From the Editor

11.

This month, Reading of the Week celebrates its 11th birthday. Thanks for continuing to read.

Does quitting social media enhance emotional wellbeing? In the first selection, Hunt Allcott (of Stanford University) and his co-authors attempt to answer this question in a paper for NBER. In a randomized trial, they assigned more than 35 000 social media users to either a social media-free group or one where people continued to use Facebook and Instagram. “Our estimates suggest that deactivating Facebook or Instagram before the 2020 election improved people’s emotional state…” We consider the paper and its implications.

In the second selection, Carolina Guzman Holst (of Oxford University) and her co-authors look at school-based mental health interventions and potential harms in a new Child and Adolescent Mental Health paper. In their scoping review, they drew on 120 studies involving CBT and mindfulness. “Overall, our study suggests that a minority (8.93%) of these interventions finds at least one negative outcome and that, to date, no adverse events linked to the intervention itself have been reported.”

And in the third selection, Alexandra Jones writes about her postpartum psychosis in a paper for The Lancet Psychiatry. After a quick labour and delivery, she notes changes with her mental health. She tries to seek care – but only becomes more ill. Eventually, she is hospitalized. “Postpartum psychosis is a psychiatric emergency, and women with postpartum psychosis deserve greater compassion and support underpinned by increased education, research and resources.”

DG



Selection 1: “The Effect of Deactivating Facebook and Instagram on Users’ Emotional State”

Hunt Allcott, Matthew Gentzkow, Benjamin Wittenbrink, et al.

NBER, April 2025

There is an active debate over how social media affect users’ psychological well-being. Do social media make people happier, for example by facilitating beneficial social connections? Or do they make people depressed and anxious, for example by reducing face-to-face interactions or increasing unfavorable social comparisons? Some analysts argue that social media have contributed to the alarming recent decline in young people’s mental health, and policymakers have responded with legislation and legal action. These high-stakes debates have relied primarily on evidence from time-series and cross-sectional correlations, plus a few relatively small randomized experiments, and scholars disagree on the implications.

In a separate trend, American elections have become increasingly stressful: an August 2020 study found that 68 percent of American adults cited the upcoming election as a significant source of stress, a material increase from 2016. Other studies find that exposure to political news reduces psychological well-being. Since many people get political news on social media, these facts raise the question of how using social media before an election affects people’s emotional state.

So begins a paper by Allcott et al.

Here’s what they did:

  • They recruited Facebook users and Instagram users who spent at least 15 minutes per day on the platforms.
  • They randomly assigned 27% of participants to a treatment group who were offered payment for deactivating their accounts for the six weeks before the election. The remaining participants formed a control group, paid to deactivate for just the first of those six weeks. 
  • The baseline and endline surveys elicited three measures of self-reported emotional state (how much of the time people felt happy, depressed, or anxious).
  • Statistical analyses were done.

Here’s what they found:

  • They recruited 19 857 Facebook users and 15 585 Instagram users.
  • Facebook. People who deactivated Facebook for the six weeks before the election reported a 0.060 standard deviation improvement in an index of happiness, depression, and anxiety, relative to controls who deactivated for just the first of those six weeks.
  • Instagram. People who deactivated Instagram for those six weeks reported a 0.041 standard deviation improvement relative to controls.
  • Subgroups. Exploratory analysis suggests the Facebook effect is driven by people over 35, while the Instagram effect is driven by women under 25.

A few thoughts:

1. This is an interesting study with clear strengths, including randomization and with a large number of participants (more than 20 times more than in past studies).

2. The main finding in seven words: less Facebook and Instagram, better emotional state. To offer more details: the Facebook result was highly statistically significant; Instagram, less so.

3. Needless to say, the study has created buzz, with headlines in big newspapers like The Washington Post – and, of course, on social media.

4. Was the shift difference big? The estimated effects were equivalent to about 4% of respondents saying they felt happy “often” instead of “sometimes.” 

5. Was the difference meaningful? To paraphrase the authors, the study found that quitting Facebook or Instagram was about one-fifth as effective as the average of psychological interventions (like mindfulness or CBT). Many questions can be asked. Let’s start here: Is this clinically meaningful? 

