impact of social media during covid 19 essay

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• v.46(Suppl 1); 2020

Social media influence in the COVID-19 Pandemic

Daniel a. gonzález-padilla.

1 University Hospital 12 de Octubre, Department of Urology, Madrid , Spain, Department of Urology, University Hospital 12 de Octubre, Madrid, Spain

Leonardo Tortolero-Blanco

2 Hospital Universitario La Moraleja, Madrid , Spain, Urology service, Hospital Universitario La Moraleja, Madrid, Spain

None declared.

Never before in human history has it been possible to communicate so quickly during a pandemic, social media platforms have been a key piece for the dissemination of information; however, there are multiple advantages and disadvantages that must be considered. Responsible use of these tools can help quickly disseminate important new information, relevant new scientific findings, share diagnostic, treatment, and followup protocols, as well as compare different approaches globally, removing geographic boundaries for the first time in history.

In order to use these tools in a responsible and useful way, it is recommended to follow some basic guidelines when sharing information on social networks in the COVID-19 era. In this paper, we summarize the most relevant information on the influence, and advantages, and disadvantages of the use of social networks during the COVID-19 pandemic.

INTRODUCTION

Social media platforms are amongst the most widely used sources of information in the World, the easy and inexpensive access to the internet and a large number of registered users in these platforms make them one of the easiest and most effective ways to disseminate information. During major events, the overall response is usually a greater search for information be it a sports event, a disease, or a natural disaster.

A good example can be seen with the peak of searches for information on the Internet and social media platforms in China preceding the peak of incidence in COVID-19 cases by 10-14 days, with which Internet and social media networks searches have a demonstrated correlation with the incidence of disease ( 1 , 2 ).

Social media platforms have also become helpful for the lay public to maintain communication with friends and family to reduce isolation and boredom which have been associated with anxiety and long-term distress, therefore becoming an important recommendation for isolation at home to help to reduce the psychological impact ( 3 ).

Some of the most relevant characteristics of social media platforms in this pandemic has been the rapid dissemination of protocols at regional, national, and international levels. Sharing protocols about treatment, personal protection equipment, or even proposals for fair allocation in scarce medical resource settings have now become the new normal ( 4 ).

This allows centers with less capacity to develop protocols at sufficient speed to be able to implement or adapt other's protocols to their particular situation or resources in minimal time, something unthinkable 20 years ago when most social media platforms had not yet been born ( 5 ). We provided in this manuscript, the most important advantages and disadvantages associated with the use of social media platforms during the pandemic.

Advantages of social media use

Social media have the great advantage of rapid dissemination of educational content in the COVID-19 era, for example, Chan et al. ( 6 ) developed an infographic about airway management of patients with suspected or confirmed COVID-19. It was shared through Twitter and WeChat, in a few days requests were received for its translation into more than ten languages, besides the distribution allowed adapting the infographic to the particularities of each healthcare setting.

Faster dissemination of information regarding preventive measures has a lot of potentials. A recent study by Basch et al. ( 7 ) evaluated the 100 most viewed videos on YouTube with the word “coronavirus”, these together had more than 165 million views as of March 5, 2020, 85% of them belonging to news channels; It was found that less than ⅓ of the videos mentioned the recommended prevention measures, less than half mentioned the most frequent symptoms, however, almost 90% commented on deaths, anxiety, and the quarantine status. This study leaves us with an important reflection on the missed opportunities for dissemination of quality information on the prevention of contagion and frequent symptoms of COVID-19 on platforms such as YouTube, which are being increasingly consulted as an information source.

When it comes to publications, studies have shown that the dissemination of scientific literature on social media platforms (Facebook, Twitter, etc.) increases the number of downloads, queries, and citations of these articles ( 8 – 10 ) which, with the COVID-19 pandemic are characteristics that have undoubtedly allowed rapid dissemination of knowledge worldwide, in addition to markedly reduced editorial times, which have gone from months of processing to days or weeks since its reception.

For this reason, before sharing medical information, we advise following some guidelines of responsible use of social media when disseminating information; these guidelines are summarized in Table-1 .

Another advantage of social media platforms during the COVID-19 pandemic has been the possibility of arranging collaborative research projects, surveys, and multi-center studies. Finally, another advantage of social media platforms is supporting continued medical education through online live and recorded webinars through platforms like YouTube, Skype, or Zoom.

Disadvantages of social media use

Among the disadvantages, we have the possibility that information transmitted is not current, has not been subjected to peer review, is invalid, incorrect, not applicable to our environment, or even false.

Another big obstacle for social media and the dissemination of information are the “bubble filters”, a concept coined by Eli Pariser in 2011 ( 11 ), which tells us about a “personalized ecosystem” towards the user, in which the algorithms through the data collected from the same user, predict their preferences and yield results that are considered similar to the likes of that user. These bubbles produce a loop of similar content that prevents the user from seeing other different sources to contrast information ( 12 ). This concept applies to any scenario or illness that is consulted in internet search engines or on social media platforms such as Facebook and Twitter.

Finally, probably the worst face of social media is the potential to disseminate erroneous, alarmist, and exaggerated information that can cause fear, stress, depression, and anxiety in people with or without underlying psychiatric illnesses.

A study by Wang et al. ( 13 ) in China, conducting an online survey with 1,210 responses, found that 53.8% of respondents considered the epidemic's psychological impact as moderate or severe; even a research group created and validated a scale called “Fear of COVID-19 scale” ( 14 ) to assess the level of stress and anxiety in the population and to establish appropriate measures to prevent sequels associated, such as post-traumatic stress disorder (PTSD) which was the most prevalent psychiatric sequelae after the Severe Acute Respiratory Syndrome (SARS) epidemic in Asia in 2003, followed by depressive disorders ( 15 ). Other more severe diseases or events such as suicides have already been reported in some parts of the World like India, Britain, Germany, and Italy ( 16 ).

Infodemic and disinformation

By April 30, 2020, there were more than 8,000 papers in PubMed with the word “COVID-19” ( 17 ), which tells us about the tsunami of information in less than 4 months since its appearance in China; with all the attention poured into the media, the avalanche of data becomes unaffordable, something also called “Infodemia” ( 18 , 19 ).

On the other hand, at the same speed information travels, disinformation does, it is for this same reason that some authors have suggested creating working groups aimed at fighting myths and disinformation in social media platforms ( 20 ). In this way, World Health Organization (WHO) developed an exclusive section on its website designed for coronavirus myth-busting ( 21 ).

Connected with this same issue, the lay public gains access to preliminary and in vitro study results through newscasts practically at the same time that this information is available to the medical community, which combined with the generalized fear of the virus and healthcare systems overwhelmed, generates pressure on patients to demand such experimental treatments for themselves or their families, and doctors may feel compelled to try them, even when there is no high-quality evidence to support their use for these purposes.

CONCLUSIONS

Social media has advantages and disadvantages, the responsible use of these tools can help during a pandemic to quickly spread new important information, sharing diagnostic, treatment and follow-up protocols, comparing different approaches from other parts of the World to adapt them to our setting and available resources, with the downside of possible dissemination of fake data, myths, and pessimist information that combined with quarantine states may lead to anxiety, depression and in some extreme cases, the suicide. Therefore, it is advisable not to contribute to the infodemic and follow a responsible use of social media when disseminating information.

ABBREVIATIONS

Special Issue: COVID-19

This essay was published as part of a Special Issue on Misinformation and COVID-19, guest-edited by Dr. Meghan McGinty (Director of Emergency Management, NYC Health + Hospitals) and Nat Gyenes (Director, Meedan Digital Health Lab).

Peer Reviewed

The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media

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We investigate the relationship between media consumption, misinformation, and important attitudes and behaviours during the coronavirus disease 2019 (COVID-19) pandemic. We find that comparatively more misinformation circulates on Twitter, while news media tends to reinforce public health recommendations like social distancing. We find that exposure to social media is associated with misperceptions regarding basic facts about COVID-19 while the inverse is true for news media. These misperceptions are in turn associated with lower compliance with social distancing measures. We thus draw a clear link from misinformation circulating on social media, notably Twitter, to behaviours and attitudes that potentially magnify the scale and lethality of COVID-19.

Department of Political Science, McGill University, Canada

Munk School of Global Affairs and Public Policy, University of Toronto, Canada

Max Bell School of Public Policy, McGill University, Canada

School of Computer Science, McGill University, Canada

Department of Languages, Literatures, and Cultures, McGill University, Canada

Computer Science Program, McGill University, Canada

Research Questions

• How prevalent is misinformation surrounding COVID-19 on Twitter, and how does this compare to Canadian news media?
• Does the type of media one is exposed to influence social distancing behaviours and beliefs about COVID-19?
• Is there a link between COVID-19 misinformation and perceptions of the pandemic’s severity and compliance with social distancing recommendations?

Essay Summary

• We evaluate the presence of misinformation and public health recommendations regarding COVID-19 in a massive corpus of tweets as well as all articles published on nineteen Canadian news sites. Using these data, we show that preventative measures are more encouraged and covered on traditional news media, while misinformation appears more frequently on Twitter.
• To evaluate the impact of this greater level of misinformation, we conducted a nationally representative survey that included questions about common misperceptions regarding COVID-19, risk perceptions, social distancing compliance, and exposure to traditional news and social media. We find that being exposed to news media is associated with fewer misperceptions and more social distancing compliance while conversely, social media exposure is associated with more misperceptions and less social distancing compliance.
• Misperceptions regarding the virus are in turn associated with less compliance with social distancing measures, even when controlling for a broad range of other attitudes and characteristics.
• Association between social media exposure and social distancing non-compliance is eliminated when accounting for effect of misperceptions, providing evidence that social media is associated with non-compliance through increasing misperceptions about the virus.

Implications

The COVID-19 pandemic has been accompanied by a so-called “infodemic”—a global spread of misinformation that poses a serious problem for public health. Infodemics are concerning because the spread of false or misleading information has the capacity to change transmission patterns (Kim et al., 2019) and consequently the scale and lethality of a pandemic. This information can be shared by any media, but there is reason to be particularly concerned about the role that social media, such as Facebook and Twitter, play in incidentally boosting misperceptions. These platforms are increasingly relied upon as primary sources of news (Mitchell et al., 2016) and misinformation has been heavily documented on them (Garrett, 2019; Vicario et al., 2016). Scholars have found medical and health misinformation on the platforms, including that related to vaccines (Radzikowski et al., 2016) and other virus epidemics such as Ebola (Fung et al., 2016) and Zika (Sharma et al., 2017). 

However, misinformation content typically makes up a low percentage of overall discussion of a topic (e.g. Fung et al., 2016) and mere exposure to misinformation does not guarantee belief in that misinformation. More research is thus needed to understand the extent and consequences of misinformation surrounding COVID-19 on social media. During the COVID-19 pandemic, Twitter, Facebook and other platforms have engaged in efforts to combat misinformation but they have continued to receive widespread criticism that misinformation is still appearing on prominent pages and groups (Kouzy et al., 2020; NewsGuard, 2020). The extent to which misinformation continues to circulate on these platforms and influence people’s attitudes and behaviours is still very much an open question.

Here, we draw on three data sets and a sequential mixed method approach to better understand the consequences of online misinformation for important behaviours and attitudes. First, we collected nearly 2.5 million tweets explicitly referring to COVID-19 in the Canadian context. Second, we collected just over 9 thousand articles from nineteen Canadian English-language news sites from the same time period. We coded both of these media sets for misinformation and public health recommendations. Third, we conducted a nationally representative survey that included questions related to media consumption habits, COVID-19 perceptions and misperceptions, and social distancing compliance. As our outcome variables are continuous, we use Ordinary Least Squares (OLS) regression to identify relationships between news and social media exposure, misperceptions, compliance with social distancing measures, and risk perceptions. We use these data to illustrate: 1) the relative prevalence of misinformation on Twitter; and 2) a powerful association between social media usage and misperceptions, on the one hand, and social distancing non-compliance on the other.

Misinformation and compliance with social distancing

We first compare the presence of misinformation on Twitter with that on news media and find, consistent with the other country cases (Chadwick & Vaccari, 2019; Vicario et al., 2016), comparatively higher levels of misinformation circulating on the social media platform. We also found that recommendations for safe practices during the pandemic (e.g. washing hands, social distancing) appeared much more frequently in the Canadian news media. These findings are in line with literature examining fake news which finds a large difference in information quality across media (Al-Rawi, 2019; Guess & Nyhan, 2018).

Spending time in a media environment that contains misinformation is likely to change attitudes and behaviours. Even if users are not nested in networks that propagate misinformation, they are likely to be incidentally exposed to information from a variety of perspectives (Feezell, 2018; Fletcher & Nielsen, 2018; Weeks et al., 2017). Even a highly curated social media feed is thus still likely to contain misinformation. As cumulative exposure to misinformation increases, users are likely to experience a reinforcement effect whereby familiarity leads to stronger belief (Dechêne et al., 2010).

To evaluate this empirically, we conducted a national survey that included questions on information consumption habits and a battery of COVID-19 misperceptions that could be the result of exposure to misinformation. We find that those who self-report exposure to the misinformation-rich social media environment do tend to have more misperceptions regarding COVID-19. These findings are consistent with others that link exposure to misinformation and misperceptions (Garrett et al., 2016; Jamieson & Albarracín, 2020). Social media users also self-report less compliance with social distancing.

Misperceptions are most meaningful when they impact behaviors in dangerous ways. During a pandemic, misperceptions can be fatal. In this case, we find that misperceptions are associated with reduced COVID-19 risk perceptions and with lower compliance with social distancing measures. We continue to find strong effects after controlling for socio-economic characteristics as well as scientific literacy. After accounting for the effect of misperceptions on social distancing non-compliance, social media usage no longer has a significant association with non-compliance, providing evidence that social media may lead to less social distancing compliance through its effect on COVID-19 misperceptions.

