Content area
Purpose
Today with the internet expansion, social media has also been identified as a factor in evolutions. Social media is the title used to refer to the set of sites and tools that have been born and developed in the space created by modern media such as communication networks, the internet and mobile phones. The effects of emerging phenomena, such as social media on human health, especially mental health, are important. As the effects of social media on users mental health is unclear, and the evidence in this field is contradictory, this study aims to determine the role of social media on mental health.
Design/methodology/approachThe current study was a review conducted in 2020. According to keywords, an extensive search was conducted on Web of Science, PubMed, Scopus, Google Scholar, Magiran and SID databases. In total, 501 articles were obtained. The articles were screened in three stages. Finally, out of 501 evaluated articles, 50 cases were carefully assessed and included in the study.
FindingsThe findings showed that social media has negative and positive effects on mental health. Negative effects included anxiety, depression, loneliness, poor sleep quality, poor mental health indicators, thoughts of self-harm and suicide, increased levels of psychological distress, cyber bullying, body image dissatisfaction, fear of missing out and decreased life satisfaction. Positive effects included accessing other people’s health experiences and expert health information, managing depression, emotional support and community building, expanding and strengthening offline networks and interactions, self-expression and self-identity, establish and maintain relationships.
Originality/valueThe impact of social media on mental health can be considered as a double-edged sword. The important thing is to be able to reduce the negative effects of social media on mental health and turn it into an opportunity by implementing appropriate strategies and actions and to increase and strengthen the positive effects.
Introduction
Today’s society is full of symbols, signs and media so that everyday life and communication are increasingly integrated with the media space. Before the advent of the internet, mass media such as television, radio and newspapers were the most effective media (Oftade, 2012), but with the advent of the internet, its use has grown increasingly and has become a powerful global communication method (Korp, 2006).
Research studies indicate that internet access and usage is increasing. Statistics state that in 2017, 3.6 billion people had internet (Dosemagen and Aase, 2017), and there are currently more than 4.5 billion internet users worldwide (Internet Live Stats, 2020). Pew Internet and American Life Project data shows that 85% of American adults use the internet (Center, 2012b). The use of the internet is 88% among teenagers (Center, 2012a).
Meanwhile, we are witnessing the emergence of tools such as smart-phones and tablets. The mobile and (internet-enabled) smart-phone market had reached 96.2% globally (internet IWSM, 2017). In total, 3.2 billion people have access to mobile phones (Dosemagen and Aase, 2017). According to the latest Pew Research Center study in early 2018, approximately 91% of Americans years of age 18–29 have smart-phones (Hitlin, 2018). A cultural norm of young people being constantly connected to the internet has been established. It is estimated that people 18 to 24 years old, look at their phones more than 80 times per day (Bratu, 2018).
Today with the internet expansion, social media has also been identified as a factor in evolutions. Social media is the title used to refer to the set of sites and tools that have been born and developed in the space created by modern media such as communication networks, the internet and mobile phones. Social media can be classified into seven groups, namely, social networks, blogs, wikis, podcasts, forums, content communities and micro-blogs, among which social networks are the most important social media.
Social networks are databases that provide users with the opportunity to share their interests, thoughts and activities with others. In other words, a social network is a set of web-based services that allow individuals to create public or private descriptions for themselves, communicating with other members of the network, sharing their resources with them and using this platform to find new connections.
Social networks, especially social networking sites, have the largest audience among social media. In total, 67% of all internet users use at least one social networking site (Brenner, 2013). Facebook is the most common and recognizable form of social media. Other commonly used social media platforms include Instagram, Twitter and Snapchat (Ellison and Vitak, 2015).
A lot of people have accounts on several different social media platforms (Ellison and Vitak, 2015). There are currently more than 2.4 billion active Facebook users worldwide. Instagram and Twitter are next with 500 million users. Most social media users are young people. In total, 88%–90% of young people use social media (Perrin, 2015; Smith and Anderson, 2018). They spend 9 to 12 h daily on social media (Nielsen, 2018).
Actually, many people cannot imagine the world without access to the internet and social media
The integration of the internet, and especially social media, into today’s life is such that the new generation is called “digital natives” (Slyke, 2013).
