Digital Health Practices Among Teens and Young Adults: Key Findings

For the latest findings, read: Coping with COVID-19: How Young People Use Digital Media to Manage Their Mental Health, sponsored by Common Sense Media, Hopelab, and California Health Care Foundation.

In July 2018, my research partner Vicky Rideout and I published an in-depth report based on a nationally representative, probability-based survey of more than 1,300 U.S. teens and young adults.

Key Findings:

The survey was conducted among 14- to 22-year-olds. Throughout the report, we refer to this population as “teens and young adults,” or TYAs. We also occasionally use the terms “youth” or “young people” as shorthand. And we discuss two developmentally distinct sub-populations as part of this broader group: “teens” (14 to 17 years old) and “young adults” (18 to 22 years old).

Teens (14- to 17-year-olds) and young adults (18- to 22-year-olds) describe making extensive use of a wide range of digital resources to access health information, tools, peer support, and providers online.

• Nearly nine out of ten (87%) teens and young adults say they have gone online for health information: the top five topics searched are fitness (63%), nutrition (52%), stress (44%), anxiety (42%), and depression (39%).
• Nearly two-thirds (64%) say they have used mobile apps related to health, including for fitness, sleep, meditation, and medication reminders.
• The majority (61%) say they have read, listened to, or watched other people share about their health experiences online, whether in podcasts, TED talks, or YouTube videos.
• About four in ten (39%) say they have gone online to try to find people with health conditions similar to their own, using methods such as participating in online forums or closed social media groups on specific issues, doing hashtag searches on social media, or following people with similar health conditions.
• One in five (20%) young people report having connected with health providers online, through tools like online messaging, apps, texting, and video chat.

Young people who report symptoms of depression are using digital tools to learn about and help address their problems.

Using the Patient Health Questionnaire depression scale (PHQ-8), survey respondents were identified as currently having either no, mild, or moderate to severe depressive symptoms. Based on these PHQ-8 scores, teens and young adults in this sample with moderate to severe depressive symptoms say they use digital health resources at higher rates than do others their age without depressive symptoms. (Note: For simplicity, we occasionally refer to respondents with no depressive symptoms as “non-depressed.”) Among teens and young adults with moderate to severe depressive symptoms:

• Nine out of ten (90%) say they have gone online for information on mental health issues (compared to 48% of those without depressive symptoms).
• Three out of four (76%) say they have used health-related mobile apps (compared to 58% of those with no symptoms). Nearly four in ten (38%) say they have used apps related to mental well-being, such as meditation, stress reduction, and depression.
• Three out of four (75%) say they have watched, listened to, or read people sharing about their health experiences online, through venues such as podcasts, blogs, TED talks, or YouTube videos (compared to 54% of those with no depressive symptoms).
• Fully half (53%) have tried to find people online with similar health concerns, through methods such as social media, blogs, and online forums (compared to 27% of those who report no depressive symptoms).
• And nearly one in three (32%) report having used online tools to connect with a health provider (such as texting, video chat, or an app), compared to 13% of those without depressive symptoms.

Social media is an integral part of young peoples’ lives, with many teens and young adults reporting a mix of both positive and negative aspects to its use.

• More than nine in ten (93%) teens and young adults report using social media – sites such as Snapchat, Instagram, Facebook, and Twitter: 81% say they use it  on a daily basis, including 17% who say they use it “almost constantly” and 54% who do so multiple times a day. Just 7% say they don’t use social media at all.
• Most teen and young adult social media users (73%) say they feel comfortable with the amount of time and energy they devote to it, but one in four (24%) say they spend too much time on social media, and half (51%) say they have taken a break from it at some point.
• Teens and young adults are far more likely to report frequently receiving positive than negative feedback from others on social media: 32% say they “often” get positive comments from others compared to just 3% who say they “often” get negative comments.
• Nearly two-thirds (65%) say they “hardly ever” or “never” feel left out when using social media, compared to about a third (34%) who say they often (7%) or sometimes (27%) do.
• On the other hand, more than half report experiencing some degree of social comparison pressure, with 57% saying they feel like other people are doing better than they are (15% “often” and 42% “sometimes” feel that way when using social media). And about half (53%) say they feel like they always have to show the best version of themselves on social media (14% strongly agree, and 39% somewhat agree with that statement).

This survey did not find a statistically significant bivariate relationship between how frequently young people use social media and their current symptoms of depression.

• Among the population of 14- to 22-year-olds as a whole, we looked at whether respondents with moderate to severe depressive symptoms, as indicated by PHQ-8 scores, reported using social media more frequently than those with no depressive symptoms.
• Twenty-one percent of those with moderate to severe depressive symptoms described themselves as “constant” users of social media, as did 16% of those with no symptoms (not a statistically significant difference). Similarly, 59% of those with moderate to severe symptoms and 62% of those with no symptoms said they use social media “several times as day,” also not a significant difference.

