research paper effects of social media

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• v.12(6); 2020 Jun

Social Media Use and Its Connection to Mental Health: A Systematic Review

Fazida karim.

1 Psychology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

2 Business & Management, University Sultan Zainal Abidin, Terengganu, MYS

Azeezat A Oyewande

3 Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

4 Family Medicine, Lagos State Health Service Commission/Alimosho General Hospital, Lagos, NGA

Lamis F Abdalla

5 Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA

Reem Chaudhry Ehsanullah

Safeera khan.

Social media are responsible for aggravating mental health problems. This systematic study summarizes the effects of social network usage on mental health. Fifty papers were shortlisted from google scholar databases, and after the application of various inclusion and exclusion criteria, 16 papers were chosen and all papers were evaluated for quality. Eight papers were cross-sectional studies, three were longitudinal studies, two were qualitative studies, and others were systematic reviews. Findings were classified into two outcomes of mental health: anxiety and depression. Social media activity such as time spent to have a positive effect on the mental health domain. However, due to the cross-sectional design and methodological limitations of sampling, there are considerable differences. The structure of social media influences on mental health needs to be further analyzed through qualitative research and vertical cohort studies.

Introduction and background

Human beings are social creatures that require the companionship of others to make progress in life. Thus, being socially connected with other people can relieve stress, anxiety, and sadness, but lack of social connection can pose serious risks to mental health [ 1 ].

Social media

Social media has recently become part of people's daily activities; many of them spend hours each day on Messenger, Instagram, Facebook, and other popular social media. Thus, many researchers and scholars study the impact of social media and applications on various aspects of people’s lives [ 2 ]. Moreover, the number of social media users worldwide in 2019 is 3.484 billion, up 9% year-on-year [ 3 - 5 ]. A statistic in Figure  1  shows the gender distribution of social media audiences worldwide as of January 2020, sorted by platform. It was found that only 38% of Twitter users were male but 61% were using Snapchat. In contrast, females were more likely to use LinkedIn and Facebook. There is no denying that social media has now become an important part of many people's lives. Social media has many positive and enjoyable benefits, but it can also lead to mental health problems. Previous research found that age did not have an effect but gender did; females were much more likely to experience mental health than males [ 6 , 7 ].

Impact on mental health

Mental health is defined as a state of well-being in which people understand their abilities, solve everyday life problems, work well, and make a significant contribution to the lives of their communities [ 8 ]. There is debated presently going on regarding the benefits and negative impacts of social media on mental health [ 9 , 10 ]. Social networking is a crucial element in protecting our mental health. Both the quantity and quality of social relationships affect mental health, health behavior, physical health, and mortality risk [ 9 ]. The Displaced Behavior Theory may help explain why social media shows a connection with mental health. According to the theory, people who spend more time in sedentary behaviors such as social media use have less time for face-to-face social interaction, both of which have been proven to be protective against mental disorders [ 11 , 12 ]. On the other hand, social theories found how social media use affects mental health by influencing how people view, maintain, and interact with their social network [ 13 ]. A number of studies have been conducted on the impacts of social media, and it has been indicated that the prolonged use of social media platforms such as Facebook may be related to negative signs and symptoms of depression, anxiety, and stress [ 10 - 15 ]. Furthermore, social media can create a lot of pressure to create the stereotype that others want to see and also being as popular as others.

The need for a systematic review

Systematic studies can quantitatively and qualitatively identify, aggregate, and evaluate all accessible data to generate a warm and accurate response to the research questions involved [ 4 ]. In addition, many existing systematic studies related to mental health studies have been conducted worldwide. However, only a limited number of studies are integrated with social media and conducted in the context of social science because the available literature heavily focused on medical science [ 6 ]. Because social media is a relatively new phenomenon, the potential links between their use and mental health have not been widely investigated.

This paper attempt to systematically review all the relevant literature with the aim of filling the gap by examining social media impact on mental health, which is sedentary behavior, which, if in excess, raises the risk of health problems [ 7 , 9 , 12 ]. This study is important because it provides information on the extent of the focus of peer review literature, which can assist the researchers in delivering a prospect with the aim of understanding the future attention related to climate change strategies that require scholarly attention. This study is very useful because it provides information on the extent to which peer review literature can assist researchers in presenting prospects with a view to understanding future concerns related to mental health strategies that require scientific attention. The development of the current systematic review is based on the main research question: how does social media affect mental health?

Research strategy

The research was conducted to identify studies analyzing the role of social media on mental health. Google Scholar was used as our main database to find the relevant articles. Keywords that were used for the search were: (1) “social media”, (2) “mental health”, (3) “social media” AND “mental health”, (4) “social networking” AND “mental health”, and (5) “social networking” OR “social media” AND “mental health” (Table  1 ).

Out of the results in Table  1 , a total of 50 articles relevant to the research question were selected. After applying the inclusion and exclusion criteria, duplicate papers were removed, and, finally, a total of 28 articles were selected for review (Figure  2 ).

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Inclusion and exclusion criteria

Peer-reviewed, full-text research papers from the past five years were included in the review. All selected articles were in English language and any non-peer-reviewed and duplicate papers were excluded from finally selected articles.

Of the 16 selected research papers, there were a research focus on adults, gender, and preadolescents [ 10 - 19 ]. In the design, there were qualitative and quantitative studies [ 15 , 16 ]. There were three systematic reviews and one thematic analysis that explored the better or worse of using social media among adolescents [ 20 - 23 ]. In addition, eight were cross-sectional studies and only three were longitudinal studies [ 24 - 29 ].The meta-analyses included studies published beyond the last five years in this population. Table  2  presents a selection of studies from the review.

IGU, internet gaming disorder; PSMU, problematic social media use

This study has attempted to systematically analyze the existing literature on the effect of social media use on mental health. Although the results of the study were not completely consistent, this review found a general association between social media use and mental health issues. Although there is positive evidence for a link between social media and mental health, the opposite has been reported.

For example, a previous study found no relationship between the amount of time spent on social media and depression or between social media-related activities, such as the number of online friends and the number of “selfies”, and depression [ 29 ]. Similarly, Neira and Barber found that while higher investment in social media (e.g. active social media use) predicted adolescents’ depressive symptoms, no relationship was found between the frequency of social media use and depressed mood [ 28 ].

In the 16 studies, anxiety and depression were the most commonly measured outcome. The prominent risk factors for anxiety and depression emerging from this study comprised time spent, activity, and addiction to social media. In today's world, anxiety is one of the basic mental health problems. People liked and commented on their uploaded photos and videos. In today's age, everyone is immune to the social media context. Some teens experience anxiety from social media related to fear of loss, which causes teens to try to respond and check all their friends' messages and messages on a regular basis.

On the contrary, depression is one of the unintended significances of unnecessary use of social media. In detail, depression is limited not only to Facebooks but also to other social networking sites, which causes psychological problems. A new study found that individuals who are involved in social media, games, texts, mobile phones, etc. are more likely to experience depression.

The previous study found a 70% increase in self-reported depressive symptoms among the group using social media. The other social media influence that causes depression is sexual fun [ 12 ]. The intimacy fun happens when social media promotes putting on a facade that highlights the fun and excitement but does not tell us much about where we are struggling in our daily lives at a deeper level [ 28 ]. Another study revealed that depression and time spent on Facebook by adolescents are positively correlated [ 22 ]. More importantly, symptoms of major depression have been found among the individuals who spent most of their time in online activities and performing image management on social networking sites [ 14 ].

Another study assessed gender differences in associations between social media use and mental health. Females were found to be more addicted to social media as compared with males [ 26 ]. Passive activity in social media use such as reading posts is more strongly associated with depression than doing active use like making posts [ 23 ]. Other important findings of this review suggest that other factors such as interpersonal trust and family functioning may have a greater influence on the symptoms of depression than the frequency of social media use [ 28 , 29 ].

Limitation and suggestion

The limitations and suggestions were identified by the evidence involved in the study and review process. Previously, 7 of the 16 studies were cross-sectional and slightly failed to determine the causal relationship between the variables of interest. Given the evidence from cross-sectional studies, it is not possible to conclude that the use of social networks causes mental health problems. Only three longitudinal studies examined the causal relationship between social media and mental health, which is hard to examine if the mental health problem appeared more pronounced in those who use social media more compared with those who use it less or do not use at all [ 19 , 20 , 24 ]. Next, despite the fact that the proposed relationship between social media and mental health is complex, a few studies investigated mediating factors that may contribute or exacerbate this relationship. Further investigations are required to clarify the underlying factors that help examine why social media has a negative impact on some peoples’ mental health, whereas it has no or positive effect on others’ mental health.

Conclusions

Social media is a new study that is rapidly growing and gaining popularity. Thus, there are many unexplored and unexpected constructive answers associated with it. Lately, studies have found that using social media platforms can have a detrimental effect on the psychological health of its users. However, the extent to which the use of social media impacts the public is yet to be determined. This systematic review has found that social media envy can affect the level of anxiety and depression in individuals. In addition, other potential causes of anxiety and depression have been identified, which require further exploration.

The importance of such findings is to facilitate further research on social media and mental health. In addition, the information obtained from this study can be helpful not only to medical professionals but also to social science research. The findings of this study suggest that potential causal factors from social media can be considered when cooperating with patients who have been diagnosed with anxiety or depression. Also, if the results from this study were used to explore more relationships with another construct, this could potentially enhance the findings to reduce anxiety and depression rates and prevent suicide rates from occurring.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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• Open access
• Published: 01 July 2020

The effect of social media on well-being differs from adolescent to adolescent

• Ine Beyens   ORCID: orcid.org/0000-0001-7023-867X 1 ,
• J. Loes Pouwels   ORCID: orcid.org/0000-0002-9586-392X 1 ,
• Irene I. van Driel   ORCID: orcid.org/0000-0002-7810-9677 1 ,
• Loes Keijsers   ORCID: orcid.org/0000-0001-8580-6000 2 &
• Patti M. Valkenburg   ORCID: orcid.org/0000-0003-0477-8429 1  

Scientific Reports volume  10 , Article number:  10763 ( 2020 ) Cite this article

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The question whether social media use benefits or undermines adolescents’ well-being is an important societal concern. Previous empirical studies have mostly established across-the-board effects among (sub)populations of adolescents. As a result, it is still an open question whether the effects are unique for each individual adolescent. We sampled adolescents’ experiences six times per day for one week to quantify differences in their susceptibility to the effects of social media on their momentary affective well-being. Rigorous analyses of 2,155 real-time assessments showed that the association between social media use and affective well-being differs strongly across adolescents: While 44% did not feel better or worse after passive social media use, 46% felt better, and 10% felt worse. Our results imply that person-specific effects can no longer be ignored in research, as well as in prevention and intervention programs.

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Introduction

Ever since the introduction of social media, such as Facebook and Instagram, researchers have been studying whether the use of such media may affect adolescents’ well-being. These studies have typically reported mixed findings, yielding either small negative, small positive, or no effects of the time spent using social media on different indicators of well-being, such as life satisfaction and depressive symptoms (for recent reviews, see for example 1 , 2 , 3 , 4 , 5 ). Most of these studies have focused on between-person associations, examining whether adolescents who use social media more (or less) often than their peers experience lower (or higher) levels of well-being than these peers. While such between-person studies are valuable in their own right, several scholars 6 , 7 have recently called for studies that investigate within-person associations to understand whether an increase in an adolescent’s social media use is associated with an increase or decrease in that adolescent’s well-being. The current study aims to respond to this call by investigating associations between social media use and well-being within single adolescents across multiple points in time 8 , 9 , 10 .

Person-specific effects

To our knowledge, four recent studies have investigated within-person associations of social media use with different indicators of adolescent well-being (i.e., life satisfaction, depression), again with mixed results 6 , 11 , 12 , 13 . Orben and colleagues 6 found a small negative reciprocal within-person association between the time spent using social media and life satisfaction. Likewise, Boers and colleagues 12 found a small within-person association between social media use and increased depressive symptoms. Finally, Coyne and colleagues 11 and Jensen and colleagues 13 did not find any evidence for within-person associations between social media use and depression.

Earlier studies that investigated within-person associations of social media use with indicators of well-being have all only reported average effect sizes. However, it is possible, or even plausible, that these average within-person effects may have been small and nonsignificant because they result from sizeable heterogeneity in adolescents’ susceptibility to the effects of social media use on well-being (see 14 , 15 ). After all, an average within-person effect size can be considered an aggregate of numerous individual within-person effect sizes that range from highly positive to highly negative.

Some within-person studies have sought to understand adolescents’ differential susceptibility to the effects of social media by investigating differences between subgroups. For instance, they have investigated the moderating role of sex to compare the effects of social media on boys versus girls 6 , 11 . However, such a group-differential approach, in which potential differences in susceptibility are conceptualized by group-level moderators (e.g., gender, age) does not provide insights into more fine-grained differences at the level of the single individual 16 . After all, while girls and boys each represent a homogenous group in terms of sex, they may each differ on a wide array of other factors.

As such, although worthwhile, the average within-person effects of social media on well-being obtained in previous studies may have been small or non-significant because they are diluted across a highly heterogeneous population (or sub-population) of adolescents 14 , 15 . In line with the proposition of media effects theories that each adolescent may have a unique susceptibility to the effects of social media 17 , a viable explanation for the small and inconsistent findings in earlier studies may be that the effect of social media differs from adolescent to adolescent. The aim of the current study is to investigate this hypothesis and to obtain a better understanding of adolescents’ unique susceptibility to the effects of social media on their affective well-being.

