Acta Psychologica 229 (2022) 103696

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Acta Psychologica
journal homepage: www.elsevier.com/locate/actpsy

Linear correlation is insufficient as the sole measure of associations: The

case of technology use and mental health
Jean M. Twenge a, *, Jessica L. Hamilton b
a
Department of Psychology, San Diego State University, United States of America
b
Department of Psychology, Rutgers University, United States of America

A R T I C L E I N F O A B S T R A C T

Keywords: It is common for psychology studies to rely solely on linear correlation (r) or similar statistics and not include
Mental health other measures of association (such as relative risk, which examines differences in the number of people
Technology use affected). For example, the association between smoking and lung cancer (r = 0.06) could be dismissed as “small”
Effect size
if only linear r is examined, even though 30 times more smokers than non-smokers get lung cancer. Many studies
Relative risk
concluding that associations between technology use and well-being as too small to be of practical importance
relied solely on linear r. We show that, across five datasets, “small” correlations between technology use and
mental health exist alongside practically important risk associations. As there are several valid types of associ­
ation, and characterizing an association based on a single type of a measure – such as linear r or r2 – can be
misleading.

1. Introduction to do with their use of social media” (BBC, 2019).

Several recent debates within psychology have focused on the size of
effects and whether they are large enough to be practically important, an
increasingly vital consideration as psychology research moves away
from statistical significance testing and the false dichotomy of the 0.05
p-value cutoff (Cumming, 2014; Funder & Ozer, 2019). These discus­
sions around effect size have occurred across several different research
areas, including the practical importance (or existence) of links between
the Implicit Association Test and behavior (Greenwald et al., 2015;
Oswald et al., 2013), violent video game play and physical aggression
(Anderson et al., 2017; Bushman & Huesmann, 2014; Elson & Ferguson,
2014; Prescott et al., 2018), and stereotype threat and performance
(Shewach et al., 2019).
Similarly, several researchers have described the association be­
tween time spent on technology and mental health as weak or too small
to be practically important (e.g., Berryman et al., 2018; Ferguson, 2017;
Ivie et al., 2020; Orben & Przybylski, 2019a, 2019b; Przybylski &
Weinstein, 2017; Stronge et al., 2019). For example, Ferguson (2017)
concluded that “excessive use of screens is only weakly associated with
negative outcomes” on the basis of a linear r of 0.13, which he called
“very small.” Similarly, Orben et al. (2019) summarized the results of
their study by saying, “99.75% of a person's life satisfaction has nothing
Most of these studies relied exclusively on linear correlation (r) or its
derivatives such as r2. Linear r measures the linear predictability of one
variable from another. However, linear r is only one aspect of the as­
sociation between two variables. For example, linear r does not measure
other types of associations such as relative risk (RR, the likelihood of
occurrence in an exposed group compared to an unexposed group;
Andrade, 2015). Relative risk (and a related statistic, odds ratio) is
commonly used in public health and medicine to understand the number
of people in one group versus another with a certain outcome (for
example, who develop a disease, die, attempt suicide, fit clinical criteria
for depression, or are above or below cutoffs on mood or mental health
scales, e.g., Baiden et al., 2020; Petrie et al., 2018; Primack et al., 2021;
Shensa et al., 2020). Linear r and relative risk can be computed from the
same data, but cannot be directly converted from one to the other as r, d,
t, and binary F can; r and RR measure different aspects of the association
(similar to area and circumference in the measurement of a circle).
Because linear r is only one type of association, relying solely on linear r
to gauge practical importance may produce misleading conclusions
(Funder & Ozer, 2019; Pearce, 2010; Rosnow & Rosenthal, 2003). We
give several examples to illustrate.
First, consider the association between smoking and lung cancer. In
2018, 13.7 % of U.S. adults smoked cigarettes out of a total of 249.6

* Corresponding author at: Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4611, United States of America.
E-mail address: jtwenge@mail.sdsu.edu (J.M. Twenge).

