The relationships between technology use and mental health have been a topic of many studies in psychology, sociology, anthropology, and medical science — especially since the mid-1990s, after the growth of the World Wide Web. Research into the negative effects of technology on mental health has explored “overuse” phenomena, commonly known as “digital addictions“, or “digital dependencies“.
These phenomena manifest differently in many societies and cultures. Some experts have investigated the benefits of moderate digital media use in various domains, including in mental health, and the treatment of mental health problems with novel technological solutions. The delineation between beneficial and pathological use of digital media remains unclear.
Is problematic technology use diagnosed as a mental disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not include diagnoses for problematic internet use, problematic social media use, and gaming disorder (commonly known as video game addiction), whereas the eleventh revision of the International Classification of Diseases (ICD-11) recognizes gaming disorder.
Experts are still debating how and when to diagnose these conditions. The use of the term addiction to refer to these phenomena and diagnoses is currently under question. Technology use and screen time have changed how children think, interact, and develop in positive and negative ways, but researchers are unsure about the existence of hypothesized causal negative effects of technology use on mental health.
Those links appear to depend on the individual and the platforms they use. Several large technology firms have made commitments or announced strategies to try to reduce the risks of excessive technology use.
The problem with the terminology for unhealthy technology use: dependence, addiction, or overuse?
Both positive and negative effects of technology on mental health have been investigated from many perspectives. There also are benefits of technology use in childhood and adolescent development. Still, researchers, clinicians, and the public express their concerns in regard to apparent compulsive behaviors of Internet users. Correlations between technology overuse and mental health problems become apparent.
Terminologies used to refer to compulsive technology use behaviors are not standardized or universally recognized. They include “digital addiction“, “digital dependence“, “problematic use“, or “overuse“, often delineated by the digital media platform used or under study (such as problematic smartphone use or problematic internet use).
Unrestrained use of technological devices may affect developmental, social, mental, and physical well-being and may result in symptoms akin to other psychological dependence syndromes, or behavioral addictions. The focus on problematic technology use in research, particularly in relation to the behavioral addiction paradigm, is becoming more accepted, despite poor standardization and conflicting research.
Internet addiction has been proposed as a diagnosis since the mid-1990s, and social media and its relation to addiction has been examined since 2009.
A 2018 Organisation for Economic Co-operation and Development (OECD) report noted the benefits of structured and limited Internet use in children and adolescents for developmental and educational purposes. It also showed that excessive Internet and technology use can have negative effects on their mental health and well-being. It noted an overall 40% increase in internet use in school-age children between 2010 and 2015, and that different OECD nations had marked variations in rates of childhood technology use, as well as differences in the platforms used.
The Diagnostic and Statistical Manual of Mental Disorders has not formally codified problematic technology use in diagnostic categories, but it deemed internet gaming disorder to be a condition for further study in 2013. Gaming disorder, commonly known as video game addiction, has been recognized in the ICD-11.
Why is the term ‘addiction’ not suitable when it comes to technology?
Different recommendations in the DSM and the ICD are due partly to the lack of expert consensus, the differences in emphasis in the classification manuals, as well as difficulties utilizing animal models for behavioral addictions. The utility of the term addiction in relation to overuse of technology has been a subject of criticism, in regard to its suitability to describe new psychiatric disorders.
Usage of the term has also been a subject for criticism for drawing parallels with substance use behaviors. Careless use of the term may cause more problems—both downplaying the risks of harm in seriously affected people, as well as overstating risks of excessive, non-pathological use of technology.
The evolution of terminology relating to excessive technology use to problematic use rather than addiction was encouraged by Panova and Carbonell, psychologists at Ramon Llull University, in a 2018 review. Due to the lack of recognition and consensus on the concepts used, diagnoses and treatments are difficult to standardize or develop.
Heightened levels of public anxiety around new media (including social media, smartphones, and video games) further obfuscate population-based assessments, as well as posing management dilemmas. Radesky and Christakis, the 2019 editors of JAMA Paediatrics, published a review that investigated “concerns about health and developmental/behavioral risks of excessive media use for child cognitive, language, literacy, and social-emotional development.”
Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may have a detrimental effect, in areas such as learning, family relationship dynamics, and overall development.
Problematic technology use and its negative effects on mental health
Though excessive technology use can have negative effects on mental health, causality has not been established; nuances and caveats published by researchers are often misunderstood by the general public, or misrepresented by the media. Females are more likely to overuse social media and males’ video games.
Following from this, problematic technology use may not be singular constructs and depends on the digital platform or specific activities (rather than an addiction to the digital medium).
What is the evidence for the negative effects of technology on mental health?
