ORIGINALES

Adolescents' perceptions about the use of social networks and their

influence on mental health
Percepções dos adolescentes sobre o uso das redes sociais e sua influência na
saúde mental
Percepciones de los adolescentes sobre el uso de las redes sociales y su influencia
en la salud mental

Rodrigo Jácob Moreira de Freitas1

Thaisa Natália Carvalho Oliveira1
Juce Ally Lopes de Melo1
Jennifer do Vale e Silva2
Kísia Cristina de Oliveira e Melo2
Samara Fontes Fernandes3
1 State University of Rio Grande do Norte – UERN. Nursing Department, campus Pau dos Ferros, RN,
Brazil. rodrigojmf@gmail.com
2 Federal Rural University of the Semi-Arid – UFERSA. Department of Health Sciences, campus

Mossoró, RN, Brazil.

3 Faculty Evolução Alto Oeste Potiguar – FACEP. Nursing Course, Pau dos Ferros, RN, Brazil.

https://doi.org/10.6018/eglobal.462631
Received: 8/01/2021
Accepted: 10/07/2021

ABSTRACT:
Objective: To identify the adolescents' perception about the use of social networks and the influence on
mental health.
Method: This is a descriptive-exploratory research study with a quantitative and qualitative approach,
carried out with adolescents aged between ten and nineteen years old who are users of social
networks. The sample consisted of 71 participants recruited using the snowball technique. The
instrument used to carry out data collection was the online questionnaire, elaborated by the researchers
and developed through the Google Forms tool, and disseminated through social networks, being
subsequently tabulated and presented in graphs and tables, through simple statistics and discussion
based on the scientific literature.
Results: Regarding the use of social networks, 100% of those surveyed stated using them frequently,
27% said that they participated in 3 social networks, with WhatsApp and Instagram being the most
used, with a total of 27% each. Regarding the risks of their use, 34% of the participants stated that it
was disclosure of personal data. The main feeling they felt in the networks was that of
embarrassment (27%); the contributions of the social networks are related to studies/updates (29.5%);
and the consequences for mental health resulting from use were invasion of privacy/disclosure of
data (20.5%) and addiction (19.3%).

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 Conclusion: The use of networks is growing and causes new forms of illness to arise, mainly of a
mental nature, requiring the health professional to approach this problem in order to intervene
effectively.

Keywords: Adolescent; Social Networking; Mental health; Nursing.

RESUMO:
Objetivo: Objetiva-se identificar a percepção dos adolescentes sobre o uso das redes sociais e a
influência na saúde mental.
Método: Trata-se de uma pesquisa descritiva-exploratória com abordagem quanti-qualitativa, realizada
com adolescentes de idade entre dez e dezenove anos que são usuários das redes sociais. A amostra
consistiu em 71 participantes coletados a partir da técnica bola de neve. O instrumento utilizado para a
realização da coleta de dados foi o questionário online, elaborado pelos pesquisadores e desenvolvido
através da ferramenta Google Forms, e divulgado através das redes sociais, sendo posteriormente
tabulados e apresentados em gráficos e tabelas, através de uma estatística simples e discussão com
base na literatura científica.
Resultados: Acerca do uso das redes sociais 100% dos pesquisados responderam utiliza-las com
frequência, 27% afirmaram fazer parte de 3 redes sociais, sendo o WhatsApp e Instagram os mais
utilizados, com um total de 27% cada uma. Acerca dos riscos do seu uso, 34% dos participantes
afirmaram ser a divulgação de dados pessoais. O principal sentimento sentido por eles nas redes foi o
de constrangimento (27%); as contribuições das redes sociais são estudos/atualizações (29,5%); e as
consequências para a saúde mental decorrente do uso foram invasão de privacidade/divulgação de
dados (20,5%) e vício (19,3%).
Conclusão: O uso das redes é crescente e faz surgir novas formas de adoecimento, principalmente de
ordem mental, necessitando que o profissional de saúde se aproxime dessa problemática para
intervirem de forma efetiva.

Palavras-chave: Adolescente; Rede social; Saúde Mental; Enfermagem.

