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Current Research in Social Psychology

Editors: michael lovaglia, university of iowa; shane soboroff, st. ambrose university.

Current Research in Social Psychology  ( CRISP ) is a peer reviewed, electronic journal publishing theoretically driven, empirical research in major areas of social psychology. Publication is sponsored by the  Center for the Study of Group Processes  at the  University of Iowa,  which provides free access to its contents. Authors retain copyright for their work. CRISP is permanently archived at the Library of the University of Iowa and at the Library of Congress. Beginning in April, 2000,  Sociological Abstracts  publishes the abstracts of CRISP articles.

Citation Format:  Lastname ,  Firstname . 1996. "Title of Article."  Current Research in Social Psychology  2:15-22 https://crisp.org.uiowa.edu

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Social psychology.

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Social Psychology publishes innovative and methodologically sound research and serves as an international forum for scientific discussion and debate in the field of social psychology. Topics include all basic social psychological research themes, methodological advances in social psychology, as well as research in applied fields of social psychology. The journal focuses on original empirical contributions to social psychological research, but is open to theoretical articles, critical reviews, and replications of published research. 

The journal was published until volume 38 (2007) as the Zeitschrift für Sozialpsychologie (ISSN 0044-3514). Drawing on nearly 50 years of experience and tradition in publishing high-quality, innovative science , Social Psychology has an internationally renowned team of editors and consulting editors from all areas of basic and applied social psychology, thus ensuring that the highest international standards are maintained. 

Social Psychology offers a transparent peer-review process and a short time-lag between acceptance of papers and publication.

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The 9 Major Research Areas in Social Psychology

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Mitchell Funk / Getty Images

Social Cognition

Violence and aggression, prosocial behavior, prejudice and discrimination.

• Social Identity

Group Behavior

Social influence, interpersonal relationships.

Social psychology is a branch of psychology that studies a wide range of subjects related to social behavior. This includes studying how people interact, factors that affect social perceptions, the formation of attitudes, and how groups influence individuals.

Research in social psychology is often focused on subjects that fall within three broad areas:

• Social influence : Social influence refers to the ways in which our opinions and behavior are affected by the presence of others. This includes studies on topics such as conformity, obedience, and social pressure.
• Social perception : Social perception refers to the ways in which we form impressions of other people. This includes research on topics including first impressions, stereotyping, and prejudice.
• Social interaction : Social interaction refers to the ways in which we interact with other people. This includes research on topics such as communication, aggression, and altruism.

This article discusses some of the major areas of research in social psychology. It also explores some examples of the types of research that social psychologists might conduct within these subject areas.

Social cognition is concerned with the processing, storage, and application of social information. For example, research in this area of social psychology may focus on the development and use of social schemas. 

Schemas are our general ideas about the world, how things are, and how things work. In the case of social schemas, these ideas relate to how we expect people to behave in different situations.

These mental categories allow us to function without constantly stopping to interpret everything around us. We also develop associations between related schemas, which play an important role in the thought process and social behavior.

One area of social cognition research concerns person perception , which is how people form impressions of others. 

First impressions are the judgments we form about someone based on limited information. Studies have shown that first impressions happen within mere milliseconds and are based on several cues, such as facial expressions, body language, voice, and the beliefs held by the observer.  

Understanding how people acquire and process social information allows researchers to better explain how it can affect social interactions and individual behavior.

Attitudes and Attitude Change

Another major research area in social psychology involves the study of attitudes . Social psychologists are interested in the components of attitudes, how attitudes develop, and how attitudes change.

Attitudes are evaluations of people, objects, or issues. They can be positive (e.g., "I like chocolate") or negative (e.g., "I dislike taxes"). Various factors contribute to the development of attitudes, including upbringing and experiences, although genetics also appears to play a role in shaping them.

Researchers have identified three core components of attitude: an affective component, a behavioral component, and a cognitive component. Often referred to as the "ABCs of attitude," these elements describe how we feel, behave, and understand.

Some other characteristics of attitudes that researchers may be interested in include:

• How they are best measured : Some attitudes can be measured through self-report questionnaires, but others might be better measured using tools like facial expression or arousal levels.
• Factors that affect their strength : Attitudes can vary considerably in terms of their intensity. The strength of these attitudes directly impacts the degree to which they will guide their actions. Direct experiences and frequent exposure to the attitude can impact its strength.
• How attitudes affect behavior : Researchers are also interested in understanding how and when these attitudes influence people's actions. For example, social psychologists might explore how attitudes develop through exposure to social media sources and how those attitudes relate to real-world actions.

Attitudes are an important research topic in social psychology because they impact how people view and interact with others.

What causes violence and aggression ? While many different factors play a role, social psychologists are interested in understanding the social influences that shape violent behavior.

Research in this area looks at numerous social factors that may cause aggression, including:

• Situational variables that might contribute to aggression
• Non-physical types of aggression such as name-calling or gossiping
• How aggression is learned via modeling, such as witnessing adults or children engage in aggressive or violent behaviors
• How violence in the media affects behavior in the real world
• Strategies that can be effective in the reduction of aggression and violence
• The role social learning plays in producing aggressive behaviors and actions
• How public policy can be used to curb violent behavior

Research into the epidemic of gun violence is an example of how social psychologists are trying to understand the variables that contribute to a problem, and then utilize that knowledge to come up with actionable solutions.

Prosocial behavior is another major research area in social psychology. Prosocial behaviors are those that involve helping and cooperating.

Researchers often look at why people help others, as well as why they sometimes refuse to help or cooperate. The bystander effect is an example of a social phenomenon in the subject area of prosocial behavior.

Much of the research in the area of bystander effect was prompted by the murder of a young woman named Kitty Genovese. This case captured national attention when reports suggested that neighbors had witnessed her attack and murder but failed to call the police for help.

Later reviews of the case indicate that few (if any) of the neighbors had a clear view of the scene and were unaware of what was happening. Nevertheless, the case became mythologized in psychology textbooks and prompted a surge of interest in prosocial behaviors.

Research inspired by the Genovese case produced a great deal of information on prosocial behavior and how and why people choose—or sometimes refuse—to help others.

Prejudice, discrimination, and stereotypes exist in any social group. Social psychologists are interested in the origins, causes, and effects of these attitudes and social categorizations.

Some questions that social psychologists explore include:

• How does prejudice develop?
• Why are stereotypes maintained in the face of contrary evidence?
• How can prejudice be measured?
• What factors contribute to the formation of prejudice and discrimination?
• Are there effective ways to reduce prejudice and discrimination?

For example, researchers have found that several factors contribute to the development of prejudice, including stereotypes, social categorization, and social influences. Another factor that plays a part is the outgroup homogeneity bias, or the tendency to view people outside of our social group as being more homogenous than members of our own group.

By learning more about the psychology of prejudice and discrimination, researchers can look for solutions to help help prevent it from happening.

Self and Social Identity

Our perceptions of social identities and ourselves are another important research area in social psychology. Some of the questions that researchers explore include:

• How do people come to know and understand themselves?
• How do these self-perceptions affect our social interactions?
• How does belonging to different social groups shape individual identity?
• How do intersecting group members influence self-perception and self-identity?

Social psychologists are interested in learning more about how this inner life influences our outer lives and social world. Self-awareness, self-esteem, self-concept , and self-expression are only a few factors that influence our social experience.

For example, social comparison is a process that can impact how people view themselves. Upward social comparison involves comparing the self to others who are perceived as higher in status and ability, while downward social comparison focuses on making comparisons to those who are lower in status or ability.

Upward comparisons can leave people feeling like they don't measure up, damaging self-esteem. Downward comparisons, on the other hand, can help enhance self-esteem.

By learning more about how social identities and self-perceptions interact, social psychologists are better able to understand how social factors can influence how individuals feel about themselves and their identities.

Group behavior is defined as the actions, feelings, or thoughts of a collective of people. Such groups involve two or more people who share something in common such as identity, purpose, and belief.

The behavior of groups is one of the largest research areas in social psychology. Most people realize that groups tend to behave differently than individuals. These group behaviors are sometimes beneficial but can also be detrimental.

Social psychologists often look at topics such as:

• Group dynamics
• Group decision making
• Cooperation
• Group influence

Norms are an example of an aspect of group behavior that can guide how group members think, behave, or act. Norms are standards that emerge and guide how another member judge one another.

Social psychologists are also interested in the role of social influence on behavior and decision-making. Topics such as the psychology of persuasion , peer pressure, conformity , and obedience are only a few of those studied in this area of social psychology.

One example of research in this area of social psychology was Milgram's obedience studies conducted during the 1960s. The experiments found that when ordered by an authority figure, participants were willing to deliver what they believed were dangerous and painful electrical shocks to another person. While the shocks were staged, the research suggested that many people were willing to go to great lengths to obey authority.

Research has helped reveal the power of social influence and has uncovered ways to help people resist influence.

Social relationships play a major role in shaping behavior, attitudes, feelings, and thoughts. Social psychologists study how these interpersonal relationships affect people by looking at attachment , liking , love , and attraction.

Some research questions that social psychologists might explore include:

• How important are interpersonal relationships to individual well-being?
• What factors play a role in attraction?
• How do interpersonal relationships influence helping behaviors in groups?
• How do close relationships affect individuals?

Close relationships are relationships in which we feel a strong sense of connection and intimacy with another person. Studies on close relationships have shown that they are associated with many benefits, such as increased happiness and satisfaction with life.

A Word From Verywell

Social psychology is a rich subject that explores how social perception, social interaction, and social influence affect both groups and individuals. Researchers in this field are interested in various topics, including attitudes, attraction, close relationships, and helping behavior. By learning more about these subjects, social psychologists can add to our understanding of social behavior and its effect on individual well-being.

Venta A, Hatkevich C, Mellick W, Vanwoerden S, Sharp C. Social cognition mediates the relation between attachment schemas and posttraumatic stress disorder . Psychol Trauma. 2017;9(1):88-95. doi:10.1037/tra0000165

Stolier RM, Hehman E, Keller MD, Walker M, Freeman JB. The conceptual structure of face impressions . Proc Natl Acad Sci U S A . 2018;115(37):9210-9215. doi:10.1073/pnas.1807222115

Markovitch N, Netzer L, Tamir M. Will you touch a dirty diaper? Attitudes towards disgust and behaviour [published correction appears in Cogn Emot . 2016;30(3):i].  Cogn Emot . 2016;30(3):592–602. doi:10.1080/02699931.2015.1020049

Olson JM, Vernon PA, Harris JA, Jang KL. The heritability of attitudes: A study of twins . J Pers Soc Psychol . 2001;80(6):845-60. PMID: 11414369.

Van Ryzin MJ, Dishion TJ. From antisocial behavior to violence: a model for the amplifying role of coercive joining in adolescent friendships .  J Child Psychol Psychiatry . 2013;54(6):661–669. doi:10.1111/jcpp.12017

Kassin SM. The killing of Kitty Genovese: What else does this case tell us?   Perspect Psychol Sci . 2017;12(3):374–381. doi:10.1177/1745691616679465

Rhodes M, Mandalaywala TM. The development and developmental consequences of social essentialism .  Wiley Interdiscip Rev Cogn Sci . 2017;8(4):10.1002/wcs.1437. doi:10.1002/wcs.1437

Hjerm M, Eger M, Danell R.  Peer attitudes and the development of prejudice in adolescence .  Socius Sociolog Res Dynamic World . 2018;4:1-11. doi:10.1177/2378023118763187

American Psychological Association.  Outgroup homogeneity bias .

Drury J, Carter H, Cocking C, Ntontis E, Tekin Guven S, Amlôt R. Facilitating collective psychosocial resilience in the public in emergencies: Twelve recommendations based on the social identity approach [published correction appears in Front Public Health . 2019 Jun 27;7:181].  Front Public Health . 2019;7:141. doi:10.3389/fpubh.2019.00141

Rahman T. Extreme Overvalued Beliefs: How Violent Extremist Beliefs Become "Normalized" .  Behav Sci (Basel) . 2018;8(1):10. doi:10.3390/bs8010010

Russell NJC.  Milgram's obedience to authority experiments: Origins and early evolution .  Br J Soc Psychol . 2011;50:140-162. doi:10.1348/014466610X492205

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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• Review Article
• Published: 07 May 2024

Mechanisms linking social media use to adolescent mental health vulnerability

• Amy Orben   ORCID: orcid.org/0000-0002-2937-4183 1 ,
• Adrian Meier   ORCID: orcid.org/0000-0002-8191-2962 2 ,
• Tim Dalgleish   ORCID: orcid.org/0000-0002-7304-2231 1 &
• Sarah-Jayne Blakemore 3 , 4  

Nature Reviews Psychology ( 2024 ) Cite this article

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• Psychiatric disorders
• Science, technology and society

Research linking social media use and adolescent mental health has produced mixed and inconsistent findings and little translational evidence, despite pressure to deliver concrete recommendations for families, schools and policymakers. At the same time, it is widely recognized that developmental changes in behaviour, cognition and neurobiology predispose adolescents to developing socio-emotional disorders. In this Review, we argue that such developmental changes would be a fruitful focus for social media research. Specifically, we review mechanisms by which social media could amplify the developmental changes that increase adolescents’ mental health vulnerability. These mechanisms include changes to behaviour, such as sharing risky content and self-presentation, and changes to cognition, such as modifications in self-concept, social comparison, responsiveness to social feedback and experiences of social exclusion. We also consider neurobiological mechanisms that heighten stress sensitivity and modify reward processing. By focusing on mechanisms by which social media might interact with developmental changes to increase mental health risks, our Review equips researchers with a toolkit of key digital affordances that enables theorizing and studying technology effects despite an ever-changing social media landscape.

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Introduction.

Adolescence is a period marked by profound neurobiological, behavioural and environmental changes that facilitate the transition from familial dependence to independent membership in society 1 , 2 . This critical developmental stage is also characterized by diminished well-being and increased vulnerability to the onset of mental health conditions 3 , 4 , 5 , particularly socio-emotional disorders such as depression, and eating disorders 4 , 6 (Fig. 1 ). Notable symptoms of socio-emotional disorders include heightened negative affect, mood dysregulation and an increased focus on distress or challenges concerning interpersonal relationships, including heightened sensitivity to peers or perceptions of others 6 . Although some risk factors for socio-emotional disorders do not necessarily occur in adolescence (including genetic predispositions, adverse childhood experiences and poverty 7 , 8 , 9 ), the unique developmental characteristics of this period of life can interact with pre-existing vulnerabilities, increasing the risk of disorder onset 10 .

Meta-analytic proportion of age of onset of anxiety (red), obsessive-compulsive disorder (purple), eating disorders (orange), personality disorders (green), schizophrenia (grey) and mood disorders (blue). The peak age of onset (dotted lines) is 5.5 and 15.5 years for anxiety, 14.5 years for obsessive-compulsive disorder, 15.5 years for eating disorders and 20.5 years for personality disorders, schizophrenia and mood disorders. Adapted from ref. 258 , CC BY 4.0 ( https://creativecommons.org/licenses/by/4.0/ ).

Over the past decade, declines in adolescent mental health have become a great concern 11 , 12 . The prevalence of socio-emotional disorders has increased in the adolescent age range (10–24 years 2 ) 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , leading to mounting pressures on child and adolescent mental health services 16 , 21 , 22 . This increase has not been as pronounced among other age groups when compared with adolescents 20 , 22 , 23 (measured in ref.  20 , ref.  22 and ref.  23 as age 12–25 years, 12–20 years and 18–25 years, respectively), even if some studies have found increases across the entire lifespan 24 , 25 . Although these trends might not be generalizable across the world 26 or to subclinical indicators of distress 15 , similar trends have been found in a range of countries 27 . Declines in adolescent mental health, especially socio-emotional problems, are consistent across datasets and researchers have argued that they are not solely driven by changes in social attitudes, stigma or reporting of distress 28 , 29 .

Concurrently, adolescents’ lives have become increasingly digital, with most young people using social media platforms throughout the day 30 . Ninety-five per cent of UK adolescents aged 15 years use social media 31 , and 50% of US adolescents aged 13–17 years report being almost constantly online 32 . The social media environment impacts adolescent and adult life across many domains (for example, by enabling social communication or changing the way news is accessed) and influences individuals, dyads and larger social systems 33 , 34 , 35 , 36 . Because social media is inherently social and relational 37 , it potentially overlaps and interacts with the developmental changes that make adolescents vulnerable to the onset of mental health problems 38 , 39 (Fig. 2 ). Thus, it has been intensely debated whether the increase in social media use during the past decade has a causal role in the decline of adolescent mental health 40 . Indeed, rapid changes to the environment experienced before and during adolescence might be a fruitful area to explore when examining current mental health trends 41 .

During adolescence, the interaction between genetic programming (yellow), social determinants (red) and environmental factors (blue), as well as the developmental changes discussed in this Review, increases the risk for onset of mental health conditions. Digital environments, mediated behaviours and experiences, and the impact that this technology has on society and economy more generally, are one aspect of the complex forces that might lead to the declines in adolescent mental health observed in the last decade. Adapted from ref. 259 , Springer Nature Limited.

Although there are many environmental changes that could be relevant, a substantial body of research has emerged to investigate the potential link between social media use and declines in adolescent mental health 42 , 43 using various research approaches, including cross-sectional studies 44 , longitudinal observational data analyses 45 , 46 , 47 and experimental studies 48 , 49 . However, the scientific results have been mixed and inconclusive (for reviews, see refs. 43 , 50 , 51 , 52 , 53 ), which has made it difficult to establish evidence-based recommendations, regulations and interventions aimed at ensuring that social media use is not harmful to adolescents 54 , 55 , 56 , 57 .

Many researchers attribute the mixed results to insufficient study specificity. For instance, the relationship between social media use and mental health varies notably across individuals 45 , 58 and developmental time windows 59 . Yet studies often examine adolescents without differentiating them based on age or developmental stage 60 , which prevents systematic accounts of individual and subgroup differences. Additionally, most studies only rely on self-reported measures of time spent on social media 61 , 62 , and overlook more nuanced aspects of social media use such as the nature of the activities 63 and the content or features that users engage with 52 . These factors need to be considered to unpack any broader relationships 35 , 64 , 65 , 66 . Furthermore, the measurement of mental health often conflates positive and negative mental health outcomes as well as various mental health conditions, which could all be differentially related to social media use 52 , 67 .

This research space presents substantial complexity 68 . There is an ever-increasing range of potential combinations of social media predictors, well-being and mental health outcomes and participant groups of varying backgrounds and demographics that can become the target of scientific investigation. However, the pressure to deliver policy and public-facing recommendations and interventions leaves little time to investigate comprehensively each of these combinations. Researchers need to be able to pinpoint quickly the research programmes with the maximum potential to create translational and real-world impact for adolescent mental health.

