Titrating Social Media Use During Adolescent Inpatient Psychiatric Hospitalization

Approximately 89% of adolescents have access to a smartphone, with 70% checking social media (eg, Snapchat, Instagram) multiple times per day.¹ Psychiatric hospitalizations for adolescents commonly involve suicidal crises with underlying interpersonal stressors, often inextricably embedded in the digital milieu. Upon psychiatric hospitalization, adolescents typically leave their smartphones with caregivers or in a locked area of the unit and enter into a social media "deprivation" period (inclusive of all digital social communication, such as texting). Generally, adolescents are reintroduced to smartphones after discharge. In many cases, they may be flooded with access to social media at this time, without the guidance of their clinical team. It is currently unclear to what extent absolute deprivation is helpful vs harmful for recovering youth. There are strong arguments for prohibiting digital media access, including the following: limiting exposure to online stressors (eg, cybervictimization) or inappropriate/risky content (eg, sexting, self-injury triggers), protecting patient privacy and safety, maintaining focus on treatment, and avoiding significant liability/logistical challenges (eg, monitoring use and information disseminated, ensuring that property is protected, ensuring equal access across patients, and need for knowledgeable staff). However, the aim of this letter is to consider potential risks of current norms of smartphone use within adolescent psychiatric hospitals. Preliminary clinical guidance and future research directions are outlined, with the goal of expanding precision medicine approaches to the reintroduction of social media to adolescents during and after psychiatric hospitalization.