Medicine:Problematic social media use

From HandWiki
Short description: proposed medical diagnosis related to overuse of social media

Problematic social media use
Other namesSocial media addiction, social media overuse
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SpecialtyPsychiatry, psychology
SymptomsProblematic smartphone use, internet addiction disorder
Risk factorsLower socioeconomic status,[1] female sex[2][3][4][5][6][7][8][9]
PreventionParental engagement and support[10]

Psychological or behavioral dependence on social media platforms can result in significant impairment in an individual's function in various life domains over a prolonged period. This and other relationships between digital media use and mental health have been considerably researched, debated, and discussed among experts in several disciplines, and have generated controversy in medical, scientific, and technological communities. Research suggests that it affects women and girls more than boys and men and that it varies according to the social media platform used.[11] Such disorders can be diagnosed when an individual engages in online activities at the cost of fulfilling daily responsibilities or pursuing other interests, and without regard for the negative consequences.

Excessive social media use has not been recognized as a disorder by the World Health Organization or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Controversies around problematic social media use include whether the disorder is a separate clinical entity or a manifestation of underlying psychiatric disorders. Researchers have approached the question from a variety of viewpoints, with no universally standardized or agreed definitions. This has led to difficulties in developing evidence-based recommendations.

Signs and symptoms

Problematic social media use is associated with mental health symptoms, such as anxiety and depression in children and young people.[12] A 2019 meta-analysis investigating Facebook use and symptoms of depression showed an association, with a small effect size.[13] However, Social media may also be utilized in some situations to improve mood.[12] In a Michigan State University study from 2015 and 2016, they found that social media users are 63% less likely to experience serious psychological distress like depression and anxiety from one year to the next. Users who are connected to extended family members further reduced their psychological distress, as long as their family member was in good health. In contrast, In a 2018 systematic review and meta-analysis, problematic Facebook use was shown to have negative affects on well-being in adolescents and young adults, and psychological distress was also found with problematic use.[14] Frequent social media use was shown in a cohort study of 15- and 16-year-olds to have an association with self-reported symptoms of attention deficit hyperactivity disorder followed up over two years.[15]

Decrease in mood

A 2016 technological report by Chassiakos, Radesky, and Christakis identified benefits and concerns in adolescent mental health in regard to social media use. It showed that the amount of time spent on social media is not the key factor but rather how time is spent. Declines in well-being and life satisfaction were found in older adolescents who passively consumed social media; however, these were not shown in those who were more actively engaged. The report also found a U-shaped, curvilinear relationship between the amount of time spent on digital media with risk of depression developing, at both the low and high ends of Internet use.[16]

Eating Disorders

According to research by Flinders University social media use correlates with eating disorders. The study found eating disorders in 52% of girls and 45% of boys, from a group of 1,000 participants who used social media.[17]

Through the extensive use of social media, adolescents are exposed to images of bodies that are unattainable, especially with the growing presence of photo-editing apps that allow you to alter the way that your body appears in a photo.[18] This can, in turn, influence both the diet and exercise practices of adolescents as they try to fit the standard that their social media consumption as set for them.[18]

Excessive use

One can evaluate their social media habits and behavior toward it to help determine if an addiction is present. Addictions are a certain type of impulse control disorder, which may lead one to lose track of time while using social media. For instance, ones psychological clock may run slower than usual and their self-consciousness is compromised.[19] Therefore, individuals may passively consume media for longer amounts of time. In fact, psychologists estimate that as many 5 to 10% of Americans meet the criteria for social media addiction today.[20] Addictive social media use will look much like that of any other substance use disorder, including mood modification, salience, tolerance, withdrawal symptoms, conflict, and relapse. In the digital age, it is common for adolescents to use their smartphones for entertainment purposes, education, news and managing their daily life. Therefore, adolescents are further at risk for developing addictive behaviors and habits. Many medical experts have looked at the survey and come up with a clear conclusion, saying that teenagers' excessive smartphone use has an impact on their behavior and even their mental health.[21]

