Problematic patterns of digital media use — including compulsive social media scrolling, gaming, or phone checking — may be more harmful to adolescent mental health than overall screen time, new research suggested.

Investigators found that teens with high or increasing levels of addictive digital use were more likely to report symptoms of depression, anxiety, and suicidal thoughts or behaviors. In contrast, total screen time showed no consistent link to mental health outcomes.

The findings support emerging evidence that addictive screen use may be a more salient risk factor for suicidality and mental health in adolescents, the researchers, led by Yunyu Xiao, PhD, Department of Population Health Sciences, Weill Cornell Medicine/New York Presbyterian, noted.

The study was published online on June 18 in JAMA.

Filling a Data Gap

Previous research has largely focused on total screen time rather than longitudinal addictive use trajectories.

To address this gap, the investigators analyzed 4 years of data from 4285 children (mean age, 10 years; 48% women) participating in the Adolescent Brain Cognitive Development study.

Validated self-report questionnaires were used to assess and track addictive use of social media, cell phones and video games, including compulsive habits, distress when not using these platforms, and failed attempts to cut back.

The researchers used latent class linear mixed models to identify different trajectories of addictive screen use and classify adolescents into subgroups based on their screen use patterns over time.

They found that nearly one third of participants had an increasing addictive use trajectory for social media or mobile phones starting at age 11 years.

In adjusted models, increasing addictive use trajectories were associated with higher risks for suicide-related outcomes than low addictive use trajectories. Increasing addictive use of social media had a risk ratio of 2.14 for suicidal behaviors.

Likewise, high addictive use trajectories across all screen types were associated with suicide-related outcomes. High-peaking addictive use of social media conferred a risk ratio of 2.39 for suicidal behaviors.

Adolescents with high-peaking or increasing social media use or high video game use also had more internalizing symptoms such as depression/anxiety or externalizing symptoms such as aggression and rule-breaking.

Notably, there was no significant correlation between baseline total screen time and any suicide-related or mental health outcomes.

Adolescence — a Risky Time

The authors of a linked editorial noted that adolescence is a vulnerable time for addictive behaviors in general and that young adolescents are particularly susceptible to screen addiction.

They pointed out that the current study underscores the “growing concern” around addictive screen use and its significant impact on the mental health of young people.

“While most interventions focus on limiting or monitoring screen time, the current study suggests that preventive strategies may also target trajectories or patterns of addictive screen use,” wrote Jason Nagata, MD, Christiane Helmer, MPH, and Abubakr Al-Shoaibi, PhD, with University of California, San Francisco.

“These results emphasize the importance of addressing not just screen time but also addictive behaviors in adolescents” and the need to “conceptualize screen time and addictive use as separate constructs, particularly when examining associations with mental health outcomes,” the editorialists added.

Experts Weigh In

Several experts offered perspective on the study in a statement from the UK nonprofit Science Media Centre.

Lisa Henderson, PhD, head of the Department of Psychology, University of York, York, England, called the study “critical and timely” and one that contributes a “much-needed large-scale longitudinal analysis to the debate on digital harms in young people.”

The fact that 1 in 2 adolescents had a high addictive use trajectory for video games, 1 in 3 for social media, and 1 in 4 for mobile phone use, is “alarming, although some caution should be taken in extrapolating these findings to now given this study spanned the pandemic,” Henderson commented.

She also noted that the study did not directly address “bidirectionality — that young people at greater risk of mental health problems may be more likely to turn to digital activities such as video gaming and social media, with this in turn feeding a further downward spiral in mental health.”

Chris Ferguson, PhD, professor of psychology, Stetson University, DeLand, Florida, highlighted two takeaways from the study — one is that time spent on screens does not predict mental health, and the other is that for some kids overusing screens can be a red flag for other problems.

Ferguson said it would be “a mistake to think that removing screens would solve those problems…; this study doesn’t show that. However, screen overuse can be a sign that kids are stressed in other areas. Other studies suggest this typically comes from schools and families, not the screens themselves.”

Amy Orben, DPhil, with the MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, England, said the study “importantly highlights that why and how young people use technologies, and how they feel technologies affect their lives, may matter more to their mental health than the time spent online. As those reporting such issues are not a small proportion of the population, supporting them should be taken seriously.”

This study was supported by grants from the National Institute of Mental Health, the American Foundation for Suicide Prevention and Google. Xiao and the editorial writers, Henderson and Ferguson, reported no relevant disclosures. Orben is a paid member of the Digital Futures for Children Centre Advisory Board and has received payment for lectures from SWGfL and Apple University, and consulting fees from Innovate UK through Opalescent Ltd.