Social Media Use Linked 'Indirectly' to Mental Health Harms

Batya Swift Yasgur, MA, LSW

August 27, 2019

Mental health harms associated with frequent use of social media may be attributable to cyberbullying, loss of sleep, or reduced physical activity —especially in young girls, new research suggests.

In a 3-year longitudinal study of almost 10,000 British adolescents between ages 13 and 16, the rate of "very frequent" social media use rose from 34% during the first year to 62% during the third year in boys, and from 51% to 75% in girls. 

Although very frequent social media use was associated with greater psychological distress in both sexes, it was higher in girls and attributable to the mediating effects of cyberbullying, insufficient sleep, and reduced physical activity.

"This means that social media effects on mental health are indirect rather than direct," senior author Dasha Nicholls, MD(Res), Imperial College School of Medicine, London, United Kingdom, told Medscape Medical News.

"Social media use was much higher in girls than boys, and it is possible that girls use social media differently from boys and are exposed to and react differently to the content they access," said Nicholls, who is also honorary consultant child and adolescent psychiatrist at Central and North West London NHS Trust and East London NHS Trust.

Their data suggest that "very frequent social media use in young people is unlikely to have directly harmful effects," the authors write, "but that harms are related to watching harmful content or by displacement of healthy activities that promote well-being," such as sleep or physical activity.

"Interventions to reduce social media use to improve mental health might be misplaced; interventions to prevent or increase resilience to cyberbullying and ensure adequate sleep and physical activity in young people should be considered," they conclude.

The findings were published online August 13 in Lancet Child and Adolescent Health.

Contradictory Evidence

More than 90% of teenagers in the UK use the Internet for social networking, raising a concern that this activity may have a deleterious effect on their mental health. However, evidence regarding this concern "remains contradictory," the investigators write.

"The study was motivated by a need to better understand the relationship between social media and mental health over time," Nicholls said. "Most of the research to date has been cross-sectional and hasn't been able to examine mechanisms by which the two may interact with each other."

Additionally, few studies have investigated the potential mechanisms by which social media might harm health.

The current researchers used data from the Our Futures study, a nationally representative, longitudinal study of young people aged 13 to 16 years that was conducted in 3 waves.

Wave 1 began in 2013 and included youngsters aged 13 to 14 years (n = 12,866); wave 2 was conducted in 2014, when the participants were aged 14 to 15 years (n = 10,963); and wave 3 was conducted in 2015, when the participants were aged 15 to 16 years (n = 9797).

During each wave of the study, participants were asked to report the frequency with which they habitually accessed or checked social media. "Very frequent" use was defined as accessing social media 3 or more times daily.

Self-reported data on mental health and well-being (life satisfaction, feeling life is worthwhile, happiness, and anxiety) were collected during waves 2 and 3, respectively.

During wave 2, participants completed the 12-item General Health Questionnaire (GHQ12) and also completed questions regarding cyberbullying, sleep duration (the entire period between bedtime and wake time), and physical activity.

In wave 3, participants completed questions concerning their overall well-being.

Analyses adjusted for a "minimal sufficient confounding structure" were performed separately for boys and girls. The researchers assessed cyberbullying, sleep adequacy, and physical activity as potential mediators of the effects.

Sample characteristics were "highly similar across waves."

Girls More Vulnerable

Almost all participants (94.5%) reported having their own mobile phone at wave 1, with Internet access reported by 98% at wave 2.

Very frequent use of social media in both sexes increased with age between wave 1 and wave 3.

Table. Very Frequent Use of Social Media, Wave 1 to Wave 3


Overall Sample (%, 95% CI*)

Boys (%, 95% CI)

Girls (%, 95% CI)


42.6  (41.2 – 44.2)

34.4 (32.4 – 36.4)

51.4 (49.5 – 53.3)


59.4 (58.1 – 60.7)

50.7 (48.8 – 52.5)

67.5 (65.7 – 69.2)


68.5 (67.3 – 69.7)

61.9 (60.3 – 63.6)

75.4 (73.8 – 76.9)

*CI = confidence interval

At wave 2, psychological distress (defined as GHQ12 score of 3 or higher) was reported by 19% of participants.

