Social Media

2023
and Youth
Mental Health
The U.S. Surgeon General’s Advisory
Contents
About the Advisory 3

Social Media and Youth Mental Health 4

Social Media Has Both Positive and Negative Impacts 5

on Children and Adolescents
The Potential Benefits of Social Media Use Among Children and Adolescents 6
The Potential Harms of Social Media Use Among Children and Adolescents 6

What Drives Mental Health and Well‑Being Concerns: 8

A Snapshot of the Scientific Evidence
Potential Risk of Harm from Content Exposure 8
Potential Risk of Harm from Excessive and Problematic Use 9

Critical Questions Remain Unanswered 11

Known Evidence Gaps 11

We Must Take Action: A Way Forward 13

What Policymakers Can Do 15
What Technology Companies Can Do 16
What Parents and Caregivers Can Do 17
What Children and Adolescents Can Do 18
What Researchers Can Do 19

Acknowledgments 20

Endnotes 21

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 2
About the Advisory

A Surgeon General’s Advisory is a public statement that calls the

American people’s attention to an urgent public health issue and provides
recommendations for how it should be addressed. Advisories are reserved
for significant public health challenges that require the nation’s immediate
awareness and action.

This Advisory calls attention to the growing concerns about the effects of social
media on youth mental health. It explores and describes the current evidence on
the positive and negative impacts of social media on children and adolescents,
some of the primary areas for mental health and well-being concerns, and
opportunities for additional research to help understand the full scope and
scale of social media’s impact. This document is not an exhaustive review of the
literature. Rather, it was developed through a substantial review of the available
evidence, primarily found via electronic searches of research articles published
in English and resources suggested by a wide range of subject matter experts,
with priority given to, but not limited to, meta-analyses and systematic literature
reviews. It also offers actionable recommendations for the institutions that can
shape online environments—policymakers and technology companies—as well
as for what parents and caregivers, young people, and researchers can do.

For additional background and to read other Surgeon General’s Advisories, visit
SurgeonGeneral.gov

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 3
Social Media and
Youth Mental Health

Social media1 use by youth is nearly universal. Up to 95% of youth ages 13–17
report using a social media platform, with more than a third saying they use
social media “almost constantly.” 2 Although age 13 is commonly the required
minimum age used by social media platforms in the U.S.,3 nearly 40% of children
ages 8–12 use social media.4 Despite this widespread use among children and
adolescents, robust independent safety analyses on the impact of social media
on youth have not yet been conducted. There are increasing concerns among
researchers, parents and caregivers, young people, healthcare experts, and
others about the impact of social media on youth mental health.5, 6

More research is needed to fully understand the impact of social media;

however, the current body of evidence indicates that while social media may
have benefits for some children and adolescents, there are ample indicators
that social media can also have a profound risk of harm to the mental health
and well-being of children and adolescents. At this time, we do not yet have
enough evidence to determine if social media is sufficiently safe for children
and adolescents. We must acknowledge the growing body of research about
potential harms, increase our collective understanding of the risks associated
with social media use, and urgently take action to create safe and healthy digital
environments that minimize harm and safeguard children’s and adolescents’
mental health and well-being during critical stages of development.

Up to 95% of youth ages

13–17 report using a
social media platform,
with more than a third
saying they use social
media “almost constantly.”

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 4
Social Media Has Both Positive and Negative
Impacts on Children and Adolescents

The influence of social media on youth mental health is shaped by many

complex factors, including, but not limited to, the amount of time children
and adolescents spend on platforms, the type of content they consume or are
otherwise exposed to, the activities and interactions social media affords,
and the degree to which it disrupts activities that are essential for health like
sleep and physical activity.6 Importantly, different children and adolescents are
affected by social media in different ways, based on their individual strengths
and vulnerabilities, and based on cultural, historical, and socio-economic
factors.7, 8 There is broad agreement among the scientific community that social
media has the potential to both benefit and harm children and adolescents.6, 9