6. Is the buzz bigger than the paper itself? They have picked a terrific topic but do they really have a terrific result?

7. Like all studies, there are limitations. The authors list several, including the reliance on self-report data.

The full NBER paper can be found here:

https://www.nber.org/papers/w33697

Selection 2: “Scoping review: potential harm from school-based group mental health interventions”

Carolina Guzman-Holst, Rowan Streckfuss Davis, Jack L. Andrews, Lucy Foulkes

Child and Adolescent Mental Health, September 2025

School-based mental health interventions are designed to reduce or prevent mental health problems in young people. In universal interventions, information is delivered to whole classes of students, regardless of need, while targeted interventions, including both selective and indicated strategies, are delivered to smaller groups of students deemed to be at risk or who are already experiencing mental health problems. Delivering such interventions to groups at school makes sense, since this is where young people spend the majority of their waking hours. Meta-analyses to date indicate that school-based mental health interventions can reduce symptoms of mental health problems in young people, although effect sizes vary considerably and tend to be larger for targeted, relative to universal, interventions.

A number of recent studies have shown that school-based mental health interventions based on principles from cognitive behavioural therapy (CBT) or mindfulness can lead to potential harm. We define potential harm as any negative outcome or adverse event that could plausibly be linked to the school intervention itself. We use the word ‘potential’ to describe harm, as a negative outcome (e.g. decrease in wellbeing) might not always be considered harmful, especially if experienced mildly or transiently. For example, one universal CBT-based intervention was found to increase internalising symptoms in the intervention group but not in the control group at six and 12 months post intervention. Other studies have found negative outcomes for specific subgroups. For example, one CBT-based intervention led to an increase in anxiety in the subgroup of children eligible for free school meals (an indicator of low parental income) and not in comparable children who received their usual classes…

So begins a paper by Guzman-Holst et al.

Here’s what they did:

  • They conducted a scoping review “following PRISMA guidelines for scoping reviews.”
  • They searched eight databases (including ProQuest), and “performed an author search and hand-searched for published and unpublished studies that evaluated controlled trials of school-based group mental health interventions based on cognitive-behavioural therapy and/or mindfulness techniques, with the aim of reducing or preventing internalising symptoms or increasing wellbeing.” 
  • Two independent raters screened studies for eligibility and assessed study quality.
  • “From eligible studies, we reviewed those that reported at least one negative outcome.”

Here’s what they found:

  • A total of 2 315 abstracts were reviewed. Of these, 117 records (describing 120 studies and 112 interventions) were eligible for inclusion. 11 records (describing 11 studies and 10 interventions) reported negative outcomes. 
  • Study characteristics. Sample sizes ranged from 127 to 8 376 students. Study participants’ mean ages varied between 12 and 16 years of age. 60% of interventions were based on cognitive-behavioural therapy (CBT) techniques and 40% were based on mindfulness techniques. All studies assessed universal interventions and came from high-income countries. 
  • Negative outcome. 10 out of 112 (8.93%) interventions (described in 120 studies) reported at least one negative outcome such as a decrease in wellbeing or an increase in depression or anxiety. 
  • Adverse events. Three out of 112 interventions (2.68%) reported the occurrence of specific adverse events, none of which were linked to the intervention. 
  • Subgroups. Negative outcomes were found for a number of subgroups including individuals deemed at high risk of mental health problems, male participants, younger children and children eligible for free school meals. 
  • Acknowledgment. About half (54.5%) of the studies acknowledged that the content of the intervention itself might have led to the negative outcome.

A few thoughts:

1. This is an interesting study.

2. The main finding in a sentence: “We found that a minority of interventions (8.93%) among those eligible reported at least one negative outcome, and when they did, it often occurred among specific subgroups of young people.”

3. Are there implications for research and public policy? The authors argue yes. “To design and implement effective school-based mental health interventions, the issues of potential harm and their related measurement and reporting challenges must be addressed.”

