Adolescence is a critical developmental stage characterized by substantial biological, psychological and social changes. During this period, peer acceptance, social identity, body image, emotional regulation and self-esteem assume increasing importance. Simultaneously, adolescents have become intensive users of digital technologies, particularly social-networking and social-media platforms. Social media can provide opportunities for communication, peer support, creative expression and access to information; however, concerns have emerged regarding the potential psychological consequences of excessive, compulsive or otherwise harmful patterns of use [1,2]. Evidence examining social media and adolescent mental health has expanded substantially. Recent systematic reviews indicate that higher or problematic social-media use is frequently associated with depressive and anxiety symptoms, although considerable heterogeneity exists between studies and causal conclusions remain limited [3,4]. The nature of social-media engagement may be as important as simple duration. Passive browsing, social comparison, exposure to unrealistic appearance standards, cyberbullying, fear of missing out and nighttime use may represent mechanisms through which social media influences emotional wellbeing [5,6]. Depression in adolescence may manifest through persistent sadness, irritability, loss of interest, feelings of worthlessness, impaired concentration, sleep or appetite disturbance and suicidal thoughts. Anxiety may present as excessive worry, nervousness, tension, difficulty relaxing and fear about social or academic situations. Both conditions can negatively affect school performance, relationships and quality of life. Brief tools such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) have demonstrated utility in assessing depressive and anxiety symptoms among adolescents [7,8]. Self-esteem is another important dimension of adolescent psychological development. Social-media environments may expose adolescents to continuous comparison with curated representations of peers, influencers and celebrities. Feedback mechanisms such as likes, comments and follower counts may also influence perceptions of social approval. Large observational research has suggested that greater social-media use can coexist with poorer body image, lower self-esteem, disturbed sleep and depressive symptoms [5]. Kelly et al., using data from more than 10,000 adolescents in the UK Millennium Cohort Study, found that heavier social-media use was associated with greater depressive symptoms. Potential pathways included online harassment, poor sleep, body-image concerns and reduced self-esteem [5]. Systematic reviews have similarly demonstrated associations between social-media use and depression, anxiety and psychological distress, while emphasizing that most available research has been observational [3,9]. More recent reviews continue to find associations, but stress substantial variation in exposure definitions, outcomes and study quality [4]. Problematic social-media engagement may therefore represent a more complex phenomenon than time spent online alone. Individual vulnerability, gender, family relationships, social support, sleep, offline activities, cyberbullying and pre-existing psychological problems may modify observed associations. Furthermore, reverse causation is possible: adolescents experiencing depression, anxiety or low self-esteem may themselves spend more time on social media. Considering the increasing integration of digital technology into adolescent life, identifying patterns of use associated with adverse psychological outcomes is important for parents, educators and healthcare professionals. The present study was therefore designed to evaluate the association between social-media use and depression, anxiety and self-esteem among adolescents. Aim To determine the association between social-media use and depression, anxiety and self-esteem among adolescents.

A school-based cross-sectional observational study was designed to assess social-media use and psychological wellbeing among adolescents. Study Setting and Study Population The study included adolescents aged 13–18 years studying in selected secondary and higher-secondary schools. Participants were recruited during the predefined study period after obtaining institutional permission and ethical approval. Sample Size For this illustrative manuscript, a sample of 300 adolescents was considered. For an actual investigation, the sample size should be calculated using an expected prevalence of depression, anxiety or problematic social-media use from previous studies, with a 95% confidence level and predefined absolute precision. Additional participants should be considered to compensate for incomplete questionnaires or non-response. Inclusion Criteria Adolescents aged 13–18 years who were enrolled in participating schools, regularly used at least one social-media platform, were able to understand the questionnaire and provided assent with parental/guardian consent as required were eligible. Exclusion Criteria Adolescents with a medical or cognitive condition preventing questionnaire completion, those unable to provide reliable responses, and those declining participation were excluded. Data Collection Data were collected using a structured, anonymous questionnaire. Sociodemographic variables included age, sex, class, residence and family type. Information regarding social-media use included age at initiation, commonly used platforms, average daily duration, nighttime use, use immediately before sleep, reasons for social-media engagement and experience of cyberbullying. For analysis, average daily social-media use was categorized as: • <2 hours/day • 2–4 hours/day • >4 hours/day The categories were used as analytical exposure groups and should not be interpreted as universally established clinical thresholds for harmful social-media use. Assessment of Depression Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 consists of nine items corresponding to depressive symptoms and produces a total score ranging from 0 to 27. It has been evaluated for detecting major depression among adolescents [7]. For the principal analysis, a score of ≥10 was considered indicative of clinically significant depressive symptoms warranting further assessment. The PHQ-9 was treated as a screening tool and not as a definitive psychiatric diagnosis. Assessment of Anxiety Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. The questionnaire consists of seven items scored from 0 to 3, generating a total score from 0 to 21. Research involving large adolescent samples has demonstrated good psychometric properties of the GAD-7 [8]. A score of ≥10 was used in the illustrative analysis to identify moderate-to-severe anxiety symptoms. Assessment of Self-Esteem Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES), a widely used 10-item measure of global self-worth [10]. Higher scores represent higher self-esteem. For this illustrative study, a predefined study-specific cut-off was used to classify participants into low and normal/high self-esteem categories. In an actual manuscript, the validated scoring convention appropriate to the language and population should be reported. Ethical Considerations Approval should be obtained from the Institutional Ethics Committee and appropriate school authorities. Written informed consent from parents/guardians and assent from adolescents should be obtained according to local ethical requirements. Participation should remain voluntary and responses confidential. Because questionnaires assessing depression may identify suicidal thoughts, a predefined safeguarding protocol should be established. Participants reporting significant distress or self-harm/suicidal thoughts should receive prompt confidential clinical assessment and appropriate referral. Statistical Analysis Data were analyzed using appropriate statistical software. Continuous variables were summarized as mean ± standard deviation or median with interquartile range, whereas categorical variables were expressed as frequencies and percentages. Associations between categories of social-media use and depression, anxiety or low self-esteem were evaluated using the chi-square test. Correlations between hours of social-media use and psychological scale scores were evaluated using Pearson's or Spearman's correlation as appropriate. Multivariable binary logistic regression was used to identify independent factors associated with depression, anxiety and low self-esteem. Adjusted odds ratios (AORs), 95% confidence intervals (CIs) and p-values were calculated. Statistical significance was defined as p<0.05.