Brain development is a critical factor to consider when assessing the risk for
harm. Adolescents, ages 10 to 19, are undergoing a highly sensitive period of
brain development.10, 11 This is a period when risk-taking behaviors reach their
peak, when well-being experiences the greatest fluctuations, and when mental
health challenges such as depression typically emerge.12, 13, 14 Furthermore, in
early adolescence, when identities and sense of self-worth are forming, brain
development is especially susceptible to social pressures, peer opinions, and
peer comparison.11, 13 Frequent social media use may be associated with distinct
changes in the developing brain in the amygdala (important for emotional
learning and behavior) and the prefrontal cortex (important for impulse control,
emotional regulation, and moderating social behavior), and could increase
sensitivity to social rewards and punishments.15, 16 As such, adolescents
may experience heightened emotional sensitivity to the communicative and
interactive nature of social media.16 Adolescent social media use is predictive
of a subsequent decrease in life satisfaction for certain developmental
stages including for girls 11–13 years old and boys 14–15 years old.17 Because
adolescence is a vulnerable period of brain development, social media exposure
during this period warrants additional scrutiny.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 5
Social Media Has Both Positive and Negative Impacts on Children and Adolescents

The Potential Benefits of Social Media Use Among

Children and Adolescents
Social media can provide benefits for some youth by providing positive
community and connection with others who share identities, abilities, and
interests. It can provide access to important information and create a space
for self-expression.9 The ability to form and maintain friendships online and
develop social connections are among the positive effects of social media use
for youth.18, 19 These relationships can afford opportunities to have positive
interactions with more diverse peer groups than are available to them offline
and can provide important social support to youth.18 The buffering effects
against stress that online social support from peers may provide can be
especially important for youth who are often marginalized, including racial,
ethnic, and sexual and gender minorities. 20, 21, 22 For example, studies have shown
that social media may support the mental health and well-being of lesbian, gay,
bisexual, asexual, transgender, queer, intersex and other youths by enabling
peer connection, identity development and management, and social support. 23
Seven out of ten adolescent girls of color report encountering positive or
identity-affirming content related to race across social media platforms. 24 A
majority of adolescents report that social media helps them feel more accepted
(58%), like they have people who can support them through tough times (67%),
like they have a place to show their creative side (71%), and more connected to
what’s going on in their friends’ lives (80%).25 In addition, research suggests that
social media-based and other digitally-based mental health interventions may
also be helpful for some children and adolescents by promoting help-seeking
behaviors and serving as a gateway to initiating mental health care.8, 26, 27, 28, 29

The Potential Harms of Social Media Use Among

Children and Adolescents
Over the last decade, evidence has emerged identifying reasons for concern
about the potential negative impact of social media on children and adolescents.

A longitudinal cohort study of U.S. adolescents aged 12–15 (n=6,595) that

adjusted for baseline mental health status found that adolescents who spent
more than 3 hours per day on social media faced double the risk of experiencing
poor mental health outcomes including symptoms of depression and anxiety.30

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 6
Social Media Has Both Positive and Negative Impacts on Children and Adolescents

As of 2021, 8th and 10th graders now spend an average of 3.5 hours per day
on social media.31 In a unique natural experiment that leveraged the staggered
introduction of a social media platform across U.S. colleges, the roll-out of the
platform was associated with an increase in depression (9% over baseline)
and anxiety (12% over baseline) among college-aged youth (n = 359,827
observations).32 The study’s co-author also noted that when applied across
the entirety of the U.S. college population, the introduction of the social media
platform may have contributed to more than 300,000 new cases of depression.32,
33
If such sizable effects occurred in college-aged youth, these findings raise
serious concerns about the risk of harm from social media exposure for children
and adolescents who are at a more vulnerable stage of brain development.

