HEALTH COMMUNICATION

https://doi.org/10.1080/10410236.2021.1888438

The Effect of Social Media on Stress among Young Adults during COVID-19 Pandemic:
Taking into Account Fatalism and Social Media Exhaustion
Annabel Ngien and Shaohai Jiang
Department of Communications and New Media, National University of Singapore

ABSTRACT
Social media has been widely used as an important source of health information, particularly during public
health crises. However, findings regarding social media’s impact on young adults’ mental health are
mixed. There is a need to identify social mechanisms underlying the effect of social media on mental
health outcomes. Our study breaks new ground by proposing and testing a moderated mediation
pathway from social media use to stress in young adults during the COVID-19 pandemic. We conducted
a two-wave online panel survey in the context of China. With a general basis of the Street’s three-stage
model, our results indicated that social media failed to directly affect young adults’ stress. Instead, fatalism
completely mediated this relationship. Also, one’s perceived social media exhaustion negatively moder­
ated this mediation pathway. The findings have significant theoretical and practical implications for the
use of social media to promote health, well-being, and quality of life among young people during public
health crises.

The COVID-19 pandemic is causing unprecedented disrup­
tions to many people’s lives. Particularly, young adults are
distressed due to isolation and social distancing, and higher
threats of potential years of life lost (Jimenez et al., 2020).
A survey study conducted in France showed that two-thirds
of college students experienced stress during COVID-19
(Husky et al., 2020). Another study among university stu­
dents in Greece also demonstrated the negative impact of
lockdown during COVID-19 on their mental health, such
as increased anxiety and depression (Kaparounaki et al.,
2020). To cope with COVID-19 related stress, many
young people turn to social media to seek health informa­
tion and peer interactions. Compared to the average indi­
viduals, youths are 63% more likely to use social media as
a key source of information and advice (Nielsen, 2009).
Despite the popularity of social media, prior research on
the influence of health-related social media use on younger
generations’ well-being has illustrated mixed findings. For
example, Asibey et al. (2017) indicated that university stu­
dents’ health-related Internet use, including social media
use for health information seeking, was positively asso­
ciated with healthy lifestyle change. However, other studies
demonstrated null or insignificant effects. For instance, Yoo
et al. (2016) found that college students’ exposure to anti-
smoking messages via social media failed to significantly
influence their smoking attitudes and intentions. Even more
concerning, excessive social media exposure to health infor­
mation during public health emergencies was found to
increase depression and anxiety (Gao et al., 2020). These
mixed findings are also reflected in a systematic review by
Pretorius et al. (2019), stating that it still remains unclear
whether health informational seeking via online platforms
(e.g., social media) is effective in improving young people’s
well-being. The inconsistent results may be due to the lack
of investigation of mechanisms underlying the effect of
health-related social media on young adults’ emotional
health. The focus on the direct effect ignores the complex
psychological consequences of social media use, which
might in turn have more direct influence on health out­
comes. Street (2003) highlighted the need to explore speci­
fic mediators influencing the relationship between
interactive media use and health outcomes. In the current
literature, scarce research has centered on young adults’
health-related social media use and its effect during public
health emergencies (i.e., COVID-19). This is concerning,
because public health crises can evoke greater threat apprai­
sal, which could lead to greater stress in youths. Also, most
previous studies are based in developed countries, with
limited empirical evidence in developing countries such as
China, the context of this study. Only 9.8% of Chinese
population have adequate health literacy as compared to
41% in developed European countries (World Health
Organisation, 2016). The lower health literacy is also
observed in Chinese young people (Guo et al., 2020).
Thus, people in China may encounter more barriers in
obtaining and interpreting health information for decision-
making during public health crises. To fill these research
gaps, the current study focused on young adults’ health
information seeking via social media (e.g., Weibo,
WeChat) during the COVID-19 pandemic in China, and
investigated the underlying mechanism of how social media
use can help young adults to cope with stress.

CONTACT Shaohai Jiang cnmjs@nus.edu.sg Department of Communications and New Media, National University of Singapore, Blk AS6, #03-41, 11 Computing
Drive, 117416, Singapore
© 2021 Taylor & Francis Group, LLC
2 A. NGIEN AND S. JIANG

