How Has Social Media Impacted Mental Health during COVID-19?

Post by Lani Cupo

Adapting to a virtual world

Since the beginning of the COVID-19 pandemic, people around the world have largely adapted to a virtual lifestyle. Business meetings, holiday gatherings, and doctor’s appointments now take place through video calls. Recent advances in technology afford clear benefits in facilitating the continuation of such activities. In particular, social media services allow people around the world to access information, spend time with their friends, and engage with their professions from the safety of their homes. However, while such services provide some obvious opportunities for mental health care, such as video-calling with therapists or accessing applications designed to help manage personal mental health like meditation apps for example, recent research also reveals the potential risk of social media usage.

The infodemic

Even as the world has adapted to the global pandemic over the past two years, the more insidious growth of the infodemic has risen to public attention. The infodemic is a term coined to refer to the spread of misinformation in the context of disease outbreak, a process that is fueled not only by mainstream media but also social media platforms.

Examining five social media platforms (Gab, Reddit, Instagram, Twitter, and Youtube), one study found relatively similar patterns of behavior in how users engaged with information across platforms. Assessing the spread of information from either mostly questionable or mostly reliable sources (categorized by the independent fact-checking organization media bias/fact-check), the researchers found similar diffusion patterns for reliable and questionable information. Their findings imply there is no discrimination between the reliability of source information when social media users share information with each other.

Some consequences of the infodemic are tangible—for example, the difficulty average consumers have in determining the accuracy of information complicates the interpretation of public health directives. However, in addition to the overt impact, the overload of information can take a toll on mental health. The stressors accompanying both the pandemic and infodemic can exacerbate psychological disorders, especially against a backdrop of increased isolation. The infodemic contributes to public distrust, increased stress, anxiety, and sleep disorders. In a study examining anxiety and sleep disturbance early in the COVID-19 pandemic, one study found that those most at risk were people who were exceptionally vigilant, constantly seeking information (high monitors) as well as people who sought to distract themselves, avoiding threatening information (high blunters). Their findings indicate the need to account for the interaction between social media use and behavior in assessing the impact of the pandemic on mental health.

COVID-19 and mental health

Beyond the direct health effects of the COVID-19 pandemic, it is imperative to consider the long-term, indirect consequences of the disease outbreak (economic instability, extended isolation and lockdown, delayed treatment for other health issues). The aggressive worldwide response to tackling the disease (lock-downs and curfews) has not been succeeded by equally aggressive policy to combat the mental health crisis primed by increased stressors and decreased access to support. Following increased reports of mental health consequences in Europe and China, a study of 10,368 citizens in the United States of America reports rates of high risk for suicidality and depression higher than averages from previous years, with heightened risk in socially vulnerable populations, such as Blacks, Hispanics, women, and younger respondents.

Researchers speculate it is still too early to understand the full brunt of the psychological impact of the COVID-19 pandemic, however, they call for an examination of some consequences that ought to be considered now. These include the fact that those with pre-existing mental health conditions may be at increased risk of exposure to and contraction of COVID-19, the potential of increased anxiety and depressive symptoms in those who did not previously report mental health conditions and the fact that mental health care providers themselves will likely be at heightened risk for contracting the virus, further straining the professional support system. Even as vaccines are developed for the virus and the world learns to adapt to the global presence of the disease, the impact of the psychological consequences is just beginning to be systematically investigated.

What role does social media play?

Several studies have already begun to investigate the potential mediating role of social media usage in the impact of the pandemic on mental health. A study in Chinese citizens revealed increased exposure to social media may increase anxiety or the combination of anxiety and depression in respondents. Another study focused specifically on those who were not infected by COVID-19 and found that while social media usage did not cause mental health issues, it did mediate the experience of traumatic emotions in response to COVID-19 news, increasing reports of stress, anxiety, depression, and vicarious trauma. Nevertheless, many participants also used social media to receive COVID-19 updates and peer support.

