Emma was a 14-year-old high school freshman, a creative and outgoing student with a passion for photography. She had no prior mental health concerns and was thriving academically and socially. When she received her first smartphone, social media quickly became a way for her to connect with friends and share her photos. Websites like Instagram and TikTok initially felt like a positive space for self-expression.
Social media has become intertwined with the experience of adolescents, becoming a rite of passage for many teenagers. It has the ability to shape how youth connect, communicate, and even define their identity. While platforms like TikTok, Instagram, and Snapchat can act as modalities for self-expression, literature, and data increasingly suggest that problematic social media use has profound negative impacts on youth mental health. Calls from the U.S. Surgeon General and professional societies urged society to better understand the impact of social media use on youth mental health and childhood development.
Over the past decade, diagnoses of mental health conditions among young people have soared, mirroring an unprecedented demand for treatment and a rise in youth suicide rates. Most notably, according to epidemiological studies, the timeline of the youth suicide crisis overlaps with the meteoric ascent of social media. Families are at the frontline of addressing social media’s impact on youth mental help and can play a vital role in prevention, intervention, and recovery.
Social Media and Mental Health: A Complicated Relationship
Social media is not inherently harmful. For many teens, social media can act as a platform for activism, creative expression, and a means to find support. LGBTQ+ youth, for example, often connect via online communities for affirmation and understanding, which they may lack in their “offline world” or day-to-day environment.
However, for many young people, social media may be problematic. Often conceptualized as excessive use, problematic social media consumption correlates with increased reports of anxiety and depression in adolescents. Passive social media use has been found to directly aggravate depressive symptoms, like loss of interest or depressive mood, and negatively impact personal well-being (Cataldo et al., 2021). The more time spent and the greater the frequency of use, the sharper the decline in mental health for youth (Zubair et al., 2023).
Designed to captivate and maximize engagement, algorithms that power social media platforms may promote sensational or emotionally charged content (Logrieco et al., 2021). According to a recent study, adolescents engaging in this type of content are at higher risk of internalizing harmful messages, creating a negative feedback loop (Nesi, J., & Prinstein et al., 2015). Adolescents, whose developing brains are sensitive to dopamine rewards, are particularly vulnerable to these mechanisms. They may find it increasingly difficult to disengage—even as their mental health begins to suffer.
Recognizing Warning Signs
Over time, however, Emma’s relationship with social media began to shift. She spent hours scrolling, comparing herself to influencers and peers whose lives seemed impossibly polished. These comparisons started to weigh heavily on her self-esteem, leaving her feeling inadequate. She became withdrawn, her grades dropped, and she frequently complained of fatigue and headaches.
Parents and family members might struggle to identify when their child’s social media use has become harmful, as changes in behavior can often be subtle. Behavioral changes can include social withdrawal, increased irritability, and changes in sleep or eating patterns. Additional warning signs include changes in mood or reports of hopelessness. These warning signs have been found in children who had been experiencing cyberbullying or were engaging in self-harm online content (John et al., 2018). Additionally, notable academic declines or frequent absence and risk-taking behavior, such as engaging in self-harm or substance use, may be a result of underlying mental health issues (Cataldo et al., 2021). Families should recognize that with children, physical complaints such as unexplained fatigue, headaches, or stomachaches, which have no clear medical cause, can suggest emotional distress as well.
Social Media, Suicidality, and Self-Harm
Her parents grew concerned when Emma started avoiding social interactions and became irritable. Their alarm peaked when her mother discovered scratches on Emma’s forearm, which Emma admitted were from self-harm. She explained that seeing others’ seemingly perfect lives on social media made her feel hopeless – like she could never measure up.
The link between social media use and increased risk of suicidality and self-harm among adolescents has been a growing concern. Research suggests that exposure to harmful online content, such as the promotion of self-harm, suicide, and other dangerous behaviors, can normalize these actions for vulnerable youth (Marchant et al., 2017). Social media can also become a vehicle for cyberbullying or online harassment, exacerbating feelings of self-isolation and worthlessness for a child who may already be struggling with depression, leading to suicidal ideation and self-harm (Livingstone et al., 2014; Twenge et al., 2019). Algorithms continue amplification of emotionally charged or harmful content, creating a cycle of exposure and distressing material (Nesi, 2020).
How Families Can Help
Families play a vital role and are the first line of defense in helping break this vicious cycle by fostering open communication and monitoring their children’s social media activity. Parents and caregivers must remain vigilant of their child’s online environment, engaging in open conversations about what content they are seeing and experiencing online. By recognizing early warning signs early, parents can prevent further escalation. The U.S. Surgeon General Advisory provides the following recommendations:
- Establish clear rules about screen time and create tech-free zones, such as during meals or before bedtime, to encourage in-person interactions.
- Demonstrate responsible social media use by limiting your own screen time and prioritizing face-to-face connections.
- Teach children to recognize harmful online content, practice critical thinking, and seek help when they feel distressed.
- Regularly talk with your child about their online experiences and monitor social media activity for signs of harmful interactions or excessive use.
The American Academy of Child and Adolescent Psychiatry (AACAP) provides the following guidelines for screen time:
- Ages 18 to 24 months: Limit screen time to high-quality educational programming and always engage with a caregiver during viewing.