Conceptual framework because of their low emotional capability to handle health

threats.
The conceptual framework is based on Street’s (2003) three-
Social media may play a key role in reducing fatalism. First,
stage model of health promotion using interactive media. The
seeking health information on social media can improve health
model highlights that media use seldom directly influences
knowledge. COVID-19 information is widely accessible via
health. Instead, in most situations, this relationship is indirect,
social media, empowering and activating users to take preven­
mediated by users’ interaction with the media platform, and its
tive actions (Gao et al., 2020). As one’s internal locus of control
subsequent intermediate outcomes.
increases during social media usage, fatalism will decrease.
Specifically, Stage 1 of the model explores the antecedents
Befort et al. (2013) found that using the Internet, including
(e.g., institutional, technological, and user-related) of media
social media, as a primary source of cancer information nega­
use. This merges into Stage 2, the user-media-message interac­
tively predicted the fatalistic belief that preventing cancer is
tion. In this process, an interplay of user (e.g., emotional state,
impossible. Second, compared to traditional media, social
desire for information), media (e.g., degree of interactivity) and
media allows people to search for information within their
message (e.g., readability, cultural appropriateness) character­
social networks, enhancing collective knowledge, social cohe­
istics occurs, resulting in certain intermediate outcomes (e.g.,
sion and rapport, which helps overcome fatalistic fears. The
knowledge, motivation, self-efficacy), which finally lead to
important role of social media use in lowering fatalism has
health outcomes (e.g., lifestyle change, healthy behavior uptake)
been documented in prior research. For instance, although
in Stage 3.
news exposure from mass media might increase fatalism,
Modeling a pathway from interactive media use to health
Internet use for health information can decrease fatalism (Lee
improvement, we (a) propose a pathway linking social media
et al., 2012). Mass media is unidirectional, while social media
use for COVID-19 information (media use) to reduced stress
features the bidirectional flow of information. Instead of inter­
(health outcome), (b) argue that fatalism (intermediate out­
preting information alone, individuals can use social media to
come) plays a mediating role, and (c) predict that this media­
ask questions, receive feedback, and collaborate with each
tion pathway will be moderated by individuals’ social media
other to cope with health challenges, resulting in less uncer­
exhaustion from social media use (user-media-message inter­
tainties and fatalistic beliefs (Ramanadhan et al., 2013). Thus,
action). This model is illustrated in Figure 1. The following
we posit:
sections discuss these key concepts of this study, and provide
evidence for the pathways proposed.
H1: Social media use is negatively related to fatalism among
young adults in China during COVID-19.
Social media use, fatalism and stress
Prior research has documented that fatalism is associated
Fatalism is the belief that one’s health is predetermined by fate, with negative health consequences. Fatalism evokes the per­
chance, luck or God and beyond the capacity of personal ceived inevitability of predestined outcomes, and thus
control (Powe & Finnie, 2003). As fatalistic individuals believe decreases one’s coping motivation. As fatalism narrows the
in the perceived inevitability of death, they are reluctant to range of resources to be utilized, it reduces capacities of tack­
adopt protective behaviors. Jimenez et al. (2020) stated that ling stressful situations, and increases the feeling of being over­
fatalism is a salient issue in the context of COVID-19, due to whelmed by emotional burdens (Pearlin et al., 1981). Also,
the lack of an effective treatment. They also found that youths fatalism is closely linked to cognitive avoidance. Fatalistic indi­
exhibit higher fatalistic COVID-19 beliefs than older adults, viduals conform to their expected fate, and avoid activities that

Social
media
exhaustion

-.09*

Social media
use Fatalism Stress
-.18*** .14***

NS

Wave 1 Wave 2

*p<.05. **p<.01. ***p<.001

NS=not significant
Figure 1. Conceptual framework. *p < .05. **p < .01. ***p < .001. NS = not significant