Limits on the use of social media have resulted in mental health benefits for
young adults and adults. A small, randomized controlled trial in college-aged
youth found that limiting social media use to 30 minutes daily over three
weeks led to significant improvements in depression severity.34 This effect was
particularly large for those with high baseline levels of depression who saw an
improvement in depression scores by more than 35%.35 Another randomized
controlled trial among young adults and adults found that deactivation of
a social media platform for four weeks improved subjective well-being (i.e.,
self-reported happiness, life satisfaction, depression, and anxiety) by about
25–40% of the effect of psychological interventions like self-help therapy,
group training, and individual therapy.36

In addition to these recent studies, correlational research on associations

between social media use and mental health has indicated reason for concern
and further investigation. These studies point to a higher relative concern of
harm in adolescent girls and those already experiencing poor mental health,
37, 38, 39
as well as for particular health outcomes like cyberbullying-related
depression,40 body image and disordered eating behaviors,41 and poor sleep
quality linked to social media use.42 For example, a study conducted among
14-year-olds (n = 10,904) found that greater social media use predicted poor
sleep, online harassment, poor body image, low self-esteem, and higher
depressive symptom scores with a larger association for girls than boys.43 A
majority of parents of adolescents say they are somewhat, very, or extremely
worried that their child’s use of social media could lead to problems with anxiety
or depression (53%), lower self-esteem (54%), being harassed or bullied by
others (54%), feeling pressured to act a certain way (59%), and exposure to
explicit content (71%).44

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 7
What Drives Mental Health and Well‑Being
Concerns: A Snapshot of the Scientific Evidence

Scientific evidence suggests that harmful content exposure as well as excessive

and problematic social media use are primary areas for concern.

Potential Risk of Harm from Content Exposure

Extreme, inappropriate, and harmful content continues to be easily and widely
accessible by children and adolescents. This can be spread through direct
pushes, unwanted content exchanges, and algorithmic designs. In certain tragic
cases, childhood deaths have been linked to suicide- and self-harm-related
content and risk-taking challenges on social media platforms.45, 46 This
content may be especially risky for children and adolescents who are already
experiencing mental health difficulties.47 Despite social media providing a sense
of community for some, a systematic review of more than two dozen studies
found that some social media platforms show live depictions of self-harm acts
like partial asphyxiation, leading to seizures, and cutting, leading to significant
bleeding.48 Further, these studies found that discussing or showing this content
can normalize such behaviors, including through the formation of suicide pacts
and posting of self-harm models for others to follow.

Social media may also perpetuate body dissatisfaction, disordered eating

behaviors, social comparison, and low self-esteem, especially among adolescent
girls.49, 50, 51, 52 A synthesis of 20 studies demonstrated a significant relationship
between social media use and body image concerns and eating disorders, with
social comparison as a potential contributing factor.41 Social comparison driven
by social media is associated with body dissatisfaction, disordered eating, and
depressive symptoms.53, 54, 55, 56 When asked about the impact of social media on
their body image, nearly half (46%) of adolescents aged 13–17 said social media
makes them feel worse, 40% said it makes them feel neither better nor worse,
and only 14% said it makes them feel better.57

Additionally, roughly two-thirds (64%) of adolescents are “often” or “sometimes”

exposed to hate-based content.58 Among adolescent girls of color, one-third or
more report exposure to racist content or language on social media platforms

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 8
What Drives Mental Health and Well‑Being Concerns: A Snapshot of the Scientific Evidence

at least monthly.24 In a review of 36 studies, a consistent relationship was found

between cyberbullying via social media and depression among children and
adolescents,40 with adolescent females and sexual minority youth more likely to
report experiencing incidents of cyberbullying.59, 60 Nearly 75% of adolescents
say social media sites are only doing a fair to poor job of addressing online
harassment and cyberbullying.61

In addition, social media platforms can be sites for predatory behaviors

and interactions with malicious actors who target children and adolescents
(e.g., adults seeking to sexually exploit children, to financially extort them
through the threat or actual distribution of intimate images, or to sell illicitly
manufactured fentanyl).62, 63, 64 Adolescent girls and transgender youth are
disproportionately impacted by online harassment and abuse, which is
associated with negative emotional impacts (e.g., feeling sad, anxious or
worried).65, 66 Nearly 6-in-10 adolescent girls say they’ve been contacted
by a stranger on certain social media platforms in ways that make them
feel uncomfortable.24