The effects of emerging phenomena, such as social media on human health, especially mental health, are important. Some people believe that social networks improve their health. From the number of researchers’ and health professionals’ point of view, these tools also have positive effects on health and can be used for changing behavior and strengthening positive health behaviors (Green et al., 2005). Some studies show that using social media causes less loneliness, more self-esteem, more life satisfaction (Lin et al., 2016), the spread of happiness and increases social capital and promotes mental health (Woods and Scott, 2016).
But recent studies have raised serious concerns about the devastating effects of using social media on health, especially mental health. The results of these studies show that using social media causes problems such as depression and anxiety (Green et al., 2005, Sampasa-Kanyinga and Lewis, 2015, Lin et al., 2016, Woods and Scott, 2016, Shensa et al., 2017), less positive mood (Wang and Saudino 2011), decreased feelings of happiness (Brooks, 2015), decreased life satisfaction (Kross et al., 2013), and propensity toward addictive and destructive behaviors of mental health (Roberts et al., 2014).
As social media is an emerging phenomenon and its exact impact on users’ mental health is unclear and the evidence in this field is contradictory, this study was conducted to determine the role of social media on mental health.
Methods
The current study was a review was conducted in 2020 by reviewing the published and available internal and external sources related to the social media and mental health by searching the Web of Science, PubMed, Scopus, Google Scholar, Magiran and SID databases with the keyword of social media, health, mental health, mental hygiene, in Persian and English language. In total, 501 articles were obtained. For purposive sampling, the articles and texts were screened in three stages:
Initial or title screening, based on the titles, which are relevant to the social media and mental health.
Secondary screening, based on the study of the abstract and introduction of the articles and tertiary screening, including a brief study, prioritization based on the conceptual richness and complete investigation of the articles.
The inclusion criteria were:
Articles only in Persian and English.
Publication date between 2000 and 2020 years.
Explicit focus on social media and mental health four access to the text of articles.
The exclusion criteria were:
Languages other than English or Persian.
Study or review protocols.
Studies focusing on the impact of social media on other aspects of health.
Insufficiency of the presented data or poor description of the applied methods.
After the identification of the relevant articles, their reference lists were also screened for finding further studies. Thereafter, the remaining articles were reviewed meticulously. Finally, out of 501 evaluated articles, 50 cases were carefully assessed and included in the study. The selection process of the articles is illustrated by a flowchart indicating the stages from unsorted search results to the total number of included articles (Figure 1).
Results
The negative effects of social media on mental health
The extensive use of social media has led to research into the relationship between social media use and mental health. There was considerable evidence that social media use is associated with negative effects on mental health. The findings suggested that using social media can be associated with problems such as anxiety, depression, loneliness, poor sleep quality, poor mental health indicators, thoughts of self-harm and suicide, increased levels of psychological distress, cyber bullying, body image dissatisfaction, fear of missing out (FoMO) and decreased life satisfaction (Table 1).
The positive effects of social media on mental health
The findings of some studies showed that social media have some positive effects on mental health. These effects include: accessing other people’s health experiences and expert health information, managing depression, emotional support and community building, expanding and strengthening offline networks and interactions, self-expression and self-identity, establish and maintain relationships (Table 2).
Discussion
The findings of this review suggested that using social media can be associated with problems such as anxiety, depression, loneliness, poor sleep quality, poor mental health indicators, thoughts of self-harm and suicide, increased levels of psychological distress, cyberbullying, body image dissatisfaction, FoMO and decreased life satisfaction.
It is important to note a few points about the consequences of anxiety and depression caused by the use of social media. First, the use of social media among young people is far greater than that of older generations.
This anxiety can have negative effects on young people’s lives. Feelings of anxiety can lead to leaving the house, not attending school and college regularly, academic failure and job failure, which, in turn, can intensify depression. Second, it seems that what is important in the first place is the duration of use and the type of use and interaction in social networks, otherwise social media is not inherently destructive. As with nearly every behavior, moderation is key. It seems that active interaction in social media (engaging in exchanges with other users) is generally associated with positive outcomes effects, but passive use (viewing others’ posts and profiles without engaging in exchanges) has detrimental effects on mental health (Frison and Eggermont, 2015).
Addictive and long-term use of social media can reduce real-life social interactions and reduce mental health functioning and well-being.
