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Child psychiatrist Ellen K. Feldman discusses her article “How social media is shaping teen mental health and what we can do about it,” highlighting the growing concerns about social media’s impact on adolescents. She emphasizes the importance of monitoring social media usage, setting screen time limits, and teaching digital literacy to help young people protect themselves from harmful content. Ellen also stresses the value of in-person socialization to counteract social media’s isolating effects, especially for teens struggling with anxiety or depression. She offers actionable strategies for parents and clinicians to support teens in developing healthy digital habits and foster emotional resilience.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Ellen K. Feldman. She is a child psychiatrist, and today’s Kevin MD article is “How social media is shaping teen mental health and what we could do about it.” Ellen, welcome to the show.

Ellen K. Feldman: Thank you so much for having me here today.

Kevin Pho: All right, so just briefly tell us a little bit about yourself and then move on to the article that you shared on Kevin MD for those who did not get a chance to read it.

Ellen K. Feldman: I am a child psychiatrist—actually, I practice general psychiatry out of North Dakota. We cover a pretty wide range in terms of North Dakota and northwest Minnesota. An interesting thing about me is the way I came to psychiatry was somewhat roundabout, through an experience I had as a teen myself. As a somewhat rebellious teen, I was facing a summer at a camp where I had gone for years. I got in trouble and was asked to leave. Having nothing else to do for the summer and being told I needed to find a job, I ended up working at a state psychiatric facility. Mm-hmm. That really shaped a lot of my thinking about what I wanted to do for the rest of my life, which at that point was writing. It gave me an experience of seeing—I do not know, this is certainly not about the article itself, but it gave me a lot of empathy for teenagers and the way they can turn their lives around and shape their lives through different experiences.

Kevin Pho: All right. Inspiring story, of course. Now, you said that your background gave you insight into the article that you shared on Kevin MD: “How social media is shaping teen mental health and what we could do about it.” Tell us about the article.

Ellen K. Feldman: I would say the article came about because I had noticed over the years—pre-pandemic, I would say—that as I worked with kids, I was hearing more and more questions. My typical way of working with kids is: I will have the parents and the kids together at first, ask the parents or guardians to leave, see the teen by themselves (or the young child by themselves, depending on age), and then bring the parents back in to answer any questions and present a plan. I started noticing that almost every session, when I would say, “What questions do you have remaining?” they would say, “What do we do about social media?” or “What do we do about our kid who is in their room all the time on their device?” I realized at that point, first, I did not have time to answer that question at the end of the session, so I started putting that into my repertoire earlier on and discussing it. But I also realized I did not have a lot of answers. It occurred to me that parents were bringing up a problem that maybe had not quite hit science or medical research yet. We were starting to see articles looking at this, but we had not quite caught up to what parents were seeing, which is that they really felt this was a problem and were not sure what to do about it.

So that spurred my interest in examining what the research tells us about social media and how we can help kids who are having difficulties managing their time or reacting and responding to social media. Another factor that spurred my interest is seeing a lot of kids, including young adults at a university, in our inpatient unit who have a very hard time giving up their phones when they come in. That can be harder than saying goodbye to their parents.

The article starts out by looking at what we do know about social media and then at what we can do. Really, what we do know is limited by the research, and the research is behind because social media keeps evolving. Research published now may have looked at Facebook, which is not the same as TikTok or the 24/7 access that many kids have today. It is very interesting to think about what can be done. One point I raise in the article is to think about putting in controls, respect, and safety measures early on—before your child has free access—so you have some management techniques in place that you can model and present to them.

Kevin Pho: Before we talk about some of the data, tell me about some of the stories that parents are telling you about the effects social media has on their kids.

Ellen K. Feldman: I do not know if it is fair to say parents specifically tell me about the “effect” social media has. I think they are talking about seeing their children withdraw more and spend a lot of time on social media—there are many forms of it. In general, parents see it as a divisive experience, not an inclusive one, and it worries them, especially when they have a kid with mental health problems. They are not sure if it is a healthy way for them to get support or if they are hearing troubling things that increase their worries.

I had a very interesting group of parents who got together and ended up doing a kind of quasi-experiment with their kids. They had “social media dinners” where, as a family, they would say, “We are not going to talk. We are just going to communicate through text during this dinner,” or use some sort of instant messenger account. Afterwards, they used the time to ask, “What did you think I was actually saying to you? What was my intention? Did I seem angry? Was I happy?” Then each person explained what they heard. A lot of the kids thought it was great because it taught them some things, and they felt their parents learned some things too. They saw it as a way for parents to reach out, to say, “What do you like about this and what do you see as dangerous about this?”—almost like meeting kids where they are.

I worked in a residential treatment facility for many years for teens. They would be there for months, no phones. The staff there used to have the kids journal, which is a classic intervention. The staff developed a “text journal” technique for kids who could not journal, where they would write back and forth on paper as if texting, and that seemed to work very well too.

Kevin Pho: I have seen articles in the New York Times and other lay press about the connection between behavioral health problems and social media—specifically anxiety. Tell us about what the data says regarding a connection between behavioral health issues and social media exposure.

Ellen K. Feldman: It is actually very interesting. There was a study that came out at the end of March from the University of South Florida, looking at about 1,500 kids. They wanted a naturalistic study, not a controlled one, because we are not taking social media away from some kids and leaving it for others. They said they had to start at age 11, because by older ages, 95 percent of kids have cell phones. They wanted to compare kids with and without phones, so they chose 11 to 13 for about 1,300 kids. They found that owning a cell phone, controlled for socioeconomic status and so forth, did not lead to any problems. In fact, the kids who had cell phones looked maybe a little better in terms of mental health compared to those who did not. That surprised them.