Potential Risk of Harm from Excessive and

Problematic Use
Excessive and problematic use of social media can harm children and
adolescents by disrupting important healthy behaviors. Social media
platforms are often designed to maximize user engagement, which has the
potential to encourage excessive use and behavioral dysregulation.67, 68, 69,
70
Push notifications, autoplay, infinite scroll, quantifying and displaying
popularity (i.e., ‘likes’), and algorithms that leverage user data to serve content
recommendations are some examples of these features that maximize
engagement. According to one recent model, nearly a third (31%) of social
media use may be attributable to self-control challenges magnified by habit
formation.71 Further, some researchers believe that social media exposure can
overstimulate the reward center in the brain and, when the stimulation becomes
excessive, can trigger pathways comparable to addiction.68, 72 Small studies
have shown that people with frequent and problematic social media use can
experience changes in brain structure similar to changes seen in individuals
with substance use or gambling addictions.73, 74 In a nationally representative
survey of girls aged 11–15, one-third or more say they feel “addicted” to a social
media platform.24 Over half of teenagers report that it would be hard to give

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 9
What Drives Mental Health and Well‑Being Concerns: A Snapshot of the Scientific Evidence

up social media.2 Nearly 3-in-4 teenagers believe that technology companies

manipulate users to spend more time on their devices.68 In addition, according to
a survey of 8th and 10th graders, the average time spent on social media is 3.5
hours per day, 1-in-4 spend 5+ hours per day and 1-in-7 spend 7+ hours per day
on social media.31

Excessive and problematic social media use, such as compulsive or

uncontrollable use, has been linked to sleep problems, attention problems,
and feelings of exclusion among adolescents.43, 75, 76, 77 Sleep is essential for
the healthy development of adolescents. A systematic review of 42 studies
on the effects of excessive social media use found a consistent relationship
between social media use and poor sleep quality, reduced sleep duration,
sleep difficulties, and depression among youth.42 Poor sleep has been linked to
altered neurological development in adolescent brains, depressive symptoms,
and suicidal thoughts and behaviors.78, 79, 80 On a typical weekday, nearly 1-in-3
adolescents report using screen media until midnight or later.58 While screen
media use encompasses various digital activities, social media applications are
the most commonly used applications by adolescents.58

In a recent narrative review of multiple studies, problematic social media use

has also been linked to both self-reported and diagnosed attention-deficit/
hyperactivity disorder (ADHD) in adolescents, although more research is
necessary to understand whether one causes the other.81 A longitudinal
prospective study of adolescents without ADHD symptoms at the beginning
of the study found that, over a 2-year follow-up, high-frequency use of digital
media, with social media as one of the most common activities, was associated
with a modest yet statistically significant increased odds of developing ADHD
symptoms (OR 1.10; 95% CI, 1.05-1.15).82 Additionally, social media-induced fear
of missing out, or “the pervasive apprehension that others might be having
rewarding experiences from which one is absent,”83 has been associated with
depression, anxiety, and neuroticism.84

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 10
Critical Questions Remain Unanswered

Nearly every teenager in America uses social media, and yet we do not have
enough evidence to conclude that it is sufficiently safe for them. Our children
have become unknowing participants in a decades-long experiment. It is critical
that independent researchers and technology companies work together to
rapidly advance our understanding of the impact of social media on children and
adolescents. This section describes the known gaps and proposes additional
areas for research that warrant urgent consideration.

Known Evidence Gaps

The relationship between social media and youth mental health is complex
and potentially bidirectional.19 There is broad concern among the scientific
community that a lack of access to data and lack of transparency from
technology companies have been barriers to understanding the full scope and
scale of the impact of social media on mental health and well-being. Most prior
research to date has been correlational, focused on young adults or adults, and
generated a range of results.85 Critical areas of research have been proposed
to fill knowledge gaps and create evidence-based interventions, resources,
and tools to support youth mental health.86 Thus, there is an urgent need for
additional research including on, but not limited to, the following questions:

• How do in-person vs. digital social interactions differ in terms of the impact
on health, and what are the unique contributions of social media behavior to
social connectedness, social isolation, and mental health symptoms?