While some social media companies have made efforts to suppress misinformation on their platforms, there continues to be a high level of misinformation relative to news media. Highly polarized political environments and media ecosystems can lead to the spread of misinformation, such as in the United States during the COVID-19 pandemic (Allcott et al., 2020; Motta et al., 2020). But even in healthy media ecosystems with less partisan news (Owen et al., 2020), social media can continue to facilitate the spread of misinformation. There is a real danger that without concerted efforts to reduce the amount of misinformation shared on social media, the large-scale social efforts required to combat COVID-19 will be undermined. 

We contribute to a growing base of evidence that misinformation circulating on social media poses public health risks and join others in calling for social media companies to put greater focus on flattening the curve of misinformation (Donovan, 2020). These findings also provide governments with stronger evidence that the misinformation circulating on social media can be directly linked to misperceptions and public health risks. Such evidence is essential for them to chart an effective policy course. Finally, the methods and approach developed in this paper can be fruitfully applied to study other waves of misinformation and the research community can build upon the link clearly drawn between misinformation exposure, misperceptions, and downstream attitudes and behaviours.

We found use of social media platforms broadly contributes to misperceptions but were unable to precise the overall level of misinformation circulating on non-Twitter social media. Data access for researchers to platforms such as Facebook, YouTube, and Instagram is limited and virtually non-existent for SnapChat, WhatsApp, and WeChat. Cross-platform content comparisons are an important ingredient for a rich understand of the social media environment and these social media companies must better open their platforms to research in the public interest. 

Finding 1: Misinformation about COVID-19 is circulated more on Twitter as compared to traditional media.

We find large differences between the quality of information shared about COVID-19 on traditional news and Twitter. Figure 1 shows the percentage of COVID-19 related content that contains information linked to a particular theme. The plot reports the prevalence of information on both social and news media for: 1) three specific pieces of misinformation; 2) a general set of content that describes the pandemic itself as a conspiracy or a hoax; and 3) advice about hygiene and social distancing during the pandemic. We differentiate content that shared misinformation (red in the plot) from content that debunked misinformation (green in the plot). 

There are large differences between the levels of misinformation on Twitter and news media. Misinformation was comparatively more common on Twitter across all four categories, while debunking was relatively more common in traditional news. Meanwhile, advice on hygiene and social distancing appeared much more frequently in news media. Note that higher percentages are to be expected for longer format news articles since we rely on keyword searches for identification. This makes the misinformation findings even starker – despite much higher average word counts, far fewer news articles propagate misinformation.

Finding 2: There is a strong association between social media exposure and misperceptions about COVID-19. The inverse is true for exposure to traditional news.

Among our survey respondents we find a corresponding strong association between social media exposure and misperceptions about COVID-19. These results are plotted in Figure 2, with controls included for both socioeconomic characteristics and demographics. Moving from no social media exposure to its maximum is expected to increase one’s misperceptions of COVID-19 by 0.22 on the 0-1 scale and decreased self-reported social distancing compliance by 0.12 on that same scale.

This result stands in stark contrast with the observed relationship between traditional news exposure and our outcome measures. Traditional news exposure is  positively  associated with correct perceptions regarding COVID-19. Moving from no news exposure to its highest level is expected to reduce misperceptions by 0.12 on the 0-1 scale and to increase social distancing compliance by 0.28 on that same scale. The effects are plotted in Figure 2. Social media usage appears to be correlated with COVID-19 misperceptions, suggesting these misperceptions are partially a result of misinformation on social media. The same cannot be said of traditional news exposure.

Finding 3: Misperceptions about the pandemic are associated with lower levels of risk perceptions and social distancing compliance.

COVID-19 misperceptions are also powerfully associated with  lower  levels of social distancing compliance. Moving from the lowest level of COVID-19 misperceptions to its maximum is associated with a reduction of one’s social distancing by 0.39 on the 0-1 scale. The previously observed relationship between social media exposure and misperceptions disappears, suggestive of a mediated relationship. That is, social media exposure increases misperceptions, which in turn reduces social distancing compliance. Misperceptions is also weakly associated with lower COVID-19 risk perceptions. Estimates from our models using COVID-19 concern as the outcome can be found in the left panel of Figure 3, while social distancing can be found in the right panel.

Finally, we also see that the relationship between misinformation and both social distancing compliance and COVID-19 concern hold when including controls for science literacy and a number of fundamental predispositions that are likely associated with both misperceptions and following the advice of scientific experts, such as anti-intellectualism, pseudoscientific beliefs, and left-right ideology. These estimates can similarly be found in Figure 3.

Canadian Twitter and news data were collected from March 26 th  to April 6 th , 2020. We collected all English-language tweets from a set of 620,000 users that have been determined to be likely Canadians. For inclusion, a given user must self-identify as Canadian-based, follow a large number of Canadian political elite accounts, or frequently use Canadian-specific hashtags. News media was collected from nineteen prominent Canadian news sites with active RSS feeds. These tweets and news articles were searched for “covid” or “coronavirus”, leaving a sample of 2.25 million tweets and 8,857 news articles.

Of the COVID-19 related content, we searched for terms associated with four instances of misinformation that circulated during the COVID-19 pandemic: that COVID-19 was no more serious than the flu, that vitamin C or other supplements will prevent contraction of the virus, that the initial animal-to-human transfer of the virus was the direct result of eating bats, or that COVID-19 was a hoax or conspiracy. Given that we used keyword searches to identify content, we manually reviewed a random sample of 500 tweets from each instance of misinformation. Each tweet was coded as one of four categories: propagating misinformation, combatting misinformation, content with the relevant keywords but unrelated to misinformation, or content that refers to the misinformation but does not offer comment. 

We then calculated the overall level of misinformation for that instance on Twitter by multiplying the overall volume of tweets by the proportion of hand-coded content where misinformation was identified. Each news article that included relevant keywords was similarly coded. The volume of the news mentioning these terms was sufficiently low that all news articles were hand coded. To identify health recommendations, we used a similar keyword search for terms associated with particular recommendations: 1) social distancing including staying at home, staying at least 6 feet or 2 meters away and avoiding gatherings; and 2) washing hands and not touching any part of your face. 1 Further details on the media collection strategy and hand-coding schema are available in the supporting materials.

For survey data, we used a sample of nearly 2,500 Canadian citizens 18 years or older drawn from a probability-based online national panel fielded from April 2-6, 2020. Quotas we set on age, gender, region, and language to ensure sample representativeness, and data was further weighted within region by gender and age based on the 2016 Canadian census.

We measure levels of COVID-19 misperceptions by asking respondents to rate the truthfulness of a series of nine false claims, such as the coronavirus being no worse than the seasonal flu or that it can be warded off with Vitamin C. Each was asked on a scale from definitely false (0) to definitely true (5). We use Cronbach’s Alpha as an indicator of scale reliability. Cronbach’s Alpha ranges from 0-1, with scores above 0.8 indicating the reliability is “good.” These items score 0.88, so we can safely construct a 0-1 scale of misperceptions from them. 

We evaluate COVID-19 risk perceptions with a pair of questions asking respondents how serious of a threat they believe the pandemic to be for themselves and for Canadians, respectively. Each question was asked on a scale from not at all (0) to very (4). We construct a continuous index with these items.

We quantify social distancing by asking respondents to indicate which of a series of behaviours they had undertaken in response to the pandemic, such as working from home or avoiding in-person contact with friends, family, and acquaintances. We use principal component analysis (PCA) to reduce the number of dimensions in these data while minimizing information loss. The analysis revealed 2 distinct dimensions in our questions. One dimension includes factors strongly determined by occupation, such as working from home and switching to online meetings. The other dimension contains more inclusive behaviours such as avoiding contact, travel, and crowded places. We generate predictions from the PCA for this latter dimension to use in our analyses. The factor loadings can be found in Table A1 of the supporting materials.

 We gauge news and social media consumption by asking respondents to identify news outlets and social media platforms they have used over the past week for political news. The list of news outlets included 17 organizations such as mainstream sources like CBC and Global, and partisan outlets like Rebel Media and National Observer. The list of social media platforms included 10 options such as Facebook, Twitter, YouTube, and Instagram. We sum the total number of outlets/platforms respondents report using and take the log to adjust for extreme values. We measure offline political discussion with an index based on questions asking how often respondents have discussed politics with family, friends, and acquaintances over the past week. Descriptions of our primary variables can be found in Table A2 of the supporting materials. 

We evaluate our hypotheses using a standard design that evaluates the association between our explanatory and outcome variables controlling for other observable factors we measured. In practice, randomly assigning social media exposure is impractical, while randomly assigning misinformation is unethical. This approach allows us to describe these relationships, though we cannot make definite claims to causality.

We hypothesize that social media exposure is associated with misinformation on COVID-19. Figure 2 presents the coefficients of models predicting the effects of news exposure, social media exposure, and political discussion on COVID-19 misinformation, risk perceptions, and social distancing. Socio-economic and demographic control estimates are not displayed. Full estimation results can be found in the Table A3 of the supporting materials. 

We further hypothesize that COVID-19 misinformation is associated with lower COVID-19 risk perceptions and less social distancing compliance. Figure 3 presents the coefficients for models predicting the effects of misinformation, news exposure, and social media exposure on severity perceptions and social distancing. We show models with and without controls for science literacy and other predispositions. Full estimation results can be found in the Table A4 of the supporting materials.

Limitations and robustness

A study such as this comes with clear limitations. First, we have evaluated information coming from only a section of the overall media ecosystem and during a specific time-period. The level of misinformation differs across platforms and online news sites and a more granular investigation into these dynamics would be valuable. Our analysis suggests that similar dynamics exist across social media platforms, however. In the supplementary materials we show that associations between misperceptions and social media usage are even higher for other social media platforms, suggesting that our analysis of Twitter content may underrepresent the prevalence of misinformation on social media writ large. As noted above, existing limitations on data access make such cross-platform research difficult.

Second, our data is drawn from a single country and language case study and other countries may have different media environments and levels of misinformation circulating on social media. We anticipate the underlying dynamics found in this paper to hold across these contexts, however. Those who consume information from platforms where misinformation is more prevalent will have greater misperceptions and that these misperceptions will be linked to lower compliance with social distancing and lower risk perceptions. Third, an ecological problem is present wherein we do not link survey respondents directly to their social media consumption (and evaluation of the misinformation they are exposed to) and lack the ability to randomly assign social media exposure to make a strong causal argument. We cannot and do not make a causal argument here but argue instead that there is strong evidence for a misinformation to misperceptions to lower social distancing compliance link. 

• / Fake News
• / Mainstream Media
• / Public Health
• / Social Media

Cite this Essay

Bridgman, A., Merkley, E., Loewen, P. J., Owen, T., Ruths, D., Teichmann, L., & Zhilin, O. (2020). The causes and consequences of COVID-19 misperceptions: Understanding the role of news and social media. Harvard Kennedy School (HKS) Misinformation Review . https://doi.org/10.37016/mr-2020-028

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Vicario, M. D., Bessi, A., Zollo, F., Petroni, F., Scala, A., Caldarelli, G., Stanley, H. E., & Quattrociocchi, W. (2016). The spreading of misinformation online. Proceedings of the National Academy of Sciences , 113 (3), 554–559. https://doi.org/10.1073/pnas.1517441113

Weeks, B. E., Lane, D. S., Kim, D. H., Lee, S. S., & Kwak, N. (2017). Incidental Exposure, Selective Exposure, and Political Information Sharing: Integrating Online Exposure Patterns and Expression on Social Media. Journal of Computer-Mediated Communication , 22 (6), 363–379. https://doi.org/10.1111/jcc4.12199

The project was funded through the Department of Canadian Heritage’s Digital Citizens Initiative.

Competing Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The research protocol was approved by the institutional review board at University of Toronto. Human subjects gave informed consent before participating and were debriefed at the end of the study.

This  is  an open access article distributed under the terms of the Creative  Commons  Attribution  License , which permits unrestricted use, distribution, and reproduction in any medium, provided that the original author and source are properly credited.

Data Availability

All materials needed to replicate this study are available via the Harvard Dataverse: https://doi.org/10.7910/DVN/5QS2XP .

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Peer-reviewed

Research Article

Perceptions of social media challenges and benefits during the Covid-19 pandemic: Qualitative findings from a cross sectional international survey

Roles Conceptualization, Formal analysis, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing

Affiliation School of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom

Roles Conceptualization, Methodology, Validation, Writing – original draft, Writing – review & editing

Affiliation School of Nursing, The University of Central Lancashire, Preston, United Kingdom

* E-mail: [email protected]

Affiliations Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway, Faculty of Health Studies, VID Specialized University, Oslo, Norway

Affiliation Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia

Roles Conceptualization, Investigation, Methodology, Validation, Writing – review & editing

Affiliations Faculty of Social and Health Sciences, Department of Health and Nursing Science, Inland Norway University of Applied Sciences, Elverum, Norway, Faculty of Health Studies, Department of Health, VID Specialized University, Stavanger, Norway

Affiliation School of Social Work, University of Michigan, Ann Arbor, MI, United States of America

Roles Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft

Roles Validation, Writing – review & editing

Affiliation Department of Social Work and Sociology, School of Humanities and Social Sciences, University of Zambia (UNZA), Lusaka, Zambia

Roles Conceptualization, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – review & editing

Affiliation Faculty of Social Sciences, Department of Social Work, Oslo Metropolitan University, Child Welfare and Social Policy, Oslo, Norway

• Mariyana Schoultz, 
• Gary Lamph, 
• Hilde Thygesen, 
• Janni Leung, 
• Tore Bonsaksen, 
• Mary Ruffolo, 
• Daicia Price, 
• Paul Watson, 
• Isaac Kabelenga, 

• Published: January 10, 2023
• https://doi.org/10.1371/journal.pgph.0001463
• Peer Review
• Reader Comments

Since the beginning of the Covid-19 pandemic in January 2020 the need for rapid information spread grew and social media became the ultimate platform for information exchange as well as a tool for connection and entertainment. With the rapid information spread along came the various public misconceptions and misinformation which consequently influenced perceptions and behaviors of the public towards the coronavirus pandemic. Thus, there was a need for identification and collation of public perceptions information to address future public health initiatives. This cross-national study aimed to examine the challenges and benefits of using social media during the Covid-19 pandemic outbreak. This study was a content analysis of the open-ended questions from a wider cross-sectional online survey conducted in Norway, UK, USA, and Australia during October/November 2020. 2368 participants out of 3474 respondents to the survey provided the open text responses included in the qualitative analysis. Thematic analysis was conducted independently by two researchers. All statements were coded to positive and negative sentiments. Three overarching themes were identified: 1. Mental health and emotional exhaustion 2. Information and misinformation; 3. Learning and inspiration.While providing a powerful mode of connection during the pandemic, social media also led to negative impact on public perceptions, including mistrust and confusion. Clarity in communications by institutions and education about credible information sources should be considered in the future. Further research is required in exploring and documenting social media narratives around COVID-19 in this and any subsequent incidents of pandemic restrictions. Understanding the public perceptions and their social narratives can support the designing of appropriate support and services for people in the future, while acknowledging the uncertainty and overwhelming impact of the pandemic that may have skewed the experiences of social media.

