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Monday, April 18, 2011
By Tristan Gorrindo, MD and Eugene V. Beresin, MD
Eugene Beresin, MD. Director, Center for Mental Health and Media, Department of Psychiatry, Massachusetts General Hospital
Earlier this month, the American Academy of Pediatrics (AAP) released a clinical report entitled, “The Impact of Social Media on Children, Adolescents, and Families.” While the report mostly describes the challenges parents, teachers, and pediatricians face in the new digital world, one piece of the report caught our attention in particular. The report makes note of a previously described phenomenon afflicting teens, “Facebook Depression.” The AAP defines this novel diagnosis as, “depression that develops when preteens and teens spend a great deal of time on social media sites, such as Facebook, and then begin to exhibit classic symptoms of depression.”
While we applaud the efforts of the AAP to bring the dangers of unmonitored or extensive social media use to the attention of parents and clinicians, we worry that the term “Facebook Depression,” might be more confusing than helpful. As child psychiatrists, what concerns us is that there is no scientific study of this diagnosis, nor are there criteria for how this diagnosis is made. This might be confusing for parents and clinicians who see it billed in this report with the same level of importance as sexting, cyberbullying, and other behaviors that we know to be detrimental to children. Additionally, the term “Facebook Depression,” confuses the real meaning of the term depression. A diagnosis of “depression” should not be based on the amount of time one spends with a particular media. Certainly, a student who practices piano five hours a day and then develops symptoms of depression, does not have “piano depression.” While it may be true that the excessive use of social media may be a form of an “addiction” or other “disorder” provided that it is dysfunctional and disrupts social, academic, or recreational functioning, these behaviors have not yet been formally labeled as disorders because careful research and clarification of these behaviors has not yet been completed – a similar process is needed before “Facebook Depression” can be deemed a valid disorder.
Tristan Gorrindo, MD. Assistant Director, Center for Mental Health and Media, Department of Psychiatry, Massachusetts General Hospital
Most importantly, we worry that using the term “Facebook depression,” might mask the true problem afflicting a child. Here we find the classic problem of which came first -- the chicken or the egg? But in this case, was it Facebook which made the child depressed, or was the child depressed and therefore spending more time on Facebook? Clinical depression is more than just being sad; it’s a neurobiological disorder that comes with a whole set of ancillary symptoms such as irritability, social isolation, changes in sleep and appetite, poor concentration.
Imagine Jimmy, a 16 year-old boy who develops (traditional) depression. If Jimmy is like most teenage boys with depression, he starts to pull away from his friends and family as his depression worsens. He might even quit his high school baseball team and his grades might start to fall. All that friends and family know of Jimmy is that he’s spending more time alone in his room, roaming around Facebook and listening to mp3’s of the Beatles. A casual observer from the outside might see this behavior and say, “oh’ Jimmy -- he’s just Facebook depressed. Look at how much time he’s spending online. What he really needs is to spend less time on Facebook and then everything will be okay.” However, limiting his access to Facebook will not improve his mood or help adjust the neurobiology which underlies his depression. Rather, what would help is referring him to his pediatrician, a counselor or therapist, or a child psychiatrist for a comprehensive treatment intervention.
In our work with depressed teens and teens with problematic internet behaviors, we see a broad number of things that could be contributing to why a child is spending a lot of time online: social anxiety or social awkwardness, feeling unsafe at school, and depression, just to name a few. In fact, one could argue from the opposite angle that a teenager with severe social anxiety might attempt to combat the fear of interacting face to face with others using Facebook as a means of “opening a door” that is too hard to do in real time.
So, what’s a parent or clinician to do with the AAP’s new diagnosis of “Facebook depression?” While we don’t personally believe that Facebook can cause depression, we agree with the AAP report that parents should be aware of how much time their children are spending online and that they should be monitoring the types of activities their children are engaging in. In fact, our advice to pediatricians and parents extends beyond what is outlined in the AAP statement:
1. For pediatricians, we recommend that they incorporate an assessment of a teens “media diet” into all their check-up visits with teens. A Media Inventory should be a core part of all medical histories for children, adolescents and adults.
2. For parents, we agree with the AAP recommendation that they should be discussing internet use with their kids. However, we feel that these discussions should start long before their children are teens. Parents should begin talking to kids about computer use as early as possible. In fact, parents should be talking with their kids about relationships, risky behavior and other important social issues from early childhood – setting a tone early on that parents are open to discussion about confusing and difficult topics.
3. From researchers, anyone who treats children needs a better understanding of what the impact of social media truly is. We need to know the true risks of prolonged social media use and we need strict criteria which help us know when a child has crossed over from excessive usage into what we would deem problematic or pathologic usage.
4. Many parents don’t understand social media websites (such as Facebook), let alone know how to offer guidance to their children about it. Parents should educate themselves using websites like http://getnetwise.org/ , http://www.netsmartz.org/Parents , or http://www.commonsensemedia.org/advice-for-parents. Pediatricians and parents should strive toward media literacy by frequenting such sites, that review internet games, sites, social media sites, etc.
5. Kids should not be on social media websites before they are emotionally ready to handle what they might encounter. Facebook draws an arbitrary line at age 13 and says that no child younger than that age should be on their website. However, that age might be different for each child. If parents are worried or don’t know, they should discuss it with school counselors or their pediatrician.
6. If you are worried about a child who appears depressed, for whatever reason, seek help.
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