• What are the potential pathways through which social media may cause harm
to children’s and adolescents’ mental health and well-being? For example:

» How does social comparison affect one’s sense of life satisfaction and
in-person relationships?
» How does the use of social media, including specific designs and features,
relate to dopamine pathways involved in motivation, reward, and addiction?

• What type of content, and at what frequency and intensity, generates the
most harm? Through which modes of social media access (e.g., smartphone,
computer) and design features? For which users and why?

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 11
Critical Questions Remain Unanswered
Known Evidence Gaps

• What are the beneficial effects of social media? For whom are the benefits
greatest? In what ways, and under what circumstances?

• What individual-, community-, and societal-level factors may protect youth

from the negative effects of social media?

• What types of strategies and approaches are effective in protecting the

mental health and well-being of children and adolescents on social media
(e.g., programs, policies, design features, interventions, norms)?

• How does social media use interact with a person’s developmental stage
for measuring risk of mental health impact?

It is critical that independent

researchers and technology
companies work together
to rapidly advance our
understanding of the impact
of social media on children
and adolescents.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 12
We Must Take Action: A Way Forward

Our children and adolescents don’t have the luxury of waiting years until we
know the full extent of social media’s impact. Their childhoods and development
are happening now. While social media use can have positive impacts for some
children, the evidence noted throughout this Surgeon General’s Advisory
necessitates significant concern with the way it is currently designed, deployed,
and utilized. Child and adolescent use of platforms designed for adults
places them at high risk of “unsupervised, developmentally inappropriate,
and potentially harmful” use according to the National Scientific Council on
Adolescence.87 At a moment when we are experiencing a national youth mental
health crisis, now is the time to act swiftly and decisively to protect children and
adolescents from risk of harm.

To date, the burden of protecting youth has fallen predominantly on children,

adolescents, and their families. Parents face significant challenges in managing
children and adolescents’ use of social media applications, and youth are
using social media at increasingly earlier ages.4, 88 Nearly 70% of parents say
parenting is now more difficult than it was 20 years ago, with technology and
social media as the top two cited reasons.89 While nearly all parents believe
they have a responsibility to protect their children from inappropriate content
online,89 the entire burden of mitigating the risk of harm of social media cannot
be placed on the shoulders of children and parents. Nearly 80% of parents
believe technology companies have a responsibility to protect children from
inappropriate content as well.89

We must provide children and their families with the information and tools
to navigate the changing digital environment, but this burden to support our
children must be further shared. There are actions technology companies can
take to make their platforms safer for children and adolescents. There are
actions researchers can take to develop the necessary research base to support
further safeguards. And there is a role for local, state, and federal policy to
implement protections for our children and adolescents.

The U.S. has a strong history of taking action in such circumstances. In the
case of toys, transportation, and medications—among other sectors that have

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 13
We Must Take Action: A Way Forward

widespread adoption and impact on children—the U.S. has often adopted a

safety-first approach to mitigate the risk of harm to consumers. According
to this principle, a basic threshold for safety must be met, and until safety is
demonstrated with rigorous evidence and independent evaluation, protections
are put in place to minimize the risk of harm from products, services, or
goods. For example, the Consumer Product Safety Commission requires toy
manufacturers to undergo third-party testing and be certified through a
Children’s Product Certificate as compliant with the federal toy safety standard
for toys intended for use by children.90 To reduce the risk of injury from motor
vehicle accidents, the National Highway Traffic Safety Administration requires
manufacturers to fit new motor vehicles with standard airbags and seat belts,
among other safety features, and conduct crash tests to be compliant with the
Federal Motor Vehicle Safety Standards.91 Medications must demonstrate safety
to the Food and Drug Administration before being made available and marketed
for use.92 Given the mounting evidence for the risk of harm to some children and
adolescents from social media use, a safety-first approach should be applied in
the context of social media products.

