Digital media use and mental health

The relationships between digital media use and mental health have been investigated by various researchers—predominantly psychologists, sociologists, anthropologists, and medical experts—especially since the mid-1990s, after the growth of the World Wide Web. A significant body of research has explored "overuse" phenomena, commonly known as "digital addictions", or "digital dependencies." These phenomena manifest differently in many societies and cultures. Some experts have investigated the benefits of moderate digital media use in various domains, including in mental health, and the treatment of mental health problems with novel technological solutions.

The delineation between beneficial and pathological use of digital media has not been established. There are no widely accepted diagnostic criteria, although some experts consider overuse a manifestation of underlying psychiatric disorders. The prevention and treatment of pathological digital media use is also not standardized, although guidelines for safer media use for children and families have been developed. The 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) do not include diagnoses for problematic internet use and problematic social media use; the ICD-11 includes a diagnosis for gaming disorder (commonly known as video game addiction), whereas the DSM-5 does not. Debate over how and when to diagnose these conditions is ongoing as of 2023. The use of the term addiction to refer to these phenomena and diagnoses has been questioned.

Digital media and screen time have changed how children think, interact and develop in positive and negative ways, but researchers are unsure about the existence of hypothesized causal links between digital media use and mental health outcomes. Those links appear to depend on the individual and the platforms they use. Several large technology firms have made commitments or announced strategies to try to reduce the risks of digital media use.

History and terminology

The relationship between digital technology and mental health has been investigated from many perspectives.^[1][2][3] Benefits of digital media use in childhood and adolescent development have been found.^[4][5] Concerns have been expressed by researchers, clinicians and the public in regard to apparent compulsive behaviors of digital media users, as correlations between technology overuse and mental health problems become apparent.^[1][5][6][7]

Terminologies used to refer to compulsive digital-media-use behaviours are not standardized or universally recognised. They include "digital addiction", "digital dependence", "problematic use", or "overuse", often delineated by the digital media platform used or under study (such as problematic smartphone use or problematic internet use).^[8] Unrestrained use of technological devices may affect developmental, social, mental and physical well-being and may result in symptoms akin to other psychological dependence syndromes, or behavioral addictions.^[9][7] The focus on problematic technology use in research, particularly in relation to the behavioural addiction paradigm, is becoming more accepted, despite poor standardization and conflicting research.^[10]

Internet addiction has been proposed as a diagnosis since the 1998^[11] and social media and its relation to addiction has been examined since 2009.^[12] A 2018 Organisation for Economic Co-operation and Development (OECD) report stated there were benefits of structured and limited internet use in children and adolescents for developmental and educational purposes, but that excessive use can have a negative impact on mental well-being. It also noted an overall 40% increase in internet use in school-age children between 2010 and 2015, and that different OECD nations had marked variations in rates of childhood technology use, as well as differences in the platforms used.^[13]

The Diagnostic and Statistical Manual of Mental Disorders has not formally codified problematic digital media use in diagnostic categories, but it deemed internet gaming disorder to be a condition for further study in 2013.^[14] Gaming disorder, commonly known as video game addiction, has been recognised in the ICD-11.^[15][16] Different recommendations in the DSM and the ICD are due partly to the lack of expert consensus, the differences in emphasis in the classification manuals, as well as difficulties using animal models for behavioural addictions.^[9]

The utility of the term addiction in relation to the overuse of digital media has been questioned, in regard to its suitability to describe new, digitally mediated psychiatric categories, as opposed to overuse being a manifestation of other psychiatric disorders.^[2][3] Usage of the term has also been criticised for drawing parallels with substance use behaviours. Careless use of the term may cause more problems—both downplaying the risks of harm in seriously affected people, as well as overstating risks of excessive, non-pathological use of digital media.^[3] The evolution of terminology relating excessive digital media use to problematic use rather than addiction was encouraged by Panova and Carbonell, psychologists at Ramon Llull University, in a 2018 review.^[17]

Due to the lack of recognition and consensus on the concepts used, diagnoses and treatments are difficult to standardize or develop. Heightened levels of public anxiety around new media (including social media, smartphones and video games) further obfuscate population-based assessments, as well as posing management dilemmas.^[2] Radesky and Christakis, the 2019 editors of JAMA Paediatrics, published a review that investigated "concerns about health and developmental/behavioral risks of excessive media use for child cognitive, language, literacy, and social-emotional development."^[18] Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may have a detrimental effect, in areas such as learning, family relationship dynamics, and overall development.^[19]

Problematic use

See also: Cyberpathology, Digital Revolution, Social aspects of television, and Television consumption

Though associations have been observed between digital media use and mental health symptoms or diagnoses, causality has not been established; nuances and caveats published by researchers are often misunderstood by the general public, or misrepresented by the media.^[3] Females are more likely to overuse social media, and males video games.^[20] Following from this, problematic digital media use may not be singular constructs, may be delineated based on the digital platform used, or reappraised in terms of specific activities (rather than addiction to the digital medium).^[21]

Access to means of communication

In 1890, 1 percent of U.S. households owned at least one telephone, while a majority did by 1946 and 75 percent did by 1957.^[22][23] In 1948, 1 percent of U.S. households owned at least one television while 75 percent did by 1955,^[23] and by 1992, 60 percent of all U.S. households received cable television subscriptions.^[24] In 1980, 1 percent of U.S. households owned at least one videocassette recorder while 75 percent did by 1992.^[23] From 1970 to 1999, the percentage of U.S. children aged 11–12 with a television in their bedroom grew from 6 percent to 77 percent.^[25]

In 2000, a majority of U.S. households had at least one personal computer and internet access the following year.^[26] In 2002, a majority of U.S. survey respondents reported having a mobile phone.^[27] In September and December 2006 respectively, Luxembourg and the Netherlands became the first countries to completely transition from analog to digital television, while the United States commenced its transition in 2008. In September 2007, a majority of U.S. survey respondents reported having broadband internet at home.^[28] In January 2013, a majority of U.S. survey respondents reported owning a smartphone.^[29] An estimated 40% of U.S. households in 2006 owned a dedicated home video game console,^[30][31] and by 2015, 51 percent of U.S. households owned a dedicated home video game console.^[32][33] In April 2015, one survey of U.S. teenagers ages 13 to 17 reported that nearly three-quarters of them either owned or had access to a smartphone, and 92 percent went online daily, with 24 percent saying they went online "almost constantly."^[34]

Screen time and mental health

See also: Criticism of Facebook § Psychological/sociological effects, and Social media and suicide