In this Review, we aim to delineate potential avenues for future research that could lead to concrete interventions to improve adolescent mental health by considering mechanisms at the nexus between pre-existing processes known to increase adolescent mental health vulnerability and digital affordances introduced by social media. First, we describe the affordance approach to understanding the effects of social media. We then draw upon research on adolescent development, mental health and social media to describe behavioural, cognitive and neurobiological mechanisms by which social media use might amplify changes during adolescent development to increase mental health vulnerability during this period of life. The specific mechanisms within each category were chosen because they have a strong evidence base showing that they undergo substantive changes during adolescent development, are implicated in mental health risk and can be modulated by social media affordances. Although the ways in which social media can also improve mental health resilience are not the focus of our Review and therefore are not reviewed fully here, they are briefly discussed in relation to each mechanism. Finally, we discuss future research focused on how to systematically test the intersection between social media and adolescent mental health.

Social media affordances

To study the impact of social media on adolescent mental health, its diverse design elements and highly individualized uses must be conceptualized. Initial research predominately related access to or time spent on social media to mental health outcomes 46 , 69 , 70 . However, social media is not similar to a toxin or nutrient for which each exposure dose has a defined link to a health-related outcome (dose–response relationship) 56 . Social media is a diverse environment that cannot be summarized by the amount of time one spends interacting with it 71 , 72 , and individual experiences are highly varied 45 .

Previous psychological reviews often focused on social media ‘features’ 73 and ‘affordances’ 74 interchangeably. However, these terms have distinct definitions in communication science and information systems research. Social media features are components of the technology intentionally designed to enable users to perform specific actions, such as liking, reposting or uploading a story 75 , 76 . By contrast, affordances describe the perceptions of action possibilities users have when engaging with social media and its features, such as anonymity (the difficulty with which social media users can identify the source of a message) and quantifiability (how countable information is).

The term ‘affordance’ came from ecological psychology and visuomotor research, and was described as mainly determined by human perception 77 . ‘Affordance’ was later adopted for design and human–computer interaction contexts to refer to the action possibilities that are suggested to the user by the technology design 78 . Communication research synthesizes both views. Affordances are now typically understood as the perceived — and therefore flexible — action possibilities of digital environments, which are jointly shaped by the technology’s features and users’ idiosyncratic perceptions of those features 79 .

Latent action possibilities can vary across different users, uses and technologies 79 . For example, ‘stories’ are a feature of Instagram designed to share content between users. Stories can also be described in terms of affordances when users perceive them as a way to determine how long their content remains available on the platform (persistence) or who can see that content (visibility) 80 , 81 , 82 , 83 , 84 . Low persistence (also termed ephemerality) and comparatively low visibility can be achieved through a technology feature (Instagram stories), but are not an outcome of technology use itself; they are instead perceived action possibilities that can vary across different technologies, users and designs 79 .

The affordances approach is particularly valuable for theorizing at a level above individual social media apps or specific features, which makes this approach more resilient to technological changes or shifts in platform popularity 79 , 85 . However, the affordances approach can also be related back to specific types of social media by assessing the extent to which certain affordances are ‘built into’ a particular platform through feature design 35 . Furthermore, because affordances depend on individuals’ perceptions and actions, they are more aligned than features with a neurocognitive and behavioural perspective to social media use. Affordances, similar to neurocognitive and behavioural research, emphasize the role of the user (how the technology is perceived, interpreted and used) rather than technology design per se. In this sense, the affordances approach is essential to overcome technological determinism of mental health outcomes, which overly emphasizes the role of technology as the driver of outcomes but overlooks the agency and impact of the people in question 86 . This flexibility and alignment with psychological theory has contributed to the increasing popularity of the affordance approach 35 , 73 , 74 , 85 , 87 and previous reviews have explored relevant social media affordances in the context of interpersonal communication among adults and adolescents 35 , 88 , 89 , adolescent body image concerns 73 and work contexts 33 . Here, we focus on the affordances of social media that are relevant for adolescent development and its intersection with mental health (Table  1 ).

Behavioural mechanisms

Adolescents often use social media differently to adults, engaging with different platforms and features and, potentially, perceiving or making use of affordances in distinctive ways 35 . These usage differences might interact with developmental characteristics and changes to amplify mental health vulnerability (Fig.  3 ). We examine two behavioural mechanisms that might govern the impact of social media use on mental health: risky posting behaviours and self-presentation.

Social media affordances can amplify the impact that common adolescent developmental mechanisms (behavioural, cognitive and neurobiological) have on mental health. At the behavioural level (top), affordances such as permanence and publicness lead to an increased impact of risk-taking behaviour on mental health compared with similar behaviours in non-mediated environments. At the cognitive level (middle), high quantifiability influences the effects of social comparison. At the neurobiological level (bottom), low synchronicity can amplify the effects of stress on the developing brain.

Risky posting behaviour

Sensation-seeking peaks in adolescence and self-regulation abilities are still not fully developed in this period of life 90 . Thus, adolescents often engage in more risky behaviours than other age groups 91 . Adolescents are more likely to take risks in situations involving peers 92 , 93 , perhaps because they are motivated to avoid social exclusion 94 , 95 . Whether adolescent risk-taking behaviour is inherently adaptive or maladaptive is debated. Although some risk-taking behaviours can be adaptive and part of typical development, others can increase mental health vulnerability. For example, data from a prospective UK panel study of more than 5,500 young people showed that engaging in more risky behaviours (including social and health risks) at age 16 years increases the odds of a range of adverse outcomes at age 18 years, such as depression, anxiety and substance abuse 96 .

Social media can increase adolescents’ engagement in risky behaviours both in non-mediated and mediated environments (environments in which the behaviour is executed in or through a technology, such as a mobile phone and social media). First, affordances such as quantifiability in conjunction with visibility and association (the degree with which links between people, between people and content or between a presenter and their audience can be articulated) can promote more risky behaviours in non-mediated environments and in-person social interactions. For example, posts from university students containing references to alcohol gain more likes than posts not referencing alcohol and liking such posts predicts an individual’s subsequent drinking habits 97 . Users expecting likes from their audience are incentivized to engage in riskier posting behaviour (such as more frequent or more extreme posts containing references to alcohol). The relationship between risky online behaviour and offline behaviour is supported by meta-analyses that found a positive correlation between adolescents’ social media use and their engagement in behaviours that might expose them to harm or risk of injury (for example, substance use or risky sexual behaviours) 98 . Further, affordances such as persistence and visibility can mean that risky behaviours in mediated and non-mediated environments remain public for long periods of time, potentially influencing how an adolescent is perceived by peers over the longer term 39 , 99 .

Adolescence can also be a time of more risky social media use. For most forms of semi-public and public social media use, users typically do not know who exactly will be able to see their posts. Thus, adolescents need to self-present to an ‘imagined audience’ 100 and avoid posting the wrong kind of content as the boundaries between different social spheres collapse (context collapse 101 ). However, young people can underestimate the risks of disclosing revealing information in a social media environment 102 . Affordances such as visibility, replicability (social media posts remain in the system and can be screenshotted and shared even if they are later deleted 39 ), association and persistence could heighten the risk of experiencing cyberbullying, victimization and online harassment 103 . For example, adolescents can forward privately received sexual images to larger friendship groups, increasing the risk of online harassment over the subject of the sexual images 104 . Further, low bandwidth (a relative lack of socio-emotional cues) and high anonymity have the potential to disinhibit interactions between users and make behaviours and reactions more extreme 105 , 106 . For example, anonymity was associated with more trolling behaviours during an online group discussion in an experiment with 242 undergraduate students 107 .

Thus, social media might drive more risky behaviours in both mediated and non-mediated contexts, increasing mental health vulnerability. However, the evidence is still not clear cut and often discounts adolescent agency and understanding. For example, mixed-methods research has shown that young people often understand the risks of posting private or sexual content and use social media apps that ensure that posts are deleted and inaccessible after short periods of time to counteract them 39 (even though posts can still be captured in the meantime). Future work will therefore need to investigate how adolescents understand and balance such risks and how such processes relate to social media’s impact on mental health.

Self-presentation and identity

The adolescent period is characterized by an abundance of self-presentation activities on social media 74 , where the drive to present oneself becomes a fundamental motivation for engagement 108 . These activities include disclosing, concealing and modifying one’s true self, and might involve deception, to convey a desired impression to an audience 109 . Compared with adults, adolescents more frequently take part in self-presentation 102 , which can encompass both realistic and idealized portrayals of themselves 110 . In adults, authentic self-presentation has been associated with increased well-being, and inauthentic presentation (such as when a person describes themselves in ways not aligned with their true self) has been associated with decreased well-being 111 , 112 , 113 .

Several social media affordances shape the self-presentation behaviours of adolescents. For example, the editability of social media profiles enables users to curate their online identity 84 , 114 . Editability is further enhanced by highly visible (public) self-presentations. Additionally, the constant availability of social media platforms enables adolescents to access and engage with their profiles at any time, and provides them with rapid quantitative feedback about their popularity among peers 89 , 115 . People receive more direct and public feedback on their self-presentation on social media than in other types of environment 116 , 117 . The affordances associated with self-presentation can have a particular impact during adolescence, a period characterized by identity development and exploration.

Social media environments might provide more opportunities than offline environments for shaping one’s identity. Indeed, public self-presentation has been found to invoke more prominent identity shifts (substantial changes in identity) compared with private self-presentation 118 , 119 . Concerns have been raised that higher Internet use is associated with decreased self-concept clarity. Only one study of 101 adolescents as well as adults reviewed in a 2021 meta-analysis 120 showed that the intensity of Facebook use (measured by the Facebook Intensity Scale) predicted a longitudinal decline in self-concept clarity 3 months later, but the converse was not the case and changes in self-concept clarity did not predict Facebook use 121 . This result is still not enough to show a causal relationship 121 . Further, the affordances of persistence and replicability could also curtail adolescents’ ability to explore their identity freely 122 .

By contrast, qualitative research has highlighted that social media enables adolescents to broaden their horizons, explore their identity and identify and reaffirm their values 123 . Social media can help self-presentation by enabling adolescents to elaborate on various aspects of their identity, such as ethnicity and race 124 or sexuality 125 . Social media affordances such as editability and visibility can also facilitate this process. Adolescents can modify and curate self-presentations online, try out new identities or express previously undisclosed aspects of their identity 126 , 127 . They can leverage social media affordances to present different facets of themselves to various social groups by using different profiles, platforms and self-censorship and curation of posts 128 , 129 . Presenting and exploring different aspects of one’s identity can have mental health implications for minority teens. Emerging research shows a positive correlation between well-being and problematic Internet use in transgender, non-binary and gender-diverse adolescents (age 13–18 years), and positive sentiment has been associated with online identity disclosures in transgender individuals with supportive networks (both adolescent and adult) 130 , 131 .

Cognitive mechanisms

Adolescents and adults might experience different socio-cognitive impacts from the same social media activity. In this section, we review four cognitive mechanisms via which social media and its affordances might influence the link between adolescent development and mental health vulnerabilities (Fig.  3 ). These mechanisms (self-concept development, social comparison, social feedback and exclusion) roughly align with a previous review that examined self-esteem and social media use 115 .

Self-concept development

Self-concept refers to a person’s beliefs and evaluations about their own qualities and traits 132 , which first develops and becomes more complex throughout childhood and then accelerates its development during adolescence 133 , 134 , 135 . Self-concept is shaped by socio-emotional processes such as self-appraisal and social feedback 134 . A negative and unstable self-concept has been associated with negative mental health outcomes 136 , 137 .

Perspective-taking abilities also develop during adolescence 133 , 138 , 139 , as does the processing of self-relevant stimuli (measured by self-referential memory tasks, which assess memory for self-referential trait adjectives 140 , 141 ). During adolescence, direct self-evaluations and reflected self-evaluations (how someone thinks others evaluate them) become more similar. Further, self-evaluations have a distinct positive bias during childhood, but this positivity bias decreases in adolescence as evaluations of the self are integrated with judgements of other people’s perspectives 142 . Indeed, negative self-evaluations peak in late adolescence (around age 19 years) 140 .

The impact of social media on the development of self-concept could be heightened during adolescence because of affordances such as personalization of content 143 (the degree to which content can be tailored to fit the identity, preferences or expectations of the receiver), which adapts the information young people are exposed to. Other affordances with similar impacts are quantifiability, availability (the accessibility of the technology as well as the user’s accessibility through the technology) and public visibility of interactions 89 , which render the evaluations of others more prominent and omnipresent. The prominence of social evaluation can pose long-term risks to mental health under certain conditions and for some users 144 , 145 . For example, receiving negative evaluations from others or being exposed to cyberbullying behaviours 146 , 147 can, potentially, have heightened impact at times of self-concept development.

A pioneering cross-sectional study of 150 adolescents showed that direct self-evaluations are more similar to reflected self-evaluations, and self-evaluations are more negative, in adolescents aged 11–21 years who estimate spending more time on social media 148 . Further, longitudinal data have shown bidirectional negative links between social media use and satisfaction with domains of the self (such as satisfaction with family, friends or schoolwork) 47 .

Although large-scale evidence is still unavailable, these findings raise the interesting prospect that social media might have a negative influence on perspective-taking and self-concept. There is less evidence for the potential positive influence of social media on these aspects of adolescent development, demonstrating an important research gap. Some researchers hypothesize that social media enables self-concept unification because it provides ample opportunity to find validation 89 . Research has also discussed how algorithmic curation of personalized social media feeds (for example, TikTok algorithms tailoring videos viewed to the user’s interests) enables users to reflect on their self-concept by being exposed to others’ experiences and perspectives 143 , an area where future research can provide important insights.

Social comparison

Social comparison (thinking about information about other people in relation to the self 149 ) also influences self-concept development and becomes particularly important during adolescence 133 , 150 . There are a range of social media affordances that can amplify the impact of social comparison on mental health. For example, quantifiability enables like or follower counts to be easily compared with others as a sign of status, which facilitates social ranking 151 , 152 , 153 , 154 . Studies of older adolescents and adults aged, on average, 20 years have also found that the number of likes or reactions received predict, in part, how successful users judge their self-presentation posts on Facebook 155 . Furthermore, personalization enables the content that users see on social media to be curated so as to be highly relevant and interesting for them, which should intensify comparisons. For example, an adolescent interested in sports and fitness content will receive personalized recommendations fitting those interests, which should increase the likelihood of comparisons with people portrayed in this content. In turn, the affordance of association can help adolescents surround themselves with similar peers and public personae online, enhancing social comparison effects 63 , 156 . Being able to edit posts (via the affordance of editability) has been argued to contribute to the positivity bias on social media: what is portrayed online is often more positive than the offline experience. Thus, upward comparisons are more likely to happen in online spaces than downward or lateral comparisons 157 . Lastly, the verifiability of others’ idealized self-presentations is often low, meaning that users have insufficient cues to gauge their authenticity 158 .

Engaging in comparisons on social media has been associated with depression in correlational studies 159 . Furthermore, qualitative research has shown that not receiving as many positive evaluations as expected (or if positive evaluations are not provided quickly enough) increases negative emotions in children and adolescents aged between age 9 and 19 years 39 . This result aligns with a reinforcement learning modelling study of Instagram data, which found that the likes a user receives on their own posts become less valuable and less predictive of future posting behaviour if others in their network receive more likes on their posts 160 . Although this study did not measure mood or mental health, it shows that the value of the likes are not static but inherently social; their impact depends on how many are typically received by other people in the same network.

Among the different types of social comparison that adolescents engage in (comparing one’s achievements, social status or lifestyle), the most substantial concerns have been raised about body-related comparisons. One review suggested that social media affordances create a ‘perfect storm’ for body image concerns that can contribute to both socio-emotional and eating disorders 73 . Social media affordances might increase young people’s focus on other people’s appearances as well as on their own appearance by showing idealized, highly edited images, providing quantified feedback and making the ability to associate and compare oneself with peers constantly available 161 , 162 . The latter puts adolescents who are less popular or receive less social support at particular risk of low self-image and social distress 35 .

Affordances enable more prominent and explicit social comparisons in social media environments relative to offline environments 158 , 159 , 163 , 164 , 165 . However, this association could have a positive impact on mental health 164 , 166 . Initial evidence suggests beneficial outcomes of upward comparisons on social media, which can motivate behaviour change and yield positive downstream effects on mental health 164 , 166 . Positive motivational effects (inspiration) have been observed among young adults for topics such as travelling and exploring nature, as well as fitness and other health behaviours, which can all improve mental health 167 . Importantly, inspiration experiences are not a niche phenomenon on social media: an experience sampling study of 353 Dutch adolescents (mean age 13–15 years) found that participants reported some level of social media-induced inspiration in 33% of the times they were asked to report on this over the course of 3 weeks 168 . Several experimental and longitudinal studies show that inspiration is linked to upward comparison on social media 157 , 164 , 166 . However, the positive, motivating side of social comparison on social media has only been examined in a few studies and requires additional investigation.

Social feedback

Adolescence is also a period of social reorientation, when peers tend to become more important than family 169 , peer acceptance becomes increasingly relevant 170 , 171 , 172 and young people spend increasing amounts of time with peers 173 . In parallel, there is a heightened sensitivity to negative socio-emotional or self-referential cues 140 , 174 , higher expectation of being rejected by others 175 and internalization of such rejection 142 , 176 compared with other phases in life development. A meta-analysis of both adolescents and adults found that oversensitivity to social rejection is moderately associated with both depression and anxiety 177 .

Social media affordances might amplify the potential impact of social feedback on mental health. Wanting to be accepted by peers and increased susceptibility to social rewards could be a motivator for using social media in the first place 178 . Indeed, receiving likes as social reward activated areas of the brain (such as the nucleus accumbens) that are also activated by monetary reward 179 . Quantifiability amplifies peer acceptance and rejection (via like counts), and social rejection has been linked to adverse mental health outcomes 170 , 180 , 181 , 182 . Social media can also increase feelings of being evaluated, the risk of social rejection and rumination about potential rejection due to affordances such as quantifiability, synchronicity (the degree to which an interaction happens in real time) and variability of social rewards (the degree to which social interaction and feedback occur on variable time schedules). For example, one study of undergraduate students found that active communication such as messaging was associated with feeling better after Facebook use; however, this was not the case if the communication led to negative feelings such as rumination (for example, after no responses to the messages) 183 .

In a study assessing threatened social evaluation online 184 , participants were asked to record a statement about themselves and were told their statements would be rated by others. To increase the authenticity of the threat, participants were asked to rate other people’s recordings. Threatened social evaluation online in this study decreased mood, most prominently in people with high sensitivity to social rejection. Adolescents who are more sensitive to social rejection report more severe depressive symptoms and maladaptive ruminative brooding in both mediated and non-mediated social environments, and this association is most prominent in early adolescence 185 . Not receiving as much online social approval as peers led to more severe depressive symptoms in a study of American ninth-grade adolescents (between age 14 and 15 years), especially those who were already experiencing peer victimization 153 . Furthermore, individuals with lower self-esteem post more negative and less positive content than individuals with higher self-esteem. Posted negative content receives less social reward and recognition from others than positive content, possibly creating a vicious cycle 186 . Negative experiences pertaining to social exclusion and status are also risk factors for socio-emotional disorders 180 .