A total of 300 adolescents were included. The mean age was 15.6 ± 1.5 years. Of these, 162 (54.0%) were female and 138 (46.0%) were male. Social-media use exceeding four hours per day was reported by 126 (42.0%) participants. Table 1. Sociodemographic and Social-Media Characteristics of Participants (n=300) Characteristic Category n % Age 13–14 years 82 27.3 15–16 years 128 42.7 17–18 years 90 30.0 Sex Male 138 46.0 Female 162 54.0 Daily social-media use <2 hours 72 24.0 2–4 hours 102 34.0 >4 hours 126 42.0 Nighttime social-media use No 119 39.7 Yes 181 60.3 Social media within 30 min before sleep No 108 36.0 Yes 192 64.0 Cyberbullying exposure No 244 81.3 Yes 56 18.7 More than two-fifths of participants reported using social media for more than four hours daily, while approximately 60% reported nighttime social-media use. Table 2. Distribution of Depression, Anxiety and Self-Esteem (n=300) Psychological outcome Category n % Depression (PHQ-9) <10 215 71.7 ≥10 85 28.3 Anxiety (GAD-7) <10 207 69.0 ≥10 93 31.0 Self-esteem Normal/high 221 73.7 Low 79 26.3 Clinically significant depressive symptoms were identified in 28.3% of participants, while 31.0% had moderate-to-severe anxiety symptoms. Low self-esteem was observed in 26.3%. Table 3. Association Between Daily Social-Media Use and Psychological Outcomes Social-media use n Depression n (%) Anxiety n (%) Low self-esteem n (%) <2 hours/day 72 10 (13.9) 12 (16.7) 10 (13.9) 2–4 hours/day 102 21 (20.6) 23 (22.5) 19 (18.6) >4 hours/day 126 54 (42.9) 58 (46.0) 50 (39.7) Total 300 85 (28.3) 93 (31.0) 79 (26.3) p-value <0.001 <0.001 <0.001 A clear gradient was observed across categories of social-media exposure. Adolescents reporting more than four hours of daily use had substantially greater frequencies of depression, anxiety and low self-esteem than adolescents reporting less than two hours. Table 4. Association of Selected Factors with Depression and Anxiety Risk factor Depression present n/N (%) p-value Anxiety present n/N (%) p-value Male 27/138 (19.6) <0.001 30/138 (21.7) <0.001 Female 58/162 (35.8) 63/162 (38.9) Social media ≤4 h/day 31/174 (17.8) <0.001 35/174 (20.1) <0.001 Social media >4 h/day 54/126 (42.9) 58/126 (46.0) No nighttime use 20/119 (16.8) <0.001 23/119 (19.3) <0.001 Nighttime use 65/181 (35.9) 70/181 (38.7) No cyberbullying exposure 55/244 (22.5) <0.001 62/244 (25.4) <0.001 Cyberbullying exposure 30/56 (53.6) 31/56 (55.4) Depression and anxiety were significantly more frequent among females, adolescents using social media for >4 hours/day, those reporting nighttime social-media use and those who had experienced cyberbullying. Table 5. Mean Psychological Scores According to Duration of Social-Media Use Daily use PHQ-9 score Mean ± SD GAD-7 score Mean ± SD RSES score Mean ± SD <2 hours 5.1 ± 3.4 4.8 ± 3.2 27.9 ± 4.2 2–4 hours 6.7 ± 4.1 6.2 ± 4.0 26.2 ± 4.5 >4 hours 10.1 ± 5.2 9.5 ± 5.0 22.7 ± 5.3 p-value <0.001 <0.001 <0.001 Mean PHQ-9 and GAD-7 scores increased across categories of greater daily social-media use, whereas mean self-esteem scores decreased. Correlation analysis demonstrated an illustrative positive correlation between daily social-media duration and PHQ-9 score (r=0.39, p<0.001) and GAD-7 score (r=0.41, p<0.001). Social-media duration showed an inverse correlation with RSES score (r=-0.34, p<0.001). Table 6. Multivariable Logistic Regression for Psychological Outcomes Outcome/Predictor Adjusted OR 95% CI p-value Depression Social-media use >4 h/day 2.58 1.43–4.65 0.002 Female sex 1.82 1.04–3.19 0.036 Nighttime social-media use 1.91 1.04–3.50 0.037 Cyberbullying exposure 2.73 1.43–5.20 0.002 Anxiety Social-media use >4 h/day 2.71 1.52–4.84 0.001 Female sex 1.96 1.14–3.39 0.015 Nighttime social-media use 2.07 1.14–3.76 0.017 Cyberbullying exposure 2.54 1.35–4.77 0.004 Low self-esteem Social-media use >4 h/day 2.37 1.30–4.31 0.005 Cyberbullying exposure 2.45 1.27–4.73 0.008 Female sex 1.44 0.82–2.53 0.205 After adjustment for potential confounders, social-media use exceeding four hours per day remained independently associated with depressive symptoms, anxiety symptoms and low self-esteem. Cyberbullying was also independently associated with all three adverse psychological outcomes.

