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DR JON GOLDIN - THE RISKS AND BENEFITS OF SOCIAL MEDIA ON THE MENTAL HEALTH OF ADOLESCENTS

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The Internet and social media now impact almost every aspect of people’s lives and have altered social interactions and ways of being. Many young people use the Internet and social media in a way that is detrimental to their mental health, with the potential of developing symptoms traditionally associated with addiction. Despite this desperation to use the Internet and social media, a recent study showed that the more time young people spend on social media, the less happy they feel about everything except their friendships. More speci cally, they felt less happy about school and school work, their appearance, their family, and life in general. It appears that girls are more a ected than boys. It is important however that we don’t blame the medium but the message. There are positive messages out there on social media, which can help young people with mental health di culties but also some very harmful messages and practices can be found online too. This talk will explore ‘The risks and bene ts of social media on the mental health of adolescents’.

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DR JON GOLDIN - THE RISKS AND BENEFITS OF SOCIAL MEDIA ON THE MENTAL HEALTH OF ADOLESCENTS

  1. 1. The risks and benefits of social media on the mental health of adolescents Dr. Jon Goldin Consultant Child and Adolescent Psychiatrist MCU
  2. 2. Overview • Context • Prevalence of social media • Clinical Examples • DSH • Anorexia Nervosa • Child Protection • Possible solutions/positive examples • Conclusion
  3. 3. Look familiar?
  4. 4. Why children use social media • Communication • Self-esteem • Expression • Confidence • Popularity • Entertainment • Sense of belonging • To ‘keep up’/receive information
  5. 5. Global context • Significantly increased use of electronic/social media amongst adolescents • YP spend on average 6 hours/day online and 25% of those surveyed have lost sleep thinking about things on the internet • School reading lists and assignments, planning social events, research, social networking • Pornography, stalking, cyber-bullying, internet gambling, researching weapons and suicide methodology
  6. 6. Social Media • Facebook, Instagram, tumblr, Twitter, Snapchat, ask.fm all open to children 13 and up • Many accessible to younger tech-savvy ‘tweens’ • The average time spent online by 3-4 year olds has increased to 8 hours 18 minutes a week, whilst 12-15 year olds spend over 20 hours a week online (Growing Up Digital, 2017). • The number of young people counselled by Childline over cyber bullying has doubled in five years, whilst the number of calls received from children affected by grooming rose by 10% to 3150 last year (NSPCC, 2016).
  7. 7. Social Media – current trends • Instagram – v popular, large user numbers • Snapchat – ‘The whole point is you can say what you want and then it’s gone’ • Twitter – ‘Photos, Videos, DM - Best of them all in one place’ • Musical.ly – Can lip-synch pop videos, option of doing it ‘live’, risky • Pinterest – ‘All you do is pin pictures on a board’ • Facebook – ‘It’s uncool because it’s pointless….for old people’ • WhatsApp – Often with family members, end to end encryption • YouTube – more on iPads, for videos • Jargon– ‘Streaks’, ‘Deep Likes’, ‘Ghosting’ • Emojis – ‘More than three seen as a little immature nowadays’ • ‘Social Media is a blessing and a curse’ - 17 yr old girl
  8. 8. Mental Health Trends • Smartphones came in in 2007 (first iPhone) • Increase in prevalence of depression and anxiety in YP over past 10 years • More teens saying they feel lonely and hopeless • Significant increase in numbers of girls aged 12-14 taking their own lives • Less time being spent in face to face interactions with families/friends
  9. 9. Other Concerns • Over half of schoolchildren would not tell their parents if they were upset by something online • Survey of 10,000 pupils in Britain aged 6-18: 90% would tell their teacher if upset by sth face to face but only a third would turn to them if upset by sth online • Children suffering in silence • Increase in depression, anxiety, DSH, ED’s amongst YP. • 44% increase in CAMHS referrals past 4 years