Social media and affective well-being

Within-person studies have provided important insights into the associations of social media use with cognitive well-being (e.g., life satisfaction 6 ), which refers to adolescents’ cognitive judgment of how satisfied they are with their life 18 . However, the associations of social media use with adolescents’ affective well-being (i.e., adolescents’ affective evaluations of their moods and emotions 18 ) are still unknown. In addition, while earlier within-person studies have focused on associations with trait-like conceptualizations of well-being 11 , 12 , 13 , that is, adolescents’ average well-being across specific time periods 18 , there is a lack of studies that focus on well-being as a momentary affective state. Therefore, we extend previous research by examining the association between adolescents’ social media use and their momentary affective well-being. Like earlier experience sampling (ESM) studies among adults 19 , 20 , we measured adolescents’ momentary affective well-being with a single item. Adolescents’ momentary affective well-being was defined as their current feelings of happiness, a commonly used question to measure well-being 21 , 22 , which has high convergent validity, as evidenced by the strong correlations with the presence of positive affect and absence of negative affect.

To assess adolescents’ momentary affective well-being (henceforth referred to as well-being), we conducted a week-long ESM study among 63 middle adolescents ages 14 and 15. Six times a day, adolescents were asked to complete a survey using their own mobile phone, covering 42 assessments per adolescent, assessing their affective well-being and social media use. In total, adolescents completed 2,155 assessments (83.2% average compliance).

We focused on middle adolescence, since this is the period in life characterized by most significant fluctuations in well-being 23 , 24 . Also, in comparison to early and late adolescents, middle adolescents are more sensitive to reactions from peers and have a strong tendency to compare themselves with others on social media and beyond. Because middle adolescents typically use different social media platforms, in a complementary way 25 , 26 , 27 , each adolescent reported on his/her use of the three social media platforms that s/he used most frequently out of the five most popular social media platforms among adolescents: WhatsApp, followed by Instagram, Snapchat, YouTube, and, finally, the chat function of games 28 . In addition to investigating the association between overall social media use and well-being (i.e., the summed use of adolescents’ three most frequently used platforms), we examined the unique associations of the two most popular platforms, WhatsApp and Instagram 28 .

Like previous studies on social media use and well-being, we distinguished between active social media use (i.e., “activities that facilitate direct exchanges with others” 29 ) and passive social media use (i.e., “consuming information without direct exchanges” 29 ). Within-person studies among young adults have shown that passive but not active social media use predicts decreases in well-being 29 . Therefore, we examined the unique associations of adolescents’ overall active and passive social media use with their well-being, as well as active and passive use of Instagram and WhatsApp, specifically. We investigated categorical associations, that is, whether adolescents would feel better or worse if they had actively or passively used social media. And we investigated dose–response associations to understand whether adolescents’ well-being would change as a function of the time they had spent actively or passively using social media.

The hypotheses and the design, sampling and analysis plan were preregistered prior to data collection and are available on the Open Science Framework, along with the code used in the analyses ( https://osf.io/nhks2 ). For details about the design of the study and analysis approach, see Methods.

In more than half of all assessments (68.17%), adolescents had used social media (i.e., one or more of their three favorite social media platforms), either in an active or passive way. Instagram (50.90%) and WhatsApp (53.52%) were used in half of all assessments. Passive use of social media (66.21% of all assessments) was more common than active use (50.86%), both on Instagram (48.48% vs. 20.79%) and WhatsApp (51.25% vs. 40.07%).

Strong positive between-person correlations were found between the duration of active and passive social media use (overall: r  = 0.69, p  < 0.001; Instagram: r  = 0.38, p  < 0.01; WhatsApp: r  = 0.85, p  < 0.001): Adolescents who had spent more time actively using social media than their peers, had also spent more time passively using social media than their peers. Likewise, strong positive within-person correlations were found between the duration of active and passive social media use (overall: r  = 0.63, p  < 0.001; Instagram: r  = 0.37, p  < 0.001; WhatsApp: r  = 0.57, p  < 0.001): The more time an adolescent had spent actively using social media at a certain moment, the more time s/he had also spent passively using social media at that moment.

Table 1 displays the average number of minutes that adolescents had spent using social media in the past hour at each assessment, and the zero-order between- and within-person correlations between the duration of social media use and well-being. At the between-person level, the duration of active and passive social media use was not associated with well-being: Adolescents who had spent more time actively or passively using social media than their peers did not report significantly higher or lower levels of well-being than their peers. At the within-person level, significant but weak positive correlations were found between the duration of active and passive overall social media use and well-being. This indicates that adolescents felt somewhat better at moments when they had spent more time actively or passively using social media (overall), compared to moments when they had spent less time actively or passively using social media. When looking at specific platforms, a positive correlation was only found for passive WhatsApp use, but not for active WhatsApp use, and not for active and passive Instagram use.

Average and person-specific effects

The within-person associations of social media use with well-being and differences in these associations were tested in a series of multilevel models. We ran separate models for overall social media use (i.e., active use and passive use of adolescents’ three favorite social media platforms, see Table 2 ), Instagram use (see Table 3 ), and WhatsApp use (see Table 4 ). In a first step we examined the average categorical associations for each of these three social media uses using fixed effects models (Models 1A, 3A, and 5A) to investigate whether, on average, adolescents would feel better or worse at moments when they had used social media compared to moments when they had not (i.e., categorical predictors: active use versus no active use, and passive use versus no passive use). In a second step, we examined heterogeneity in the within-person categorical associations by adding random slopes to the fixed effects models (Models 1B, 3B, and 5B). Next, we examined the average dose–response associations using fixed effects models (Models 2A, 4A, and 6A), to investigate whether, on average, adolescents would feel better or worse when they had spent more time using social media (i.e., continuous predictors: duration of active use and duration of passive use). Finally, we examined heterogeneity in the within-person dose–response associations by adding random slopes to the fixed effects models (Models 2B, 4B, and 6B).

Overall social media use.

The model with the categorical predictors (see Table 2 ; Model 1A) showed that, on average, there was no association between overall use and well-being: Adolescents’ well-being did not increase or decrease at moments when they had used social media, either in a passive or active way. However, evidence was found that the association of passive (but not active) social media use with well-being differed from adolescent to adolescent (Model 1B), with effect sizes ranging from − 0.24 to 0.68. For 44.26% of the adolescents the association was non-existent to small (− 0.10 <  r  < 0.10). However, for 45.90% of the adolescents there was a weak (0.10 <  r  < 0.20; 8.20%), moderate (0.20 <  r  < 0.30; 22.95%) or even strong positive ( r  ≥ 0.30; 14.75%) association between overall passive social media use and well-being, and for almost one in ten (9.84%) adolescents there was a weak (− 0.20 <  r  < − 0.10; 6.56%) or moderate negative (− 0.30 <  r  < − 0.20; 3.28%) association.

The model with continuous predictors (Model 2A) showed that, on average, there was a significant dose–response association for active use. At moments when adolescents had used social media, the time they spent actively (but not passively) using social media was positively associated with well-being: Adolescents felt better at moments when they had spent more time sending messages, posting, or sharing something on social media. The associations of the time spent actively and passively using social media with well-being did not differ across adolescents (Model 2B).

Instagram use

As shown in Model 3A in Table 3 , on average, there was a significant categorical association between passive (but not active) Instagram use and well-being: Adolescents experienced an increase in well-being at moments when they had passively used Instagram (i.e., viewing posts/stories of others). Adolescents did not experience an increase or decrease in well-being when they had actively used Instagram. The associations of passive and active Instagram use with well-being did not differ across adolescents (Model 3B).

On average, no significant dose–response association was found for Instagram use (Model 4A): At moments when adolescents had used Instagram, the time adolescents spent using Instagram (either actively or passively) was not associated with their well-being. However, evidence was found that the association of the time spent passively using Instagram differed from adolescent to adolescent (Model 4B), with effect sizes ranging from − 0.48 to 0.27. For most adolescents (73.91%) the association was non-existent to small (− 0.10 <  r  < 0.10), but for almost one in five adolescents (17.39%) there was a weak (0.10 <  r  < 0.20; 10.87%) or moderate (0.20 <  r  < 0.30; 6.52%) positive association, and for almost one in ten adolescents (8.70%) there was a weak (− 0.20 <  r  < − 0.10; 2.17%), moderate (− 0.30 <  r  < − 0.20; 4.35%), or strong ( r  ≤ − 0.30; 2.17%) negative association. Figure  1 illustrates these differences in the dose–response associations.

The dose–response association between passive Instagram use (in minutes per hour) and affective well-being for each individual adolescent (n = 46). Red lines represent significant negative within-person associations, green lines represent significant positive within-person associations, and gray lines represent non-significant within-person associations. A graph was created for each participant who had completed at least 10 assessments. A total of 13 participants were excluded because they had completed less than 10 assessments of passive Instagram use. In addition, one participant was excluded because no graph could be computed, since this participant's passive Instagram use was constant across assessments.

WhatsApp use

As shown in Model 5A in Table 4 , just as for Instagram, we found that, on average, there was a significant categorical association between passive (but not active) WhatsApp use and well-being: Adolescents reported that they felt better at moments when they had passively used WhatsApp (i.e., read WhatsApp messages). For active WhatsApp use, no significant association was found. Also, in line with the results for Instagram use, no differences were found regarding the associations of active and passive WhatsApp use (Model 5B).

In addition, a significant dose–response association was found for passive (but not active) use (Model 6A). At moments when adolescents had used WhatsApp, we found that, on average, the time adolescents spent passively using WhatsApp was positively associated with well-being: Adolescents felt better at moments when they had spent more time reading WhatsApp messages. The time spent actively using WhatsApp was not associated with well-being. No differences were found in the dose–response associations of active and passive WhatsApp use (Model 6B).

This preregistered study investigated adolescents’ unique susceptibility to the effects of social media. We found that the associations of passive (but not active) social media use with well-being differed substantially from adolescent to adolescent, with effect sizes ranging from moderately negative (− 0.24) to strongly positive (0.68). While 44.26% of adolescents did not feel better or worse if they had passively used social media, 45.90% felt better, and a small group felt worse (9.84%). In addition, for Instagram the majority of adolescents (73.91%) did not feel better or worse when they had spent more time viewing post or stories of others, whereas some felt better (17.39%), and others (8.70%) felt worse.

These findings have important implications for social media effects research, and media effects research more generally. For decades, researchers have argued that people differ in their susceptibility to the effects of media 17 , leading to numerous investigations of such differential susceptibility. These investigations have typically focused on moderators, based on variables such as sex, age, or personality. Yet, over the years, studies have shown that such moderators appear to have little power to explain how individuals differ in their susceptibility to media effects, probably because a group-differential approach does not account for the possibility that media users may differ across a range of factors, that are not captured by only one (or a few) investigated moderator variables.

By providing insights into each individual’s unique susceptibility, the findings of this study provide an explanation as to why, up until now, most media effects research has only found small effects. We found that the majority of adolescents do not experience any short-term changes in well-being related to their social media use. And if they do experience any changes, these are more often positive than negative. Because only small subsets of adolescents experience small to moderate changes in well-being, the true effects of social media reported in previous studies have probably been diluted across heterogeneous samples of individuals that differ in their susceptibility to media effects (also see 30 ). Several scholars have noted that overall effect sizes may mask more subtle individual differences 14 , 15 , which may explain why previous studies have typically reported small or no effects of social media on well-being or indicators of well-being 6 , 11 , 12 , 13 . The current study seems to confirm this assumption, by showing that while the overall effect sizes are small at best, the person-specific effect sizes vary considerably, from tiny and small to moderate and strong.

As called upon by other scholars 5 , 31 , we disentangled the associations of active and passive use of social media. Research among young adults found that passive (but not active) social media use is associated with lower levels of affective well-being 29 . In line with these findings, the current study shows that active and passive use yielded different associations with adolescents’ affective well-being. Interestingly though, in contrast to previous findings among adults, our study showed that, on average, passive use of Instagram and WhatsApp seemed to enhance rather than decrease adolescents’ well-being. This discrepancy in findings may be attributed to the fact that different mechanisms might be involved. Verduyn and colleagues 29 found that passive use of Facebook undermines adults’ well-being by enhancing envy, which may also explain the decreases in well-being found in our study among a small group of adolescents. Yet, adolescents who felt better by passively using Instagram and WhatsApp, might have felt so because they experienced enjoyment. After all, adolescents often seek positive content on social media, such as humorous posts or memes 32 . Also, research has shown that adolescents mainly receive positive feedback on social media 33 . Hence, their passive Instagram and WhatsApp use may involve the reading of positive feedback, which may explain the increases in well-being.

Overall, the time spent passively using WhatsApp improved adolescents’ well-being. This did not differ from adolescent to adolescent. However, the associations of the time spent passively using Instagram with well-being did differ from adolescent to adolescent. This discrepancy suggests that not all social media uses yield person-specific effects on well-being. A possible explanation may be that adolescents’ responses to WhatsApp are more homogenous than those to Instagram. WhatsApp is a more private platform, which is mostly used for one-to-one communication with friends and acquaintances 26 . Instagram, in contrast, is a more public platform, which allows its users to follow a diverse set of people, ranging from best friends to singers, actors, and influencers 28 , and to engage in intimate communication as well as self-presentation and social comparison. Such diverse uses could lead to more varied, or even opposing responses, such as envy versus inspiration.