Some types of potentially problematic internet use are associated with psychiatric or behavioural problems such as depression, anxiety, hostility, aggression and attention deficit hyperactivity disorder (ADHD). The studies could not determine if causal relationships exist; it was unclear, for example, whether people with depression might overuse the internet because they were already depressed, or if using the internet too much triggered the depression.^[1] While overuse of digital media has been associated with depressive symptoms, digital media may also be used in some situations to improve mood.^[35][36] Symptoms of ADHD have been positively correlated with digital media use in a large prospective study.^[37] The ADHD symptom of hyperfocus may cause affected individuals to overuse video games, social media, or online chatting; however the correlation between hyperfocus and problematic social media use is weak.^[38]

A 2018 review found associations between the self-reported mental health symptoms by users of the Chinese social media platform WeChat and excessive platform use. However, the motivations and usage patterns of WeChat users affected overall psychological health, rather than the amount of time spent using the platform.^[7]

An analysis of data from the Monitoring the Future survey, the Millennium Cohort Study, and the Youth Risk Behavior Surveillance System found that digital technology use (including, playing video games, watching television, using social media, etc.) accounted for only 0.4% of the variation in adolescent well-being.^[39] Additional research found little evidence for substantial negative associations for digital screen engagement and adolescent well-being.^[40] However, looking exclusively at the effect social media usage has on girls, there was a strong association between using social media and poor mental health.^[41][42]

The evidence, although of mainly low to moderate quality, shows an correlation between heavy screen time and a variety of health physical and mental health problems.^[6] However, moderate use of digital media is also correlated with benefits for young people in terms of social integration, mental health, and overall well-being.^[6]

A 2017 UK large-scale study of the "Goldilocks hypothesis"—of avoiding both too much and too little digital media use^[43]—was described as the "best quality" evidence to date by experts and non-government organisations (NGOs) reporting to a 2018 UK parliamentary committee. That study concluded that modest digital media use may have few adverse affects, and some positive associations in terms of well-being.^[44]

Social media and mental health

Excessive time spent on social media may be more harmful than digital screen time as a whole. Some research found a "substantial" association between social media use and mental health issues, but most found only a weak or inconsistent relationship.^[45][46][47] There is nuanced evidence for a relationship between social media usage and flourishing.^[48]

There is a significant association between social media use and depression, with the association especially high for adolescent girls.^[49]

Proposed diagnostic categories

See also: Computer addiction, Internet addiction disorder, Internet sex addiction, Nomophobia, Problematic smartphone use, Problematic social media use, Television addiction, and Video game addiction

Gaming disorder has been considered by the DSM-5 task force as warranting further study (as the subset internet gaming disorder), and was included in the ICD-11.^[14] Concerns have been raised by Aarseth and colleagues over this inclusion, particularly in regard to stigmatization of heavy gamers.^[50]

Christakis has asserted that internet addiction may be "a 21st century epidemic".^[51] In 2018, he commented that childhood Internet overuse may be a form of "uncontrolled experiment[s] on ... children".^[52] International estimates of the prevalence of internet overuse have varied considerably, with marked variations by nation. A 2014 meta-analysis of 31 nations yielded an overall worldwide prevalence of six percent.^[53] A different perspective in 2018 by Musetti and colleagues reappraised the internet in terms of its necessity and ubiquity in modern society, as a social environment, rather than a tool, thereby calling for the reformulation of the internet addiction model.^[54]

Some medical and behavioural scientists recommend adding a diagnosis of "social media addiction" (or similar) to the next Diagnostic and Statistical Manual of Mental Disorders update.^[55][56][7] A 2015 review concluded there was a probable link between basic psychological needs and social media addiction. "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users 'hooked'."^[57]

Internet sex addiction, also known as cybersex addiction, has been proposed as a sexual addiction characterized by virtual internet sexual activity that causes serious negative consequences to one's physical, mental, social, and/or financial well-being.^[58][59] It may be considered a form of problematic internet use.^[60]

Related phenomena

Online problem gambling

Main article: Online gambling § Problem gambling

A 2015 review found evidence of higher rates of mental health comorbidities, as well as higher amounts of substance use, among internet gamblers, compared to non-internet gamblers. Causation, however, has not been established. The review postulates that there may be differences in the cohorts between internet and land-based problem gamblers.^[61]

Cyberbullying

Main article: Cyberbullying

Cyberbullying, bullying or harassment using social media or other electronic means, has been shown to have effects on mental health. Victims may have lower self-esteem, increased suicidal ideation, decreased motivation for usual hobbies, and a variety of emotional responses, including being scared, frustrated, angry, anxious or depressed. These victims may also begin to distance themselves from friends and family members.^[62][63][64]

According to the EU Kids Online project, the incidence of cyberbullying across seven European countries in children aged 8–16 increased from 8% to 12% between 2010 and 2014. Similar increases were shown in the United States and Brazil.^[65]

Media multitasking

Main article: Media multitasking

Concurrent use of multiple digital media streams, commonly known as media multitasking, has been shown to be associated with depressive symptoms, social anxiety, impulsivity, sensation seeking, lower perceived social success and neuroticism.^[66] A 2018 review found that while the literature is sparse and inconclusive, overall, heavy media multitaskers also have poorer performance in several cognitive domains.^[67] One of the authors commented that the data does not "unambiguously show that media multitasking causes a change in attention and memory", therefore it is possible to argue that it is inefficient to multitask on digital media.^[68]

Distracted road use

Main articles: Mobile phones and driving safety and Smartphones and pedestrian safety

See also: Distracted driving, Human multitasking, and Texting while driving

In March 2023, Accident Analysis & Prevention published a systematic review of 47 samples across 45 studies investigating associations between problematic mobile phone use and road safety outcomes (including 32 samples of drivers, 9 samples of pedestrians, 5 samples with road use type unspecified, and 1 sample of motorcyclists and bicyclists) that found that problematic mobile phone use was associated with greater risk of simultaneous mobile phone use and road use and risk of vehicle collisions and pedestrian collisions or falls.^[69]

Noise-induced hearing loss

See also: Tinnitus and Occupational hearing loss

This section is an excerpt from Noise-induced hearing loss § Video game sound levels.[edit]

In January 2024, BMJ Public Health published a systematic review of 14 studies investigating associations between sound-induced hearing loss and playing video games and esports that found a significant association between gaming and hearing loss or tinnitus and that the average measured sound levels during gameplay by subjects (which averaged 3 hours per week) exceeded or nearly exceeded permissible sound exposure levels.^[70]

