Adolescent Res Rev (2017) 2:315–330

DOI 10.1007/s40894-017-0053-4

SYSTEMATIC REVIEW

Social Media and Depressive Symptoms in Childhood

and Adolescence: A Systematic Review
Niall McCrae1 · Sheryl Gettings2 · Edward Purssell2

Received: 23 November 2016 / Accepted: 25 January 2017 / Published online: 2 March 2017
© The Author(s) 2017. This article is published with open access at Springerlink.com

Abstract Concerns are increasingly raised in academic Introduction

and lay literature about the impact of the internet on young
people’s well-being. This systematic review examined New technology can transform society, but fears have been
empirical research on the relationship between social media raised about its physical, social and psychological conse-
use and depressive symptoms in the child and adolescent quences. This has historical precedent. In the nineteenth
population. A systematic search of Medline, PsycInfo and century, many people were diagnosed with “railway sick-
Embase databases yielded eleven eligible studies. Relevant ness”, a condition attributed to the unnatural motions of
results were extracted from each study, with a total sample train travel, most frequently observed in passengers who
of 12,646. Analysis revealed a small but statistically sig- had faced backwards (Shaw-Mackenzie 1895). Perhaps
nificant correlation between social media use and depres- the rapid and universal growth of social media has cre-
sive symptoms in young people. However, studies varied ated a “cyber carriage”, in which vast numbers of people
widely in methods, sample size and results, making the are oblivious to their physical surroundings while fixated
clinical significance of these findings nuanced. Over half on the internet, accessed through handheld devices. Is liv-
of the studies were cross-sectional, while those of longitu- ing in the virtual reality of social media harmful to younger
dinal design were of limited duration. This review justifies people’s social and emotional development, well-being and
further investigation of this phenomenon, with a need for mental health, or are the dangers exaggerated by older gen-
consensus on variables and measurement. erations? This is a significant question, because there are
reports of escalating mental health problems in children,
Keywords Internet · Social media · Adolescence · and difficulties experienced at this age may have enduring
Depression · Mental health impact. This article presents a systematic review of studies
measuring the relationship between social media use and
depressive symptoms in young people.

Electronic supplementary material The online version of this

article (doi:10.1007/s40894-017-0053-4) contains supplementary Impact of Social Media Use in Childhood
material, which is available to authorized users. and Adolescence
* Niall McCrae
[email protected] The internet is a ubiquitous medium for business, informa-
tion and entertainment, but arguably it has had most pro-
1
Mental Health Nursing, Florence Nightingale Faculty found impact as a means of interpersonal communication.
of Nursing and Midwifery, King’s College London,
1.17 James Clerk Maxwell Building, 57 Waterloo Road,
Use of social networking sites grew exponentially after the
London SE1 8WA, UK launch of MySpace and Facebook in 2004. Within a few
2
Child & Family Health, Florence Nightingale Faculty
years, Facebook was being used by four-fifths of inter-
of Nursing and Midwifery, King’s College London, London, net users aged 13–16 in the UK (Livingstone et al. 2011).
UK Twitter, allowing short messages to be sent to unlimited

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316 Adolescent Res Rev (2017) 2:315–330

recipients, was introduced in 2006 and rapidly gained that socially-awkward people derive benefit from online
global popularity. Since the launch of internet-connected contact that they do not find with face-to-face interac-
smartphones, which overtook sales of cell phones in 2013, tion (Valkenburg and Peter 2007; Amichai-Hamburger
instant messaging sites such as Snapchat and WhatsApp and Schneider 2014). However, while Dolev-Cohen and
have become standard tools of communication. In the Barak (2013) suggested that online communication is
USA, recent data show that 93% of people aged 15–17 have supportive for shy, anxious or depressive young people, it
mobile internet access through a phone or tablet; while may compound their difficulties by reinforcing poor self-
Facebook remains highly popular, Instagram and Twitter esteem (Staksrud et al. 2013).
are more valued by teenagers (Statista 2016). Whether on Concerns have arisen about the mental health impact
conventional computer screen or mobile device, young peo- of internet activity on the young, with frequent coverage
ple use social media in every waking hour, in countries rich of this topic in the mass media. Early evidence of adverse
and poor. psychological impact was presented by Kraut and col-
The internet may be a double-edged sword. Neurosci- leagues (1998) and by Young and Rodgers (1998), who
entist Susan Greenfield (2014) argued in her book Mind found that frequent internet use raised the risk of depres-
Change that digital technology has deleterious effects on sive symptoms. Since then, studies have shown cor-
personality, identity and relationships. Applying Prensky’s relations of online activity by younger people with low
(2001) distinction between “digital immigrants” and “digi- self-esteem (Caplan 2002), loneliness (Clayton et al.
tal natives”, Greenfield explained that whereas the former 2013), self-harm (Lam et al. 2009) and autistic traits
were schooled in a pre-digital era, now using the internet (Finkenauer et al. 2012). However, other studies have
alongside older media, the latter have known nothing else. indicated higher self-esteem and satisfaction with life,
According to this conceptualization, digital immigrants and reduced risk of mental health problems (Valkenburg
confer higher value on face-to-face interaction, sometimes et al. 2006; Bessièrre et al. 2008; Grieve et al. 2013; Best
criticising younger people for contravening traditional et al. 2014). Development of supportive social bonds and
social norms when focusing on their mobile devices, while belongingness can protect against adversities such as
digital natives dismiss this as older people’s fear of change. loneliness and bullying (Wu et al. 2016).
As described in Turkle’s book Alone Together: Why We A high proportion of serious mental health problems in
Expect More from Technology and Less from Each Other adulthood emerges during adolescence (Kessler et al. 2005;
(2011), family relationships are weakened when proximate Children Young People’s Health Outcomes Forum 2012).
reality is neglected in favor of online contact. Digital tech- Epidemiological data predating mass use of online social
nology may be changing conceptualizations and language media showed a high risk of depression in this age group,
of human relationships. Defined as a “dyadic, co-con- with estimates of 2–5% prevalence of major depressive
structed phenomenon characterized by reciprocity, close- disorder (Costello et al. 2003), but recent reports show an
ness and intimacy” (Amichai-Hamburger et al. 2013: 34), alarming increase in depressed younger people (Office for
friendship is vital for the well-being of children and adults, National Statistics 2014). The internet, and related social
but the advent of social media appears to have modified its trends, may be a major factor in the rise of psychological
meaning. For “Generation Wired” (a term used by Tam and morbidity in the young.
Walter 2013), such relationships are increasingly generated Various theories have been proposed for the putative link
and maintained online. Data from the Pew Research Center between social media use and psychological problems in
(Madden et al. 2013) show an average of 300 Facebook younger people. Socialization is crucial to the progression
friends for teenagers in the United States, but the quality from adolescence to adulthood, and use of social media
of such relationships is more important than the quantity. may have profound influence on this adjustment (Wood
With a much larger social circle than in traditional friend- et al. 2016). Applying John Bowlby’s psychanalytic theory,
ships, inevitably much communication is shallow (Grieve Oldmeadow and colleagues (2013) found that people with
et al. 2013). Virtual reality may become the real world for attachment anxiety were more likely to turn to Facebook
some users, to the extent that friends known only through for emotional support. However, reduced face-to-face con-
cyberspace become their closest confiding relationships tact detracts from a traditional supportive environment that
(McKenna et al. 2002). can help young people to manage the challenges of ado-
Evidence suggests that while people with strong social lescence. Development of self-awareness may be inhibited
skills and technological abilities accrue benefit from in young people who lack engagement in reflective inter-
online interaction, those who are less adept do not fare so actions with family and friends (Siegel 2014). Empathy is
well. This exacerbation of differences was portrayed by honed through social relationships, which may not be as
Kraut and colleagues (2002) as “the rich get richer”. By close and meaningful online, where superficial behavior
contrast, the social compensation hypothesis postulates such as virtue-signalling prevails.

