This study demonstrates that, in a nationally representative sample of adolescents, television and overall media exposure are associated with the development of depressive symptoms in young adulthood, especially in young men. These results held despite controlling with multiple covariates, including baseline CES-D score. Exposure to videocassettes, video games, and radio were not associated with development of depression. The association of certain media exposures in this study with the subsequent presence of depressive symptoms is consistent with the findings of others who have associated media exposure with other mental health conditions.18,58
Of the various media exposures measured in the Add Health study, we found television and overall media exposure to be most closely linked to depression. These findings are consistent with the hypothesis that excessive media exposure may detract from protective experiences or lead to poor sleep. Among the 4 media exposures measured, television viewing is unique in that it consumes a large amount of time,8
and participants who had the highest levels of baseline television exposure were most likely to develop depression (). Although radio exposure is also large, it more commonly is present in the background and frequently accompanies other activities.8
However, the finding that television was the medium most strongly associated with the development of depression in young adulthood is also consistent with the hypothesis that the specific content of certain media may lead to depression. For example, television contains more advertising than either videocassettes or computer games, and advertisements are often designed to make the viewer believe that he or she requires a certain product or lifestyle to feel adequate.59
Although radio also contains advertising, the combined visual and aural experience of television may be more effective and compelling.60
Another difference between videocassettes and television is that content on videocassettes is generally specifically chosen by the viewer, whereas television is more likely to be provided by default (ie, channel surfing).31
Television also contains the most compelling and dramatic news reports, many of which are anxiogenic,49,50
and repeated exposure to these messages may lead not only to anxiety but also to depression.3,16
Television also seems to contain the most stereotyping among media messages.25,26,61,62
In general, television is no more likely than other media such as movies or music to contain risk-taking behavior.33,35,36
Thus, our results suggest that the mechanism by which media exposure may influence development of depression is related to a combination of factors including displacement of protective experiences, poor sleep, self-comparison with unattainable images, stereotyping, and anxiety-provoking content.
Although we did not find that overall exposure to any of these types of media was associated with less depression, this does not rule out the hypothesis that certain humorous or life-affirming media exposures may reduce the likelihood of depression.41,42
Because we were not able to differentiate specific exposures, certain exposures still may be beneficial to some. However, it is noteworthy that this study shows that total television and total media exposure are associated with an increase, not a reduction, in depression.
It was an interesting and unexpected finding that young women did not exhibit a stronger association between media exposure and development of depression. Indeed, they had significantly lower odds of developing depression in the model involving total media exposure. Men and women use different coping mechanisms when dealing with depression; women are more likely to internalize and ruminate about their condition, whereas men are more likely to engage in externalizing or distracting activities.63,64
Similarly, adolescent girls may develop closer and more intimate social ties than their male counterparts, giving them more social reserve than adolescent boys.63,64
Thus, whereas adolescent girls may be more likely to seek comfort from peers, parents, or professionals, adolescent boys may use distractions such as television and other media to cope with underlying subsyndromal depression until different stressors and demands emerge later in life, leading to more substantial symptoms of depression. Thus, excessive time devoted to media may affect male users more substantially.4,22,65,66
It is also possible that actual media content may have more of a detrimental effect on male psychologic development than has been previously appreciated. The dominant fiction of idealized masculinity and sex roles to which boys are exposed while watching television may reinforce feelings of marginalization and worthlessness.22,67,68
The depressogenic media exposure in combination with preexisting negative cognitions may make unpopular or rejected boys feel even more outcast. Future research may explore questions such as these by examining moderating effects of other factors such as strength of interpersonal relationships on the link between media use and depression.
These findings have implications for clinicians working in a variety of fields. Psychiatrists, pediatricians, family physicians, internists, and other health care providers who work with adolescents may find it useful to ask their patients about television and other media exposure. When high amounts of television or total exposure are present, a broader assessment of the adolescent's psychosocial functioning may be appropriate, including screening for current depressive symptoms and for the presence of additional risk factors. If no other immediate intervention is indicated, encouraging patients to participate in activities that promote a sense of mastery and social connection may promote the development of protective factors against depression.
Helping children at risk of depression to bolster social support and involvement in activities is routine for child psychiatrists and other mental health professionals who work with adolescents; however, these clinicians may also want to consider an assessment of television exposure as a marker of vulnerability to the development of depressive symptoms. Further research will be necessary to understand how television exposure may correlate with the development of depressive symptoms in psychiatric clinical populations or with the clinical course of diagnosed depression. At the population level, as our understanding of the links between the mass media and adolescent depression become further refined, prevention programs may wish to incorporate these research findings into educational efforts aimed at adolescents and their families.
Our study was limited in that we relied on self-report of media exposure. Although self-report of media habits is subject to recall bias, it is currently standard practice in research of this type when it is not feasible to use recognition measures.37,69,70
It should also be noted that our independent variables were based on a single point estimate of media exposure, and there is no assurance that this remained stable over time. It is also disappointing that the baseline survey did not assess Internet exposure; however, this is a known limitation of the Add Health survey.
Insofar as the dependent variable, the Add Health study included only 9 items from the CES-D at follow-up, preventing us from using the complete 20-item scale. However, Add Health personnel carefully selected these particular 9 items because of their excellent face validity for adolescents and based on psychometric testing that showed that they represented the vast majority of the variance in the complete 20-item scale. Another limitation of the CES-D in general is its lack of specificity; for example, it tends to detect anxiety and depression.
It should be emphasized that, although our study showed a longitudinal association between media exposure in adolescence and development of depressive symptoms at later follow-up, this association does not necessarily imply causality. For example, it may be that adolescents with preexisting vulnerability to later developing depression are differentially attracted to watching television, perhaps owing to behavioral inhibition or aversive interpersonal and family relationships.
In conclusion, the present study breaks new ground in linking media use in adolescence to the development of depressive symptoms in young adulthood, especially relative to television exposure and overall media use. The study also highlights a previously unappreciated potential vulnerability to media exposure in male adolescents in particular. Its longitudinal design and large nationally representative sample are important strengths. Despite this study's limitations, these findings suggest important directions for future research and interventions with the goal of reducing the massive toll of depression.