‘I want my child back!’ How social media make kids’ anxiety and depression worse
By Michael Rich
This distressed parent expressed what too many children are experiencing. And national research has shown significant increases in adolescent anxiety and depression that have paralleled their social media use, gaming, and smartphone ownership.
Since the pandemic lockdown, demand for care at the Clinic for Interactive Media and Internet Disorders at Boston Children’s Hospital has skyrocketed. Problematic Interactive Media Use — online behaviors from social media to gaming that impaired sleep, academic performance, relationships, and mental health — have affected even more children and adolescents since the pandemic. They sought distraction and comfort online but often felt worse. Seemingly lost in another world, they experience anxiety, moodiness, anger, and depression and have parents, teachers, and clinicians worried and asking the question: Do social media and gaming cause mental health problems?
Facebook encourages users to connect with old friends and make new ones. Users compete to “friend” as many people as possible. But as a society, we lost something when “friend” became a verb. One patient came to CIMAID distraught and confused. Her high school best friend — who had friended 967, shared exciting travels, hot boyfriends, and a never-ending stream of new looks — had just attempted suicide alone in her dorm room. Her life looked perfect. Why did she do that?
he stares at that phone all day … and all night, for
all I know! She’s withdrawn from our family,
failing in school, and flies into a rage when I ask her to put the phone down. I’ve lost her to social media. I want my child back!”
— A parent
‘S
In their efforts to friend others, youth often post only the best online. They use social media to market themselves to the world. But are they connecting? Do they develop deep and sustaining relationships with the apparently happiest, most successful people? Or do their real friendships happen with people whom they feel care about their real selves, with all their limitations?
Adolescents working their way through an exciting, confusing, exceedingly self-conscious — but not fully self-aware — stage of their lives are particularly caught up in social media. They seek not only connection but affirmation that they are OK as they develop independence, sort out their individuality distinct from their families, and figure out how to connect with peers.
Text-based social media serves many as a place to explore their identities, allegiances, and incipient relationships in a less vulnerable-feeling space. Protected from face-to-face awkwardness, youth could try out emerging identities and tentative relationships. Social media became the modern-day mall, the place where youth gathered. During the pandemic lockdown, adolescents, who are developmentally driven to connect with their peers, could do so only online. Data have shown that adolescents who were not online at all did less well psychologically than those who were online for a few hours daily.
Some youths have harnessed social media’s connectivity to find and engage with communities of peers online, lifesaving for many who were bullied or marginalized due to health issues, sexuality, or any aspect that made them feel as though they were “other” in their local communities. By being authentic, and acknowledging their limitations online and off, they built genuine, sustaining relationships.
Social media continuously evolve. As text gave way to image-based social media, youth migrated away from Facebook (their parents were there) to Instagram, then Snapchat, and now TikTok. To impress and attract, adolescents are constantly taking selfies, posting them, and watching vigilantly for how, and how quickly, they are responded to. “Likes” encourage hypervigilance. “Read receipts” reinforce anxiety.
A recent study of early adolescents found that the “seen” function (display of who and/or how many have seen a post) is their greatest stressor. Whether posts are seen and corresponding response times are metrics for the quality of relationships. In a visual social media environment, the self-consciousness of adolescence has evolved for some into rapid-cycling self-objectification, narcissism, and anxiety.
Instant accessibility of anyone on social media has changed how we behave. Phones are prioritized over face-to-face interactions. The deep, sustained social connectedness that developed during awkward in-person interactions has been diluted by constant near-infinite connectivity.
Youth have always pushed the envelope, both to test their limits and to draw attention. Before visual social media, youthful indiscretions were limited in effect and frequently forgotten. But what is posted online goes far, goes fast, and is “sticky” — it can be captured, saved, and reposted anytime. I advise my patients to observe the “grandma rule”: Do not post anything online you don’t want grandma to see.
Social media are not going away. They are evolving. Boston Children’s Digital Wellness Lab pulse surveys during the pandemic found that kids connected and communicated as frequently through online gaming as through social media. They talked about multiuser gaming as “hanging out” rather than competing with each other. Daily users of TikTok average 46 minutes each day. Daily users of Roblox, a prototype of the coming “metaverse,” average 156 minutes per day of chatting while gaming. All interactive media have become social.
Social media do not cause anxiety and depression; they enable it.
Mobile devices, social media, and applications are not toys; they are powerful tools. Just as we teach children to drive a car, parents should introduce interactive media when children need them and can use them responsibly, respecting themselves and others. Parents should learn social media together with (and from) their children, helping them navigate the human complexities they face and mentoring them to be smart, healthy, kind, and authentic.
As the parent who was worried about her child said, “Well, it wasn’t easy to stop playing cop and sitting with her to learn social media, but we did it! And we are talking and actually enjoying each other … I will miss her when she leaves for college this weekend, but we will keep talking — on social media.”
Dr. Michael Rich is director of the Digital Wellness Lab and the Clinic for Interactive Media and Internet Disorders at Boston Children’s Hospital. He is an associate professor of pediatrics at Harvard Medical School and of social and behavioral sciences at the Harvard T.H. Chan School of Public Health.
One patient came to CIMAID distraught and confused. Her high school best friend — who had friended 967, shared exciting travels, hot boyfriends, and a never-ending stream of new looks — had just attempted suicide alone in her dorm room. Her life looked perfect. Why did she do that?
Social media do not cause anxiety and depression; they enable it.
WHATSAPP
A free instant messaging service released in 2009, WhatsApp currently has about 2.44 billion unique active users monthly worldwide, making it the most popular messaging system in the world. It was purchased by Meta in 2014.
Launched in 2004, Facebook was the first exposure to social media for many users. Teens 13-17 now account for only 4.5% of Facebook users: the largest user group is ages 25-34, at 23.5%.
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FACEBOOK
It is not using social media but how social media are used that can accelerate and amplify the anxiety, confusion, and rapidly changing emotions of youth. We are all in this digital ecosystem together, and we must all contribute to living well in it.
Policymakers should support legislation like US Senator Ed Markey’s Children and Media Research Advancement bill, designating National Institutes of Health funding to investigate how media use affects our mental, physical, and social health. Tech companies must retool existing algorithms that work for business but exacerbate adolescent angst. Clinical research and care of youth who have struggled and those who have thrived in our digital ecosystem must inform tech development at its earliest stages in order to improve, rather than fear and criticize, this environmental health influence of our time. Parents must recognize that youth move seamlessly between their offline and online worlds, and we must be present with and for them. We must move beyond our fears, stop policing them (which young people will only work around), model the digital behaviors we seek in them, and support their success with the skills and tools they need.
Just as we teach children to drive a car, parents should introduce interactive media when children need them and can use them responsibly, respecting themselves and others.
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Editor's note: The Digital Wellness Lab at Boston Children's Hospital receives financial support from Meta and TikTok