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YOUR HEALTH

The truth about teens,

social media and the mental
health crisis
April 25, 2023 · 9:28 AM ET
Heard on All Things Considered

Michaeleen Doucleff

8-Minute Listen

For years, the research picture on how social media affects teen
mental health has been murky. That is changing as scientists
find new tools to answer the question.
Olivier Douliery /AFP via Getty Images

Back in 2017, psychologist Jean Twenge set

off a firestorm in the field of psychology.

Twenge studies generational trends at San

Diego State University. When she looked at
mental health metrics for teenagers around
2012, what she saw shocked her. "In all my
analyses of generational data — some
reaching back to the 1930s — I had never
seen anything like it," Twenge wrote in the
Atlantic in 2017.

Twenge warned of a mental health crisis on

the horizon. Rates of depression, anxiety and
loneliness were rising. And she had a
hypothesis for the cause: smartphones and all
the social media that comes along with them.
"Smartphones were used by the majority of
Americans around 2012, and that's the same
time loneliness increases. That's very
suspicious," Twenge told NPR in 2017.

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But many of her colleagues were skeptical.

Some even accused her of inciting a panic
with too little — and too weak — data to back
her claims.

Now, six years later, Twenge is back. She has

a new book out this week, called Generations,
with much more data backing her hypothesis.
At the same time, several high-quality studies
have begun to answer critical questions, such
as does social media cause teens to become
depressed and is it a key contributor to a rise
in depression?

In particular, studies from three different

types of experiments, altogether, point in the
same direction. "Indeed, I think the picture is
getting more and more consistent," says
economist Alexey Makarin, at the
Massachusetts Institute of Technology.

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A seismic change in how teens

spend their time
In Generations, Twenge analyzes mental
health trends for five age groups, from the
Silent Generation, who were born between
1925 and 1945, to Gen Z, who were born
between 1995 and 2012. She shows
definitively that "the way teens spend their
time outside of school fundamentally changed
in 2012," as Twenge writes in the book.

Take for instance, hanging out with friends,

in person. Since 1976, the number of times
per week teens go out with friends — and
without their parents — held basically steady
for nearly 30 years. In 2004, it slid a bit. Then
in 2010, it nosedived.

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"It was just like a Black Diamond ski slope

straight down," Twenge tells NPR. "So these
really big changes occur."

At the same time, around 2012, time on social

media began to soar. In 2009, only about half
of teens used social media every day, Twenge
reports. In 2017, 85% used it daily. By 2022,
95% of teens said they use some social media,
and about a third say they use it constantly, a
poll from Pew Research Center found.

"Now, in the most recent data, 22% of 10th

grade girls spend seven or more hours a day
on social media," Twenge says, which means
many teenage girls are doing little else than
sleeping, going to school and engaging with
social media.

Not surprisingly, all this screen time has cut

into many kids' sleep time. Between 2010 and
2021, the percentage of 10th and 12th graders
who slept seven or fewer hours each night
rose from a third to nearly one-half. "That's a
big jump," Twenge says. "Kids in that age
group are supposed to sleep nine hours a
night. So less than seven hours is a really
serious problem."

SHOTS - HEALTH NEWS

Teen girls and LGBTQ+ youth

plagued by violence and trauma,
survey says

On its own, sleep deprivation can cause

mental health issues. "Sleep is absolutely
crucial for physical health and for mental
health. Not getting enough sleep is a major
risk factor for anxiety and depression and
self-harm," she explains. Unfortunately, all of
those mental health problems have continued
to rise since Twenge first sounded the alarm
six years ago.

"Nuclear bomb" on teen social life

"Every indicator of mental health and
psychological well-being has become more
negative among teens and young adults since
2012," Twenge writes in Generations. "The
trends are stunning in their consistency,
breadth and size."

Across the board, since 2010, anxiety,

depression and loneliness have all increased.
"And it's not just symptoms that rose, but
also behaviors," she says, "including
emergency room visits for self-harm, for
suicide attempts and completed suicides."
The data goes up through 2019, so it doesn't
include changes due to COVID-19.

