Children & Adolescents' Mental Health in the Digital Age & Adolescents' Mental Health in the Digital Age

1. Plugged in and tuned out
Children & Adolescents'
Mental Health in the
Digital Age
Mohamed Ibrahim
CYMHS Registrar
Sept 2021

2. Definition
Social Media – Is a category of online media where people
are talking, participating, sharing, networking, and
bookmarking online.
Examples - email, instant messaging, text or picture
messages, social networking sites, picture tagging, websites,
gaming sites, blogs, chat rooms, and skype.

3. Popularity of social media
Social media has become a common method of communication and
online gaming provides a further avenue for interaction.
Rapid access to instant communication is increasingly the norm, and
access from highly portable sources has created a climate where there
is constant access to the digital world.
A survey by the Australian Psychological Association (2017) found
that adolescents spend 3.3 hours a day on social media with some
logging on as much as 50 times per day.

4. Worldwide Statistics
About 350 million photos are
uploaded to Facebook each day.
There are approximately 58 million
Tweets sent per day.
95% of teens ages 12-17 are using
internet. 26% are using twitter, and
11% are on Instagram.

5. Worldwide Statistics
29% of relationships involving a sex crime were initiated on a social
networking site.
25% of teens between ages 11-17 have forwarded a “sext”.
68% of girls were asked to send a picture, whereas 42% of boys have
been asked to send pictures.

6. Pros of Social Media
Global connectivity (whenever and wherever)
Fostering of socialization skills and sense of social
inclusion
Emotional ventilation - a space where children
and young people feel able to discuss topics that
might be trickier in their offline lives.
Enhances technology and creative skills –
employment prospects
Australian Psychological Society, 2017).

7. Pros of Social Media
Providing a greater understanding of global issues.
Educational enhancement - engagement in self-
directed learning, collaborating on group projects
or exchange ideas about homework.
Physical and psychological health promotion -
information about various physical and
psychological health problems
Carras, M. et al. (2018)

8. Cons of social media
Despite the many clear benefits about exposure
to, and appropriate use, of media technology,
there is much we do not know. A significant
unknown is the impact of excessive exposure to
digital technology such as on development.

9. Problem Internet Use (PIU)
PIU is ‘the pervasive long term and heavy
use by a person of internet and computer-
based technologies, including gaming, that
is out of keeping with one’s educational,
social or occupational role, wellbeing and
health’
Tam, 2011

10. Gaming Disorder
ICD 11 defines Gaming Disorder as “a pattern of
gaming behavior (“digital-gaming” or “video-
gaming”) characterized by impaired control over
gaming, increasing priority given to gaming over
other activities to the extent that gaming takes
precedence over other interests and daily
activities, and continuation or escalation of
gaming despite the occurrence of negative
consequences”
Gaming Disorder is considered a form of PIU

11. Problems associated with PIU
Significant social isolation and withdrawal– prioritizing social
networking over face-to-face family and friend relationships.
Lessening communication skills – talking less, difficulty articulating
thoughts into words, inattentive when others are speaking.
Focusing problems – easily distracted and loss of ability to
concentrate.
FoMo (fear of missing out) - fear of missing opportunities while
offline leading to an urge to stay continually connected with what
others are doing.

12. Problems associated
with PIU
Psychological – depression and anxiety
Neurovegetative - sleep disturbances,
pronounced weight gain/ loss.
Vocational - Poor school/work performance
physical discomfort such - Carpal Tunnel
Syndrome, dry eyes or strained vision,
back/neck aches, severe headaches.

13. Problem Internet Use
(PIU)
PIU is relatively new and not formally recognized
as a mental disorder
May require input from mental health or addiction
services.
Research into treatment is still at an early stage.

14. A False Sense of Connection
According to Cornell University's Steven Strogatz,
“Social media sites can make it more difficult for
us to distinguish between the meaningful
relationships we foster in the real world, and the
numerous casual relationships formed through
social media. By focusing so much of our time
and psychic energy on these less meaningful
relationships, our most important connections, he
fears, will weaken.”
Jung, Brian. (2013). The Negative Effect of Social Media on Society and
Individuals. The Huston Chronicle.

