Associations of Social Media Use Frequency with Sadness or Hopelessness among U.S. Adolescents: A Cross-Sectional Analysis of the 2023 Youth Risk Behavior Surveillance System

Abstract

Background: Adolescent mental health problems, including persistent sadness or hopelessness, are major public health concerns in the United States. Recent increases in adolescent mental health problems coincide with the near-ubiquitous adoption of social media. The relationship between social media use frequency and adolescent mental well-being is complex, with varying existing theories, such as the "Goldilocks hypothesis" (suggesting that moderate use is optimal). However, comprehensive evidence is lacking requiring further research that offers empirical validation. Sleep duration, often compromised in adolescents and potentially influenced by social media, is another critical factor for mental health. However, its precise role in the social media-mental health relationship remains underexplored.Objectives: This study aimed to quantify associations of social media use frequency (low, moderate, high) with feelings of sadness or hopelessness among U.S. high school students. It also examined whether sleep duration mediates or modifies the relationship between social media use frequency and sadness or hopelessness. Methods: A cross-sectional analysis was conducted using data from 12,675 U.S. high school students (grades 9-12) participating in the 2023 Youth Risk Behavior Surveillance System (YRBSS), a study representative of the national population of high school students. The primary exposure was social media use frequency (Low: no use to few times per week; Moderate: about once per day; High: several times per day to >once per hour). The primary outcome was self-reported sadness or hopelessness. Sleep duration was dichotomized (Sufficient: 8-9 hours; Insufficient/Excessive: <8 or ≥10 hours). In complete case analyses, survey-weighted logistic regression models (adjusted for age, sex, race/ethnicity, household adult support and academic performance, with or without sleep duration) were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Effect modification by sleep duration was assessed using stratified adjusted models and testing sleep duration by social media use frequency interaction terms. Results: Social media use was reported as low by 6.0 % of students, moderate by 13.8%, and high by 80.2%. Overall, 40% of students reported sadness or hopelessness, and 78.9% reported insufficient or excessive sleep. Compared to moderate social media use, low social media use was not associated with lower or higher odds of sadness or hopelessness (AOR = 0.96; 95% CI: 0.75, 1.23; p = 0.734), while high social media use was significantly associated with higher odds of sadness or hopelessness (AOR 1.62; 95% CI 1.29-2.05; p < 0.001). In stratified analyses, among students with sufficient sleep (8-9 hours), neither low social media use (AOR = 0.69; 95% CI: 0.34, 1.39; p = 0.290) nor high social media use (AOR = 1.67; 95% CI: 0.93, 3.00; p = 0.082) were significantly associated with sadness or hopelessness compared to moderate social media use. Among students with insufficient or excessive sleep (<8 or ≥10 hours), high social media use was significantly associated with increased odds of sadness or hopelessness (AOR = 1.60; 95% CI: 1.24, 2.08; p < 0.001) while low social media use was not associated with sadness or hopelessness (AOR = 1.02; 95% CI: 0.74, 1.40; p = 0.911). The interaction term between social media use and sleep duration was not statistically significant (p = 0.193). Conclusion: High social media use frequency is significantly associated with increased odds of persistent sadness or hopelessness among U.S. adolescents. The results suggest that public health interventions should focus on reducing high social media use and promoting sufficient sleep hygiene. Longitudinal studies with more nuanced measures of digital engagement and mental health measures are needed to establish causal relationships and inform evidence-based interventions. Keywords: adolescent mental health, social media, sleep duration, YRBS, sadness, hopelessness