Computer-mediated communication, social media, and mental health: A conceptual and

empirical meta-review

Adrian Meier & Leonard Reinecke

Department of Communication

Johannes Gutenberg University Mainz, Germany

This is a post-print version of the manuscript as published in Communication Research.

Please find the published version here: https://doi.org/10.1177/0093650220958224

Acknowledgments

We are grateful for the financial support of this research by the Forschungsschwerpunkt

Medienkonvergenz (Research Center for Media Convergence) at Johannes Gutenberg

University Mainz, Germany. We extend our thanks to Catalina Toma and four anonymous

reviewers, who have given invaluable feedback to earlier versions of this manuscript. Our

deep gratitude also goes to Alicia Gilbert, Robin Riemann, Mareike Weiß, Lea Wilke, and

Alicia Ernst for their assistance in various stages of this project.

Author Disclosure Statement

No competing financial interests exist.

CMC AND MENTAL HEALTH: A META-REVIEW 1

Abstract

Computer-mediated communication (CMC), and specifically social media, may affect the

mental health (MH) and well-being of its users, for better or worse. Research on this topic has

accumulated rapidly, accompanied by controversial public debate and numerous systematic

reviews and meta-analyses. Yet, a higher-level integration of the multiple disparate

conceptual and operational approaches to CMC and MH and individual review findings is

desperately needed. To this end, we first develop two organizing frameworks that systematize

conceptual and operational approaches to CMC and MH. Based on these frameworks, we

integrate the literature through a meta-review of 34 reviews and a content analysis of 594

publications. Meta-analytic evidence, overall, suggests a small negative association between

social media use and MH. However, effects are complex and depend on the CMC and MH

indicators investigated. Based on our conceptual review and the evidence synthesis, we devise

an agenda for future research in this interdisciplinary field.

Keywords: computer-mediated communication, social media, mental health, well-being,

psychopathology, meta-analysis
CMC AND MENTAL HEALTH: A META-REVIEW 2

Computer-mediated communication, social media, and mental health: A conceptual and

empirical meta-review

Computer-mediated communication (CMC), the Internet, and now social and mobile

media have repeatedly been characterized as a blessing or a curse for users’ mental health

(MH). Widely different claims about the impact of CMC on MH have been reiterated for

decades and across disciplines (e.g., Burke & Kraut, 2016; Chan, 2015; Meier et al., 2020;

Orben & Przybylski, 2019; Twenge et al., 2018). Research on this relationship has

accumulated particularly rapidly in recent years, with a strong focus on social media (Meier et

al., 2020). Yet, the fast-paced, interdisciplinary, and fragmented nature of the field requires

researchers to keep track of a staggering, ever-growing, and seemingly incompatible evidence

base (for initial meta-reviews, see Appel et al., 2020; Orben, 2020).

A key driver as well as consequence of this state of the field is the conceptual diversity

of researchers’ approaches to CMC and MH. Many studies and reviews seem to work from

narrow, unsystematic approaches to CMC and MH, investigating widely different technology

indicators (e.g., “screen time”, self-presentation on SNS, intensity of Facebook use) and a

disconnected smorgasbord of MH indicators (e.g., self-esteem, loneliness, depression, life

satisfaction) (e.g., Huang, 2017; Twomey & O'Reilly, 2017). Recent specification curve

analyses demonstrate that the relationship between CMC and MH can differ drastically,

depending on how researchers operationalize them (e.g., Orben & Przybylski, 2019). Hence,

without a higher-level conceptual and empirical integration, the bigger picture of associations

between CMC and MH cannot be systematically evaluated. In addition, the choice of

indicators and identification of research gaps remain largely idiosyncratic.

This study addresses the need for such higher-level integration twofold. We first

develop two organizing frameworks that specify how CMC and MH are conceptualized and

operationalized in the literature. These frameworks allow researchers to navigate the field

more reliably and facilitate systematic identification of patterns, gaps, and conceptual
CMC AND MENTAL HEALTH: A META-REVIEW 3

conflation. Moreover, they provide the background of our empirical analysis, a meta-review

of systematic reviews and meta-analyses on CMC and MH. This empirical meta-review aims

to (a) synthesize the main findings on the relationships between CMC and MH indicators

from existing reviews. In addition, (b) we seek to apply the two organizing frameworks to the

primary studies included in these reviews, to systematically identify the conceptual foci of

prior research, potential conceptual conflation, and research gaps.

To this end, we first develop the theoretical frameworks of CMC and MH based on

conceptual reviews and relevant empirical literature. Using these frameworks as organizing

principles for the empirical meta-review, we then synthesize the findings from 34

systematically identified meta-analyses and systematic reviews as well as 594 publications

included in these syntheses. By reflecting on the empirical meta-review findings through the

lens of the new organizing frameworks, we conclude with an agenda for future research.

The Hierarchical CMC Taxonomy

We understand computer-mediated communication (CMC) as an inclusive umbrella

term for multimodal human-to-human social interaction mediated by information and

communication technologies (ICTs). Social interaction here includes all forms of

interpersonal message exchange, encompassing everything from mere social attention (e.g.,

browsing through the Instagram feed) to deep communication (e.g., a conversation via

WhatsApp voice call; Hall, 2018). This meta-review also limits ICTs to those whose primary

and original—though not exclusive—function is the facilitation of CMC as social interaction

(e.g., email, mobile texting, instant messenger, social network sites, but not, e.g., games).

These ICTs have been at the center of recent public concern and research regarding MH

effects (e.g., Twenge et al., 2018), thus representing a reasonable focus for this meta-review.

A first step of our synthesis is a systematization of the conceptual and operational

approaches to CMC. A key question guided this conceptual review: How can we organize as

many CMC indicators with as few levels of analysis as possible? Since no such framework
CMC AND MENTAL HEALTH: A META-REVIEW 4

existed, we used concept mapping (Booth et al., 2012) on all CMC indicators included in

literature reviews on CMC and MH (see Method for the sample of included reviews). That is,

we iteratively mapped out existing CMC measures in a conceptual space to reveal their key

conceptual and operational similarities, hierarchies, and differences. This was done until

theoretical saturation was reached, meaning that no further levels were needed to encompass

all available indicators. Additionally, we grounded the identified levels and approaches in

literature that theorizes CMC (see next section). This approach was advantageous over

adopting, for instance, an affordances approach (Evans et al., 2017), since none of the

reviewed empirical studies on CMC and MH used measures that explicitly operationalized

distinct affordances as commonly defined in the literature.

Instead, by breaking down CMC measures into their basic levels of analysis, we build

a parsimonious taxonomy that applies not just to one single or a few ICTs (e.g., Facebook,

smartphones), but remains useful even in the face of technological change (Ellison & boyd,

2013). This taxonomy should further be exhaustive enough to encompass a wide range of

CMC variables and hence facilitate navigation through the entire research landscape. With

both analytical parsimony and conceptual inclusivity as our guiding principles, we propose

The Hierarchical CMC Taxonomy (see Fig. 1).

[Figure 1 about here]

Channel-Centered vs. Communication-Centered Conceptual Approaches to CMC

To explicate the taxonomy, we first distinguish two overarching conceptual

approaches to CMC: the channel-centered and the communication-centered approach (e.g.,

Carr & Hayes, 2015; Ledbetter, 2014). The channel-centered approach aligns with classic

(mass) media uses and effects research that studies the channel as a whole but treats the

communication within the channel largely as a black box. Typical examples for the channel-

centered approach are investigations of “screen time” spent on a device (e.g., the smartphone)

in relation to MH (e.g., Twenge et al., 2018). The communication-centered approach, on the

CMC AND MENTAL HEALTH: A META-REVIEW 5

contrary, opens up the channel black box and investigates communication as a complex social

process of interaction via messages that enfolds within (Walther, 2010).

We propose that channels—and, hence, the channel-centered approach—can be

further differentiated into four main levels of analysis: (1) device, (2) type of application, (3)

branded application, and (4) feature. Likewise, the communication-centered approach can be

differentiated into (5) an interaction and (6) a message level. These levels of analysis are

crucial to reflect upon for at least two reasons. First, each level focusses on unique aspects of

CMC. For instance, studies at the device level imply that the presence, absence, or usage of

the device (e.g., the smartphone) itself has implications for MH, irrespective of the specific

applications or features used, or the exact nature of the communication via the device (e.g.,

Gonzales & Wu, 2016). In contrast, studies at the message level may, for instance, assume

that certain message content is the crucial driver of CMC effects on MH (e.g., Holland &

Tiggemann, 2016). Studies differing in the levels at which they operationalize CMC are likely

to differ drastically in how they can explain effects of CMC on MH. They will thus differ in

their implications for users, ICT developers, and MH practitioners.

Second, depending on the level of CMC analysis, studies may differ in the effects they

find. For instance, studies at the interaction level may find that CMC and face-to-face

communication reinforce one another and, thus, CMC can be beneficial for MH. However,

this does not preclude that studies at the device level come to the conclusion that CMC is

negatively related to MH, for instance, because the device can distract from other activities.

Researchers wishing to draw conclusions about the bigger picture of relationships between

CMC and MH need to consider the multiple levels of analysis at which CMC can be studied.

In the following, we therefore briefly illustrate how each level is conceptualized.

Six Levels of CMC Analysis

(1) Devices represent the physically palpable ICTs (e.g., laptops, smartphones, or

tablets) that enable CMC. Research at the device level, for instance, investigates how the
CMC AND MENTAL HEALTH: A META-REVIEW 6

number of devices used to connect to strong and weak ties (i.e., media multiplexity; Chan,

2015), smartphone use during face-to-face interactions (“phubbing”; Gonzales & Wu, 2016),

or overall “screen time” (Twenge et al., 2018) relates to MH.

(2) Devices enable CMC because they allow access to types of applications built

around mediated social interaction and user-generated content. As unique applications often

share a specific set of core characteristics and features, they are studied under a common label

(Ellison & boyd, 2013). For instance, classic types of CMC applications include email, chat

rooms, or discussion boards, later joined by texting and instant messengers. More recently,

applications allowing users to engage in interactions with both broad and narrow audiences

have been defined under the labels of social media, with social network sites (SNS) often

considered a sub-type (see Bayer et al., 2020, for a detailed discussion). Studying such types

of applications is typically more precise than the device level, as it avoids conflating CMC

and non-CMC device uses in a simplistic overall measure of “screen time”.

(3) The branded application level refers to variables that focus only on one or several

branded application(s), such as Facebook or Instagram. While these branded applications can

be subsumed under the broader types outlined above (e.g., SNS), they are frequently studied

individually as key exemplars (e.g., Meier & Schäfer, 2018). It is important to distinguish this

level of analysis from the previous one, as unique applications may have properties and user

cultures that diverge from related applications or their broader types. For instance, while both

Facebook and Twitter are considered SNS, Facebook currently affords more diverse uses

(e.g., closed groups formed around specific interests). Finally, whether research investigates

types of applications, or just single brands, affects the generalizability of findings.

(4) CMC channels, at their most detailed level of analysis, are constituted by

individual features, the building blocks of applications. We understand a feature as “a

technical tool […] that enables activity on the part of the user” (Smock et al., 2011, p. 2323).