The impact of social media experiences on self-esteem can be very heterogeneous, varying substantially across individuals. As a benefit, positive social feedback obtained via social media can increase users’ self-esteem 115 , an association also found among adolescents 187 . For instance, receiving likes on one’s profile or posted photographs can bolster self-esteem in the short term 144 , 188 . A study linking behavioural data and self-reports from Facebook users found that receiving quick responses on public posts increased a sense of social support and decreased loneliness 189 . Furthermore, a review of reviews consistently documented that users who report more social media use also perceive themselves to have more social resources and support online 52 , although this association has mostly been studied among young adults using social network sites such as Facebook. Whether such social feedback benefits extend to adolescents’ use of platforms centred on content consumption (such as TikTok or Instagram) is an open question.

Social inclusion and exclusion

Adolescents are more sensitive to the negative emotional impacts of being excluded than are adults 170 , 190 . It has been proposed that, as the importance of social affiliation increases during this period of life 134 , 191 , 192 , adolescents are more sensitive to a range of social stimuli, regardless of valence 193 . These include social feedback (such as compliments or likes) 95 , 194 , negative socio-emotional cues (such as negative facial expressions or social exclusion) 174 and social rejection 172 , 185 . By contrast, social inclusion (via friendships in adolescence) is protective against emotional disorders 195 and more social support is related to higher adolescent well-being 196 .

Experiencing ostracism and exclusion online decreases self-esteem and positive emotion 197 . This association has been found in vignette experiments where participants received no, only a few or a lot of likes 198 , or experiments that used mock-ups of social media sites where others received more likes than participants 153 . Being ostracized (not receiving attention or feedback) or rejected through social media features (receiving dislikes and no likes) is also associated with a reduced sense of belonging, meaningfulness, self-esteem and control 199 . Similar results were found when ostracism was experienced over messaging apps, such as not receiving a reply via WhatsApp 200 .

Evidence on whether social media also enables adolescents to experience positive social inclusion is mostly indirect and mixed. Some longitudinal surveys have found that prosocial feedback received on social media during major life events (such as university admissions) helps to buffer against stress 201 . Adult participants of a longitudinal study reported that social media offered more informational support than offline contexts, but offline contexts more often offered emotional or instrumental support 202 . Higher social network site use is, on average, associated with a perception of having more social resources and support in adults (for an overview of meta-analyses, see ref. 52 ). However, most of these studies have not investigated social support among adolescents, and it is unclear whether early findings (for example, on Facebook or Twitter) generalize to a social media landscape more strongly characterized by content consumption than social interaction (such as Instagram or TikTok).

Still, a review of social media use and offline interpersonal outcomes among adolescents documents both positive (sense of belonging and social capital) and negative (alienation from peers and perceived isolation) correlates 203 . Experience sampling research on emotional support among young adults has further shown that online social support is received and perceived as effective, and its perceived effectiveness is similar to in-person social support 204 . Social media use also has complex associations with friendship closeness among adolescents. For example, one experience sampling study found that greater use of WhatsApp or Instagram is associated with higher friendship closeness among adolescents; however, within-person examinations over time showed small negative associations 205 .

Neurobiological mechanisms

The long-term impact of environmental changes such as social media use on mental health might be amplified because adolescence is a period of considerable neurobiological development 95 (Fig.  3 ). During adolescence, overall cortical grey matter declines and white matter increases 206 , 207 . Development is particularly protracted in brain regions associated with social cognition and executive functions such as planning, decision-making and inhibiting prepotent responses. The changes in grey and white matter are thought to reflect axonal growth, myelination and synaptic reorganization, which are mechanisms of neuroplasticity influenced by the environment 208 . For example, research in rodents has demonstrated that adolescence is a sensitive period for social input, and that social isolation in adolescence has unique and more deleterious consequences for neural, behavioural and mental health development than social isolation before puberty or in adulthood 206 , 209 . There is evidence that brain regions involved in motivation and reward show greater activation to rewarding and motivational stimuli (such as appetitive stimuli and the presence of peers) in early and/or mid adolescence compared with other age groups 210 , 211 , 212 , 213 , 214 .

Little is known about the potential links between social media and neurodevelopment due to the paucity of research investigating these associations. Furthermore, causal chains (for example, social media increasing stress, which in turn influences the brain) have not yet been accurately delineated. However, it would be amiss not to recognize that brain development during adolescence forms part of the biological basis of mental health vulnerability and should therefore be considered. Indeed, the brain is proposed to be particularly plastic in adolescence and susceptible to environmental stimuli, both positive and negative 208 . Thus, even if adults and adolescents experienced the same affective consequences from social media use (such as increases in peer comparison or stress), these consequences might have a greater impact in adolescence.

A cross-sectional study (with some longitudinal elements) suggested that habitual checking of social media (for example, checking for rewards such as likes) might exacerbate reward sensitivity processes, leading to long-term hypersensitization of the reward system 215 . Specifically, frequently checking social media was associated with reduced activation in brain regions such as the dorsolateral prefrontal cortex and the amygdala in response to anticipated social feedback in young people. Brain activation during the same social feedback task was measured over subsequent years. Upon follow-up, anticipating feedback was associated with increased activation of the same brain regions among the individuals who checked social media frequently initially 215 . Although longitudinal brain imaging measurements enabled trajectories of brain development to be specified, the measures of social media use were only acquired once in the first wave of data collection. The study therefore cannot account for confounds such as personality traits, which might influence both social media checking behaviours and brain development. Other studies of digital screen use and brain development have found no impact on adolescent functional brain organization 216 .

Brain development and heightened neuroplasticity 208 render adolescence a particularly sensitive period with potentially long-term impacts into adulthood. It is possible that social media affordances that underpin increased checking and reward-seeking behaviours (such as quantifiability, variability of social rewards and permanent availability of peers) might have long-term consequences on reward processing when experienced during adolescence. However, this suggestion is still speculative and not backed up by evidence 217 .

Stress is another example of the potential amplifying effect of social media on adolescent mental health vulnerability due to neural development. Adolescents show higher stress reactivity because of maturational changes to, and increased reactivity in, the hypothalamic–pituitary–adrenal axis 218 , 219 . Compared with children and adults, adolescents experience an increase in self-consciousness and associated emotional states such as self-reported embarrassment and related physiological measures of arousal (such as skin conductance), and heightened neural response patterns compared with adults, when being evaluated or observed by peers 220 . Similarly, adolescents (age 13–17 years) show higher stress responses (higher levels of cortisol or blood pressure) compared with children (age 7–12 years) when they perform in front of others or experience social rejection 221 .

Such changes in adolescence might confer heightened risk for the onset of mental health conditions, especially socio-emotional disorders 6 . Both adolescent rodents and humans show prolonged hypothalamic–pituitary–adrenal activation after experiencing stress compared with conspecifics of different ages 218 , 219 . In animal models, stress during adolescence has been shown to result in increased anxiety levels in adulthood 222 and alterations in emotional and cognitive development 223 . Furthermore, human studies have linked stress in adolescence to a higher risk of mental health disorder onset 218 and reviews of cross-species work have illustrated a range of brain changes due to adolescent stress 224 , 225 .

There is still little conclusive neurobiological evidence about social media use and stress, and a lack of understanding about which affordances might be involved (although there has been a range of work studying digital stress; Box  1 ). Studies of changes in cortisol levels or hypothalamic–pituitary–adrenal functioning and their relation to social media use have been mixed and inconclusive 226 , 227 . These results could be due to the challenge of studying stress responses in adolescents, particularly as cortisol fluctuates across the day and one-point readings can be unreliable. However, the increased stress sensitivity during the adolescent developmental period might mean that social media use can have a long-term influence on mental health due to neurobiological mechanisms. These processes are therefore important to understand in future research.

Box 1 Digital stress

Digital stress is not a unified construct. Thematic content analyses have categorized digital stress into type I stressors (for example, mean attacks, cyberbullying or shaming) and type II stressors (for example, interpersonal stress due to pressure to stay available) 260 . Other reviews have noted its complexity, and categorized digital stress into availability stress (stress that results from having to be constantly available), approval anxiety (anxiety regarding others’ reaction to their own profile, posts or activities online), fear of missing out (stress about being absent from or not experiencing others’ rewarding experiences) and communication overload (stress due to the scale, intensity and frequency of online communication) 261 .

Digital stress has been systematically linked to negative mental health outcomes. Higher digital stress was longitudinally associated with higher depressive symptoms in a questionnaire study 262 . Higher social media stress was also longitudinally related to poorer sleep outcomes in girls (but not boys) 263 . Studies and reviews have linked cyberbullying victimization (a highly stressful experience) to decreased mental health outcomes such as depression, and psychosocial outcomes such as self-esteem 103 , 146 , 147 , 264 , 265 . A systematic review of both adolescents and adults found a medium association ( r  = 0.26–0.34) between different components of digital stress and psychological distress outcomes such as anxiety, depression or loneliness, which was not moderated by age or sex (except for connection overload) 266 . However, the causal structure giving rise to such results is still far from clear. For example, surveys have linked higher stress levels to more problematic social media use and fear of missing out 267 , 268 .

Thus, the impact of digital stress on mental health is probably complex and influenced by the type of digital stressor and various affordances. For example, visibility and availability increase fear of negative public evaluation 269 and high availability and a social norm of responding quickly to messages drive constant monitoring in adolescents due to a persistent fear of upsetting friends 270 .

A range of relevant evidence from qualitative and quantitative studies documents that adolescents often ruminate about online interactions and messages. For example, online salience (constantly thinking about communication, content or events happening online) was positively associated with stress on both between-person and within-person levels in a cross-sectional quota sample of adults and three diary studies of young adults 271 , 272 . Online salience has also been associated with lower well-being in a pre-registered study of momentary self-reports from young adults with logged online behaviours. However, this study also noted that positive thoughts were related to higher well-being 273 . Furthermore, although some studies found no associations between the amount of communication and digital stress 272 , a cross-sectional study found that younger users’ (age 14–34 years and 35–49 years) perception of social pressure to be constantly available was related to communication load (measured by questions about the amount of use, as well as the urge to check email and social media) and Internet multitasking, whereas this was not the case for older users aged 50–85 years 274 . By contrast, communication load and perceived stress were associated only among older users.

Summary and future directions

To help to understand the potential role of social media in the decline of adolescent mental health over the past decade, researchers should study the mechanisms linking social media, adolescent development and mental health. Specifically, social media environments might amplify the socio-cognitive processes that render adolescents more vulnerable to mental health conditions in the first place. We outline various mechanisms at three levels of adolescent development — behavioural, cognitive and neurobiological — that could be involved in the decline of adolescent mental health as a function of social media engagement. To do so, we delineate specific social media affordances, such as quantification of social feedback or anonymity, which can also have positive impacts on mental health.

Our Review sets out clear recommendations for future research on the intersection of social media and adolescent mental health. The foundation of this research lies in the existing literature investigating the underlying processes that heighten adolescents’ risk of developing socio-emotional disorders. Zooming in on the potential mechanistic targets impacted by social media uses and affordances will produce specific research questions to facilitate controlled and systematic scientific inquiry relevant for intervention and translation. This approach encourages researchers to pinpoint the mechanisms and levels of explanation they want to include and will enable them to identify what factors to additionally consider, such as participants’ age 60 , the specific mental health outcomes being measured, the types of social media being examined and the populations under study 52 , 228 . Targeted and effective research should prioritize the most promising areas of study and acknowledge that all research approaches have inherent limitations 229 . Researchers must embrace methodological diversity, which in turn will facilitate triangulation. Surveys, experience sampling designs in conjunction with digital trace data, as well as experimental or neuroimaging paradigms and computational modelling (such as reinforcement learning) can all be used to address research questions comprehensively 230 . Employing such a multi-method approach enables the convergence of evidence and strengthens the reliability of findings 231 .

Mental health and developmental research can also become more applicable to the study of social media by considering how studies might already be exploring features of the digital environment, such as its design features and perceived affordances. Many cognitive neuroscience studies that investigate social processes and mental health during adolescence necessarily design tasks that can be completed in controlled experimental or brain scanning environments. Consequently, they tend to focus on digitally mediated interactions. However, researchers conceptualize and generalize their results to face-to-face interactions. For example, it is common across the discipline to not explicitly describe the interactions under study as being about social processes in digital environments (such as studies that assess social feedback based on the number of ‘thumbs up’ or ‘thumbs down’ received in social media 232 ). Considering whether cognitive neuroscience studies include key affordances of mediated (or non-mediated) environments, and discussing these in published papers, will make studies searchable within the field of social media research, enabling researchers to broaden the impact of their work and systematically specify generalizations to offline environments 233 .

To bridge the gap between knowledge about mediated and non-mediated social environments, it is essential to directly compare the two 233 . It is often assumed that negative experiences online have a detrimental impact on mental health. However, it remains unclear whether this mechanism is present in both mediated and non-mediated spaces or whether it is specific to the mediated context. For instance, our Review highlights that the quantification of social feedback through likes is an important affordance of social media 160 . Feedback on social media platforms might therefore elicit a greater sense of certainty because it is quantified compared with the more subjective and open-to-interpretation feedback received face to face 151 . Conducting experiments in which participants receive feedback that is more or less quantified and uncertain, specifically designed to compare mediated and non-mediated environments, would provide valuable insights. Such research efforts could also establish connections with computational neuroscience studies demonstrating that people tend to learn faster from stimuli that are less uncertain 234 .

We have chosen not to make recommendations concerning interventions targeting social media use to improve adolescent mental health for several reasons. First, we did not fully consider the bidirectional interactions between environment and development 35 , 235 , or the factors modulating adolescents’ differential susceptibility to the effects of social media 45 , 58 . For example, mental health status also influences how social media is used 47 , 58 , 59 , 236 , 237 (Box  2 ). These bidirectional interactions could be addressed using network or complexity science approaches 238 . Second, we do not yet know how the potential mechanisms by which social media might increase mental health vulnerability compare in magnitude, importance, scale and ease and/or cost of intervention with other factors and mechanisms that are already well known to influence mental health, such as poverty or loneliness. Last, social media use will probably interact with these predictors in ways that have not been delineated and can also support mental health resilience (for example, through social support or online self-help programmes). These complexities should be considered in future research, which will need to pinpoint not just the existence of mechanisms but their relative importance, to identify policy and intervention priorities.

Our Review has used a broad definition of mental health. Focusing on specific diagnostic or transdiagnostic symptomatology might reveal different mechanisms of interest. Furthermore, our Review is limited to mechanisms related to behaviour and neurocognitive development, disregarding other levels of explanation (such as genetics and culture) 34 , and also studying predominately Western-centric samples 239 . Mechanisms do not operate solely in linear pathways but exist within networks of interacting risk and resilience factors, characterized by non-linear and complex dynamics across diverse timescales 9 . Mechanisms and predisposing factors can interact and combine, amplifying mental health vulnerability. Mental health can be considered a dynamic system in which gradual changes to external conditions can have substantial downstream consequences due to system properties such as feedback loops 240 , 241 , 242 . These consequences are especially prominent in times of change and pre-existing vulnerability, such as adolescence 10 .

Indeed, if social media is a contributing factor to the current decline in adolescent mental health, as is commonly assumed, then it is important to identify and investigate mechanisms that are specifically tailored to the adolescent age range and make the case for why they matter. Without a thorough examination of these mechanisms and policy analysis to indicate whether they should be a priority to address, there is insufficient evidence to support the hypothesis that social media is the primary — or even just an influential and important — driver of mental health declines. Researchers need to stop studying social media as monolithic and uniform, and instead study its features, affordances and outcomes by leveraging a range of methods including experiments, questionnaires, qualitative research and industry data. Ultimately, this comprehensive approach will enhance researchers’ ability to address the potential challenges that the digital era poses on adolescent mental health.

Box 2 Effects of mental health on social media use

Although a lot of scientific discussion has focused on the impact of social media use on mental health, cross-sectional studies cannot differentiate between whether social media use is influencing mental health or mental health is influencing social media use, or a third factor is influencing both 51 . It is likely that mental health status influences social media use creating reinforcing cycles of behaviour, something that has been considered in the communication sciences literature under the term ‘transactional media effects’ 58 , 236 , 237 . According to communication science models, media use and its consequences are components of reciprocal processes 275 .

There are similar models in mental health research. For example, people’s moods influence their judgements of events, which can lead to self-perpetuating cycles of negativity (or positivity); a mechanism called ‘mood congruency’ 276 . Behavioural studies have also shown that people experiencing poor mental health behave in ways that decrease their opportunity to experience environmental reward such as social activities, maintaining poor mental health 277 , 278 . Although for many people these behaviours are a form of coping (for example, by avoiding stressful circumstances), they often worsen symptoms of mental health conditions 279 .

Some longitudinal studies found that a decrease in adolescent well-being predicted an increase in social media use 1 year later 47 , 59 . However, other studies have found no relationships between well-being and social media use over long-term or daily time windows 45 , 46 . One reason behind the heterogeneity of the results could be that how mental health impacts social media use is highly individual 45 , 280 .

Knowledge on the impact of mental health on social media use is still in its infancy and studies struggle to reach coherent conclusions. However, findings from the mental health literature can be used to generate hypotheses about how aspects of mental health might impact social media use. For example, it has been repeatedly found that young people with anxiety or eating disorders engage in more social comparisons than individuals without these disorders 281 , 282 , and adolescents with depression report more unfavourable social comparisons on social media than adolescents without depression 283 . Similar results have been found for social feedback seeking (for example, reassurance), including in social media environments 159 . Specifically, depressive symptoms were more associated with social comparison and feedback seeking, and these associations were stronger in women and in adolescents who were less popular. Individuals from the general population with lower self-esteem post more negative and less positive content than individuals with higher self-esteem, which in turn is associated with receiving less positive feedback from others 185 . There are therefore a wide range of possible ways in which diverse aspects of mental health might influence specific facets of how social media is used — and, in turn, how it ends up impacting the user.

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The moderating role of psychological power distance on the relationship between destructive leadership and emotional exhaustion

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• Yavuz Korkmazyurek   ORCID: orcid.org/0000-0001-8329-4080 1 &
• Metin Ocak   ORCID: orcid.org/0000-0002-1142-3661 1  

Destructive leadership, a prevalent negative behavior in modern organizations, continues to captivate the interest of scholars and professionals due to its detrimental aftermath. Drawing from social psychological (culture) and conservation of resources theory, we explore the moderating impact of psychological power distance on the link between destructive leadership and emotional exhaustion. The main contribution of this study is that it has created new information about the moderating role of some specific sub-dimensions of psychological power distance (e.g., hierarchy, prestige) in the relationship between destructive leadership and emotional exhaustion. Our findings also reveal a positive correlation between a destructive leadership style and emotional exhaustion. Furthermore, the prestige aspect of psychological power distance amplifies the influence of deficient leadership abilities and unethical conduct on emotional exhaustion. Notably, our study highlights that in the Turkish context, characterized by high power distance, and escalating hierarchies the impact of nepotism disparities on emotional exhaustion. In conclusion, these novel insights underscore a significant research avenue regarding cultural facets.