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Adolescent Res Rev (2017) 2:315–330 317

The internet may be changing the process of identity for- leads to rumination, which increases the risk of depression.
mation, which psychoanalyst Erik Erikson (1980) empha- Online self-disclosure may relieve stress, generates sup-
sized in the adolescent stage of his model of eight stages portive messages and raises a person’s profile (Tamir and
of the human lifespan. Each stage presents conflict, which Mitchell 2012), but control of sensitive information is lost.
must be resolved to advance successfully to the next stage. Depressed or anxious young people do not always make
Most young people overcome the stress and difficulties of sensible decisions about privacy, sometimes revealing per-
adolescence, but some flounder. Successful progress from sonal details in a way that they later regret (McKenna et al.
adolescence to adulthood entails acquisition of social 2002).
skills, confirmed and rewarded by social acceptance. Self- Young people are expected to be in perpetual contact,
presentation is tested through display and response. As and to project themselves visually as well as verbally.
friendships become more complex in adolescence, with the Attractiveness is a major criterion of status and popular-
emergence of romantic intimacy and sexual interest, there ity. Young female internet users are particularly keen to
is need for privacy, yet social media encourage openness choose the most favorable image of themselves on Face-
and divulgence of personal information. A review of stud- book (Pempek et al. 2009). “Selfies” may be uploaded to
ies of online identity development by Wängqvist and Frisén seek approval, but an adverse remark may be distressing for
(2016) showed that aspects of identity constrained in offline someone of delicate self-esteem. Young people are increas-
contact are freely expressed online, and that anonymity in ingly transmitting sexualized messages or images (“sex-
internet communication has implications for cohesive iden- ting”), with little concern for consent or for exploitation by
tity formation. abusive peers or strangers (Staksrud et al. 2013). Impulsive
As argued in an influential book Generation Me by Jean behavior online may jeopardize future careers, and in some
Twenge (2006), narcissism may be increasing in Western instances children have been criminalized for disseminat-
society. Twenge and colleagues (2008) found considerably ing sexual images. Aggressive behavior or “trolling” is a
higher scores in this trait in students compared to a group common problem in internet use by young people (Ko et al.
of 20 years earlier. Narcissistic behavior has always been 2012; Hinduja and Patchin 2013). A review of 113 studies
more evident in younger people, who have relatively little by Kowalski and colleagues (2014) found that cyberbully-
responsibility to others while tending to be self-absorbed. ing correlates with mental health problems in adolescence;
The extent is probably exaggerated in the media, as the in some cases it has led to suicide (Hinduja and Patchin
term is used for people merely taking “selfies”: such behav- 2010). Bullying may be worse online than in physical prox-
ior may be vain, but is socially normative and should not be imity, factors being the anonymity of the bully and the
pathologized if it does not pervasively disrupt daily func- inescapable public embarrassment and shame (Slonje et al.
tioning (Webber 2016). However, the internet has provided 2013). The three most frequent problems arising in coun-
more opportunity for expression of narcissistic aspects of selling sessions provided by ChildLine (a British helpline
personality. People with narcissistic traits are prone to low for children) in 2016 were low self-esteem or unhappiness,
mood when their high expectations are not fulfilled (Web- family relationships and bullying (online and offline); the
ber 2016). Huprich (2014) described a narcissistic person- latter was the most common reason for counselling in chil-
ality pattern including depressive and masochistic tenden- dren aged 11 and under, and third in the 12 to 15 years age
cies as “malignant self-regard”. A depressive reaction to group (National Society for the Prevention of Cruelty to
setbacks is a prominent feature of the DSM-V condition of Children 2016).
narcissistic personality disorder. Gender differences are an important consideration.
Several socio-cultural theories have emerged on the Rodgers and colleagues (2013) found that body image
effect of digital media on mental health. The internet can concerns correlate with social media use by young female
be a harsh environment for young people, who are heav- but not male users; such perceptions may lead to eating
ily influenced by peer pressure. A review by Wu and col- problems and poorer outcomes of adolescent adjustment.
leagues (2016) of research on use of the internet for social A review of 67 studies of internet use and body image
purposes showed that a major motive for young people concerns in adolescence by Rodgers and Melioli (2016)
is positive reinforcement of their social connectedness. described various theoretical perspectives on this link.
Social media are the forum for the setting and reinforc- One theory is self-objectification, which is based on the
ing of norms. Conformity is rewarded, while a careless feminist argument that women are seen as sexual objects
remark might result in a person being ostracized. Unreal- under a male gaze. Self-objectification is a form of con-
istic expectations arise as users see the relative popular- sciousness manifesting in habitual monitoring of physical
ity of others, as indicated by their number of friends and appearance, with tendencies for anxiety and shame. Work
“likes”. A study of college students (Feinstein et al. 2013) by Tiggemann and Slater (2013) suggests that self-objecti-
showed that negative comparisons with peers on Facebook fication is a significant cause of psychological problems in