Assessment and treatment

Rigorous, evidence-based assessment of problematic digital media use is yet to be comprehensively established. This is due partially to a lack of consensus around the various constructs and lack of standardization of treatments.^[71] The American Academy of Pediatrics (AAP) has developed a Family Media Plan, intending to help parents assess and structure their family's use of electronic devices and media more safely. It recommends limiting entertainment screen time to two hours or less per day.^[72][73] The Canadian Paediatric Society produced a similar guideline. Ferguson, a psychologist, has criticised these and other national guidelines for not being evidence-based.^[74] Other experts, cited in a 2017 UNICEF Office of Research literature review, have recommended addressing potential underlying problems rather than arbitrarily enforcing screen time limits.^[3]

Different methodologies for assessing pathological internet use have been developed, mostly self-report questionnaires, but none have been universally recognised as a gold standard.^[75] For gaming disorder, both the American Psychiatric Association^[76] and the World Health Organization (through the ICD-11)^[15] have released diagnostic criteria.

There is some limited evidence of the effectiveness of cognitive behavioral therapy and family-based interventions for treatment. In randomized controlled trials, medications have not been shown to be effective.^[71] A 2016 study of 901 adolescents suggested mindfulness may assist in preventing and treating problematic internet use.^[77] A 2019 UK parliamentary report deemed parental engagement, awareness and support to be essential in developing "digital resilience" for young people, and to identify and manage the risks of harm online.^[44] Treatment centres have proliferated in some countries, and China and South Korea have treated digital dependence as a public health crisis, opening 300 and 190 centres nationwide, respectively.^[78] Other countries have also opened treatment centres.^[79][80]

NGOs, support and advocacy groups provide resources to people overusing digital media, with or without codified diagnoses,^[81][82] including the American Academy of Child and Adolescent Psychiatry.^[83][84]

A 2022 study outlines the mechanisms by which media-transmitted stressors affect mental well-being. Authors suggest a common denominator related to problems with the media's construction of reality is increased uncertainty, which leads to defensive responses and chronic stress in predisposed individuals.^[85]

Associated psychiatric disorders

ADHD

Main article: Attention deficit hyperactivity disorder

In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found an 85% correlation between IGD and ADHD.^[86] In October 2018, PNAS USA published a systematic review of four decades of research on the relationship between children and adolescents' screen media use and ADHD-related behaviours and concluded that a statistically small relationship between children's media use and ADHD-related behaviours exists.^[87] In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits.^[88] In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and impulsivity.^[89] In January 2021, the Journal of Psychiatric Research published a systematic review of 29 studies including 56,650 subjects that found that ADHD symptoms were consistently associated with gaming disorder and more frequent associations between inattention and gaming disorder than other ADHD scales.^[90]

In July 2021, Frontiers in Psychiatry published a meta-analysis reviewing 40 voxel-based morphometry studies and 59 functional magnetic resonance imaging studies comparing subjects with IGD or ADHD to control groups that found that IGD and ADHD subjects had disorder-differentiating structural neuroimage alterations in the putamen and orbitofrontal cortex (OFC) respectively, and functional alterations in the precuneus for IGD subjects and in the rewards circuit (including the OFC, the anterior cingulate cortex, and striatum) for both IGD and ADHD subjects.^[91] In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and ADHD symptoms in children.^[92] In April 2022, Developmental Neuropsychology published a systematic review of 11 studies where the data from all but one study suggested that heightened screen time for children is associated with attention problems.^[93] In July 2022, the Journal of Behavioral Addictions published a meta-analysis of 14 studies comprising 2,488 subjects aged 6 to 18 years that found significantly more severe problematic internet use in subjects diagnosed with ADHD to control groups.^[94]

In December 2022, European Child & Adolescent Psychiatry published a systematic literature review of 28 longitudinal studies published from 2011 through 2021 of associations between digital media use by children and adolescents and later ADHD symptoms and found reciprocal associations between digital media use and ADHD symptoms (i.e. that subjects with ADHD symptoms were more likely to develop problematic digital media use and that increased digital media use was associated with increased subsequent severity of ADHD symptoms).^[95] In May 2023, Reviews on Environmental Health published a meta-analysis of 9 studies with 81,234 child subjects that found a positive correlation between screen time and ADHD risk in children and that higher amounts of screen time in childhood may significantly contribute to the development of ADHD.^[96] In December 2023, the Journal of Psychiatric Research published a meta-analysis of 24 studies with 18,859 subjects with a mean age of 18.4 years that found significant associations between ADHD and problematic internet use,^[97] while Clinical Psychology Review published a systematic review and meta-analysis of 48 studies examining associations between ADHD and gaming disorder that found a statistically significant association between the disorders.^[98]

Anxiety

Main articles: Generalized anxiety disorder and Social anxiety disorder

In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found a 92% correlation between IGD and anxiety and a 75% correlation between IGD and social anxiety.^[86] In August 2018, Wiley Stress & Health published a meta-analysis of 39 studies comprising 21,736 subjects that found a small-to-medium association between smartphone use and anxiety.^[99]

In December 2018, Frontiers in Psychiatry published a systematic review of 9 studies published after 2014 investigating associations between problematic SNS use and comorbid psychiatric disorders that found a positive association between problematic SNS use and anxiety.^[100] In March 2019, the International Journal of Adolescence and Youth published a systematic review of 13 studies comprising 21,231 adolescent subjects aged 13 to 18 years that found that social media screen time, both active and passive social media use, the amount of personal information uploaded, and social media addictive behaviors all correlated with anxiety.^[101] In February 2020, Psychiatry Research published a systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and anxiety and positive associations between higher levels of problematic smartphone use and elevated risk of anxiety,^[102] while Frontiers in Psychology published a systematic review of 10 studies of adolescent or young adult subjects in China that concluded that the research reviewed mostly established an association between social networks use disorder and anxiety among Chinese adolescents and young adults.^[103]

In April 2020, BMC Public Health published a systematic review of 70 cross-sectional and longitudinal studies investigating moderating factors for associations for screen-based sedentary behaviors and anxiety symptoms among youth that found that while screen types was the most consistent factor, the body of evidence for anxiety symptoms was more limited than for depression symptoms.^[104] In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and anxiety.^[89] In November 2020, Child and Adolescent Mental Health published a systematic review of research published between January 2005 and March 2019 on associations between SNS use and anxiety symptoms in subjects between ages of 5 to 18 years that found that increased SNS screen time or frequency of SNS use and higher levels of investment (i.e. personal information added to SNS accounts) were significantly associated with higher levels of anxiety symptoms.^[105]

