Social Media and Depressive Symptoms in Childhood and Adolescence a Systematic Review
Review
Abstract
Background: Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews accept indicated their possible preventive issue.
Objective: The aim of this review was to synthesize the current evidence on the association between MTSM employ and the development or prevention of depressive disorders in adolescents.
Methods: An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM employ were included. Screening of titles, abstracts, and full texts was performed. Afterward selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out.
Results: The search retrieved 338 documents, from which seven systematic reviews (3 meta-analyses) were selected for information extraction. There were 11-70 studies and 5582-46,015 participants included in the vii reviews. All reviews included quantitative research, and ii reviews besides included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results.
Conclusions: Excessive social comparison and personal interest when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assist for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger show.
doi:10.2196/16388
Keywords
Introduction
Depression is one of the most oftentimes occurring mental diseases worldwide, generating significant disability, dependence, and expenditure for health systems [-]. Equally shown in previous literature [-], adolescence is a particularly relevant period for developing depressive disorders. It should be noted that during adolescence, depressive symptomatology may exist broader than in adulthood, manifesting itself through irritability, aggression, avoidance, or other behaviors in addition to the typical depressive behaviors []. Furthermore, during this period, young people tin can be peculiarly influenced by sociocontextual factors, such as the employ of mobile technologies and social media (MTSM). However, the effect of the exposure to these technologies on the development of depressive disorders in this age group remains unclear.
The utilise of MTSM has profoundly increased over recent years, especially since the 1990s, and adolescents can at present exist considered "digital natives," pregnant they take been exposed to mobile devices and technologies like cellphones or tablets since birth [-]. This generalized exposure to social media implies a change in the mode adolescents interact and communicate, naturally integrating the use of these technologies inside their schemes of social perception [,]. Therefore, the use of MTSM could exist particularly relevant, given the potential influence on adolescents' health, specifically their mental health and the development or prevention of depression.
One of the main uses of MTSM amongst adolescents is advice and social interaction with their peer groups through various means, including instant messaging apps (eg, WhatsApp and social networks). A few that stand out for their use in this population are Instagram, Snapchat, Twitter, and Facebook [,]. Using MTSM could show beneficial in the sense that they may promote creativity, increment presence and social participation, and provide adolescents with quick access to different types of information, including that related to promoting salubrious behaviors and habits [,,]. However, the use of MTSM could also be related to problems similar addictive internet behavior, absenteeism and failure in schoolhouse, deterioration of family relationships and friendships, and different physical and mental wellness bug (including self-inflicted bodily impairment, eating disorders, and low) [,,]. Furthermore, MTSM use may also promote behavior that is damaging to wellness including, amidst other things, autolytic behavior, suicide, violence, and specific harmful behaviors such as cyberbullying, grooming, or sexting that are derived from the utilize of these technologies. Despite the affluence of literature, including systematic reviews and meta-analyses, near of the existing evidence is based on cross-sectional studies or surveys. Pooling or synthesizing data and using the broadest possible approach (eg, an umbrella review) could be valuable in determining the current knowledge on whether the utilise of MTSM is the crusade or consequence of depressive symptomatology.
Although there is a wide diverseness of advantages and disadvantages that the use of new technologies can nowadays for young people, the influence that their utilise could have on developing depression is unclear. Therefore, the aim of this review was to synthesize the bear witness available on the clan (intensity and direction) between depression and the apply of MTSM in adolescents.
Methods
Study Design and Information Sources
An umbrella review on the association betwixt the utilise of MTSM and depression was conducted, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA), and registered in PROSPERO. The following databases were used as sources of information: PubMed/MEDLINE, PsycINFO, Web of Science, and Cochrane Reviews. All documents included in these databases published up to June 2019 were considered.
A search filter () was specifically designed to reach the study objectives, taking into account pathology, target population, exposure (social network OR social media OR mobile phone OR *phone), and the languages in which the search was performed. Afterwards carrying out a preliminary search and observing the number of systematic reviews and meta-analyses institute equally well equally the differences between the studies, an additional filter for study design was included. The filter was designed for PubMed/MEDLINE and adjusted for other databases. The search strategy was based on previous studies in other areas with the intention of maximizing the number of identified documents [,]. In improver, the references in the final selected studies were used to place other systematic reviews and meta-analyses, and key authors were contacted.
