An Assessment of Digital Media-related Admissions in Psychiatrically Hospitalized Adolescents

Author(s): Meredith Gansner*, Erin Belfort, Caroline Leahy, Danielle Mirda, Nicholas Carson

Journal Name: Adolescent Psychiatry

Volume 9 , Issue 3 , 2019

Become EABM
Become Reviewer
Call for Editor


Background: Prevalent adolescent digital media use has brought clinical attention to its potential associated risks. While excessive digital media use has been connected to adolescent difficulties with mood and impulsivity, no study has examined digital media’s role in precipitating adolescent psychiatric admissions.

Objective: Our study aims were to identify and characterize digital media-related admissions in a sample of psychiatrically hospitalized adolescents, and to recognize unique patterns of digital media use within this sample. We hypothesized that adolescents with digital mediarelated admissions would endorse higher amounts of digital media use and problematic online behaviors.

Methods: We administered a cross-sectional survey of psychiatrically hospitalized adolescents between 2012 and 2016. Admissions were considered related to digital media use either by adolescent report or documentation in the medical record. Unadjusted comparisons were used to examine relationships between digital media-related psychiatric admissions, online behaviors and suicide-related risk factors.

Results: 68 of 218 participants (31.2%) had digital media-related admissions. The most frequent cause of digital media-related admission was cyberbullying (31.9%). Teens with digital- media related admissions were significantly more likely to sext, use social media, and be cyberbullied; these adolescents were also at increased risk of suicide planning and hopelessness.

Conclusion: Efforts should be made by mental health clinicians to identify and address online relational conflict, as well as to screen for cyberbullying and sexting. Clinicians should consider that adolescents with digital media-related presentations may be at elevated risk of self-harm, with higher rates of suicide planning and hopelessness compared to hospitalized peers with admissions unrelated to digital media.

Keywords: Adolescent, psychiatric hospitalization, internet, social media, cyberbullying, sexting.