Limitations and directions for future research

The current study extends our understanding of differential susceptibility to media effects, by revealing that the effect of social media use on well-being differs from adolescent to adolescent. The findings confirm our assumption that among the great majority of adolescents, social media use is unrelated to well-being, but that among a small subset, social media use is either related to decreases or increases in well-being. It must be noted, however, that participants in this study felt relatively happy, overall. Studies with more vulnerable samples, consisting of clinical samples or youth with lower social-emotional well-being may elicit different patterns of effects 27 . Also, the current study focused on affective well-being, operationalized as happiness. It is plausible that social media use relates differently with other types of well-being, such as cognitive well-being. An important next step is to identify which adolescents are particularly susceptible to experience declines in well-being. It is conceivable, for instance, that the few adolescents who feel worse when they use social media are the ones who receive negative feedback on social media 33 .

In addition, future ESM studies into the effects of social media should attempt to include one or more follow-up measures to improve our knowledge of the longer-term influence of social media use on affective well-being. While a week-long ESM is very common and applied in most earlier ESM studies 34 , a week is only a snapshot of adolescent development. Research is needed that investigates whether the associations of social media use with adolescents’ momentary affective well-being may cumulate into long-lasting consequences. Such investigations could help clarify whether adolescents who feel bad in the short term would experience more negative consequences in the long term, and whether adolescents who feel better would be more resistant to developing long-term negative consequences. And while most adolescents do not seem to experience any short-term increases or decreases in well-being, more research is needed to investigate whether these adolescents may experience a longer-term impact of social media.

While the use of different platforms may be differently associated with well-being, different types of use may also yield different effects. Although the current study distinguished between active and passive use of social media, future research should further differentiate between different activities. For instance, because passive use entails many different activities, from reading private messages (e.g., WhatsApp messages, direct messages on Instagram) to browsing a public feed (e.g., scrolling through posts on Instagram), research is needed that explores the unique effects of passive public use and passive private use. Research that seeks to explore the nuances in adolescents’ susceptibility as well as the nuances in their social media use may truly improve our understanding of the effects of social media use.

Participants

Participants were recruited via a secondary school in the south of the Netherlands. Our preregistered sampling plan set a target sample size of 100 adolescents. We invited adolescents from six classrooms to participate in the study. The final sample consisted of 63 adolescents (i.e., 42% consent rate, which is comparable to other ESM studies among adolescents; see, for instance 35 , 36 ). Informed consent was obtained from all participants and their parents. On average, participants were 15 years old ( M  = 15.12 years, SD  = 0.51) and 54% were girls. All participants self-identified as Dutch, and 41.3% were enrolled in the prevocational secondary education track, 25.4% in the intermediate general secondary education track, and 33.3% in the academic preparatory education track.

The study was approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences at the University of Amsterdam and was performed in accordance with the guidelines formulated by the Ethics Review Board. The study consisted of two phases: A baseline survey and a personalized week-long experience sampling (ESM) study. In phase 1, researchers visited the school during school hours. Researchers informed the participants of the objective and procedure of the study and assured them that their responses would be treated confidentially. Participants were asked to sign the consent form. Next, participants completed a 15-min baseline survey. The baseline survey included questions about demographics and assessed which social media each adolescent used most frequently, allowing to personalize the social media questions presented during the ESM study in phase 2. After completing the baseline survey, participants were provided detailed instructions about phase 2.

In phase 2, which took place two and a half weeks after the baseline survey, a 7-day ESM study was conducted, following the guidelines for ESM studies provided by van Roekel and colleagues 34 . Aiming for at least 30 assessments per participant and based on an average compliance rate of 70 to 80% reported in earlier ESM studies among adolescents 34 , we asked each participant to complete a total of 42 ESM surveys (i.e., six 2-min surveys per day). Participants completed the surveys using their own mobile phone, on which the ESM software application Ethica Data was installed during the instruction session with the researchers (phase 1). Each 2-min survey consisted of 22 questions, which assessed adolescents’ well-being and social media use. Two open-ended questions were added to the final survey of the day, which asked about adolescents’ most pleasant and most unpleasant events of the day.

The ESM sampling scheme was semi-random, to allow for randomization and avoid structural patterns in well-being, while taking into account that adolescents were not allowed to use their phone during school time. The Ethica Data app was programmed to generate six beep notifications per day at random time points within a fixed time interval that was tailored to the school’s schedule: before school time (1 beep), during school breaks (2 beeps), and after school time (3 beeps). During the weekend, the beeps were generated during the morning (1 beep), afternoon (3 beeps), and evening (2 beeps). To maximize compliance, a 30-min time window was provided to complete each survey. This time window was extended to one hour for the first survey (morning) and two hours for the final survey (evening) to account for travel time to school and time spent on evening activities. The average compliance rate was 83.2%. A total of 2,155 ESM assessments were collected: Participants completed an average of 34.83 surveys ( SD  = 4.91) on a total of 42 surveys, which is high compared to previous ESM studies among adolescents 34 .

The questions of the ESM study were personalized based on the responses to the baseline survey. During the ESM study, each participant reported on his/her use of three different social media platforms: WhatsApp and either Instagram, Snapchat, YouTube, and/or the chat function of games (i.e., the most popular social media platforms among adolescents 28 ). Questions about Instagram and WhatsApp use were only included if the participant had indicated in the baseline survey that s/he used these platforms at least once a week. If a participant had indicated that s/he used Instagram or WhatsApp (or both) less than once a week, s/he was asked to report on the use of Snapchat, YouTube, or the chat function of games, depending on what platform s/he used at least once a week. In addition to Instagram and WhatsApp, questions were asked about a third platform, that was selected based on how frequently the participant used Snapchat, YouTube, or the chat function of games (i.e., at least once a week). This resulted in five different combinations of three platforms: Instagram, WhatsApp, and Snapchat (47 participants); Instagram, WhatsApp, and YouTube (11 participants); Instagram, WhatsApp, and chatting via games (2 participants); WhatsApp, Snapchat, and YouTube (1 participant); and WhatsApp, YouTube, and chatting via games (2 participants).

Frequency of social media use

In the baseline survey, participants were asked to indicate how often they used and checked Instagram, WhatsApp, Snapchat, YouTube, and the chat function of games, using response options ranging from 1 ( never ) to 7 ( more than 12 times per day ). These platforms are the five most popular platforms among Dutch 14- and 15-year-olds 28 . Participants’ responses were used to select the three social media platforms that were assessed in the personalized ESM study.

Duration of social media use

In the ESM study, duration of active and passive social media use was measured by asking participants how much time in the past hour they had spent actively and passively using each of the three platforms that were included in the personalized ESM surveys. Response options ranged from 0 to 60 min , with 5-min intervals. To measure active Instagram use, participants indicated how much time in the past hour they had spent (a) “posting on your feed or sharing something in your story on Instagram” and (b) “sending direct messages/chatting on Instagram.” These two items were summed to create the variable duration of active Instagram use. Sum scores exceeding 60 min (only 0.52% of all assessments) were recoded to 60 min. To measure duration of passive Instagram use, participants indicated how much time in the past hour they had spent “viewing posts/stories of others on Instagram.” To measure the use of WhatsApp, Snapchat, YouTube and game-based chatting, we asked participants how much time they had spent “sending WhatsApp messages” (active use) and “reading WhatsApp messages” (passive use); “sending snaps/messages or sharing something in your story on Snapchat” (active use) and “viewing snaps/stories/messages from others on Snapchat” (passive use); “posting YouTube clips” (active use) and “watching YouTube clips” (passive use); “sending messages via the chat function of a game/games” (active use) and “reading messages via the chat function of a game/games” (passive use). Duration of active and passive overall social media use were created by summing the responses across the three social media platforms for active and passive use, respectively. Sum scores exceeding 60 min (2.13% of all assessments for active overall use; 2.90% for passive overall use) were recoded to 60 min. The duration variables were used to investigate whether the time spent actively or passively using social media was associated with well-being (dose–response associations).

Use/no use of social media

Based on the duration variables, we created six dummy variables, one for active and one for passive overall social media use, one for active and one for passive Instagram use, and one for active and one for passive WhatsApp use (0 =  no active use and 1 =  active use , and 0 =  no passive use and 1 =  passive use , respectively). These dummy variables were used to investigate whether the use of social media, irrespective of the duration of use, was associated with well-being (categorical associations).

Consistent with previous ESM studies 19 , 20 , we measured affective well-being using one item, asking “How happy do you feel right now?” at each assessment. Adolescents indicated their response to the question using a 7-point scale ranging from 1 ( not at all ) to 7 ( completely ), with 4 ( a little ) as the midpoint. Convergent validity of this item was established in a separate pilot ESM study among 30 adolescents conducted by the research team of the fourth author: The affective well-being item was strongly correlated with the presence of positive affect and absence of negative affect (assessed by a 10-item positive and negative affect schedule for children; PANAS-C) at both the between-person (positive affect: r  = 0.88, p < 0.001; negative affect: r  = − 0.62, p < 0.001) and within-person level (positive affect: r  = 0.74, p < 0.001; negative affect: r  = − 0.58, p < 0.001).

Statistical analyses

Before conducting the analyses, several validation checks were performed (see 34 ). First, we aimed to only include participants in the analyses who had completed more than 33% of all ESM assessments (i.e., at least 14 assessments). Next, we screened participants’ responses to the open questions for unserious responses (e.g., gross comments, jokes). And finally, we inspected time series plots for patterns in answering tendencies. Since all participants completed more than 33% of all ESM assessments, and no inappropriate responses or low-quality data patterns were detected, all participants were included in the analyses.

Following our preregistered analysis plan, we tested the proposed associations in a series of multilevel models. Before doing so, we tested the homoscedasticity and linearity assumptions for multilevel analyses 37 . Inspection of standardized residual plots indicated that the data met these assumptions (plots are available on OSF at  https://osf.io/nhks2 ). We specified separate models for overall social media use, use of Instagram, and use of WhatsApp. To investigate to what extent adolescents’ well-being would vary depending on whether they had actively or passively used social media/Instagram/WhatsApp or not during the past hour (categorical associations), we tested models including the dummy variables as predictors (active use versus no active use, and passive use versus no passive use; models 1, 3, and 5). To investigate whether, at moments when adolescents had used social media/Instagram/WhatsApp during the past hour, their well-being would vary depending on the duration of social media/Instagram/WhatsApp use (dose–response associations), we tested models including the duration variables as predictors (duration of active use and duration of passive use; models 2, 4, and 6). In order to avoid negative skew in the duration variables, we only included assessments during which adolescents had used social media in the past hour (overall, Instagram, or WhatsApp, respectively), either actively or passively. All models included well-being as outcome variable. Since multilevel analyses allow to include all available data for each individual, no missing data were imputed and no data points were excluded.

We used a model building approach that involved three steps. In the first step, we estimated an intercept-only model to assess the relative amount of between- and within-person variance in affective well-being. We estimated a three-level model in which repeated momentary assessments (level 1) were nested within adolescents (level 2), who, in turn, were nested within classrooms (level 3). However, because the between-classroom variance in affective well-being was small (i.e., 0.4% of the variance was explained by differences between classes), we proceeded with estimating two-level (instead of three-level) models, with repeated momentary assessments (level 1) nested within adolescents (level 2).

In the second step, we assessed the within-person associations of well-being with (a) overall active and passive social media use (i.e., the total of the three platforms), (b) active and passive use of Instagram, and (c) active and passive use of WhatsApp, by adding fixed effects to the model (Models 1A-6A). To facilitate the interpretation of the associations and control for the effects of time, a covariate was added that controlled for the n th assessment of the study week (instead of the n th assessment of the day, as preregistered). This so-called detrending is helpful to interpret within-person associations as correlated fluctuations beyond other changes in social media use and well-being 38 . In order to obtain within-person estimates, we person-mean centered all predictors 38 . Significance of the fixed effects was determined using the Wald test.

In the third and final step, we assessed heterogeneity in the within-person associations by adding random slopes to the models (Models 1B-6B). Significance of the random slopes was determined by comparing the fit of the fixed effects model with the fit of the random effects model, by performing the Satorra-Bentler scaled chi-square test 39 and by comparing the Bayesian information criterion (BIC 40 ) and Akaike information criterion (AIC 41 ) of the models. When the random effects model had a significantly better fit than the fixed effects model (i.e., pointing at significant heterogeneity), variance components were inspected to investigate whether heterogeneity existed in the association of either active or passive use. Next, when evidence was found for significant heterogeneity, we computed person-specific effect sizes, based on the random effect models, to investigate what percentages of adolescents experienced better well-being, worse well-being, and no changes in well-being. In line with Keijsers and colleagues 42 we only included participants who had completed at least 10 assessments. In addition, for the dose–response associations, we constructed graphical representations of the person-specific slopes, based on the person-specific effect sizes, using the xyplot function from the lattice package in R 43 .

Three improvements were made to our original preregistered plan. First, rather than estimating the models with multilevel modelling in R 43 , we ran the preregistered models in Mplus 44 . Mplus provides standardized estimates for the fixed effects models, which offers insight into the effect sizes. This allowed us to compare the relative strength of the associations of passive versus active use with well-being. Second, instead of using the maximum likelihood estimator, we used the maximum likelihood estimator with robust standard errors (MLR), which are robust to non-normality. Sensitivity tests, uploaded on OSF ( https://osf.io/nhks2 ), indicated that the results were almost identical across the two software packages and estimation approaches. Third, to improve the interpretation of the results and make the scales of the duration measures of social media use and well-being more comparable, we transformed the social media duration scores (0 to 60 min) into scales running from 0 to 6, so that an increase of 1 unit reflects 10 min of social media use. The model estimates were unaffected by this transformation.

