The upsurge in youth screen time and social media usage parallels growing mental health concerns. While causality remains unproven, many studies associate screen and social media use as anxiety risk factors. Social media can benefit some youth in forming connections and shaping identity, but it may also trigger or exacerbate anxiety, emphasizing the need for balanced and mindful use. This article reviews existing literature on the potential risks and benefits of screen and social media use on youth anxiety, and proposes strategies for managing mental and digital health challenges attributed by the rapidly evolving landscape of youth engagement with technology.
Key points
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The prevalence of anxiety disorders, already the most common behavioral health conditions in youth and teens, is increasing over the last decade. Social media and other screen habits and experiences impact the development of youth and may promote or worsen disorders of anxiety.
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Given the potential effects of increased exposure to social media, “healthy” digital habits are essential to mitigate harm.
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Elevated exposure to social media has given rise to new manifestations of anxiety among youth (eg, nomophobia, fear of missing out, cyberchondria, among others).
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Social media can benefit youth via transmission of knowledge and facilitating peer support.
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Understanding the connections between use of social media and anxiety is an evolving area of study. Current literature has focused on studies that include anxiety as a variable alongside other indicators of mental health, such as depression, suicidality, loneliness, and others. Providers must stay abreast of this evolving field of study.
Introduction
Most of the world’s population, including youth, regularly access the digital world for learning, recreation, commerce, working, and/or socializing. In October 2023, an estimated 5.3 billion of the worldwide population of 8.1 billion used social media. Over the last twenty years, social media engagement has surged dramatically, growing from 5% in the United States in 2005 to nearly 70% worldwide today. , Merriam-Webster defines social media as “forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos).” In December 2023, the Pew Research Center released findings from an online survey of 1453 US teens, indicating that YouTube, TikTok, Snapchat, and Instagram are the online platforms used most by American adolescents.
Access and the use of handheld screen devices (eg, smartphones) has increased in youth of all ages. In 2017, nearly 95% of all children (0–8 years) in the United States had exposure and/or individual access to a smartphone, up from the 63% reported in 2013. The Pew survey indicated that 95% of US teens aged 13 to 17 years own a smartphone. Survey results indicated that 50% of older teens were constant Internet users, as compared to 40% of younger teens. The increased use of smartphones and other screen devices has been accompanied by elevated exposure to social media. Alarmingly, nearly 40% of youth aged 8 to 12 years use social media despite the standard age requirement for social media being set at 13 years. Further, socializing in a distant, asynchronous manner via social media may be appealing for youth suffering anxiety disorders, as it allows for avoidance of anxiety-producing situations including the immediacy of potentially awkward in-person social interactions and the need to leave the home environment.
Anxiety is the most common mental health condition among youth, with a lifetime prevalence reported at 28.8% and a median age of onset noted at 11 years. The presentation of anxiety in children and teens changes developmentally, with separation anxiety disorder presenting in younger children and increasing through mid-childhood, social anxiety disorder generally manifesting in early adolescence, and generalized anxiety disorder typically emerging in later adolescence and early adulthood. The prevalence of anxiety among youth increased by nearly 30% from 2016 to 2019, predating the COVID-19 pandemic. Soaring rates of pediatric mental illness following the COVID-19 pandemic led to a declaration of a pediatric mental health national emergency by the American Academy of Pediatrics (AAP) in 2021, followed by the US Surgeon General’s advisory “Protecting Youth Mental Health” which includes 20 references to social media. ,
The rise in mental health needs and anxiety among young individuals mirror increases in screen time and social media usage in the same population, suggesting a significant relationship. A research study with 17,409 youth in the United Kingdom found that the impact of social media on life satisfaction varied during specific age ranges in adolescence. For male individuals, the critical periods were at ages 14 to 15 years and 19 years, while for females, it was at ages 11 to 13 years and 19 years. The study further showed that higher social media use predicted lower life satisfaction 1 year later, and vice versa, depending on these age groups. A recent longitudinal cohort study of kindergarteners in Shanghai, China, sought to understand the relationship of screen time, screen content, and mental health. Exposure to educational screen media was not found to be a risk factor for mental health difficulties, but both screen time and social media exposure were. While causation is yet to be proven, findings from multiple correlational studies have sparked major concerns about the influence of social media on the mental health of young individuals. This has led to the issuance of an advisory issued in 2023 by the US Surgeon General warning that social media use may adversely affect youth mental health.
