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Youth, smartphones and social media use

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Introduction

In this section, current research is presented on youth smartphone and social media use, two experiences that are highly connected given that smartphones are a primary way of accessing social media and social networking sites (Kuss & Griffiths, 2017). Although this is still an area of emerging research, this page will present some promising practices that you can incorporate into your work supporting young people. As new research becomes available, the information on this page will be updated.

Adolescence is the phase of life between childhood and adulthood, typically ages 10 to 19 (World Health Organization, n.d.). However, research into smartphones and social media can also include young people up to 24 years of age. Today’s youth, a generation of young people who are sometimes referred to as “Gen Z,” “Digital Natives” or “iGen,” have grown up using the Internet and other digital technologies from a very young age (Twenge, 2017). The way young people engage with technology today is an area that attracts discussion and debate. The term “addiction” is often used in the news media when referring to excessive technology use (Yu & Sussman, 2020). There has also been increased concern about this topic in recent years given the increased time spent online and using digital technologies during the COVID-19 pandemic (Masaeli & Farhadi, 2021).

It is important to note that there is no formal clinical diagnosis for smartphone, social media or Internet addiction in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) or the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2020). To date, only Internet gaming disorder has received formal recognition in the ICD-11 and has been included in the DSM-5 as a condition requiring further research (Parekh, 2018; World Health Organization, 2020).

At the Centre for Addiction and Mental Health (CAMH), we recommend using person-first language that reduces stigma and does not pathologize young people’s experiences. For example, “youth who engage with/have a relationship with technology” acknowledges both the beneficial and detrimental aspects of technology use. When a young individual is experiencing significant harms related to their technology use, we suggest using terms such as “youth experiencing” problem technology use (PTU), problem smartphone use (PSU) or problem social media use (PSMU). Using these terms rather than “addiction” can help to reduce stigma.

It also acknowledges how people’s relationship to technology can change across time and different contexts, and that there is no fixed, universal diagnostic criteria or threshold for harmful smartphone or social media use (Throuvala et al., 2019; Yu & Sussman, 2020). This is supported by the research that suggests moving away from an addiction framework and considers sociocultural contexts of technology use, balancing problematic use with functional, enjoyable use and an individual’s motivations for using technology (Panova & Carbonnell, 2018).

What does the evidence say?

Prevalence

The 2019 CAMH Ontario Student Drug Use and Health Survey is a longitudinal survey of the mental health and well-being of youth in Ontario. Although there are encouraging findings that show that the majority of Ontario students do not experience problem technology use, below are some key findings regarding youth technology use in Ontario (Boak et al., 2020):

The findings from this large, provincial survey were similar to those found across large-scale studies in the United States and internationally (Sohn et al., 2019; Twenge, 2017).

Negative impacts of PTU

In the last decade, across Ontario and North America, social media use has significantly increased in parallel with the number of children and adolescents reporting moderate to severe mental distress, including suicidal ideation or attempts (Abi-Jaoude et al., 2020; Boak et al., 2020). Today’s youth also report lower life satisfaction and higher rates of loneliness compared to previous generations (Fischer-Grote et al., 2021; Twenge, 2017). Although it is difficult for researchers to definitively say this rise in mental distress is related to the arrival of smartphone technology and social media, empirical, cross-sectional, longitudinal research links the increased prevalence in technology with depression, anxiety, chronic stress and low self-esteem (Abi-Jaoude et al., 2020; Elhai et al., 2017; Twenge, 2017).

Multiple systematic reviews of studies conducted across many countries (including the UK, China, Germany, Japan, Finland, Israel and the USA) have found that, for young people, excessive smartphone use was associated with an increased risk of depression and anxiety, high levels of perceived stress levels, and poor sleep quality and shorter sleep duration (Sohn et al., 2019; Thomée, 2018). Sleep quality, in particular, is thought to be negatively affected by technology use and can result in later bedtimes, sleep onset latency, shorter sleep duration, insomnia or sleep problems, reduced sleep quality and reduced daytime functioning due to tiredness (Thomée, 2018). Phone use around bedtime was also found to be associated with depressive symptoms, anxiety and stress, low self-esteem and, in some instances, reduced cognitive performance (Thomée, 2018).

Social media has also been shown to affect young people’s self-image and interpersonal relationships, promote social comparison, and facilitate cyberbullying and self-harming behaviours (Abi-Jaoude et al., 2020). Increased media multitasking (i.e., moving between multiple social media applications) can also negatively affect sleep, cognitive control, academic performance and socioemotional functioning (Abi-Jaoude et al., 2020). Young people today also have to navigate interacting with a range of potentially harmful content such as misinformation, conspiracy theories and deliberately polarizing content (Jiang et al., 2021).