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Introduction

The actions of leaders in charge of societies and organizations have far-reaching effects, influencing organizational culture and the mental well-being of employees. On the other hand, culture is also recognized to influence various organizational relationships. Concordantly, one cultural element that can explain variations in leadership effectiveness, work attitudes, or job performance is an employee’s power distance orientation (Leonidou et al., 2021 ; Matta et al., 2022 ). Power distance at an individual level also serves as a moderating factor on various aspects, such as the effectiveness of leadership, employees’ perceptions and opinions of their organizations, and the core impacts of HR practices on employees (e.g., Adamovic, 2023 ; Li et al., 2017 ; Loi et al., 2012 ). In this context, despite some recent studies exploring the nature of power and its effects on leader behavior and employee responses from a psychological standpoint (e.g., Kelemen et al., 2020 ; Liao et al., 2021 ; Peng et al., 2021 ), given the extensive influence of psychological power, it is challenging to assert that the literature has fully developed.

According to the Conservation of Resources (COR) theory, resources are broadly defined as objects, personal characteristics, conditions, or energies that are valued because they help one to either directly obtain his or her goals or thwart his or her goal-relevant tendencies (Hobfoll, 2011 ). However, some non-constructive leadership behaviors such as DL continue to threaten the motivation level of employees (Rasid et al., 2013 ), individual resources (Hobfoll, 2011 ), and the welfare of organizations (Brouwers & Paltu, 2020 ; Veldsman, 2012 ). This fact creates a need to understand the contextual development of DL in organizations. DL can be seen as a new type of leadership where leaders engage in systematic and prolonged psychological abuse of subordinates (Ryan et al., 2021 ). Previous research has indicated that the impact of DL may depend on the context, as relationships can vary based on cultural and situational factors (e.g., Burns, 2021 ; Fors Brandebo, 2020 ). In parallel, numerous studies reveal the consequences of such leadership styles (Tepper, 2000 ) and propose theoretical models explaining the mechanisms of these styles (Einarsen et al., 2007 ; Wang et al., 2010 ). More specifically, negative leadership styles have been associated in the current literature with Emotional Exhaustion (EE) (Gkorezis et al., 2015 ; Koç et al., 2022 ), turnover intentions (Badar et al., 2023 ), and counterproductive work behavior (Murad et al., 2021 ). Besides, there is also an increasing research trend regarding the roles played by leadership in the moods and emotions of subordinates (Bono et al., 2007 ; Gooty et al., 2010 ).

“National culture has a crucial role in influencing the occurrence of leadership style” (Zhang & Liao, 2015 , p. 960), and shapes subordinates’ reactions toward these leadership styles (Hofstede, 2001 ; Tepper et al., 2017 ). One of these leadership styles is Destructive Leadership (DL) which is increasing in today’s societal and business areas (Krasikova et al., 2013 ) and prevents proper organizational functioning (Cascio & Aguinis, 2008 ). Organizations invest substantial resources in safeguarding and enhancing employee well-being (Salas-Vallina et al., 2021 ). Within this framework, COR, rooted in the resource-based perspectives of organizations, underscores individuals’ endeavors to safeguard, uphold, and cultivate their resources, highlighting bad management and stress as perceived threats to these resources (Hobfoll, 2011 ). Therefore, based on the COR, enhancing our understanding of the phenomenon of DL by exploring the impact of Psychological Power Distance (PPD) experienced by subordinates on their perceptions of leaders’ abusive behaviors is also significant in terms of decreasing employees’ level of Emotional Exhaustion (EE). EE, is expressed as “feelings of being emotionally drained by one’s work” (Bakker & Costa, 2014 , p. 2), and one of the primary emotional states experienced by employees today. In conclusion, the COR theory as a factor in work-related stress and destructive leadership can be used as a basis to eradicate the harmful effects of destructive leadership for the betterment of professional environments.

As a cultural factor, “Power Distance” (PD) assesses the probability that individuals facing greater inequality within the same social framework will recognize and expect unequal power distribution (Gonzalez, 2021 ). Hence, PD is a distinguishing feature among societies (Meydan et al., 2014 ). In this line, the PD beliefs of subordinates also vary depending on different leadership styles (Yang, 2020 ). For instance, in some cultures, leaders garner respect for taking decisive action, while in others, collaborative and participative decision-making methods hold more significance (Ahmad et al., 2021 , p. 1112). However, the issue of low reliability persists in many power distance scales (Taras, 2014 ). In this context, Adamovic ( 2023 ) contends that the measurement components of the Psychological Power Distance (PPD) scale he created amalgamate a broad power distance aspect and encompass noteworthy, though distinct, facets of power distance. Besides, although the concepts of hierarchy and power are often used as substitute concepts, the distinction between these two concepts has been significantly neglected in previous research (Aïssaoui & Fabian, 2015 ). For example, “in France, employees often do not tolerate power differences, but they tend to value a strong hierarchy” (Adamovic, 2023 , p. 3; d’Iribarne, 1996 ).

However, empirical research on the effects of psychological power distance on DL and related outcomes such as employee EE is surprisingly scarce. This paper seeks to address this gap in the literature. Thus, we aim to explore the potential moderating impact of the newly defined PPD on the connection between DL and EE to achieve trustworthy empirical findings. On the other hand, the study specifically focuses on a sample of Turkish employees, given that Türkiye is the largest economy in the Middle East and Turkish cultural values have had a profound impact on the way organizations are managed in the Middle East region. Besides, most countries in the Middle East were founded with the dissolution of the Ottoman Empire and are societies that come from the same traditions and customs (Lindholm, 2008 ). Thus, as a society that traditionally values respect and compliance with authority, Türkiye represents an ideal context to study the effects of psychological power distance.

Theoretical background

Destructive leadership.

“Destructive leadership is conceptualized as a broad umbrella” (Mackey et al., 2021 , p. 707) that ranges from abusive supervision (Tepper, 2000 ; Tepper et al., 2017 ) to overburdening followers (Schmid et al., 2019 ). Therefore, a wide variety of theories and different approaches, such as the Psychodynamic approach (Pillay & April, 2022 ) or Strain theory (Chen & Cheung, 2020 ) which is a criminological theory, have been used to explain the behaviors and effects of Destructive Leadership (DL). On the other hand, researchers have discovered that a rise in disruptive behaviors, which can deplete individuals’ psychological resources, may stem from factors like heightened anxiety (Byrne et al., 2014 ), work-related stress (Rosenstein, 2017 ), or excessive job pressure (Lam et al., 2017 ). Concurrently, the field of DL is experiencing increased diversity. Within this realm, DL manifests in various structural forms. As per Einarsen et al. ( 2007 ) and Larsson et al. ( 2012 ), these forms can be categorized as active or passive. Active behaviors encompass traits such as arrogance, unfairness, and intimidating or disciplining subordinates. Passive behavioral patterns highlight leader qualities like disinterest, avoidance of conflict, or poor planning skills (Larsson et al., 2012 ). Active behaviors are systematic and deliberate, while passive forms indicate deficiencies in leaders’ work and responsibilities (Einarsen et al., 2007 ). In addition, DL is divided into two dimensions in the literature: task and relationship. Task-related behaviors represent perceptions of the leader’s competence, including:

Isolation from outside interference and excessive control.

Lack of determination and uncertainty.

Stress and loss of control.

The relationship-related behaviors dimension refers to the leader’s skills in human relations, such as:

Low ability to relate to colleagues and subordinates and lack of job satisfaction.

Lack of understanding and self-centered behavior (Fors et al., 2016 ).

On the other hand, “employees will attribute leadership behavior in the process of interaction with the leaders” (Jiao & Wang, 2023 , p. 2), and the psychological states of subordinates will also be affected depending on their attribution. As a result, based on attribution theory (Heider, 1958 ; Weiner, 1985 ), it should not be ignored that whether the above-mentioned behaviors will be perceived as destructive or non-destructive may differ depending on the psychological state and perceptions of the subordinates in addition to cultural impact (Kong & Jogaratnam, 2007 ; Ojo, 2012 ).

Emotional exhaustion

Burnout, a psychological syndrome brought on by a prolonged reaction to ongoing workplace stressors (Maslach et al., 2001 ), is a significant issue that is becoming worse as workers are subjected to increasing pressure and demands from their managers under different cultural contexts (Rattrie et al., 2020 ). Moreover, burnout has been associated with several negative organizational outcomes, including job performance, emotional labor, and reduced employee well-being (Moon & Hur, 2011 ; Qiu et al., 2023 ; Maslach et al., 2001 ). “It is generally accepted to encompass three dimensions that occur in a developmental sequence” (Strack et al., 2015 , p. 578): from emotional exhaustion (EE) to depersonalization and subsequent decline in achievement (Cordes & Dougherty, 1993 ; Maslach et al., 2001 ). Within this framework, EE refers to the extent to which an individual is depleted or lacking in physical and psychological resources to cope with an interpersonal stress situation (Maslach et al., 2001 ). Employees who experience EE at work feel extremely stressed because they lose their physical and mental endurance (Obi et al., 2020 ) which ultimately leads to unhealthy tendencies as well as anxiety, stress, and depression (Bianchi et al., 2015 ; Weigl et al., 2017 ). On the other hand, the main characteristics of EE at the organizational level are the desire to quit work, absenteeism, and low morale (Maslach, 1996 ). Ultimately, the chronic experience of negative emotions in both individual and organizational contexts and the difficulties employees experience in regulating them can deplete their cognitive and emotional resources, which emerges as an important risk factor for EE (Chang, 2009 ; Hsieh et al., 2011 ).

Destructive leadership and emotional exhaustion

Different leadership styles have a known impact on employees’ emotions (Baig et al., 2021 ), and “employees’ perceptions about the leader are likely to affect their attitudes” (Gkorezis et al., 2015 , p. 622). In this context, destructive leadership styles (e.g., abusive supervision, petty tyranny, negative leadership) may trigger negative emotional reactions from employees (Schilling & Schyns, 2015 ), and increase employees’ emotional exhaustion (Chi & Liang, 2013 ). According to the Emotional Dissonance theory, negative supervision may also lead employees to conceal their true emotions (Naseer & Raja, 2021 ). Thus, scholars are focusing on leaders’ negative behavioral impact on employees’ emotional exhaustion levels (Gkorezis et al., 2015 ) to increase employee well-being at work (Hetrick et al., 2022 ). In addition, interpersonal stressors that diminish the well-being of employees are frequently experienced within the organizational atmosphere dominated by DL due to the nature of this harmful style (Hetrick et al., 2022 ). According to the Emotional Dissonance theory, negative supervision may also lead employees to conceal their true emotions (Naseer & Raja, 2021 ). Within this framework, scholars are focusing on leaders’ negative behavioral impact on employees’ emotional exhaustion levels (Gkorezis et al., 2015 ) to increase employee well-being at work (Hetrick et al., 2022 ), interpersonal stressors that diminish the well-being of employees are frequently experienced within the organizational atmosphere dominated by DL due to the nature of this harmful style (Hetrick et al., 2022 ), this article bases the theoretical connection between Destructive Leadership (DL) and Emotional Exhaustion (EM) on the definition of Einarsen et al. ( 2007 ).

[..] is the systematic and repeated behavior of a leader or manager that harms the organization’s legitimate interests by undermining the organization’s resources, and effectiveness, motivation, and job satisfaction of subordinates (p. 208).

Current studies have explored the positive relationship between despotic, toxic, and destructive leadership with emotional exhaustion (e.g., Shahzad et al., 2023 ; Koç et al., 2022 ). In this context, “meta-analytic evidence demonstrates that DL has negative consequences for followers’ workplace behaviors (e.g., job performance, organizational citizenship behaviors [OCBs], workplace deviance)” (Mackey et al., 2019 , p. 3). These empirical findings may suggest that DL outputs could also result in EM among employees. In conclusion, destructive leaders can cause fundamental problems in business life, such as increasing the level of emotional exhaustion (Krumov et al., 2016 ), and subordinates who are constantly exposed to leaders’ destructive practices experience frustration and emotional exhaustion (Glasø & Vie, 2009 ). Given the theoretical discussions above, the research’s first hypothesis was formulated as follows.

H1: There is a positive relationship between destructive leadership and emotional exhaustion.

Psychological power distance

The PPD concept originates from a multidisciplinary field of study called cross-cultural psychology, which seeks to understand how culture impacts the cognitive and behavioral outcomes of individuals and groups (Yang, 2020 ). According to Hofstede ( 1991 , p. 27), “power distance can be described as the degree to which individuals who are less powerful within a country’s institutions and organizations anticipate and acknowledge the unequal distribution of power”. In this context, “Shore and Cross ( 2005 , p. 57) underlined that power is distributed more equitably in low power distance cultures and unequally in high power distance cultures. For instance, the power distance index (Khakhar & Rammal, 2013 ) shows that the Arab world, which values traditional authority highly (Inglehart, 1997 ), scores highly in this index, and people working in these cultures strictly follow higher hierarchical orders (Chiaburu et al., 2015 ; Korkmazyurek & Korkmazyurek, 2023 ). In summary, “individuals who score highly on psychological power distance also tend 1) accept and tolerate power differences in the workplace, 2) avoid conflict with authority figures, 3) prefer a clear hierarchy at work, 4) strive for status and prestige, and 5) expect a social distance between managers and employees.” (Adamovic, 2023 , p. 2).

Psychological power distance as a moderator

It has been suggested that various cultures have their norms regarding what constitutes good or bad leadership, and these norms may be reflected in the perception of psychological power distance (Tang et al., 2020 ). In this context, numerous studies explore the connection between PD and leaders’ influence tactics as PD decides if subordinates in a culture would accept a leader’s influence and the specific situations in which a leader might face resistance from a group of subordinates. Thus, investigating the role of PD in employees’ perception of leaders and better understanding the impact of leaders on employee well-being, will not only inform practices for workplace health intervention but also enlighten leadership researchers in discussing the universal and contingency theory of leadership. On the other hand, several power distance measures, like the ones created by Cable & Edwards ( 2004 ), Dorfman & Howell ( 1988 ), and Maznevski and colleagues ( 2002 ), have produced interesting findings on the importance of power distance concerning employee results and leadership (Adamovic, 2023 , p. 2). As an example, Tepper ( 2007 ) claims that “countries with high power distance experience more abusive supervision”. Thus, individuals characterized by large power distance have a high tolerance for lack of autonomy and rely more on centralization and formalization of authority (Hofstede, 1980 ). In this context, PPD influences how people feel, think, and act about problems of status and power at work and is crucial in understanding how leaders and subordinates interact (Adamovic, 2023 , p. 1).

The moderating impact of PD on the link between workers’ job satisfaction, performance, and absenteeism was highlighted by Lam and Friends ( 2002 . p.14). On the other hand, Farh and Friends ( 2007 : 721) found in their study that PD had a negative moderating effect on the relationship between work outcomes such as organizational commitment, job performance, and conscientiousness. According to the findings above, we can argue that PPD has a deterministic effect on the functioning of the theoretical mechanisms between DL and EM. Besides, In countries with high power distance, abuse by superiors is quite normative and consistent for subordinates in superior-subordinate relationships (Tepper, 2007 ). In this regard, the need for power in the prestige dimension (Carl et al., 2004 ; Hofstede, 2001 ; Schwartz, 2014 ), which is an organic extension of previous power distance studies, is also associated with narcissistic and Machiavellian actions and attitudes (Jonason et al., 2022 ). “People with high power distance orientation in the workplace typically accept status disparities, whereas people with low power distance orientation frequently support treating everyone equally regardless of status symbols.” (Adamovic, 2023 , p. 3). Conversely, workers with a low power distance orientation favor participatory leadership and decision-making processes which is not as prevalent under abusive supervision (Rao & Pearce, 2016 ). As a result, in countries with low power distance, abusive supervision may affect the emotional state of subordinates (Meydan et al., 2014 ).

De Clercq and colleagues ( 2021 ) discovered that PPD is positively associated with subordinates’ perception of superiors’ destructive leadership. This indicates that when subordinates perceive high PPD, they are more likely to view their leaders as engaging in such destructive behaviors. This correlation can also be attributed to abusive supervision, a form of destructive leadership behavior. According to social learning theory (Rumjaun & Narod, 2020 ), when leaders’ power is internalized and reflected as subordinates’ psychological power distance, the aggressive behaviors displayed by leaders are likely to be observed and learned by subordinates. These aggressive behaviors could then lead to emotionally exhausting reactions in the subordinates. Correlationally, this study suggests that psychological power distance mediates the link between destructive leadership behaviors and subordinates’ emotional exhaustion levels.

H2: Psychological power distance has a moderating role in the relationship between perceived destructive leadership and emotional exhaustion.

The causal research method which is one of the quantitative research methods is used in the study. Cross-sectional data were collected using an electronic survey form through the convenience sampling method. Participants received the link to the electronic survey form via social media and email. The statistical analyses were carried out with AMOS 24 and SPSS 27.

Sample and procedure

The survey sample size was determined by the Non-random convenience sampling method and the process of its determination was as follows: The sample size that can numerically represent the universe of working people was calculated with the formula below (Ding et al., 2022 ).

In this formula, n represents the required sample size and Z represents the z-statistic at a 90% confidence level (Z = 1.64). σ represents the standard deviation of the overall population and takes the value of 0.5. d is the tolerance error or sampling error. It is the difference between the universe parameter and the statistical value obtained from the sample. Since such a research model has not been studied before in the Turkish culture, the tolerance error for the sample was accepted as 10%. The final required sample size was calculated as 67.

Along this line, in a homogenous group with a reliability of 0.90 and a sampling error of 0.10, a sample group of 61 people can represent a universe of 100 million people (Yazıcıoğlu & Erdoğan, 2004 ). Moreover, in a heterogeneous group, a sample size of 96 is sufficient. Data were collected from a total of 222 employees working in different jobs by using the convenience sampling method via an online survey. This sample strategy allows us to collect data that covers more industries in Türkiye. The participation of participants in the research was voluntary. Working in a workplace was the only criterion for participants. In this context, it was accepted that the sample size was large enough to represent the universe.

117 (53%) of the participants were female, and 105 (47%) were male. The participants have 14.48 (sd = 10.46) mean years of working experience, while their age was between 19 and 67 years, with a mean value of 40.87 (sd = 9.42). % 24.9 of the participants were between 19 and 34, % 24.9 between 35 and 40, % 25.8 between 41 and 47, and % 24,4 between 47 and 67 years old.

