Over half of the adolescent population suffering from suicidal tendencies are seen and treated by their primary care provider. It is crucial for primary care providers to screen for social media usage and identify potential contemplation or preoccupation with self-inflicted death in the adolescent population.
Social Media’s Influence on Suicidality in Adolescents
Kelsey Smith PA-C, Caitlin Hoeing PA-C, Maria Aramburu de la Guardia MD, Hatim Omar MD
Lehigh Valley Reilly Children’s Hospital, Lehigh Valley Health Network, Allentown PA
Correspondence: Kelsey Smith PA-C. Email: Kelsey.smith2@lvhn.org
Received: 14/11/2023; Revised: 20/11/2023; Accepted: 24/11/2023
Key words: Suicidality, suicidal ideation, depression, social media, adolescents
[citation: Smith, Kelsey; Hoeing, Caitlin; Aramburu de la Guardia, Maria; and Omar, Hatim (2023). Social media’s influence on suicidality in adolescents. DHH, 10(1):https://journalofhealth.co.nz/?page_id=2986].
Introduction
The term social media refers to online platforms used to share content, express ideas, network with others, and promote interactivity among users. Examples of these platforms include YouTube, TikTok, Facebook, Instagram, Snapchat, online connection sites, and many more. It is estimated that 97% of youth between the ages of 13 and 17 participate in at least one form of social media on a daily basis (Nesi et al. 2021). With the increasing use of social media among the youth population, understanding its potential impact on the exponential rise of deaths by suicide is crucial for primary care providers to recognize and intervene upon.
An association between suicidality among adolescents who utilize social media sites has been demonstrated in recent years (Vidal et al. 2020). Suicidality is a term that broadly defines the risk of suicidal action, indicated by suicidal ideation or intent (Harmer et al. 2023). Although rates of suicide related deaths are impacted by various socio- economic and demographic variables, a rise has consistently been noted in teenagers (Harmer et al. 2023). It is estimated that 1 in every 7 young adults have suicidal thoughts at some point during their lifetime (O’Rourke et al. 2023). According to the Center for Disease Control, suicide rates among young adults ages 10-24 increased 62% from 2007 to 2021, reaching a record number of lives taken. In 2021, suicide was the second leading cause of death in the above-described age group (Curtin et al. 2023).
Over half of the adolescent population suffering from suicidal tendencies are seen and treated by their primary care provider. It is crucial for primary care providers to screen for social media usage and identify potential contemplation or preoccupation with self-inflicted death in the adolescent population.
Discussion
Over recent decades, studies, including systematic reviews and meta-analysis (e.g. Vidal et al. 2020, Muppalla et al. 2023, Nesi et al. 2023), have shown a positive correlation between increasing social media use, worsening depression, and suicidality. Overuse of social media sites results in limited interpersonal interactions, risk of cyber bullying, increased life comparison and dissatisfaction, and higher rates of exposure to suicide related accounts.
An increase in screen time has been positively correlated with lessened face-to-face interaction with previously established companions, leading to a sense of isolation and worsening mental health (Nesi et al. 2021). Likewise, studies show that increased screen time prior to bedtime has a negative impact on the young adult body’s natural sleep schedule, making teens feel more awake and alert during the time frame the body would naturally prepare for rest. Inadequate quality and quantity of sleep in adolescence has been attributed to worsening mental health status (Vidal et al. 2020). In addition to impacting social relationships and sleep routines, the addictive nature of social media distracts from developing hobbies, physical activity, and academic performance (Nesi et al. 2021).
Additionally, cybervictimization, more frequently referred to as cyber bullying, has been correlated with increased rates of suicide among teens. Cybervictimization refers to the use of social networking sites and other online forums to inflict emotional harm on others, via threatening messages, embarrassment, harassment, and more. Due to adolescents’ increased accessibility to social media sites, the perpetrators’ ability to make fun of peers is easier, and often results in lessened repercussions. As a result, young adults who value peer evaluation and are more emotionally vulnerable to criticism could develop suicidal tendencies. Studies show that greater investment in social media content may be associated with poorer emotional functioning (Vidal et al. 2020). Adolescents who utilize social media to fulfill their social needs and determine their self-worth based on peers’ interactions with their accounts are at increased risk of a negative emotional experience with social media (Vidal et al. 2020).