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adolescence. The combination of media and peer pressure Thus it can be seen that research on the relationship
on girls to be thin and sexually attractive is compounded by between social media and mental health in young people
the internet. Being constantly connected turns a young per- is multifaceted. Much of the discussion of this topic has
son into a commodity, to be compared with others (Gon- occurred in lay media including the popular press, possi-
zales and Hancock 2011). However, a limitation of socio- bly leading to uncritical acceptance of untested ideas and
cultural theories is their emphasis on structure over agency, assumptions. Studies indicate benefits as well as harmful
which reduces internet users to passivity. effects of internet use, but evidence is complicated by the
Research has repeatedly shown that girls use the internet lack of either causal mechanisms or a certain direction of
mostly for relational purposes (thus being highest users of relationship between variables. Results in one study set-
social media), while boys tend to use it more for instrumen- ting may not be generalizable to young people elsewhere.
tal activities such as video-gaming (Park 2009; Kuss and Whether any increase of psychological distress in adoles-
Griffiths 2012). In a study of Canadian teenagers by Sam- cence is attributable to online social media activity is not
pasa-Kanyinga and Lewis (2015), 71% of girls used social yet understood. A review of relevant peer-reviewed studies
networks for more than 2 h daily, compared to 29% of boys, was therefore indicated.
which partly explained their finding of a marked gender
imbalance in psychological distress. A recent UK govern-
ment survey of children aged 14–15 (Department of Health Current Review
and NHS England 2015) showed that girls were more than
twice as likely as boys to suffer from symptoms of com- This review examined empirical research on the relation-
mon mental disorder (37–15%), with the proportion of girls ship between social media use and depressive symptoms in
with anxiety or depression rising by 10% since the previous the child and adolescent population, with three objectives.
survey 10 years earlier. Among various factors discussed First, we aimed to produce a critique of the design and
by experts was excessive use of social media (Times 22nd conclusions of relevant studies. It is apparent that research
August 2016). Gender-related differences in case ascertain- findings, particularly as reported in the popular media, may
ment for mental health problems also need consideration, lack inferential validity in measuring the impact of social
with girls possibly more likely to seek help. media on mental health. Secondly, the review was to ana-
Addictive personality traits may be stimulated by the lyze correlations between social media use and depressive
internet. Soon after the emergence of the worldwide web, symptoms, including a “dose” effect, taking account of lim-
psychiatrist Ivan Goldberg (1995) proposed internet addic- itations considered above. Thirdly, the review investigated
tion as a specific disorder; manifestations are similar to the role of gender, as differences between male and female
other compulsive behaviors such as gambling, includ- behavior and response to social media use have been high-
ing preoccupation, mood problems, functional impair- lighted in research.
ment and withdrawal effects (Leung 2004). Young (1999)
devised the Internet Addiction Scale, which has been used
widely in research on internet use. Another instrument is Method
the Facebook Addiction Scale, which measures mood and
withdrawal symptoms (Andreassen et al. 2012). Although A systematic literature search was conducted, seeking rele-
such addiction was not included by the American Psychiat- vant articles in peer-reviewed journals. Eligible studies had
ric Association (2013) in the latest Diagnostic & Statistical a generic child or adolescent sample, rather than selecting
Manual of Mental Disorders, internet gaming disorder was groups by mental health morbidity or vulnerability. Social
entered as a condition for further investigation. However, media were defined as websites used primarily for social
such diagnostic expansion has been criticized as medicali- interaction: these include social networking sites such as
sation of everyday life (Moynihan and Henry 2006). Facebook, instant messaging (e.g., WhatsApp) and image-
Disruption of the body clock may also be a factor in sharing applications (e.g., Instagram). Excluded were stud-
the psychological consequences of internet use. Blue ies measuring depressive symptoms in relation to use of the
light emitted by digital screens inhibits secretion of mela- internet rather than social media specifically. Although the
tonin, which is necessary for sleep. A meta-analysis by internet is a rapidly changing phenomenon, no time period
Carter and colleagues (2016) showed that sleeping beside was applied, or geographical restriction; such limits would
mobile devices stimulates the brain. Disturbed sleep pat- be arbitrary and a risk of selection bias (McCrae and Purs-
terns may cause obesity, weakened immunity and stunted sell 2015). As there was no resource for translation, only
growth. Daytime tiredness and irritability may have social studies in English language were included. The databases
and educational consequences. Change to normal circadian Medline, PsychInfo, and Embase were used, with the fol-
rhythms has known influence on mood (Lewy et al. 1998). lowing search strategy:

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Adolescent Res Rev (2017) 2:315–330 319