The present illustrative study identified a significant association between greater social-media use and adverse psychological outcomes among adolescents. Clinically relevant depressive symptoms were found in 28.3% of participants, anxiety symptoms in 31.0%, and low self-esteem in 26.3%. Adolescents reporting more than four hours of daily social-media use demonstrated considerably higher rates of all three outcomes compared with those using social media for less than two hours. These observations are broadly consistent with previous research. Keles et al., in a systematic review examining social-media use and adolescent mental health, found associations between social-media exposure and depression, anxiety and psychological distress, although methodological limitations and predominantly cross-sectional designs restricted causal interpretation [3]. More recent systematic reviews have similarly reported that social-media use—particularly problematic patterns—is associated with symptoms of depression and anxiety among children and adolescents [4]. A large population-based study by Kelly et al. demonstrated increasing depressive symptoms with greater social-media use among 14-year-olds, with stronger associations among girls. The study suggested that poor sleep, online harassment, low self-esteem and body-image concerns may partly explain the relationship [5]. Our illustrative finding of higher depression and anxiety among adolescents reporting nighttime use is compatible with the possibility that sleep disruption represents an important pathway. Female adolescents demonstrated higher prevalence of depression and anxiety in the present analysis. Differences in social comparison, appearance-related pressure, exposure to certain forms of online interaction, psychological vulnerability and baseline sex differences in internalizing symptoms may contribute to this pattern. Importantly, social-media effects are unlikely to be uniform across adolescents, and individual susceptibility and social context should be considered. Cyberbullying showed a strong independent association with depression, anxiety and low self-esteem. Social-media environments can extend peer victimization beyond traditional school settings, potentially increasing the duration and visibility of harassment. Online victimization may contribute to feelings of helplessness, isolation and diminished self-worth. Kelly et al. similarly identified online harassment as one potential pathway linking social-media engagement with poorer mental health [5]. Self-esteem decreased as social-media exposure increased in the illustrative analysis. Social comparison represents one plausible mechanism. Adolescents may compare their own appearance, achievements and social lives with selectively curated content posted by others. Such comparisons may generate feelings of inadequacy, particularly among psychologically vulnerable individuals. A recent meta-analysis examining social-media addiction among students reported positive correlations with anxiety and depression and a negative correlation with self-esteem [11]. Nevertheless, social-media use should not automatically be viewed as inherently harmful. Digital platforms can facilitate peer connection, social support, identity exploration, educational engagement and access to supportive communities. Current expert guidance emphasizes that the relationship between social media and youth mental health is complex and that the available evidence does not support a simple universal causal effect [1]. The psychological impact may depend on content, context, type of engagement, individual vulnerability and whether online activities displace sleep, exercise or in-person relationships.

Greater social-media use was significantly associated with higher levels of depressive symptoms, anxiety symptoms and lower self-esteem among adolescents in this illustrative cross-sectional study. Adolescents reporting more than four hours of social-media use per day had substantially higher psychological morbidity than those reporting less than two hours. Nighttime social-media use, female sex and cyberbullying exposure were additional factors associated with depression and anxiety, while greater social-media exposure and cyberbullying were independently associated with low self-esteem. School-based digital-literacy and mental-health programmes, together with accessible counselling and referral pathways, may help adolescents develop healthier relationships with social-media platforms.

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