A number of studies have highlighted that young females are more at risk of experiencing PSU, PSMU and cyberbullying than males (Boak et al., 2020; Twenge 2017; Yu & Sussman, 2020). They are also more likely to report mental distress, self-injuring behaviour and suicidality related to their smartphone or social media use (Abi-Jaoude et al., 2020).

Suicide. It is important to note that there is significant research linking problem technology use to increased risk of non-suicidal self-harming behaviours, suicidal ideation and exposure to harmful content or “challenges” online (Deslands & Coutinho, 2020; Thomée, 2018; Steinbüchel et al., 2018). These online challenges take place on social media platforms where young people are encouraged to take part in risky and/or self-harming behaviour and document it on the platform, sometimes triggering competition between individuals. An example of this would be ingesting harmful substances, such as the “Tide Pod Challenge” or drinking alcohol gel (Canadian Broadcasting Corporation, 2018; Deslands & Coutinho, 2020).

Data for young people in North America indicates that risk for suicide increases with screen time of two or more hours per day (five or more hours per day was linked to considerably higher risk for suicide; Twenge, 2017). One of the contributing factors to this risk might be that two thirds of young people who experience cyberbullying have at least one suicide risk factor (Twenge, 2017). However, being online can also provide young people facing these issues with access to online support communities, crisis support and reduced feelings of isolation (Marchant et al., 2017; Thomée, 2018).

Positive impacts

Some of the most apparent positive impacts of social media and smartphones are increased social connectedness, identity formation, access to information and entertainment (Kuss & Griffiths, 2017; Ryding & Kuss, 2020). For some young people, being online also meets a basic need for safety and connection when gathering in person may not feel safe or may not be feasible due to safety concerns from parents or caregivers (Kuss & Griffiths, 2017). Young people also use social media and online communities in creative ways to produce digital media on platforms such as YouTube, Instagram and TikTok. These online communities and opportunities to create meaningful digital content allow young people to acquire and co-create knowledge and contribute to social causes they feel passionately about, like stigma reduction (Zahn et al., 2014).

Regarding social media specifically, one systematic review found that social networking platforms can provide opportunities to find social support, form an identity, build self-esteem, and support communication and learning for youth at risk of or experiencing depression or other mental health concerns (Best et al., 2014; Rice et al., 2014). Social networking in these instances can increase self-esteem, create a sense of belonging and social support, and lower barriers to self-disclosure, therefore acting as a desirable alternative to traditional help-seeking behaviours (Best et al., 2014).

Social media sites can also offer micro-boosts to young people’s self-esteem when they experience receiving a friend request or being “liked” or “followed” by peers (Cole et al., 2017). Finding sources of social support online can also be particularly meaningful for young people who have weaker in-person social networks (Cole et al., 2017). Online friends can be an important source of social support, particularly for 2SLGBTQ+ youth (Ybarra et al., 2015). However, it is important to note that rates of online peer victimization and sexual victimization are also particularly high among 2SLGBTQ+ youth, which means this group of young people may need spaces in which they feel safe and supported online.

There is also promising research that shows the use of technology, such as video games, in supporting psychotherapy and psychoeducation for young people (Ceranoglu, 2010; Jung & Gillet, 2011). Recently, there has been a large number of evidence-based mental health applications that are accessible to young people via their smartphones. Please see the Resources section below for more information.

Risk factors

So, what might predispose a young person to use technology in a harmful or problematic way? Some researchers have suggested that distracted, habitual and problem smartphone use are associated with the following factors:

How do I put this evidence into practice?

One of the challenges for professionals working with young people can be trying to determine when technology use becomes problematic or harmful, rather than something that is enjoyable or serves a function in the young person’s life. There is the added difficulty of trying to separate what behaviours a technological device such as a smartphone or digital device may be facilitating (e.g., playing video games, texting, e-mail, social media applications, media streaming, online shopping or pornography use; Ryding & Kuss, 2020; Yu & Sussman, 2020).

Screening for problem smartphone use

A lack of standardized criteria with which to measure problem smartphone use makes screening and assessment challenging for clinicians.