All these rapid changes coincide with what,

Twenge says, may be the most rapid uptake in
a new technology in human history: the
incorporation of smartphones into our lives,
which has allowed nearly nonstop
engagement with social media apps. Apple
introduced the first iPhones in 2007, and by
2012, about 50% of American adults owned a
smartphone, the Pew Research Center found.

The timing is hard to ignore, says data

scientist Chris Said, who has a Ph.D. in
psychology from Princeton University and
has worked at Facebook and Twitter. "Social
media was like a nuclear bomb on teen social
life," he says. "I don't think there's anything
in recent memory, or even distant history,
that has changed the way teens socialize as
much as social media."

Murky picture becomes clearer on

causes of teen depression
But the timing doesn't tell you whether social
media actually causes depression in teens.

In the past decade, scientists have published

a whole slew of studies trying to answer this
question, and those studies sparked intense
debate among scientists and in the media.
But, Said says, what many people don't
realize is scientists weren't using — or didn't
even have — the proper tools to answer the
question. "This is a very hard problem to
study," he says. "The data they were analyzing
couldn't really solve the problem."

MENTAL HEALTH

The mental health of teen girls and LGBTQ+

teens has worsened since 2011

So the findings have been all over the place.

They've been murky, noisy, inconclusive and
confusing. "When you use tools that can't
fully answer the question, you're going to get
weak answers," he says. "So I think that's one
reason why really strong evidence didn't show
up in the data, at least early on."

On top of it, psychology has a bad track

record in this field, Said points out. For
nearly a century, psychologists have
repeatedly blamed new technologies for
mental and physical health problems of
children, even when they've had little — or
shady — data to back up their claims.

For example, in the 1940s, psychologists

worried that children were becoming
addicted to radio crime dramas, psychologist
Amy Orben at the University of Cambridge
explains in her doctoral thesis. After that,
they raised concerns about comic books,
television and — eventually — video games.
Thus, many researchers worried that social
media may simply be the newest scapegoat
for children's mental health issues.

A handful of scientists, including MIT's

Alexey Makarin, noticed this problem with
the data, the tools and the field's past failures,
and so they took the matter into their own
hands. They went out and found better tools.

Hundreds of thousands of more

college students depressed
Over the past few years, several high-quality
studies have come that can directly test
whether social media causes depression.
Instead of being murky and mixed, they
support each other and show clear effects of
social media. "The body of literature seems to
suggest that indeed, social media has negative
effects on mental health, especially on young
adults' mental health," says Makarin, who led
what many scientists say is the best study on
the topic to date.

In that study, Makarin and his team took

advantage of a once-in-a-lifetime
opportunity: the staggered introduction of
Facebook across U.S. colleges from 2004 to
2006. Facebook rolled out into society first
on college campuses, but not all campuses
introduced Facebook at the same time.

For Makarin and his colleagues, this

staggered rollout is experimental gold.

"It allowed us to compare students' mental

health between colleges where Facebook just
arrived to colleges where Facebook had not
yet arrived," he says. They could also measure
how students' mental health shifted on a
particular campus when people started to
spend a bunch of their time on social media.

Luckily, his team could track mental health at

the time because college administrators were
also conducting a national survey that asked
students an array of questions about their
mental health, including diagnoses, therapies
and medications for depression, anxiety and
eating disorders. "These are not just people's
feelings," Makarin says. "These are actual
conditions that people have to report."

They had data on a large number of students.

"The data comes from more than 350,000
student responses across more than 300
colleges," Makarin says.

This type of study is called a quasi-

experiment, and it allows scientists to
estimate how much social media actually
changes teens' mental health, or as Makarin
says, "We can get causal estimates of the
impact of Facebook on mental health."

So what happened? "Almost immediately

after Facebook arrives on campus, we see an
uptick in mental health issues that students
report," Makarin says. "We especially find an
impact on depression rates, anxiety disorders
and other questions associated with
depression in general."