4. School-based interventions are much discussed these days; in New York City, for example, students are encouraged to spend time every week on mindfulness exercises. Are we overdoing things? Some, including psychologist Lucy Foulkes (of Oxford University) argue that they contribute to a prevalence inflation, convincing youth that minor and transient problems are, in fact, mental disorders. (Foulkes is a co-author on this paper, for the record.) Others believe that such efforts can help youth recognize their problems but without offering them then needed tools to address these problems – in a sense, the worst of both worlds.

5. Like all studies, there are limitations. The authors note several, including: “Since this is a scoping review, we did not conduct a meta-analysis, and thus cannot comment on the average effect sizes for negative outcomes.”

The full Child and Adolescent Mental Health paper can be found here:

https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12760


Selection 3: “High as a kite: motherhood and psychosis”

Alexandra Jones

The Lancet Psychiatry, October 2025

‘Stop pushing!’ These two words are not often heard in a maternity delivery room. But barely an hour after my waters broke, after just a few contractions, this is what my obstetrician said to me. So, I stopped pushing and moments later my first child was born – Holly (in a hurry) rushed feet-first into the world, courtesy of a natural breech delivery. There had been no time to prepare an operating theatre for the scheduled C-section, not even time for the anaesthetist to arrive. But none of that mattered. I was a mother, and I felt a rush of love and joy as Holly was laid on my chest. Born 3 weeks early, Holly was whisked away to spend 10 days in a humidicrib. I returned to my hospital room alone and probably a little shocked. Undeterred, I sat up on the bed calling family and friends, full of excitement and energy. It was hard to believe I had only just given birth. Everyone said I was doing so well.

Looking back on those first moments of motherhood, I was already not quite myself. I became euphoric immediately, manic within days, and psychotic and suicidal within 2 weeks.

So begins a paper by Jones.

She describes her illness. “I now know these were the early symptoms of a mania that would eventually develop into postpartum psychosis. Oblivious, I careered along. I was interpreting coded messages from the television (conspiracies are real after all!). I discovered that shopping was even more fun than cleaning (fortunately my penchant was for shoes rather than diamonds). My libido was supercharged (ironically, I simultaneously believed my obliging but worn-out husband was beating me). And annoyingly, no one seemed to realise just how smart I was…”

She lacked any history of problems. “50% of women with first-episode postpartum psychosis have no mental illness history… Mine was a blue sky case with no prior mental illness history.”

Recognizing difficulties, she goes to her family doctor who tells her to “try to get some rest.” The maternity nurses “failed to see I was not well.” Her husband asks for a mental health crisis team visit but “their threshold for a psychosis diagnosis and medical intervention was evidence of delusions and hallucinations.” 

She has a brief admission at a private facility which doesn’t help. Indeed, she gets worse. “Talking through silent yoga classes, pestering other patients to form a theatre troupe, accusing a staff member of rape (bleeding from childbirth feeding a delusion of sexual assault), escaping and then hiding in plain sight in the maternity ward (looking for my baby), and later breaking the emergency glass to open the main doors that had been locked on my account (I was overjoyed when the fire brigade arrived, lights flashing and sirens wailing). Eventually, they concluded I needed a higher level of care.”

“I went on to receive the very best medical care once I re-entered the public hospital. That care was professional, compassionate, and literally saved my life.” She receives ECT. She comments: “ECT was a frightening prospect given its terrible reputation and early history. However, my psychiatrist carefully explained that today, ECT is considered a safe and effective treatment, albeit of last resort, for acute psychosis. I had several rounds of ECT. Even after the first one there was a significant improvement – I was more rational and cognisant of my illness, and for the first time I asked what was wrong with me and started to feel more like myself.”

She notes her journey. “I eventually made a full recovery and for that I will always be grateful. But the delays in referral, diagnosis, and treatment likely made my case longer and more severe, and they risked my and my baby’s safety. Awareness of perinatal mental health conditions, such as depression and anxiety, have improved, but postpartum psychosis remains in the shadows.”

A few thoughts:

1. This is a moving and honest essay.

2. She made repeated attempts at getting help.

3. As she notes, “What are now anecdotes and misadventures could have been something much worse.” Much, much worse.

The full Lancet Psychiatry paper can be found here:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00236-6/fulltext

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.