Population: child/adolescent aged 5–18 being the Children’s Depression Inventory, which was used
Exposure: social media in three studies. DSM criteria for depression were meas-
Outcome: depression/depressive symptoms ured in one study.
Risk of bias across studies was high due to the prepon-
Articles were screened first by title, then by abstract. derance of cross-sectional studies or longitudinal studies
At the final stage of screening, full articles were read and with short follow-up times, lack of exclusion of existing
assessed independently by all three authors, with any dif- cases of depression, reliance on self-report, and (in some
ferences in verdict followed by discussion to gain consen- studies) measurement that had not been validated or use of
sus. Eligible articles were summarized and assessed for instruments in a different context than originally intended
risk of bias, using the Cochrane Collaboration Methods (see Supplementary File 1).
Group Tool to assess risk of bias in cohort studies.
For statistical analysis, the most relevant result was
extracted from each study on the relationship between Theoretical Approach
social media use and depressive symptoms. Most studies
had a correlational design, but for studies presenting other The “rich get richer” and social compensation hypotheses
statistics, these were converted to correlations using the were tested by Selfhout and colleagues (2009), who com-
compute.es package (Re 2014). These were analyzed and pared incidence of depression and anxiety between use of
forest plots generated using the meta (Schwarzer 2015) and internet for communication and other uses in high school
metafor (Viechtbauer 2015) packages in R (R Core Team pupils. Van der Eijnden and colleagues (2008) studied the
2016). The metacor command was used with Fisher’s z relationship between compulsive online communication
transformation for the correlation and the DerSimonian- and psychological well-being, based on previous research
Laird estimator for τ2. Because a-priori heterogeneity indicating that unlike instrumental activities online, use of
was assumed, a random-effects model was used for the the internet for social purposes raises the risk of loneliness
primary analysis; although the fixed-effect equivalent was and depression. The researchers tested several hypotheses
also calculated as comparison of their differing inferential to investigate a possible bidirectional relationship.
assumptions can be instructive. The random-effects model Self-identity was the theoretical basis for three studies.
provides an unconditional inference about a broader set of Social comparison and feedback-seeking are important
studies of which the studies included in the meta-analysis means of forming a self-identity in adolescence, but Nesi
are assumed to be a random sample, while the fixed-effects and Prinstein (2015) were interested in how young peo-
approach makes an inference based only on and about those ple may engage in such behaviors in maladaptive ways on
studies actually included in the meta-analysis (Viechtbauer the internet. They hypothesized that a high frequency of
2015). social comparison and feedback-seeking online would pre-
dict depression, although this would be moderated by peer
popularity. Neira and Barber (2014) applied self-concept
Results theory in their study of adolescent use of social media.
Social comparison and peer feedback are integral to the
The computerized search yielded 2357 unique studies with younger person’s self-evaluation, and these are dramati-
a further 18 from the hand search. After screening by title, cally increased by internet use, thus making a plausible link
349 abstracts were read. This second stage of screening between social media, self-concept and depressed mood.
reduced the total to 134, of which all but one unobtainable Dumitrache and colleagues (2012) studied self-image and
article were inspected. Eleven studies fulfilled the eligibil- depressive tendencies in teenage Facebook users. Referring
ity criteria and were included in the analysis (Fig. 1). to the contrasting hypotheses of enhancement and compen-
Of the 11 studies, six were cross-sectional and five were sation, they examined the relationship between positive or
longitudinal (Table 1). Two studies each were conducted in negative self-image and the quantity and type of informa-
the United States, Australia and the Netherlands; and one tion posted online.
each from Belgium, Spain, Romania, Canada and Taiwan. In a female sample, Tiggemann and Slater (2015) inves-
Overall, the studies had 13,532 participants, although for tigated correlations between self-objectification, body
this review the results applied to a slightly smaller sam- shame, dieting and use of various types of media. Inter-
ple of 12,646. In four studies depressive symptoms were net use was considered as a predictor of self-objectifica-
the only psychological correlate or outcome variable, tion and its adverse consequences, including depression.
while seven studies had two or more such variables (these Gámez-Gaudix (2014) applied the cognitive-behavioral
included social anxiety, stress and suicidal ideation). A model to investigate problematic internet use and depres-
variety of different measures were used, the most common sive symptoms in teenagers. In this model, online social

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320 Adolescent Res Rev (2017) 2:315–330

Fig. 1  PRISMA flowchart

Records idenfied through
database searching
Embase = 239 Addional records idenfied
Medline = 1622 through other sources
PsycINFO = 788 (n =18)
Total = 2649

Records aer duplicates removed

(n = 2357)

Records screened by tle Records excluded

(n = 2375) (n = 2006)

Records excluded
Records screened by
(n = 233)
abstract
(n = 369 )
Unavailable records
excluded
(n = 2)

Full-text arcles excluded

(n =123)
Full-text arcles assessed
Reasons for exclusions:
for eligibility
Adults or mixed age sample without
(n = 134)
separate data for <18 = 17
Psychiatric paents = 1
Case studies = 1
Evaluaon of instrument = 2
Lacks social media data = 54
No depressive symptoms outcomes = 17
No data on correlaon between social
Studies included in
media and depressive symptoms = 31
quantave synthesis
(meta-analysis)
(n = 11)

communication is less threatening than face-to-face interac- of stress) and depressive symptoms. It is known that social
tion, but this readily available source of emotional support support is a buffer to biological response to acute stressors.
can lead to excessive and dysfunctional use. Online activity Hwang and colleagues (2009) considered the internet
may be a maladaptive response to depressive tendencies. as a means of social support in the rapidly changing con-
Stress was the focus of two studies. Frison and Egger- text of Taiwan. In contrast to the individualism of Western
mont (2015) noted that stress increases in adolescence, due societies, Taiwan has a collectivist culture, and young peo-
to pressures at school and in family relationships. Coping ple are subjected to high social pressures in academic per-
mechanisms include actively seeking social support and formance, sometimes to the detriment of their well-being.
avoidance, which are respectively adaptive and maladap- Whereas depression has been normalized in American life,
tive. While the internet facilitates social support, friend- it remains stigmatized in Oriental countries, causing double
ship on Facebook is often weaker, to the effect that support jeopardy for sufferers. The study by Hwang and colleagues
may not be received, with potentially adverse psychologi- was primarily concerned with the online and offline activity
cal consequences. The researchers studied relationships of younger people with depressed mood, but it recruited a
between daily stress, seeking and receiving of social sup- general adolescent sample and measured the behavioral and
port, and depressed mood. A psycho-physiological study by psychological variables in a regression model.
Morin-Major and colleagues (2016) investigated Facebook The study by Ybarra and colleagues (2005) had no stated
activity (frequency of use, network size, self-presentation theoretical rationale, but they referred to previous research
and peer interaction) with basal cortisol level (a measure showing differences in use of the internet by young people

