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The Mediating Effect of Poor Body Image Between Depression and Image-Based Social Media

Usage

Allison Bateman, BA, MPH(c), 006728651

Rae Chelle Gabriel, BS, MPH(c), 003833699

Andrea Pineda-Gutierrez, BS, MPH(c), 004544630

Department of Health Science and Human Ecology

HSCI 608: Health Research Methods

Dr. Yen Ang

California State University, San Bernardino

November 21st, 2019

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Abstract

Active social media usage has become the most popular choice of leisure activity among

adolescents. Since adolescents are an undeniably vulnerable population, it puts them at high risk

of peer pressure and development of mental health conditions, such as depression. While there

are several studies that focus on the relationships between social media and depression, more in

depth research is needed to specifically identify the effects of engagement in imaged-based

social media and depression with body image as a mediator effect on high school students. The

goal of this research is to determine if there is a relationship between image-based social media

usage and depression and its’ influence on body image perception. It is hypothesized that an

increase in image-based social media usage has an effect both directly and indirectly (through the

mediating effect of body image) on depression. Since there has been a drastic increase in

depression rates among high school students in Orange County, CA, an observational, cross-

sectional study design will be implemented among high schools throughout Orange County to

help further understand this increase. Upon the proper approval processes, a 26-question survey

instrument that measures social media usage, body image perceptions, and depression will be

completed by randomly chosen high school students. If the proposed hypothesis is significant,

this research will help the betterment of mental health programs, education, screening, and

treatment to alleviate the high rates of depression among high school students in Orange County.

Introduction

Social media has risen in popularity through the years and is accessible to anyone that has

a connection to the internet. Social media is defined as “forms of electronic communication

through which users create online communities to share information, personal messages, videos

and ideas”. 1 Individuals can share content, communicate, and engage with others by building a
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social network through online platforms.2 While there are several advantages to using social

media, such as connecting with loved ones, body image concerns and depression, on the other

hand, are a few of the many disadvantages to it.3,4

Social media usage is generally consumed among all age groups, but it is more prevalent

among adolescents and is considered the most popular choice for leisure activity among this age

group.5 It is reported that 75% of teenagers own a smartphone and 92% of these teens go online

daily, including 24% who say they go online “almost constantly.''6 Additionally, 71% of

adolescents use image-based social media such as Instagram and Snapchat several times a day.

The high consumption of social media is now questioning adolescent well-being among parents,

health professionals, and educators.7

The increasing concern and issue with the popularity of social media consumption is that

adolescents form attitudes and image concerns from these platforms 6. Adolescence is the stage

between childhood and adulthood and is one of the most vital stages in one’s life.7 During this

transition, several changes occur, including an increase in self-esteem and well-being.8 Thus, this

population is at a higher risk and more vulnerable to the poor outcomes of social media usage

due to pressure among their peers.9 It has been reported that half of all mental health problems

develop by adolescence.10 Additionally, adolescents are most prone to body image issues

because they go through physical and psychological changes.11 There are several factors that

influence how an adolescent regards his or her body including identity development Today,

social media also plays a critical role with adolescents seeking validation from their friends

through 'likes' for their photos.11

Body image dissatisfaction among children and adolescents can be influenced by family

and peers. However, since social media platforms are a popular leisure option, this trend
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influences one’s body image in several ways.12 Image-based social media platforms may have a

strong association with women’s body image concerns. Exposure to objectified images has been

associated with self-objectification and body dissatisfaction.13 Various studies have found a

correlation between body dissatisfaction and internalizing symptoms, such as anxiety and

depression, in adolescents.14,15 Additionally, a previous study found that exposure to the thin

ideal and athletic ideal images in the form of ‘fitspiration’ also leads to a significant increase in

body dissatisfaction.16

Depression rates are on the rise in the United States with no indication that they will

decrease anytime soon. Although, it is impossible to pinpoint a specific causal agent of

depression it would be worthy to investigate the possible associations, if any, with the

engagement of the more recently developed image-based social media sites and depression. It

has been reported that approximately 10-20% of young adults suffer from mental health issues.14

Of the list of possible mental health issues, depression is considered to be one of the top two

highest disorders seen in this age group.14 In most cases, the onset of depression starts in young

adulthood, which is a cause of concern.17 Depression that develops at a young age could

potentially influence self-harm and suicidal ideation. 18Additionally, among the latest research,

there have been conflicting results in studies. Some suggest the use of social media has an

association with depression rates whereas other research has found there to be higher life

satisfaction with the use of social media.17 A more recent study done in July 2019, found there

to be a moderate increase of depression as well as other issues seen in adolescents associated

with the use of social media.19 A year prior, a study yielded similar results in the use of social

media and depression. This study analyzed the comments an individual left on Instagram by

various users and found there to be a significant relationship between the comments and
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depression.20 With the conflicting results given, it is worthy to continue research on this topic to

gain a better understanding.

Previous lines of research have focused on similar topics in regard to social media,

depression and body image but none have investigated more specifically on the effects of

engagement in imaged-based social media and depression with body image as a mediator effect

on high school students. While several studies have been conducted in various geographical

locations, most studies have focused primarily on adult females. Subsequently, the

hospitalization rates for depression among the youth population in Orange County, CA has

increased by 99% since 200721 so, it would be beneficial to add to the line of research fixated on

active social media engagement and depression to compare results found in previous similar

studies, and build stronger reliable data in Orange County, California.