RESUMEN:
Objetivo: Identificar la percepción que tienen los adolescentes sobre el uso de las redes sociales y la
influencia en la salud mental.
Método: Investigación descriptiva-exploratoria con abordaje cuantitativo y cualitativo, realizada con
adolescentes de entre diez y diecinueve años que son usuarios de las redes sociales. La muestra
estuvo formada por 71 participantes seleccionados mediante la técnica de bola de nieve. El instrumento
utilizado para llevar a cabo la recolección de datos fue el cuestionario online, desarrollado por los
investigadores por medio de la herramienta Google Forms, y difundido a través de las redes sociales.
Los datos fueron tabulados y presentados en gráficos y tablas, a través de estadísticas simples y
discusión basada en literatura científica.
Resultados: En cuanto al uso de redes sociales, el 100% de los encuestados respondió que las usaba
con frecuencia, 27% dijo formar parte de 3 redes sociales, siendo WhatsApp e Instagram las más
utilizadas, con 27% cada una. En cuanto a los riesgos de su uso, 34% de los participantes manifestó
que se trataba de la divulgación de datos personales. El principal sentimiento que manifestaron en las
redes fue el de vergüenza (27%); las contribuciones de las redes sociales son estudios/actualizaciones
(29,5%); las consecuencias para la salud mental resultantes del uso fueron la invasión de la
privacidad/divulgación de datos (20,5%) y la adicción (19,3%).
Conclusión: El uso de las redes es cada vez mayor y provoca el surgimiento de nuevas formas de
enfermedad, principalmente mentales, por lo tanto, es necesario que los profesionales de la salud
aborden esta problemática para intervenir de forma efectiva.

Palabras clave: Adolescente; Red Social; Salud Mental; Enfermería.

INTRODUCTION
Adolescence is a stage in the lives of individuals in which intense physiological,
psychological and relational changes occur, ranging from ten to nineteen years old(1).
In this period of intense transformations, they can be understood as stressful factors
for these subjects, which influence the construction of their identity, with the possibility

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 of exerting an influence on the construction of a phase of conflicts, which lead to risky
and self-harmful behaviors(2).

Therefore, for cognitive, emotional, sexual and psychological development to occur in

a healthy way, it is necessary for the young person to move in comfortable
environments, which transmit security, support and protection,(1) enabling self-
discovery in a safe manner, by increasing autonomy and by a growing focus on
identity development and socialization,(3) which currently occurs through groups of
friends and social networks.

Social networks are already an intense part of any adolescent's life, as they are a
powerful new way of relating to others. Today's young people were born in the “digital
age” and, therefore, are familiar with the Internet and all its possibilities, due to having
grown surrounded by technological devices and Internet access(4).

Thus, the use of social networks is becoming more frequent in their daily lives, using
this resource to communicate, which ends up influencing social interaction among
adolescents, with the possibility of becoming harmful and even addictive(3).

Also in this direction, adolescents are easily exposed to related issues such as
cyberbullying, which occurs in the virtual space, through calls on cell phones and
through messages in the social networks; exaggerated and inappropriate exposure,
which can lead to a false reality exposed on the networks that does not match their
reality outside the Internet; sharing photographs that expose too much intimacy as well
as personal information; sharing erotic content; the construction of self-image and
dissatisfaction with the body; and the difficulty of dealing with the different(5).

Thus, the concern is not only with the physical, but also with the psychological well-
being of these adolescents. Problems that were previously unknown gained greater
visibility, especially those linked to mental disorders. Some examples are the “13
Reasons Why” series and the “Blue Whale” game, which are strongly linked to issues
of emotional well-being and psychological health, mainly aimed at adolescents(6). Both
discuss depression, bullying, self-mutilation and suicide, problems that have been
contributing significantly to the increase in morbidity and mortality among
adolescents(1).

The Internet and the social networks also allow for transformations in the personal and
social bonds, favoring the emergence of new friendships, with spaces to make new
friends, connect to various communication means simultaneously, being a source of
new information and news, research studies, in addition to allowing not only access to
information, but also the ability to produce it(7), as well as sharing experiences, ideas,
perceptions and feelings easily and quickly.

