Lille, France — When it comes to the link between mental health and social networks, be careful of jumping to conclusions. This warning came from Margot Morgiève, PhD, sociology researcher at the French National Institute of Health and Medical Research and the Center for Research in Medicine, Science, Health, Mental Health, and Society (Inserm-Cermes 3). She delivered her remarks at the opening session of the Pediatric Societies Congress organized by the French Society of Pediatrics (SFP), based on an increasing amount of scientific literature on the subject.
In 2021, 4.2 billion people, or more than half the world's population, used social networks, and 80.3% of French citizens had a social network account.
Between those who condemn social networks for causing problems in adolescents and those who, in contrast, view it as a lifeline, what do we really know about their impact on the mental health of young people?
Although several studies have found a significant association between the heavy use of social networks and anxiety, depressive symptoms, and stress, there have also been reports of decreased life satisfaction, as well as reduced general well-being and self-esteem.
"Due to an increased [concurrence] between mood disorders or depression and the use of social networks, researchers wanted to establish a new disorder: 'Facebook Depression,' " commented Morgiève, who is also a clinical psychologist and coordinator of the chat and social network unit for the French national suicide prevention hotline 3114.
"But they quickly realized that it would be wrong to recognize it as a characterized disorder, because it would appear that the harmful effects of social networks on mental health are not linked to the social network itself, but rather to problematic social network use."
There are three major categories of problematic social network use, the first being social comparison. This refers to the spontaneous tendency of social beings to compare themselves to individuals who appear to be more attractive than them.
This is nothing new, but it is exacerbated on social networks. Users emphasize the positive aspects of their life and present themselves as balanced, popular, and satisfied.
However, this leads to strong normative constraints, which result in a negative self-assessment, thereby lowering self-esteem and promoting the emergence of depressive symptoms. "Thus, it isn't the social network that creates depression, but rather the phenomenon of comparison, which it pushes to the extreme," summed up Morgiève.
The second problem associated with social networks is their propensity to promote addictive behavior through [observational learning], which can give rise to compulsive and uncontrolled behavior, as illustrated by "FOMO," or fear of missing out.
Hence the idea of defining a specific entity called "social network addiction," which was also quickly abandoned. It is the very features of social networks that generate this fear and thus this tendency, just like news feeds (constant updating of a personalized news list).
"Substitutive" use is the third major category. This is when time spent in the online environment replaces that spent offline. Excessive users report a feeling of loneliness and an awareness of a lack of intimate connections.
Initial studies using artificial intelligence and machine learning tend to show that a digital language of distress exists. Authors noticed that themes associated with self-loathing, loneliness, suicide, death, and self-harm correlated with users who exhibited the highest levels of depression.
The very structure of the language (more words, more use of "I," more references to death, and fewer verbs) correlated with users in distress.
According to the authors, the typical social network practice of vaguebooking — writing a post that may incite worry, such as "better days are coming" — is a significant predictive factor of suicidal ideation. A visual language of distress also reportedly exists — for example, the use of darker shades, like the black-and-white inkwell filter with no enhancements in Instagram.
Digital environments entail many risks and dangers. Suicide pacts and online suicides (like the suicide of a young girl on Periscope in 2016) remain rare but go viral. The same is true of challenges. In 2015, the Blue Whale Challenge consisted of a list of 50 challenges ranging from the benign to the dramatic, with the final challenge being to "hang yourself."
Its huge media coverage might well have added to its viral success had the social networks not quickly reacted in a positive manner.
Trolling, for its part, consists of posting provocative content with the intent of either sparking conflict or causing distress.
Cyberbullying, the most common online risk adolescents face, is the repeated spreading of false, embarrassing, or hostile information.
A growing danger is sexting (sending, receiving, or passing on sexually explicit photographs, messages, or images). The serious potential consequences of sexting include revenge porn or cyber rape, which is defined as the distribution of illicit content without consent, the practice of which has been linked to depression and involvement in risky behavior.
The risk of suicide exposure should no longer be overlooked, in view of the hypothesis that some online content relating to suicide may produce a suggestive effect with respect to the idea or the method of suicide, as well as precipitating suicide attempts.
"People who post suicidal comments are in communities that are closely connected by bonds of affiliation (memberships, friendships) and activities (retweets, likes, comments)," explained Morgiève.
But in these communities, emotionally charged information that spreads rapidly and repetitively could promote co-rumination, hence the concept of "suicidocosme [suicide world]", developed in 2017 by Charles-Edouard Notredame, MD, of the Child and Adolescent Psychiatry Department at Lille University Hospital. This, in turn, can produce and increase the suicide contagion based on the Werther effect model.
