The invention and widespread use of Social Networking Sites (SNS) has arisen alongside the New Media Age. Websites such as Facebook, Instagram or Twitter were designed primarily for communication purposes, where one can instantly message contacts, share photos, videos, or statements (1); but also for entertainment, socialising or sharing news. As the use of SNSs is still a relatively novel phenomenon, the long- and short-term effect on health, especially mental health, is somewhat unknown and largely controversial (2, 3). In Sweden, the number of SNS users has risen steadily. In 2017, 81% of the population aged above 12 were using them, 56% on a daily basis; compared to 53% and 28%, respectively, in 2010. Individuals aged between 12 and 35 most commonly use SNS on a daily basis, women more than men. The most commonly used site in Sweden is Facebook, whereby in 2017, 76% of Internet users aged 16-25 and 74% aged 26-35 used Facebook on a daily basis. (4)
Mental health problems are on the rise worldwide (5), largely due to an increase in depression (5, 6). Depressive disorders reside in the top three leading causes of Years Living with Disabilities (YLD), globally (6), with recent estimates predicting around 270 million affected individuals (5). Depression correlates with an increased mortality, especially suicide (7), which is the second most common cause of death among 15 – 29-year olds (5). In Sweden, the level of poor mental health in children and young adults has also risen in recent years, with no apparent aetiology (8). The parallel rise in SNS use and poor mental health prevalence among young adults may suggest the former is affecting the latter (9).
1.1 Mental Health and Frequency of SNS Use
It has been postulated that the mechanism linking SNS use and mental health issues may be increased time spent on SNS, thereby interfering with routine obligations and functioning (3). One longitudinal study, using the experience sampling method, showed that increased SNS use predicted declines in affective well-being and life satisfaction (10). Users may expect to ‘feel better than before’ after using Facebook for about 20 minutes, according to a three-part study on Facebook’s emotional consequences (11). However, in an experimental part of this same study, increased time on Facebook prior to an assessment of emotional status correlated with negative mood (11). Essentially, these results may suggest that if users' subjective well-being is consistently undermined over a sustained period, this could lead to depression (2).
However, some articles posit that there is no significant effect of frequency of SNS use on depression (12, 13). Others suggest that certain types of activity and their specific SNS use predict depression. For example, passive SNS use (in the case of Facebook), would include browsing the newsfeed and reading contacts’ posts and profiles. During active Facebook use, one is actively posting content, engaging with other people’s content or communicating. (2) This could be an issue, because in an experimental and experience sampling study, passive Facebook use was shown to decrease affective well-being, whereas active Facebook use did not (14). Several studies concern themselves with specific negative feelings associated with SNS use, such as envy (14, 15), loneliness (16) or worry (10). For instance, the relationship between passive Facebook use and affective well-being was mediated by envy, so that passive Facebook use increased feelings of envy which in turn decreased well-being (14). Similarly, Tandoc et al. (2015) (15) found that depression occurred when envy was triggered during passive Facebook use. If envy did not occur, use of Facebook correlated positively with lower levels of depression (15).
The majority of studies have investigated the use of Facebook (2), though the use of Instagram also seems relevant. In Sweden, Instagram is used by 52% of the population, mostly by younger individuals (4). Frequency of Instagram use was positively correlated with depressive symptoms, anxiety and self-esteem issues in a cohort study of 129 women between 18 and 35 years of age. These associations were partially mediated by social comparison. (17) Similarly, in another study of a mixed gender population, more frequent use of Instagram was significantly positively associated with depression (18).
1.2 Mental Health and the Number of SNS Contacts
The number of SNS contacts is a frequently studied factor that may influence the relationship between SNS use and mental well-being (2, 3). Considering the results of the studies from section 1.1, these may suggest that more SNS contacts exposes the individual to more content that could be detrimental to their mental well-being, for example due to a tendency to compare themselves or ruminate. In the Instagram study, the number of accounts participants were following as well as the participants’ number of followers correlated positively with depressive symptoms (17). A further Instagram inquiry also found a positive association between Instagram use and symptoms of depression when following disproportionately more strangers than real life acquaintances. When following more acquaintances than strangers, increased Instagram use correlated with decreased depression. (18) This study is interesting in that it suggests there is a point at which following too many strangers can be detrimental to one’s well-being. Moreover, having a high number of Facebook friends predicted worsened life satisfaction for those who used Facebook for making new connections as opposed to strengthening current friendships (19). In contrast, a study with a Finnish population, of whom most were students, concluded that the number of Facebook friends had no association with happiness nor life satisfaction, as this was confounded by personality traits (20). It seems reasonable to hypothesise that having increasingly more SNS friends increases the likelihood of a larger proportion of these being distant acquaintances, superficial types of relationships or even total strangers, as was revealed in a study of college students’ Facebook friendship networks (21). This might increase the exposure of other people’s SNS profiles and posts with whom and which one is less familiar with, in turn increasing the chances of using SNS in a less active and more passive way. Alternatively, a higher number of online contacts may, via the same logic, potentially increase negative social comparison, fuelling feelings of envy and thereby contributing to depressive mood (18, 22).
1.3 Perceived Emotional Support
Perceived emotional support (PES) is defined as subjectively perceived support, which provides empathy or advice during times of trouble from important others, such as family, friends and partners, which differs from received support (the support you actually receive) (23). Having low PES has been associated with increased depression and anxiety (24), poor general health, quality of life and other mental health outcomes (25).
Previously, interest in PES derived online from the use of SNS in association with mental well-being has been far greater, given SNS are social portals and so a potential source of PES (2). However, it seems no study so far has investigated the role of “offline PES” in the relationship between SNS use and mental health. Understanding people’s environmental social factors such as their level of PES, could yield a better understanding of the associations between SNS use and mental health. In addition, as the above account of studies has shown, it is unlikely to be social media use alone that impacts mental health, but rather a combination with other factors, such as personality and social support structures.
In summary, research into the impact of frequency of SNS use and network size on mental health has provided mixed findings (2). The immense interest into this topic has fuelled the production of a large research literature. Yet, despite this, results are conflicting and largely inconclusive (2, 3). SNS are also constantly evolving; new networks join, while others lose in popularity (26), all while people’s networks tend to expand (21).
The aim of this study was to examine the association of SNS use, in itself, and in relation to ”offline“ PES, with mental health of young adults aged 18–34 in Sweden. More specifically, the questions are:
a) Does an association exist between the frequency of SNS use or the number of SNS contacts with the mental health of young adults in Sweden?
b) Are young adults living in Sweden who have a high level of PES protected from the potentially detrimental effects of frequent SNS use or having a large number of SNS contacts?