Facebook users, for instance, may use the site for status updates, comments, private messages,
CMC AND MENTAL HEALTH: A META-REVIEW 7

groups, the news feed, or any combination of these features, resulting in a unique user

experience, with unique relations to MH (e.g., Burke & Kraut, 2016). Crucially, research

investigating the feature level specifies in more detail the kind of interactions a specific

channel enables. It thus allows researchers to test channel effects even while channels change

in design (i.e., lose or gain certain features).

(5) Moving from the channel-centered to the communication-centered approach, we

specify the interaction level. In contrast to previous levels, this level goes beyond the mere

technological properties of channels and instead clarifies the process of how and with whom

users communicate within a channel. Early on, CMC research conceptualized the

configuration of interaction partners (e.g., one-to-one, one-to-many, many-to-one), clarifying

the source and audience size of a communication episode, and distinguished between

synchronous and asynchronous communication (e.g., Morris & Ogan, 1996). Beyond their

configuration, the characteristics of communication partners (e.g., their tie strength) can be

specified and studied in relation to MH (Burke & Kraut, 2016). If either the sender or receiver

of a mediated communication is a group of individuals (“many”), the characteristics of the

network structure of this group (e.g., network size, diversity) can also be considered at this

level. Interactions may further differ in their interaction functions, such as self-disclosure or

self-presentation (Walther, 2010). Another key concept clarifying the how of communication

is the directionality of interaction. Rafaeli’s (1988) definition of interactivity specifies

interaction as a continuum of contingent responsiveness between communication partners,

reaching from two-way truly interactive (e.g., a continuous message exchange), over two-way

reactive (e.g., an Instagram like), to one-way non-interactive communication (e.g., browsing

through the Instagram feed). Similarly, in research on CMC (specifically, SNS) and MH,

usage is often grouped into “active” and “passive”. While active usage, in its broadest sense,

refers to “activities that facilitate direct exchanges with other(s)” (Verduyn et al., 2017,

p. 281), passive usage refers to the mere consumption of messages from status updates,
CMC AND MENTAL HEALTH: A META-REVIEW 8

comments, profiles, or stories without any direct response to the sender, akin to classic mass

media usage (e.g., watching TV). Thus, passive usage is entirely non-interactive and instead

can be thought of as one-way communication from the recipient’s perspective, solely entailing

non-directed messages (i.e., messages not sent in reaction to a previous message) (Burke &

Kraut, 2016). Active usage, in contrast, may entail both non-interactive one-way

communication from the sender’s perspective (e.g., posting a status update without getting

any response), as well as two-way reactive, and fully interactive communication (Rafaeli,

1988). In conclusion, the interaction level focusses on social interaction as the process of

message exchange, including instances in which this “exchange” is one-sided (i.e., sending or

receiving without any response).

(6) While interactions have specific properties, each individual message within an

interaction can be considered as the final level of analysis (Ledbetter, 2014). A first

distinction is made between different modes of messages (e.g., text, image, voice, video, or

one-click reactions such as likes or emojis; Burke & Kraut, 2016; Walther, 2010). While

originally a property of separate (types of) applications (e.g., email vs. video-conferencing),

many modes of communication can now be readily switched within a single application or

even a message exchange (e.g., receiving a text message in WhatsApp and replying with a

short voice recording). The mode of a communication is thus best placed at the message level.

Along with the mode varies bandwidth (i.e., the available cues) and social presence (Walther,

2010). Similarly, the persistence versus ephemerality of a message used to be a fixed channel

characteristic but can now often be modified from message to message (e.g., on Snapchat).

The same applies to the accessibility of a message, varying on a continuum from private to

public (O’Sullivan & Carr, 2018). The content of a message is another key variable at this

level, with multiple possible specifications (e.g., concerning topic or valence).

Note that the taxonomy organizes the six CMC levels in a hierarchy, emphasizing that

each lower level (e.g., a single message) can be nested in a higher level (e.g., an interaction).
CMC AND MENTAL HEALTH: A META-REVIEW 9

Thus, necessarily, properties of lower levels (e.g., whether an interaction is active or passive)

can be incorporated at higher levels (e.g., active vs. passive use of Instagram). The six levels

of analysis are conceptualized as rigorously distinguishable ideal types. However, empirical

research may often (inadvertently) conflate hierarchical analytical levels, that is, combine

properties of several levels in a single CMC indicator. For instance, “passive usage of the

Facebook news feed” entails information on a unique branded application, a feature, and the

directionality of an interaction process. Finding that such an indicator affects MH raises the

question whether this is caused by Facebook (but not other applications), the news feed (but

not other features), or passive usage (but not other forms of engaging with the Facebook news

feed). We hope that by reflecting on the conceptualization of CMC more systematically

through the taxonomy, researchers will be better able to identify at which level(s) of analysis

their explanatory focus is located, hence avoiding conflation and increasing construct validity.

Technology-Centered vs. User-Centered Operational Approaches

Beyond the two conceptual approaches (channel- vs. communication-centered) and the

six levels of analysis, we supplement our taxonomy with two operational approaches to

separate measurement from level of analysis. Prior research on CMC and MH has used a

staggering number of measures, ranging from time spent with a device, over types of self-

presentation on Facebook, to the content of messages encountered on SNS (e.g., Holland &

Tiggemann, 2016; Twenge et al., 2018; Twomey & O'Reilly, 2017). We contend that the

operationalizations of CMC differ crucially in whether they are technology-centered or user-

centered. Technology-centered operationalizations are descriptive measures that capture some

aspect of technology usage, such as its volume (time spent, frequency) or message content,

which can principally be observed (e.g., digitally tracked), though they are often measured via

self-report. User-centered operationalizations, in contrast, have a psychological-perceptual

component that qualifies how a person processes using a CMC technology or why he or she

uses it, which is often most validly captured by self-reports (e.g., attitudes about technology,
CMC AND MENTAL HEALTH: A META-REVIEW 10

motivations for usage, perceptions of message content). This distinction is critical, because

the two approaches imply drastically different explanatory foci when relating a CMC variable

to MH. Essentially, the technology-centered approach argues that the mere exposure to some

aspect of a technology itself is related to MH, whereas the user-centered approach explains

any relation between CMC and MH through the user’s psychology in interaction with the

technology. We note that, in principle, both operational approaches can be applied to all six

levels of analysis.

The Extended Two-Continua Model of Mental Health

Mental health (MH), according to the World Health Organization, is more than the

absence of mental disorders, but “a state of well-being in which every individual realizes his

or her own potential, can cope with the normal stresses of life, can work productively and

fruitfully, and is able to make a contribution to her or his community” (World Health

Organization, 2005, p. 2). Although this comprehensive understanding of MH is now widely

recognized and implemented in policy and practice (e.g., Saxena et al., 2013), research on

MH is still mostly divided into two distinct perspectives, psychopathology and psychological

well-being. Psychopathology (PTH) refers to “any pattern of behavior—broadly defined to

include actions, emotions, motivations, and cognitive and regulatory processes—that causes

personal distress or impairs significant life functions, such as social relationships, education,

work, and health maintenance” (Lahey et al., 2017, p. 143). While well-being, in contrast,

means “how well individuals are doing in life, including social, health, material, and

subjective dimensions of well-being” (Diener et al., 2018, p. 3), psychological well-being

(PWB), specifically, is understood as “optimal psychological functioning and experience”

(Ryan & Deci, 2001, p. 142).

The present study builds on a two-continua model of mental health that integrates

these two perspectives into a single coherent framework (Greenspoon & Saklofske, 2001;

Keyes, 2007). Several arguments call for such a twofold perspective on MH. First, PTH and
CMC AND MENTAL HEALTH: A META-REVIEW 11

PWB represent different psychological states. PTH indicates severe disturbance of a person’s

psychological functioning (i.e., dysfunction). PTH narrows an individual’s attention towards

the source(s) of disturbance and inhibits normal functioning until the disturbance has been

mitigated or eliminated (Lahey et al., 2017). PWB, in turn, indicates how well a person is

doing and how much (s)he thrives psychologically. Higher PWB is associated with a variety

of positive outcomes such as longevity and prosocial behavior (Diener et al., 2018). Thus,

PWB is not the absence of PTH, just as PTH is not the absence of PWB. Second, PTH and

PWB are sensitive to different individual and environmental influences (e.g., genes, age, life

events) and their indicators fluctuate in unique patterns and timeframes (Diener et al., 2018;

Lahey et al., 2017). Third, PTH and PWB are sometimes empirically dissociated. That is,

individuals can show high levels on some aspects of PWB while also reporting moderate to

high levels on indicators of PTH, or vice versa (e.g., Greenspoon & Saklofske, 2001; Hides et

al., 2020). In conclusion, researchers should understand and assess MH as two continua, PTH

and PWB, and reflect upon which of these continua is relevant for their research.

Since researchers in the field of CMC and MH employ a variety of so far disconnected

MH indicators (e.g., loneliness, self-esteem, life satisfaction, depression, or anxiety; see, e.g.,

Huang, 2017; Liu et al., 2019), we refine and explicate the classic two-continua model by

integrating main dimensions and manifestations of both PTH and PWB, as well as risk and

resilience factors, in an Extended Two-Continua Model of Mental Health (see Fig. A1 in

Online Appendix I). In doing so, we enable researchers to locate and reflect upon MH

indicators within the broader context of MH research, both clinical and non-clinical. This

should not only facilitate integration of future research on CMC and MH but also lays the

foundation for our empirical meta-review. In the following, we will outline how PTH and

PWB are further differentiated into main dimensions and manifestations.

Dimensions and Manifestations of Psychopathology

CMC AND MENTAL HEALTH: A META-REVIEW 12

PTH research and practice traditionally distinguishes categorically separable disorders

from symptoms (e.g., Lahey et al., 2017). Clusters of symptoms represent the (more or less)

manifest basis for the categorical diagnosis of disorders, which are described in diagnostic

manuals such as the DSM-5 (American Psychiatric Association, 2013). A disorder comprises

a set of symptoms relevant for a specific diagnosis (e.g., depressive symptoms for major

depressive disorder). While clinical disorders are categorically diagnosed as either present or

absent (American Psychiatric Association, 2013), symptoms are often measured via self- or

other-report on a continuum (e.g., depressive symptomatology). This reflects that PTH is

“continuously distributed in the population” (Conway et al., 2019, p. 428) and individuals

healthy from a clinical point of view can show sub-clinical levels of PTH symptomatology.

Recently, MH research increasingly (re-)discovers that categorical distinctions

between PTH disorders are largely artificial, as symptoms across disorders show high

systematic covariation (i.e., comorbidity; Lahey et al., 2017). Specifically, researchers now

believe PTH manifestations (symptoms and, hence, disorders) to be expressions of several

underlying latent dimensions (see Conway et al., 2019, for a detailed mapping of disorders

onto PTH dimensions). In the context of CMC research, we focus on the internalizing and

externalizing dimensions of PTH, as these (a) are most widely recognized, especially in

Clinical Psychology research on children and adolescents (e.g., Lahey et al., 2017), and (b)

show the clearest connections to CMC (e.g., Sarmiento et al., 2018). While internalizing PTH

refers to overcontrolled behavior, cognitions, and emotions (e.g., anxiety, social phobia, and

depression), externalizing PTH refers to undercontrolled behavior, cognitions, and emotions

(e.g., hyperactivity, aggression, delinquency, and substance abuse; Conway et al., 2019;

Lahey et al., 2017). We thus extend the dual-factor model of MH by clustering PTH

manifestations in the two dimensions of internalizing and externalizing PTH. Crucially,

instead of investigating disconnected PTH indicators, this allows for the recognition of effect

patterns between CMC and higher-level dimensions and manifestations of PTH (see Conway
CMC AND MENTAL HEALTH: A META-REVIEW 13

et al., 2019, for additional arguments supporting a dimensional approach to PTH). However,

as the research integration of major PTH dimensions is still ongoing (Conway et al., 2019),

future revisions of the MH model may include additional PTH dimensions. Moreover,

categorical diagnoses are expedient for clinical practice and thus remain relevant.

