Social media use (SMU), the use of “internet-based networks that enable users to interact with others, verbally and visually,” [1] is exceedingly popular among youths as it combines their desire to connect with peers with their interest in engaging technologies. Increasing rates of SMU over time [2-4] have been correlated with rising rates of youth mental health problems [5-7]; however, a proposed contributory relationship remains unproven. Much attention has been paid to the potential link between SMU and rates of major depression [8], with the latter having increased dramatically in the United States and abroad over the past one to two decades, particularly among adolescents and young women [9,10].

Although some evidence suggests that children and adolescents with high-frequency SMU experience increased rates of mental health problems and greater depressive symptoms, the overall data are inconclusive, with some studies demonstrating no difference or even suggesting minor psychological benefits [11,12]. A recent study examined 6 systematic reviews from the past decade, 3 large-scale national cohort studies, and 5 diary and ecological momentary assessment (EMA) studies examining associations between SMU and adolescent mental health [13]. Although some studies demonstrated negative associations with small effect sizes, the larger picture revealed a combination of mixed, null, and positive associations between SMU and mental health. One of the reviews demonstrated that SMU accounted for only 0.4% of the variation in well-being, paling in comparison with factors such as family socioeconomic status, family history of depression or anxiety, and exposure to adverse childhood experiences, which account for 5% to 20% of the differences in mental health symptoms [14,15]. Another large-scale review examined >80 key studies, systematic reviews, and meta-analyses, concluding that there exists a small, negative association between SMU and psychological well-being but emphasizing the ongoing need for higher-quality data with a more nuanced view of different types of SMU and the role of potential confounders [12].

Variations in the relationships between SMU and mental health outcomes may have resulted from how SMU was defined and measured, what mental health symptoms were considered, and the potential influence of confounders. When SMU is considered as a binary or duration-of-use variable, without discriminating among user characteristics or their specific SMU behaviors, a more granular and useful understanding of how SMU can affect mental health may be lost.

Most SMU studies thus far have relied on retrospective self-reports, which may experience recall bias. Studies that incorporate EMA, which allows for in-the-moment data collection by asking participants to report on recent lived experiences, can produce more reliable and complete data, capturing specific patterns of SMU [16].

Some recent studies have taken a more nuanced look at different patterns of SMU and their relationship with specific mental health outcomes [17,18]. Evidence suggests that certain SMU characteristics may help determine whether one experiences any SMU-related negative mental health consequences. For instance, individuals who report using greater numbers of social media platforms or longer durations of SMU are more likely to experience depression or other mental health problems [19-21]. Similarly, individuals whose SMU comprises more negative interactions or who perceive themselves to be less popular or successful than their peers on social media experience decreased levels of happiness [22-25].

Regarding individual patterns of use, SMU that is active rather than passive has been associated with improved mental health outcomes [26-29]. Active SMU, which is characterized by the act of engaging in direct interactions with other users, sharing life experiences, or creating new content, is associated with decreased depressive symptoms in adults. As a potential explanation, active SMU is theorized to lead to an improved sense of well-being by increasing one’s social capital among acquaintances and eliciting more emotional support and positive feedback from friends [30]. An alternative explanation is that individuals who are less depressed may be more likely to engage in active SMU.

On the other hand, passive SMU, characterized by the act of lurking or observing while maintaining low engagement with other users, is associated with higher levels of depressive symptoms [28,29,31,32]. Passive SMU may result in more instances of upward social comparison, in which one negatively evaluates oneself in comparison with the perceived realities of others [33]. Alternatively, individuals who are more depressed may be more likely to engage in passive SMU. Therefore, when studying the relationship between SMU and mental health outcomes, distinguishing between active versus passive SMU is likely an important consideration.

This study has 3 aims. The first is to investigate, within a sample of youths with depression, momentary associations between SMU and three types of affective states: positive affect, negative affect, and sadness. The second aim is to investigate whether adolescents’ active and passive SMU are related to these affective states. The third aim is to determine whether there are racial/ethnic differences in momentary affective states during SMU and in the associations between SMU and affect.

The sample was mostly female and comprised similar percentages of Black non-Hispanic, White non-Hispanic, and Hispanic participants (Table 1). Approximately 5% (3/55) of participants were excluded from the analysis because of a lack of EMA data. Overall, participants responded to more than half of the EMA prompts. The average PHQ-9 score from enrollment revealed moderate amounts of depressive symptoms with a normal distribution. On the basis of the EMA survey data, participants reported SMU during 14.2% (139/976) of EMA responses, texting/asynchronous messaging during 13.8% (135/975) of EMA responses, making a voice/video call during 2.4% (23/975) of EMA responses, and having a face-to-face conversation during 19% (185/975) of EMA responses.

