Five years ago, I wrote a column about how parents could tell the difference between normal teenage mood swings and possible mental illness. I said then that most depression in teenagers was a sign of psychiatric disease. Since then, I’ve come to think that most teen depression now is caused not by biology, but by our culture, specifically by what one organization calls a new “public health crisis of the digital age.”
Twice as many teenagers now have depression as a generation ago. This high rate of depression has no biological explanation. Instead, it appears to be caused by engagement with social media on smartphones.
It’s now clear that there’s a strong association between use of social media and depression in adolescents. The more depressed adolescents are, the more they use social media; the more they use social media, the more depressed they are. Which causes which is unclear, but whatever the cause, it’s a vicious cycle.
There is no other factor that has changed notably in the last decade other than the prevalence of smartphones, digital technology, and social media to explain the extraordinary increase in the frequency of depression among adolescents. Right now about 22 percent of teenagers exhibit multiple symptoms of depression. This increased depression is highest in those with three or more hours per day of digital technology usage—and that data is self-reported, probably not capturing the true rates, which is likely higher.
These numbers are concerning. The lifetime prevalence rate of a full clinical depressive episode in the overall U.S. population is 5 to 10 percent. In adolescents, that number has now doubled in a generation. There is no biological explanation; instead, a major cultural change should be suspected.
The average adolescent sends about three thousand text messages monthly, or about one hundred daily. This activity does not include equal or more frequent messaging on social media, such as Snapchat or Instagram. Most adolescents sleep with their phones, and this constant interaction goes on often past midnight and into their sleeping hours—and they might well also be awakened early in the morning by friends who are texting or chatting.
According to the CDC, 1,769 teenagers committed suicide in 2015, up from 1,386 in 2010. This is an increase of almost 20 percent. Again, causality can’t be proven, just as one cannot do so with cigarette usage and lung cancer. But the association is there, and there are a number of well-known cases where cyberbullying led to suicide. Laws enacted in some states about that issue have had little effect.
Teens realize that there is a problem with social media, but they can’t be expected to provide the solutions. Nor should their natural resistance preclude attempts at limiting social media usage. In a survey in the U.K. of some 1,500 teens and young adults, the respondents reported increased depression and anxiety symptoms after using four of the five main social media networks, in order from worst to best: Instagram, Snapchat, Facebook, Twitter, and YouTube. YouTube was the only network that was associated with overall positive results for mental health outcomes. Everything else lowered the sense of well-being and mental health of teenagers, with Snapchat and Instagram being the worst.
The Bigger Picture
Let’s back up here to understand the psychological context. With adolescence, we face a major biological and social problem. Biologically, adolescents are pseudo-adults, physically as large as adults, and sexually mature. Yet their brains are only half-developed, with about a decade left of myelination—completion of neuronal communication—of important parts of the brain like the frontal lobe, which controls impulsivity and judgment.
In a way, they have the worst of both worlds: the bodies of adults with still child-like brains. But in fact they are fully neither. Their bodies still have maturation and growth ahead of them, and their brains are in fact more developed than children’s brains: they are capable of abstract reasoning and can rationalize their thoughts and behavior quite well.
These are the physical and biological aspects of the adolescent problem. The social aspect comes in to create a dangerous mix. I refer now to the social norms of the U.S. and other Western cultures. In the West, adolescent rebellion is accepted, and even supported to some degree. The thinking is that rebellion in adolescence can immunize against more problems later in life, that the experimentation with sex and drugs/alcohol can lead to more mature decisions later.
These days, marijuana is available and increasingly normalized in our society, a change that adolescents have embraced strongly. Estimates suggest that marijuana use is increasing and beginning to approach frequency of alcohol use in adolescence (about 40 percent frequency for marijuana and 60 percent for alcohol by the end of high school). Studies show that exposure to marijuana before age sixteen is associated with long-term cognitive impairment years later. Marijuana isn’t benign, just as alcohol isn’t. Being legal is not the same thing as being safe.