Measure of psychological power distance

The PPD perception was measured with the scale, developed by Adamovic ( 2023 ). This scale is a five-point Likert-type scale (1 strongly disagree to 5 strongly agree) comprising fifteen items under five factors (Power, Conflict with Authority Figure, Hierarchy, Prestige, and Social Distance). Ascending numbers indicate the extent to which power distance was perceived. The overall original psychological power distance scale demonstrated strong reliability (α = 0.82). The scale has not been used in Turkish before. For this reason, firstly, this scale was adapted to Turkish, and then the validity and reliability of the scale were tested. By adopting this scale, the method suggested by Brislin et al. ( 1973 ) was used. This method includes five basic steps: translation into the target language, evaluation of the translation into the target language, back-translation into the source language, evaluation of the back-translation into the source language, and final evaluation with experts. After the adaptation process, exploratory factor analysis was applied for the validity of the scale. In the exploratory factor analysis, the Principal Axis Analysis method and the Varimax Rotation Technique were applied to calculate factor loadings. Factors with eigenvalues greater than 1 were taken into consideration. As a result of the factor analysis, it was seen that all factor loadings were higher than 0.30 and there were no overlapping items. The lowest factor loading value recommended for a good factor analysis is 0.30 (Tavakol & Wetzel, 2020 ). As a result of the exploratory factor analysis, the KMO (Kaiser-Meyer-Olkin) value was found to be 0.76, and the result of Bartlett’s test was found to be p  < 0.001. After that, Confirmatory Factor Analysis was performed to examine the structural validity of the measurement tool. The single-factor, first-level related, unrelated, and second-level related models were tested and Psychological Power Distance Scale showed the highest goodness of fit in the first-level related model (Δχ2 = 145.18, p  < 0.001, SD = 79, Δχ2/SD = 1.84, RMSEA = 0.06, CFI = 0.92, IFI = 0.92, TLI = 0,90) which verified it’s original five-factor dimension. In our study, the Psychological Power Distance scale showed generally strong reliability (α = 0.78).

Measurement of destructive leadership

Destructive Leadership was measured with the scale which was developed by Aydinay ( 2022 ). Five Point Likert-type scale (1 strongly disagree to 5 strongly agree) comprises 26 items under five factors (Inadequate leadership skills and unethical behaviors, Authoritarian leadership, Inability to deal with new technology and other changes, Nepotism (favoritism), Callousness toward subordinates). Ascending numbers indicate the extent to which destructive leadership was perceived. The original scale’s reliability was reported using Cronbach’s coefficient alpha of α = 0.97, which showed that the scale was reliable. The validity of the scale was tested with confirmatory factor analysis, (Δχ2 = 590.23, p  < 0.01, SD = 280, Δχ2/SD = 2.11, RMSEA = 0.07, CFI = 0.94, IFI = 0.94, TLI = 0,93) which verified it’s original five-factor dimension. In our study, the Destructive Leadership scale showed generally strong reliability (α = 0.97).

Measurement of emotional exhaustion

In the study, to measure the emotional exhaustion levels the emotional exhaustion dimension scale in the Maslach Burnout Inventory (MTE) (Maslach et al. 1996 ), translated into Turkish by Ergin ( 1992 ), was used. Five-point Likert-type scale (1 strongly disagree to 5 strongly agree) comprises 9 items under one factor. The original scale’s reliability was reported using Cronbach’s coefficient alpha of α = 0.86, which showed that the scale was reliable. The validity of the scale was tested with confirmatory factor analysis, (Δχ2 = 40.51, p  < 0.006, SD = 21, Δχ2/SD = 1.93, RMSEA = 0.07, GFI = 0.96, CFI = 0.98, IFI = 0.98, TLI = 0,97) which verified it’s original one-factor dimension. In our study, the Emotional Exhaustion scale showed generally strong reliability (α = 0.91).

Table  1 displays the variables’ descriptive statistics as well as the Pearson correlation coefficients. Examining the correlations between the variables of the study, all sub-dimensions of Destructive Leadership [Inadequate leadership skills and unethical behaviors ( r  = 0.46, p  < 0.01), Authoritarian leadership ( r  = 0.49, p  < 0.01), Inability to deal with new technology and other changes ( r  = 0.42, p  < 0.01), Nepotism ( r  = 0.40, p  < 0.01), Callousness toward subordinates ( r  = 0.40, p  < 0.01)] were positively correlated with emotional exhaustion. There was no correlation between Psychological Power Distance sub-dimensions (Power, Conflict with Authority Figures, Hierarchy, Prestige, and Social Distance) and emotional exhaustion. Moreover, there was no correlation found between sub-dimensions of Destructive Leadership and Psychological Power Distance.

Using SPSS 27 software, a multiple regression analysis was executed to test the research’s first hypothesis. First of all, by controlling the effects of gender and age, the direct relationship between destructive leadership dimensions and emotional exhaustion was examined. Table  2 displays the analysis findings. The variance explained by emotional exhaustion in this model is R2 = 0.31. The results indicate that Authoritarian leadership (b = 0.29, p  < 0.01) is positively and significantly associated with emotional exhaustion. The study’s first hypothesis is supported by this result. The other sub-dimensions of Destructive leadership (Inadequate leadership skills and unethical behaviors, Inability to deal with new technology and other changes, Nepotism, and Callousness toward subordinates) aren’t associated with emotional exhaustion ( p  > 0.05).

Next, to test hypothesis 2, the moderating effect of psychological power distance sub-dimensions in the relationship between destructive leadership sub-dimensions and emotional exhaustion was examined through SPSS PROCESS 4.1 macro (Hayes, 2018 ). Totally twenty-five regression analyses were conducted. Model 1 of the PROCESS was applied in all analyses, based on 5000 bootstrap samples. As a result of all analyses, it was found that the Inadequate Leadership Skills and Unethical Behaviors X Prestige interaction variable (b = 0.17, 0.05 < 95% CI < 0.28), the Inability to Deal with New Technology and Other Changes X Hierarchy interaction variable (b = 0,13, 0.02 < 95% CI < 0.24), the Inability to Deal with New Technology and Other Changes X Prestige interaction variable (b = 0.16, 0.05 < 95% CI < 0.27), Nepotism X Hierarchy interaction variable (b = 0.10, 0.009 < 95% CI < 0.20) was significantly and positively associated with emotional exhaustion. All the other interactions were not significant.

To understand the interaction of Inadequate Leadership Skills and Unethical Behaviors X Prestige interaction, we examined the levels of independent variables based on the levels of moderator variables. To establish low and high values as a default setting, the 16th and 84th percentiles of the moderator variable by PROCESS are taken into consideration (Hayes, 2018 ). In our analysis when the prestige level is low, the association between Inadequate Leadership Skills, Unethical Behaviors, and emotional exhaustion (b = 0.25, 0.11 < 95% CI < 0.39), was relatively low. In contrast, when the prestige was high, Inadequate Leadership Skills and Unethical Behaviors were relatively highly related to emotional exhaustion (b = 0.54, 0.40 < 95% CI < 0.67). As the level of prestige increases, Inadequate Leadership Skills, Unethical Behaviors, and emotional exhaustion association also increase. This demonstrates that prestige strengthens the relationship between Inadequate Leadership Skills and Unethical Behaviors and Emotional Exhaustion. Along this line, we can say that prestige positively moderates the relationship between Inadequate Leadership Skills and Unethical Behaviors, and Emotional Exhaustion. This result validates the study’s second hypothesis.

To figure out the mechanism of the moderating effect of prestige, a simple slope plot was drawn as seen in Fig.  1 . It shows that in the case of a low level of prestige (dashed line) the increase in the Inadequate Leadership Skills and Unethical Behaviors leads to a moderately significant difference in emotional exhaustion. However, in the case of a high level of prestige (dashed straight line) differences in the Inadequate Leadership Skills and Unethical Behaviors lead to a relatively higher significant change in emotional exhaustion.

Simple slope for inadequate leadership skills and unethical behaviors by Prestige interaction

To understand the interaction of the Inability to Deal with New Technology and Other Changes X Hierarchy interaction, we examined the levels of independent variables according to the levels of moderator variables. To establish low and high values as a default setting, the 16th and 84th percentiles of the moderator variable by PROCESS are taken into consideration (Hayes, 2018 ). In our analysis when the hierarchy level is low, the association between Inability to Deal with New Technology and Other Changes and emotional exhaustion (b = 0.28, 0.12 < 95% CI < 0.43), was relatively low. On the contrary, when the hierarchy was high, the Inability to Deal with New Technology and Other Changes was relatively highly related to emotional exhaustion (b = 0.49, 0.35 < 95% CI < 0.63). As the level of hierarchy increases, the Inability to Deal with New Technology and Other Changes and emotional exhaustion association also increase. This shows that hierarchy strengthens the relationship between the Inability to Deal with New Technology and Other Changes and emotional exhaustion. Accordingly, we can say that hierarchy positively moderates the relationship between the Inability to Deal with New Technology and Other Changes and emotional exhaustion. This finding supports the second hypothesis of the study.

To figure out the mechanism of the moderating effect of hierarchy, the basic slope plot was created, as seen in Fig.  2 . It shows that in the case of a low level of hierarchy (dashed line) the increase in the Inability to Deal with New Technology and Other Changes leads to a moderately significant difference in emotional exhaustion. However, in the case of a high level of hierarchy (dashed straight line) differences in the Inability to Deal with New Technology and Other Changes lead to a relatively higher significant change in emotional exhaustion.

Simple slope for inability to deal with technology and other changes by Hierarchy interaction

To understand the interaction of the Inability to Deal with New Technology and Other Changes X Prestige interaction we examined the levels of independent variables according to the levels of moderator variables. To establish low and high values as a default setting, the 16th and 84th percentiles of the moderator variable by PROCESS are taken into consideration (Hayes, 2018 ). In our analysis when the prestige level is low, the association between the Inability to Deal with New Technology and Other Changes and emotional exhaustion (b = 0.27, 0.13 < 95% CI < 0.42), was relatively low. On the contrary, when the prestige was high, the Inability to Deal with New Technology and Other Changes was relatively highly related to emotional exhaustion (b = 0.54, 0.39 < 95% CI < 0.68). As the level of prestige increases, the Inability to Deal with New Technology and Other Changes, and emotional exhaustion association also increase. This shows that prestige strengthens the relationship between the Inability to Deal with New Technology and Other Changes and emotional exhaustion. Accordingly, we can say that prestige positively moderates the relationship between the Inability to Deal with New Technology and Other Changes and emotional exhaustion. This finding supports the second hypothesis of the study.

To figure out the mechanism of the moderating effect of prestige, the basic slope plot was created, as seen in Fig.  3 . It shows that in the case of a low level of prestige (dashed line) the increase in Inability to Deal with New Technology and Other Changes leads to a moderately significant difference in emotional exhaustion. However, in the case of a high level of prestige (dashed straight line) differences in Inability to Deal with New Technology and Other Changes lead to a relatively higher significant change in emotional exhaustion.

Simple slope for inability to deal with technology and other changes by Prestige interaction

To figure out the mechanism of the moderating effect of the Nepotism X Hierarchy interaction we examined the levels of independent variables according to the levels of moderator variables. To establish low and high values as a default setting, the 16th and 84th percentiles of the moderator variable by PROCESS are taken into consideration (Hayes, 2018 ). In our analysis when the hierarchy level is low, the association between Nepotism and emotional exhaustion (b = 0.21, 0.08 < 95% CI < 0.33), was relatively low. On the contrary, when the hierarchy was high, Nepotism was relatively highly related to emotional exhaustion (b = 0.38, 0.26 < 95% CI < 0.49). As the level of hierarchy increases, Nepotism, and emotional exhaustion association also increase. This shows that hierarchy strengthens the relationship between Nepotism and emotional exhaustion. Accordingly, we can say that hierarchy positively moderates the relationship between Nepotism and emotional exhaustion. This finding supports the second hypothesis of the study.

To figure out the mechanism of the moderating effect of hierarchy, the basic slope plot was drawn as seen in Fig.  4 . It shows that in the case of a low level of hierarchy (dashed line) the increase in Nepotism leads to a moderately significant difference in emotional exhaustion. However, in the case of a high level of hierarchy (dashed straight line) differences in Nepotism lead to a relatively higher significant change in emotional exhaustion.

Simple slope for nepotism by Hierarchy interaction

Discussion and conclusion

The study holds some important theoretical implications. The findings of this study offer valuable insights into the moderating role of newly conceptualized Psychological Power Distance (PPD) on the relationship between Destructive Leadership (DL) and Emotional Exhaustion (EE). First, our empirical results support previous research findings regarding the positive correlation between negative leadership styles such as toxic and narcissistic (e.g., Badar et al., 2023 ) and EE. Similar to the findings of Abubakar et al.‘s ( 2017 ) study on nepotism and workplace withdrawal, nepotism, one of the components of DL, was found to be positively correlated ( r  = 0.40, p  <.01) with EE. Hierarchy and nepotism pose risks in different forms (Tytko et al., 2020 ). A great example is the risk of possible downfall when concentrating all power on a small group of privileged relatives and the organs of that group. Also, it explains in terms of the risk of mutual support under hierarchy. When a society is structured in a certain way and has a social structure that allows powerful groups to protect each other’s interests, as is common in Middle Eastern societies, the privilege of that group is guaranteed (Shamaileh & Chaábane, 2022 ). And this mutual reinforcement can be a stable thing over time. Subsequently, the risks and consequences of these dysfunctional and corruptive practices in the context of organizational performance may also be possible.”

On the other hand, we can discuss our empirical results based on the concept of Perceived external prestige (Kamasak & Bulutlar, 2008 ) and social identity theory (Tajfel & Turner, 2004 ), which are also shaped around the concepts of social value and status. “According to the literature, perceived external prestige, unlike corporate image or corporate reputation, is based on employees’ beliefs (Šulentić et al., 2017 ). Within this framework, when we look at the items measuring the prestige dimension of PPD, we encounter statements that gaining respect and status is important for employees to exert social influence (Cheng et al., 2013 ). Previous studies have shown that the concept of prestige/status is also associated with EE (Sessions et al., 2022 ) and narcissism which is one of the main characteristics of DL (e.g., Cheng et al., 2010 ; Haertel et al., 2023 ; Zeigler et al., 2019 ). Correlationally, our empirical findings also show that prestige also strengthens the relationship between inadequate leadership skills, unethical behaviors, and EE. Besides, This study also created new information about the moderating role of some specific sub-dimensions of PPD in the relationship between DL and EE. Furthermore, the prestige aspect of PPD amplifies the influence of deficient leadership abilities and unethical conduct on EE.

On the other hand, “hierarchies may produce undesirable or dysfunctional consequences” in organizations (Magee & Galinsky, 2008 ; Leavitt, 2005 ). In this context, the fact that differences in Nepotism lead to a relatively higher significant change in EE in case the hierarchy is high can be considered as an empirical finding that may lead to undesirable and dysfunctional results in the organizational context. Additionally, in the context of this research, a specific mediating link of prestige/status seeking emerged in the effect of destructive leadership style on EE. Although this finding is limited, it can be generalized to Middle Eastern countries (e.g., Syria, Lebanon, Iraq) where power distance is high. Therefore, The study holds some managerial implications. These results may assist organizations and leadership training experts in developing interventions to reduce employee EE and abusive supervisory behaviors. In addition, the interactional effect of high levels of hierarchy on the relationship between DL and EE also sheds light on the cultural and psychological processes in societies where PPD is high.

When the prestige was high, the Inability to Deal with New Technology and Other Changes was relatively highly related to EE (b = 0.54, 0.39 < 95% CI < 0.68). In other words, as the level of prestige increases, the challenges of inability to adopt new technology, and EE association also increase. This shows that prestige strengthens the relationship between the challenges of the inability to adopt new technology and EE. Most of the time, it is seen that introducing new technology to the workplace may create fear in the employees. Techniques such as training, communication, and support should be used by the management to minimize these challenges (Ivanov et al., 2020 ). In this context, power distance measures the extent to which subordinates accept control from their leaders or supervisors, or the extent of freedom that they can practice their own beliefs, values, and behaviors (Guzman & Fu, 2022 ). In high power distance cultures, subordinates are not allowed to raise their voice to their supervisor- no matter right or wrong they think. Traditionalists think that this rigid stratification may stop the implementation of new technology developed in high power distance countries like China or Malaysia (e.g., Rithmire, 2023 ). In conclusion, our empirical findings point out a well-established path for future study which focuses on the impact of power distance theories on organizational behavior like technology adaptation.

In a recent research by Harms and his colleagues, they found that the negative effects of DL on EE (Hattab et al. 2022 ) could be reduced by PPD. This means that when subordinates do not perceive a large power distance between them and their leaders, the harmful effect of DL on EE may be minimized. This may be because when subordinates have low PPD from their leaders, they are likely to question the necessity of coping with EE and evaluate demands made by the leaders. On the contrary, when subordinates perceive a large psychological power distance, they are more likely to accept the situation and engage in EE because it is a reflection of decorum or cultural practices. Moreover, it has been suggested that different cultures have their norms about what is good or bad leadership, and these norms can be reflected in the perception of PPD. Investigating the role of power distance in employees’ perception of leaders and better understanding the impact of leaders on employee well-being, will not only inform practices for workplace health intervention but also enlighten leadership researchers in discussing the universal and contingency theory of leadership.

The study of the moderating role of PPD will be advantageous for the following reasons. Firstly, fostering a transparent and merit-based work culture in high PPD countries is a way to reduce and prevent nepotism in the employment setting (Kirya, 2020 ). Secondly by identifying how and under what circumstances different types of leaders may impact differently on employees, human resource practitioners will have better insight into leader selection and training. For example, if an organization operates in a relatively low power distance culture such as the United States (Hofstede, 2001 ), then the findings from our research suggest that both supportive and directive leadership styles may be effective in reducing employees’ EE. However, if the same organization aims to expand to countries with higher power distance, especially those in the Middle East, it will be beneficial to have leaders with less directive and more supportive leadership styles in charge. In this circumstance, human resource practitioners can use the cultural dimensions of different societies such as power distance to evaluate the suitability of leaders’ approaches and make necessary modifications.

Limitations and future research directions

Because most concepts in the social sciences are interrelated in some way, theoretical frameworks that provide a holistic perspective are particularly important in facilitating research.

Therefore, in order not to expand the scope of the research too much, thereby the theoretical structure is limited to specific correlated variables. On the other hand, organizations are rich in complex interpersonal interactions, and these relational dynamics, combined with unique organizational factors, can differentiate the relationship of DL and EE from one organization to another. Besides, culture is another important antecedent predictor in terms of organizational outcomes. For example, the culture that affects the follower’s questioning, ethical decision-making, or tolerance of the unethical behavior of the supervisor (Cohen, 1995 ). Therefore, it should not be ignored that the level of EE may differ depending on the level of exposure to DL along with culture, situational circumstances, level of motivation, or personality characteristics of employees.

The PPD is a newly conceptualized notion. In this context, we also believe that the hypothesis and the results of our study may lead to new research questions for unexplored fields. In addition, there are several practical implications within our research. We explained the organic mechanism between DL and EE under the moderation of PPD. In this sense, employees and practitioners need to understand the motivation and psychological contract (Rousseau, 1990 ) level of employees under the reign of DL. On the other hand, based on our conceptual elaboration in this paper, we also suggest future research on gender, because, male and female forms of destructive leadership can differ significantly in terms of gender barriers and catalysts such as role fit. Finally the complex nature of the research variables, qualitative research is needed to explore which individual resources (e.g., self-efficacy) or behaviors will be negatively affected to cope with destructive leaders. As an additional comment, the significant effect of hierarchy on emotional exhaustion in the Turkish sample, where power distance is high (Hofstede, 2001 ) could be a starting point for future research in the context of the impact of cultural homogenization/globalization via internal uniformity (Conversi, 2014 ).

