The United States Surgeon General has declared a youth mental health crisis. He says social media is a primary driver and he’s calling for immediate action. Let’s see what’s up.
When asked about the impact of social media on their body image, 46% of adolescents aged 13-17 said social media makes them feel worse…
Molly Rose Russell was 14-years-old when she died on November 21, 2017.
At the conclusion of last September’s judicial inquiry, her death was attributed to “…an act of self-harm while suffering from depression and the negative effects of online content.”
It was the first ruling of its kind.
Social media and youth mental health advisory
On May 23, 2023, the United States Department of Health and Human Services issued a news release announcing that Surgeon General Dr. Vivek Murthy is urging action to ensure social media environments are healthy and safe.
Citing the risk of harm to the mental health and well-being of children and adolescents, he called on policymakers, technology companies, researchers, families, and young people to gain insight into the full impact of social media use.
The goal is to create safer and healthier online environments.
As we consider the crisis, it’s important to keep in mind that children and adolescents are in critical stages of brain development. And that makes them especially vulnerable.
The release introduces a 25-page PDF, “Surgeon General’s Advisory on Social Media and Youth Mental Health.”
Reality
Up to 95% of young people ages 13-17 report using a social media platform and more than a third say they use it “almost constantly.”
From Surgeon General Murthy
Let’s get right on it by going to the source, Surgeon General Murthy…
The most common question parents ask me is, ‘is social media safe for my kids’. The answer is that we don’t have enough evidence to say it’s safe, and in fact, there is growing evidence that social media use is associated with harm to young people’s mental health.
He goes on to point out that children and adolescents are often exposed to violent and sexual content on social media, as well as bullying and harassment.
And for too many young people, hanging out on social media compromises sleep and in-person time with family and friends.
According to Murthy…
We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.
Good, sounds like he means business.
The impact of social media on children and adolescents
Of course, the impact of social media on children and adolescents depends upon a number of factors…
Amount of time spent on platforms
Type of content being selected or to which they’re exposed
Degree to which the content disrupts health essential activities, such as sleep and physical activity
Cultural, historical, and socio-economic factors
No doubt, there are more.
Benefits
Is it too much to hope for?
Can children and adolescents benefit from social media? Sure they can, as long as rules pertaining to the factors above are made – and monitored.
That’s not unreasonable, is it?
Let’s catch the view from the adolescent side of the fence. They report that social media helps them feel more accepted (58%), like they have people who can support them through tough times (67%), like they have a place to show their creative side (71%), and more connected to what’s going on in their friends’ lives (80%).
The dark side
Okay, we know social media use can be excessive and problematic for some children and adolescents. Let’s do details…
Recent research shows that adolescents who spend more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, such as depression and anxiety
Relating to the previous point, a recent survey of teenagers found that the average amount of time spent on social media is 3.5 hours a day
One-third or more of girls aged 11-15 say they feel “addicted” to certain social media platforms and over half of teenagers report that it would be hard to give up
When asked about the impact of social media on their body image, 46% of adolescents aged 13-17 said social media makes them feel worse, 40% said it makes them feel neither better nor worse, and only 14% said it makes them feel better
64% of adolescents are “often” or “sometimes” exposed to hate-based content through social media
Studies have shown a relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth
Extremely problematic, don’t you think?
The Surgeon General’s recommendations
The Surgeon General certainly makes the case for a major crisis. And a tip of the hat to him for suggesting ways to address it. Let’s take a look…
Policymakers
Murthy calls upon policymakers to take steps to strengthen safety standards and limit access in ways that make social media safer for children and adolescents. He also suggests funding for additional research.
Tech companies
Murthy states that tech companies can better and more transparently assess the impact of their products on young people, as well as make design and development decisions that prioritize safety and health.
He emphasizes protecting privacy, better adherence to age minimums, and improving systems to provide effective and timely responses to complaints.
Parents and caregivers
For my money, this is where it’s at. Murthy recommends establishing tech-free zones that better foster in-person relationships, teaching kids about responsible online behavior and serving as a model, and reporting problematic content and activity.
Children and adolescents
Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse.
Researchers
Researchers need to further prioritize social media and youth mental health work that can support the establishment of standards and evaluation of best practices to support the health of children and adolescents.