A 2019 systematic map of reviews suggested associations between some types of potentially problematic internet use and psychiatric or behavioral problems such as depression, anxiety, hostility, aggression, and attention deficit hyperactivity disorder (ADHD). The studies could not determine if causal relationships exist, reviewers emphasizing the importance of future prospective study designs.
While the overuse of technology has negative mental health effects, such as depressive symptoms, digital media may also improve mood in some situations. Symptoms of ADHD have been positively correlated with technology use in a large prospective study. The ADHD symptom of hyperfocus may cause affected people to overuse technology such as video games or online chatting.
Negative effects of social media use on mental health
A 2016 technical report by Chassiakos, Radesky, and Christakis identified benefits and negative effects on adolescent mental health regarding technology use. It showed that the manner of social media use was the key factor, rather than the amount of time engaged. A decline in well-being and life-satisfaction was found in older adolescents who passively consumed social media, but these were not apparent in those who were more actively engaged.
The report also found a U-shaped curvilinear relationship in the amount of time spent on social media, with the risk of depression increasing at both the low and high ends of internet use. A 2018 review into the Chinese social media platform WeChat found associations of self-reported mental health symptoms with excessive platform use.
However, the motivations and usage patterns of WeChat users affected overall psychological health, rather than the amount of time spent using the platform. In the United Kingdom, a study of 1,479 individuals aged 14–24 compared psychological benefits and problems for five large social media platforms: Facebook, Instagram, Snapchat, Twitter, and YouTube.
It concluded that YouTube was the only platform with a net positive rating “based on the 14 health and wellbeing-related questions“, and the other platforms measured had net negative ratings, Instagram having the lowest rating. The study identified Instagram as having some positive effects including self-expression, self-identity, and community. But it also found that these were outweighed by the negative effects, specifically on sleep, body image, and “fear of missing out”.
Negative effects of technology on adolescent mental health
A report published in Clinical Psychological Science in 2018 featured two cross-sectional surveys of 506,820 American high school students and found that the use of technology had associations with higher rates of depressive symptoms and suicidality. They concluded that more time engaged with electronic devices, and less time on “non-screen activities” (such as in-person social interaction, sports/exercise, homework, and attending religious services) was correlated with depressive symptoms and suicide-related outcomes (suicidal ideation, plans, and attempts), especially among girls.
A later report in the same publication questioned the survey’s research methodology, citing “inaccurate research measurements, negligible correlations between the main variables, [and] insufficient and inadequate statistical analyses”. The relationship between bipolar disorder and technology use has been investigated in a singular survey of 84 participants for Computers in Human Behavior.
The survey found marked variations in technology use based on self-reported mood states. The authors of the report then postulated that for patients with bipolar disorder, technology may be a “double-edged sword”, with potential benefits and negative effects.
What is the role of screen time?
A systematic examination of reviews, published in 2019, concluded that evidence, although of mainly low to moderate quality, showed an association of screen time with a variety of health problems including: “adiposity, unhealthy diet, depressive symptoms and quality of life”. They also concluded that moderate use of technology may have benefits for young people in terms of social integration, a curvilinear relationship found with both depressive symptoms and overall well-being.
A research study on urban adolescents in China revealed that more than a quarter of adolescents in China had over 2 hours of screen time per day. The study found that screen time and physical activity had independent associations with mental health. Specifically, an increase in screen time and a decrease in physical activity contributed to an additional risk for mental health productivity by increasing depressive anxiety symptoms and life dissatisfaction.
A 2017 UK large-scale study of the “Goldilocks hypothesis”—of avoiding both too much and too little digital media use—was described as the “best quality” evidence to date by experts and non-government organizations (NGOs) reporting to a 2018 UK parliamentary committee. That study concluded that modest technology use may have few negative effects, and some positive associations in terms of mental health and well-being.
The 21st-century epidemic
Gaming disorder has been considered by the DSM-5 task force as warranting further study (as the subset internet gaming disorder) and was included in the ICD-11. Concerns have been raised by Aarseth and colleagues over this inclusion, particularly in regard to the stigmatization of heavy gamers.
Christakis has asserted that internet addiction may be “a 21st-century epidemic”. In 2018, he commented that childhood Internet overuse may be a form of “uncontrolled experiment[s] on […] children”. International estimates of the prevalence of internet overuse have varied considerably, with marked variations by the nation.
A 2014 meta-analysis of 31 nations yielded an overall worldwide prevalence of six percent. A different perspective in 2018 by Musetti and colleagues reappraised the internet in terms of its necessity and ubiquity in modern society, as a social environment, rather than a tool, thereby calling for the reformulation of the internet addiction model.