Thus, considering all the factors addressed, the question is as follows: How do
adolescents perceive the use of social networks and their relationship with mental
health? The relevance of this paper is to address a topic of great social concern, in
which the adolescents spend a lot of time online, forgetting about offline life, causing
social imbalance, and being exposed to the negative sides of this new way of relating
and of sharing information. It will provide the production of knowledge about the reality
of these adolescents in relation to the use of this online universe, allowing for
problematization, facing it as a new social health need of this population and,
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 therefore, assisting in the construction of knowledge that supports health care and the
nursing/health work process.

Thus, the objective is to identify the adolescents' perception about the use of social
networks and the influence on mental health.

METHOD
This is a descriptive-exploratory research study with a quantitative-qualitative
approach(8). The research was carried out through the social networks, that is, the
online digital media. The participants of this research were Brazilian adolescents aged
between ten and nineteen years old, as recommended by the World Health
Organization (WHO).

Non-probabilistic sampling through the snowball strategy was used. Some people with
the necessary profile for the research were selected to initiate collection, making it
possible to start the contacts to be researched. Subsequently, the individuals who
were chosen were asked to indicate new contacts with the characteristics necessary
for the research, from the social network itself, and thus, successively, increasing
sampling for each questionnaire answered. Thus, this method proved to be a process
of permanent collection of information(9).

The following inclusion criteria were considered: a) being aged between ten and
nineteen years old; b) using some social network; and d) having Internet access. The
individuals excluded were those who: a) were not available to answer the survey;
b) sent partially answered questionnaires, without the Free and Informed Consent
Form (FICF) or Free and Informed Assent Form (FIAF) signed.

The instrument used to carry out data collection for this research was the online
questionnaire, elaborated by the researchers and developed through the
Google Forms tool, and disseminated through the social networks (WhatsApp,
Facebook and Instagram), thus allowing for more convenience to be answered and
shared with the individuals to be surveyed. This questionnaire consisted of closed
questions (multiple choice, where more than one option could be selected), and open
questions about the profile of the use of the social networks and what motivations and
feelings they caused in the users.

Data collection was carried out during March 2019, with a period of eight days being
stipulated for receiving the answers. A total of 71 completed questionnaires were
obtained, which received a copy of the Free and Informed Assent Form (FIAF) for
children and adolescents, consisting of a clarification page about the research, such
as the objectives, the risks and the benefits, in addition to requesting authorization to
use the data.

Initially, the results of the closed questions (multiple choice) were tabulated and
presented in graphs, using simple statistics, presenting frequency distribution. After
being organized and described, the open questions (discursive) allowed establishing
analysis categories, which were discussed from the perspective of the relevant
theoretical framework.

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 The research met all ethical issues according to Resolutions No. 466/12 and
No. 510/16 of the National Health Council (Conselho Nacional de Saúde, CNS) and
was approved by the Research Ethics Committee (Comitê de Ética e Pesquisa, CEP)
of the State University of Rio Grande do Norte (Universidade do Estado do Rio
Grande do Norte, UERN) on March 15th, 2019 with Opinion Number: 3,202,624 and
CAAE number: 06892818.6.0000.5294.

RESULTS
Among the 71 adolescents who participated in the research, 61% (n=43) were female
and 39% (n=28) were male. The majority, 44% (n=31), were aged between 12 and
14 years old, 42% (n=30) were between 15 and 17 years old, and 14% (n=10) were
over 18 years old. Regarding the school level, 11% (n=8) were in 8th grade of
Elementary School, 39% (n=28) in 9th grade of Elementary School, 14% (n=10) were
in 1st year of High School, 9% (n=6) in 2nd year of High School, and 27% (n=19) in
3rd year of High School.

Regarding the monthly income of the head of the house, 42% (n=30) answered that it
was 1 minimum wage, 40% (n=28) reported that it was 2 wages and only 1% (n=1)
stated having an income above 5 minimum wages. The main city of residence was the
municipality of Pau dos Ferros-RN, with 38% (n=38) of the adolescents, followed by
Natal-RN, with 5% (n=5).