Will we pull out of it?
So what do you think? Does the Surgeon General make the case for a social media and youth mental health crisis? How do you feel about his recommendations?
Most important of all, do you think we’ll pull out of it?
My take
We’ve been in an escalating state of social media and youth mental health crisis – along with several contributing crises – for a number of years. And I wouldn’t bet the farm we’ll pull out of it.
Just a few of the things on my mind…
I wrote the first of six Chipur articles on social media’s negative impact upon mental health, most backed by research, 11 years ago. And here we are.
During last year’s judicial inquest into Molly Russell’s death, representatives of the two platforms involved – Pinterest and Instagram (Meta – also owns Facebook) were required to give in-person testimony under oath. That was a first, by the way. The Pinterest rep was contrite. The Meta rep was defiant. Lots of money and power in the equation.
Policymakers and researchers go with the dough. Reference the previous point.
I wonder if we’re past the point of no return when it comes to the involvement of parents and caregivers – children and adolescents. I mean, there are way too many seductive hooks in the world of social media. And the frantic pace of life makes it hard to slow down, consider all the angles, and make adjustments. Our biggest hope are the children, but parents, older siblings, adult family members, and caregivers need to amp up the modeling and guidance.
Pessimistic, I know. Still, I really do believe hope springs eternal.
The chips are down, the stakes are high
The United States Surgeon General has declared a youth mental health crisis. Social media is a primary driver and immediate action is required.
The chips are down, the stakes are high. Will we answer the call?
The coroner ruled it was “…an act of self-harm while suffering from depression and the negative effects of online content.” The truth about social media and teenage suicide – the heartbreaking, yet hopeful, Molly Russell story…
’If you’re struggling, please speak to someone you trust or one of the many support organizations, rather than engage with online content that may be harmful.’ Molly’s father, Ian Russell
Molly Rose Russell was 14-years-old when she died on November 21, 2017.
The inquest – judicial inquiry – at North London Coroner’s Court ended this past Friday.
Coroner Andrew Walker attributed Molly’s death to…
…an act of self-harm while suffering from depression and the negative effects of online content.
He went on to say the online material Molly viewed on platforms, including Pinterest and Instagram, “was not safe” and “should not have been available for a child to see.”
The Molly Russell story
Molly Russell lived in Harrow, a northwest suburb of London. According to her father, she showed no obvious signs of severe emotional or mental illness until a year before her death.
It was then that the family noticed major changes, including feelings of worthlessness, a deepened sense of helplessness, and social withdrawal.
Still, to her family, Molly’s life appeared to be normal.
Her mother’s statement
During the inquiry, a statement was read to the court on behalf of Molly’s mother, detailing the discovery of her daughter’s body.
Mrs. Russell said she was doing household chores on the morning of Molly’s death. After sending one of her other daughters off to school, she began searching the house for Molly – but couldn’t find her.
Then the shock and heartbreak…
I knew then something wasn’t right. I saw a load of her clothes on the floor (of her bedroom). For some reason I thought Molly had run away.
As I looked in her room, I found her…I had no doubt it was her.
I can’t even imagine.
Social media and teenage suicide
Molly Russell
Mr. Walker’s ruling – “…an act of self-harm while suffering from depression and the negative effects of online content.” – was unprecedented.
It was the first of its kind to directly and officially blame a child’s death on social media.
Also unprecedented was requiring the in person, under oath testimony of representatives of the two platforms involved.
Jud Hoffman, Global Head of Community Operations, stood for Pinterest. Meta, owner of Instagram, sent Head of Health & Well-Being Policy, Elizabeth Lagone.
We’ll get into some telling cross-examination details in just a bit.
Molly’s online activity
In her father’s words, Molly’s online environment was “the bleakest of worlds.”
During the inquiry he stated a lot of the content Molly was viewing seemed to “normalise” self-harm and suicide, while discouraging people from pursuing mental health care.
When Mr. Russell looked at Molly’s YouTube account he saw numerous normal teenage “likes” and “follows.” And there were a similar high number of disturbing posts pertaining to anxiety, depression, self-harm, and suicide.