Dimensions and Manifestations of Psychological Well-Being

Research on PWB distinguishes two key dimensions, hedonic well-being and

eudaimonic well-being (Huta & Waterman, 2014; Martela & Sheldon, 2019; Ryan & Deci,

2001). According to the hedonic view, happiness and well-being are defined purely by a

subjective experience of pleasure and contentment. A prominent operationalization of this

approach is Diener et al.’s subjective well-being (Diener et al., 2018; Huta & Waterman,

2014), consisting of the two interrelated components affective well-being (high positive and

low negative affect) and cognitive well-being (satisfaction with life overall and specific life

domains). In contrast, the eudaimonic view understands well-being as more than just pleasure

and satisfaction. Instead, it propagates the realization of a “true self” (i.e., the daímōn), a

concept often associated with striving for meaning and purpose, personal growth, authenticity,

and excellence (Huta & Waterman, 2014). At its core, hedonic well-being is about “feeling

well”, whereas eudaimonic well-being is about “doing well” (Martela & Sheldon, 2019).

While appearing somewhat “elitist” at first glance, eudaimonic well-being is present in the

everyday lives of the general population (for recent reviews, see Huta, 2017; Huta &

Waterman, 2014; Martela & Sheldon, 2019). Individuals may experience eudaimonic well-

being by pursuing their personal or professional goals, engaging in meaningful social

interactions, or living autonomously (Martela & Sheldon, 2019). Importantly, experiencing

hedonic well-being does not have to be associated with increased eudaimonic well-being and

vice versa (Huta, 2017). From this, it follows that investigations into the relationship between

CMC and PWB should consider both sides of well-being, hedonic and eudaimonic.
CMC AND MENTAL HEALTH: A META-REVIEW 14

The two dimensions of hedonic and eudaimonic well-being can be further

distinguished by their manifestations in daily life. Huta (2017; Huta & Waterman, 2014)

proposes that PWB concepts can be differentiated by their (1) category of analysis and (2)

level of measurement (trait vs. state). The category of analysis specifies what exactly the

well-being indicator measures: orientations (i.e., values, motives, and goals), behaviors (i.e.,

overt activities such as socializing or writing a diary), experiences (i.e., subjective cognitive

and affective states), and functioning (i.e., how well a person is doing, e.g., concerning

abilities, accomplishments, or healthy habits; see Huta, 2017, for a detailed description).

Finally, the level of measurement distinguishes between traits that are relatively stable

over time, though not immutable, and states that capture the construct of interest with regard

to a specific timeframe (e.g., in the moment, the last week, or the last month). As these

distinctions crucially specify what exactly researchers are studying when they employ PWB

measures, we incorporate Huta’s distinctions into the MH model (see Fig. A1 in Online

Appendix I). We refer readers interested in the multitude of potential PWB indicators and

their place in this model to Huta (2017), as a detailed mapping of all indicators goes beyond

the scope of this paper.

Risk and Resilience Factors

As a final extension of the original two-continua model of MH (Greenspoon &

Saklofske, 2001; Keyes, 2007), we complement it with risk and resilience factors. Adding

these factors appears necessary, as they comprise several variables that have been studied

extensively in relation to CMC and are often interpreted as directly indicative of MH (e.g.,

Huang, 2017; Liu et al., 2019). However, they do not distinctively map onto underlying

dimensions of PTH (internalizing, externalizing) or PWB (hedonic, eudaimonic) as defined in

the MH literature (see the sections above). Instead, risk factors are here defined as sub-clinical

aspects of psychosocial functioning that are (a) non-specific to PTH or PWB dimensions and

(b) may increase an individual’s vulnerability to develop PTH symptomatology or decrease

CMC AND MENTAL HEALTH: A META-REVIEW 15

PWB (and vice versa for resilience factors). Risk factors may include perceived loneliness,

actual social isolation, perceived stress, or poor sleep quality, among many others. Resilience

factors include, for instance, social capital, social support, self-esteem, or high sleep quality.

The Present Study

With these two newly developed organizing frameworks as theoretical background, we

turn our attention to the evidence on the relationship between CMC and MH. Currently,

researchers, practitioners, and members of the general public (e.g., parents, teachers, policy

makers, or entrepreneurs) are left with a disconnected and fast-growing review literature that

lacks higher-level conceptual and empirical integration. We thus aim to move this field

forward by conducting a meta-review—a review of reviews.

First, we aim to synthesize the main findings on the relationship between CMC and

MH, considering all available evidence that matches the definitions of CMC and MH. Based

on this evidence, we can arrive at (1) more reliable conclusions about the associations

between CMC and MH and (2) the current state of the field as well as (3) discover higher-

level patterns of results. These efforts are guided by the following research question:

RQ1: What are the main findings of research syntheses on the relationship between

CMC and MH?

Beyond reviewing the findings of research syntheses, we also aim to apply the two

newly developed organizing frameworks to the empirical studies conducted on CMC and MH

so far. Specifically, we seek to explore which levels of CMC analysis and which dimensions

of MH have been primarily investigated so far. In doing so, we will be able to systematically

identify patterns of prior research focus, discuss their implications, and uncover where

research attention may be particularly needed. This is guided by the following question:

RQ2: Which (a) indicators of CMC and (b) indicators of MH have been studied by

prior research and (c) which gaps can be identified based on this assessment?
CMC AND MENTAL HEALTH: A META-REVIEW 16

The literature proposes multiple theoretical links and boundary conditions for CMC

and MH effects. These include displacement or disruption of activities beneficial for well-

being, such as face-to-face communication or sleep (e.g., Sbarra et al., 2019); social

comparison (Verduyn et al., 2017); or relational maintenance (Burke & Kraut, 2016), among

many others. While these mechanisms currently lack higher-level integration, as well, this is

outside the scope of the present study. Instead, we prioritize conceptual approaches to the key

variables, CMC and MH, and their empirical association.

Method

Meta-Review as a Method of Research Synthesis

Meta-reviews, also called overviews or umbrella reviews, “compile information from

multiple systematic reviews to provide a comprehensive synthesis of evidence” (Ballard &

Montgomery, 2017, p. 92), focusing “on breadth rather than depth of coverage” (Thomson et

al., 2010, p. 198). Therefore, they typically investigate broader constructs (here: CMC and

MH) and include a range of operationalizations. They allow comparisons between research

foci, results, and conclusions from multiple reviews. Thus, meta-reviews help identify

inconsistencies and discord in the literature and point to future directions (Polanin et al.,

2017).

While the methodology of meta-reviews is still developing (Ballard & Montgomery,

2017), researchers can generally apply the steps undertaken in systematic reviews of primary

research to conduct a meta-review (Polanin et al., 2017). Accordingly, we (1) state pre-

defined eligibility criteria, (2) use a systematic, multi-step literature search, and (3)

systematically synthesize and present the characteristics and findings of included reviews

(Booth et al., 2012). As a deviation from common meta-review methodology, we also

synthesize information from the primary research included in all reviews to answer RQ2.

Eligibility Criteria
CMC AND MENTAL HEALTH: A META-REVIEW 17

To be eligible, a review had to meet seven inclusion criteria concerning scope (i.e.,

meet our definitions of (1) CMC and (2) MH, (3) their conceptual independence, and (4)

include investigations of non-clinical samples) and methodology (i.e., synthesis articles had to

be (5) systematic (Booth et al., 2012), (6) synthesize empirical evidence, and be (7) written in

English and published). A more detailed description as well as exclusions resulting from these

criteria can be found in Online Appendix II. Note that we purposefully excluded research on

problematic or addictive ICT usage, as this research, by default, defines and measures CMC

as a pathological behavior that impairs MH. Similarly, we excluded clinical samples since we

were interested in CMC and MH in the general population. In case a review included

evidence on excluded constructs (e.g., pathological usage) or populations (e.g., clinical

participants) next to evidence matching our inclusion criteria, we included it and synthesized

only eligible evidence (e.g., on non-pathological usage or non-clinical participants).

Systematic Literature Search and Selection

Following recommendations from research synthesis literature (e.g., Polanin et al.,

2017), we combined several methods to maximize recall of eligible reviews. As part of a

larger effort to review literature on CMC and MH, we conducted standardized academic

database searches, citation searches, and reference searches. This was complemented by a

Google Scholar title search, targeted specifically at finding systematic reviews and meta-

analyses. A detailed description of all steps undertaken in the literature search and selection,

including reliability analysis, can be found in Online Appendix III. The search was first

completed in December 2017 and then updated during peer review in September 2019. The

final sample consisted of 34 reviews, described in detail in Online Appendix IV.

A common issue in meta-reviews is overlap, meaning that more weight is given to

publications included in more than one review (Pieper et al., 2014). Our sample of reviews

included 1313 unique publications. Based on the formula provided by Pieper et al. (2014),
CMC AND MENTAL HEALTH: A META-REVIEW 18

overlap can be characterized as “slight”, with a corrected covered area (CCA) of 1.3%. Bias

due to overlap is thus very unlikely.

Methods of Synthesis

Synthesis was conducted in two stages. In stage one, we descriptively synthesized the

information (i.e., narrative conclusions, investigated constructs, effect sizes) from the 34

reviews to answer RQ1. In stage two, we synthesized the CMC and MH indicators

investigated in all relevant primary research publications included in the 34 reviews to answer

RQ2. For this stage, a coding protocol was developed. We first determined whether a

publication was eligible for our meta-review (see eligibility criteria 1-4 and 7) and then coded

all relevant CMC and MH indicators. A description of the coding protocol and results of inter-

coder reliability tests can be found in Online Appendix III.

Results

Main Findings of Reviews and Meta-Analyses

To answer RQ1, we first summarize the narrative conclusions about the relationship

between CMC and MH from all 34 reviews. Since the reviews included 14 meta-analyses and

these provide more informative and conclusive evidence synthesis than narrative reviews, we

then summarize the meta-analytic effects, effect heterogeneity, and moderator analyses.

Narrative Conclusions

First results on RQ1 (see Online Appendix IV for details) show that 14 out of 34

reviews concluded the relationship was mixed, finding evidence for positive, negative, and

non-significant associations between CMC and MH. Notably, these were mostly narrative

reviews rather than meta-analyses. While an additional 11 reviews concluded that negative

relationships prevailed, 6 found predominantly positive relationships between CMC and MH.

However, these six reviews exclusively synthesized evidence on social resources (capital or

support) and/or older adults. Notably, 24 of 34 reviews qualified the investigated effects as
CMC AND MENTAL HEALTH: A META-REVIEW 19

conditional, emphasizing that their strength or direction depended on moderators or

mediators. Finally, 7 reviews qualified the evidence as insufficient for a definitive conclusion.