Increasingly, users of social media share their life adversities and negative experiences online, which then become easily accessible to other users experiencing similar feelings. Sharing suicide related content may reinforce such behavior in individuals already susceptible to suicidal tendencies. On the other hand, being exposed to others’ over-glamorized personal lives on a daily basis could also result in decreased personal life satisfaction, increased comparison, and feelings of lower self-worth in developing adolescents (Nesi et al. 2021).
Furthermore, some studies suggest that social media usage in moderation has been correlated with various benefits among the adolescent population (Vidal et al. 2020). Access to social networking sites allow for more interpersonal connections and provides accessible support from like-minded individuals. For instance, adolescents who would otherwise feel isolated and non-supported in their everyday environments might find additional emotional support via social media. Adolescents enduring the same life stressors can create connections and bonds that would otherwise not develop. Social media has also acted as a vehicle for accessing mental health services. With the unlimited access adolescents have to internet resources, their mental health could in turn benefit from locating resources suggested by a healthcare professional or trusted adult (Vidal et al. 2020).
Adolescence is the bridge between childhood and adulthood, in which individuals undergo extensive physical, emotional, and social development. Given that most adolescents seek care from a general pediatrician or primary care provider, it is imperative for providers to be screening for suicidality among adolescents who consume social media on a daily basis. One way to streamline the social history in a teenager is to utilize the home, education/employment, activities, drug use, sexuality, and suicidality (HEADSS) approach. Inquiring about relationships and routines in the home, in the educational setting, activities participated, drug use, sleep, safety, and suicidality can provide insight to a patient’s social media use and subsequent overall mental health. A thorough mental status test and screening tools such as the Patient Health Questionnaire (PHQ9) and Columbia-Suicide Severity Rating Scale (C-SSRS) can be implemented to further assess depressive and suicidal symptoms. If a primary care provider identifies risk factors such as large amounts of “screen time”, disrupted sleep habits from electronic use, limited friendships and activities involved in due to phone use, strained relationships in the home, academic struggles, closer monitoring and appropriate adolescent medicine or pediatric psychiatry referrals can be made. Identifying teens at risk for suicidality is the first step in appropriate treatment and holistic management.
Any solution to curb social media overuse must include parents or guardians of adolescents. Allowing a reduced amount of time per day for both parents and the adolescent between social media apps, could help reduce over exposure and at the same time permit the benefits of social networking. Dedicating the time recovered from reducing social media overuse on face to face contact and activities that both parents and adolescents can participate would greatly benefit mental health and emotional wellbeing as well help sustain it (Muppalla et al. 2023).
In our practice, patients who describe depressive symptoms and increasing suicidal ideation often have multifactorial explanations. One of the more recurring causes is some form of blatant cyber bullying or self-inflicted inner trouble associated with content subconsciously consumed on social media. As mentioned above, it is useful to adopt a screening tool, to ensure a thorough care by timely referrals, immediate initiation of multidisciplinary resources, and continued consistent administration of screening programs.
Conclusion
A review of the literature between the years 2020 and 2023, as reported above, suggests a positive association between the overuse of social media and increased suicidality among adolescents. As more social media apps reach the young consumers, it is crucial for primary care providers and pediatricians alike to understand the association between its use and increased risk of suicidality. If not addressed promptly, by allowing social media to play a detrimental role in the lives of developing youth, we risk setting them up for chronic mental health issues in adulthood. After reviewing current clinical guidelines, there is an urgent need for a streamlined approach for the detection, intervention, and prevention of suicidality in adolescents for primary care providers. By identifying and acknowledging the risk young adults face by simply utilizing various social media platforms, primary care providers can better assist parents in implementing interventions that limit its use. Intensive management can then be implemented for suicidal ideation or intent. Despite social media’s impact on suicidality becoming a widely researched topic, there are still gaps in research suggesting proper screening and clinical therapeutics, to manage social media usage in this age group. In addition to new clinical trials, future studies should aim to include the aforementioned content.
References
Curtin S. C., Garnett M. F. (2023) Suicide and homicide death rates among youth and young adults aged 10-24: United States, 2001-202. Center for Disease Control and Prevention. Accessed October 21, 2023. https://www.cdc.gov/nchs/data/databriefs/db471.pdf.
Harmer, B., Lee, S., Duong, T. V. H., & Saadabadi, A. (2023). Suicidal Ideation. In StatPearls. StatPearls Publishing. Accessible from: https://pubmed.ncbi.nlm.nih.gov/33351435/
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