This study has some limitations. First of all, this study is conducted in a rather small region in Türkiye. Examining this research model at the international level in different provinces and different cultures will make strong contributions to the literature. The second is the investigation of the proposed causal relationship through the application of a cross-sectional research methodology. Thirdly, because our study relies on self-reported questionnaires, it is susceptible to common method biases and social desirability.

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Korkmazyurek, Y., Ocak, M. The moderating role of psychological power distance on the relationship between destructive leadership and emotional exhaustion. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06016-2

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ORIGINAL RESEARCH article

Word frequency and cognitive effort in turns-at-talk: turn structure affects processing load in natural conversation.

• 1 University of Freiburg, Freiburg, Germany
• 2 Leibniz Institute for the German Language (IDS), Mannheim, Baden-Württemberg, Germany

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Frequency distributions are known to widely affect psycholinguistic processes. The effects of word frequency in turns-at-talk, the nucleus of social action in conversation, have, by contrast, been largely neglected. This study probes into this gap by applying corpus-linguistic methods on the conversational component of the British National Corpus (BNC) and the Freiburg Multimodal Interaction Corpus (FreMIC). The latter includes continuous pupil size measures of participants of the recorded conversations, allowing for a systematic investigation of patterns in the contained speech and language on the one hand and their relation to concurrent processing costs they may incur in speakers and recipients on the other hand. We test a first hypothesis in this vein, analyzing whether word frequency distributions within turns-at-talk are correlated with interlocutors' processing effort during the production and reception of these turns. Turns are found to generally show a regular distribution pattern of word frequency, with highly frequent words in turn-initial positions, mid-range frequency words in turn-medial positions, and low-frequency words in turn-final positions. Speakers' pupil size is found to tend to increase during the course of a turn at talk, reaching a climax towards the turn end. Notably, the observed decrease in word frequency within turns is inversely correlated with the observed increase in pupil size in speakers, but not in recipients, with steeper decreases in word frequency going along with steeper increases in pupil size in speakers. We discuss the implications of these findings for theories of speech processing, turn structure, and information packaging. Crucially, we propose that the intensification of processing effort in speakers during a turn at talk is owed to an informational climax, which entails a progression from highfrequency, low-information words through intermediate levels to low-frequency, high-information words. At least in English conversation, interlocutors seem to make use of this pattern as one way to achieve efficiency in conversational interaction, creating a regularly recurring distribution of processing load across speaking turns, which aids smooth turn transitions, content prediction, and effective information transfer.

Keywords: conversation, processing, Pupillometry, Word frequencies, Corpora

Received: 18 Apr 2023; Accepted: 13 May 2024.

Copyright: © 2024 Rühlemann and Barthel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Christoph Rühlemann, University of Freiburg, Freiburg, Germany

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• Open access
• Published: 10 May 2024

Digital media use, depressive symptoms and support for violent radicalization among young Canadians: a latent profile analysis

• Diana Miconi 1 ,
• Tara Santavicca 2 ,
• Rochelle L. Frounfelker 3 ,
• Aoudou Njingouo Mounchingam 4 &
• Cécile Rousseau 5  

BMC Psychology volume  12 , Article number:  260 ( 2024 ) Cite this article

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Despite the prominent role that digital media play in the lives and mental health of young people as well as in violent radicalization (VR) processes, empirical research aimed to investigate the association between Internet use, depressive symptoms and support for VR among young people is scant. We adopt a person-centered approach to investigate patterns of digital media use and their association with depressive symptoms and support for VR.

A sample of 2,324 Canadian young people (M age = 30.10; SD age = 5.44 ; 59% women) responded to an online questionnaire. We used latent profile analysis to identify patterns of digital media use and linear regression to estimate the associations between class membership, depressive symptoms and support for VR.

We identified four classes of individuals with regards to digital media use, named

Average Internet Use/Institutional trust, Average internet use/Undifferentiated Trust, Limited Internet Use/Low Trust and Online Relational and Political Engagement/Social Media Trust. Linear regression indicated that individuals in the Online Relational and Political Engagement/Social Media Trust and Average Internet Use/Institutional trust profiles reported the highest and lowest scores of both depression and support for VR, respectively.

Conclusions

It is essential to tailor prevention and intervention efforts to mitigate risks of VR to the specific needs and experiences of different groups in society, within a socio-ecological perspective. Prevention should consider both strengths and risks of digital media use and simulteaneously target both online and offline experiences and networks, with a focus on the sociopolitical and relational/emotional components of Internet use.

Peer Review reports

The recent increase in support for – and direct engagement in – ideologically motivated violence among youth can be associated with the increase in social polarization in society [ 1 ] as well as the specificities of adolescence and early adulthood, a seminal period for the development of ideologies [ 2 , 3 ]. Violent radicalization (VR) is a complex and multidimensional phenomenon [ 4 ] defined as a process whereby an individual or a group increases support for violence as a legitimate means to reach a specific (e.g., political, social, religious) goal [ 5 ]. Noteably, VR processes are increasingly occurring online [ 6 , 7 ]. Internet use has been primarily investigated in the field of terrorism studies and with samples of radicalized individuals [ 6 , 8 ]. Less is known about the association of digital media use, social polarization and attitudes towards support for VR among young people. Although the association between attitudes and behaviors is not a linear one, positive attitudes towards VR can contribute to the creation of socially polarized environments that fuel conflicts and shatter social solidarities, resulting in some cases in extremist ideologies and the normalization of violence. In such contexts, vulnerable individuals - such as those experiencing significant social grievances - are at higher risk of engaging in violent acts and extremism. Thus, in a primary prevention perspective, a reduction in support of VR among youth can result in an overall decrease of violence in our societies in the short and long-term [ 9 , 10 , 11 ].

Although numerous interventions target online literacy and social media use as potential ways to counter violent extremism [ 7 ], empirical research on their effectiveness is scarce and the role that Internet use plays in the development of positive attitudes towards VR among young people is largely understudied. While depressive symptomatology, which has also been increasing among young people in the past decade [ 12 , 13 ], is associated with both digital media use and support for VR [ 14 , 15 , 16 , 17 ], empirical research has not yet examined the associations between these variables simultaneously in one study. The current study aims to fill this gap in the literature by empirically investigating if and how patterns of digital media use are differently associated with depressive symptoms and support for VR among a sample of Canadian young people via a person-centered approach. Given the prominent role that digital media use play in both VR processes and mental health among young people, a better understanding of risk and protective factors associated with digital media use is warranted to inform and tailor evidence-based prevention programs that could significantly help reduce social ruptures and the associated risk of violence.

Digital media use and support for VR

The online space has become a central developmental context for young people [ 18 , 19 ]. Empirical evidence remains mixed, suggesting that digital media use can be either a risk or protective factor across multiple developmental outcomes depending on a complex interplay between both online and offline factors [ 18 ]. A consensus is now emerging that the specific behaviors in which youth engage online, rather than overall digital media per se, are key determinants of well-being. Yet, gaps in knowledge remain [ 20 ].

On the one hand, digital media can be used to connect with peers and to counter isolation, thus extending or reinforcing one’s social support network and possibly one’s trust in institutions and in democracy. On the other hand, the Internet can provide instant and unfiltered access to content and groups that propagate fake news, extreme beliefs and encourage violent actions, representing one of the main settings that can facilitate disaffiliation phenomena and recruitment of young people by extremist groups [ 7 , 21 , 22 , 23 , 24 ]. Notably, whereas the majority of young people go online, only a minority of them get involved in VR processes. As such, it is likely that digital media use does not have a linear relationship with support for VR, but that specific constellations of digital media use are differentially associated with support for VR [ 8 , 25 ].

Young people’s use of digital media is complex and heterogeneous [ 18 ], making the measurement and conceptualization of digital media use a challenging area [ 26 , 27 ]. In this study, we focus on some aspects of digital media use that have been theoretically and/or empirically associated with VR, namely time on social media, reasons for Internet use (work, informational, entertainment, social), news literacy, trust in specific online sources of information (news, peers, influencers, government, youtube), preference for online social interactions and online political interactions.

The Internet can be used for multiple purposes, spanning from work or entertainment, to relational maintenance and social interaction [ 18 , 28 ]. Although spending more time online has been associated with increased exposure to extremist content [ 23 ], whether this exposure is associated with risks of VR is yet unclear [ 29 ]. Overall, the impact of time spent on social media on a variety of social and health outcomes including VR varies based on the specific online activities and experiences [ 8 , 18 , 20 ].

Of importance, the Internet is currently the most important source of information for young people [ 30 , 31 ], but trust on the validity of information from official governmental websites as well as from social media (e.g., Instagram, Twitter, Youtube) can vary between individuals. Misinformation and beliefs in conspiracy theories have been associated with higher support for VR [ 32 , 33 ]. News literacy is considered a potential avenue to countering both misinformation, social polarization and online extremism [ 34 , 35 ]. News literacy is defined as the ability to find/identify/recognize news, critically evaluate and produce them [ 36 ]. However, empirical research that examines the association between news literacy and support for VR is lacking.

Prior research has found that preference for online social interactions over face-to-face relationships represents a risk factor for support for VR [ 37 , 38 ]. Preference for online social interactions is characterized by beliefs that one is safer, more confident, more comfortable and appreciated when online as opposed to offline [ 39 ] and is considered a component of problematic Internet use as it implies problematic relational experiences offline.

Some studies suggest that actively seeking and engaging with extremist content online is associated with higher risk of VR [ 8 , 22 , 25 ]. Although online interactions with strangers have been associated with higher risk of psychological distress [ 17 , 40 ], the extent to which interactions with known and unknown people around political or current issues are associated, if at all, with support for VR has yet to be explored [ 23 ].

Given the variety in online experiences and type of digital media use, a person-centered approach via a latent profile analysis (LPA) facilitates examining different constellations of digital media use among young adults and associations between latent groups and support for VR. As VR is the result of complex and unique interplays between personal and social/contextual variables [ 4 , 41 , 42 ], identifying patterns of vulnerabilities online via a person-centered approach can inform the development of tailored VR prevention programs targeting digital media use.

The present study

The present study adopts a person-centered approach to investigate: 1) patterns of digital media use among young Canadians. Specifically we focus on reasons for digital media use (i.e., work, entertainment, socialization, information), reported trust in different sources of online information (i.e., official government and news websites and social media), news literacy, time on social media, preference for online social interactions and online political interactions (e.g., posting/discussing with peers vs strangers, having conflicts online about these issues); 2) the association between patterns of digital media use and levels of depressive symptoms; and 3) the association between patterns of digital media use and support for VR. We expect to identify at least two groups of young people who differ in their reported digital media use. Given that we do not have a priori knowledge of the class structure in the data, we did not have a priori hypotheses about the association between each profile and depressive symptoms. However, we anticipate that the group(s) that will report the highest levels of depressive symptoms will also be at higher risk of supporting VR.

Participants

A total of 2,695 participants answered an online survey; missing outcome data ( n =362) and individuals identifying as “other” gender ( n =9) were removed for methodological concerns given the very small sample size of this gender group. Final sample size was 2,324 participants (59.3% women; mean age = 30.10; SD = 5.44 ). Socio-demographic characteristics are presented in Table 1 .

Data were collected in November 2021, during the COVID-19 pandemic in Alberta, Ontario, and Quebec. Participants were recruited through the Leger360 online platform with over 500,0000 registered members and answered the survey in either English or French [ 43 ]. informed consent to participate was obtained electronically from all of the participants in the study, and response rate was 53.8%. Exclusion criteria were individuals under the age of 18 or above 41. Study protocol and procedures were approved by the Institutional Review Board of.

Support for VR

The Radicalism Intention Scale (RIS) is a 4-item subscale of the Activism and Radicalism Intention Scales (ARIS) [ 44 ]. It assesses an individual’s readiness to participate in illegal and violent behavior in the name of one’s group or organization. Respondents rated their agreement with four statements on a seven-point Likert scale, with higher scores indicating more support for VR (range 4-28). The scale has good psychometric properties among young adults [ 45 ] (α = .89; Ω = 0.89).

Time spent on social media (daily)

Participants were asked to identify how many hours they spend on social media on a typical day (i.e., less than 2 hours, 2-4 hours, 4-6 hours, and 6 hours or more).

Reasons for Internet use

Four statements on Internet use were presented (i.e., using Internet: for personal relationships, to actively search for information/news, for entertainment, and for work). Participants were asked to indicate on a 5-point Likert scale how much they used the Internet for each reason (not at all, a little, moderately, a lot, most of the time).

News literacy

Was measured as a subscale of the literacy scale by Jones-Jang et al. [ 36 ]. Participants were asked using a 5-point Likert scale how much they agreed with each statement (six items, from 1-strongly disagree to 5- strongly agree, range 6 - 30)(α = .80; Ω = 0.80).

Trust on online sources of information

Five statements around trusting different sources of online information were presented, namely trust in news, peers, influencers, government, and YouTube sources of information. Participants were asked to indicate how often they trust each source of information on a 4-point Likert scale (never, rarely, sometimes, often).

Preference for online social interactions

(PFOSI) was measured with the 13-item Social Comfort subscale of the Online Cognition Scale [ 46 ]. Participants rated on a 8-point Likert scale (range 0 – 91) how much they agreed with statements describing their relationships with people who they know primarily through the Internet (e.g., chat rooms, message boards, online gaming communities). Higher scores indicate more preference for online social interactions (α = .92; Ω = 0.92).

Online political interactions

Participants were asked to indicate on a 6-point Likert scale (from “None/No time at all”, to “Several times a day”) how often their online interactions were oriented around these four statements: posted information about politics/current affairs on social media, discussed politics/current affairs with people you know, discussed politics/current affairs with people you do not know, had verbal conflicts with known people around information shared/posted online.

Depressive symptoms

Depressive symptoms were measured by using the 15-item subscale of the Hopkins Symptom Checklist-25 (HSCL-25) [ 47 ]. Items are rated on a Likert scale from 1 (not at all) to 4 (extremely) based on how much discomfort that problem has caused them during the past seven days, and a total score is obtained by computing the mean of all items. The clinical cut-off is set at 1.75 (score range from 1 to 4) and scores have been recoded as below (0) or above (1) this cut-off. The HSCL-25’s psychometric qualities have been well established [ 48 ] (α = .94; Ω = 0.94).

Socio-demographic variables

Participants provided information on their age, gender (man or woman), education (None/Less than high school, High school graduate, Apprenticeship, technical institute, trade or vocational school, College, CEGEP or other non-university certificate or diploma or University certificate, diploma or degree), Income ($19,999 or less, $20,000- $39,999, $40,000- $59,999, $60,000 - $79,999, $80,000- $99,999, $100,000 or more), employment (not employed, employed -essential, employed – non-essential), generational status (first-generation immigrant, second-generation immigrant, and third generation or more immigrant/non-immigrant), province (Alberta, Ontario, Quebec), religious beliefs (no religion, religion), and age.

Statistical analyses

Analyses were conducted using R software [ 49 ]. Missing data were imputed using the Random Forest method via the mice package [ 50 , 51 ]. Sensitivity analysis suggested that missing data and multiple imputations did not alter the observed patterns of associations. First, we estimated the LPA model around variables related to digital media use via the tidyLPA package [ 52 ]. LPA is an analytic strategy that attempts to identify subgroups of people within a heterogeneous population who has a high degree of homogeneity in responses on a set of indicators. The appropriate number of latent profiles was selected based on the Akaike information criterion (AIC), the Bayesian information criterion (BIC), the Sample-size-adjusted BIC (SABIC), Bootstrap Likelihood Ratio Test (BLRT), characteristics of the profiles (interpretability of response profiles or uniqueness) and a conservative profile sample size (>10%) [ 53 , 54 , 55 , 56 ]. Lower AIC, BIC and SABIC values and a statistically significant BLRT indicate a better model fit [ 53 , 54 ]. Once the best LPA solution was identified, the level of entropy (acceptable if >.70) and Average Posterior Class Probability (AvePP; acceptable if >.70) were examined to determine the accuracy of classification [ 57 ].

Next, based on the predicted probabilities of profile membership made by the LPA, we assigned each participant to a specific profile. Analyses were then conducted on the univariable associations between sociodemographic characteristics and profile membership. Frequencies of profile membership by sociodemographic characteristics can be found in Table 3 .

Lastly, we conducted linear regression analyses that estimated support for VR as a function of profile membership. A sequential model building approach was used to evaluate the associations between profiles and support for VR. Model 1 presents the unadjusted association between profile and support for VR; model 2 adjusts for sociodemographic characteristics, and model 3 adjusts for sociodemographic characteristics and depression.

Latent Profile Structure

LPA models 2 through 6 are presented in Table 2 along associated BIC and log-likelihood values. The four-class solution was selected as the best fit for sample size of profiles (>10%) and interpretability of findings, despite not having the lowest BIC value. Figure 1 presents profile membership item response probabilities for digital media use. Participants in all profiles had a high probability of reporting average levels of news literacy. Unique class characteristics emerged around time spent on social media and overall Internet use preference for online social interactions, online political interactions and trusting multiple sources of information. Profile 1, named Average Internet use/Undifferentiated trust is characterized by individuals who demonstrated average Internet use yet infrequently used the Internet for interactions around politics/current affairs and showed undifferentiated trust towards information found on-line, regardless of the source. Participants in Profile 2, named Limited Internet use/Low Trust , infrequently used the Internet across the considered reasons and reported a low probability of trusting news and government sources compared to information from social media (e.g., peers, influencers, youtube). Profile 3, named Average Internet use/Institutional trust , is characterized by participants with average and undifferentiated internet use, who were more likely to report greater trust in institutional sources of online information (e.g., news, government) compared to other social media sources. Profile 4, named Online relational and political engagement/Social media trust , consists of individuals with a high probability of preferring online, as opposed to in person, social interactions and spending a large amount of time on social media on a daily basis. In addition, participants in Profile 4 had a high probability of using the Internet for discussing politics and other issues with both peers and strangers, actively posting on-line about politics, and were more likely to report conflicts online compared to all other profiles. Profile 4 participants had a lower probability of trusting news and government sources compared to other sources of information online (peers, influencers, youtube). Overall, Profile 1 and 3 included 46.8% and 27.9% of participants, respectively. Profile 2 was smaller and included 11.4% of participants, while Profile 4 included 13.9% of participants.

Four-Profile Solution with Standardized Mean by Item Responses ( N = 2324)

Note. PFOSI Preference for online social interactions

Profile belonging, sociodemographic characteristics and depressive symptoms

Table 3 represents sociodemographic characteristics and depressive symptoms by profile for study participants. All variables were significantly associated ( p < 0.05) with profile belonging at the univariable level. The Average Internet use/Undifferentiated trust profile included a higher representation of women, non-immigrant, employed and non-religious participants, as well as participants who reported high education and income. A total of 45% of participants in this profile scored above the clinical cut-off for depressive symptoms. Participants in the Limited Internet use/Low Trust profile had a higher probability of being less educated, reporting a lower income and more unemployement. Participants in this profile were more likely to live in Alberta. Profile 3, Average Internet use/Institutional trust included participants who were highly educated, had high income, without an immigration background (third generation or more) and without a religion. Participants in this profile reported also the lowest levels of depression (37.5% above clinical cut-off) and more of them lived in Quebec. Finally, the Online relational and political engagement/Social media trust profile had an overrepresentation of men, immigrants, participants with a religion and who lived mainly in Ontario. In addition, participants in this group were overall educated but reported low income and high unemployment. A total of 70% of participants in this profile scored above the clinical cut-off to our measure of depressive symptoms.