Inclusion and Exclusion Criteria
The PICO (Population, Intervention, Comparison, and Result) criteria were used to identify and include reviews in English that focused on the boyish population (up to 20 years old), low (in a broad sense, not specific diagnoses similar major depressive disorder or dysthymia), and the possible relationship between low and the use of MTSM.
Reviews that included studies with participants older than 20 years and studies that did not differentiate the effect by age group, if they included people older than xx years, were excluded. Due to difficulties in extrapolating the results for the general adolescent population, studies on genetic or environmental factors and studies carried out in specific population groups, like those with specific characteristics or pathologies (eg, attention deficit hyperactivity disorder), were excluded. Finally, studies focusing on treatments administered through an electronic device or the cyberspace as well as opinion articles and proposals with theoretical or conceptual frameworks that were not based on a systematic literature review or meta-analysis were also excluded.
Review Procedure
A review of titles, abstracts, and full texts was carried out independently past 2 expert reviewers (JAT and XG), and discrepancies were resolved by a third researcher (EP) with expertise in conducting systematic reviews. After written report selection, a synthesis of the bear witness obtained from the 7 selected reviews was carried out. The quality of each review was considered by taking into account the quality of the studies evaluated and the tools used to assess the studies. Owing to heterogeneity in the characteristics of the studies and in the presentation of outcome variables and exposures, a meta-analysis of the results was not possible; therefore, a narrative synthesis of the results was carried out. Information from the included reviews was extracted and summarized in ii tables of testify [].
Results
The search retrieved 338 articles (154 from PubMed, 80 from the Cochrane Library, 41 from PsycINFO, 55 from Spider web of Science, and eight from a transmission search). After removing 34 duplicates, a total of 304 studies were deemed potentially eligible. The full text of 20 documents was reviewed, and xiii articles were excluded (7 non-systematic or narrative reviews, five documents based on other pathologies, and one for the disability to differentiate between results reported for adults versus adolescents). Finally, vii systematic reviews were selected for data extraction () [,-].
shows the characteristics of the included systematic reviews, all of which were published between 2014 and 2019. In these reviews, PsycINFO, Medline, and CINAHL databases were searched most frequently. Two reviews explored dissertations and thesis databases [,]. Most reviews assessed the relationship between low and apply of social networks in full general [,,,] or problematic Facebook utilize in particular []. 1 written report by Wu et al [] reviewed the association between internet use in general and low. Wellbeing, anxiety, and loneliness were besides assessed in two reviews [,]. At that place were xi-lxx studies and 5582-46,015 participants included in the reviews. Near studies included in the reviews were quantitative and used cross-sectional and survey-based data. While ii reviews used specific criteria developed by the authors to assess the quality of studies [,], four used validated cess tools [,,,], and 1 did non specify the tool []. In add-on, 2 meta-analyses were included [,].
shows the results of the included reviews. 4 studies were undertaken specifically with adolescents (historic period range ten-21 years) [,,,]. Seabrook et al [] also included adults in their review (2 studies with adults and xviii studies with the general population), and Marino et al [] reported a mean age range of sixteen.5-32.iv years. While 2 reviews reported a positive clan betwixt depressive symptoms and social media apply (overall random effects pooled estimate: r=0.13, 95% CI 0.05-0.two) [] and problematic Facebook use (r=0.34, 95% CI 0.28-0.39) [], the other 5 reviews reported mixed associations between social media use and depression. Keles et al [] reported a positive clan for the relationships betwixt fourth dimension spent on social media and depression and between social media addiction and depression. Two reviews reported a gender influence with mixed furnishings []. McCrae et al [] found that iv studies reported girls having more than depressive symptoms related to social media use and 2 studies showed that boys were more than likely to show depressive symptoms. The residue of the studies included in their review did not show a gender issue. In the review by Keles et al [], one written report establish that social media might have negative effects in girls simply could exist considered a positive leisure activity for boys, and 2 studies did not testify gender effects. In addition to mixed results for the associations betwixt social media use and wellbeing, associations with anxiety and loneliness were also found [,,].
