ICD-11-Based Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Adolescents

Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review

Previous reviews have often shown a link between digital media ADHD symptom levels. However, longitudinal studies are needed to find stronger evidence of a causal effect as well as to determine the direction of effects. The aim of the present review (PROSPERO CRD42021262695) was therefore to provide a systematic review of studies meeting the following inclusion criteria: (1) include longitudinal data investigating associations between digital media (i.e., gaming and social media) and later ADHD symptoms or vice versa, (2) be published within the past 10 years (i.e., 2011 until June 2021), (3) be published in a peer-reviewed journal in English, and (4) include children or adolescents (age 0-17 years). After a systematic search in the Web of Science and PsycInfo databases, we included 28 studies, all with adequate or high quality. Results showed support for reciprocal associations between digital media and ADHD symptoms, with associations being more consistent for problematic use of digital media than for screen time. Thus, children with ADHD symptoms appear more vulnerable to developing high or problematic use of digital media (i.e., selection effects), and digital media also have effects on later ADHD symptom levels, either because of specific characteristics of digital media or because of indirect effects on, for example, sleep and social relations (i.e., media effects). However, it should be emphasized that further studies investigating potential moderators and mediators are needed if we are to better understand the complex associations between digital media and ADHD symptom levels.

Investigating Parental Factors for Adolescent Problematic Gaming and Social Media Use - A Cross-sectional and Longitudinal Approach

PURPOSE

Increasing concern has been raised on the addictive potential of digital games and socialmedia platforms, especially in adolescent users. Hence, investigating the etiology of problematic gaming (PG) and problematic social-media use (PSMU) is of great scientific and clinical interest. Parental factors have not been sufficiently addressed yet. Therefore, this study aims to investigate the predictive values of parental demographic, psychological, parenting, and role model factors for adolescent PG/PSMU.

METHODS

In a representative parent-child (10-17 years) sample parental factors and adolescent PG/PSMU were assessed cross-sectionally (Ndyads = 1221) and longitudinally (Ndyads = 659) using online-questionnaires at two measurement points 14 months apart. Parental factors included parental media-use patterns, sociodemographic aspects, (digital) emotion regulation, stress perception, (digital) parental self-efficacy, and media rules. Best subset linear regression models were estimated to identify parental factors with greatest predictive values. These were included in prospective linear regression analyses.

RESULTS

At the cross-sectional level, 18% of model variance predicting PG and 24% predicting PSMU could be explained by parental media-use patterns, media rules, and (digital) parental self-efficacy after controlling for adolescent age. Longitudinally, 33% of variance in the PG model and 34% of variance of the PSMU model could be explained by parental media-use patterns and parental self-efficacy after controlling for adolescent age and baseline PG/PSMU.

DISCUSSION

This study is the first to differentially investigate parental factors in the context of adolescent PG/PSMU in a prospective representative parent-child study. Aspects of digital parental role modeling and parenting could be identified as promising anchors for prevention and treatment.

Screen exposure, mental health and emotional well-being in the adolescent population: is it time for governments to take action

During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.

[Digital media use and mental health in adolescents-a narrative review]

The opportunities and hazards of digital media, especially with regard to children and adolescents, are currently the subject of frequent family, school, and social debates.Digital platforms can support the accomplishment of adolescent developmental tasks through gaming and social exchange as well as communication and contact promotion, learning, and health promotion, and are widely used for entertainment. In Germany, almost all adolescents own a smartphone. During the COVID-19 pandemic, an intensification of the use of digital games, social media, and streaming offers by adolescents was observed. Exposure to age-uncensored content such as the depiction of violence, extreme political views, and conspiracy theories, as well as personal attacks through cyberbullying, unfiltered initiation of contact including cybergrooming, dysfunctional role models, and addiction-promoting aspects are associated with mental health risks.Cyberbullying affects about 5% of children and adolescents in Germany. A bidirectional relationship with mental health could be shown. The gaming disorder is the first digital media use disorder (DMUD) that has been included in the ICD-11 and thus internationally recognized as a mental illness. Adolescents are affected disproportionately often and experience impairments in their mental development and levels of functioning.Services are available to promote adolescent media literacy, and their expansion, structured application, and evaluation are needed. Evidence-based prevention and treatment options for DMUD are currently largely lacking. Their development, review, and dissemination should be further supported.

An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial

Background

Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap.

Methods

Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models.

Discussion

Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings.

Clinical trial registration

https://drks.de, DRKS00031043.