To better safeguard the mental health and well-being of children and

adolescents, policymakers, technology companies, researchers, families,
and young people must all engage in a proactive and multifaceted approach.
Through the recommendations below, we can provide more resources and
tools to children and families, we can gain a better understanding of the full
impact of social media, and we can maximize the benefits and minimize the
harms of social media platforms to create safer, healthier online environments
for children.

We can maximize the

benefits and minimize
the harms of social media
platforms to create
safer, healthier online
environments for children.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 14
What Policymakers Can Do
Policymakers play an important role in addressing the complex and multifaceted
issues related to social media use and in protecting youth from harm.

• Strengthen protections to ensure greater safety • Ensure technology companies share data
for children interacting with all social media relevant to the health impact of their platforms
platforms, in collaboration with governments, with independent researchers and the public in
academic organizations, public health experts, a manner that is timely, sufficiently detailed, and
and technology companies. protects privacy.

» Develop age-appropriate health and safety

• Support the development, implementation, and
standards for technology platforms. Such evaluation of digital and media literacy curricula
standards may include designing technology in schools and within academic standards.
that is appropriate and safe for a child’s Digital and media literacy provides children and
developmental stage; protecting children and educators with digital skills to strengthen digital
adolescents from accessing harmful content resilience, or the ability to recognize, manage, and
(e.g., content that encourages eating disorders, recover from online risks (e.g., cyberbullying and
violence, substance abuse, sexual exploitation, other forms of online harassment and abuse, as
and suicide or discusses suicide means); well as excessive social media use).
limiting the use of features that attempt to
maximize time, attention, and engagement; • Support increased funding for future research on
developing tools that protect activities that both the benefits and harms of social media use
are essential for healthy development like sleep; and other technology and digital media use for
and regularly assessing and mitigating risks children, adolescents, and families.
to children and adolescents.
» Require a higher standard of data privacy
• Engage with international partners working to
protect children and adolescents against online
for children to protect them from potential
harm to their health and safety.
harms like exploitation and abuse. Six-in-ten
adolescents say they think they have little or no
control over the personal information that social
media companies collect about them.32
» Pursue policies that further limit access—in
ways that minimize the risk of harm—to social
media for all children, including strengthening
and enforcing age minimums.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 15
What Technology Companies Can Do
Technology companies play a central role and have a fundamental responsibility
in designing safe online environments and in preventing, minimizing, and
addressing the risks associated with social media.

• Conduct and facilitate transparent and • Design, develop, and evaluate platforms,
independent assessments of the impact of social products, and tools that foster safe and healthy
media products and services on children and online environments for youth, keeping in mind
adolescents. Assume responsibility for the impact the needs of girls, racial, ethnic, and sexual and
of products on different subgroups and ages of gender minorities. The platform design and
children and adolescents, regardless of the intent algorithms should prioritize health and safety as
behind them. the first principle, seek to maximize the potential
benefits, and avoid design features that attempt
» Be transparent and share assessment
to maximize time, attention, and engagement.
findings and underlying data with independent
researchers and the public in a privacy • Share data relevant to the health impact of
protecting manner. platforms and strategies employed to ensure
» Assess the potential risks of online interactions safety and well‑being with independent
and take active steps to prevent potential researchers and the public in a manner that is
misuse, reducing exposure to harms. When timely and protects privacy.
proactive responses fail, take immediate action
to mitigate unintended negative effects. • Create effective and timely systems and
processes to adjudicate requests and complaints
» Establish scientific advisory committees
from young people, families, educators, and
to inform approaches and policies aimed at
others to address online abuse, harmful content
creating safe online environments for children.
and interactions, and other threats to children’s
Scientific advisory committees should be
health and safety. Social media platforms should
comprised of independent experts and members
take these complaints seriously, thoroughly
of user subgroups, including youth.
investigate and consider them, and respond in
• Prioritize user health and safety in the design a timely and transparent manner.
and development of social media products
and services.93, 94, 95, 96 Prioritize and leverage
expertise in developmental psychology and
user mental health and well-being in product
teams to minimize risks of harm to children
and adolescents.