| Author (year) | Objective of the review | Databases searched | Number of studies included | Number of participants | Quality assessment of studies included | Methodology |
| Best et al (2014) [] | To appraise the touch on of social media use on mental wellbeing in young people | ASSIAa, Communication abstracts, CINAHL, ERICb, Medline (Ovid), PsycINFO (Ovid), SCOPUS, SSCIc | 43 | NSd | Specific criteria developed by the authors of the review | 32 quantitative, 9 qualitative, 2 mixed methods or others |
| Wu et al (2016) [] | To examine the clan betwixt internet use, social connection, and levels of depression, anxiety, and loneliness | CINAHL, ERIC, Psychology and Behavioral Serial Collection, Scientific discipline and Engineering science Drove, EBSCO social sciences database | 12 | 5582 | Specific criteria developed by the authors of the review | 9 quantitative (all cross-sectional), i mixed methods, and 2 qualitative |
| Seabrook et al (2016) [] | To examine the relationship between the use of social networks and depression and anxiety as well as links with wellbeing and potential mediators and moderators of these relationships | PsycINFO, MEDLINE (Ovid), Scopus, IEEE Xplore, CINAHL, Education Resources Information Center, SSCI, Communication and Mass Media Complete | 70 | 46,015 | Adaptation of the Cochrane bias tool | NS |
| McCrae et al (2017) [] | To examine the association between social media (websites used primarily for social interaction) and low or depressive symptoms | Medline, PsycINFO, EMBASE | 11 | 12,646 | Robins-Ie, Cochrane Collaboration Methods Group Tool to assess risk of bias in accomplice studies | Quantitative (7 cross-exclusive, 4 longitudinal) |
| Marino et al (2018) [] | To examine the clan betwixt Facebook utilise (problematic, abusive, overuse, compulsive) and psychological disorders in adolescents and immature adults | PsycINFO, PubMed, Scopus, ResearchGate, Google Scholar, Dissertation Abstracts International, Pro-Quest Dissertations and Theses Open, Open up Admission Theses and Dissertations | 23 | 13,929 | Specific criteria adult by the authors of the review | Quantitative |
| Keles et al (2019) [] | To examine the influence of using social networks on low in adolescents | PsycINFO, Medline, EMBASE, CINAHL, SSCI | 13 | 21,231 | NIHf | Quantitative (12 cross-exclusive, 1 longitudinal) |
| Yoon et al (2019) [] | To examine the relationship between the apply of social networking sites and depression | PsycINFO, PubMed, ProQuest Dissertations & Theses Global | 55 | 22,099 | NS | Quantitative |
aASSIA: Applied Social Sciences Index and Abstracts.
bERIC: Educational activity Resource Information Center.
cSSCI: Social Sciences Commendation Alphabetize.
dNS: not specified.
eHazard of bias tool to assess nonrandomized studies of interventions.
fNIH: National Institutes of Health Quality Cess Tool for Observational Cohort and Cantankerous-Exclusive Studies.
| Author (year) | Sample (number of studies) or age (years) | Use of MTSMa | Association(s) | Gender effect | Other associations |
| Best et al (2014) [] | Adolescents (age range not specified) | Communication and social interaction | Mixed results in the association of social media technologies and depression | Does not distinguish nor consider this factor | Mixed results on self-esteem, social support, loneliness, and cyberbullying |
| Wu et al (2016) [] | 10-21 | Use of cyberspace and related technologies | one of five studies plant that social media technology apply can lead to depressive feelings; 4 of v studies did non find an association. | Takes into business relationship the population of the studies (10 mixed gender, 2 only boys), simply not in terms of the results | Mixed results on social connectivity, anxiety, and loneliness |
| Seabrook et al (2016) [] | Adolescents (eight), immature adults (40), general population (18), adults (two), clinical low (1), others (1) | Utilize of social networks | Mixed results: positive interactions, social support, and connectivity in social networks related with lower levels of depression; negative interactions and social comparing related with higher levels of depression | Not considered as a variable in the included studies simply considered in the discussion of the results | Mixed results for anxiety and wellbeing |
| McCrae et al (2017) [] | 10-17 (ane study included "loftier school students" but did non specify age range) | Apply of social media | Small but statistically significant overall correlation between social media use and depressive symptoms | four studies establish that girls had more depressive symptoms related to social media use; two studies showed that boys were more than likely to show depressive symptoms; the residue showed no gender differences | NSb |
| Marino et al (2018) [] | Mean 21.9 (SD 3.97); 16.5-32.4 (mean age range) | Problematic Facebook use | Association between problematic Facebook utilize and depression | Proportion of girls (lx.7%) did not moderate the effect | Correlation between problematic Facebook apply and psychological distress was greater in samples with a higher hateful age. |
| Keles et al (2019) [] | xiii-xviii | Time spent, activity (quality and quantity of user's engagement and interaction with social media sets and other users), investment (fourth dimension spent on social media), addiction (state of being dependent on social media) | Time spent: 1 study showed association, i did not, 2 did not notice association; activity: ii studies showed positive association, and 1 did not; investment: 3 studies showed association; addiction: 3 studies showed positive association | 4 studies measured the effect of gender betwixt social media–related variables and mental health outcomes. two studies did not detect effects on gender, while 1 found that social media might accept negative effects in girls and can be considered a positive leisure activity for boys. Facebook had a negative impact on both genders. | There was a relationship between historic period, heavy social media utilize, and negatively internalizing symptoms. Younger adolescents were more likely to experience internalizing symptoms (being anxious, depressed, withdrawn). Nigh studies highlighted the fact that the relationships observed were too complex for straightforward statements and mediating and moderating factors should be taken into account. |
| Yoon et al (2019) [] | 17.83-24.76 (hateful age range) | Use of SNSc: time spent and SNS checking; social comparison and "upward" social comparison | Positive statistically pregnant difference between depression and time spent on its employ, frequency of use, social comparison, and "upwards" comparison | No deviation | NS |
aMTSM: mobile technologies and social media.