15. Isolation and Loneliness

16. Body Image & Self-Esteem
Social Currency - tying up our self-worth with what
others think of us (likes comments shares).
A survey by the Australian Psychological Association
(2017) found that high use of social media and
technology impacts self-esteem, with two in three
adolescents feeling pressure to look good.
There has been increasing awareness of the potentially
harmful impact of promoting particular body images
in traditional media, including mental health problems
such as depression
Xie et al., 2010

17. Body Image & Self-Esteem
Highlight Reel - Social media is unique as it allows
individuals to present the most attractive images of
themselves and remove images they think are
unattractive
Social media usage is associated with body image
concerns among young men and women, as well as
linked to disordered eating.
Research has shown that eating disorders can be
transmitted "like a virus" through social networks.”
Fardouly and Vartanian, 2016

18. Sleep Disturbance
A significant association has been found between
playing video games in the evening and sleep
deprivation among teenagers, where a 30-minute
increase in time spent on computer games
increases the likelihood of reporting lack of sleep
by 50% compared to the average.
Billari, Giuntella and Stella, 2018

19. Invasion of Privacy
Exposure to scams, identity theft, hackers, fraud, and defamation of
character
Many online activities, such as subscribing to content, entering
competitions and playing online games, require users to enter personal
information. This information may then be misused by others
including spam, scams, identity theft and fraud.
Young people are also specifically targeted by advertisers who may
sell their personal information to other organizations/marketers.
(Office of the eSafety Commissioner, 2015)

20. Cyberbullying
Cyberbullying is deliberately using digital media to communicate
false, embarrassing, hurtful, harmful or hostile information about
another person.
50% of teens have reported being cyberbullied.
70% of teens have witnessed cyberbullying.
Only 1 in 10 teens will tell a parent if they have been cyberbullied.
(O’Keefe and Clarke-Pearson, 2011)

21. Cyberbullying
Cyberbullying is associated with a wide range
of negative outcomes, including depressive
symptoms, substance use, and suicide
(Bottino et al., 2015).
Over 20% of cyberbullying victims have
contemplated suicide(Stolz and Chilcott,
2013).

22. Sexting
Sexting is the sending of provocative or
sexual photos, messages, or videos (Office
of the eSafety Commission).
Sexting can have serious, and in some cases,
disastrous consequences. Reputations, social
lives, future academics, and careers can be
ruined as a result of nude pictures going
public.

23. Sexting
There can also be serious implications for the victim’s mental health.
Victims may feel humiliation, low self-esteem, and in some instances,
suicide has been attributed directly to sexting.
Sexting can be a particular form of cyberbullying. Young people who
engage in this kind of cyberbullying may be charged with criminal
offences.
Over 15% of sexting victims have contemplated suicide.

24. Sexualisation of children
Sexualization of children refers to the imposition of adult models of
sexual behavior and sexuality onto children and adolescents at
developmentally inappropriate stages.
The Australian Institute of Family Studies report found that 44% of
children aged 9–16 had encountered sexual images in the last month
and that this exposure to mainstream, online pornography can have a
range of negative effects on knowledge, attitudes, and beliefs about
sex and gender; sexual practices; mental well-being and the risk of
sexual aggression (AIFS, 2017).

25. Sexualisation of children
There is evidence that premature exposure to
adult sexual images and values has a negative
impact on the psychological development of
children, particularly on self-esteem, body
image and understanding of sexuality and
relationships (APA, 2010).
Exposure to sexualizing messages contributes
to girls defining their self-worth and popularity
in terms of sexual attractiveness, with negative
impact on self-esteem (Lumby and Albury,
2010).

26. Aggression
There continues to be controversy about the extent to which exposure
to media violence causes aggression.
Impacts are likely to be different at different ages and any effects will
be mediated by other influences to which a child or young person is
exposed.
(Gentile et al., 2011)

27. Suicide
Cyberbullying has been tied to increased suicide risks, particularly
among teenagers.
Social media helps form suicide pacts among complete strangers with
only this one thing in common.
There is online information on “how-to” methods for committing
suicide
Video sites, such as YouTube, are increasingly playing a role in
providing pro-suicide and self-harm content.
UNICEF (2017),

28. Depression and
anxiety
Extreme internet users (more than 6
hours a day) were most likely to have
lower life satisfaction and wellbeing.
Moderate internet users (1-2 hours a day)
had the highest life satisfaction, even
when compared to those who used the
internet one hour or less on a weekday.
(OECD, 2017)