Social anxiety

Social media allows users to openly share their feelings, values, relationships and thoughts. With the platform social media provides, users can freely express their emotions. However, not all is great with social media, it can also cause discrimination and cyberbullying. Discrimination and cyberbullying are more prevalent online because people have more courage to write something bold rather than to say it in person.[22] There is also a strong positive correlation between social anxiety and social media usage; and in particular between cyberostracism and social media disorder.[23] The defining feature of social anxiety disorder, also called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation.[24] Many users with mental illnesses, such as social anxiety, go to the internet as an escape from reality, so they often withdraw from in-person communication and feel most comfortable with online communication. People usually act differently on social media than they do in person, resulting in many activities and social groups being different when using social media.[25] The pros and cons of social media are heavily debated; although using social media can satisfy personal communication needs, those who use them at higher rates are shown to have higher levels of psychological distress.[26]

Symptoms of social anxiety include: excessive sweating, blushing, trembling, rapid heart rate, nausea, rigid body posture, lack of eye contact, quiet speaking, difficulty interacting with people, feeling insecure, and avoiding places with a lot of people.[27]

Mechanisms

A 2017 review article noted the "cultural norm" among adolescence of being always on or connected to social media, remarking that this reflects young people's "need to belong" and stay up-to-date, and that this perpetuates a "fear of missing out". Other motivations include information seeking and identity formation, as well as voyeurism and cyber-stalking. For some individuals, social media can become "the single most important activity that they engage in". This can be related to Maslow's hierarchy of needs, with basic human needs often met from social media. Positive-outcome expectations and limited self-control of social media use can develop into "addictive" social media use. Further problematic use may occur when social media is used to cope with psychological stress, or a perceived inability to cope with life demands.[3]

Cultural anthropologist Natasha Dow Schüll noted parallels to the gambling industry inherent in the design of various social media sites, with "'ludic loops' or repeated cycles of uncertainty, anticipation and feedback" potentially contributing to problematic social media use.[28] Another factor directly facilitating the development of addiction towards social media is implicit attitude towards the IT artifact.[29]

Griffiths also postulated in 2014 that social networking online may fulfill basic evolutionary drives, after mass urbanization worldwide. The basic psychological needs of "secure, predictable community life that evolved over millions of years" remain unchanged, leading some to find online communities to cope with the new individualized way of life in some modern societies.[30]

According to Andreassen, empirical research indicate that addiction to social media is triggered by the dispositional factors (such as personality, desires, self-esteem), but specific socio-cultural and behavioral reinforcement factors remain to be investigated empirically.[31]

A secondary analysis of a large English cross-sectional survey of 12,866 13 to 16 year olds published in Lancet found that mental health outcomes problematic use of social media platforms may be in part due to exposure to cyberbullying, as well as displacement in sleep architecture and physical exercise, especially in girls.[32] Through cyberbullying and discrimination researchers have found that depression rates among teens have drastically increased. In a study done of 1,464 random users on Twitter, 64% of those people were depressed, while the majority of depressed users were in between 11 and 20. The study was associated with a lack of confidence due to stigma for those who were depressed. In fact out of the 64% that were depressed, over 90% of them were extremely low in profile images and shared media. Moreover, the study also found a strong correlation between the female gender and expression of depression, concluding that the female-to-male ratio is 2:1 for major depressive disorder.[33]

In 2018, Harvard University neurobiology research technician Trevor Haynes postulated that social media may stimulate the reward pathway in the brain.[34] An ex-Facebook executive, Sean Parker, has also espoused this theory.[35]

Platform-specific risks

Studies have shown differences in motivations and behavioral patterns among social media platforms, especially in regards to the problematic use of it.[36][37] In the United Kingdom, a study of 1,479 people between 14 and 24 years old compared the psychological benefits and deficits of the five largest social media platforms: Facebook, Instagram, Snapchat, Twitter, and YouTube. Negative effects of smartphone use include “phubbing,” which is snubbing someone by checking one's smartphone in the middle of a real-life conversation. The study was used to check the direct and indirect associations of neuroticism, trait anxiety, and trait fear of missing out with phubbing via state fear of missing out and problematic Instagram use. The total number of 423 adolescents and emerging adults between the ages of 14 to 21 years old (53% female) participated in the study. With the findings indicating that females had the significantly higher scores of phubbing, fear of missing out, problematic Instagram use, trait anxiety, and neuroticism. Problematic social media use (PSMU) presented in the study that was invested also in the influences of demographics and Big Five personality dimensions on social media use motives; demographics and use motives on social media site preferences; and demographics, personality, popular social media sites, and social media use motives on PSMU. The study consisted of 1008 undergraduate students, between the age of 17 and 32 years old. Participants who preferred Instagram, Snapchat, and Facebook reported higher scores of problematic social media use. The study concluded that YouTube was the only platform with a net positive rating based on 14 questions related to health and well-being, followed by Twitter, Facebook, Snapchat, and finally Instagram. Instagram had the lowest rating: it was identified to having some positive effects such as self-expression, self-identity, and community, but ultimately was outweighed by its negative effects on sleep, body image, and "fear of missing out".[38]

