Symptom-level analysis of problematic social media use and its associations with health, well-being, and lifestyle in Lithuanian adolescents: a cross-sectional study

Abstract

Problematic social media use among adolescents is increasingly recognized as a multidimensional phenomenon with distinct symptom profiles. While aggregate scoring approaches are common, examining individual symptoms may offer a more efficient entry point for identifying adolescents at higher risk. This study examined the prevalence of individual problematic social media use symptoms and their associations with health, mental well-being, and lifestyle indicators among Lithuanian adolescents. A cross-sectional study was conducted using data from the 2022 Health Behaviour in School-aged Children survey in Lithuania (n = 6628; aged 11-17 years). Problematic social media use was assessed using the nine-item Social Media Disorder scale with binary response options. Fifteen outcomes were examined across three domains: health (subjective health, somatic complaints), psychological well-being (life satisfaction, psychological complaints, psychological well-being, anxiety, loneliness, happiness), and lifestyle (daily physical activity, vigorous physical activity, cigarette smoking, e-cigarette smoking, alcohol consumption, sleep duration, sleep quality). Logistic regression analyses were performed for each symptom-outcome pair, adjusting for gender, age, and socioeconomic status. Escape-motivated use was the most prevalent symptom (51.2%), followed by loss of control (39.2%) and preoccupation (27.2%). Escape-motivated use was also the strongest predictor of adverse outcomes, showing strong evidence for associations across 14 out of 15 health and lifestyle indicators. Girls endorsed seven of nine symptoms at higher rates than boys, with the largest disparities observed for escape-motivated use and loss of control. An inverse age pattern was observed, with younger adolescents reporting higher symptom prevalence than older ones. Symptom-level analysis reveals meaningful variation in the predictive relevance of individual problematic social media use criteria, with escape-motivated use emerging as the symptom most consistently associated with adverse outcomes.