Associations of profile membership with support for VR

Profile membership was associated with scores on the RIS ( p < 0.001). Participants in the Online relational and political engagement/Social media trust profile were more likely to report higher levels of support for VR compared to the other profiles in both unadjusted and adjusted models. Specifically, belonging to this profile was associated with a 0.91 ( SE = 0.06, p < 0.001) increase in support for VR compared to the Average Internet use/Undifferentiated trust profile when controlling for sociodemographic variables and depressive symptoms (Table 4 ). Belonging to the Average Internet use/Institutional trust profile was associated with a -0.267 ( SE = 0.046, p < 0.001) decrease in support for VR compared to the Average Internet use/Undifferentiated trust profile when controlling for sociodemographic variables and depression (Table 4 ). Gender, generation, province, age, and depressive symptoms were also associated with support for VR ( p < 0.05). Men, first generation immigrants, participants from Ontario, younger participants, and participants reporting more depressive symptoms were more likely to report higher support for VR. Religion, income and education were not significantly associated with support for VR (Table 4 ).

The current study investigated patterns of digital media use in a sample of young adults from three Canadian provinces. In addition, we examined whether these patterns were differentially associated with depressive symptoms and support for VR. Four profiles emerged from our LPA, confirming the pertinence of using a person-centered approach to shed light on the complex patterns of digital media use among young people. Overall, profiles differentiated participants mostly in terms of trust on specific sources of information and level and type of online engagement.

The two largest profiles ( Average Internet use/Undifferentiated trust and Average Internet use/Insitutional trust) differed primarily in their trust of online sources of information. Specifically, individuals in the Average Internet use/Insitutional trust profile reported to trust more frequently institutional sources of information (i.e., government and news) rather than social media (i.e., youtube, influencers, and peers), suggesting an overall acceptance of mainstream information and of the status quo. In contrast, the Average Internet use/Undifferentiated trust group showed average levels of trust to all sources of information alike. This group spent slightly more time online than the Average Internet use/Insitutional trust one , but overall these two groups did not differ much in their online social or political interactions. These two groups included 74.7% of participants, indicating a divide in the population mostly linked to what online sources to trust for information. The remaining participants were equally distributed between the Online relational and political engagement/Social media trust and the Low Internet use/Low trust profiles. Participants in both of these profiles trusted more frequently alternative social media sources of information compared to institutional ones, but they differed in overall levels of trust, with the Limited Internet use/Low trust group reporting overall low levels of trust, especially for institutional sources of information. Participants in the Online relational and political engagement/Social media trust profile reported high levels of trust in alternative social media sources of information and were more actively and politically engaged online with both peers and especially with strangers. They spent more time online and preferred online social interactions more compared to the other profiles. Taken together, these findings suggest that patterns of digital media use echo the increasing polarization in our societies [ 58 , 59 ] around issues of trust/distrust, engagement/disengagement as well as a variety of negative/positive online experiences. Indeed, the most important variables to differentiate the four profiles were related to the frequency of trusting different online sources of information as well as specific social and political interactions online, rather than reasons for Internet use or news literacy, which on the contrary did not seem to play a significant role in determining profile membership.

We suggest that the divide around trust in online information and engagement needs to be situated in the broader socio-political context, which can partly explain the socio-demographic differences we found across profiles.The Average Internet use/Insitutional trust and the Average Internet use/Undifferentiated trust profiles consisted of more affluent and more educated participants, mostly employed and without an immigration background. Participants in these profiles may benefit from more privileges in society, which can favor their trust in mainstream institutional sources of information online [ 60 , 61 , 62 ] . Indeed, participants in the Average Internet use/Institutional trust group were more likely to report the highest levels of education and income as well as the lowest levels of depressive symptoms followed by the Average Internet use/Undifferentiated trust profile. The difference in levels of depression between these two profiles can also be associated with the presence of younger participants and more women in the Average Internet use/Undifferentiated trust profile compared to the Average internet use/Institutional trust one. The Low Internet use/Low trust and Online relational and political engagement/Social media trust profiles included more participants reporting lower income. Participants in the Online relational and political engagement/Social media trust group included a higher percentage of men, participants with an immigration background and professing a religion – although participants in this profile reported an education level similar to the two larger profiles. This profile reported concerning levels of depression (70.2% above clinical cut-off). Relying on the internet for relational and political purposes combined with more frequent trust in alternative social media sources of information and less privileges in society can jeopardize young people’s mental health. Within a socio-ecological perspective, the fact that this profile is made up of primarily educated men with an immigrant background may represent a form of double-bind in which some groups may feel alienated because official discourses and stances about equity in Canada are contradicted by daily life experiences. This group’s pattern of digital media use may be related to the hardships, grievances and social deprivation experienced by minorities both online and offline. The combination of negative life experiences with high emotional distress may lead to experience overall negative and conflictual online social and political exchanges, subsequently legitimazing violence as an ultimate solution [ 16 , 17 , 63 ]. Besides reporting low income similarly to the Online relational and political engagement/Social media trust group, the Limited Internet use/Low trust profile included less educated and more unemployed participants compared to all other profiles, mostly without an immigration background. Participants in this group may not be content with their socio-political reality, and disengage from social and political issues, at least online. Noteworthy, our profiles suggest that digital media use is closely intertwined with social experiences offline. Interventions should consider this complex interaction and adopt a socio-ecological approach to both research and intervention, tailored not only to the different groups in society but also addressing the gap between them to mend the social fabric.

With regards to depressive symptoms and support for VR, the Online relational and political engagement/Social media trust reported the highest levels of depression and support for VR, followed by the Limited Internet use/Low trust profile. The fact that the two groups that reported less trust in institutional sources of information compared to alternative social media showed more depressive symptoms and support for VR indicates that issues of trust are important to address with young people in prevention and intervention efforts. Given that individuals in these groups had overall a lower status in society, compared to the other two profiles, it is possible that they may have been experiencing more social deprivation and grievances during the pandemic and have been more sensitive to the anti-system rhetoric which provided meaning to this perceived injustice [ 60 ]. This divide aligns with the emergence of polarized social movements in the whole of Canada (e.g., pro- and anti-vaxx groups during the pandemic). Promoting a sense of agency and belonging as well as ensuring that young people can express their opinions and have a purpose in life may help decrease depressive symptoms and reduce overall socio-political distrust and disengement both online and offline, which can in turn contribute to reduce the legitimation of violence. However, such interventions need to consider the social adversity and deprivation experienced by young people and be tailored to the specific needs and challenges that they face. Multi-level systemic interventions that target online and offline socio-political macro-determinants of mental health and injustices in our societies are needed above and beyond individual intervention programs.

The association between membership to the Online relational and political engagement/Social media trust profile and support for VR aligns with prior studies pointing to an association between active online political engagement and interactions and support for VR [ 8 , 23 , 35 ]. Noteworthy, this was a characteristic that clearly distinguished the Online active political engagement/Social media trust profile from all other profiles. Online relational and political engagement should be addressed in prevention and intervention, while also addressing possible isolation and injustices experienced offline. The association between membership to the Limited Internet use/Low trust and support for VR can be related to an overall distrust in society and especially in government and official institutions, which has been found to represent a risk factor for VR [ 32 ].

As expected, the group that was at higher risk of supporting VR was also the one that reported the highest level of depressive symptoms, which were significantly and positively associated with support for VR, confirming prior evidence [ 38 , 64 , 65 , 66 , 67 ]. Depressive symptoms do not necessarily lead to greater risk of VR [ 68 ]. Yet, multiple studies indicate a positive association between depressive symptoms and support for VR [ 38 , 64 , 65 , 66 , 67 ]. Although directionality of associations remain to be established, available evidence suggests that youth who interact more with strangers online [ 17 , 40 ], who prefer online social interactions [ 69 , 70 , 71 ] and who experience more social adversity [ 14 , 67 ] are at higher risk of depression, which can partly explain the higher scores of depressive symptoms found among the Online relational and political engagement/Social media trust profiles . Identifying as a man and being younger were also risk factors for support for VR, in line with prior studies [ 7 , 15 ], underlining the pertinence for future studies to focus on young people and to consider specificities by gender in VR studies [ 14 , 29 , 32 , 45 ].

Limitations

This study has several limitations. Most importantly, the cross-sectional design prevents us from drawing any conclusions about causality. Longitudinal studies are needed to shed light on the trajectories of associations between patterns of digital media use, depressive symptoms and support for VR. Second, our study is based on a convenience sample with a relatively high socio-economic level and education. This means that our results may not be generalizable to a larger, general population of young adults. Nonetheless, our online method of recruitment is appropriate given the sensitivity of the topic and the challenges of conducting research during a pandemic. Third, all data are based on young people’s self-reports and social desirability biases cannot be excluded. Fourth, our measures of digital media use were limited and not comprehensive of the broad range of possible online experiences. Given the rapidly evolving and dynamic aspects of the Internet, the availability of validated measures for different facets of Internet use remains a challenge for future studies. Last, our data were collected during the COVID-19 pandemic in three Canadian provinces, and results cannot be easily generalized to other provinces or countries, nor to a non-pandemic context.

Despite these limitations, our findings suggest that digital media use, psychological distress and their interaction play a role in processes of VR among young people and need to be situated and understood within a socio-ecological and social justice perspective. Specifically, trust in different sources of information and social and political experiences online are as relevant as the emotional and relational experiences of young people. The dynamic associations among these key elements have to be considered simultanously when reflecting on VR prevention and digital media use among young people. Prevention efforts should be adapted to the needs of specific populations and consider the diversity of their online/offline experiences. Indeed, our results suggests that online experiences are intertwined with offline experiences in society, in particular with grievances, and that an attention to the rapidly evolving socio-political scenario is warranted when designing intervention programs to prevent processes of VR among young people targeting their digital media use. The fact that self-reported news literacy did not differ across profiles questions the pertinence of VR prevention programs that target mainly news literacy skills among youth. Our findings support preliminary results that showed that media literacy did not protect youth from exposure to extremist content online [ 35 ] or risks of VR [ 25 ]. It has been argued that programs aimed to foster digital literacy may be associated with improved technical competence but leave participants “critically naïve” [ 72 ], failing to situate digital competence within the broader socio-political context. Although digital literacies may still be relevant skills to promote among young people, our findings suggest that, when it comes to the prevention of VR processes, critical thinking skills, supportive environments and a social justice approach to intervention may be equally important.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon request.

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Our work is funded by a Digital Citizen Contribution Program grant awarded to DM by Canadian Heritage and by a project grant awarded to CR by the Canadian Institute of Health Research (CIHR).

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Diana Miconi

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Miconi, D., Santavicca, T., Frounfelker, R.L. et al. Digital media use, depressive symptoms and support for violent radicalization among young Canadians: a latent profile analysis. BMC Psychol 12 , 260 (2024). https://doi.org/10.1186/s40359-024-01739-0

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TikTok Tourette’s: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use?

Jessica frey.

1 Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA

Kevin J Black

2 Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA

Irene A Malaty

3 Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA

Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.

Introduction

Tourette’s syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor tics and at least one phonic tic, typically preceded by a premonitory urge. 1 , 2 To fulfill DSM-5 criteria, these symptoms must be present for at least one year and must be present before the age of 18. 2 TS is more common in males compared to females (~4:1), and most commonly begins during childhood around ages 4–8. 3 Chronic tic disorder (CTD) is diagnosed when an individual has either motor or phonic tics but not both. 1 There is often a decrease in tic frequency starting around the ages of 12–17, with 75% of children having considerable tic improvement during adulthood and up to 32% having complete tic remission. 4 , 5 However, although tics may improve during puberty, adolescents report this period of time as the most challenging from a social perspective since exclusion amongst peers due to tic symptoms often becomes more prominent. 6 In addition to tics, TS is associated with comorbid symptoms such as obsessive-compulsive behavior (OCB), attention deficit hyperactivity disorder (ADHD), and mood disorders. 7

Quality of life can be severely impaired in patients with TS due to tics, including difficulties with family relationships in 29%, difficulties in making friends in 27%, difficulties with socialization in 20%, and feeling self-conscious of tics in 15%. 8 Beyond tics, up to 70% of individuals with TS reported non-tic-related impairments in quality of life, including difficulties in the school, home, or social environment. 9 School difficulties include increased likelihood of having an individualized education plan (IEP), increased likelihood of needing to repeat a grade, and higher rates of absenteeism. 10 , 11 One study of tic disorder impact involving 623 parents of children and 281 adults found that 35% of children and 77% of adults reported that tics interfered with achieving education commensurate with intellectual ability, and almost 20% of adult respondents reported subsequent limitation to their career paths as a result. 12 These barriers result from negative stigmas surrounding TS, often due to misperceptions of TS in the larger community by teachers, peers, and parents. 8 These stigmas can in turn lead to bullying and discrimination, with up to 75% of parents reporting that their child was treated differently due to their tics. 11 In addition, societal stigmas often lead to self-stigmatization, along with higher rates of depression and anxiety compared to the general population. 8 , 13 Many studies conclude that increasing education and awareness about what TS is and how it impacts an individual’s life can improve the overall well-being and quality of life for that individual. 8 , 10 , 13 For example, a few studies evaluating the knowledge of teachers and children about TS revealed only a basic knowledge that was amenable to educational interventions. 14 , 15

Since the onset of the COVID-19 pandemic, there has been a significant rise in sudden-onset, complex, and significantly disruptive tics with atypical features (described later). These presentations have been more consistent with functional neurological symptoms, which are thought to comprise a separate disorder, with characteristics distinct from typical organic tics. Sometimes referred to as functional tic-like behavior (FTLB), these tics can be seen in youth with no prior history of tics, and can also be seen to complicate the course of some youth with known tics and TS. This global phenomenon has resulted in concern that in the context of isolation and stress, attention and exposure to inaccurate portrayals of tics on social media may be fueling this notable rise. 16 , 17 There are also concerns that these social media platforms may unintentionally increase misperceptions of TS, furthering stigma and the sequelae of living with a stigmatized disorder. 16 , 18 Therefore, it is important not only to educate the general public about TS but also to educate individuals presenting with functional tics thought to be largely influenced by social media in order to reduce stigma, improve quality of life for those who have TS, and improve outcomes for individuals with functional tics. 3

This review will evaluate the complex relationship between social media, COVID-19, and the impact each of these has on tic-related disorders.

Functional Tics

Functional tics fall under the larger umbrella of functional movement disorders (FMDs), generally thought to be an external manifestation or reaction to underlying psychosocial stressors. 19 Functional tics have previously been referred to as pseudo-tics, psychogenic tics, and non-organic tics; however, the etiology of these non-typical tics has still not been well established and therefore the term functional tics is most often used as convention in recent years. 20

The phenomenological characteristics of tics in TS are somewhere between volitional movement and involuntary movement, 21 which makes distinguishing between typical tics of TS and functional tics challenging. There have been several proposals on how best to differentiate between typical tics and FTLBs, mainly based on clinical observations and case series of patients with atypical tics. Clues to the diagnosis of functional tics include a later onset in adolescence or young adulthood as opposed to childhood, sudden onset, complex tics at onset, and association with other functional neurologic disorders such as pseudoseizures. They occur more often in females as opposed to males, with a lack of childhood or family history of tics. 17 , 20–22 In addition, functional tics may be associated with a lack of premonitory sensation, unusual premonitory symptoms, a perception of being totally involuntary, poor response to typical tic medications, difficulty with suppression, and higher rates of suggestibility. 17 , 20–22 Certain behaviors are more common with functional tics, such as blocking tics, speaking in accents, as well as echo-, pali-, and coprophenomena. 3 , 23 The characteristics of the tics themselves may also have features distinctive of organic tics, such as occurring more often in the trunk and extremities as opposed to the head, face, and neck. 24 , 25 In addition, functional coprolalia is marked by longer and more complex phrases as well as a higher number of obscene words per individual. 21 The tics themselves may be more self-injurious or functionally limiting than is typically seen in TS. 3 , 23 However, shared risk factors such as anxiety and impulsivity, as well as overlap of clinical features can make it difficult to tell typical and functional tics apart. 23 This is further complicated by the fact that individuals with a typical history of TS can later develop functional tics that may co-occur with their previous tics. 20 , 21 , 23 , 26

There may be some overlap between the pathophysiology of typical tics and functional tics. In general, the pathophysiology of typical tics has clear influence of genetic determinants and is thought to be driven by a combination of two mechanisms, including enhanced reinforcement of motor learning via abnormally enhanced dopamine pathways and disinhibition of the cortico-thalamo-cortical loops leading to motor overflow. 23 Similar neural pathways have been postulated in association with functional neurologic disorders, where enhanced limbic-cortical activity may lead to reinforcement of abnormal motor patterns of movements and eventually lead to habituation of movement. 23 Functional tics may additionally be modified by attention to tics, perception of whether or not movements are voluntary, skewed sense of agency over movements, and behavioral reinforcement. 23 These modifiers, especially behavioral reinforcement, have become particularly relevant in the context of FTLBs seen recently. Observation of tics online via social media may lead to learning of this tic-like behavior and eventual habituation, which is discussed in more detail below.