Limiting the Use of Social Media

A three-week study for limiting social media usage was conducted on 108 female and 35 male undergraduate students at the University of Pennsylvania.[39] Prior to the study, participants were required to have Facebook, Instagram, and Snapchat account on an iPhone device. This study observed the student's well-being by sending a questionnaire at the start of the experiment, as well as at the end of every week. Students were asked questions about their well-being on the scale of: “social support,” “fear of missing out,” “loneliness,” “anxiety,” “depression,” “self-esteem,” and “autonomy and self-acceptance.” The conclusion of the study revealed that limiting social media usage on a mobile phone to 10 minutes per platform per day had a significant impact on well-being.[39] Loneliness and depressive symptoms declined with the group that had limited social media usage. Students with depressive symptoms had a much higher impact with social media restriction if they began with higher levels of depression.[39]

Diagnosis

There are many ways that an addiction to social media can be expressed in individuals. According to Andreassen and colleagues, there are four potential factors that indicate a person's dependence to social media:[40]

  1. Mood swings: a person uses social media to regulate his or her mood, or as a means of escaping real world conflicts
  2. Relevance: social media starts to dominate a person's thoughts at the expense of other activities
  3. Tolerance: a person increases their time spent on social media to experience previously associated feelings they had while using social media;
  4. Withdrawal: when a person can not access social media their sleeping or eating habits change or signs of depression or anxiety can become present.
  5. Conflicts in real life: when social media is used excessively, it can affect real-life relationships with family and friends.

In addition to Andreassen's factors, Griffiths further explains that someone is addicted to social media if their behavior fulfills any of these six criteria:[30]

  1. Salience: social media becomes the most important part in someone's life;
  2. Mood modification: a person uses social media as a means of escape because it makes them feel "high", "buzzed", or "numb";
  3. Tolerance: a person gradually increases their time spent on social media to maintain that escapist feeling;
  4. Withdrawal: unpleasant feelings or physical sensations when the person is unable to use social media or does not have access to it;
  5. Conflict: social media use causes conflict in interpersonal dynamics, loses desire to participate in other activities, and becomes pervasive;
  6. Relapse: the tendency for previously affected individuals to revert to previous patterns of excessive social media use.

He continues to add that excessive use of an activity, like social media, does not directly equate with addiction because there are other factors that could lead to someone's social media addiction including personality traits and pre-existing tendencies.[30]

Turel and Serenko summarize three types of general models people might have that can lead to addictive social media use:[41]

  1. Cognitive-behavioral model – People increase their use of social media when they are in unfamiliar environments or awkward situations;
  2. Social skill model – People pull out their phones and use social media when they prefer virtual communication as opposed to face-to-face interactions because they lack self-presentation skills;
  3. Socio-cognitive model – This person uses social media because they love the feeling of people liking and commenting on their photos and tagging them in pictures. They are attracted to the positive outcomes they receive on social media.

Based on those models, Xu and Tan suggest that the transition from normal to problematic social media use occurs when a person relies on it to relieve stress, loneliness, depression, or provide continuous rewards.[42]

Management

No established treatments exist, but from research from the related entity of Internet addiction disorder, treatments have been considered, with further research needed.[31] Screen time recommendations for children and families have been developed by the American Academy of Pediatrics.[43][44]

Possible therapeutic interventions published by Andreassen include:

  • Self-help interventions, including application-specific timers;
  • Cognitive behavioral therapy; and
  • Organizational and schooling support.[45]

Possible treatment for social anxiety disorder includes cognitive behavioral therapy (CBT) as well. CBT helps victims of social anxiety to improve their ways of thinking, behaving, and reacting to stressful situations. Withal, most CBT is held in a group format to help improve social skills.[46]

Medications have not been shown to be effective in randomized, controlled trials for the related conditions of Internet addiction disorder or gaming disorder.[45]

