The present study investigated the association between focus on self-presentation on social media and mental health and quality of life among adolescents. Overall, a high focus on self-presentation was associated with more mental health problems and reduced quality of life. The strength of the associations with symptoms of depression and anxiety was medium to large, while it was medium for quality of life according to suggested guidelines on magnitude of effect . In the gender-stratified analyses, the association was similar for boys and girls in relation to symptoms of anxiety. For symptoms of depression, the association was stronger for girls compared to boys. With regards to quality of life, focus on self-presentation on social media was only significantly associated for girls. In sum, our findings are preliminary evidence of a medium strong relationship between focus on self-presentation on social media and symptoms of anxiety and depression for both genders, albeit with potential important gender differences. This is in accord with recently reported associations between types of social media use and mental health indicators among adolescents and young adults [20, 40]. Although we report an association between focus on self-presentation on social media and poor mental health and lower quality of life, we cannot assert the direction of the association. So, while it may be that increased focus on self-presentation is related to poorer mental health, it may also be true that pre-existing mental health problems lead to an increased focus on self-presentation. It is also just as likely that both relationships co-exist, so that both factors form part of a self-reinforcing cycle, which lead to both increased focus on self-presentation and poorer mental health.
Importantly, the present study investigated to what degree self-reported attention to self-presentation on social media and the importance of feedback was associated with mental health, rather than just how much time the participants spent engaged in self-presentation behavior. Our results do not necessarily indicate that engaging in self-presentation behavior per se is associated with poor mental health and well-being, but rather that the focus on these aspects of social media are important factors to gauge. Although the frequency and duration of self-presentation behaviors is likely to be closely related to the time spent engaging in these behaviors, it is also possible that adolescents may engage in self-presentation behavior without caring much about the feedback they receive. In fact, Frison and Eggermont  found that adolescents that actively presented themselves on social media reported less depressive symptoms than those who did not. Thus, self-presentation on social media in itself may not be harmful, but preoccupation with presenting oneself in a manner that elicit a wanted feedback from others may be detrimental to mental health. Differential associations with mental health and well-being is also likely to be related to true versus strategic self-presentation practices as reported by Jang and colleagues .This notion is further echoed by a qualitative study of adolescent girls which reported on the importance put on self-presentation on social media in relation to self-esteem and insecurity by the participants . The participants reported, for instance, that they would delete posted photographs with few likes out of frustration or embarrassment.
Only one of the items used in the present study explicitly asked about appearance-related self-presentation (retouching selfies to look better), while the other items asked about content in general. One underlying mechanism for the negative association between self-presentation and mental health found in this study may be related to appearance-related self-presentation. In line with this, a recent study found that social media engagement and behaviors involving appearance comparisons and judgements thereof is of particular importance for symptoms of depression and anxiety among adolescents and young adults . This may be due to the immediacy of comparison facilitated by pictures as compared to other media , as well as the importance put on – females’ in particular - appearance and attractiveness emphasized in most cultures . Furthermore, posting pictures of themselves may leave them more vulnerable to negative feedback or lack of feedback.
Self-presentation on social media was recently highlighted as a potentially important part of the puzzle to increase our understanding of the relationship between social media use and mental health and well-being among adolescents . In our sample, a relatively large proportion reported at least some focus on self-presentation on social media, but for four out five indicators (except “retouching”), the girls reported more focus on these aspects compared to boys. This is in line with other findings, where adolescent and young adult women report higher preoccupation with self-presentation on social media compared to boys , but are somewhat at odds with findings from younger age groups, where boys and girls displayed similar levels of self-oriented social media activity . A study investigating selfie-taking and posting patterns found, however, consistent gender differences across broad age groups (aged 12 to 50 years). In that study, adolescents (aged 12 to 19 years) were found to be more likely than older aged groups to take own- and group-selfies, post their own selfies, and use filters. Furthermore, females were in general more likely to take personal and group selfies, post personal selfies, crop photos and use filters compared to males, a gender-difference that was more pronounced during in the adolescent group . Based on these findings, it may be that one of the underlying mechanisms for our observed gender differences the relationship between self-presentation and mental health are due to differences in the selfie-culture between boys and girls. If so, the differences in selfie-culture must be understood in light of the prevailing general gender culture, where female physical attractiveness is highly valued .
The present results should also be juxtaposed to findings suggesting a link between false self-presentation and poor mental health . It is possible that adolescents who are preoccupied with self-presentation and the feedback they receive on social media are more likely to present themselves in a way that generates positive feedback, which may not correspond to their true self. This may be particularly true for use of social media platforms that very much are based on visual self-presentation, and thus may confer more use of retouching of self-portraits.
Implications and public health relevance
For adolescents, our findings highlight the importance of awareness regarding how different types of activities on social media may be related to mental health outcomes. Today’s adolescents are social media ‘natives’ , i.e., they have grown up in an “online world”. In contrast, many adults are “social media immigrants”, and this native/immigrant distinction may reduce parents’ understanding of and insight into adolescents’ online lives . Parental involvement in relation to social media use has been reported to be stronger in younger ages . Continued parental involvement during late childhood and early adolescence may therefore be important to mitigate potential negative effects of social media use [48, 49]. Gómez and colleagues encourages for instance the empowerment of parents to moderate their offspring . Similarly, the schools and teachers may play an important role in increasing awareness and knowledge about the use of social media. Chua and Chang suggest that educational programs that increase social media literacy can be beneficial when they also target negative consequences due to excessive peer comparison and the need for online feedback .
Our findings suggest that not only the amount of use on social media should be considered but also the role of self-presentation. A recent review covering the association between social media use and well-being among adolescents highlighted among other things the negative association between well-being and social media use through high investment and negative feedback . They also asserted the need for intervention programs and educational programs that could address potential risks of social media relation to subjective well-being . Specifically, they listed improved education and awareness among adolescents themselves, as well as the school as an optimal place to facilitate critical thinking about social media use and potential consequences.
Strengths and limitations
The present study holds some strengths. First, the measures of mental health and quality of life are widely used and validated scales [30–32]. Second, the questions related to focus on self-presentation on social media were specifically developed for the purposes of the survey. Specifically, the questions related to focus on self-presentation were derived from four focus-groups where social media, mental health and well-being was the overarching topic. Third, the survey is recent and included both girls and boys. Several limitations are also important to mention. First, the study is cross-sectional, and causality cannot be inferred. Second, the sample size is relatively small, limiting the meaningfulness of subgroup analyses, and the inclusion of potential confounders and moderators in our analyses due to lack of statistical power. For instance, the finding of a non-significant association between focus on self-presentation and quality of life among boys may reflect the true relationship between the variables, be due to limited statistical precision or due to confounding factors. Third, the survey did not include measures of frequency or duration of social media use among adolescents. However, such measure are likely to be inaccurate and biased [50, 51], and may be non-germane [5–7, 20]. Fourth, the study population was limited to one senior high school in Norway, which is likely to reduce the generalisability of our findings. Related to this, the participation was moderate, and this may impact the validity of our findings vis-à-vis the study population. However, several studies have indicated that low participation rate is more detrimental to prevalence estimates than estimates related to associations between variables . Fifth, only a small proportion of the sample reported retouching pictures, and given the general availability of different photo-filters in different social media apps, our numbers seem low. Although we cannot confirm it, there is a strong possibility that this question was taken as editing of photos which goes beyond built-in filters and more along the lines of manually editing particular parts of the photos.