The link between Facebook addiction and depression among university students: Evidence from a lower-middle income country

Background and Aims

Among all the social media, Facebook is the most popular social networking site among students. That raises a chance of excessive Facebook usage being a form of addiction to hamper students' mental health. The primary goal of this study was to find the association of Facebook addiction with the depression level of university students during the COVID-19 pandemic.

Method

Four hundred ten university students from Bangladesh were selected randomly as samples for this investigation. In this study, the Bergen Facebook Addiction Scale and nine-item Patient Health Questionnaire were used to assess the level of Facebook Addiction and depression status of the students, respectively. Ordered probit models were employed to identify the connection between Facebook addiction and depression. Ordinary least square models were utilized further to check the robustness of the findings.

Results

Ordered probit results confirm that Facebook addiction increases the likelihood of having heightened depression among university students. Besides, sex, household income, and history of being infected by COVID-19 also appeared to be correlated with the depression level of the students.

Conclusion

Creating opportunities for students to participate in more physically demanding outdoor activities should be prioritized as it could ultimately enhance their capacity to mitigate depression. Appropriate measures must be taken to increase the number of recreational facilities on the campus for students, considering their age, gender, and preferences.

Implicit cognitions in problematic social network use

Implicit cognitions may be involved in the development and maintenance of specific Internet use disorders such as problematic social network use (PSNU). In more detail, implicit attitude, attentional biases, approach and avoidance tendencies as well as semantic memory associations are considered relevant in the context of PSNU. This viewpoint article summarizes the available literature on implicit cognitions in PSNU. We systematically reviewed articles of implicit cognitions in PSNU from PubMed, Scopus, Web of Science, and ProQuest databases based on a targeted search strategy and assessed using predefined inclusion and exclusion criteria. The present findings suggest that specific implicit cognitions are important in the context of PSNU and therefore show parallels to other addictive behaviors. However, the empirical evidence is limited to a few studies on this topic. Implicit cognitions in PSNU should be explored in more depth and in the context of other affective and cognitive mechanisms in future work.

Quality of life and mental health of adolescents: Relationships with social media addiction, Fear of Missing out, and stress associated with neglect and negative reactions by online peers

Social networking is proliferating globally and in Vietnam, but this led to several negative aspects of adolescents' health, including physical activity, sleep quality, and depressive and anxiety symptoms. This study aimed to identify the relationship between social media usage and examine risk factors (Fear of Missing out and Risk of Neglect) on social media usage, and the overall quality of life and mental health among individuals actively using social media networks. An online cross-sectional study was conducted in three cities in Vietnam (Hanoi, Tuyen Quang, and Can Tho) from September through to October 2021. A structured questionnaire assessed for characteristics of social media use and other associated factors. 1891 participants were recruited, with 98.4% having access to social media. s. Factors like "PHQ-9 score", "Problematic Internet use", and "Time average used social media per day", were negatively associated with the EQ5D5L Index. By contrast, "Gender", and "Using smartphone" were positive factors of the EQ5D5L Index. "FOMO score" and "self-harm and suicide" were positive factors of the PHQ-9 score while "Using smartphone" was negative. In terms of self-harm and suicide, "FOMO score" and "Problematic Internet use" were positive factors, by contrast, "Using smartphone" was a negative factor. This is the first study to examine social media addiction among Vietnamese adolescents, its relationship with FOMO score, stresses associated with rejection and neglect, and the overall quality of life. Our results highlighted there is a relationship between FOMO score and impaired overall quality of life, increased depressive symptoms, and an association between stresses relating to negative rejection and FOMO score.

Psychometric Properties of Screening Instruments for Social Network Use Disorder in Children and Adolescents: A Systematic Review

IMPORTANCE

Children and adolescents spend considerable time on the internet, which makes them a highly vulnerable group for the development of problematic usage patterns. A variety of screening methods have already been developed and validated for social network use disorder (SNUD); however, a systematic review of SNUD in younger age groups has not been performed.

OBJECTIVE

To review published reports on screening tools assessing SNUD in children and adolescents with a maximum mean age of 18.9 years.

EVIDENCE REVIEW

To identify instruments for the assessment of SNUD, a systematic literature search was conducted in the databases PsycINFO, PubMed, Web of Science, PsycArticles, and Scopus. The final search took place on May 2, 2022. Psychometric properties of available tools were examined and evaluated to derive recommendations for suitable instruments for individuals up to 18 years of age.