In January 2021, Frontiers in Psychiatry published a systematic review of 44 studies investigating social media use and development of psychiatric disorders in childhood and adolescence that concluded that the research reviewed established a direct association between levels of anxiety, social media addiction behaviors, and nomophobia, longitudinal associations between social media use and increased anxiety, that fear of missing out and nomophobia are associated with severity of Facebook usage, and suggested that fear of missing out may trigger social media addiction and that nomophobia appears to mediate social media addiction.^[106] In March 2021, Computers in Human Behavior Reports published a systematic review of 52 studies published before May 2020 that found that social anxiety was associated with problematic social media use and that socially anxious persons used social media to seek social support possibly to compensate for a lack of offline social support.^[107] In June 2021, Clinical Psychology Review published a systematic review of 35 longitudinal studies published before August 2020 that found that evidence for longitudinal associations between screen time and anxiety was lacking.^[108] In August 2021, a meta-analysis was presented at the 2021 International Conference on Intelligent Medicine and Health of articles published before January 2011 that found evidence for a negative impact of social media on anxiety.^[109]

In January 2022, The European Journal of Psychology Applied to Legal Context published a meta-analysis of 13 cross-sectional studies comprising 7,348 subjects that found a statistically significant correlation between cybervictimization and anxiety with a moderate-to-large effect size.^[110] In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and anxiety in children,^[92] while Adolescent Psychiatry published a systematic review of research published from June 2010 through June 2020 studying associations between social media use and anxiety among adolescent subjects aged 13 to 18 years that established that 78.3% of studies reviewed reported positive associations between social media use and anxiety.^[111] In April 2022, researchers in the Department of Communication at Stanford University performed a meta-analysis of 226 studies comprising 275,728 subjects that found a small but positive association between social media use and anxiety,^[112] while JMIR Mental Health published a systematic review and meta-analysis of 18 studies comprising 9,269 adolescent and young adult subjects that found a moderate but statistically significant association between problematic social media use and anxiety.^[113]

In May 2022, Computers in Human Behavior published a meta-analysis of 82 studies comprising 48,880 subjects that found a significant positive association between social anxiety and mobile phone addiction.^[114] In August 2022, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and anxiety.^[115] In November 2022, Cyberpsychology, Behavior, and Social Networking published a systematic review of 1,747 articles on problematic social media use that found a strong bidirectional relationship between social media use and anxiety.^[116] In March 2023, the Journal of Public Health published a meta-analysis of 27 studies published after 2014 comprising 120,895 subjects that found a moderate and robust association between problematic smartphone use and anxiety.^[117] In July 2023, MDPI Healthcare published a systematic review and meta-analysis of 16 studies that established correlation coefficients of 0.31 and 0.39 between nomophobia and anxiety and nomophobia and smartphone addiction respectively.^[118]

In September 2023, Frontiers in Public Health published a systematic review and meta-analysis of 37 studies comprising 36,013 subjects aged 14 to 24 years that found a positive and statistically significant association between problematic internet use and social anxiety,^[119] while BJPsych Open published a systematic review of 140 studies published from 2000 through 2020 found that social media use for more than 3 hours per day and passive browsing was associated with increased anxiety.^[120] In January 2024, the Journal of Computer-Mediated Communication published a meta-analysis of 141 studies comprising 145,394 subjects that found that active social media use was associated with greater symptoms of anxiety and passive social media use was associated with greater symptoms of social anxiety.^[121] In February 2024, Addictive Behaviors published a systematic review and meta-analysis of 53 studies comprising 59,928 subjects that found that problematic social media use and social anxiety are highly and positively correlated,^[122] while The Egyptian Journal of Neurology, Psychiatry and Neurosurgery published a systematic review of 15 studies researching associations between problematic social media use and anxiety in subjects from the Middle East and North Africa (including 4 studies with subjects exclusively between the ages of 12 and 19 years) that established that most studies found a significant association.^[123]

Autism

Main article: Autism spectrum

In September 2018, the Review Journal of Autism and Developmental Disorders published a systematic review of 47 studies published from 2005 to 2016 that concluded that associations between autism spectrum disorder (ASD) and screen time was inconclusive.^[124] In May 2019, the Journal of Developmental and Behavioral Pediatrics published a systematic review of 16 studies that found that children and adolescents with ASD are exposed to more screen time than typically developing peers and that the exposure starts at a younger age.^[125] In April 2021, Research in Autism Spectrum Disorders published a systematic review of 12 studies of video game addiction in ASD subjects that found that children, adolescents, and adults with ASD are at greater risk of video game addiction than those without ASD, and that the data from the studies suggested that internal and external factors (sex, attention and oppositional behavior problems, social aspects, access and time spent playing video games, parental rules, and game genre) were significant predictors of video game addiction in ASD subjects.^[126] In March 2022, the Review Journal of Autism and Developmental Disorders published a systematic review of 21 studies investigating associations between ASD, problematic internet use, and gaming disorder where the majority of the studies found positive associations between the disorders.^[127]

In August 2022, the International Journal of Mental Health and Addiction published a review of 15 studies that found that high rates of video game use in boys and young males with ASD was predominantly explained by video game addiction, but also concluded that greater video game use could be a function of ASD restricted interest and that video game addiction and ASD restricted interest could have an interactive relationship.^[128] In December 2022, the Review Journal of Autism and Developmental Disorders published a systematic review of 10 studies researching the prevalence of problematic internet use with ASD that found that ASD subjects had more symptoms of problematic internet use than control group subjects, had higher screen time online and an earlier age of first-time use of the internet, and also greater symptoms of depression and ADHD.^[129] In July 2023, Cureus published a systematic review of 11 studies that concluded that earlier and longer screen time exposure for children was associated with higher risk of a child developing ASD.^[130] In December 2023, JAMA Network Open published a meta-analysis of 46 studies comprising 562,131 subjects that concluded that while screen time may pose a developmental risk of ASD in childhood, associations between ASD and screen time were not statistically significant when accounting for publication bias.^[131]

Bipolar disorder

Main article: Bipolar disorder

In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits.^[88] In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found that a weak-to-moderate positive association between mobile phone addiction and impulsivity.^[89]

In April 2021, a meta-analysis of 3 studies comprising 9,142 subjects was presented at the International Conference on Big Data and Informatization Education that found that problematic internet use is a risk factor for bipolar disorder.^[132] In December 2023, the Journal of Psychiatric Research published a meta-analysis of 24 studies with 18,859 subjects with a mean age of 18.4 years that found significant associations between problematic internet use and impulsivity.^[97]

