The negative emotions stemming from teens' involvement with social media have been grabbing the headlines. But adults may also be experiencing depression because of their use of social media, suggests a new study.
Use of social media has been linked to increased anxiety and depression, as well as reduced well-being in adolescents and young adults, but similar associations in older adults have not been well studied, and longitudinal data are lacking, Ron H. Perlis, MD, of Massachusetts General Hospital, Boston, and colleagues wrote in their paper, which was published in JAMA Network Open.
To examine the association between social media use and depressive symptoms in older adults, the researchers reviewed data from 13 waves of an internet survey conducted each month between May 2020 and May 2021. The survey respondents included individuals aged 18 years and older, with a mean age of 56 years.
In the study the researchers analyzed responses from 5,395 individuals aged 18 years and older, with a mean age of 56 years. The study participants had minimal or no depressive symptoms at baseline, according to scores on the nine-item Patient Health Questionnaire (PHQ-9).
Overall, 8.9% of the respondents reported a worsening of 5 points or more on the PHQ-9 score on a follow-up survey, which was the primary outcome. Participants who reported using social media platforms Snapchat, Facebook, or TikTok were significantly more likely to report increased depressive symptoms, compared with those who did not report use of social media. The fully adjusted odds ratio was largest for Snapchat (aOR, 1.53), followed by Facebook (aOR, 1.42), and TikTok (aOR, 1.39).
Incorporating recent television and internet news terms, such as COVID-19, changed the association for Snapchat, for which the aOR decreased from 1.53 to 1.12 when news source terms were included in the survey. TikTok and Facebook associations remained similar.
When the results were further stratified by age, use of TikTok and Snapchat was associated with depressive symptoms in those aged 35 years and older, but not in those younger than 35 years. However, the opposite pattern emerged for Facebook; use was associated with depressive symptoms for individuals younger than 35 years, but not in those aged 35 years and older (aOR, 2.60 vs. aOR, 1.12).
The association between increased self-reported depressive symptoms and use of certain social media platforms was not impacted by baseline social support or face-to-face interactions, the researchers noted.
Family Physician Was Surprised Results Weren't More Significant
In the current study, "I was honestly surprised the results weren't more significant," Mary Ann Dakkak, MD, of Boston University said in an interview. "That said, social media uses during the COVID pandemic may have been a necessary social outlet and form of connection for many people who were otherwise isolated."
To still see a significant increase in depression when social media could have been a positive force may suggest a heavier impact during "normal" times, she added.
"It is not surprising that what we see in youth is shown among adults," noted Dakkak, who was not involved with this study. "I always tell my patients that what is good for their children is good for the adults too, and vice versa.
"We expect to see outcomes of this on youth and adults who have been more isolated, who have used more screen time for learning, work, connection and boredom, in the near future," she said. "The complex nature of why social media may have been used more heavily for connection during a time when in-person meetings were not possible may be a heavy confounder as the typical profile of heavy social media users may have differed during the COVID shutdowns."
Psychiatrist: Balance Benefits of Social Media With Mental Health Risks
The current study was likely conducted before the recent news on "hidden" Facebook data and the implications that Facebook knew it was contributing to worsened mental health in teens, particularly around self-esteem, Jessica "Jessi" Gold, MD, a psychiatrist at Washington University, St. Louis, said in an interview.
"If you look more specifically at other studies, however, the data around social media and mental health is constantly varied, with some showing benefits and some showing negatives, and none conclusively suggesting either way," said Gold, who also was not involved with the new research. "More data are needed, especially longitudinally and on a broader age group, to understand social media's impact on mental health over time.
"It is also even more important in the wake of COVID-19, as so many people have turned to social media as a primary source of social support and connection, and are using it even more than before," she emphasized.
In the current study, "I think the most interesting information is that, for TikTok and Snapchat, the effects seemed to be more pronounced in those older than 35 years who used social media," said Gold.
What this study leaves unanswered is "whether people who might develop depression are simply more prone to use social media in the first place, such as to seek out social support," Gold said. "Also, we don't know anything about how long they are using social media or what they are using it for, which to me is important for understanding more about the nuance of the relationship with mental health and social media."
Experts Advise Clinicians to Discuss Social Media With Patients
This new research suggests that clinicians should be talking to their patients about how social media impacts their emotional reactions, as well as their sleep, Gold said.
"Patients should be asking themselves how they are feeling when they are on social media and not using it before sleep. They should also be considering time limits and how to effectively use social media while taking care of their mental health," she said. This conversation between clinician and patient should be had with any patient of any age, who uses social media, not only with teenagers.
"This is also a conversation about moderation, and knowing that individuals may feel they benefit from social media, that they should balance these benefits with potential mental health risks," she said.
"Studies such as this one shed light onto why social media consumption should be at least a point of discussion with our patients," said Dakkak.
She advised clinicians to ask and listen to patients and their families when it comes to screen time habits. "Whenever I see a patient with mood symptoms, I ask about their habits — eating, sleeping, socializing, screen time — including phone time. I ask about the family dynamics around screen time.
"I've added screen time to my adolescent assessment. Discussing safe use of cell phones and social media can have a significant impact on adolescent behavior and wellbeing, and parents are very thankful for the help," she said. "This study encourages us to add screen time to the assessments we do at all adult ages, especially if mood symptoms exist," Dakkak emphasized.
Suggestions for Future Research
Dakkak added that more areas for research include the differences in the impact of social media use on content creators versus content consumers. Also, "I would like to see research using the real data of use, the times of use, interruptions in sleep and use, possible confounding variables to include exercise, presence of intimate relationship and school/job performance."
Given the many confounding variables, more controlled studies are needed to examine mental health outcomes in use, how long people use social media, and the impact of interventions such as time limits, Gold said.
"We can't ignore the benefits of social media, such as helping those with social anxiety, finding peer support, and normalizing mental health, and those factors need to be studied and measured more effectively as well, she said.
It is important to recognize that the current study represents a correlation, not causality, said Gold. In addressing the issues of how social media impact mental health, "as always, the hardest thing is that many people get their news from social media, and often get social support from social media, so there has to be a balance of not removing social media completely, but of helping people see how it affects their mental health and how to find balance."
The study findings were limited by several factors, including the inability to control for all potential confounders, the inability to assess the nature of social media use, and the lack of dose-response data, the researchers noted. Although the surveys in the current study were not specific to COVID-19, the effects of social media on depression may be specific to the content, and the findings may not generalize beyond the COVID-19 pandemic period.
Approximately two-thirds (66%) of the study participants identified as female, and 76% as White; 11% as Black; 6% as Asian; 5% as Hispanic; and 2% as American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or other.
The National Institute of Mental Health provided a grant for the study to Pelis, who disclosed consulting fees from various companies and equity in Psy Therapeutics. The study's lead author also serves as associate editor for JAMA Network Open, but was not involved in the decision process for publication of this study. Gold disclosed conducting a conference for Johnson & Johnson about social media and health care workers, and was on the advisory council.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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Cite this: Adults May Also Be Experiencing Depression Because of Social Media Use, Study Suggests - Medscape - Nov 23, 2021.