The complexities of social media's impact on psychological well-being are not straightforward as a cautionary label may imply.
Among specialists, doubts persist about the precise function of social media in the psychological well-being of kids and teens. Authors of a comprehensive review of research on social media and mental health state that critical data is still absent to determine whether prevention plans and interventions will succeed.
In the research paper, published on Monday in the medical journal JAMA Pediatrics, researchers examined close to 150 studies on the relationship between social media and adolescent mental health. They discovered a general link between anxiety and sadness in adolescents and the time they spend on social media platforms, as well as a correlation between the activities and content they interacted with. However, the degree of impact varied enough to propose that the findings shouldn't be generalized to the entire population.
The researchers found that only a few studies assessed the relationship between social media usage and adolescents who were struggling with mental health issues at clinically significant levels — those needing health services or having an active diagnosis, for instance — which further complicates the findings.
"There's a 'real risk that we are incorrectly generalizing results from the general population to young people with mental health issues,'" wrote the study authors, from the University of Cambridge in the United Kingdom and Stellenbosch University in South Africa.
"In a world increasingly saturated by digital technology, we cannot afford to develop prevention programs, interventions, and regulations without knowing that they work for everyone, especially those who are most vulnerable."
Another examination of existing research, published by National Academies of Sciences, Engineering, and Medicine in December, also raised key questions that still need answers.
"There is not enough evidence to state that social media causes changes in adolescent health at the population level," according to a news release from the independent organization about the report. And "despite many years of research, the evidence clarifying precisely how social media impacts health is limited."
While the science suggests a connection between social media and mental health, there is often a lack of clarity on whether social media is influencing an individual's mental health or whether an individual's mental health is influencing their use of social media, said Dr. Sandro Galea, chair of an ad-hoc National Academies committee that authored the analysis of research and dean of the Boston University School of Public Health.
Future research should focus on tracking trends over time — following the mental health of the same children before and after exposure to social media to see what effects it has — and diving deeper into more specific measures that capture how social media is used, he said.
For Murthy, the urgency of the youth mental health crisis is crucial — and there's enough evidence to act now. In a New York Times op-ed, Murthy advocated for a warning label that would "regularly remind parents and adolescents that social media has not been proven safe" among other interventions.
Murthy cited two key reports in support of a warning label: one study from 2019 that found that adolescents who spent more time on social media faced increased risk for anxiety and depression and one survey from 2022 in which nearly half of adolescents said that social media negatively affects their body image.
"One of the most important lessons I learned in medical school was that in an emergency, you don't have the luxury to wait for perfect information. You assess the available facts, you use your best judgment, and you act quickly," Murthy wrote in his essay. "The mental health crisis among young people is an emergency — and social media has emerged as an important factor."
Public health often lacks ‘perfect’ data
Many experts agree that the surgeon general is initiating an essential discussion and that the need for more information should not lead to inaction, but a social media warning label will require careful language and implementation. It will also require Congress to act to make it a reality.
"The Surgeon General is identifying something that he sees as a challenge to public health and considering ways to address the challenge. Through that lens, I think he's doing exactly what a surgeon general should do," Galea said. "Public health action, not infrequently, has to happen absent complete or perfect data."
The National Academies committee specifically recommended against a social media ban. Despite potential hazards — such as unhealthy social comparisons and hindering other essential healthy behaviors like sleep, exercise, and studying — social media can also benefit young people by helping to foster connections with friends and family, and online support communities.
But there is an essential distinction between benefits and safety, Murthy said Friday on The Daily, a podcast from the New York Times.
"It's important to look at the research question broadly. What we're trying to understand first and foremost is the answer to the question parents are asking us: 'Is social media safe for my kids?' And if you ask researchers, 'What does data tell us about safety? Where is the data that tells us these platforms are safe?' That data is not there. So there's not evidence of safety. There is growing evidence of harm."
"There are certain benefits, but getting some benefits does not justify forcing kids to endure significant harm."
Nevertheless, social media is not the same as cigarettes. Smoking has a much stronger and more direct link with negative health effects, and abstinence is not the ultimate goal with social media. Instead, a social media warning label should be more like those on bicycles and motor vehicles, said Pamela Wisniewski, an associate professor in human-computer interaction at Vanderbilt University, whose research has focused on the relationship between social media, privacy, and online safety for adolescents.
"The important thing is to devise strategies that equip the younger generation with decision-making power and avenues to optimize the perks of online platforms, all while reducing potential hazards, compared to enforcing stringent and invasive policies born out of fear," she stated. The primary objective should be to foster responsible use rather than solely emphasizing the perils and harms.
It's crucial for goods that kids engage with to pass safety inspections, and a warning on social media could convey a straightforward message that there are numerous safety loopholes, according to Dr. Jenny Radesky, Joint Medical Director of the American Academy of Pediatrics Center of Excellence on Social Media and Youth Mental Health.
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"We assume that baby food is tested for germs, toys are tested for toxic paint, and there are safety standards for everything from baby cots to automobiles. However, these safety guidelines that prioritize the well-being of our youth in digital products are absent in the U.S.," she explained.
However, warning labels can be short and nuanced concepts can easily get overlooked in the "cacophony of the internet," Radesky noted. "Adequate discussions to promote healthy media consumption take time and need to be ongoing."
For the Surgeon General, a warning label is part of a comprehensive approach to reduce the dangers that social media imposes on American youth. Substantial design modifications by the platforms and legislation to support these changes continue to be the main focus.
"It's essential to emphasize that, on its own, a warning label won't render social media safe for young individuals," he wrote. "These issues aren't the result of a lack of willpower or parenting; they're the outcome of releasing potent technology without putting in place necessary safety measures, transparency, or accountability."
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The research paper published in JAMA Pediatrics and the report from National Academies of Sciences, Engineering, and Medicine both emphasize that there is not enough evidence to definitively say that social media causes changes in adolescent mental health at a population level.
Despite the lack of conclusive evidence, Dr. Sandro Galea, chair of an ad-hoc National Academies committee, stated that while the science suggests a connection between social media and mental health, there is often a lack of clarity on whether social media is influencing an individual's mental health or whether an individual's mental health is influencing their use of social media.
