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Over the last decade, the deterioration in mental-emotional health among U.S. children and adolescents has generated alarm, and concerns have centered around one cause in particular. Escalating rates of youth anxiety and depression and, in turn, suicidal thoughts and behaviors have been linked to the amount of time spent on various forms of screen media—perhaps most notably social media and video games.

Research on how engagement with smartphones, tablets, and video-game consoles affects youth mental health has previously focused on total screen time. However, it turns out that the total amount of times kids and teens spend on screen technology may be less important than the nature of their relationship with that technology.

New research published in JAMA that followed more than 4,000 children across the country demonstrated an unexpected outcome: More hours per day, or greater overall screen time, among 10-year-olds was not directly associated with higher rates of suicidal ideation/behavior at age 14.

Instead, the study found that the youth at higher risk were those who self-reported that they believed their use of screen technology had become addictive. Addictive use, in the study, was defined by kids’ self-reported compulsive use, difficulty disengaging, and emotional distress when not using these technologies. Importantly, some exhibited these behaviors even when their total screen time was comparatively low.

Researchers found compulsive screen-related behavior to be common among children/teens—especially in their use of smartphones, where nearly half demonstrated such use. By age 14, children with high or increasing compulsive screen use were two-to-three times as likely as other children to have thoughts of suicide or of harming themselves.[1]

The study analyzed changes in screen use among 4,285 children beginning at age 10, regularly assessing them for compulsive use, difficulty disengaging, and distress when not given access to screen technology. At age 14, 31.3 percent showed increasing compulsive use related to social media (TikTok, YouTube, Instagram, Facebook), and 24.6 percent for mobile smartphones.

Both high and increasing compulsive screen use was associated with measurably worse mental health. Youths with high levels of such use of social media showed the largest increase in externalizing symptoms like aggression and rule-breaking, while those with high compulsive video game use had the largest increase in anxiety and depression. Moreover, high or increasing compulsive screen use correlated with elevated risks of suicidal ideation and behavior compared with lower use. Among the children in the study, 17.9 percent experienced suicidal ideation and 5.1 percent demonstrated suicidal behavior, such as attempting suicide or taking steps toward preparing for an attempt.

For nearly half of the children in the study, self-reported addictive smartphone use was consistently high from age 11; another 25 percent began with low addictive use that increased significantly. Notably, 30 to 40 percent of kids who started with low self-reported addictive use at age 10 progressed to higher levels by age 14.

Unfortunately, addictive engagement is a feature rather than a “bug” of screen media and its technology. In interviews, former engineers who participated in the development of this technology have described it as being specifically designed to facilitate and maintain users’ obsessive-compulsive involvement.

Indications of Compulsive Use

Screen use—the time spent engaging with electronic devices such as mobile smartphones, tablets, and video game consoles—becomes compulsive when individuals’ attention is increasingly focused on it as evidenced by engaging with it obsessively (through thinking) and compulsively (through acting), experiencing difficulty stopping or refusing to stop, along with tolerance (needing more or more intensive screen use over time) and/or withdrawal discomfort/reactions when screen use is not accessible.

Screen-use addiction is not a recognized condition in the DSM-5, but drawing on DSM-5 criteria for other forms of addiction, including gambling and substance use disorders, the defining features of screen use addiction for children and teens would center around screen use behavior that disrupts personal, family, social, and/or academic pursuits. Specific signs would include:

Preoccupation with using social media, video gaming, or other forms of screen media.

Engagement with screen media is an increasing priority, interfering with obligations at home or school, and supplanting other interests and activities (including sleep).

Emotional distress (frustration, anger, anxiety, highly charged/over-the-top reactions, tantruming) is evident when adults attempt to limit screen use.

Lying to minimize or deny the extent of involvement with screen use.

Restlessness or irritability when attempting to cut down or discontinue screen use.

The essential features of screen use withdrawal involve distress that occurs in reaction to the discontinuation or significant reduction of screen use, such as:

Irritability, anger, or aggression

Nervousness or anxiety

Sleep difficulty (e.g., insomnia)

Decreased appetite or weight loss

Restlessness

Depressed mood

Despite this new research, public health concerns related to youth screen use are likely to continue to focus on screen time. After all, U.S. teens spend an average of 4.8 hours per day on social media platforms, according to a 2023 Gallup poll, the most recent year for which data is available.[2]

There remain inarguable mental-emotional health benefits to limiting screen time for children and teens. These include increased opportunity for real-life interactions with others, stronger social connections, greater present-centeredness, and attentional awareness. And there is evidence of success in limiting the screen engagement of children in familial as well as school environments. In addition to schools that have gone phone-free, there are reports of groups of parents whose children are friends that have banded together for support in reducing/limiting their children’s screen time by providing non-smartphones without online access.

Screen time itself remains a useful metric because it’s easier to measure and it crowds out important activities like sleep, exercise, and face-to-face socializing. That notwithstanding, the relationship kids and teens have with screen media may well matter more than the total amount of time they spend engaged with such technology.

Copyright 2025 Dan Mager, MSW