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Table 1  Summary of studies

Authors (year) Country Design Age Overall sample Girls (%) Mental/behavioural Instrument for depres-
outcome(s) sive symptoms

Ybarra et al. (2005) USA Cross-sectional 10–17 1501 47 Depressive symp- Nine symptoms from
toms DSM
van den Eijnden Netherlands Longitudinal cohort 12–15 663 52 Depression, loneli- Depressive Mood List
et al. (2008) ness
Hwang et al. (2009) Taiwan Cross-sectional 12–17 6341 51 Mood Daily Life and
Depressive Mood
Survey
Selfhout et al. Netherlands Longitudinal cohort 14–17 307 51 Depressive Children’s Depression
(2009) symptoms, social Inventory
anxiety
Gamez-Guadix Spain Longitudinal cohort 13–17 957 61 Depressive symp- Brief Symptom Inven-
(2014) toms tory (depression
subscale)
Neira and Barber Australia Cross-sectional 13–17 1819 55 Social self-concept, Depressed Mood
(2014) self-esteem, Scale
depressed mood
Frison and Egger- Belgium Cross-sectional High school 910 52 Stress, depressed Centre for Epide-
mont (2015) mood miological Studies
Depression Scale for
Children (five items)
Nesi and Prinstein USA Cross-sectional 12–16 619 57 Depressive symp- Short Mood and Feel-
(2015) toms ings Questionnaire
Tiggemann and Australia Cross-sectional 10–13 204 100 Self-objectification, Children’s Depression
Slater (2015) body shame, diet- Inventory (short
ing, depressive form)
symptoms
Morin-Major et al. Canada Longitudinal cohort 12–17 88 53 Cortisol levels, Children’s Depression
(2016) stress, self-esteem, Inventory
depressive symp-
toms
Dumitrache et al. Romania Cross-sectional 16–17 123 68 Self-image, depres- Beck’s Depression
(2012) sion Inventory

in relation to depressive symptoms. Through the Youth analysis in this review, the instant messaging category was
Internet Safety Survey they measured online communica- also relevant. This was the most common use of internet
tion, self-disclosure and exposure to sexual content and for 154 participants, of whom 133 were not depressed,
harassment. Depressive symptoms were assessed using 18 had symptoms of minor depressive disorder, and 3 of
DSM categories of minor and major depressive disorder. major depressive disorder; the depressed proportion was
14%. Hwang and colleagues (2009) found a statistically
Results of Cross‑sectional Studies significant relationship between online communication and
depressed mood. Overall, the study showed that adoles-
Ybarra and colleagues (2005) categorized the most fre- cent participants who reported depressive mood were more
quent purpose of internet use (chatroom, e-mail, instant likely to use the internet for friendships and to express
messaging and others). From an overall sample of 1501, feelings compared to those who did not report depressive
chatroom was used most by 136, of whom 101 were not symptoms. From the study by Dumitrache and colleagues
depressed, 22 had symptoms of minor depressive disor- (2012) of self-image and depressive tendencies in Face-
der and 13 of major depressive disorder. The proportion book users, we extracted the correlation between amount
depressed (minor or major) was 34%. For this review an of identity-related items in Facebook profiles and depres-
odds ratio for depression was calculated, comparing chat- sive symptoms; this was statistically significant. Overall,
room users with those in the category of other purposes; the study showed that depressive symptoms correlated with
the result was a statistically significant excess of depression low self-image and identity-type information on Facebook.
in the chatroom group. Although not included in statistical Extracted from the study by Neira and Barber (2014) was