In summary, during moments of active SMU, participants reported higher overall levels of negative affect and sadness. However, this relationship was observed only among Black non-Hispanic participants and was not observed in White non-Hispanic participants. Similarly, during moments of passive SMU, participants reported lower overall levels of positive affect, and this finding was observed only among White non-Hispanic participants and not among Black non-Hispanic or Hispanic participants.

This study attempts to enrich our understanding of the complex interrelations between SMU and affective states. Previous research has revealed that the association between SMU and indicators of mental health varies considerably among individual youths [54]; however, our understanding of what drives these differences is extremely limited. Our findings indicate that race may be an individual characteristic that determines the associations between SMU and mental health. Using our full sample, we found that certain types of SMU were linked to more sadness and negative affect and less positive affect. Through follow-up interaction analyses, we discovered that these results hold true only for specific racial/ethnic groups in our sample.

Differences in media and SMU by ethnicities were well-documented during the emergence of mobile and social media, as minority youths (ie, Black, Hispanic, and Asian) were shown to consume 4.5 hours a day more media than their White peers and were more likely to be early users of social networking sites [55]. The size, closeness, and racial homogeneity of web-based social networks may differ across racial and ethnic groups. Although Black and White youths were shown to have similar numbers of friends on Facebook (when it was the dominant social media platform for youths), Black youths had weaker ties among those relationships, indicating an effort to diversify their social network and potentially increase their social capital [45]. Social media offers ethnic minorities a dualistic environment: the opportunity to develop a supportive community of similar peers tempered by increased levels of cyberaggression driven by racism [56]. These opposing forces shape the web-based communication of Black youths into experiences that likely vary greatly from those of White youths. Although our findings provide evidence that racial/ethnic differences are apparent in SMU and possible mental health effects, this area remains understudied. Additional research may help reveal how web-based experiences translate into different affectual and mental health experiences across racial/ethnic groups.

Our findings regarding differences in affect during active and passive SMU may be most informative in enhancing our understanding of different ethnic/racial groups’ experiences in web-based interactions. For White youths in our sample, passive SMU was linked to lower levels of concurrent positive affect. This result is consistent with other research showing that lurking, scrolling, and other passive uses of social media are linked to more symptoms of depression [29]. It is notable that lower levels of positive affect more aptly describe classic symptoms of depression (eg, fatigue, difficulty in concentrating, and loss of interest) than increases in negative affect, which include feelings of hostility and irritability. Therefore, the findings for our White non-Hispanic participants are in line with prior studies in this area that used mostly White samples, which are likely not generalizable to more diverse populations [57]. Overall, our study supports the idea that for this subsample of users, passive SMU is linked to indicators of depression.

However, considering that our participants were determined to be at least mildly depressed before the study, this result may be better understood as indicating that young people who are depressed are more likely to engage in passive SMU when experiencing lower levels of positive affect. Entertainment has been identified as the highest-rated motivation for SMU [58,59]. It seems that White youths with depression are likely to turn toward social media for entertainment and distraction when experiencing low levels of positive affect. Being actively engaged with others may not be congruent with such an affective state. Although this interpretation is consistent with our findings, our methods did not test the contributory relationship of this association. Additional research is necessary to fully reveal the complex interplay between SMU and momentary affect.

For Black non-Hispanic participants in our study, interacting directly with other people while using social media (active SMU) was associated with higher levels of negative affect. This finding is somewhat counter to other research showing that the active use of media is protective against symptoms of depression [26]. Although feelings of hostility and irritability are not necessarily indicators of depression, youths with depression have been shown to have higher levels of hostility both on the web and offline [60]. In our study, active SMU may have elicited an increase in negative affect among Black non-Hispanic youths who are depressed rather than providing a type of social support that could reduce negative symptoms.

Such a response by Black non-Hispanic adolescents may be explained by the dual nature of SMU for minority youths. The risk of experiencing racism-based cyberaggression, blatant acts of racism, microaggressions, and other forms of systemic oppression on social media, which can be further amplified by platform-based algorithms, may lead to different SMU experiences for minority-identifying individuals than for their White peers [61,62]. Lower levels of minority representation and fewer minority voices on social media, in general, may contribute to a less welcoming social media environment, leading to more negative affective experiences.

Even in web-based community building and activism, the positive side of the dual nature of SMU for minorities may hold experiences that could be more upsetting for Black non-Hispanic youths as they can include being exposed to, sharing experiences about, and building solidarity and organizing against racism and inequality. Previous research has demonstrated that Black and Hispanic participants report higher rates of active SMU in the form of political activism and that Black participants are more likely to engage actively with news stories posted on social media [63,64]. Considering the potential for exposure to race-related or underrepresentative news and political content on social media, it is reasonable to expect that activism and responses related to this material might contribute to greater negative affect. Although this interpretation may explain our findings, our study did not test it directly. Additional research is necessary to determine what aspects of active SMU might differ by race/ethnicity and translate into more negative affect for Black non-Hispanic youths.