Among girls, a dose-response relationship was found between the frequency of social media use and a high GHQ12 score at wave 2; 27.5% (range, 25.6 - 29.5%) of girls with very frequent use scored highly on the GHQ12 vs 19.9% (range, 15.3 - 25.5) who used social media weekly or less.

This gradient was less pronounced among boys, affecting 14.9% (range, 13.1% - 16.8%) with very frequent use vs 10.2% (range, 8.0 - 12.9) of those who used social media weekly or less.

Adjusting for the confounding variables of presence of a long-term condition, parental connection with school, substance use, and truancy made little difference to the findings in either sex.

Persistent, very frequent social media use across waves 1 and 2 predicted lower well-being among girls:

  • Life satisfaction: adjusted odds ratio (OR), 0.86 (95% CI, 0.74 - 0.99), P = .039

  • Happiness: OR, 0.80 (95% CI, 0.70 - 0.92), P = .0013

  • Anxiety: OR, 1.28 (95% CI, 1.11 - 1.48), P = .0007

When the researchers adjusted for cyberbullying, sleep, and physical activity, the associations of social media use with GHQ12 high score were attenuated (proportion mediated [58.2%], life satisfaction [80.1%], happiness [47.7%], and anxiety [32.4%]) in girls, such that these associations (except for anxiety) were no longer significant.

By contrast, the association with GHQ12 high score among boys remained significant, being mediated only 12.1% by these factors.

"The main findings were that there is a dose-response relationship between frequency of social media use and later markers of mental health and well-being, which was true for boys and girls," Nicholls said.

"However, when potential mechanisms by which social media might influence mental health were examined, these fully accounted for the relationship in girls," she said.

Ask About Online Bullying

Commenting on the study for Medscape Medical News, Ann DeSmet, PhD, professor in the Department of Communication Studies at the University of Antwerp in Belgium, said that the longitudinal design and large sample size "add to the strength of available evidence on this topic."

In addition, "social media does not necessarily need to be harmful in itself," said DeSmet, who authored an accompanying editorial.

However, it can become harmful if it replaces time that could be spent on physical activity and sleep, "or when it increases involvement in cyberbullying," she added.

"Prevention and mental health promotion programs should therefore include supports for healthy lifestyle, as well as teach youth how to use social media in a 'healthy manner,' " DeSmet said.

Also commenting for Medscape Medical News, Ric Steele, PhD, professor of psychology and applied behavioral science and director of the Clinical Child Psychology Doctoral Program at the University of Kansas in Lawrence, said the data regarding UK-based youth parallel "data suggesting that adolescents in the United States are also heavy users of social media."

Also, there is "quite a bit of evidence that females and males use social media differently," said Steele, who was not involved with the current research.

For example, "the literature suggests that females may be more likely to use social media as a means of expressing emotions, gaining support, and increasing feelings of belonging, whereas males may be more likely to use social media for more instrumental (ie, less relational) purposes," he said.

Adolescent girls "trying to get social support" may be especially vulnerable to bullying, Steele noted.

"Further, girls' use of social media to maintain relationships might also explain why increased social media use might impact sleep, as they may feel more obligated to be available online when friends post and/or text at all hours of the night," he said.

Nicholls reiterated the importance of keeping a balance so that social media does not displace other important activities, such as a good night's sleep, physical activity, and in-person contact with peers.

"It's also important to be aware of the potential for online bullying, which may only be known by asking directly," she added.

Nicholls and DeSmet have disclosed no relevant financial relationships. The other study authors' disclosures are fully listed in the original article. Steele's empirical research has been funded by grants from the US DHHS maternal Child Health Bureau, the Health Card Foundation of Greater Kansas City, and the National Institutes of Health.

Lancet Child Adolesc Health. Published online August 13, 2019. Abstract, Editorial

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