There are at least 78 validated scales of problem smartphone use, but many are based on DSM-IV or DSM-5 criteria for gambling disorder or substance use disorder, despite ongoing debate as to whether problem smartphone use should be considered an “addiction” as opposed to a “maladaptive behaviour” (Harris, Regan et al., 2020). Some screening tools use Griffiths’ (2005) six-component model of addiction (conflict withdrawal, tolerance, salience, mood and relapse) while others are an adaptation of Young’s (1999) Internet addiction test.

Comparing these scales to determine which is the most valid and reliable is challenging because some scales lack measures for internal consistency and test-retest reliability (Harris, Regan et al., 2020). However, one scale that has been found by several systematic reviews to be the most popular and appropriate for use with adolescents (Harris, McCredie & Fields, 2020; Thomée, 2018; Yu & Sussman, 2020) is the 10-item Smartphone Addiction Scale–Short Version for Adolescents (SAS-SV).

Originally developed to detect problem smartphone use with South Korean adolescents (Kwon et al., 2013), the SAS-SV’s reliability and validity have also been confirmed by research with 18- to 24-year-olds in the United States as an accurate indicator of problem smartphone use (Harris, McCredie & Fields, 2020).

The scale is currently open access and asks individuals for a rating of strongly disagree (1), disagree (2), weakly disagree (3), agree (4) and strongly agree (5) for the following 10 statements:

  • Missing planned work due to smartphone use
  • Having a hard time concentrating in class, while doing assignments, or while working due to smartphone use
  • Feeling pain in the wrists or at the back of the neck while using a smartphone
  • Won’t be able to stand not having a smartphone
  • Feeling impatient and fretful when I am not holding my smartphone
  • Having my smartphone in my mind even when I am not using it
  • I will never give up using my smartphone even when my daily life is already greatly affected by it
  • Constantly checking my smartphone so as not to miss conversations between other people on Twitter or Facebook
  • Using my smartphone longer than I had intended
  • The people around me tell me that I use my smartphone too much

SAS-SV scores of 31 for males and 33 for females have been proposed as a potential clinical cut-off point indicating problem smartphone use, although this has been interpreted by researchers with caution (Harris, Regan et al., 2020). We therefore recommend using the statements in this scale as a starting point to discuss harmful smartphone use with clients as part of your overall assessment to discover more about their experiences of technology.

Screening for problem social media use

The Bergen Social Media Addiction Scale (BSMAS) is regarded as an accurate and valid measure of problem social media use among adolescents (Bányai et al., 2017; Cheng et al., 2021). The scale is based on addictions theory and uses Griffiths’ (2005) aforementioned six-component model of addiction (Andreassen et al., 2017).

All items are scored on the following scale: very rarely (1), rarely (2), sometimes (3), often (4) and very often (5). During the last year how often have you:

  • spent a lot of time thinking about social media or planned use of social media?
  • felt an urge to use social media more and more?
  • used social media in order to forget about personal problems?
  • tried to cut down on the use of social media without success?
  • become restless or troubled if you have been prohibited from using social media?
  • used social media so much that it has had a negative impact on your job/studies?

BSMAS scores over 19 and 24 have both been proposed as a potential clinical cut-off point indicating problem social media use (Bányai et al., 2017; Luo et al., 2021). However, as with the SAS-SV, we recommend using the items in this screening tool as a starting point to discuss social media use with clients to determine if they are experiencing problem social media use.

Alternative measures of PSU/PSMU

Asking questions about the following categories has also been suggested by researchers an alternative source of discovering information about a young person’s technology use:

If a young person is gaming via their smartphone, it may be worth asking about their hours spent playing, player ranking/leaderboard scores or trophies they have earned (Harris, Regan et al., 2020; Ryding & Kuss, 2020).

The above measures can also be more valuable than measuring total screen time alone, which may not indicate what areas of a young person’s technology use (if any) may be harmful or problematic (Ryding & Kuss, 2020). Exploring these behaviours with the young person using a data monitoring app or their phone’s built-in settings can complement self-reporting data, which can often underestimate unconscious or compulsive behaviours. This option may be worth exploring with clients if they feel comfortable sharing this information (Ryding & Kuss, 2020). We recommend that you keep informed of current data tools available via applications and through the most popular smartphone operating systems (i.e., Android’s Digital Wellbeing settings and iOS Screen Time monitoring features).

