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Can Social Media Escalate Adolescent Self-Harm to Suicidality?


News Headlines Highlight the Risks: We Examine the Evidence

Over the past ten years, parents have worried that screen time and social media use are harmful to their children’s development. For parents who grew up without smartphones and the internet, it’s an easy position to take. The way kids, tweens, and teens spend their spare time now is quite different than the way a child of the 70s or 80s spent their spare time.

We all know the differences because we’ve all seen the memes. They go something like this:

“No helmets, no seat belts, we were the last generation to… [insert anything kids in the 70s or 80s did: stay out of the house from sunrise to sunset, ride big wheels over jumps in the driveway, look for crawfish in the creek, etc.] … and we survived just fine.”

They’re typically accompanied by a picture of a kid in shorts and tube socks doing something that looks fun, but dangerous by today’s standards.

The first thing we want to do in this article is debunk any attitude that assumes that because something is new and different, it’s therefore bad and dangerous.

Are there dangers to screen time and social media use?

Yes, there absolutely are: we’ll present the evidence in a moment.

Is screen time and social media use categorically dangerous for teens?

No, it’s not.

We understand the temptation to see this issue in black and white, with a simple, definitive, yes/no answer. However, all available – and reliable – evidence indicates the issue is neither simple nor black and white. It’s nuanced: social media use has different effects on different people.

Let’s look at the latest evidence, which will help us understand two things: why parents worry about social media, and why they need to understand the big picture – and focus their energy where it can help their teens.

Increase in Depression, Anxiety, and Suicidality Among Teens: 2000-2018

We do understand where the no social media or screen time parents are coming from. Sensationalist headlines play a role, but so do the widely reported parenting practices of tech icons like Bill Gates, the founder of Microsoft, and Steve Jobs, the founder of Apple. Bill Gates limited screen time for his kids when they were young, and Steve Jobs didn’t allow his kids to use one of his signature products, the iPad, until they were older.

In addition to those factors, the increase in mental health disorders and suicide among young people over the past twenty years caused, and continues to cause, significant alarm among parents. Let’s have a look at those trends so we understand the big picture.

Trends in Teen/Young Adult Mental Health: 2000 Through 2019 (Pre-Pandemic)

  • Depression among girls 14-17 increased by over 4% between 2005 and 2014.
  • From 2005 to 2014, depression among boys 14-17 increased by 1.2% percentage points
  • In 2015, suicide became the second leading cause of death among people age 10-24.
  • From 2007 to 2017, suicide among youth and young adults (age 10-24) rose 56%
  • From 1999 to 2017, suicide among girls (10-14) increased 400%
  • In 2018, 1,400 girls (10-14) and over 5,000 boys (10-14) died by suicide
  • From 2009 to 2019, the percentage of high school students seriously considering suicide increased by 36%
  • From 2009 and 2019, the percentage of high school students with a suicide plan increased by 44%

Those statistics are alarming. Many people – parents and professionals alike – look at those numbers, then think about smartphones and the rise of social media. They connect the increase in suicide between 2007 and 2017 directly to social media and the invention and prevalence of smartphone use, because those years match almost perfectly. The smartphone appeared around 2007, and social media became popular not long after.

The proximity in time makes the connection appear obvious: when smartphones and social media appeared and ascended to popularity, depression, anxiety, and suicide among teens rose dramatically at the same time.

Hold that thought for a moment. We need to look at teen mental health data now, post-pandemic, or rather, in this long pandemic denouement. Here’s the latest data from the Centers for Disease Control (CDC) and the Surgeon General of the United States:

Worldwide Youth Mental Health: 2021 Compared to 2019

  • General Mental Health:
    • Anxiety and depression symptoms increased by 100%
      • 20% of adolescents had symptoms of depression
      • 25% of adolescents had symptoms of anxiety
    • Mental Health Emergencies:
      • Visits to hospital emergency rooms for psychiatric emergencies increased 31%
      • Visits to hospital emergency rooms for suspected suicide attempts increased:
        • 51% for teenage females
        • 4% for teenage boys

That’s where we are now. According to the Surgeon General, our youth and adolescents are in trouble. At the moment they’re either in a crisis or on the verge of a crisis. We can attribute these latest increases the to pandemic.

But what about the increases before the pandemic – specifically those related to suicidal behavior. Did social media and smartphones play a role in those increases?

A study published in early February 2021 may have the answers.

About the Research: A Note For Parents

There’s an interesting phenomenon that occurs in research about the relationship between social media, screentime, and teen mental health. Almost all studies begin with the hypothesis that the relationships will be clear, and that screen time and social media are detrimental to teen mental health. And almost all studies conclude the same thing:

The relationship is complicated, and further research is needed.

The reasons most publications say further research is needed are twofold. First, there are almost no long-range studies on the subject. Second, the studies rely on self-reports with no control group. And with regards to smartphones, social media, and suicidal behavior, most look at the effect of social media and screen time on mental health in general. To date, very few studies have focused on the relationship of social media and screen time with suicidal behavior, specifically.

That’s why the latest study is of interest.

Social Media, Screen Time, and Suicidal Behavior: 2009-2019

This new study – Suicide Risk in Emerging Adulthood: Associations With Screen Time Over 10 years – rectifies two of those procedural shortcomings. The study tracked five hundred teens over ten years. They began with baseline questionnaires administered between ages 12-15, then followed up with questionnaires and phone interviews at regular intervals between age 12-15 and age 22-25. The researchers focused on suicidality and suicidal behavior, rather than overall mental health, which is most often tracked using the symptoms of anxiety and/or depression as primary metrics, rather than suicidality and suicidal behavior.

