DEPRESSION AND ANXIETY 33:323–331 (2016)

Research Article
ASSOCIATION BETWEEN SOCIAL MEDIA USE
AND DEPRESSION AMONG U.S. YOUNG ADULTS
Liu yi Lin, B.A.,1,2 Jaime E. Sidani, Ph.D.,1,2 Ariel Shensa, M.A.,1,2 Ana Radovic, M.D., M.Sc.,3,4
Elizabeth Miller, M.D., Ph.D.,3,4 Jason B. Colditz, M.Ed.,1,2 Beth L. Hoffman, B.Sc.,1,2 Leila M. Giles, B.S.,1,2
and Brian A. Primack, M.D., Ph.D.1,2,3 ∗

Background: Social media (SM) use is increasing among U.S. young adults, and
its association with mental well-being remains unclear. This study assessed the
association between SM use and depression in a nationally representative sample
of young adults. Methods: We surveyed 1,787 adults ages 19 to 32 about SM
use and depression. Participants were recruited via random digit dialing and
address-based sampling. SM use was assessed by self-reported total time per day
spent on SM, visits per week, and a global frequency score based on the Pew Inter-
net Research Questionnaire. Depression was assessed using the Patient-Reported
Outcomes Measurement Information System (PROMIS) Depression Scale Short
Form. Chi-squared tests and ordered logistic regressions were performed with
sample weights. Results: The weighted sample was 50.3% female and 57.5%
White. Compared to those in the lowest quartile of total time per day spent on
SM, participants in the highest quartile had significantly increased odds of de-
pression (AOR = 1.66, 95% CI = 1.14–2.42) after controlling for all covariates.
Compared with those in the lowest quartile, individuals in the highest quartile of
SM site visits per week and those with a higher global frequency score had signif-
icantly increased odds of depression (AOR = 2.74, 95% CI = 1.86–4.04; AOR =
3.05, 95% CI = 2.03–4.59, respectively). All associations between independent
variables and depression had strong, linear, dose–response trends. Results were
robust to all sensitivity analyses. Conclusions: SM use was significantly asso-
ciated with increased depression. Given the proliferation of SM, identifying the
mechanisms and direction of this association is critical for informing interven-
tions that address SM use and depression. Depression and Anxiety 33:323–331,
2016. 
C 2016 Wiley Periodicals, Inc.

Key words: social media; internet; communications media; depression; young

adult

Contract grant sponsor: National Institute of Mental Health; Con-

tract grant number: R25-MH054318; Contract grant sponsor: Na-
1 Division of General Internal Medicine, Department of tional Cancer Institute; Contract grant number: R01-CA140150.
Medicine, University of Pittsburgh School of Medicine, Pitts-
burgh, Pennsylvania ∗ Correspondence
2 Center for Research on Media, Technology, and Health, Uni- to: Brian A. Primack, 230 McKee Place Suite
600, Pittsburgh, PA 15213.
versity of Pittsburgh School of Medicine, Pittsburgh, Pennsyl-
E-mail: [email protected]
vania
3 Division of Adolescent and Young Adult Medicine, De- Received for publication 28 July 2015; Revised 19 November 2015;
Accepted 24 December 2015
partment of Pediatrics, University of Pittsburgh School of
Medicine, Pittsburgh, Pennsylvania DOI 10.1002/da.22466
4 Children’s Hospital of Pittsburgh of the University of Pitts- Published online 19 January 2016 in Wiley Online Library
burgh Medical Center, Pittsburgh, PA (wileyonlinelibrary.com).


C 2016 Wiley Periodicals, Inc.
324 Lin et al.

INTRODUCTION our sample from a large-scale web-based research panel developed and

