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Join us as we explore the profound impact of social media on mental health, particularly among young people, with our guest, Mohammed Umer Waris. As a family medicine resident, Mohammed brings a unique perspective on the intersection of technology and well-being, shedding light on the challenges and potential solutions in this digital age. Tune in for an insightful discussion on the effects of social media and the path forward to prioritize real connections and community.

Mohammed Umer Waris is a family physician.

He discusses the KevinMD article, “Regulating social media’s effects on mental health.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Mohammed Umer Waris. He’s a family physician. Today’s KevinMD article is titled “Regulating social media’s effects on mental health.” Mohammed, welcome back to the show.

Mohammed Umer Waris: Thank you so much, Dr. Pho. It’s a pleasure and an honor.

Kevin Pho: So Mohammed’s been on the show in the past. Go to KevinMD.com/podcast, go to the search icon in the upper right-hand corner, and you can look for his last episode and hear his story. But today, let’s jump right into your most recent KevinMD article, “Regulating social media’s effects on mental health.” How did this article come together?

Mohammed Umer Waris: Thank you, Dr. Pho. How this article came together was similar to my last conversation with you. There’s a preponderance, a barrage, of public health headlines and news bulletins related to the historic decline in U.S. life expectancy, to the lowest point it has been since the 1990s, the largest drop in 100 years, and the first time in our history we’ve seen such a decline. Alongside that is the decline in pediatric life expectancy, children’s life expectancy, for the first time in our history. And it had me thinking: What does that tell us about the health of our society, when our most precious population is no longer as healthy as previous generations? All of this is going alongside the rise in drug overdose deaths, the rise in suicide deaths and the rise of the loneliness epidemic, and all of it is obviously happening against the backdrop of increased social media use and technology use and the effect that is having on youth mental health.

This has become such a large public health issue that the Surgeon General, just in April, released two public health advisories on these topics, one related to the loneliness epidemic and the other relating to social media and youth mental health. To put that into perspective, the other times the Surgeon General has released a public health advisory have been on issues of such importance as the obesity epidemic, cigarette use, the HIV/AIDS epidemic and so on. That has been the magnitude of the crises that public health advisories have addressed in the past, and now they have been released with a similar message: elevating the discourse and making the loneliness epidemic, and social media and youth mental health, public health issues.

Regarding social media and youth mental health, which was the topic of my article, the evidence the Surgeon General presented was astounding. It was a collection of the latest evidence on why this is now a crisis and what needs to be done. For example, one piece of evidence noted that adolescents using social media for just more than three hours a day had double the risk of depression and anxiety, and that just by reducing use by 30 minutes a day among adolescents and children, you had a decrease in depression and anxiety as large as if the patients were doing psychological interventions like self-help therapy, counseling and so on. This goes on for other conditions as well, such as body image concerns, ADHD and loneliness.

I also wanted to bring up the fact, which I mentioned in my own article, that Facebook’s own internal research found that its algorithms were exacerbating youth mental health and body image concerns, and this was only brought to the public’s attention through whistleblower testimony in Congress. Then there is other evidence that increased social media use and technology use is linked to brain changes in children and other people similar to the brain changes found in those with substance abuse and other addictions. This is what Dr. Anna Lembke, an addiction specialist at Stanford and one of their addiction clinic leads, means when she says that our cell phones are now the new hypodermic needles of our time, when we’re talking about addiction and brain changes. And of course, when you’re thinking about these neurologic changes, it’s no surprise that increased frequency of technology use is now linked to nearly double the odds of ADHD.

And this is even before we talk about what it is doing to our social connections, to our sense of community, which I’m sure we will get to in the course of this conversation. Now 95 percent of people, particularly children, who use social media report having difficulty reducing their use or cutting it out entirely. That’s 95 percent. So it’s no surprise that as social media use increases, the same people also report increased odds of social isolation.

If we then take a further step back, we know, as the Surgeon General’s report on the loneliness epidemic elucidated earlier, that right now we’re having a loneliness and social connection crisis, where all the major markers of social connection have declined. You talk about companionship, you talk about engagement with friends and family: All of them have been in decline, and the major inflection points in all of those markers were noted in and around 2012 and 2013, just around the time social media, technology and smartphones became more prevalent and more prominent in our daily lives.

So to sum it all up, Dr. Pho, the Surgeon General’s evidence, as well as all the major public health headlines and bodies, are now putting forth that this is a public health crisis: that increased social media use and increased technology use have been linked to the rise in all sorts of mental health conditions, depression, anxiety, body image concerns, ADHD, loneliness and so on. We have to take a step forward, as clinicians, as policymakers and as members of our community, to address this, because if we do not get a hold of it soon enough, we may be facing a crisis even larger than the one we are in at this moment.