bNS: not specified.
cSNS: social networking sites.
Give-and-take
The results from the included reviews suggest that social comparison and excessive personal involvement by adolescents when using MTSM could exist related to the evolution of depressive symptoms. However, the use of MTSM when properly adapted could besides promote healthy behaviors, better social support, and even become a point of access of information and help for adolescents at risk of depression.
Both mobile technologies and social media are important aspects of how nosotros interact today and have transformed the way in which the generations adopting MTSM and digital natives communicate [,]. The use of MTSM presents dandy opportunities in terms of creativity and means of learning but tin can also entail certain risks such equally isolation and restricted social interaction. Despite this, studying the possible effects on wellness, specifically on depression, of adolescents using MTSM is a relatively recent phenomenon. As such, it should exist noted that all reviews included in this report were published in the concluding v years.
The evidence from dissimilar studies published until now, and particularly since 2017, suggests a positive and meaning association between some aspects of social media utilize and the presence of depressive symptoms among adolescents [-]. Two relevant factors that increased the magnitude of this association were the problematic utilize of social networks and excessive social comparison [-]. There is less relevant testify pointing to other factors related to the undesirable furnishings of social networks, like a higher level of personal involvement on the networks, defined as the caste of exposure and personal information that adolescents publish on networks or the exposure to content that promotes depressive-like behaviors [,]. Finally, it is worth mentioning that a loftier volume of studies indicating associations between the use of social networks and other undesirable effects like feet, harassment, or internet or smartphone addiction was identified [,,-]. Regarding internet habit, the total usage time, frequency of consultation, and other variables related to backlog use, both in frequency and time, may be more than relevant than the variables found in this study, which focus specifically on depressive symptomatology.
Information technology should be noted that the affect of the identified factors, particularly of social comparison, on the development of depression might be afflicted by the level of the welfare and wealth of the family [-]. Appropriately, those who are from families with lower socioeconomic status might take a loftier run a risk of developing depression when exposed to more wealthy people. In addition, these factors might be specially related to the development of some specific depressive symptoms (eg, sleep bug or macerated ability to retrieve or concentrate). Further longitudinal research focused on specific factors, like family environment, and accounting for specific depressive symptoms might be valuable in preventing the potential evolution of depression in MTSM users.
Emphasizing the fact that social networks do not necessarily imply a negative touch on young people'south moods, other studies accept described the desirable effects that social media use might take [,,]. In this sense and in line with the results of these studies, the evidence found in this study suggests that social networks can promote social support and even become points of admission to data and help for people with depressive disorders [,]. As suggested, the use of MTSM under adult supervision might be related to promoting healthy apply of MTSM, equally well as preventing possible negative consequences that arise similar depressive symptomatology []. In addition, the use of new technologies could facilitate young people's connection with multiple social circles, reducing their perception of loneliness or isolation [].
Some studies identified differences between boys and girls in the bear upon that social networks have on developing depressive symptoms. Previous research proposed [] that the prevalence of intensive use of mobile technologies might be greater in women than in men. Furthermore, the utilise of mobile technologies could exist mainly for relational purposes amidst teenage women and instrumental or for leisure among teenage men, making women more likely to be exposed to the effects of social networks [,,]. Although the meta-assay by McCrae et al [] did not determine a theoretical footing for the potential differences, there are some studies included within the analysis and one study included in the systematic review by Keles et al [] that show a greater correlation between social comparison and low in women. This might let usa to hypothesize that focusing preventive measures on social comparison in adolescent women and on leisure platforms, like gaming platforms, in adolescent men could be effective in preventing the undesirable furnishings of social networks and mobile engineering apply among adolescents. Further research aimed at proving this hypothesis could be valuable.