D epression is highly prevalent in the United States

maintained by a survey research company called Growth from Knowl-
edge (GfK).[22] Participants were recruited via random digit dialing and
and the incidence is increasing.[1, 2] It accounts for more address-based sampling, reaching a sampling frame of over 97% of the
disability-adjusted life years (DALYs) than all other U.S. population.[22] GfK is continuously recruiting individuals to be a
mental disorders,[3] and it is projected to become the part of their survey panel. Individuals are also free to withdraw from
leading cause of disability in high-income countries by the panel at any point. The GfK Knowledge Panel R
model has been
2030.[4] The economic burden of depression is estimated shown to be a statistically valid method for surveying and analyzing
at 83 billion dollars annually from reduced worker pro- health indicators from a nationally representative sample.[23, 24]
From October 2014 to November 2014, our web-based survey was
ductivity, increased medical expenses, and suicide.[5] Re-
sent via email to a random sample of 3,048 noninstitutionalized adults
currence is frequent, and comorbidity with other psychi- between the ages of 19 to 32 who had consented to participate in a
atric illnesses such as anxiety and substance use disorder previous study wave. Participation for this initial wave was 54%, a
is common.[1, 6] strong response rate for the use of Internet panels in the recruitment
Depression often begins around young adulthood.[7, 8] of study subjects.[25, 26] The current data were collected during the
Although multiple factors contribute to depression,[9] 18-month follow-up of this study, which assessed multiple health be-
there is growing interest in the potential influence of haviors among individuals ages 18 to 30 at baseline. We used only the
social media (SM) use on psychological well-being. 18-month follow-up data for the current analysis because the social
SM, which can be defined as “a group of Internet- media items were not asked at baseline. Thus, although the overall
based applications that allow the creation and exchange survey was part of a longitudinal study, the data specific to social me-
dia use and depression were only asked at one-time point. Responses
of user-generated content,”[10] has become an inte-
were received from 1,787 participants (59%).
gral component of connecting with friends and fam- The survey research company (GfK) instituted multiple strategies
ily, sharing personal content, and obtaining news and to improve data quality. For example, they screened all data sets for pat-
entertainment.[11, 12] Use of SM sites such as Facebook terns suggestive of lack of effort. GfK also instituted procedures such
and Twitter has particularly increased among young as minimizing survey length whenever possible, reducing the need for
adults, who are at critical junctures surrounding devel- scrolling, and avoiding the use of long grids. Furthermore, if individu-
opmental tasks such as identity development and estab- als did not answer a question they were prompted once to answer with
lishment of social norms.[13] As many as 90% of young the statement “your answer is important to us. Please put your best
adults in the United States use social media, and the ma- guess.”
jority of users visit these sites at least once a day.[14] SM The median time for survey completion was 15 min and participants
received $15 for their participation. This study was approved by the
use accounts for about 20% of time online on personal
University of Pittsburgh Institutional Review Board and was granted a
computers and 30% of time online via mobile phones.[15] Certificate of Confidentiality from the National Institutes of Health.
Published studies on the association between so-
cial media use and depression have yielded mixed
results.[16, 17] Some studies suggest that SM users may MEASURES
experience decreased depression,[18] possibly from an in- Participants completed online survey items including depression
crease in social capital, perceived social support, and life (dependent variable), social media use (independent variable), and co-
satisfaction.[19, 20] Other studies, however, indicate that variates.
Depression. We assessed depression using a 4-item scale de-
frequent use of social media may be associated with de-
veloped by the Patient-Reported Outcomes Measurement Informa-
clines in subjective well-being, life satisfaction, and real- tion System (PROMIS). PROMIS is a National Institutes of Health
life community.[17, 21] All of these prior studies, however, Roadmap initiative whose aim is to provide precise, valid, reliable,
have been limited by small and/or localized samples. Fur- and standardized questionnaires measuring patient-reported outcomes
thermore, they have tended to focus on one specific plat- across the domains of physical, mental, and social health.[27] The
form, Facebook,[16, 21] while real-life usage, especially PROMIS depression scale was developed using item response theory to
among young adults, tends to incorporate a diverse array promote greater precision and decrease respondent burden.[28] Specif-
of social media sites such as Twitter, Google+, Insta- ically, the PROMIS depression scale has been correlated and validated
gram, Tumblr, Snapchat, and Vine.[14, 15] In this study, with other commonly used depression instruments, including the Cen-
we aimed to examine a broader range of SM exposures ter for Epidemiological Studies Depression Scale (CES-D), the Beck
Depression Inventory (BDI-II), and the Patient Health Questionnaire
and to determine the association between SM expo-
(PHQ-9).[29, 30] The 4-item PROMIS depression scale asked partici-
sure and depression in a large, nationally representative pants how frequently in the past 7 days they had experienced depres-
sample of young adults. Understanding the relationship sion, including feeling hopeless, worthless, helpless, or depressed.[31]
between SM use and depression could allow the devel- These items were scored on a 5-point Likert scale ranging from 1 to 5,
opment of interventions or preventative strategies for corresponding to responses of “Never,” “Rarely,” “Sometimes,” “Of-
at-risk populations. ten,” and “Always.” Thus, the total possible raw score was between 4
and 20. Based upon the nonnormal distribution of data, the raw scores
were collapsed into tertiles of “low,” “medium,” and “high” for pri-
MATERIALS AND METHODS mary analysis. This was appropriate because one of the specific aims
of the PROMIS depression scale is to grade the severity of depression,
DESIGN, PARTICIPANTS, AND SETTING instead of merely providing a dichotomous cutoff for clinical depres-
We surveyed a nationally representative sample of U.S. young adults sion. We classified those who did not endorse any depression as those
aged 19 to 32 regarding their depression and social media use. We drew in the “low” group (raw score = 4), which represented 44.5% of the