And yet many parents appear to tolerate use of marijuana and alcohol by adolescents, just as they also appear to tolerate early and frequent sexual activity. Again, about one-half of adolescents have had sexual intercourse. About 15 percent are reported to have four or more sexual partners before age eighteen. Given the availability of smartphone technology, much of this sexual activity is facilitated by texting and social media, especially Snapchat and Instagram. “Sexting” has become rampant, even though it is illegal. Estimates suggest that about 20 percent of adolescents engage in sexting. District attorneys decline to prosecute such adolescents in general, leaving little risk to such behavior.
A key aspect to this increased sexuality is access to internet pornography, which is changing how adolescent boys and girls understand sex. The new Internet-based sex culture is influencing boys to demand porn-like sex, and it is causing girls to allow it. About one-third of all Internet activity involves pornography, and much of social media directs teenagers towards a hypersexual culture.
Almost three-quarters of Snapchat photos are selfies, mostly by teen girls and young women, typically in sexualized poses. About 1000 selfies are posted on Instagram every ten seconds. Such new cultural norms leads to lowered self-esteem and anxiety and depression related to how one’s body looks, or how successfully one conforms to the new norms of an overly sexualized culture, driven by a huge money-making industry.
How Parents Can Respond
In short, I have nothing but bad news to offer. It used to be we’d only have to worry about biological diseases, like bipolar illness or recurrent unipolar depression. Those conditions still happen, and the best indicator that they might be relevant is family genetics for those illnesses.
But today, the rates of adolescent depression and drug abuse and sexual impulsivity are much higher than can be explained by known psychiatric illnesses. Instead, a massive social experiment is happening, with its harms obvious, but with a major part of the economy dependent on its continuation. Like the tobacco industry, the sellers of digital technology look away and deny the harms caused by social media and smartphones.
Parents can’t afford to look away, but most do. I write as a clinical psychiatrist who specializes in depression and bipolar illness, but also as a father. I know this is difficult for parents, but there are potential solutions.
Adolescents will grow and mature. They can realize what is in their best interest as they get into late adolescence, but they’ll need more control and support in their middle adolescence years, especially ages fourteen to sixteen. Delaying smartphone use and social media until high school, preferably after age sixteen, can help.
Parents need to set new standards, and parents also should demonstrate control of their own smartphone and social media usage. We know children learn by example, and unfortunately some surveys show that social media use in adults in their thirties and forties is similar to usage among teenagers.
Parents of teenagers with anxiety or depression of any kind should institute strict restrictions on use of digital technology—and better yet, such social media usage should be stopped altogether. If not ended completely, less than two hours daily should be the goal, and overnight usage should be prohibited.
Smartphones should be treated like alcohol, something that is best managed in adulthood, with limitations beforehand. The same approach holds, in my view for marijuana usage and for sexual activity. Most adolescents aren’t psychologically mature enough to engage in sexual behavior responsibly, just as most cannot drink responsibly. Some may debate whether marijuana can be safely used at any age, but all would agree that it is not proven safe in adolescence.
It’s not easy to set limits on adolescents, especially in contemporary Western culture. But limits are especially needed for those with depression, anxiety, and mood swings. There are few resources for parents, but one new option is Culture Reframed, a nonprofit website founded by Dr. Gail Dines, a sociologist and expert on pornography, aimed at “the public health crisis of the digital age.” Focused on sexuality, but relevant to social media and other aspects of digital culture, this group has provided a program to help parents understand some of these problems and get help in talking to and protecting their children.
In addition to tight limits on social media and smartphone usage, I would encourage individual psychotherapy as soon as possible in adolescents with any depression or mood swings, which can help them make the changes needed in their use of digital technology, and in exploring their attitudes toward drugs and sexuality. Parents need as much help as they can get. Psychotherapists can serve as important allies to parents in their struggle to help Generation Z enter a world in which no one has lived before.
In the era of Snapchat depression, parents are faced with an old world that hasn’t gone away, and a new one that has been thrust upon them. The old world still exists—so pay attention to depression and mood swings as possible psychiatric disease if there is a family genetic history of such illness.
But a new world has arisen and we need to pay attention to digital technology use, limit it, and push back on drug usage and sexual behavior. Depression and mood swings in adolescents now are likely to be caused by these factors much more so than by psychiatric illness.
Nassir Ghaemi is a professor of psychiatry at the Tufts School of Medicine.