Citation: Schoultz M, Lamph G, Thygesen H, Leung J, Bonsaksen T, Ruffolo M, et al. (2023) Perceptions of social media challenges and benefits during the Covid-19 pandemic: Qualitative findings from a cross sectional international survey. PLOS Glob Public Health 3(1): e0001463. https://doi.org/10.1371/journal.pgph.0001463

Editor: Joel Msafiri Francis, University of the Witwatersrand, SOUTH AFRICA

Received: April 2, 2022; Accepted: December 10, 2022; Published: January 10, 2023

Copyright: © 2023 Schoultz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: A minimal anonymized data set is within the Supporting Information file.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: CDC, Centre for Disease Control and Prevention; UK, United Kingdom; USA, United states of America; SARS, Severe Acute Respiratory Syndrome; WHO, World Health Organization

Introduction

The first case related to the corona virus pandemic was identified in Wuhan, China in December 2019 [ 1 ]. Since, the world has seen dramatic changes to normal living in most countries. Common changes that have taken place include restricting social gatherings, local and international travelling, maintaining social distancing, and working from home just to mention a few [ 1 , 2 ]. This has led to devastating disruptions to the social and economic functioning of nations that is comparable to the impact of the Spanish flu pandemic of 1918 [ 3 ]. Since the initial outbreak, many of the restrictions for travel and social distancing remained (to various degrees) in most countries across Europe, America, and Australia with only a periodical easing off in some areas.

These long-term restrictions led to people having to spend more time at home with very little social interactions outside of their immediate households. For many, this meant increased job uncertainty and fear for their future livelihood [ 4 ], while others became less trusting of the governments and their management of the pandemic [ 5 ]. High Social Capital is a key determinant of positive health. Considering that social interactions and trust foster social capital, pandemic restrictions reduced that. Restrictions also negatively impacted mental health and contributed towards pandemic-related anxiety and depression [ 6 ]. All these events influenced how people socialized, worked, and interacted with each other as well as on how people coped and were able to access information. Hence, social media became even more so than pre-pandemic, the fastest and most accessible means for gathering and broadcasting information. It was used as a way of staying connected to family, friends and work and as a way of coping with life during the pandemic [ 6 ].

Social media provides many benefits and provides a source of information, entertainment and a source of connection via a cumulation of different electronic platforms [ 6 ]. Such messaging platforms include WhatsApp, SnapChat, Facebook, Twitter, Instagram, LinkedIn, TikTok, and YouTube. All of these outlets have billions of users worldwide and have had a major global impact on how people perceive life during the pandemic [ 6 ]. While many users of these platform are personal users, there has been a rapid organizational utilization of the platforms to support and disseminate reliable information. These organizations include the World Health Organization (WHO) and Centers of Disease Control and Prevention (CDC) as well as the local governments and health authorities in each country, each of which has gained hundreds of thousands of followers during the pandemic owing to the increased interest in decision making of local, national and international science and government policy directives aligned to the pandemic and restrictions.

As a result of the ongoing severity of the COVID-19 pandemic, there was a need for rapid information spread. However, the rapid information spread brought a new type of purposefully spread of disinformation and misinformation, particularly on social media platforms [ 7 ]. This infodemic contributed to public mistrust, fear, and misconceptions of the pandemic which consequently influenced the public perceptions and behaviors sometimes with a detrimental effect [ 8 ]. Thus, in order to dispel further misinformation and ensure the correct type of future public initiatives are designed, brough on an important need for identification and collation of public perceptions information. Hence, the aim of this study was to examine the public perceptions of the benefits and challenges of using social media during the Covid-19 pandemic outbreak.

The consolidated criteria for reporting qualitative research (COREQ) were used to enhance the rigour and guide the structure of this paper [ 9 ].

Ethics statement

The introductory information accompanying the survey explained the purpose and anonymity of the study and consent was obtained by completing the first page of the survey. The study was approved by OsloMet (20/03676) and the regional committees for medical and health research ethics (REK; ref. 132066) in Norway, reviewed by the University of Michigan Institutional Review Board for Health Sciences and Behavioral Sciences (IRB HSBS) and designated as exempt (HUM00180296) in USA, by Northumbria University Health Research Ethics (HSR1920-080) in UK and University of Queensland (HSR1920-080 2020000956) in Australia.

Study design

This study was a content analysis of the open-ended questions from a wider on-line survey [ 10 ] about mental health, wellbeing, worry and the use of social media during the pandemic conducted in Norway, UK, USA, and Australia. The cross-sectional survey was available between October and November 2020. Invitations to take part in the survey were placed on social media such as Twitter, Facebook and Instagram in Norway, USA, UK, and Australia. Data was collected simultaneously in each country for approximately 4 weeks. Each country had a landing site for the survey at the following universities: OsloMet—Oslo Metropolitan University, Norway; University of Michigan, USA; Northumbria University, UK; and the University of Queensland, Australia.

Participants and setting

AØG from OsloMet initiated the project, however each participating university/country had a project lead adhering to local ethical approvals. Participants in the study were from the general population in the participating countries. To participate in the survey, the participants had to: 1) be of age of 18 or over and 2) speak Norwegian or English.

Questionnaire

The survey was simultaneously co-developed by the researchers in two languages, Norwegian and English, and was based on previous research conducted by the research group in the early phase (April 2020) of the Covid-19 pandemic [ 10 , 11 ].

The secure Qualtrics survey platform was used to design and disseminate the survey [ 12 ] which had 85 questions in total and took approximately 10 min to complete. Only the responses from the last two open-ended question are presented in this paper (see research question below). All open responses were reviewed in detail to identify common themes.

Survey questions

• Overall, what benefits have you experienced in using social media during the COVID-19 pandemic?
• Overall, what challenges have you experienced in using social media during the COVID-19 pandemic?

Two researchers (MS, PW) independently coded the data to minimize subjectivity. All data were analysed using a thematic analysis approach [ 13 ]. Thematic analysis is a rigorous method of qualitative data analysis, consisting of six phases. These phases provide structure for the data to be organised, coded and a framework for theme identification.

Phase 1—Familiarizing yourself with your data

Data was inputted into an excel spreadsheet. The two researchers immersed themselves into this data by reading through it all twice for familiarization purposes.

Phases 2—Generating initial codes, and 3 -Searching for themes

From this data the two researchers independently generated initial codes and then searched for themes worthy of reporting. At this stage the researchers then met to discuss their findings and to extract the main themes for reporting.

Phase 4 –Reviewing themes, and Phase 5 –Defining and naming themes

Both researchers then reviewed the themes against the raw data and through discussion the themes were named to inform a wider research team report.

Phase 6 –Producing the report

A report on the findings was then presented to the wider research team and discussed.

Qualitative studies are often judged by trustworthiness and rigour, meaning that integrity and competence are required to be demonstrated within a study [ 14 ]. Analysis was conducted by two researchers independently which satisfies the above criteria. MS and PW met at three points (after the third, fifth and sixth step) to discuss findings and settle any potential disputes–there were none in this case. Rigour with sampling was ensured through maximum variation sampling (diverse sample) to make the data “information rich” [ 15 ].

Demographics

A total of 2368 participants provided answer to the open-ended questions included for qualitative analysis. Table 1 includes the demographic data of the sample.

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https://doi.org/10.1371/journal.pgph.0001463.t001

Themes emerged

Boundaries between the themes reported are fluent rather than fixed, hence materials reported in one theme may also have relevance to others. All statements were coded to positive and negative sentiments. Three main themes were identified: 1. Mental health and emotional exhaustion 2. Information and misinformation; 3. Learning and inspiration.

1. Mental health and emotional exhaustion.

This theme was the most prominent and commonly reported theme and had links to all the other themes. The general sentiment of this theme was the negative impact on mental health and the overall emotional exhaustion that people felt due to various reasons such as: negativity and internet addiction, stress, and anxiety. Each of these subthemes will be elaborated on and aligned with context to the data collected.

Negativity and internet addiction . Mainly, people felt that there was too much negativity on social media that made them feel overwhelmed which contributed to anxiety, distress, sadness, and had an overall negative impact on their mental health. Examples of which included:

‘I get overwhelmed when negativity is rampant . Anxiety increases and , to a degree , sadness’ . (Participant 684 ) ‘Too much … . negativity (and arguments on social media) having an overall negative impact on my mental health . ’ (Participant 154 )

For some people the negative interactions over social media had a more profound effect, in that it forced them to either block or unfriend people to protect their mental health.

‘Too much negative . People who I thought were my friends were posting negative comments on my feed , lots of hateful and racial bigotry . Had to unfriend people who were very close to me . ’ (Participant 364 )

Additionally, many participants reported and recognised the addictive nature of using social media use:

‘My experience is almost an addiction and a need to check for updates more than necessary . ’ (Participant 314 )

The addictive nature of social media check in was even compared to a smoking addiction, as underscored in the below quote:

‘It’s become an addiction . First thing I do in the morning is check FB , and it’s the last thing I do before bed . Similar to a smoker needing cigarette immediately after waking up . ’ (Participant 1433 )

Whilst the addictive reports of social media were common some participant also described how this also impacted negatively upon mental health and wellbeing, and that it influenced general outlook of life and the future.

‘Reading the comments on posts can be very stressful but oddly addictive , not good for mental health . ’ (Participant 146 )

Stress and anxiety . The general feeling is that many people found using social media more stressful than helpful. This was promoted by the different quarrels and disputes participant were reporting to have encountered on social media or the headlines that some media outlets were using:

‘I think social media during the pandemic has been more harmful than good . It usually makes me feel more stressed out than I was before I went on the social media . ’ (Participant 1378 ) ‘Overall , it greatly increases stress . It’s just a bunch of people yelling out into the echo chamber and compounding each other’s anxieties . On the balance , I think it’s very bad for my mental health . ’ (Participant 676 )

Others started to question if this heightened stress was due to quarantine or other factors rather than directly coming from their social media experience, hence questioning the catalyst for the social media negativity, stress, and anxieties. The following quote underscore this :

‘Trying to decide if what a person said genuinely made me this angry or if it’s just quarantine stress . ’ (Participant 1020 )

Using social media brought for some feelings of fear, being scared and descriptions of this went as far as claiming it had a paralysing impact on allowing people to get on with their lives. For some, this fear was due to the constant influx of information about the dangers of Covid-19. For others, it was due to seeing people not following the guidelines:

‘I feel scared a lot when I see people not following guidelines . ’ (Participant 1058 )

The general feeling and mental health impact reported in this theme highlights how social media had contributed to the reported tiredness and emotional exhaustion, resulting from being overly connected with social media information and the associated heightened emotions reported by the participants. Additionally, navigating through the many harmful interactions that took place on social media further contributed to the emotional exhaustion reported. Also, people were fatigued of interaction via screens and the lack of face-to-face interactions.

‘tired of staring at screens . ’ (Participant 118 )

Participants report of making comparisons of themselves with the people/friends they follow on social media also contributed to stress and anxiety amongst our sample.

‘Emotional exhaustion from being overly connected to the stress and worry from the media , stress from watching friends and strangers become confident behind their keyboard leading to arguments , name calling , and other negative interactions … . ’ ( Participant 463)

2. Information and misinformation.

This theme focused on information and misinformation, that was influenced by insights into participants views on control over information and its spread and the associated frustrations then encountered relating to misinformation.

Control over information and its spread . Many participants reported that they used social media to connect to friends and family or find news about their local area and news from around the world. Some said that they felt social media gave them control over information and how its spread.

‘Information , e . g ., from the newspapers are shared very fast , and it makes it easier to keep updated . ’ (Participant 2 ) ‘I felt good curating information for my friends and family . ’ (Participant 1025 )

On the other hand, others felt complete anger and frustration from the spread of misinformation, and even sadness about how information and misinformation caused division among people and somewhat reduced empathy and humanity. Many reported that while information-seeking online, the sheer volume of Covid-19 related information and misinformation, left them feeling stressed, worried, and overwhelmed.