Depression

Main article: Major depressive disorder

In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found an 89% correlation between IGD and depression.^[86] In July 2018, JMIR Mental Health published a systematic review of 11 studies investigating social media use and depression among lesbian, gay, and bisexual (LGB) users that found that while qualitative research found that social media use could lead to greater social support and less loneliness for LGB users, LGB users were more likely to be cyberbullied than heterosexual users, that cyberbullying of LGB users was associated with depression among victims, and constant monitoring of accounts by LGB users was also found to be a stressor associated with depression.^[133]

In December 2018, Frontiers in Psychiatry published a systematic review of 9 studies published after 2014 investigating associations between problematic SNS use and comorbid psychiatric disorders that found a positive association between problematic SNS use and depression.^[100] In March 2019, the International Journal of Adolescence and Youth published a systematic review of 13 studies comprising 21,231 adolescent subjects aged 13 to 18 years that found that social media screen time, both active and passive social media use, the amount of personal information uploaded, and social media addictive behaviors all correlated with depression.^[101] In April 2019, the Journal of Affective Disorders published a meta-analysis assessing associations between SNS use and higher levels of depression that found that greater SNS screen time and frequency of checking SNS accounts had small but statistically significant associations with higher levels of depression, that greater general social comparisons on SNS had a small to moderate association, and greater upward social comparisons on SNS had a moderate association.^[134] In November 2019, BMC Public Health published a systematic review and meta-analysis of 12 cross-sectional studies and 7 longitudinal studies that found that screen time-based sedentary behavior is associated with depression risk.^[135]

In January 2020, Translational Psychiatry published a meta-analysis of 12 prospective studies comprising 128,553 subjects that found that while sedentary behavior and depression risk had a significant positive association, television viewing and other mentally passive sedentary behaviors were positively associated with depression risk but computer use and other mentally active sedentary behaviors were not.^[136] In February 2020, Psychiatry Research published a systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and depression and positive associations between higher levels of problematic smartphone use and elevated risk of depression.^[102] Also in February 2020, Frontiers in Psychology published a systematic review of 10 studies of adolescent or young adult subjects in China that concluded that the research reviewed mostly established an association between social networks use disorder and depression among Chinese adolescents and young adults.^[103] In March 2020, the Review of General Psychology published a meta-analysis that found a small association between social networking service (SNS) use and self-reported depression.^[137] In April 2020, BMC Public Health published a systematic review of 70 cross-sectional and longitudinal studies investigating moderating factors for associations for screen-based sedentary behaviors and depression symptoms among youth that found that the most consistent factor was for screen type since television viewing was not as strongly associated with depression symptoms as other screen types.^[104]

In August 2020, the Journal of Medical Internet Research published an umbrella review of 7 systematic reviews on research investigating associations between depression and use of mobile technologies and social media by adolescents that concluded that while mobile technology and social media may promote social support, excess social comparison and personal involvement (i.e. increased exposure in general, exposure to specific content that promotes depressive symptoms, and the degree of personal information posted on social media) could be associated with symptoms of depression.^[138] In October 2020, the Journal of Affective Disorders published a meta-analysis of 12 studies with subjects aged 11 to 18 years that found a small but statistically significant positive correlation between social media use and depressive symptoms among adolescents,^[139] while the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and depression.^[89] In November 2020, Child and Adolescent Mental Health published a systematic review of research published between January 2005 and March 2019 on associations between SNS use and depression in subjects between ages of 5 to 18 years that found that increased SNS screen time or frequency of SNS use and problematic and addictive SNS use were significantly associated with higher levels of depression symptoms.^[105]

In January 2021, Frontiers in Psychiatry published a systematic review of 44 studies investigating social media use and development of psychiatric disorders in childhood and adolescence that concluded that passive social media use (e.g. browsing other user photos or scrolling through comments or news feeds) and depression are bidirectionally associated and that problematic social media use and depressive symptoms are mediated by social comparisons.^[106] In February 2021, Research on Child and Adolescent Psychopathology published a meta-analysis of 62 studies comprising 451,229 subjects that found SNS screen time and SNS use intensity to have weak but statistically significant associations with depression symptoms, while problematic SNS use was found to have a moderate association with depression symptoms.^[140] In March 2021, Youth & Society published a systematic review of 9 studies that found an association between SNS use and adolescent subjective well-being including mood, but that the results over whether the association was positive or negative were mixed.^[141] In April 2021, the Journal of Affective Disorders published a systematic review and meta-analysis of 92 studies comprising 15,148 subjects across 25 countries investigating associations between depression and internet gaming disorder found that one-third of the IGD subjects had been diagnosed with depression and major severe depressive symptoms were found in IGD subjects globally without a formal diagnosis in comparison to the general population.^[142]

In May 2021, Current Psychology published a meta-analysis of 55 studies comprising 80,533 subjects that found a small but positive and statistically significant association between SNS use and self-reported depression symptoms.^[143] In June 2021, Clinical Psychology Review published a systematic review of 35 longitudinal studies published before August 2020 that found that an association between screen time and subsequent depressive symptoms among young people was small and varied by device type and use.^[108] In July 2021, Translational Medicine Communications published a systematic review of 9 studies published between October 2010 and December 2018 with Instagram user subjects between the ages of 19 and 35 years that found an association between Instagram use and depression symptoms.^[144] In January 2022, The European Journal of Psychology Applied to Legal Context published a meta-analysis of 13 cross-sectional studies comprising 7,348 subjects that found a statistically significant correlation between cybervictimization and depression with a moderate-to-large effect size.^[110] In February 2022, the International Journal of Social Psychiatry published a meta-analysis of 131 studies comprising 244,676 subjects that found a moderate mean correlation between problematic social media use and depression.^[145]

In March 2022, Computers in Human Behavior published a systematic review and meta-analysis of 531 cross-sectional or longitudinal studies with subjects aged 10 to 24 years that found a small bidirectional association between online media use and depressive symptoms and that the effect size did not differ between general internet use, smartphone use, social media use, or online gaming, but also found that studies that measured online media use with media addiction scales rather than by screen time found significantly greater associations.^[146] Also in March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and depression in children,^[92] while Adolescent Psychiatry published a systematic review of research published from June 2010 through June 2020 studying associations between social media use and depression among adolescent subjects aged 13 to 18 years that established that 82.6% of studies reviewed reported positive associations between social media use and depression.^[111] In April 2022, the International Journal of Environmental Research and Public Health published a meta-analysis of 21 cross-sectional studies and 5 longitudinal studies comprising 55,340 adolescent subjects that found that social media screen time had a linear dose–response association with depression risk among adolescents and that depression risk increased by 13% for each additional hour of social media screen time.^[147]