Meta-Analytic Effects

We collected all meta-analytic effect sizes on relationships between CMC and MH

indicators that matched our conceptual definitions. Almost all meta-analyses focused on

indicators of global SNS use (i.e., time spent, frequency, and/or intensity). We refer to these

simply as SNS use below and summarize all effects of SNS use in Fig. 2. As meta-analyses

mostly assessed the type of or branded application levels, we organize this section along the

MH dimensions. Wherever available, we highlight findings on CMC indicators other than

SNS use, if they rely on k > 2 effect sizes. If multiple effects for the same relationship are

available, we only report the one relying on the largest number of k effect sizes within the

text. For details on all effect sizes, meta-analyses, and references, see Online Appendix V.

[Figure 2 about here]

Resilience factors. Consistent with narrative conclusions, all meta-analyses on social

resources (capital and support) showed small to moderate positive associations with SNS use.

While general Internet use, blogs, chat, and email were not significantly associated with

perceived social resources, SNS (r = .30, 95% CI [.14; .46]) and forum use (r = .14, 95% CI

[.09; .20]) were. Notably, user-centered attitudinal measures of “intensity” (e.g., the Facebook

intensity scale) consistently generated larger effect sizes than technology-centered ones (time

spent or frequency). Almost all SNS features and interaction properties of SNS use were

positively associated with increased social resources, albeit at varying strength (see Online

Appendix V for details and references). Only few meta-analyses specifically investigated self-

esteem, and none reported findings on other resilience factors. General time spent online was

unrelated to self-esteem, but SNS use was slightly negatively related to self-esteem in three

meta-analyses finding similar effect sizes (e.g., r = -.05, 95% CI [-.09; -.01]).
CMC AND MENTAL HEALTH: A META-REVIEW 20

Psychological well-being. The only meta-analyzed indicator tapping into hedonic

well-being was life satisfaction. No meta-analytic results on eudaimonic well-being were

found (see also RQ2 below). General time spent online showed a small negative association

with life satisfaction (r = -.05, 95% CI [-.12; -.01]). SNS use, however, showed no significant

association with life satisfaction in two meta-analyses. One meta-analysis reported an overall

effect size of SNS use (i.e., global use, number of friends, active and passive use) on “positive

indicators of MH”, comprising life satisfaction, well-being, self-esteem, and positive affect (r

= .05, 95% CI [.01; .08]). However, when separated by SNS indicators, only the number of

SNS friends showed a small positive association with “positive MH” (r = .13, 95% CI [.05;

.21]). Three other meta-analyses reported effects on “well-being” that included reverse coded

negative indicators (e.g., depressive symptoms or loneliness) alongside resilience factors (e.g.,

self-esteem) and life satisfaction. Time spent online was found to be slightly negatively

associated with such “overall well-being” (r = -.04, 95% CI [-.07; -.01]), though this

relationship was nonsignificant for social Internet use. SNS use, however, was slightly

negatively associated with overall well-being in two meta-analyses (e.g., r = -.06, 95% CI [-

.09; -.03]). Differentiating between SNS uses revealed that “self-presentational” use (status

updates, photos) was unrelated to overall well-being, “content consumption” (browsing,

searching, monitoring) was negatively (r = -.14, 95% CI [-.20; -.08]), and “interactions”

(replying, commenting, liking) were positively related (r = .14, 95% CI [.08; .20]). While

phone calls showed a small positive association with overall well-being (r = .10, 95% CI [.06;

.15]), texting and instant messenger use were not related to overall well-being.

Risk factors. Findings on risk factors are limited to loneliness and stress. While two

smaller meta-analyses (both k = 23) found a small positive association between SNS use and

loneliness, a considerably larger one (k = 196) found no association (r = .01, 95% CI [-.02;

.05]). Phone calls, texting, and instant messaging showed small negative associations with
CMC AND MENTAL HEALTH: A META-REVIEW 21

loneliness, though based on only a few studies each (see Online Appendix V for details). SNS

use showed a small positive association with stress (r = .13, 95% CI [.05; .21]).

Psychopathology. The most commonly meta-analyzed indicator of internalizing PTH

was depressive symptoms. No meta-analyses of externalizing PTH were found (see also RQ2

below). Five meta-analytic effect sizes for the relationship between SNS use and depressive

symptoms existed, all showing a small positive association (e.g., r = .11, 95% CI [.08; .14]).

In addition, one meta-analysis reported a small positive association between general social

comparison on SNS and depressive symptoms (r = .23, 95% CI [.12; .34]), and a somewhat

higher one for upward comparison (r = .33, 95% CI [.20; .47]). General time spent online was

slightly negatively associated with reverse-coded depressive symptoms (r = -.05, 95% CI [-

.07; -.02]), while instant messaging was not associated. SNS use further showed a small

positive relation to social anxiety (r = .10, 95% CI, [.05; .15]) and to anxiety symptoms in

general (r = .10, 95% CI [.03; .18]). Time spent online, instant messaging, texting, or email

use were not related to (social) anxiety. However, social comfort experienced online (r = .34,

95% CI [.25; .41]) and comfort specifically due to reduced non-verbal cues online (r = .27,

95% CI [.23; .31]) showed moderate positive associations with social anxiety.

One meta-analysis focused on SNS and body image disturbance, which can be

considered an indicator of internalizing PTH. Combining all measures of SNS use (general

use and appearance-focused use), there was a small positive association with disturbed body

image (r = .17, 95% CI [.13; .21]). When analyzed separately, similar effects were found for

using multiple SNS or Facebook, but not for Instagram or other SNS (though based on k < 5).

Notably, technology-centered measures of SNS use showed about a third of the effect (r =

.11, 95% CI [.08; .15]) of appearance-focused use (r = .31, 95% CI [.22; .39]), which included

upward comparison and appearance-related interactions on SNS. Finally, one meta-analysis

reported an overall effect of SNS use (i.e., global use, number of friends, active and passive

use) on “negative indicators of MH”, comprising depression, anxiety, and loneliness (r = .06,
CMC AND MENTAL HEALTH: A META-REVIEW 22

95% CI [.03; .09]). However, when separated by indicators, only global SNS use (time spent,

frequency) showed a small association with negative MH (r = .11, 95% CI [.06; .15]).

Effect Heterogeneity, Moderator Analyses, and Publication Bias

All meta-analyses tested for effect size heterogeneity based on the Q statistic, and

nearly all concluded that there was “significant heterogeneity”, with I² often exceeding 75%.

We thus synthesized findings from moderator analyses on three key sample characteristics

(i.e., age, gender, and culture/country) as well as on publication bias.

Age. Of the 14 meta-analyses, 11 reported moderation effects of sample age. Two

found that with increasing age the effects of SNS use on MH became less negative

(concerning body image disturbance) or more positive (concerning social support),

respectively. Two others found that the relationship between several CMC measures and

social anxiety was stronger in older samples. Seven meta-analyses found no effect of age.

Overall, there is little evidence for age effects, but age had a range restricted to young users in

most analyses.

Gender. Ten meta-analyses reported moderation effects of the proportion of females

in study samples. Three meta-analyses found some evidence for a moderation by gender,

albeit with no consistent overall trend for who benefited more or less from SNS use. Seven

meta-analyses found no gender effects. Overall, there is little meta-analytic evidence for

gender effects.

Culture/country. Seven meta-analyses reported moderation effects of culture or

country. Only one found no moderation effect. However, the evidence from the remaining six

is incoherent, with two finding more positive effects in Western/individualistic countries, two

in Eastern/collectivistic countries, and two finding mixed results. Overall, culture seems to be

an important moderator, but yields complex effect patterns.

CMC AND MENTAL HEALTH: A META-REVIEW 23

Publication bias. Seven meta-analyses concluded that there was “no bias” at all.

Three meta-analyses concluded there was “little bias” and two found “some bias” for specific

CMC indicators. Accordingly, meta-analysts overall found little evidence of publication bias.

CMC and MH Indicators

One key source of the high heterogeneity of effects in previous meta-analyses may be

the diversity with which CMC and MH are operationalized in studies. To systematize this

diversity and answer RQ2, we turn to the primary research included in all 34 reviews. Of the

1313 publications coded, 594 (45%) met our eligibility criteria 1-4 and 7. The remaining 719

publications were excluded due to lack of a relevant MH (30%) or CMC variable (15%), the

manuscript being unpublished (16%) or its full text unavailable (10%), or because the

publication exclusively investigated addictive or problematic usage (17%). Moreover, 7%

contained only qualitative research, which was unsuitable for this stage of synthesis.

Regarding CMC, most publications included either one (23%) or two (24%)

indicators, followed by three (19%), four (16%), or more (18%) (M = 3, SD = 2.1). Of the

1829 CMC indicators in total, 51% addressed more than just one of the six CMC levels of

analysis. This demonstrates considerable conflation of analytical levels within many CMC

measures. Turning to the four levels of the channel-centered approach, 16% of all indicators

addressed the device level (of which 68% mobile/smartphone, 19% computer, 8% various1,

5% other), 27% the types of application level (43% SNS, 15% various, 13% texting, 12%

social media, 6% email, 4% instant messenger, 7% other), 54% the branded application level

(78% Facebook, 4% Instagram, 9% various, 9% other), and 15% the feature level (37%

various, 24% status update, 15% profile, 8% comment, 16% other). With regard to the two

levels of the communication-centered approach, 39% of all indicators addressed the

interaction level (27% network characteristics, 18% sending messages one-to-one or one-to-

1
“Various“ refers to measures that address several manifestations of the same level (e.g., several devices, apps,
interaction characteristics) in a single indicator.
CMC AND MENTAL HEALTH: A META-REVIEW 24

many, 9% self-disclosure, 8% passive usage, 38% other) and 9% the message level (51%

content, 24% content of images, 9% accessibility, 6% various, 10% other).

Overall, most indicators (55%) were exclusively channel-centered, in contrast to only

5% being exclusively communication-centered. A high number of indicators (35%), however,

addressed aspects of both channel and communication, suggesting that lower levels

(interaction or message) were often studied in the context of a specific channel (e.g., a

branded application). Six percent of indicators assessed generalized “Internet use”, neither

specifying channel nor communication aspects. Concerning operationalization approaches,

most indicators followed the technology-centered (69%) rather than the user-centered

approach (28%). Three percent of indicators included aspects of both.

Concerning MH, most publications included only one MH indicator (43%), followed

by two (28%), three (16%) or more (13%) (M = 2, SD = 1.5). Of the 1258 MH indicators in

total, 28% addressed internalizing PTH (of which 39% depressive symptoms, 22% social

anxiety/social phobia, 14% anxiety symptoms, 11% eating disorder symptoms, 14% other),

3% externalizing PTH (e.g., substance abuse, aggression, AD/HD), 18% hedonic PWB (36%

life satisfaction, 25% domain-specific satisfaction, 21% affect, 10% discrete emotions, 8%

other), 2% eudaimonic PWB (e.g., meaning, authenticity, mastery), 17% risk factors (53%

loneliness, 20% poor sleep, 19% stress, 8% other) and 31% resilience factors (38% self-

esteem, 24% social support, 22% social capital, 8% good sleep, 8% other). Thus, the most

studied indicators overall were risk and resilience factors (47%), followed by PTH (31%) and

PWB (20%). A majority of PTH (57%) and PWB (79%) indicators as well as risk (84%) and

resilience factors (91%) were measured at the trait level, without specifying a timeframe.