‘I find there is even more a blame culture , little empathy and miscommunication between people and disinformation . ’ ( Participant 340)

Anger and frustration . This sub-theme describes feelings of frustration and anger directed at political and mainstream media. Mistrust in relation to political issues is described locally, nationally and censorship of information were all felt to be causing division in societies views on the pandemic:

‘The censorship of conservatives , and anyone who has a different opinion other than the current media narratives is disgusting and outrageous . ’ (Participant 342 )

Expressions of frustration and anger was shared amongst participants aligned to frustration due to political issues and of their countries handling of the pandemic:

‘I have felt very frustrated and angry due to politics of people . I feel even more frustrated and angry with the families I see acting reckless and allowing their kids to hang out in large groups , not distancing and not masking , having meals in restaurants , sleepovers , etc and the rest of us have to isolate because of their selfish behaviour . ’ (Participant 377 )

Many reported additional frustrations owing to a portion of the population not taking the pandemic seriously and therefore not complying with national guidance. Mistrust in political and mainstream narratives from authorities and the media were felt to have individual and wider impacts, with some participants noting how political disagreements had negatively impacted upon friendships with some participants being compelled to unfriend people they would normally interact with. Some described how they had ‘ watched friendships end because of politics . ’ (Participant 1987) .

Others felt that there is too much censorship on Facebook and other social media platforms which made them feel like their rights have been infringed:

‘Right or left is irrelevant … . but I hate the one sidedness and censorship that has developed over the past couple months . ’ (Participant 1834 )

A strong feeling is shared owing to participant-observed perceptions of censorship, which led to reservations in trusting their governments. Others felt deeply saddened by the division caused due to politics and bias.

‘Online bullying , especially for my political views . Censorship is also a problem on social media . ’ (Participant 1214 )

3. Learning and inspiration.

Despite a majority of participants expressing strong negative emotions and experiences with social media during the pandemic, others emphasized its positive impacts. Through our analysis we identified four related sub-themes. Social media was by some experienced as a providing connection. Others described it as providing as a welcome distraction or providing inspiration by support new knowledge and skills acquisition, for others it was reported to provide self-help and self-care support.

Providing connection

‘It’s been nice to keep in touch with my friends from college who live far away . There is a sense of comradery and community in that we’re all doing this together . ’ (Participant 1146 )

Participants identified a striving for connection and search for a sense of community during the pandemic. However, conversely, others described the opposite and instead reported on how social media helped them feel closer to other people, helped their mood, reduced loneliness and, importantly, provided opportunities to be part of communities that they otherwise could have not encountered, due to accessibility and geography.

‘It’s been so easy to feel disconnected from community and to feel lonely . To have a flourishing online group of people like me did wonders for my mood and my feelings of disconnection . ’ (Participant 1464 )

A welcome distraction . For some social media provided a welcome distraction from the daily stress of the pandemic and created for some new opportunities for development of new interests or engagement with past interests:

‘I have been inspired to create by the artists I follow on social media . Social media can also provide a welcome distraction from the stress I’m dealing with due to my college classes , my job , extracurriculars , and having to make important decisions regarding my future . ’ (Participant 897 )

New knowledge and skill acquisition . Other participants saw social media as providing a unique opportunity to enhance their knowledge about the world, nutrition, health or even business. For some of the participants this resulted in acquiring new hobbies or getting reacquainted with past interests and hobbies:

‘But I look at it this way—they say learning all these new things is good for my aging brain . Hoping Facebook doesn’t disappear , but if it does , I’ll probably learn to use some other social media . ’ (Participant 679 )

Self-help and self-care . For some participants social media has been a helpful tool in learning more about self-care and self-help activities, while for others it has provided inspiration for home renovation and DIY projects. While challenging to adapt to at the start of the pandemic, social media has, for some, turned out to be a great way of learning not only new digital skills for connecting, but also in guiding and supporting new physical activities that has helped them stay active.

‘Keeping new thoughts and ideas fresh on a daily basis . ‘Learn something new each day . Entertainment is delightful . ’ (Participant 193 )

The primary aim of this study was to explore the public perceptions on benefits and challenges of using social media during the timeframe when lockdown and restrictions were most severe in the participating countries.

The findings present a strong view and unique insight relating to the negative impact the pandemic had upon people’s mental health and wellbeing, which has been compounded by feelings of negativity, fear, stress, anxiety, and emotional tiredness. However, the findings also reveal that for some people, the use of social media has been an important resource for learning and inspiration.

Social media usage has increased since the start of the pandemic [ 16 ]. Whilst it has been established to be a useful mode for information sharing and updates, this has been conflicted by the spread of misinformation and ‘fake news’, leading to extra anxiety and public confusion [ 17 , 18 ]. These polarised views of social media use and perceptions are evident in our research. Due to the wealth and ‘barrage’ of information on social media, the public was sometimes led to ill-informed decision-making processes. For example, the sheer volume of information and conflicting messages was challenging for individuals having to interpret and understand this information in order to form their own views, opinions and to inform their responses to the first pandemic to occur in a century [ 10 , 18 ]. The high and frequent use of social media over the course of the pandemic has been identified as having a negative impact on mental health, wellbeing, and loneliness [ 19 , 20 ]. Whilst social media allowed news to be spread fast, it was also compromised by the lack of governance and misinformation shared based on personal opinions. Thus, Social Media Guidance and signposting to credible sources of information would have been useful for social media users. Additionally, educational institutions could have responded to this by providing informative support in spotting credible sources of information and differentiating from ‘fake news’ [ 20 ].

The rapidly changing landscape of COVID-19 information sharing could be partially responsible for opening the door to negative misinformation from non-credible sources. Nonetheless, information and misinformation, has undoubtably contributed to the feeling of stress, anxiety and participants reports of feeling emotionally overwhelmed.

Politics and lack of trust in governments and institutions were often reported in the qualitative data, which feed into this confusion [ 20 ]. The findings of this study provide insight into the key challenges around social media use and their impact upon mental health during and after the initial pandemic lockdowns. These concerns were further compromised via fear that came from social media, and the persistent uncertainty/changing status of the pandemic and associated guidance. Subsequently this led to concerns relating to income security, thus leading to some parts of society choosing to ignore guidance and breaking of rules, owing to real societal fears such as job losses [ 21 ].

Our results also need to be considered in the context of the individual participants. Those expressing frustration by social media may have had confidence in the guidance provided, and those who experienced minimal disruptions to their roles, income or employment are likely to report the responses differently to those who feel unsupported or let down by the authorities. It has however been found that those who were remote working reported better overall mental health outcomes owing to the ability to still carry out occupational duties outside of the workplace [ 21 ]. Hence the experiences and judgements shared are likely to be influenced by participants own unique social circumstances. However, despite this, our quantitative data provided evidence of a split in trust of local and national handlings of the pandemic, with higher levels of trust reported in Norway and Australia, and much lower levels of trust reported in the UK and USA [ 20 ].

At the same time, it is important to emphasize that social media has also played an important role in providing a platform for connecting people during the lockdown, that without this would have left people feeling even more isolated. Passive social media engagement e.g., aimlessly scrolling and information sourcing can result in increased loneliness and lowered life satisfactions [ 22 , 23 ]. Hence increased social media engagement during the pandemic could have inadvertently resulted in negative impacts and consequences for some of our participants.

In our previous study [ 24 ] we mainly focused on the negative emotional impact of the pandemic. However, as the pandemic prolonged into subsequent lockdowns, the views of participants have expanded into individual perspectives of the government handlings, responses and political frustrations that have arose. Growing social frustrations, debates and polarised personal opinions relating to the pandemic have emerged amongst the cross-national sample and there was clear evidence of frustration and in some cases highlighted stress and distress.

The pandemic appears to have created opportunities for some of our participants who reported that they gained new digital skills and ability to engage with social media forums. However, it should be noted that many older people had reservations of engaging with social media and digital platforms owing to the cultural differences, such as online application of social etiquette and the technological skills and knowledge to effectively engage [ 24 ].

Strengths and limitation

A strength of this study is the diverse sample of participants in the four countries and the method of qualitative thematic analysis we have undertaken that has explored the benefits and challenges associated with using social media by the multinational population since the start of the pandemic. The findings from this study expand upon the findings of this research teams first survey at the start of the pandemic [ 10 , 24 ], and whilst similar themes have been identified, the complexity of qualitative reporting has been increased and also displays the emerging shift in attitudes towards the handling of the pandemic.

This study is not without its limitations. Selection bias may have been encountered as those who participated were self-selected. Hence it could be argued that only those who have the strongest feelings about the pandemic took time to complete this survey. This survey was completed digitally. Therefore, we are likely to have received only the opinions of those with access to and those most comfortable with technology completing the surveys. Only two open questions that were focused on social media experiences during the pandemic were included in the survey, and hence drawing conclusions from this data is unlikely to be representative of whole populations. Future research should consider in-depth interviews or focus groups to further explore why some people felt more connected with social media while some others had increased anxiety. But despite this, the data does provide some useful insights not previously explored in a cross-national format.

While providing a powerful mode of connection during the pandemic, social media use also led to negative impact on public perceptions, including mistrust and confusion. Clarity in communications by institutions and education about credible information sources should be considered in the future. Further research is required in exploring and documenting the social media narratives around COVID-19 in western societies in this and any subsequent incidents of pandemic restrictions. Understanding the public perceptions and their social narratives can support the designing of appropriate support and services for people in the future, while acknowledging the uncertainty and overwhelming impact of the pandemic that may have skewed the experiences of social media. When harnessing technology for benefits, further considerations should be considered to minimize the adverse impact of using social media on users.

Supporting information

S1 data. minimal anonymized dataset..

https://doi.org/10.1371/journal.pgph.0001463.s001

Acknowledgments

The authors acknowledge the time and efforts spent by the participants when responding to the survey.

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• http://orcid.org/0000-0003-1512-4471 Emily Long 1 ,
• Susan Patterson 1 ,
• Karen Maxwell 1 ,
• Carolyn Blake 1 ,
• http://orcid.org/0000-0001-7342-4566 Raquel Bosó Pérez 1 ,
• Ruth Lewis 1 ,
• Mark McCann 1 ,
• Julie Riddell 1 ,
• Kathryn Skivington 1 ,
• Rachel Wilson-Lowe 1 ,
• http://orcid.org/0000-0002-4409-6601 Kirstin R Mitchell 2
• 1 MRC/CSO Social and Public Health Sciences Unit , University of Glasgow , Glasgow , UK
• 2 MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing , University of Glasgow , Glasgow , UK
• Correspondence to Dr Emily Long, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G3 7HR, UK; emily.long{at}glasgow.ac.uk

This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the nature of the public health response. We then introduce four distinct domains of social relationships: social networks, social support, social interaction and intimacy, highlighting the mechanisms through which the pandemic and associated public health response drastically altered social interactions in each domain. Throughout the essay, the lens of health inequalities, and perspective of relationships as interconnecting elements in a broader system, is used to explore the varying impact of these disruptions. The essay concludes by providing recommendations for longer term recovery ensuring that the social relational cost of COVID-19 is adequately considered in efforts to rebuild.

• inequalities

Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study. Data sharing not applicable as no data sets generated or analysed for this essay.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/jech-2021-216690

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Introduction

Infectious disease pandemics, including SARS and COVID-19, demand intrapersonal behaviour change and present highly complex challenges for public health. 1 A pandemic of an airborne infection, spread easily through social contact, assails human relationships by drastically altering the ways through which humans interact. In this essay, we draw on theories of social relationships to examine specific ways in which relational mechanisms key to health and well-being were disrupted by the COVID-19 pandemic. Relational mechanisms refer to the processes between people that lead to change in health outcomes.

At the time of writing, the future surrounding COVID-19 was uncertain. Vaccine programmes were being rolled out in countries that could afford them, but new and more contagious variants of the virus were also being discovered. The recovery journey looked long, with continued disruption to social relationships. The social cost of COVID-19 was only just beginning to emerge, but the mental health impact was already considerable, 2 3 and the inequality of the health burden stark. 4 Knowledge of the epidemiology of COVID-19 accrued rapidly, but evidence of the most effective policy responses remained uncertain.

The initial response to COVID-19 in the UK was reactive and aimed at reducing mortality, with little time to consider the social implications, including for interpersonal and community relationships. The terminology of ‘social distancing’ quickly became entrenched both in public and policy discourse. This equation of physical distance with social distance was regrettable, since only physical proximity causes viral transmission, whereas many forms of social proximity (eg, conversations while walking outdoors) are minimal risk, and are crucial to maintaining relationships supportive of health and well-being.

The aim of this essay is to explore four key relational mechanisms that were impacted by the pandemic and associated restrictions: social networks, social support, social interaction and intimacy. We use relational theories and emerging research on the effects of the COVID-19 pandemic response to make three key recommendations: one regarding public health responses; and two regarding social recovery. Our understanding of these mechanisms stems from a ‘systems’ perspective which casts social relationships as interdependent elements within a connected whole. 5

Social networks

Social networks characterise the individuals and social connections that compose a system (such as a workplace, community or society). Social relationships range from spouses and partners, to coworkers, friends and acquaintances. They vary across many dimensions, including, for example, frequency of contact and emotional closeness. Social networks can be understood both in terms of the individuals and relationships that compose the network, as well as the overall network structure (eg, how many of your friends know each other).

Social networks show a tendency towards homophily, or a phenomenon of associating with individuals who are similar to self. 6 This is particularly true for ‘core’ network ties (eg, close friends), while more distant, sometimes called ‘weak’ ties tend to show more diversity. During the height of COVID-19 restrictions, face-to-face interactions were often reduced to core network members, such as partners, family members or, potentially, live-in roommates; some ‘weak’ ties were lost, and interactions became more limited to those closest. Given that peripheral, weaker social ties provide a diversity of resources, opinions and support, 7 COVID-19 likely resulted in networks that were smaller and more homogenous.

