Yes, social media use is linked to depression in teens
Readers had many questions after my recent column linking worsening mental health in teens to social media use.
Ben, a 16-year-old from New York, disputes the association. “If you want to know what’s making me anxious about the world, it’s police shootings of unarmed Black people,” he wrote. “It’s the destruction of our planet. It’s assault rifles in schools.”
Esther from North Carolina attributes the rise in depression and anxiety to isolation from covid-19. “When will we finally acknowledge the damage that was done to kids from closing schools?”
Of course, they certainly are correct that covid was extremely disruptive to many young people. And some individuals could be experiencing anxiety or depression as a reaction to other things happening in the news. But on a population level, the clearest correlation is between smartphone and social media use and mental distress, self-injuring behavior and suicidality.
To sort out possible contributing factors, I spoke with Jean M. Twenge, a psychology professor at San Diego State University. Twenge’s extensive research led her to write a book, “iGen,” about the generation of children born after 1995 whose entire adolescence occurred in the time of the smartphone. She is convinced that smartphone use – social media in particular – is the primary contributor to the disturbing trend of worsening teen depression.
As she explained, multiple studies have shown that “the increases in mental health issues among teens began in the early 2010s.” This coincided with the period when most adult Americans gained access to smartphones and when teen smartphone use became the norm.
“These trends were going on for eight years before covid,” Twenge said. “You can make a pretty strong argument that injustice based on race was much higher in the 1960s when depression rates were a lot lower.” In addition, “concerns about environmental issues in this age group peaked in the ‘90s, not recently,” and media attention around school shootings also predated this period.
Several readers asked whether certain types of digital technology were worse than others. As Annie, a parent of two in Massachusetts, wrote, “Surely letting my kids watch Mickey Mouse Clubhouse isn’t as bad as scrolling through TikTok videos.”
Twenge agreed. She said her research shows that “screen time spent on social media and general internet use had the strongest link to depression,” whereas “time spent on gaming and watching TV had a weaker link.”
There is also a dose-response relationship, meaning that the more time spent on social media, the worse the mental health effects.
Many social media platforms set a minimum age of 13 for users, but this is rarely verified or enforced. Twenge told me that in her experience, there are a lot of 10 – and 11-year-olds on these platforms. That’s far too young – and so is 13. She thinks the minimum age should be at least 16.
She also said she would love to see apps that stop functioning in the middle of the night. “I mean, there are certainly situations where you might need to make a phone call or even text but who really needs to use TikTok at 2 a.m.?” she asked.
Another parent, Sarah from Maryland, is wary of phones but wants a way for her child to contact her if needed.
Twenge has been there, too. When her daughter was 13, their family had moved and the bus stop was further away. She felt better with her child having a phone in case the bus was running late or for other emergencies. Instead of giving her a “full-blown smartphone,” she gave her a Gabb phone – a device that can make calls and allow texts, but has no internet access and no social media.
My discussion with Twenge and other experts has given me a lot to think about. My children are still young – the oldest is still in kindergarten – but I am already speaking with my husband and our kids’ friends about how we can plan together to delay smartphone access.
The research has also made me more aware of my own behavior. I’ve cut back on my own social media use and have become more mindful about looking at my phone around my kids.
And I’ve become much more aware of the need to address the loneliness epidemic that’s engulfing teens and adults. Doing so requires holistic solutions that include helping our children develop healthy relationships with technology – and with one another.
Ask Dr. Wen
“You wrote empathetically about Sen. [John] Fetterman being hospitalized for depression. Why do some people need to be hospitalized while others can be OK getting medicines and therapies from their doctor? I take medications for depression but never needed to be hospitalized.” – Jane from New York
Let’s consider another common medical ailment: diabetes. Some patients with diabetes do fine with outpatient treatment. Depending on the type of diabetes they have, they may need insulin, oral medications, dietary changes or a combination of these options. Over time, the medication regimen might need to be adjusted. Some patients with Type 2 diabetes, for example, start with lifestyle medications and then move to oral medications. Years later, they might require insulin.
There might even be circumstances in which a patient must be hospitalized for diabetes. Perhaps their blood sugar becomes very high. Or perhaps they have a complication due to their disease.
The same applies for depression. While most patients with major depressive disorder can be treated as outpatients, some might need inpatient care. After addressing the acute issues, the patient can be transitioned back to outpatient treatment.
“I am 69 and severely immunocompromised. I remain extremely careful and do not want to get covid. I’d like to find a way to see my brother, whom I haven’t seen in four years. He is currently taking no precautions. If he flies to France in June and wants to stay with me there in my home, is there a way this can be done safely? What if he will not be staying in my home but wants to travel for trips of up to an hour with me in my car?” – Lynne from France
The safest way for your brother to stay with you is to ask your brother to essentially quarantine for five days before his trip. He should wear an N95, KN95 or KF94 mask in all indoor public settings and avoid indoor meals with others during that time. And he should continue to mask during his flight and other travels. Just before his flight, and then again upon arrival to you, he should take a rapid at-home antigen test. While he is with you, he should continue masking in all indoor settings. He should not dine indoors or associate with others indoors unless he is wearing a mask.
If he is not staying in your home and presumably not following precautions, but you want to travel with him in the car together, you could both wear N95 or equivalent masks while in the car. Keep the windows open while driving and socialize with one another outdoors.
I hope the trip happens and that you and your brother can reunite!
“My wife and I are both 78. She underwent cancer surgery late last year and is undergoing chemotherapy this year. As a result of some of the meds, she has developed atrial fibrillation. The cardiologist put her on Xarelto to help prevent a stroke. That made sense to me, but then I read that if a person on Xarelto contracts covid, they cannot take Paxlovid due to interference between the two drugs. Is this true of Eliquis as well? Should she change medications?” – Jim from Kentucky
Both Xarelto (generic name rivaroxaban) and Eliquis (apixaban) are anticoagulants. Like other anticoagulants such as Coumadin (warfarin), they have significant interactions with Paxlovid.
The Food and Drug Administration says Xarelto should not be co-administered with Paxlovid. You should discuss with your physician about what happens if your wife were to get covid. Would it be possible to hold Xarelto for the five-day period that she would be on Paxlovid? Eliquis, too, has significant interactions, depending on the dosage. In deciding which anticoagulant is best for your wife, it’s reasonable to also consider the potential interactions with Paxlovid, because she is at high risk for severe disease due to her age and other medical conditions.
What I’m reading
A new report from the American Cancer Society shows that 1 in 5 new cases of colorectal cancer in the United States are diagnosed in people younger than 55. This is twice the rate compared to 1995, when only 11 percent of cases were in this age group. The cause for this concerning trend is unclear, as is another worrisome finding from the study that showed 60 percent of patients have an advanced stage of the disease at diagnosis, which is an increase from 52 percent from the mid-2000s.