The goal of this research is to determine if there is a relationship between image-based

social media usage and depression and its’ influence on body image perception among high

school-aged students. It is hypothesized that an increase in image-based social media usage has

an effect both directly and indirectly (through the mediating effect of body image) on depression.

Methods

The sample population will consist of approximately 5,000 high school students chosen

at random attending a public high school in Orange County, California. Participants will be

chosen at random and will consist of students from grades nine through twelve. Judgment

sampling will be done since data will be collected from a target population in a specific county

that demonstrated high levels of depression. Although the goal of this study is to investigate the

relationship between image-based social media usage and depression rates (with body image as

mediator) among high school students in public high schools in Orange County, all the criteria
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data received from the surveys will be included in the analysis. All information collected from

the survey is relevant to the objective of identifying relationships. This means that even if a

student indicates that they do use an image-based social media platform, their response will still

be valuable in this particular study.

The dependant variable in this study is depression levels. Whereas the amount of time

spent on image-based social media pages is the independent variable. This study will include a

mediator effect which is satisfaction with body image. Some confounding variables will exist in

this study, as with any study. A few of the confounding variables which may be present in this

study are sex, genetic history, age, race and involvement in sports or clubs. To account for

confounding variables, multivariate analysis will need to be done. This will control for the

mentioned multiple confounding variables, that will be present in this study. Furthermore, a

statistical equation model will need to be used to help identify the relationships, if any, between

the dependent variable, independent variable and the mediator.

The method to be used is a survey questionnaire designed to develop or contribute to

generalizable knowledge of social media and body image, and how it can affect the mental health

of high schoolers. The survey was created using a combination of validated surveys and a

number of general confounding questions developed by the research team. Validated questions

were applied to the questionnaire to truly measure depression and body image perception. To

measure depression and the severity of it, the eight-item Patient Health Questionnaire (PHQ-8),

was integrated into the survey. The PHQ-8 has been validated among large population-based

studies to measure depression for populations.22 “The PHQ-8 as a Measure of Current

Depression in the General Population.”. Each question on the PHQ-8 is coded as a numbered

score. The sum of the participant’s score determines their depression level and the severity of
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their condition is based on their responses.23 A result gathered of a score greater than 10 indicates

major depression of the participant. Furthermore, other questions were pulled from a similar

study since this has not been done executed before. The remaining questions were pulled from a

study that researched the effects of social media usage on body comparison tendencies and body

self-esteem. 24 Each survey had validated questions on social media, body image and depression

that were appropriate for the audience. Questions are age-appropriate and easy to understand for

the sample population. A sample of the survey can be found on pages 11-13.

In order to conduct the study an application needs to be submitted to the Institutional

Review Board (IRB). The application consists of a title, a summary of the study to conduct,

specifics on the target population, the surveys for approval as well as information on the research

team. Before submitting an application the research team must complete a Collaborative IRB

Training Initiative (CITI) Human Subjects Training. Once IRB approves the research study, the

team can move on to the next step and start delivering the surveys.

The survey will be administered to random female and male high school students

throughout Orange County. It is important to address that this research will be conducted on

underaged students. Since the research population will be minors, besides the approved IRB

application, parental consent and school district permission is required for high school students

to be included as research subjects. In order to obtain permission from the school district, form

(attached on page 13-22) will be completed to request approval to administer the survey to the

students. Once permission is granted, consent forms that will include details and study

information can be properly distributed to parents/guardians for their review. Parents/guardians

will sign permission slips to allow their child(ren) to participate in the study. Only those students

with a consent form signed by their parent/guardian will be given a survey to complete. In
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addition, students will also be given an assent form to fill out (page 23) to ensure they agree to

participate in the study.

Public Health Implications

This proposal would shed light on the rising popularity of social media and the

disadvantages that it can come of it. Social media is often positively portrayed since it has the

ability to connect people together all across the globe. However, if there is a significant

relationship between depression mediated by body image portrayal through social media usage,

this will emphasize the need for better investment in education policies and programs on

adolescent mental health education, screenings, and services. Mental health conditions develop

during childhood and adolescence, and since the majority of their time is spent in school, it is

vital to routinely screen for these conditions as often as other routine checks. Routine screening

will provide appropriate treatment and early intervention, and alleviate the high rates of

depression in adulthood. Additionally, the relevance of positive healthy body image and

acceptance will contribute to better body image portrayal. The significance of this research will

bring awareness and education to parents, how it can negatively impact their children, and how

to address these concerns before entering adulthood to reduce the likelihood of self-harm and

suicide.

Conclusion

Ultimately, adolescents suffering from depression in Orange County is at staggering rates

and further research is needed due to the vulnerability of the population. Since previous studies

have indicated that social media has both positive and poor associations, more investigation is

needed focusing on the popularity of image-based social media. The results of this study will
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help bring further understanding of a linkage to depression, and pave the way for beneficial

policies and programs for adolescents.

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