Adolescents may be a particularly vulnerable population to the disruption of their social lives. During adolescence, humans are uniquely sensitive to the perspectives of their peers, often making them the ideal consumer for social media platforms. As schools and extracurricular activities are closed, teenagers turn increasingly to social media for connecting with their peers. Much of the previous research investigating teenagers’ mental health and social media usage collapsed across websites, online activities, and applications, making it difficult to disentangle the consequences beyond “screen time”. It may be that screen time itself is less important than the activities teenagers are engaging in. During COVID-19, teenagers can use social media to share creative outlets, learn new skills, engage with their coursework, and connect with their peers. Nevertheless, they may also be more at risk of exposure to misinformation, and time engaging with social media may exacerbate negative emotional responses to the COVID-19 crisis.

Social media does present positive benefits to a world facing social separation, easing interpersonal connection and allowing for the fast transmission of information. Nevertheless, it also poses potential risks that should be considered as well. In order to fully establish the impact of COVID-19 on mental health and the role social media plays in the relationship, continued research must survey individuals from multiple age groups, cultural backgrounds, and countries to understand the impact on diverse populations. Preliminary research provides evidence that social media may increase stress and anxiety, potentially exacerbating underlying mental health issues, however, further research will need to establish the continued impact in coming years.

References +

Fitzpatrick, K. M., Harris, C. & Drawve, G. How bad is it? Suicidality in the middle of the COVID-19 pandemic. Suicide Life Threat. Behav. 50, 1241–1249 (2020). Access the original scientific article here.

Cullen, W., Gulati, G. & Kelly, B. D. Mental health in the COVID-19 pandemic. QJM 113, 311–312 (2020). Access the original scientific article here.

Gao, J. et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One 15, e0231924 (2020). Access the original scientific article here.

Rathore, F. A. & Farooq, F. Information Overload and Infodemic in the COVID-19 Pandemic. J. Pak. Med. Assoc. 70(Suppl 3), S162–S165 (2020). Access the original scientific article here.

Hamilton, J. L., Nesi, J. & Choukas-Bradley, S. Teens and social media during the COVID-19 pandemic: Staying socially connected while physically distant. (2020) doi:10.31234/osf.io/5stx4. Access the original scientific article here.

Cheng, C., Ebrahimi, O. V. & Lau, Y.-C. Maladaptive coping with the infodemic and sleep disturbance in the COVID-19 pandemic. J. Sleep Res. 30, e13235 (2021). Access the original scientific article here.

Cinelli, M. et al. The COVID-19 social media infodemic. Sci. Rep. 10, 16598 (2020). Access the original scientific article here.

Zhong, B., Jiang, Z., Xie, W. & Qin, X. Association of Social Media Use With Mental Health Conditions of Nonpatients During the COVID-19 Outbreak: Insights from a National Survey Study. J. Med. Internet Res. 22, e23696 (2020). Access the original scientific article here.

Having More Education Does Not Slow Down Brain Aging

Post by Shireen Parimoo

The takeaway

Higher educational attainment does not protect against brain volume loss that typically occurs in older age.

What's the science?

Educational attainment is thought to slow down the effects of aging on the brain. For example, studies have shown that older adults with more years of education have larger brain region volumes than those with fewer years of education. However, much of this research is cross-sectional (i.e. occurring at one point in time), and little is known about the longitudinal impact of education on brain aging. This week in PNAS, Nyberg and colleagues assessed the long-term impact of educational attainment on rates of brain volume loss.

How did they do it?

The authors used two large longitudinal datasets: the UK Biobank (UKB) and the European Lifebrain project (LB) for their study. Participants reported their educational attainment and completed two or three structural MRI scanning sessions over a period of two to four years. Educational attainment for the LB sample was measured as years of education, whereas participants in the UKB were categorized based on whether they had a college/university degree or not. Estimates of total brain volume and hippocampal volume, which are known to atrophy in older age, were obtained.

The authors performed both cross-sectional and longitudinal analyses to examine the relationship between age, brain volume, and educational attainment. The cross-sectional analysis was based on age and the brain volume at the final timepoint, and provided insight into whether participants with more education also have larger volumes. In contrast, the longitudinal analysis was based on baseline age and time since the first scan. This analysis allowed them to determine whether higher educational attainment was associated with a slower rate of brain volume change over time, particularly in older adults. Finally, they conducted a Bayesian hypothesis test in the LB sample to assess the competing hypotheses that education is or is not associated with the rate at which brain volume changes in older age.

