How to make social media a positive force for teen mental health – STAT – STAT

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By Jessica SchleiderApril 1, 2024
Since the U.S. surgeon general’s 2023 advisory on social media and teen mental health, public concern has skyrocketed around adolescents’ digital lives. Major news organizations and even state governments have pinned social media apps as addictive, dangerous, and the cause of the youth mental health crisis. In turn, calls to ban teens from social media apps have started to emerge, with mixed reception from policymakers nationwide.
Adolescents face overwhelming mental health challenges. It is essential for public online spaces to be safe for teens to use. But the fear and focus on social media’s possible harms (on which the science is actually quite mixed) may prevent key decision- and policymakers from considering another possibility: social media holds unprecedented promise to support adolescent mental health, especially for teens facing barriers to treatment.
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In the long term, solving the youth mental health crisis will require structural solutions, like training more therapists, fighting achievement culture, and addressing stigma against seeking help. But millions of teens are suffering now. More than 50% of teens with mental health needs do not access treatment, and access gaps are starkest for LGBTQ+ youths and youths of color. The shortage of therapists is so severe that it would be impossible to narrow the treatment access gap through expanding the workforce alone. Teens desperately need mental health supports that can meet them where they are — online — sooner than the mental health care landscape is able to change.
New regulations to ensure social media’s safety for youth, while important steps, will do little to increase teens’ access to care. Policymakers and tech leaders must go a step further by actively embedding science-backed, scalable mental health supports, such as single-session interventions and peer support systems, where teens already seek help.
For many young people, especially those with minoritized identities, digital spaces (including social media apps) are the first or only point of contact for seeking mental health support. This is especially true for teens who feel unable to ask their parents for help. In the U.S., consent for traditional, face-to-face mental health treatment generally requires active parent permission until age 18. This system works well for some youths, but it prevents many others from accessing needed support, such as teens who wish to keep their symptoms, worries, or identities private; those who fear burdening their families with added emotional distress or costly treatments; or those who expect unsupportive responses from their parents.
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As a result, parents may be unaware of their teens early or worsening symptoms, including self-injury, up to 80% of the time. By embedding safe, evidence-based digital interventions into online spaces that teens frequent, and allowing teens to access these tools independently, all teens — not just those in supportive households — would be able to access support when and where they need it. Doing so can simultaneously help teens who would otherwise access nothing, and increase teens’ odds of reaching out for further care in moments of need.
Of course, the challenge here is finding interventions that actually work, rather than just offering platforms a way to pay lip service. But there is good news on that front.
Research from my lab and several others shows that light-touch, single-session interventions (SSIs) embedded into online spaces can accomplish both these goals. In randomized trials, my research group has tested online, self-guided SSIs teaching bite-sized components from longer, evidence-based interventions (like cognitive behavioral therapy). These single-session interventions include brief education about an evidence-backed coping skill, and scientific evidence for why the skill can help; personal coping narratives from other adolescents facing similar challenges; an invitation to share anonymous coping advice with others experiencing depression, anxiety, or related concerns; and a chance to create an action plan to take their best next step toward a future they want.
Research shows that such SSIs can meaningfully reduce depression and anxiety in teens, even months later — and the effects are only slightly smaller, on average, than those of traditional multi-session therapy. When offered as just-in-time tools within popular social media platforms like Tumblr and Discord, these programs reduce near-term ratings of hopelessness and self-hate and increase desires to stop self-harming, with effects considered large within the scientific community. They also double rates of outreach to crisis resources among youths flagged as at-risk for self-harm based on their social media searches, from 38% to 78%.
Other evidence that brief, social media-embedded tools can help comes from research led by scientists at Harvard University in collaboration with The Mighty, an online social platform that connects people with shared health-related experiences. In this randomized trial, people at risk for suicide who read fellow platform users’ personal stories about surviving suicide attempts reported a lower desire to die than the people who didn’t. The effect was modest but, when it comes to preventing suicide, even a small improvement can have life-altering consequences.
Many LGBTQ+ youths, especially those living with family members who don’t affirm their identity, have reported the importance of online social platforms for their mental well-being, especially those designed to help them maintain connections and build community, such as TrevorSpace, Discord Servers, and Q Chat, among others. In fact, studies from Koko (a digital mental health nonprofit that embeds mental health tools into large, online platforms) have shown that helping peers via online social platforms can reduce depression symptoms and boost positive coping skills.
Of course, not all available online mental health resources are created equal, and there is plenty of unhelpful content out there too. Ample mental health misinformation is shared in digital spaces, along with harmful content that may trigger teens at-risk for eating disorders or self-harm.
But the kneejerk reaction — to propose blanket bans on teens’ social media use — is unrealistic and short-sighted.
Instead, given the inevitability of teens’ digital lives, policy-makers and tech companies have a responsibility to support the creation of social media platforms that include not only enforceable guardrails against harmful content but that also embed helpful tools for youth mental health. Collaborations with scientists, clinicians, young people, and social media companies could make these online mental health tools a major force for good by connecting millions more adolescents with effective mental health tools, when many might otherwise access no support at all. Even if the average effects of these tools on individuals is modest, their public health benefits could be substantial if widely-deployed, much like adding fluoride to drinking water to prevent population-wide rates of tooth decay. Although that approach doesn’t eliminate cavities, it can make them a less frequent and severe.
With these kinds of partnerships, social media companies could choose to reconstruct their platforms to direct teens away from psychologically harmful content and toward resources that work. The online interventions that are most likely to succeed are ones that lean into teens’ natural drives for independence and autonomy, such as those that are accessible when and where teens want to use them and those that promote social connection with peers who share identities or experiences.
Of course, when it comes to testing new ways to support teens online, it is dangerous to assume that any seemingly helpful something is better than nothing. For instance, some social media companies have released large language model- or AI-driven chatbots that teens informally use for mental health support, though they tend to have opaque, insufficient guardrails, creating unpredictable risks for exposing adolescents to harm.
To date, numerous mental health apps have been released despite including few to no evidence-based treatment elements — an alarming trend that needs to change. For any new mental health tool, ongoing evaluation and oversight will be essential. But decision-makers have a responsibility to the next generation to find the online mental health supports that work, and safely deliver them to teens through the digital spaces where they’re most likely to find them.
Jessica Schleider is an associate professor of medical social sciences, pediatrics, and psychology at Northwestern University in Evanston, Illinois; director of the Lab for Scalable Mental Health; and author of “Little Treatments, Big Effects” (Robinson, 2023).
children’s health
LGBTQ+
social media
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