Researcher of the Month

July 14, 2025

Do teens with mental health conditions use social media differently than their peers?

Do teens with mental health conditions use social media differently than their peers?

As Luisa Fassi, our new Researcher of the Month, comments, "The link between social media use and youth mental health is hotly debated, but hardly any studies look at young people already struggling with clinical-level mental health symptoms". In fact, Luisa's large systematic review and meta-analysis found that only 11% of papers published on the topic since 2007 focused on young people with clinical conditions.

It also showed that the data used to evidence mental health conditions in these existing studies is not always strong or especially robust. Many report links between social media and mental health on the basis of short self-report questionnaires, where young people are asked about symptoms. Similarly, very few papers differentiate between different mental health conditions, or examine different symptoms or conditions (such as anxiety, ADHD or eating disorders) in isolation.

To address this research gap, Luisa and colleagues have recently published a fascinating and nuanced paper.

It analyses both quantitative and qualitative data from a nationally representative survey of 3,340 teens in the UK aged between 11 and 19 years old, which was conducted by NHS Digital in 2017. Rather than gathering mental health data from self-report questionnaires, the young people in the survey underwent a full clinical screening, which included interviews with the young people, their parents and teachers. Information about social media use came from questionnaires completed by participants. They were not asked about specific platforms. Luisa used this data to gather novel insights into how social media and mental health are related in teens who both meet and do not meet diagnostic criteria for a wide range of mental health conditions.

The study does not establish any causal links, but it does reveals a range of differences between young people with and without mental health conditions when it comes to social media.

Summary

Luisa and her team embarked on the study with various strong hypotheses based on previous research and on our understanding of the offline behaviours associated with different common mental health conditions.

Generally, young people with mental health conditions tend to be less happy with their friends, tend to experience lower self-esteem and engage in more social comparisons offline. The team assumed that these well known offline behaviours would translate into online settings. She expected teens with a mental health condition to report engaging with social media differently than those without a condition. For example, she hypothesised that teens with mental health conditions might feel less happy with their number of online friends, feel less control over the time they spent online, engage more in online social comparison and feel a greater impact on mood from online feedback. She also thought that people with a mental health condition would engage in less honest self-presentation than young people without one. She also predicted that for those with mental health conditions, social media use would vary between young people with different symptomatology, particularly whether they had internalising or externalising conditions.

In order to assess potential differences, Luisa and her team needed to set benchmarks. To do so, they considered well known offline behavioural differences between young people with and without mental health conditions. Existing research shows that young people with mental health conditions tend to sleep more poorly and exercise less than those without. Only findings comparable to known differences in levels of sleep and physical activity within these populations were considered significant.

Luisa found that teens with a mental health condition reported spending roughly 50 minutes more per day on social media than those without a mental health condition.

It's important to note that this was based on their own estimate of use, rather than objective data, and that teens with mental health conditions may be perceiving that they spend more time on social media rather than actually doing so. These teens were also less happy with their number of online friends.

However, when comparing teens with and without mental health conditions, the research team did not find meaningful differences for other types of engagement, such as online social comparison, lack of control over time spent online, honest self-disclosure online, or the impact of online feedback on mood.

Teens with internalising conditions (such as anxiety or depression) seemed to experience more differences than teens with externalising conditions (such as ADHD or conduct disorders).

Luisa examined whether teens with either internalising conditions or externalising conditions used social media differently when compared to teens without mental health conditions. As predicted, she found that teens with internalising conditions reported greater differences in engagement, spending more time on social media and engaging in more social comparison than teens with no mental health condition. They also felt a greater lack of control over the time they spent online and more difficulty in regulating their social media use, and felt that social media feedback impacted their mood. They were less happy about the number of friends that they had and engaged in less honest self-disclosure about their emotions and feelings. For teens with externalising conditions, the only differences were a greater time spent online and a small difference in the impact of feedback on their mood.

The study confirms that well understood offline experiences for teens with certain kinds of mental health conditions, such as difficulties with peer relationships, are frequently replicated online for these young people.

Finally, the team compared the experiences of teens with internalising and externalising conditions, and found that those with internalising conditions engaged in higher levels of online social comparison. This finding aligns with existing research indicating that adolescents with depressive and anxious symptomatology tend to unfavourably compare themselves with others on social media. Teens with internalising conditions were also less happy about their number of online friends than those with externalising conditions, who seemed to experience greater satisfaction with their online friendships.

Implications

This study, "Highlights aspects of social media use that might present an increased risk to this already vulnerable group and provides a window for future research to ensure that the digital world is safe for all children regardless of mental health status". Luisa Fassi, et al., (2025)

What can parents do?

Remember that the online world is nuanced. As in offline life, young people are likely to encounter some negative experiences online, but they are also likely to forge positive connections.

Understand that the online and offline worlds are not functionally distinct. Together, they happen on a continuum. The experiences that we have offline can spill over and translate to our online lives. There is a continuous interaction between the way we engage with technology online and with people offline.

Support genuine online friendships. Sometimes, as adults, we place less value on social relationships online. Let’s try not to. Initiate open conversations about online and offline relationships, talk about your teens' experiences of friendship, and look for ways to scaffold support if/when instances of exclusion happen.

Remember that each experience of social media is individual. Different young people might respond differently to identical content due to their feelings and attitudes. One young person might see images of friends together and feel a sense of connection. Another might feel excluded, or it might impact their feelings of self-worth. If you notice that your child struggles more with these kinds of issues, or if they already feel anxious or have depression, it is even more important to support them to reframe experiences that they tend to interpret as negative.

Be aware of the features of online spaces which enable inclusion or exclusion. On social media, young people can make friend lists, create groups including or excluding specific people, or show stories only to certain friends. Try to open conversations about these kinds of features and be curious about your child’s experiences and feelings.

Try to learn about how platforms work. Try out the platforms that your children use, if you don’t use them already. This will help greatly with meaningful conversation. Why not ask them to show you?

Encourage critical self-reflection. Help young people to understand that what they see online can be created and idealised. Since seeing a lot of idealised content can increase feelings of social comparison, and so it’s important to talk about the difference and potential mismatch between online personas and real life.

Model emotional regulation on social media. Together, you might go through your own feed or theirs. Talk about the kinds of strategies that can help us to feel better about what we are seeing, such as self-compassion or reframing negative feedback.

Co-develop rules and guidelines around social media use. Rather than simply instating rules, decide on them together. This provides young people with a sense of agency and helps them to feel part of creating an online space that feels safe, fun and supportive.

Remember that correlation is not causation. Just because two things happen at the same time doesn’t mean one causes the other. We still need better evidence and better data to show whether exposure to social media directly causes harms or benefits.

And what about at school?

Luisa stresses the importance of a strong digital literacy curriculum. This should help young people understand how algorithms work, consider how they want to create and curate their social media feeds, what content might be healthy and what might be harmful, and when and how they can report something that distresses them.

She notes that peer-led interventions might be beneficial. Lusia suggests that schools might consider training young people as digital ambassadors who can help other students with their digital experiences.

Consider offering anonymous reporting. Enabling young people to share distressing online encounters anonymously, perhaps using an online tool, might help some students feel more comfortable about honest disclosure.

Tooled Up members can listen to our interview with Luisa Fassi here. Remember, if you are a Tooled Up member, you also have access to our whole platform, which is packed with evidence-based resources designed to support children in the digital world.

Luisa Fassi

Luisa Fassi

PhD researcher at the University of Cambridge

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