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Original Investigation
September 11, 2019

Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth

Author Affiliations
  • 1Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 3Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
  • 4Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
  • 5Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 6Department of Behavioral and Community Health, University of Maryland, College Park, College Park
  • 7Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
  • 8Washington State Department of Health, Olympia
JAMA Psychiatry. Published online September 11, 2019. doi:10.1001/jamapsychiatry.2019.2325
Key Points

Question  Is time spent using social media associated with mental health problems among adolescents?

Findings  In this cohort study of 6595 US adolescents, increased time spent using social media per day was prospectively associated with increased odds of reporting high levels of internalizing and comorbid internalizing and externalizing problems, even after adjusting for history of mental health problems.

Meaning  Adolescents who spend more than 3 hours per day on social media may be at heightened risk for mental health problems, particularly internalizing problems.

Abstract

Importance  Social media use may be a risk factor for mental health problems in adolescents. However, few longitudinal studies have investigated this association, and none have quantified the proportion of mental health problems among adolescents attributable to social media use.

Objective  To assess whether time spent using social media per day is prospectively associated with internalizing and externalizing problems among adolescents.

Design, Setting, and Participants  This longitudinal cohort study of 6595 participants from waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October 30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the Population Assessment of Tobacco and Health study, a nationally representative cohort study of US adolescents, assessed US adolescents via household interviews using audio computer-assisted self-interviewing. Data analysis was performed from January 14, 2019, to May 22, 2019.

Exposures  Self-reported time spent on social media during a typical day (none, ≤30 minutes, >30 minutes to ≤3 hours, >3 hours to ≤6 hours, and >6 hours) during wave 2.

Main Outcomes and Measure  Self-reported past-year internalizing problems alone, externalizing problems alone, and comorbid internalizing and externalizing problems during wave 3 using the Global Appraisal of Individual Needs–Short Screener.

Results  A total of 6595 adolescents (aged 12-15 years during wave 1; 3400 [51.3%] male) were studied. In unadjusted analyses, spending more than 30 minutes of time on social media, compared with no use, was associated with increased risk of internalizing problems alone (≤30 minutes: relative risk ratio [RRR], 1.30; 95% CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours: RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82; >30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15; 95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73); associations with externalizing problems were inconsistent. In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78; 95% CI, 1.15-2.77) and comorbid internalizing and externalizing problems (>3 to ≤6 hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43) but not externalizing problems alone.

Conclusions and Relevance  Adolescents who spend more than 3 hours per day using social media may be at heightened risk for mental health problems, particularly internalizing problems. Future research should determine whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.

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