https://doi.org/10.1016/j.actpsy.2022.103696
Received 28 March 2022; Received in revised form 27 July 2022; Accepted 1 August 2022
Available online 11 August 2022
0001-6918/© 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
J.M. Twenge and J.L. Hamilton
million adults (CDC, 2020). There are approximately 228,820 new cases
of lung cancer each year (Seigel et al., 2020), a rate of 0.092 %. Between
10 % and 25 % (an average of 17.5 %) of lung cancer cases occur among
non-smokers, and the rest among smokers (Bhopal et al., 2019). In a
hypothetical sample of 1 million U.S. adults, there would be 920 lung
cancer cases each year. If 17.5 % of these lung cancer cases occurred
among non-smokers, 161 would be among non-smokers and 759 among
smokers, leaving 862,839 non-smokers unaffected and 136,241 smokers
unaffected. According to an effect size calculator for a 2 by 2 contin­
gency table (Wilson, 2020), this produces linear r = 0.06, r2 = 0.036 %.
If we apply the same reasoning used by psychologists describing results
on technology use and well-being of a similar size, we would conclude
that smoking has little to no practical importance for getting lung cancer
and that 99.64 % of getting lung cancer has nothing to do with smoking.
Does this mean people might as well start smoking because it's not
related to lung cancer? No, because linear r is only one type of associ­
ation; it does not capture the risk of developing lung cancer based on
smoking. These same numbers produce a relative risk of 29.86 –
meaning that people who smoke are 30 times more likely to develop
lung cancer than non-smokers. Because most smokers don't develop lung
cancer in a given year, the linear r is low. However, the relative risk of
smoking on lung cancer is very high; smokers are much more likely to
get lung cancer than non-smokers.
Second, consider the association between getting a COVID vaccine
and developing the disease. In the Moderna vaccine trial of 30,000
participants in 2020, 185 people who received the placebo developed
COVID-19, compared to 11 in the vaccine group (Loftus, 2020). If we
assume there were 15,000 participants in each group, 14,815 in the
placebo group did not get sick, and 185 did; 14,989 in the vaccine group
did not get sick and 11 did. This produces linear r = 0.07, r2 = 0.049 %.
This r would typically be considered small in psychology and might be
labeled as having little practical value. So was the vaccine ineffective
and of little practical value in 2020? No, because linear r does not
capture the risk of developing COVID based on receiving the vaccine or
not. These same numbers produce a relative risk (RR) of 0.06, or a 94 %
reduction in disease in the vaccine group (an RR of 1 means no effect;
RR's above 1 indicate increases and RR's below 1 indicate reductions).
Thus, the RR indicates substantial effectiveness and practical value,
despite the low linear r.
Third is the association between wearing a seat belt and dying in a
car accident. In Pennsylvania in 2014, there were 121,317 reportable
car accidents and 1195 deaths. Of those who got in a car accident, 78.7
% wore a seatbelt; of those who died, 51.9 % wore a seat belt (Edgar
Snyder and Associates, 2020). Thus, 620 of those who died in car acci­
dents were wearing seat belts and 575 were not, leaving 94,856 seat belt
wearers alive and 25,266 non-wearers alive. These numbers yield r =
0.07 (r2 = 0.049 %) but a relative risk of 3.43 – so those not wearing seat
belts are more than three times as likely to die in a car accident as those
wearing a seat belt. Thus, an association that explains less than on half of
1 % of the variance (which could be characterized as “99.5% of dying in
a car accident has nothing to do with wearing a seat belt”) shows a
tripling of risk when comparing one behavior vs. another.
Fourth, consider the association between gender and suicide at­
tempts among adolescents. In the 1991–2019 Youth Risk Behavior
Surveillance System (YRBSS) administered by the Centers for Disease
Control, 5.3 % of U.S. high school males attempted suicide in the past 12
months, as did 10.7 % of females. These numbers produce r = 0.10, but
RR = 2.02, meaning that females are twice as likely to have attempted
suicide than males. An association that could be dismissed as “explain­
ing only 1% of the variance” shows a substantially higher risk of suicide
attempts among adolescent girls.
Fifth, we should consider an example with continuous variables, as
some might argue that linear r should not be used for binary or ordinal
variables (although it often is in psychology, including for studies
examining technology use and mental health: e.g., Orben & Przybylski,
2019a). Exercise frequency and BMI in YRBSS (controlled for gender,
2
Acta Psychologica 229 (2022) 103696
race, and grade) correlate r = − 0.07. However, those who exercise 3 or
fewer days/week are 42 % more likely to be obese (BMI > 30) than those
who exercise 4 or more days/week (16.7 % vs. 11.8 %; RR = 1.42). If the
highest exercise group (exercising every day, 9.5 % obese) is compared
to the lowest exercise group (never exercising, 17.6 % obese), as is often
done in studies published in medical journals (e.g., Petrie et al., 2018;
Primack et al., 2021; Riehm et al., 2019), RR = 1.85, so never-exercisers
are 85 % more likely to be obese than every-day-exercisers. Thus, even
when variables are initially continuous, linear r can be low when relative
risk suggests practical importance.
To research psychologists trained to rely on linear r, these examples
may seem shocking – how can data with such low r's have such large
relative risks and thus considerable potential for practical importance?
Does this disconnect frequently occur with data relevant to psycholog­
ical factors? We address this question in this paper, analyzing five
example datasets assessing time spent on technology and mental health.
We focused on studies in the area of technology use and well-being with
publicly available data that had been analyzed using only linear r or
related statistics and not with relative risk or odds ratios. We began with
three previously published papers on technology use and mental health
(Ferguson, 2017; Orben & Przybylski, 2019b; Przybylski, 2014) and
then added one dataset provided by the authors of a paper that used
linear regression only (Stronge et al., 2019) and one other publicly
available dataset that had not been examined cross-sectionally in a
published paper.
There is considerable precedent in published research for using
relative risk or odds ratios (a related statistic) to examine associations
between technology use and mental health (e.g., Kelly et al., 2019; Kim
et al., 2020; Kremer et al., 2014; Lin et al., 2016; Mathers et al., 2009;
Messias et al., 2011; Primack et al., 2017, 2021; Riehm et al., 2019;
Sampasa-Kanyinga & Lewis, 2015; Shensa et al., 2020). For example,
Messias et al. (2011) used odds ratios to compare non-users to those
reporting <1 h, 1 h, 2 h, 3 h, 4 h, and 5+ h of electronic device use on
mental health variables in YRBSS. Riehm et al. (2019) used relative risk
to compare non-users of social media to those reporting <30 min, 30
min to <3 h, 3 to 6 h, and 6 or more hours of daily use on whether they
met cutoffs for internalizing and externalizing mental health issues.
Primack et al. (2021) used odds ratios to compare those in the lowest
quartile of social media use to those in higher quartiles of use on whether
they met a cutoff for depression on a 9-item scale.
However, it is rare for the same datasets to be analyzed using both
linear r and relative risk, perhaps because linear r is more commonly
used in psychology and communications and relative risk is more
commonly used in public health and medicine. This might be one reason
why researchers in different areas end up talking past each other, with
little consensus around the practical importance of the associations be­
tween time spent on technology and mental health. Generally, re­
searchers (including meta-analyses) using linear r have reported weak
associations between technology use and mental health (e.g., Berryman
et al., 2018; Ferguson, 2017; Ivie et al., 2020; Orben & Przybylski,
2019a, 2019b; Przybylski & Weinstein, 2017; Stronge et al., 2019),
while researchers using relative risk have reported practically signifi­
cant associations (e.g., Kelly et al., 2019; Kim et al., 2020; Kremer et al.,
2014; Lin et al., 2016; Mathers et al., 2009; Messias et al., 2011; Primack
et al., 2017, 2021; Riehm et al., 2019; Shensa et al., 2020). This may be
one reason why some observers have concluded that the literature in this
area is inconclusive (e.g., Best et al., 2014; Meier & Reinecke, 2021). We
attempt to provide some clarity by examining the same datasets using
both linear r and relative risk. We focus on cross-sectional studies; thus,
they can establish associations but not causation.
2. Study 1: UK Understanding Society Youth Panel Wave 1
We first examined the association between electronic gaming and
well-being in the UK Understanding Society Youth Panel Wave 1. These
data were originally analyzed by Przybylski (2014), who used linear
J.M. Twenge and J.L. Hamilton Acta Psychologica 229 (2022) 103696

regression and concluded that links between gaming time and well-
being were “small,” explaining <1.6 % of the variance. We analyze
the same dataset using linear r as well as relative risk analyses similar to
those in other studies of technology use and mental health, which
generally compare the percentage of participants above or below cutoffs
on measures of mental health across levels of technology use (e.g., Kim
et al., 2020; Primack et al., 2021; Riehm et al., 2019).
Method. Participants (n = 4873; 48.5 % female; ages 10 to 15, mean
age = 12.5 years old) reported time spent on electronic gaming (game
console and computer gaming) on a typical school day (none, 1 h, 1–3 h,
4–6 h, 7 or more hours). Participants also completed two measures of
well-being to assess externalizing problems, internalizing problems,
prosocial behavior, and life satisfaction. The Strengths and Difficulties
Questionnaire (Goodman, 1997) measured externalizing problems,
internalizing problems, and prosocial behavior. Life satisfaction was
assessed using a measure in which participants rated happiness on a
scale of 1 (‘completely happy’) to 7 (‘not at all happy’) across the 6
domains of school, schoolwork, appearance, family, friends, and life as a
whole. The cutoff for problematically low prosocial behavior on the SDQ
is 5 and under (Youth in Mind, 2016). For life satisfaction, internalizing
problems, and externalizing problems scores in the lowest or highest
~15 % of the sample were considered high, as this is a common cutoff
for clinical issues (Schalet et al., 2014). The cutoff scores were 5 and
under for life satisfaction, 9+ for internalizing problems, and 11+ for
externalizing problems.
Analytic Approach. We used the specifications of the original
article (Przybylski, 2014): sample weights but no controls. For linear
analyses to calculate r and r2, gaming hours were recoded as 0 = 0, less
than an hour = 0.5; 1 to 3 h = 2; 4–6 h = 5; 7 or more = 8. For relative
risk, we compared non-users to each of the other categories as is
frequently done in studies of technology use and mental health pub­
lished in medical journals (e.g., Kim et al., 2020; Messias et al., 2011;
Riehm et al., 2019).
Although the technique of comparing each category of use to a
reference category is very common, some may argue that it leaves out
some of the data in each comparison. Thus, the data may also be
analyzed by dichotomizing the variable (for example, by a median split),
which includes all of the data in a single comparison (although it also
has the disadvantage of less specificity). We also examined the data this
way to determine if relative risk still produced effect sizes that seemed
practically significant when all of the data were included.
Results. Table 1 presents the original results (r2 from contrast-coded
regressions comparing non-users to heavy users), linear correlations and
their associated r2 (expressed as a percent, given the common use of
“percent variance explained”), outcomes within usage groups, and
relative risk comparisons. The contrast-coded regressions and linear
correlations both produced effects usually considered to be small, with
r2 < 4 % and often <1 %. Yet, compared to non-users, youth who spend
4+ h on console gaming (heavy users) are three times more likely to be
low in prosocial behavior (9.3 % vs. 30.6 %, RR = 3.09) and twice as
likely to have high levels of externalizing problems (13.4 % vs. 27.9 %,
RR = 2.08); see Table 1 and Fig. 1. Thus, although r and r2 appear low,
comparisons using relative risk produce differences that seem practi­
cally significant.
Comparing two usage groups (up to an hour vs. an hour or more),
and thus utilizing all of the data, also produces seemingly important
effects. For example, twice as many light/non-users of console games
(10.5 %) than heavier users (21.4 %) were low in prosocial behaviors. In
addition, 55 % more heavier users of computer games were high in
externalizing symptoms (see Supplemental Table 1). Thus, seemingly
meaningful differences also appear when all of the data are included.
Discussion. Playing video games 4+ h a day is associated with a
substantially increased risk of negative outcomes such as externalizing
problems and low prosocial behavior. Yet this the same data, with
identical analytical specifications for measures, weighting, and controls,
that yielded r2 of 1 % of the variance in Przybylski (2014).
Why the discrepancy? Linear r shows how one variable can be pre­
dicted from another. However, linear r cannot answer other important
research questions, such as identifying the increased risk of getting lung
cancer if one smokes (vs. not) or the increased likelihood of having