Also in April 2022, researchers in the Department of Communication at Stanford University performed a meta-analysis of 226 studies comprising 275,728 subjects that found a small but positive association between social media use and depression,^[112] while JMIR Mental Health published a systematic review and meta-analysis of 18 studies comprising 9,269 adolescent and young adult subjects that found a moderate but statistically significant association between problematic social media use and depression.^[113] In August 2022, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and depression and a stronger association between binge-watching and depression was found during the COVID-19 pandemic than pre-pandemic.^[115] In November 2022, Cyberpsychology, Behavior, and Social Networking published a systematic review of 1,747 articles on problematic social media use that found a strong bidirectional relationship between social media use and depression.^[116] In December 2022, Frontiers in Psychiatry published a meta-analysis of 18 cohort studies comprising 241,398 subjects that found that screen time is a predictor of depressive symptoms.^[148] In March 2023, the Journal of Public Health published a meta-analysis of 27 studies published after 2014 comprising 120,895 subjects that found a moderate and robust association between problematic smartphone use and depression.^[117]

In April 2023, Trauma, Violence, & Abuse published a systematic review and meta-analysis of 17 studies comprising 79,202 adolescent subjects between the ages of 10 and 19 years that found that depression was three times more common among cyberbullying victims than control groups.^[149] In July 2023, Current Psychology published a meta-analysis of 38 studies comprising 14,935 subjects in Turkey that found a small but positive association between problematic social media use and depression.^[150] In September 2023, Clinical Psychological Science published a preregistered review and meta-analysis of 34 articles published between 2018 and 2020 studying associations between adolescent depression and social media use to identify the proportion of samples taken from the Global North and Global South, and found that more than 70% examined Global North populations and that associations in the Global North were positive and significant while associations in the Global South were null and non-significant.^[151] In September 2023, BJPsych Open published a systematic review of 140 studies published from 2000 through 2020 that found that social media use for more than 3 hours per day and passive browsing was associated with increased depression in children, adolescents, and young adults.^[120] In February 2024, The Egyptian Journal of Neurology, Psychiatry and Neurosurgery published a systematic review of 15 studies researching associations between problematic social media use and depression in subjects from the Middle East and North Africa (including 4 studies with subjects exclusively between the ages of 12 and 19 years) that established that most studies found a significant association.^[123]

Insomnia

Main article: Insomnia

In August 2018, Sleep Science and Practice published a systematic review and meta-analysis of 19 studies comprising 253,904 adolescent subjects that found that excessive technology use had a strong and consistent association with reduced sleep duration and prolonged sleep onset latency for adolescents 14 years of age or older.^[152] Also in August 2018, Sleep Science published a systematic review of 12 studies investigating associations between exposure to video games, sleep outcomes, and post-sleep cognitive abilities that found the data present in the studies indicated associations between a reduction in sleep duration, increased sleep onset latency, modifications to rapid eye movement sleep and slow-wave sleep, increased sleepiness and self-perceived fatigue, and impaired post-sleep attention span and verbal memory.^[153] In October 2019, Sleep Medicine Reviews published a systematic review and meta-analysis of 23 studies comprising 35,684 subjects that found a statistically significant odds ratio for sleep problems and reduced sleep duration for subjects with internet addiction.^[154] In February 2020, Psychiatry Research published a systematic review and meta-analysis of 14 studies that found positive associations between problematic smartphone use and poor sleep quality and between higher levels of problematic smartphone use and elevated risk of poor sleep quality.^[102]

Also in February 2020, Sleep Medicine Reviews published a systematic review of 31 studies examining associations between screen time and sleep outcomes in children younger than 5 years and found that screen time is associated with poorer sleep outcomes for children under the age of 5, with meta-analysis only confirming poor sleep outcomes among children under 2 years.^[155] In March 2020, Developmental Review published a systematic review of 9 studies that found a weak-to-moderate association between sleep quantity and quality and problematic smartphone use among adolescents.^[156] In October 2020, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 80 studies that found that greater screen time was associated with shorter sleep duration among toddlers and preschoolers,^[157] while the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found a weak-to-moderate positive association between mobile phone addiction and poor sleep quality.^[89] In April 2021, Sleep Medicine Reviews published a systematic review of 36 cross-sectional studies and 6 longitudinal studies that found that 24 of the cross-sectional studies and 5 of the longitudinal studies established significant associations between more frequent social media use and poor sleep outcomes.^[158]

In June 2021, Frontiers in Psychiatry published a systematic review and meta-analysis of 34 studies comprising 51,901 subjects that established significant associations between problematic gaming and sleep duration, poor sleep quality, daytime sleepiness, and other sleep problems.^[159] In September 2021, BMC Public Health published a systematic review of 49 studies investigating associations between electronic media use and various sleep outcomes among children and adolescents 15 years of age or younger that found a strong association with sleep duration and stronger evidence for an association with sleep duration between the ages of 6 and 15 years than for 5 years of age or younger, while evidence for associations between electronic media use with other sleep outcomes was more inconclusive.^[160] In December 2021, Frontiers in Neuroscience published a systematic review of 12 studies published from January 2000 to April 2020 that found that adult subjects with higher gaming addiction scores were more likely to have shorter sleep quantity, poorer sleep quality, delayed sleep timing, and greater daytime sleepiness and insomnia scores than subjects with lower gaming addiction scores and non-gamer subjects.^[161] In January 2022, Early Childhood Research Quarterly published a systematic review and meta-analysis of 26 studies that found a weak but statistically significant association with increased smartphone and tablet computer use and poorer sleep in early childhood.^[162]