Some medical and behavioral scientists recommend adding a diagnosis of “social media addiction” (or similar) to the next Diagnostic and Statistical Manual of Mental Disorders update. A 2015 review concluded there was a probable link between basic psychological needs and social media addiction.
“Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users ‘hooked’.”
Internet sex addiction, also known as cybersex addiction, has been proposed as a sexual addiction characterized by virtual Internet sexual activity that causes serious negative consequences to one’s physical, mental, social, and/or financial well-being. It may be considered a form of problematic internet use.
Conditions associated with the negative effects of technology on mental health
1. Online problem gambling
A 2015 review found evidence of higher rates of mental health comorbidities, as well as higher amounts of substance use, among internet gamblers, compared to non-internet gamblers. Causation, however, has not been established. The review postulates that there may be differences in the cohorts between the internet and land-based problem gamblers.
Cyberbullying, bullying, or harassment using social media or other electronic means, has been shown to have negative effects on mental health. Victims may have lower self-esteem, increased suicidal ideation, decreased motivation for usual hobbies, and a variety of emotional responses, including being scared, frustrated, angry, anxious, or depressed. These victims may also begin to distance themselves from friends and family members.
According to the EU Kids Online project, the incidence of cyberbullying across seven European countries in children aged 8–16 increased from 8% to 12% between 2010 and 2014. Similar increases were shown in the United States and Brazil.
3. Media multitasking
Concurrent use of multiple digital media streams, commonly known as media multitasking, has been shown to be associated with depressive symptoms, social anxiety, impulsivity, sensation seeking, lower perceived social success, and neuroticism. A 2018 review found that while the literature is sparse and inconclusive, overall, heavy media multitaskers also have poorer performance in several cognitive domains.
One of the authors commented that the data does not “unambiguously show that media multitasking causes a change in attention and memory”. Therefore, it is possible to argue that it is inefficient to multitask on digital media.
Are there any treatments for technology overuse?
Rigorous, evidence-based assessment of problematic technology use is yet to be comprehensively established. This is due partially to a lack of consensus around the various constructs and lack of standardization of treatments. The American Academy of Pediatrics (AAP) has developed a Family Media Plan, intending to help parents assess and structure their family’s use of electronic devices and media more safely.
It recommends limiting entertainment screen time to two hours or less per day. The Canadian Paediatric Society produced a similar guideline. Ferguson, a psychologist, has criticized these and other national guidelines for not being evidence-based. Other experts, cited in a 2017 UNICEF Office of Research literature review, have recommended addressing potential underlying problems rather than arbitrarily enforcing screen time limits.
Different methodologies for assessing pathological internet use have been developed, mostly self-report questionnaires, but none have been universally recognized as a gold standard. For gaming disorder, both the American Psychiatric Association and the World Health Organization (through the ICD-11) have released diagnostic criteria.
There is some limited evidence of the effectiveness of cognitive-behavioral therapy and family-based interventions for treatment. In randomized controlled trials, medications have not been shown to be effective. A 2016 study of 901 adolescents suggested mindfulness may assist in preventing and treating problematic Internet use.
Are there any mental health benefits of technology use?
Yes, there are. Individuals with mental illness can develop social connections over social media, which may foster a sense of social inclusion in online communities. Sufferers of mental illness may share personal stories in perceived safer space, as well as gaining peer support for developing coping strategies.
People with mental illness are likely to report avoiding stigma and gaining further insight into their mental health condition by using social media. This comes with the risk of unhealthy influences, misinformation, and delayed access to traditional mental health outlets.
Other benefits include connections to supportive online communities, including illness or disability-specific communities. Furthermore, children can enjoy the educational benefits of technology use.
Digital mental health care and its benefits
Digital technologies have also provided opportunities for the delivery of mental health care online. There are benefits computerized cognitive behavioral therapy provides for depression and anxiety. Research of digital health interventions in young people is preliminary, with a meta-review unable to draw firm conclusions because of problems in research methodology.
Potential benefits according to one review include “the flexibility, interactivity, and spontaneous nature of mobile communications […] in encouraging persistent and continual access to care outside clinical settings”. The mindfulness-based online intervention has been shown to have small to moderate benefits on mental health.
The greatest effect size was found for the reduction of psychological stress. There are other benefits regarding depression, anxiety, and well-being too. Smartphone applications have proliferated in many mental health domains, with “demonstrably effective” recommendations listed in a 2016 review encouraging cognitive behavioral therapy, addressing both anxiety and mood.
The review did, however, call for more randomized controlled trials to validate the effectiveness of their recommendations when delivered by digital apps.
The Lancet Commission on global mental health and sustainability report from 2018 evaluated both benefits and negative effects of technology. It considered the roles of technologies in mental health, particularly in public education; patient screening; treatment; training and supervision; and system improvement.
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