Facing the Truth about Social Media Psychopathology among Social Media Users

25% of teenagers use social media now. Technology can be used to learn new information as well as finding self help techniques to have a better mental health as well as getting information that can be very harmful to the wellbeing. This literature review addresses the benefits as well as the downsides of having social media in our lives. This includes having a larger support network, being able to socialize, suicide prevention on one hand, as well as depression, cyber bullying, addiction, insomnia, psychosis and many more on the other hand.  Following the modern spatial imaginary entitled "Psychopathologies of Modern Space" Anthony Vidler talked about the history of "space" One way of tracing this history would be to check the expansion of territories and boundaries like Henri Lefebvre commonly did. A second way would be to see the different forms of spatial representation, including the symbolic forms, creating a relationship between an individual "psycho physiological space" universal geometrical space, that Erwin Panofsky detailed. A third way would be to describe the psychical, or interior space, and the space as projection like Sigmund Freud and Jacques Lacan did. Social media provides a space for the mental life of modernity, which as defined by Georg Simmel, has its own psychic foundation of the urbanite individual: the "growth of nerve life, stimulated by the rapid uninterrupted exchange of internal and external impressions"[1] Seventy five percent of teenagers own cell phones. Of these, 25% use them for social media. Technology can lead to an increase in skills and social benefits but there is also the potential for harm such as sexting, cyber bullying, privacy issues, and Internet addiction, all of which can affect health. With new innovations, there can be associated psychopathology, but there is often a time lag in detecting it. The association of internet use with psychopathology has been well documented  There have been findings that there are psychopathologies associated with social media use, on such sites as Facebook. This includes addiction, insomnia and psychosis as well as a report of Facebook precipitated suicide. In this report, we present data of reported cases and studies about social mediainduced psychopathology.  A Medline /pub med search using the key words, social media, Facebook, suicide, depression, psychopathology, insomnia, psychosis, mental health, mental illness. Articles retrieved were analyzed and the data is presented in categories.  Internet based therapy and use Greater access to and use of the Internet by those with mental illness has led to considerations of technology based interventions. Things to consider are feasibility and impact, as well as ethical considerations  Mental health care professionals are starting to incorporate Internet technologies into their professional lives, but they remain divided on the ethics and utility of using these technologies in clinical care, and practices and attitudes differ among clinicians with different levels of experience and in different settings of practice  Preliminary evidence indicated that online and mobilebased interventions showed promise in improving positive psychotic symptoms, hospital admissions, socialization, social Central Mattar et al. (2016)  (2016) 2/6 connectedness, depression and medication adherence [5] Telemental health, for example, offers a means to unite primary care and mental health physicians. Online therapies can offer a first step of treatment of disorders including depression and anxiety  One study found that internet delivered cognitive behavioral therapy is effective and acceptable for use in populations over 60 years old [7] Moreover, internet administrated cognitive behavior therapy (iCBT) has been found to be an effective treatment for Social Anxiety Disoder [8] Something else to consider is the potential usefulness of internet advertising to recruit participants for trials. Google advertising was successful in recruiting participants to a trial evaluating online depression intervention. Results suggest that Internet based recruitment to mental health interventions is feasible and can be relatively affordable [9] There are other ways that social media is being used to try to help improve health outcomes, reduce costs and decrease rehospitalizations. One such example is "Louise," a virtual patientdischarge advocate. Another example shows us a secure social networking community that is helping case managers better support patients who are on the road to recovery from addiction. Another description is of a hospital's use of a virtual world to help train staff for emergency evacuation. It has been argued that social media can be used to deliver more patient centered care and fluent care processes between patients and physicians  DEPRESSION It may seem that Facebook can fulfill a basic human need for social connection. However, current findings may suggest that Facebook undermines well being instead of improving it. One study showed that the more people used Facebook, the worse they felt the next time they were text messaged by investigators. Also, the more they used Facebook over two weeks the more their life satisfaction levels declined over time. These negative outcomes could not be predicted by interacting with other people directly, and were not moderated by the size of the person's Facebook network, perceived supportedness and motivation for using Facebook, gender, loneliness, self esteem or depression [11] There are many aspects of the relationship between depression and social media use that could be important to consider. Is there is any relationship between social networking and depression? One study found that participants who were positive for depression based on their PHQ 9 score were more likely to display depression symptom references  Some results indicate that online social networking is related to depression, and have shown a statistically significant correlation between Beck Depression Inventory scores and the time spent on social networking [13] Other studies have not found evidence for a relationship between social media use and depression, and counseling patients or parents on the risk of "Facebook Depression" may not be warranted [14] However families should be educated and understand the importance of healthy internet use in their children, and be encouraged to monitor for problems with cyberbullying, "sexting," and exposure to inappropriate content. Pediatricians are in a unique position to help families with this. "Facebook depression," sexting, and exposure to inappropriate content [1] College students commonly display symptoms consistent with depression on Facebook, and it's suggested that those who receive online reinforcement from friends are more likely to discuss depressive symptoms publicly on Facebook  A study used an app called Emotion Diary which was believed to successfully evaluate depressive symptoms as well as provide useful tips and facts to users. It was demonstrated that the more depressed someone is, the more they will read tips and facts about depression. Depressed people also had significantly fewer interactions with others as measured by decreased number of friends and location tagging. These results could make it possible to examine Facebook activities to identify depressed individuals [16] In addition, one study provided support that adolescents use public Web sites to display comments about their suicidal thoughts, behaviors, and possible intentions  Studies have also shown that depressed people display more depressive symptoms references on their networking site. At schools, programs that encourage resident advisors and peers to respond to a student's signs of depression displayed on Facebook and to encourage treatment may represent a way to improve access to care for depression. In person communication would be the preferred way to raise such concerns [18] It has been found that mental health references varied from being serious calls for help to jokes or attention seeking behavior. Responses to mental health references depended on the participants' offline relationship with the poster. Students would contact close friends through a phone call or in person conversation, but would not approach acquaintances [19] Another study using a Social Networking Peer Experiences Questionnaire highlighted the importance of examining the effects of aversive peer experiences that occur on social media. Negative social networking experiences were associated with youths' symptoms of social anxiety and depression, even when controlling for traditional peer victimization [20] Recent studies have shown that social wellbeing seems to play a bigger role than psychological health when it comes to negative effects from internet use. Although all psychosocial health variables (except for shyness) were correlated with generalized pathological internet use (GPIU) general loneliness was the only significant predictor of GPIU. Further there was a stronger correlation between the frequency of communicative services (most significant being chat rooms and "adult" websites) and GPIU as opposed to leisure or informational sites. It seems that GPIU is related to the social aspect of the internet and the unique environment to communicate in  There are some examples in the literature of positive interactions and social improvement through the use of Facebook. Results showed that only for less extraverted individuals, chatting with peers found exclusively online directly predicted higher self esteem and indirectly predicted less depressive symptoms through increases in supportiveness. It seemed that social media could help socially integrate more reclusive patients [22] Central Mattar et al. (2016)  (2016) 3/6 Suici