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Digital media use and mental health
Young people in Romania using smartphones
Typessocial media addiction, gaming disorder, internet addiction disorder
RelatedDigital sociology, Psychiatry, Digital anthropology, Psychology

Digital media use has been complicated by digital media overuse, variously termed digital addictions or digital dependencies. These constructs are biopsychosocial and cultural phenomena, that behave differently in various societies and cultures.[1] They have been under study and analysis for some years.[2] "Psychologists and sociologists have ... been studying and debating about screens and their effects for (some) years,"[3] as have some anthropologists[4][5] and medical experts.[6] Some reviews have considered evidence of benefits of digital media use, stating that current evidence shows "moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world",[7] however a 2019 systematic review of reviews in the British Medical Journal found no evidence of net health benefits yet proven scientifically.[2]

From a medical perspective, in 2010, the current editor of JAMA Pediatrics published, "while not (at the time)... officially codified within a psychopathological framework, (internet addiction disorder is)... growing both in prevalence and within the public consciousness as a potentially problematic condition with many parallels to existing recognized disorders", and it may be "a 21st century epidemic".[6] He has also stated that "we're sort of in the midst of a natural kind of uncontrolled experiment on the next generation of children."[8]

A 2014 review of the proposed medical diagnosis of social media addiction stated "while the exclusion of social media addiction from the Diagnostic and Statistical Manual of Mental Disorders may give the impression that social media addiction is not a legitimate mental disorder, there is a growing body of evidence suggesting otherwise."[9][10] "There is empirical evidence indicating that compulsive social media use is a growing mental health problem, particularly among adolescent smartphone users."[10] The concept of social media and its relation to addiction has been examined since 2009.[11] However, the use of the English word "addiction" in relation to these phenomena and diagnoses has come under question.[12]

Social media has unintentionally altered the ways that children think, interact and develop; in some cases in a positive way, and sometimes in a very negative way.[13][14] While mental health problems have occurred throughout human history, scientists are unclear as to the direct links between social media and mental health outcomes. They appear to depend on the individual, and the social media platform used.[15]

Origins

Founded in current research on the adverse consequences of overusing technology,[16][17] "digital addiction" , or "digital dependence" has been used as an overarching phrase to suggest an increasing trend of compulsive behaviour amongst users of technological devices.[1]

Unrestrained use of technological devices may impact upon developmental, social, mental and physical well-being and result in symptoms akin to other behavioural addictions.[18] Several clinics worldwide now offer treatment for internet addiction disorder,[19][20] and several studies have sought to establish a connection between the use of the internet and patterns of behaviour.[21][22]

As a critical review published in the International Journal of Mental Health Addiction in 2018 specifically considered the term "addiction" in relation to overuse of the internet, questioning its suitability as a separate psychiatric entity, or whether it is a manifestation of other psychiatric disorders. They proposed that due there is a lack of recognition and consensus on the concept, treatments and diagnoses are difficult, concluding "new media has been subject to such moral panic and thus this serves a historical tradition within societal conception." They suggested that cultural shift may "enable a more critical insight into the antecedents of problematic behaviour to aid treatment, rather than simply revoking access from the Internet for such individuals."[23]

Childhood technology use

An image uploaded to the internet in 2018 entitled "Boy Mobile Phone Addiction"

One review considered "continued concerns about health and developmental/behavioral risks of excessive media use for child cognitive, language, literacy, and social-emotional development, (and) applied (the evidence to) clinical care".[24] Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may also have a detrimental effect.[25][26][27]

In regard to childhood technology use, the American Academy of Pediatrics (AAP) developed a Family Media Plan. The intention of such a plan would be to help parents assess and structure their family's use of electronic devices and media more safely.[28] The Canadian Paediatric Society produced a similar guideline. However, a systematic review of reviews published in 2019 commented that these and other national guidelines have been criticised in lacking evidence. They reviewed previous reviews on the issue, concurring that the evidence was of mainly low to moderate quality. However they considered that overall, there is evidence associating sceentime with poorer psychological health including symptoms such as inattention, hyperactivity, low self esteem, and behavioural issues in childhood and adolescence. They did not find evidence for any positive health benefits of screen time. In regard to quality of life, they discussed that "Suchert[29] reported that there was a positive association between screentime and poorer psychological well-being or perceived quality of life in 11/15 studies. Costigan[30] reported a negative association between screentime and perceived health in 4/4 studies.[2]

Digital media in the treatment of mental health problems

There is preliminary evidence that mental health problems can be effectively treated through interventions delivered digitally, be that online[31][32] or via a smartphone.[33][34]

Multidisciplinary collaboration

As awareness of these issues increased, many disciplines continue to work on their mitigation, on improving understanding of the issues, and on potential innovative solutions. The Lancet commission on global mental health and sustainability 2018 report considered benefits and harms of technology, discussing its ethical risks and challenges for those with codified diagnoses and without. It considered technologies roles in mental health, namely public education, patient screening, treatment, training/supervision and system improvement. It commented on the specific risks such as cyber-bullying, privacy and confidentiality, potential lawmaker discrimination, and future unintended consequences of the widening digital divide in mental health. It commented that it digital media use in healthcare is unregulated in most countries, stating that "policies are needed to guide the safe and effective application of digital technologies in health care. [35]

NGOs and educational sector

The ADDitude magazine online page continues to support those with the known correlated digital dependencies, to those with or without codified diagnoses, as well as providing a United States directory of educational resources for children.[36][37] Similar resources are available from NGOs and other support or advocacy groups operating, including from the American Academy of Child and Adolescent Psychiatry.[38][39]