In May 2022, the Journal of Affective Disorders published a meta-analysis of 29 studies comprising 20,041 subjects that found a weak-to-moderate association between mobile phone addiction and sleep disorder and that adolescents with mobile phone addiction were at higher risk of developing sleep disorder.^[163] In August 2022, the International Journal of Environmental Research and Public Health published a systematic review and meta-analysis of 16 studies comprising 8,077 subjects that established a significant association between binge-watching and sleep problems and a stronger association between binge-watching and sleep problems was found during the COVID-19 pandemic than pre-pandemic.^[115] In October 2022, Reports in Public Health published a systematic review of 23 studies that found that excessive use of digital screens by adolescents was associated with poor sleep quality, nighttime awakenings, long sleep latency, and daytime sleepiness.^[164] In December 2022, Sleep Epidemiology published a systematic review of 18 studies investigating associations between sleep problems and screen time during COVID-19 lockdowns that found that the increased screen time during the lockdowns negatively impacted sleep duration, sleep quality, sleep onset latency, and wake time.^[165] In March 2023, the Journal of Clinical Sleep Medicine published a systematic review and meta-analysis of 17 studies comprising 36,485 subjects that found that smartphone overuse was closely associated with self-reported poor sleep quality, sleep deprivation, and prolonged sleep latency.^[166]

In April 2023, Sleep Medicine Reviews published a systematic review of 42 studies that found digital media use to be associated with shorter sleep duration and poorer sleep quality and bedtime or nighttime use with poor sleep outcomes, but only found associations for general screen use, mobile phone use, computer and internet use, internet, and social media and not for television, game console, and tablet use.^[167] In July 2023, MDPI Healthcare published a systematic review and meta-analysis of 16 studies that established a correlation coefficient of 0.56 between nomophobia and insomnia.^[118] In September 2023, PLOS One published a systematic review and meta-analysis of 16 studies of smartphone addiction and sleep among medical students found that 57% of subjects had poor sleep and 39% of subjects had smartphone addiction with a correlation index of 0.3,^[168] while Computers in Human Behavior published a meta-analysis of 23 longitudinal studies comprising 116,431 adolescent subjects that found that adolescent screen time with computers, smartphones, social media, and television are positively associated with negative impacts on sleep health later in life.^[169]

Narcissism

Main article: Narcissistic personality disorder

In April 2018, a meta-analysis published in the Journal of Personality found that the positive correlation between grandiose narcissism and SNS usage was replicated across platforms (including Facebook and Twitter).^[170] In July 2018, a meta-analysis published in Psychology of Popular Media found that grandiose narcissism positively correlated with time spent on social media, frequency of status updates, number of friends or followers, and frequency of posting self-portrait digital photographs.^[171] In March 2020, the Review of General Psychology published a meta-analysis that found a small-to-moderate association between SNS use and narcissism.^[137] In June 2020, Addictive Behaviors published a systematic review finding a consistent, positive, and significant correlation between grandiose narcissism and problematic social media use.^[172]

OCD

Main article: Obsessive–compulsive disorder

In April 2018, the International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found a 75% association between IGD and obsessive–compulsive disorder symptoms.^[86]

Mental health benefits

 

Smartphones and other digital devices are ubiquitous in many societies.

Individuals with mental illness can develop social connections over social media, that may foster a sense of social inclusion in online communities.^[4][5] People with mental illness may share personal stories in a perceived safer space, as well as gaining peer support for developing coping strategies.^[4][5]

People with mental illness are likely to report avoiding stigma and gaining further insight into their mental health condition by using social media. This comes with the risk of unhealthy influences, misinformation, and delayed access to traditional mental health outlets.^[4]

Other benefits include connections to supportive online communities, including illness or disability specific communities, as well as the LGBTQIA community.^[5] Young cancer patients have reported an improvement in their coping abilities due to their participation in an online community.^[173] The uses of social media for healthcare communication include providing reducing stigma and facilitating dialogue between patients and between patients and health professionals.^[174]

Furthermore, in children, the educational benefits of digital media use are well established.^[4] For example, screen-based programs can help increase both independent and collaborative learning. A variety of quality apps and software can also decrease learning gaps and increase skill in certain educational subjects.^[175]

Other disciplines

Digital anthropology

Daniel Miller from University College London has contributed to the study of digital anthropology, especially ethnographic research on the use and consequences of social media and smartphones as part of the everyday life of ordinary people around the world. He notes the effects of social media are very specific to individual locations and cultures. He contends "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context."^[176]

Digital anthropology is a developing field which studies the relationship between humans and digital-era technology. It aims to consider arguments in terms of ethical and societal scopes, rather than simply observing technological changes.^[177] Brian Solis, a digital analyst and anthropologist, stated in 2018, "we've become digital addicts: it's time to take control of technology and not let tech control us".^[178]

Digital sociology

Digital sociology explores how people use digital media using several research methodologies, including surveys, interviews, focus groups, and ethnographic research. It intersects with digital anthropology, and studies cultural geography. It also investigates longstanding concerns, and contexts around young people's overuse of "these technologies, their access to online pornography, cyber bullying or online sexual predation".^[179]

A 2012 cross-sectional sociological study in Turkey showed differences in patterns of internet use that related to levels of religiosity in 2,698 subjects. With increasing religiosity, negative attitudes towards internet use increased. Highly religious people showed different motivations for internet use, predominantly searching for information.^[180] A study of 1,296 Malaysian adolescent students found an inverse relationship between religiosity and internet addiction tendency in females, but not males.^[181]

A 2018 review published in Nature considered that young people may have different experiences online, depending on their socio-economic background, noting lower-income youths may spend up to three hours more per day using digital devices, compared to higher-income youths.^[182] They theorized that lower-income youths, who are already vulnerable to mental illness, may be more passive in their online engagements, being more susceptible to negative feedback online, with difficulty self-regulating their digital media use. It concluded that this may be a new form of digital divide between at-risk young people and other young people, pre-existing risks of mental illness becoming amplified among the already vulnerable population.^[182]

Neuroscience

A 2018 neuroscientific review published in Nature found the density of the amygdala, a brain region involved in emotional processing, is related to the size of both offline and online social networks in adolescents. They considered that this and other evidence "suggests an important interplay between actual social experiences, both offline and online, and brain development". The authors postulated that social media may have benefits, namely social connections with other people, as well as managing impressions people have of other people such as "reputation building, impression management, and online self-presentation". It identified "adolescence [as] a tipping point in development for how social media can influence their self-concept and expectations of self and others", and called for further study into the neuroscience behind digital media use and brain development in adolescence.^[183] Although brain-imaging modalities are under study, neuroscientific findings in individual studies often fail to be replicated in future studies, similar to other behavioural addictions; as of 2017, the exact biological or neural processes that could lead to excessive digital media use are unknown.^[3]

Impact on cognition

There is research and development about the cognitive impacts of smartphones and digital technology. A group reported that, contrary to widespread belief, scientific evidence does not show that these technologies harm biological cognitive abilities and that they instead only change predominant ways of cognition – such as a reduced need to remember facts or conduct mathematical calculations by pen and paper outside contemporary schools. However, some activities – like reading novels – that require long focused attention-spans and do not feature ongoing rewarding stimulation may become more challenging in general.^[184][185] How extensive online media usage impacts cognitive development in youth is under investigation^[186] and impacts may substantially vary by the way and which technologies are being used – such as which and how digital media platforms are being used – and how these are designed. Impacts may vary to a degree such studies have not yet taken into account and may be modulatable by the design, choice and use of technologies and platforms, including by the users themselves.