Before this study, the best information we had on social media and teen mental health appeared in a report published by Common Sense Media.  Their research showed negative effects of screen time/social media on six categories of youth:

  • Females between ages 10-14
  • Teens between ages 13-18 diagnosed a mental health disorder
  • Teens who report bullying
  • Tweens and teens with low self-esteem/self-image
  • Teens who engage in negative self-talk
  • Teens who are heavy social media users

This new study clarifies these findings and adds a new risk group that we haven’t seen before. Here’s what they found.

For Girls:

  • Heavy social media and heavy screen time (defined as over two hours per day) in early adolescence followed by an increase over time predicted increased suicide risk during early adulthood.
  • Early adoption of video game playing, with video game playing time increasing during adolescence, predicted an increased suicide risk for girls during early adulthood.
  • Heavy video game playing during adolescence combined with being bullied (online or in real life) increased suicide risk for girls during early adulthood.

For Boys:

  • Using reading apps during adolescence was associated with increased suicide risk during early adulthood.
  • Using any education app during adolescence was associated with increased suicide risk during early adulthood.
    • This risk increased for boys who use social media in ways that are considered negative.

Let’s address those two findings about boys. It’s important to recognize that the study authors do not recommend that boys stop using reading or educational apps. Here’s how the study authors explain their findings:

“This link likely represents some underlying issue related to mental health, such as high levels of perfectionism or anxiety. where boys may be obsessively checking education type apps or feeling increased stress over school assignments. Boys are also less likely to seek out help in education and may feel more alone if stressed.”

That’s logical.

It also presents a perfect transition to a question the findings bring up, for boys and girls: what exactly is negative social media use?

How Teens Use Social Media: Practices Associated with Negative Outcomes

According to Common Sense Media, there are four types of social media use associated with negative outcomes: status comparison, appearance comparison, toxic interaction, and heavy use. We’ll describe those now.

  1. Status Comparison

    • Teens who compare themselves to others they think have higher social increases risk for anxiety and depression.
  2. Appearance Comparison

    • Teens who compare themselves to others they think are more attractive or more fashionable report higher rates of anxiety and depression than teens who don’t compare themselves to others on social media.
  3. Toxic Interaction

    • Teens who post updates or pictures that lead to negative comments, negative direct messages, or negative reactions (angry emojis, etc.) report higher rates of anxiety and depression than teens whose posts do not lead to negative reactions, messages, or comments.
  4. Heavy Use

    • Teens who use social media for more than two hours per day or check social media sites more than three times per day report higher levels of anxiety, depression psychological distress than teens who use social media and check sites less often.

Parents of teens whose social media use puts them at risk can use this information to protect their teens from the harms associated with social media use. Dr. Sarah Coyne, a lead researcher and author of the study, explains in this interview why she thinks teen girls are particularly vulnerable to the negative effects of social media:

“Something about that specific social media use pattern is particularly harmful for young girls. Research shows that girls and women in general are very relationally attuned and sensitive to interpersonal stressors, and social media is all about relationships. At 13, girls are just starting to be ready to handle the darker underbelly of social media, such as FOMO, constant comparisons and cyberbullying. A 13-year-old is probably not developmentally ready for three hours of social media a day.”

Dr. Coyne goes on to help parents understand how they can help their teenage girls avoid the negative consequences of social media use, and prevent any escalation from self-harming behavior or suicidal ideation to suicide attempts:

“The goal is to teach them to be healthy users of social media, to use it in a way that helps them feel good about themselves and connect with other people, which is its real purpose. It’s parents’ job to scaffold or pre-arm children so that they can deal with some of the heavy stuff that often comes with using social media.”

That’s helpful advice. But how exactly can parents scaffold or pre-arm their teenage girls?

Healthy Social Media Use for Teens: Prevent Escalation to Suicide

We located a list on The Child Mind Institute website that meets parental needs perfectly. Here are there top five tips – with some interpretation on our part – about on how parents can encourage healthy social media use in their vulnerable teens:

1. Turn off Notifications

Teens do not need a flashing red light to appear every time someone comments on their posts.

2. Moderate Use

Establish rules that limit social media use to a maximum of 2 hours per day.

3. Mindful Use

For adolescent females, this is critical. Give them power and agency by reminding them they are in control of their online behavior. Teach these girls that they don’t have to visit sites that make them feel uncomfortable emotions, and they can block or report anyone that’s negative, mean, or bullying.

4. Improve Sleep Habits

Establish a rule at home: all screens off 20 minutes before bedtime. Sleep deprivation can increase the risk of depression, anxiety, suicidal ideation, and suicidal behavior.

5. Walk the Walk

Parents should model appropriate smartphone use. If parents are on their phone 24/7, teenagers are unlikely to listen to or follow rules that limit their social media/smartphone use to less than two hours per day.

These five tips are most important for parents of teenage girls with a previously diagnosed mental health disorder, a history of self-harming behavior or suicidal ideation, or both. More important than all these tips, however, is for parents to approach this subject with empathy, compassion, and understanding. While evidence indicates that there are negative types of social media use, evidence also indicates that in some cases, teens use social media in positive ways that improve, rather than degrade, overall mental health and wellbeing.

An honest conversation can help parents find out how their teens use social media. Once they know what their kids are doing on social media, they can help them improve how – which makes all the difference.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

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