Youth is a critical time for the onset of common mental disorders, especially among those attending college. About 24% of college students from low- and middle-income countries report depressive symptoms [1
]. In China, 23.8% of college students had depression by 2020 estimates [2
]. This is concerning given depression’s role in serious social and educational impairments [3
] and its facilitation of suicide. While multiple factors are known to contribute to depression in college students, there is growing interest in the potential influence of problematic social media use on depressive outcomes. Various forms of social media are very popular among college students, including blogs, Wechat, and other online social networks [5
]. Social media use has become an integral component of connecting with friends and family [7
]. As many as 21.4% of college students in China use social media services (e.g., WeChat and QQ), and 40% of the time college students spend on mobile phones is on social media [8
Although most college students’ use of social media is non-problematic, there is a small percentage of users whose usage of social networking sites is excessive or compulsive. Problematic social media use is a behavioral addiction characterized by being overly concerned about social media activity, being driven by uncontrollable urges to log on to or use social media, and devoting time and effort to social media in such great amounts to negative impact on important life areas [9
]. Epidemiological studies have adopted validated scales to screen individuals who suffer from social media use [10
]. The prevalence of problematic social media use has been found to be rather high in low- and middle-income countries. For example, 15.2% of college students in China have problematic social media use [11
], and 19.9% of college students in India that use social media [12
]. Problematic social media use has begun to be detrimentally linked to college students’ mental health [9
Despite the considerable prevalence of problematic social media use, its associations with depressive outcomes have not been well-studied among college students in China. Only one small sample size study from the city of Wuhan, China has showed that problematic social media use was associated with increased risk of depression among college students [13
]. More studies are needed to further explore this phenomenon among college students. Much is also unknown about the potential mechanisms by which problematic social media use might increase depressive symptoms in college students. In what little literature exists, however, social media usage has been found to be indirectly associated with depressive symptoms through greater social isolation, lower perceived social support, and loneliness [14
]. Moreover, studies have found that social media use was positively associated with social media violence among young people [15
], while social media violence was associated with more depressive symptoms among adolescents [16
]. Therefore, social media violence may serve as another mediator of the associations between problematic social media use and depressive outcomes among college students [17
]. However, the mediating effect of social media violence on associations between problematic social media use and depressive symptoms remains unstudied among college students.
Satir Transformational Systemic Therapy (STST) [18
] is used to improve relationships and communication within the family structure through focusing on a person’s actions, emotions, and perceptions [20
]. This theory was developed by Virginia Satir, who is considered to be one of the primary pioneers of family therapy. The foundational concept of STST is the belief all people are connected through a universal life energy, which can be accessed to achieve transformational change, develop and strengthen relationships, change behaviors, and develop positive life energy [18
]. According to the STST, the psychological pain people experience is the result of the way they manage their perceptions, expectations, emotions, and behaviors. Therefore, through STST treatment, people can examine their experiences and relationships, develop goals, and work toward change [18
A study showed that STST may increase perceived social support and reduce loneliness of college students [21
], as well as ameliorate experiences of social media violence and, therefore, be an appropriate means with which to counteract potential mediators of the social media addiction–depression relation among college students. Thus far, however, no studies (to our knowledge) have attempted to test the effectiveness of STST on reducing problematic social media use to improve depressive symptoms among college students.
To address these knowledge gaps, we conducted two studies. In Study 1, an observational study, we examined cross-sectional associations between problematic social media use and depressive outcomes and the potential mediating effects of perceived social support, loneliness, and social media violence within a large-scale sample of college students in Shaanxi, China (Figure 1
). Then, based on the findings of Study 1, we designed a randomized controlled trial in Study 2 to test the effectiveness of an STST-based intervention in college students to improve problematic social media use, perceived social support, loneliness, and social media violence to ultimately reduce depression symptoms.
In particular, we hypothesized that: (1) more problematic social media use was associated with more depressive symptoms and higher prevalence of depression; (2) problematic social media use was associated with lower perceived social support, higher loneliness, and social media violence, which in turn were associated with higher depressive outcomes; (3) the STST-theory-based intervention could reduce problematic social media use, loneliness, and social media violence, and increase perceived social support and ultimately reduce depression symptoms among college students in Shaanxi, China.
This two-part study is the first of its size to investigate epidemiological associations between problematic social media use and depressive outcomes and then construct and test the effectiveness of an RCT to reduce depressive symptoms related to problematic social media use informed by our observational findings among college students in Shaanxi, China. Our results from the observational study showed more problematic social media use was positively associated with depressive symptoms as well as the risk of probable depression among college students, and such associations were mediated by lower perceived social support, higher loneliness, and experiencing social media violence. From our subsequent RCT of psychological intervention based on STST, we found our intervention was successful in reducing depressive symptoms, problematic social media use, loneliness, and social media violence, as well as increasing perceived social support among college students in China.
Discussion for Study 1
Was problematic social media use associated with depressive outcomes among college students in China?
