Abstract
Introduction: Social media is a central part of adolescents’ daily lives, and frequent use has been associated with poorer mental health. These associations may be particularly pronounced among female adolescents, who are more likely to engage with appearance-related content. However, the psychosocial factors underlying these associations remain unclear. This study examined the association between frequent social media use and depressive symptoms among U.S. high school students classified as female and assessed the roles of cyberbullying and weight misperception in this association. Methods: We analyzed nationally representative cross-sectional data from the 2023 Youth Risk Behavior Survey, including 4,902 high school students classified as female (mean age=16.06 years [SD=1.22]). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, grade, and race/ethnicity. Results: Overall, 55.4% of participants reported depressive symptoms and 40.8% reported frequent social media use. Frequent social media use (defined as use at least once per hour) was associated with higher odds of depressive symptoms (OR=1.39, 95%CI=1.26-1.53), cyberbullying (OR=1.76, 95%CI=1.57-1.98), and weight misperception (OR=1.15, 95%CI=1.01-1.30). Cyberbullying (OR=3.70, 95%CI=3.17-4.31) and weight misperception (OR=1.50, 95%CI=1.31-1.71) were also associated with depressive symptoms. The association between frequent social media use and depressive symptoms remained significant but was attenuated after adjustment for cyberbullying and weight misperception (OR=1.17, 95%CI=1.05-1.31). Conclusion: Cyberbullying and weight misperception may be important psychosocial factors associated with the relationship between frequent social media use and depressive symptoms among female adolescents. Interventions addressing cyberbullying and promoting healthy body image may help improve adolescent mental health.