Technology management

As awareness of these issues has increased, many technology and medical communities have continued to work together to develop novel solutions. Apple Inc. purchased a third-party application and incorporated it as "screen time", promoting it as an integral part of iOS 12.[47] A German technology startup developed an Android phone specifically designed for efficiency and minimizing screen time.[48] News Corp reported multiple strategies for minimizing screen time.[49] Facebook and Instagram have announced "new tools" that they think may assist with addiction to their products.[50] In an interview in January 2019, Nick Clegg, then head of global affairs at Facebook, claimed that Facebook committed to doing "whatever it takes to make this safer online especially for [young people]". Facebook committed to change, admitting "heavy responsibilities" to the global community, and invited regulation by governments.[51]

Government response

A survey conducted by Pew Research Center from January 8 through February 7, 2019, found that 80% of Americans go online everyday.[52] Among young adults, 48% of 18- to 29-year-olds reported going online 'almost constantly' and 46% of them reported going online 'multiple times per day.'[52] Young adults going online 'almost constantly' increased by 9% just since 2018. On July 30, 2019, U.S. Senator Josh Hawley introduced the Social Media Addiction Reduction Technology (SMART) Act that is intended to crack down on "practices that exploit human psychology or brain physiology to substantially impede freedom of choice". It specifically prohibits features including infinite scrolling and Auto-Play.[53][54]

A study conducted by Junling Gao and associates in Wuhan, China, on mental health during the COVID-19 outbreak revealed that there was a high prevalence of mental health problems including generalized anxiety and depression.[55] This had a positive correlation to 'frequent social media exposure.'[55] Based on these findings, the Chinese government increased mental health resources during the COVID-19 pandemic, including online course, online consultation and hotline resources.[55]

Scales and measures

Problematic social media use has been a concern for over a decade. There have been several scales developed and validated that help to understand the issues regarding problematic social media use. One of the first scales was an eight-item scale that was used for Facebook use.[56] The Facebook Intensity Scale (FBI) was used multiple times and showed good reliability and validity. This scale only covered three areas of social media engagement, which left the scale lacking. Although the FBI was a good measure it lacked the needed component of purpose of use. The Multi-dimensional Facebook Intensity Scale (MFIS) investigated different dimensions of use that include overuse and reasons for use.[57] The MFIS is composed of 13 items and has been used on several samples. The MFIS also had good reliability and validity, but the scale was directed toward the use of Facebook, and social media is far more than just one platform. The Social Networking Activity Intensity Scale (SNAIS) was created to look at the frequency of use of several platforms and investigated three facets of engagement with a 14-item survey. This scale looked at the purposes of use both entertainment and social function, and the scale as a whole had acceptable reliability and validity.[58] The Social Media Disorder Scale (SMD) is a nine-item scale that was created to investigate addiction to social media and get to the heart of the issue.[59] This scale has been used in conjunction with multiple scales and does measure social media addiction. The SMD has been tested and good reliability and validity. This tool can be used by itself or in conjunction with other measures for future research and appears to be a reliable scale. There are many other scales that have been created, however there is not one single scale that is being used by all researchers.[60][61]

History

Because technological advances are considered “progress,” it becomes more challenging to admit and confront the negative effects associated with them.[62]

Causality has not been established, despite associations between digital media use and mental health symptoms and diagnoses being observed. Nuances and caveats published by researchers are often misunderstood by the general public and misrepresented by the media.[63] According to a review published in 2016, Internet addiction and social media addiction are not well-defined constructs. No gold standard diagnostic criteria or universally agreed upon theories on the interrelated constructs exist.[64]

The proposed disorder is generally defined if "excessive use damages personal, family and/or professional life" as proposed by Griffiths, a chartered psychologist focusing on the field of behavioral addictions. The most notable of these addictions being: gambling disorder, gaming addiction, Internet addiction, sex addiction, and work addiction.[64]

Several studies have shown that women are more likely to overuse social media while men are more likely to overuse video games.[2]

There have been studies linking extraversion to overuse of social media, and other addictive tendencies. Along with extraversion, neuroticism has also been linked to increased risk to developing social media addiction. It has been shown that people who are high in neuroticism are more keen to use a screen to interact with people rather than face to face contact because they find that easier.[65][3][4][5][6][7] This has led multiple experts cited by Hawi and colleagues to suggest that digital media overuse may not be a singular construct, with some calling to delineate proposed disorders based on the type of digital media used.[2][8][9] A 2016 psychological review stated that "studies have also suggested a link between innate basic psychological needs and social network site addiction [...] Social network site users seek feedback, and they get it from hundreds of people—instantly. Alternatively, it could be argued that the platforms are designed to get users 'hooked'."[45]