Technology

Various technology firms have implemented changes to mitigate the negative effects of excessive Internet use. In December 2017, Facebook admitted passive consumption of social media could be harmful to mental health, although they said active engagement can have a positive effect. In January 2018, the platform made major changes to increase user engagement.[40][41]

In 2018, Alphabet Inc released an update for Android smartphones, including a dashboard app that it considers will "enable (people) to set time limits via an app timer, and give you warnings when (they've) been using it for too long".[42] Apple Inc purchased a third party application and then incorporated it as "screen time", promoting it as an integral part of iOS 12.[43] Journalists have questioned the functionality and motivations of both of these interventions from these corporations for users and for parents.[42][44]

Two large investors in Apple Inc in 2018 "believe(d) both the content and the amount of time spent on phones need to be tailored to youths, and they are raising concern about the public-health effects of failing to act. They point to research from... a “growing body of evidence” of “unintentional negative side effects,” including studies showing concerns from teachers. The group wants Apple to help find solutions to questions like what is optimal usage and to be at the forefront of the industry’s response—before regulators or consumers potentially force it to act."[45] They published an open letter in regard to this.[46] Apple Inc responded that they have "always looked out for kids, and (they) work hard to create powerful products that inspire, entertain, and educate children while also helping parents protect them online," planning "new features and enhancements planned for the future, to add functionality and make these tools even more robust." They asserted "Apple would once again be playing a pioneering role, this time by setting an example about the obligations of technology companies to their youngest customers".[47]

People using phones whilst walking

A German technology startup developed an Android phone specifically designed for efficiency and minimizing screen time.[48] News Corp reported multiple strategies for minimizing screen time.[49] Facebook and Instagram announced "new tools" that they consider may assist with dependence on their products.[50]

Digital anthropology

Anthropologists have been exploring "the borderland between anthropology, medicine and psychiatry" for some decades.[51] Professor Daniel Miller, a professor of anthropology at the University College London, commenced in 2018 a five year study called "ASSA", the Anthropology of Smartphones, Aging and Mental Health. It is based on ethnographies from 15 field sites in Brazil, Chile, industrial and rural China, England, India, Italy, Trinidad and Turkeyconsisting of "ten simultaneous fifteen month ethnographies across the world." [52] He notes that the effects of social media are very specific to individual locations and cultures. He contends that "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context." The University College London offers a free five week course in relation to this, entitled Anthropology of Social Media: Why we Post, as well as offering other free e-books in relation to the issue.[53] Professor Miller states that "On almost any day one can find newspaper articles which tell us we have lost our humanity to smartphone or selfie addiction." "Digital anthropology is an arena within which developments are constantly used to make larger normative and ethical arguments rather than merely observe and account for the consequences of technological change."[54]

Digital anthropology is a developing field which studies the relationship between humans and digital-era technology. Brian Solis, a digital analyst, anthropologist and keynote speaker working in the field, in 2018 stated "we’ve become digital addicts: it’s time to take control of technology and not let tech control us."[55]

A man sitting alone with his smartphone in Giardino di Boboli, Florence, Tuscany

Digital sociology

Digital sociology, overlapping with digital anthropology and considering cultural geographies, explores "the ways in which people interact with and use digital media using both qualitative methodologies (such as interviews, focus groups and ethnographic research)." It also investigates the various contextualisations of longstanding concerns in relation to young peoples dependence on "these technologies, their access to online pornography, cyber bullying or online sexual predation."[56] A Turkish sociological study in 2012 noted that "various interpretations of religion enable culture-specific observations on Internet consumption patterns, and its relation with different levels of religiosity. The findings revealed that the level of religiosity has a significant effect on the patterns of Internet consumption."[57]

Three journalists from Guardian Media Group discussed the moral panic around screen time in 2018, considering it may be partially attributable to search algorithms, as "Google does not sort search output by quality; it ranks search input by popularity". They commented "there is very little good research in the area", and that "technology use is incredibly diverse, and while pretending it is a unitary concept may be convenient, it makes meaningful understandings or interventions impossible."[58]

Psychology

A 2015 psychological review concluded there was a link suggested between basic psychological needs and social media addiction. "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users “hooked”."[59]

Psychiatry

Psychiatric experts have called for further studies to explore psychiatric correlates with digital media use in childhood and adolescence. "Over the past 10 years, the introduction of mobile and interactive technologies has occurred at such a rapid pace that researchers have had difficulty publishing evidence within relevant time frames."[60] A 2019 systematic review confirmed that most prior reviews were of low or moderate quality, suggesting "higher levels of screentime is associated with a variety of health harms (in childhood and adolescence, including) adiposity, unhealthy diet, depressive symptoms and quality of life".[2]

Neuroscience

The Trends in Cognitive Sciences Journal noted in 2015 that "Neuroscientists are beginning to capitalize on the ubiquity of social media use to gain novel insights about social cognitive processes."[61] A 2018 neuroscientific review published in Nature commented that this and other evidence "suggests an important interplay between actual social experiences, both offline and online, and brain development." It considered social media is good for "at least the following two important functions: 1. (social connection) with others (the need to belong) and (2.) manag(ing) the impression individuals make on others (reputation building, impression management, and online self-presentation)." It called for further study, considering "adolescence a tipping point in development for how social media can influence their self-concept and expectations of self and others."[62]

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