In this study using EMA to measure media exposure, we found that increasing use of audio-based media (eg, MP3 players and compact disc players) was linearly associated with increasing likelihood of MDD diagnosis. We also found a negative association between reading print material and MDD. Although point estimates suggested weak positive associations of MDD with other electronic media exposures, these associations were not statistically significant.
Lower nonelectronic media use among those with MDD is consistent with other work in this area, which found book exposure during adolescence to be inversely associated with development of MDD by young adulthood.10
The use of the more rigorous EMA assessment technique in the present investigation supports and strengthens that finding. Because the previous study was longitudinal, it suggests that reading may somehow subsequently protect against MDD.10
However, it may also be that those with MDD tend to lack the concentration and/or motivation to read, which requires more cognitive energy than consumption of other media.23–25
That same large study found that television exposure was associated with MDD,10
whereas the present study found that an initially significant bivariable association between television or movie exposure and MDD did not persist after correction for sociodemographic variables. The previous study was longitudinal; thus, it is possible that this association is not present initially but that, over time, increased television exposure may become more strongly associated with MDD. However, because the present study used a more rigorous EMA-based measurement of media exposure, it is also possible that the previous study, which relied on participant self-report, may have been affected by recall bias and that the hypothesized association between television exposure and depression may not be as strong as suggested.
After adjustment for sociodemographic variables, audio (music) exposure had a strong linear association with MDD, but television exposure did not bear this association. Association of music exposure with MDD has been hypothesized. For example, sadness is a common theme in popular music, and it may be that individuals with depression turn to these messages to make themselves feel less alone in their sadness.43–46
Conversely, it may also be that individuals with MDD turn to happy music to “tune out” their negative moods or to elevate their moods.47
Other researchers have suggested that heavy exposure to the sometimes dark themes of popular music may contribute to the development of conditions such as MDD.43–46
Whatever the mechanism, this empirical study suggests that this association may be stronger than previously considered.
Although MDD was not significantly associated with Internet or video game use, there was a nonsignificant trend toward higher use/exposure to video games among those with MDD. Previous studies30,48
have demonstrated associations between depression and video games in adolescents, and a recent study49
linked video game use with MDD in women. The authors of the last study noted that women may self-medicate for depression by “losing themselves” in virtual game worlds.49
It is also possible that women may be particularly vulnerable to stereotypical and/or otherwise negative portrayals of female characters in video games.17,50
Web-based media may be processed similarly to print,51
suggesting that computer use (much of which is Web based) and print media use may have similar associations with MDD. However, more recent work52
highlights the fact that individuals tend to selectively scan Web content rather than absorbing it more fully, suggesting that in other ways Web use may be more similar to television use. Our results—which did not find statistically significant associations between Internet use and MDD—are consistent with the Web as a possible amalgamation of print- and television-type content.
Recruitment for this study focused on a particular geographic region and was not randomly generated; therefore, these results are not necessarily broadly generalizable. The cross-sectional method also precludes inferences about the directionality of the associations observed herein. Future studies will need to more specifically assess the hypothesized relationships in either direction. Another limitation is related to the EMA method, which relies on probability to accurately measure media exposures. Although in general we would expect that EMA-based estimates of media exposure will correspond to actual exposure and be less error prone than self-reported data, any intermittent sampling method may be subject to error.
In addition, our study used types of media exposures as independent variables without assessing specific types of media use (eg, Internet use for real-time social networking vs browsing) and/or contextual elements of use (eg, whether television viewing occurs with friends, family, or alone). Future research in this area may find it valuable to use more nuanced independent variables. Two final limitations involve the outcome variable (psychiatric diagnosis). Of our participants with depression, 74% had a comorbid anxiety disorder. Thus, owing to the high occurrence of both disorders within individuals, it may be hard to tease apart the associations between depression and media use from those between anxiety and media use. Finally, although we used an intensive method to determine diagnoses, we were not able to update this process during the 8-week period of the study, suggesting that diagnosis could have changed during that time, particularly if youth improved in treatment. However, this limitation should have the effect of biasing our findings toward the null hypothesis (because of regression to the mean and potential improvements in depression). Therefore, it does not diminish our credence in the major findings noted in this study.