FINDINGS

A total of 5746 publications were identified, of which 2155 were excluded as duplicates. Of the remaining 3591 nonredundant publications, 3411 studies were assessed as not relevant after title and abstract screening. A full-text analysis of 180 remaining studies classified as potentially eligible resulted in a final inclusion of 29 studies revealing validation evidence for a total of 19 tools. The study quality was mostly moderate. With regard to validation frequency, 3 tools exhibited the largest evidence base: Social Media Disorder Scale (SMDS), the short version of the Bergen Facebook Addiction Scale, and Bergen Social Media Addiction Scale-Short Form (BSMAS-SF). Among these, 1 study tested a parental version (SMDS-P) for its psychometric properties. Taking all criteria into account, the strongest recommendation was made for the SMDS and BSMAS-SF.

CONCLUSIONS AND RELEVANCE

Results suggest that the SMDS-SF and BSMAS-SF were appropriate screening measures for SNUD. Advantages of the SMDS are the availability of a short version and the possibility of an external parental rating.

Parents Rate Problematic Video Streaming in Adolescents: Conceptualization and External Assessment of a New Clinical Phenomenon Based on the ICD-11 Criteria of Gaming Disorder

In recent years, video streaming (VS) increased substantially. Adolescents are at significant risk of presenting problematic VS patterns associated with a spectrum of mental-health difficulties. Because VS platforms rely on similar mechanisms as digital games, the ICD-11 criteria for Gaming Disorder (GD) have been successfully implemented to measure Streaming Disorder (StrD) in adolescents. For proper diagnoses, external rating scales are urgently required in addition to self-reports. The Streaming Disorder Scale for Parents (STREDIS-P) was created and validated in a representative sample of n = 891 adolescent-parent dyads. Mental health problems were assessed with standardized instruments. Confirmatory factor analysis was conducted to examine the underlying factor structure. Cutoff scores were determined using ROC analysis. Accordance between parental and adolescents' self-ratings was calculated. Consistent with the results of previous validation studies for screening instruments assessing similar phenomena based on ICD-11-GD criteria, two factors, cognitive-behavioral symptoms and negative consequences, were confirmed. STREDIS-P demonstrated good to excellent internal consistency, criterion validity, and discriminatory power. Accordance with adolescents' self-ratings was moderate. STREDIS-P is the first screening tool for assessing StrD in adolescents by parental ratings. It is highly relevant for conceptualizing a new phenomenon in clinical routine and academic research.

Research trends in social media addiction and problematic social media use: A bibliometric analysis

Despite their increasing ubiquity in people's lives and incredible advantages in instantly interacting with others, social media's impact on subjective well-being is a source of concern worldwide and calls for up-to-date investigations of the role social media plays in mental health. Much research has discovered how habitual social media use may lead to addiction and negatively affect adolescents' school performance, social behavior, and interpersonal relationships. The present study was conducted to review the extant literature in the domain of social media and analyze global research productivity during 2013-2022. Bibliometric analysis was conducted on 501 articles that were extracted from the Scopus database using the keywords social media addiction and problematic social media use. The data were then uploaded to VOSviewer software to analyze citations, co-citations, and keyword co-occurrences. Volume, growth trajectory, geographic distribution of the literature, influential authors, intellectual structure of the literature, and the most prolific publishing sources were analyzed. The bibliometric analysis presented in this paper shows that the US, the UK, and Turkey accounted for 47% of the publications in this field. Most of the studies used quantitative methods in analyzing data and therefore aimed at testing relationships between variables. In addition, the findings in this study show that most analysis were cross-sectional. Studies were performed on undergraduate students between the ages of 19-25 on the use of two social media platforms: Facebook and Instagram. Limitations as well as research directions for future studies are also discussed.

Reactions to naturalistic smartphone deprivation among psychiatrically hospitalized adolescents

The standard of care among youth who are psychiatrically hospitalized typically involves smartphone confiscation for the duration of treatment. However, very little is known regarding how youth respond to this period of smartphone "deprivation," factors that may influence this response, and ensuing clinical effects. The present exploratory mixed-methods study sought to elucidate the experience of psychiatrically hospitalized adolescents as it relates to smartphone deprivation, and to evaluate the impact of this widespread treatment approach. Psychiatrically hospitalized adolescents (N = 181; Mean age = 15.29 years) completed qualitative and quantitative measures assessing the experience of smartphone deprivation during hospitalization. Associations among reactions to smartphone deprivation and smartphone and social media use patterns were explored. Analyses additionally evaluated whether reactions to smartphone deprivation were associated with clinical symptom severity (e.g., suicidal ideation, internalizing and externalizing symptoms) and readiness for psychotherapy. Negative reactions to smartphone deprivation were significantly positively correlated with daily smartphone hours, addictive patterns of use, and both negative and positive emotional responses to social media use. Reactions to smartphone deprivation were not associated with clinical symptom severity. However, negative reactions to smartphone deprivation were associated with lower readiness for therapy, while positive reactions were associated with greater readiness. This preliminary work illustrates the complexities of smartphone use in adolescents and the potential positive and negative effects of smartphone deprivation during psychiatric hospitalization. Future prospective research with adolescents should clarify optimal smartphone access during inpatient hospitalization.

