The longitudinal impact of social media use on adolescent mental health in the UK

Abstract Background Cross-sectional studies have suggested a relationship between social media use and depression and anxiety in young people. We examined the longitudinal relationship between social media use and young people's mental health and the role of self-esteem and social connectedness as potential mediators. Methods The sample comprised 3,228 young people from the UK Longitudinal Household Study (waves 1-10). Mental health at age 14 or 15 was measured by the SDQ Total Difficulties score. The number of hours spent on social media was measured at age 12 or 13. Self-esteem at age 13 or 14 was measured via eight questions and social connectedness was measured by two questions. Multilevel linear regression models explored whether social media use at age 12 or 13 predicted mental health at age 14 or 15. Path analysis with structural equation modelling investigated the mediation pathways. Results In unadjusted analysis, for those who spent 7 or more hours on social media vs none, their mental health problems trended upwards by 3.87 (95% CI, 0.71-7.03) but this relationship was attenuated after including covariates. In unadjusted path analysis, more social media use was associated with lower self-esteem (b=-0.10, p < 0.05), which in turn was associated with more mental health problems (b=-6.80, p < 0.001). The indirect effect (b = 0.70, p < 0.05) showed that 68% of the effect of social media use on mental health two years later was mediated by self-esteem. This relationship was attenuated after adjusting for covariates and in imputed data, and social connectedness was not associated. Conclusions This study shows the importance of longitudinal evidence, as we found there was little evidence to suggest a causal relationship between social media use and mental health issues two years later. Interventions that address social media use alone may not improve young people's mental health but those that consider factors like self-esteem may be more effective. Key messages • Longitudinal data suggests there is limited evidence that high social media use causes poorer mental health in adolescents despite indications from cross-sectional analyses. • Policy makers should consider that targeting social media use alone is unlikely to prevent poor adolescent mental health and factors like self-esteem may be more important prevention targets.


Background:
Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between family affluence and adolescent health behaviours is stronger in some countries than in others.

Methods:
Using data from adolescents aged 11-15 years from 32 different countries, participating in the 2017/2018 wave of the Health Behaviour in School-aged Children (HBSC) study (N = 185,086), we employed multilevel regression models with cross-level interactions to examine whether country-level social mobility moderates the association between family affluence and adolescent health behaviours (i.e. moderate-tovigorous physical activity, vigorous physical activity, healthy foods consumed, unhealthy foods consumed, having breakfast regularly, weekly smoking).

Results:
Higher family affluence was more strongly associated with higher levels of physical activity in countries characterized by high levels of social mobility (cross-level interaction linear regression coefficient 0.34; 95% CI 0.08 to 0.60; p = 0.009 for moderate-to-vigorous physical activity, and 0.31; 0.11 to 0.50; p = 0.002 for vigorous physical activity). No cross-level interactions were found for any of the other health behaviours.

Conclusions:
Our findings suggest that differences in social mobility at the country-level may contribute to cross-national variations in socioeconomic inequalities in adolescent physical activity. Further research can shed light on the mechanisms linking country-level social mobility to inequalities in adolescent physical activity to identify targets for policy and interventions.

Key messages:
This is one of the first studies to investigate country-level social mobility in relation to health equity. Inequalities in adolescent physical activity were steeper in socially mobile countries. Stronger efforts to engage adolescents from low-affluent families in physical activity may be necessary in countries characterized by high levels of social mobility.

Background:
Cross-sectional studies have suggested a relationship between social media use and depression and anxiety in young people. We examined the longitudinal relationship between social media use and young people's mental health and the role of self-esteem and social connectedness as potential mediators.

Methods:
The sample comprised 3,228 young people from the UK Longitudinal Household Study (waves 1-10). Mental health at age 14 or 15 was measured by the SDQ Total Difficulties score. The number of hours spent on social media was measured at age 12 or 13. Self-esteem at age 13 or 14 was measured via eight questions and social connectedness was measured by two questions. Multilevel linear regression models explored whether social media use at age 12 or 13 predicted mental health at age 14 or 15. Path analysis with structural equation modelling investigated the mediation pathways.

Results:
In unadjusted analysis, for those who spent 7 or more hours on social media vs none, their mental health problems trended upwards by 3.87 (95% CI, 0.71-7.03) but this relationship was attenuated after including covariates. In unadjusted path analysis, more social media use was associated with lower self-esteem (b = -0.10, p < 0.05), which in turn was associated with more mental health problems (b = -6.80, p < 0.001). The indirect effect (b = 0.70, p < 0.05) showed that 68% of the effect of social media use on mental health two years later was mediated by self-esteem. This relationship was attenuated after adjusting for covariates and in imputed data, and social connectedness was not associated.

Conclusions:
This study shows the importance of longitudinal evidence, as we found there was little evidence to suggest a causal relationship between social media use and mental health issues two years later. Interventions that address social media use alone may not improve young people's mental health but those that consider factors like self-esteem may be more effective.

Background:
Lay and professional people may use terms for mental health and mental health problems differently, causing difficulties in adequately addressing associated needs. Despite the public health issue of increased mental health problems among adolescents, there is limited research on perceptions of mental health concepts among young people. This study aimed to explore conceptual views of mental health and mental health problems among adolescents.

Methods:
During October and November 2020, a total of 32 adolescents (15-18 years old) living on Sweden's largest island Gotland were interviewed in focus groups or individual interviews. The interviews were semi-structured and audio recorded. Data were analysed thematically according to Systematic Text Condensation.

Results:
Three themes emerged from the analysis: Mental health is about how we feel; One's mental health depends on one's situation, thoughts and ways of coping; and Mental health problems should be taken seriously and can get severe. The adolescents described mental health as an overarching concept encompassing both positive mental health and mental health problems. Mental health problems were perceived as something other than normal challenges in life, however ranging from minor problems to severe illness. Good mental health was understood as a condition with absence of mental health problems and presence of symptoms of positive mental health.

Conclusions:
The adolescents' had a complex and holistic understanding of mental health concepts, consistent with definitions used by the World Health Organization and Swedish authorities. They suggested both positive mental health and mental health problems to be considered when assessing and discussing their mental health. Further, the results highlight the need of support for young people on how to cope with difficulties in life and support for those suffering from minor mental health problems.

Key messages:
The adolescents' understanding of mental health and mental health problems were highly consistent with current accepted definitions of the concepts. According to the participants, both positive mental health and mental health problems should be considered simultaneously to understand and address adolescents' mental health.
Abstract citation ID: ckac129.056 Help-seeking behaviors among survivors of intimate partner violence during pregnancy in 54 LMICs