This cohort study assesses whether time spent using social media is associated with
internalizing and externalizing mental health problems among adolescents. Is time
spent using social media associated with mental health problems among adolescents?
In this cohort study of 6595 US adolescents, increased time spent using social media
per day was prospectively associated with increased odds of reporting high levels
of internalizing and comorbid internalizing and externalizing problems, even after
adjusting for history of mental health problems. Adolescents who spend more than 3
hours per day on social media may be at heightened risk for mental health problems,
particularly internalizing problems. Social media use may be a risk factor for mental
health problems in adolescents. However, few longitudinal studies have investigated
this association, and none have quantified the proportion of mental health problems
among adolescents attributable to social media use. To assess whether time spent using
social media per day is prospectively associated with internalizing and externalizing
problems among adolescents. This longitudinal cohort study of 6595 participants from
waves 1 (September 12, 2013, to December 14, 2014), 2 (October 23, 2014, to October
30, 2015), and 3 (October 18, 2015, to October 23, 2016) of the Population Assessment
of Tobacco and Health study, a nationally representative cohort study of US adolescents,
assessed US adolescents via household interviews using audio computer-assisted self-interviewing.
Data analysis was performed from January 14, 2019, to May 22, 2019. Self-reported
time spent on social media during a typical day (none, ≤30 minutes, >30 minutes to
≤3 hours, >3 hours to ≤6 hours, and >6 hours) during wave 2. Self-reported past-year
internalizing problems alone, externalizing problems alone, and comorbid internalizing
and externalizing problems during wave 3 using the Global Appraisal of Individual
Needs–Short Screener. A total of 6595 adolescents (aged 12-15 years during wave 1;
3400 [51.3%] male) were studied. In unadjusted analyses, spending more than 30 minutes
of time on social media, compared with no use, was associated with increased risk
of internalizing problems alone (≤30 minutes: relative risk ratio [RRR], 1.30; 95%
CI, 0.94-1.78; >30 minutes to ≤3 hours: RRR, 1.89; 95% CI, 1.36-2.64; >3 to ≤6 hours:
RRR, 2.47; 95% CI, 1.74-3.49; >6 hours: RRR, 2.83; 95% CI, 1.88-4.26) and comorbid
internalizing and externalizing problems (≤30 minutes: RRR, 1.39; 95% CI, 1.06-1.82;
>30 minutes to ≤3 hours: RRR, 2.34; 95% CI, 1.83-3.00; >3 to ≤6 hours: RRR, 3.15;
95% CI, 2.43-4.09; >6 hours: RRR, 4.29; 95% CI, 3.22-5.73); associations with externalizing
problems were inconsistent. In adjusted analyses, use of social media for more than
3 hours per day compared with no use remained significantly associated with internalizing
problems alone (>3 to ≤6 hours: RRR, 1.60; 95% CI, 1.11-2.31; >6 hours: RRR, 1.78;
95% CI, 1.15-2.77) and comorbid internalizing and externalizing problems (>3 to ≤6
hours: RRR, 2.01; 95% CI, 1.51-2.66; >6 hours: RRR, 2.44; 95% CI, 1.73-3.43) but not
externalizing problems alone. Adolescents who spend more than 3 hours per day using
social media may be at heightened risk for mental health problems, particularly internalizing
problems. Future research should determine whether setting limits on daily social
media use, increasing media literacy, and redesigning social media platforms are effective
means of reducing the burden of mental health problems in this population.