Altbäcker, A., Plózer, E., Darnai, G., Perlaki, G., Horváth, R., Orsi, G. … Janszky, J. (2015) Problematic internet use is associated with structural alterations in the brain reward system in females. Brain Imaging and Behav., 953-959.
Battle, C.L., Shea, M.T., Johnson, D.M., Yen, S., Zlotnick, C., Zanarini, M.C. … Morey, L.C. (2004) Childhood Maltreatment Associated With Adult Personality Disorders: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal of Personality Disorders., 18(2), 193-211.
Carson, N.J., Gansner, M., & Khang, J. (2018). Assessment of Digital Media Use in the Adolescent Psychiatric Evaluation. Child and Adolescent. Psychiatric. Clinics of North America., 27(2), 133-143.
Centers of Disease Control and Prevention. (2017). Youth Risk Behavior Survey. Retrieved October 11, 2018, from
Chamberlain, S. R., & Grant, J. E. (2018). Minnesota Impulse Disorders Interview (MIDI): Validation of a structured diagnostic clinical interview for impulse control disorders in an enriched community sample. Psychiatry Research, 265(August 2017), 279–283.
Durkee, T., Kaess, M., Carli, V., Parzer, P., Wasserman, C., Floderus, B. … Wasserman, D. (2012) Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction, 107(12), 2210-2222.
Emeagwali, N.A., Bailey, R.K., & Azim, F. (2012). Textmania: Text messaging during the manic phase of bipolar i disorder. Journal of. Health Care for the Poor and Underserved, 23(2), 519-522.
Englander, E.K. (2012) Low risk associated with most teenage sexting : A study of 617 18-year-olds. Massachusetts Aggression Reduction Center, 5, 1–12.
Flaherty, A. (2005). Frontotemporal and dopaminergic control of idea generation and creative drive. Journal of Comparative Neurology, 493(1), 147-153.
Frankel, A., Bass, S., Patterson, F., Dai, T., & Brown, D. (2018). Sexting, risk behavior, and mental health in adolescents : An examination of 2015 Pennsylvania Youth Risk Behavior Survey. Journal of School Health, 88(3), 190-199.
Gámez-Guadix, M., Borrajo, E., & Almendros, C. (2016). Risky online behaviors among adolescents: Longitu-dinal relations among problematic Internet use, cyberbullying perpetration, and meeting strangers online. Journal of. Behavioral. Addictions., 5(1), 100-107.
Gansner, M., Belfort, E., Cook, B., Leahy, C., Colon-Perez, A., Mirda, D., & Carson, N.J. (2018). Problematic internet use and associated high-risk behavior in an adolescent clinical sample: results from a survey of psychiatrically hospitalized youth. Unpublished manuscript.
Grant, J., Levine, L., Kim, D., & Potenza, M. (2005). Impulse control disorders in adult psychiatric inpatients. American Journal of Psychiatry, 162(11), 2184-2188.
Grant, J., Williams, K., & Potenza, M. (2007). Impulse-control disorders in adolescent psychiatric inpatients: Co-occurring disorders and sex differences. Journal of Clinical Psychiatry, 68(10), 1584-1592.
Ioannidis, K., Chamberlain, S.R., Treder, M.S., Kiraly, F., Leppink, E.W., Redden, S.A. … Grant, J. E. (2016) Problematic internet use (PIU): associations with the impulsive-compulsive spectrum. An application of machine learning in psychiatry. Journal of Psychiatr. Res., 83, 94-102.
Jelenchick, L. A., Eickhoff, J., Christakis, D. A., Brown, R. L., Zhang, C., Benson, M., & Moreno, M. A. (2014) The Problematic and Risky Internet Use Screening Scale (PRIUSS) for adolescents and young adults: scale development and refinement. Computers in Human Behavior, 35
Kross, E., Verduyn, P., Demiralp, E., Park, J., Lee, D.S., Lin, N. … Ybarra, O. (2013) Facebook use predicts declines in subjective well-being in young adults. PLoS One, 8(8), 1-6.
[ journal.pone.0069841]
Landoll, R. R., La, A. M., Lai, B. S., Chan, S. F., & Herge, W. M. (2015). Cyber victimization by peers : Prospective associations with adolescent social anxiety and depressive symptoms. Journal of Adolescence, 42, 77-86.
[ adolescence.2015.04.002]
Lenhart, A. (2015, April). Teens, social media and technology overview 2015. Pew Research Center, retrieved from
Lewis, S.P., & Seko, Y. (2016). A double-edged sword: a review of benefits and risks of online nonsuicidal self-injury activities. Journal of. Clinical. Psychology, 72(3), 249-262.
Liu, T.C., Desai, R.A., Krishnan-Sarin, S., Cavallo, D.A., & Potenza, M.N. (2011). Problematic internet use and health in adolescents: Data from a high school survey in Connecticut. Journal of. Clinical. Psychiatry, 72(6), 836-845.
Medrano, J. L. J., Rosales, F. L., & Gámez-guadix, M. (2018). Assessing the links of sexting, cybervictimization, depression, and suicidal ideation among university students. Archives of Suicide Research, 22(1), 153–164.
Minnesota Department of Health. (2017). Patient Health Questionnaire-2 (PHQ-2) instrument review. Retrieved October 11, 2018, from
Mitchell, K.J., Finkelhor, D., & Wolak, J. (2001). Risk Factors for and Impact of Online Sexual Solicitation of Youth. Journal of the American Medical Association, 285(23), 3011-3014.
Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6), e20161878-e20161878.
Muller, K., Ammerschlager, M., Freediving, F., Beutel, M., & Wolfling, K. (2012). Addictive internet use as a comorbid disorder in the youth psychiatric setting: prevalence and psychopathological symptom burden. Journal of Child and Adolescent Psychiatry and Psychotherapy, 40, 331-339.
Ouytsel, J., Van, , Walrave, M., Lu, Y., Temple, J. R., & Ponnet, K. (2018). The associations between substance use, sexual behavior, deviant behaviors and adolescents’ engagement in sexting: does relationship context matter? Journal of Youth and Adolescence, 47(11), 2353-2370.
Ranney, M., Patena, J., Nugent, N., Spirito, A., Boyer, E., Zatzick, D., & Cunningham, R. (2016). PTSD, cyberbullying, and peer violence: prevalence and correlates among adolescent emergency department patients. Gen. Hosp. Psychiatry, 39, 32-38.
Richardson, L.P., Rockhill, C., Russo, J.E., Grossman, D.C., Richards, J., McCarty, C. … Katon, W. (2010) Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics, 125(5), e1097-e1103.
Rideout, V. (2015). The Common Sense Census: Media use by tweens and teens. Common Sense Media, 1–104.
Rideout, V., & Fox, S. (2018). Digital health practices, social media use, and mental well-being among teens and young adults in the U.S: a national survey sponsored by Hopelab and Well Being Trust. Retrieved from
Schneider, S., Donnell, L. O., Stueve, A., & Coulter, R. W. S. (2012) Cyberbullying, school bullying, and psychological distress: a regional census of high school students, 102(1), 171–177
Scholes-Balog, K., Francke, N., & Hemphill, S. (2016) Relationships between sexting, self-esteem, and sensation seeking among Australian young adults. Sexualization, Media, and Society, 2(2), 237462381 5627790.
Shapira, N.A., Goldsmith, T.D., Keck, P.E., Khosla, U.M., & McElroy, S.L. (2000). Psychiatric features of individuals with problematic internet use. Journal of Affective Disorders, 57(1–3), 267-272.
Twenge, J.M., Joiner, T.E., Rogers, M.L., & Martin, G.N. (2017). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science.
Van Geel, M., Vedder, P., & Tanilon, J. (2014). Relationship between peer victimization, cyberbullying, and suicide in children and adolescents a meta-analysis. JAMA Pediatr., 168(5), 435-442.
Wells, M., & Mitchell, K.J. (2008). How do high-risk youth use the internet? Characteristics and implications for prevention. Child Maltreat., 13(3), 227-234.
Wolak, J., Mitchell, K. J., & Finkelhor, D. (2003). Escaping or connecting ? Characteristics of youth who form close online relationships, 26, 105–119.
Ybarra, M.L., Espelage, D.L., & Mitchell, K.J. (2007). The co-occurrence of Internet harassment and unwanted sexual solicitation victimization and perpetration: associations with psychosocial indicators. Journal of Adolesc. Health, 41(6) (SUPPL.), S31-S41.
Yen, S., Shea, M., & Battle, C. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the collaborative longitudinal personality disorders study. Journal of Nervous and Ment. Dis., 190(8), 510-518.
Zhang, J-T., Ma, S-S., Li, C-S.R., Liu, L., Xia, C-C., Lan, J. … Fang, X.-Y. (2016). Craving behavioral intervention for internet gaming disorder: remediation of functional connectivity of the ventral striatum. Addict. Biol.
Zhou, Y., Lin, F., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2011). Gray matter abnormalities in Internet addiction: A voxel-based morphometry study. European Journal of Radiology, 79(1), 92-95.

open access plus

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 10 January, 2020
Page: [220 - 231]
Pages: 12
DOI: 10.2174/2210676609666190221152018

Article Metrics

PDF: 26
PRC: 2