Pediatricians like us care for more adolescents than usual with depression, anxiety and eating disorders. Facebook can highlight positive news.
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Talk to a pediatrician and we will tell you: We are going through a mental crisis in teenagers. The pandemic has brought school closings and stay-at-home restrictions that resulted in social isolation among youth. With more than 721,000 COVID-19 deaths across the country, many teens know a deceased person personally and in some cases have even lost a parent.
Unsurprisingly, pediatricians like us are at the forefront of caring for more than twice as many teenagers struggling with depression, anxiety, and eating disorders.
With this in mind, social media giant Facebook – owner of Instagram, a platform used by more than half of teenagers in the United States – plays a key role. Amid these rising and unprecedented rates of mental illness among teenagers, will Facebook be part of the problem or the solution?
Instagram and eating disorders
Whistleblower and former Facebook product manager Frances Haugen recently testified before Congress that internal research by the company showed that Instagram may have worsened the mental health of young people. In these studies, teenage girls reported feeling worse about their bodies on Instagram, increasing eating disorders, and having thoughts of suicide more often.
We’ve seen examples of this in our own eating disorders clinic, where teenagers often tell us Instagram exposes them to posts that perpetuate unrealistic body shapes and share harmful diet tips.
Facebook’s internal research confirms a 2018 study by the Pew Research Center that shows 1 in 4 teenagers say social media negatively affects their lives because they experience bullying and harassment, unrealistic views about their lives Develop colleagues and get distracted from spending too much time online.
Again, these are concerns we often hear from teenagers in our practice. Such issues are likely to be compounded among teenagers who spend more time on social media, which is particularly worrying given that nearly 90% of teenagers visiting Instagram and other platforms do so several times a day.
This time of immense control presents Facebook with a pivotal opportunity to support, rather than hurt, teenage mental health. Legislators have proposed stepping in and regulating the platform, and as pediatricians we are inclined to support these measures if they are aimed at improving the health and well-being of teenagers. However, despite regulation, social media is likely to play a permanent role in teenage lives for years to come. Facebook should seize this moment to take action to clearly improve and support teenage mental health.
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Perhaps most importantly, Facebook and other social media companies should reinforce healthy messages. In the same study by the Pew Research Center, 1 in 3 teenagers reported that social media had a positive impact on their lives, most often because it helped them connect with others or find important information.
However, algorithms in Facebook and Instagram – which are kept secret from public scrutiny – are based on how many people like, share and comment. This approach encourages bombastic, misleading, and unhealthy posts.
We need health-oriented algorithms
Instead, social media companies could specifically curate and actively promote messages about health and wellbeing. Numerous pediatric influencers (e.g. @teenhealthdoc, specialist in youth health in New York) already offer evidence-based advice and health information for adolescents and their families on Instagram and other platforms. Facebook could set up an advisory board of clinicians to assess the quality of influencers’ posts, offer health care providers a review (with the invaluable “blue check mark” that shows a user is authentic and remarkable), and make their posts accessible to a youthful audience do.
Social media companies should also encourage young people to post accurate, health-promoting content themselves.
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This approach would require Facebook to change its algorithms, which the company is likely to resist unless regulation enforced. Social media companies have come under constant fire for being too late to respond to misleading or harmful posts, which contributes to bad press and negative regulatory attention.
We claim that Facebook should be proactive in its approach and promote high quality content that is interesting to teens. Done right – with an infusion of creativity, thoughtful design, and humor – positive, health-promoting posts can receive a tremendous number of likes, shares, and comments, but may need to be actively promoted amid the negative messages currently prevailing. Realizing that it has a duty to block misinformation about COVID-19, Facebook has to take similar steps to protect teenagers’ mental health.
Facebook can also help facilitate moderation in the use of its platforms among young people. The current business models of social media companies are driven by the persistent, compulsive use of their products and the advertising revenue generated by them. In his credit, Facebook has imposed advertising restrictions on teenagers.
The company should build on this by helping teenagers put their smartphones down. To reduce screen time, Apple introduced Screen Time, an iPhone and iPad integration that allows parents to limit the time teens spend using social media apps. However, workarounds are easy to find for teenagers. Facebook should introduce its own functionality that would allow parents to limit teenagers’ use of its platforms.
We will address the after-effects of COVIC-19 on teenage mental health in the years to come. The reality is that while many of us pediatricians would like to remove social media from the lives of our teenage patients entirely, Instagram and other popular platforms are going nowhere. Social media companies wield tremendous power over young people. You should use it to empower – not hinder – the hard work we pediatricians are doing on the front lines to fight mental illness.
Dr. Scott Hadland is the Chief Medical Officer of Adolescent Medicine at MassGeneral Hospital for Children and Harvard Medical School (@DrScottHadland on Twitter and Instagram). Dr. Kathryn Brigham is the medical director of the Teenage Eating Disorders Program at MassGeneral Hospital for Children and Harvard Medical School.
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