Reporting summary

Further information on the research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

The dataset generated and analysed during the current study is available in Figshare 45 . The preregistration of the design, sampling and analysis plan, and the analysis scripts used to analyse the data for this paper are available online on the Open Science Framework website ( https://osf.io/nhks2 ).

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Acknowledgements

This study was funded by the NWO Spinoza Prize and the Gravitation grant (NWO Grant 024.001.003; Consortium on Individual Development) awarded to P.M.V. by the Dutch Research Council (NWO). Additional funding was received from the VIDI grant (NWO VIDI Grant 452.17.011) awarded to L.K. by the Dutch Research Council (NWO). The authors would like to thank Savannah Boele (Tilburg University) for providing her pilot ESM results.

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Ine Beyens, J. Loes Pouwels, Irene I. van Driel & Patti M. Valkenburg

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I.B., J.L.P., I.I.v.D., L.K., and P.M.V. designed the study; I.B., J.L.P., and I.I.v.D. collected the data; I.B., J.L.P., and L.K. analyzed the data; and I.B., J.L.P., I.I.v.D., L.K., and P.M.V. contributed to writing and reviewing the manuscript.

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Beyens, I., Pouwels, J.L., van Driel, I.I. et al. The effect of social media on well-being differs from adolescent to adolescent. Sci Rep 10 , 10763 (2020). https://doi.org/10.1038/s41598-020-67727-7

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Pros & cons: impacts of social media on mental health

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• Marc Eric S. Reyes   ORCID: orcid.org/0000-0002-5280-1315 3  

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The use of social media significantly impacts mental health. It can enhance connection, increase self-esteem, and improve a sense of belonging. But it can also lead to tremendous stress, pressure to compare oneself to others, and increased sadness and isolation. Mindful use is essential to social media consumption.

Social media has become integral to our daily routines: we interact with family members and friends, accept invitations to public events, and join online communities to meet people who share similar preferences using these platforms. Social media has opened a new avenue for social experiences since the early 2000s, extending the possibilities for communication. According to recent research [ 1 ], people spend 2.3 h daily on social media. YouTube, TikTok, Instagram, and Snapchat have become increasingly popular among youth in 2022, and one-third think they spend too much time on these platforms [ 2 ]. The considerable time people spend on social media worldwide has directed researchers’ attention toward the potential benefits and risks. Research shows excessive use is mainly associated with lower psychological well-being [ 3 ]. However, findings also suggest that the quality rather than the quantity of social media use can determine whether the experience will enhance or deteriorate the user’s mental health [ 4 ]. In this collection, we will explore the impact of social media use on mental health by providing comprehensive research perspectives on positive and negative effects.

Social media can provide opportunities to enhance the mental health of users by facilitating social connections and peer support [ 5 ]. Indeed, online communities can provide a space for discussions regarding health conditions, adverse life events, or everyday challenges, which may decrease the sense of stigmatization and increase belongingness and perceived emotional support. Mutual friendships, rewarding social interactions, and humor on social media also reduced stress during the COVID-19 pandemic [ 4 ].

On the other hand, several studies have pointed out the potentially detrimental effects of social media use on mental health. Concerns have been raised that social media may lead to body image dissatisfaction [ 6 ], increase the risk of addiction and cyberbullying involvement [ 5 ], contribute to phubbing behaviors [ 7 ], and negatively affects mood [ 8 ]. Excessive use has increased loneliness, fear of missing out, and decreased subjective well-being and life satisfaction [ 8 ]. Users at risk of social media addiction often report depressive symptoms and lower self-esteem [ 9 ].

Overall, findings regarding the impact of social media on mental health pointed out some essential resources for psychological well-being through rewarding online social interactions. However, there is a need to raise awareness about the possible risks associated with excessive use, which can negatively affect mental health and everyday functioning [ 9 ]. There is neither a negative nor positive consensus regarding the effects of social media on people. However, by teaching people social media literacy, we can maximize their chances of having balanced, safe, and meaningful experiences on these platforms [ 10 ].

We encourage researchers to submit their research articles and contribute to a more differentiated overview of the impact of social media on mental health. BMC Psychology welcomes submissions to its new collection, which promises to present the latest findings in the emerging field of social media research. We seek research papers using qualitative and quantitative methods, focusing on social media users’ positive and negative aspects. We believe this collection will provide a more comprehensive picture of social media’s positive and negative effects on users’ mental health.

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Acknowledgements

Ágnes Zsila was supported by the ÚNKP-22-4 New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.

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Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary

Ágnes Zsila

Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary

Department of Psychology, College of Science, University of Santo Tomas, Manila, 1008, Philippines

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AZ conceived and drafted the Editorial. MESR wrote the abstract and revised the Editorial. All authors read and approved the final manuscript.

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Zsila, Á., Reyes, M.E.S. Pros & cons: impacts of social media on mental health. BMC Psychol 11 , 201 (2023). https://doi.org/10.1186/s40359-023-01243-x

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Problematic social media use and psychological symptoms in adolescents

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This study examined time trends in significant child and adolescent psychological symptoms and explored the association of frequent and problematic social media use with these symptoms.

Time trends in psychological symptoms were assessed using data from five waves of the international survey of Health Behavior in School-aged Children (HBSC), conducted between 2001 and 2018 (N = 1,036,869). The associations of frequent and problematic social media use with significant psychological symptoms were assessed by hierarchical multinomial logistic regression using data from 2001–2002 and the 2017–2018 survey waves. The direction of effect between social media use variables and psychological symptoms was explored using Linear Non-Gaussian Acyclic Models (LiNGAM).

Prevalence of more severe psychological symptoms increased from 6.7% in 2001–2002 to 10.4% in the 2017–2018 survey waves. The increase was especially large among 15-year old and older girls: from 10.9 to 19.1%. The higher prevalence of more severe psychological symptoms in 2017–2018 compared with 2001–2002 was eliminated after adjusting the model for problematic social media use. LiNGAM analysis supported the direction of effect going from social media use and problematic social media use to psychological symptoms.

Conclusions

The findings suggest that frequent and problematic use of social media contribute to the increasing trend of psychological symptoms in adolescents in recent years.

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Introduction

There is growing evidence that the prevalence of child and adolescent psychological symptoms including depressed mood, anxiety, negative thoughts about self, and suicidal thoughts or behaviors has increased since early 2010s [ 1 , 2 , 3 , 4 ]. This trend coincided with dramatic growth in the use of social media [ 5 ]. Several cross-sectional, longitudinal and experimental studies have found evidence linking psychological symptoms with excessive social media use [e.g., 6 , 7 – 11 ]. This literature has also been extensively reviewed in past meta-analyses [ 8 , 12 , 13 , 14 , 15 , 16 ]. The link appears to be especially strong for problematic or addictive social media use [ 12 , 15 ], in which users forgo other important social and academic activities to engage in social media interactions and experience craving and withdrawal when not using these media [ 17 ].

Although a number of investigators have speculated on the potential role of increased social media use in the trends of psychological symptoms among children and adolescents in recent years [ 18 ], few studies have directly examined these associations [ 19 , 20 ].

This report uses data from the Health Behaviour in School-aged Children (HBSC) survey to examine trends in psychological symptoms in adolescents in the years between 2001 and 2018—the period of introduction and rapid growth in the use of social media in adolescents. The study further examines the relationship between frequent and problematic social media use over this period with psychological symptoms.

Several past studies have examined temporal trends and correlates of mental health outcomes using HBSC, with somewhat mixed results [ 21 , 22 , 23 , 24 , 25 , 26 ]. A study based on all participating countries recorded only a small increase in average symptoms over time [ 24 ]. Whereas, research from individual HBSC country sites has recorded a disproportionately higher increase in more severe symptoms [ 27 ] and in older adolescent girls [ 25 , 26 ]. The present study differs from past research by focusing on trends in mild, moderate or severe psychological symptoms separately by age and sex across all participating countries.

Studies have also examined association of social media use with mental health outcomes in HBSC [ 28 , 29 , 30 ]. The present study compares severe psychological symptoms between two periods, one before the introduction of current social media platforms (2001–2002) [ 31 ] and, another, after their widespread use (2017–2018). Lastly, the causal direction between social media variables and psychological symptoms are explored using the novel method of Linear Non-Gaussian Acyclic Models (LiNGAM) using HBSC 2017–2018 data [ 32 ].

The HBSC survey and its methods have been described in more detail elsewhere [ 33 ]. Briefly, HBSC is a cross-national survey sponsored by participating countries and conducted in partnership with the World Health Organization. The survey is conducted every 4 years to monitor the health behaviors of adolescents aged 11–15 across 47 countries in Europe, North America, Middle East and Central Asia (Online Resource 1) [ 33 ].

The survey uses a standardized research protocol across countries and over time, allowing for pooling the data. Stratified random cluster sampling is used with primary sampling unit defined at the level of schools in some countries and classes within schools in other countries. Participants complete anonymous questionnaires in classroom settings. Questionnaires were translated from English into national languages with back-translation and comparison of the back translated versions with original English by independent experts, following a standard protocols [ 33 ]. Institutional ethical approval in each participating country and participating schools as well as informed consent from parents and adolescents were obtained by HBSC investigators.

Data from five rounds of HBSC (2001–2002, 2005–2006, 2009–2010, 2013–2014, 2017–2018) were used in this study for assessing trend, from two rounds (2001–2002 and 2017–2018) for examining association between social media use and psychological symptoms and from the 2017–2018 round for LiNGAM analyses.

Measurements

• Psychological symptoms

Adolescent psychological symptoms were measured using HBSC Symptom Checklist (HBSC-SC), a brief validated measure of psychological and somatic symptoms in adolescents [ 34 ]. Past factor analysis has verified the two-factor structure of HBSC-SC: a psychological symptom factor and a somatic factor, each with 4 items [ 35 ]. In this study the psychological symptoms were used which included questions about the frequency of feeling low, irritability or bad temper, feeling nervous, and difficulties in getting to sleep over the past 6 months. For each question, frequency was reported on a scale from “rarely or never” ( = 0) to “about every day” ( = 4). A summary score was computed based on these responses (score range: 0–16). The scale had adequate internal consistency in this sample (Cronbach alpha = 0.74).

Frequency of social media use

Frequency of social media use was measured using four questions about frequency of online contact with close friends, friends from a larger friend group, online friends, and other people (e.g., parents, siblings, classmates, teachers). Responses ranged from “never or almost never” (0) to “all the time” (4). The items were not expected to be correlated as being online all the time with one group of contacts would reduce the likelihood of being online with other contacts. As such, consistent with past research [ 28 ], no summary measure was computed. Instead, the maximum frequency of use across the four items was computed (range: 0–4).

Problematic social media use

Problematic or addictive social media use was assessed using the validated nine-item Social Media Disorder Scale [ 36 ] which assessed past-year symptoms of preoccupation with social media, withdrawal and tolerance, neglect of other activities, use of social media to cope with distress, inability to cut-down on use of social media, lying about the extent of social media use and trouble in interpersonal relationships because of it. Responses to each item are in yes ( = 1) or no ( = 0) format. The scores are summed to create a total score (range = 0–9). The items were moderately to strongly correlated (tetrachoric correlations range: 0.39–0.64) and the scale had adequate internal consistency (KR20 = 0.77). A score of ≥ 5 has been proposed for defining problematic use or social media disorder [ 36 ].

Analyses additionally adjusted for self-reported sex (male/female) and age.

Analytic approach

Analyses were conducted in 3 stages. First, trends in psychological symptoms across the five waves of HBSC in all participants and across sex and age groups were examined. Because past research based on HBSC suggested that temporal trends in symptoms may be more pronounced for more severe symptoms [ 27 ], psychological symptoms were categorized into 4 mutually exclusive categories of severity based on symptom scores: 0–3, 4–7, 8–11 and 12–16. The models adjusted for the fixed effect of country.

Second, a series of hierarchical multinomial logistic regression analyses were conducted to examine whether adding the variables of frequency of social media use or problematic use to the models could reduce the magnitude of the regression coefficient for the survey wave variable (i.e., 2017–2018 vs. the 2001–2002 period). The 2001–2002 survey predated the introduction of all major social media platforms (e.g., Facebook in 2004, Twitter in 2006, Instagram in 2010, Pinterest in 2010, Snapchat in 2011, TikTok in 2016). Thus, although questions about social media were not asked in this survey wave, participants were assumed to have never used social media and not to meet any of the problematic social media use criteria ( = 0 on both variables).

Variables were added at each level of the hierarchical analysis and change in the regression coefficient associated with survey wave (HBSC 2001–2002 = 0 and HBSC 2017–2018 = 1) after adding the new variables was examined. The outcome of interest in these models was psychological symptoms categorized into four categories (0–3, 4–7, 8–11 and 12–16). Model 1 only adjusted for the fixed effect of country; sex and age were added in model two. The variables of frequency of social media use and problematic use of social media were each added separately in the third and fourth models. Because the fifth model with both frequency of social media use and problematic use of social media produced results very similar to the model with problematic social media use, only the results of the first four models are presented here.

Multiple imputations using chained equations [ 37 ] with five imputed datasets were used to impute missing data in hierarchical regression analyses. Complete case analyses were also conducted as a sensitivity analysis. In further sensitivity analysis, participants for the hierarchical analyses were limited to 29 countries that were surveyed in both 2001–2002 and 2017–2018.

