Twenge et al. (2018). Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time. Clinical Psychological Science, 6(1), 3–17.

[Summary from abstract …]

“Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely.” (p 3)

[Human neural and social systems intertwined …]

“It is worth remembering that humans’ neural architecture evolved under conditions of close, mostly continuous face-to-face contact with others (including nonvisual and nonauditory contact; i.e., touch, olfaction; Baumeister & Leary, 1995; Lieberman, 2013) and that a decrease in or removal of a system’s key inputs may risk destabilization of the system (e.g., Badcock, Davey, Whittle, Allen, & Friston, 2017).” (p 4)

[In-person closeness; introduction and growth of smartphone market …]

“In-person social interaction (also known as face-to-face communication) provides more emotional closeness than electronic communication (Sherman, Minas, & Greenfield, 2013)…. Some research suggests that electronic communication, particularly social media, may even increase feelings of loneliness (Song et al., 2014), and time spent on electronic communication has increased considerably since the smartphone (a mobile phone with Internet access) was introduced in 2007 and gained market saturation around 2012 (Smith, 2017).” (p 4)

[Theories of suicide …]

“… the interpersonal theory of suicide ( Joiner, 2005; Van Orden et al., 2010) proposes that the desire for suicide results from the combination of two interpersonal risk factors: thwarted belongingness (i.e., social disconnection/alienation, loneliness) and perceived burdensomeness (i.e., feeling as though one is a burden on others).” (p 4)

[Survey instrument …]

“MtF is a nationally representative survey of 8th, 10th, and 12th graders administered every year since 1991 (Johnston, Bachman, O’Malley, Schulenberg, & Miech, 2016).” (p 5)

[Survey instrument …]

“The YRBSS is a nationally representative sample of high school students (9th, 10th, 11th, and 12th graders) administered by the CDC every other year since 1991. … (CDC, 2016).” (p 5)

[“Assessments” …]

[Scale used for depressive symptoms …]

“Depressive symptoms. MtF included six items from the Bentler Medical and Psychological Functioning Inventory depression scale (Newcomb, Huba, & Bentler, 1981) …” (p 5)

[Other survey variables …]

“Suicide-related outcomes … Electronic device use … Social media use … Internet news … TV watching … Homework … In-person social interaction … Print media … Sports or exercise … Religious services … Paid job … Demographic moderators and controls … Economic factors …” (p 5-7)

[“Statistical analyses” …]

“We examined correlations between the mental health indicators (depressive symptoms and suicide-related outcomes) and screen and nonscreen activities. … We first present bivariate correlations, followed by partial correlations controlling for sex, race/ethnicity, grade, US region, and SES (using dummy codes for race/ethnicity, grade, and region), and correlations for boys and girls separately. We also report partial correlations for depressive symptoms controlling for in-person social interaction (to capture the unique effects of activities on depressive symptoms apart from in-person social interaction) and examine levels of depressive symptoms among those low and high (±1 SD) in inperson social interaction and low and high in social media use (low = never; high = use almost every day).” (p 7)

[“Results” …]

[“Trends in mental health indicators” …]

[“Correlations with screen and nonscreen activities” …]

“Adolescents who spent more time on screen activities were significantly more likely to have high depressive symptoms or have at least one suicide-related outcome, and those who spent more time on nonscreen activities were less likely. These nonscreen activities included print media, suggesting that only some types of media use (e.g., screens) were associated with higher risk. Time spent on homework was negatively correlated with depressive symptoms. The correlations were similar when controlled for sex, race, grade, SES, and region (see Table 2). The correlations between mental health and new media screen activities were higher among girls than among boys; for example, social media use was significantly correlated with depressive symptoms among girls, r(37,830) = .06, p < .001, but not among boys, r(36,291) = .01, p = .08 (with demographic controls).” (p 9)

[Depressive symptoms from screens vs non-depressive symtoms…]

“All activities associated with higher depressive symptoms or suicide-related outcomes involved screens, and all activities associated with lower depressive symptoms or suicide-related outcomes did not involve screens …” (p 9)

[Elevated suicide risk with prolonged daily usage …]

“Risks became elevated after 2 hours or more a day of electronic device use, when 33% of adolescents had at least one suicide-related outcome, compared to 29% of those using electronic devices 1 hour a day. Among those who used electronic devices 5 or more hours a day, 48% had at least one suicide-related outcome. Thus, adolescents using devices 5 or more hours a day (vs. 1 hour) were 66% more likely to have at least one suicide-related outcome.” (p 9)

[In-person interactions mediate effects of screen usage? …]

“In-person social interaction was the only nonscreen activity correlated > .20 with social media use3 creating the possibility of additive or suppressive effects…. Adolescents low in in-person social interaction and high in social media use reported the highest levels of depressive symptoms (see Fig. S3 in the Supplemental Material).”