» Ensure default settings for children are set to

highest safety and privacy standards. Provide
easy-to-read and highly visible information
about policies regarding use by children.
» Adhere to and enforce age minimums in ways
that respect the privacy of youth users.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 16
What Parents and Caregivers Can Do
The onus of mitigating the potential harms of social media should not be placed
solely on the shoulders of parents and caregivers, but there are steps they can
take to help protect and support children and adolescents against the risk of harm.

• Create a family media plan.97 Agreed-upon • Teach kids about technology and empower
expectations can help establish healthy them to be responsible online participants at
technology boundaries at home – including social the appropriate age.100 Discuss with children the
media use. A family media plan can promote open benefits and risks of social media as well as the
family discussion and rules about media use and importance of respecting privacy and protecting
include topics such as balancing screen/online personal information in age-appropriate ways. Have
time, content boundaries, and not disclosing conversations with children about who they are
personal information. For information on creating connecting with, their privacy settings, their online
a family media plan, visit www.healthychildren. experiences, and how they are spending their time
org/MediaUsePlan. online. Empower and encourage them to seek help
should they need it. Learn more about the benefits
• Create tech-free zones and encourage children to and risks of social media use and get guidance
foster in-person friendships.98 Since electronics from experts at AAP’s Center of Excellence on
can be a potential distraction after bedtime and Social Media and Youth Mental Health and from
can interfere with sleep, consider restricting the American Psychological Association‘s Health
the use of phones, tablets, and computers for Advisory on Social Media Use in Adolescence.
at least 1 hour before bedtime and through the
night. Consider keeping family mealtimes and • Report cyberbullying and online abuse and
in-person gatherings device-free to build social exploitation. Talk to your child about their reporting
bonds and engage in a two-way conversation. options, and provide support, without judgment,
Help your child develop social skills and nurture if he or she tells or shows you that they (a) are
his or her in-person relationships by encouraging being harassed through email, text message,
unstructured and offline connections with others online games, or social media or (b) have been
and making unplugged interactions a daily priority. contacted by an adult seeking private images or
See the American Academy of Pediatrics (AAP) asking them to perform intimate or sexual acts.
guidelines for media use. You or your child can report cyberbullying to the
school and/or the online platform, or your local law
• Model responsible social media behavior. enforcement.101 Visit CyberTipline, Take it Down, or
As children often learn behaviors and habits contact your local law enforcement to report any
from what they see around them, try to model instances of online exploitation.
the behavior you want to see.97, 99 Parents can
set a good example of what responsible and • Work with other parents to help establish shared
healthy social media use looks like by limiting norms and practices and to support programs
their own use, being mindful of social media and policies around healthy social media use.
habits (including when and how parents share Such norms and practices among parents
information or content about their child), and facilitate collective action and can make it easier
modeling positive behavior on your social to set and implement boundaries on social media
media accounts. use for children.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 17
What Children and Adolescents Can Do
The burden of mitigating the potential harms of social media does not rest solely
on the shoulders of children and adolescents, but there are measures they can
take to navigate social media in a safe and healthy way.