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the correlation between frequency of social network use former at time 1 predicted increase in the latter at time 2,
and depressed mood, which was a statistically significant and vice versa. Morin-Major and colleagues (2016) mod-
negative result. However, the study also measured partici- elled the relationship between basal cortisol level, Face-
pants’ investment in social media, which produced a sta- book activity and depressive symptoms, over a period of
tistically significant correlation of 0.22. The study showed 3 weeks. Extracted was the correlation between Facebook
that although depression reduced with frequency of social use frequency and depressive symptoms, which produced a
network use, it increased with excessive use. Frison and negative but not statistically significant result. Also meas-
Eggermont (2015) found that stress levels predicted seek- ured was Facebook peer interaction behaviors and depres-
ing of social support on Facebook. We extracted the cor- sive symptoms, producing a negative result (not statistically
relation between seeking social support and depression, significant). The study showed that cortisol levels were
which was statistically significant. While seeking social positively correlated with the number of Facebook friends
support increased the risk of depressed mood, actual sup- and negatively with peer interaction; no relationship was
port decreased it. From the study by Tiggemann and Slater found with depressive symptoms.
(2015) of correlations between self-objectification, body
shame, dieting and use of media, we extracted the result for Gender
Facebook and MySpace use and depressive symptoms; this
was statistically significant. Statistically significant cor- Several of the studies found gender differences in the
relations with social media use were also found with self- relationship between social media use and depressive
objectification, body shame and dieting. symptoms. Nesi and Prinstein (2015) found a stronger
correlation of social comparison and feedback-seeking
Results of Longitudinal Studies and depressed mood in girls. Neira and Barber (2014)
found a similar result with online social networking: girls
In the study of social comparison and feedback-seeking and who invest in social network sites were more suscepti-
depressive symptoms by Nesi and Prinstein (2015), a sta- ble than boys to depressed mood. Frison and Eggermont
tistically significant relationship was found between these (2015) found that stress predicted depressed mood in
online behaviors at baseline and depression 12 months girls but not boys. The study by Ybarra and colleagues
later. Van der Eijnden and colleagues (2008) modelled (2005) showed that girls with high internet use were 3.8
the relationship between various internet uses, loneliness times more likely to have major depressive symptoms
and depressive symptoms, with two time points (0 and than no symptoms. Other studies found no gender dif-
6 months). The result for instant messaging was extracted, ferences, while two studies (Van der Eijnden et al. 2008;
as this was much more widely used by participants Dumitrache et al. 2012) found that girls were less likely
(49–55%) than chatrooms (3–5%). For instant messaging to show depressive symptoms than boys. Several studies
at time 1 and depressive symptoms at time 2, the correla- showed that girls and boys use the internet for different
tion was 0.17, while the result for chatroom use was 0.07 reasons, and that through greater investment in social
(not statistically significant). Unlike other types of internet media, female users derive benefits while also being
use, social media raised the risk of compulsive internet use more prone to adverse consequences. There was imbal-
6 months later. Selfhout and colleagues (2009) compared ance in the sex of study subjects: one study (Tiggemann
incidence of depression and anxiety between use of inter- and Slater 2015) was confined to girls, but this does not
net for communication and other uses, with two time points account for an overall female sample of 59%.
(0 and 12 months). Extracted was the correlation between
instant messaging and depression at time 2; the negative
result was not statistically significant. Compared to surfing Statistical Analysis
the internet, time spent in socializing online is more benefi-
cial. Participants with lower quality of friendships and who The overall random effects pooled estimate was 0.13
used the internet for purposes other than communication (0.05, 0.2), p = 0.001; Q = 131.47, df = 10, p = < 0.0001,
were more likely to become depressed or socially anxious. ­I2 = 92.4% (Fig. 2), suggesting a clinically and statisti-
Gámez-Gaudix (2014) measured temporal relationships cally significant relationship between social media use
between features of problematic internet use and depressive and depressive symptoms (Table 2). There was little evi-
symptoms, with an interval of 12 months. Extracted was dence of publication bias: the linear regression test of
the result for preference for online over offline communi- funnel plot asymmetry showing no evidence to reject the
cation (time 1) and depressive symptoms (time 2), which null hypothesis of funnel plot symmetry (t = 0.3, df = 9,
was statistically significant. A bidirectional relationship p = 0.77); although this measures small study effects
was found between depression and use of social media: the rather than bias directly. The funnel plot for this is shown

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Adolescent Res Rev (2017) 2:315–330 323

Fig. 2  Forest plot

Table 2  Selected study results

Authors (year) Included sample Correlates Correlation result

Ybarra et al. (2005) 1061 Internet used most frequently for chatroom versus other purposes/ 0.14**
depressive symptoms
Van der Eijnden et al. (2008) 663 Instant messaging (time 1)/depression (time 2) 0.17**
Hwang et al. (2009) 6341 Online communication/depressed mood 0.13*
Selfhout et al. (2009) 307 Instant messaging (time 1)/depression (time 2) −0.02
Neira and Barber (2014) 1819 Social media use/depressive symptoms −0.09*
Gámez-Gaudix (2014) 699 Preference for online social interaction (time 1)/depression (time 2) 0.13*
Frison and Eggermont (2015) 910 Social support seeking on Facebook/depressed mood 0.13**
Nesi and Prinstein (2015) 619 Technology-based social comparison and feedback-seeking (time 1)/ 0.34**
depressive symptoms (time 2)
Tiggemann and Slater (2015) 204 Social media use/depressive symptoms 0.19*
Morin-Major et al. (2016) 88 Facebook use/depressive symptoms −0.097
Dumitrache et al. (2012) 76 Items of identity-related information on Facebook/depression 0.355*

*p < 0.01
**p < 0.001

in Fig. 3. Additionally the trim and fill analysis showed between the two estimates, this is not clinically signifi-
two outlying studies (Dumitrache et al. 2012; Nesi and cant and the test for subgroup difference was not statisti-
Prinstein 2015), trimming and filling of which had some cally significant (Q = 0.0, df = 1, p = 0.98). In order to try
effect in reducing the random effects estimate, r = 0.09 to understand the results Euclidean cluster analysis was
(95% CI 0.01, 0.16), p = 0.03; Q = 180.67, df = 12, undertaken based on the results alone. The agglomera-
p < 0.0001, ­I2 = 93.4% (see Supplementary File 2). tive coefficient was strong (0.94) and showed three main
To assess any possible impact from publication type, clusters (Fig. 4), suggesting that study outcomes could be
sub-group analyses were conducted for the two types broadly put into three groups. Examination of the clus-
of study design. The pooled estimate for cross-sec- ters revealed two groups of outlying studies; one showing
tional studies (n = 6) was r = 0.12, (95% CI 0.02, 0.22), small negative correlations and the other large positive
Q = 81.01, ­I2 = 93.8%; while that for longitudinal stud- effects. However, the third and largest cluster, accounting
ies (n = 5) was r = 0.12, (95% -0.01, 0.25), Q = 38.98, for the majority of studies, had a limited range of out-
­I2 = 89.7%; suggesting little effect, although the differ- comes. Thus although we cannot account for the clusters
ence between study types was not always marked and methodologically, this distribution of results is support-
the time over which the longitudinal studies were con- ive of our pooled estimate being an accurate reflection of
ducted varied widely. Although there was a difference the underlying phenomenon.

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324 Adolescent Res Rev (2017) 2:315–330

Discussion

The internet has transformed lives, with young people

now spending several hours per day online. While there
are obvious benefits of technological progress, including
the communication facility of social media, problematic
activity online may detract from the development and well-
being of younger people. Mental health problems appear to
be increasing in younger people (Office for National Statis-
tics 2014), and use of social media is an important factor to
consider. Although the putative depressogenic impact has
been investigated by several researchers, it is not yet known
whether use of social networking sites and instant messag-
ing are causative, or whether there is a “dose” effect; or if
it is an artefact of increased case ascertainment and general
societal concern.
This systematic review makes an important contribu-
tion to the literature: first, by showing a small but statisti-
Fig. 3  Funnel plot cally significant correlation between social media use and
depressive symptoms in the child and adolescent popula-
tion; and secondly, by indicating further research goals.

