Overview
Which comes first: mental health difficulties, or problematic social media use? This is one of the central questions in the field. Using data from a large Dutch cohort study, we followed 645 adolescents across two time points separated by roughly two years. The study examined both social media use and gaming alongside a broad set of mental health indicators: emotional problems, ADHD symptoms, conduct difficulties, and prosocial behaviour. Sex and perceived social support were tested as potential moderators. Cross-lagged panel modelling was used to examine the direction of associations over time.
What we found
Emotional problems emerged as the key predictor. Adolescents who reported more emotional difficulties at the first time point were more likely to show problematic social media use and gaming more than a year later. This pattern, however, differed between boys and girls:
- Girls: Emotional problems predicted both problematic social media use and gaming over time, consistent with the idea that girls may turn to digital media to cope with distress.
- Boys: Gaming predicted later emotional problems — the reverse direction — while ADHD-related symptoms (hyperactivity/inattention) predicted later social media problems.
- Social support: Adolescents with higher perceived social support were less likely to develop gaming problems as a consequence of emotional difficulties, suggesting social support buffers this pathway.
Study design
The study used data from the fifth and sixth waves of the Amsterdam Born Children and their Development (ABCD) cohort, collected at two time points: 2019–2020 (Time 1) and 2021 (Time 2). The analysis sample consisted of 645 adolescents (64% boys; average age 15.8 at Time 1). Participants completed validated measures of problematic social media use (Social Media Disorder Scale), problematic gaming (Internet Gaming Disorder Scale), and mental health (Strengths and Difficulties Questionnaire), along with the Multidimensional Scale of Perceived Social Support. Ethics approval for the original cohort study was provided by the Medical Ethics Review Committee of the Academic Medical Centre Amsterdam (reference decisions W19_130#19.163 and W20_396#20.444).
What this means
These findings suggest that emotional problems are a meaningful risk factor for problematic digital media use in adolescents, particularly for girls, consistent with the view that digital media can function as a maladaptive coping mechanism. For boys, gaming may itself contribute to emotional difficulties over time. Social support emerges as a protective factor, reinforcing the importance of strong social connections in adolescent development. From a practical standpoint, the findings point to the value of addressing emotional difficulties as a way of reducing risk, rather than focusing solely on screen time or usage limits.