'Addiction to Screen Time Tied to Suicidality in U.S. Kids'

 

• Addictive screen use trajectories were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids in a large study.
• Increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories, and high addictive use trajectories for all screen types -- social media, mobile phones, and video games -- were associated with suicide-related outcomes.
• Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, and the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

Addictions to social media, mobile phones, and video games were associated with suicidal behaviors and ideation as well as worse mental health among U.S. kids, a cohort study suggested.

Addictive use as indicated by kids' self-reported compulsive use, difficulty disengaging, and distress when not using these technologies was common, with nearly one-third of participants scoring increasingly higher for addiction to social media or mobile phones beginning at age 11 years, Yunyu Xiao, PhD, of Weill Cornell Medicine/NewYork-Presbyterian in New York City, and colleagues reported in JAMAopens in a new tab or window.

Increasingly addictive use trajectories for social media and mobile phones were associated with higher risks of suicide-related outcomes, as were high addictive use trajectories for all three screen types in the cohort of 4,285 kids age 10 years who were followed for 4 years.

Compared with low addictive use trajectories, the high video game addictive use trajectory showed the largest relative difference in internalizing symptoms like anxiety and depression, while the increasing social media addictive use trajectory showed the largest relative difference in externalizing symptoms like aggression and rule-breaking.

"While most existing research has focused on total screen timeopens in a new tab or window, emerging evidence suggests that addictive screen use may be a more salient risk factoropens in a new tab or window for suicidality and mental health in youths," Xiao and colleagues wrote. "Addictive use may vary by platform and follow distinct developmental trajectories. However, addictive use trajectories among youths have not been well characterized, and how they may relate to suicide-related and mental health outcomes remains largely unknown."

Indeed, the study's findings "suggest that addictive screen use is more strongly linked to negative mental health outcomes than screen time alone," wrote Jason Nagata, MD, MSc, of the University of California San Francisco, and colleagues in an accompanying editorialopens in a new tab or window. "These results emphasize the importance of addressing not just screen time but also addictive behaviors in adolescents."

High and/or increasing addictive screen use trajectories were common among study participants, who had a mean age of 10 years at baseline. Nearly one-third of kids had an increasing addictive use trajectory for social media or mobile phones beginning at 11 years of age. And about 41% of participants had a high addictive use trajectory for video games.

Notably, there were 30% to 40% of kids who "started with low addiction use and ended up with higher addiction use," Xiao told MedPage Today in emailed remarks. "[I]f you do not follow the kids over time, you would miss this substantial group that shifts from low risk to higher risk."

Overall, 5.1% of participants reported suicidal behaviors and 17.9% reported suicidal ideation at follow-up of 4 years. Child and parent reports over the prior year were assessed via the Kiddie Schedule for Affective Disorders and Schizophreniaopens in a new tab or window, which covers nine outcomes ranging from passive ideation to preparatory actions for imminent suicidal behavior and suicide attempt. For other mental health concerns, there were parent-reported internalizing and externalizing symptoms using the Child Behavior Checklistopens in a new tab or window.

For social media, patterns of use that peaked with high addictive use scores or that grew increasingly addictive were associated with significantly higher risk of suicidal behaviors (RR 2.39 and 2.14, respectively, P<0.001 for both) and of suicidal ideation (RR 1.51 and 1.46, P<0.001 for both) compared with the low addictive risk trajectory.

For mobile phones, the high addictive use trajectory was associated with higher risk of suicidal behaviors and suicidal ideation (RR 2.17 and 1.50, both P<0.001) than the low addictive use trajectory. And the increasing addictive use trajectory was modestly associated with a greater relative risk of suicidal ideation (RR 1.22, P<0.001).

As for video games, the high addictive use trajectory was associated with higher risk of suicidal behaviors (RR 1.54, P=0.004) and suicidal ideation (RR 1.53, P<0.001) than the low addictive risk trajectory.

Total screen time at baseline was not associated with suicidal behaviors or ideation or internalizing or externalizing symptoms, they found.

The study used data from the Adolescent Brain Cognitive Development (ABCD) study, with population-based samples from 21 sites across the U.S.

Limitations included the observational nature of the study and reliance on self-reported data, Xiao and colleagues noted. Also, the pandemic could have influenced screen time, the ABCD study did not assess multitasking across screen platforms, and 4-year follow-up data were not available for all participants.

Additionally, psychosocial and behavioral factors like bullying, adverse childhood experiences, and social determinants of health were not assessed, they noted.

Ultimately, "[n]ow that we know the addictive use pattern is so important," Xiao said, "we need to develop intervention strategies and test them in controlled clinical trials."

Disclosures

The study was supported by funding from the National Institute of Mental Health, the American Foundation for Suicide Prevention, and Google.

Xiao disclosed no relevant relationships with industry. A co-author of the study reported receipt of royalties for commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene and the Columbia Pathways App from Columbia University.

The editorialists did not report any relevant conflicts of interest.

Primary Source

JAMA

Source Reference: opens in a new tab or windowXiao Y, et al "Addictive screen use trajectories and suicidal behaviors, suicidal ideation, and mental health in US youths" JAMA 2025; DOI: 10.1001/jama.2025.7829.

Secondary Source

JAMA

Source Reference: opens in a new tab or windowNagata JM, et al "Beyond screen time -- Addictive screen use patterns and adolescent mental health" JAMA 2025; DOI: 10.1001/jama.2025.8135.

https://www.medpagetoday.com/pediatrics/generalpediatrics/116127