Increased social media use and television viewing are linked to worsening teenage depression, researchers say, and the more time adolescents spend on social media and in front of the television, the more severe their symptoms become.
The study of 1,786 girls and 2,028 boys aged 12 to 16 found if they reported their social media use and TV viewing surpassed their overall mean level of use in a given year, then their symptoms also increased that year.
There was no evidence screen time had an impact on adolescent depression by reducing their involvement in physical activities but the data did indicate that interacting with media outlets that were more conducive to promoting upward social comparisons was associated with a drop in self-esteem.
Canadian researchers also found evidence that social media - and not other screen-based activities - may promote depressive symptoms in those already suffering them, through a reinforcing spiral process.
The scientists from CHU Sainte-Justine and Universite de Montreal say their study, published in JAMA Pediatrics, could have important implications for how youth and families choose to regulate digital screen time.
Dr Michael Bloomfield, head of translational psychiatry research group and consultant psychiatrist, University College London, said: "This study found that television and social media use were associated with increased risk of depression.
"However, even with this type of study it is possible that the relationship isn't causative. For example, it may be that if a young person is going to become depressed that could make them more likely to have more screen time.
"However, this study did not look at the content of what young people were actually seeing online and on TV - so I think it's too early to say with much certainty what might be causing this, if indeed the relationship is causative."
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