challenge what they believe is inevitable (Peng et al., 2021). In
the COVID-19 pandemic, Jimenez et al. (2020) found that
fatalistic beliefs led to avoidance of recommended preventive
behaviors, intensifying COVID-19 related fear and stress. This
is especially so for young people who exhibit higher avoidance
tendencies due to the lack of problem-solving skills and experi­
ences that facilitate effective emotion management (Nieto et al.,
2019).
While the effect of fatalism on stress has seldom been
examined, previous studies drew the link between fatalism
and reduced well-being in youths. In an adolescents-based
study, Roberts et al. (2000) found that fatalism resulted in
greater pessimism, lower self-esteem, and more passive coping.
Similarly, fatalistic youths engaged in higher suicide planning,
had more accepting attitudes toward suicide and were more
impulsive (Jamieson & Romer, 2008). Extending from the
literature, we predict:
H2: Fatalism is positively related to stress among young adults
in China during COVID-19.
In light of the above, one pathway linking social media use
to stress will likely be indirect through the mediating variable
of fatalism. Specifically, when individuals use social media for
health information, they have better understanding of the
health issue, lowering their fatalistic beliefs. The reduced fatal­
ism can in turn decrease users’ stress, as they become more
confident in coping with the health challenge (Go & You,
2018). Fatalism is particularly prevalent in the Confucian-
influenced China. As Confucianism suggests to leave to heaven
to take care of things man cannot do, Chinese people are often
fatalistic when facing misfortunes, which impedes coping
motivations and efforts (Li et al., 2015). Supporting this indir­
ect relationship, Street (2003) emphasized the need to examine
health-related mediators linking media use to health outcomes.
He also argued that these mediators should be situated within
socio-cultural factors for more context-sensitive analyses.
While past research has not explored the mediation pathway
we proposed, several studies supported the indirect effect of
social media use on emotional health outcomes. For instance,
participation in a WeChat HIV intervention program indir­
ectly reduced depression via the mediator of active coping
(Zhu et al., 2019). Wen et al. (2016) found that WeChat use
predicted subjective well-being through the mediator of user
motivations. Thus, in line with the documented indirect effect
of social media use, we posit:
H3: Fatalism will mediate the relationship between social
media use and stress among young adults in China during
COVID-19.
The moderating role of social media exhaustion
As noted earlier, the extent to which social media use affects
emotional well-being varies vastly. While scholars have pro­
posed several reasons for the inefficacy of social media, such as
lack of trust in online content, low desire for information, and
limited technology skills (Eysenbach et al., 2004), we argue that
HEALTH COMMUNICATION 3
one important contributing factor is social media exhaustion,
or the self-evaluated and subjective sense of tiredness from
social media use. Particularly among young adults, fear of
missing out, or “pervasive apprehension that others might be
having rewarding experiences from which one is absent”
(Przybylski et al., 2013, p. 8) has been prevalent. When inter­
acting with others on social media, they are expected to main­
tain a good personal image, reply quickly to messages, and
sustain growing online ties. Such online interaction requires
much time and energy, leading to social burnout. Particularly
during COVID-19, users rely heavily on social media for work
and leisure connections in the lockdown period, exposing
young adults to an influx of social demands.
In the present study, we posit that social media exhaustion
might serve as a moderator that weakens the benefits of social
media. According to the three-stage model, the effectiveness of
interactive media use on health promotion depends on the
user’s experience with the website and its online content.
Social media exhaustion can therefore tap into the user-
media-message interaction process, where users feel fatigue
when facing a plethora of information from social media.
During COVID-19, people often have excessive social media
use, and the sheer amount and complexity of information
encountered from social media would result in social media
exhaustion, which decreases individuals’ information proces­
sing capabilities, and increases cognitive overload. Under such
circumstances, users become unable to sufficiently absorb
health information and utilize the medical knowledge to exe­
cute preventive behaviors, weakening the influence of social
media use on reducing fatalism. Further, social media exhaus­
tion prompts social withdrawal, an increasingly common ten­
dency amongst youths who isolate themselves from others to
re-charge (Li & Wong, 2015). This discourages individuals
from seeking health information from online communities,
reducing sources of advice that can promote proactive health
measures (Straughan & Seow, 1998). As such, we propose:
H4a: Social media exhaustion will weaken the negative rela­
tionship between social media use and fatalism among young
adults in China during COVID-19.
Assuming social media exhaustion negatively moderates the
association between social media use and fatalism, it is also
likely that social media exhaustion conditionally influences the
strength of the indirect relationship between social media use
and stress, demonstrating a pathway of moderated mediation
between the study variables.
H4b: Social media exhaustion will moderate the negative and
indirect effect of social media use on stress, through the mediator
of fatalism among young adults in China during COVID-19.
Methods
Sampling
We conducted two waves of online surveys among young
adults (aging from 18 to 30) in China during the outbreak of
4 A. NGIEN AND S. JIANG
COVID-19 pandemic. The samples were recruited by an online
survey company (www.wjx.cn). This company had an online
