Jo Carlowe Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances. Today, I’m interviewing Dr. Jessica Hamilton, Assistant Professor in the Department of Psychology, Rutgers University, New Jersey, USA. Jessica is the first author of the paper, “Positive and Negative Social Media Experiences and Proximal Risk for Suicidal Ideation in Adolescents,” recently published in the JCPP. This paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues. All listeners to this and, indeed, any of the ACAMH podcasts, are eligible for a free CPD certificate. Do please visit acamhlearn.org, for details of this, together with information on how you can access hundreds of hours of free talks, lectures, interviews, all of which you can also get free CPD certificates for. The URL is www.a.c.a.m.h.l.e.a.r.n.org. Jessica, welcome, nice to meet you. Can you start with an introduction about who you are, and what you do? Dr. Jessica Hamilton Hi, thank you so much for having me today. So, I am a Professor at Rutgers University in the clinical psychology area, where I direct the Hamilton Lab. I study risk and protective factors for suicidal thoughts and behaviours in teens, with a focus on social media and sleep. So, as part of my research and lab mission, we also participate in community engagement events, and work directly with teens on our Youth Advisory Board, to both inform our research and, also, to promote team mental health more broadly. Jo Carlowe Thank you very much. Now, social media has received considerable attention as a potential risk factor for adolescent suicide. Before we go into the detail of the paper, can you set the scene for us? What are the perceived narratives around social media and suicide risk? Dr. Jessica Hamilton Social media is a hot topic right now, with most of the narratives driven by the media and policymakers, and even some Researchers. They suggest that social media is bad, it is harmful and damaging for youth, and that we need to take steps to both remove it from teens and prevent them from having it. But there are several problems with this narrative, with the most important being that the data and research just don’t support it, especially when it comes to suicide risk. There have been few studies that actually look at these relationships prospectively, meaning that they typically ask teens to report about social media and suicidal thoughts and behaviours at one time, and then they look at how they’re related. But we know that social media use changes on a day-to-day basis, and how teens experience social media does not look the same every day. So, my research uses more rigorous methods to look at these relationships day-to-day, to help us better understand how social media and suicide risk may be related. Jo Carlowe Great. So, we’re going to look at this, in the context of your JCPP paper, this is, “Positive and Negative Social Media Experiences and Proximal Risk for Suicidal Ideation in Adolescents.” Jessica, what did you look at in the paper, and why? Dr. Jessica Hamilton So, most research on social media and suicide risk focuses on screentime, or how much teens are using social media. But a meta-analysis, or a large review of existing studies, conducted by Jackie Nesi and colleagues, found that experiences that teens have on social media, for example, cyberbullying and seeing self-harm content, often matter more in how it affects them. So, this study examined negative experiences more generally, such as having – you know, feeling bad about oneself or having negative interactions with others, like fights or arguments, and understanding how that may be related with teens’ daily suicidal thoughts. But we also wanted to move beyond just a focus on the negative to better understand how positive experiences that someone has on social media, such as feeling more connected to others or having positive interactions, may actually protect against having suicidal thoughts in teens. And despite the narrative of social media and suicide risk, this study is the first to examine the daily associations of social media and suicidal thoughts in teens. Jo Carlowe Can you tell us a little about the methodology that you used? Dr. Jessica Hamilton So, we recruited teens, aged 14 to 17 years old, from the United States, and recruited them from social media, to participate in our ecological momentary assessment study. So, basically we sent them brief surveys three times a day for two months, and in these surveys, we asked about their experiences on social media and whether they had suicidal thoughts that day, among other questions. And all of our procedures were conducted remotely, which allowed us to have teens from all across the United States participate, and we did end up having a highly diverse sample in terms of race, ethnicity, gender identity and sexual orientation. Also, our analyses focused on the individual. So, this allows us to look at how higher or lower levels of social media experiences on any given day compared to how much a person typically experienced on – over the study period, and look at whether, ultimately, having higher or lower levels, compared to their usual amount, was related to suicidal thoughts at an individual level. Jo Carlowe Jessica, can you elaborate further on the inclusion of young people in the process? Dr. Jessica Hamilton For our research, and any research that’s focusing on social media, or even mental health more broadly in teens, we really need to be bringing teens into the conversation. They are central to our understanding of what is happening that is increasing the teen mental health crisis, they’re also central in helping us find the problems. So, in my work, I really prioritise including young people in the design of our studies, helping provide feedback on the measures that we’re using, and the actual items we’re using, especially when it comes to social media, because teens really are the experts in how they’re using social media. But oftentimes in research, we do our research and then we leave it there, right? We never take steps that move beyond the academic journals, which is why I appreciate this podcast, to be able to then disseminate it more broadly, especially with young people. So, that’s a broader goal of our work, and we work with the RISE team to be able to do that, and to, hopefully, help give them the information to both the teens more broadly in their communities and schools, so that we can really make a difference. Jo Carlowe Brilliant, that sounds so important. So, what did you find? What would you like to highlight? Dr. Jessica Hamilton Our study points really to a more complex and nuanced relationship, in which social media confers both risk for suicidal thoughts and protects against suicidal thoughts, on a daily basis, in teens. So, our findings suggest that there are proximal impacts of both negative and positive social media experiences on the likelihood of having thoughts of suicide that day. But there was no effect of suicidal thoughts on next day positive or negative social media experiences. So, said another way, on days when teens were more likely, or had more frequent negative