Kevin Pho: What is it about social media platforms that makes them so addictive and habit-forming, and that consumes so much of our teens’ time?

Mohammed Umer Waris: That’s a very good, fair question, and it might get to the bottom of why we have such a crisis at this time. We know that social media companies and these technology companies deliberately design their products in a way that maximizes user engagement, to keep users’ eyes on their products as long and as firmly as possible. That is essentially their business model, as you can imagine. And in that, the latest marketing and psychological research is employed, research, by the way, that is often not done transparently and is not available to the public to know and see. That research is then designed into, for example, the constant notifications we get, the infinite scrolling we have on our devices, and the content presented in short, compelling morsels that quickly switch over to the next, so you find yourself scrolling without knowing how much time you have spent or what exactly you have even done by the end of it. These are some of the tools they employ, and those are just a few examples. That’s why, as I mentioned earlier, it is so difficult for some people, particularly children, 95 percent of whom say it’s hard for them to cut down on their social media use and technology use.

This is particularly concerning, Dr. Pho, because in young children and adolescents, these changes are happening at times of crucial brain development. Of course, we know the resilience of young brains is strong, so there’s strong hope that as you take preventive measures and protective measures, those brain changes can be reversed. But nonetheless, the risk is there, and if action is not taken soon enough, the harm that is done may be indelible. That is what the Surgeon General also mentioned: So much of the research indicates that, along with the addictive potential and the mental health concerns, healthy brain maturation is now at risk from the increased use and the design of these products.

Kevin Pho: Now tell us what we can do as individual physicians. We’re both primary care doctors. You’re a family physician, so you definitely see more teenagers than I do as an internal medicine physician, but we’re just individuals, and we’re competing against the might of billion-dollar tech conglomerates whose very products are designed to be habit-forming and addictive. And let’s be honest, they’re going to have much more influence than the 15 minutes we have in the exam room with each of these patients. So what do you do as a family physician to help combat this phenomenon?

Mohammed Umer Waris: Dr. Pho, I have made it one of the essential points of my counseling with patients, particularly after the Surgeon General’s public health advisories came out presenting the magnitude of this challenge. Part of the counseling, and I do this for teenagers, children and adults, is mentioning how important social connection is to our well-being. And when I mention social connection, I’m not talking about virtual connections, the profile pics and the likes and dislikes on social media. I’m talking about real, meaningful connections in person, and how important it is to foster and cherish those connections, because they are tied to our well-being. I mention to them that loneliness, whether or not we recognize it, in all its forms, has been linked to an increase in mortality as large as that from smoking 15 cigarettes per day. That’s the latest research on this.

I mention to them that, as part of addressing loneliness and building social connection, we need to make sure, particularly for our young people, that social media use is cut down to a maximum of two hours per day. We need to make sure that family time and dinnertime are entirely cellphone- and technology-free, and that includes even television; those are technology-free times when your phone and your television are off and away. At bedtime, the phone is turned off one hour before bed and kept away from the bed. That is for the general population and for teenagers. But when we get to the younger populations, children younger than 12 years old, I advise, and the latest research advises, cutting it down to even less than two hours, or even to having no technology and social media time at all. If they are using it, make sure that it is reputable, educational resources being provided to the child. That is because the risk to the youngest of our children is even higher than it is for our teenagers, given that at those young ages brain development is happening at an even more rapid and crucial pace.

That’s just some of the counseling that I do. And I mention to them, and this is borrowing from the words of other leading family physicians and addiction medicine specialists, that no medication can do for your health what exercise, good company and good friendships in person can do for you. I make sure that is a strong part of all my counseling with all of my patients, and I make it part of my counseling at well-child visits with all children as well.

The other step that I think we need to take strongly as physicians, outside of the clinic, is being involved in policymaking and advocacy efforts through our organized medical societies, but not limited to them; in our communities as well. We know, as you mentioned, that these companies carry enormous influence, and so much of how they have designed their products has thus far not been regulated. The research on it has just been starting to become available, and the surprising fact is that they have their own internal research that is not provided to the public or to independent researchers, so we still do not even know the full extent of how damaging some of these products can be. An example: Had it not been for the whistleblower from Facebook, we would not have had that internal research available.

So part of our advocacy as physicians must involve standing on the grounds of public health, of children’s and adolescent health, and pointing to the backdrop of declining life expectancy related to this declining mental health, to say that this research should be publicly available for independent researchers to evaluate and draw their conclusions on whether it is safe or not, and that advisories should then be put in place for those products before they are in the hands of children.