Table 1
Electronic gaming and well-being, UK Understanding Society Youth Panel, Wave 1, UK.
Low prosocial behavior Low life satisfaction Internalizing problems Externalizing problems

Console gaming
Linear r
Contrast coded regression (0 vs. 4+), r2 0.74 % 0.46 % 0.90 % 1.2 %
r (r2) − 0.19*** (3.6 %) 0.08*** (0.64 %) 0.05** (0.25 %) 0.17*** (2.9 %)
Relative risk
None 9.3 % (1154) 16.0 % (1146) 11.9 % (1153) 13.4 % (1153)
Ref. Ref. Ref. Ref.
0.5 h 11.3 % (1614) 12.5 % (1603) 11.1 % (1612) 11.0 % (1610)
1.22 (0.97, 1.53) 0.78 (0.65, 0.94) 0.93 (0.76, 1.52) 0.82 (0.67, 1.01)
1–3 h 19.5 % (1410) 16.0 % (1401) 13.4 % (1411) 16.8 % (1412)
2.10 (1.71, 2.59) 1.00 (0.84, 1.20) 1.13 (0.92, 1.38) 1.25 (1.04, 1.51)
4+ h 30.6 % (297) 23.9 % (299) 14.2 % (295) 27.9 % (295)
3.09 (2.39, 3.98) 1.49 (1.17, 1.90) 0.82 (0.87, 1.65) 2.08 (1.64, 2.63)
Computer gaming
Linear r
Contrast coded regression (0 vs. 4+), r2 0.29 % 0.81 % 0.90 %^ 1.5 %
r (r2) all values − 0.09*** (0.81 %) − 0.15*** (2.3 %) 0.11*** (1.2 %) 0.16*** (2.6 %)
Relative risk
None 13.4 % (654) 14.5 % (649) 8.8 % (654) 11.9 % (652)
Ref. Ref. Ref. Ref.
0.5 h 12.8 % (1640) 10.9 % (1625) 10.0 % (1636) 10.5 % (1636)
0.96 (0.79, 1.16) 0.75 (0.60, 0.95) 1.13 (0.85, 1.50) 0.87 (0.68, 1.12)
1–3 h 14.1 % (1902) 15.7 % (1886) 13.1 % (1901) 15.1 % (1901)
1.05 (0.88, 1.28) 1.08 (0.87, 1.34) 1.48 (1.13, 1.94) 1.26 (1.00, 1.59)
4+ h 19.4 % (404) 27.2 % (409) 18.9 % (404) 25.5 % (404)
1.44 (1.13, 1.85) 1.87 (1.46, 2.39) 2.12 (1.54, 2.92) 2.13 (1.63, 2.78)

Notes: 1. Contrast-coded regressions are from Przybylski (2014). 2. Linear r's are partial correlations with controls, and r2 are given as percentages (1 % = 0.01, given
the common use of “percent variance explained”). 3. ^ = reported as 9 % in Przybylski (2014); assumed to be 0.90 % given other results. 4. For relative risk cells,
numbers are % with low well-being, (n), relative risk, and (95 % confidence interval). 5. Specifications: Weighted, no controls. 6. RR's with 95 % CI's not including 1 are
in bold.

3
J.M. Twenge and J.L. Hamilton
30
25
% low well being
20
15
10
Hours a day console gaming
Fig. 1. Associations between console gaming time and low well-being, UK Understanding Society Youth Panel Wave 1.
externalizing problems if one plays video games 4+ h a day (vs. not at
all). Comparing outcomes between groups using relative risk can do
that, and it appears that there is in fact a practically important associ­
ation between playing video games more frequently and negative out­
comes such as externalizing problems. This was true whether relative
risk calculations compared each group to non-users or included all of the
data by combining usage groups to make a dichotomous variable. Thus,
the association between time spent on technology and mental health
outcomes can appear small and supposedly insignificant when only
linear r is examined, but more practically significant when statistics
more commonly used in medicine and public health are employed.
3. Study 2: Youth Risk Behavior Surveillance System 2013
In Study 2, we sought to examine differences among effect size
metrics in another large study measuring digital media use and well-
being originally analyzed using linear regression (Ferguson, 2017).
This study includes several dichotomous measures of depression,
addressing concerns about dichotomizing continuous variables. With an
ordinal (not continuous) measure of technology use and dichotomous
measures of depression and suicidal ideation, this dataset is an excellent
candidate for the use of relative risk.
Method. The 2013 Youth Risk Behavior Surveillance System
(YRBSS) collected data from youth from the U.S. state of Florida in 2013.
Participants included 6089 adolescents in 9th through 12th grade (ages
12–18) who were 51 % female. Participants reported their hours per day
of 1) television and 2) electronic device use. In the original analysis,
these two items were summed to create a total “screen time” measure.
To measure depression, Ferguson (2017) added together three dichot­
omous items (feeling sad or hopeless for two weeks or more, thinking
4
Acta Psychologica 229 (2022) 103696
Externalizing
Problems
high
Internalizing
Problems
high
Prosocial
Behavior low
Life
sasfacon
low
about suicide, and making a suicide plan) over the last 12 months.
Analytic Approach. Ferguson (2017) analyzed the 2013 YRBSS data
using four contrast-coded regressions by dividing total screen time into
four groups: abstainers (no screen time), low users (<2 h/day), mod­
erate users (3–6 h/day defined as +/− 1 SD of mean on screen time), and
excessive users (>1 SD above the mean of screen time). We used spec­
ifications based on Ferguson (2017): no weighting and the inclusion of
control variables for gender, sleep, and physical activity.
We also analyzed the data using the specifications of a previous
analysis using a similar dataset (Twenge et al., 2018): examining elec­
tronic device use separately, including controls for race and grade level
in addition to gender, and following current guidance to exclude
possible mediators (sleep, physical activity) from the list of control
variables (Rohrer, 2018; Schisterman et al., 2009). The YRBSS measured
electronic device time using the following response choices: None, less
than an hour, one hour, two hours, three hours, four hours, and five or
more hours.
For linear r analyses, TV and electronic device use in hours was
recoded as 0, 0.5, 1, 2, 3, 4, and 6. We examined mental health using
both a summary variable (endorsement of at least one of the three
dichotomous depression and suicidal ideation items) and by examining
each dichotomous item separately. Percentage increases for each hour of
use were calculated by averaging relative risks between consecutive
usage levels.
Results. In the original contrast-coded regressions (Ferguson, 2017),
the r2 for total screen time and the sum of the depression and suicide
items was 1.7 %. However, when outcomes are compared between usage
groups using relative risk, 50 % more heavy users of screens than non-
users endorsed at least one of the depression and suicide items (see
Table 2 and Fig. 2). The contrast between the results using linear r and
J.M. Twenge and J.L. Hamilton Acta Psychologica 229 (2022) 103696

