Mental health complaints over 20 years and associations with social media use among German adolescents: findings from the HBSC study

PURPOSE: This study examines mental health complaints among adolescents in Germany over 20 years and investigates intensive electronic media communication (EMC), problematic social media use (PSMU), and their associations with mental health complaints in 2018 and 2022. METHODS: We used data from six waves (2002-2022) of the German Health Behaviour in School-aged Children (HBSC) study, comprising repeated cross-sectional samples of 11-, 13-, and 15-year-olds (N = 34,712). Mental health complaints were assessed across all waves; intensive EMC and PSMU were assessed in 2018 and 2022. Weighted multilevel regression models accounted for the hierarchical sampling structure. RESULTS: Mental health complaints were highest in 2022, with increases particularly pronounced among girls and older adolescents. In 2022, 46.1% of adolescents reported intensive EMC and 11.1% PSMU. Intensive EMC was more prevalent among girls and 11-year-olds, whereas PSMU was more prevalent among girls and gender-diverse adolescents in 2022. In the joint multilevel model, both intensive EMC (b = 0.089, 95% CI [0.018, 0.159], β = 0.043) and PSMU (b = 0.612, 95% CI [0.494, 0.730], β = 0.183) were associated with higher mental health complaints, with a larger standardized association for PSMU. CONCLUSION: The findings highlight the importance of distinguishing intensive electronic media communication from problematic social media use when considering adolescent mental health. The marked increase in problematic social media use and its association with mental health complaints underscore the relevance of problematic patterns of social media use for prevention and health promotion.