panel of more than 2.6 million members in China in diversified
geographical locations and demographics. In February 2020,
633 people completed the Wave 1 survey. The same question­
naire was sent to Wave 1 participants after three months in
May 2020. 423 people completed the Wave 2 survey, with the
retention rate of 67%.
Measurement
All questionnaire items were first created in English and trans­
lated into Chinese. Back translation was conducted by two
graduate students who know both languages to make sure the
Chinese and English items had the similar meaning. In Table 1,
we presented descriptive statistics in both Wave 1 and Wave 2.
Social media use was measured by two items that asked
respondents whether they have actively searched for COVID-
19 information on (1) social media (e.g., Weibo), and (2) social
networking sites (e.g., WeChat). These two items were dichot­
omous (1 = Yes, 0 = No), and adapted from previous studies
(Liu & Jiang, 2021). Responses were summed up for data
analysis. Weibo and WeChat are two popular social media
platforms in China. Similar to other social media (e.g.,
Facebook), Weibo and WeChat allow users to post updates in
text, photo, or video to their friends or followers, with like,
comment or share functions.
Fatalism was measured by five items drawn from prior
research (Shen et al., 2009). Respondents were asked to indicate
their agreement with five statements on a 5-point Likert scale
(1 = strongly disagree to 5 = strongly agree). Sample items were
“My health is determined by fate”, and “My health is deter­
mined by luck”. We averaged the responses to create one scale.
The higher the value, the greater perceived fatalism (Wave 1:
Cronbach’s alpha = .83; Wave 2: Cronbach’s alpha = .87).
Stress was measured by five items, drawn from the SF-36
scale (Ware & Sherbourne, 1992). Respondents were asked to
report in the past four weeks, how frequently they have
encountered the following emotional states: (1) “Have you
been a nervous person”; (2) “Have you felt so down in the
dumps that nothing could cheer you up”; (3) “Have you felt
calm and peaceful”; (4) “Have you felt downhearted and blue”;
and (5) “Have you been a happy person”. Responses were on
a 5-point scale ranging from 1 = very frequently to 5 = very
rarely. Items (1), (2), and (4) were reversely coded. The higher
score represented greater stress (Wave 1: Cronbach’s
alpha = .80; Wave 2: Cronbach’s alpha = .81).
Table 1. Descriptive statistics.
Wave 1 (N = 633) Mean Wave 2 (N = 423) Mean
Variables (SD) (SD)
Age 24.69 (3.73) 25.14 (3.69)
Gender (being male) 40.1% 38.5%
Education 3.66 (.73) 3.71 (.72)
Income 2.41 (1.31) 2.47 (1.31)
Social media use 1.64 (.60) 1.64 (.60)
Fatalism 1.82 (.79) 1.83 (.80)
Stress 2.30 (.78) 2.20 (.75)
Social media 2.56 (1.00) 2.57 (1.01)
exhaustion
Social media exhaustion was measured by three items
adapted from prior research (Maier et al., 2015). Respondents
were asked to identify to what degree they agreed with the
following three statements: During the COVID-19 pandemic,
in the past four weeks, (1) “Activities that require me to use
social media make me feel exhausted”; (2) “Using social media
makes me feel tired”; and (3) “Using social media is a burden to
me”. The responses were on a 5-point Likert scale where
1 = strongly disagree and 5 = strongly agree. The higher
value demonstrated higher level of social media exhaustion
(Wave 1: Cronbach’s alpha = .82; Wave 2: Cronbach’s
alpha = .84).
Demographic variables including age, gender (1 = male,
2 = female), education (ranging from 1 = middle school or
below to 5 = postgraduate), and personal monthly income in
Chinese Yuan (CNY) from 1 = CNY 3000 or below to
6 = above CNY 18000 were controlled.
Statistical analysis
All statistical analyses were performed using Stata 14. To test
the mediation effect, we conducted path analysis using struc­
tural equation modeling (SEM). In the covariance structure
analysis, maximum likelihood of estimation was used. In SEM,
the control variables served as exogenous variables while endo­
genous variables included social media use, fatalism, and stress.
Paths were drawn from exogenous variables to all endogenous
variables. Consistent with Figure 1, paths were also drawn from
social media use to fatalism and stress, and from fatalism to
stress. For social media use and fatalism variables, Wave 1 data
were used. For stress, Wave 2 data were used. Also, to reduce
confounding effects, following previous studies (Chae & Lee,
2019), stress at Wave 1 was controlled, and all the demographic
variables were controlled as well. In the panel survey design,
Eveland and Morey (2011) contended that the length of time
necessary for a cause to produce an effect was a central con­
cern. In our study, we considered that social media use for
health information (Wave 1) could quickly produce an effect
on one’s fatalistic beliefs (Wave 1). However, the time to
produce an impact on mental health outcome, in this case,
stress (Wave 2) would be longer, as prior research demon­
strated that changing one’s health behaviors or outcomes
could take weeks or even months (Slater, 2007). To examine
the mediation effect more closely, running SEM using Stata 14
can generate the bootstrapped confidence interval (CI). At the
.05 level with 5,000 re-samples, if the lower and upper CIs are
either both below or above zero, the mediation effect is
supported.
To test the moderation effect, we performed hierarchical
regression analysis. In the first step, fatalism was regressed on
demographic variables, social media use, and social media
exhaustion. In the second step, an interaction term between
social media use and social media exhaustion (after being mean
centered) was entered into the model. This inclusion of inter­
action term provided test for moderation effect.
To further examine the moderated mediation effect or con­
ditional indirect effect, we adopted a normal theory-based
approach that has been widely used in previous studies
(Preacher et al., 2007). Specifically, we looked at the
 HEALTH COMMUNICATION 5

