There can be no denying that, since its mass-scale introduction, social media has encompassed more and more of our lives, particularly in the lives of young people. As of 2022, among teens ages 13 to 17 years old, 95 percent report using social media, with more than half reporting that it would be hard to give it up.

As this technology has grown, so has its grasp over our time and attention, often at the expense of human connection. Not surprisingly, a correlation has been noted between increasing social media use and the rise in loneliness. For example, a U.S. study of young adults found those using social media for more than two hours a day have more than double the odds of increased perceptions of social isolation.
Despite its widespread use, the effect of social media on our health, particularly on young developing minds, has only recently started to receive due attention.

The picture beginning to emerge is disturbing: a synthesis across 20 studies found a significant relationship between social media views, body image concerns, and eating disorders, citing “social comparison” as the largest contributing factor. This should be taken alongside whistleblower testimony to Congress by a former high-ranking Facebook employee corroborating these findings. Her testimony uncovered the company’s own internal research, revealing that its algorithms were exacerbating youth eating and mental health disorders without any concomitant action to address this by Facebook itself.

As troubling as these findings are, the Surgeon General’s report shows how the social media consequences on youth mental health extend beyond just body image concerns.

It is no secret that social media products are deliberately designed to maximize user engagement. To that end, the most cutting-edge marketing and psychological strategies are deployed targeting the reward centers of the brain: think of features on these apps such as infinite scrolling, constant notifications, and fast-paced content presented in short, compelling morsels that quickly switch over to the next — these are just a few examples of their gripping designs.

The results of these strategies to lure and keep users’ eyes’ on their products, as long and firmly as possible, are far from benign. Nearly 1 in 3 teenagers report using screen media until midnight or later compromising their sleep at ages when it is essential for healthy growth. Research has also found that frequent social media use is linked to changes in brain structure similar to those in individuals with substance abuse or gambling addiction. These findings can explain how high-frequency use of social media is associated with increased odds of developing ADHD.

Such revelations demonstrating the profound neurological and behavioral consequences of these products are deeply concerning: the potential for harm done to children and adolescents during their most critical years of brain development – particularly to those areas as essential to healthy maturation as the prefrontal cortex (impulse control), amygdala (emotional control) and hippocampus (memory) – cannot be taken lightly.

In its closing statements, the Surgeon General’s report on Social Media and Youth Mental Health soberly remarks, “Our children have become unknowing participants in a decades-long experiment … Lack of access and lack of transparency from technology companies have been barriers to understanding the full scope and scale of the impact of social media on mental health and well-being.”

The path forward: Choosing connection and community

As complex and multifaceted as these looming threats of loneliness and social media are, so must our response be comprehensive and multi-pronged. The reports provide many recommendations that can be implemented at all levels of society to meet these emerging crises.

As health care providers, we can begin to incorporate counseling on loneliness and tools for its diagnosis and measuring its severity within our visits, similar to how it is already done with other mental conditions such as depression and anxiety. The UCLA Loneliness Score and the Berckman-Styme Social Network Index are two such validated tools. By having a baseline on the state of our connection with our patients, we can then begin to address loneliness in our primary, secondary, and tertiary prevention strategy for all diseases — recognizing how significant a risk factor it is for all-cause mortality.

“Treatment” of the loneliness that is engulfing so many will require more than prescribing pills. Pro-social interventions, both within and outside our clinic, a concept known as “social prescribing,” whereby patients are connected to community groups, activities, and even group-based therapy, can be a powerful antidote to these otherwise rising tides of isolation.

These strategies must be done in conjunction with others to also untether the prevailing grip of technology on our minds and its downstream effects upon our health.

In recognition of this growing challenge, the American Academy of Pediatrics has released guidelines on how parents and children can be counseled on social media use. Among its salient recommendations are: avoiding all social media use in those younger than 18 months, limiting screen time to 1 hour a day for those ages 2 to 5; turning off all electronics 1 hour before bedtime; keeping bedrooms, mealtimes, and parent–child playtimes screen free for children and parents.

Additionally, resources are available on creating a Family Social Media Use Plan and a tip sheet for adolescents to use these products safely.

Action must invariably turn to policy and systems-level changes, given the scale of the issues we face.

Lack of transparency and access to data from technology companies has impeded a full understanding of the impact of their products. We can begin by demanding that technology companies begin sharing both real-time and long-term data with independent researchers to better assess their technologies’ effect on our health, particularly youth mental health.

Learning from the product-approval process of other industries, the report also recommends a “safety-first” standard be applied to social media products as well. This principle requires a certain threshold of safety to be met and verified by independent evaluators before products are marketed and available to the public. It is the same standard applied by the Food and Drug Administration (FDA) for the pharmaceutical industry and the Consumer Product Safety Commission for toymakers. The preponderance of evidence on the rising toll of these technologies on mental health, particularly upon children and adolescents, should raise the alarm for regulators and policy-makers to now apply the same “safety-first” standard to any new social media product introduction.

Implementing these measures may feel impassable, implausible, or both. But if the evidence presented thus far means anything, they are absolutely necessary.

The Surgeon General’s report ended on an ominous note as it warned, “a fraying of the social fabric can also be seen more broadly in society. Trust in each other and major institutions is near historic low …”

At stake, in the larger sense, may very well be our sense of belonging, connection and, ultimately, well-being in these contested times. It is up to us to choose community — real and meaningful, not virtual or artificial — as our path forward.

Mohammed Umer Waris is a family medicine resident.