Analyses of trends and the hierarchical regression models adjusted for survey weights and other survey elements. The survey commands of Stata 18 (StataCorp, LLC, College Station, TX, 2023) were used for these analyses. All percentages reported are weighted unless indicated otherwise. A conservative p -value of < 0.01 was used to determine statistical significance.

LiNGAM was used to explore causal direction suggested by the data. LiNGAM is based on the assumption that in the regression model with a correctly specified causal direction, the putative cause and the error term are independent. Whereas, in the incorrectly specified model the two are not independent. To be able to suggest a direction, the distribution of at least one of the variables needs to deviate from normality. If both the putative cause and the putative effect are normally distributed, the causal direction cannot be inferred. LiNGAM is based on the strong assumption of no confounding, which cannot be confirmed given the cross-sectional nature of the data. Additionally, LiNGAM assumes a linear relationship between the two variables. Although, as Shimuzu notes, linear relationships almost never exist in the real world [ 38 ]. But, in general, linear models provide better results in comparison to non-linear models for exploring the direction of causality [ 38 ]. The R Implementation of the DirectLiNGAM algorithms [ 39 ] in the rlingam package by Genta Kikuchi ( https://github.com/gkikuchi/rlingam ) was used. Both social media variables and psychological symptoms were standardized to range from 0 to 1 for the LiNGAM analyses. A more detailed description of the DirectLiNGAM is provided in Online Resource 2.

Causal direction was tested in 1000 bootstrapped replications. Mean and confidence intervals of the LiNGAM regression coefficients from these bootstrapped replicates were computed [ 40 ].

As a sensitivity analysis, three sets of further LiNGAM analyses with simulated data were conducted in which variables of frequency of social media use, problematic social media use and psychological symptoms were included as independent variables (cause) and dependent variables (effect) were simulated for each using ordinary least square. Sensitivity analyses then sought to examine whether LiNGAM could detect the correct causal direction among these causes and the simulated effects.

A total of 1,036,869 adolescents participated in the five HBSC surveys. Breakdown of the sample by country is presented in Online Resource 1. Of these, 985,441 (95.0% unweighted) responded to the psychological symptoms, age and sex questions and comprised the sample for the trend analyses. The average age of these participants was 13.6 (standard deviation [SD] = 1.6) years and 51.2% were female. The mean of psychological symptom score in the sample was 4.9 (SD = 4.0).

The mean psychological symptom score increased modestly from 4.74 in 2001–2002 to 5.32 in 2017–2018—a change of approximately 0.15 standard deviations. However, the change was not even across levels of severity. For example, while the risk for symptoms in the 4–7 score category increased by 9% (adjusted risk ratio [ARR] = 1.09, 99% confidence interval [CI] 1.06–1.13), the risk for symptoms in the 12–16 score category increased by 66% (ARR = 1.66, 99% CI 1.57–1.74; Online Resource 3). Risk ratios from multinomial logistic regression analysis for comparison of each psychological symptom level against the 0–3 symptom level category are presented in Fig. 1 .

Temporal trends in psychological symptoms across the 2001–2002 to 2017–2018 waves of Health Behaviour in School-aged Children survey. Adjusted risk ratios are derived from multinomial logistic regression analyses with outcome categories based on the levels of psychological symptoms (4–7, 8–11 and 12–16, with the 0–3 score category as the reference) (Online Resource 3). Each survey wave was compared with the 2001–2002 survey wave. Models adjusted for the fixed effect of country, for survey weights, stratification, and clustering

The time trend across symptom levels was most pronounced among older adolescent girls (Fig 2 A-F; Online Resource 3). For example, while the risk of symptoms in the 12–16 score category increased only by 14% in boys < 13 (ARR = 1.14, 99% CI 1.02–1.27) it more than doubled in girls > 15 (ARR = 2.31, 99% CI 2.10–2.53) (Online Resource 3).

A-F Temporal trends in psychological symptoms across the 2001–2002 to 2017–2018 waves of Health Behaviour in School-aged Children survey according to sex and age group. Adjusted risk ratios are derived from multinomial logistic regression analyses with outcome categories based on levels of psychological symptoms (4–7, 8–11 and 12–16, with the 0–3 score category as the reference category) (Online Resource 3). Each survey wave was compared with the 2001–2002 survey wave. Models adjusted for the fixed effect of country, for survey weights, stratification, and clustering

The mean score on the social media frequency of use scale in 2017–2018 was 2.8 (SD = 1.2); 36.0% of adolescents reported being on social media “all the time” (score = 4). The mean score on the problematic social media use scale was 1.8 (SD = 2.1), with 12.5% scoring in the social media disorder range (score ≥ 5) [ 36 ]. The sex and age pattern of frequency of social media use and social media disorder paralleled the patterns in psychological symptoms, with older adolescent girls being more likely to report using social media all the time and to meet criteria for social media disorder (Figure 3 A-B, Online Resource 4).

A-B Percent of participants of the 2017–2018 Health Behaviour in School-aged Children survey who reported using social media “all the time” ( A ) or reported problematic social media use at a level to qualify for social media disorder ( ≥ 5 on Social Media Disorder Scale[ 36 ]), according to sex and age

Hierarchical multinomial logistic regression analyses that were based on data from HBSC 2001–2002 and 2017–2018 (n = 403,256) and adjusted for country, produced similar results as the main trend analysis, indicating significantly higher prevalence of the more severe psychological symptoms in the later period (ARR = 1.72, 99% CI 1.64–1.81; Table 1 ). Adjusting for sex and age did not modify the effect of survey wave appreciably (Table 1 ). However, entering the variable of frequency of social media use in the model reduced the coefficient for survey wave (ARR = 1.18, 99% CI 1.10–1.28). After entering the variable of problematic social media use, the regression coefficient for survey wave was reduced to less than one (ARR = 0.79, 99% CI 0.75–0.84, p < 0.001, Table 1 ). Both variables of frequency of social media use and problematic use of social media were significantly associated with psychological symptoms, especially more severe symptoms (ARR = 1.16, 99% CI 1.13–1.18, p < 0.001, and ARR = 1.48, 99% CI 1.47–1.50, p < 0.001, respectively) (Table 1 ).

Results were quite similar in complete case analyses (Online Resource 5) and in analysis limited to countries participating in both 2001–2002 and 2017–2018 surveys (Online Resource 6).

Before conducting the LiNGAM analyses, deviation from normality of the distribution of the social media variables and psychological symptoms and linear relationship were tested. The relationship between frequency of social media use and psychological symptoms was mostly linear (Online Resource 7), although the quadratic term was significant in regression analysis (regression coefficient for quadratic term = 0.120, standard error [SE] = 0.008, p < 0.001). Similarly, the relationship between problematic use of social media and psychological symptoms was linear across most of the range of scores with minor deviation from linearity at extreme values (Online Resource 8) (coefficient for quadratic term = 0.073, SE = 0.005, p < 0.001). The distribution of all three variables was highly skewed, significantly deviating from normality based on the Kolmogorov-Smirnov test ( p < 0.001 for all three variables).

The results of DirectLiNGAM analysis suggested a direction from frequency of social media use to psychological symptoms. This result was confirmed in all 1000 bootstrap replications (mean regression coefficient = 0.090, 95% CI 0.086–0.094). Similarly, the suggested direction of effect was consistently from problematic use of social media to psychological symptoms in all of the 1000 bootstrap replications (mean regression coefficient = 0.333, 95% CI 0.328–0.339).

In sensitivity analyses, the simulated “effect” variables created were correctly detected in the LiNGAM analyses in all simulations for frequency of social media use and for problematic use as well as for psychological symptoms.

There were three main findings in this study. First, the prevalence of more severe psychological symptoms among adolescents appears to have increased in the past two decades. This increase was especially pronounced among adolescent girls over age 15—the group using social media most frequently and being most likely to experience problematic use.

Second, the higher prevalence of severe psychological symptoms in 2017–2018 compared to 2001–2002 period disappeared after taking account of problematic social media use. In the model adjusting for this variable, the risk ratio for survey wave was less than one. This could suggest that in the absence of problematic social media use, adolescents would have had fewer psychological symptoms in 2017–2018 compared to 2001–2002. This explanation is consistent with the results of past research suggesting that social media use is a risk factor for increased prevalence of psychological symptoms [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The alternative explanation of the study’s findings is that the increase in psychological symptoms over time has led children and adolescents to problematic use of social media. Yet another explanation is that a third factor caused both an increase in severe psychological problems in recent years and problematic social media use in the same group of children and adolescents who experienced the increase in symptoms. Lastly, in some cases, the causation may be reciprocal as suggested by some past research [ 41 , 42 , 43 ].

Third, the results of DirectLiNGAM analysis are consistent with the direction of effect being from frequent and problematic use of social media to psychological symptoms and not vice versa. As noted, these analyses are based on the strong assumption of no confounding.

In interpreting the results of this study its limitations should be considered. First, this report focused on the negative effects of frequent or problematic use of social media. Social media use in moderation may have beneficial effects for some adolescents [ 44 ]. Second, data on social media use for 2001–2002 were inferred, not directly measured. However, this inference is based on the fact that all major social media platforms were introduced in subsequent years and very few adolescents could be using social media in the 2001–2002 period. Although they may have been engaging in other forms of screen activity, they were not exposed to the specific effects of social media. Nevertheless, the findings do not confer the same level of certainty as a randomized controlled trials given the possibility of confounding by unmeasured variables. However, randomized trials beyond brief social media holidays are not feasible given the widespread use of these media among adolescents. Third, the LiNGAM analyses are based on the strong assumption of no confounding, an assumption that could not be tested given the cross-sectional nature of the data. Also because of the cross-sectional nature of the data, change in adolescents’ mental health as a result of change in social media use could not be examined.

In conclusion and in the context of these limitations, the results of this study are in line with past longitudinal, quasi-experimental and short-term experimental studies suggesting that excessive and problematic use of social media may have a detrimental effect on the mental health of adolescents. These concerns led to a recent advisory by US Surgeon General which calls attention to the mental health harms associated with excessive and problematic use of social media as an “urgent public health issue” [ 45 ]. Interventions by parents and families to limit social media use, as well as policies to limit use of algorithms that are conducive to problematic use of these media may help reduce their negative mental health impact in the coming years.

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Likes, Shares, and Beyond: Exploring the Impact of Social Media in Essays

Table of contents

• 1 Definition and Explanation of a Social Media Essay
• 2.1 Topics for an Essay on Social Media and Mental Health
• 2.2 Social Dynamics
• 2.3 Social Media Essay Topics about Business
• 2.4 Politics
• 3 Research and Analysis
• 4 Structure Social Media Essay
• 5 Tips for Writing Essays on Social Media
• 6 Examples of Social Media Essays
• 7 Navigating the Social Media Labyrinth: Key Insights

In the world of digital discourse, our article stands as a beacon for those embarking on the intellectual journey of writing about social media. It is a comprehensive guide for anyone venturing into the dynamic world of social media essays. Offering various topics about social media and practical advice on selecting engaging subjects, the piece delves into research methodologies, emphasizing the importance of credible sources and trend analysis. Furthermore, it provides invaluable tips on structuring essays, including crafting compelling thesis statements and hooks balancing factual information with personal insights. Concluding with examples of exemplary essays, this article is an essential tool for students and researchers alike, aiding in navigating the intricate landscape of its impact on society.

Definition and Explanation of a Social Media Essay

Essentially, when one asks “What is a social media essay?” they are referring to an essay that analyzes, critiques, or discusses its various dimensions and effects. These essays can range from the psychological implications of its use to its influence on politics, business strategies, and social dynamics.

A social media essay is an academic or informational piece that explores various aspects of social networking platforms and their impact on individuals and society.

In crafting such an essay, writers blend personal experiences, analytical perspectives, and empirical data to paint a full picture of social media’s role. For instance, a social media essay example could examine how these platforms mold public opinion, revolutionize digital marketing strategies, or raise questions about data privacy ethics. Through a mix of thorough research, critical analysis, and personal reflections, these essays provide a layered understanding of one of today’s most pivotal digital phenomena.

Great Social Media Essay Topics

When it comes to selecting a topic for your essay, consider its current relevance, societal impact, and personal interest. Whether exploring the effects on business, politics, mental health, or social dynamics, these social media essay titles offer a range of fascinating social media topic ideas. Each title encourages an exploration of the intricate relationship between social media and our daily lives. A well-chosen topic should enable you to investigate the impact of social media, debate ethical dilemmas, and offer unique insights. Striking the right balance in scope, these topics should align with the objectives of your essays, ensuring an informative and captivating read.

Topics for an Essay on Social Media and Mental Health

• The Impact of Social Media on Self-Esteem.
• Unpacking Social Media Addiction: Causes, Effects, and Solutions.
• Analyzing Social Media’s Role as a Catalyst for Teen Depression and Anxiety.
• Social Media and Mental Health Awareness: A Force for Good?
• The Psychological Impacts of Cyberbullying in the Social Media Age.
• The Effects of Social Media on Sleep and Mental Health.
• Strategies for Positive Mental Health in the Era of Social Media.
• Real-Life vs. Social Media Interactions: An Essay on Mental Health Aspects.
• The Mental Well-Being Benefits of a Social Media Detox.
• Social Comparison Psychology in the Realm of Social Media.

