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Recent studies have suggested doctors include questions about social media use with their teenage patients during checkups.

During visits with your kids’ doctor, they will often use the HEADSSS assessment (Home, Education and Employment, Activities, Drugs, Sexuality, Safety, Suicide and Depression) to figure out how your child is doing in a variety of areas. The questions can range from fairly broad to extremely personal: How are your relationships at home? Have you been suspended from school? Do you wear your seat belt? How often do you drink alcohol? How often do you have sex? Have you ever thought about hurting yourself?

And now, an editorial in the medical journal Pediatrics encourages healthcare providers to add questions about social media to the mix.

The three authors — a medical student, a health policy professor and a pediatrician — wrote that “excessive social media usage may contribute to the development of mental health disturbance in at-risk teenagers.” They claim clear correlations between patients’ mental health and social media usage.

The researchers suggest possible conversations about which apps kids are using and how much time they spend on social media. The authors also propose providers bring up other topics including cyberbullying, sexting and how social media affect feelings of self-worth. The researchers report the average teenager spends 71 minutes each day on social media, with female teens spending the most time on social networks, reporting daily average use of 142 minutes.

The authors wrote that while there are some positive benefits of the social connection these online networks provide, teens who use social media the most have an increased risk of negative consequences. The authors include sexting, cyberbullying, depression and decreased self-worth as some of the downsides that can occur during these high levels of social media usage.

In May at the annual meeting of the Association for Psychological Science, researchers presented a study identifying social media behaviors linked with depression. Live Science reports the study found people with depression were more likely to compare themselves with others they believed were “better off than me.” Those with depression also scored higher on a social media addiction survey and were bothered when someone tagged them in an unflattering photo. Note that the study shows correlation, not causation. So yes, people who are depressed have these social media habits, but one doesn’t necessarily cause the other.

Lead researcher Krista Howard, an associate professor of psychology at Texas State University, told Live Science that social media isn’t always bad.

“It can be [bad], but it can also provide social support,” Howard said. “It can give people an outlet to be around people that are similar to them.”

The Pediatrics opinion piece pointed out we have to be careful that social media doesn’t replace face-to-face contact. It also noted “many mentally ill teenagers express their daily thoughts and stressors via social networking platforms.”

During the HEADSSS assessment, oftentimes parents are not in the room while providers ask questions about home life, education, activities, drugs, sex, safety and suicide. These researchers suggest adding a fourth S to the acronym to include social media questions for patients older than age 11.

The clinical information website Healio lists the following questions suggested by the editorial’s authors:

Which social media sites and/or apps do you use regularly?

How long do you spend on social media sites and/or apps each day? (If the child answers more than 120 minutes per day, this would be a concerning response.)

Do you think you use social media too much? (If they answer yes, ask if they have attempted to remedy it.)

Does viewing social media increase or decrease your self-confidence?

Have you personally experienced cyberbullying, sexting or an online user asking to have a sexual relationship with you?

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The researchers wrote that gathering this additional information about kids’ social media activity “may provide a more complete picture of their psychosocial risk profile.”

Whether or not healthcare providers decide to add social media questions to their evaluations, all of the topics included in the HEADSSS assessment (including the proposed social media ones) should be part of regular conversations parents have with their kids in their own homes. Common Sense Media lays out some great ways to talk with your children about issues parents deal with in this digital age and how to make sure our kids are OK. That’s the whole point, right?