  10. 10. Education Policy Institute (EPI) report, 2017 • Over a third of UK 15 year olds are ‘extreme internet users’, spending > 6 hours online outside of school • 95% of 15 year olds in UK use social media before or after school in 2015 • 12% of children who spend no time on social media have symptoms of mental ill health • 27% of children who are on social media > 3 hrs/day have symptoms of mental ill health (ONS, 2015)
  11. 11. However…. • Must not confuse correlation with causation • Currently no evidence from neuroscience studies that typical internet use harms the adolescent brain • In terms of social interaction and empathy, adolescents’ use of social media can enhance existing friendships and the quality of relationships (for some more than others) • If used to avoid social difficulties, reduced wellbeing. If used to deal with social challenges, outcomes improve. (Bell et al, BMJ, 15.8.15)
  12. 12. Advantages of access to internet/social media • Need to learn to access the online space thoughtfully and responsibly • A central part of contemporary life, which YP may depend on for communication and interaction ‘You can keep up to date with friends who you don’t always see’ 16 year old boy • Availability of knowledge, information about the world, current affairs etc
  13. 13. Disadvantages of access to internet/social media • Cyber-bullying – ‘People say a lot more behind a computer screen than they would in real life’ • Age-inappropriate content • Location services • Grooming/child protection issues • Inappropriate content eg pro-Ana sites, DSH, ‘How to kill yourself’
  14. 14. Instagram et al • Royal Society for Public Health (RSPH) 2017 report called #StatusofMind • Surveyed 1500 young people aged 14-24 • Instagram, snapchat, Facebook and Twitter all showed negative affects on YP mental health • YouTube found to have the most positive impact • Link between isolation and social media use • Filters and photo editing particularly detrimental, YP need to know about these altered images • Worse if more than 2 hours/day spent on social media • YP need to learn how to cope with social media, can also be positives, danger of blaming the media for the message
  15. 15. Social Anxiety • Isolation – social media encourages this and reduces ‘real-world’ contact eg in parks, shopping centres etc • YP focussed on making large numbers of superficial connections, concerned re how they are perceived, rather than making close friendships which are protective for mental health • Social anxiety associated with physical symptoms of anxiety, panic attacks and substance abuse • FOMO. Compulsion to check smartphone.
  16. 16. Girls suffer under pressure of online 'perfection', poll finds • Quest to create the image of a “perfect” life on social media is affecting the wellbeing of one in three girls • Poll of more than 1,000 YP by UK charity Girlguiding found 35% girls aged 11-21 said their biggest worry online was comparing themselves and their lives with others • Parents failed to recognise this as a problem • Girls included grooming, how photographs they took could be altered or used out of context online, and threats from strangers. A third also worried about how they looked in photos • Sense of self bound to numbers of ‘likes’ received. • Culture of narcissism c.f. Donald Trump!
  17. 17. Deliberate self-harm • Voyeurism/exhibitionism • Glamorises/romanticises self-harm? • Adolescents seek feeling of belonging and being ‘understood’ that such websites can provide • Competition between peers/’badge of honour’ • Advice re ‘how to do it’ • Suicide pacts/people meeting on line • Education/increased awareness
  18. 18. Tallulah W • 15 year old girl who died in 2012 after being run over by a train at King’s Cross • She had posted self-harm images on networking site Tumblr, had 18,000 followers. • Her mother spoke of her daughter being involved in a "toxic digital world". • Created a fantasy cocaine-taking on-line character • Online life kept separate from rest of life, makes it harder for healthcare professionals to intervene effectively
  19. 19. Anorexia Nervosa • ‘Thinspiration’ • Competition/peer encouragement/‘tips’ • Reduced sense of isolation but often unhelpful peer group • Doctored images, ‘photoshop’ leads to further reduction in self-esteem and subsequent self- harm risk • Some helpful websites eg Beat
  20. 20. Pro-Ana websites • ‘The pro-Ana lifestyle forever’ • Wear a rubber band around your wrist and snap it when you want to eat. Food = pain. • ‘PLEAS SOMEBODY BE MY ANA BUDDY’, attempt to reduce loneliness, isolation, feel ‘connected’ • The ‘rules’, numerous tips • Should these be taken down? But impossible to fully control….
