key: cord-1048259-3a1iu9i9
authors: Burke, T. A.; Kutok, E. R.; Dunsinger, S.; Nugent, N. R.; Patena, J. V.; Riese, A.; Ranney, M. L.
title: U.S. adolescents' mental health and COVID-19-related changes in technology use, Fall 2020
date: 2021-03-17
journal: nan
DOI: 10.1101/2021.03.15.21253598
sha: 00fdf41937db27d1455123a005f8ac77fb9de0ab
doc_id: 1048259
cord_uid: 3a1iu9i9

Preliminary reports suggest that during COVID-19, adolescents' mental health has worsened while technology and social media use has increased. Much data derives from early in the pandemic, when schools were uniformly remote and personal/family stressors related to the pandemic were limited. This cross-sectional study, conducted during Fall 2020, examines the correlation between mental wellbeing and COVID-19-related changes in technology use, along with influence of COVID-19-related stressors, school status (in-person versus remote), and social media use for coping purposes, among 978 U.S. adolescents. Results suggest self-reported daily social media and technology use increased significantly from prior to COVID-19 through Fall 2020. Increased social media use was significantly associated with higher levels of anxiety and depressive symptoms regardless of other theoretical moderators or confounders of mental health (e.g., demographics, school status, importance of technology, COVID-19-related stress). Despite literature suggesting that remote learning may result in adverse mental health outcomes, we did not find local school reopening to be associated with current depressive/anxiety symptoms, nor with COVID-19-related increases in technology use. Self-reported use of social media for coping purposes moderated the association between increased social media use and mental health symptoms; in other words, some social media use may have positive effects. Although much prior research has focused on social media use as a marker of stress, we also found that increased video gaming and TV/movie watching were also associated with internalizing symptoms, in accordance with others' work. Future research should explore in more granular detail what, if any, social media and technology use is protective during a pandemic, and for whom, to help tailor prevention efforts.

Preliminary reports suggest that during COVID-19, adolescents' mental health has worsened while technology and social media use has increased. Much data derives from early in the pandemic, when schools were uniformly remote and personal/family stressors related to the pandemic were limited. This cross-sectional study, conducted during Fall 2020, examines the correlation between mental wellbeing and COVID-19-related changes in technology use, along with influence of COVID-19-related stressors, school status (in-person versus remote), and social media use for coping purposes, among U.S. adolescents.

From September 23 to December 16, 2020, English-speaking adolescents (ages 13-17) residing in the United States were recruited using Instagram for an online survey, with approval from the Institutional Review Board. Assent was waived, with approval from the Institutional Review Board. Self-report measures (adapted from Pew Internet Survey 1 ) assessed average daily duration of technology use (social media, phone/video calls, video games, TV/movie/videos) 30 days before initial COVID-19-related school closures versus past week. Standard measures for past week anxiety and depressive symptoms (PROMIS) 2 , well-being (WHO-5) 3 , and cybervictimization 4 were used. Use of social media for coping through social connection was assessed using an adapted measure for the purpose of the present study. School status (open fulltime or hybrid versus closed) was determined through the use of the COVID-19 US State Policy Database. 5 COVID-19-related stressors 6 , perceived importance of social media 7 , and demographics were also assessed.

Generalized linear models were used to examine associations between changes in technology use and current mental health outcomes, adjusting for COVID-19-related stressors All rights reserved. No reuse allowed without permission.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 17, 2021. ;

and importance of social media (identified as confounders in preliminary analysis); potential moderators were examined.

We recruited 978 youth from 42 states ( Table 1 ). All forms of technology use significantly increased from pre-COVID until the time of assessment (Table 2a) . After adjustment for confounders, self-reported increases in social media use were associated with higher anxiety (b = .07, SE = .03, p = .02) and depressive symptoms (b = .11, SE = .03, p < .001) (Table 2b ). Low use of social media for coping moderated the association between social media use and depressive symptoms (b = .15, SE = 0.07, p = .02). Increases in video gaming and TV/movie watching were associated with higher depressive symptoms (b = .06, SE = .03, p = .04; b = .10, SE = .03, p = .002), and video gaming was associated with higher anxiety (b = .09, SE = .03, p = .01).

There were no associations between changes in any form of technology use and wellbeing or cybervictimization. Neither local school status, nor level of COVID-19-related stressors, nor self-perceived importance of technology, were significant confounders or moderators of the observed effect.

In this geographically diverse sample of adolescents across the United States, selfreported daily social media and technology use increased significantly from prior to COVID-19 through Fall 2020. Increased social media use was significantly associated with higher levels of anxiety and depressive symptoms regardless of other theoretical moderators or confounders of mental health (e.g., demographics, school status, importance of technology, COVID-19-related stress). Despite literature suggesting that remote learning may result in adverse mental health All rights reserved. No reuse allowed without permission.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.15.21253598 doi: medRxiv preprint outcomes 8 , we did not find local school reopening to be associated with current depressive/anxiety symptoms, nor with COVID-19-related increases in technology use. Selfreported use of social media for coping purposes moderated the association between increased social media use and mental health symptoms; in other words, some social media use may have positive effects. 9 Although much prior research has focused on social media use as a marker of stress, we also found that increased video gaming and TV/movie watching were also associated with internalizing symptoms, in accordance with others' work. 10 Future research should explore in more granular detail what, if any, social media and technology use is protective during a pandemic, and for whom, to help tailor prevention efforts. Limitations include use of some nonvalidated measures, reliance on self-report of technology use, and use of a national database to assess school status.

In conclusion, our study shows that, although adolescents' self-reported technology use increased from prior to the pandemic until Fall 2020 and was associated with poorer mental health, the relationship may be more nuanced than previously reported. All rights reserved. No reuse allowed without permission.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 

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Social life media: 2018 teens reveal their experiences

Change in time on phone or video calls b=.02

Change in time on video games b=.09, SE=.03* b=.06, SE=.03* b=-.03, SE=.14 b=

Change in time on TV, movies, videos b=.06, SE=.03 b=.10, SE=.03* b=-.05, SE=.15 b=-.06

Changes in technology time reflect differences: past 7 days -one month before school closures; Models adjusted for COVID-19-specific stressors and importance of social media; b=unstandardized regression coefficient

The content is solely the responsibility of the authors and does not necessarily represent the official views of the university or the TAM program. Taylor Burke supported by NIMH T32 MH019927.