In this podcast, we are joined by Lizzy Winstone, Senior Research Associate in Epidemiology at Bristol Medical School, the University of Bristol.
The focus of this podcast is on the JCPP Advances paper ‘Adolescent social media user types and their mental health and well-being, results from a longitudinal survey of 13 to 14-year-olds in the United Kingdom’ (doi.org/10.1002/jcv2.12071).
Lizzy sets the scene by detailing a summary of the paper and sharing insight into the methodology used for the research.
In previous studies, distinctions are made between active and passive social media. Lizzy explains why her paper suggests that this distinction may be too simplistic and comments on the four classes of social media users identified in her paper – high communicators, moderate communicators, broadcasters, and minimal users – including how each of these different groups behave.
Lizzy then highlights the key findings from the paper and provides further commentary on her finding that moderate social media screen time was beneficial to well-being, in comparison to no use at all.
Lizzy also discusses if there were any gender differences in her research, plus what the implications are of her findings overall for CAMH professionals.
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My mixed methods research focuses on how young people engage with their peers, family and the wider public through social media, and whether this is determined by, or has an impact on their mental health. I am exploring whether it is ‘healthier’ (in terms of self-harm, depression, anxiety and well-being) to use social media passively compared to using it for communicating with friends or to share content and express one’s identity. I am also focusing on how social media use more generally predicts how connected young people feel to their peers, family and school.
Before starting my PhD I worked for several years as a survey methodologist for the European Social Survey, a cross-sectional general attitudes survey conducted every two years in more than 20 countries. Based at City University London, I specialised in questionnaire design, (cross-national) equivalence, survey non-response and survey project management. I have also previously worked in local authority public health teams as a data analyst, researcher and strategist, specialising in Joint Strategic Needs Assessments of local populations. (Bio and Image from University of Bristol)
[00:00:31.850] Jo Carlowe: Hello. Welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. And I have with me Lizzie Winstone, Senior Research Associate in Epidemiology at Bristol Medical School, the University of Bristol. Lizzie is a co-author of the paper “Adolescent social media user types and their mental health and well-being, results from a longitudinal survey of 13 to 14-year-olds in the United Kingdom,” recently published in JCPP Advances.
JCPP Advances is one of the three journals produced by the Association for Child and Adolescent Mental Health. ACAMH also produces the Journal of Child Psychology and Psychiatry and the CAMH. If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform. Let us know how we did with the rating or review and do share with friends and colleagues. Lizzie, welcome. Can you start by introducing yourself?
[00:01:30.370] Lizzie Winstone: Hi, thanks for having me. I’m a researcher at the University of Bristol with a focus on young people’s mental health. So, I’ve just actually finished my mixed methods PhD, which was funded by the NIHR School for Public Health Research. And that was looking at social media use and adolescent mental health and well-being.
[00:01:47.520] Jo Carlowe: Thank you. Let’s turn to the paper. So “Adolescent social media user types and their mental health and well-being, results from a longitudinal survey of 13 to 14-year-olds in the United Kingdom,” recently published in JCPP Advances. Lizzie, can you give us a summary and to set the scene for us?
[00:02:04.465] Lizzie Winstone: This paper details the quantitative part of my PhD. So previous research suggests that different types of social media use may have different implications for mental health. And we looked at how adolescents use social media in terms of their proclivity for different activities, and also, whether this changed between the ages of 13 and 14. We then examined whether mental health outcomes varied according to these different patterns of use.
[00:02:30.005] Jo Carlowe: What methodology did you use for the research?
[00:02:32.380] Lizzie Winstone: We surveyed adolescents across 19 UK secondary schools at two different time points. So the first was October 2019 when participants were aged 13 and then a year later, age 14. And at both time points, they answered questions about their social media use, including frequency of different social media activities. For example, sending messages, looking at photos or videos, listening to music, and posting content. And then also questions about their mental health.
So, we included measures of anxiety and depressive symptoms, well-being, and self-harm over the past year. And then, in terms of the analysis, we developed a typology of social media users using latent class analysis. So, in other words, identifying subgroups of user based on their probability of responding, never, rarely, quite often, and very often to each social media activity. So, deriving the groups or the latent classes is based on shared patterns within these response probabilities.
Each individual is then assigned a kind of most likely class based on an inclusion probability to allow us a sense of the prevalence of these classes in the sample. So, for example, somebody might have a probability of 0.8 of belonging to class 1 and then 0.2 of belonging to Class 3. They’re assigned to class 1 as their most likely class. But then we can factor in this kind of uncertainty in the final stage of analysis.
So just before coming onto that final stage, we next use latent transition modelling. So there, we can see whether the same classes or social media user types can be identified at the second time point a year later. And we can also look at the probability of someone moving from one class to another over time. And then the final stage is then to test associations with those distal mental health outcomes. So, we use something called a bias-adjusted three-step approach. And it’s essentially using logistic regression to regress mental health on social media user type, where user type is treated as a categorical indicator.
[00:04:31.240] Jo Carlowe: Great, thank you. In previous studies, distinctions are made between active and passive social media use. Your paper suggests this distinction may be too simplistic. Can you explain why?
