In a recent article published in JAMA Network Open, researchers performed a cross-sectional study amongst 1,231 transgender, nonbinary (TGNB), and cisgender youths in the USA (U.S.) to find out how gender identity moderated the association between social media use (SMU) and indicators of mental health.

Study: Evaluation of Social Media Use, Mental Health, and Gender Identity Amongst US Youths. Image Credit: Marina Demidiuk/Shutterstock.com

This included internalizing and externalizing problems, comparable to depression, body image, and conduct issues.

Background

Many TGNB individuals experience gender dysphoria, a distressed state arising from the disconnect between one’s birth-assigned sex and self-perceived gender identity. In addition they experience minority stress amid a majority social environment fostered through societal processes that harass and discriminate against TGNB individuals. 

Social media activities can provide TGNB individuals an outlet for portraying themselves how they see fit, construct positive connections, and create support systems to guard their mental health. Nonetheless, how TGNB youths use social media outside gender identity exploration is understudied.

There are concerns that SMU can adversely impact mental health, with some researchers suggesting that there may be an association between time spent on social media and struggles with mental health. On this study, researchers considered the minority stress theory and hypothesized that whilst this trend could also be true for cisgender youths, for TGNB youths SMU is likely to be more protective and will not raise the danger for mental health.

In regards to the study

In the current study, researchers used a Qualtrics panel to recruit transgender adolescent participants aged 10 to 17 who resided within the U.S. and readily filled out a web based survey between May and August 2021. 

They selected this age group as representing U.S. youth because substantial gender identity development occurs during adolescence. The study participants self-reported their race and ethnicity, which included American Indian, Asian, Pacific Islander, Black, Hispanic, White, and mixed. 

The team used a patient health questionnaire (PHQ-8) to measure depression, with responses starting from 1 (in no way) to 4 (nearly day-after-day). They used the five-item Strengths and Difficulties Questionnaire (SDQ) to measure emotional and conduct problems. Moreover, they used a five-point Likert scale to judge body image, with 1 and 5 indicating never shamed to at all times shamed. 

The study variables covered: social media use duration; age on the time of using the smartphone for the primary time; whether the use was lively or passive; how they compared social media sites; did they take intentional breaks from their smartphones; did they find SMU problematic; the digital well-being of faculties attended; whether or not they cleaned or curated their social media feed or followers; and their mindfulness around SMU.

Finally, the team recruited seven adolescents as an advisory board from two focus groups to co-interpret the study findings allowing insider perspectives. The primary and second focus groups comprised 4 cisgender adolescents aged 14 to 17 and three TGNB adolescents aged 14 to 16, respectively.

Results

The study had many essential findings. First, in comparison with cisgender youth, TGNB youth had higher depression, emotional and conduct issues, and negative body image. Nonetheless, their use of social media was related to fewer mental health problems as they is likely to be cautiously creating digital spaces free from the negative interactions that plagued them elsewhere, e.g., in school. 

Accordingly, cleansing and curating feeds lowered depression levels amongst TGNB youths but not for cisgender youths. Researchers hypothesize that this might be as a consequence of TGNB youths curating a secure space as a consequence of bullying and harassment. One participant talked about having more control over online space as they surrounded themselves with people having similar beliefs.

Further investigation is required into why the pattern was the alternative for cisgender youths. The researchers hypothesise that perhaps there was fear of offending peers by unfollowing them on social media, meaning that they benefited from a social media break relatively than curating feeds.

One other commentary that reinstated the fragile balance of gender identity-related risks and advantages of SMU in youth was that taking intentional technology breaks was markedly related to increased depression and emotional issues for TGNB but not cisgender youths. 

Indeed, for TGNB youths, social media was a key avenue for social acceptance; thus, breaks were potentially detrimental to their mental health. For TGNB youths, attending a faculty with a powerful media literacy program was related to positive outcomes. It facilitated greater intentionality around SMU.

Conclusions

TGNB youths face on a regular basis minority stress, but social media might actually confer protective effects for TGNB youths, and their parents and guardians could focus more on how social media generally is a resource for his or her children relatively than specializing in how screen time could also be leading to mental health struggles.
 
Likewise, policymakers and faculty personnel should design policies considering the differential associations of SMUs based on gender identity. Policies severely limiting SMU amongst youths is probably not the most effective consequence for TGNB youths. As an alternative, schools should encourage school media literacy programs. 

Most significantly, pediatricians or doctors treating adolescents should consider asking them about the small print of SMU. Their questions should transcend screen time during consultations, and their approach ought to be more nuanced based on the patient’s gender identity.

The study results suggested that while TGNB youths are at a better risk for antagonistic mental health outcomes than cisgender youths, this higher risk will not be related to time spent on social media. 

Quite the opposite, SMU appeared to lower their mental health issues. Social media might even be protective for some TGNB youths, particularly when used appropriately. It highlights and emphasizes that while examining the associations between SMU and health, researchers should look specifically at gender identity.