Research exploring the impact of social media on mental health is rapidly evolving, as is related policy development. This article serves as a brief review of the current literature on the interplay of social media and anxiety among youth living in the digital age. It discusses potential risks and benefits of social media use for youth and offers strategies for preventing and managing social media-induced anxiety.
A brief review of the literature
While causation remains unproven, research suggests an association between excessive social media exposure and elevated anxiety. A longitudinal study on a community sample of teens living in Canada (aged 13–14 years at the initial time of the study, and then followed up a year later) evaluated how social media use (ie, passive, active, and problematic) predicts depression and anxiety symptoms. Active and problematic social media use was associated with subsequent anxiety symptoms, with extraversion moderating these effects.
Exposure to social media has been associated with heightened anxiety for a variety of reasons. Youth with active social media engagement may base self-worth on their number of likes and followers, and disappointing social media response may lead to worries about status and self-efficacy. A 3-year longitudinal study of sixth and seventh graders in rural North Carolina, United States, found that habitual social media checking may alter brain sensitivity to social rewards, evidenced by changes in functional MRI. Comparing peers’ social media posts may influence self-worth development, and potentially harm self-esteem. Realizing that peers have more followers or likes makes one feel less popular, likable, and interesting, potentially exacerbating low self-esteem and social anxiety.
Social media users curate an online persona by posting the most positive images experiences, achievements, and accomplishments, contributing to a false impression of peers and unfair social comparisons. A survey of Singapore youth found higher levels of engagement in Instagram were positively correlated with social anxiety. Due to this tendency toward positive self-presentation, users who excessively use social media can find themselves struggling with upward social comparisons, mistakenly perceive themselves as inferior. These tendencies can adversely impact self-esteem and trigger social anxiety. ,
The tendency of social media to exacerbate anxiety may disproportionately affect female adolescents. The Quebec Longitudinal Study of Child Development investigated the relationships of generalized and social anxiety with Internet use among Canadian teens. Girls who started using the Internet for social engagements at the age of 15 years had a higher likelihood of having generalized anxiety and social anxiety when they reached 17 years of age. In contrast, no relationship between Internet use and mental health symptoms was found for boys. A longitudinal study on individuals aged 10 to 15 years in the United Kingdom assessed the time spent on social media at ages 12 to 13 years, followed by measuring self-esteem and social connectedness between the ages of 13 and 15 years, and finally evaluating mental health at ages 14 to 15 years. Findings revealed a linear trend linking increased social media time to deteriorating mental health. This trend was potentially moderated by positive self-esteem, although the association was not statistically significant. Further longitudinal research is needed to elucidate the relationship between social media use and anxiety, and how this relationship changes across stages of development and varies by gender.
Adolescents may feel pressured to project idealized online images, which can subsequently cause or exacerbate anxiety. Edited and filtered images and videos posted online create unrealistic standards. Social media algorithms reinforce these expectations by favoring content similar to what teens are already viewing. Adolescents unconsciously internalize the unattainable beauty standards set by social media profiles despite rationally understanding that they may not represent reality. Youth may feel the pressure to compete with idealized peer profiles by using editing apps and filters to alter their facial and body features and post flawless images of themselves. This cycle, particularly affecting girls, can lead to dissatisfaction with appearance, doing excessive photo editing, and an increased vulnerability to anxiety. , Frequent social media engagement may thus foster unrealistic body ideals and lead to body dysmorphic disorder, eating disorders, anxiety, and depression. ,
Social media also has positive effects. It provides an alternative means for socially anxious youth to practice social skills and connect with others, which can be perceived as being less intimidating than traditional face-to-face interactions. An Italian study explored the impact of social media on highly socially anxious teens compared to peers. This cross-sectional study found that socially anxious teens perceived asynchronicity offered through social media interaction as a positive feature since it allows users to take time to craft a social response. Conversely, social media posts often trigger fears of judgment, leading to rumination and self-doubt. This overthinking can spiral to thoughts such as “did I offend someone?” or “did what I post sound stupid or awkward?” resulting in compulsively checking posts to assess likes and comments or needless re-editing. A study of 1740 college students in China found a positive correlation between passive social media use (ie, looking at other’s posts without commenting or posting oneself) and social anxiety, while active use showed a negative correlation. The study suggests that socially anxious teens may improve their communication skills by actively engaging in social media, instead of being passive users. Improved communication skills could enhance self-esteem, resulting in more positive online interactions that might carry over to improving in-person social engagements.