Molly had accounts with Instagram, Pinterest, YouTube, and two with Twitter (one secret).
She used her Instagram account up to 120 times a day.
Of the 16,300 posts she saved, shared, or liked on Instagram in the six-month period before her death, 2,100 were depression, self-harm, or suicide-related.
Mr. Russell expressed shock when he saw the subject lines of the emails were clearly promoting depression-related content.
Trapped by algorithms
Perhaps most exasperating of all, some of the emails were selected and provided without a request from Molly.
How horrific was the material? A testifying child psychiatrist said even he found it disturbing and distressing. After the inquiry, he said there were times over several weeks that he was unable to sleep well.
And given that a depressed 14-year-old viewed the material over a period of months, there could be no doubt Molly was affected.
Even after her death, the disturbing content continued to be delivered.
John Naughton of The Guardian nailed it when he wrote, “Molly Russell was trapped by the cruel algorithms of Pinterest and Instagram.”
Pinterest and Meta respond
During the inquiry, cross-examination of the two company representatives spoke volumes.
The Russell family’s lawyer, Oliver Sanders KC, walked Mr. Hoffman of Pinterest through the last 100 posts Molly had seen before she died.
Hoffman expressed deep regret that she was able to access some of the content.
He even admitted that recommendation emails sent by Pinterest to Molly, such as “10 depression pins you might like,” contained disturbing content and images he wouldn’t show his children.
Meta’s turn
It was a little different with Ms. Lagone of Meta. Evidence was presented showing that, as said earlier, of the 16,300 posts Molly saved, shared, or liked on Instagram in the six-month period before her death, 2,100 were depression, self-harm, or suicide-related.
Sanders then asked if she believed the material is safe for children.
Lagone’s first reply was it’s safe for people to be able to express themselves. Not satisfied, he asked again. Lagone said she didn’t find it a binary question.
Sanders was relentless. He asked, “So you are saying yes, it is safe or no, it isn’t safe?”
Lagone replied, “Yes, it is safe.”
The aftermath
Advocate for health and peace for our young people.
Instagram already announced in 2019 that it will ban all graphic self-harm images and drawings as part of a series of changes made in response to Molly’s death.
Mr. Hoffman admitted Pinterest was “not safe” in 2017, when Molly died. And they have since introduced measures to limit access to dangerous content.
However, when the co-founder of Pinterest, Ben Silbermann – a father of two, was asked at his home if he believed his platform is dangerous for kids, he replied, “I don’t have any comment.”
Her father’s grace and vision
In response to the coroner’s ruling, Molly’s father had the grace and vision to say “there is always hope” no matter how “dark it seems.”
More of his wisdom and love…
If you’re struggling, please speak to someone you trust or one of the many support organizations, rather than engage with online content that may be harmful.
Thank you, Molly, for being my daughter. Thank you.
We should not be sitting here. This should not happen because it does not need to happen. We told this story in the hope that change would come about.
During the inquiry Mr. Russell emphasized “It’s OK not to be OK.”
International attention
The coroner’s ruling received well-deserved international attention. Here’s what Prince William tweeted from the official Prince and Princess of Wales account…
No parent should ever have to endure what Ian Russell and his family have been through. They have been so incredibly brave. Online safety for our children and young people needs to be a prerequisite, not an afterthought.
Well said.
No more denial and ignorance
The coroner ruled “…an act of self-harm while suffering from depression and the negative effects of online content” killed Molly Russell.
And we all know she isn’t the only one.
Molly’s story is heartbreaking, but now hopeful. Social media’s deadly impact upon our youth can no longer be denied – ignored.
Let’s advocate for health and peace for our young people – and continue to monitor the work of Silicon Valley.
Be sure to connect with the Molly Rose Foundation. Established in Molly’s memory by family members and friends, its mission is to reach out to those under the age of 25 who are at risk of suicide. The foundation provides a ton of help, support, and practical advice.
If you or someone you care about needs help or are in immediate danger, the Foundation has incredible resources. Go to their Find Help page and tap on the green box: “To use the Find a Helpline service click here.” There are other resources available as well.