Table 2
Screen time or electronic device time and well-being, U.S. Youth Risk Behavior Surveillance System, Florida, 2013.
At least 1 of 3 depression/suicide items Depression (Y/N) Suicidal thoughts (Y/N) Suicide plan (Y/N)

Total screen time

Linear r
Contrast coded regression (0 vs. 7+), r (r)2 0.13*** (1.7 %) – – –
r (r2) 0.10*** (1.0 %) 0.08*** (0.64 %) 0.09*** (0.81 %) 0.07*** (0.49 %)
Relative risk
None 25.0 % (252) 22.2 % (255) 12.1 % (255) 10.4 % (252)
Ref. Ref. Ref. Ref.
0.5–2.5 h 27.3 % (1633) 23.7 % (1646) 11.4 % (1646) 8.4 % (1641)
1.09 (0.87, 1.37) 1.06 (0.83, 1.35) 0.94 (0.66, 1.34) 0.82 (0.55, 1.21)
3–6.5 h 31.6 % (2248) 26.8 % (2277) 14.2 % (2272) 10.6 % (2257)
1.26 (1.01, 1.58) 1.20 (0.94, 1.52) 1.17 (0.83, 1.65) 1.03 (0.70, 1.51)
7+ h 37.5 % (1150) 32.2 % (1171) 19.0 % (1167) 13.0 % (1155)
1.50 (1.20, 1.88) 1.44 (1.13, 1.84) 1.56 (1.10, 2.22) 1.26 (0.85, 1.87)
Electronic device time
Linear r
r (r2) all values 0.13*** (1.7 %) 0.13*** (1.7 %) 0.13*** (1.7 %) 0.10*** (1.0 %)
Relative risk
None 28.2 % (911) 24.3 % (921) 11.4 % (881) 9.2 % (876)
Ref. Ref. Ref. Ref.
<1 h 26.4 % (805) 23.3 % (813) 11.6 % (757) 7.7 % (753)0
0.94 (0.80, 1.09) 0.95 0(0.80, 1.12) 1.02 (0.78, 1.34) .83 (0.60, 1.15)
1h 22.5 % (688) 19.8 % (697) 11.1 % (650) 8.7 % (647)0
0.80 (0.67, 0.95) 0.81 (0.67, 0.98) /98 (0.73, 1.30) .94 (0.68, 1.30)
2h 25.9 % (875) 22.7 % (889) 10.4 % (836)0 8.3 % (831)0
0.92 (0.79, 1.07) 0.93 (0.79, 1.10) .92 (0.70, 1.21) .90 (0.66, 1.22)
3h 29.4 % (719) 23.9 % (725) 14.8 % (701) 10.6 % (698)
1.04 (0.90, 1.21) 0.98 (0.83, 1.17) 1.31 (1.01, 1.69) 1.15 (0.85, 1.55)
4h 35.6 % (422) 28.0 % (426) 18.6 % (409) 12.1 % (407)
1.26 (1.07, 1.49) 1.15 (0.95, 1.39) 1.64 (1.24, 2.15) 1.30 (0.93, 1.82)
5+ h 40.5 % (1135) 34.9 % (1154) 20.8 % (1119) 14.2 % (1106)
1.44 (1.27, 1.63) 1.44 (1.25, 1.65) 1.83 (1.48, 2.28) 1.54 (1.19, 1.98)
1 h vs. 5+ h 1.80 (1.54, 2.10) 1.76 (1.49, 2.09) 1.88 (1.47, 2.40) 1.64 (1.23, 2.19)
Mean % increase with each hour after 1 h/day 15.9 % 15.4 % 18.4 % 13.7 %

Notes: 1. Contrast-coded regressions are from Ferguson (2017). 2. Linear r's are partial correlations with controls, and r2 are given as percentages (1 % = 0.01, given the
common use of “percent variance explained”). 3. For relative risk cells, numbers are % endorsing at least one depression item, (n), relative risk, and (95 % confidence
interval). 4. Specifications: Total screen time: No weighting; controlled for gender, sleep, physical activity. Electronic device use only: Weighted; controlled for gender,
grade, and race. 5. RR's with 95 % CI's not including 1 are in bold.

relative risk was also apparent when examining each of the dichotomous
items separately. Although the r2 for total screen time and suicidal
thoughts was 0.81 % (“less than 1% of the variance”), heavy users were
56 % more likely than non-users to have thought about suicide. How­
ever, relative risks for total screen time and making a suicide plan were
not significant.
Using specifications based on another previous analysis (electronic
devices only, and controlling for gender, race, and grade) also produced
linear r and r2 often considered low, but notable comparisons between
groups. For example, 44 % more heavy users (vs. non-users) endorsed at
least one depression or suicide item, and 83 % more had thought about
suicide (see Table 3).
The dose-response curve for electronic device use shows evidence of
non-monotonic effects with the lowest depression among light users (see
Fig. 2), suggesting it may be useful to also compare light users (an hour a
day) to heavy users (5+ h a day). Heavy users were 80 % more likely to
endorse at least one depression or suicide item than light users. With
each additional hour of electronic device use beyond one hour, 16 %
more adolescents were depressed, and 18 % more thought about suicide.
Discussion. As in Study 1, smaller linear r's co-occur with substan­
tially higher risks between groups. This was true even when examining
items that were already dichotomous, suggesting that the discrepancy
between linear r and relative risk is similar whether continuous vari­
ables are dichotomized or the measure is already dichotomous.
4. Study 3: Growing Up in Ireland
In Study 3, we examined differences between linear r and relative
risk in a study using contemporaneous time diaries to measure screen
time rather than the retrospective reports used in the other datasets.
Method. Data for Growing Up in Ireland (GUI) was collected August
2011 to March 2012 from 5023 13-year-olds (51 % female) in primary
schools (recruited via random sampling; full study details are elsewhere
(Williams et al., 2009)). Participants selected one activity (out of 21 pre-
coded activities) for each 15-minute period on the time-use diary.
Following Orben and Przybylski (2019b), we examined the media ac­
tivities “using the internet/emailing (including social networking,
browsing etc.),” “playing computer games (e.g., PlayStation, PSP, X-Box
or Wii),” “talking on the phone or texting,” or “watching TV, films,
videos or DVDs,” which were used to calculate the total number of hours
that participants engaged in electronic device use. To be consistent with
Orben & Przybylski, we include only time diaries from days during the
school term, and to be consistent with other datasets we included only
time diaries from weekdays (N = 3373). Well-being was measured using
the adjustment domains of the Strengths and Difficulties Questionnaire,
which included the sum of items assessing hyperactivity or inattention,
emotional symptoms, conduct problems, and peer-relationship prob­
lems. Depression symptoms over the past 2 weeks were assessed using
the short form of the Mood and Feelings Questionnaire.
Analytic Approach. Consistent with the specifications of Orben and
Przybylski (2019b), weighting was not used and gender and age were
included as controls. Low well-being was defined as those scoring ~15 %
above the mean, which was 8+ for depression and 11+ for the SDQ.
Results. As Orben and Przybylski (2019b) did, we found small effect
sizes when using r and r2. However, the relative risk of depression was
53 % higher for heavy users (5+ h) than non-users (see Table 3 and
Fig. 3). Each additional 2 h of screen time beyond 1 h was associated
with 20 % more youth high in depressive symptoms or adjustment

5
J.M. Twenge and J.L. Hamilton Acta Psychologica 229 (2022) 103696

40

% 1+ depression/suicidal ideaon items 35

Electronic
device me

30

Total screen
me

25

20

Hours a day electronic devices/ total screen me

Fig. 2. Associations between electronic device time/total screen time and depression, Youth Risk Surveillance System, Florida, 2013.