New terminology for potential association of social media and anxiety
The evolving and pervasive nature of the digital world, has led to the following terms for contemporary social media-related anxieties.
Nomophobia
Nomophobia, short for “no mobile phone phobia,” refers to the fear of being without a smartphone or not being unable to connect to social media. A recent systematic review found nomophobia was endorsed by 15.2% to 99.7% of youth, depending on age, gender, location, and daily usage. An unhealthy overreliance on smartphones to maintain a near-constant social media connection can negatively impact academic performance, sleep quality, and anxiety-inducing habits. ,
Fear of Missing Out
“Fear of missing out” (FOMO) is linked to excessive social media use. Daily exposure to social media to curated photos of peers having fun, looking good, or celebrating achievements can make youth feel excluded, inferior, lonely, and inadequate. , These feelings are related to a sense of regret for failing to have similar experiences and may result in an intense need for immediate social engagement. Teens experiencing FOMO compulsively monitor social media activities to stay updated, often intensifying the cycle of feeling excluded. Habitual checking habits can be problematic for some youth (eg, by constantly interrupting important tasks or in-person socializing), especially those who may be predisposed to obsessive compulsive disorder. Any combination of social comparison, negative online interactions, and FOMO could elevate stress and anxiety , that subsequently detract from sleep quality, academic performance, overall mood, and well-being. , , ,
Cyberchondria
The Internet has become a massive repository of knowledge, both accurate and inaccurate. Individuals contribute to and extract information at will. Health information circulating on the Internet is largely unregulated and may lack factual verification. Individuals may compulsively search for health information online, misinterpret normal experiences as signs of severe illness, and eschew seeking professional medical advice. , Increased tendency to conduct self-diagnoses via the Internet has given rise to “cyberchondria”, which is defined as an excessive anxiety of having a severe medical condition as triggered by information obtained through online research and social media. With the advent of TikTok, health care providers are seeing youth utilizing social media mental health content to self-diagnose mental health conditions. A recent meta-analysis noted a significant positive correlation between seeking health information online and anxiety, and between anxiety and cyberchondria. Seeking information through copious Internet searches can also lead to information overload and decision fatigue, which may further elicit greater anxiety, and consequently creating a vicious cycle.
Strategies for managing social media-induced anxiety in adolescents
Considering engagement with social media is virtually inevitable, it is imperative for youth to learn healthy social media habits through self-management strategies. This section explores various strategies for fostering a healthier relationship with social media and promote positive mental well-being for youth living in the digital era.
Establishing Healthy Screen and Social Media Habits
Setting screen time limits
Studies indicate that extended screen time is associated with unhealthy lifestyle habits such as being sedentary, increased junk food consumption, poor sleep, reduced time outdoors, and limited sunlight exposure (summarized in Glover and colleagues ). As such, the Office of the US Surgeon General recommends individuals, especially adolescents who are at a crucial physiologic growth stage, establish a daily screen usage limit. The time limit should clearly distinguish between education and recreational screen use including social media interactions. This recommendation is consistent with the results of a recent study on 230 undergraduate students from a university in the Midwestern United States. Findings indicated that limiting social media use to approximately 30 minutes per day resulted in significant improvement in mental health, including a reduction in anxiety, depression, and FOMO.
