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Addictive Screen Use Trajectories and Suicidal Behaviors,

Suicidal Ideation, and Mental Health in US Youths

1. Yunyu Xiao, PhD¹; Yuan Meng, PhD¹; Timothy T. Brown, PhD²

 JAMA

Published Online: June 18, 2025

2025;334;(3):219-228. doi:10.1001/jama.2025.7829

Key Points

Question  Are addictive screen use trajectories associated with suicidal behaviors, suicidal ideation, and mental health outcomes in US youth?

Findings  In this cohort study of 4285 US adolescents, 31.3% had increasing addictive use trajectories for social media and 24.6% for mobile phones over 4 years. High or increasing addictive use trajectories were associated with elevated risks of suicidal behaviors or ideation compared with low addictive use. Youths with high-peaking or increasing social media use or high video game use had more internalizing or externalizing symptoms.

Meaning  Both high and increasing addictive screen use trajectories were associated with suicidal behaviors, suicidal ideation, and worse mental health in youths.

Abstract

Importance  Increasing child and adolescent use of social media, video games, and mobile phones has raised concerns about potential links to youth mental health problems. Prior research has largely focused on total screen time rather than longitudinal addictive use trajectories.

Objectives  To identify trajectories of addictive use of social media, mobile phones, and video games and to examine their associations with suicidal behaviors and ideation and mental health outcomes among youths.

Design, Setting, and Participants  Cohort study analyzing data from baseline through year 4 follow-up in the Adolescent Brain Cognitive Development Study (2016-2022), with population-based samples from 21 US sites.

Exposures  Addictive use of social media, mobile phones, and video games using validated child-reported measures from year 2, year 3, and year 4 follow-up surveys.

Main Outcomes and Measures  Suicidal behaviors and ideation assessed using child- and parent-reported information via the Kiddie Schedule for Affective Disorders and Schizophrenia. Internalizing and externalizing symptoms were assessed using the parent-reported Child Behavior Checklist.

Results  The analytic sample (n = 4285) had a mean age of 10.0 (SD, 0.6) years; 47.9% were female; and 9.9% were Black, 19.4% Hispanic, and 58.7% White. Latent class linear mixed models identified 3 addictive use trajectories for social media and mobile phones and 2 for video games. Nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones beginning at age 11 years. In adjusted models, increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories (eg, increasing addictive use of social media had a risk ratio of 2.14 [95% CI, 1.61-2.85] for suicidal behaviors). High addictive use trajectories for all screen types were associated with suicide-related outcomes (eg, high-peaking addictive use of social media had a risk ratio of 2.39 [95% CI, 1.66-3.43] for suicidal behaviors). The high video game addictive use trajectory showed the largest relative difference in internalizing symptoms (T score difference, 2.03 [95% CI, 1.45-2.61]), and the increasing social media addictive use trajectory for externalizing symptoms (T score difference, 1.05 [95% CI, 0.54-1.56]), compared with low addictive use trajectories. Total screen time at baseline was not associated with outcomes.

Conclusions and Relevance  High or increasing trajectories of addictive use of social media, mobile phones, or video games were common in early adolescents. Both high and increasing addictive screen use trajectories were associated with suicidal behaviors and ideation and worse mental health.

Introduction

The increasing use of social media, video games, mobile phones, and other screen-based activities among adolescents, combined with rising rates of suicidal behaviors and mental health problems in children and younger adolescents, has raised concerns,^1–4 including a US surgeon general warning label.⁵ While most existing research has focused on total screen time,^6–11 emerging evidence suggests that addictive screen use may be a more salient risk factor for suicidality and mental health in youths.^12–15 Addictive use may vary by platform^16,17 and follow distinct developmental trajectories. However, addictive use trajectories among youths have not been well characterized, and how they may relate to suicide-related and mental health outcomes remains largely unknown.^18,19

To address these gaps, this study used nationwide data from the Adolescent Brain Cognitive Development (ABCD) Study, a population-based, longitudinal cohort of children and adolescents, to (1) characterize longitudinal trajectories of addictive use of social media, mobile phones, and video games; (2) assess whether addictive use trajectories were associated with suicidal behaviors, suicidal ideation, and internalizing and externalizing symptoms over 4 years, controlling for baseline demographics and clinical characteristics; and (3) examine whether addictive use trajectories were associated with outcomes after adjusting for total screen time.

Methods

This study used the most recent available data from the ABCD Study (release 5.1),²⁰ a longitudinal cohort study of participants aged 9 to 10 years recruited from 21 US sites at baseline (n = 11 868) and followed up annually. Data collection spanned 2016 through January 2022, covering both the COVID-19 prepandemic and postpandemic years. Because the 4-year follow-up data release is ongoing, we used the available random subset (n = 4754). χ² Automatic interaction detection (CHAID) analysis comparing baseline characteristics of participants with and without year 4 follow-up data showed no selection bias (eAppendix 1 in Supplement 1).²¹

Our analytic sample included 4285 participants with complete data on addictive screen use from the year 2 to year 4 follow-up surveys and baseline demographics (Figure 1).^22–24 This study was approved by institutional review boards at each site, with central institutional review board approval from the University of California, San Diego. Parents or guardians provided written informed consent. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.