significance level of conditional indirect effects at three differ­
ent values of the moderator, social media exhaustion, including
high (1 standard deviation above the mean), medium (the
mean), and low (1 standard deviation below the mean).
Results
The initial SEM was saturated, failing to generate a chi-
square value. Of the paths from endogenous variables, we
found that the path from social media use to stress was
insignificant (β = −.01, p = .80, 95% CI [−.0895 to .0687]).
To seek the most parsimonious explanation, previous
research suggested to trim non-significant paths (McCoach,
2003). Therefore, we pruned the path from social media to
stress. The pruned SEM model had a satisfactory fit, χ2
(1) = 0.07, p = .80; RMSEA = .000 (90% confidence interval:
.000–.082); CFI = 1.000; and SRMR = .001 (Hu & Bentler,
1999).
H1 proposed that social media use was negatively related to
fatalism. As shown in Table 2, social media use had a negative
and significant relationship with fatalism (β = −.18, p < .001,
95% CI [−.2680 to −.0904]), suggesting that the greater social
media use, the less perceived fatalism, supporting H1.
H2 posited that fatalism was positively associated with
stress. As illustrated in Table 2, this relationship was positive
and significant (β = .14, p < .001, 95% CI [.0625 to .2230]),
meaning that as one’s perception of fatalism increased, his or
her stress level would also increase, supporting H2.
H3 examined the mediating role of fatalism on the relation­
ship between social media use and stress. The bootstrapping
approach offered support for the mediation effect of fatalism
(95% CI [−.0496 to −.0155]), supporting H3. Given the insig­
nificant direct effect of social media on stress, the complete
mediation was supported.
H4a hypothesized that social media exhaustion would
weaken the negative relationship between social media use
and fatalism. As demonstrated in Table 3, the interaction
term between social media use and social media exhaustion
was negative and significant (β = −.09, p < .05, 95% CI [−.1538
to −.0018]). This results showed that social media exhaustion
strengthened the negative effect of social media use on fatalism,
which illustrated a different direction of moderation effect as
predicted. Thus, H4a was not supported. When individuals had
a higher level of social media exhaustion, the role of social
media in reducing fatalistic feelings was stronger.
H4b explored the moderated mediation effect, specifically
the conditional indirect effect of social media use on stress,
through fatalism, at three levels of social media exhaustion.
Our results showed that no matter whether social media users
reported low, moderate, or high levels of social media exhaus­
tion, fatalism remained a significant mediator, demonstrating
a significant moderated mediation effect. However, the direc­
tion of the moderated mediation effect was different from our
expectation. As shown in Table 3, as the level of social media
exhaustion increased, the negative and indirect effect of social
media use on stress also increased. Therefore, H4b was not
supported. The indirect and negative effect of social media use
on stress was stronger for those who reported higher levels of
social media exhaustion.
Discussion
Despite the prevalence of social media use among young
adults, research on the direct impacts of social media on their
mental health has often produced conflicting results. The pre­
sent study broke new ground by empirically testing
a moderated mediation pathway linking social media to stress
among young adults during COVID-19 pandemic in China.
Our results showed that social media reduced fatalism,
a finding consistent with past studies that supported the posi­
tive impact of social media on coping with health-related issues
(Farpour et al., 2017). Young adults often use social media to
consume health information due to its easy access and inde­
pendence from parental support (Fergie et al., 2016). This
reduces worries and fears about health consequences that will
happen next, diminishing feelings of fatalistic helplessness. In
China, fatalism has long been prevalent, and it has a negative
connotation, Ming, meaning that one’s health status is prede­
termined by fate. Thus, many Chinese people feel incapable,
hopeless and pessimistic in health crises (Cheng et al., 2013).
Social media for health purposes can promote individuals’
informational sense-making, which helps de-mystify the public
health issue and increase their locus-of-control. The uncer­
tainty management theory supports this positive relationship,
positing that individuals perceive greater control over the
future when uncertainty about situations is managed through
information seeking (Brashers, 2001). Further, during pan­
demics, social media overcomes social isolation limitations by
enabling users to connect with one another online. As younger
generations heavily use social media and depend on peer