  21. 21. ‘Recovery’ websites • Broad range on the internet • ‘You can live your life free from an eating disorder. Recovery is possible’. • ‘Stories of Hope’ • Mentors and mentees may be paired to promote recovery from Eating Disorders, peer support • Sometimes OTT: ‘If you want to eat everything in your kitchen, then go do so, because if your body is asking for the entire content of your kitchen, then your body needs it’.
  22. 22. Child Protection (1) • Inappropriate exposure to indecent images • ‘Sexting’, disinhibition because ‘anonymous’ • Cyber-bullying eg private images being circulated more widely • Suicides of gay teenagers, homophobia, videos have gone viral, leading to extreme shame, humiliation
  23. 23. Child protection (2) • Grooming (eg musical.ly) • Easy to pretend you are someone you aren’t • Anonymity • Location services
  24. 24. ‘Sexting’ • ‘Sexting’ has become part of the ‘normal’ flirting ritual for many young people. But sexting carries significant risks. Images which are supposed to remain private are often shared with a much wider audience, and can be used to bully and control. • Young people must be better aware of the risks they face, with almost a third of 15 year olds admitting to having sent a naked photo of themselves online (OFCOM, 2016). • Sexting is also influenced by pornography, which is now accessed on-line by a high proportion of boys, and which can introduce inappropriate expectations into young people’s relationships. • Child sexting cases have doubled in past two years and police investigate 17 cases/day • It was recently disclosed that, over a three year period, there were 5,500 alleged sexual offences recorded in UK schools. This included over 600 alleged rapes and nearly 4,000 alleged physical sexual assaults. • We need to help young people address the risks through open discussion and education.
  25. 25. Possible solutions? • Family-friendly filters on devices but young people often know more than adults about disabling these • The new national curriculum aims to teach children aged five to 16 about internet safety in a sensible, age-appropriate way. Education important. • Parents need to try to view world through their child’s eyes. • Website providers need to police their sites more closely? Better legal framework? • Searches related to depression and self-harm, may be intercepted with users directed to counselling and resources that can offer support • Maintain certain boundaries eg no social media in bedroom/after a certain time. See e.g. ourpact.com • Instant support eg apps like @TalkLifeApp
  26. 26. Government response to risk • Responsibilities placed on internet and online commercial providers was enlarged by The Digital Economy Act 2017, which aims to protect children from viewing pornographic and inappropriate content that may cause harm. • The Act mandates introduction of robust age verification controls for pornographic content.
  27. 27. Big White Wall • A safe online community of people who are anxious, down or not coping who support and help each other by sharing what’s troubling them, guided by trained professionals. • Available 24/7, Big White Wall is completely anonymous so users can express themselves freely and openly. • Professionally trained Wall Guides ensure the safety and anonymity of all members. Option of live support. • 95% of members feel better, 73% share an issue for the first time, 80% self-manage their difficulties.
  28. 28. Information and Online Resources • Childnet International www.childnet.com • UK Safer Internet Centre www.saferinternet.org.uk includes a ‘Parents’ Guide to Technology’ • Digizen www.digizen.org advice on cyberbullying • Kidsmart www.kidsmart.org.uk includes ‘Early Surfers’ Zone’ for 3-7 year olds • To make a report: CEOP (if concerns re online grooming or sexual behaviour online) or Internet Watch Foundation www.iwf.org.uk
  29. 29. Conclusion • ‘The Genie is out of the bottle’ • Adults need to understand seriousness of some of the internet content out there and what young people may be exposed to • Can’t turn back time, need to inform ourselves, educate, monitor, discuss openly • Appropriate boundaries important eg up to 2 hours/day on social media and not in bedroom at night • Mental health can be harmed but also can be helpful aspects. Focus on the message rather than the medium. • Can be good to ‘disconnect to connect’
  30. 30. Thank you for listening • jon.goldin@gosh.nhs.uk • Twitter: @DrJonGoldin

Editor's Notes

  • Social Media is everywhere
  • Impact on family life…
  • Business! Mint and Gum….