Limiting screen use before bedtime
Sufficient quality sleep is related to mental and physical well-being and can improve mood and cognitive performance. The blue light emitted by digital devices suppresses the natural nighttime release of melatonin, a hormone that causes drowsiness. Using screens within an hour of bedtime can disrupt natural sleep cycles and adversely impact sleep quality. Browsing social media feeds before sleep may induce over-thinking and ruminations resulting in increased arousal and anxiety that can impair sleep. Youth should be encouraged to cease screen use at least an hour before bedtime, and to engage in calming activities like reading for enjoyment, breathing exercises and meditation to promote better sleep. Youth should also avoid using screen media in bed to avoid deconditioning one’s connection with the bed as a place only for sleep.
Periodically practicing “digital detox”
Although this is a new area of study and results have mixed findings, taking intentional prolonged breaks from online entertainment, including social media, has been recommended as an approach to achieve more “balanced” digital habits. A cross-sectional study of 68 university students in Lebanon observed that majority of participants who temporarily abstained from social media activity reported mood improvement, decreased anxiety, and better sleep quality during and immediately following the offline break. Individuals also tended to replace online engagements with in-person social activities during the digital detoxing period. Such periodic offline experiences can promote a more conscious and intentional approach to technology and social media use, and a time to recalibrate, focus, and reset priorities.
Building a Supportive Social Media Environment
Cultivating positive online connections
Nurturing positive online connections is pivotal for youth who use social media. Encouraging healthy online friendships and supportive group dynamics can foster a positive community which may mitigate the negative effects of social media. Being selective about the types of social media platforms used is also important. Choosing platforms that facilitate positive interactions and connection while avoiding those that contribute to anxiety or stress (eg, platforms which foster abusive behavior by allowing users to make public statements while remaining anonymous) can nurture mental well-being.
Recognizing and managing negative thoughts related to social media experiences
Repetitive negative thought patterns attributed to social media experiences can be detrimental to well-being. For example, FOMO and social comparisons can contribute to an adolescent’s negative thoughts about themselves and their self-worth. Strategies such as using social media actively (instead of passively scrolling through posts), using social media purposefully and for prescribed periods of time, setting boundaries with peers (eg, “I don’t respond to messages after 10 pm ”), and prioritizing authentic or in-person interactions could help counteract negative thoughts. Adolescents can develop emotional regulation skills under the guidance of parents and mental health professionals. Seeking support from friends, family, and/or mental health professionals offers valuable perspectives and coping strategies to navigate the complexities of social media-induced emotions.
Oversight at Home: What Can Parents and Caregivers Do?
Parents’ screen and social media habits
Parents and caregivers can model healthy digital habits for their children by limiting their own social media and screen use. This may include taking digital breaks, putting their devices out of access before bed and during dinner and other family times, and replacing social media connections with in-person socializing and spending time outdoors. A combination of these efforts reinforces the message that quality family time and in-person interaction is prioritized alongside social media. Parents and caregivers can openly discuss their own experiences with social media by sharing both negative and positive aspects. Such conversations could build trust, encourage children to share their own experiences, and facilitate productive discussions on ways to navigate complex social dynamics that arise on social media.
Managing social media exposure and screen use
Parents and caregivers should set clear guidelines for social media use that are tailored to each child’s maturity. New users are encouraged to use a single social media platform to understand its navigation and social dynamics before expanding into others. Children and teens should have a clear understanding of their parents’ guidelines and expectations for screen time and social media use as well as potential consequences for misuse. Parents and caregivers should follow their children’s social media accounts or designate a trusted adult or sibling to provide oversight. Software exerting parental control can be helpful in both restricting and monitoring online activities, although no type of supervision can fully protect against the evasion of technology savvy, motivated youth. Beginning with close supervision and tight restrictions, which gradually relax as youth demonstrate responsible social media use, is recommended.
Establishing social media communication do’s and don’ts
Each family should develop their own set of expectations and guidelines around social media use to reflect the needs and values of family. A written document could be posted in a common area. This document should include the consequences for rule violations. Signing a social media contract can also be considered. It is important that all members of the family are involved in the discussion and in agreement with these guidelines prior to implementation. Other recommendations of social media etiquettes that parents can use as points of discussions are listed in Table 1 . The AAP has a family media plan template that can be tailored for kids and teens (see link on Table 2 ).
