in two countries (n = 221,096), light users (<1 h a day) of digital media reported substantially higher psychological well-being than heavy users (5+ hours a day). Datasets initially presented as supporting opposite conclusions produced similar effect sizes when analyzed using the same strategy. Heavy users (vs. light) of digital media were 48% to 171% more likely to be unhappy, to be in low in well-being, or to have suicide risk factors such as depression, suicidal ideation, or past suicide attempts. Heavy users (vs. light) were twice as likely to report having attempted suicide. Light users (rather than non- or moderate users) were highest in well-being, and for most digital media use the largest drop in well-being occurred between moderate use and heavy use. The limitations of using percent variance explained as a gauge of practical impact are discussed.

Fear of missing out (FoMO) and rumination mediate relations between social anxiety and problematic Facebook use

Introduction

Prior research has found that psychopathology constructs such as depression and anxiety are associated with problematic use of Facebook (PFU). In the present study, we examined a structural equation model whereby depression, social anxiety and lower life satisfaction predicted PFU severity, while analyzing mediating variables including rumination, fear of missing out (FoMO), and frequency of Facebook use, as well as age and gender as covariates.

Method

Participants were 296 college students administered a web survey of instruments measuring these constructs.

Results

Modeling results demonstrate that FoMO and rumination were significantly related to PFU severity. Facebook use frequency was related to PFU severity. FoMO and rumination each mediated relations between social anxiety and PFU severity.

Conclusions

Results are discussed in the context of prior work on FoMO and excessive technology use, as well as several relevant theoretical frameworks.

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Fear of missing out (FoMO) was related to problematic Facebook use (PFU) severity.

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Facebook use frequency related to PFU severity.

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Rumination was associated with PFU severity.

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Rumination mediated relations between social anxiety and PFU severity.

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FoMO mediated relations between social anxiety and PFU severity.