Depression is a major cause of disability around the world and imposes a huge economic burden on societies. Therefore, the relevant authorities must take the necessary actions in this regard.
Sleep and mental health are closely related. Lack of proper sleep can damage mental health. This is even more important in adolescents and young people because brain development occurs during this time, and insufficient sleep can have negative effects. Additionally, adequate sleep is essential for an active and successful day.
Youth sleep problems are an important area of concern for parents, educators, practitioners and policymakers, as insufficient and poor-quality sleep has negative consequences across a range of dimensions, including mental health, academic achievement and interpersonal functioning. Inadequate sleep can also gradually cause physical and mental problems such as diabetes, high blood pressure, obesity and depression (Korp, 2006).
Body satisfaction is problematic, especially in adolescents and young adults. Statistics show that 9 in 10 girls say they are unhappy with their bodies and are worried about their body image (Dosemagen and Aase, 2017). We are also witnessing the growing number of unnecessary cosmetic surgeries in the younger generation, which can also have negative effects on physical health. The manipulations that users do in the photos uploaded on social media also show the importance of body image for young people. This concern can have side effects on people’s mental health. Therefore, informing and educating the community, especially adolescents and youth, about the duration and how to use social media, as well as the supervision of parents, schools and universities are important.
About the positive effects of social media on mental health should also pay attention to a few points. Today, social media is widely available in every geographic point and because people use them daily, especially through cell phones, it makes them an interesting locus for public health interventions in the behavioral domain. Social media is an important and advanced source for providing information on health-related issues. In other words, the media are the greatest educators in our world. To identify the correct pattern of life, continuous education is important. Part of this education aimed at improving knowledge, learning and creating a desirable behavior and ultimately maintaining health is called health education.
All levels and social classes always need health education. Even if this education is limited to informing and raising the level of knowledge of individuals, having the right information can be the basis for learning and changing the attitude and practice (Kia and Hosseinpour, 2013).
Social media can make people aware of the mental health risks and solutions to these dangers by creating effective communication with the audience in the health area, create motivation, teach the skills needed to reduce the risks, increase the demand for desirable health services, reduce the demand for undesirable services and help audiences choose preventive strategies, programs and treatments (Kia and Hosseinpour, 2013).
However, it should be noted that just as reliable and accurate information in the field of health is useful and constructive, receiving incorrect or even incomplete information can pose a greater threat to people’s health. The high volume of health information a person receives through social media and wrong interpretations about them makes it a more complicated issue. Therefore, the level of health literacy of individuals should be considered, which means that the individual can assess the validity of information and also understand the content of the information for its proper use. Information overload in this area can confuse people when interpreting information. This is even more important for the younger generation. Because this group has less experience, and on the other hand, is more dependent on social media and its information. Therefore, accurate and reliable information should be available from trusted ports, and users should have the necessary capabilities to evaluate the information or in other words, have a high level of health literacy.
Regarding the positive effect of social media on building relationships and social support, it should be noted that the use of social media has led to social displacement (Hall et al., 2019a), but the quality of relationships and social support may be more important than quantity (Teo et al., 2013). It seems that SNS can provide a platform for building and maintaining close and intimate relationships, but these relationships are less profound than real-world relationships. Therefore, we should try to use more active interactions in social media and use these interactions to strengthen communication in the real world.
Conclusion
The findings of the present study on the role of social media on mental health, show that these media have positive and negative effects on mental health, each in its place is important. Therefore, the impact of social media on mental health can be considered as a double-edged sword.
The important thing is to be able to reduce the negative effects of social media on mental health and turn it into an opportunity by implementing appropriate strategies and actions and to increase and strengthen the positive effects. The following actions are recommended in this regard:
Designing and using a warning system as a message to heavy users of social media while using it about the harms of social media addiction.
Designing and implementing appropriate training for pupils and students about the safe use of social media, including, social media addiction, body image and social media, cyber bullying and other possible effects of social media on mental health.
Training adequate skills for assessing and validating information on social media from adolescence, especially in schools.
Developing standard principles for disseminating health-related information through social media by the national health system (NHS).
Supervising the dissemination of health-related information by NHS.
Given the limitations of our study, which examined only the effects of social media on mental health, it is suggested that the effects of social media on other aspects of health be considered.
