Exploring the Relationship Between Public Social Media Accounts, Adolescent Mental Health, and Parental Guidance in England: Large Cross-Sectional School Survey Study
Authors: Mabaso Wakithi Siza , Hein Sascha , Pavarini Gabriela ,   The OxWell Study Team, Fazel Mina 
Published: December 2024

Background
Although associations between social media use and adolescent mental health have been described, more information is needed on the potential components characterizing this complex exposure, in particular, those related to maintaining a public social media account.

Objective
This study aims to investigate the association between having a public social media account and anxiety and depression in school-going adolescents.

Methods
Overall, 80 secondary schools and further education colleges in England were sampled using a cross-sectional web-based survey as part of the 2023 OxWell Student Survey. Social media exposure was categorized among the adolescents as having a public social media account versus not having a public social media account. The risk of clinical anxiety and depression was determined using the Revised Child Anxiety and Depression Scale-11. Adolescents self-reported the content and platforms accessed in the previous 24 hours. Associations between having a public social media account and symptoms of anxiety and depression were assessed using logistic regression controlling for age, sex, the experience of being bullied, parental guidance of online behavior (describing perceived parental approaches to adolescents’ online activity), the proportion of close friendships engaged with online, poverty status, and placement in statutory care. Age, sex, and parental guidance of online behavior were assessed for primary association effect modification.

Results
Data collected from 16,655 adolescents (aged 11-18 y) were analyzed. Of these 16,655 adolescents, 6734 (40.43%) had a public social media account, while 9921 (59.57%) either had a private social media account or no social media account. Moreover, 32.6% (5429/16,655) of the adolescents screened positive for symptoms of anxiety and depression. Those with a public social media account had higher odds of anxiety and depression (odds ratio [OR] 1.41, 95% CI 1.32-1.50) than those without a public social media account in an unadjusted and fully adjusted model (OR 1.39, 95% CI 1.29-1.49). Adolescents reporting active parental guidance had lower odds of anxiety and depression (OR 0.85, 95% CI 0.75-0.93) than those reporting no parental guidance, and these parental approaches to online behaviors significantly modified the association between having a public social media account and symptoms of anxiety and depression (P=.004; χ22=11.1).

Conclusions
Our OxWell study findings suggest a potential mental health risk for adolescents with a public social media account. We show evidence indicating some protection from anxiety and depression among adolescents who do not have a public social media account and those reporting some form of parental guidance of their online behavior. This was pronounced in adolescents reporting active parental guidance compared to stricter regulatory approaches or no guidance at all. The specific roles that social media account choices and parental guidance of online behavior may play in supporting the mental health of adolescents are highlighted for further investigation.

International Registered Report Identifier (IRRID)
RR2-10.1136/bmjopen-2021-052717