Depression and Anxiety

 Research Article: Social Media and Depression 325

population. We then classified a “high” group based on both the distri- outcome variable as dichotomous instead of in tertiles. For these
bution of the data and the clinical cutoff for depression recommended analyses, those above the APA cutoff for the PROMIS depression
by the American Psychiatry Association (APA).[32] This cutoff corre- scale were compared with all others.[32] Second, we conducted all
sponded to a raw score of 9 or more (out of 20), which corresponds to analyses with independent variables as continuous instead of or-
a T-score of 57.3. Because the APA uses 55 as a cutoff for diagnosing dered categorical variables. Third, we conducted all analyses us-
clinical depression, individuals in the “high” group have a high like- ing only covariates that had a bivariable association of P <
lihood of experiencing some depression.[32] This group represented .15 with the outcome. Fourth, we conducted all analyses with-
26.3% of the population. Those with raw scores between 5 and 8 were out survey weights. Results from all sensitivity analyses showed
classified as “medium” and comprised 29.2% of the population. similar levels of significance and magnitude to those described
Social Media Use. We assessed participants’ social media use here.
in three complementary ways. First, participants were asked to esti- Statistical analyses were performed with Stata 12.1 (Stata Corp.,
mate total time per day on social media for personal use. This item College Station, TX), and two-tailed P-values < .05 were considered
specifically instructed participants to not count any time spent on so- to be significant.
cial media for work. Participants provided estimates in numerical fields
for hours and minutes on an average day. Second, participants were
asked to report their use of each of 11 widely used social media plat- RESULTS
forms, including Facebook, Twitter, Google+, YouTube, LinkedIn,
PARTICIPANTS
Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit.[14, 15] Seven
response choices ranged from “I do not use this platform” to “I use A total of 1,787 participants completed the ques-
this platform 5 or more times a day.” We based these items on the tionnaire. The weighted sample was 50.3% female,
measures used by Pew Internet Research.[14] Using weighted averages 57.5% White, 13.0% African American, 20.6% His-
based on the frequency responses, we computed social media site vis- panic, and 8.9% biracial/multiracial or other. Of these,
its per week. Finally, we summed responses across platforms to obtain slightly more than half (55.6%) were in a commit-
a total score without weighting values for frequency. Because there ted relationship and approximately a third (35.7%)
were seven response choices for each item, which we coded as 0 to
reported living with a significant other. In terms of
6, the resulting global frequency score ranged from 0 to 66. In order
to improve interpretability of results, we collapsed all independent
household income, 22.9% were in the “low” category
variables into quartiles for primary analyses. To ensure robustness of (under $30,000) and 38.7% were in the “high” cat-
results, we also conducted all analyses with independent variables as egory ($75,000 and above). About one-third (36.0%)
continuous. of participants had not attended any college, while a
Covariates. For analysis, we divided the sample into three age quarter (25.8%) had a B.A. or higher (Table 1). There
groups (19–23; 24–26; 27–32) and race/ethnicity into five mutually were no differences between responders and nonrespon-
exclusive groups (White, non-Hispanic; Black, non-Hispanic; His- ders in terms of age (P = .12), sex (P = .07), or race
panic; Bi-racial, multiracial; or other non-Hispanic). We also assessed (P = .21).
other environmental and personal factors that may affect depression
and social media use.[1, 14] These included relationship status (single
DEPRESSION
or in a committed relationship), living situation (with a parent or
guardian; with a significant other; or other situation), household in- Accounting for survey weights, 44.5% of the sample
come (under $30,000; $30,000–$74,999; or $75,000 or more) and edu- reported no indicators of depression in the past week
cation level (high school or less; some college; or bachelor’s degree or and were placed in the “low” group. About one-fourth
higher). (26.3%) were classified as “high,” and the remaining
29.2% of participants were in the “medium” group.
DATA ANALYSIS
We included all participants who had complete data on the SOCIAL MEDIA USE
PROMIS depression scale and the social media items. Because only Median total time on social media was 61 min/day (in-
1% of participants had missing data for these variables, this did not terquartile range [IQR] = 30–135). Median social media
affect our results. To describe our sample, we computed percentages site visits per week across all platforms was 30 (IQR =
of the dependent variable, each of the three independent variables, 9–57) and median global frequency score was 11 (IQR
and the seven covariates. Next, we used chi-square tests to determine
= 6–17). Only 58 individuals (3.2%) reported zero site
bivariable associations between each of the independent variables and
covariates and the PROMIS depression scale score. After confirm-
visits per week.
ing that the proportional odds assumption was met, we used ordered
logistic regression with appropriate sample weights to examine bivari- BIVARIABLE ANALYSES
able and multivariable associations between each social media variable Bivariable analyses showed significant associations be-
and depression. We decided a priori to include all covariates in our tween all social media use variables, depression, age, sex,
primary multivariable models. We also used regression analyses to ex- race/ethnicity, and education level (Table 1). A greater
amine whether there was an overall linear trend between each ordered
percentage of participants aged 27–32 were in the “high”
categorical independent variable and the dependent variable. In order
to take advantage of the nationally representative nature of the data,
depression category (38.7%) as compared to participants
all primary analyses were conducted using survey weights, which took aged 19–23 (28.8%) and 24–26 (32.5%). Female sex and
into account sex, age, race/ethnicity, education, household income, lower education level were also both associated with be-
census region, metropolitan area, and Internet access. ing in the “high” depression group. Additionally, bivari-
We also conducted four sets of sensitivity analyses to examine the able analyses demonstrated significant associations be-
robustness of our results. First, we conducted all analyses with the tween total time per day on social media and age, sex,
Depression and Anxiety
326 Lin et al.