Several limitations of the current study deserve discussion. First is the lack of longitudinal or experimental prove in relation to the use of social networks and mobile technologies and their affect on depressive symptomatology. In this sense, most of the studies included in the literature reviewed were cross-sectional and survey-based, precluding the establishment of causal relationships between variables. As such, it is difficult to make up one's mind whether the use of social networks and mobile technologies is the cause or consequence of depressive symptomatology, and further longitudinal studies to test these hypotheses could be valuable. We should as well mention the possible heterogeneity of health problems and of the patterns made or activities observed in the studies when using MTSM. While some were focused on clinical low diagnosed past a professional person, others were focused on less valid depression criteria, which could limit the comparability of the reviews included. Furthermore, some of the reviews included cyberspace addicts. Despite this, the wide aim of this review was to determine the human relationship betwixt depressive disorders and the use of MTSM, which we consider completed through the studies included in this commodity, independent of the depression metrics and specific populations used in the selected reviews.
Another limitation is the lack of solid evidence or a conceptual framework on the specific behaviors, like online gaming or uploading photos to social networks, that could be related to depressive symptomatology. This lack of evidence may be due to the relative novelty of the social network phenomenon and the shortage of valid, reliable health information pertaining to it. However, certain behaviors that could be related to the development of low as a protective cistron were identified, like searching for assist or preventive information. Another limitation is that only reviews in English language were included, maybe omitting scientific literature written in other languages. Finally, nosotros should mention the limitation of having actively excluded studies on cyberbullying, habit to new technologies, or other symptoms and harmful behaviors that could exist part of or related to a depressive illness. Given their importance and the abundance of prove on these phenomena, these behaviors deserve to be treated as separate entities, and, as previous inquiry suggests, specific reviews should exist performed on these behaviors [,].
In conclusion, our study shows that, during boyhood, the utilise of MTSM and particularly excessive social comparison and personal involvement when using it could be associated with developing depressive symptomatology. Nevertheless, the adaptive utilise of MTSM could likewise assist prevent the development of depression, promote social back up, and fifty-fifty become a signal of information admission and assist for people with depressive disorders or symptoms. Other variables, like fourth dimension spent on the net and social networks, the frequency of consultation, and factors related to backlog use, both in frequency and in fourth dimension, may be more relevant in developing other problems like cyberspace addiction. Due to the heterogeneity in methodology and the contradictory findings from the reviews included in this umbrella review, prospective research, especially longitudinal cohort studies and randomized controlled trials, could be valuable in providing stronger show on these relationships.
Acknowledgments
Nosotros acknowledge Antoni Parada and Kayla Smith for their support and CIBER Epidemiology and Public Health (CIBERESP) for its funding.
Conflicts of Involvement
None declared.
Abbreviations
| ASSIA: Applied Social Sciences Index and Abstracts |
| ERIC: Education Resource Data Middle |
| MTSM: mobile technologies and social media |
| NIH: National Institutes of Health Quality Cess Tool for Observational Cohort and Cross-Sectional Studies |
| NS: not specified |
| PICO: Population, Intervention, Comparison and Effect |
| PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria |
| SSCI: Social Sciences Citation Index |
Edited by Thousand Eysenbach; submitted 25.09.19; peer-reviewed by KB Lankarani, D Saleh, C Summers, A Benetoli; comments to author 14.05.20; revised version received 21.05.twenty; accepted 03.06.20; published 26.08.20
Copyright©Jorge Arias-de la Torre, Elisa Puigdomenech, Xavier García, Jose M Valderas, Francisco Jose Eiroa-Orosa, Tania Fernández-Villa, Antonio J Molina, Vicente Martín, Antoni Serrano-Blanco, Jordi Alonso, Mireia Espallargues. Originally published in the Journal of Medical Net Enquiry (http://www.jmir.org), 26.08.2020.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/four.0/), which permits unrestricted utilize, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic data, a link to the original publication on http://www.jmir.org/, as well every bit this copyright and license information must be included.
Source: https://www.jmir.org/2020/8/e16388/
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