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Cited by 511Impact of Technology on AdolescentsChild Development and Digital TechnologyChild and Adolescent Psychosocial and Emotional Development

Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth.

Open access
Riehm, Kira E., Feder, Kenneth A., Tormohlen, Kayla N., Crum, Rosa M., Young, Andrea S., Green, Kerry M., Pacek, Lauren R., La Flair, Lareina N. +1 more·2019·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2019.2325PMC PMC6739732
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Abstract

To assess whether time spent using social media per day is prospectively associated with internalizing and externalizing problems among adolescents.

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2019.2325

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 17 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    In unadjusted analyses, spending more than 30 minutes per day on social media, compared with no use, was associated with increased risk of internalizing problems alone.

    “In unadjusted analyses, spending more than 30 minutes of time on social media, compared with no use, was associated with increased risk of internalizing problems alone (Յ30 minutes: relative risk ratio [RRR], 1.30; 95% CI, 0.94-1.78;>30 minutes to Յ3 hours: RRR, 1.89; 95% CI, 1.36-2.64;>3 to Յ6 hours: RRR, 2.47; 95% CI, 1.74-3.49;>6 hours: RRR, 2.83; 95% CI, 1.88-4.26)”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was no statistically significant interaction between social media use and sex for internalizing, externalizing, or comorbid problems.

    “We observed no statistically significant interaction between social media use and sex for internalizing (F 4,96 = 0.84, P = .50),externalizing (F 4,96 = 0.32, P = .86),or comorbid problems (F 4,96 = 0.73, P = .57).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was a significant linear trend in the coefficients for internalizing problems as time on social media increased.

    “We observed a significant linear trend in the coefficients for both internalizing (F 1,99 = 8.86, P = .004)”
    Quote in the paperSubstantial claim
  • Findingown data

    In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with comorbid internalizing and externalizing problems.

    “and comorbid internalizing and externalizing problems (>3 to Յ6 hours: RRR, 2.01; 95% CI, 1.51-2.66;>6 hours: RRR, 2.44; 95% CI, 1.73-3.43)”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no association between time on social media and externalizing problems in the linear trend test.

    “In contrast, we observed no association for externalizing problems (F 1,99 = 2.25, P = .14).”
    Quote in the paperSubstantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 19
  • The quote only partly states this claim. 2

  • May combine two claims.

    Study design and conductown data

    The study measured overall time spent on social media, not platform-specific or nature of use, which may limit the findings.

    “A limitation of our study is that we measured overall time spent on social media; prior studies [30][31][32] have found that social media use may be positively or negatively associated with mental health depending on which platforms are used and how.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [30] 30. Seabrook EM, Kern ML, Rickard NS. Social networking sites, depression, and anxiety: a systematic review. JMIR Ment Health. 2016;3(4): e50. doi:10.2196/mental.5842 source
    • cites [31] 31. Baker DA, Algorta GP. The relationship between online social networking and depression: a systematic review of quantitative studies. Cyberpsychol Behav Soc Netw. 2016;19(11):638-648. doi:10.1089/cyber.2016.0206 source
    • cites [32] 32. Ilakkuvan V, Johnson A, Villanti AC, Evans WD, Turner M. Patterns of social media use and their relationship to health risks among young adults. J Adolesc Health. 2019;64(2):158-164. doi:10.1016/j. jadohealth.2018.06.025 source

  • May combine two claims.

    Premisecitation

    Numerous cross-sectional studies and a limited number of longitudinal studies suggest that high levels of social media use are associated with internalizing problems, including depressive and anxiety symptoms, although results are not entirely consistent.

    “Numerous cross-sectional studies and a limited number of longitudinal studies suggest that high levels of social media use are associated with internalizing problems, including depressive and anxiety symptoms, [3][4][5][6] although results are not entirely consistent.7”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [3] 3. Zink J, Belcher BR, Kechter A, Stone MD, Leventhal AM. Reciprocal associations between screen time and emotional disorder symptoms during adolescence. Prev Med Rep. 2019;13:281-288. doi:10.1016/j.pmedr.2019.01.014 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [4] 4. McCrae N, Gettings S, Purssell E. Social media and depressive symptoms in childhood and adolescence: a systematic review. Adoles Res Rev. 2017;2(4):315-330. doi:10.1007/s40894-017-0053- 4 source

      The review reports an association between social media use and depressive symptoms, drawing on predominantly cross-sectional studies and some short longitudinal studies (p. 1); its cross-sectional and longitudinal results also vary (pp. 7–8). It does not establish a general association between high levels of social media use and anxiety symptoms: the anxiety finding on p. 8 concerns participants with poorer friendships who used the internet for purposes other than communication. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [5] 5. Primack BA, Swanier B, Georgiopoulos AM, Land SR, Fine MJ. Association between media use in adolescence and depression in young adulthood: a longitudinal study. Arch Gen Psychiatry. 2009;66 (2):181-188. doi:10.1001/archgenpsychiatry.2008.532 source

  • May combine two claims.

