Smartphones offer apps for more or less everything. Mental health is no exception, as is clear from websites for organisations such as MIND, or the NHS.
There are apps designed to help teenagers overcome mental health problems such as depression, anxiety, phobias, even manic-depression and other serious disorders. The hope is that such apps will give individuals in trouble instant access to therapeutic support, bypassing the waiting lists and limited resources of Child and Adolescent Mental Health Services (CAMHS).
Therapy through a phone app might also bypass the stigma still attached to mental health issues, encouraging the young to address their problems early on. These are grand aspirations, and maybe worth a try. Alas, a major review (Grist et al, 2017) concludes that as yet, we simply don’t have research demonstrating whether or not these apps are effective.
In stark contrast to this optimism there are pundits who believe that mobile phones are causing mental health problems. For example, Jean Twenge (2017) sees a sinister coincidence of timing between the rise in mental health problems and the rise in smartphone use in adolescents.
She argues that these phones have transformed the way teenagers live. Where in the past they “hung out” together, socialising face-to-face, she claims that they now socialise online from the isolation of their bedrooms.
The quality of their lives is impoverished, as is their scope for learning how to cope with the challenges of life. Twenge argues this consequence of the smartphone poses serious risks for mental health for a whole generation, directly causing the rise in depression, anxiety and other mental health problems that we have observed in recent years, and that unless we do something about it we are sliding toward a major mental health crisis. This is a startling and alarming claim. But is it true?
Twenge cites 2012 as the turning point, where the majority of teenagers had access to smartphones and rates of mental health problem began a steep rise.
However, research in the UK casts doubt on this claim. Rates of adolescent mental health problems have been rising for at least 30 years, and with occasional sharper upturns well before the smartphone became commonplace (Collishaw et al, 2004).
So it is clear that smartphone use cannot be the main explanation of the upward trend in mental health problems in the young, and may not be a major factor in this trend at all. There are, after all, many reasons why the current generation of teenagers may be increasingly stressed.
The news cycle is progressively darker, whether the focus is on the economy, or on the expansion of terrorism into our streets and concert halls, threats of cyber war, nuclear war, chemical attack, or cataclysmic climate change destroying our planet.
Overall, what the research suggests is that smartphone use may indeed pose mental health risks for some, though even this is less clear than one might suppose. For example, teenagers who were consistently heavy users of texts over a period of six years were more likely to be depressed than other, lighter users (Coyne et al, 2017). Similar results are found for every aspect of phone use, from social media to gaming or information search: higher users are more likely to be not only depressed but anxious and generally stressed.
However, such results are less than straightforward to interpret. First, the data come from teenage self-report, which has numerous limitations. Moreover, the data report correlations – causal connections are harder to establish. For instance: the teenagers who were consistently heavy text users in Coyne et al’s study were more depressed from the outset than others who texted less frequently. Did they use their phones more because they were depressed, rather than becoming depressed because they used their phones more?
The relationship between levels of phone use and mental health problems seems to be complex. Research shows that online experience mirrors offline experience (George & Odgers, 2015). Individuals who are basically balanced and happy in their offline lives are less likely to suffer depression and anxiety through online activities than those who have pre-existing problems and vulnerabilities in their offline lives. Pre-existing social, emotional or behavioural problems in everyday life may well be exacerbated by high phone use.
Equally, it seems that offline vulnerabilities of one sort or another dispose certain individuals toward higher phone use. Depression may be one example. Another is loneliness, which may lead to increased use of social media (George & Odgers, 2015). Sometimes this helps the lonely to improve social skills and build friendships, but often, the effort simply exacerbates their sense of social isolation. And social anxiety can lead to high mobile phone use even in the socially skilled, for example through the phenomenon of “FOMO” – otherwise known as a “fear of missing out”.
Sufferers from this anxiety often spend a lot of time checking social media and feel great stress if their phone is unavailable for some reason (Przybylski et al, 2013).
High levels of mobile phone use and compulsive checking of the phone can lead to what is thought by some to be a mental health problem in its own right: an addiction as real as any other addictive substance use. Smartphone addiction is defined as a compulsive and dysfunctional use of the phone at excessive levels, in inappropriate situations, to the neglect of other aspects of life, and is marked by withdrawal symptoms, anxiety and irritability if the phone is unavailable.