Such changes were not inevitable nor necessarily enduring, since social networks are also adaptive and responsive to change, in that a disruption to usual ways of interacting can be replaced by new ways of engaging (eg, Zoom). Yet, important inequalities exist, wherein networks and individual relationships within networks are not equally able to adapt to such changes. For example, individuals with a large number of newly established relationships (eg, university students) may have struggled to transfer these relationships online, resulting in lost contacts and a heightened risk of social isolation. This is consistent with research suggesting that young adults were the most likely to report a worsening of relationships during COVID-19, whereas older adults were the least likely to report a change. 8

Lastly, social connections give rise to emergent properties of social systems, 9 where a community-level phenomenon develops that cannot be attributed to any one member or portion of the network. For example, local area-based networks emerged due to geographic restrictions (eg, stay-at-home orders), resulting in increases in neighbourly support and local volunteering. 10 In fact, research suggests that relationships with neighbours displayed the largest net gain in ratings of relationship quality compared with a range of relationship types (eg, partner, colleague, friend). 8 Much of this was built from spontaneous individual interactions within local communities, which together contributed to the ‘community spirit’ that many experienced. 11 COVID-19 restrictions thus impacted the personal social networks and the structure of the larger networks within the society.

Social support

Social support, referring to the psychological and material resources provided through social interaction, is a critical mechanism through which social relationships benefit health. In fact, social support has been shown to be one of the most important resilience factors in the aftermath of stressful events. 12 In the context of COVID-19, the usual ways in which individuals interact and obtain social support have been severely disrupted.

One such disruption has been to opportunities for spontaneous social interactions. For example, conversations with colleagues in a break room offer an opportunity for socialising beyond one’s core social network, and these peripheral conversations can provide a form of social support. 13 14 A chance conversation may lead to advice helpful to coping with situations or seeking formal help. Thus, the absence of these spontaneous interactions may mean the reduction of indirect support-seeking opportunities. While direct support-seeking behaviour is more effective at eliciting support, it also requires significantly more effort and may be perceived as forceful and burdensome. 15 The shift to homeworking and closure of community venues reduced the number of opportunities for these spontaneous interactions to occur, and has, second, focused them locally. Consequently, individuals whose core networks are located elsewhere, or who live in communities where spontaneous interaction is less likely, have less opportunity to benefit from spontaneous in-person supportive interactions.

However, alongside this disruption, new opportunities to interact and obtain social support have arisen. The surge in community social support during the initial lockdown mirrored that often seen in response to adverse events (eg, natural disasters 16 ). COVID-19 restrictions that confined individuals to their local area also compelled them to focus their in-person efforts locally. Commentators on the initial lockdown in the UK remarked on extraordinary acts of generosity between individuals who belonged to the same community but were unknown to each other. However, research on adverse events also tells us that such community support is not necessarily maintained in the longer term. 16

Meanwhile, online forms of social support are not bound by geography, thus enabling interactions and social support to be received from a wider network of people. Formal online social support spaces (eg, support groups) existed well before COVID-19, but have vastly increased since. While online interactions can increase perceived social support, it is unclear whether remote communication technologies provide an effective substitute from in-person interaction during periods of social distancing. 17 18 It makes intuitive sense that the usefulness of online social support will vary by the type of support offered, degree of social interaction and ‘online communication skills’ of those taking part. Youth workers, for instance, have struggled to keep vulnerable youth engaged in online youth clubs, 19 despite others finding a positive association between amount of digital technology used by individuals during lockdown and perceived social support. 20 Other research has found that more frequent face-to-face contact and phone/video contact both related to lower levels of depression during the time period of March to August 2020, but the negative effect of a lack of contact was greater for those with higher levels of usual sociability. 21 Relatedly, important inequalities in social support exist, such that individuals who occupy more socially disadvantaged positions in society (eg, low socioeconomic status, older people) tend to have less access to social support, 22 potentially exacerbated by COVID-19.

Social and interactional norms

Interactional norms are key relational mechanisms which build trust, belonging and identity within and across groups in a system. Individuals in groups and societies apply meaning by ‘approving, arranging and redefining’ symbols of interaction. 23 A handshake, for instance, is a powerful symbol of trust and equality. Depending on context, not shaking hands may symbolise a failure to extend friendship, or a failure to reach agreement. The norms governing these symbols represent shared values and identity; and mutual understanding of these symbols enables individuals to achieve orderly interactions, establish supportive relationship accountability and connect socially. 24 25

Physical distancing measures to contain the spread of COVID-19 radically altered these norms of interaction, particularly those used to convey trust, affinity, empathy and respect (eg, hugging, physical comforting). 26 As epidemic waves rose and fell, the work to negotiate these norms required intense cognitive effort; previously taken-for-granted interactions were re-examined, factoring in current restriction levels, own and (assumed) others’ vulnerability and tolerance of risk. This created awkwardness, and uncertainty, for example, around how to bring closure to an in-person interaction or convey warmth. The instability in scripted ways of interacting created particular strain for individuals who already struggled to encode and decode interactions with others (eg, those who are deaf or have autism spectrum disorder); difficulties often intensified by mask wearing. 27

Large social gatherings—for example, weddings, school assemblies, sporting events—also present key opportunities for affirming and assimilating interactional norms, building cohesion and shared identity and facilitating cooperation across social groups. 28 Online ‘equivalents’ do not easily support ‘social-bonding’ activities such as singing and dancing, and rarely enable chance/spontaneous one-on-one conversations with peripheral/weaker network ties (see the Social networks section) which can help strengthen bonds across a larger network. The loss of large gatherings to celebrate rites of passage (eg, bar mitzvah, weddings) has additional relational costs since these events are performed by and for communities to reinforce belonging, and to assist in transitioning to new phases of life. 29 The loss of interaction with diverse others via community and large group gatherings also reduces intergroup contact, which may then tend towards more prejudiced outgroup attitudes. While online interaction can go some way to mimicking these interaction norms, there are key differences. A sense of anonymity, and lack of in-person emotional cues, tends to support norms of polarisation and aggression in expressing differences of opinion online. And while online platforms have potential to provide intergroup contact, the tendency of much social media to form homogeneous ‘echo chambers’ can serve to further reduce intergroup contact. 30 31

Intimacy relates to the feeling of emotional connection and closeness with other human beings. Emotional connection, through romantic, friendship or familial relationships, fulfils a basic human need 32 and strongly benefits health, including reduced stress levels, improved mental health, lowered blood pressure and reduced risk of heart disease. 32 33 Intimacy can be fostered through familiarity, feeling understood and feeling accepted by close others. 34

Intimacy via companionship and closeness is fundamental to mental well-being. Positively, the COVID-19 pandemic has offered opportunities for individuals to (re)connect and (re)strengthen close relationships within their household via quality time together, following closure of many usual external social activities. Research suggests that the first full UK lockdown period led to a net gain in the quality of steady relationships at a population level, 35 but amplified existing inequalities in relationship quality. 35 36 For some in single-person households, the absence of a companion became more conspicuous, leading to feelings of loneliness and lower mental well-being. 37 38 Additional pandemic-related relational strain 39 40 resulted, for some, in the initiation or intensification of domestic abuse. 41 42

Physical touch is another key aspect of intimacy, a fundamental human need crucial in maintaining and developing intimacy within close relationships. 34 Restrictions on social interactions severely restricted the number and range of people with whom physical affection was possible. The reduction in opportunity to give and receive affectionate physical touch was not experienced equally. Many of those living alone found themselves completely without physical contact for extended periods. The deprivation of physical touch is evidenced to take a heavy emotional toll. 43 Even in future, once physical expressions of affection can resume, new levels of anxiety over germs may introduce hesitancy into previously fluent blending of physical and verbal intimate social connections. 44

The pandemic also led to shifts in practices and norms around sexual relationship building and maintenance, as individuals adapted and sought alternative ways of enacting sexual intimacy. This too is important, given that intimate sexual activity has known benefits for health. 45 46 Given that social restrictions hinged on reducing household mixing, possibilities for partnered sexual activity were primarily guided by living arrangements. While those in cohabiting relationships could potentially continue as before, those who were single or in non-cohabiting relationships generally had restricted opportunities to maintain their sexual relationships. Pornography consumption and digital partners were reported to increase since lockdown. 47 However, online interactions are qualitatively different from in-person interactions and do not provide the same opportunities for physical intimacy.

Recommendations and conclusions

In the sections above we have outlined the ways in which COVID-19 has impacted social relationships, showing how relational mechanisms key to health have been undermined. While some of the damage might well self-repair after the pandemic, there are opportunities inherent in deliberative efforts to build back in ways that facilitate greater resilience in social and community relationships. We conclude by making three recommendations: one regarding public health responses to the pandemic; and two regarding social recovery.

Recommendation 1: explicitly count the relational cost of public health policies to control the pandemic

Effective handling of a pandemic recognises that social, economic and health concerns are intricately interwoven. It is clear that future research and policy attention must focus on the social consequences. As described above, policies which restrict physical mixing across households carry heavy and unequal relational costs. These include for individuals (eg, loss of intimate touch), dyads (eg, loss of warmth, comfort), networks (eg, restricted access to support) and communities (eg, loss of cohesion and identity). Such costs—and their unequal impact—should not be ignored in short-term efforts to control an epidemic. Some public health responses—restrictions on international holiday travel and highly efficient test and trace systems—have relatively small relational costs and should be prioritised. At a national level, an earlier move to proportionate restrictions, and investment in effective test and trace systems, may help prevent escalation of spread to the point where a national lockdown or tight restrictions became an inevitability. Where policies with relational costs are unavoidable, close attention should be paid to the unequal relational impact for those whose personal circumstances differ from normative assumptions of two adult families. This includes consideration of whether expectations are fair (eg, for those who live alone), whether restrictions on social events are equitable across age group, religious/ethnic groupings and social class, and also to ensure that the language promoted by such policies (eg, households; families) is not exclusionary. 48 49 Forethought to unequal impacts on social relationships should thus be integral to the work of epidemic preparedness teams.

Recommendation 2: intelligently balance online and offline ways of relating

A key ingredient for well-being is ‘getting together’ in a physical sense. This is fundamental to a human need for intimate touch, physical comfort, reinforcing interactional norms and providing practical support. Emerging evidence suggests that online ways of relating cannot simply replace physical interactions. But online interaction has many benefits and for some it offers connections that did not exist previously. In particular, online platforms provide new forms of support for those unable to access offline services because of mobility issues (eg, older people) or because they are geographically isolated from their support community (eg, lesbian, gay, bisexual, transgender and queer (LGBTQ) youth). Ultimately, multiple forms of online and offline social interactions are required to meet the needs of varying groups of people (eg, LGBTQ, older people). Future research and practice should aim to establish ways of using offline and online support in complementary and even synergistic ways, rather than veering between them as social restrictions expand and contract. Intelligent balancing of online and offline ways of relating also pertains to future policies on home and flexible working. A decision to switch to wholesale or obligatory homeworking should consider the risk to relational ‘group properties’ of the workplace community and their impact on employees’ well-being, focusing in particular on unequal impacts (eg, new vs established employees). Intelligent blending of online and in-person working is required to achieve flexibility while also nurturing supportive networks at work. Intelligent balance also implies strategies to build digital literacy and minimise digital exclusion, as well as coproducing solutions with intended beneficiaries.

Recommendation 3: build stronger and sustainable localised communities

In balancing offline and online ways of interacting, there is opportunity to capitalise on the potential for more localised, coherent communities due to scaled-down travel, homeworking and local focus that will ideally continue after restrictions end. There are potential economic benefits after the pandemic, such as increased trade as home workers use local resources (eg, coffee shops), but also relational benefits from stronger relationships around the orbit of the home and neighbourhood. Experience from previous crises shows that community volunteer efforts generated early on will wane over time in the absence of deliberate work to maintain them. Adequately funded partnerships between local government, third sector and community groups are required to sustain community assets that began as a direct response to the pandemic. Such partnerships could work to secure green spaces and indoor (non-commercial) meeting spaces that promote community interaction. Green spaces in particular provide a triple benefit in encouraging physical activity and mental health, as well as facilitating social bonding. 50 In building local communities, small community networks—that allow for diversity and break down ingroup/outgroup views—may be more helpful than the concept of ‘support bubbles’, which are exclusionary and less sustainable in the longer term. Rigorously designed intervention and evaluation—taking a systems approach—will be crucial in ensuring scale-up and sustainability.

The dramatic change to social interaction necessitated by efforts to control the spread of COVID-19 created stark challenges but also opportunities. Our essay highlights opportunities for learning, both to ensure the equity and humanity of physical restrictions, and to sustain the salutogenic effects of social relationships going forward. The starting point for capitalising on this learning is recognition of the disruption to relational mechanisms as a key part of the socioeconomic and health impact of the pandemic. In recovery planning, a general rule is that what is good for decreasing health inequalities (such as expanding social protection and public services and pursuing green inclusive growth strategies) 4 will also benefit relationships and safeguard relational mechanisms for future generations. Putting this into action will require political will.

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Twitter @karenmaxSPHSU, @Mark_McCann, @Rwilsonlowe, @KMitchinGlasgow

Contributors EL and KM led on the manuscript conceptualisation, review and editing. SP, KM, CB, RBP, RL, MM, JR, KS and RW-L contributed to drafting and revising the article. All authors assisted in revising the final draft.

Funding The research reported in this publication was supported by the Medical Research Council (MC_UU_00022/1, MC_UU_00022/3) and the Chief Scientist Office (SPHSU11, SPHSU14). EL is also supported by MRC Skills Development Fellowship Award (MR/S015078/1). KS and MM are also supported by a Medical Research Council Strategic Award (MC_PC_13027).

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Carrie Pohlman

Introduction

In the previous chapter, we mentioned how we can help reduce our sense of isolation by staying connected through digital means of communication. However, in this chapter we will discuss the unique challenges and issues that this approach brings. During stressful and uncertain times, like the COVID-19 pandemic, we often resort to social media platforms to stay connected and informed on what is going on in the world. While social media does allow us to stay connected to our friends and family in a COVID-friendly way, we tend not to realize how it can negatively impact our mental health as well. In this chapter, we will learn about how social media usage during the COVID-19 pandemic has negatively impacted the mental health of college students in the United States during a period where mental health has been more important than ever.