- Ages 2 to 5 years: Restrict non-educational screen time to no more than one hour per weekday and up to four hours on weekend days.
- Ages 6 years and older: Encourage healthy habits, establish clear boundaries, and limit screen time to ensure it does not interfere with sleep, physical activity, or face-to-face interactions.
When to Seek Help and the Role of Therapists and Psychiatrists
Emma’s parents sought help from a child psychiatrist, who diagnosed her with major depressive disorder, exacerbated by excessive and problematic social media use. Her treatment plan included cognitive-behavioral therapy (CBT) to help her identify and challenge negative thought patterns, develop healthier coping strategies, and reframe her self-perception. To further support her mood, the psychiatrist started her on a low-dose selective serotonin reuptake inhibitor (SSRI), explaining that medication could help alleviate the more persistent depressive symptoms while therapy took effect.
The psychiatrist also recommended practical lifestyle changes, including setting limits on her screen time, enrolling in offline activities like a local photography club, and establishing structured daily routines to foster stability. With a combination of therapy, medication, and family support, Emma began to see gradual improvements. She became more engaged in school, reconnected with friends, and found joy again in photography.
While families are instrumental in providing initial support, sometimes professional help is necessary. Parents should consider reaching out to a mental health professional if their child exhibits persistent signs of emotional distress, such as:
- Hopelessness or suicidal thoughts: Frequent expressions of despair, lack of purpose, or discussions about self-harm or wanting to die.
- Self-harming behaviors or preoccupation with harmful content: Recurrent self-injury or fixation on disturbing or triggering material online.
- Severe mood swings or withdrawal: Persistent irritability, emotional outbursts, isolation from friends and family, or loss of interest in activities they once enjoyed.
- Unexplained physical complaints: Ongoing fatigue, headaches, or other physical symptoms without a medical explanation, which may indicate underlying emotional distress.
- Academic or behavioral changes: Significant drops in academic performance, skipping school, or engaging in risky or impulsive behaviors, such as experimenting with substances or engaging in unsafe online activities.
Families are uniquely positioned to protect their children from the potential harms of social media by fostering open communication, modeling healthy online behaviors, and setting clear boundaries around technology use. By staying engaged, recognizing warning signs, and seeking professional help when necessary, parents and caregivers can create a supportive environment that promotes resilience and prioritizes their child’s mental health in an increasingly digital world.
Abraham Abdulrazzak, DO, is a Resident Psychiatrist at SUNY Downstate Health Sciences University and a Fellow with the Brooklyn LEND (Leadership Education in Neurodevelopmental Disabilities) program at SUNY Downstate. Samuel Jackson, MD, serves as the Clinical Director of Psychiatry at Erie Family Health and Co-Director of Public Psychiatry Education at SUNY Downstate Health Sciences University. For more information, email abraham.abdulrazzak@downstate.edu or samuel.wesley.jackson@gmail.com.
References
American Academy of Child and Adolescent Psychiatry. (2024). Children and watching TV. AACAP. Retrieved December 8, 2024, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx
Cataldo, I., Lepri, B., Neoh, M. J. Y., & Esposito, G. (2021). Social Media Usage and Development of Psychiatric Disorders in Childhood and Adolescence: A Review. Frontiers in psychiatry, 11, 508595. https://doi.org/10.3389/fpsyt.2020.508595
John, A., Glendenning, A. C., Marchant, A., Montgomery, P., Stewart, A., Wood, S., Lloyd, K., & Hawton, K. (2018). Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. Journal of medical Internet research, 20(4), e129. https://doi.org/10.2196/jmir.9044
Livingstone, S., & Smith, P. K. (2014). Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence, and management of sexual and aggressive risks in the digital age. Journal of child psychology and psychiatry, and allied disciplines, 55(6), 635–654. https://doi.org/10.1111/jcpp.12197
Logrieco, G., Marchili, M. R., Roversi, M., & Villani, A. (2021). The Paradox of TikTok Anti-Pro-Anorexia Videos: How Social Media Can Promote Non-Suicidal Self-Injury and Anorexia. International journal of environmental research and public health, 18(3), 1041. https://doi.org/10.3390/ijerph18031041
Marchant, A., Hawton, K., Stewart, A., Montgomery, P., Singaravelu, V., Lloyd, K., Purdy, N., Daine, K., & John, A. (2017). A systematic review of the relationship between internet use, self-harm, and suicidal behavior in young people: The good, the bad and the unknown. PloS one, 12(8), e0181722. https://doi.org/10.1371/journal.pone.0181722
Nesi, J., & Prinstein, M. J. (2015). Using Social Media for Social Comparison and Feedback-Seeking: Gender and Popularity Moderate Associations with Depressive Symptoms. Journal of abnormal child psychology, 43(8), 1427–1438. https://doi.org/10.1007/s10802-015-0020-0
Nesi J. (2020). The Impact of Social Media on Youth Mental Health: Challenges and Opportunities. North Carolina medical journal, 81(2), 116–121. https://doi.org/10.18043/ncm.81.2.116
Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. Journal of abnormal psychology, 128(3), 185–199. https://doi.org/10.1037/abn0000410
Zubair, U., Khan, M. K., & Albashari, M. (2023). Link between excessive social media use and psychiatric disorders. Annals of medicine and surgery (2012), 85(4), 875–878. https://doi.org/10.1097/MS9.0000000000000112