TABLE 1. Whole sample characteristics and bivariable associations with depression

Depression
Independent variables Whole sample (N = 1,787) Low (n = 731) Medium (n = 544) High (n = 512) P Valuea
Column %b

Social media use

Total time per day (min) .006
Q1 (0–30) 29.8 36.0 24.9 24.7
Q2 (31–60) 20.8 22.0 22.7 16.6
Q3 (61–120) 24.0 20.3 24.1 30.1
Q4 (121 and above) 25.5 21.8 28.3 28.6
Visits per weekc <.001
Q1 (0–8) 28.3 36.6 23.8 19.4
Q2 (9–30) 25.1 24.0 25.6 26.4
Q3 (31–57) 24.1 23.1 24.2 25.5
Q4 (58 and above) 22.5 16.4 26.4 28.7
Global frequency scorec,d <.001
Q1 (0–6) 27.5 35.6 21.0 20.9
Q2 (7–11) 27.0 28.1 27.5 24.8
Q3 (12–17) 22.4 20.1 25.0 23.6
Q4 (18–66) 23.1 16.2 26.6 30.7
Covariates
Age, y .03
19–23 33.6 34.5 36.6 28.8
24–26 24.7 20.5 24.2 32.5
27–32 41.6 45.0 39.2 38.7
Sex .006
Female 50.3 44.1 57.7 52.5
Male 49.7 55.9 42.3 47.5
Race/ethnicity .02
White, non-Hispanic 57.5 60.0 54.9 56.1
Black, non-Hispanic 13.0 15.9 10.5 10.7
Hispanic 20.6 18.9 21.1 23.0
Othere 8.9 5.2 13.5 10.2
Relationship status .08
Singlef 44.4 39.9 47.7 48.6
Committed relationshipg 55.6 60.1 52.4 51.4
Living situation .10
Parent/Guardian 34.0 33.1 30.5 39.4
Significant other 35.7 39.0 33.5 32.4
Otherh 30.4 27.9 36.0 28.2
Household income .003
Under $30,000 22.9 19.0 20.4 32.3
$30,000–$74,999 38.4 38.7 38.5 37.8
$75,000 and above 38.7 42.3 41.1 29.9
Education level .002
High school or less 36.0 32.7 31.6 46.3
Some college 38.3 37.9 40.1 36.8
B.A. or higher 25.8 29.4 28.3 16.9
aP value derived using Chi-square analyses comparing proportion of users in each category.
b Column percentages are based upon survey weighted data, therefore may not be congruent with the cell frequency proportion of total N. Values
may not total 100 due to rounding.
c Includes Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit.
d Based on a 7-point Likert-type response scale ranging from “I don’t use this platform” to “5 or more times a day.” A summary score was created

for the 11 SM platforms with scores ranging from 0 to 66.

e Includes multiracial.
f Includes widowed, divorced, and separated.
g Includes engaged, married, and in a domestic partnership.
h Defined as not living with a parent/guardian or significant other.

Depression and Anxiety

 Research Article: Social Media and Depression 327

TABLE 2. Associations between covariates and social media use

Total time per day, mina

Covariate 0-30 31–60 61–120 121+ P Valueb
Column %c

Age, y <.001
19–23 26.7 27.6 37.2 43.3
24–26 27.4 20.3 26.1 23.2
27–32 45.9 52.1 36.8 33.5
Sex
Female 42.7 43.4 53.4 61.0 <.001
Male 57.3 56.6 46.6 39.0
Race/ethnicity
White, non-Hispanic 63.5 63.7 54.0 48.4 .13
Black, non-Hispanic 10.5 10.4 15.0 16.6
Hispanic 16.5 17.3 23.3 25.4
Otherd 9.4 8.6 7.8 9.6
Relationship status .09
Singlee 41.3 38.3 46.8 50.5
Committed relationshipf 58.7 61.7 53.2 49.5
Living situation .13
Parent/guardian 31.3 29.5 36.9 37.7
Significant other 41.0 40.4 31.2 29.1
Otherg 27.7 30.1 32.0 33.3
Household income .17
Under $30,000 18.2 20.7 24.4 28.0
$30,000–$74,999 41.4 36.2 41.4 34.1
$75,000 and above 40.4 43.2 34.1 37.9
Education level .003
High school or less 31.9 26.3 38.4 45.0
Some college 37.1 41.7 39.1 36.9
B.A. or higher 31.0 32.0 22.5 18.2
a Includes Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit.
bP value derived using Chi-square analyses comparing proportion of users in each category.
c Values may not total 100 due to rounding.
d Includes multiracial.
e Includes widowed, divorced, and separated.
f Includes engaged, married, and in a domestic partnership.
g Defined as not living with a parent/guardian or significant other.