Just one of many examples is Marilyn Monroe's suicide in 1962, which increased the suicide rate by 40% in Los Angeles. The Werther effect is especially significant because two biases are present: the prestige bias (identification with the person one admires) and similarity bias (identification with the person who resembles me).
Similarity bias is the most decisive in adolescence. It should be noted that the positive counterpart to the Werther effect is the Papageno effect. The Belgian singer-songwriter Stromae's TV appearances earlier this year, in which he spoke about his suicidal ideations, enabling young people to recognize their suffering and seek help, is an example of the Papageno effect.
Social networks can increase connectedness, i.e., the feeling of being connected to something meaningful outside oneself. Connectedness promotes psychological well-being and quality of life.
The very characteristics of social networks can enhance elements of connectedness, both objectively by increasing users' social sphere, and subjectively by reinforcing the feeling of social belonging and subjective well-being.
Taking Facebook and its "anniversary" feature as an example, it has been shown that the greater the number of Facebook friends, the more individuals saw themselves as being connected to a community.
"Millennials, or people born between the beginning of the 1980s and the end of the 1990s, are thus more likely to take advantage of the digital social environment to establish a new relationship with psychological suffering and its attempts to ease it," stated Morgiève.
They are also more likely to naturally turn to the digital space to look for help. More and more of them are searching the Internet for information on mental health and sharing experiences to get support."
An example is the It Gets Better Project, which is a good illustration of the structure of online peer communities, with stories from LGBTQ+ individuals who describe how they succeeded in coping with adversity during their adolescence. In this way, social media seems to help identify peers and positive resources that are usually unavailable outside of the digital space. As a result, thanks to normative models on extremely strong social networks that are easy to conform to, these online peer-support communities have the potential to facilitate social interactions and reinforce a feeling both of hope and of belonging to a group."
In Morgiève's opinion, "access to care, particularly in the area of adolescent mental health, is extremely critical, given the lack of support precisely when they need it the most, as [evidenced] by the number of suicide attempts.
"There are two types of barriers to seeking help which can explain this. The first is structural barriers: help is too expensive or too far away or the wait is too long. The second refers to personal barriers, including denying the need for help, which may involve a self-sufficiency bias, the feeling that one cannot be helped, refusal to bother close friends and family, fear of being stigmatized, and a feeling of shame."
These types of barriers are particularly difficult to overcome because the beliefs regarding care and caregivers are limiting (doubts about caregiver confidentiality, reliability, and competence). This is observed especially in adolescents because of the desire for emancipation and development of identity. So [the help relationship] may be experienced as subordination or alienation.
On a positive note, it is the very properties of social networks that will enable these obstacles to seeking help to be overcome. The fact that they are available everywhere makes up for young people's lack of mobility and regional disparities. In addition, it ensures discretion and freedom of use, while reducing inhibitions.
The fact that social networks are free of charge overcomes structural obstacles, such as financial and organizational costs, as well as personal obstacles, thereby facilitating engagement and lessening the motivational cost. The dissociative pseudonymity or anonymity reduces the feeling of vulnerability associated with revealing oneself, as well as fears of a breach of confidentiality.
Morgiève summed it up by saying, "While offline life is silent because young people don't talk about their suicidal ideations, online life truly removes inhibitions about speaking, relationships, and sharing experiences. Thus, the internet offers adolescents new opportunities to express themselves, which they're not doing in real life."
France records one suicide every hour (8885 deaths a year) and one suicide attempt every 4 minutes. Since the 1950s, government-funded telehealth prevention and assistance (PADS) programs, such as S.O.S. Amitié, Suicide Écoute, SOS Suicide Phénix, etc, have been developed. Their values and principles are anonymity, nondirectivity, nonjudgment, and neutrality. In addition to these nonprofit offerings, a professional teleprevention program, the confidential suicide prevention hotline 3114 — with professionals who are available to listen 24 hours a day, 7 days a week — was launched by the Ministry of Health and Prevention last October.
Its values and principles include confidentiality, proactivity, concern and caring for others. To date, 13 of 17 centers have opened. In the space of 6 months, they have received 50,000 calls, with an average of 400 to 500 calls a day. The dedicated chat application was co-designed with users (suicide attempters). And now social networks are joining in. For example, the hotline number 3114 appears whenever a TikTok user types the word "suicide."
Morgiève states that she has no conflicts of interest regarding the subject presented.
This article was translated from the Medscape French edition.
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