Children break. It isn’t the norm, but fragility has consequences. In the midst of COVID-19 we’re doing all we can to keep them physically safe. But what about emotionally and mentally? Here’s just one major area of concern…
‘Children may not always be able to describe or verbalise their concerns clearly, so we are looking for marked changes in behaviour or worries…’
Take a look at our buddy above. Cute kid. Of course, the mask is prominent, as we’d expect these days. Who knows what he makes of it, and the death threat behind it?
Perhaps he understands, and he’s okay with it. Maybe not.
I was a second-grader during the Cuban Missile Crisis in 1962. I didn’t understand the death threat, so I wasn’t okay with it. Those drills: sitting under my desk, walking home from school mid-morning with students from my neighborhood – in a straight line like soldiers. Yes, the memories.
But back to our buddy and his peers – even teens. What emotional and mental challenges has COVID-19 brought to their worlds?
Are we doing all we can to keep them safe?
COVID-19 health anxiety among children
Snooping around for article ideas over the weekend, a press release from the University of Bath caught my attention. Seems a team of Bath clinical psychologists published a study on how to respond to COVID-19 generated health anxieties among children and young people. Their work recently appeared in the journal Behavioural and Cognitive Psychotherapy.
In the study, the Bath psychologists emphasized how health anxieties may be triggered by significant changes such as returning to school after a prolonged COVID-19 driven absence.
The team submitted that young people need time to readjust to routine and to deal with their emotions. For some, ongoing health concerns, triggered by the viral threat, hold the potential to be life-interfering. Therefore, parents and teachers need to be aware of telling signs.
Signs of COVID-19 stress in children
“Mommy, I don’t feel good.”
The team pointed-out that not all children and young people will experience or develop COVID-19 triggered health anxiety.
Many of them show incredible resilience. However, for some, especially those already vulnerable to worry and anxiety, the viral events can cause some unpleasant consequences.
Bath clinical psychologist Dr. Jo Daniels makes these important observations…
Children are not immune to worries about their health, or the health of those around them. It is essential that we are able to recognise when normal concerns around COVID become more problematic.
Signs of stress in children may include tummy ache, sleeping problems and not engaging in normally enjoyable activities; for those particularly affected by health related anxiety, you might expect to see excessive hand-washing, exaggerated avoidance of touching objects for fear of picking up the virus, or repeated reassurance-seeking from adults in addition to the usual signs of stress and worry.
Children may not always be able to describe or verbalise their concerns clearly, so we are looking for marked changes in behaviour or worries that get in the way of living life to the full. Teachers also now have a role in this when children return back to school, as they tend to know the children well and school is where they will be spending a large part of their day.
It’s important to note that the team suggest the health anxieties may be triggered by an immediate family member becoming ill. Elevated family tensions due to intense parental worry may also be a problem.
How to best intervene
According to Dr. Maria Loades, also a Bath psychologist…
As children and young people return to school, they need to have the opportunity to catch up, not just academically, but also socially and emotionally.
A big part of this is having the time and space to connect with one another, through play, which gives them a chance to process the emotions and to share their experiences with others. It will take time for children and young people to adjust. While we want to avoid pathologizing normal responses to the pandemic, in children and young people especially, it is vital to spot the signs and intervene early.
The team recommend that parents or teachers who notice that a child or young person is worried about health should offer the opportunity to talk about their worries by gently listening to their concerns. Then it’s about encouraging them to find ways to gradually face and overcome their fears.
When it comes to a child or young person seeking excessive reassurance from others, it’s important to remember that although this may help them in the short-term, it can keep their worries going over time.
Worrying about health at a time like this is understandable, and the team submit it’s important to work with young people to find ways to resolve and understand their worries. It may only take correcting misunderstandings surrounding COVID and the necessary precautions.
The team emphasize that although most children and young people will overcome their fears without specialist help, some may experience levels of anxiety that inhibit functioning and cause significant distress. When this occurs, it’s time to call on those specialists.
Thanks, docs
Yes, though it isn’t the norm, children break – they can be fragile. Of course, they’re also highly resilient, so even if trouble develops during these COVID times, a robust recovery can be expected.
But that’s if troubling signs are detected and addressed.