Table 3
Total screen time on weekdays and well-being, Growing up in Ireland.
Depression SDQ adjustment problems

Linear r
r (r2) 0.06*** (0.36 %) 0.07*** (0.49 %)
Relative risk
None 12.1 % (367) 14.7 % (368)
Ref. Ref.
<1 h 13.3 % (473) 15.8 % (476)
1.11 (0.78, 1.59) 1.07 (0.78, 1.48)
1–2.99 h 12.9 % (1737) 14.4 % (1740)
1.08 (0.79, 1.46) 0.98 (0.75, 1.29)
3–4.99 h 13.5 % (553) 18.7 % (554)
1.13 (0.80, 1.60) 1.28 (0.95, 1.73)
5+ h 18.2 % (234) 20.6 % (235)
1.53 (1.04, 2.26) 1.39 (0.98, 1.99)
<1 h vs. 5+ h 1.38 (0.97, 1.97) 1.42 (1.07, 1.87)
Mean % increase with each 2 h after 1 h/day 19.7 % 20.0 %

Notes: 1. Linear r's are partial correlations with controls, and r2 are given as percentages (1 % = 0.01, given the common use of “percent variance explained”). 2. For
relative risk cells, numbers are % endorsing at least one depression item, (n), relative risk, and (95 % confidence interval). 3. Specifications: During term, weekdays
only; no weighting; control for gender and age. 4. RR's with 95 % CI's not including 1 are in bold.

difficulties.
Discussion. Orben and Przybylski (2019b) concluded that the su­
perior and less confounded measurement of time diaries might explain
why the effects in the GUI were smaller than those found in studies using
retrospective reports. However, comparisons using relative risk in this
dataset are fairly similar to those found in studies using retrospective
reports, suggesting the difference might instead lie in the statistical test
used.
5. Study 4: New Zealand Attitudes and Values Study
In Study 4, we examined adults from the New Zealand Attitudes and
Values Study (NZAVS). Data were generously supplied by Stronge et al.
(2019). This dataset provides a view of technology use and mental
health among adults using a mental health measure with a well-
established cutoff for serious issues.
Method. The 2016 NZAVS included complete responses from 18,438
participants from a national probability sample of New Zealand adults
(mean age = 49.45, 62 % women). Participants answered an array of
demographic questions, two questions about health indicators (average
sleep time and body mass index) as well as estimating the number of
hours a week they spent on social media, working, doing housework,
looking after children, exercising, using the internet, playing video/
computer games, commuting, watching or reading the news, watching

6
J.M. Twenge and J.L. Hamilton
20
% wth high score
15
10
Hours a day total screen me
Fig. 3. Associations between screen time and depression/SDQ adjustment, Growing up in Ireland.
TV/Netflix/movies, and volunteering. Participants also completed the
Kessler-6, a widely used screening tool for serious mental distress that
shows substantial concordance with DSM structured clinical interviews
(Kessler et al., 2003, 2010). Serious mental distress is indicated with
scores of 13 or higher (Prochaska et al., 2012).
Analytic Approach. We used the same specifications as Stronge
et al. (2019): No weighting and entering all other variables into the
regression equation. To follow current guidance not to include possible
mediators, we also performed an analysis excluding time use variables
and the two health indicator questions as controls.
Results. As Stronge et al. (2019) also found, there was only a small
correlation between frequency of social media use and mental distress.
Yet heavy users were 41 % more likely than non-users, and 62 % more
likely than light users, to have serious mental distress. When possible
mediators are excluded as controls, heavy users were 81 % more likely
than non-users and twice as likely than light users to have serious mental
distress (see Table 4 and Fig. 4).
Discussion. Not surprisingly, given that they were relying on linear
regression and found small Betas, Stronge et al. (2019) concluded that
the practical impact of social media use on psychological distress is
“questionable” and that “social media use is typically not a serious risk
factor for psychological distress.” However, when comparing usage
groups, the risk of serious psychological distress is notably elevated with
heavy social media use.
6. Study 5: UK Understanding Society Youth Panel at Wave 8
In Study 5, we examined Wave 8 of the UK Understanding Society
Youth Panel, a dataset that has not previously been examined cross-
sectionally in published research. Like the datasets in Studies 1 and 2,
the measure of time use is ordinal and not continuous.
Method. Wave 8 of the UK Understanding Society Young Panel
7
Acta Psychologica 229 (2022) 103696
SDQ
adjustment
problems
Depression
included 1818 10- to 15-year-olds (51 % female). To measure social
media use, participants responded to the following question, “How
many hours do you spend chatting or interacting with friends through a
social web-site or app like that on a normal school day?” Response op­
tions included “None,” “Less than an hour”, “1–3 h”, “4–6 h”, and “7 or
more hours.” Similar to Study 1 (Wave 1 of the UK Understanding So­
ciety Youth Panel), life satisfaction was assessed using the sum of par­
ticipant's happiness across the six domains of school, schoolwork,
appearance, family, friends, and life as a whole. Response options
ranged from 1 (‘completely happy’) to 7 (‘not at all happy’) and were
recoded so higher scores reflect higher levels of life satisfaction. The
other measures from Study 1 (prosocial behavior, internalizing prob­
lems, and externalizing problems) were not included in this wave of the
study.
Analytic Approach. Data were weighted by cross-sectional youth
interview weight (to correct for sampling biases and make the sample
nationally representative) and controlled for age, rural/urban location
and (for combined analyses) sex. For linear analyses, social media hours
were recoded to none = 0, <1 h = 0.50, 1–3 h = 2, 4–6 h = 5, and 7+ h
= 8. For relative risk analyses, the cutoff for low life satisfaction was the
lowest 15 % (~1 SD below the mean: 4.83 or below). Given a substantial
non-monotonic effect (see Fig. 5), light users (<1 h a day) served as the
reference group for relative risk comparisons.
Results. Social media use and in life satisfaction produced relatively
low linear r and r2. However, 65 % more heavy users of social media (vs.
light users) experienced low life satisfaction (see Table 5 and Fig. 5).
With each additional two hours of social media use after one hour a day,
the chances of a youth being low in life satisfaction increased 28 %.
Discussion. These results again illustrate that the same data pro­
ducing linear r's often considered small also produce practically signif­
icant relative risks. As in several other datasets, the association was non-
monotonic (consistent with some past research: Przybylski & Weinstein,
J.M. Twenge and J.L. Hamilton Acta Psychologica 229 (2022) 103696

Table 4
Social media use and serious mental distress, New Zealand adults.
Serious mental distress

Linear r
r (r2) all controls 0.05*** (0.03 %)
r (r2) demo controls only 0.08*** (0.64 %)
Relative risk
All controls
None 6.1 % (5385)
Ref.
<1 h 5.3 % (9755)
0.87 (0.76, 1.01)
1–2 h 5.3 % (2503)
0.87 (0.72, 1.06)
2–3 h 5.3 % (895)
0.86 (0.64, 1.16)
4+ h 8.6 % (421)
1.40 (1.01, 1.95)
<1 h vs. 4+ h 1.61 (1.17, 2.23)
Non-mediator controls only
None 5.8 % (5156)
Ref.
<1 h 5.2 % (9456)
0.90 (0.78, 1.03)
1–2 h 5.7 % (2415)
0.99 (0.81, 1.20)
2–3 h 6.2 % (863)
1.08 (0.82, 1.43)
4+ h 10.5 % (394)
1.79 (1.32, 2.45)
<1 h vs. 4+ h 2.00 (1.48, 2.71)
Mean % increase with each hour after 1 h/day 29.3 %

Notes: 1. Linear r's are partial correlations with controls, and r2 are given as percentages (1 % = 0.01, given
the common use of “percent variance explained”). 2. For relative risk cells, numbers are % endorsing at least
one depression item, (n), relative risk, and (95 % confidence interval).

