Exploring Use Patterns and Racial and Ethnic Differences in Real Time Affective States During Social Media Use Among a Clinical Sample of Adolescents With Depression: Prospective Cohort Study

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Youth mental health problems have risen in parallel to increasing durations of interactive media use, but the nature of this relationship remains unclear. To better understand how interactive media use may be influencing mental health, we need a more nuanced understanding of how different patterns of media use interact with specific individual factors to play a role in mediating outcomes. Studies suggest that active social media use (SMU) may offer some mental health benefits compared to passive SMU. Furthermore, literature suggests important differences in media use and affective experiences may occur among those identifying as racial/ethnic minorities. Objective: Using Ecological Momentary Assessment (EMA), the present study investigated potential differences in affective experience during active versus passive SMU and whether any existing differences may vary by race/ethnicity. Methods: We recruited patients with Patient Health Questionnaire (PHQ-9) documented depressive symptoms seeking care at a large, urban adolescent medicine clinic. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day asking about real-time SMU behaviors and scoring affective experiences using Positive and Negative Affect Schedule – Expanded Form (PANAS-X) subscales. To correct for non-independent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the level of the individual to examine associations between EMA-reported SMU and affective scores, while adjusting results for age, gender, race/ethnicity, PHQ-9 score, and EMA response rate, where appropriate. Results: A racially/ethnically diverse group of 55 adolescents aged 14-19 provided a total of 976 EMA responses, averaging 17.76 responses/participant with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F=3.86, SE=0.05, t=1.96, P=.051) and lower mean levels of positive affect during passive SMU (F= 3.90, SE=0.09, t=-1.98, P=.049). However, within different racial/ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black, Non-Hispanic (Black-NH) participants (F=6.31, SE=0.05, t=2.51, P=0.01). Similarly, lower levels of positive affect during passive SMU were seen only among White, non-Hispanic (White-NH) participants (F=10.52, SE=0.13, t=-3.24, P=0.001). Conclusions: When examined in aggregate, adolescents with depressive symptoms experience more negative affect during active SMU and less positive affect during passive SMU. However, each of these affective outcomes is driven entirely by one racial/ethnic group: greater negative affect with active SMU by Black-NH participants, lower positive affect with passive SMU by White-NH. SMU by Black-NH youth that is more activist in intent may expose users to micro-aggressions; SMU by White-NH youth that focuses on social connections may result in more social comparison. Further exploration of interactions among intentionality, content and context of SMU by youth of different racial and ethnic identities will be critical to designing a healthier, more equitable digital environment.