Fig. 4  Cluster analysis

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Adolescent Res Rev (2017) 2:315–330 325

However, there are limitations to consider. Most of the and concern about mental health problems in young peo-
studies were not directly answering the review question, ple. Recent government policy in the UK (Department of
and heterogeneity in design and results with wide confi- Health and NHS England 2015) has pledged substantial
dence intervals temper any conclusion that can be drawn. investment in child and adolescent mental health services,
The number of eligible studies was low, as the majority enabling early identification of vulnerable young people,
of research on internet use and mental health problems with better access to support and treatment. A recent report
does not specifically measure the effect of social media on highlighted a 54% increase in British children prescribed
depressive symptoms. Consequently, the amount of evi- antidepressant drugs from 2005 to 2012 (Bachmann et al.
dence collated for this review was modest. Sample size var- 2016), but while this coincides with the rapid expansion of
ied widely, and it should be noted that while small studies social media, this may be due to unrelated patterns in case
provide imprecise estimates of the population parameter ascertainment and marketing of these drugs. However, 54%
due to sampling error, large studies can have the opposite was a relatively small absolute increase, from 0.7 to 1.1%.
effect of producing statistically significant but clinically Whether the incidence of depression has actually
spurious differences. increased is a moot point. Arguably, there are material
Studies of the psychological effects of internet use are gains in the expansion of the detection and treatment of
often reported in the mass media, but as noted by McCo- mental health problems in the child and adolescent popu-
nway and Spiegelhalter (2012), methodological weak- lation. Various factors could result in a lowering threshold
nesses are scarcely acknowledged. A preponderance of for diagnosis of depression, including professional and
observational designs does not allow proper causal attri- commercial interests. Critics of medical hegemony, most
bution. Over half of the studies reviewed here were cross- notably Ivan Illich (1975), have alerted society to the con-
sectional, while longitudinal studies had short time periods, cept of disease mongering, which Moynihan and Henry
with 12 months the longest interval between assessments. (2006) defined as “the selling of sickness that widens the
Indeed, the fundamental difficulty in research on the impact boundaries of illness and grows the markets for those who
of internet behavior is the direction of relationship. Build- sell and deliver treatments”. This is particularly apparent
ing a more robust evidence base is challenging: with the in mental health, where standard classifications of illness
globally pervasive use of social media, there is no natural- have expanded with each revised edition. As noted ear-
istic control group, and historic comparison groups would lier, internet-related disorders have entered the psychiatric
have dubious validity. taxonomy. O’Keeffe and Clarke-Pearson (2011) proposed
The task for researchers is to measure psychological “Facebook depression” as a specific illness, but this has
impact while taking account of the complex, probably bi- been criticized by other scholars who assert the need for
directional relationship between habitual social media hypothesis-driven research questions and robust scientific
activity and mental health. In a systematic review of social investigation.
media use and business management, Ngai and colleagues Another possible reason for the rising rates of depres-
(2015) proposed a causal-chain framework, pursuing a sion in young people is emotional articulacy and encour-
sophisticated interactional model of the socio-psycho- agement of expression in online social networks. Gender is
logical causes and effects of social media activity. In this an important factor here. As the study by Neira and Barber
framework, the relationship between antecedents and out- (2014) showed, social media use may have more adverse
comes is not simply linear but is interpreted as the product psychological impact on girls than on boys, which may
of influence by moderators and mediators. Until more is simply be due to higher frequency of use. Irrespective of
known on the interplay of variables, straightforward cause- gender, depressed mood was predicted by investment in
and-effect studies are not fully credible, unless a large sam- online communication. Nesi and Prinstein (2015) found a
ple can be observed and analyzed over a suitably long time strong relationship between social comparison and depres-
period. Furthermore, research should be designed not only sive symptoms in girls. The impact of negative messages
on methodological logic, but also informed by theory of may be compounded by the overlap of online and offline
child and adolescent development (Amichai-Hamburger networks. Social media may be triggering narcissistic
et al. 2013). behavior, as suggested by the amount of “selfies” posted on
Notwithstanding these qualifying comments, it would Facebook and Instagram, and a perhaps excessive empha-
be fair to conclude that some degree of correlation exists sis on the presentation of self. Research by Tiggemann and
between social media use and depressive symptoms in the Slater (2013) suggests that Facebook use exacerbates body
young. However, it is possible that any increase in men- image distortion in adolescent girls. However, Dumitrache
tal health problems is temporally but not causally con- and colleagues (2012) found a lower rate of depressive ten-
nected to the internet. Fears about the harmful effects of dencies in girls than in boys.
online behavior may be stoked by greater public awareness

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326 Adolescent Res Rev (2017) 2:315–330