The Ethics Committee in National Agency for Strategic Research in Medical Education (NASR) approved this study with code 972545. The authors wish to thank National Agency for Strategic Research in Medical Education (NASR) for their support to do and complete this research.
Conflicts of Interests: The authors have declared that no competing interests exist.
Funding Source: This research was funded by the National Agency for Strategic Research in Medical Education. Tehran. Iran (Grant No. 972544).
Flowchart of study selection process
The negative effects of social media on mental health
| Criteria | Findings |
|---|---|
| Loneliness | A positive association between social media use and depressive symptoms (Kelly et al., 2018) |
| Increased use of social media, depressive symptom, online harassment, poor sleep, low self-esteem and poor body image also increases (Song et al., 2014) | |
| A positive association between use and loneliness (Chang et al., 2017) | |
| Loneliness correlates with worse mental health outcomes, including depression, dementia and suicide (Health RSfP, 2017) | |
| loneliness has a significant predictor of both indices of suicidal risk (Power et al., 2017) | |
| Social media use is linked with increased rates of anxiety, depression and poor sleep (O’Keeffe and Clarke-Pearson, 2011) | |
| One in five young people regularly wake up in the night to send or check messages on social media (Gámez-Guadix, 2014) | |
| Suicide and self-harm | Time spent on-screen activities increased rates of depressive symptoms and risk for suicide-related outcomes (Twenge et al., 2018) |
| As the hours spent daily visiting social network sites increased, there was a 32% increase in the likelihood of self-harm (Hartas, 2019) | |
| Poor sleep | Use of Twitter, Facebook, Snap Chat and Instagram reduce sleep (Health RSfP, 2017) |
| The greater social media use causes online harassment, poor sleep, low self-esteem and, poor body image; in turn, these cause higher depressive symptom scores (Kelly et al., 2018) | |
| Increased social media use is significantly associated with poor sleep quality. The use of social media on phones, laptops and tablets at night before bed is also associated with poor sleep quality (Scott et al., 2016; Woods and Scott, 2016; Xanidis and Brignell, 2016) | |
| Young people tend to check their devices regularly, even at night, therefore, this can reduce sleep quality, low mood, anxiety, feelings of inadequacy and reduced life satisfaction (Health RSfP, 2017; Przybylski et al., 2013) | |
| Anxiety and depression | limiting social media usage does have a direct and positive impact on subjective well-being over time, especially for decreasing loneliness and depression (Twenge et al., 2018; Hunt et al., 2018) |
| The use of social media by children, adolescents and adults causes depression (McCrae et al., 2017; Shensa et al.,2017) | |
| The use of social media causes loneliness, anxiety and depression in young people and fear of parents (Barry et al., 2017) | |
| The use of Facebook, Twitter or Instagram causes poorer mental health and manifesting symptoms of anxiety and depression (Health RSfP, 2017; Sampasa-Kanyinga and Lewis, 2015; Becker, 2013; Oliva et al., 2018) | |
| Long-term use of social media poses a mental health threat to youth and can produce detrimental outcomes such as depression, anxiety, loneliness and substance abuse (O’Keeffe and Clarke-Pearson, 2011; Gámez-Guadix, 2014) | |
| Young people tend to check their devices regularly, even at night, therefore, this can reduce sleep quality, low mood, anxiety, feelings of inadequacy and reduced life satisfaction (Health RSfP, 2017; Przybylski et al., 2013) | |
| The quality of everyday tasks and lifesatisfaction | Young people tend to check their devices regularly, even at night, therefore, this can reduce sleep quality, low mood, anxiety, feelings of inadequacy and reduced life satisfaction (Health RSfP, 2017; Przybylski et al., 2013) |
| limiting Facebook usage significantly increases life satisfaction and decreases depressive symptoms (Brailovskaia et al., 2020) | |
| One in five young people regularly wake up in the night to send or check messages on social media. This night-time activity is making teenagers three times more likely to feel tired at school than their peers who do not log on at night (Power et al., 2017) | |
| limiting social media usage increased time spent engaged in seven activities, browsing the internet, working, childcare and cooking/cleaning (Hall et al., 2019a) | |
| Cyberbullying | Cyber bullying is a growing problem with 7 in 10 young people saying they have experienced it (Health RSfP, 2017) |
| Long-term use of social media by young people can make them susceptible to cyberbullying and other forms of online harassment (O’Keeffe and Clarke-Pearson, 2011; Gámez-Guadix, 2014) | |
| Dissatisfaction with body image | Every hour on Facebook alone, 10 million new photos are uploaded, which shows the importance of appearance and body for people (Mayer-Schönberger and Cukier, 2013) |