Estimates of the prevalence of smartphone addiction vary from country to country. In the UK it is estimated at about 10 per cent (Lopez-Fernandez. et al, 2014). Girls may be slightly more at risk than boys (Van Duersen et al, 2014). Again, vulnerabilities in “real life”, such as depression, the social anxiety of FOMO, or a general impulsiveness and poor executive control predict the development of addictive phone use.
Smartphone addiction has a damaging effect on school work, creates social isolation, and exacerbates stress, depression and other mental health problems.
In sum, overall the evidence suggests that it is individuals with pre-existing vulnerabilities, rather than the general population of teenagers whose mental health is at risk from mobile phone use.
There is, however, one area of exception to this. Virtually all teenagers say that they leave their phones on overnight and virtually all continue to use them well after lights out (Vernon et al, 2018). The resulting sleep deprivation can be seriously damaging to cognitive processes and mental health, whether a teenager had pre-existing vulnerabilities or not.
The greater the overnight use, the greater the negative impact. Those with pre-existing vulnerabilities may be more likely to use their phones heavily overnight, compounding their risks, but any teenager using the phone all night is at risk.
Practical implications?
- The most important intervention here is obviously to teach the young about the importance of sleep, the dangers of overnight phone use, and the wisdom of switching right off at bed time.
- Phone addiction is a problem in its own right, and may well be a marker for other mental health problems extending beyond phone use. An adolescent who can’t switch off or is agitated if separated from his/her phone has a problem which is well worth investigating, and may need expert intervention.
- Conversely: since mental health issues can dispose teenagers to higher phone use it may be worth looking into patterns of phone use in any teenager who is depressed, anxious or otherwise unhappy and disturbed. Is high phone use, even if it is far short of addiction, exacerbating their problems? Should intervention to support the underlying mental health issue also address patterns of phone use for these individuals?
- Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development. To read Dr Thornton’s previous articles in SecEd, go to http://bit.ly/2o1BVxK. The fourth article in this series will publish on June 28.
References
- Psychological predictors of problem mobile phone use, Bianchi & Phillips, March 2005, CyberPsychology and Behavior: http://bit.ly/2MpjiMD
- Time trends in adolescent mental health, Collishaw, Maughan, Goodman & Pickles, June 2008, Journal of Child Psychology and Psychiatry: http://bit.ly/2l9ccQ2
- A six-year longitudinal study of texting trajectories during adolescence, Coyne, Padilla-Walker & Holmgren, May 2017, Child Development.
- Seven fears and the science of how mobile technologies may be influencing adolescents in the digital age, George & Odgers, November 2015, Perspectives on Psychological Science: http://bit.ly/2J0PlR0
- Mental health mobile apps for preadolescents and adolescents: A systematic review, Grist, Porter, Stallard, May 2017, Journal of Medical Internet Research: http://bit.ly/2JOtpwc
- Prevalence of problematic mobile phone use in British adolescents, Lopez-Fernandez, Honrubia-Serrano, Freixa-Blanxart & Gibson, 2014, CyberPsychology, Behavior and Social Networking: http://bit.ly/2t4KOpZ
- Motivational, emotional, and behavioral correlates of fear of missing out, Przybylski, Murayama, DeHaan & Gladwell, July 2013, Computers in Human Behavior, Vol 23, Issue 4: http://bit.ly/2l8fVNO
- iGen: Why today’s super-connected kids are growing up less rebellious, more tolerant, less happy – and completely unprepared for adulthood – and what that means for the rest of us, Twenge J, 2017, Atria Books.
- Modeling habitual and addictive smartphone behaviour: The role of smartphone usage types, emotional intelligence, social stress, self-regulation, age, and gender, Van Deursen, Bolle, Hegner & Kommers, April 2015, Computers in Human Behavior Vol 45.
- Mobile phones in the bedroom: Trajectories of sleep habits and subsequent adolescent psychosocial development, Vernon, Modecki & Barber (2018) Child Development.