• Reach out for help. If you or someone you • Be cautious about what you share. Personal
know is being negatively affected by social information about you has value. Be selective with
media, reach out to a trusted friend or adult for what you post and share online and with whom, as
help. For information from experts, visit AAP’s it is often public and can be stored permanently.
Center of Excellence on Social Media and Youth If you aren’t sure if you should post something, it’s
Mental Health. If you or someone you know is usually best if you don’t. Talk to a family member
experiencing a mental health crisis, contact or trusted adult to see if you should.
the 988 Suicide and Crisis Lifeline by calling or
texting 988 for immediate help. • Protect
 yourself and others. Harassment
that happens in email, text messaging, direct
• Create boundaries to help balance online and messaging, online games, or on social media is
offline activities. Limit the use of phones, tablets, harmful and can be cyberbullying. It might involve
and computers for at least 1 hour before bedtime trolling, rumors, or photos passed around for
and through the night to enable sufficient and others to see – and it can leave people feeling
quality sleep. Keep mealtimes and in-person angry, sad, ashamed, or hurt. If you or someone
gatherings device-free to help build social bonds you know is the victim of cyberbullying or other
and engage in two-way conversations with forms of online harassment and abuse:
others. Nurture your in-person relationships by
» Don’t keep online harassment or abuse a secret.
connecting with others and making unplugged
Reach out to at least one person you trust, such
interactions a daily priority.
as a close friend, family member, counselor, or
• Develop protective strategies and healthy teacher, who can give you the help and support
practices such as tracking the amount of time you deserve. Visit stopbullying.gov for helpful
you spend online, blocking unwanted contacts tips on how to report cyberbullying. If you have
and content, learning about and using available experienced online harassment and abuse by
privacy and safety settings, learning and utilizing a dating partner, contact an expert at Love is
digital media literacy skills to help tell the Respect for support or if your private images
difference between fact and opinion, and ensuring have been taken and shared online without your
you are connecting with peers in-person. See this permission, visit Take it Down to help get them
Tip Sheet on Social Media Use and Mental Health removed.
for healthy social media use created for and by » Don’t take part in online harassment or abuse.
young people. Avoid forwarding or sharing messages or images
and tell others to stop. Another way is to report
offensive content to the site or network where
you saw it.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 18
What Researchers Can Do
Researchers play a critical role in helping to gain a better understanding of the
full impact of social media on mental health and well-being and informing policy,
best practices, and effective interventions.

• Establish the impact of social media on youth • Develop and establish standardized definitions
mental health as a research priority and develop and measures for social media and mental
a shared research agenda.102 Research should health outcomes that are regularly evaluated
include but not be limited to: and can be applied across basic research,
population surveillance, intervention evaluation,
» Rigorous evaluation of social media’s impact
and other contexts.
on youth mental health and well-being,
including longitudinal and experimental studies. • Evaluate best practices for healthy social media
This could also include research on specific use in collaboration with experts including
outcomes and clinical diagnoses (e.g., sleep healthcare providers, parents, and youth.94, 103, 104
duration and quality, attention, depression,
anxiety, and body image), among specific • Enhance research coordination and collaboration.
populations (e.g., racial, ethnic, and sexual Example opportunities include developing an
and gender minorities), and based on specific accessible evidence database and forming a
aspects of social media (e.g., designs, features, consortium of researchers focused on examining
and algorithms). the positive and negative effects of social media
» Role of age, developmental stage, cohort on mental health and well-being. Researchers
processes, and the in-person environment should work with community partners to
in influencing the onset and progression of make research findings publicly accessible
poor mental health outcomes among social and digestible.
media users.
» Benefits and risks associated with specific
social media designs, features, and content.
» Long-term effects on adults of social media
use during childhood and adolescence.

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 19
Acknowledgments

We are grateful to all of the experts, academic researchers, associations, and

community-based organizations across the country who shared their insights.

The U.S. Surgeon General’s Advisory on Social Media and Youth Mental Health
was prepared by the Office of the Surgeon General with valuable contributions
from partners across the U.S. Government, including but not limited to:

Office of the Assistant Secretary for Health (OASH)

Office of the General Counsel (OGC)

Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Centers for Disease Control and Prevention (CDC)

Office of the Director
National Center for Injury Prevention and Control (NCIPC)


Health Resources and Services Administration (HRSA)

National Institutes of Health (NIH)

Eunice Kennedy Shriver National Institute of Child Health and Human

Development (NICHD)

National Institute of Mental Health (NIMH)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 20
Endnotes

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