Social Dynamics

• Social Media and its Impact on Interpersonal Communication Skills: A Cause and Effect Essay on Social Media.
• Cultural Integration through Social Media: A New Frontier.
• Interpersonal Communication in the Social Media Era: Evolving Skills and Challenges.
• Community Building and Social Activism: The Role of Social Media.
• Youth Culture and Behavior: The Influence of Social Media.
• Privacy and Personal Boundaries: Navigating Social Media Challenges.
• Language Evolution in Social Media: A Dynamic Shift.
• Leveraging Social Media for Social Change and Awareness.
• Family Dynamics in the Social Media Landscape.
• Friendship in the Age of Social Media: An Evolving Concept.

Social Media Essay Topics about Business

• Influencer Marketing on Social Media: Impact and Ethics.
• Brand Building and Customer Engagement: The Power of Social Media.
• The Ethics and Impact of Influencer Marketing in Social Media.
• Measuring Business Success Through Social Media Analytics.
• The Changing Face of Advertising in the Social Media World.
• Revolutionizing Customer Service in the Social Media Era.
• Market Research and Consumer Insights: The Social Media Advantage.
• Small Businesses and Startups: The Impact of Social Media.
• Ethical Dimensions of Social Media Advertising.
• Consumer Behavior and Social Media: An Intricate Relationship.
• The Role of Social Media in Government Transparency and Accountability
• Social Media’s Impact on Political Discourse and Public Opinion.
• Combating Fake News on Social Media: Implications for Democracy.
• Political Mobilization and Activism: The Power of Social Media.
• Social Media: A New Arena for Political Debates and Discussions.
• Government Transparency and Accountability in the Social Media Age.
• Voter Behavior and Election Outcomes: The Social Media Effect.
• Political Polarization: A Social Media Perspective.
• Tackling Political Misinformation on Social Media Platforms.
• The Ethics of Political Advertising in the Social Media Landscape.
• Memes as a Marketing Tool: Successes, Failures, and Pros of Social Media.
• Shaping Public Opinion with Memes: A Social Media Phenomenon.
• Political Satire and Social Commentary through Memes.
• The Psychology Behind Memes: Understanding Their Viral Nature.
• The Influence of Memes on Language and Communication.
• Tracing the History and Evolution of Internet Memes.
• Memes in Online Communities: Culture and Subculture Formation.
• Navigating Copyright and Legal Issues in the World of Memes.
• Memes as a Marketing Strategy: Analyzing Successes and Failures.
• Memes and Global Cultural Exchange: A Social Media Perspective.

Research and Analysis

In today’s fast-paced information era, the ability to sift through vast amounts of data and pinpoint reliable information is more crucial than ever. Research and analysis in the digital age hinge on identifying credible sources and understanding the dynamic landscape. Initiating your research with reputable websites is key. Academic journals, government publications, and established news outlets are gold standards for reliable information. Online databases and libraries provide a wealth of peer-reviewed articles and books. For websites, prioritize those with domains like .edu, .gov, or .org, but always critically assess the content for bias and accuracy. Turning to social media, it’s a trove of real-time data and trends but requires a discerning approach. Focus on verified accounts and official pages of recognized entities.

Analyzing current trends and user behavior is crucial for staying relevant. Platforms like Google Trends, Twitter Analytics, and Facebook Insights offer insights into what’s resonating with audiences. These tools help identify trending topics, hashtags, and the type of content that engages users. Remember, it reflects and influences public opinion and behavior. Observing user interactions, comments, and shares can provide a deeper understanding of consumer attitudes and preferences. This analysis is invaluable for tailoring content, developing marketing strategies, and staying ahead in a rapidly evolving digital landscape.

Structure Social Media Essay

In constructing a well-rounded structure for a social media essay, it’s crucial to begin with a strong thesis statement. This sets the foundation for essays about social media and guides the narrative.

Thesis Statements

A thesis statement is the backbone of your essay, outlining the main argument or position you will explore throughout the text. It guides the narrative, providing a clear direction for your essay and helping readers understand the focus of your analysis or argumentation. Here are some thesis statements:

• “Social media has reshaped communication, fostering a connected world through instant information sharing, yet it has come at the cost of privacy and genuine social interaction.”
• “While social media platforms act as potent instruments for societal and political transformation, they present significant challenges to mental health and the authenticity of information.”
• “The role of social media in contemporary business transcends mere marketing; it impacts customer relationships, shapes brand perception, and influences operational strategies.”

Social Media Essay Hooks

Social media essay hooks are pivotal in grabbing the reader’s attention right from the beginning and compelling them to continue reading. A well-crafted hook acts as the engaging entry point to your essay, setting the tone and framing the context for the discussion that will follow.

Here are some effective social media essay hooks:

• “In a world where a day without social media is unimaginable, its pervasive presence is both a testament to its utility and a source of various societal issues.”
• “Each scroll, like, and share on social media platforms carries the weight of influencing public opinion and shaping global conversations.”
• “Social media has become so ingrained in our daily lives that its absence would render the modern world unrecognizable.”

Introduction:

Navigating the digital landscape, an introduction for a social media essay serves as a map, charting the terrain of these platforms’ broad influence across various life aspects. This section should briefly summarize the scope of the essay, outlining both the benefits and the drawbacks, and segue into the thesis statement.

When we move to the body part of the essay, it offers an opportunity for an in-depth exploration and discussion. It can be structured first to examine the positive aspects of social media, including improved communication channels, innovative marketing strategies, and the facilitation of social movements. Following this, the essay should address the negative implications, such as issues surrounding privacy, the impact on mental health, and the proliferation of misinformation. Incorporating real-world examples, statistical evidence, and expert opinions throughout the essay will provide substantial support for the arguments presented.

Conclusion:

It is the summit of the essay’s exploration, offering a moment to look back on the terrain covered. The conclusion should restate the thesis in light of the discussions presented in the body. It should summarize the key points made, reflecting on the multifaceted influence of social media in contemporary society. The essay should end with a thought-provoking statement or question about the future role of social media, tying back to the initial hooks and ensuring a comprehensive and engaging end to the discourse.

Tips for Writing Essays on Social Media

In the ever-evolving realm of digital dialogue, mastering the art of essay writing on social media is akin to navigating a complex web of virtual interactions and influences. Writing an essay on social media requires a blend of analytical insight, factual accuracy, and a nuanced understanding of the digital landscape. Here are some tips to craft a compelling essay:

• Incorporate Statistical Data and Case Studies

Integrate statistical data and relevant case studies to lend credibility to your arguments. For instance, usage statistics, growth trends, and demographic information can provide a solid foundation for your points. Case studies, especially those highlighting its impact on businesses, politics, or societal change, offer concrete examples that illustrate your arguments. Ensure your sources are current and reputable to maintain the essay’s integrity.

• Balance Personal Insights with Factual Information

While personal insights can add a unique perspective to your essay, balancing them with factual information is crucial. Personal observations and experiences can make your essay relatable and engaging, but grounding these insights in factual data ensures credibility and helps avoid bias.

• Respect Privacy

When discussing real-world examples or case studies, especially those involving individuals or specific organizations, be mindful of privacy concerns. Avoid sharing sensitive information, and always respect the confidentiality of your sources.

• Maintain an Objective Tone

It is a polarizing topic, but maintaining an objective tone in your essay is essential. Avoid emotional language and ensure that your arguments are supported by evidence. An objective approach allows readers to form opinions based on the information presented.

• Use Jargon Wisely

While using social media-specific terminology can make your essay relevant and informed, it’s important to use jargon judiciously. Avoid overuse and ensure that terms are clearly defined for readers who might not be familiar with their lingo.

Examples of Social Media Essays

Title: The Dichotomy of Social Media: A Tool for Connection and a Platform for Division

Introduction

In the digital era, social media has emerged as a paradoxical entity. It serves as a bridge connecting distant corners of the world and a battleground for conflicting ideologies. This essay explores this dichotomy, utilizing statistical data, case studies, and real-world examples to understand its multifaceted impact on society.

Section 1 – Connection Through Social Media:

Social media’s primary allure lies in its ability to connect. A report by the Pew Research Center shows that 72% of American adults use some form of social media, where interactions transcend geographical and cultural barriers. This statistic highlights the platform’s popularity and role in fostering global connections. An exemplary case study of this is the #MeToo movement. Originating as a hashtag on Twitter, it grew into a global campaign against sexual harassment, demonstrating its power to mobilize and unify people for a cause.

However, personal insights suggest that while it bridges distances, it can also create a sense of isolation. Users often report feeling disconnected from their immediate surroundings, hinting at the platform’s double-edged nature. Despite enabling connections on a global scale, social media can paradoxically alienate individuals from their local context.

Section 2 – The Platform for Division

Conversely, social media can amplify societal divisions. Its algorithm-driven content can create echo chambers, reinforcing users’ preexisting beliefs. A study by the Knight Foundation found that it tends to polarize users, especially in political contexts, leading to increased division. This is further exacerbated by the spread of misinformation, as seen in the 2016 U.S. Presidential Election case, where it was used to disseminate false information, influencing public opinion and deepening societal divides.

Respecting privacy and maintaining an objective tone, it is crucial to acknowledge that social media is not divisive. Its influence is determined by both its usage and content. Thus, it is the obligation of both platforms to govern content and consumers to access information.

In conclusion, it is a complex tool. It has the unparalleled ability to connect individuals worldwide while possessing the power to divide. Balancing the personal insights with factual information presented, it’s clear that its influence is a reflection of how society chooses to wield it. As digital citizens, it is imperative to use it judiciously, understanding its potential to unite and divide.

Delving into the intricacies of social media’s impact necessitates not just a keen eye for detail but an analytical mindset to dissect its multifaceted layers. Analysis is paramount because it allows us to navigate through the vast sea of information, distinguishing between mere opinion and well-supported argumentation.

This essay utilizes tips for writing a social media essay. Statistical data from the Pew Research Center and the Knight Foundation lend credibility to the arguments. The use of the #MeToo movement as a case study illustrates its positive impact, while the reference to the 2016 U.S. Presidential Election demonstrates its negative aspects. The essay balances personal insights with factual information, respects privacy, maintains an objective tone, and appropriately uses jargon. The structure is clear and logical, with distinct sections for each aspect of its impact, making it an informative and well-rounded analysis of its role in modern society.

Navigating the Social Media Labyrinth: Key Insights

In the digital age, the impact of social media on various aspects of human life has become a critical area of study. This article has provided a comprehensive guide for crafting insightful and impactful essays on this subject, blending personal experiences with analytical rigor. Through a detailed examination of topics ranging from mental health and social dynamics to business and politics, it has underscored the dual nature of social media as both a unifying and divisive force. The inclusion of statistical data and case studies has enriched the discussion, offering a grounded perspective on the nuanced effects of these platforms.

The tips and structures outlined serve as a valuable framework for writers to navigate the complex interplay between social media and societal shifts. As we conclude, it’s clear that understanding social media’s role requires a delicate balance of critical analysis and open-mindedness. Reflecting on its influence, this article guides the creation of thoughtful essays and encourages readers to ponder the future of digital interactions and their implications for the fabric of society.

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This paper is in the following e-collection/theme issue:

Published on 10.4.2024 in Vol 26 (2024)

Effectiveness of a Web-Based Individual Coping and Alcohol Intervention Program for Children of Parents With Alcohol Use Problems: Randomized Controlled Trial

Authors of this article:

Original Paper

• Håkan Wall 1 , PhD   ; 
• Helena Hansson 2 , PhD   ; 
• Ulla Zetterlind 3 , PhD   ; 
• Pia Kvillemo 1 , PhD   ; 
• Tobias H Elgán 1 , PhD  

1 Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden

2 School of Social Work, Faculty of Social Sciences, Lund University, Lund, Sweden

3 Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Lund, Sweden

Corresponding Author:

Tobias H Elgán, PhD

Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research

Department of Clinical Neuroscience

Karolinska Institutet, & Stockholm Health Care Services

Norra Stationsgatan 69

Stockholm, 11364

Phone: 46 700011003

Email: [email protected]

Background: Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents.

Objective: This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems.

Methods: Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL).

Results: For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d =–0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention.

Conclusions: The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence.

Trial Registration: ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712

International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-12-35

Introduction

Children who grow up with parents who have substance use problems or disorders face extraordinary challenges. Approximately 20% of all children have parents with alcohol problems [ 1 - 5 ], while approximately 5% have parents with alcohol use disorders [ 4 , 6 , 7 ]. Children growing up with parental substance abuse are at an increased risk of several negative outcomes, such as psychiatric morbidity [ 8 - 12 ]; poor intellectual, cognitive, and academic achievement [ 13 - 15 ]; domestic physical abuse [ 16 ]; and early drinking onset and the development of substance use problems [ 9 , 17 , 18 ]. Thus, children exposed to parental substance abuse comprise a target group for selective interventions and prevention strategies [ 19 - 22 ].

In Sweden, municipalities account for most of the support offered to these children. An annual survey by the junior association of the Swedish branch of Movendi International (ie, an international temperance movement) reported that 97% of all municipalities provided support resources [ 23 ]. However, estimates from the same survey showed that approximately 2% of the children in the target group received support. Hence, an overwhelming majority never receives support, mainly because of difficulties in identifying and attracting them to intervention programs [ 22 , 24 ].