Functional tics have been reported previously as a reaction to psychosocial stressors. 27 , 28 However, functional tics were previously reported as relatively rare compared to other functional movement disorders (2%) 20 and also rare compared to organic tics (1.9%). 29 , 30 Explosive or acute onset of tics was previously reported to represent only 5–8% of cases of TS. 24 , 31 Within the last several years, there has been a tremendous increase in acute-onset tics, tic attacks, and FTLBs, 24 , 25 , 30 , 32 with at least one study reporting a tenfold increase in the prevalence of FTLBs. 33 Although the rise of functional tics has been seen in a variety of distinctive geographic regions, the quality of the functional tics is similar and often exactly mimics the same symptoms posted online, leading many researchers to posit that the common thread between these individuals is the portrayal of functional tics in social media. 26

Social Media and COVID-19

In response to the COVID-19 pandemic, quarantining and physical social distancing quickly became strategies to try to prevent further spread of the disease. In so doing, many individuals turned to social media to continue to feel connected to the rest of society and to cope with increasing anxiety, fear, and uncertainty for the future. One study of over 2000 adolescents found that social media was overall a constructive coping strategy during the pandemic, leading to increased happiness in individuals with anxiety and loneliness. 34 While older children and adolescents used social media as a tool to become more informed about the pandemic, younger children often used social media to escape from the negativity associated with the pandemic and to seek out emotional support from others with an online presence. 34 , 35 As reliance on and interest in using social media has grown during the pandemic, there has also been a corresponding increase in excessive social media use, leading to addictive tendencies in some cases. 36 Interestingly, particular social media platforms were more likely to be associated with more addictive behaviors. For example, TikTok was found to be the most addictive social media platform amongst adolescents during the pandemic. 36 This finding correlates well with the fact that TikTok also had a tremendous increase in use during the pandemic. 24

Social media can be a valuable tool for disseminating information quickly, especially during a pandemic when time to publication could delay important information from becoming available to the public. 37 It may also allow for a sense of connectedness in otherwise isolated individuals. However, social media is a double-edged sword in that it can cause harm either directly by spreading misleading or false claims or indirectly by overwhelming social media posts with misinformation and making accurate content more difficult to find or engage with. 37 Misinformation spread via social media is not specific to TS or tics. In fact, several studies have demonstrated that information regarding COVID-19 on YouTube and TikTok is generally not useful or actually misleading. 38–40 Another study evaluated information accuracy regarding ADHD, a common comorbid symptom of TS, and found that 52% of the TikTok videos about ADHD were misleading. 41 Similar rates of misinformation have been reported for other medical conditions portrayed in social media such as acne and diabetes. 41 Social media therefore could potentially exert a detrimental influence on healthcare outcomes, as misinformation may lead to increased healthcare anxiety surrounding various conditions or inappropriate utilization of healthcare resources, based on representations that are viewed. 37 , 41

Portrayal of Tics in Media

Even before social media was a commonly used platform, tics and TS have been represented to the public in a variety of capacities, often through television, film, and literature. Many of these portrayals include exaggerated stereotypes and even incorrect depictions of individuals with TS. For example, characters with TS are often used as comic relief by demonstrating swearing tics or using profanity, even though the Tourette Association of America has concluded that only a small minority of patients experience coprolalia. 1 Studies have reported rates of coprolalia ranging from 10% to 30% and indicate that having coprolalia leads to a much poorer quality of life as opposed to the comedic representation of coprolalia seen in the media. 42–44 In addition, characters that were intended to have TS were incorrectly represented as having autism spectrum disorder instead, and interpersonal relationships with friends and family were often negatively portrayed, with increased conflict, difficulty communicating, and toxic relationship tendencies. 45 Other studies have also demonstrated that although some depictions can be realistic, the vast majority of depictions of tics are stereotyped portrayals, which inadvertently worsen the stigmatization of individuals with TS. 42 , 45–47 One study evaluating adolescents’ perceptions of peers with TS found that individuals with TS were thought to be deprived of agency and in need of assistance, leading to a “benevolence stigma” in combination with a reluctance to initiate any close or meaningful relationships with these individuals, due to fears of “social contamination.” 42 This study went on to conclude that the reason for these misperceptions primarily stemmed from misrepresentations of the condition in the media, which may be the only baseline exposure non-affected individuals are aware of from which to derive their understanding of TS. 42 These misrepresentations can also be seen on the internet. For example, online support groups can be an invaluable source of information and acceptance for individuals with TS, reducing social isolation and enabling accessibility when face-to-face resources may not be available or appropriate. 48 However, even though these support groups typically have good intentions, users have identified tic triggers, tic suggestibility, and conflict among other users of the online support groups as negatively affecting their experience and worsening their tics. 48 In some online forums, participants are encouraged to rate how severe their individual tics are and to compare to one another, leading to another layer of complexity in the psychodynamics of promoting illness or wellness. Finally, excessive engagement with tic-related content may lead to excessive focus on tics and detract from recognizing the individual as a whole person or other aspects of an individual’s identity and connectedness.

Portrayal of Tics in Social Media

The skewed portrayal of tics in social media is not new. In fact, a study from 2012 analyzed TS portrayals on YouTube and found that although there were some accurate and positive portrayals of TS available to view, negative portrayals of TS were associated with significantly more views. 47 This bias may inadvertently reinforce negative stereotypes and spread misinformation. 47 As early as 2016, there were documented cases of “tic attacks”, which were thought to represent a combination of tics and non-suppressible, disabling functional movements that could last for minutes to hours and often appeared to mimic seizure-like activity. 31 The authors concluded that these tic attacks likely stem from both internal and external contextual factors, including increased attentional focus on tics, a cognitive-affective feedback loop leading to increasing anxiety, and greater interoceptive awareness. 31

During the pandemic, there was an increased interest in TS via social media, leading to “#tourette” being viewed nearly 5 billion times on the TikTok platform alone. 3 , 49 Social media can, in fact, be a positive support system in which users have acknowledged that social media portrayals of tics have led to peer support and a sense of belonging. 24 However, there may be unintended consequences of viewing inaccurate portrayals of tics on social media, including reinforcement of maladaptive behaviors. Unfortunately, some of the misinformation propagated via social media may be financially motivated. For example, TikTok tic influencers sell merchandise related to the content of their videos or may even be paid to make an appearance. The videos with more views tend to be the videos portraying the most frequent, extraordinary, and violent tics, even when these are inaccurate portrayals. 24 These same popular videos are the ones that are most likely to generate the most income for the uploader. 24

Studies have sought to determine if there is a difference in phenomenology between organic and functional tics by analyzing the most-viewed videos on various social media platforms involving tics and TS. 17 , 24 Among 28 videos of TikTok influencers with a keyword of Tourette or tic, the average age was 19, 64% were female, 64% had tic attacks, 93% had coprolalia, and 86% had injurious behavior, features that are not consistent with the typical individual experiencing TS. 24 Similarly, another study also found higher rates of coprophenomena, self-injurious behavior, and environmental influences in videos labeled as “Tourette” on social media platforms such as TikTok, but that were believed to portray FTLB. 17 There are concerns from experts in the TS community that inaccurate and popular portrayals of tics such as these may actually increase stigmatization and marginalization of individuals with tics. 33 , 50

Social Media and COVID-19: Influence on Tic-Related Disorders

The COVID-19 pandemic clearly had an impact on tics, but this impact is complex and more nuanced than was originally thought. This complex influence will be analyzed for a variety of tic-related disorders including FMDs, PANDAS/PANS, and both typical and functional tics below.

Functional Movement Disorders (FMDs)

Since the onset of COVID-19, there has been growing interest in the number of functional movement disorders that have been reported across multiple institutions. Although there was no significant worsening of symptoms in patients who have preexisting FMD, there was an increase in the number of people who newly presented to clinic with FMD during the pandemic. 19 , 49 , 51 At least one study reported a 60.1% increase in new patients diagnosed with FMD between March 1, 2020 and October 30, 2020. 19 The majority of these new presentations occurred in female patients (75.6%), and the most common type of functional movement disorder reported was tremor (53.3%) followed by dystonia (31.1%). 19 Although functional tics have garnered quite the presence in news and media outlets, this study reported that functional tics accounted for only 8.9% of the FMDs that presented during COVID-19. 19 In addition, the rate of new-onset FMD following infection with COVID-19 was low, reported to only be 3% in comparison to other movement disorders seen following infection with COVID-19. 52

Although the pathophysiology of FMDs is unclear, stress does seem to play a role as a precipitating factor. In addition, altered connectivity between the limbic and motor networks as well as decreased activation of the SMA may represent neurobiological differences in individuals who develop FMDs. 19 It is hypothesized that prior traumas or other psychosocial stressors reshape the connectivity of the brain to make the brain more susceptible to having an FMD. 19 During a time when psychosocial stressors are high secondary to COVID-19, these risk factors could at least in part account for the increase in FMDs being seen at movement disorder clinics. The treatment for FMD remains challenging, but a combination of psychoeducation and cognitive behavioral therapy may be helpful. 53 Avoiding inadvertent reinforcement of the movements and addressing comorbidities such as depression, anxiety, and insomnia can also benefit patients with FMD. 54

Tic Triggers in Other Disorders

Given the longstanding controversial consideration that rare cases of immune-triggered tics may follow certain types of infections, one study sought to characterize tic and other symptom changes during the COVID-19 pandemic in individuals with a prior diagnosis of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANDAS/PANS). Of note, evidence in support of a link between streptococcal infection and acute tic onset or exacerbation has been equivocal, 3 , 55 , 56 and association with other non-streptococcal infections has also been postulated. Among 108 included individuals that previously met the diagnostic criteria for PANDAS/PANS, 57 71% reported an increase in overall symptoms during the pandemic lockdown. 58 Interestingly, tics were more commonly reported to increase (56%) than were symptoms from other domains, all of which were below 50%, although it is unclear why tics were reported to have increased more in comparison to other symptoms. 58 Environmental factors were suspected to account for worsening symptoms in these individuals, with sleep disruption proposed to be a key contributor. This same study identified the following risk factors for worsening neuropsychiatric symptoms: changes in parental work routine, parental stress or anxiety transmitted to children, boredom, being quarantined to a small living space, and inadequate information related to COVID-19. 58 These same risk factors have also been identified for symptom worsening in disorders other than PANDAS/PANS, including TS. 18 , 53 , 55 This highlights the importance of psychosocial environment in aggravating pre-existing symptoms.

Some individuals with tics may traverse the pandemic with no major changes in baseline tic severity, or even experience reduced tics during periods of less frequent social interactions. However, overall presentations to American emergency departments for tics increased substantially during the pandemic peak. 59 , 60 The pandemic has exerted a negative influence on tics in the following three manners: worsening of tics in individuals who already have a preexisting history of tics, the acute onset of tic attacks or FTLBs, or a combination of worsening functional and typical tics in a single individual. However, because phenomenological features of TS and FTLB can overlap, distinguishing the symptoms can be difficult. 17

Early in the pandemic, a study revealed that 48% of individuals with preexisting TS or CTD reported worsening of their tics and cited reasons such as increased anxiety due to fears surrounding the future, quarantining, fewer distractions, and changes in routine. 61 Similarly, there was a worsening of symptoms in 67% of adolescents during the beginning of the pandemic, including more severe tics, hyperactivity, rage attacks, obsessions/compulsions, and anxiety. 18

The COVID-19 pandemic was initially postulated to impact tic symptoms through a variety of avenues, including anxiety related to the pandemic, confinement/quarantine, alterations in tics specific to the pandemic, and neurotropic effects of COVID-19. 55 The neurotropic effects are now thought much less likely to contribute to tic symptoms, and indirect impacts of COVID-19 are more likely to modify tic symptoms. For example, fears related to the pandemic, changes in work or financial stability, poor health of loved ones, or restricted freedom due to quarantine may contribute to anxiety that can in turn lead to worsening of tics. Indeed, one study found that in parents of children with tics, 32% had a significant reduction in income and 17% experienced unexpected unemployment in both parents. 18 On the other hand, some individuals reported improvements in their tics because quarantining or virtual school removed many of the triggers that usually lead to worse tics. 18 Up to 87% of children with tics have reported participating in online learning at home during the pandemic, and aside from school activities, the most popular pastimes were playing video games (69%) and interacting on social media (54%). 18 Finally, pandemic-specific tics such as coughing or throat clearing may become more troubling or lead to worse stigmatization given public fears of contamination and spread of viral disease. 55

In addition to alterations in tic symptoms in individuals who already carry a diagnosis of TS or CTD, there have also been reports of increasing cases of functional tics. Given the rapid onset and similarity to many tics represented in social media, it was proposed that these functional tics may be an example of a mass sociogenic illness. 33 This is not the first time that tics have been “spread” by observing another individual’s behaviors. For example, there was an infamous outbreak of tic-like behavior in 19 students at Le Roy High School in 2012, sometimes referred to as “mass hysteria.” 33 Due to their spread via social media, these functional tics may be a new digital equivalent termed “mass social media-induced illness” (MSMI). 33 Some of the signs linking these functional tics to social media include the nearly identical replication of some tics (such as saying “beans”, or “woo hoo” or specific self-injurious or incapacitating tics similar to those seen online), 62 as well as adoption of similar behaviors such as giving a name to the tic symptoms. 33 , 50 Other indications that these functional tics may be a distinctive entity are that the tics tend to be severe enough to limit performing unpleasant tasks but abate when doing enjoyable activities, and remission of these tics was seen in some patients after a diagnosis of TS was excluded. 33 Of course, it is important to remain cautious in identifying any causative forces without clear supporting evidence. 63 Indeed, several studies have proposed that the functional tics seen in association with social media use are likely caused by a combination of complex factors, including predisposing factors such as pre-existing genetic risk factors for depression and anxiety, poor adaptive or coping behaviors, family and peer-related stressors, pandemic-specific impacts on mental health, social isolation, and behavioral modeling through exposure to social media. 16 , 30 , 62

Regardless, several case reports, case series, and cohort studies have collectively identified over 100 patients that have been newly presented to a variety of institutions with what is believed to be FTLB ( Table 1 ). Although the causative effect of social media has not been definitively linked to the onset of FTLBs, it is hard to ignore the similarities in pattern and behavior between the social media influencers and the patients presenting to movement disorder clinics around the world.

Summary of Studies Evaluating FTLB Patients, Including Demographic Information, Exposure to Social Media Portrayals of Tics Prior to Onset, Tic Characteristics, and Comorbid Features

Those presenting with FTLB share similar characteristics across reports: tic onset tends to be sudden and in teenage years, the majority are female, and few have a history of childhood or family tics. Tic characteristics are also strikingly similar: acute onset of complex movements predominately involving the trunk and extremities rather than the more usual tic onset with simple tics evolving over time to more complex and without the usual rostro-caudal evolution. In addition, there were high percentages of self-injurious behavior, coprophenomena, tic attacks, comorbid FMDs, and comorbid depression or anxiety. 25 , 30 , 32 , 62 , 64–66 A high percentage of patients with FTLB were first seen in the emergency department due to the acuity and severity of their initial presentation. 64 While there are several features that distinguish FTLBs from typical tics, there are also features that may or may not be present in either manifestation of tics, and may not necessarily help to differentiate between them. Specifically, suppressibility, premonitory urges, and comorbid symptoms such as anxiety could be seen in either population. 25 , 62 , 64 , 65 In general, there were higher rates of anxiety and depression, lower rates of ADHD and OCD, and a lack of agency over movements was more often reported in patients with FTLBs compared to patients with typical tics. 30 , 62 , 65 The demographic and clinical features of these patients are consistent with the videos posted in social media portraying FTLB. 17 , 24 In addition, these features are also consistent with prior descriptions that have sought to differentiate functional tics from TS. 20–22 Finally, many patients reported watching social media tic-related videos prior to their presentation to a movement disorder clinic with FTLB, although duration of exposure to this social media content was not documented in most studies. 25 , 30 , 32 , 62 , 64 , 65

A 6-month follow-up of the patients with FTLB in the studies by Howlett et al found that there was an average decrease in the Yale Global Tic Severity Scale (YGTSS) of 31.9 and 19.6 points in adolescents and adults, respectively, which suggests that adolescents may have a better prognosis than adults, or at least respond more quickly. 67 The most effective treatment approaches for achieving reduction in functional tic symptoms are still being investigated. To date, there are no randomized controlled studies dedicated to treatments specifically for functional tics. Some studies observed improvement in functional tics when treating underlying comorbidities such as anxiety and depression. 67 In general, pharmacologic therapies used for the treatment of typical tics (ie alpha-2-adrenergic agonists, antipsychotics, etc.) have not been as effective for functional tics, and lack of response to pharmacotherapy may actually be an indicator of functional disease, 23 although formal studies assessing the efficacy of pharmacologic therapy for functional tics have not yet been performed. Motor retraining aiming to reestablish normal movement patterns through physical and occupational therapy may be helpful for functional tics. 24 Cognitive behavioral therapy (CBT) is a type of behavior modification that has been effectively used to improve symptoms of other functional neurologic disorders 68 and may therefore also be helpful for functional tics. CBT works by teaching patients competing or distracting maneuvers to refocus attention away from the abnormal movements. 23 , 68 An alternative behavioral modification approach, called comprehensive behavioral intervention for tics (CBIT), combines habit reversal therapy, relaxation training, and psychoeducation to help identify tic triggers or reinforcers and to redirect abnormal movements into a competing, voluntary action. CBIT is an efficacious treatment for typical tics, and while there may be some role for CBIT in the treatment of functional tics, studies have not yet directly assessed CBIT for functional tics. In addition, since exposure to functional tics via social media may lead to inadvertent behavioral reinforcement of such tics, exposure reduction should be considered by limiting social media with misleading content. Educating the patient and family about appropriate, valid, and reliable resources is one of the first steps to reducing exposure to misleading social media content. Other mechanisms of reducing exposure to misinformation have been proposed including redesigning social media search algorithms so that credible sources of information are elevated to the top, tagging content that is evidenced based versus not evidence based, using systematic surveillance to detect spread of misinformation, and training clinicians how to help patients identify reliable sources of information. 69 Finally, educating the patient and family members about functional tics is extremely important for fostering acceptance of the diagnosis and working toward symptom and quality of life improvement. 62 Similarly, educating the public about functional diagnoses such as FTLB will help to reduce the stigma that comes with both FMDs and TS.

To summarize, the FTLBs that have been observed during the pandemic may be a distinct subtype of functional tics strongly influenced by portrayals in social media. Tic characteristics such as higher rates of coprophenomena, predominant arm and trunk involvement, intense and potentially self-injurious movements, and complex vocalizations along with distinctly later onset may flag the need to consider FTLB. A greater representation of females among those affected, association with other functional neurologic disorders, and lack of prior history of childhood tics can be helpful in distinguishing FTLB, but must be considered together with clinical features and overall clinical presentation. Importantly, clinicians should remain diagnostically cautious since FTLB and organic tics can coexist in a single individual.

While there are many factors that have likely contributed to the increase in FTLB seen during the pandemic, there is no question that social media is one of these factors given the rapid rise across geographic and cultural borders and striking similarities between the tics on social media and the FTLB seen in clinic. 30 , 49 , 62 , 64 , 66 In a somewhat ironic cycle, the influence of social media on tics has gained popularity in news and media outlets, spreading the popularity of these videos to even wider audiences. However, the relationship between these social media posts and the onset of new FTLB is much more complex than a straightforward cause-and-effect relationship. Other factors such as social isolation during the pandemic, increased rates of social media use during the pandemic, increased rates of depression and anxiety, and instability as a direct or indirect result of the pandemic also likely contribute to the rising rates of FTLB that have been documented during the pandemic.

Given this era of increased social media consumption and reliance on virtual technology to communicate remotely, the rise of FTLB is unlikely to be the only mass sociogenic illness spread. Indeed, it will be important for clinicians to remain vigilant about where and how medical information is consumed and to properly educate patients regarding medical diagnoses and treatments. Recognizing FTLB as a separate entity is important for many reasons, including treatment for the functional symptoms, avoiding unnecessary hospitalizations, minimizing unnecessary diagnostic tests, and allocating appropriate resources and treatments for patients. The more that clinicians are able to identify risk factors for and make accurate diagnoses of FTLB, the more that patients will be able to receive proper treatment and care and ultimately achieve a better quality of life.

Dr Jessica Frey reports grants from the Tourette Association of America, outside the submitted work. Dr Kevin J Black reports personal fees from SK Life Science, Inc., Medscape, Mededicus, and Huntington Study Group; grants from Emalex Biosciences, outside the submitted work; and he is also an invited member of a working group on functional tic-like behavior convened by the Tourette Association of America. Dr Irene A Malaty participated in research funded by Teva/Nuvelution, outside the submitted work; and she serves on the medical advisory board of the Tourette Association of America (uncompensated). The authors report no other conflicts of interest in this work.