    Premisecitation

    The PATH study is a nationally representative, longitudinal cohort of adolescents.

    “We used data from the Population Assessment of Tobacco and Health (PATH) study, which is a nationally representative, longitudinal cohort of adolescents.15”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] 15. Hyland A, Ambrose BK, Conway KP, et al. Design and methods of the Population Assessment of Tobacco and Health (PATH) Study. Tob Control. 2017;26(4):371-378. doi:10.1136/tobaccocontrol-2016- 052934 source

      The PATH Study Design Features section describes PATH as a national longitudinal cohort with a nationally representative sample that includes 13,651 youths aged 12–17. The claim captures its adolescent participants but describes the study as a cohort of adolescents, omitting the 32,320 adults who were also in the cohort. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study produced mixed results regarding the possible moderating effect of sex.

    “Furthermore, a previous study 4 produced mixed results regarding the possible moderating effect of sex.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] 4. McCrae N, Gettings S, Purssell E. Social media and depressive symptoms in childhood and adolescence: a systematic review. Adoles Res Rev. 2017;2(4):315-330. doi:10.1007/s40894-017-0053- 4 source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisereasoning

    The concern that studies on technology use and well-being are limited by publication bias is legitimate.

    “Some researchers have raised concerns that studies on technology use and well-being are limited by publication bias.36 We believe that this is a legitimate concern given that many studies on this topic, including the present study, are secondary analyses of data not collected for the purpose of studying social media.36”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] 36. Orben A, Przybylski AK. The association between adolescent well-being and digital technology use. Nat Hum Behav. 2019;3(2):173-182. doi:10.1038/s41562-018-0506-1 source

      The paper describes secondary analyses of large-scale social datasets and warns that researchers can selectively report analytical paths (p. 3); it also says small effects are easily publishable (p. 4). These passages support a concern about biased reporting, but the paper does not specifically identify publication bias across studies as the limitation. (LLM, conf=0.79)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    To avoid improperly adjusting for mediating variables, covariates measured at wave 1 were used instead of wave 2.

    “To ensure that we did not improperly adjust for mediating variables, 22 we used covariates measured at wave 1 instead of wave 2.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [22] 22. Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology. 2009;20 (4):488-495. doi:10.1097/EDE.0b013e3181a819a1 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    During wave 3, of the sample of 6595 adolescents, 611 (9.1%) reported internalizing problems alone, 885 (14.0%) reported externalizing problems alone, 1169 (17.7%) reported comorbid internalizing and externalizing problems, and 3930 (59.3%) reported no or low problems.

    “During wave 3, of the sample of 6595 adolescents, 611 (9.1%) reported internalizing problems alone, 885 (14.0%) reported externalizing problems alone, 1169 (17.7%) reported comorbid internalizing and externalizing problems, and the remaining 3930 (59.3%) reported no or low problems.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    During wave 2, 1125 adolescents (16.8%) reported no social media use, 2082 (31.8%) reported 30 minutes or less, 2000 (30.7%) reported more than 30 minutes to 3 hours or more, 817 (12.3%) reported more than 3 hours to 6 hours or less, and 571 (8.4%) reported more than 6 hours of use per day.

    “During wave 2, a total of 1125 adolescents (16.8%) reported no social media use, 2082 (31.8%) reported 30 minutes or less, 2000 (30.7%) reported more than 30 minutes to 3 hours or more, 817 (12.3%) reported more than 3 hours to 6 hours or less, and 571 (8.4%) reported more than 6 hours of use per day.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S4 (based). The quote only partly states this claim.

    Findingown data

    There was a significant linear trend in the coefficients for comorbid internalizing and externalizing problems as time on social media increased.

    “and comorbid problems (F 1,99 = 35.16,P < .001)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    If adolescents using social media for more than 30 minutes per day had instead used it for 30 minutes or less, there would have been 9.4% fewer high internalizing problem cases and 7.3% fewer high externalizing problem cases.

    “In fact, the PAFs obtained in our study suggest that if adolescents using social media for more than 30 minutes per day had instead used it for 30 minutes or less, there would have been 9.4% fewer high internalizing problem cases and 7.3% fewer high externalizing problem cases.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: A causal effect of social media use on mental health problems.
    • The authors state this as an assumption: No confounding in the PAF analysis.

  • The quote only partly states this claim.

    Findingown data

    In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone.

    “In adjusted analyses, use of social media for more than 3 hours per day compared with no use remained significantly associated with internalizing problems alone (>3 to Յ6 hours: RRR, 1.60; 95% CI, 1.11-2.31;>6 hours: RRR, 1.78; 95% CI, 1.15-2.77)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    It remains possible that mental health problems are prospectively associated with social media use, but we could not examine this in the present study because of data limitations.