The Association between Appetitive Aggression and Social Media Addiction Mediated by Cyberbullying: The Moderating Role of Inclusive Norms

Appetitive aggression, i.e., the motivation to obtain rewards through aggressive behaviors, has been suggested as a key driver of cyberbullying. Due to the contextual properties of cyberspace (e.g., anonymity), it is assumed that the negative effects of cyberbullying are masked, leading to a preponderance of its positive outcomes (e.g., thrill). Since cyberbullying occurs predominantly in social media, reward-learning effects may lead to problematic social media use, such as addiction. Anti-cyberbullying inclusive norms might act as a buffering factor to break this chain. However, while inclusive norms are known to reduce cyberbullying in general, their influence on the indirect effect of appetitive aggression via cyberbullying on social media addiction is yet unknown. The present study examined this indirect effect, while taking the moderating role of inclusive norms into account. A total of 1064 adolescents (42.05% male, M_age = 14.07, SD = 2.15) completed questionnaires. Results revealed the indirect effect of appetitive aggression on social media addiction through cyberbullying as expected. Surprisingly, this indirect effect was amplified with increasing anti-cyberbullying inclusive norms. Our findings indicate that appetitive aggression, which manifests in cyberbullying, contributes to the development of social media addiction. The unexpected results and the implications of our findings were discussed.

International Classification of Diseases-11-Based External Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Parents

Social media use disorder (SMUD) is associated with substantial impairments in daily functioning, and adolescents are particularly at risk. The 11th revision of the International Classification of Diseases (ICD-11) criteria of gaming disorder (GD) could be shown to be suitable to describe SMUD in adolescents. Since adolescents' insight might be limited due to young age or symptom denial, it is essential to include their parents in the diagnostic process. The development and validation of a parental scale are, therefore, of great interest to clinicians and scientists. The Social Media Use Disorder Scale for Parents (SOMEDIS-P) was developed by clinical experts and validated in 944 parent-child dyads. Adolescents were 10-17 years old and frequently used social media (SM). Besides SM use times, standardized questionnaires were applied to assess SM use patterns according to ICD-11 and Diagnostic and Statistical Manual of Mental Disorders-5 criteria of (Internet) GD, psychological stress, and depressive symptoms in an online survey. Item structure was investigated by confirmatory factorial analysis. Receiver operating characteristic curve analyses to determine cutoff values and accordance with adolescent self-ratings were computed. A presumed two-factorial structure of SOMEDIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency and criterion validity with moderate to strong correlations, excellent discriminatory characteristics, and moderate accordance with the adolescents' self-ratings. As the first successfully validated tool for the assessment of ICD-11-based SMUD in adolescents by parental judgment, SOMEDIS-P can make an important contribution to reliable SMUD screening in clinical practice and research.

Applying ICD-11 criteria of Gaming Disorder to identify problematic video streaming in adolescents: Conceptualization of a new clinical phenomenon

Background and aims

Internet video streaming (VS) has become a popular leisure activity among the majority of adolescents, especially under the COVID-19 pandemic. Research on binge watching patterns in adults suggests an addictive potential of VS. To date, no unified conceptualization on problematic VS and no standardized assessment tools for adolescents exist even though they might be especially vulnerable.

Methods

STREDIS-A is based on the ICD-11 criteria of gaming disorder. It was validated in a representative sample of 959 dyads of 10- to 17-year old adolescents with frequent VS and a respective parent using standardized questionnaires on Internet addiction, depressive and anxiety symptoms, insomnia, loneliness, and academic performance in an online survey. Item structure was investigated by factorial analyses. Cutoffs were estimated and latent profile analysis was performed.

Results

The two-factorial structure of STREDIS-A describes cognitive-behavioral symptoms and negative consequences of VS. Internal consistency and criterion validity were good to excellent. It could excellently discriminate between affected and non-affected adolescents.