And the effect isn't small, he says. Across the

population, the rollout of Facebook caused
about 2% of college students to become
clinically depressed. That may sound modest,
but with more than 17 million college
students in the U.S. at the time, that means
Facebook caused more than 300,000 young
adults to suffer from depression.

For an individual, on average, engaging with

Facebook decreases their mental health by
roughly 22% of the effect of losing one's job,
as reported by a previous meta-analysis,
Makarin and his team found.

Facebook's rollout had a larger effect on

women's mental health than on men's mental
health, the study showed. But the difference
was small, Makarin says.

He and his colleagues published their

findings last November in the American
Economic Review. "I love that paper," says
economist Matthew Gentzkow at Stanford
University, who was not involved in the
research. "It's probably the most convincing
study I've seen. I think it shows a clear effect,
and it's really credible. They did a good job of
isolating the effect of Facebook, which isn't
easy."

Of course, the study has limitations,

Gentzkow says. First off, it's Facebook, which
teens are using less and less. And the version
of Facebook is barebones. In 2006, the
platform didn't have a "like" button" or a
"newsfeed." This older version probably
wasn't as "potent" as social media now, says
data scientist Chris Said. Furthermore,
students used the platform only on a
computer because smartphones weren't
available yet. And the study only examined
mental health impacts over a six-month
period.

Nevertheless, the findings in this study

bolster other recent studies, including one
that Gentzkow led.

Social media is "like the ocean" for

kids
Back in 2018, Gentzkow and his team
recruited about 2,700 Facebook users ages 18
or over. They paid about half of them to
deactivate their Facebook accounts for four
weeks. Then Gentzkow and his team looked
to see how a Facebook break shifted their
mental health. They reported their findings in
March 2020 in the American Economic
Review.

This type of study is called a randomized

experiment, and it's thought of as the best
way to estimate whether a variable in life
causes a particular problem. But with social
media, these randomized experiments have
big limitations. For one, the experiments are
short-term — here only four weeks. Also,
people use social media in clusters, not as
individuals. So having individuals quit
Facebook won't capture the effect of having
an entire social group quit together. Both of
these limitations could underestimate the
impact of social media on an individual and
community.

Nevertheless, Gentzkow could see how

deactivating Facebook made people, on
average, feel better. "Being off Facebook was
positive across well-being outcomes," he says.
"You see higher happiness, life satisfaction,
and also lower depression, lower anxiety, and
maybe a little bit lower loneliness."

Gentzkow and his team measured

participants' well-being by giving them a
survey at the end of the experiment but also
asking questions, via text message, through
the experiment. "For example, we sent people
text messages that say, 'Right now, would you
say you're feeling happy or not happy,'" he
explains.

Again, as with Makarin's experiment, the

effect was moderate. Gentzkow and his
colleagues estimate that temporarily quitting
Facebook improves a person's mental health
by about 30% of the positive effect seen by
going to therapy. "You could view that
meaning these effects are pretty big," he
explains, "or you could also see that as
meaning that the effects of therapy are
somewhat small. And I think both of those
things are true to an extent."

Scientists still don't know to what extent

social media is behind the rising mental
health issues among teenagers and whether it
is the primary cause. "It seems to be the case
— like it's a big factor," says MIT's Alexey
Makarin, "but that's still up for debate."

Still, though, other specifics are beginning to

crystallize. Scientists are narrowing in on
what aspects of social media are most
problematic. And they can see that social
media won't hurt every teen — or hurt them
by the same amount. The data suggests that
the more hours a child devotes to social
media, the higher their risk for mental health
problems.

Finally, some adolescents are likely more

vulnerable to social media, and children may
be more vulnerable at particular ages. A study
published in February 2022 looked to see
how time spent on social media varies with
life satisfaction during different times in a
child's life (see the graphic).

Teen social media use and

life satisfaction
An analysis of British survey data found a relationship between
social media use and lower life satisfaction in certain
age/gender groups — for example, among 12-to-14-year-old
girls. Life satisfaction ratings are on a scale of 1 to 7, with 7
meaning completely happy or satisfied. For social media use,
respondents were asked about their habits on a
typical weekday.

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