10

8
% with serious mental distress

All controls
6

4 Demographic
controls

Hours a day social media use

Fig. 4. Associations between social media time and serious mental distress, New Zealand adults.

8
J.M. Twenge and J.L. Hamilton Acta Psychologica 229 (2022) 103696

25

% low in life sasfacon

Girls
20

All

15

Boys

10

Hours a day social media use

Fig. 5. Associations between social media time and low life satisfaction, UK Understanding Society Youth Panel, Wave 8.

Table 5
Social media time and life satisfaction, UK Understanding Society Youth Panel, Wave 8.
All Girls Boys

Linear r
r (r2) all values − 0.14*** (2.0 %) − 0.15*** (2.3 %) − 0.10*** (1.0 %)
Relative risk
None 23.3 % (113) 21.1 % (32) 23.0 % (81)
1.54 (1.06, 2.25) 1.27 (0.64, 2.54) 1.76 (1.11, 2.82)
<1 h 15.0 % (763) 17.3 % (372) 13.2 % (391)
Ref. Ref. Ref.
1–3 h 19.3 % (646) 18.3 % (365) 20.4 % (281)
1.30 (1.03, 1.63) 1.07 (0.78, 1.46) 1.53 (1.08, 2.15)
4+ h 24.6 % (296) 26.2 % (195) 21.3 % (101)
1.65 (1.27, 2.14) 1.52 (1.10, 2.10) 1.64 (1.05, 2.56)
Mean % increase with each 2 h after 1 h/day 28.1 % 24.5 % 29.5 %

Notes: 1. Linear r's are partial correlations with controls, and r2 are given as percentages (1 % = 0.01, after the common use “percent variance explained”). 2.
Specifications: Weighted, controlled for age, urban/rural location, sex.

2017). Thus, the association may not be well-captured by an effect size
metric such as r (and r2) that assumes a linear, monotonic relationship
(though a technique such as LOESS might capture it).
7. General discussion
Across five datasets on technology use and mental health, linear r's
were at levels often considered small, while relative risk was seemingly
practically important. This has broad implications for psychology
research as a whole: How many datasets analyzed with linear correlation
and dismissed as producing only small effects would show substantial
relative risks if analyzed that way? This is especially important for in­
vestigations of technology use and mental health as studies on this topic
are published in journals across a variety of disciplines, including psy­
chology, communication, public health, and medicine. If studies pub­
lished in psychology and communication journals rely solely on linear r
and conclude that the association is small, and studies published in
public health and medicine journals rely solely on relative risk and
conclude that the association is practically significant, results appear
mixed and general conclusions are difficult to draw. Given this state of