and education level (Table 2). Younger age, female sex, media site visits per week (AOR = 2.74, 95% CI = 1.86–
and lower education level were all associated with greater 4.04) and global frequency score (AOR = 3.05, 95%
time per day on social media. Age was the only covariate CI = 2.03– 4.59) reported greater depression. Sensitiv-
significantly associated with social media site visits per ity analyses demonstrated that all associations between
week (P < .001), with younger age associated with be- independent variables and depression had strong, linear,
ing in the highest category of site visits per week. Age, dose–response trends (P = .002 for total time per day and
living situation, and household income were all signifi- P < .001 for both visits per week and global frequency
cantly associated with the global frequency score (P from score).
<.001 to .03), with younger age, not living with a signif-
icant other, and being in the highest tertile of household
income associated with a greater global frequency score DISCUSSION
(data not shown). This study demonstrates a strong and significant as-
sociation between social media use and depression in a
MULTIVARIABLE ANALYSES nationally representative sample of U.S. young adults.
In fully adjusted models, participants in the highest There was a linear association between social media use
quartile of total time per day on social media had sig- and depression for all three social media use variables.
nificantly greater odds of having depression (AOR = While some prior studies have found no association or
1.66, 95% CI = 1.14–2.42) compared to those in the mixed results,[16, 33] our findings are consistent with prior
lowest quartile (Fig. 1). Compared to those in the low- research that showed an association between social me-
est quartile, participants in the highest quartiles of social dia use and mood dysregulation.[17, 34]
Depression and Anxiety
328 Lin et al.

Figure 1. Multivariable associations between depression and social media use variables. Each social media use variable is divided into
quartiles from lowest (Q1) to highest (Q4). Vertical bars represent 95% confidence interval and point estimates of adjusted odds ratio.
P value for overall linear effect was .002, <.001, and <.001, respectively, for each social media use variable. The multivariable model
adjusted for age, sex, race, relationship status, living situation, household income, and education level.

Our findings regarding prevalence of depression were elicits feelings of envy and the distorted belief that others
generally consistent with prior research. In particular, lead happier and/or more successful lives.[43, 44] Conse-
Christakis et al. found that 56% of college-aged adults quently, these envious feelings may lead to a sense of
reported no depression according to the PHQ-9,[35] self-inferiority and depression over time.[45] It is also
which has been validated against the PROMIS depres- possible that the feeling of “time wasted” by engag-
sion measure.[36] Our findings regarding the linear as- ing in activities of little meaning on social media neg-
sociation between social media use and depression were atively influences mood.[34] Additionally, the substan-
somewhat surprising given prior research that has shown tial rise in the amount of time young individuals spend
increased depression in those with low Internet use.[33] on the Internet—particularly on social media—has led
However, one reason for our finding may be that our some to call for the recognition of “Internet addiction”
sample had so few individuals who did not use social as a distinct psychiatric condition that is closely asso-
media (only 3.2% of the sample). It is notable that our ciated with depression.[46, 47] Finally, it is possible that
results showed a consistent linear trend between the in- increased social media exposure may increase the risk
dependent and dependent variables even when the inde- of cyber-bullying, which may also increase feelings of
pendent variable was operationalized as continuous. depression.[48, 49]
Because our data were cross-sectional, the directional- Regardless of the direction of association between so-
ity of this association is not clear. It may be that individ- cial media use and depression, these findings should be
uals with depression tend to use more social media. For of interest to clinicians and public health practitioners.
example, depressed individuals with a diminished sense For example, it may be valuable for clinicians to assess
of self-worth may turn to social media based interactions social media use among depressed individuals to probe
for validation.[37, 38] Subsequently, individuals may suffer for maladaptive patterns of use, which may be contribut-
from continuous rumination and guilt surrounding In- ing to mood dysregulation. Additionally, there may be
ternet use, while feeling compelled to continue the cycle useful ways of leveraging social media to decrease stigma
due to low self-efficacy and negative self-appraisal.[37, 39] of depression and identify individuals at risk, such as de-
Due to the high accessibility of social media and the tecting self-disclosures of depression on social media.[50]
possibility of socialization in a controlled setting, indi- Because social media has become an integrated compo-
viduals with underlying depression and anhedonia may nent of human interaction, it is important for clinicians
be more drawn to social media interactions rather than interacting with young adults to recognize the important
face-to-face interactions.[40, 41] balance to be struck in encouraging potential positive
It may also be that those who use increased amounts use but redirecting from problematic use. With regard
of social media subsequently develop increased depres- to public health practitioners, these findings suggest that
sion. Multiple studies have linked social media use social media may provide valuable venues to screen for
with declines in subjective mood, sense of well-being, depression or to disseminate targeted educational mes-
and life satisfaction.[17, 21, 34] For example, passive con- sages regarding depression. Such messages could pro-
sumption of social media content—as opposed to ac- mote awareness regarding maladaptive use and its asso-
tive communication—has been associated with decrease ciation with mood disorders.
in bonding and bridging social capital and increase in The teams behind some social media sites have already
loneliness.[42] One explanation may be that exposure to begun to reach out to users who show signs of serious
highly idealized representations of peers on social media depression. When one searches blog site Tumblr for tags