Other areas worth exploring as part of your assessment with a young person can be some common risk factors and negative impacts of problem smartphone and social media use, such as:

Suicidality

Given the links between problem social media/smartphone use and increased risk of suicide, it is highly recommended that you carry out ongoing risk assessment for suicide and self-harming behaviours when working with young people. One suggestion from the research is to ask young people experiencing or at risk of self-harm, suicidal ideation or behaviours about their Internet and social media use during the assessment process. This could include asking about the role of images/videos and designing treatment plans that seek to maximize beneficial online behaviours and reduce harmful behaviours (Marchant et al., 2017).

For additional resources and information about suicide and crisis interventions approaches, visit our Suicide Evidence-Informed Practice page.

Interventions

Research on effective interventions for young people experiencing PSU/PSMU is still needed. Whatever approaches you use in your work, it is important to consider the following general therapeutic guidelines when working with young people:

For specific intervention approaches, current research has predominantly focused on three interrelated areas:

Behavioural interventions

Behavioural interventions focusing on behaviour change are an effective way to begin to reduce harmful PSU/PSMU and can be used in combination with cognitive behavioural therapy (CBT) and educational interventions (see below). Working with youth in a group counselling/support format also allows young people to participate socially, improve their interpersonal communication and share space with others going through similar experiences and emotions (Liu et al., 2017). Group counselling has also been linked to a reduction in feelings of depression, anxiety and aggression when paired with CBT and sports interventions (Liu et al., 2017). Sports interventions in particular can be a low-cost way for young people to reduce harmful smartphone or social media use and has been linked with an improvement in executive function, impulse control and redirecting attention (Liu et al., 2019).

CBT

Individual and group CBT sessions have been found to reduce self-reported levels of depression, aggression, stress, and anxiety, and can lead to improved peer relations (Khalily et al., 2021; Liu et al., 2017). Components of CBT interventions can include:

Education interventions

Providing education to young people about the risks and impacts of PSU/PSMU was an intervention component found throughout the research literature, whether it formed part of an individual or group intervention, or was part of a wider-level education/prevention program (i.e., school-based prevention; Khalily et al., 2021; Liu et al., 2019; Malinauskas & Malinauskiene, 2019). Education interventions can involve:

Limitations

The main limitation to consider is that there is a large amount of growing evidence into problem smartphone use, problem social media use and problem technology use more broadly. As noted previously, there is a lack of agreement in the research how PSU/PSMU should be conceptualized, defined, or measured, and whether these behaviours could constitute a behavioural addiction (similar to gambling disorder or Internet gaming disorder) or whether they should be conceptualized differently (Harris, Regan et al., 2020).

Of the literature reviewed, many of the studies focusing on youth took place in South, Southeast or East Asian countries. This may limit the generalizability of some of the findings of these studies unless they are replicated with youth in North America (Malinauskas & Malinauskiene, 2019; Yu & Sussman, 2020).

Although the evidence reviewed on this page includes many large-scale trials, meta-analyses and systematic reviews, it has been noted by some researchers that only a small number of these studies used a longitudinal design or follow-up (Thomée, 2018). An overreliance on self-report data and convenience sampling in these studies could also be considered a limitation (Ryding & Kuss, 2020; Thomée, 2018). However, there are promising attempts to collect more objective data via randomized controlled trials (RCTs) with bigger sample sizes happening in this area of research (Yu & Sussman, 2020).

Additional resources

  1. 2019 Mental Health and Well-Being of Ontario Students: Detailed Findings from the Ontario Student Drug Use and Health Survey
  2. The App Evaluation Model: An evaluation model for mental health and addictions service providers and their clients to evaluate the suitability and effectiveness of mental health applications.
  3. Common Sense Media: A non-profit organization providing education and information about digital media including Digital Citizenship and age-appropriateness ratings for movies, TV, applications and games. It includes a helpful “Parents Need to Know” guide on cellphones, screen time and online privacy and safety.
  4. Cybertip.ca: Additional resources about online exploitation and victimization of young people and ways to report online abuse and exploitation of children and young people.
  5. Problem Technology Use Evidence-Informed Practice page: GGTU’s evidence-informed practice page on problem technology use.
  6. GGTU's Suicide Evidence-Informed Practice page: GGTU’s evidence-informed practice page on suicide.
  7. NeedHelpNow.ca: Resources aimed directly at youth who may be at risk of or experiencing cyberbullying, or who have had personal or graphic images shared online or on social media.
  8. One Mind PsyberGuide: This non-profit website reviews mental health apps for their credibility, user experience and transparency.
  9. ProtectKidsOnline.ca: Resources aimed at families, caregivers and professionals for protecting young people online, including information about online exploitation, cyberbullying, healthy online relationships and boundary setting.

References

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