| Seeking elective interventions by young people to improve their appearance in social media can have long term mental or physical health consequences (Rana and Kelleher, 2018) | |
| Young girls who use Facebook are more concerned about their body image compared to non-users (Tiggemann and Slater, 2014) |
The positive effects of social media on mental health
| Criteria | Findings |
|---|---|
| Getting health information | A tool for accessing other people’s health experiences and expert health information (Korp, 2006; Tatari, 2018; Ziebland and Wyke, 2012) |
| In total, 61% of adults use the internet for health care communications (Neuhauser and Kreps, 2003) | |
| Of the 17,000 American adults, 56% looked for health information from the internet and state that this information has affected their understanding of health (Fox and Duggan, 2011) | |
| In total, 63% of young people believed that social media is a good source of health information and nearly half of young people in the sample; (46%) reported changing their health-related behaviors as a direct result of accessing content from social media. A sizeable minority of young people; (43%) reported that health-related content on social media positively impacts their health (Goodyear et al., 2018) | |
| In total, 59% of patients use twitter for health counseling and 52.3% use Facebook for social counseling (Antheunis et al., 2013) | |
| In total, 33% of adults in American use Facebook and Twitter for health information and more than 80% of those aged 18–24 years old are sharing health information through social networks (PricewaterhouseCoopers, 2012) | |
| Mental health resource | Social media use has positive effects on mental health (Verduyn et al., 2015) |
| A resource for managing depression (Park et al., 2013) | |
| Social networks as a useful source of information for analyzing mental health problems (Stephen and Prabu, 2019) | |
| The appropriate tool to present the health information required by the community; Availability of physicians to provide information online for young people (Wong et al., 2014) | |
| The tool for emotional support | Approximately seven out of 10 teens use social media to control their emotions during difficult and challenging times (Health RSfP, 2017) |
| Twitter with 300 million users has a major platform for expressing personal views that researchers use it as an excellent source of information to analyze mental health problems and emotions (Stephen and Prabu, 2019) | |
| Young people can feel vulnerable discussing sensitive issues in face-to-face encounters and digital communication allows for greater honesty and openness (Gibson and Trnka, 2020) | |
| Maintaining relationships and reducing the risks of depression | Users can facilitate relationships with others through Facebook and strengthen them in an adaptive way (Simoncic et al., 2014) |
| The primary motivation of Facebook users is maintaining relationships and keeping in touch with friends (Smock et al., 2011) | |
| Facebook help peoples form and maintain social capital (Ellison et al., 2007) | |
| The proper use of social media can reduce the risks of developing depression (Fujiwara and Kawachi, 2008) | |
| Social media can provide a platform for people to overcome barriers of distance and time to connect and reconnect with others, thereby expanding and strengthening their offline networks and interactions despite geographical separation (Hall et al., 2019b; Russell and Fish, 2016) | |
| Social media can help people with self-expression and self-identity (Ifinedo, 2016) | |
| Active engagement with peers, friends and family | Social media are venues for personal disclosures, active interaction with peers and the spread of social relationships (Verduyn et al., 2015) |
| Online support has the potential to provide networks of support to young people that have implications for both their online and offline friendships (Hall et al., 2019b; Antoci et al.,2015) | |
| Social media can provide online socializing with friends and family around the world (Sainsbury and Benton, 2017) | |
| Entertainment | Youth pervasively use social media for a variety of reasons including identity formation, entertainment, social enhancement and maintaining interpersonal connections (Ifinedo, 2016) |
| Self-expression | People can also share their favorite topics and create content through social media. Getting likes or followers can create an identity list that helps shape young people’s identities (Orehek and Human, 2017) |
| Social media is also space where people can express their political identities (Stangor and Walinga, 2010) | |
| Increasing self-esteem and life satisfaction | Social capital and social ties can increase psychological well-being indicators such as self-esteem and life satisfaction (Ellison et al., 2007; Nabi et al., 2013) |
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