Discussion and conclusions

The present study makes a significant contribution to the conceptualization of a new phenomenon. It provides the very first tool to assess streaming disorder in adolescents for clinical and research settings. Clinical validation is highly warranted.

Examining the Interplay of Smartphone Use Disorder, Mental Health, and Physical Symptoms

The current study examined antecedents and possible consequences of smartphone use disorder (SmUD). In particular, we aimed to increase the understanding of the interplay of SmUD, mental health, and physical symptoms. Studies found that SmUD is associated with diverse psychological and physical health impairments, ranging from depression and anxiety to headaches and sleep disturbances. Based on existing works, we assumed that mental problems mediate the relationship between SmUD and bodily problems. We conducted a cross-sectional random-quota online survey among 938 German smartphone owners aged 14 to 64 years. An instrument based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was used to measure SmUD severity. The data was analyzed using structural equation modeling. We identified a rate of 4.0% potentially disordered users. Males and younger participants showed more signs of SmUD. As expected, SmUD severity was found to be associated with physical (more frequent headaches, sleep disturbances, gastrointestinal problems) as well as psychological (higher levels of loneliness, stress, depression/anxiety) health impairments. Investigating the interplay of these variables showed that depression and anxiety, and stress partially mediated the relationship between SmUD severity and physical symptoms. Taken together, our results confirm that increased SmUD severity is associated with mental problems as well as with somatic symptoms. We assume complex (and presumably circular) relationships, which future studies should examine in more detail. SmUD prevention and intervention programs should follow a broad approach that considers decreases in physical and mental health, possibly causing or resulting from SmUD.

Assessment of Criteria for Specific Internet-use Disorders (ACSID-11): Introduction of a new screening instrument capturing ICD-11 criteria for gaming disorder and other potential Internet-use disorders

Background and aims

With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may also be applied to other potential specific Internet-use disorders, which may be classified in ICD-11 as other disorders due to addictive behaviors, such as online buying-shopping disorder, online pornography-use disorder, social-networks-use disorder, and online gambling disorder. Due to the heterogeneity in existing instruments, we aimed to develop a consistent and economic measure of major types of (potential) specific Internet-use disorders based on ICD-11 criteria for gaming disorder.

Methods

The new 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) measures five behavioral addictions with the same set of items by following the principles of WHO's ASSIST. The ACSID-11 was administered to active Internet users (N = 985) together with an adaptation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and screeners for mental health. We used Confirmatory Factor Analyses to analyze the factor structure of ACSID-11.

Results

The assumed four-factorial structure was confirmed and was superior to the unidimensional solution. This applied to gaming disorder and to the other specific Internet-use disorders. ACSID-11 scores correlated with IGDT-10 as well as with the measures of psychological distress.

Discussion and Conclusions

The ACSID-11 seems to be suitable for the consistent assessment of (potential) specific Internet-use disorders based on ICD-11 diagnostic criteria for gaming disorder. The ACSID-11 may be a useful and economic instrument for studying various behavioral addictions with the same items and improving comparability.

#Trending: A Systematic Review of Social Media Use’s Influence on Adolescent Anxiety and Depression

Background:

With new technological advancements, adolescents can obtain devices that give them virtually unlimited access to social media (SM) which may impact adolescent mental health.

Objectives:

This literature review aims to evaluate the influence of social media use on adolescent anxiety and depression.

Methods:

A literature search of PubMed from June 2010 through June 2020 was completed for the following MeSH terms: social media, adolescent, anxiety, depression, and mental health. English language articles that discussed adolescents aged 13 to 18 years, anxiety and/or depression and SM were included. Extracted data included the SM platform, impact on anxiety and depression, interventions, temporal and dose-response relationships, and observed versus self-reported usage.

Results:

The majority of articles positively associated depression (82.6%) and anxiety (78.3%) with SM use. depression corresponded with cyber-bullying (42.1%), negative social perspective (21.0%), diminished self-esteem (15.8%), and sleep disturbance (10.5%). Anxiety corresponded with a negative social perspective (44.4%), diminished self-esteem (33.3%), sleep disturbance (16.7%), and cyber-bullying (16.7%). Many studies suggested the use of interventions to reduce depression (72.7%) and anxiety (72.7%), such as screen time restrictions (n=6) and social support (n=4), but lacked evaluation of their implementation.

Conclusion:

Current literature suggests a positive association between adolescent SM use with anxiety and depression. Our study highlights the need for further investigation of temporal and dose-response associations between SM use and adolescent mental health, and the potential benefits of SM-driven interventions.