See also

References

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  2. ↑ 2.0 2.1 2.2 Hawi, Nazir; Samaha, Maya (1 February 2019). "Identifying commonalities and differences in personality characteristics of Internet and social media addiction profiles: traits, self-esteem, and self-construal". Behaviour & Information Technology 38 (2): 110–119. doi:10.1080/0144929X.2018.1515984. 
  3. ↑ 3.0 3.1 3.2 Kuss, Daria J.; Griffiths, Mark D. (2017). "Social Networking Sites and Addiction: Ten Lessons Learned". International Journal of Environmental Research and Public Health 14 (3): 311. doi:10.3390/ijerph14030311. PMID 28304359. 
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  33. ↑ Yazdavar, Amir Hossein; Mahdavinejad, Mohammad Saeid; Bajaj, Goonmeet; Romine, William; Sheth, Amit; Monadjemi, Amir Hassan; Thirunarayan, Krishnaprasad; Meddar, John M. et al. (10 April 2020). "Multimodal mental health analysis in social media". PLOS ONE 15 (4): e0226248. doi:10.1371/journal.pone.0226248. PMID 32275658. Bibcode: 2020PLoSO..1526248Y. 
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  37. ↑ Balta, Sabah; Emirtekin, Emrah; Kircaburun, Kagan; Griffiths, Mark D. (June 2020). "Neuroticism, Trait Fear of Missing Out, and Phubbing: The Mediating Role of State Fear of Missing Out and Problematic Instagram Use". International Journal of Mental Health and Addiction 18 (3): 628–639. doi:10.1007/s11469-018-9959-8. 
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  39. ↑ 39.0 39.1 39.2 Hunt, Melissa G.; Marx, Rachel; Lipson, Courtney; Young, Jordyn (December 2018). "No More FOMO: Limiting Social Media Decreases Loneliness and Depression". Journal of Social and Clinical Psychology 37 (10): 751–768. doi:10.1521/jscp.2018.37.10.751. 
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  43. ↑ "How to Make a Family Media Use Plan". http://www.healthychildren.org/English/family-life/Media/Pages/How-to-Make-a-Family-Media-Use-Plan.aspx. 
  44. ↑ Korioth, Trisha (2018-12-12). "Family Media Plan helps parents set boundaries for kids". AAP News. http://www.aappublications.org/news/2016/10/21/MediaParents102116. Retrieved 2019-07-05. 
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  46. ↑ "Cognitive Behavioral Therapy". https://www.psychologytoday.com/us/basics/cognitive-behavioral-therapy. 
  47. ↑ Ceres, Pia (2018-09-25). "How to Use Apple's Screen Time Controls on iOS 12". Wired. https://www.wired.com/story/how-to-use-screen-time-ios-12/. 
  48. ↑ "The Blloc Zero 18 is a minimalist's smartphone with some great ideas". 2018-10-23. https://www.androidauthority.com/blloc-zero-18-pre-order-917309/. 
  49. ↑ "Phone addiction: Apple, Google, YouTube screen management tools". 2018-09-25. https://www.news.com.au/technology/gadgets/mobile-phones/the-best-ways-to-kick-your-zombie-check-habits-revealed/news-story/89b3b28cf82c9a7011ade74039cd98a2. 
  50. ↑ Booth, Callum (2018-08-01). "Facebook and Instagram officially announce new tools to fight social media addiction". https://thenextweb.com/facebook/2018/08/01/social-media-addiction-facebook-instagram/. 
  51. ↑ Rajan, Amol (2019-01-28). "Can Nick Clegg help Facebook grow up?". BBC News. https://www.bbc.com/news/entertainment-arts-47036000. 
  52. ↑ 52.0 52.1 "About three-in-ten U.S. adults say they are 'almost constantly' online" (in en-US). https://www.pewresearch.org/fact-tank/2019/07/25/americans-going-online-almost-constantly/. 
  53. ↑ Hern, Alex (31 July 2019). "US could ban 'addictive' autoplay videos and infinite scrolling online". The Guardian. https://www.theguardian.com/media/2019/jul/31/us-could-ban-addictive-autoplay-videos-and-infinite-scrolling-online. 