Discussion

Extending prior work (Appel et al., 2020; Orben, 2020), this study synthesized the

fast-growing—yet conceptually and empirically fragmented—literature on CMC, social

media, and MH through a meta-review. Our contribution to the literature is twofold. First, we
CMC AND MENTAL HEALTH: A META-REVIEW 25

contribute to theory building by presenting two parsimonious frameworks that offer increased

organizing power, harmonize conceptual overlaps, and allow comparisons between

conceptual approaches to CMC and MH. Second, we contribute to evidence synthesis by

connecting and comparing review findings (RQ1) as well as units of analysis (RQ2).

Evidence on the Association Between CMC and MH

In a first step, we synthesized main findings of prior reviews (RQ1). This offers

several key insights. (1) Meta-analyses condensing various CMC and MH measures into one

overall effect size find a (very) small negative association (r ≈ -.05 to -.15). Yet, when

associations are investigated by CMC and MH indicators separately, effect patterns become

more complex. (2) There is consistent evidence that those who use SNS more intensely

perceive moderately (r ≈ .20 to .40) increased social resources (social capital and support).

However, there is little evidence for other positive associations between CMC and MH. (3)

The remaining evidence consistently suggests those who use SNS more intensely experience

slightly (r ≈ .05 to .20) more internalizing PTH (e.g., depressive symptoms), stress, and lower

self-esteem. (3) Meta-analyses show no evidence for an association between SNS use and life

satisfaction, the only meta-analyzed PWB indicator. Thus, SNS use is not associated with the

cognitive side of hedonic well-being. The largest available meta-analysis also revealed no

association between SNS use and loneliness. (4) There was little indication of publication bias

across meta-analyses. Nonetheless, effect sizes should be interpreted in light of evidence that

meta-analyses produce almost three-times larger effects than preregistered replication studies

(Kvarven et al., 2020).

(5) For applications other than SNS, the evidence base is small and, overall, shows

little to no association with MH. There is narrative review evidence for a negative association

between the device level and MH, specifically for mobile CMC. However, this requires

further meta-analytic synthesis. (6) The meta-analytic evidence for the feature or interaction

level (e.g., active vs. passive use) is scarce and inconsistent (cf. Online Appendix V).
CMC AND MENTAL HEALTH: A META-REVIEW 26

However, it currently suggests that effects are more nuanced than for higher levels of the

CMC taxonomy (i.e., types of or branded applications). The clearest pattern for the message

level is a positive association between appearance-focused content and body image

disturbance. Overall, findings suggest the need for more systematic research relating the

feature, interaction, and message levels to MH. (7) Across several meta-analyses, there was

consistent evidence that user-centered measures (e.g., attitudes toward Facebook, social

comparison on SNS) resulted in two- to three times larger effect sizes than technology-

centered ones (e.g., time spent, frequency). Whether this suggests that user-centered measures

reveal stronger, potentially more relevant effects or produce artifacts due to, for instance,

common method variance of self-report scales remains an important question.

(8) Among all 34 reviews, the most common narrative conclusion was that effects

depended on moderators and/or mediators. However, meta-analyses revealed little evidence

for moderating effects of age and gender—despite popular concerns about more negative

effects particularly among younger and female users (e.g., Twenge et al., 2018). It should be

noted, however, that the age range was quite restricted (participants were mostly adolescents

or young adults) and that narrative reviews on CMC among older adults highlighted mostly

positive effects, specifically on social resources. Thus, future research needs to sample across

the life span (e.g., Chan, 2015). The culture or country a study was conducted in did emerge

as a relevant moderator in meta-analyses, yet showed no consistent trend. Future research

should thus compare cultures more systematically. Overall, research needs to test additional

moderators (e.g., personality) to explain the large heterogeneity found in meta-analyses.

Conceptual and Operational Approaches to CMC and MH

Given the range of average effects across meta-analyses (i.e., r ≈ .00 to |.40|), how

researchers measure CMC and MH seems to matter considerably for the conclusions drawn in

this field (see also Orben & Przybylski, 2019). In a second step, we thus synthesized
CMC AND MENTAL HEALTH: A META-REVIEW 27

conceptual and operational approaches (RQ2). Based on the detailed analysis of 1829 CMC

and 1258 MH indicators from 594 publications, we arrive at several implications.

Measuring CMC and Social Media Use

(1) Research has largely relied on the channel-centered (e.g., devices, applications)

rather than the communication-centered (e.g., interactions, messages) approach. Notably, the

default approach of the field has been to study individual branded applications, specifically

Facebook. This limits the evidence base severely, as findings on single applications may

demonstrate little generalizability over time (e.g., due to changes in design or popularity).

Instead, identifying key features used for CMC in numerous applications (e.g., status updates,

profiles, private messages) should be a more future-proof way to study channels (Bayer et al.,

2020).

(2) The measures of CMC in this field show considerable conflation of analytical

levels, thus potentially resulting in misattribution of effects to the wrong causes (e.g., to

“screen time” on a device rather than to a certain type of interaction). Research on the

communication-centered approach (i.e., the interaction and message level), specifically, has

conflated most measures with individual channels (e.g., “passive Facebook use”). Given that

users now communicate via a multitude of channels simultaneously (i.e., media multiplexity;

Chan, 2015) and the dynamic design changes of these channels, the low generalizability of the

channel-centered approach also applies to most of the available evidence at the interaction and

message level. Research should thus strive to develop measures that capture interaction and

message characteristics independently of users’ devices or applications. In addition to (a) the

low generalizability of the current channel-centered approach (Bayer et al., 2020), studying

characteristics of interactions or messages (b) avoids technological determinism (i.e., social

media as overall “good” or “bad”); (c) helps clarify whether one assumes effects to result

from mass communication, interpersonal communication, or masspersonal communication

(O’Sullivan & Carr, 2018) rather than unspecific “screen time”; and (d) allows for more
CMC AND MENTAL HEALTH: A META-REVIEW 28

nuanced conclusions about the causes of any effects, hence facilitating the development of

effective interventions, if necessary.

(3) Beyond illuminating conceptual approaches, our analysis shows that researchers

have largely relied on technology-centered (e.g., time spent, frequency) rather than user-

centered operational approaches (i.e., how technology use was processed). However, both

approaches have their pitfalls. Technology-centered measures of exposure, especially self-

reports, are notoriously unreliable (Orben, 2020) and risk conflation of distinct phenomena

such as interpersonal and mass communication (O’Sullivan & Carr, 2018). User-centered

measures, in contrast, may artificially inflate the association between outcome (i.e.,

perceptions of MH) and predictor (i.e., perceptions of CMC). Moreover, they may result in

misattributing outcomes of psychological processing to technology. For instance, a study

finding upward comparison on Instagram negatively affects well-being cannot inform upon

whether this is an effect of upward comparison, characteristics of Instagram, or both (e.g.,

Meier & Schäfer, 2018). Our recommendation for future research is therefore a combination

of the technology- and user-centered approaches. Studies should strive to measure technology

use descriptively, ideally via digital tracking (e.g., Bayer et al., 2018) and at multiple levels of

the taxonomy, to allow level comparisons. Additionally, studies should assess key

motivations and psychological processes that occur across channels (e.g., social comparison

or social support seeking), and test how these processes are modulated by channel features

and their affordances (Evans et al., 2017).

(4) Finally, we observe a discrepancy between the CMC measures meta-analyzed so

far and the measures identified in our conceptual synthesis. Meta-analytic evidence is mostly

limited to “global SNS use”, that is, time spent on, frequency of, or intensity of using a SNS,

while many more CMC measures exist. More research on the other levels (i.e., devices,

features, interactions, messages), and meta-analyses comparing these levels, are needed to

ground conclusions about the role of CMC for MH in a more comprehensive evidence base.
CMC AND MENTAL HEALTH: A META-REVIEW 29

Measuring Mental Health

(1) Existing research focusses largely on internalizing PTH, the cognitive side of

hedonic PWB (i.e., life satisfaction and domain-specific satisfaction), and risk and resilience

factors. Research has paid less attention to eudaimonic and affective PWB as well as

externalizing PTH. Yet, these dimensions capture relevant and unique aspects of MH.

Ignoring them in empirical research on CMC may thus overlook crucial effect patterns.

Recent research, for instance, suggests that conclusions about the effects of social comparison

on SNS partly depend on whether one investigates internalizing PTH (e.g., depression) or

outcomes such as inspiration (eudaimonic PWB) and positive affect (hedonic PWB) (Meier &

Schäfer, 2018). Externalizing PTH (e.g., aggression) could, in turn, be affected by online

incivility and may be a more relevant PTH indicator among men (e.g., Kramer et al., 2008).

The field should thus broaden its empirical approach in order to cover the two continua of

MH more completely.

(2) A second finding is a strong reliance on risk (e.g., loneliness) and resilience factors

(e.g., self-esteem). These factors tap into important aspects of psychosocial functioning,

relevant to MH in multiple ways. They are crucial predictors or boundary conditions for MH

(e.g., social support as a buffer that increases PWB; Burke & Kraut, 2016) or link CMC

indirectly to more central MH indicators (e.g., stress as a risk factor for depressive symptoms;

Aalbers et al., 2019). However, our review of MH literature reveals that none of the

prominent risk and resilience factors (e.g., self-esteem, loneliness, social capital) is integrated

into current conceptual models of PTH or PWB. This remains an important task for MH

research at large. For researchers interested in effects of CMC on MH, this suggests, however,

that to truly measure MH studies should include indicators more central to our current

understanding of PWB and PTH, next to risk and resilience factors.

(3) We identified a great diversity of MH indicators across the empirical literature on

CMC, which hinders research synthesis. The field should thus agree on a core outcome set of
CMC AND MENTAL HEALTH: A META-REVIEW 30

MH indicators (Brunton et al., 2020). If studies were to measure a set of the same indicators,

tapping into core aspects of MH, this would greatly enhance evidence accumulation and

research integration (e.g., meta-analyses). Our tentative proposal for such an outcome set

would be a selection of cross-culturally validated scales covering the most central

internalizing and externalizing PTH symptoms (Conway et al., 2019); cognitive and affective

well-being (Diener et al., 2018); meaning as the most useful “proxy for eudaimonic

experience” (Huta, 2017, p. 22); and competence, autonomy, and relatedness need satisfaction

as a self-determination theory approach to eudaimonia (Martela & Sheldon, 2019). This set

may, of course, be complemented by key risk and resilience factors (e.g., self-esteem,

loneliness, social resources, or perceived stress) or limited to only a sub-set.

(4) Finally, findings show that most evidence on CMC and MH relies on trait level

assessments of MH, that is, measures that do not specify a timeframe. This is problematic for

several reasons. First, individual MH constructs (e.g., affective well-being) fluctuate in

specific timeframes (e.g., Diener et al., 2018), which the measurement should reflect. Second,

MH constructs may be temporally connected to each other—and to CMC—in unique ways.

For instance, from a network perspective on PTH, phenomena such as depression are “a

complex, dynamic network of symptoms that cause each other” (Aalbers et al., 2019,

p. 1454). Thus, risk factors such as stress, and depressive symptoms such as sad mood, may

cause other, increasingly more severe symptoms (e.g., suicidal ideation; Aalbers et al., 2019).

Identifying at which points of this temporal symptom network CMC is particularly relevant is

thus a crucial direction for future research. More generally, MH research should theorize and

test the dynamic interplay between PTH and PWB indicators over time. For instance,

individuals suffering from internalizing PTH may lack the energy necessary to pursue

eudaimonic PWB. Finally, a temporal perspective on MH and CMC would also sensitize for

prospective or reciprocal effects of MH on CMC (e.g., Aalbers et al., 2019).