Regarding the use of the social networks, 100% of the respondents reported using
them frequently, with 93% (n=66) stating that they accessed them more than 5 days,
for a daily time of more than 8 hours (35%, n=25), and only 5% (n=4) reported
accessing for up to 1 hour a day.

In relation to the number of social networks, 27% (n=19) stated taking part in 3 social
networks and only 3% (n=2) reported having only one social network, with WhatsApp
and Instagram being the most used, as shown in Graph 1.

Graph 1: Which social media do you use most? Pau dos Ferros, RN, Brazil.
2019.

Source: Elaborated by the author, 2019.

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 Regarding the means to access the social networks, 52% (n=58) stated that they used
them through mobile devices and 29% (n=32), from computers. In relation to the
purpose of this use, 37% (n=56) of the participants reported that it was for
leisure/entertainment, 32% (n=49) for communication, 24% (n=36) for schoolwork, and
7% (n=11) answered “others”. In relation to establishing relationships through the
Internet, 69% (n=49) of the participants answered that it is possible, as can be seen in
Graph 2.

Graph 2: Do you believe that relationships can be established through the social
networks? Pau dos Ferros, RN, Brazil. 2019.

Source: Elaborated by the author, 2019.

In the question referring to the advantages of having a profile on a social network,

according to the participants, information exchange is easy and quick, with
47% (n=51), followed by new friendships (24%, n=26), monitoring of
updates (22%, n=24), and even 6% (n=6) of the participants stated that there were
others, such as using accounts for online games, for studies and school work, as well
as following artists' news. In this question, the participants were also able to choose
more than one option. In relation to the risks of using social networks, the participants
mentioned the disclosure of personal data and invasion of privacy, as shown in
Graph 3.

Graph 3: What do you believe is the biggest risk in using social networks?
Pau dos Ferros, RN, Brazil. 2019.

Source: Elaborated by the author, 2019.

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 When asked about some situations that have already happened on social networks,
the participants claimed to have received messages with inappropriate content, as can
be seen in Graph 4.

Graph 4: Has any of these situations ever happened to you?

Pau dos Ferros, RN, Brazil. 2019.

Source: Elaborated by the author, 2019.

The participants were also asked if they thought it was important to have a cell phone,
obtaining 97% of affirmative answers. And when asked about its purpose, they stated
that they like to access the social networks and talk with friends, with 34% (n=62)
each, and only 6% (n=10) stated that it would be another topic, such as news, medical
matters, games, memes, DIY , videos and music, and studies.

From the answers obtained in the open questions, fifty-four key expressions were
extracted, which were grouped into twenty-nine central ideas, whose representations
were divided into three categories, namely: (1) Adolescents' feelings about the
situations experienced in the social networks. The main feelings recorded were
“Embarrassment” (27%) and “Discomfort Insecurity” (25%); (2) Influence and
contributions of the social networks on the adolescents' lives. The influences and
contributions detected were “Studies/Updates” (29.5%), “Communication/New
Friends” (26.7%), and “Dreary, boring and bad life without the Internet” (18%); and
(3) The consequences of the social networks for the mental health of adolescents. The
main consequences for mental health resulting from the use of social networks were
“Invasion of privacy/Disclosure of data” (20.5%), “Addiction” (19.3%) and
“Confusions/Fights/Cyberbullying” (17.8%).

DISCUSSION
The study results corroborate the Brazilian Media Survey (Pesquisa Brasileira de
Mídias, BMS), which found that most of the adolescents use the Internet seven days a
week, since the vast majority of young people have Internet access in their homes,
using cell phones and computers(10).

These devices also offer a form of entertainment and social stimulation, also providing
an “integration” between people. In general, cell phones have become constant
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 companions of the adolescents, serving, in a social context, to include and exclude
friends, organize, improve and relive experiences, as well as to redefine the social
space(3).

Internet use is multiple and is directly related to the interest of young people when
navigating this space, given that, although communication appears as an important
activity performed, research and leisure also stand out,(11) in addition to being an
environment used to make new friends and seek love relationships(12).