    “Sixth, it remains possible that mental health problems are prospectively associated with social media use, but we could not examine this in the present study because of data limitations.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data for analyses were weighted to be representative of 12- to 15-year-old adolescents living in the United States in 2013 to 2014.

    “Data for analyses were weighted to be representative of 12to 15-year-old adolescents living in the United States in 2013 to 2014.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Adolescents self-reported the exposure and outcome, which may inflate the observed associations.

    “First, adolescents self-reported the exposure and outcome, which may inflate the observed associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Social media use continues to change rapidly over time; the data may not reflect current trends.

    “Fourth, social media use continues to change rapidly over time; although our data were collected relatively recently, they may not reflect current trends.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The analyses adjusted for mental health problems measured before the exposure, which reduces the influence of reverse causality.

    “Unlike a prior study, 16 we adjusted for mental health problems measured before the exposure, which is critical for reducing the influence of reverse causality.”
    • Also stated in: § Discussion · hedged
      “This association remained significant after adjusting for demographics, past alcohol and marijuana use, and, most importantly, a history of mental health problems, which mitigates the possibility that reverse causality explains these findings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] 16. VanderWeele TJ, Jackson JW, Li S. Causal inference and longitudinal data: a case study of religion and mental health. Soc Psychiatry Psychiatr Epidemiol. 2016;51(11):1457-1466. doi:10.1007/ s00127-016-1281-9 source

  • Classified as probably not a substantial claim.

    Premisenone given

    An increasing body of literature suggests that social media use is associated with mental health problems in adolescence.

    “An increasing body of literature suggests that social media use is associated with mental health problems in adolescence.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Of the 7595 adolescents who completed all 3 PATH survey waves, 1000 (13.2%) were excluded because they were missing data on at least 1 variable required for this analysis; the remaining 6595 adolescents comprised the analytic sample.

    “Of these, 1000 adolescents (13.2%) were excluded because they were missing data on at least 1 variable required for this analysis; the remaining 6595 adolescents comprised the analytic sample (eFigure in the Supplement).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Although the study design mitigates the possibility of reverse causality, some residual confounding from imprecise measurement of prior mental health problems may have been present.

    “Fifth, although our study design mitigates the possibility of reverse causality, some residual confounding from imprecise measurement of prior mental health problems may have been present.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The validity of self-reported time spent on social media in the PATH study is unknown.

    “Third, the validity of self-reported time spent on social media in the PATH study is unknown.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Results of analyses using multiple imputation methods did not differ appreciably from the main analyses.

    “Results of analyses using multiple imputation methods did not differ appreciably from the main analyses (eTable 2 in the Supplement).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    It is possible that the observed associations were an artifact of unmeasured confounding.

    “Seventh, it is possible that the observed associations were an artifact of unmeasured confounding.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Many studies on this topic, including the present study, are secondary analyses of data not collected for the purpose of studying social media.

    “many studies on this topic, including the present study, are secondary analyses of data not collected for the purpose of studying social media.36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] 36. Orben A, Przybylski AK. The association between adolescent well-being and digital technology use. Nat Hum Behav. 2019;3(2):173-182. doi:10.1038/s41562-018-0506-1 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The weighted response rate for adolescents during wave 1 was 78.4%, and the weighted retention rate during wave 3 was 83.3%.

    “The weighted response rate for adolescents during wave 1 was 78.4%, and the weighted retention rate during wave 3 was 83.3%.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] 17. US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study. Ann Arbor, MI: PATH; 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Mental health problems were measured with a self-report questionnaire rather than a diagnostic interview.

    “Second, we measured mental health problems with a self-report questionnaire rather than a diagnostic interview.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The GAIN-SS is a screening measure intended to identify a probable mental health disorder and assess symptom severity, and it has been validated in adolescents.

    “The GAIN-SS is a screening measure intended to identify a probable mental health disorder and assess symptom severity; it has been validated in adolescents 19”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] 19. McDonell MG, Comtois KA, Voss WD, Morgan AH, Ries RK. Global Appraisal of Individual Needs Short Screener (GSS): psychometric properties and performance as a screening measure in adolescents. Am J Drug Alcohol Abuse. 2009;35(3): 157-160. doi:10.1080/00952990902825421 source
26 of 26

  • The authors state this as an assumption.

    A causal effect of social media use on mental health problems.

    “assuming a causal effect of social media use and no confounding-both strong assumptions.”

  • The authors state this as an assumption.

    No confounding in the PAF analysis.

    “On the basis of our adjusted model assuming no confounding”
    “assuming a causal effect of social media use and no confounding-both strong assumptions.”