The internet has become an appealing way to reach and support a large number of people [ 25 , 26 ]. Web-based interventions seem particularly attractive to adolescents, as they generally use digital technology and social media. Furthermore, research has shown that adolescents regard the internet as inviting because it is a readily accessible, anonymous way of seeking help [ 27 ]. Web-based interventions can reduce the stigma associated with face-to-face consultations in health care settings [ 28 ], and young people appreciate the flexibility of completing web-based sessions to fit their own schedules [ 29 ]. The positive effects of web-based interventions have been detected across a broad range of conditions. A recent review by Hedman-Lagerlöf et al [ 30 ] concluded that therapist-supported internet-based cognitive behavioral therapy for adults yielded similar effects as face-to-face therapy. To date, most web-based interventions have been designed for adults. Although the number of web-based interventions targeting children or adolescents is increasing [ 25 , 31 - 33 ], the number of digital interventions aimed at children of substance-abusing parents is still scarce [ 22 , 34 - 38 ]. Those described in the literature, however, all have in common that they are quite extensive, with a duration over several weeks, and a brief digital intervention could complement these more extended interventions. For instance, our research group initiated a study on a web-based group chat for 15- to 25-year-old individuals who have parents with mental illness or substance use problems [ 35 ]. The duration of the program is 8 weeks, and it is a translated version of a program from the Netherlands [ 34 ], which has been shown to have inconclusive treatment effects [ 39 ]. In Sweden, 2 other programs with inconclusive treatment effects have been tested that target significant others and their children [ 37 , 38 ]. Finally, a digital intervention developed in Australia for 18- to 25-year-old individuals with parents with mental illness or substance use disorder [ 36 ] was tested in a pilot study demonstrating positive findings [ 40 ].

To meet the need for a brief, web-based intervention that targets adolescents having parents with alcohol problems and build on the evidence base of digital interventions targeting this vulnerable group, we developed a novel internet-delivered therapist-assisted self-management intervention called “Alcohol and Coping.” Our program originated from a manual-based face-to-face intervention called the “Individual Coping and Alcohol Intervention Program” (ICAIP) [ 41 , 42 ]. Previous studies on both the ICAIP, which aimed at college students having parents with alcohol problems, and a coping skills intervention program, which aimed at spouses of partners with alcohol dependency [ 43 ], have demonstrated positive effects regarding decreased alcohol consumption and improved mental health and coping behaviors [ 41 - 44 ]. Furthermore, the results from these studies underscore the importance of improving coping skills [ 42 , 44 ]. Among college students, those who received a combination of coping skills and an alcohol intervention program had better long-term outcomes [ 42 ].

The aim of this study was to test the effectiveness of Alcohol and Coping among a sample of adolescents aged 15-19 years with at least 1 parent with alcohol use problems. We hypothesized that the intervention group would be superior to the control group in improving coping skills. Secondary research questions concerned the participants’ improvement in (1) depression, (2) alcohol consumption, and (3) quality of life.

This study was a parallel-group randomized controlled trial in which participants were randomized to either the intervention or waitlist control group in a 1:1 allocation ratio. The trial design is illustrated in Figure 1 .

Recruitment and Screening

The participants were recruited from August 2012 to December 2013 through advertisements on social media (Facebook). The advertisements targeted individuals aged 15-19 years with Facebook accounts. Participants were recruited on the internet through advertisements on websites containing health-related information about adolescents. The advertisements included the text, “Do your parents drink too much? Participate in a study.” The advertisement contained an invitation to perform a web-based, self-assessed screening procedure. In addition to questions about age and sex, participants were screened for having parents with alcohol problems using the short version of the Children of Alcoholics Screening Test-6 (CAST-6), developed from a 30-item original version [ 45 ]. The CAST-6 is a 6-item true-false measure designed to assess whether participants perceive their parents’ alcohol consumption to be problematic. The CAST-6 has demonstrated high internal consistency ( r =0.92-0.94), test-retest reliability ( r =0.94), and high validity as compared to the 30-item version ( r =0.93) using the recommended threshold score of 3 or higher [ 45 , 46 ]. We previously translated the CAST-6 into Swedish and validated the translated version among 1450 adolescents, showing good internal consistency (α=.88), excellent test-retest reliability (intraclass correlation coefficient=0.93), and loading into 1 latent factor [ 47 ]. Additional inclusion criteria included having access to a computer and the internet and being sufficiently fluent in Swedish. Participants were excluded from the study and were referred to appropriate care if there were indications of either suicidal or self-inflicted harmful behaviors. Individuals eligible for inclusion received further information about the study and were asked to provide consent to participate by providing an email address.

Data Collection and Measures

All assessments were administered through email invitations containing a hyperlink to the web-based self-reported assessments. Up to 3 reminders were sent through email at 5, 10, and 15 days after the first invitation. A baseline assessment (t 0 ) was collected before randomization, and follow-up assessments were conducted at 2 and 6 months (t 1 and t 2 , respectively) after the initial assessment.

Participants were asked for age, sex, whether they lived with a parent (mother and father, mother or father, mother or father and stepparent, or alternate between mother and father), where their parents were born (Sweden or a Nordic country excluding Sweden or outside of the Nordic countries), parental status (employed, student, on parental leave, or unemployed), and any previous or present participation in support activities for children having parents with alcohol use problems. The primary outcome was coping, measured using the Coping With Parents Abuse Questionnaire (CPAQ) based on the Coping Behavior Scale developed by Orford et al [ 48 ]. Secondary outcomes were the Center for Epidemiological Studies Depression Scale (CES-DC) [ 49 ], the 3-question Alcohol Use Disorders Identification Test (AUDIT-C) [ 50 ], and the Ladder of Life (LoL), which measures the overall quality of life by asking about the participants’ past, present, and future ratings of their overall life satisfaction [ 50 ]. CPAQ has been shown to be reliable [ 41 , 42 ]. For this study, this scale was factor-analyzed to reduce the number of questions from 37 to 20. The resulting scale measures 6 coping typologies (discord, emotion, control, relationship, avoidance, and taking specific action) using a 4-point Likert scale, with a threshold score above 50 points (out of 80) indicating dysfunctional coping behavior. The CES-DC measures depressive symptoms during the past week using a 4-point Likert scale, where a higher total score indicates more depressive symptoms [ 49 ]. A cutoff score of ≥16 indicates symptoms of moderate depression, while a score of ≥30 indicates symptoms of severe depression [ 51 , 52 ]. The scale measures 4 dimensions of depression: depressed mood, tiredness, inability to concentrate, and feelings of being outside and lonely, and has positively stated items [ 52 ]. Additionally, this scale is a general measure of childhood psychopathology [ 53 ] and has been demonstrated to be reliable and valid among Swedish adolescents [ 52 ]. Alcohol consumption was measured using a modified AUDIT-C, which assesses the frequency of drinking, quantity consumed on a typical occasion, and frequency of heavy episodic drinking (ie, binge drinking) [ 50 ] using a 30-day perspective (as opposed to the original 12-month perspective). These questions have previously been translated into Swedish [ 54 ], and a score of ≥4 and ≥5 points for women and men, respectively, was used as a cutoff for risky drinking. This scale has been demonstrated to be reliable and valid for Swedish adolescents [ 55 ]. Furthermore, 2 questions were added concerning whether the participants had ever consumed alcohol to the point of intoxication and their age at the onset of drinking and intoxication. The original version of the LoL was designed for adults and asked the respondents to reflect on their, present, and future life status from a 5-year perspective on a 10-point Visual Analogue Scale representing life status from “worst” to “best” possible life imaginable [ 56 ]. A modified version for children, using a time frame of 1 year, has been used previously in Sweden [ 57 ] and was used in this study.

Randomization

After completing the baseline assessment, each participant was allocated to either the intervention or the control group. An external researcher generated an unrestricted random allocation sequence using random allocation software [ 58 ]. Neither the participants nor the researchers involved in the study were blinded to group allocation.

Based on the order in which participants were included in the study, they were allocated to 1 of the 2 study groups and informed of their allocation by email. Additionally, those who were randomized to the intervention group received a hyperlink to the Alcohol and Coping program, whereas the control group participants received information that they would gain access to Alcohol and Coping after the last follow-up assessment (ie, the waitlist control group). All participants were informed about other information and support available through web pages, notably drugsmart [ 59 ], which contains general information and facts about alcohol and drugs, in addition to more specific information about having substance-abusing parents. Telephone numbers and contact information for other organizations and primary health care facilities were also provided.

The Intervention

As noted previously, Alcohol and Coping is derived from the aforementioned manual-based face-to-face ICAIP intervention program [ 41 , 42 ]. The ICAIP consists of a combination of an alcohol intervention program, which is based on the short version of the Brief Alcohol Screening and Intervention for College Students program [ 60 ], and a coping intervention program developed for the purpose of the ICAIP [ 41 , 42 ]. Like the original ICAIP intervention, Alcohol and Coping builds on psychoeducational principles and includes components such as film-based lectures, various exercises, and both automated and therapist-assisted feedback. Briefly, once the participants logged into the Alcohol and Coping platform, they were introduced to the program, which followed the pattern of a board game ( Figure 2 ). Following the introduction, participants took part in 3 film-based lectures (between 8 and 15 minutes each, Figure 3 ) concerning alcohol problems within the family. The respective lectures included information about (1) dependency in general as well as the genetic and environmental risks for developing dependency, (2) family patterns and how the family adapts to the one having alcohol problems, and (3) attitudes toward alcohol and how they influence drinking and the physiological effects of alcohol. After completing the lectures, the participants were asked to answer 2 questions about their own alcohol consumption (ie, how often they drink and how often they drink to intoxication), followed by an automatic feedback message that depended on their answers. It was then suggested that the participants log out of the intervention for a 1- to 2-day break. The reason for this break was to give the participants a chance to digest all information and impressions. When they logged back into the intervention, they were asked to answer 20 questions about their coping strategies, which were also followed by automatic feedback. This feedback comprised a library covering all the prewritten feedback messages, each of which was tailored to the participants’ specific answers. The participants then participated in a 5-minute–long film-based lecture on emotion and problem-focused coping in relation to family alcohol problems ( Figure 3 ). This was followed by 4 exercises where the participants read through vignette-like stories from 4 fictional persons describing their everyday lives related to coping and alcohol problems in the family. The stories are presented by film-based introductions that are each 1-2 minutes long. Participants were then requested to respond to each story by describing how the fictive person could have coped with their situation. As a final exercise, participants were asked to reflect on their own family situation and how they cope with situations. The participants then had to take a break for a few days.

During the break, a therapist composed individual feedback that covered reflections and confirmation of the participant’s exercises and answers to questions and included suggestions on well-suited coping strategies. Additionally, the therapist encouraged the participants to talk to others in their surroundings, such as friends, teachers, or coaches, and seek further support elsewhere, such as from municipal social services, youth health care centers, or other organizations. Finally, the therapist reflected on the participants’ alcohol consumption patterns and reminded them of increased genetic and environmental risks. Those who revealed patterns of risky alcohol use were encouraged to look at 2 additional film-based lectures with more information about alcohol and intoxication (4 minutes) and alcohol use and dependency (5 minutes). Participants received this feedback once they logged back into the program, but they also had the opportunity to receive feedback through email. The total estimated effective time for completing the program was about 1 hour, but as described above, there was 1 required break when the individualized feedback was written. To keep track of the dose each participant received, each of the 15 components in the program ( Figure 1 ) is equal to completing 6.7% (1/15) of the program in total.

Sample Size

The trial was designed to detect a medium or large effect size corresponding to a standardized mean difference (Cohen d >0.5) [ 61 ]. An a priori calculation of the estimated sample size, using the software G*Power (G*Power Team) [ 62 ], revealed that a total of 128 participants (64 in each group) were required to enroll in the trial (power=0.80; α=.05; 2-tailed). However, to account for an estimated attrition rate of approximately 30% [ 34 ], it was necessary to enroll a minimum of 128/(1 – 0.3) = 183 participants in the trial. After a total of 204 individuals had been recruited and randomized into 2 study arms, recruitment was ended.

Statistical Analysis

Data were analyzed according to the intention-to-treat (ITT) principle, and all randomized participants were included, irrespective of whether they participated in the trial. The 4 research variables were depression (CES-DC), coping (CPAQ), alcohol use (AUDIT-C), and life status (LoL).

Data analysis consisted of comparing outcome measurements at t 1 and t 2 . The baseline measurement t 0 value was added as an adjustment variable in all models. The resulting data from CPAQ, CES-DC, and LoL were normally distributed and analyzed using linear mixed models. The resulting AUDIT-C scores were nonnormally distributed, with an excess of 0 values, and were analyzed using a 2-part model for longitudinal data. This model is sufficiently flexible to account for numerous 0 reports. This was achieved by combining a logistic generalized linear mixed model (GLMM) for the 0 parts and a skewed continuous GLMM for the non-0 alcohol consumption parts. R-package brms (Bayesian regression models using Stan; R Foundation for Statistical Computing) [ 63 ], a higher-level interface for the probabilistic programming language Stan [ 64 ], and a custom brms family for a marginalized 2-part lognormal distribution were used to fit the model [ 65 ]. The logistic part of the model represents the subject-specific effects on the odds of reporting no drinking. The continuous part was modeled using a gamma GLMM with a log link. The exponentiated treatment effect represents the subject-specific ratio of the total AUDIT-C scores between the treatment and waitlist control groups for those who reported drinking during the specific follow-up period.

Handling of Missing Data

GLMMs include all available data and provide unbiased ITT estimates under the assumption that data are missing at random, meaning that the missing data can be explained by existing data. However, it is impossible to determine whether the data are missing at random or whether the missing data are due to unobserved factors [ 66 ]. Therefore, we also assumed that data were not missing at random, and subsequent sensitivity analyses were performed [ 66 ]. We used the pattern mixture method, which assumes not missing at random, to compare those who completed the follow-up at 6 months (t 2 ) with those who did not (but completed the 2-month follow-up). The overall effect of this model is a combination of the effects of each subgroup. We also tested the robustness of the results by performing ANCOVAs at the 2-month follow-up, both using complete cases and with missing values imputed using multilevel multiple imputation.

