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Correspondence to Dr Miguel A Martinez-Gonzalez, PREVENTIVE MEDICINE AND PUBLIC HEALTH, University of Navarra, Pamplona, NAVARRA, Spain; [email protected]
Background
Prolonged daily exposure to screens has become rapidly ubiquitous in everyday life. Given that these devices are portable and they can be used anywhere at any time, the likelihood for their problematic or addictive use is high. Indeed, the prevalence of behavioural addictions and emotional well-being issues arising from problematic internet use worsened during the lockdown periods of the pandemic.1 2
In this essay, we will explore the impact of these exposures on adolescent mental health. The importance of these potential hazards cannot be understated. Even particular social networks have been forbidden in some countries, like TikTok in India. Also, in some cases legal actions have been taken (eg, the Seattle public school district sued the social network providers in January 2023, or a prohibition was set by the Italian government for minor access to some contents in November 2023). In this context, a critical examination of the evidence is needed before governments may adopt structural interventions for the sake of public health.
Relevant exposures
To date, no consensus has been found on nomenclature and definitions of concepts regarding problems associated with social media use. Based on the published diagnostic criteria, each of the different uses can be defined as follows: use of social network: subjects who use appropriately a website or app allowing people to connect with each other on a common platform. Problematic use of social network: subjects who have problems associated with the use in any of the following dimensions: preoccupation, withdrawal, tolerance, persistence, continuation, deception, escape, displacement and conflict.3 Addictive use of social network: according to the ICD-11,4 addictive behavior is a diagnosis that can be used when there is a pattern of persistent or recurrent behavior that takes precedence over other life interests. However, the ICD-11 does not include a specific diagnosis for social network addiction.
Screen time has been the most frequently assessed exposure,5 showing, for example, a direct association with the risk of depression in a quantitative meta-analysis of 18 prospective studies (total=241 398 participants).6 Screen time was also associated with psycho-behavioural problems in 82% of the assessed studies in another large meta-analysis.7