However, they also found that public posting on social media was associated with more anxiety and depressive symptoms in kids—again, symptoms, not necessarily a formal diagnosis. Very strongly associated in that study was any cyberbullying reported by the kids. That linked strongly with decreased self-esteem, among other issues. It is a fascinating study, but what they do not know is whether the kids without cell phones were different to begin with. Maybe parents had noticed something else and said, “You are not ready for a cell phone yet.” That group is continuing a 25-year study now, expanding it to 8,000 kids, and will be reporting findings every six months. All the studies we have so far are like that—observational, not controlled. We do see an association between more social media use (especially public posting) and more depression and anxiety, but it could be that those kids also have less supervision or other factors.

What I tell the parents I work with is, if you can build something in early on—whether it is how you yourself use social media or how you talk about it—and really model that you are not overly invested in what other people say about you or in how many people like your post, that helps kids see how to build in safety techniques and strategies moving forward.

Kevin Pho: Now, whenever you see kids in your office for depression and anxiety, does the topic of social media come up? If so, how is that broached in the exam room?

Ellen K. Feldman: As I said earlier, it used to come up at the end when I would ask, “Any remaining questions?” and parents would mention it then. Now, I bring it up early on. Usually, kids will roll their eyes and say, “I know all that. I know not to post. I know whatever I put online stays forever. We hear all this in school.” But I certainly have kids who will come in and say, “I just deleted my contacts because I do not have the bandwidth to handle the interaction that I am getting.” What I work on with kids is self-awareness: thinking about what social media gives you and what it takes away. Does it give you satisfaction? Is it a stress reliever? Is it more helpful than other things you could be doing? Often, you need parents or guardians in that discussion because, depending on a child’s age, it may not be something they can manage well on their own. Kids want to feel better, and so do adults. Sometimes they do not have the ability to wait for a healthier way to cope.

Kevin Pho: You mentioned that the best approach is really to address social media before a child is fully exposed to it. When you talk about “limits,” what exactly do you mean? Strict time limits, supervised activity—what are some examples?

Ellen K. Feldman: I wish I could say science tells us exactly what to do—X, Y, and Z. I go back to thinking about cars. When you take your child home from the hospital, they must be in a car seat. In the late ’70s or early ’80s, a pediatrician in Tennessee said too many kids were dying in car crashes; we need car seats. He and his wife helped advocate for the first car seat law in Tennessee, and that law cut children’s deaths in half. Then other states followed suit. We could say there were cars around well before the ’70s and ’80s, but once the cars got faster and more ubiquitous, we realized we needed regulations and safety measures. It is similar to the internet.

Yes, I think the industry will eventually catch up, but until then, parents cannot wait for that. Part of being a physician is thinking about prevention. We do not know social media is causing anything; we only see a correlation. But why not do what we can to prevent potential harm?

I cannot dictate precisely how much time a child should or should not have. Sometimes school is online. Look at what happened during the pandemic. Instead, parents should teach self-awareness: show kids the good and the bad, model how you yourself use social media, and show that you do not base your self-worth on likes or comments. Even exaggerate that if necessary, depending on whether your child responds better to words or actions. All the literature consistently advises that kids understand the permanence of what they post, learn how to critically examine incoming information, understand the impact on themselves, and recognize that immediate impulses—like posting a heated reply—are not always wise. Finally, consider postponing public posting until later adolescence.

Kevin Pho: What about the child who is already experiencing behavioral health effects from spending too much time on social media—one who cannot simply self-regulate and quit when it becomes harmful? How would you approach that scenario?

Ellen K. Feldman: I often tell parents—and the kids—if you cannot handle it, you need to shrink your world a bit. The first skill you need is emotional regulation. It may be that social media is age-appropriate in general, but if your child cannot handle it well right now, focus on self-control first. Reintroduce it gradually when they have learned some regulation skills.

Kevin Pho: One point you mention in your article is how in-person socialization can sometimes counterbalance negative effects of social media. Talk more about that connection.

Ellen K. Feldman: I am not sure I would say it “counters” the effects, but we do know that balance is important. Going back to that South Florida study, they noticed that the kids who had cell phones—and were doing well—got together in person with friends more often. Does that link to mental health? We do not know. It is just an association. Social media might be a proxy for something else. But we do know from our own experience that there are different skills involved in face-to-face conversation compared to screen-based interaction. Kids need both. Like anything else, too much of even a good thing may become detrimental.

Kevin Pho: One question I often hear is about the responsibility of social media companies themselves. Their products can be addictive, and there is research linking them to behavioral health issues. How much responsibility should they take?

Ellen K. Feldman: That is a tough question. It may be akin to holding car manufacturers responsible for seat belts or airbags, or the ratings system for movies. Yes, social media companies should absolutely take responsibility if they are aware their platforms are addictive. But I would not wait for that. We can focus on what we can control: physicians learning from patients, parents advocating for safety controls, and kids speaking up if they want changes.

Kevin Pho: We are talking to Ellen Feldman. She is a child psychiatrist. Today’s Kevin MD article is “How social media is shaping teen mental health and what we could do about it.” Ellen, let us finish up by asking: what are some take-home messages you would like to leave with the Kevin MD audience?

Ellen K. Feldman: I would say exactly what you just said: learn from patient experiences, listen to them, and it is fine to generalize and say, “I am seeing a trend—what do I do about it?” Then think about how to incorporate that into your daily practice or how to help other patients. And for parents, have the courage and be empowered to control what you can to shape how social media is used in your household. Ideally, your kids will carry that awareness and self-regulation with them as they grow into more independence.

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

Ellen K. Feldman: All right, Kevin, thank you very much for having me.