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US Surgeon General Dr Vivek Murthy last week called for tobacco-like warnings on social media, saying the youth mental health crisis was an emergency that required action without waiting for “complete information”.
Questions remain among experts about what role social media plays in the mental health of children and adolescents, and the authors of a comprehensive new review of research on social media and mental health say we still lack critical information to know whether prevention programs and interventions are effective.
In studyIn a paper published Monday in the medical journal JAMA Pediatrics, researchers reviewed nearly 150 studies on the relationship between social media and adolescent mental health. They found a general association between adolescent anxiety and depression and the time they spend on social media platforms, as well as between the types of activities and content they engage with. But the levels of impact varied widely, suggesting the findings shouldn’t be generalized to the entire population.
The researchers found that few studies have assessed the relationship between social media use and adolescents experiencing mental health symptoms at a clinical level, such as seeking medical services or currently receiving a diagnosis, further obscuring the findings.
“There is a real risk that findings from the general population may be inaccurately generalised to young people with mental illness,” wrote the study authors, from the University of Cambridge in the UK and Stellenbosch University in South Africa.
“In a world increasingly permeated with digital technologies, we cannot afford to design prevention programs, interventions and regulations without knowing that they will work for everyone, especially the most vulnerable.”
another analysis An existing research report published in December by the National Academies of Sciences, Engineering, and Medicine also raised important unanswered questions.
“There is insufficient evidence to definitively say that social media makes a difference to adolescent health at the population level,” the independent news release announcing the report said, adding, “Despite years of research, there is limited evidence to clarify exactly how social media affects health.”
While science suggests there is a link between social media and mental health, it’s often not clear whether social media is affecting an individual’s mental health or whether an individual’s mental health is affecting social media use, said Dr. Sandro Galea, chair of the task force. He is a member of the National Academies committee that wrote the study analysis and is dean of the Boston University School of Public Health.
Future studies should focus on tracking trends over time, such as tracking the mental health of the same kids before and after exposure to social media to see how it affects them, and digging into more specific measures that capture how social media is used, he said.
For Mursi, the urgency of the youth mental health crisis is paramount, and there is enough evidence to act now. In a New York Times op-ed, Mursi advocated for warning labels “to regularly remind parents and adolescents that social media has not been proven safe,” among other interventions.
Murthy cited two major reports as justification for the warning labels: a 2019 study that found adolescents who spend a lot of time on social media are at increased risk for anxiety and depression, and a 2022 survey that found nearly half of adolescents said social media makes them feel bad about their bodies.
“One of the most important lessons I learned in medical school is that in an emergency, you can’t afford to wait for perfect information. Evaluate the facts you have available, use your best judgment, and act quickly,” Murthy writes in his book. essay“The youth mental health crisis is an emergency, and social media is emerging as a key contributing factor.”
Many experts agree that the Surgeon General has started an important conversation and shouldn’t be reluctant in asking for more information, but social media warning labels will require nuance in their wording and implementation, and they will likely require congressional action to make them a reality.
“The surgeon general is identifying what he sees as a public health challenge and then thinking about ways to act to mitigate that challenge, and from that standpoint, I think he’s doing exactly what a surgeon general should do,” Galea said. “Public health actions often have to be taken without complete or perfect data.”
A committee from the National Academy of Sciences specifically recommended against banning social media. Despite potential harms, such as unhealthy social comparisons and interference with other important health behaviors like sleep, exercise, and studying, social media can also benefit young people by helping them foster connections with friends, family, and online support communities.
But there’s an important distinction between benefit and safety, Murthy said Friday. dailyThe New York Times podcast.
“It’s important to look at the research question broadly. The first thing we’re trying to understand is the answer to the question parents ask us, which is ‘Is social media safe for kids?’ When we ask researchers ‘What does the data tell us about safety? Where is the data that shows these platforms are safe?’ The data doesn’t exist. So there is no evidence of safety. There is growing evidence of harm,” he said.
“There are certainly benefits, but some benefits do not justify inflicting significant harm on children.”
Still, social media is not the same as cigarettes: smoking has a stronger and more direct relationship to adverse health effects, and quitting smoking is not the end goal of social media.
Social media warning labels should be similar to those that are placed on bicycles and cars, said Pamela Wisniewski, an associate professor of human-computer interaction at Vanderbilt University who studies the relationship between social media, privacy and online safety for teens.
“The key is to focus on solutions that empower young people and give them choices and opportunities to maximise the benefits of social media use and minimise the risks, as opposed to taking a restrictive, surveillance-based approach that is deeply rooted in fear,” she said. The goal should be to ensure appropriate use, rather than focusing solely on risks and harms.
Products that children come into contact with are expected to have been safety tested, and warning labels on social media can send a clear message that “there are a lot of safety deficiencies,” said Dr. Jenny Radesky, co-medical director of the American Academy of Pediatrics’ Center for Research on Social Media and Adolescent Mental Health.
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“We expect baby formula to be tested for bacteria, toys to be tested for lead paint and there to be safety regulations for everything from cribs to cars. These safety guardrails that prioritize children’s health when it comes to digital products don’t exist in the U.S.,” she said.
Still, warning labels are brief, and nuances can get lost in “internet noise,” Radesky said. “Family conversations about supporting healthy media use take time and require a lot of repetition.”
For the Surgeon General, warning labels are part of a comprehensive strategy to reduce the risks that social media poses to young people in the United States. Systemic design changes by the platforms, and legislation to support those changes, remain a priority.
“To be clear, warning labels alone will not make social media safe for young people,” he wrote. “These harms are not the result of willpower or failures of parenting, but the result of unleashing powerful technologies without sufficient safeguards, transparency, and accountability.”