  54. ↑ Pietsch, Bryan (30 July 2019). "Oh Snap: U.S. senator proposes bill to ban Snapchat 'Snapstreaks'". Reuters. https://www.reuters.com/article/us-snap-senate-streaks/oh-snap-u-s-senator-proposes-bill-to-ban-snapchat-snapstreaks-idUSKCN1UP26I. 
  55. ↑ 55.0 55.1 55.2 Gao, J., Zheng, P., Jia, Y., Chen, H., Mao, Y., Chen, S., Wang, Y., Fu, H., & Dai, J. (2020). "Mental health problems and social media exposure during COVID-19 outbreak". PLOS ONE 15: 1–10. https://web-a-ebscohost-com.gonzaga.idm.oclc.org/ehost/detail/detail?vid=4&sid=228e1f33-bc4a-457f-95c6-f3d588c5a38d%40sessionmgr4007&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=142762133&db=a9h. 
  56. ↑ Ellison, Nicole B.; Steinfield, Charles; Lampe, Cliff (July 2007). "The Benefits of Facebook 'Friends:' Social Capital and College Students' Use of Online Social Network Sites". Journal of Computer-Mediated Communication 12 (4): 1143–1168. doi:10.1111/j.1083-6101.2007.00367.x. 
  57. ↑ Orosz, Gábor; Tóth-Király, István; Bőthe, Beáta (October 2016). "Four facets of Facebook intensity — The development of the Multidimensional Facebook Intensity Scale". Personality and Individual Differences 100: 95–104. doi:10.1016/j.paid.2015.11.038. http://real.mtak.hu/42248/1/1-s2.0-S0191886915300593-main%20%285%29.pdf. 
  58. ↑ Li, Jibin; Lau, Joseph T. F.; Mo, Phoenix K. H.; Su, Xuefen; Wu, Anise M. S.; Tang, Jie; Qin, Zuguo (31 October 2016). "Validation of the Social Networking Activity Intensity Scale among Junior Middle School Students in China". PLOS ONE 11 (10): e0165695. doi:10.1371/journal.pone.0165695. PMID 27798699. Bibcode: 2016PLoSO..1165695L. 
  59. ↑ van den Eijnden, Regina J.J.M.; Lemmens, Jeroen S.; Valkenburg, Patti M. (August 2016). "The Social Media Disorder Scale". Computers in Human Behavior 61: 478–487. doi:10.1016/j.chb.2016.03.038. 
  60. ↑ Bányai, Fanni; Zsila, Ágnes; Király, Orsolya; Maraz, Aniko; Elekes, Zsuzsanna; Griffiths, Mark D.; Andreassen, Cecilie Schou; Demetrovics, Zsolt (9 January 2017). "Problematic Social Media Use: Results from a Large-Scale Nationally Representative Adolescent Sample". PLOS ONE 12 (1): e0169839. doi:10.1371/journal.pone.0169839. PMID 28068404. Bibcode: 2017PLoSO..1269839B. 
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  62. ↑ Cain, Jeff (1 September 2018). "It's Time to Confront Student Mental Health Issues Associated with Smartphones and Social Media". American Journal of Pharmaceutical Education 82 (7): 6862. doi:10.5688/ajpe6862. PMID 30323396. 
  63. ↑ Kardefelt-Winther, Daniel (2017-02-01). "How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? - An evidence-focused literature review". UNICEF Office of Research – Innocenti. https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf. 
  64. ↑ 64.0 64.1 Guedes, Eduardo; Sancassiani, Federica; Carta, Mauro Giovani; Campos, Carlos; Machado, Sergio; King, Anna Lucia Spear; Nardi, Antonio Egidio (28 June 2016). "Internet Addiction and Excessive Social Networks Use: What About Facebook?". Clinical Practice and Epidemiology in Mental Health 12 (1): 43–48. doi:10.2174/1745017901612010043. PMID 27418940. 
  65. ↑ Blackwell, David; Leaman, Carrie; Tramposch, Rose; Osborne, Ciera; Liss, Miriam (October 2017). "Extraversion, neuroticism, attachment style and fear of missing out as predictors of social media use and addiction". Personality and Individual Differences 116: 69–72. doi:10.1016/j.paid.2017.04.039. 

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Walton, A. G. (2018, November 18). New Studies Show Just How Bad Social Media Is For Mental Health. Retrieved from https://www.forbes.com/sites/alicegwalton/2018/11/16/new-research-shows-just-how-bad-social-media-can-be-for-mental-health/#24b43ac67af4




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