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Cite as: CMAJ 2020 February 10;192:E136-41. doi: 10.1503/cmaj.190434
CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/190434-ana
In the last decade, increasing mental distress and treatment for mental health conditions among youth in North America has paralleled a steep rise in the use of smartphones and social media by children and adolescents.
In Ontario, the proportion of teenagers reporting moderate to serious mental distress increased from 24% in 2013, to 34% in 2015 and to 39% in 2017,1 with parallel increases in health service utilization. Inpatient hospital admissions of children and adolescents for mental health reasons increased substantially across Canada between 2007 and 2014, while admissions for other medical conditions in this age group decreased by 14%.2 Between 2009 and 2014, admissions to hospital for intentional self-harm increased by 110% in Canadian girls.3 Suicide is now the second leading cause of death for Canadian youth.4 A recent analysis of survey data found the 12-month prevalence of suicidal ideation, attempts and nonsuicidal self-injury to be 8.1%, 4.3% and 8.8%, respectively, among adolescents aged 14 to 17 years, with all rates being higher in girls.5 Similarly, administrative data in the United States show that presentations to hospital for suicidal ideation or attempts among children and adolescents almost doubled between 2008 and 2015, with the highest increase for adolescent girls.6 Self-poisoning rates among 10- to 18-year-olds, which had declined in the US since the turn of the century, increased substantially from 2011 to 2018, primarily among girls.7 Surveys of high school students in the US have shown a similar pattern for self-reported symptoms of depression, major depressive episodes and suicidality over the last 2 decades.8,9
At the same time, social media use has increased markedly. In the US, the proportion of young people between the ages of 13 and 17 years who have a smartphone has reached 89%, more than doubling over a 6-year period; moreover, 70% of teenagers use social media multiple times per day, up from a third of teens in 2012.10 The percentage of Ontario's teenagers who reported spending 5 or more hours a day on social media increased from 11% in 2013, to 16% in 2015 and to 20% in 2017.1 An analysis of Australian longitudinal data found that 86% of students owned smartphones in grade 8,...