  • The paper relies on this without support.

    Evidence of the association between social media use and mental health problems in nationally representative samples is scarce, and little is known about whether reducing time spent on social media might influence the prevalence of mental health problems at a national level.

    “However, evidence of this association in nationally representative samples is scarce, and little is known about whether reducing time spent on social media might influence the prevalence of mental health problems at a national level.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Results from studies with shorter follow-up periods and younger samples suggest that the impact of social media on mental health may be stronger earlier in adolescence, potentially decreasing as individuals grow older.

    “For instance, results from studies with shorter follow-up periods and younger samples [17,18] suggest that the impact of social media on mental health may have a stronger influence earlier in adolescence, potentially decreasing as individuals grow older.”

    From Long-Term Consequences of Time Spent on Social Media in Adolescence on Mental Health in Young Adulthood: A Cohort Study From Sweden. (2026) · cites this paper as [18]

    The Participants and Discussion sections describe a younger adolescent sample, a one-year follow-up, and a prospective association between social media use and mental health problems. The paper does not report that this association is stronger earlier in adolescence or decreases with age; its findings cannot establish that age trend. Page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In a cohort of 6,595 U.S. adolescents, social media use is associated with increased risk of comorbid internalizing and externalizing problems but not with externalizing symptoms alone.

    “Among a cohort of 6,595 U.S. adolescents, Riehm et al. (2019) found that although social media use is associated with increased risk of comorbid internalizing and externalizing problems, it shares no association with externalizing symptoms alone.”

    From Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review (2022) · cites this paper as Riehm et al., 2019

  • Other studies have reported prospective associations between social media use and mental health problems.

    “However, other studies have reported prospective associations between social media use and mental health problems [17–19].”

    From Long-Term Consequences of Time Spent on Social Media in Adolescence on Mental Health in Young Adulthood: A Cohort Study From Sweden. (2026) · cites this paper as [18]

  • Adolescents who spend more than three hours per day on social media are significantly more likely to experience mental health issues, particularly increased anxiety and depression.

    “Research also suggests that adolescents who spend excessive time on social media (more than three hours per day) are significantly more likely to experience mental health issues, particularly increased symptoms of anxiety and depression [4].”

    From The Impact of Social Media &amp; Technology on Child and Adolescent Mental Health (2025) · cites this paper as [4]

  • Studies indicate that storing guns safely, for example in a safe or lockbox, is linked to fewer firearm suicide attempts among at-risk adolescents.

    “Research has shown that safe storage practices (eg, keeping guns in a safe or a lockbox) are associated with fewer firearm suicide attempts among adolescents at risk for suicide.25”

    From Trends in the Incidence and Lethality of Suicidal Acts in the United States, 2006 to 2015 (2020) · cites this paper as [25]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Results text assigns externalizing estimates to internalizing problems

    Minor

    The Results text describes the estimates of 1.22 and 1.40 as risks of internalizing problems alone. Table 2 instead lists those values for adjusted externalizing problems alone; its adjusted internalizing estimates for the same use categories are 1.60 and 1.78.

1 of 1

Cites

Flagged first, then by citations

2 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration Center for Tobacco Products, 2017, Population Assessment of Tobacco and Health (PATH) Study

Cited by

Sorted by citations

Related

Authors
Riehm, K. E., Feder, K. A., Tormohlen, K. N., Crum, R. M., Young, A. S., Green, K. M., Pacek, L. R., La Flair, L. N., & Mojtabai, R.
Affiliations
  • Johns Hopkins University (US)
  • University of Maryland, College Park (US)
  • Duke University (US)
  • Washington State Department of Health, Olympia
Corresponding author
Riehm, Kira E.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2019-12-01
Volume
76
Issue
12
Pages
1266
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2019.2325
PMC
PMC6739732
OpenAlex
W2972459530
Semantic Scholar
e7f11d4a6b31685c0d541592b17e545ecd6342f7
Cited by
511
References
40
Citations by year
2026: 103 · 2025: 100 · 2024: 88 · 2023: 64 · 2022: 54 · 2021: 55 · 2020: 43 · 2019: 4
FWCI
78.36
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research
  • National Institute on Drug Abuse (K23DA044288, K01DA043413, F31DA044699, T32DA007292)
Topics
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Education › Child Development and Digital Technology
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
social media use, adolescents, internalizing problems, externalizing problems, adolescent mental health, screen time, attributable proportion, Population Assessment of Tobacco and Health Study, longitudinal cohort, substance use, gender identity, sexual minority youth, peer victimization, bullying victimization, academic performance
MeSH terms
Adolescent, Adolescent Behavior, Mental Disorders, Behavioral Symptoms, Child, Female, Health Surveys, Humans, Longitudinal Studies, Male, Risk, Time Factors, United States, Social Media

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