Limitations
CMC AND MENTAL HEALTH: A META-REVIEW 31

Several limitations need to be considered. First, evidence on the relationship between

CMC and MH is largely based on small-scale, cross-sectional studies. The findings on the

association, let alone causal order, of CMC and MH should be treated as preliminary (for an

extended discussion, see Orben, 2020). In addition, our review, while relying on

comprehensive conceptual approaches to CMC and MH and an extensive evidence base, is

limited. First, we excluded some research areas, particularly on “addictive” usage of CMC

and cyberbullying. These may come to different conclusions about the relationship between

CMC and MH. Second, we excluded evidence from clinical samples, as research on these

populations differs markedly from the evidence reviewed here. Third, we did not review

theoretical mechanisms on the relationship between CMC and MH. Several reviews provide

crucial syntheses of such mechanisms (e.g., Bayer et al., 2020; Liu et al., 2019; Sbarra et al.,

2019). However, a comprehensive theoretical review of all relevant mechanisms and

boundary conditions is outside the scope of our work. Fourth, our conceptual framework of

MH by no means reflects and integrates all approaches to, and dimensions of, MH. For

instance, there may be several additional dimensions of PTH beyond the internalizing and

externalizing spectra (see Conway et al., 2019). Rather, our proposed MH model presents a

working model covering the most relevant aspects of PTH and PWB that current theorizing

from Clinical and Positive Psychology can agree on. We call on future researchers to revise

the MH model based on new developments in MH research. Fifth, a necessary limitation of

any literature review is a time lag between the available evidence and the evidence included in

the review. Thus, there may be conceptual and empirical approaches to CMC and MH this

meta-review does not include. However, given the scope of our evidence base, spanning

nearly 20 years of research, we are confident that this meta-review is reasonably

representative of the field’s conceptualization of and findings on CMC and MH.

Conclusion
CMC AND MENTAL HEALTH: A META-REVIEW 32

Public concern and research attention on the impact of CMC, specifically social

media, on the mental health and well-being of (young) users has dramatically increased in

recent years. This study offers a conceptual and empirical review of reviews. Findings suggest

an overall (very) small negative association between using SNS, the most researched CMC

application, and mental health. Findings further show, however, that associations partly

depend on the choice of MH indicators. On both conceptual and empirical grounds, research

thus needs to develop and measure a more comprehensive set of MH outcomes, so as not to

overlook effects. Moreover, associations become more complex when research addresses not

just the channels used for CMC (i.e., “screen time” spent on devices or applications), but the

types of interactions and messages transmitted via those channels. Instead of investigating

“screen time” monolithically, the new decade of research on CMC, social media, and MH

should operationalize channels through their core features, tease apart the types of interactions

users engage in across channels, and consider the characteristics of messages they send and

receive. Ideally, research tests how these interactions and messages are modulated by the core

features and affordances of social media. By reflecting on the CMC taxonomy proposed here,

specifically by avoiding conflation of its levels in measures, future research can more

rigorously test which uses of social media contribute to, impair, or are irrelevant for mental

health.
CMC AND MENTAL HEALTH: A META-REVIEW 33

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CMC AND MENTAL HEALTH: A META-REVIEW 40

Figures

Figure 1. The hierarchical CMC taxonomy

CMC AND MENTAL HEALTH: A META-REVIEW 41

Mental health k effect True effects

Publication N
indicator sizes [95% confidence interval]

Note. Effects within as well as between individual publications are not independent, due to overlap of primary studies. Empty cells are due to missing
information. Larger effect size squares correspond to narrower confidence intervals. Effect sizes are sorted by resilience factors, positive MH
indicators, risk factors, negative MH indicators. *Liu and Baumeister reported 95% credible intervals instead of confidence intervals.

Figure 2. Forest plot of effect sizes for global SNS use (i.e., time spent, frequency, and/or intensity) and mental health
CMC AND MENTAL HEALTH: A META-REVIEW – ONLINE APPENDIX 42

Computer-mediated communication, social media, and mental health: A conceptual and

empirical meta-review

-- Online Appendix --

Contents
Appendix I: The Extended Two-Continua Model of Mental Health ....................................... 43

Appendix II: Detailed Eligibility Criteria and Review Exclusions .......................................... 45

Appendix III: Details of the Systematic Literature Search and Coding ................................... 50

Appendix IV: Descriptive Overview of Included Meta-Analyses and Systematic Reviews ... 54

Appendix V: Detailed Findings of Meta-Analyses on CMC and Mental Health .................... 58

References in the Online Appendix.......................................................................................... 62

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 43

Appendix I: The Extended Two-Continua Model of Mental Health

Figure A1
The extended two-continua model of mental health
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 44

Note. The two-continua model of mental health is based on Greenspoon and Saklofske (2001) and Keyes (2005). The distinction between

internalizing and externalizing PTH dimensions is based on various sources (e.g., Conway et al., 2019; Krueger et al., 2001; Lahey et al., 2017). The

explication of PTH manifestations as disorders and symptoms is based on the DSM-5 (American Psychiatric Association, 2013). The distinction

between the hedonic and eudaimonic well-being dimensions is based on various sources (e.g., Diener et al., 2018; Huta & Waterman, 2014; Martela

& Sheldon, 2019; Ryan & Deci, 2001). Manifestations of PWB (i.e., category of analysis and level of measurement) are explicated in Huta (2017)

and Huta and Waterman (2014). The distinction of risk and resilience factors is made by the authors, based on extensive literature on these concepts

and their lacking integration into existing models of PTH and PWB.
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 45

Appendix II: Detailed Eligibility Criteria and Review Exclusions

Below, we note all seven eligibility criteria of the meta-review in detail and explain

synthesis exclusions resulting from the respective criterion, if applicable.

1. The synthesis had to investigate CMC as non-pathological usage of ICTs whose primary

and original function is the facilitation of human social interaction.

a. In line with our CMC definition and previous work in this field (Huang, 2017;

Wu et al., 2016), we excluded reviews that exclusively investigated

problematic Internet use, generalized Internet addiction, or specific Internet

addictions such as SNS addictions (cf., e.g., Çikrıkci, 2016; Elhai et al., 2017;

Ryan et al., 2014; Tokunaga & Rains, 2010). Research on problematic or

addictive usage does not provide evidence about the relationship between non-

pathological, everyday usage of CMC and MH, which is the focus of this

meta-review.

b. For this reason, we also excluded research on extreme forms of mediated social

interaction (e.g., cyberbullying or sexting). While certainly prevalent and

relevant for MH, these forms of CMC are highly specific concerning message

style, interaction context, and user characteristics. Moreover, they have been

extensively reviewed elsewhere and thus lie outside the scope of this review

(Chen et al., 2017; Kosenko et al., 2017; Kowalski et al., 2014; Kwan et al.,

2020; Tokunaga, 2010).

c. Furthermore, and in line with our focus on CMC, we excluded reviews on

Internet-based mass communication and MH. Specifically, this refers to mass

communication or interactive entertainment media that are nowadays

predominantly accessed online such as pornography, video streaming, and

games. The effects of online pornography and online games on MH (e.g., on

sexual satisfaction and aggression, respectively) are researched in highly

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 46

specialized fields and comparatively well-reviewed (e.g., Anderson et al.,

2010; Ferguson et al., 2011; Greitemeyer & Mügge, 2014; Li et al., 2016;

Wright et al., 2017). Moreover, these lines of research do not predominantly

investigate mediated social interaction, which is the focus of this meta-review.

d. Finally, reviews that only investigated the physical proximity of information

and communication technology devices (e.g., mobile phones) and its

physiological and psychological effects (e.g., of electromagnetic fields) were

also excluded (e.g., Klaps et al., 2016), as these do not inform research on

CMC as a form of social interaction.

2. The synthesis had to investigate MH with at least one construct that is an established

marker of either psychopathology or psychological well-being, or a risk or resilience

factor commonly associated with PTH or PWB.

a. Whether a variable is an established marker of PTH or PWB or a risk or

resilience factor was determined via the extended dual-factor model of MH

(see Appendix II) and the literature this model is based on (e.g., Conway et al.,

2019; Huta & Waterman, 2014). Thus, if a review assessed only outcomes not

considered indicators of MH as defined in our model (e.g., attitudes, academic

or cognitive performance, friendship closeness), it was excluded (e.g., Liu et

al., 2017; Liu & Yang, 2016; Yang & Shen, 2018). If a review confounded

relevant indicators (e.g., loneliness) with irrelevant ones (e.g., extraversion) in

all analyses, it was also excluded (Song et al., 2014).

b. Reviews assessing CMC only in relation to personality traits such as

narcissism or the “big five” were excluded (e.g., Gnambs & Appel, 2018; Liu

& Campbell, 2017). Personality is reflective of genetic dispositions (Lahey et

al., 2017) and is predictive of certain sets of adaptive or dysfunctional behavior

(DeYoung, 2015), hence systematically affecting MH. However, personality is

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 47

not indicative of MH per se, particularly due to its relatively high temporal

stability. However, syntheses of variables that are often interpreted as

resilience factors or even markers of MH, albeit originally being

conceptualized as personality constructs (specifically, self-esteem; Chung et

al., 2014), were included in this review (e.g., Liu & Baumeister, 2016).

3. The synthesis had to be based on research that assessed CMC and MH as distinct and

conceptually independent variables, in order to be able to make claims about their

association.

a. If a review mostly included studies that did not empirically distinguish

between CMC and a MH variable, it was excluded. For instance, reviews

predominantly focusing on identity expression (Wängqvist & Frisén, 2016),

self-disclosure (Ruppel et al., 2017), or emotion expression in CMC (Derks et

al., 2008) were excluded for this reason (see also Gilmour et al., 2020). While

these reviews provide insights into processes crucial to CMC research, they do

not explicitly inform research on the empirical association between CMC and

MH. For instance, the review by Derks et al. (2008) synthesized evidence on

how emotions are differently communicated in CMC vs. face-to-face contexts.

While emotions are certainly key to MH (e.g., affective well-being or anxiety),

studies that investigate emotion expression in CMC contexts inherently

confound the usage of CMC channels with a potential MH indicator. Thus,

from this research, it is impossible to assess a media effect, that is, whether

CMC has led to “changes in cognitions (including beliefs), emotions, attitudes,

and behavior” as a result from technology usage (Valkenburg et al., 2016,

p. 316)—or whether changes in cognitions, emotions, attitudes, and behavior

have led to changes in CMC usage. On a more practical level, meta-analyses

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 48

on topics such as self-disclosure in CMC do not provide effect sizes that

indicate changes in MH (Ruppel et al., 2017).

b. For the same reason, reviews assessing how CMC content (e.g., Facebook

status updates) can be analyzed for indications of MH issues were excluded

(Wongkoblap et al., 2017).

4. Fourth, the synthesis had to include studies with healthy, non-clinical participants from

the general population.

a. Reviews investigating CMC (e.g., SNS or online support groups) as a means of

treatment or intervention to improve well-being in clinical populations were

excluded for this reason (e.g., Grajales et al., 2014, Laranjo et al., 2015; Rains

& Young, 2009)

b. Research on the effects of CMC among people with special needs (e.g.,

disabilities; Cheatham, 2012) was also excluded based on this criterion.