Additionally, and this was mentioned in the Surgeon General’s report, given that we now have enough evidence to see the extent of the harm being done, we must also look at applying to these social media products the same safety-first standard that we apply to toymakers when they introduce toys, or to drug companies before they introduce drugs into the market, where regulatory bodies independently test their safety for the health of the general public before they are allowed out for mass consumption. I think that has to be a baseline regulatory stance, because these products are more widely available than even many drugs and toys are, and hence the extent of their reach and of their effect on our mental health is that much more urgent and essential, and regulating them is that much more essential and urgent as well.

I wanted to point out, to put it in as stark terms as possible, a statement from the Surgeon General’s advisory that paints, in very ominous but very clear terms, the challenge we face. He wrote: “Our children have become unknowing participants in a decades-long experiment of social media and technology use. 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 part where he says our children have become unknowing participants in a decades-long experiment needs to be emphasized. We cannot let this experiment go on any longer without some intervention and some oversight, because the health of our children, and our health in general as a public and as a country, is at stake.

Kevin Pho: Now, when you give this advice to teens and their families, what kind of pushback, if any, do you get? Because I have two teenage daughters, and implementing some of the suggestions you make is sometimes easier said than done. For those parents listening to you here, any tips on how they could implement some of your suggestions?

Mohammed Umer Waris: A great question, a great question. I think we should begin by pointing out, as we have throughout the course of this discussion, the urgency of this. We are now advised by the Surgeon General and by many other leading health regulatory bodies and public health bodies to counsel patients and children about social media, just as we are counseling them about drug use, physical activity and other such healthy behaviors. Based on all of the latest evidence, social media use is now of that same importance. So I think it begins with sharing clearly the harm that can be done and why we are doing this counseling.

Second, there are many resources, including from the American Academy of Pediatrics on its advisory page, that show how parents and children can have these conversations, including a toolkit with resources on what constitutes good social media use and how to have these conversations. I advise parents to avail themselves of those resources. There are social media use plans and a tip sheet for adolescents, and many times I print those out and give them to the parents in the room to take with them and have these conversations, and to bring them back at their next visit to see what was done, so this is an ongoing conversation. As we’ve talked about, this is not going to be an easy or quick fix, knowing how hard it is already for people to bring down their use on their own. But if we make it an ongoing conversation where we follow up with them, perhaps that repeated instruction and discussion can lead to some changes.

Additionally, I point out to the children, again, the magnitude of the harm that can be done to them. Honestly, Dr. Pho, I mention it to them in the larger context of, “Hey, just as we counsel you on other unhealthy behaviors, because we know that in the long term they affect your well-being and your success as an adult, I’m counseling you in the same light on this. This is tied to your well-being and your success.” It is with that mindset that I present these resources and this counseling and then have ongoing discussions about it. And hopefully, and I have seen it, they come back having shown improvements and a recognition that this is a challenge, and talking about it with their own peers as well. I’ve been pleasantly surprised, when I’ve had follow-up discussions with the children and the parents, that they have come back reporting, by and large, good results and good changes.

Kevin Pho: We’re talking to Mohammed Umer Waris. He’s a family physician. His KevinMD article is titled “Regulating social media’s effects on mental health.” Mohammed, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Mohammed Umer Waris: My take-home message for the audience would be this: Let us value our social connections. As I closed in my other articles, we must choose community, real and meaningful, not virtual and artificial, as our path forward in responding to this social media, youth mental health and technology crisis. The loneliness epidemic that we are facing cannot be addressed simply in the clinics. It cannot be addressed with any simple prescription or pills. There is no substitute for human connection. That means speaking about it, emphasizing it and fostering it in our own lives, encouraging our patients to do it when we are seeing them in the clinic, and then doing it ourselves outside of the clinic, being models of the healthy behaviors we are talking about, and seeing the need to be a model for that in our larger communities, as citizens, as fellow family members and as parents.

The Surgeon General closed his advisory on the loneliness epidemic by writing that a fraying of the social fabric can be seen more broadly in society: “Trust in each other and major institutions is at near-historic lows.” Obviously we’re seeing the manifestations of that at all levels of society, in all sorts of sociological and political phenomena, which we don’t have the time to go into here. But as clinicians concerned about public health, we are certainly seeing its effect on the health of our patients. It’s up to us now, as physicians and as everyday citizens, to make sure that we are engaging and fostering connections and building the social infrastructure that fosters connection in our lives, whether that is community events, volunteer organizations or even faith-based organizations, places people have gone to for centuries, for millennia, throughout human history, for meaning and connection. We are facing a crisis in that. Social media use and technology use are just a part of the problem we need to address, but the larger problem and the larger crisis is one of connection and meaning. I hope we can make that a priority in each of our lives, and make those connections, and the institution-building for those connections, a priority in each of our lives, because the health of our children and ourselves is at stake at this moment.

Kevin Pho: Mohammed, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Mohammed Umer Waris: My pleasure. Thank you, Dr. Pho, for everything you do.