 

Measured results of the study

A study suggests that in children aged 8–12 during two years, time digital gaming or watching digital videos can be positively correlated with measures intelligence, albeit correlations with overall screen time (including social media, socializing and TV) were not investigated and 'time gaming' did not differentiate between categories of video games (e.g. shares of games' platform and genre), and digital videos did not differentiate between categories of videos.^[187][188]

Impact on social life

Worldwide adolescent loneliness in contemporary schools and depression increased substantially after 2012 and a study found this to be associated with smartphone access and Internet use.^[189][190]

Mitigation

Industry

Several technology firms have implemented changes intending to mitigate the adverse effects of excessive use of their platforms.

In December 2017, Facebook admitted passive consumption of social media could be harmful to mental health, although they said active engagement can have a positive effect. In January 2018, the platform made major changes to increase user engagement.^[191] In January 2019, Facebook's then head of global affairs, Nick Clegg, responding to criticisms of Facebook and mental health concerns, stated they would do "whatever it takes to make this environment safer online especially for youngsters". Facebook admitted "heavy responsibilities" to the global community, and invited regulation by governments.^[192] In 2018 Facebook and Instagram announced new tools that they asserted may assist with overuse of their products.^[193] In 2019, Instagram, which has been investigated specifically in one study in terms of addiction,^[194] began testing a platform change in Canada to hide the number of "likes" and views that photos and videos received in an effort to create a "less pressurised" environment.^[195] It then continued this trial in Australia, Italy, Ireland, Japan, Brazil and New Zealand^[196] before extending the experiment globally in November of that year. The platform also developed artificial intelligence to counter cyberbullying.^[197]

In 2018, Alphabet Inc. released an update for Android smartphones, including a dashboard app enabling users to set timers on application use.^[198] Apple Inc. purchased a third-party application and then incorporated it in iOS 12 to measure "screen time".^[199] Journalists have questioned the functionality of these products for users and parents, as well as the companies' motivations for introducing them.^[198][200] Alphabet has also invested in a mental health specialist, Quartet, which uses machine learning to collaborate and coordinate digital delivery of mental health care.^[201]

Two activist investors in Apple Inc voiced concerns in 2018 about the content and amount of time spent by youth. They called on Apple Inc. to act before regulators and consumers potentially force them to do so.^[202] Apple Inc. responded that they have, "always looked out for kids, and [they] work hard to create powerful products that inspire, entertain, and educate children while also helping parents protect them online". The firm is planning new features that they asserted may allow them to play a pioneering role in regard to young people's health.^[203]

Public sector

In China, Japan, South Korea and the United States, governmental efforts have been enacted to address issues relating to digital media use and mental health.

China's Ministry of Culture has enacted several public health efforts from as early as 2006 to address gaming and internet-related disorders. In 2007, an "Online Game Anti-Addiction System" was implemented for minors, restricting their use to 3 hours or less per day. The ministry also proposed a "Comprehensive Prevention Program Plan for Minors' Online Gaming Addiction" in 2013, to promulgate research, particularly on diagnostic methods and interventions.^[204] China's Ministry of Education in 2018 announced that new regulations would be introduced to further limit the amount of time spent by minors in online games.^[205][206] In response, Tencent, the owner of WeChat and the world's largest video game publisher, restricted the amount of time that children could spend playing one of its online games, to one hour per day for children 12 and under, and two hours per day for children aged 13–18.^[207] Effective 2 September 2023, those under the age of 18 can no longer access the Internet on their mobile device between 10 pm and 6 am without parental bypass. Smartphone usage is similarly capped by default at 40 minutes a day for children younger than eight and at two hours for 16- and 17-year-olds.^[208]

Japan's Ministry of Internal Affairs and Communications coordinates Japanese public health efforts in relation to problematic internet use and gaming disorder. Legislatively, the Act on Development of an Environment that Provides Safe and Secure Internet Use for Young People was enacted in 2008, to promote public awareness campaigns, and support NGOs to teach young people safe internet use skills.^[204]

South Korea has eight government ministries responsible for public health efforts in relation to internet and gaming disorders. A review article published in Prevention Science in 2018 stated that the "region is unique in that its government has been at the forefront of prevention efforts, particularly in contrast to the United States, Western Europe, and Oceania."^[204] Efforts are coordinated by the Ministry of Science and ICT, and include awareness campaigns, educational interventions, youth counseling centres, and promoting healthy online culture.^[204]

In May 2023, the United States' Surgeon general took the rare measure of issuing an advisory on Social media and mental health.^[209][210] In October, 41 U.S. states commenced legal proceedings against Meta. This included the attorneys general of 33 states filing a combined lawsuit over concerns about the addictive nature of Instagram and its impact on the mental health of young people.^[211][212]

Digital mental health care

 

"Wellmind", a United Kingdom National Health Service smartphone application

Digital technologies have also provided opportunities for delivery of mental health care online; benefits have been found with computerized cognitive behavioral therapy for depression and anxiety.^[213] Mindfulness based online intervention has been shown to have small to moderate benefits on mental health. The greatest effect size was found for the reduction of psychological stress. Benefits were also found regarding depression, anxiety, and well-being.^[214]

The Lancet commission on global mental health and sustainability report from 2018 evaluated both benefits and harms of technology. It considered the roles of technologies in mental health, particularly in public education; patient screening; treatment; training and supervision; and system improvement.^[215] A study in 2019 published in Front Psychiatry in the National Center for Biotechnology Information states that despite proliferation of many mental health apps there has been no "equivalent proliferation of scientific evidence for their effectiveness."^[216]

Steve Blumenfield and Jeff Levin-Scherz, writing in the Harvard Business Review, claim that "most published studies show telephonic mental health care is as effective as in-person care in treating depression, anxiety and obsessive-compulsive disorder." The also cite a 2020 study done with the Veterans Administration as evidence of this as well.^[217]

See also

• Evolutionary psychiatry
• Instagram's impact on people
• Screen time
• Social aspects of television

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