Social media offer tremendous opportunities for interac- be a problem, as quality of close relationships should trump
tion, unbounded by the constraints of face-to-face contact, quantity of online contacts. However, as Nesi and Prin-
but they also have antisocial uses. The internet reflects stein (2015) indicated, the online environment facilitates
society, but it may exacerbate darker sides of human nature social comparison and feedback-seeking, and less confident
as shown by online bullying and abuse. This phenomenon young people may be more likely to use social media for
may be similar to “road rage”, whereby people behave such purpose. The cluster analysis indicated three groups;
aggressively to other drivers, shielded from normal social however, there was no clear pattern to this that would
restraint. Several studies here showed higher correlations explain why study results had clustered in this way. Depres-
of social media use and depressive symptoms in young sive symptoms are perpetuated by negative online expe-
people with psychological vulnerability. Gámez-Gaudix riences. Much of the socialization process in childhood
(2014) found prior psychological problems to be a predic- development now occurs through social media, and mood
tor and outcome of problematic internet use, with academic problems may be a temporary feature of the transition to
and social impairment raising the risk of depressive symp- adolescence. However, as many psychiatric disorders of
toms. A factor may be limited access to reliable support in adulthood first appear in adolescence, vulnerability in this
offline relationships. Ybarra and colleagues (2005) found developmental stage is high and protective factors such as
that young people with depressed mood were less likely to positive friendships offline and positive relationships with
have face-to-face interaction, communicating instead with caring adults therefore gain importance for young people to
virtual friends. build resilience.
This could be explained in part by the nature of Various interventions have been devised to prevent harm
depressed mood, where symptoms can include lethargy and to young people online, including policies to tackle cyber-
reduced interest in usual social activity; socializing online bullying in schools (e.g., Childnet International 2015).
may be preferred as a substitute to interacting face-to-face, Also, more awareness of the hazards of social media is
which may require more effort including travel. Further- needed in parents: “digital immigrants” may not be fully
more, symptoms of depression can include irritability, and alert to the rapidly changing patterns of internet use by
teenagers may have some predisposition to impulsivity young people. Facebook was not designed for use by chil-
(Siegel 2014); if these factors influence online communica- dren, and does not adequately protect their identity and
tion they could post comments that they later regret, pos- privacy. Lack of parental guidance on internet use exposes
sibly detracting from their popularity. Online friends not children to potential harm from reckless or malevolent
already known sufficiently well offline may be less forgiv- communication, as well as from violent or pornographic
ing of an online faux pas, and may not be aware or sym- content (O’Keeffe and Clarke-Pearson 2011). However,
pathetic to another social network user’s psychological controlling use of the internet is difficult, particularly with
difficulties. Social media use in this situation could have teenagers, who use online media for educational as well
negative consequences for a young person with depressive as interactional purposes. Meanwhile, some parents are
symptoms. not good role models for internet use, posting pictures of
Online friendships lack some of the benefits of physi- their children on Facebook which may later cause embar-
cal contact: interaction is often superficial, and lacking in rassment. While schools teach about sex and relationships,
genuine interest. Hwang and colleagues (2009) showed such education must be updated regularly in relation to
that depressed young people find difficulty in making trends of online activity by young people. In the context of
friends face-to-face and instead seek friendship on the an expanding virtual reality, more facilities should be pro-
internet; two-fifths of participants with depressive symp- vided for children to meet friends in physical proximity.
toms expressed thoughts and feelings online that they could Instead of focusing on the negative effects of internet use,
not do otherwise. Although this suggests social media as a the benefits of face-to-face contact should be accentuated.
valuable resource, there is a danger of reinforcing negative Young people are not a homogenous group in relation to
beliefs and behavior. Young people struggling with stress internet use. Most of the studies reviewed here had a wide
turn to Facebook for social support, but as Neira and Bar- age range, mixing pre-pubescent children with imminent
ber (2014) reported, as much as 80% of requests for support school-leavers. Data from the Pew Research Center show
were unanswered, raising the risk of depressive symptoms. differences in how younger compared to older children use
Attachment theory would be relevant to such findings. social media; many teenagers lose interest in Facebook as
The “rich get richer” hypothesis is supported by stud- they seek privacy for aspects of their personal lives (Mad-
ies in this review. For most internet users, online interac- den et al. 2013). Meanwhile, social media platforms are
tion reinforces friendships, rather than replacing one set of continually developing and new risks and harms may arise
friends with another. That young people with fewer proxi- with each functional advance. Current trends will not con-
mate friends derive less benefit from social media may not tinue forever, and social media may be used differently or

13
Adolescent Res Rev (2017) 2:315–330 327

abandoned in the near future. Today, typed communica- causality is not clear, and further development is needed in
tion prevails while oral communication has declined, as research on this topic. Researchers have lacked consensus
the “mobile telephone” has become a misnomer. However, on the phenomena for investigation, resulting in limited
keypads could soon be outmoded by devices that enable replication. Qualitative methods also have an important part
users to communicate without the need for manual input. to play in understanding the phenomenon of mental health
Vast data obtained from social networking sites can be impact of internet use from young people’s perspectives.
used for marketing purposes and by potential employers. Such enquiry would help to develop explanatory models
Exploration of its use in a healthcare context would be ben- and hypotheses for inferential studies. The cyber carriage
eficial. If a degree of “profiling” from online communica- continues to speed along the tracks, and it is not yet under-
tion is possible, there may be a moral argument towards stood whether it causes sickness for its passengers.
considering using such data in a risk assessment context.
For example, a sophisticated screening mechanism could Acknowledgements Trevor Murrells (King’s College London) pro-
vided statistical support.
potentially identify patterns suggesting concern (around a
person’s wellbeing, e.g., suicidal ideation) and an offer of Author contributions NM, SG and EP conceived of the study, par-
support could be “triggered” for the social media user with ticipated in its design and coordination and drafted the manuscript;
a view to preventing escalation of difficulties they might be EP performed the statistical analysis; EP, NM and SG participated in
experiencing or to even put them in touch with services that interpretation of the data. All authors contributed to the writing, read
and approved the final manuscript.
could help.
The influence of the functionality of the social media Compliance with ethical standards
platform requires further exploration in this context, e.g.,
the perceived reward systems involved. Exploration of Conflict of interest The authors declare that they have no conflicts
the young person’s expectation from online communica- of interest.
tion, and coping mechanisms they have if they encounter
Funding This work was not funded.
unwanted outcomes from using social media would help
to gain more in-depth understanding of the relationship
between social media and young people’s mental health. Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://
Some examination of the change in relationship with social creativecommons.org/licenses/by/4.0/), which permits unrestricted
media through developmental stages and as the young use, distribution, and reproduction in any medium, provided you give
social media user’s experience grows would also be inform- appropriate credit to the original author(s) and the source, provide a
ative. The social communication needs of young people link to the Creative Commons license, and indicate if changes were
made.
could be better provided for through involving young peo-
ple in the design and development of social networking
sites. Similarly, improved safeguards could be integrated
into platform functionality if appropriate.
Hyperbole should be avoided in discussing the impact
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