Population Care

What doctors wish patients knew about social media’s toxic impact

Sara Berg, MS , News Editor

Many people enjoy staying connected on social media platforms such as Facebook, Instagram, Twitter and LinkedIn. Yet a growing body of research is finding that excessive use—more than three hours a day—can exacerbate mental health problems, such as anxiety and depression, in teens and young adults. Such use can also lead to isolation and fear of missing out. That’s why it is important to understand the potentially harmful impact of social media platforms for younger users.

AMA Moving Medicine Podcast

AMA Moving Medicine highlights innovation and the emerging issues that impact physicians and public health today.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

For this installment, two AMA members took time to discuss what doctors wish patients knew about the potentially harmful effects of social media. They are:

  • Nusheen Ameenuddin, MD, MPH, a pediatrician at the Mayo Clinic in Rochester, Minnesota, and chair of the American Academy of Pediatrics Council on Communications and Media.
  • Carl Streed, MD, MPH, an internist and assistant professor of medicine at Boston University School of Medicine. He is also a young physician representative for the AMA Advisory Committee on LGBTQ Issues.

“There are a lot of benefits of social media too, especially as we live through a pandemic or when we were in lockdown and kids couldn't go to school and interact with people normally,” said Dr. Ameenuddin.

For example, “kids who are marginalized, who might not find support because they feel minoritized in their community or in their family, can actually go online and find support groups,” she said. “We know that there can be a real good potential for use of social media, but that there are also harms.”

Dr. Streed said “the research that has been done around social media usage and its harms are very specific to this idea of comparison.” This means “using social media as a way to compare yourself to what people are presenting on social media, particularly Instagram.”

“Sometimes that’s looking at celebrities and seeing their fabulous life and thinking, ‘My life isn’t as fabulous,’ or even with some friends, comparing who has the better outfit or house,” said Dr. Ameenuddin. “That can actually be a trigger that can lead to decreased mood.”

“But when these same kids use social media and are not using it for social comparisons—they’re just using it to connect with friends or stay in touch—then it can actually be quite positive, and they don’t have those feelings of negativity about themselves and there isn’t as much FOMO, or the fear of missing out,” she added.

Dr. Streed noted that when people post to social media, they “are presenting their best self, their best lives or best versions of their lives, and that constant comparison when people are scrolling is what is believed to lead to harm,” said Dr. Streed. These harms include “body-image issues, body dysmorphia and often comparisons of success in life.”

“As we get older, there might be more maturity to recognize how your comparisons can affect you,” he said. But it is especially difficult “for kids who don’t have their frontal lobe and executive functions of the brain mature yet.”

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“While it has been positive to be able to still connect with grandparents, with other friends and even to potentially make new friends around the world and have support in different ways, it also just means that you're going to get a higher volume of what's available,” said Dr. Ameenuddin.

“There are really positive ways to get online—to share art, to share stories, to do TikTok dances—but a couple of clicks … can lead them down some bad pathways,” she said. “In moderation and with the right kind of content, social media can be a very positive experience.”

But given ongoing restrictions on large, indoor unmasked gatherings in many areas, “the fact that they’re cut off from many of their normal sources of fun has been hard on people.”

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“While there is a degree of maturity as we get older in terms of understanding what social media does present, there’s probably still potential harm for adults or persons of any age as it relates to this tendency to compare ourselves to the images we’re presented,” said Dr. Streed.

Social media “can totally impact adults,” said Dr. Ameenuddin. This is because social media is “very targeted,” which can be “hard for adults” as well as teens and younger children.

Learn more from this JAMA Network Open study, “Association Between Social Media Use and Self-reported Symptoms of Depression in US Adults.”

“As pediatricians, we generally tell people if your time on media—or your use of devices—is interfering with sleep, we really want to make sure that we have some boundaries in place,” said Dr. Ameenuddin.

“I always get a little bit of a laugh and eye roll from patients when I ask, ‘What’s the latest you’re on a screen,’” said Dr. Streed. “And their response is often, ‘Until I close my eyes and try to go to bed.’”

“The light itself is not helping and then, of course, if the interaction is causing negative thoughts, that’s also not helping,” he said. Dr. Streed advises patients to make sure their last screen time happens 30 minutes to an hour before retiring to bed.

“Then put the phone away. Don’t keep the phone by your bed, things like that,” Dr. Streed added. “Or even just using features that reduce our reward center when we’re using social media, because these programs, these apps, are really designed to get your attention.”

“The push notification, the bright colors, the use of red for notifications, all of these trigger you to want to open it up and use it,” he said, adding that “you can either desaturate the color—getting rid of the color helps reduce some of that reward-center component—or just making sure that we’re reducing blue-light exposure, which actually keeps you awake.”

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“If you're finding that your child is using it more for” comparing their life to someone else’s, “it’s hard to pull kids out of that, but it's also important to be able to set limits and say, ‘Maybe we need to take a break from this for a while,’” said Dr. Ameenuddin. “Sometimes kids and teens have also said, ‘I felt like I needed a break and after a week of being off, I felt better.’”

“It's good to take breaks once in a while and say, ‘If this content is bothering me, I'm maybe not going to follow that account anymore,’” she said, adding that it is important to “focus on important things that keep you grounded.”

Dr. Streed recommends avoiding the habit of relying on social media to relieve boredom.

Instead, have “very discrete times when you plan on using it, be very specific about how you’re using it and what your goal is for using social media in general,” he said. “And being very particular about how it makes you feel.”

For example, are you following a celebrity, brand or social media maven “because this person is inspiring and that actually motivates me to want to do better and I feel good about that?” Or, alternatively, does that social media presence instead inspire jealousy or body-image issues?

“That constant negative emotion—we need to be mindful of and aware of,” Dr. Streed said. “Then you just have to unfollow or delete it from your phone.”

So set “realistic expectations and be explicit about what your goal is for participating in social media,” said Dr. Streed.

“As somebody who is very focused on LGBTQ health in terms of clinical care, education and research, it's a way to engage folks around those topics,” he said. “It's all about what are your goals for using it.”

Editor’s note: U.S. Surgeon General Vice Adm. Vivek Murthy, MD, has released an advisory on social media use and its impact on the mental health of children and adolescents.

“With near universal social media use by America’s young people, these apps and sites introduce profound risk and mental health harms in ways we are only now beginning to fully understand,” AMA President Jack Resneck Jr., MD, said in a statement. “As we grapple with the growing, but still insufficient, research and evidence in this area, we applaud the surgeon general for issuing this important advisory to highlight this issue and enumerate concrete steps stakeholders can take to address concerns and protect the mental health and well-being of children and adolescents.”