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A new study finds that addiction to social media, mobile phones and video games is linked to a higher risk of suicidal thoughts and behaviors.

 on Wednesday, looked at data on more than 4,000 kids from an ongoing longitudinal study following them for years, starting at ages 9 to 10. It found that by age 14, about a third of the kids had become increasingly addicted to social media, about a quarter had become increasingly addicted to their mobile phone and more than 40 percent showed signs of addiction to video games.

"And these youth are significantly more likely to report suicidal behaviors and thoughts," says study author 

, a professor at Weill Cornell Medicine in New York.

"It's an important study and raising awareness about screen addiction," says 

, a pediatrician specializing in adolescent screen use at the University of California, San Francisco. "It shows that elements of addiction related to screen use are more strongly predictive of poorer mental health and even suicide risk compared to just screen time. So, I think that it provides more nuance."

Xiao and her colleagues used data from a large-scale ongoing longitudinal study called the 

Adolescent Brain Cognitive Development (ABCD) Study

. It's been following thousands of kids over the years, and assessing them periodically for both their average daily screen time as well as for symptoms of addiction, which also allowed them to see how these addictive behaviors changed over time.

They assessed addiction with a standardized questionnaire asking them to respond to statements like, "'I spend a lot of time thinking about social media apps or planning to use the social media apps,'" explains Xiao. "'I try to use the social media app less, but I can't.' And also 'I feel stressed and or upset if I am not allowed to use my social media apps' or 'I use it so much already it has a bad effect on my schoolwork.'"

Her team was able to group the teens based on how these answers changed over time.

With social media, they found that almost 60 percent had low levels of addiction to social media and that stayed stable over the years. But about a tenth had increasing addiction that peaked around year three and four of the study, and a third showed increasing addiction.

With mobile phone use, about half showed high addiction and a quarter had increasing addiction. With video games, they found only two groups — with about 60 percent showing low addiction that stayed stable over time, and 41 percent were highly addicted to it through the period.

The study also evaluated suicidal thoughts and behaviors. It uses a questionnaire that asked about passive and active thoughts of suicide, as well as any suicide attempts. At year four of the study, nearly 18 percent reported having had suicidal thoughts, and 5 percent admitted to suicidal behaviors, which includes making suicide plans and attempts.

The groups with high and increasing addiction to mobile phone and social media were associated with a higher risk of suicidal thoughts and behaviors. The highly addictive group for video games also had a higher risk of suicidal thoughts and behaviors compared to the group with low addictive use. However, total screen time was not linked to a higher suicide risk.

"What surprised us is that these are substantial groups, and they are associated with 2 to 3 times [risk] of suicidal behaviors," says Xiao.

Screen time is not inherently good or bad

Researchers, educators, and parents often point to the amount of time teens spend on their screens to gauge problematic use, say Xiao and Nagata.

"We all get reports from our phones about our weekly screen time," says Nagata. "Screen time is an easily understandable metric because it's minutes or hours a day that we're spending on screens."

But, he adds, screen time isn't inherently good or bad, so he welcomes the nuance this study adds to the conversation since it flags signs of addiction.

"Some kids might spend their time on screen reading the news, and some might be trolling some pretty dangerous sites," says psychologist 

, a professor at University of North Carolina at Chapel Hill. "So it's really hard to know what to make of screen time as a risk factor."

That's why screen time alone is "not a helpful measure," says psychologist Mary Alvord. It's more important to understand how a teen is using their screen time.

"They may be talking to a friend, but are they talking to a friend I-R-L, or are they talking to an avatar created by AI?" says Alvord. "And are they using screens to avoid things in real life?"

One of the statements in the addictive use questionnaire is: "I play video games so I can forget about my problems."

"Avoidance is a key symptom of both anxiety and depression," says Alvord, and it is revelatory about a teen's mental health status and relationship with video games or screens in general.

"We're starting to really try and understand what are the specific features or the specific behaviors that might be more concerning," explains Prinstein, who has co-chaired the American Psychological Association's 

advisory panel on social media use in adolescents

. "And the extent to which kids say, 'I can't stop even when I'm trying to. I'm having withdrawal, dependence, tolerance symptoms,' that's important."

Nagata has also used data from the ABCD study

 to understand how teens are using social media

 over time and how that's affecting their risk of mental health symptoms.

"One thing that was really striking to me is that, unfortunately, these symptoms of screen addictions are actually pretty common," says Nagata. He also found that some of the symptoms get more common over time.

He and his colleagues found that 47.5 percent of 11-12 year olds said that "I lose track of how much I am using my phone," 22.5 percent said "I spend a lot of time thinking about social media apps or planning my use of social media apps" and 18.4 percent said "I use social media apps so I can forget about my problems."

25 percent said they use social media to forget about their problems

, and 25 percent admitted to spending a considerable amount of time thinking about social media apps.

Using the same data from the ABCD study, he and his colleagues also found that time on social media increased for preteens over the course of the study. "At the beginning of the study, the average time was only 7 minutes a day, but four years later, the average time was over 70 minutes a day."

 the more time these kids spent on social media

, the more their depressive symptoms increased.

"Parents, teachers, clinicians should be, on the lookout for warning signs for screen addictions, particularly as they may relate to higher depression risk or suicide risk in teenagers," Nagata says.

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Rhitu Chatterjee

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The study, published in JAMA, followed teens for years and evaluated addictive behaviors, as well as suicidality.

Screen addiction and suicidal behaviors are linked for teens, a study shows

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