[00:04:44.303] Lizzie Winstone: Yeah. So many studies have gone beyond screen time to look at different types of social media use, and that’s often been conceptualized as either active or passive use. So typically, passive use is thought to be associated with depression or poor wellbeing. It’s been suggested this might be due to things like fear of missing out, a negative social comparison, envy, and guilt about time wasting.
However, findings are much less consistent when it comes to active social media use, and what counts as active use is not consistently defined. I think it’s important to recognize that active use is not a kind of homogeneous concept. So we can think of active direct or active private use as sending direct messages to someone, which might have practical and social or emotional benefits. And then, we can also think about active social media use that’s more public, such as posting content publicly or to a defined audience.
And this might have some benefits, in terms, of identity expression and development. But it also may carry more social and emotional risks of negative feedback or peer ostracization. There are lots of grey areas, and challenges in defining these different types of social media use, and I don’t think we as a research community have got it quite right yet. So, in our study, we see that those who are engaging most in passive social media use are also the users who are most likely to frequently post content.
So that active public use. So instead of treating passive or active use as our exposure variable, we’re looking at how individuals might engage in different patterns or combinations of these different activities.
[00:06:12.250] Jo Carlowe: In your study, Lizzie, you identified four classes of social media user high communicators, moderate communicators, broadcasters, and minimal users. How do each of these different groups behave?
[00:06:26.145] Lizzie Winstone: So, the largest user group we identified, we named high communicators, and this group represented roughly half of the sample at age 13. And these were users who were likely to very often send messages, listen to music, and look at photos. They rarely or quite often shared selfies or other photos. Our next user group were named moderate communicators, and they represented around a third of the sample. These users were likely to quite often send messages and look at photos. And likely to never or rarely share selfies or other photos, never share quizzes or opinions, and never use social media to meet new people or to arrange events.
We then had a group named broadcasters, and they represented just under 13% of the sample at age 13. These users were likely to very often engage in all social media activities across the board. And they stood out from the other groups in terms of their proclivity for sharing content, in addition to things like messaging or looking at photos. And then, finally, we had this small minimal user group around 7%. And this group included those who said they didn’t use any social media at all or who never or rarely engaged in any of the activities.
[00:07:35.080] Jo Carlowe: What are the key findings that you’d like to highlight?
[00:07:37.655] Lizzie Winstone: Well, I think the first thing to note is that these groups are relatively unstable over the two-time points of our study. So, at age 14, the minimal user group had more or less disappeared. And the prevalence of the remaining user groups changed fairly dramatically. So, while the high communicators were still the largest group at follow-up, broadcasters overtook moderate communicators to represent over a third of the sample, with the moderate communicator group falling from 33% at age 13 to 11% a year later.
And then, in terms of individual transitions, those participants who were broadcasters at time 1 were very likely to remain broadcasters at time 2. High communicators at time 1 had a kind of 50/50 probability of remaining high communicators or transitioning to that broadcaster group. And then, moderate communicators at time 1 were very likely to become high communicators at time 2. And then, in terms of the mental health outcomes, I think there are two key things to highlight.
The first is that outcomes were consistently poor for the broadcasters group. So this is after adjusting for things like screen time and baseline mental health. And the second is that outcomes were generally best for moderate communicators. And this group had the lowest risk of self-harm and poor well-being, with outcomes either better or not significantly worse for moderate communicators compared to those minimal users.
[00:09:00.290] Jo Carlowe: Let’s look at those findings in more detail. Your study showed that moderate social media screen time was beneficial to well-being compared to no use at all. Can you talk us through that finding?
[00:09:13.677] Lizzie Winstone: I think we can think about different outcomes for these different groups in terms of an accumulation of social media benefits and risks. So when we think about the minimal user group representing little or no use. This group are not exposed to some of those digital stressors that we know about, like social comparisons or cyberbullying. But they also gain none of the benefits of social media use, such as keeping in touch with friends. Then we have the moderate and high communicative groups who have the better mental health outcomes. And these two groups seem to enjoy the benefits of moderately socializing online and using social media for entertainment, without some of those stresses or risks attached to the more intensive or excessive use.
And then, for broadcasters, they may well be reaping some rewards from their social media use. But they’re also then accumulating risks or digital stressors attached to excessive passive use, risks attached to excessive messaging, and then risks attached to broadcasting. Such as vulnerability to cyberbullying, to receiving negative feedback, or being ostracized. And this is a different way of thinking about what’s called the digital Goldilocks hypothesis. So previously, this has been conceptualized in terms of a just right amount of screen time, so in hours or minutes. And here we’re conceptualizing optimal social media use that looks like moderate messaging, moderate passive use, but very little, if any, broadcasting or sharing of content online.
[00:10:38.100] Jo Carlowe: Let’s focus more on the broadcasters because you say they have the poorest mental health outcomes. So, in the paper entities, they had the highest risk of self-harm anxiety, depression, and poor well-being. Why do you think this is?