Consistent with our hypotheses, we found that problematic social media use was positively associated with depressive symptoms and depression among college students in Shaanxi, China. These findings were consistent with findings of similar studies from other low- and middle-income countries. In one analysis among 384 college students from Afghanistan, problematic social media use was reported to have a positive correlation with depression [34
]. Another study of 440 children from India also showed that problematic social media use was a risk factor of depression [35
]. However, other studies also reported the positive effects of social media on adolescents, such as connecting with friends, greater levels of self-expression [36
], and means of education [5
]. Therefore, the effects of social media on depressive symptoms among college students remain not confirmed due to the cross-sectional design of this study and the complicated associations between them. High-quality longitudinal studies with larger sample size in this area are needed.
Did perceived social support, loneliness, and social media violence mediate the associations between problematic social media use and depressive symptoms among adolescents in China?
Our mediation analyses provide insights on the mechanisms of the influence of problematic social media use on depressive outcomes. Consistent with our hypotheses, problematic social media use appeared to be able to increase depressive symptoms through reducing perceived social support, increasing loneliness, and social media violence. These findings replicate previous research in other populations demonstrating that more social media use (i.e., physically-isolated interactions) is associated with reduced real-life social support and increased loneliness [37
] and social media violence [38
]. We proposed that these findings could be due to the nature of communication over social media. Typical interactions on social media consist of simple reactions and written comments, and these interactions are therefore superficial and indirect. Heavy social media usage can therefore serve to create or increase psychological distance between individuals by decreasing face-to-face interactions while simultaneously reducing depth and quality of interactions between family members and friends, thus it has negative impacts on college students’ relationships with family and friends [38
]. Therefore, heavy use of social media may reduce perceived social support, and indeed, a longitudinal study among 221 college students from the USA found an association between increased problematic use of social media with less tangible social support [40
]. This in turn may increase the risk of depressive outcomes.
The mediating role of loneliness between problematic social media use and depressive symptoms was consistent with the results of studies among college students in China [41
], which showed that social media users have stronger needs for communication than those who do not use social networks. When they heavily use social media, they may inadvertently replace real-world interactions with virtual relationships, which may then increase perceived social isolation [42
]. Heavy users or those with problematic social media use may then feel lonelier and more unsatisfied with interpersonal needs [41
], again potentially culminating in depressive symptoms.
Furthermore, we found that problematic social media use could increase social media violence exposure, which in turn increased depressive symptoms among college students. One study found the level of social media usage to be associated with an increased risk of social media violence in a dose–response manner among Canadian adolescents [43
]. Given that social media is increasingly becoming omnipresent in the daily routines of most college students, a better understanding of strategies to avoid, manage, or combat social media violence exposure is desirable. Overall, the above findings support interventions increasing perceived social support, reducing social media violence and loneliness to reduce depressive symptoms among college students in China.
Discussion for Study 2
Was STST-theory-based intervention effective in reducing problematic social media use, loneliness, social media violence, and depressive symptoms, and in increasing perceived social support among college students in China?
Consistent with our hypotheses, STST-based cognitive reconstruction group counseling was effective in improving the ability of interpersonal relationships, network interpersonal communication, and time management among Chinese college students. These psychological interventions could reduce problematic social media use, social media violence and loneliness, and increase perceived social support, thus improved the depressive outcomes of college students. Though the prevalence of probable depression in the intervention group was higher than that of control group at baseline, after one-month intervention, the depressive symptoms of the intervention group were significantly lower than that of the control group. Furthermore, depressive symptom scores in the control group did not change significantly throughout the course of our RCT. Thus, these findings further support the effectiveness of STST-theory-based group psychological counseling in improving the depressive outcomes of Chinese college students. Findings from studies in other Chinese adults also showed that an intervention based on the STST can be effective in ameliorating mental health problems [30
]. However, the small sample size of our intervention study precludes its generalizability to other college students. Future large-scale intervention studies employing STST against social media use are needed to test its effectiveness among college students.
This study has several strengths. First, the study design combined a large-scale cross-sectional observational study and an RCT to examine the effects of decreasing problematic social media use, social media violence, and loneliness, and increasing perceived social support on depressive outcomes among college students. All the scales used in this study were validated in the Chinese population.
Limitations of This Research
This study also has some limitations. First, the cross-sectional design of Study 1 prevents inference of causality. Second, the survey sampled students in Shaanxi province in China, so findings are not generalizable to students in other provinces or beyond China. However, the sample of Study 1 encompassed all types of college-level schools in China, and all majors and grades in these schools; therefore, our findings could provide useful insights for the design of interventions to address problematic social media use and improve mental health in a broad range of college students. Third, data were self-reported and thus may be subject to response bias. Fourth, we did not inform the college students with probable depression screened by the CESD in Study I. Future studies may inform the students with probable depression and take some strategies to improve their mental health after screening. Fifth, the sample size in our RCT was small, limiting the representativeness of our sample. Large-scale RCTs based on the STST theory and our findings will be necessary to further test the effectiveness of these intervention strategies on improving depressive outcomes of college students. Sixth, we did not consider the potential influence of COVID-19 on the effectiveness of our RCT study, as COVID-19 happened before the conducting of the RCT, and it may be related to depressive outcomes of adolescents. Future studies should measure and consider this factor.