How did the COVID-19 pandemic impact sleep, mental health and social media use in female adolescents?
Adolescents with high use of social media often experience poor sleep, which increases the risk of depression and anxiety levels. A recent BMC Pediatrics study assessed the association between sleep quality, mental health, and the use of social media in adolescent females.
Background
The importance of good sleep quality has been highlighted in many studies. Good sleep improves attention span, emotional regulation, memory, behavior, learning, and mental and physical health. In contrast, insufficient sleep has been associated with diabetes, obesity, depression, and hypertension.
Adolescents with inadequate sleep have shown higher behavioral risks, such as suicide attempts and self-harm. Although adolescents are recommended to sleep for at least 8 to 10 hours/day, this recommendation is often not met. For instance, the average sleep duration among adolescents in Thailand is 7 hours/day.
In adolescents, sleep duration was found to decrease with increasing age. This could be due to academic performance pressure, caffeine consumption, and the use of electronic media.
In Thailand, adolescents use social media, particularly YouTube, Line, Facebook, and Twitter, for recreation. High use of social media is robustly associated with poor sleep quality, lower self-esteem, and higher levels of depression and anxiety.
A meta-analysis revealed that during the coronavirus disease 2019 (COVID-19) pandemic, sleep quality in adolescents worsened despite increasing sleep duration. This could be due to altered bedtime routines and increased screen time usage during the pandemic.
Compared to males, a stronger relationship between time spent on social media and greater emotional distress has been observed in females. It is important to uncover the association between social media use and sleep quality, particularly in a female cohort.
About the study
The current prospective cohort study assessed the connection between sleep characteristics, social media use, and mental health in adolescents during COVID-19 lockdowns and after school re-opening. This study was conducted between December 2019 and September 2020.
Participants, i.e., female adolescents between 12 and 18 years of age, were recruited from a private all-girl school in Bangkok, Thailand. Participants with a history of obstructive sleep apnea and mental health illnesses were excluded. A total of 219 participants were included in this study.
They completed self-administered electronic questionnaires at three points in time: baseline, after 3 months, and after 6 months.
The questionnaire included the Pittsburgh Sleep Quality Index (PSQI) Instruments, the Thai version of the Screen for Child Anxiety-Related Emotional Disorders (SCARED), and the Thai version of the Patient Health Questionnaire (PHQ-9).
Study findings
The mean age of the participants was around 14 years of age. Around 54% of the cohort consumed caffeine after lunch and felt depressed.
It was seen that during COVID-19 lockdowns, 81.3% of the study cohort experienced increased sleep-related problems, particularly long sleep latency. It was also observed that female adolescents used electronic devices and social media considerably more during the COVID-19 lockdown period.
No significant difference in the frequency of anxiety and depression was found between the three periods. A strong correlation between poor sleep quality and the use of social media was observed after the lockdown, but not during the lockdown. This difference could be due to the flexibility of the school schedules.
This finding was consistent with previous studies that revealed social media use was linked with poor sleep quality. Many studies have shown that delayed bedtimes and increased screen-based media consumption lead to reduced sleep duration and worsened sleep quality.
The current study revealed that sleep quality was not correlated with social media use during school breaks, which could be because participants had the opportunity to sleep longer during school breaks than during semesters. However, since the total duration of sleep was still below the recommended level, no improvement in sleep quality scores was found.
During COVID-19 lockdowns, Thai students were encouraged to undertake online learning using computers and mobile devices, which increased their access to social media. The use of social media and online gaming during lockdown periods, particularly during the break between the two semesters, was significantly more than during the semester period.
In general, students did not use social media before school start time because they were inclined to wake up late. However, this pattern changed during the second-semester final examination period and the amount of social media use after midnight increased significantly on weekdays and weekends.
Consistent with previous studies, this study also indicated that poor sleep quality increases the risk of anxiety and depression.
Conclusions
It was observed that female adolescents were more attracted to electronic devices and social media during the COVID-19 lockdown. Subsequently, they experienced increased sleep problems.
However, no significant difference in the incidence of anxiety and depression was observed between the three points in time. Interestingly, the association between poor sleep quality and social media use was observed after the lockdown, but not during the lockdown.
Since poor sleep quality results in psychological distress, one must take necessary care to prevent sleep-related problems.