29. Depression and anxiety
A small association between social media use and depression has been
found, with a similar link found between anxiety symptoms and high
daily social media use.
For young children, using screen entertainment for more than 2 hours
a day is found to be associated with emotional and conduct problems
in 5-year-old girls.
(Vannucci, Flannery and Ohannessian, 2017)

30. Starting to address some of the problems
The Office of the eSafety Commissioner (Australia) and Netsafe (New
Zealand) take a lead role in assisting young people and their families to
have positive online experiences, providing online safety education, a
complaints service for people experiencing cyberbullying and a system
to address illegal online content. This resource can help promote
appropriate use of social media and is a useful resource for those who
have experienced difficulties associated with cyberbullying.

31. E-health related benefits of digital technology
There is a growing body of evidence supporting the effectiveness of e-
health interventions for a number of mental health problems, which can
be provided in a timely manner, in privacy and at the individual’s
discretion.
(Rice et al., 2016; Peek et al., 2015)

32. E-health related benefits of digital technology
There are an increasing number of apps designed for children and
adolescents that encourage behaviors such as healthy activity,
enhanced medication adherence and smoking cessation, as well as
specific mental health support (e.g. Headspace).
E-health interventions may be used to increase access to treatment in
remote and rural areas where distance and workforce shortages are a
challenge.

33. E-health related benefits of digital technology
Mental health promotion, including to promote resilience, support
parenting and family mental health, address risk factors for mental
health problems and disorders, and increase mental health literacy
(e.g. KidsMatter).
Digital health interventions, particularly computerized cognitive
behavioural therapy (cCBT) for depression and anxiety in adolescents
and young adults, have shown some promising signs
(Hollis et al., 2017)

34. E-health related benefits of digital technology
Digital Dog in Australia is developing a suite of online mobile apps,
websites and games to help lower depression, lower suicide risk,
reduce stress and promote wellbeing.
Apps such as Rally Round allow parents, friends and carers to
organize support for a child with an illness or challenging behavior;

35. E-health related benefits of digital technology
BlueIce and CalmHarm helps young people manage their emotions
and reduce urges to self-harm; while Catch It and SilverCloud help
to manage feelings of anxiety and depression.
Online safe spaces such as ReachOut.com allow children and young
people to share experiences and seek online support with mental
health, mental illness and wellbeing.

36. Recommendations
EMPOWER children and young people to be responsible online participants
EMPOWER
EDUCATE families about appropriate digital use and risks
EDUCATE
ENCOURAGE industry to develop appropriate and accessible content
ENCOURAGE
ENSURE children and young people who show signs of mental illness get
help early.
ENSURE

37. EMPOWER
children and
young people
to be
responsible
online
participants
❑e-mental health resources - websites,
apps
❑Children should take as much
responsibility as they can - Facebook
Bullying Prevention Hub
❑Help young people set reasonable
limits around media usage
❑School-based media literacy programs

38. EDUCATE
families
about
appropriate
digital use
and risks
Psychiatrists should become familiar
with the impact of media on children and
adolescents and can provide advice to
children and young people and those that
care for them about:
❖Ready access to e-health resources that
promote social health and emotional
well-being to enhance recovery
❖Harms to well-being that may arise from
internet use

39. ENCOURAGE
industry to
develop
appropriate and
accessible
content
Age-appropriate content.
Easy-to-use safety features that are
accessible to those with basic digital
literacy.
Online guides and video demonstrations
on setting time limits and content
restrictions
Apps to help limit screen time: Moment,
AntiSocial, Space, and App Detox
Tools to monitor daily use could act as an
additional factor in encouraging children
to moderate their time online.

40. ENSURE
children and
young people
who show
signs of
mental illness
get help early.
Assessment of children and adolescents’
use of medica should by an integral part
of the metal health assessment.
Intervene early when children and young
people show signs and symptoms of
mental illness.
Offer guidance and support for people
presenting with Problem Internet Use.
Paying more attention to mental health
and mental illness in schools and other
services for children and young people

41. Future Directions
More research is needed in this field. In Australia, children and young
people have ready access to technology. Arguably however, research
lags significantly behind China and Europe. It is recognized that there
are problems but there is no research agenda to explore these. It is
important that the impact of technology is understood in Australian
contexts so that the best advice and support can be given.