9
J.M. Twenge and J.L. Hamilton
the literature, it is tempting to conclude, as several observers have, that
studies in this area are inconclusive (Best et al., 2014; Meier & Reinecke,
2021), perhaps due to biased analysis choices (Orben & Przybylski,
2019a). However, when datasets are analyzed using both linear r and
relative risk, the associations are fairly consistent across studies. Thus,
the root of the disagreement across disciplines appears to primarily rest
not in different datasets, measures, or control variables, but in the sta­
tistics researchers choose for their data analyses. This is not to say that
relative risk is better than linear r, but that both provide important
information.
There are also practical implications for therapists, physicians, policy
makers, and parents who wish to gauge the practical importance of as­
sociations to make well-informed decisions on issues around technology
use and mental health (such as, for example, whether heavy technology
use warrants more careful screening for mental health issues, or,
assuming some of the causation goes from technology use to low well-
being, limiting hours of device use to moderate levels). These de­
cisions might be very different if decision-makers hear that technology
time explains <1 % of the variance in well-being (based on linear r), as
opposed to hearing that twice as many heavy users of technology are
depressed, dissatisfied with their lives, and/or disinclined to help others
(based on relative risk). These results suggest that linear r's of ≅ 0.10,
often considered “small,” are often not small in terms of practical
importance. As an additional example, the association between child­
hood exposure to lead and adult IQ is r = 0.11 (Reuben et al., 2017).
Technology use and mental health are not unique examples of this
discrepancy. Linear r does not capture the substantial association be­
tween smoking and lung cancer, receiving a COVID vaccine and devel­
oping the disease, wearing a seat belt and dying in a car accident, gender
and suicide attempts, or BMI and exercise. Although the largest dis­
crepancies between linear r and relative risk appear when base rates are
low (such as lung cancer), they also appear when base rates exceed 1 in
10 (such as exercise and obesity and in the datasets analyzed here on
technology use and mental health). Some have argued that medical
research examples like these should not be compared to psychology
examples in terms of effect size (Ferguson, 2009). However, as our re­
sults demonstrate, the discrepancy between linear r and relative risk
appears when both are used to analyze the same data on psychological
questions. Thus, this is not just an issue of comparing medical research
to psychological research, but an issue of differences between statistical
tests.
We are not the first to point out the limitations of linear correlation
and percent variance explained (r-squared) as gauges of practical
importance. Rosnow and Rosenthal (1989, 2003) provided several ex­
amples of low correlations that mask large relative risks. In their article
on effect sizes, Funder and Ozer (2019) concluded that r2 “allows writers
to disparage certain findings that they find incompatible with their own
theoretical predilections.” There is also the matter of which research
question is actually being answered by the data at hand. Linear corre­
lation answers the question: How much can Y predict X among all other
factors? Given that most studies do not include all possible factors that
may influence outcomes (including genetic predisposition), that may
not be the research question most studies of behavior and well-being are
designed to answer. The relevant research question may instead be:
What is the difference in mental health factors between those who
behave one way vs. another? Comparing groups using relative risk thus
can provide information that linear correlation cannot.
Given the limitations of linear correlations, research psychology may
want to consider including relative risk comparisons in addition to linear
r. In this we concur with Funder and Ozer (2019), who recommend that
researchers focus on effect sizes capturing the number of people
affected. This could be done in addition to reporting linear r or d; thus, it
would add information rather than taking anything away, especially as
each statistic has its strengths and weaknesses. If this recommendation is
headed, some principles should be kept in mind to minimize the po­
tential downsides of using relative risk. First, relative risk should not be
10
Acta Psychologica 229 (2022) 103696
reported without the absolute numbers on which it is based. A relative
risk of 2 could mean an increase in prevalence from 1 % to 2 %, from 10
% to 20 %, or from 40 % to 80 %, all of which may have different im­
plications for practical importance. Second, decisions for selecting
groups must be explained; the necessity of cutting continuous variables
to use relative risk is one of the primary reasons linear r is more often
used in psychology. In some cases, creating groups to compare is
straightforward: For example, if hours of technology use are measured
within categorical survey response categories (“none,” “less than an
hour,” etc.), or if well-being measures are dichotomous (e.g., a yes or no
answer to whether a respondent has self-harmed in the last year). Some
continuous mental health measures have established cutoffs in the
published literature (e.g., a score of 13 or above is indicative of serious
mental distress on the Kessler-6), while other cutoffs may need to be set
with by other means, such as the commonly used guideline of a score one
standard deviation above (or below) the mean (Schalet et al., 2014).
However, dichotomization does not appear to be the reason for the
discrepancies between linear r and relative risk; as Study 2 showed,
similar discrepancies between linear r and relative risk appear whether
mental health measures are continuous or already dichotomous. Third,
even if researchers choose not to use relative risk, including a figure
showing the data distribution between the primary variables should be
standard. Figures immediately reveal non-monotonic (curvilinear) pat­
terns, as well as illustrating the size of differences across groups.
Of course, correlational studies like these cannot determine causa­
tion (for example, whether technology use causes depression, depression
causes technology use, or third variables cause both). Thus, statements
such as “heavy users are 50% more likely to be depressed” could instead
note that “depressed people are 50% more likely to be heavy users.”
Although several random-assignment experiments have established a
causal link between social media use and lower well-being (e.g., Allcott
et al., 2020), studies of association such those analyzed here should not
be assumed to show the direction of the causal arrow. In addition, more
research is needed to establish mediators of the link – if heavy tech­
nology use does cause depression, why, and how?
In conclusion, researchers need to consider more than linear corre­
lation when trying to establish the association between two variables. As
the examples of smoking and lung cancer, seat belts and car accident
deaths, and exercise and BMI show, linear correlation can lead one to
conclude that associations are not practically important when in fact
they are. Five datasets on technology use and mental health also show
that data with relatively small linear correlations can produce substan­
tial differences between groups. It may be time for psychology to
regularly add relative risk comparisons in research.
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.actpsy.2022.103696.
Declaration of competing interest
J.M.T. has received speaking honoraria for presenting research, has
consulted for law firms and state attorneys general about social media
and mental health, and receives royaltes from several books, most
recently iGen: Why Today's Super-Connected Kids Are Growing Up Less
Rebellious, More Tolerant, Less Happy – and Completely Unprepared for
Adulthood. J.L.H. declares no conflicts of interest.
Acknowledgements
The authors thank David Stein for statistical consulting. J.L.H. was
supported by an Institutional National Research Service Award by the
National Heart, Lung, and Blood Institute (NHLBI: T32).
References
Allcott, H., Braghieri, L., Eichmeyer, S., & Gentzkow, M. (2020). The welfare effects of
social media. American Economic Review, 110, 629–676.
J.M. Twenge and J.L. Hamilton
Anderson, C. A., Bushman, B. J., Bartholow, B. D., Cantor, J., Christakis, D., Coyne, S. M.,
Donnerstein, E., Brockmyer, J. F., Gentile, D. A., Green, S., Huesmann, R.,
Hummer, T., Krahé, B., Strasburger, V. C., Warburton, W., Wilson, B. J., & Ybarra, M.
(2017). Screen violence and youth behavior. Pediatrics, 140(5, Supp 2). S142–S147.
Andrade, C. (2015). Understanding relative risk, odds ratio, and related terms: As simple
as it can get. Clinical and Practical Psychopharmacology, 76, e857–e861.
Baiden, P., LaBrenz, C. A., Asiedua-Baiden, G., & Muehlenkamp, J. J. (2020). Examining
the intersection of race/ethnicity and sexual orientation on suicidal ideation and
suicide attempt among adolescents: Findings from the 2017 youth risk behavior
survey. Journal of Psychiatric Research, 125, 13–20.
BBC. (2019, May 7). Social media effect 'tiny' in teenagers, large study finds.
https://www.bbc.com/news/health-48147378.
Berryman, C., Ferguson, C. J., & Negy, C. (2018). Social media use and mental health
among young adults. Psychiatric Quarterly, 89, 307–314.
Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media and
adolescent wellbeing: A systematic narrative review. Children and Youth Services
Review, 41, 27–36.
Bhopal, A., Peake, M. D., Gilligan, D., & Cosford, P. (2019). Lung cancer in never-
smokers: a hidden disease. Journal of the Royal Society of Medicine, 112(7), 269–271.
Bushman, B. J., & Huesmann, L. R. (2014). Twenty-five years of research on violence in
digital games and aggression revisited: A reply to elson and Ferguson (2013).
