Summary:
The rising use of social media, video games, and mobile devices among adolescents has coincided with increasing rates of mental health problems and suicidal behaviors. While much research has focused on total screen time, emerging evidence suggests that addictive patterns of screen use may be a stronger predictor of mental health risks than overall usage. These patterns can differ by platform and follow distinct developmental trajectories, yet their links to suicide-related outcomes and psychological symptoms remain poorly understood. This study is a longitudinal cohort analysis using data from the Adolescent Brain Cognitive Development (ABCD) Study, which follows children across 21 US sites. The study aimed to identify trajectories of addictive use of social media, mobile phones, and video games from ages 10-14, and assess whether these trajectories are associated with suicidal behaviors, suicidal ideation, and internalizing or externalizing symptoms over four years. Internalizing behaviors refer to emotional difficulties directed inward, such as anxiety, depression, or social withdrawal, whereas externalizing behaviors involve outwardly directed actions, including aggression, hyperactivity, or rule-breaking. The study also examined whether these associations persist after accounting for total screen time. The sample included 4,285 participants. Addictive use was measured via validated surveys across years 2-4. Nearly one-third of participants showed increasing addictive use of social media or mobile phones beginning around age 11. Participants with high or increasingly addictive use had higher risks of suicidal behaviors and ideation than those with low use. For example, increasing addictive social media use was associated with a more than twofold risk of suicidal behaviors. Addictive video game use was linked to greater internalizing symptoms, while increasing social media addiction predicted higher externalizing symptoms. Total screen time at baseline was not associated with any outcomes. Overall, this study found that high or addictive use of social media, mobile phones, or video games is common in early adolescence and is associated with suicidal behaviors, ideation, and poorer mental health. These findings highlight the importance of distinguishing addictive patterns of screen use from overall screen time when assessing mental health risks in youth.
Abstract:
Importance: Increasing child and adolescent use of social media, video games, and mobile phones has raised concerns about potential links to youth mental health problems. Prior research has largely focused on total screen time rather than longitudinal addictive use trajectories. Objectives: To identify trajectories of addictive use of social media, mobile phones, and video games and to examine their associations with suicidal behaviors and ideation and mental health outcomes among youths. Design, Setting, and Participants: Cohort study analyzing data from baseline through year 4 follow-up in the Adolescent Brain Cognitive Development Study (2016-2022), with population-based samples from 21 US sites. Exposures Addictive use of social media, mobile phones, and video games using validated child-reported measures from year 2, year 3, and year 4 follow-up surveys. Main Outcomes and Measures: Suicidal behaviors and ideation assessed using child- and parent-reported information via the Kiddie Schedule for Affective Disorders and Schizophrenia. Internalizing and externalizing symptoms were assessed using the parent-reported Child Behavior Checklist. Results: The analytic sample (n = 4285) had a mean age of 10.0 (SD, 0.6) years; 47.9% were female; and 9.9% were Black, 19.4% Hispanic, and 58.7% White. Latent class linear mixed models identified 3 addictive use trajectories for social media and mobile phones and 2 for video games. Nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones beginning at age 11 years. In adjusted models, increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories (eg, increasing addictive use of social media had a risk ratio of 2.14 [95% CI, 1.61-2.85] for suicidal behaviors). High addictive use trajectories for all screen types were associated with suicide-related outcomes (eg, high-peaking addictive use of social media had a risk ratio of 2.39 [95% CI, 1.66-3.43] for suicidal behaviors). The high video game addictive use trajectory showed the largest relative difference in internalizing symptoms (T score difference, 2.03 [95% CI, 1.45-2.61]), and the increasing social media addictive use trajectory for externalizing symptoms (T score difference, 1.05 [95% CI, 0.54-1.56]), compared with low addictive use trajectories. Total screen time at baseline was not associated with outcomes. Conclusions and Relevance: High or increasing trajectories of addictive use of social media, mobile phones, or video games were common in early adolescents. Both high and increasing addictive screen use trajectories were associated with suicidal behaviors and ideation and worse mental health.
Article Publication Date: 18/06/2025
DOI: 10.1001/jama.2025.7829
