Reprinted from the summer issue of The Ohio Family Physician
By: Alysia Herzog, MD, Program Director; and Roma Amin, MD, OhioHealth Grant Family Medicine Residency
In 2005, only 5% of Americans used social media. By 2018, that number had increased to 69% of adults and 81% of teenagers.1 The same 2018 study reported that 45% of teens reported being “online constantly” with a sense of belonging and connection being the main motivator of their social media use. Raising awareness around certain issues was another important contributor.1 However, many adolescents deriving social connections have also become more susceptible to cyberbullying, feelings of exclusion, exposure to political stunts, and displacement of healthy behaviors with time online. As individual users, we may never come to a consensus of whether social media causes more harm or help, but research clearly shows several trends, especially in adolescents.
The first is that the earlier teenagers start using social media, the worse the mental health impact can be.2 In order to feel accepted, teenagers often share online without thinking through potential negative consequences. Rumors spread almost instantaneously. Negative self-perceptions during formative years can lead to increased rates of anxiety and worse overall mental health into adulthood.2
Another concerning trend is social media’s displacement of other activities – particularly sleep. Many teenagers engage with social media late at night and report sleeping next to their phone or waking at night to check social media.3 Some studies show associations with night time use of social media and rates of depression.4 More importantly, sleep deprivation in teenagers can lead to serious consequences, including increased high risk behavior, more accidents, worse physical health, and decreased school performance.3
A final concern is social media’s ability to distort perspectives of reality. Photo editing is now available to everyone. At a stage when external validation is crucial, Photoshopped pictures can lead to a sense that everyone else is happier—or any number of other comparators— leading to isolation and worsened mental health.
What can we do to address this? Social media platforms are likely here to stay and unlikely to regulate themselves. We must adjust how we engage with these platforms. They are designed to be addictive. The unpredictable nature, ease of comparison with others, and fleeting effects of dopamine with each “like” keep us hooked. Increased attention to development of social media literacy is an important area for further work.
As family physicians, we also have the rare opportunity to engage entire families in conversations. It’s crucial that discussions start from a framework of setting healthy boundaries, staying safe, and enhancing health. We must go beyond a cursory mention of “screen time” to consider what and why our adolescent patients are engaging with social media. We can remind parents of the importance of peer acceptance and social connections at this stage of development and promote the importance of boundaries that hold the entire family accountable.
We should remind parents that effective boundary setting requires them to set a good example and follow through on their own commitments. Studies show that adolescents who have arbitrary limits without further discussion and engagement can display worsened rates of anxiety and depression, defeating the purpose of these rules.4 Limits and boundaries should also prioritize times such as meals and sleep. While parental controls can be a tool, self-monitoring is also an effective strategy, especially in older teens.
Additionally, we can empower our adolescent patients to reflect on how social media is affecting their mental health. We can share tactics that help with social media intake and remind them about the pervasiveness of photo editing. Through compassionate discourse and engagement with our patients, we have the ability to empower them to utilize these platforms to stay connected and build community with others, while also protecting and valuing their mental health.
References available on the Ohio Academy of Family Physicians website.