  • Edwards (2013) 9 users driven to suicide on ask.fm
    On 6 August 2013 it was reported that Hannah Smith, a 14-year-old girl from Leicestershire, England, had killed herself, and that her father blamed her death on bullying responses she had received on the site. He called for tighter controls against social networking sites like ASKfm, saying that he had seen the abuse his daughter had received and it was wrong that it was anonymous.
    The Smith family calls were echoed by the parents of Goosnargh, Lancashire teenager Joshua Unsworth, who was reported to have been "cyberbullied" on the site prior to his suicide.[21] The company responded by stating it was 'happy to help police'.[22]
    Better policed since then
  • Deep Like – accidentally favoriting an old post on Instagram when scrolling back through someone’s feed, a major faux pas apparently
    Ghosting – when you get ignored online
  • Acc to Jean Twenge, Psychology Professor at San Diego State University, the number of US teenagers spending time with friends nearly every day dropped by more than 40% between 2000-2015, with rates of loneliness sharply increasing.
    Uhis et al (2014) ‘Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues’
    Non-screen activities eg sports associated with greater happiness, screen activities correlated with lower happiness
    Spending time with family and friends associated with greter ahppiness so doing this less is a bad sign
    One study where people gave up FB for a week and had better wellbeing than those who had not.
    Uhis et al (2014) The Impact of Media Use and Screen Time on Children, Adolescents, and Families
    American College of Pediatricians – November 2016
  • A clear association between excessive social media use and symptoms of mental ill health
  • False reality Friedman 1999 – ‘fosters a false sense of connection and intimacy, exempting us from the real work required to build intimacy’.
    Can shrink attention span, important to ensure closeness and concentration when talking to friends in real life.
  • Guardian 23.8.17
    Ruth Marvel, deputy chief executive of Girlguiding, said girls had spoken of the “increasing pressure to live the ‘perfect’ life online and the negative impact this is having on their wellbeing”, adding: “We need to listen and take girls’ voices seriously to protect their happiness, wellbeing and opportunities in life, both online and offline.”
    The Labour MP Jess Phillips said the results were “worrying” and that “perfection is nothing more than a marketing tool”.
    “Improving how girls and women feel about themselves isn’t just important to stop hurt feelings, as some may claim,” she added. “It matters because women trying to reach some unattainable goal of how our faces, bodies, homes and lifestyles should be seeps into real life and sees women feeling inferior in the workplace and in their personal relationships.”
    Fellow Labour MP Karen Buck said: “There is much that is positive about modern communications technology and social media, and it’s not likely that this tide is going to be turned back any time soon.
    “However, there is also evidence, which this report adds to, that social media can fuel anxiety and depression, as people are drawn to constant comparisons with often idealised versions of the lives, and bodies, of others.
    “Though boys are certainly not immune, the pressure on girls to look a certain way is particularly intense,” Buck added. “We should be building a culture of resilience in young people, encouraging open discussion and helping young people challenge the distorting effects of social media.”
    Half of UK girls are bullied on social media, says survey
    Charity says girls face specific types of abuse and calls for more to be done to tackle sexism in online world
    Read more
    Of the 11- to 21-year-olds polled, 36% said their biggest worry online was grooming, defined as when someone lies about their age or who they are to get closer to a child. They also expressed concern about threats from strangers.
    The Girls’ Attitudes Survey found that fewer than half (47%) of those questioned felt their parents understood the pressures they faced online. The majority said they believed their parents were most worried about the threat of online grooming (59%).
    Rhiannon Lambert, a Harley Street nutritionist, said that in the past year twice the usual number of children and young teenagers had come to her saying they felt inadequate after comparing themselves to others online.
    “They are … thinking they are not healthy enough, or asking why they are not getting strong enough or not putting on weight,” Lambert said. “They look on Instagram and follow fitness accounts and want to look like the people who post pictures.