Again, because this survey only captures respondents’ own reports about their social media use, we do not know how well these findings correlate with objectively-measured behavior. And because this survey asked “how often” but did not ask respondents to estimate the total amount of time they spend on social media per day, it is possible that there are differences in the length of time devoted to social media use that don’t show up in our measures of frequency of use. And finally, the data presented here are for the population of 14- to 22-year-olds as whole; it is possible that more detailed future analyses may uncover relationships in specific subsets of this population.

Young people with moderate to severe depressive symptoms report having heightened responses to social media – both positive and negative—than those without symptoms of depression.

• Respondents with moderate to severe depressive symptoms, as indicated by PHQ-8 scores, are nearly twice as likely as respondents without depressive symptoms to say that social media helps connect them to useful support and advice during these periods (25% v. 13%), but they are also more likely than others their age to say it makes them feel worse during periods when they are feeling depressed, stressed, or anxious (22% v. 7%).
• On balance, those with moderate to severe depressive symptoms are slightly more likely to say that using social media during these periods makes them feel better (30%) than they are to say it makes them feel worse (22%). (A plurality (47%) say that when they are feeling depressed, stressed, or anxious, using social media doesn’t make them feel better or worse.)

For young people with moderate to severe depressive symptoms, social media may be more important than for youth without depressive symptoms when it comes to feeling less alone, finding inspiration, and providing a venue for creative self-expression.

• Social media users with moderate to severe depressive symptoms, as indicated by PHQ-8 scores, are more likely than those with no symptoms to say that social media is “very” important to them for:

  • Feeling less alone (30% for those with moderate to severe depressive symptoms, compared to 7% for those with no symptoms);

  • Getting inspiration from others (27%, compared to 13%); and

  • Expressing themselves creatively (26%, compared to 13%).

• In addition, young people with moderate to severe depressive symptoms who use social media are more likely to say they prefer communicating with people through social media than in person (42% of those with moderate to severe symptoms agree with that statement, compared to 25% of those with no symptoms), including 17% who “strongly agree” (compared to 4% of those with no symptoms).

However, teens and young adults with moderate to severe depressive symptoms are more likely than other young people to say they have certain negative experiences on social media.

They are more likely to say they:

• Get negative comments from others, at least sometimes (38% v. 17% of those with no depressive symptoms);
• Post things but get few comments or likes (29% v. 7% often);
• Feel like others are doing better than they are (32% v. 7% often);
• Feel left out when using social media (18% v. 1% often);
• Use social media to avoid dealing with problems (14% v. 3% often);
• See so much bad news in social media that it makes them stressed or anxious (21% v. 4% strongly agree);
• Have been “trolled” on social media (having somebody intentionally create conflict with them; 31% v. 14% ever);
• Have “stalked” someone on social media (checking people out online without them knowing about it; 31% v. 16% ever); and
• Have deleted a social media account after a personal conflict (30% v. 10% ever).

This survey did not find a statistically significant association between depressive symptoms and whether respondents reported engaging in more “active” or “passive” behaviors on social media.

• Some previous research has suggested that “passive” social media use (e.g., scrolling through people’s feeds without posting or commenting) may be correlated with increased depression while “active” use (liking, commenting, and posting) may be correlated with lower levels of depression (see footnote). Therefore this survey explored whether young people with moderate to severe depressive symptoms report engaging in these and other common social-media actions at a different frequency than their peers.
• In this sample, respondents with moderate to severe depressive symptoms, as indicated by PHQ-8 scores, were no less likely than those with no depressive symptoms to say they post content on social media on a daily basis (29% say they do so daily, compared to 32% of those with no depression), comment on other people’s posts (16% vs. 18% “often” do so), send private messages to people (29% vs. 28% do so “often”), create and share original content (20% vs. 18% “often”), or share content created by others (18% vs. 13% of non-depressed youth say they “often” do so).

• The only surveyed action that young people with moderate to severe depressive symptoms report doing with a different frequency than their non-depressed peers is “like” other people’s posts, which they report doing more frequently than others do: 62% of young people with moderate to severe depressive symptoms say they often “like” others’ posts, compared to 47% of non-depressed youth.

• There is no difference in how often young people with moderate to severe depressive symptoms vs. those with no symptoms report passively browsing other people’s feeds without liking or commenting on them (32% vs. 24% say they “often” do that).

• The data presented here are for the population of 14- to -22-year-olds as whole; it is possible that more detailed future analyses may uncover relationships in specific subsets of this population, or may detect subtler patterns of use not evident in these direct comparisons.

Females and LGBTQ youth are more likely than others their age to report seeking online resources related to mental well-being.

• Teenage girls and young women are more likely than males their age to report going online for information about anxiety (55% vs. 29% of males) or depression (49% vs. 27% of males).
• Young people who identify as gay, lesbian, or bisexual are by far the most likely to report looking online for information about depression, anxiety, or stress.
• More than three out of four LGBTQ youth (76%) say they have looked for online information about depression, compared to 32% of straight youth;
• 75% have looked for information about anxiety, compared to 36% of their straight peers.
• 68% have looked for information on stress, compared to 40% of straight youth.