Are Smartphones Really Driving the Rise in Teenage Depression?

Today—a closer critical look at the relationship between smartphones and mental health. One of the themes we’ve touched on more than any other on this show is that American teenagers—especially girls—appear to be “engulfed” in historic rates of anxiety and sadness. The numbers are undeniable. The Youth Risk Behavior Survey, which is published by the Centers for Disease Control and Prevention, showed that from 2011 to 2021, the share of teenage girls who say they experience “persistent feelings of sadness or hopelessness” increased by 50 percent.

But there is a fierce debate about why this is happening. The most popular explanation on offer today in the media says: It’s the smartphones, stupid. Teen anxiety increased during a period when smartphones and social media colonized the youth social experience. This is a story I’ve shared on this very show, including with Jonathan Haidt, the author of the new bestselling book The Anxious Generation.

But this interpretation is not dogma in scientific circles. In fact, it’s quite hotly debated. In 2019, an Oxford University study titled “The Association Between Adolescent Well-Being and Digital Technology Use” found that the effect size of screen time on reduced mental health was roughly the same as the association with “eating potatoes.”

Today, I want to give more space to the argument that it’s not just the phones. Our guest is David Wallace-Wells, bestselling science writer and a columnist for The New York Times. He says something more complicated is happening. In particular, the rise in teen distress seems concentrated in a handful of high-income and often English-speaking countries. So what is it about the interaction between smartphones, social media, and an emerging Anglophonic culture of mental health that seems to be driving this increase in teen distress?

If you have questions, observations, or ideas for future episodes, email us at PlainEnglish@Spotify.com.

Links

• My original essay on the teen anxiety phenomenon
• “Are Smartphones Driving Our Teens to Depression?” by David Wallace-Wells
• The Anxious Generation, by Jonathan Haidt
• Haidt responds to his critics
• Our original episode with Haidt

In the following excerpt, Derek talks to David Wallace-Wells about whether smartphones are really responsible for the mental health crisis among young adults.

Derek Thompson: I wanted to have you on the show because we’ve done a number of episodes about the youth anxiety crisis, and my belief is that phones are a major contributor to that anxiety crisis among teens and young people. This is the subject of a bestselling book, The Anxious Generation, by a friend of the show, Jonathan Haidt. I’ve had Haidt on the show to talk through the thesis that he expounds on in that bestselling book. I know his argument. I respect it. I believe it, I think. Your new column in The New York Times is critical of this Haidt argument that smartphones are a major driver of the teen anxiety crisis. You don’t entirely buy the case that smartphones and social media are behind this phenomenon. I want you to walk us through your argument and walk us through your critique. But first, I want to begin at the highest level. Do you think there is a teen anxiety crisis to begin with?

David Wallace-Wells: I think a lot hangs on what you mean by the word “crisis” there. In general, I think it’s fair to say most people interacting with teenagers, especially in the U.S., but indeed around the rich world, are seeing more and more of them experiencing and reporting mental distress. We’re seeing in most countries, though not all, increases in the rates of depression and anxiety among teens. The scale of those changes is different place to place, but the direction of change, I think, is pretty clear. But exactly how much of that is an increase in what experts call the underlying incidence, which is to say, how many people are really suffering more acutely than their counterparts did 10 or 20 or 30 years ago? And how much of it is changes in the way that we talk about, think about mental health, mental illness, the stigma around treatment and therapy, how open we are to treatment, how clinicians have been trained in different ways over the years, I think is very much an open question.

And over the last five years, we’ve seen a sort of conventional wisdom take hold among, really, people like us. That is to say, people in the pundit class, but also a lot of people with whom we share a lot of demographic characteristics, like relatively well-off, relatively well-educated people who are now in childbearing years. And I think it’s quite conventional wisdom now among that cohort that phones are really, really damaging to the mental health of teens. And the thing that’s been most striking to me in doing this work and this thinking about this and the research I’ve done, the people I’ve spoken to, is that that is not conventional wisdom among the academics and scientists who study this work.

Thompson: The first compelling objection to the smartphone thesis is that we are measuring mental health very differently than we used to. You brought to my attention for the first time a 2024 analysis from New Jersey which found that what appeared to be a sharp increase in suicidal behavior in children was mostly driven by changes in screening recommendations. This can get a little bit technical, but can you explain in simple terms what this paper looked at?

Wallace-Wells: The first is that as part of the rollout of the Affordable Care Act, it was recommended for the first time that primary care physicians screened teenage girls for depression annually. And that meant that you just immediately started seeing a significant rise in the number of people who were being identified as depressed, being referred to other doctors for treatment for depression, but also if they were to come into contact with the hospital system, they would be regarded as someone with a history of depression.

And that happened nationally. It wasn’t just in New Jersey. It also happened nationally that for the first time this was required to be covered by health insurers, which means, again, that you’re probably seeing some amount of change in the way that clinicians are interacting with patients, not just the manner but the scale of that interaction. And then there was another change, actually two adjacent changes, in which the U.S. adopted—it’s all technical and bureaucratic—but adopted a new way of coding hospital admissions such that they used to require you to put in a data point for what the injury was that brought the person to the hospital.

And then in a second column, in a second place, you could say whether this was an intentional injury or an accidental injury. And in a lot of cases, the admissions process meant that they just didn’t fill out that second form. And the WHO recommended this set of changes, actually a long time ago in the late ’90s, it swept across the world. Different countries adopted the policy change at different times. And in the U.S. at the national level, you can see when that happened actually overnight in almost doubling the reporting of self-harm admissions to hospitals across all age groups, not just among young women or young men. Then in New Jersey, there was a related second coding recommendation put out to clarify exactly how this should be done. And actually within New Jersey, that had the bigger impact on exactly how many people were reported as being hospitalized for attempted suicide.

And the authors of this paper show that if you factor in all these things, you actually see what looked like a quite alarming trend line from, say, 2010 to 2018 completely disappear, that there’s no trend line at all within New Jersey. Now, New Jersey is not necessarily a representative state; it’s wealthy. Basically, everybody already had health insurance before, may have been ahead of the curve nationally in terms of openness to therapy and that kind of thing. But nevertheless, in this setting, which is the only one that’s been studied extensively, we saw that what looked like these really alarming trend lines completely disappeared when we accounted for just a couple of these changes in the way that we think about and process mental illness at the individual level and at the sort of hospital-system level.

This excerpt was edited for clarity. Listen to the rest of the episode here and follow the Plain English feed on Spotify.

Host: Derek Thompson
Guest: David Wallace-Wells
Producer: Devon Baroldi

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