The application of cerebellar repetitive transcranial magnetic stimulation on aphasia after stroke: A randomized controlled trial protocol.

Human social interaction has been fundamentally transformed in the 21st century by exponential growth in social media and texting apps on smartphones []. Traditionally defined, social media refers to internet-based apps enabling user-generated content to be shared from one to many, and texting refers to apps for sending text and images one to one [-]; however, the distinction is becoming increasingly less clear []. Adolescents and emerging adults (10‐24 years) [] are frequent users of social media and texting apps, with 96% of 16‐24-year-olds using online social interaction apps for an average of 3 hours per day [,]. In parallel to this increased opportunity for online social interaction, we have witnessed annual increases of 12%‐13% in anxiety and depression in 10-19-year-olds globally from 2019 to 2021 [], reflecting longer-term trends observed in countries across the world, including Australia [,] and the United States [], since the advent of smartphones. Whether these phenomena are causally linked has been the focus of much public and academic debate [,]. Efforts to inform the debate should start to unpack the mechanisms through which these apps may be detrimental to mental health. Prior research has investigated the relationship between adolescent mental health and both device use and social media use (variably defined with and without texting apps included), with a converging view that it is social media use on smartphone devices that is the issue []. However, research to date has largely operationalized smartphone or social media use as “time spent,” which has yielded conflicting results [,]. Meta-analyses and reviews of reviews have found only a weak positive association [,], or no relationship at all [,], between the time individuals spent on social media or texting apps and mental health symptoms. One potential reason for these inconsistent results may be the use of memory-reliant, self-reported time spent on smartphones, and social media and texting apps. Several individual [-] and meta-analytic studies have demonstrated that self-reported time deviates significantly from logged screentime data [,], with one study finding 42% of participants overestimated their time spent online while 26% underestimated their usage []. However, Ferguson et al [] did not find the type of reporting (ie, self-report or objective measurement of time) to be a moderating factor in their meta-analysis of the association between social media and mental health studies. Measurement of time spent may be less accurate when relying on self-report, but it is unlikely to be the sole cause of mixed evidence. Another source of variation in these associations that is not well captured by time spent on social media is the unique affordances of online interactions. While the concern about online social interactions is that they are detrimental compared with offline (in-person) social interactions [], few studies have compared young people’s on- and offline interactions. Some of these studies suggest that online sociability has a stronger positive relationship with well-being than offline social activities []. However, others indicate that fulfilling self-determination needs (ie, autonomy, relatedness, and competence) through offline, rather than online, connections is predictive of better adolescent mental health []. A few studies have used ecological momentary assessments (EMAs) to compare responses to online and offline interactions in real time, or close to real time, in participants’ natural environment [,]. This research shows that, on balance, in-person interactions have a more positive effect on mood, feelings of inclusion, and self-esteem than online interactions, both immediately and over time [-]. However, these EMA studies did not investigate the link between different momentary responses to online and offline social interactions and mental health.