No doubt we do all we can to keep our children physically safe. Let’s make sure we’re doing the same for them emotionally and mentally.
he number of times I relied upon learning and understanding cause to hold me over when I had no idea how to find relief. Can’t count. Lots of comfort in connecting dots, you know. As it applies to depression, consider this biology…
Child abuse and neglect can be perceived as agents for neurodevelopmental disruption and, depending on when it occurs, can cause serious neurological ‘scars’ in some structures…
Been there? You have no idea how to make those pounding headaches go bye-bye. But there you are on the internet comparing symptoms, desperately trying to at least figure out what’s causing them.
We all feel better (even though we really don’t) when we know what we have – and why it’s happening.
Here’s the biological scoop on one particular cause of depression. Perhaps it’ll hit home…
“Early life stress, HPA axis, and depression”
Came upon a research piece from the journal Psychology & Neuroscience. “Early life stress, HPA axis, and depression” was presented by a team from the Universidade de São Paulo.
The team get things started by pointing-out that adaptive physiological responses occur in our bodies in the midst of acute stress. One of these is increased adrenocorticol hormone secretion, primarily cortisol.
(Okay, stop. To get the most out of this article you have to become at least acquainted with something known as the HPA axis. This oldie but goodie Chipur article will handle the introduction.)
These adaptive responses alter our internal homeostasis – “balance.” And when that happens illness is the likely result. Of particular interest to the team was psychological stress and the interactions with the nervous, endocrine, and immune systems.
Early Life Stress to Mood and Anxiety Disorders
The team consider early life stress as assorted traumatic experiences that occur during childhood and adolescence, which may have repercussions in adulthood. Included are parental loss, separation from parents, childhood illness, family violence, physical/emotional/sexual abuse, and emotional and physical neglect.
The team note that considerable evidence from assorted studies suggests early adverse experiences play a starring role in the development of mood and anxiety disorders.
Their take…
Child abuse and neglect can be perceived as agents for neurodevelopmental disruption and, depending on when it occurs, can cause serious neurological ‘scars’ in some structures, which could make some individuals vulnerable to certain types of psychopathology, especially depression, posttraumatic stress disorder (PTSD), and substance abuse.
Enter the HPA Axis
HPA Axis
So the team submit that changes in homeostasis is a major illness trigger. Enter the HPA axis. Seems the response of the HPA axis is a vivid reflection of an individual’s stress response. To the core, when the HPA axis is activated during the developmental process it becomes permanently unstable, hyperstimulated, vulnerable, or dysfunctional. And that equates to a compromised ability to respond to stress, which for our discussion opens the gates to depression.
During depression, dysfunction of limbic structures, including the hypothalamus (the “H” in HPA axis) and hippocampus, results in hypersecretion of corticotropin-releasing factor (CRF) and other hormones, which determines HPA activation.
Any kink in this system caused by, say, excessive stress, social isolation, or chronic irritability and anger causes difficulty in adapting to stress. And that can predispose an individual to depression by impairing the transmission of serotonin in the hippocampus.
Fact is, hyperactivity of the HPA axis in major depression is one of the most consistent findings in psychiatry. Yep, a significant percentage of patients with major depression have been shown to exhibit increased concentrations of cortisol in plasma, urine, etc. And, go figure, these patients typically show an enlargement of the pituitary and adrenal glands.
The Bottom-Line
Okay, we reviewed what I believe to be a likely common cause of depression. And if you endured early life stress and find yourself wrestling with depression, you now have some connected dots.
And even though there isn’t a 100% “fix,” there’s at least a large measure of comfort in knowing and understanding what’s going-on. Again, that was always huge for me.
But we need to address one more reality. The dynamics we reviewed strongly suggest permanence. And as bitter a pill as that may be to swallow, acceptance (not acquiescence) of our circumstances is always the first step toward recovery.
Never forget, permanence and acceptance don’t equate to the absence of options and relief. I crossed that insight threshold a long time ago and have been so much all the better for it.
So a reasonable biological explanation for depression. Does it help?
If you’re a parent enduring a mood or anxiety disorder, sooner or later that “tell the kids” moment will arrive. After all, your stuff isn’t going anywhere too terribly soon. What will you do when the time comes? Has it?