Depression and Anxiety

 Research Article: Social Media and Depression 329

indicative of a mental health crisis such as “depressed,” on self-report. However, it was a limitation of our work
“suicidal,” or “hopeless,” the search function redirects that we were unable to use “gold standard” measures of
to a message which begins with “Everything okay?” and social media exposure such as ecological momentary as-
provides links to pertinent resources.[51] Similarly, in sessment or empirical data from social media sites due to
early 2015, Facebook tested a feature by which users’ the large sample size. Additionally, our frequency mea-
friends could easily and anonymously report worrisome sure, although it was adapted from a validated scale,[14]
posts.[52] Authors of problematic content received pop- may not have been sufficient for modern users. In partic-
up messages on their next visit to the site voicing concern ular, the highest exposure level we assessed for each plat-
and encouraging them to speak with a friend or helpline form was “5 or more times per day,” while other scales
worker. Although this button has since been removed, include options such as use “several times an hour” and
Facebook still accepts reports of suicidal content via an “all the time.”[55] It may be valuable for future studies
online form. Continued research into the factors that to use more fine-grained measures such as these. It is
relate SM and depression will allow sites to refine their also a limitation that we were unable to conduct a com-
procedures and reach out to those with greatest need. plete diagnostic interview to determine if participants
It is important to note that there are many different met clinical diagnosis of depression. Further longitudi-
types of interactions that can occur over social media, nal studies involving ecological momentary assessment
and our study assessed only overall time spent and fre- or empirical data from multiple social media platforms
quency of visits to social media sites. Moreover, because may help identify the directionality of the association
previous work in this area has tended to focus on one between social media and depression and guide antic-
specific platform, most commonly Facebook, we aimed ipatory guidance around social media use for patients
to look at the relationship between total social media use with depression in particular.
and depression,[16, 21] as opposed to focusing on specific
platforms. Our fine-grained assessment of multiple plat-
forms likely improved our measurement of overall fre- CONCLUSION
quency of social media use. However, given the unique
features of each platform, it may be valuable for future In conclusion, this study assessed depression and so-
work to assess associations between specific social media cial media use across multiple social media platforms in a
sites and depression. large, nationally representative sample of young adults.
Furthermore, it will be an important task of future Given the increasing prevalence of social media and the
qualitative and quantitative research to comprehensively substantial morbidity and mortality associated with de-
assess content and contextual elements related to social pression worldwide, the positive association we found
media use. For example, time on social media may be between social media use and depression has important
primarily spent viewing profiles, or it may be spent as implications for future research and intervention. For ex-
an active participant, and these distinct patterns of use ample, longitudinal evaluation and finer-grained assess-
may have differential associations with mood conditions. ment of content and contextual factors will ultimately
Thus, it may be that those who are more active users improve our understanding of these associations and our
feel more engaged and derive more sense of social capi- ability to intervene. Additionally, social media platforms
tal from social media interactions.[19, 53] However, it may may be a useful tool to identify individuals at risk for
also be that active users are more prone to having nega- depression and to provide intervention.
tive exposures, which can affect self-cognitions. There-
fore, active versus passive character of social media in- Acknowledgments. Liu yi Lin is supported by a
teraction and its effect on mood may be valuable to assess
grant from the National Institute of Mental Health
in the future.
Additionally, it will be important to assess the over- (R25-MH054318). Dr. Primack is supported by a grant
all emotional valence of social media interactions. Some from the National Cancer Institute (R01-CA140150).
individuals may primarily spend time “liking” others’ The funding agencies had no role in the design and con-
posts, wishing friends happy birthday, and making posi- duct of the study; collection, management, analysis and
tive comments. Others, however, may be prone to post- interpretation of the data; and preparation, review, or
ing negative status updates or engaging in contentious approval of the manuscript.
interactions, which may be detrimental to relationship Conflicts of interests. We have no conflicts of in-
building and lead to depression.[54] terest to report.
Compliance with ethical standards. All proce-
dures performed in studies involving human participants
LIMITATIONS were in accordance with the ethical standards of the in-
Given the rapid proliferation of social media plat- stitutional and/or national research committee and with
forms, we attempted to capture broad and representa- the 1964 Helsinki declaration and its later amendments
tive use of social media by young adults by including or comparable ethical standards. Informed consent was
multiple social media platforms and creating three com- obtained from all individual participants included in the
plementary methods of assessing social media use based study.
Depression and Anxiety
330 Lin et al.