experiences on social media than they typically did, they were more likely to report having suicidal thoughts that day. However, more positive experiences on social media than usual were associated with a lower likelihood of having suicidal thoughts on that day. Jo Carlowe So, this focus on screentime has perhaps been all wrong really. So, if I’ve understood it correctly from reading the paper, your research suggests that screentime itself has no significant effect on suicidal ideation. So, I want to check that’s correct, but, also, whether you found that surprising, and given that finding, is too much attention placed upon screentime? Dr. Jessica Hamilton Yes, you’re correct, in that we did not find a significant effect of social media screentime on suicidal thoughts that day, and this finding may be surprising to most people, given the narrative of social media. But when you think about it, it makes sense that what happens on social media is a more important factor for suicide risk than just how much you use it. So, based on our research, and the existing research to date, I would say there is too much emphasis placed on social media screentime, and our study suggests that the experiences that teens are having on social media, and how they engage with it, matters more in their suicide risk and mental health. And I do think that this focus on screentime does a disservice to teens. It prevents meaningful conversations about social media with teens and, actually, may get in the way of working with industry and social media companies to improve their platforms to promote its potential benefits and protective aspects. Jo Carlowe Can you elaborate a bit further on this finding, that teens are more likely to report suicidal ideation following negative experiences on social media, and less likely following positive experiences? Just to dig a bit deeper. Dr. Jessica Hamilton Yeah, so, we did some exploratory analysis to really figure out, you know, of the different experiences that we looked at, you know, was there one negative experience or positive experience that were really driving those effects? And we found that, in fact, social comparison, or feeling worse about oneself compared to others, was the main negative experience on social media that was associated with having suicidal thoughts that day. Unfortunately, we don’t know from this one item what specific area they might have been comparing themselves or feeling worse about themselves in. So it really could be a number of domains, such as achievement or appearance, but still suggests that social comparison may be a key experience linked with suicidal thoughts. Similarly, you know, feeling more supported or encouraged by others on social media was the main driving positive experience that protected against suicidal thoughts. Jo Carlowe Jessica, how do you envisage your research informing CAMH professionals, in terms of interventions and prevention of suicide in children and young people? Dr. Jessica Hamilton Often, young people don’t feel comfortable talking about social media with adults, in part, because they think adults are going to villainize social media and try to take it away or limit it. And for many teens, social media has become central to how they socialise, especially since COVID-19, when social media was the only way to socially connect for many young people. So, I hope the study helps Clinicians recognise that social media can also be positive for teens and, in fact, feeling more supported or connected can help protect against suicidal thoughts. And at the same time, Clinicians can ask teens openly about their experiences on social media, be open to learning from teens directly, and help them recognise when social media can be both helpful and harmful. Jo Carlowe What recommendations emerged from your research for policymakers and other stakeholders? Dr. Jessica Hamilton Instead of focusing solely on taking away social media from teens, or limiting their screentime, stakeholders should consider policies, social media features or programmes that help facilitate social support, encouragement and connectedness, while reducing features that increase social comparison and other negative social media experiences. Policymakers and other stakeholders should really move beyond social media screentime if the goal is to reduce suicide risk and promote adolescent mental health and wellbeing. Jo Carlowe Thank you. Jessica, is there anything else in the paper that you would like to highlight? Dr. Jessica Hamilton Yeah, so, as I mentioned, I, you know, run the Hamilton Lab at Rutgers University, and I work with an amazing team, so I want to highlight that my lab played an essential role in making this research happen. But I also want to acknowledge several members of our Youth Advisory Board, the RISE team, provided feedback on this paper, to help us interpret the findings and ensure it was accessible and understandable to young people who might read it, as well. We are also continuing to work with them to create infographics and social media posts, find – summarising the findings, in addition to our other work. And, to me, it’s really essential that we focus on disseminating research to the people that we ultimately aim to target, such as young people. Jo Carlowe Let’s focus on your other work. Well, are you planning any follow-up to the research, or is there anything else in the pipeline that you would like to share with us? Dr. Jessica Hamilton Yeah, so, while this study sheds light on broader emotional experiences teens may have on social media, we’re really interested in learning more about the specific types of events and experiences that are related to suicidal thinking, and better understanding who may be most at risk, and when. Specifically, we have an ongoing study, focusing on violence exposure on social media and suicide risk, and particularly gun violence in the United States, as you know, that is a major problem, as well as how teens are engaging with social media to support their identity development, particularly for youth who hold minoritised identities, and ultimately seek support online for mental health. So, really diving in deeper to better understand how social media, why it might be harmful for teens and what we can do about it, but then, also, how it might be beneficial and really promote their mental health, as well. Jo Carlowe Finally, what is your take home message for our listeners? Dr. Jessica Hamilton When it comes to suicide risk, teens experiences on social media are more important than how much teens are using social media. And while more negative experiences can confer risk for suicidal thoughts, social media also has benefits, and positive experiences on social media can protect against suicidal thinking in teens. Moving beyond a focus on social media screentime is essential if we really want to reduce teen suicide risk and promote their mental health. Jo Carlowe Jessica, thank you ever so much. For more details on Dr. Jessica Hamilton, please visit acamhlearn.org. The URL is www.a-c-a-m-h-l-e-a-r-n.org, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.