    “It’s becoming the norm to aspire to be a figure on social media now – people [are] growing up to want to be influencers and that is now a job role ... I am not sure if parents are fully aware of the pressure people face and it must be difficult to understand waking up every day and scrolling through a feed of images.”
    Dr Louise Theodosiou, from the Royal College of Psychiatrists, said: “The ready availability of internet-connected devices means that for most children and young people, communicating online is a standard part of life. That’s why it’s so important to address both the positive and the negative effects of the internet.
    Are smartphones really making our children sad?
    US psychologist Jean Twenge, who has claimed that social media is having a malign affect on the young, answers critics who accuse her of crying wolf
    Read more
    “For many young people, the internet can be a safe way to develop friendships, express opinions and gain valuable information – for example, about their emotional wellbeing. But we must also find ways to teach children how to keep themselves safe online, acknowledging the dangers of grooming and the use of pictures. The publication of this data will hopefully pave the way towards parents and daughters starting a valuable dialogue about their online lives.”
    Tom Madders, director of campaigns and communications at the charity YoungMinds, said: “Young people now face the pressure of creating a personal brand from a young age, and seeking reassurance in the form of likes and shares.
    “With feeds full of idyllic holiday photos or groups of friends, it can be hard not to compare yourself to others or feel like you should be living the ‘perfect life’. While it’s important to recognise and teach young people against dangers online, it’s also really important to acknowledge that social media can have an impact on young people’s wellbeing or exacerbate feelings of being left out.
    “What young people see on social media doesn’t reflect real life, and we need to do more to help young people build resilience to the pressures of being online.”
  • Encouragement to ‘catch the bus’…(commit suicide)
    Essentially, to catch the bus is to commit suicide.
    Earlier this year during a period of morbidity, I spent a lot of time browsing the alt.suicide.holiday Usenet newsgroup, or, as its members affectionately call it, ASH. A place of discussion for those contemplating suicide, new members are generally greeted with a hearty "Welcome to ASH, sorry you're here." Often misunderstood and demonized, ASHers have become a little insular over the years and even developed their own vernacular. Psychiatrists are Pdocs, to come out of the closet is to confess to somebody that you're suicidal and to catch the bus (or sometimes train) is to kill yourself. That last one has always been my favorite. You see, ASHers like to think of their group as "a bus stop where several people have decided to stop and chat before deciding on whether or not to get on the bus," which is generally a good way to describe it. Anyway, this brings me to my point here: while browsing the newsgroup one night, I found the most melancholy, resigned thing I think I'll ever read.
    Its almost time to catch the train. I want to clean up my room first so no one else has to go through that depressing process, you know? Basically a series of events have put me with no other option. Debt, University grades, etc. I think Ill go with the car in garage deal.That looks most painless, pretty quick. Now I just have to write a note. Even death requires an essay. 
  • Lemma (2010) wrote about cyberspace offering adolescents struggling with their bodily changes a virtual universe where the actual corporeal self is left behind and the self-representation is reinvented at will.
  • Patient who allowed himself to be photographed naked by another 10 year old boy then photo texted to rabbi…rabbi’s wife informed mother
    Another patient 13 year old girl sent explicit pics of herself to an adult, seeking attention, affirmation…
  • Musically – public ‘live’ option
  • Over 18s more likely to send naked selfies than young people but is especially risky for YP.
    Forces in England and Wales recorded 6238 underage sexting offences in 2016-17, peak age investigated is 14. reports received from children as young as 10.
    Sharing and processing these images is against the law.

    While these are ‘alleged’ and not proven, the figures indicate a serious level of inappropriate behaviour among young people.
  • ‘Digital literacy’
  • Create a Brick
    Express your feelings by creating a Brick using pictures and images. Self assessment, online guided support courses, access useful information, make friends
  • Clare Lilly, NSPCC safer Internet lead "The genie is out of the bottle."
  • ×