[00:10:51.775] Lizzie Winstone: Well, it’s important to note that the particularly high levels of reported screen time in this group account for a lot of the variance in mental health. However, these poor outcomes for the broadcasters group endure after we adjust for screen time, suggesting that we need to think about these patterns of use. So, we’ve done some qualitative research to triangulate against these quantitative findings. And going back to this idea of an accumulation of risks, we heard from young people about their experiences of different digital stresses relating to different types of social media use.
So just to recap, broadcasters report very frequent messaging. And our qualitative findings suggest that excessive messaging can feel overwhelming or smothering for both the sender and receiver. And then broadcasters also report very frequent passive social media use. And previous studies have found that access to this vast amount of information about what other people are doing in their daily lives can lead to these feelings of envy, of inferiority, or a fear of missing out.
Now, our own qualitative work, young people reported lots of benefits to passive use, such as relaxation and entertainment. However, the very intensive passive use was also accompanied by feelings of guilt that this wasn’t a kind of meaningful way to spend their time. And then, finally and most noteworthy, I think, the broadcasters reported very frequent sharing of content or broadcasting.
And our qualitative findings indicated that when young people share content, particularly beyond their close friends, they can feel very vulnerable to being judged harshly by others in terms of how they look or the opinions that they express. Vulnerability to being bullied, as well as data privacy breaches. And the stresses or risks attached to broadcasting may feel particularly acute or impactful in terms of one’s sense of self for younger social media users who are at this key stage of identity development. And younger users can also lack the skills needed to judge what content is appropriate to share and with whom.
[00:12:51.630] Jo Carlowe: As you’ve stated, the paper stated that the baseline mental health was poorest in broadcasters. Does this imply a need for frequent content sharing signals of potential risk of underlying mental health difficulties? Or is there something about broadcasting that in itself creates the risk?
[00:13:08.748] Lizzie Winstone: Well, that’s something we don’t really know for sure. I mean, the type of analysis we conducted couldn’t take account of cross-lagged associations. So we can’t say very much about the effect of baseline mental health on subsequent social media user group membership. And the qualitative work I’ve just mentioned reflects more on broadcasting as a risky activity. However, we also found qualitatively that is, that social media risks generally may be more acute for young people who are struggling with their mental health.
So in terms of broadcasting specifically, our qualitative findings suggested that those younger adolescents who share their struggles on social media, particularly relating to self-harm, for example, can be interpreted as attention seeking rather than help-seeking. They are often judged harshly by peers and sometimes ostracized from their peer groups.
[00:13:56.767] Jo Carlowe: I don’t know if you looked. Were there any gender differences?
[00:13:59.805] Lizzie Winstone: There were some gender differences. So, girls, for example, were much more likely to belong to the broadcasters and high communicators groups compared to boys. We looked at differences in terms of other demographics but didn’t find anything else there.
[00:14:14.190] Jo Carlowe: Lizzie, what are the implications of your findings overall for CAMH professionals?
[00:14:19.100] Lizzy Winstone: I think the real takeaway message for CAMH professionals is that when considering the role of social media in a young person’s mental health, try not to overemphasize the importance of screen time. Of course, screen time is still important if it’s getting in the way of somebody’s sleep or relationships. But it’s also important to consider that not all screen time is equal. I think if a young person is struggling with their mental health, it may be helpful to consider how they’re using social media.
So they might be encouraged to reflect on whether they’re sending excessive messages, whether they’re viewing content that makes them feel good about themselves or not. And whether the content they post is having a positive or negative impact on their self-esteem and their social relationships.
[00:15:01.260] Jo Carlowe: And that’s something that CAMH professionals can do, you know to sort of educate or discuss how they’re using their social media?
[00:15:09.270] Lizzie Winstone: Yeah, I think it’s about that kind of reflection and mindfulness about the activities rather than just a blanket restriction on screen time that’s important.
[00:15:18.028] Jo Carlowe: Are you planning to follow up research that you can share with us?
[00:15:21.195] Lizzie Winstone: Well, I’ve only very recently finished my PhD. [LAUGHING] So I can’t say too much. I’ve got a few ideas about exploring this broadcasting behaviour in more detail, but they’re not fully developed ideas just yet.
[00:15:34.030] Jo Carlowe: OK, we’ll watch this space. Finally, Lizzie, what take-home message do you have for those listening to our conversation?
[00:15:42.130] Lizzie Winstone: I think it’s really time to move away from thinking about social media use as this homogeneous activity in terms of screen time. I think we should also stop thinking about it in this linear sense, as not all social media use is harmful. It’s such a huge part of daily life for most young people and for many adults as well that I don’t think it does anybody any good to demonize it as an activity. I think we really need to take a more nuanced approach to assessing the risks and benefits. So thinking about the impact of different online experiences, different interactions, different content, and so on. Rather than viewing social media use as this one activity that’s somehow distinct from everyday life.
[00:16:22.390] Jo Carlowe: Thank you. Brilliant. For more details on Lizzie Winstone, please visit the ACAMH website www.acamh.org, and Twitter @acamh. ACAMH is spelled A-C-A-M-H. Let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.