[Over time, more use of risk-related behaviours …]

“The only activities that (a) predicted lower depressive symptoms and (b) decreased at d ≥ .05 since 2011/2012 are in-person [page break] social interaction, print media use, sports/exercise, and religious service attendance. …since 2010: Teens have spent more time on activities associated with increased risk of mental health issues and less time on activities associated with decreased risk of mental health issues.” (p 9, 13)

[Increased hours of screen-use correlates with suicide risks …]

“Fig. 2. Exposure-response relationship between electronic device use and having at least one suicide-related outcome, bivariate and with demographic controls for race, sex, and grade, 9–12th graders, Youth Risk Behavior Surveillance Survey (YRBSS), 2009–2015.” (p 12)

[“Economic factors and new media by year” …]

[“Discussion” …]

[New media and screens as suicide risk factor …]

“After declining or staying stable for several decades, depressive symptoms, suicide-related outcomes, and suicide deaths became more prevalent among American adolescents between 2010 and 2015, especially among females. …new media screen time should be understood as an important modern risk factor for depression and suicide.” (p p 13)

[Elevated risk in females …]

“The rise in depressive symptoms and suicide-related outcomes was exclusive to females. This suggests that screen time, perhaps especially social media, may have larger effects on adolescent girls’ mental health than on boys’ (and that is indeed what we found, with social media significantly correlated with depressive symptoms only among girls in some analyses and stronger correlations in others).” (p 13)

[Connections to SES/income inequality …]

“… there is some evidence that income inequality is related to the rise in mental health issues, particularly suicide; this is consistent with previous research finding links between income inequality and lower happiness (Oishi et al., 2011).” (p 14)

[Most intervention needed in low in-person, high social media behaviours …]

“Adolescents low in in-person social interaction and high in social media use reported the highest levels of depressive symptoms, suggesting this group is the most in need of intervention.” (p 14)

[Facebook example re moods and depressive symptoms …]

“One study using a longitudinal daily diary method found that the more participants used Facebook, the more negative mood they later felt. In contrast, negative mood did not lead to more Facebook use (Kross et al., 2013). Second, an experiment randomly assigned adults to either continue their usual Facebook use or to give up Facebook use for a week. Those who gave up Facebook reported fewer depressive symptoms at the end of the week than those still using Facebook, suggesting that Facebook use causes higher depressive symptoms (Tromholt, 2016).” (p 14)

[Insomnia and sleep patterns are of interest …]

“Insomnia and/or reduced sleep time may be of particular interest, as previous research has linked screen time to reduced sleep (Hysing et al., 2015) and short sleep duration is a risk factor for depression and suicide (Glozier et al., 2010; Zhai, Zhang, & Zhang, 2015).” (p 15)

Selected References

  • Badcock, P., Davey, C., Whittle, S., Allen, N., & Friston, K. (2017). The depressed brain: An evolutionary systems theory. Trends in Cognitive Sciences, 21, 182–194.
  • Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529.
  • Centers for Disease Control. (2016). Youth Risk Behavior Surveillance System (YRBSS). Division of Adolescent and School Health. Retrieved from
  • Glozier, N., Martiniuk, A., Patton, G., Ivers, R., Li, Q., Hickie, I., Senserrick, T., Woodward, M., Norton, R., & Stevenson, M. (2010). Short sleep duration in prevalent and persistent psychological distress in young adults: The DRIVE study. Sleep, 33, 1139–1145.
  • Hysing, M., Pallesen, S., Stormark, K. M., Jakobsen, R., Lundervold, A. J., & Sivertsen, B. (2015). Sleep and use of electronic devices in adolescence: Results from a large population-based study. BMJ Open, 5(1), e006748.
  • Johnston, L. D., Bachman, J. G., O’Malley, P. M., Schulenberg, J. E., & Miech, R. A. (2016). Monitoring the Future: A continuing study of American youth (8th- and 10th-Grade Surveys), 2015 (ICPSR36407). Ann Arbor: Institute for Social Research, The University of Michigan.
  • Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
  • Kross, E., Verduyn, P., Demiralp, E., Park, J., Lee, D. S., Lin, N., . . . Ybarra, O. (2013). Facebook use predicts declines in subjective well-being in young adults. PLOS One, 8, e69841. doi:10.1371/journal.pone.0069841
  • Lieberman, M. (2013). Social: Why our brains are hardwired to connect. New York, NY: Crown.
  • Newcomb, M. D., Huba, G. J., & Bentler, P. M. (1981). A multidimensional assessment of stressful life events among adolescents: Derivation and correlates. Journal of Health and Social Behavior, 22, 400–415.
  • Oishi, S., Kesebir, S., & Diener, E. (2011). Income inequality and happiness. Psychological Science, 22, 1095–1100.
  • Sherman, L. E., Minas, M., & Greenfield, P. M. (2013). The effects of text, audio, video, and in-person communication on bonding between friends. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 7(2), article 3.
  • Smith, A. (2017, January 12). Record shares of Americans now own smartphones, have home broadband. Pew Research Center. Retrieved from
  • Song, H., Hayeon, S., Anne, Z.- S., Jinyoung, K., Adam, D., Angela, V., . . . Mike, A. (2014). Does Facebook make you lonely? A meta analysis. Computers in Human Behavior, 36, 446–452.
  • Tromholt, M. (2016). The Facebook experiment: Quitting Facebook leads to higher levels of well-being. Cyberpsychology, Behavior, and Social Networking, 19, 661–666.
  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. J. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.
  • Zhai, L., Zhang, H., & Zhang, D. (2015). Sleep duration and depression among adults: A meta-analysis of prospective studies. Depression and Anxiety, 32, 664–670.
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