REFERENCES 21. Chou HTG, Edge N. “They are happier and having better lives
than I am”: The impact of using Facebook on perceptions of oth-
1. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, ers’ lives. Cyberpsychol Behav Soc Netw 2012;15(2):117–121.
and comorbidity of 12-month DSM-IV disorders in the Na- 22. GfK KnowledgePanel R
. KnowledgePanel Design Summary.
tional Comorbidity Survey Replication. Arch Gen Psychiatry 2013. Available at: http://www.webcitation.org/6ajEWO5mb.
2005;62(6):617–627. 23. Baker R, Blumberg SJ, Brick JM, et al. Research synthesis. Public
2. Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. The epidemi- Opin Q 2010;74(4):711–781.
ology of major depressive episodes: results from the International 24. Wagner TH, Baker LC, Bundorf MK, Singer S. Use of the In-
Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J ternet for health information by the chronically ill. Prev Chronic
Methods Psychiatr Res 2003;12(1):3–21. Dis 2004;1(4):A13.
3. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years 25. Cleveland MJ, Reavy R, Mallett KA, et al. Moderating effects
(DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a of positive parenting and maternal alcohol use on emerging
systematic analysis for the Global Burden of Disease Study 2010. adults’ alcohol use: does living at home matter? Addict Behav
Lancet 2012;380(9859):2197–2223. 2014;39(5):869–878.
4. Mathers CD, Loncar D. Projections of global mortality and bur- 26. Shiffman S, Ferguson SG, Rohay J, Gitchell JG. Perceived safety
den of disease from 2002 to 2030. PLoS Med 2006;3(11):e442. and efficacy of nicotine replacement therapies among US smokers
5. Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic and ex-smokers: relationship with use and compliance. Addiction
burden of depression in the United States: how did it change be- 2008;103(8):1371–1378.
tween 1990 and 2000? J Clin Psychiatry 2003;64(12):1465–1475. 27. Cella D, Riley W, Stone A, et al. The Patient-Reported Out-
6. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin comes Measurement Information System (PROMIS) developed
Psychol Rev 2007;27(8):959–985. and tested its first wave of adult self-reported health outcome item
7. Burke KC, Burke JD, Rae DS, Regier DA. Comparing age at banks: 2005–2008. J Clin Epidemiol 2010;63(11):1179–1194.
onset of major depression and other psychiatric disorders by birth 28. Cella D, Gershon R, Lai J-S, Choi S. The future of outcomes mea-
cohorts in five US community populations. Arch Gen Psychiatry surement: item banking, tailored short-forms, and computerized
1991;48(9):789–795. adaptive assessment. Qual Life Res 2007;16(Suppl 1):133–141.
8. Hankin BL, Abramson LY, Moffitt TE, et al. Development of 29. Choi SW, Schalet B, Cook KF, Cella D. Establishing a common
depression from preadolescence to young adulthood: emerging metric for depressive symptoms: linking the BDI-II, CES-D, and
gender differences in a 10-year longitudinal study. J Abnorm Psy- PHQ-9 to PROMIS depression. Psychol Assess 2014;26(2):513–
chol 1998;107(1):128–140. 527.
9. Hasler G. Pathophysiology of depression: do we have any solid ev- 30. Pilkonis PA, Yu L, Dodds NE, et al. Validation of the de-
idence of interest to clinicians? World Psychiatry 2010;9(3):155– pression item bank from the Patient-Reported Outcomes Mea-
161. surement Information System (PROMIS) in a three-month
10. Kaplan AM, Haenlein M. Users of the world, unite! The chal- observational study. J Psychiatr Res 2014;56:112–119.
lenges and opportunities of social media. Bus Horiz 2010;53:59– 31. Pilkonis PA, Choi SW, Reise SP, et al. Item banks for measur-
68. ing emotional distress from the Patient-Reported Outcomes Mea-
11. Subrahmanyam K, Reich SM, Waechter N, Espinoza G. On- surement Information System (PROMIS R
): depression, anxiety,
line and offline social networks: use of social networking sites by and anger. Assessment 2011;18(3):263–283.
emerging adults. J Appl Dev Psychol 2008;29(6):420–433. 32. American Psychiatric Association. LEVEL 2 - Depression - Adult.
12. Fox S, Rainie L. The Web at 25 in the US. Pew Re- 2013. Available at: http://www.webcitation.org/6eVeBFb6E.
search Center. The Web at 25 in the US. 2014. Available at: 33. Moreno MA. Depression and Internet use among older adoles-
https://www.webcitation.org/6eVfaSdN6. cents: an experience sampling approach. Psychology 2012;3:743–
13. Roisman GI, Masten AS, Coatsworth JD, Tellegen A. Salient 748.
and emerging developmental tasks in the transition to adulthood. 34. Sagioglou C, Greitemeyer T. Facebook’s emotional conse-
Child Dev 2004;75:123–133. quences: Why Facebook causes a decrease in mood and why people
14. Pew Research Center. Social Media Update 2014. 2015. Available still use it. Comput Human Behav 2014;35:359–363.
at: http://www.webcitation.org/6ajEhvS11. 35. Christakis DA, Moreno MM, Jelenchick L, et al. Problematic
15. Nielsen. State of the Media: The Social Media Report 2012. 2012. internet usage in US college students: a pilot study. BMC Med
Available at: http://www.webcitation.org/6bXTvRwTJ.2012. 2011;9(1):77.
16. Jelenchick LA, Eickhoff JC, Moreno MA. “Facebook depression?” 36. Choi SW, Schalet B, Cook KF, Cella D. Establishing a common
Social networking site use and depression in older adolescents. metric for depressive symptoms: linking the BDI-II, CES-D, and
J Adolesc Heal 2013;52(1):128–130. PHQ-9 to PROMIS depression. Psychol Assess 2014;26(2):513–
17. Kross E, Verduyn P, Demiralp E, et al. Facebook use predicts 527.
declines in subjective well-being in young adults. PLoS One 37. Caplan SE. Problematic Internet use and psychosocial well-being:
2013;8(8):e69841. Development of a theory-based cognitive-behavioral measure-
18. Bessière K, Pressman S, Kiesler S, Kraut R. Effects of internet use ment instrument. Comput Human Behav 2002;18(5):553–575.
on health and depression: a longitudinal study. J Med Internet Res 38. Sanders CE, Field TM, Diego M, Kaplan M. The relationship of
2010;12(1):e6. Internet use to depression and social isolation among adolescents.
19. Ellison NB, Steinfield C, Lampe C. The benefits of Facebook Adolescence 2000;35(138):237–242.
“friends:” social capital and college students’ use of online social 39. Davis RA. Cognitive-behavioral model of pathological Internet
network sites. J Comput Commun 2007;12(4):1143–1168. use. Comput Human Behav 2001;17(2):187–195.
20. Valenzuela S, Park N, Kee KF. Is there social capital in a so- 40. Morahan-Martin J, Schumacher P. Loneliness and social uses of
cial network site?: facebook use and college students’ life satisfac- the Internet. Comput Human Behav 2003;19(6):659–671.
tion, trust, and participation. J Comput Commun 2009;14(4):875– 41. Young KS, Rogers RC. The relationship between depression and
901. Internet addiction. Cyber Psychol Behav 1998;1(1):25–28.

