pediatric mental health

Social Media, Self-Esteem, and Teen Suicide

The suicide rate for children and teens is rising. According to a September 2020 report by the U.S. Department of Health and Human Services, the suicide rate for pediatric patients rose 57.4% from 2007 to 2018. It is the second largest cause of death in children, falling short only of accidents. Here we’ll explore possible causes for this increase, including why social media may not be a viable cause, and outline the resources available both for families and for the healthcare professionals caring for them.

The Impact of Social Media on Teens

When seeking reasons for adolescent suicide, it’s tempting to place blame on social media -- it is, after all, an all-encompassing medium for communication, entertainment, and creativity that many parents (and pediatricians) didn’t experience for themselves as teens. Some parents and experts have suggested that using social media exposes kids to cyberbullying, soaring standards of beauty and performance, and peer pressure, not to mention the physical effects of sacrificing sleep and exercise that can lead to poor mental health or exacerbate an existing mental health condition.

These negative effects are indeed possible and not uncommon in adolescents, but it’s important to note that these effects change when you examine how a child is using social media, and how often. Teens in the U.S. who spend more than 3 hours a day on social media may be at a heightened risk for mental health issues, according to a 2019 study in JAMA Psychiatry. The study, which was adjusted for previous mental health diagnoses, concludes that while adolescents using social media more intensively have increased risk of internalizing problems or reporting mental health concerns, more research is needed on “whether setting limits on daily social media use, increasing media literacy, and redesigning social media platforms are effective means of reducing the burden of mental health problems in this population.”

Therefore, since we cannot effectively quantify whether spending more time on social media is worse for teens’ mental health, whether it can be used as a positive or negative coping mechanism for existing mental health conditions, or even whether increasing media literacy nullifies the negative effects observed in adolescents, experts say that there is not enough evidence to support social media use as a factor in adolescent suicide. It is also worth nothing that similar statistics of adolescent suicide are not prevalent in other countries where social media has likewise increased.

At your practice, this research may boil down to a couple of simple conclusions. For one, attributing overuse or even general use of social media to a patient’s mental health concerns is a broad answer to an individual patient’s often complex circumstances. Secondly, a review by Pew Research explored the opinions of teens on their use of social media and found that while bullying, peer pressure, and high standards of performance were a concern, 31% adolescents find social media a great tool for communication, expressing sexuality and identity, accessing information, and exploring interests. 

How could this be a positive thing? Simply put: context. Other factors in suicide or attempted suicide could be related to abuse or neglect, untreated mental illness, fears over expectations, fears about their future, or a lack of healthy outlets for a child’s physical or emotional needs, which includes their blossoming identities as a young adult. When a child’s family, support network, and healthcare team work together to recognize the warning signs of depression, suicidal ideations, self harm, and possible suicide attempts, contextual evidence from the patient’s history and life can help physicians and families to understand the causes of suicide and prevent it from happening.

Warning Signs of Depression

Depression or other mental health concerns may disguise themselves in “typical teenage” behaviors. Some of the biggest signs that a child might be depressed are:

  • Sadness or hopelessness
  • Irritability, anger, or hostility
  • Tearfulness or frequent crying
  • Withdrawal from friends and family
  • Loss of interest in activities
  • Poor school performance
  • Changes in eating and sleeping habits
  • Restlessness and agitation
  • Feelings of worthlessness and guilt
  • Lack of enthusiasm and motivation
  • Fatigue or lack of energy
  • Difficulty concentrating
  • Unexplained aches and pains

Access Our Guide to Integrate Behavioral Health into Your Practice

How You Can Help Prevent Teen Suicide

According to the CDC, population level awareness, education, and resources are key in supporting patients of all ages to prevent suicide. Their guide, Preventing Suicide: A Technical Package of Policy, Programs, and Practices, goes into detail about building the structures and communities that will help create the support system necessary to prevent suicide not only for every patient you see, but their families and communities. 

The headings in bold below are some of the goals covered verbatim from the CDC’s guide, as well as our own suggestions your pediatric practice might utilize to support or grow your suicide prevention efforts:

  • Strengthen economic supports, providing financial security to families
      • Where appropriate, offer financial resources such as payment plans, discounts, and educational resources.
      • Host or contribute to community efforts that support families in need of financial support, such as food, clothing, or gift drives.
  • Strength access and delivery of suicide care
      • Advocate for payor coverage of mental health procedures
      • Aid the work to reduce provider shortages by integrating behavioral health into your practice. (See our guide on this topic for more information.)
      • Practice consistent behavioral health screenings.
      • Screening tools and services to make screenings efficient.
  • Create protective communities
      • Encourage safe environments with resources on healthy relationships, drug use, and violence, to name a few.
  • Promote connectedness
    • Build trusting patient relationships.
    • Offer mental health resources and lead awareness campaigns.
    • Provide resources for parents such as, which can help promote important conversations.

Think of the measures your office is already taking to support patients’ mental health and safety. How might you improve measures to improve access to care in your office, at your local schools, or online? Measures as simple as providing links or videos on your practice website are important steps to building a practice culture that allows for open conversations about mental health and suicide prevention. You can go even further: screening tools are imperative for catching signs of mental distress early and providing access to resources and care for patients. CHADIS is a screening tool that provides mental health as well as many other screening options -- there are even self-administered screens that some patients might be more comfortable completing.

There is always help available -- if a patient is experiencing burnout or suicidal ideations, you can connect them to the National Suicide Prevention Lifeline 24 hours a day at 800-273-8255.

Burnout, Loss, and Suicide Prevention

It’s not as easy to define the causes of adolescent suicide as simply attributing social media as a large factor, but while this leaves room for more research, it also gives physicians and families plenty to do to create the supportive resources and communities that will protect adolescent patients and offer them the care they need. Screenings remain a vital part of any suicide prevention program, but they’re only a part of what your practice can do to offer support. If you’re considering offering behavioral health services at your practice, you can weigh all your options before committing with PCC’s ebook, Integrating Behavioral Health: A Guide to Expanding Access.

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Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.