Table 2. Predictors of endogenous variables in SEM. Table 3. Regression results for moderated mediation effect.
Social Predictor β SE t p
media Block 1: Main Predictors Fatalism
Effect Age Gender Education Income use Fatalism Social media use (SM) −.15 .06 −3.28 .001
Social Direct −.05 .13** .10 .04 Social media exhaustion (SME) .26 .04 5.46 .000
media Block 2: Interaction Terms
use Social media use (SM) −.15 .06 −3.15 .002
Indirect NA NA NA NA Social media exhaustion (SME) .26 .04 5.56 .000
Fatalism Direct .04 −.02 .08 −.06 −.18*** SM*SME −.09 .04 −2.01 .045
Indirect .01 −.02 −.02 −.01 NA Conditional indirect effect
Stress Direct .01 −.06 .01 −.12* P .14*** Stress
Indirect .01 −.01 .01 −.01 −.03 *** NA M-1 SD −.038 .02 −2.36 .018
*p < .05. **p < .01. ***p < .001. M −.044 .02 −2.22 .027
Coefficients are standardized. M + 1 SD −.051 .02 −2.09 .037
NA = not applicable; P = pruned path Note: Numbers in bold indicate significant effect.
6 A. NGIEN AND S. JIANG
interactions for support, health information obtained from
young adults’ online social networks strengthens the belief
that they are in charge of their health destinies. This result is
especially pertinent to China, where its collectivist culture
facilitates more interdependence within one’s social network,
and Chinese people have greater interpersonal trust of health
information or resource from in-group members, such as close
friends (Van Hoorn, 2014).
Our paper also demonstrated a positive relationship
between fatalism and stress. This finding is in line with prior
research that supported the association between fatalism and
poor mental health (Wagner et al., 2020). As fatalism is linked
to the belief in the efficacy of divine or spiritual instead of
personal forces in shaping life outcomes (Straughan & Seow,
1998), it prompts perceived uncontrollability of the future
which increases stress. Roseman (1996) suggested that events
appraised as having low control potential (e.g., COVID-19)
results in accommodative (i.e., resignation to aversive condi­
tions) feelings, such as depression or stress, instead of reactive
(i.e., resistance to aversive conditions) ones like motivation to
fight against stress. This is particularly true for young adults
who are less emotionally capable than older people to handle
COVID-19 related threats, due to the lack of maturity and
social resources (Ellwood, 2020).
An important finding from this study is the insignificant
direct effect of social media on mental health. This result is
consistent with the core tenet of the three-stage model and the
growing body of research supporting complete mediation
effects (Oh et al., 2020). The process of interactive media use
for health promotion is complicated and dynamic. Prior
research has suggested that health-related Internet use influ­
ences health indirectly through its effects on factors directly
contributing to health improvement (Jiang & Street, 2016). In
our study, social media affects stress through fatalism. When
users receive health information from social media, they
become empowered to believe their actions can produce
desired health outcomes, which reduces stress. Thus, a direct
statement that social media can be linked to good or poor
emotional well-being is uninformative. We need to identify
the social mechanisms underlying this relationship.
Another important finding pertains to the moderating role
of social media exhaustion. Although the moderation effect is
significant, its direction diverges from our expectations. The
results showed that social media use had a stronger negative
effect on fatalism as well as greater negative indirect effect on
stress for people with higher levels of social media exhaustion.
This result is different from prior research which suggests that
when people feel exhausted from receiving a plethora of infor­
mation on social media, they would be less motivated to lever­
age on tips or encouragement for desired outcomes, inhibiting
the potential of social media to decrease fatalism (Bang & Reio,
2017). To explain why social media exhaustion strengthens the
benefits of social media in coping with fatalism and stress,
selective exposure might be important to note. During the
COVID-19 pandemic, people often expose to a large amount
of negative content on social media (e.g., the increasing num­
ber of death, miserable story). When they feel exhausted from
social media interactions, they might choose to turn to more
positive information, such as role models of handling this
disease, and ignore negative ones to maintain better emotional
well-being. This explanation is supported by the mood man­
agement theory which suggests that exhausted individuals use
media to block dysphoric moods or substitute negative emo­
tions with positive ones (Zillmann, 1988). In addition, Sweller’s
(1988) cognitive load theory also states that people have
a limited working memory load, and to overcome this limita­
tion, during exhaustion, they would resort to selective infor­
mation exposure. Particularly, young adults have higher health
literacy and digital skills than their older counterparts. When
facing exhaustion from social media use, they can more easily
locate useful information source and better distinguish
between accurate and fake health news (Loos & Nijenhuis,
2020). Given their focus on selective reliable source rather
than a wider range of alternative sources during social media
fatigue, young adults might be more capable of dealing with
fatalistic beliefs and stress.
Several limitations should be noted. First, this study used
convenience samples recruited from online surveys, which
limit the generalizability of our findings. Future studies may
ideally use probability samples that cover a broader diversity of
participants. Second, the present study only measured whether
or not participants used social media and social networking
sites to seek health information, while it failed to identify more
nuanced information behaviors, such as the type and amount
of information searched for. The operationalization in our
study may result in biased results, and a general statement
that using social media for health information is beneficial
would be uninformative. It is important to understand which
types of information and the level of social media usage are
associated with better health-related outcomes. Therefore,
future research should include more diverse dimensions of
health information acquisition and explore if our model can
be well applied. Third, we only examined one mediation path­
way from social media to stress, via fatalism, while other user-
media-message interaction process and intermediate outcomes
could be at play as well. For instance, during periods of dis­
connectedness (i.e., sudden shortfall in social support or
resources), social media can increase problem-solving skills,
which helps to lower stress (Hoek et al., 2012). Fourth, this
study only collected data in China, and thus its generalizability
in other countries could be limited. Given that COVID-19 is
a global health crisis, more comparative research is needed,
particularly in societies with different health challenges and
health care systems.
Despite the limitations, our study has important theoretical
implications. First, we extended the three-stage model by con­
sidering moderation effects. Our model offers a more compre­
hensive framework by highlighting the need to situate social
factors (e.g., social media exhaustion) as moderating the effect
of media use on personal health-related factors (e.g., fatalism).
Second, to the best of our knowledge, our moderated media­
tion pathway is the first to demonstrate the effect of young
adults’ social media use on mental health during global health
emergencies. Future research can use this analytical model to
study social media for youths’ health promotion during pan­
demics. Third, we expanded the cultural applicability of the
three-stage model. While the model was initially designed for
the Western general public, we demonstrated that it is

