Clinical Review
Interplay between social media use, sleep quality, and mental health in youth: A systematic review

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Summary

Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16–25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality and negative mental health (n = 16) were found. In longitudinal studies, frequent social media use was a risk factor for both poor mental health (n = 6) and poor sleep outcomes (n = 5). Some studies showed sleep quality mediating the relationship between social media use and negative mental health outcomes in youth. Overall, included evidence links excessive social media use to poor sleep quality and negative mental health in youth. Given the public health implications of sleep problems, excessive social media use warrants further investigation to clarify the directionality and strength of their associations with poor sleep quality and negative mental health outcomes.

Introduction

Restful sleep is necessary for optimal physical and mental health. However, insufficient sleep is a prevalent and pressing health issue in today's fast-paced connected society [1]. Sleep loss generally refers to sleep duration shorter than the seven to 9 h necessary for restful sleep, whereas sleep disturbance refers to poor sleep quality that hinders daily functioning [2]. Poor sleep is associated with excessive daytime sleepiness, depressed mood, and difficulty concentrating [3], as well as more insidious, long-term outcomes such as chronic disease [2]. In Canada, 32% of adults (aged 18–64) reported sleeping for fewer than 7 h per night [4] and approximately 70 million adults in the US and around 45 million in Europe are suffering from a chronic sleep disorder [1,[5], ∗[6], [7]]. This is a particularly important issue for youth, as sleep disruption has a negative effect on psychosocial health and may promote risky behaviors such as abuse of nicotine and marijuana [8]. However, the current literature suggests links between sleep hygiene and psychological issues to be bidirectional [9]. Thus, the relationship between poor sleep and emotional and behavioral difficulties in youth should be further investigated.

Recently, there has been a growing body of literature surrounding social media use and its effects on sleep quality and mental health in youth. Social media are defined as Internet-based applications that facilitate exchange and exploration of user-generated content [10,11]. Social media and other internet-based technologies are a pervasive part of today's connected world with the greatest adopters being young adults, 60% of whom report using screens within an hour before bedtime [12,13]. According to a recent report, 81% of youth report use social media [14]. By virtue of being interactive, social media platforms have their benefits (e.g., spreading and engaging in healthy practices) and risks (e.g., sedentary behavior, longer sleep latency, depression) [15]. Adolescence is characterized by a need for identity development and peer acceptance, which social media currently plays a role in facilitating, often at the expense of sleep and sound mental health [15,16].

The current body of evidence on the directionality and relationships between social media use, mental health, and sleep is inconclusive. It has been suggested that the amount of time spent online can have bidirectional effects on depressive symptoms and attention deficit hyperactivity disorder (ADHD), and this risk is particularly heightened in those with pre-existing poor mental health [17]. Moreover, it has been suggested that social media use closer to bedtime is associated with increased cognitive arousal, leading to delayed sleep latency and difficulties maintaining sleep [18]. Several hypotheses have been posed regarding this relationship, including time spent online “displacing” time spent on sleep and face-to-face interactions, compensating for lack of social skills and inability to sleep, and an obligation to always be available [18,19]. Youth are most prone to peer pressure as they are still developing a sense of self-regulation as they mature. As such, they may be at higher risk for adverse effects of social media use, notably poorer sleep and mental health outcomes [20,21]. Therefore, knowing the effects of social media use on sleep and mental health is important for both informing health policies and personal decisions, as well as assessing social media as a facilitator for health improvement.

The objective of this systematic review was to describe the association between social media use, sleep quality, and mental health in youth. As a secondary objective, we also sought evidence on the role of these variables as mediators, moderators, or confounders of this relationship.

Section snippets

Protocol and registration

The protocol for this review was registered with the International Prospective Register of Systematic Reviews (Prospero; CRD42019127527) on March 5, 2019. This review follows the reporting guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [22].

Search strategy

We searched MEDLINE, PsychInfo, EMBASE, and Scopus electronic databases in February 2019 using a combination of controlled vocabulary and keywords, and the search was updated in November 2019.

Study selection

After removing duplicates, 1176 articles were identified from the four databases. Forty-three articles were selected for full-text screening, of which 33 met our inclusion criteria. An updated search was also conducted in which we identified one relevant article. Eight additional studies were identified through forwards and backwards citation tracing for a total of 42 included studies. An overview of our study selection process, along with reasons for exclusion, is outlined in the PRISMA

Discussion

This systematic review synthesized prior evidence on the interplay between social media use, sleep quality, and mental health in youth. In the 42 included studies, excessive internet use and mobile phone use were the most commonly examined forms of social media, with depression and anxiety being the most commonly assessed mental health outcomes. The findings of this review suggest an association between excessive social media use and poor mental health – specifically anxiety, depression, and

Conclusions

The current review examines the interplay between social media use, sleep quality and duration, and poor mental health. Despite heterogeneity in the included studies, longitudinal studies suggest poor sleep quality and frequent sleep disturbances may partially explain the association between excessive social media use and poor mental health outcomes. Cross-sectional studies, inherent in their design, cite more equivocal and multidirectional effects between the three health variables. Social

Conflicts of interest

The authors do not have any conflicts of interest to disclose.

Acknowledgments

The authors are grateful for Western Libraries for database access and would also like to thank Mrs. Marisa Tippett's assistance in literature search protocols.

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