Connection to STS Theory

The Modernization Theory has to do with the process of scientific and technological advancements within societies. Societies today are largely impacted by science and technology. When science and technology are modernized, societies experience a great impact as well. An example of this is social media in society. Social media was nonexistent until technology allowed for its modern existence, and once social media really took full form it led to a monumental societal impact. Part of this large impact includes the negative effects on mental health as a direct result of social media. In today’s society we have access to so much more information in a much faster and easier way than we ever did before. Without the Modernization Theory, technology would not have been improved this much to allow us to have access to such things.

Social Media Usage During the Pandemic

Social media usage during the pandemic in the United States has increased and there are many resulting effects. In an article, the results of a study done on college students showed that a higher level of social media usage was significantly associated with worse mental health ( Zhao & Zhou , 2020). In other articles, social media was demonstrated to have a negative impact through the surge of numerous rumors, hoaxes , and widespread misinformation regarding the disease ( Garfin , et al. 2020) and ( Tasnim , et al. 2020). Spread of this misinformation about COVID-19 included false or misleading information about the etiology, outcomes, prevention, and potential cures of the disease. Furthermore, aspects  such as repeated media exposure to false information can lead to increased anxiety, heightened stress responses, and misplaced health-protective and health-seeking behaviors. Reading misinformation is masking healthy behaviors and promoting inaccurate practices that actually increase the spread of the virus. False information in the media was a problem even before the pandemic. Reading and believing false information during times like this is much worse. There has been an increased use of social media throughout the pandemic and there are numerous proven negative effects on people because of it.

Voices from Clemson Undergraduate Students

“It’s crazy to see how much my screen time has increased during this pandemic. I’m always on my phone to keep me busy since there’s nothing else to do when I’m alone in my dorm.” -Carrie Pohlman

Mental Health During the Pandemic

Mental health has been impacted in many negative ways during the COVID-19 pandemic. In some articles, studies and evidence have analyzed the association between the COVID-19 pandemic and risk of anxiety and depression symptoms ( Wang , et al. 2020) and ( Torales , et al. 2020). The outbreak is leading to additional health problems such as stress, anxiety, depression, insomnia , denial, anger, and fear on a global scale. Anxiety is defined as “apprehensive uneasiness or nervousness usually over an impending or anticipated ill” (Merriam Webster). During this pandemic there have been many unknowns and many young peoples have preferred to rely on social media to get essentially all of the answers. When relying on social media, though, not all of the information we read is correct. Intertwined misinformation increases our anxiety of the unknown. Another article talks about how the negative effects on mental health will only continue throughout and after the pandemic, so data should be obtained to learn about it and to later be applied to treating mental illnesses ( Tandon , R. 2020). Our mental health has been impacted in many negative ways during the pandemic, for many different reasons, and we should find new ways to learn and apply our knowledge to it to reduce these risks.

COVID-19 Impact on College Students

College students in the United States have been greatly impacted by the pandemic. In two articles, studies were performed on college students ( Gao , et al. 2020) and ( Wang , 2020). These studies assessed mental health based on social media exposure and the association between the pandemic and mental health symptoms. These studies proved that social media exposure has affected mental health in many negative ways. Through an online study, the prevalence of anxiety and depression symptoms were 7.7% and 12.2% respectively. In another online study resulting in increa s ed anxiety and depression symptoms, more than 80% of the participants reported frequent exposure to social media. College students are put under a lot of pressure and now they must attend college and learn online while isolated in their dorms all day. There is an enormous lack of social interaction while isolated at college and students resort to social media, which ends up making things worse. Many college students have never had such little interaction with their friends and family, and therefore have suffered large tolls to their mental health. 

Clemson’s Response: CAPS Mental Heath Support

The Counseling and Psychological Services provided some tips to help Clemson students deal with the pandemic:

• Practice social distancing.
• Stay informed.
• Avoid drawing firm conclusions, and take a flexible attitude.
• Stay connected.
• Mind the body.
• Structure your day.
• Know when to seek additional help

The COVID-19 pandemic has had many negative effects on humans. Not only are people worrying about their physical health, but the stress of these uncertain times is negatively affecting mental health and wellbeing. The isolation has lead to an increase in the use of popular social media platforms, which in turn is negatively affecting mental health without the consumer even realizing it. The negative effects of social media are especially evident in the mental toll experienced by college students in the United States. Society needs to be aware of these effects and use our knowledge to minimize the damage it can cause so that society can benefit from the positive aspects of social media. The modernized science and technology in society may seem appealing, but like all tools, it must be carefully observed to ensure it does not cause more harm than good.

Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, Wang Y, Fu H, Dai J.    Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020 Apr 16;15(4):e0231924. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231924

Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure.  Health Psychology, 39 (5), 355-357.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735659/

Tandon, R. (2020). COVID-19 and mental health: Preserving humanity, maintaining sanity, and promoting health.  Asian Journal of Psychiatry, 51,  102256.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305748/ 

Tasnim, S., Hossain, M., & Mazumder, H. (2020, March 29). Impact of rumors or misinformation on coronavirus disease (COVID-19) in social media.  https://doi.org/10.31235/osf.io/uf3zn

Torales, J., O’Higgins, M., Castaldelli-Maia, J.M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health.  International Journal of Social Psychiatry, 66 (4), 317-320.  https://doi.org/10.1177/0020764020915212

Wang, Z.-H., Yang, H.-L., Yang, Y.-Q., Liu, D., Li, Z.-H., Zhang, X.-R., Zhang, Y.-J., Shen, D., Chen, P.-L., Song, W.-Q., Wang, X.-M., Wu, X.-B., Yang, X.-F., & Mao, C. (2020). Prevalence of anxiety and depression symptom, and the demands for psychological knowledge and interventions in college students during COVID-19 epidemic: A large cross-sectional study.  Journal of Affective Disorders, 275,  188-193. https://reader.elsevier.com/reader/sd/pii/S0165032720323922?token=3FABC93196E37D05D9F4775B18A1DD8288E3022C82E860C8EBE3EF3C7DEC49EF5991F4A32A1D690E825B1A1EB094AB87&originRegion=us-east-1&originCreation=20220107182844

Zhao, N., & Zhou, G. (2020). Social Media Use and Mental Health during the COVID-19 Pandemic: Moderator and Role of Disaster Stressor and Mediator Role of Negative Affect.  Applied Psychology: Health and Well-Being. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536964/ 

Image 1: “Covid-19 mental health impact in the United States July 2020”     by Statista / Huffington Post is licensed under CC BY 4.0

Image 2: “Person Holding Iphone Showing Social Networks Folder” by Tracy Le Blanc / Pexels is licensed under CC0

To the extent possible under law, Carrie Pohlman has waived all copyright and related or neighboring rights to COVID 19: A Student Perspective , except where otherwise noted.

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• Open access
• Published: 17 May 2022

Social media use and mental health during the COVID-19 pandemic in young adults: a meta-analysis of 14 cross-sectional studies

• Youngrong Lee 1 ,
• Ye Jin Jeon 2 ,
• Sunghyuk Kang 2 , 3 ,
• Jae Il Shin 4 ,
• Young-Chul Jung 3 &
• Sun Jae Jung 1 , 2  

BMC Public Health volume  22 , Article number:  995 ( 2022 ) Cite this article

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Metrics details

Public isolated due to the early quarantine regarding coronavirus disease 2019 (COVID-19) increasingly used more social media platforms. Contradictory claims regarding the effect of social media use on mental health needs to be resolved. The purpose of the study was to summarise the association between the time spent on social media platform during the COVID-19 quarantine and mental health outcomes (i.e., anxiety and depression).

Studies were screened from the PubMed, Embase, and Cochrane Library databases. Regarding eligibility criteria, studies conducted after the declaration of the pandemic, studies that measured mental health symptoms with validated tools, and studies that presented quantitative results were eligible. The studies after retrieval evaluated the association between time spent on social media platform and mental health outcomes (i.e. anxiety and depression). The pooled estimates of retrieved studies were summarised in odds ratios (ORs). Data analyses included a random-effect model and an assessment of inter-study heterogeneity. Quality assessment was conducted by two independent researchers using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This meta-analysis review was registered in PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ , registration No CRD42021260223, 15 June 2021).

Fourteen studies were included. The increase in the time spent using social media platforms were associated with anxiety symptoms in overall studies (pooled OR = 1.55, 95% CI: 1.30–1.85), and the heterogeneity between studies was mild (I 2  = 26.77%). Similarly, the increase in social media use time was also associated with depressive symptoms (pooled OR = 1.43, 95% CI: 1.30–1.85), and the heterogeneity between studies was moderate (I 2  = 67.16%). For sensitivity analysis, the results of analysis including only the “High quality” studies after quality assessment were similar to those of the overall study with low heterogeneity (anxiety: pooled OR = 1.45, 95% CI: 1.21–1.96, I 2  = 0.00%; depression: pooled OR = 1.42, 95% CI: 0.69–2.90, I 2  = 0.00%).

Conclusions

The analysis demonstrated that the excessive time spent on social media platform was associated with a greater likelihood of having symptoms of anxiety and depression.

Peer Review reports

Introduction

Despite the tremendous worldwide efforts including the introduction of vaccines, developing therapeutics and social distancing, the coronavirus outbreak is not expected to dampen due to the continuous emergence of new viral strains and difficulty in effective quarantine interventions. As a result of strong quarantine measures, private meetings, gatherings, and physical contact with intimate relatives have been reduced [ 1 ]. Prolonged social distancing and loss of intimate interpersonal contact increase feelings of frustration, boredom, anxiety, and potentially depression [ 2 ].

Studies have found that young, socially active populations or workers at high risk of infection, especially college students and frontline healthcare workers, bear a disproportionate burden of mental health problems worldwide (e.g., high levels of anxiety and depression), highlighting the need for appropriate intervention in these populations [ 3 , 4 ].

Social media in digital platforms is reportedly considered as a new channel of communication that could relieve aforementioned negative aspects of isolation through helping people escape negative emotions [ 5 ], projecting their personality as they desire, and evoking the impression of gaining back some control [ 6 ]. Social media may be helpful for relieving anxiety and depression by providing information regarding the pandemic [ 7 , 8 ].

However, prolonged use of social media by the isolated could be a double-edged sword that can adversely affect mental health due to sustained exposure to excessive information and misinformation [ 9 , 10 , 11 ]. While social media in digital platforms does help to promote social inclusion among adolescents and young adults, the risk associated with their excessive or problematic use cannot be overlooked [ 12 ]. Due to conflicting evidence and views regarding the effect of social media platform on the mental health, the recommendation for the use of social media in pandemic has been questioned.

Therefore, a meta-analysis was conducted to solve the contradictory effects of social media platform on anxiety and depression based on studies reporting an association between the use of social media and mental health outcomes (i.e., anxiety and depression) on the pandemic setting.

Eligibility criteria

Studies were included which met the following criteria: (1) use of the English language; (2) conducted after March 11, 2020 (date the WHO declared a pandemic) and published by December 20, 2020; (3) collected data using a validated tool of mental health symptoms (e.g., Patient Health Questionnaire: PHQ9, Generalized Anxiety Disorder-7 items: GAD-7); (4) full texts available; (5) measured time spent on social media platform in either continuous or categorical variable; (5) provided their results in OR, β, and/or Pearson’s r, and (6) studies measured mental health symptoms such as anxiety and depression.

Studies with the following characteristics were excluded: (1) Studies examined traditional social media (e.g., television and radio); (2) case reports, letters, comments, and narrative reviews without quantitative results, and (3) studies using a language other than English.

Studies investigating the association between time spent on social media and mental health outcomes (e.g., anxiety and depression) were summarised in Supplementary Material 1 . The pooled effect size of this meta-analysis was mainly presented in an odds ratio (Fig.  2 ).

Study selection

The search strategy principles were as follows: (1) “Social media” or individual names of social media in the title, keyword and abstract results; (2) Terms referring to mental health with COVID-19 specified in the title (e.g. depression, anxiety or blue).

A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed to identify studies. Publication date restrictions are from March 2020 to December 20, 2020. The search terms for a systematic search were as following: (1) (“COVID-19“ OR “corona“) AND (“mental health” OR depress* OR anxiety) AND (“social media” OR “Instagram” OR “Facebook” OR “twitter”) for PubMed, (2) (“coronavirus disease 2019’/exp/mj) AND (“mental health“/exp/mj OR “depression“/exp OR “anxiety“/exp) AND (“social media”/exp./mj OR “Facebook”/exp. OR “twitter”/exp. OR “Instagram“/exp) for Embase; (3) (“COVID-19″ OR “corona”) AND (“mental health“ OR depress* OR “anxiety”) AND (“social media“ OR ‘Instagram” OR “Facebook” OR “twitter”) for Cochrane Library.

Articles were first screened by reviewing titles, followed by a full-text review. Every selection stage involved three independent researchers (two medical doctors [SJJ and YRL] and one graduate student from the Epidemiology Department [YJJ]). Every article was independently evaluated by two researchers (YJJ and YRL) in first hand, and a third researcher (SJJ) mediated the final selection in case of differences in opinion.

Data extraction

Study data were extracted by two independent researchers (YRL and YJJ). A single author first extracted the information and a second author checked for accuracy. The extracted information is as follows: country of study, participant group sampled, age group of sample, date of data collection, mental health measures, effect size information, social media use time, and whether the adjustment was made for each analysis (see Supplementary Material 1 ). Studies were subdivided into categories according to the summary estimate of effect sizes (odds ratio [OR], beta estimate from multiple linear regression [β], and correlation coefficient [Pearson’s r]).

