Smartphones, social media, and teenage mental health (2024)

Smartphones, social...
Smartphones, social media, and teenage mental health

Editorials BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2024-079828 (Published 28 May 2024) Cite this as: BMJ 2024;385:e079828

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Greg Hartwell, clinical assistant professor1,
Maeve Gill, specialty registrar in public health2,
Marco Zenone, research associate3,
Martin McKee, professor of European public health1

¹London School of Hygiene and Tropical Medicine, London, UK
²Royal Free Hospital NHS Foundation Trust, London, UK
³Health Law Institute, University of Alberta, Canada
Correspondence to: G Hartwell gregory.hartwell{at}lshtm.ac.uk

A precautionary public health response is needed

The tragic deaths of two UK teenagers continue to raise debate about the challenges that smartphones—and the unlimited access to social media they provide—may pose for adolescent mental health.1 Molly Russell took her own life in 2017 aged 14 after being exposed on Instagram to what her father has described as a constant stream of “dark harmful material.”1 Sixteen year old Brianna Ghey was murdered by two fellow pupils in 2023. Her mother believes that Brianna’s heavy mobile phone use increased her vulnerability before her death, and recently called for alerts on parents’ phones when their children use their own devices to search for violent material, as her daughter’s killers did.12

This debate lies within broader concerns about the parlous state of adolescent mental health, with decreasing happiness reported among UK teenagers for a decade, alongside sharp increases in depression and anxiety, particularly among older girls.34 These findings cannot easily be dismissed as artefact arising from changes to diagnostic criteria, reduced stigma, or greater willingness to seek help; they have coincided with marked rises in other measures such as teenage self-harm and suicidal behaviours, especially among teenage girls.35

But can smartphones and social media be blamed? Population based data suggest a dose-response relationship between social media use and depressive symptoms in teenagers, especially girls. Systematic reviews report links to other harmful behaviours,6789 and heavy adolescent smartphone use has been associated with sleep deprivation and poorer socioemotional functioning.910 Nonetheless, by age 12, smartphone ownership is near universal in the UK, and almost two thirds of 8-11 year olds already use social media.11

Yet many macroeconomic, environmental, and social factors contribute to mental health at all ages. The relationships between social media, smartphones, and mental health are also vexed by a suite of potential confounders and questions of reverse causality.1213 Furthermore, young people are adept at harnessing technology’s power to make positive changes in their lives, connecting with peers across borders, mobilising youth movements, or advocating for social change.1415 Social media can facilitate engagement with health services, provide access to safe online spaces, and support help seeking in crises.16

A precautionary response

So how should we protect children from harms linked to smartphones and social media, while maximising potential benefits? Three groups have roles to play: technology producers, parliamentarians who regulate them, and the public who use these products.

Firstly, the argument that social media firms simply provide a communication medium is wearing thin. The EU has launched various investigations into platforms’ addictiveness for young people,17 while a US Senate committee recently condemned social media chief executives as having “blood on their hands,”18 partly reflecting Meta’s research showing Instagram had toxic effects on girls.19 Inevitably, these companies advocate self-regulation, yet we know this is ineffective.2021

Smartphones and social media should instead be seen as products to be regulated, like all commercial goods and services with potential to harm.2223 Restricting sales or advertising of cigarettes, vapes, alcoholic drinks, and gambling products is relatively uncontroversial, even though producers work to circumvent restrictions. Conversely, in the UK, the US, and elsewhere, social media access is permitted from age 13 across major platforms, a threshold with no health rationale, stemming instead from US legislation allowing collection of personal data from that age without parental consent.24

Secondly, while parliamentarians must balance risks and benefits, the current UK government’s flagship Online Safety Act and Data Protection and Digital Information Bill have not allayed concerns.225 Its non-statutory guidance recommending banning smartphones in schools also had a lukewarm reception26; many schools already have such policies, and the guidance echoes a classic industry narrative emphasising individual responsibility, which shifts accountability for harm from policy makers or manufacturers to schools, parents, and pupils.

Thirdly, the public clearly have doubts about children and young people’s access to smartphones and social media, but parents also fear their children being excluded from online friendship groups and want to maintain contact for safety reasons.11 Seeking to square this circle, an impromptu grassroots movement has recently grown across the UK calling on parents to collectively delay smartphone and social media uptake.27 The UK’s children’s commissioner has voiced similar frustrations, while stressing the importance of involving young people themselves in shaping ways forward.28

Debate will continue about exact associations between smartphones, social media, and mental health,29 and further experimental research must be an urgent priority for funders and the academic community. But in the meantime, we must adopt the precautionary principle: measures to prevent harm should not be delayed where evidence is still contested. Health professionals and their organisations must act and advocate to ensure that smartphones and social media are framed clearly as commercial determinants of health; to guide advocacy efforts based on systematic syntheses of high quality evidence; and to amplify the voices of young people in research and policy. All will be critical if we are to facilitate technology’s potential positives while firmly safeguarding our young people’s mental health.

Footnotes

Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: MM is past president of the BMA. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf.
Provenance and peer review: Not commissioned; externally peer reviewed.

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See Also
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