What If Screen Time Is the Wrong Measure of Digital Harm?

The Health Cost of Scrolling May Lie in How We Use Social Media, Not How Long We Stay Online

Public debate around digital well-being has become fixated on a convenient metric: screen time. However, two people can spend the same number of hours on their phones while having radically different experiences, from work and messaging to compulsive scrolling, appearance comparison and emotionally disruptive social media use. New research suggests this distinction could be critical for understanding how digital behaviour intersects with mental health and physical activity.

The study, "Social Media Disorder, Mental Health, and Physical Activity," published in Healthcare, was conducted by Abeer F. Almarzouki, Fisal Rajkhan, Khalid A. Alsulami, Ahmad R. Alnoiqy, Mohammed Aljihani, Mohamad Hetta, Omer Shawosh, Yousef Almuqbil, Ibraheem Al Rezqi, Hasan Banaweer and Albasil H. Badawi of King Abdulaziz University in Saudi Arabia. Rather than treating smartphone exposure as a single health risk, the researchers examined a web of relationships connecting phone use, problematic social media behaviour, appearance anxiety, depressive symptoms, body mass index and commitment to physical activity.

Their analysis of 405 adults points toward a more complicated digital health problem than excessive screen exposure alone. Higher phone use was associated with greater social media disorder scores, but problematic social media use statistically accounted for substantial parts of the relationships between phone use and both appearance anxiety and depressive symptoms. The findings suggest that the behavioural character of online engagement may be more revealing than the number of hours recorded on a device.

Screen Time May Be Measuring the Wrong Part of the Problem

The researchers surveyed adults in Saudi Arabia between February 2024 and May 2025, recruiting participants mainly through local gyms and social media networks. The sample had an average age of 26.3 years, 69.1 percent were men and average reported phone use was 5.7 hours a day. Participants completed established measures covering social media disorder, depressive symptoms, appearance anxiety, physical activity and commitment to exercise.

A notable feature of the sample was the prevalence of problematic patterns of social media engagement. Some 52.6 percent of participants scored in the "risky" category on the Social Media Disorder scale and another 21.2 percent fell within the "problematic" category. Combined, almost three quarters of the participants were classified in one of those two ranges.

Longer daily phone use was associated with greater appearance related avoidance, camouflaging and threat monitoring, as well as higher social media disorder scores. Yet the relationship changed when researchers examined problematic social media use as an intermediary. Social media disorder statistically mediated 52 percent of the relationship between phone use and appearance avoidance, 39 percent for camouflaging anxiety and 29 percent for threat monitoring.

Once that indirect pathway was included, the direct association between phone use and appearance anxiety was no longer statistically significant. The result does not mean that time online is irrelevant, but it does weaken the assumption that duration alone adequately captures digital health risk. Two hours of compulsive appearance focused comparison may carry a very different psychological meaning from two hours spent communicating with friends, studying or working.

Social Media Behaviour Sits Between Phone Use and Psychological Distress

A similar pattern appeared for depressive symptoms. Higher scores on the depression measure were associated with both longer phone use and greater social media disorder, while problematic social media use statistically mediated 39 percent of the association between phone use and depressive symptoms. After that pathway was taken into account, researchers did not find a significant remaining direct association between phone use and the depression score.

Policies that rely mainly on daily screen limits assume exposure is the principal concern. The study instead points toward behavioural dependence, social comparison and the psychological consequences of engagement as potentially more informative targets for prevention.

Nearly 78.3 percent of participants reported at least mild depressive symptoms on the PHQ 9 questionnaire. The authors caution strongly against interpreting this figure as a rate of clinical depression because the questionnaire measured symptom severity rather than providing a psychiatric diagnosis. The finding is therefore better understood as an indication of elevated self reported symptom burden within this particular sample.

The research also fits with a wider concern around appearance based social comparison. Social platforms expose users to highly curated images, idealised bodies and fitness content that can shift perceptions of what is normal or desirable. The study did not measure specific content exposure, so it cannot determine whether particular platforms, influencers or recommendation systems produced the observed relationships.

Body Image May Quietly Shape Who Keeps Exercising

The analysis becomes more revealing when digital behaviour is connected with physical activity. Participants with higher BMI reported greater camouflaging anxiety, a form of appearance concern involving efforts to conceal perceived physical flaws. Higher BMI was also associated with lower commitment to physical activity and shorter workouts.

Camouflaging anxiety statistically mediated about 17 percent of the association between higher BMI and weaker commitment to exercise, although a direct relationship remained after the mediation effect was considered. Lower commitment to physical activity was, in turn, associated with less moderate and vigorous exercise, though not with walking.

Such findings complicate conventional approaches to physical inactivity. Health campaigns frequently emphasise motivation, weight control, facilities and awareness of exercise benefits. The study indicates that perceived visibility and fear of appearance related judgment may also influence whether some individuals feel able or willing to participate consistently.

Gym and fitness environments can therefore carry psychological barriers even when physical access exists. A person may know exercise is beneficial and have access to facilities, yet remain reluctant to participate if the environment intensifies self consciousness or body comparison. For public health systems attempting to increase activity levels, body image may need to be considered alongside affordability, accessibility and behavioural motivation.

Digital Health Policy Needs Better Targets, but the Evidence Is Not Yet Causal

The study offers a useful conceptual shift, but it cannot establish that problematic social media use causes appearance anxiety, depressive symptoms or reduced exercise. Its cross sectional design captures relationships at one point in time, leaving open the possibility that psychological distress encourages problematic online behaviour, that appearance concerns affect both exercise and social media habits, or that the relationships operate in several directions simultaneously.

Generalisability is another constraint. Participants were recruited largely through gyms and social media announcements, meaning they were likely more physically active and digitally engaged than the broader adult population. The sample was also predominantly male, relatively young and dependent on self reported measures for important variables including weight, height, phone use and physical activity.

Despite the limitations, the research raises a consequential policy question. Digital well-being strategies built around reducing total screen hours may miss the forms of engagement most closely associated with distress. Schools, universities, health providers and community programmes could eventually benefit from approaches that distinguish ordinary digital participation from compulsive use, appearance comparison and behaviour that interferes with mental or physical well-being.

Longitudinal research and intervention studies are now needed to establish direction and test whether changing problematic social media behaviour or reducing appearance related anxiety produces measurable improvements in physical activity and mental health. The authors themselves call for broader samples and prospective research before intervention effects can be claimed.

The broader lesson is that digital health may be poorly served by counting minutes while ignoring what happens during them.