Exposure variables

The final studies after retrieval measured the amount of time spent on social media, which was either categorical or continuous variables (see Supplementary Material 1 ). It was measured based on the response to an item in the questionnaire: “How often were you exposed to social media? [categorical]” and “How long (in hours) were you exposed to social media? [continuous].” The measurement of exposure was expressed in different wordings as follows: “Less” vs. “Frequently,” “Less” vs. “Often”, “less than 1 hour” vs. “2 hours or more,” or “less than 3 hours” vs. “3 hours or more.” To calculate the overall effect, these individually measured exposure levels were operationally redefined (e.g., “Less” and “Few” were considered the same as “less than 2 hours;” “less than 1 hour,” “Frequently,” and “Often” were treated the same as “2 hours or more” and “3 hours or more”).

Outcome variables

The outcomes of included studies were “anxiety”, and “depression”. Anxiety was ascertained by using GAD-7 (cut-off: 10+), DASS-21, and PHQ-9, while depression was measured using PHQ-9 (cut-off: 10+), WHO-5 (cut-off: 13+), and GHQ-28 (cut-off: 24+). Anxiety and depression measured by using screening tools with cut-offs presented results in odds ratios (see Supplementary Material 1 ).

Statistical analysis

All statistical analyses and visualisations were performed with the “meta,” “metaphor,” and “dmeter” package of R version 3.6.3 ( https://cran.r-project.org/ ), using a random-effect model [ 13 , 14 , 15 ]. The effect measures were odds ratio, regression coefficient, and Pearson’s r, which calculated the association between the increase in social media use time and anxiety and depressive symptoms. In each study, the association with the mental health level of the social media frequent use group (compared to the low frequency group) was calculated as the odds ratio, and the association with the increase in the mental health level per hour increase was calculated as the regression coefficient (β) and Pearson’s r. Statistics used for calculating pooled effects (e.g., odds ratio, regression coefficient, and Pearson’s r) were utilized as its adjusted value with covariates from each study, not the unadjusted crude values.

The pooled effect sizes, Cochrane’s Q, and I 2 to assess heterogeneity were calculated. The pooled effect sizes, CIs, and prediction intervals were calculated by estimating the pooled effect and CIs using the Hartung-Knapp-Sidik-Jonkman method, which is known as the one of the most conservative methods [ 16 ]. The degree of heterogeneity was categorised as low, moderate, or high with threshold values of 25, 50, and 75%, respectively [ 17 ]. Possible causes of heterogeneity among study results were explored by statistical methods such as influential analysis, the Baujat plot, leave-one-out analysis, and Graphic Display of Heterogeneity analysis [ 18 ]. In addition, publication bias was assessed using funnel plots, Egger’s tests, and the trim-and-fill method [ 19 ].

Quality assessment

Quality assessment was conducted by two independent researchers, a psychiatrist (SHK) and an epidemiologist (YRL), using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS), which can assess cross-sectional studies [ 20 ]. RoBANS has been validated with moderate reliability and good validity. RoBANS applies to cross-sectional studies and comprises six items: participant selection, confounding, exposure measurement, blinding of outcome assessments, missing outcomes, and selective reporting of outcomes. Each item is measured as having a “high risk of bias,” “low risk of bias,” or “uncertain.” For example, based on “participant selection,” each researcher marked an article as having a “high risk of bias” if, for example, the patient definitions of depression were generated by self-reported data. In cross-sectional studies, misclassification cases due to an unreliable self-contained questionnaire for categorizing depressive patients were rated as “high risk.” For the qualitative assessment, studies with two or more “high risk of bias” grades were then classified as “low quality”. The study was rated as “high quality” only if the evaluation of both raters was congruent. For sensitivity analysis, additional analysis including only “high quality” studies was conducted and it compared with the pooled estimates of overall results (see Table  1 ).

Ethical approval

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines 2020 were followed for this study. No ethical approval and patient consent are required since this study data is based on published literature. This meta-analysis review was registered with PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ , registration No CRD42021260223, 15 June 2021).

Included and excluded studies

Total of 346 studies were selected from the database search (288 from PubMed, 34 from Embase, and 24 from the Cochrane Library). After removing 19 duplicate publications, 327 studies were included for the title and full-text review (see Fig.  1 ). Non-original studies and those conducted with irrelevant subjects ( n  = 218) were excluded. Another 95 studies were excluded finally due to inconsistent study estimates. As summarised in Supplementary material 1 and 8 , 13 papers studied anxiety as an outcome (6 studies in odds ratio, 3 in regression coefficient, 4 in Pearson’s r), and a total of 9 papers studied depression as an outcome (6 studies in odds ratio, 3 in regression coefficient). Each of the final distinct 14 studies (after excluding duplicate studies) measured multiple mental health outcome variables (i.e., anxiety and depression), and pooled effect sizes were calculated for each outcome. Six studies that dealt with anxiety symptoms and six with depression (Supplementary Material 1 –1-1, 1–2-1) reported ORs and their 95% confidence intervals (CIs) ( n  = 9579 and n  = 13,241 for anxiety and depressive symptoms, respectively). Three studies each on anxiety and depression (Supplementary Material 1 –1-2, 1–2-2) reported their findings in β ( n  = 2376 and n  = 2574 for anxiety and depression, respectively). All included studies were cross-sectional studies. The pooled effect size was presented in odds ratio.

Flowchart of literature search and selection of the publications

Time spent on social media and mental health outcomes

Table 1 shows the result of the meta-analysis about the relationship between time spent on social media and mental health outcomes (i.e., anxiety and depression) of the selected cross-sectional studies. The increase in the time spent using social media platforms were associated with anxiety symptoms in overall studies (pooled OR = 1.55, 95% CI: 1.30–1.85, prediction intervals: [1.08–2.23]), and the heterogeneity between studies was mild (I 2  = 26.77%) (see Fig. 2 ). The three cross-sectional studies (presented in β) were insignificant (β = 0.05, 95% CI: − 0.32–0.15; a unit increment of each screening tool score per hour) with relatively high inter-study heterogeneity (I 2  = 76.07%). The overall estimate of the four cross-sectional studies (Pearson’s r) was 0.18 (95% CI: 0.10–0.27) with high inter-study heterogeneity (I 2  = 73.04%). The increase in social media use time was also associated with depressive symptoms (pooled OR = 1.43, 95% CI: 1.30–1.85, prediction intervals: [0.82–2.49]), and the heterogeneity between studies was moderate (I 2  = 67.16%) (see Fig. 2 ).

Forest plot for social media exposure and symptoms of mental health (i.e. anxiety & depression) in cross-sectional studies. Estimates presented in odds ratios (OR)

As result of quality assessment analysis, pooled effect size of studies classified as “high quality” was presented in Table 1 . The results were similar to the overall outcome (anxiety: OR = 1.45, 95% CI: 1.21–1.96; depression: OR = 1.42, 95% CI: 0.69–2.90). High-quality studies had low inter-study heterogeneity (anxiety: I 2  = 0.00%; depression: I 2  = 0.00%). The kappa statistic (inter-rater agreement) was 33.3%, indicating fair agreement.

Publication bias

Publication bias was assessed by funnel plot analysis and Egger’s test (Supplementary Material 4 –1). Funnel-plot analyses revealed symmetrical results (Supplementary Material 4 –2). In addition, all results of the Egger test were statistically insignificant, indicating improbable publication bias. After applying the trim-and-fill method, the funnel plot revealed no asymmetry (Supplementary Material 5 ), indicating no significant publication bias.

The study aimed to present a comprehensive direction of relevance by analysing studies investigating the association between time spent on social media during the COVID-19 pandemic and mental health symptoms (i.e., anxiety and depressive) among the public. The increase in the time spent on social media in digital platforms was associated with symptoms of anxiety and depression.

The pooled results are in line with previous systematic reviews and meta-analysis performed before the pandemic. A systematic literature review before the COVID-19 outbreak (2019) found that the time spent by adolescents on social media was associated with depression, anxiety, and psychological distress [ 21 ]. A meta-analysis of 11 studies (2017) also reported a weak association between social media use and depressive symptoms in children [ 22 ]. A meta-analysis of 23 studies (2018) reported significant correlation between social media use and psychological distress [ 23 ]. Likewise, this study also observed a similar trend of a negative effect of social media on mental health outcomes in the COVID-19 pandemic. However, the estimates of inter-study heterogeneity of these meta-analysis were relatively high (meta-analysis of 11 studies: I 2  = 92.4%; meta-analysis of 23 studies: I 2  = 62.00% for anxiety, I 2  = 80.58% for depression) compared to the analysis, which implies relatively higher homogeneity of the study population and reliable results.

Unverified information and opinions can be easily disseminated on social media platform and perceived as facts without verification. There has been a stream of news regarding the pandemic, creating a sense of urgency and anxiety. Repeated exposure to the news may affect the construct of external reality and may lead to a delusion-like experience, which has been linked to anxiety and social media overuse [ 24 , 25 ].

Additionally, discrimination and stigma related to COVID-19 on social media can make people fearful of being infected and exacerbate depression and anxiety [ 26 ]. Fear of COVID-19 may be compounded by coexisting depression and anxiety disorders [ 27 ]. Due to the high accessibility of social media platform and the ease of socialisation in a controlled setting, individuals with underlying depression may be more drawn to social media interactions rather than face-to-face ones, more so in the pandemic era [ 28 ].

Also, implementation of social distancing mandates new norms limiting physical conducts in almost all sectors of life, including educational institutes and vocational venue. Rapid transition to the new remote educational environment and telecommuting may trigger mental health issues [ 29 ].

In interpreting the findings of this study, several limitations should be considered. First, all the studies included were cross-sectional design. The possibility of a reverse causal relationship cannot be ruled out. Further studies with longitudinal data are warranted. Second, the results do not represent the general population since most of the studies recruited participants through a web-based survey, which may have had a selection bias. Lastly, some of the analysis showed a relatively high inter-study heterogeneity (range: I 2  = 0.00–80.53%). The results of the statistical approaches to identify the cause of heterogeneity (i.e. influential analysis, Baujat plot, leave-one-out analysis, and GOSH analysis) were summarised in Supplementary Material 6 and 7 .

Despite these limitations, this study exhibits a number of strengths; to the best of our knowledge, the study is the first meta-analysis to examine the relationship between use of social media and mental health outcomes during the COVID-19 pandemic, to validate the results by various verification methods such as trim-and-fill methods, influential analysis, and heterogeneity analysis. In addition, sensitivity analysis was also conducted with unbiased “high quality” studies through quality assessment.

The analysis demonstrates that excessive time spent on social media platform is associated with increased anxiety and depressive symptoms in the pandemic. While social media may be considered as an alternative channel for people to connect with their peers in the pandemic, the findings suggest that excessive use of social media can be detrimental for mental health. Further observation studies with longitudinal design to determine the true effect of social media platform are required.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Coronavirus disease 2019

Confidence interval

Patient Health Questionnaire-9

Shortened version of PHQ

General Health Questionnaire-28

Depression Anxiety and Stress Scales

World Health Organization-Five Well-Being Index

Generalized Anxiety Disorder-7

Shortened version of GAD

Risk of Bias Assessment Tool for Nonrandomized Studies

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Acknowledgements

The authors would like to thank the Editage ( www.editage.co.kr ) for English language editing.

This study was supported by the National Research Foundation of Korea, funded by the Ministry of Science and ICT (2020R1C1C1003502), awarded to SJJ.

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Contributions

Conceptualization: YRL, SJJ. Data curation: SJJ, JIS, YCJ, YRL. Formal analysis: YRL, SJJ. Funding acquisition: SJJ. Methodology: JIS, YCJ, YRL, SJJ. Project administration: SJJ. Visualization: YRL. Writing – original draft: YRL, YJJ, SHK, SJJ. Writing – review & editing: YRL, YJJ, SHK, JIS, YCJ, SJJ. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The author(s) read and approved the final manuscript.

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Correspondence to Sun Jae Jung .

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Lee, Y., Jeon, Y.J., Kang, S. et al. Social media use and mental health during the COVID-19 pandemic in young adults: a meta-analysis of 14 cross-sectional studies. BMC Public Health 22 , 995 (2022). https://doi.org/10.1186/s12889-022-13409-0

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Exploring the effects of social media on mental health during COVID

Fariha hanif, mariley polanco, and fatima warda.

The role of social media in COVID-19

Social media, on an individual basis, is used for keeping in touch with friends and family. This, however, can be expanded to encompass using social media as a networking tool for career options, finding people across the globe with similar interests, and simply as a means to vent their frustrations/emotions. While these applications are still used for similar purposes today, they are most definitely used more frequently as a result of the forced isolation that came about from the pandemic. People who didn’t enjoy using social media and avoided it at all costs as a method of communication have reluctantly given into trying these platforms to stay in touch with their loved ones. Whether it is via the direct messaging features available on various apps or through posting pictures from their daily lives, people try to depict their lives in the best way possible on these virtual platforms. The way social media has been used prior to and during the pandemic has a strong relationship to the idea of the social self. 