What did they find?

Higher education was associated with greater cortical volume around the left central sulcus in the cross-sectional analysis but was not associated with the rate of volume change over time. Longitudinal analyses revealed that in the LB sample, occipital and lateral temporal areas showed greater volume loss in older ages (LB). Similarly, increasing age in the UKB sample was associated with more volume loss in the medial parietal, lateral, and medial frontal and temporal areas. However, these volume changes over time were not associated with educational attainment. Moreover, though hippocampal volume also decreased in older age in both the LB and UKB samples, the rate of hippocampal volume loss was not related to education. Thus, education is related to brain volume at a given point in time, but it does not slow down the rate at which brain volume changes in older age.

What's the impact?

This study found that higher educational attainment does not serve as a protective factor against the rate of regional brain atrophy. These findings are interesting because while they show that more education is associated with larger brain region volume, they contradict the notion that it has a protective effect on brain aging.

Access the original scientific publication here.

An Enzyme Made by the COVID-19 Virus Can Destroy Brain Blood Vessels

Post by D. Chloe Chung

The takeaway

The COVID-19 virus produces a protein enzyme. This enzyme can damage blood vessels in the brain by  NEMO, a protein essential for the survival of brain endothelial cells (i.e. cells lining blood vessels).

What's the science?

Many COVID-19 patients report experiencing a wide range of neurological and psychiatric symptoms. Several studies have found that blood vessels and the blood-brain barrier can be disrupted in the brain of COVID-19 patients. Yet, it was unclear how blood vessels in the brain can be damaged due to infection with SARS-CoV-2, the virus that causes COVID-19. Recently in Nature Neuroscience, Wenzel and colleagues demonstrated how a major enzyme produced by the COVID-19 virus can kill endothelial cells and destroy blood vessels in the brain.

How did they do it?

The authors first determined the degree of brain blood vessel pathology induced by COVID-19 by staining brain tissue of people who passed away from COVID-19 with antibodies against endothelial cell markers and collagen. They defined thin tubes of collagen without the endothelial cell marker as damaged blood vessels. The authors performed a similar analysis using brain samples of mouse and hamster models infected with the COVID-19 virus. To determine whether protein-cleaving enzymes made by the COVID-19 virus can be the culprit of blood vessel damage, the authors incubated the purified enzyme with a protein called NEMO that is essential for host cell immune response. They also tested whether the enzyme can subsequently affect the brain endothelial cell survival as well as inflammatory pathways downstream of NEMO. Using a conditional knockout mouse model, the author directly manipulated NEMO in the brain’s endothelial cells to examine if it is sufficient to induce vascular pathology in the brain. The authors also used this mouse model to further investigate potential therapeutic strategies against the vascular pathology in COVID-19 by genetically deleting or pharmacologically inhibiting kinases important in cell survival.

What did they find?

First, the authors found that the brain tissue from COVID-19 patients contained more “string vessels,” which are capillaries remaining after the death of blood vessels, compared to control brain tissue. String vessels were also increased in animal models of COVID-19, suggesting that COVID-19 can induce microvascular pathology in the brain. Next, the authors found that the enzyme (termed Mpro) made by the COVID-19 virus can cleave NEMO, a protein critical for the survival of brain endothelial cells. Mpro was found to not only chop off NEMO but also impair inflammatory responses downstream of NEMO. Interestingly, the authors learned that endothelial cells expressing this enzyme are more likely to die than cells without it, which suggests that Mpro can indeed induce endothelial cell death. Importantly, this effect was absent when Mpro was mutated to lose its protein-cleaving ability.  These findings show that the enzymatic activity of Mpro is critical for cell death and vascular pathology

What's the impact?

This study has suggested one of the potential mechanisms through which the COVID-19 virus can damage the brain — which could potentially contribute to the neurological symptoms seen in COVID-19 patients. Notably, this work is the first to evaluate vascular pathology in the brain based on the presence of string vessels. Future investigation into ways to protect brain blood vessels may help alleviate or prevent neurological issues in COVID-19 patients.