European Psychologist, 19, 47–55.
Centers for Disease Control. (2020). Cigarette Smoking Among U.S. Adults Hits All-Time
Low. https://www.cdc.gov/media/releases/2019/p1114-smoking-low.html.
Cumming, G. (2014). The new statistics: Why and how. Psychological Science, 25(1),
7–29. https://doi.org/10.1177/0956797613504966
Edgar Snyder and Associates. (2020). Seat belt statistics. Retrieved from: https://www.
edgarsnyder.com/car-accident/defective-products/seat-belts/seat-belts-statistics.ht
ml.
Elson, M., & Ferguson, C. J. (2014). Twenty-five years of research on violence in digital
games and aggression: Empirical evidence, perspectives, and a debate gone astray.
European Psychologist, 19, 33–46.
Ferguson, C. (2009). Is psychological research really as good as medical research? Effect
size comparisons between psychology and medicine. Review of General Psychology,
13, 130–136.
Ferguson, C. (2017). Everything in moderation: Moderate use of screens unassociated
with child behavior problems. Psychiatric Quarterly, 88, 797–805. https://doi.org/
10.1007/s11126-016-9486-3
Funder, D. C., & Ozer, D. J. (2019). Evaluating effect size in psychological research:
Sense and nonsense. Advances in Methods and Practices in Psychological Science, 2,
156–168.
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note.
Journal of Clinical Psychology and Psychiatry, 38, 581–586.
Greenwald, A. G., Banaji, M. R., & Nosek, B. A. (2015). Statistically small effects of the
implicit association test can have societally large effects. Journal of Personality and
Social Psychology, 108, 553–561.
Ivie, E. J., Pettit, A., Moses, L. J., & Allen, N. B. (2020). A meta-analysis of the association
between adolescent social media use and depressive symtoms. Journal of Affective
Disorders, 275, 165–174.
Kelly, Y., Zilanawala, A., Booker, C., & Sacker, A. (2019). Social media use and
adolescent mental health: Findings from the UK millennium cohort study.
EClinicalMedicine, 6, 59–68. https://doi.org/10.1016/j.eclinm.2018.12.005
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E.,
Howes, M. J., Normand, S. L., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M.
(2003). Screening for serious mental distress in the general population. Archives of
General Psychiatry, 60, 184–189.
Kessler, R. C., Green, J. G., Gruber, M. J., Sampson, N. A., Bromet, E., Cuitan, M., …
Zaslavsky, A. M. (2010). Screening for serious mental distress in the general
population with the K6 screening scale: Results from the WHO world mental health
(WMH) survey initiative. International Journal of Methods in Psychiatric Research, 19
(Suppl. 1), 4–22.
Kim, S., Favotto, L., Halladay, J., Wang, L., Boyle, M. H., & Georgiades, K. (2020).
Differential associations between passive and active forms of screen time and
adolescent mood and anxiety disorders. Social Psychiatry and Psychiatric
Epidemiology, 55, 1469–1478.
Kremer, P., Elshaug, C., Leslie, E., Toumbourou, J. W., Patton, G. C., & Williams, J.
(2014). Physical activity, leisure-time screen use and depression among children and
young adolescents. Journal of Science and Medicine in Sport, 17, 183–187.
Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., & Primack, B. A.
(2016). Association between social media use and depression among U.S. young
adults. Depression and Anxiety, 33, 323–331. https://doi.org/10.1002/da.22466
Loftus, P. (2020, November 30). Moderna asks health regulators to authorize its COVID-
19 vaccine. Wall Street Journal. https://www.wsj.com/articles/moderna-to-ask-h
ealth-regulators-to-authorize-its-covid-19-vaccine-11606737602.
Mathers, M., Canterford, L., Olds, T., Hesketh, K., Ridley, K., & Wake, M. (2009).
Electronic media use and adolescent health and well-being: Cross-sectional
community study. Academic Pediatrics, 9, 307–314.
Meier, A., & Reinecke, L. (2021). Computer-mediated communication, social media, and
mental health: A conceptual and empirical meta-review. Communication Research, 48
(8), 1182–1209.
Messias, E., Castro, J., Saini, A., Usman, M., & Peeples, D. (2011). Sadness, suicide, and
their association with video game and internet overuse among teens: Results from
the youth risk behavior survey 2007 and 2009. Suicide and Life-threatening Behavior,
41, 307–315.
11
Acta Psychologica 229 (2022) 103696
Orben, A., Dienlin, T., & Przybylski, A. K. (2019). Social media’s enduring effect on
adolescent life satisfaction. PNAS Proceedings of the National Academy of Sciences of
the United States of America, 116(21), 10226–10228.
Orben, A., & Przybylski, A. K. (2019a). The association between adolescent well-being
and digital technology use. Nature Human Behaviour, 3, 173–182. https://doi.org/
10.1038/s41562-018-0506-1
Orben, A., & Przybylski, A. K. (2019b). Screens, teens, and psychological well-being:
Evidence from three time-use-diary studies. Psychological Science, 30, 682–696.
https://doi.org/10.1177/0956797619830329
Oswald, F. L., Mitchell, G., Blanton, H., Jaccard, J., & Tetlock, P. E. (2013). Predicting
ethnic and racial discrimination: A meta-analysis of IAT criterion studies. Journal of
Personality and Social Psychology, 105(2), 171–192.
Pearce, N. (2010). Epidemiology in a changing world: Variation, causation, and
ubiquitous risk factors. International Journal of Epidemiology, 40, 503–512.
Petrie, K. J., Pressman, S. D., Pennebaker, J. W., Øverland, S., Tell, G. S., & Sivertsen, B.
(2018). Which aspects of positive affect are related to mortality? Results from a
general population longitudinal study. Annals of Behavioral Medicine, 52, 571–581.
Prescott, A. T., Sargent, J. D., & Hull, J. G. (2018). Meta-analysis of the relationship
between violent video game play and physical aggression over time. PNAS, 115,
9882–9888.
Primack, B. A., Shensa, A., Sidani, J. E., Whaite, E. O., Lin, L. Y., Rosen, D., … Miller, E.
(2017). Social media use and perceived social isolation among young adults in the U.
S. American Journal of Preventive Medicine, 53, 1–8.
Primack, B. A., Shensa, A., Sidani, J. E., Escobar-Viera, C. G., & Fine, M. J. (2021).
Temporal associations between social media use and depression. American Journal of
Preventive Medicine, 60, 179–188.
Prochaska, J. J., Sung, H.-Y., Max, W., Shi, Y., & Ong, M. (2012). Validity study of the K6
scale as a measure of moderate mental distress based on mental health treatment
need and utilization. International Journal of Methods in Psychiatric Research, 21,
88–97.
Przybylski, A. K. (2014). Electronic gaming and psychosocial adjustment. Pediatrics, 134
(3), e716–e722. https://doi.org/10.1542/peds.2013-4021
Przybylski, A. K., & Weinstein, N. (2017). A large-scale test of the goldilocks hypothesis.
Psychological Science, 28, 204–215. https://doi.org/10.1177/0956797616678438
Reuben, A., Caspi, A., Belsky, D. W., Broadbent, J., Harrington, H., Sugden, K.,
Houts, R. M., Ramrakha, S., Poulton, R., & Moffitt, T. E. (2017). Association of
childhood blood lead levels with cognitive function and socioeconomic status at age
38 years and with IQ change and socioeconomic mobility between childhood and
adulthood. JAMA, 317, 1244–1251.
Riehm, K. E., Feder, K. A., Tormohlen, K. N., Crum, R. M., Young, A. S., Green, K. M., &
Mojtabai, R. (2019). Associations between time spent using social media and
internalizing and externalizing problems among US youth. JAMA Psychiatry, 1–9.
https://doi.org/10.1001/jamapsychiatry.2019.2325
Rohrer, J. M. (2018). Thinking clearly about correlations and causation: Graphical causal
models for observational data. Advances in Methods and Practices in Psychological
Science, 1, 27–42.
Rosnow, R. L., & Rosenthal, R. (1989). Definition and interpretation of interaction
effects. Psychological Bulletin, 105, 143–146.
Rosnow, R. L., & Rosenthal, R. (2003). Effect sizes for experimenting psychologists.
Canadian Journal of Experimental Psychology, 57, 221–237.
Sampasa-Kanyinga, H., & Lewis, R. F. (2015). Frequent use of social networking sites is
associated with poor psychological functioning among children and adolescents.
Cyberpsychology, Behavior, and Social Networking, 18, 380–385.
Schalet, B. D., Cook, K. F., Choi, S. W., & Cella, D. (2014). Establishing a common metric
for self-reported anxiety: Linking the MASQ, PANAS, and GAD-7 to PROMIS anxiety.
Journal of Anxiety Disorders, 28(1), 88–96. https://doi.org/10.1016/j.
janxdis.2013.11.006
Shewach, O. R., Sackett, P. R., & Quint, S. (2019). Stereotype threat effects in settings
with features likely versus unlikely in operational test settings: A meta-analysis.
Journal of Applied Psychology, 104, 1514–1534.
Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009). Overadjustment bias and
unnecessary adjustment in epidemiologic studies. Epidemiology, 20(4), 488–495.
https://doi.org/10.1097/EDE.0b013e3181a819a1
Shensa, A., Sidani, J. E., Escobar-Viera, C. G., Switzer, G. E., Primack, B. A., & Choukas-
Bradley, S. (2020). Emotional support from social media and face-to-face
relationships: Associations with depression risk among young adults. Journal of
Affective Disorders, 260, 38–44.
Siegel, R. L., Miller, K. D., & Jamal, A. (2020). Cancer statistics, 2020. CA: A Cancer
Journal, 70, 7–30.
Stronge, S., Mok, T., Ejova, A., Lee, C., Zubielevitch, E., Yogeeswaran, K., Hawi, D.,
Osborne, D., Bulbulia, J., & Sibley, C. G. (2019). Social media use is (weakly) related
to psychological distress. Cyberpsychology, Behavior, and Social Networking, 22,
604–609.
Twenge, J., Joiner, T. E., Rogers, A. E., & Martin, G. N. (2018). 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, 6,
3–17.
Williams, J. S., Greene, S., Doyle, E., Harris, E., Layte, R., McCoy, S., & McCrory, C.
(2009). Growing up in Ireland national longitudinal study of children: The lives of 9-year-
olds. Dublin, Ireland.
Wilson, D. B. (2020). Practical meta-analysis effect size calculator: 2 by 2 contingency
(frequency) table. https://campbellcollaboration.org/escalc/html/EffectSizeCa
lculator-R4.ph.
Youth in Mind. (2016). Scoring the strengths & difficulties questionnaire for ages 4–17 or
18+. Retrieved from https://www.ehcap.co.uk/content/sites/ehcap/uploads/New
sDocuments/236/SDQEnglishUK4-17scoring-1.PDF.