5. Fifth, concerning review methodology, the synthesis had to contain a systematic and, in

principle, replicable literature search (i.e., use databases and search terms), clearly

specified eligibility criteria, and should not fully overlap with a more recent review.

a. We therefore excluded all non-systematic, selective reviews from our analysis,

even if they reviewed relevant research literature and provided insights into

their respective subject matter (e.g., Bargh & McKenna, 2004; Verduyn et al.,

2017). Non-systematic narrative reviews are a common form of literature

synthesis that is widespread in many fields. However, due to their

unstandardized approach and because they do not necessarily use keywords

such as “review” or “meta-analysis” in the title, they are particularly difficult

to identify in a systematic literature search. More importantly, this form of

synthesis is an inherently selective assessment of the literature. Including

selective reviews would thus introduce bias. Solely relying on systematic

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 49

reviews and meta-analyses, in contrast, is a means of bias control without

engaging in the controversial technique of quality coding (Card, 2012).

b. We excluded Mingoia et al. (2017) since a more recent meta-analysis including

all studies from Mingoia et al. (2017) was available (i.e., Saiphoo & Vahedi,

2019).

6. Sixth, the synthesis article had to contain empirical studies (quantitative and/or

qualitative) as the reviewed literature.

a. We are unaware of any articles that would have to be excluded for this reason,

but nonetheless specified this criterion to emphasize our reliance on empirical

evidence.

7. Seventh, we only included articles written in English and those that were published or

accepted for publication in a peer-reviewed outlet.

a. We are unaware of any articles that would have to be excluded for this reason,

but nonetheless specified this criterion to emphasize our reliance on

internationally accessible (i.e., written in English) and peer-reviewed evidence.

CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 50

Appendix III: Details of the Systematic Literature Search and Coding

1. Systematic search and selection of synthesis articles

As recommended in method literature (Card, 2012), we combined several methods of

searching the literature, which are outlined in detail below.

(1) First, as part of an ongoing effort to identify relevant literature on CMC and MH,

we searched seven academic databases (EBSCO: Business Source Premier, Communication

Abstracts, EconLit, LISTA, PSYNDEX; ScienceDirect; and Web of Science) using pretested

search terms. The search string used Boolean operators to combine synonyms of CMC with

synonyms of MH. The generic string for all databases was:

(Internet OR cyber* OR web OR online OR chat* OR “e-mail” OR “computer-

mediated” OR “CMC” OR mobile OR smartphone OR “instant mess*” OR “IM” OR “mobile

messaging applications” OR “MMA” OR text* OR “social media” OR “social network” OR

“SNS” OR "ICT" OR "information and communication technology" OR Facebook) AND

(“Well-being” OR wellness OR happiness OR functioning OR flourishing OR “the good life”

OR “quality of life” OR “the full life” OR “life satisfaction” OR “satisfaction with life” OR

“SWL” OR “positive affect” OR “negative affect” OR “PANAS” OR “subjective well-being”

OR “SWB”).

A number of search terms (e.g., social support, social capital, psychopathology, mental

health, depression) were considered during string development, but excluded from the final

string. We decided to exclude these terms due to very high rates of false-positive hits

(sometimes in the tens of thousands), which would have decreased search precision and thus

impeded feasibility. This first search was restricted to the timespan from January 1995 to

April 2016.

We retrieved 9.427 abstracts from the database searches, which were then pre-

screened for relevant articles (both primary research studies and reviews) by three trained
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 51

student coders (two undergraduates, one graduate) based on a coding protocol. Inclusion and

exclusion criteria for the screening were the same as the ones outlined in Appendix III, with

two exceptions. For this first step of the search, we also included research on problematic or

addictive forms of CMC as studies in this field often assess regular CMC as well (i.e., not just

scales of problematic or pathological usage, but also of regular usage) and often rely on non-

clinical samples (see, e.g., Tokunaga & Rains, 2010). Moreover, at this point, we still

included all non-systematic review articles on CMC and MH.

Inclusion versus exclusion decisions had inter-coder reliabilities of pairwise

agreement = 96% and Krippdendorf’s alpha = .73. Intra-coder reliabilities with a one month

difference between T1 and T2 were Coder 1: Pairwise agreement = 96%, Krippendorf’s alpha

= .68; Coder 2: Pairwise agreement = 96%, Krippendorf’s alpha = .68; Coder 3: Pairwise

agreement = 93%, Krippendorf’s alpha = .62. It should be noted that the comparatively low

alpha coefficients are strongly influenced by the highly skewed distribution of coding

decisions (i.e., zero-inflation, indicating that most of the coding decisions in abstract

screening were exclusions, as is typical for systematic reviews) (Lacy et al., 2015). The

pairwise agreements show that reliabilities were overall acceptable.

The pre-screening of studies resulted in a reduced sample of 409 records that were

then “forward searched” (Card, 2012) via Google Scholar’s “cited by” function by the same

student coders. For each article, coders screened the first 50 citations, thereby retrieving an

additional 381 articles. All articles were entered into a literature database, which was

subsequently searched for the terms “review” and “meta-analysis” to identify eligible research

synthesis articles. This resulted in the identification of seven review articles.

(2) Second, to accommodate for any limitations of our previous database search

attempts, we then “forward searched” all citations and “backward searched “ all references of

the identified seven review articles and repeated this procedure for any new review articles

found in the process. This procedure is highly common for meta-reviews as synthesis articles
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 52

typically cite related syntheses in order to clarify their unique contribution in contrast to

already published syntheses articles (Polanin et al., 2017). These searches resulted in nine

additional review articles.

(3) Finally, we conducted a complementary Google Scholar title search targeted

specifically at finding systematic reviews and meta-analyses on CMC and MH. In doing so,

we were able to compare the results of our previous broader systematic literature search with

a more targeted search, testing whether our previous search attempts were exhaustive. This

final search used the search string from the systematic database search and several additional

terms omitted from the first string (e.g., “social support” or “social capital”). The resulting

string was then combined with the terms “systematic review”, “narrative review”, “review”,

and “meta-analysis”. This complementary search resulted in only five additional review

articles in December 2017, underlining the exhaustiveness and validity of our previous search

efforts. This last step of the search was then updated during peer review in September 2019,

resulting in an additional 15 reviews published in 2018 and 2019. The final sample of eligible

reviews consisted of 34 publications.

2. Coding of primary research publications

An inter-coder reliability analysis was conducted with 20 randomly selected primary

research publications from the review articles and including 58 MH and 74 CMC indicators

overall. Based on recommendations by Lacy et al. (2015), we report simple agreement

alongside Krippendorf’s α, as several categories showed skewed distributions. For ratio-

scaled data, we only report α. For most categories, reliability was sufficient: number of MH

variables in a publication (α = .83), number of CMC variables in a publication (α = .96), MH

dimension (97%, α = .95), MH manifestation (91%, α = .88), MH trait vs. state measurement

(95%, α = .89), CMC device (100%, α = 1.00), type of application (96%, α = .87), branded

application (97%, α = .94), interaction (93%, α = .86), and message level (92%, α = .66), and
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 53

the conceptual approach to CMC (91%, α = .84). For the operational approach (80%, α = .55)

and the feature level (88%, α = .46), α values were low. These disagreements were discussed

until consensus was reached and the full dataset was recoded accordingly.
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 54

Appendix IV: Descriptive Overview of Included Meta-Analyses and Systematic Reviews

Table A1
Descriptive overview of included meta-analyses and systematic reviews

Narrative
Review Population Publications Type of CMC concept(s) MH concept(s) conclusion
Author(s) Year
type investigated included studies synthesized synthesized about overall
relationship
Baker & 2016 SR General 30 QN SNS use (various) Depression Mixed;
Algorta Conditional
Best et al. 2014 SR Adolescents 43 QN & QL SM use (various) Various (e.g., self-esteem, (Mixed;
social support, social Conditional)
capital, social isolation,
depression)
Cheng et al. 2019 MA General 161 QN SNS use (various) Social capital, social Mixed:
anxiety, loneliness Conditional
Dobrean & 2016 SR General 20 QN SNS use (various) Social anxiety (Mixed)
Pasarelu
Domahidi 2018 MA General 63 QN Internet, SM & SNS use Social support, social Positive;
(various) capital Conditional
Erfani & 2018 SR General 22 QN & QL SNS use (various) Various (e.g., life Mixed:
Abedin satisfaction, self-esteem, Conditional
affect)
Forsman & 2015 SR Older 32 QN & QL Internet use (various) Various (e.g., quality of Positive
Nordmyr Adults life, depression,
loneliness)
Frost & 2017 SR General 65 QN FB use (various) Various (e.g., anxiety, Mixed;
Rickwood depression, disordered Conditional
eating, alcohol abuse)
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 55

Holland & 2016 SR General 20 QN SNS use (various) Eating disorder symptoms (Negative;
Tiggemann Conditional)
Huang 2010 MA General 40 QN Internet use (various) Various (depression, Negative
loneliness, self-esteem,
life satisfaction)
Huang 2017 MA General 61 QN SNS use (time spent) Various (depression, Negative;
loneliness, self-esteem, Conditional
life satisfaction)
Keles et al. 2019 SR Adolescents 13 QN SM use (various) Depression, anxiety, Negative;
distress Conditional
Khosravi et 2016 SR Older 34 QN ICT & SNS use (various) Social isolation, Positive
al. Adults loneliness
Krause et 2019 SR General 49 QN SNS use (various) Self-esteem Mixed;
al. Conditional
Liu, 2016 MA General 58 QN SNS use (various) Social capital Positive;
Ainsworth Conditional
et al.
Liu & 2016 MA General 80 QN SNS use (various) Self-esteem, loneliness Negative;
Baumeister Conditional
Liu, 2019 MA General 124 QN ICT & SNS use (various) Various (e.g., anxiety, Mixed;
Baumeister, depression, happiness, Conditional
et al. loneliness, self-esteem)
Liu, 2018 MA Students 31 QN SNS use (various) Social support Positive;
Wright, et Conditional
al.
McCrae et 2017 MA Children & 11 QN SM use (various) Depression (Negative;
al. Adolescents Conditional)
Meng et al. 2017 SR General 88 QN SNS use (various) Social support Unclear
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 56

Prizant- 2016 MA General 23 QN Internet use (various) Social anxiety Mixed;

Passal et al. Conditional
Rodgers & 2016 SR General 67 QN & QL Internet & SNS use Eating disorder symptoms Negative
Melioli (various)
Rus & 2017 SR General 26 QN SNS use (various) Relationship satisfaction, (Mixed;
Tiemensma jealousy Conditional)
Saiphoo & 2019 MA General 56 QN SNS use (various) Various (e.g., body Negative;
Vahedi satisfaction, body esteem, Conditional
eating disorder
symptoms)
Sarmiento 2018 SR Adolescents 68 QN SM use (various) Anxiety, depression, (Negative;
et al. loneliness Conditional)
Seabrook et 2016 SR General 70 QN & QL SNS use (various) Depression, anxiety Mixed;
al. Conditional
Shapiro & 2014 SR Adolescents 27 QN SNS use (various) Various (e.g., Mixed;
Margolin connectedness, self- Conditional
esteem)
Thomée 2018 SR General 290 QN Mobile phone use Various (e.g., depression, (Negative)
(various) sleep problems, stress,
anxiety)
Twomey & 2017 SR General 21 QN Self-presentation on FB Various (e.g., self-esteem, Mixed;
O’Reilly social support, social Conditional
anxiety, depression)
Vahedi & 2019 MA General 55 QN SNS use (various) Depression Negative;
Zannella Conditional
Williams 2019 SR General 54 QN & QL SNS use (various) Social capital Positive
Wu et al. 2016 SR Adolescents 12 QN Internet & SM use Various (e.g., Mixed
(various) connectedness, loneliness,
social isolation,
depression, anxiety)
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 57