applicable to young adults despite media environment and
socio-economic variances. For instance, this model is relevant
to the intensified fatalistic culture in China.
This study also offers significant practical implications.
First, our study demonstrated that social media for health
information can reduce stress. Thus, during public health
emergencies, young adults should more often utilize social
media for health purposes as an effective way to cope with
emotional burdens. Second, the moderating role of social
media exhaustion documented in this study informs us that
facing the plethora of health information and the increasing
information sharing during COVID-19, health communicators
should teach young people to focus on some preferred and
reliable social media sources and make more meaningful con­
nections with online peers for productive discussion. Third,
our study also found that fatalism reduced emotional well-
being. As such, health communicators need to make efforts to
lower people’s fatalistic beliefs. Some strategies might include
introducing a role model to enhance young adults’ motivation
to cope with health problems, and teaching effective self-
management skills. It is important to note that more culturally
appropriate training problems are needed, as fatalism is influ­
enced by the unique culture rooted in China.
Funding
The authors have no funding to report.
References
Asibey, B. O., Agyemang, S., & Dankwah, A. B. (2017). The internet use
for health information seeking among Ghanaian University students: A
cross-sectional study. International Journal of Telemedicine and
Applications, 2017, 1756473. https://doi.org/10.1155/2017/1756473
Bang, H., & Reio Jr, T. G. (2017). Examining the role of cynicism in the
relationships between burnout and employee behavior. Journal of Work
and Organizational Psychology, 33(3), 217–228. https://doi.org/10.
1016/j.rpto.2017.07.002
Befort, C. A., Nazir, N., Engelman, K., & Choi, W. (2013). Fatalistic cancer
beliefs and information sources among rural and urban adults in the
USA. Journal of Cancer Education, 28(3), 521–526. https://doi.org/10.
1007/s13187-013-0496-7
Brashers, E. (2001). Communication and uncertainty management.
Journal of Communication, 51(3), 477–497. https://doi.org/10.1111/j.
1460-2466.2001.tb02892.x
Chae, J., & Lee, C. J. (2019). The psychological mechanism underlying
communication effects on behavioral intention: Focusing on affect and
cognition in the cancer context. Communication Research, 46(5),
597–618. https://doi.org/10.1177/0093650216644021
Cheng, H., Sit, J. H., Twinn, S. F., Cheng, K. F., & Thorne, S. (2013).
Coping with breast cancer survivorship in Chinese women: The role of
fatalism or fatalistic voluntarism. Cancer Nursing, 36(3), 236–244.
https://doi.org/10.1097/NCC.0b013e31826542b2
Ellwood, B. (2020, May 26). Social support and sense of belonging may
protect against the psychological impact of COVID-19. PsyPost. https://
www.psypost.org/2020/05/social-support-and-sense-of-belonging-
may-protect-against-the-psychological-impact-of-covid-19-56873
Eveland, W. P., & Morey, A. C. (2011). Challenges and opportunities of
panel designs. In E. P. Bucy & R. L. Holbert (Eds.), Sourcebook for
political communication research: Methods, measures, and analytical
techniques (pp. 19–33). Routledge.
Eysenbach, G., Powell, J., Englesakis, M., Rizo, C., & Stern, A. (2004).
Health related virtual communities and electronic support groups:
Systematic review of the effects of online peer to peer interactions.
HEALTH COMMUNICATION 7
BMJ, 328(7449), 1166–1170. https://doi.org/10.1136/bmj.328.7449.
1166
Farpour, H. R., Habibi, L., & Owji, S. H. (2017). Positive impact of social
media use on depression in cancer patients. Asian Pacific Journal of
Cancer Prevention, 18(11), 2985–2988. https://doi.org/10.22034/
APJCP.2017.18.11.2985
Fergie, G., Hunt, K., & Hilton, S. (2016). Social media as a space for
support: Young adults’ perspectives on producing and consuming user-
generated content about diabetes and mental health. Social Science &
Medicine, 170, 46–54. https://doi.org/10.1016/j.socscimed.2016.10.006
Gao, J., Zheng, P., Jia, Y., Chen, H., Mao, Y., Chen, S., Wang, Y., Fu, H., &
Dai, J. (2020). Mental health problems and social media exposure
during COVID-19 outbreak. PLoS ONE, 15(4), e0231924. https://doi.
org/10.1371/journal.pone.0231924
Go, E., & You, K. H. (2018). Health-related online information seeking
and behavioral outcomes: Fatalism and self-efficacy as mediators. Social
Behavior and Personality, 46(5), 871–879. https://doi.org/10.2224/sbp.
6501
Guo, S., Yu, X., Davis, E., Armstrong, R., Riggs, E., & Naccarella, L. (2020).
Adolescent health literacy in Beijing and Melbourne: A cross-cultural
comparison. International Journal of Environmental Research and
Public Health, 17(4), 1242. https://doi.org/10.3390/ijerph17041242
Hoek, W., Schuurmans, J., Koot, H. M., & Cuijpers, P. (2012). Effects of
internet-based guided self-help problem-solving therapy for adoles­
cents with depression and anxiety: A randomized controlled trial.
PLoS ONE, 7(8), e43485. https://doi.org/10.1371/journal.pone.
0043485
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance
structure analysis: Conventional criteria versus new alternatives.
Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.
https://doi.org/10.1080/10705519909540118
Husky, M. M., Kovess-Masfety, V., & Swendsen, J. D. (2020). Stress and
anxiety among university students in France during COVID-19 man­
datory confinement. Comprehensive Psychiatry, 102, 152191. https://
doi.org/10.1016/j.comppsych.2020.152191
Jamieson, P. E., & Romer, D. (2008). Unrealistic fatalism in U.S. youth
ages 14 to 22: Prevalence and characteristics. Journal of Adolescent
Health, 42(2), 154–160. https://doi.org/10.1016/j.jadohealth.2007.07.
010
Jiang, S., & Street, R. L. (2016). Pathway linking internet health informa­
tion seeking to better health: A moderated mediation study. Health
Communication, 32(8), 1024–1031. https://doi.org/10.1080/10410236.
2016.1196514
Jimenez, T., Restar, A., Helm, P. J., Cross, R. I., Barath, D., & Arndt, J.
(2020). Fatalism in the context of COVID-19: Perceiving coronavirus
as a death sentence predicts reluctance to perform recommended pre­
ventive behaviors. SSM - Population Health, 11, 100615. https://doi.org/
10.1016/j.ssmph.2020.100615
Kaparounaki, C. K., Patsali, M. E., Mousa, D. V., Papadopoulou, E. V.,
Papadopoulou, K. K., & Fountoulakis, K. N. (2020). University stu­
dents’ mental health amidst the COVID-19 quarantine in Greece.
Psychiatry Research, 290, 113111. https://doi.org/10.1016/j.psychres.
2020.113111
Lee, C., Niederdeppe, J., & Freres, D. (2012). Socioeconomic disparities in
fatalistic beliefs about cancer prevention and the internet. Journal of
Communication, 62(6), 972–990. https://doi.org/10.1111/j.1460-2466.
2012.01683.x
Li, T. M., & Wong, P. W. (2015). Youth social withdrawal behavior
