The decline in youth mental health in recent years, including an alarming rise in suicidal behavior, has increased scrutiny of screen time, with the U.S. surgeon general even calling it out as a concern in an advisory on the impact of social media on youth.
However, a recent study from physicians and researchers at NewYork-Presbyterian, Columbia, and Weill Cornell Medicine finds that patterns of addictive screen use (for example, excessive use that interferes with school or home activities, or loss of control) are a more significant predictor of mental health outcomes, including suicidal behaviors and ideation.
Published in the Journal of the American Medical Association, the study analyzed data from 4,285 children with an average age of 10 who were enrolled in the longitudinal Adolescent Brain Cognitive Development Study, and whose screen use was tracked over four years. Researchers discovered that baseline total screen time use was not associated with negative mental health outcomes at the fourth-year follow-up; rather, it was the degree of a child’s addictive use of social media, mobile phones, and video games.
Our study is shifting the paradigm and focus of the conversation from screen time to the signs of addiction.
— Dr. Yunyu Xiao
“While previous studies and surveys have documented rising screen use, our study is the first to map addictive use trajectories,” says Yunyu Xiao, Ph.D., lead author and assistant professor of population health sciences at Weill Cornell Medicine. “It’s shifting the paradigm and focus of the conversation from time to the signs of addiction.”
“Parents often notice that when they turn off the computer or television, their kids become irritable,” says J. John Mann, M.D., Ph.D., a psychiatrist at NewYork-Presbyterian and Columbia and professor of translational neuroscience at Columbia, a co-director of the Columbia Center for the Prevention and Treatment of Depression, and senior author of the study. “This is a really striking observation for parents — they realize that maybe it's not just about the time their children spend on screens, but rather how difficult is it for them to stop and what the implications are of not being able to stop. When you think of it in those terms, it becomes clearer why patterns of addictive severity are important.”
Identifying the Patterns That Put Youth Mental Health at Risk
Three distinct addictive trajectories were identified for both social media and mobile phone use: a low addictive use group, an increasing addictive use group, and a group that had high addictive use from the start. For video games, two trajectories were found, high and low. “Using longitudinal data to identify trajectories and risk patterns was extremely important,” says Dr. Mann. “You really have to follow kids over time to see how their use and behaviors evolve, and to detect who starts with low addiction and evolves into high addiction over time.”
Nearly one-third of the adolescents were on an increasing addictive use trajectory for social media, and a quarter were on a similar path with mobile phones. These children initially started with low use, but their addictive behaviors escalated over the four-year period. Additionally, 41% had a high addictive use trajectory for video games.
Demographically, females were more likely to have high or increasing addictive use of social media and mobile phones, whereas males were more likely to have high addictive use of video games. The study also found that youths who were Black, Hispanic, from lower-income households, from less-educated households, or who had unmarried parents were more likely to be in high addictive use trajectories, mirroring the negative impact of disparities found in other studies on childhood cognition and development. “Our study also shows that social determinants of health and factors like exposure to racism or adverse childhood experiences can make children from underserved communities more susceptible to adverse outcomes," says Dr. Xiao.
The Link Between Addictive Screen Use and Suicidal Behaviors
At the study’s fourth-year follow-up, about 5% of participants reported suicidal behaviors (ranging from making preparations for a suicide attempt to actual suicide attempts) and nearly 18% reported suicidal ideation.
There is a whole toolbox of strategies for managing addictions that need to be examined and adapted for use in this age group.
— Dr. J. John Mann
The analysis showed a strong correlation with addictive use patterns, finding that high addictive use trajectories for all screen types were associated with a higher risk of worsening mental health, including anxiety and depression, and suicide-related outcomes. Notably, adolescents in the high and increasing trajectory for social media and the high trajectory for mobile phone use had more than twice the risk of suicidal behaviors and ideation than the low use groups.
The study also concluded that total screen time at baseline was not associated with any of the suicide-related or mental health outcomes measured.
“We now understand that this isn’t just about screen time. It’s about the type of screen time,” says Dr. Mann, emphasizing that addiction to screen use should be treated and managed the way any other addictions would be. “There is a whole toolbox of strategies for managing addictions that need to be examined and adapted for use in this age group. We feel confident that we can find population-level and individual-level strategies that make a difference.”
Dr. Xiao adds that addressing this challenge societally will require a broad, collaborative approach. “This is also about public health, and to address this issue, you need to leverage different stakeholders,” she says. “We worked with data scientists, social scientists, epidemiologists, economists, and psychiatrists to study this. The next step will be to understand what factors shape addictive screen use so we understand what puts children at risk and what can protect them.”