Especially with the pandemic, social media has brought light to another layer of healthcare. Various healthcare providers created public accounts on these social media platforms, such as YouTube, Facebook, Instagram, Twitter, Tiktok, and etc. to provide information/updates about what is going on with the pandemic, social distancing guidelines, and updates about the vaccine. In a peer reviewed article published prior to COVID, the authors explored the various benefits and risks of being an active user on social media. Some of these benefits include increasing interactions with others, having more accessible information, social support, and having the potential to influence many policies related to health (Moorhead et al., 2013). Many of these healthcare providers whose following blew up during the pandemic have even branched out into making social media a side gig, taking monetary compensation for everything that they post, even collaborating with major companies to encourage people to stay safe and healthy during the pandemic. A good example is the user @lifeofadoctor on Tiktok, whose following grew exponentially after making daily/weekly updates on COVID statistics during the pandemic to encourage his followers to stay home. His following grew so much in that brief period of time that he was among one of the first few creators on TikTok to be a recipient of $1 billion creator fund.

https://vm.tiktok.com/ZMJgx4KYe/

However, the increased use of social media during the pandemic wasn’t completely without faults. It impacted the areas of an individual’s social self and the dynamic between various groups. A social psychology concept that can be applied to the use of social media is the self-discrepancy theory. This theory states that individuals compare their “actual” selves to their “ideal” self and if there are any inconsistencies between the two, it causes immense discomfort in the individual. This can specifically apply to how social media is used as it further encourages people to compare their “actual” selves to their “ideal” selves depicted on platforms. While trying to depict their life in the best way possible, people may start to see themselves in two different ways (their “actual” self in real life versus their “ideal” self-depicted in social media) and because of this, a lot of discomfort may arise within individuals as they may feel a strong urge to be their “ideal” self, but it may not be realistic to the type of lifestyle they currently live. A study conducted in 2006 explored the relationship between self-discrepancy in terms of body image and how this affects participation in social comparison. It found that women who had high levels of self-discrepancy were more likely to compare themselves to others from being exposed to the thin-ideal, and they found that these comparisons can result in self-inflicted negative consequences (Bessenoff, 2006).  This effect may be amplified in teenagers who see the “idealized” view of many of their favorite celebrities/peers and start to believe that everyone is portraying their “actual” selves instead of their “idealized” selves, which can be very damaging to their self-esteem. All influencers, at one point or another, can be accused of doing so. It would be hard to find a celebrity that posts the negative events going on in their lives and not showing a glamorized view of what they do on a daily basis.

This can also tie into how social media is used to boost an individual’s self-esteem as many use social media to depict the highlights of their life, completely neglecting to post the negatives. With this close to ideal depiction of one’s self on social media, it can cause many to comment on how great you look and how great your life is, which can directly affect (and boost) someone’s self-esteem. People depict themselves on social media the way they think they are seen by others or the way they want to be seen, which can be very problematic for the younger generation that are frequenting these platforms, giving them unrealistic expectations of what they should look like and how life is. A good example of this is the supermodel Gigi Hadid – she is rarely found depicting the hardships of motherhood, it was only until recently that she even posted pictures of herself being pregnant. Similarly, another influencer on social media who has a particular presence on there is James Charles. He is mainly seen on Instagram wearing glamorous makeup looks and living a lavish lifestyle, but when the paparazzi catches him, he can be seen without makeup and shows that there is much more to him apart from his makeup looks.

Despite the negative effects that social media may have on self-esteem, it can also be used to enhance one’s own self-image. In a study conducted by Gonzalez and Hancock in 2011, they found that, interestingly enough, increasing the exposure to information on your own Facebook profile can enhance self-esteem, especially when an individual selectively-self presents themselves on the internet (Gonzalez and Hancock, 2011).

Another concept of social psychology that can be applied to the use of social media, especially amongst teenagers, is the Common Ingroup Identity Model that was developed by Gaertner and Dovidio. The model suggests that if members of various groups can recategorize themselves as members of a more superior group, the intergroup relations can drastically improve. This can specifically apply to social media in the sense that people all over the world have various attitudes towards other members of other racial and socioeconomic groups and social media can expose people to others who they would not normally interact with, allowing them to find some common/shared identities with members of the outgroup, which would further initiate the formation of other new, more superior groups that are based primarily on shared interests/beliefs. For example, my brother, being stuck at home, ventured out to different social media platforms where he was exposed to people that he typically did not interact with on a daily basis prior to the pandemic, and actually ended up developing a different perspective on racial minorities as he found many individuals who fit into that group that he shared a common identity with.

Interestingly enough, although many thinks that the increase in the use of social media may be temporary and that once the pandemic is over, the new users would stop using these platforms, eMarketer actually predicts the opposite. Using data collected from the Harris Poll, they found that approximately half of the respondents reported using social media more frequently than they ever had before (seen in image below) and made inferences about how these platforms would be used in the future in a world post-pandemic. Those who, during the pandemic, learned how to use all types of video platform services are more likely to continue doing so even when lockdown restrictions are lifted. Additionally, eMarketer predicts that the amount of time we will spend on messaging platforms will also increase by approximately four minutes. Lastly, they note that US adults will probably spend about seven more minutes a day on social media, but they expect this to decline in 2021 once the pandemic is controlled (Samet, 2020).

Overall, while social media may initially seem like a great way to keep in touch with loved ones while maintaining the social distancing rules across the globe, it can also bring about many negative effects and challenges. People may feel more comfortable behind a phone/computer screen and take advantage of this comfort by cyberbullying their peers and influencers. According to a peer-reviewed study done this year exploring the role of social media during COVID, they found that this comfort may also result in individuals exploiting public opinions and committing other hate crimes that they would not have the courage to do otherwise in person. For example, there are many individuals who comment hateful things on many celebrities’/influencers’ social media accounts, but if they saw the celebrity in person, they would pretend to be a fan. Furthermore, many rely on the Internet for the latest news and updates in the world and social media has started to evolve into sharing information about important current events, but many users on social media can “troll” on the platform by disseminating misinformation. The spread of misinformation can easily result in mass hysteria about current events (Sahni & Sharma, 2020). Lastly, while social media may boost one person’s self-esteem, it may destroy an impressionable individual’s own self-esteem with the hopes of achieving an unattainable reality depicted.

Bibliography

• Bessenoff, G. R. (2006). Can the Media Affect Us? Social Comparison, Self-Discrepancy, and the Thin Ideal. Psychology of Women Quarterly, 30(3), 239–251. https://doi.org/10.1111/j.1471-6402.2006.00292.x
• Gonzales, A. L., & Hancock, J. T. (2011). Mirror, mirror on my Facebook wall: Effects of exposure to Facebook on self-esteem.  Cyberpsychology, behavior, and social networking ,  14 (1-2), 79-83.
• Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C. A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication. J Med Internet Res 2013;15(4):e85. URL: https://www.jmir.org/2013/4/e85 . DOI: 10.2196/jmir.1933. PMID: 23615206. PMCID: PMC3636326
• Sahni, H., & Sharma, H. (2020, June 29). Role of social media during the COVID-19 pandemic: Beneficial, destructive, or reconstructive? International Journal of Academic Medicine , 6 (2), 70-75. https://www.ijam-web.org/article.asp?issn=2455-5568;year=2020;volume=6;issue=2;spage=70;epage=75;aulast=SahniSamet, A. (2020, July 29). How the Coronavirus Is Changing US Social Media Usage. eMarketer . https://www.emarketer.com/content/how-coronavirus-changing-us-social-media-usage
• Samet, A. (2020, July 29). How the Coronavirus Is Changing US Social Media Usage. eMarketer . https://www.emarketer.com/content/how-coronavirus-changing-us-social-media-usage

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Home News How the Pandemic Changed Children’s Relationships With Social Media back to News

How the Pandemic Changed Children’s Relationships With Social Media

Jenna glover, phd, talks about a cu school of medicine study on teenagers and technology..

minute read

Responding to concerns over increased screen time for teenagers during the pandemic and the potential negative effects of social media use, CU School of Medicine psychology faculty members Jenna Glover , PhD, Sandra Fritsch , MD, and Merlin Ariefdjohan , PhD, reviewed recent studies on children and digital technology, synthesizing their findings in a paper published this month in the journal Child and Adolescent Psychiatric Clinics of North America.

We spoke with Glover — a psychologist and director of psychology training at Children's Hospital Colorado — about the study and the team’s findings.

What were some of your primary findings when it comes to the ways children are using social media during the pandemic?

Both in the United States and in other countries, children’s rates of anxiety and depression doubled — and in some places tripled — during the pandemic. So we knew the pandemic was having a big impact on mental health. What was interesting to me is that initially, social media was an important source of connection and information-finding for children. Because this was so new, and it was rapidly evolving, it was a great place for people to connect, share information and frustrations, and get support.

I know a lot of parents were very worried about, “Oh, my gosh, my kid has so much screen time now,” but what the research was finding is that children being online a lot was not the important thing. It was the way that they were engaging with being online. For example, we know that active use can be helpful for a child’s mental health, and it certainly was during the pandemic. If you are creating content, like creating YouTube videos, or if you're gaming with a friend, and talking with them while you're doing it, you're doing something active. That's super helpful. If you're passively scrolling TikTok or passively viewing YouTube videos for three or four hours, that's toxic for your mental health.

The important takeaway was that the pandemic made it so that we're on screens a lot more, but it's not the amount of time that you're on it; it's how you're using it that really is a difference-maker. There was a huge benefit, during the pandemic, to still being able to interact with peers, see family members, and still have those relationships and build those relationships. There were certainly major benefits of social media that were really helpful for a child’s resiliency.

What accounts for that difference? What is so toxic about scrolling through TikTok videos for hours?

One of the nice things about social media and technology use is that it helps children explore their identity and express their identity, which is a developmental task. Social support is an important aspect of their growth as well, and that active use allows children to meet those two developmental tasks. In contrast, with the passive use, you're not interacting with somebody; you're not exploring aspects of your identity. One of the things we compared it to is calories. Not all calories are created equal. There's good nutrition and there's bad nutrition, and technology is the same way. That passive use tends to be more like junk food. It fills children up, but there's nothing that's helpful or substantive for their growth in it.

Were there any other findings around the good or bad effects of increased screen time?

One of the other interesting things that came from the paper is moving away from the idea of specific guidelines in terms of hours that children can be online, and looking more to see if there are core activities in place to support a child’s wellness. If children are sleeping, eating, doing chores and homework, and interacting with peers and family, then the amount of screen time is not that important. It's when those things get disrupted that screen time needs to be looked at to see if that's what's disrupting those activities. That's a real shift in the literature. And it's a shift in our social consciousness that it's not about hours; it's more about healthy activities as the foundation and making sure screen time is supporting those things, not taking away from them.

In a way, is that just an acknowledgement of how important the online world is to children? That screen time is part of their life, not a distraction from it?

That's exactly right. There is some other interesting research that was recently done that showed that teenagers, in general, see social media as an incredibly vital part of their life. They see it as important in terms of expressing who they are and connecting with other people, whereas parents who were surveyed about social media see it as a waste of time and a distraction. It's really important that we don't minimize the importance of this platform for youth, even if adults don't see the same value in it, because they have grown up in a way that most people who are parenting them — or their caregivers, their physicians, their teachers — haven't. It's part of our life, and you can't take it away from children. Doing so actually could be harmful for their future progress and education and occupations.

Is that something you see in your patients or the children that you deal with, that they have that same kind of relationship to it?

Most definitely. It's an essential part of their life. There's actually research that shows that when parents try to use taking away a child’s phone as a punishment, it can increase depression and suicidal ideation in children. I see it all the time in my clinical work — it is how they experience their world. They need to be taught how to do it in a healthy way, but sometimes I think people look at it as a dichotomy, like it's a good or bad thing. But it's a both thing. And it's an essential part of life for these children.

Is there anything you recommend that parents do to communicate with their children about technology use?

Families should have ongoing conversations about media use in general, and what it means to be a responsible digital citizen. In the same way that we teach our children to be good citizens in the world, it’s important to talk about how they show up online. It's important for parents have explicit conversations about what is and isn't OK to post, and why that is. And also having conversations about how many different accounts a child has. The more social media accounts they have, the higher likelihood they have to develop anxiety and depression. Having just one account is better than having three accounts. Parents need to think about how their child can be online in a way that is moderated and healthy.

Do you think the pandemic is going to permanently alter the amount of screen time these children have, or how they interact with technology and social media?

I think this will permanently alter the course of how we utilize technology and the amount of time we are on screens. I think things like snow days will go away, because there will always be a virtual option. This is going to be embedded in our lives, for children and adults, for a long period of time. I don't think we understand yet the impact this will have on us, positive or negative, but I anticipate that this will change things and that we will have more screen time than we've ever had. And that will persist. So it’s important to go back to those foundational things — do you have those core habits in your life that are essential for physical and mental health? If those are in place, then if increased screen time turns out to have negative impact, it will be mitigated by that.

Topics: Research , Community , COVID-19 , Child & Adolescent , CU Medicine Today

Jenna Glover, PhD

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• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
• COVID-19 and substance abuse. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes. Accessed March 12, 2024.
• COVID-19 resource and information guide. National Alliance on Mental Illness. https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Resource-and-Information-Guide. Accessed March 15, 2024.
• Negative coping and PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/gethelp/negative_coping.asp. Accessed March 15, 2024.
• Health effects of cigarette smoking. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#respiratory. Accessed March 15, 2024.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed March 15, 2024.
• Your healthiest self: Emotional wellness toolkit. National Institutes of Health. https://www.nih.gov/health-information/emotional-wellness-toolkit. Accessed March 15, 2024.
• World leprosy day: Bust the myths, learn the facts. Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/world-leprosy-day/. Accessed March 15, 2024.
• HIV stigma and discrimination. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/hiv-stigma/. Accessed March 15, 2024.
• Diabetes stigma: Learn about it, recognize it, reduce it. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed March 15, 2024.
• Phelan SM, et al. Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine. 2023; doi:10.1370/afm.2924.
• Stigma reduction. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/od2a/case-studies/stigma-reduction.html. Accessed March 15, 2024.
• Nyblade L, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Medicine. 2019; doi:10.1186/s12916-019-1256-2.
• Combating bias and stigma related to COVID-19. American Psychological Association. https://www.apa.org/topics/covid-19-bias. Accessed March 15, 2024.
• Yashadhana A, et al. Pandemic-related racial discrimination and its health impact among non-Indigenous racially minoritized peoples in high-income contexts: A systematic review. Health Promotion International. 2021; doi:10.1093/heapro/daab144.
• Sawchuk CN (expert opinion). Mayo Clinic. March 25, 2024.

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