Will Facebook be part of the problem or solution for the teens we treat with mental illness?

·5 min read

Talk to any pediatrician and we’ll tell you: We are living through a teen mental health crisis. The pandemic brought school closures and stay-at-home restrictions that bred social isolation among teens. With more than 721,000 COVID-19 deaths nationwide, many teens personally know someone who has died, and in some cases might have even lost a parent.

Unsurprisingly, on the front lines, pediatricians like us are caring for more than double the usual number of teens struggling with depression, anxiety and eating disorders.

Against this backdrop, social media giant Facebook – owner of Instagram, a platform used by more than half of teenagers in the USA – has a key role to play. Amid these rising and unprecedented rates of teen mental illness, will Facebook be part of the problem or the solution?

Instagram and eating disorders

Whistleblower and former Facebook product manager Frances Haugen recently testified to Congress that the company had internal research showing that Instagram might have worsened the mental health of young people. In these studies, teen girls reported that Instagram made them feel worse about their bodies, intensified eating disorders and made suicidal thoughts more frequent.

We’ve seen examples of this in our own eating disorder clinic, where teens commonly tell us that Instagram exposes them to posts that perpetuate unrealistic body shapes and share harmful dieting advice.

Facebook’s internal research reconfirms a 2018 study from the Pew Research Center showing that 1 in 4 teens said social media negatively impacts their life because they experience bullying and harassment, develop unrealistic views of their peers’ lives and become distracted from spending too much time online.

These are, again, concerns we commonly hear from the teens in our practice. Such problems are likely amplified in teens who spend more time on social media, which is especially concerning because nearly 90% of teens who visit Instagram and other platforms do so multiple times daily.

Logging onto Facebook in Palo Alto, Calif., in 2012.
Logging onto Facebook in Palo Alto, Calif., in 2012.

This time of immense scrutiny presents a critical opportunity for Facebook to help, rather than hurt, teen mental health. Lawmakers have suggested that they might step in and regulate the platform, and as pediatricians, we’re inclined to support these measures if they are aimed at improving teens’ health and well-being. Even with regulation, however, social media is likely to play an enduring role in teens’ lives for years to come. Facebook should seize this moment to begin taking measures to unequivocally improve and support teen mental health.

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Perhaps most important, Facebook and other social media companies should amplify healthy messages. In the same Pew Research Center study, 1 in 3 teens reported that social media has a positive impact on their life, most commonly because it helps them connect with others or find important information.

However, algorithms in Facebook and Instagram – kept secret from public scrutiny – are based on how many people like, share and comment. This approach boosts bombastic, misleading and unhealthy posts.

We need health-focused algorithms

Social media companies could instead selectively curate and actively promote messages of health and well-being. Numerous pediatrician influencers (for example, @teenhealthdoc, a specialist on adolescent health in New York) already provide evidence-based advice and health information for teens and their families on Instagram and other platforms. Facebook could establish an advisory board of clinicians to assess the quality of influencers’ posts, offer verification to health care providers (providing the invaluable “blue checkmark” showing that a user is authentic and notable) and boost their posts to teen audiences.

Similarly, social media companies should lift up teens who themselves post accurate, health-promoting content.

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This approach would require Facebook to change its algorithms, which the company is likely to resist unless forced through regulation. Social media companies have consistently come under fire for being too late to act on posts that are misleading or cause harm, contributing to bad press and negative attention from lawmakers.

We assert that Facebook should be proactive in its approach, fostering high-quality content that is engaging for teens. Done right – with an infusion of creativity, thoughtful design and humor – positive, health-promoting posts can garner enormous numbers of likes, shares and comments, but may need to be actively promoted amid the negative messaging that currently prevails. Facebook has recognized it has an obligation to block misinformation about COVID-19, and now needs to take similar measures to protect the mental health of teens.

Facebook can also help support moderation in the use of its platforms among teens. Social media companies’ current business models are driven by persistent, compulsive use of their products and the advertising revenue this generates. To its credit, Facebook has placed limits on advertising to teens.

The company should build on this further by helping teens put down their smartphones. To reduce screen time, Apple introduced "Screen Time," an iPhone and iPad integration that allows parents to limit the amount of time teens spend on social media apps. However, workarounds are easy for teens to find. Facebook should introduce its own functionality allowing parents to cap teens’ use across its platforms.

We will be grappling with the after-effects of COVIC-19 on teens’ mental health for years to come. The reality is that although many of us pediatricians would happily remove social media altogether from the lives of our teen patients, Instagram and other popular platforms aren’t going anywhere. Social media companies wield enormous power over teens. They should use it to bolster – not hinder – the hard work we pediatricians do on the front lines to address mental illness.

Dr. Scott Hadland is the chief of adolescent medicine at MassGeneral Hospital for Children and Harvard Medical School (@DrScottHadland on Twitter and Instagram). Dr. Kathryn Brigham is the medical director of the teen eating disorder program at MassGeneral Hospital for Children and Harvard Medical School.

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This article originally appeared on USA TODAY: Facebook should modify algorithms to make social media safer for teens

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