Currently, the social networks occupy an important space in the lives of young people
and influence the construction of their identities and behaviors, as contemporary
society has assumed a dynamic of carrying out activities in a solitary way, hindering
social interaction and compromising the establishment of love relationships
constructed socially and offline(13). Thus inducing the increased demand for online
relationships built and awakened from dating apps, which also increase sexual risk
behaviors, such as unprotected sex, multiple partners and sexual violence, mostly
developed by young individuals(12,14).

The development of virtual relationships, although highly sought after, is not credible
by 69% of the research participants, who believe that online relationships are weaker
and more superficial. A number of studies(15-16) show the propensity of the subjects,
mainly men, to seek casual sex and not for serious relationships, causing a high
degree of frustration in people due to unmet expectations and divergent intentions.

Adolescents are increasingly immersed in the technological universe, making this a

primordial environment for relationships via social networks and, therefore, considering
them as an indispensable tool for modern life.(11) They are also important consumers
of trends, among them, they intensively use social media as a means of
communication and new information, and these, in turn, seem to exert an important
influence on various aspects of their lives(5), in addition to using them for educational
purposes.

This becomes important during this period, since belonging to groups of people not
only provides support but also assists in the construction of identity. Presence in the
virtual world has become essential for individuals to be socially included.(17) However,
the need to meet the beauty and life standards imposed by society has increased,
causing intense dissatisfaction with their body image, reinforcing patterns of
narcissistic behavior and consumerism(5).

The excessive and ungoverned use of social media can develop dependence and a
high need for acceptance on young people, hindering self-knowledge and the
construction of healthy social practices,(18) which can cause family conflicts, difficulties
in, in social interaction and in dialog, as well as anxiety disorders and attention
deficit(19).

The continuous and intense use of technological updates and social networks can lead
to addiction and dependence on the part of their users, as young people claim to use
social networks in their homes, at school and in various places to interact virtually,
distancing themselves from the context around them, reflecting on problems in the
social, personal and educational spheres, also interfering in the student's learning
performance, as well as in other aspects of daily life(11).
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 In addition to developing some risks, such as cyberbullying, depression, suicide, mood
and behavior changes and affective vulnerability, among other various emotional and
mental problems; they favor the emergence of psychological problems, such as:
shyness, panic, social phobia, social isolation and affective disorder, as this stage
initiates the process of affective relationships, which are always undergoing changes,
making adolescents insecure(20).

Cyberbullying favors the emergence of disorders, such as academic and psychosocial

problems, depression, low self-esteem and externalized hostility, among others. The
types of cyberbullying related to episodes in which the aggressor was an adult,
publication of a photograph of the child or adolescent, and episodes accompanied by
aggressive offline contacts, such as receiving a phone call or when the aggressor went
to the victim's home, are related to a three-fold risk of emotional distress; reporting that
nearly 68.5% of the adolescents experienced some negative emotions, such as anger,
upset, worry, stress, fear and "depressive feelings", while 24.5% them do not worry
about the incidents(4).

The study(21) showed that the probability of a suicide attempt was up to two times
higher among victims and aggressors, when compared to those who were not involved
in cyberbullying. This is due to emotional stress and to the emergence of negative
emotions such as anger, fear and depression due to stress and social anxiety, which
can lead to drug use and depressive symptoms, emphasizing that situations leading to
psychological discomfort can induce suicidal thoughts and even suicide(2).

The participants reported that they know people who had their image exposed and that
several problems occurred later, as well as they stated that many peers use the social
networks to provoke people they do not like, thus being possible to show that social
networks can promote situations of embarrassment for the participants, as well as
other reactions and social conflicts, such as discomfort and insecurity, among
others(22).

In Brazil, cybercrimes are becoming routine, the most common being slander, insults,
defamation, revealing third-party secrets, disclosing intimate material such as
photographs and documents, obscene acts, apology for crime, prejudice/racism and
pedophilia. Users of the Internet and of the social networks often disclose personal
data on these networks, making confidential information accessible that could be
misused, for example, by identity thieves and other malicious parties(23).