The effect of the program was estimated using Cohen d , where a value of approximately 0.2 indicates a small effect size and values of approximately 0.5 and 0.8 indicate medium and large effect sizes, respectively [ 61 ].

Ethical Considerations

All procedures were performed in accordance with the ethical standards of the institutional or national research committees, the 1964 Helsinki Declaration and its later amendments, and comparable ethical standards. Informed consent was obtained from all the participants included in the study. This study was approved by the Swedish Ethical Review Authority (formerly the Regional Ethical Review Board in Stockholm, No. 2011/1648-31/5).

To enhance the response rates, participants received a cinema gift certificate corresponding to approximately EUR 11 (US $12) as compensation for completing each assessment. If a participant completed all assessments, an additional gift certificate was provided. The participants could subsequently receive 4 cinema gift certificates totaling EUR 44 (US $48).

The trial profile is depicted in Figure 1 and reveals that 2722 individuals who were aged between 15 and 19 years performed the screening procedure. A total of 1448 individuals did not fulfill the inclusion criteria and were excluded, leaving 1274 eligible participants. Another 1070 individuals were excluded because they did not provide informed consent or complete the baseline assessment, leaving 204 participants who were allocated to 1 of the 2 study groups. A total of 140 (69%) and 131 (64%) participants completed t 1 and t 2 assessments, respectively. Of the participants in the intervention group (n=101), 63% (n=64) registered an account on the Alcohol and Coping website, 35% (n=35) completed the alcohol intervention section, and 24% (n=24) completed both the alcohol and coping intervention sections.

Sample Characteristics

The mean age of the sample was 17.0 (SD 1.23) years, and the vast majority were female, with both parents born in Sweden and currently working ( Table 1 ). Approximately one-third of the participants reported living with both parents. The mean score on the CAST-6 was 5.33 (SD 0.87) out of a total of 6, and the majority of the sample (147/204, 72.1%) perceived their father to have alcohol problems. Approximately 12% (25/204) had never consumed alcohol, whereas approximately 70% (144/204) had consumed alcohol at a level of intoxication. The mean age at onset was 13.7 (SD 2.07) years and the age at first intoxication was 14.8 (SD 1.56) years. The proportion of participants with symptoms of at least moderate depression was 77.5% (158/204), of whom 55.1% (87/158) had symptoms of severe depression and 42.6% (87/204) had symptoms of dysfunctional coping behaviors. The percentage of participants who consumed alcohol at a risky level was 39.7% (81/204). Table 1 provides complete information regarding the study sample.

a Significance levels calculated by Pearson chi-square statistics for categorical variables and 2-tailed t tests for continuous variables.

Treatment Effects

For the primary outcome, coping behavior (CPAQ), we found a small but inconclusive treatment effect in favor of treatment at both 2 (t 1 ) and 6 (t 2 ) months (Cohen d =–0.05 at both t 1 and t 2 ). For the secondary outcome, alcohol use (AUDIT-C), we found a treatment effect in that the intervention group scored 38% less than the control group on the continuous part (ie, drinking when it occurred) at t 1 and 46% less at t 2 . Regarding depression (CES-DC) and life status (LoL), all between-group comparisons of treatment effects were inconclusive at both follow-up time points ( Table 2 ).

a CPAQ: Coping With Parents Abuse Questionnaire.

b CES-DC: Center for Epidemiological Studies Depression Scale.

c LoL: Ladder of Life.

d AUDIT-C: Alcohol Use Disorders Identification Test.

e N/A: not applicable.

Missing Data

In contrast to the ITT analyses, the sensitivity analyses showed that the treatment group, averaged over the levels of dropout, scored higher (ie, a negative effect) on the main outcome, coping behavior (CPAQ), at t 1 (2.44; P =.20). However, the results remain inconclusive.

Dose-Response Effects

We did not find any evidence for greater involvement in the program being linked to improved outcomes with regard to coping behavior.

We did not find any support for the primary hypothesis: the intervention was not superior to the control condition with regard to coping behavior. Inconclusive results with small effect sizes were observed at both follow-up time points. However, for the secondary outcomes, we found that those in the intervention group who drank alcohol drank approximately 40%-50% less than those in the control group at both follow-ups. These results corroborate previous findings on the precursor face-to-face ICAIP intervention program, demonstrating that participants who received a combined alcohol and coping intervention reported superior outcomes with regard to alcohol-related outcomes compared to participants in the other 2 study arms, who received only a coping or alcohol intervention [ 41 , 42 ]. In contrast to this study, Hansson et al [ 42 ] found that all groups improved their coping skills, although the between-group comparisons were inconclusive and the improvements were maintained over time. These differences could be explained by the different settings in which the precursor program was provided (ie, face-to-face to young adults in a university setting), whereas this study targeted young people (15-19 years of age) through a web-based digital intervention. Additionally, the poor adherence in this study may explain the absence of primary results favoring the intervention group. In a recent study, parents without alcohol problems were recruited to participate in a randomized trial evaluating the web-based SPARE (Supportive Parenting and Reinforcement) program to improve children’s mental health and reduce coparents’ alcohol use. In line with our study, the authors did not find the primary outcome of the SPARE program to be superior to that of the active control group (which received written psychoeducation); however, both groups reported decreased coparental alcohol consumption [ 38 ].

Considering that approximately 3600 children in 2022 participated in various forms of support provided by Swedish municipalities [ 23 ], our recruitment activities reached a large number of eligible individuals, pointing to the potential of finding these children on these platforms. There were unexpectedly high levels of depression among the participants in this study. Although the intervention did not target depressive symptoms per se , there was a trend for the intervention group to have decreased depression levels compared to the control group. A large proportion of participants had symptoms of severe depression, which may have aggravated their capacity for improvement at follow-up [ 28 , 67 ]. Targeting dysfunctional coping patterns could affect an individual’s perceived mental health, and studies have shown that healthy coping strategies positively affect depression and anxiety in a positive way [ 68 ]. Using dysfunctional coping strategies, such as negative self-talk and alcohol consumption, can lead to depressive symptoms [ 69 ]. Targeting these symptoms in the context of healthy and unhealthy coping strategies may be a viable route to fostering appropriate coping strategies that work in the long run. Given that the young people who were reached by the intervention in this study displayed high levels of depression, future interventions for this group should include programs targeting depressive symptoms.

Almost 37% (37/101) of the intervention group did not log into the intervention at all, and only 24% (24/101) of the intervention group participants completed all parts of the program. The fact that a high proportion of the participants had symptoms of severe depression could explain the low adherence. Another reason could be that the initial film-based lectures were too long to maintain the participants’ attention, as the lectures ranged from 8-15 minutes. Yet a final reason could be that we had a 1- to 2-day break built into the intervention, and for unknown reasons, some participants did not log back into the intervention. However, we did not find a dose-response relationship indicating favorable outcomes for those who completed more of the program content. High levels of attrition are not uncommon in self-directed programs such as the one in this study; for example, in a study on a smoking cessation intervention, 37% of the participants never logged into the platform [ 70 ], and in a self-directed intervention for problem gamblers, a majority dropped out after 1 week and none completed the entire program [ 71 ]. Increased intervention adherence is a priority when developing new digital interventions, particularly for young people. One method is to use more persuasive technologies, such as primary tasks, dialogue, and social support [ 72 ]. Considering children whose parents have mental disorders, Grové and Reupert [ 73 ] suggested that digital interventions should include components such as providing information about parental mental illness, access to health care, genetic risk, and suggestions for how children might initiate conversations with parents who have the illness. These suggestions should be considered in future studies on interventions for youths whose parents have substance use problems. Representatives of the target group and other relevant stakeholders should also be involved in coproducing new interventions to increase the probability of developing more engaging programs [ 74 ]. Moreover, one cannot expect study participants to return to the program more than once, and for the sake of adherence, briefer interventions should not encourage participants to log-out for a break. To keep adherence at an acceptable level, similar future interventions for this target group should also consider having symptoms of severe depression as an exclusion criterion [ 28 , 67 ]. Further, to improve adherence, strategies of coproduction could be used where all stakeholders, including the target group, are involved in intervention development [ 75 ]. Other important factors identified to improve adherence to digital interventions are to make the content relatable, useful, and even more interactive [ 76 ]. Those participants who have symptoms of severe depression should be referred to other appropriate health care. Finally, it is probably beneficial to develop shorter psychoeducative film-based lectures than ours, lasting up to 15 minutes. Future self-directed digital interventions targeting this population should, therefore, focus on a very brief and focused intervention, which, based on theory, has the potential to foster healthy coping behaviors that can lead to an increased quality of life and improved mental health for this group of young people.

Another concern for future projects would be to use a data-driven approach during the program development phase, where A/B testing can be used to test different setups of the program to highlight which setup works best. Another aspect that must be considered is the fast-changing world of technology, where young people are exposed to an infinite number of different apps that grab their attention, which also calls for interventions to be short and to the point. Furthermore, if the program is to spread and become generally available, one must consider that keeping the program alive for a longer period will require funding and staffing for both product management and technical support.

Strengths and Limitations

This study had several strengths. First, Alcohol and Coping is a web-based intervention program, and it appears as if the internet is a particularly promising way to provide support to adolescents growing up with parents with alcohol problems because it offers an anonymous means of communicating and makes intervention programs readily accessible [ 25 ]. Our recruitment strategies reached a considerable number of interested and eligible individuals, demonstrating the potential for recruiting through social media and other web platforms. Additionally, this program is one of the first brief web-based interventions aimed at adolescents with parents with alcohol-related problems. We used the CAST-6, which has been validated among Swedish adolescents [ 47 ], to screen eligible participants. Another strength is that the intervention program involved personalized, tailored feedback in the form of prewritten automatic messages and therapist-written personalized feedback, both of which have proven to be important components of web-based interventions aimed at adolescents [ 77 , 78 ]. Finally, this study evaluated the effectiveness of the Alcohol and Coping program using a randomized controlled trial design, which is considered the strongest experimental design with regard to allocation bias.

This study had some limitations. First, the design with a passive waitlist control group and an active intervention group, both unblinded to study allocation, may have resulted in biased estimates of treatment effects. Intervention adherence was low, and most of the study participants had symptoms of depression, where 55% (87/158) had symptoms of severe depression. This may have contributed to the small and overall inconclusive effects on the primary outcomes of this study. Many digital interventions have problems with low adherence, and in a review by Välimäki et al [ 79 ], some studies reported adherence rates as low as 10%. A vast proportion of the study participants were women, making the findings difficult to generalize to men. However, another limitation concerns selection bias and external validity. We recruited study participants through social media and other relevant websites containing health-related information, including information about parents with alcohol-related problems. It is, therefore, possible that the study population can be classified as “information-seeking” adolescents, who may have different personality traits relative to other adolescents in the same home situation. Additionally, as an inclusion criterion was having ready access to computers and the internet, it is possible that participants belonging to a lower socioeconomic class were underrepresented in the study. It should also be noted that the data presented here were collected approximately 10 years ago. However, we believe our findings make an important contribution to the field since, like our intervention, many recent web-based interventions use strategies of psychoeducation, films, exercises, questions, and feedback. Further, the number of web-based interventions for this target group remains scarce in the literature, which underscores the need for future research. Finally, the study was powered to detect a medium effect size. However, given the small effect sizes detected in this study, it is plausible that too few participants were recruited to detect differences between the groups.

Implications for Practice

Although growing up with parents who have alcohol problems per se is not sufficient for developing psychosocial disorders, many children need support to manage their situation. Therefore, it is difficult to recruit children to support these groups. In Sweden, not even 2% of all children growing up with parental alcohol problems attend face-to-face support groups provided by municipalities.

Offering support through web-based intervention programs seems particularly attractive to adolescents whose parents have alcohol-related problems. To date, evidence for such programs is scarce, and there is an urgent need to develop and evaluate digital interventions targeting this group of adolescents. This study makes important contributions to this novel field of research. The results provide insight into effective strategies for delivering intervention programs to children of parents with substance abuse issues, highlighting the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents. Our findings underscore the need to develop more engaging interventions in coproduction with the target group.

Conclusions

We found that a digital therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems contributed to a reduction in the adolescents’ own alcohol consumption. This result highlights the potential for digital interventions to reach a large, vulnerable, and hard-to-reach group of adolescents with support efforts. Findings were inconclusive for all other outcomes, which may be attributable to low adherence. This points to the need for future research on developing more engaging digital interventions to increase adherence among adolescents.

Acknowledgments

This work was undertaken on behalf of the Swedish Council for Information on Alcohol and Other Drugs (CAN) and was supported by grants from the Swedish National Institute of Public Health and the Swedish Council for Working Life and Social Research.

Conflicts of Interest

HH and UZ developed the study interventions. However, the parties did not derive direct financial income from these interventions. HW, PK, and THE declare no conflicts of interest.

CONSORT-eHEALTH checklist (V 1.6.1).

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Abbreviations

Edited by YH Lin; submitted 24.08.23; peer-reviewed by X Zhang, C Asuzu, D Liu; comments to author 28.01.24; revised version received 08.02.24; accepted 27.02.24; published 10.04.24.

©Håkan Wall, Helena Hansson, Ulla Zetterlind, Pia Kvillemo, Tobias H Elgán. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.04.2024.

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