(hikikomori): A systematic review of qualitative and quantitative
studies. Australian & New Zealand Journal of Psychiatry, 49(7),
595–609. https://doi.org/10.1177/0004867415581179
Li, Y., Chen, P. Y., Chen, F., & Wu, W. (2015). Roles of fatalism and
parental support in the relationship between bullying victimization and
bystander behaviors. School Psychology International, 36(3), 253–267.
https://doi.org/10.1177/0143034315569566
Liu, P. L., & Jiang, S. (2021). Patient-centered communication mediates
the relationship between health information acquisition and patient
trust in physicians: A five-year comparison in China. Health
Communication, 36(2), 207–216. https://doi.org/10.1080/10410236.
2019.1673948
8 A. NGIEN AND S. JIANG
Loos, E., & Nijenhuis, J. (2020). Consuming fake news: A matter of age?
The perception of political fake news stories in Facebook ads. In Q. Gao
& J. Zhou (Eds.), International Conference on Human-Computer
Interaction (pp. 69–88). Cham: Springer.
Maier, C., Laumer, S., Eckhardt, A., & Weitzel, T. (2015). Giving too much
social support: Social overload on social networking sites. European
Journal of Information Systems, 24(5), 447–464. https://doi.org/10.
1057/ejis.2014.3
McCoach, D. B. (2003). SEM isn’t just the Schoolwide enrichment model
anymore: Structural equation modeling (SEM) in gifted education.
Journal for the Education of the Gifted, 27(1), 36–61. https://doi.org/
10.1177/016235320302700104
Nielsen. (2009). How teens use media. https://www.nielsen.com/wp-
content/uploads/sites/3/2019/04/How-Teens-Use-Media.pdf
Nieto, M., Romero, D., Ros, L., Zabala, C., Martínez, M., Ricarte, J. J.,
Serrano, J. P., & Latorre, J. M. (2019). Differences in coping strategies
between young and older adults: The role of executive functions. The
International Journal of Aging and Human Development, 90(1), 28–49.
https://doi.org/10.1177/0091415018822040
Oh, S., Lee, S. Y., & Han, C. (2020). The effects of social media use on
preventive behaviors during infectious disease outbreaks: The mediat­
ing role of self-relevant emotions and public risk perception. Health
Communication. Advance online publication. https://doi.org/10.1080/
10410236.2020.1724639
Pearlin, L. E., Menaghan, E. G., Lieberman, M. A., & Mullan, J. T. (1981).
The stress process. Journal of Health and Social Behavior, 22(4),
337–356. https://doi.org/10.2307/2136676
Peng, W., Carcioppolo, N., Occa, A., Ali, K., Yang, Q., & Yang, F. (2021).
Feel worried, overloaded, or fatalistic? The determinants of cancer
uncertainty management preferences. Health Communication, 36(3),
347–360. https://doi.org/10.1080/10410236.2019.1692489
Powe, B. D., & Finnie, R. (2003). Cancer fatalism: The state of the science.
Cancer Nursing, 26(6), 454–465. https://doi.org/10.1097/00002820-
200312000-00005
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moder­
ated mediation hypotheses: Theory, methods, and prescriptions.
Multivariate Behavioral Research, 42(1), 185–227. https://doi.org/10.
1080/00273170701341316
Pretorius, C., Chambers, D., & Coyle, D. (2019). Young people’s online
help-seeking and mental health difficulties: Systematic narrative review.
Journal of Medical Internet Research, 21(11), e13873. https://doi.org/10.
2196/13873
Przybylski, A. K., Murayama, K., DeHaan, C. R., & Gladwell, V. (2013).
Motivational, emotional, and behavioral correlates of fear of missing
out. Computers in Human Behavior, 29(4), 1841–1848. https://doi.org/
10.1016/j.chb.2013.02.014
Ramanadhan, S., Mendez, S. R., Rao, M., & Viswanath, K. (2013). Social
media use by community-based organizations conducting health pro­
motion: A content analysis. BMC Public Health, 13(1), 1129. https://
doi.org/10.1186/1471-2458-13-1129
Roberts, R. E., Roberts, C. R., & Chen, I. G. (2000). Fatalism and risk of
adolescent depression. Psychiatry, 63(3), 239–252. https://doi.org/10.
1080/00332747.2000.11024917
Roseman, I. J. (1996). Appraisal determinants of emotions: Constructing
a more accurate and comprehensive theory. Cognition & Emotion, 10
(3), 241–278. https://doi.org/10.1080/026999396380240
Shen, L., Condit, C. M., & Wright, L. (2009). The psychometric property
and validation of a fatalism scale. Psychology & Health, 24(5), 597–613.
https://doi.org/10.1080/08870440801902535
Slater, M. D. (2007). Reinforcing spirals: The mutual influence of media
selectivity and media effects and their impact on individual behavior
and social identity. Communication Theory, 17(3), 281–303. https://doi.
org/10.1111/j.1468-2885.2007.00296.x
Straughan, P. T., & Seow, A. (1998). Fatalism reconceptualized:
A concept to predict health screening behavior. Journal of
Gender, Culture, & Health, 3(2), 85–100. https://doi.org/10.1023/
A:1023278230797
Street, R. L. (2003). Mediated consumer–provider communication in
cancer care: The empowering potential of new technologies. Patient
Education and Counseling, 50(1), 99–104. https://doi.org/10.1016/
S0738-3991(03)00089-2
Sweller, J. (1988). Cognitive load during problem solving: Effects on
learning. Cognitive Science, 12(2), 257–285. https://doi.org/10.1207/
s15516709cog1202_4
Van Hoorn, A. (2014). Individualist–collectivist culture and trust radius.
Journal of Cross-Cultural Psychology, 46(2), 269–276. https://doi.org/
10.1177/0022022114551053
Wagner, G., Glick, P., Khamma-sh, U., Shaheen, M., Brown, R.,
Goutam, P., Karam, R., Linnemayr, S., & Massad, S. (2020). Exposure
to violence and its relationship to mental health in Palestinian youth.
Eastern Mediterranean Health Journal, 26(2), 189–197. https://doi.org/
10.26719/2020.26.2.189
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-ltem short-form
health survey (SF-36). Medical Care, 30(6), 473–483. https://doi.org/10.
1097/00005650-199206000-00002
Wen, Z., Geng, X., & Ye, Y. (2016). Does the use of WeChat lead to
subjective well-being?: The effect of use intensity and motivations.
Cyberpsychology, Behavior and Social Networking, 19(10), 587–592.
https://doi.org/10.1089/cyber.2016.0154
World Health Organisation. (2016). The role of governments in promoting
health literacy. World Health Organization. https://www.who.int/
healthpromotion/conferences/9gchp/health-literacy-government-role
/en/
Yoo, W., Yang, J., & Cho, E. (2016). How social media influence college
students’ smoking attitudes and intentions. Computers in Human
Behavior, 64, 173–182. https://doi.org/10.1016/j.chb.2016.06.061
Zhu, M., Cai, W., Li, L., Guo, Y., Monroe-Wise, A., Li, Y., Zeng, C.,
Qiao, J., Xu, Z., Zhang, H., Zeng, Y., & Liu, C. (2019). Mediators of
intervention effects on depressive symptoms among people living with
HIV: Secondary analysis of a mobile health randomized controlled trial
using latent growth curve modeling. JMIR mHealth and uHealth, 7(11),
e15489. https://doi.org/10.2196/15489
Zillmann, D. (1988). Mood management: Using entertainment to full
advantage. In L. Donohew, H. E. Sypher, & E. T. Higgins (Eds.),
Communication Social Cognition, and Affect (pp. 147–171). Lawrence
Erlbaum Associates.