Therefore, it can be noticed that the use of social media has consequences for the
mental health of these adolescents, such as compulsive use, in which there are
difficulties in controlling use, extreme dependence and psychological, social and
biological problems, such as: alienation, anxiety, intolerance, isolation, individualism,
depression and, in more extreme cases, suicide, causing difficulties in concentration
and aggression.

However, there are many benefits involved in the ideal use of the social networks,
such as increasing information diversity, for use in the school environment and in
groups of friends, favoring indirect contact with people with matters of their interest(24).

In the social networks, mainly through photographs, young people seek to express
themselves in order to build an image of themselves for the others. Thus, it is quite
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 common for them to disseminate/post photographs with different contents, carrying out
identity experiments on their profiles, emphasizing or hiding some of their
characteristics, bearing in mind that shy individuals also gain from social media, as
they can improve sociability with the help of the network.(24,25)

As there is a large concentration of people in the social networks, these forms of

communication needed to adapt to the new demands that emerge every day. Thus,
social networks have become platforms in which they disseminate their contents and,
in this way, it is possible to stay informed about the most diverse subject matters, such
as diverse news, educational issues, etc.

Computer-mediated communication offers certain anonymity as it allows people to feel

less inhibited and express themselves in a way that they would not feel comfortable in
person, whether because of shyness, appearance, sexuality and age(3). Thus, these
adolescents can develop a more "open" relationship. This online disinhibition allows
for a reduction in social presence, as it allows the members to choose the extent to
which they want to be identified, and to express only their most desirable
characteristics and, in this way, they are able to feel comfortable enough to reveal
personal details that they normally would not disclose in a face to face conversation.

It is necessary to make young individuals seek to understand the extent of the harms
they cause to themselves and how important real interaction with the other is. It is
worth emphasizing the role of Primary Health Care (PHC) in being a transforming and
stimulating means of new social practices, in addition to being the care level that
works with the prevention of vicious practices and suicidal behavior,(2) emphasizing the
role of the Family Health Support Center (Núcleo de Apoio à Saúde da Família, NASF)
in strengthening the mental health of adolescents through group work promoted by
psychologists, whether in health units, communities or schools(11).

Making the adolescent see the problem and try to solve it can improve self-esteem
and, consequently, the search for solutions. Hence the importance of health
professionals, performing therapeutic listening, creating a climate of trust, better
understanding, allowing for a good connection between people, and thus intervening
more effectively in the complaints of these adolescents.

As a member and coordinator of a multidisciplinary team, the Nurse plays an important

role in the care for the mental health of adolescents, so that it occurs in a holistic
manner and in all health care spaces, contributing to reducing the number of mental
illness cases among young individuals(2).

A limitation of the study is the data collection time and strategy, which was reduced,
thus not allowing for a general overview of the country, only of some locations, since
the data obtained could have shown another reality. Strategies are needed to gain
greater participation in online research studies. In addition to that, the socioeconomic
and cultural reality needs to be analyzed, as the experiences of adolescence are
diverse and influenced by other social determinants of health not presented in this
study.

This research contributes to the nursing and health work process, as knowing the main
characteristics and habits of these adolescents will enable new ways to intervene in
health needs. Thus, there is a need for educational, interdisciplinary and intersectoral
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 work, as the issue of the social networks and their influence on health permeates other
economic, social, political and health issues. It becomes indispensable to implement
public policies with a health promotion character aimed at the interests of children and
adolescents.

FINAL CONSIDERATIONS
The research objectives were achieved, as the perception of adolescents about the
use of the social networks and the influence on mental health was identified. The
participants use them frequently, participating in three social networks, with WhatsApp
and Instagram being the most used. The greatest risks of use for mental health are
disclosure of personal data/invasion of privacy and addiction, with embarrassment
being the main feeling involved.

It is suggested that new studies be carried out to better clarify how the Internet and the
social networks affect the lives of adolescents and society in general, as the use of
networks is growing and has resulted in new forms of illness, as well as the conduction
of studies that evaluate effective intervention programs, considering the school, health
services and other sectors of the community.

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