Depression and Anxiety

 Research Article: Social Media and Depression 331

42. Burke M, Marlow C, Lento T. Social network activity and social 49. Pew Research Center. Cyberbullying. 2007. Available at: http://
wellbeing. In: CHI 10: Proceedings of the SIGCHI Conference on www.webcitation.org/6eVgbqVbe.
Human Factors in Computing Systems. 2010 April 10-15; Atlanta, 50. Moreno MA, Jelenchick LA, Egan KG, et al. Feeling bad on Face-
GA. pp. 1909–1912. book: depression disclosures by college students on a social net-
43. Krasnova H, Wenninger H, Widjaja T, Buxmann P. Envy on working site. Depress Anxiety. 2011;28(6):447–455.
Facebook: a hidden threat to users’ life satisfaction? Presented 51. Tumblr. “Everything Okay?” 2014. Available at: http://www
at the 11th International Conference on Wirtschaftsinformatik. .webcitation.org/6aKw1PTdP.
2013 February. Leipzig, Germany. 52. Facebook. Updates in Facebook Safety. 2015. Available at:
44. Tandoc EC, Ferrucci P, Duffy M. Facebook use, envy, and depres- http://www.webcitation.org/6aKw1PTdP.
sion among college students: is facebooking depressing? Comput 53. Burke M, Kraut R, Marlow C. Social capital on facebook. In:
Human Behav. 2015;43:139–146. CHI11: Proceedings of the SIGCHI Conference on Human Fac-
45. Smith RH, Kim SH. Comprehending envy. Psychol Bull tors in Computing Systems. 2011 May 7–12. Vancouver, BC. pp.
2007;133:46–64. 571–580.
46. Block JJ. Issues for DSM-V: internet addiction. Am J Psychiatry 54. Forest AL, Wood JV. When social networking is not work-
2008;165(3):306–307. ing: individuals with low self-esteem recognize but do not
47. Morrison CM, Gore H. The relationship between excessive In- reap the benefits of self-disclosure on Facebook. Psychol
ternet use and depression: a questionnaire-based study of 1,319 Sci 2012;23(3):295–302. Available at: http://www.ncbi.nlm.nih.
young people and adults. Psychopathology 2010;43(2):121–126. gov/pubmed/22318997.
48. O’Keeffe GS, Clarke-Pearson K. The impact of social media on 55. Rosen LD, Whaling K, Carrier LM, et al. The media and technol-
children, adolescents, and families. Pediatrics 2011;127(4):800– ogy usage and attitudes scale: an empirical investigation. Comput
804. Human Behav 2013;29:2501–2511.

Depression and Anxiety