Yin et al. 2019 MA General 63 QN SNS use (various) Various (e.g., depression, Mixed;
loneliness, anxiety, envy, Conditional
affect, life satisfaction,
self-esteem)
Yoon et al. 2019 MA General 45 QN SNS use (various) Depression Negative;
Conditional
Note. Review type: SR: systematic narrative review, MA: meta-analysis. Type of studies: QN: quantitative, QL: qualitative. SNS: social network

sites. SM: social media. FB: Facebook. ICT: information and communication technology. PTH: psychopathology. PWB: psychological well-

being. Conclusion: The conclusion refers to the relationship between CMC and MH as operationalized in the respective review, with higher

levels of MH meaning higher levels of PWB and lower levels of PTH. Negative: negative relationships between CMC and MH prevail. Positive:

positive relationships prevail. Mixed: positive, negative, and/or non-significant relationships were found. Unclear: no explicit conclusion about

the relationship was articulated. Conditional: the strength and/or direction of the relationships depend on moderators (e.g., age, gender, culture,

concepts or measures investigated) and/or mediators. Brackets indicate that author(s) found the evidence insufficient for a definitive conclusion.
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 58

Appendix V: Detailed Findings of Meta-Analyses on CMC and Mental Health

Table A2
Effect sizes of the relationship between CMC and MH indicators from fourteen meta-analyses
Effect size r
k effect N par-
Publication CMC indicator MH indicator 95% CI [LL;
sizes ticipants
UL]

Global SNS use Loneliness 196 — .01 [-.02; .05]

Cheng

2019b
et al.,

Social anxiety 194 — .10 [.05; .15]

Internet use Social resources 108 78,958 .06 [-.01; .12]

(capital/support)
Domahidi,
2018a,b,d

SNS use 99 27,779 .30 [.14; .46]

Forum use 41 8,171 .14 [.09; .20]
Blog use 21 8,501 .20 [-.01; .42]
Chat use 18 5,432 .06 [-.18; .31]
Email use 11 3,970 -.01 [-.24; .22]

Time spent online Well-being (total) 39 — -.04 [-.07; -.01]

Huang, 2010

-- Loneliness(r) 37 — -.02 [-.05; .02]

-- Depression(r) 33 — -.05 [-.07; -.02]
-- Life satisfaction 7 — -.05 [-.12; -.01]
-- Self-esteem 5 — -.01 [-.06; .05]
Social Internet use Well-being (total) 22 — -.02 [-.08; .02]

Time spent on SNS Well-being (total) 67 19,652 -.07 [-.09; -.04]

-- Self-esteem 30 — -.04 [-.08; -.00]
Huang,
2017

-- Depression(r) 24 — -.11 [-.15; -.07]

-- Loneliness(r) 20 — -.08 [-.13; -.04]
-- Life satisfaction 8 — -.03 [-.11; .05]

Global SNS use (total) Bridging social 50 22,290 .32 [.27; .37]
capital
-- intensity 32 14,711 .35 [.34; .36]
-- time 13 5,726 .15 [.12; .17]
Liu, Ainsworth et al., 2016a

-- frequency 5 1,853 .19 [.14; .23]

Information seeking 13 4,532 .25 [.18; .32]
(direct questions,
following status updates)
Replying and maintaining 11 5,221 .36 [.27; .44]
Self-disclosure (status 9 3,792 .19 [.11; .26]
updates, photos, sharing
information)
Including offline friends 6 1,937 .23 [.19; .27]
Initiating online 2 1,055 .09 [.03; .15]
friendships
Global SNS use (total) Bonding social 43 19,439 .22 [.21; .24]
capital
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 59

-- intensity 27 12,551 .27 [.25; .28]

-- time 10 4,547 .14 [.11; .17]
-- frequency 6 2,341 .14 [.10; .18]
Information seeking 9 2,765 .18 [.14; .21]
(direct questions,
following status updates)
Replying and maintaining 9 4,418 .24 [.21; .27]
Self-disclosure (status 7 2,768 .20 [.16; .24]
updates, photos, sharing
information)
Including offline friends 5 1,817 .25 [.21; .30]
Initiating online 2 1,055 .03 [-.03; .09]
friendships

Global SNS use Loneliness 23 7,397 .17 [.09; .24]

Baumeister,

Global SNS use Self-esteem 33 10,627 -.09 [-.14; -.03]

2016a,c
Liu &

No. of friends 11 3,035 .07 [.01; .14]

No. of photos 8 1,964 -.01 [-.13; .10]
Status updates 4 685 -.02 [-.10; .07]
Interactions 3 969 -.09 [-.14; -.03]

Global SNS use Well-being (total) 94 34,475 -.06 [-.09; -.03]

-- Self-esteem 34 — -.05 [-.09; -.01]
-- Depression 25 — .13 [.09; .17]
-- Loneliness 23 — .11 [.06; .16]
-- Satisfaction 16 — .09 [-.02; .19]
-- Anxiety 14 — .10 [.03; .18]
-- Stress 5 — .13 [.05; .21]
-- Happiness 1 — .14 [.06; .22]
Self-presentation (status Well-being (total) 13 3,012 .02 [-.04; .08]
updates, photos)
Liu, Baumeister, et al., 2019

Content consumption 9 3,384 -.14 [-.20; -.08]

(browsing, searching,
monitoring)
Interactions (replying, 5 1,366 .14 [.08; .20]
commenting, liking)
Phone calls Well-being (total) 9 3,257 .10 [.06; .15]
-- Loneliness 5 — -.11 [-.20; -.03]
-- Self-esteem 2 — .03 [-.05; .11]
-- Satisfaction 1 — .13 [.04; .21]
-- Happiness 1 — .13 [.06; .20]
Texting Well-being (total) 9 2,063 .10 [.02; .17]
-- Loneliness 8 — -.16 [-.22; -.11]
-- Anxiety 4 — -.14 [-.34; .06]
-- Satisfaction 2 — -.01 [-.10; .07]
-- Self-esteem 2 — .07 [-.01; .15]
Instant messaging Well-being (total) 8 3,981 .06 [-.06; .16]
-- Loneliness 4 — -.06 [- .11; -.02]
-- Depression 3 — .00 [-.22; .22]
-- Anxiety 2 — -.21 [-.27; -.15]
-- Satisfaction 1 — -.03 [-.09; .03]
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 60

-- Self-esteem 1 — -.28 [-.40; -.15]

Global SNS use Social support 21 7,214 .29 [.21; .36]

(total)
-- Offline 17 5,842 .18 [.11; .24]
Liu, Wright et al., 2018a

-- Online 10 3,504 .39 [.25; .51]

No. of friends 8 2,039 .13 [.09; .17]
Self-presentation (status 6 2,689 .28 [.20; .36]
updates, photos)
Interactions 5 938 .13 [-.14; .38]
Content consumption 2 1,114 .29 [-.01; .54]
SNS use (total) Emotional support 5 1,734 .38 [.32; .43]
Informational 5 1,744 .23 [.04; .42]
support
Tangible support 2 329 .23 [-.11; .52]
Esteem support 2 295 .11 [-.17; .37]

Social media use Depression 11 12,646 .13 [.05; .20]

McCrae et
al., 2017

(various) symptoms

Social comfort online Social anxiety 10 — .34 [.25; .41]

Prizant-Passal et

Time spent online 7 — .07 [-.05; .18]

al., 2016b

Time spent on instant 7 — .12 [-.10; .32]

messaging
Time spent on email 3 — -.03 [-.09; .04]
Comfort due to reduced 4 — .27 [.23; .31]
non-verbal cues

SNS use (total) Body image 63 36,552 .17 [.13; .21]

disturbance (total)
-- general/ 39 — .13 [.08; .19]
Saiphoo & Vahedi, 2019

evaluative
-- behavioral 12 — .21 [.14; .28]
-- cognitive 9 — .23 [.17; .29]
-- Multiple SNS Body image 31 — .16 [.12; .20]
disturbance (total)
-- Facebook 23 — .21 [.14; .29]
-- Instagram 5 — .10 [-.18; .36]
-- Other SNS 4 — .10 [-.06; .25]
-- General use 44 — .11 [.08; .15]
-- Appearance-focused 16 — .31 [.22; .39]
use

Global SNS use Depression 34 44,027 .11 [.07; .14]

Vahedi &
Zannella,

symptoms
2019
CMC AND MENTAL HEALTH: A META-REVIEW - ONLINE APPENDIX 61

SNS use (total) Positive MH 62 23,442 .05 [.01; .08]

indicators (e.g.,
life satisfaction,
positive affect,
self-esteem)
-- Global SNS use 27 13,007 .04 [-.02; .10]
-- No. of friends 18 3,543 .13 [.05; .21]
Yin et al., 2018

-- Active use 9 2,674 .04 [-.07; .14]

-- Passive use 8 4,218 -.10 [-.20; .01]
SNS use (total) Negative MH 82 27,240 .06 [.03; .09]
indicators (e.g.,
depression,
loneliness,
anxiety)
-- Global SNS use 36 10,392 .11 [.06; .15]
-- No. of friends 17 3,946 -.03 [-.10; .04]
-- Active use 17 6,698 .04 [-.02; 10]
-- Passive use 12 6,204 .07 [-.01; .14]

Time spent on SNS Depression 37 15,881 .11 [.08; .14]

Yoon et al., 2019

symptoms
Frequency of checking 14 8,041 .10 [.03; .16]
SNS
General social 8 1,715 .23 [.12; .34]
comparison on SNS
Upward social 6 2,298 .33 [.20; .47]
comparison on SNS

Note. Effect sizes within as well as between individual meta-analyses should not be treated as
independent. Effect sizes statistically significant at p < .05 or lower are highlighted in bold.
Empty cells in the N participants column are due to missing information (i.e., (sub-)sample
sizes were not reported in the respective publications). If publications reported information on
indicators that did not match our definitions of CMC (e.g., gaming, entertainment) or MH
(e.g., narcissism), this information was omitted. Effect sizes collapsing indicators that
matched and did not match our definitions were also omitted (e.g., an effect size including
both general and problematic usage). As far as possible, we used the CMC and MH indicator
labels as used by the original author(s) to facilitate reproducibility. However, the labeling was
also slightly extended and harmonized across publications to facilitate interpretability of
findings. “Global SNS use” refers to time spent on the SNS, frequency of, and/or intensity of
use.
a
Author(s) conducted a Hunter & Schmidt correction of effect sizes based on internal
consistency (e.g., Cronbach’s alpha) of the measures.
b
Author(s) conducted a three-level (random effects or mixed effects) meta-analysis. All other
findings are based on random effects models.
c
Author(s) report credible intervals instead of confidence intervals.
d
Author(s) used robust standard errors and confidence intervals.
(r)
Measure was reversed by the author(s).
CMC AND MENTAL HEALTH: A META-REVIEW 62

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