‘Mommy’s brain is sick. But she goes to doctors. When mom is feeling good we have fun and do lots of stuff. When she isn’t…’
My children are twenty-six and twenty-three. I had my “tell the kids” moment many moons ago. And in addition to my anxiety circumstances, the chat included the stark reality of my alcoholism – with family history.
In my mind, the talk had to happen. And for me, it wasn’t so much about explaining my behavior, rather giving my children a heads-up as to what they may encounter on their own journey. That genes thing, right?
Danielle Workman and the International Bipolar Foundation
Okay, let me set the table. I really wanted to post something on bipolarity this week.
So as I was looking around, I bumped into the International Bipolar Foundation’s site. And lo and behold, they have a blog. So I hit it and found the work of Danielle Workman. Yeah, there she is.
Danielle, her husband, and son call Salt Lake City home. She’s been writing for some twenty years and says her niche is creative non-fiction. Go figure, the title of her first book is Beautiful Bipolar. I’ll pop you some links at the end.
“Mommy’s Bipolar”
So I’m eye-balling Danielle’s blog titles and “Mommy’s Bipolar” grabs my attention. I open the piece and knew within seconds I wanted to feature it here on Chipur. I wrote Danielle, asking for permission, and here we are.
Danielle begins her article by acknowledging that some would consider even thinking about telling her son about her bipolar disorder controversial. And she went on to say that when people would ask if he knew, she’d confirm and add that he’s fine with it. With that, most would gasp, shake their heads in disapproval, or even tear-up.
Still, Danielle knew full well why she told her son, and why she’ll continue to talk to him about her mental situation.
“Mommy’s Brain Is Sick.”
Danielle’s son was three-years-old when she was diagnosed. At twenty-five, she’d had symptoms for some ten years. So now she’s embarking upon a treatment journey and wanted everyone on board.
One day, Danielle and hubby were chatting treatment and their son came into the room. He asked what they were talking about and, well, they told him. The kid nodded and went on about playing with his toys.
Well, about a week later Danielle was in the midst of an emotional breakdown. Boom! Locked in her bedroom, she was sobbing loudly, had self-harmed, and busted-up some picture frames. With the help of her rescue meds she settled-down a bit and her husband entered the room. After surveying the mess he began yelling at Danielle.
That’s when their son made the scene saying, “Please don’t yell at mommy. She has a sick brain.”
It was then that Danielle said, “I think we all need to see a therapist.” And a year into her therapy, and three months stable on meds, the whole family showed at Danielle’s therapist’s office.
After each family member had a chance to talk, the therapist asked their son what he thought about what was going-on. The boy replied…
Mommy’s brain is sick. But she goes to doctors. When mom is feeling good we have fun and do lots of stuff. When she isn’t, daddy and I get to do the fun stuff, and we just have to check-in on mommy to make sure she’s okay.
Smiling, wanting to cry, and with a lump in her throat, it was then that Danielle knew talking to her son about her mental illness was educating him – not harming.
Danielle was proud of the family, and each of its members.
The Key to Her Insight
It isn’t uncommon for Danielle to recall moments with her mentally ill parents – and feel sick. Unlike her son, Danielle knew nothing about mental illness as a child because she was kept in the dark about her parents’ circumstances.
As a result, Danielle says she constantly felt scared for herself, as well as her parents. I mean, she had no idea if when someone was angry they were really that angry or something else was going-on. Danielle believes if she’d have known it was their mental illness talking and not actually, say, mommy talking, she’d have felt so much safer and more secure with her parents.
From Danielle…
Bipolar disorder is ugly, but hiding bipolar disorder is even uglier. And for all the reasons why you shouldn’t tell your children about your mental illness diagnosis, I can think of so many more reasons why you should.
Let’s Wrap It Up
I am so grateful for Danielle’s wisdom and her willingness to share. And as powerful as this portion of her mesage is, there was actually more to her piece. So I encourage you to read it thoroughly, along with her other articles and books.
No doubt about it, that “tell the kids” moment is going to arrive, if it already hasn’t. How will you respond? What will you say? I mean, these are life-changing decisions for your children (and you).
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Okay, let me set the table. I really wanted to post something on bipolarity this week.