Again, it is important to remember that our study did not test the direction of effect. Black non-Hispanic youths may turn to active SMU when they are experiencing higher levels of negative affect or active SMU may increase their negative affect or both. Given that Black non-Hispanic youths may have web-based social networks with a wider variety of relationship types (strong and weak) [45] than their White non-Hispanic peers, they may be more likely to have web-based social resources to cope with high levels of negative affect. Future research should examine how youths of different ethnicities differ in their motivations for and expectations of SMU to help understand whether and why minority youths are at a higher risk for poorer mental health outcomes.

On the basis of these findings, researchers should investigate the possibility that SMU is not experienced uniformly. One’s racial/ethnic identity may be an important mediator of affective experiences during SMU. Although depression and anxiety have often been a major focus of research on the effects of SMU, there may be value in studying affect in greater detail, given the relationship between lower positive affect and depression and between higher negative affect driven by irritability/hostility and activist solidarity.

From a clinical standpoint, as associations between SMU and behavioral health conditions become more clear, clinicians will need to become comfortable with assessing and providing counseling on problematic interactive media use behaviors as they do with other well-established health risk behaviors. It may be clinically useful to consider how affective states may drive school or homework avoidance and/or excessive interactive media use. Conversely, we need to better understand individuals’ intentions and the context of SMU, as this may be a modifiable factor that can influence affective outcomes. Our society has grown increasingly dependent on the use of digital communication for critical life activities, from education to employment and communication to interpersonal connections and relationships. If differences exist in the overall experience and impact of SMU among different racial/ethnic groups, it will be important to understand these differences and translate them into effective screening and equitable treatment of patients.

If it is found that the design of social media platforms may contribute to inequitable SMU experiences or unhealthy behavioral outcomes, technology companies will have the opportunity to respond with design changes that promote greater equity and more positive mental health outcomes. In 2019, the social media platform Instagram started testing the potential value of hiding like counts to reduce user exposure to social evaluations that might threaten users’ self-esteem. Instagram’s chief executive officer Adam Mosseri promised, “We will make decisions that hurt the business if they help people’s well-being and health.” [65] In May 2021, after 2 years of testing, Instagram announced that although removing likes was beneficial for some users, it annoyed others, and it did not meaningfully depressurize their platform [66]. As a result, Instagram and parent company Facebook decided to offer users the option of turning off likes but leaving them viewable to others by default. Similar observations of different affective experiences of SMU by various racial/ethnic groups and considerations of design changes could improve digital wellness.

The study’s limitations include the relatively small sample size, which reduces the generalizability of the results. However, the sample included a diverse group of participants drawn from a population of patients with evidence of at least mild depression, which is an at-risk group of great clinical interest. In addition, our analyses were performed at the moment level, thereby increasing the statistical power.

Although the overall EMA survey response rate (approximately 50%) was similar to that of other studies using this methodology with adolescents, it does represent a potential selection bias. Participants with higher response rates could provide qualitatively different responses than those with lower response rates. For instance, participants with higher levels of social anxiety exhibited higher EMA response rates. In addition, adolescents may have avoided answering surveys during SMU, especially when they were actively engaged in it. However, EMA measures essentially eliminate recall bias, which likely greatly enhances the reliability of patient reports.

Another limitation of this study was the inability to prove that SMU contributes to mental health problems. Given the dynamic nature of social media, our results may be sensitive to the specific period during which the study was performed. Study participants’ SMU characteristics and affective experiences may be highly dependent on news stories that happened to be trending at a given point, creating the potential for chronology bias.

Moving forward, it will be important to measure momentary affective responses to SMU in more detail, with larger populations, with different social media designs, and over longer periods to achieve greater granularity and demonstrate the stability of these findings. Given the significant differences in affective experiences among racial/ethnic groups, future research should broaden to include gender, culture, and other experience-influencing user characteristics.

At a time marked by increasing trends in mental health problems and unprecedented levels of interactive media use among children and adolescents, there is a real urgency to achieve a better understanding of the relationships between different media use behaviors and mental health problems. Identifying helpful and harmful digital design features and risk and protective factors in users will be of paramount importance, as will be the continued study of the role of racial/ethnic identities and other individual factors as potential moderators of media use experiences. As the nature of our social interactions continues to evolve in an increasingly digital landscape, so too must our understanding of the potential influence of these behaviors on the health and well-being of the children, adolescents, and young adults we serve.