INTRODUCTION

Adolescence is a stage in the lives of individuals in which intense physiological, psychological and relational changes occur, ranging from ten to nineteen years old^1). In this period of intense transformations, they can be understood as stressful factors for these subjects, which influence the construction of their identity, with the possibility of exerting an influence on the construction of a phase of conflicts, which lead to risky and self-harmful behaviors².

Therefore, for cognitive, emotional, sexual and psychological development to occur in a healthy way, it is necessary for the young person to move in comforTable environments, which transmit security, support and protection,¹ enabling self-discovery in a safe manner, by increasing autonomy and by a growing focus on identity development and socialization,³ which currently occurs through groups of friends and social networks.

Social networks are already an intense part of any adolescent's life, as they are a powerful new way of relating to others. Today's young people were born in the “digital age” and, therefore, are familiar with the Internet and all its possibilities, due to having grown surrounded by technological devices and Internet access⁴.

Thus, the use of social networks is becoming more frequent in their daily lives, using this resource to communicate, which ends up influencing social interaction among adolescents, with the possibility of becoming harmful and even addictive³.

Also in this direction, adolescents are easily exposed to related issues such as cyberbullying, which occurs in the virtual space, through calls on cell phones and through messages in the social networks; exaggerated and inappropriate exposure, which can lead to a false reality exposed on the networks that does not match their reality outside the Internet; sharing photographs that expose too much intimacy as well as personal information; sharing erotic content; the construction of self-image and dissatisfaction with the body; and the difficulty of dealing with the different⁵.

Thus, the concern is not only with the physical, but also with the psychological well-being of these adolescents. Problems that were previously unknown gained greater visibility, especially those linked to mental disorders. Some examples are the “13 Reasons Why” series and the “Blue Whale” game, which are strongly linked to issues of emotional well-being and psychological health, mainly aimed at adolescents⁶. Both discuss depression, bullying, self-mutilation and suicide, problems that have been contributing significantly to the increase in morbidity and mortality among adolescents¹.

The Internet and the social networks also allow for transformations in the personal and social bonds, favoring the emergence of new friendships, with spaces to make new friends, connect to various communication means simultaneously, being a source of new information and news, research studies, in addition to allowing not only access to information, but also the ability to produce it⁷, as well as sharing experiences, ideas, perceptions and feelings easily and quickly.

Thus, considering all the factors addressed, the question is as follows: How do adolescents perceive the use of social networks and their relationship with mental health? The relevance of this paper is to address a topic of great social concern, in which the adolescents spend a lot of time online, forgetting about offline life, causing social imbalance, and being exposed to the negative sides of this new way of relating and of sharing information. It will provide the production of knowledge about the reality of these adolescents in relation to the use of this online universe, allowing for problematization, facing it as a new social health need of this population and, therefore, assisting in the construction of knowledge that supports health care and the nursing/health work process.

Thus, the objective is to identify the adolescents' perception about the use of social networks and the influence on mental health.

METHOD

This is a descriptive-exploratory research study with a quantitative-qualitative approach⁸. The research was carried out through the social networks, that is, the online digital media. The participants of this research were Brazilian adolescents aged between ten and nineteen years old, as recommended by the World Health Organization (WHO).

Non-probabilistic sampling through the snowball strategy was used. Some people with the necessary profile for the research were selected to initiate collection, making it possible to start the contacts to be researched. Subsequently, the individuals who were chosen were asked to indicate new contacts with the characteristics necessary for the research, from the social network itself, and thus, successively, increasing sampling for each questionnaire answered. Thus, this method proved to be a process of permanent collection of information⁹.

The following inclusion criteria were considered: a) being aged between ten and nineteen years old; b) using some social network; and d) having Internet access. The individuals excluded were those who: a) were not available to answer the survey; b) sent partially answered questionnaires, without the Free and Informed Consent Form (FICF) or Free and Informed Assent Form (FIAF) signed.

The instrument used to carry out data collection for this research was the online questionnaire, elaborated by the researchers and developed through the Google Forms tool, and disseminated through the social networks (WhatsApp, Facebook and Instagram), thus allowing for more convenience to be answered and shared with the individuals to be surveyed. This questionnaire consisted of closed questions (multiple choice, where more than one option could be selected), and open questions about the profile of the use of the social networks and what motivations and feelings they caused in the users.

Data collection was carried out during March 2019, with a period of eight days being stipulated for receiving the answers. A total of 71 completed questionnaires were obtained, which received a copy of the Free and Informed Assent Form (FIAF) for children and adolescents, consisting of a clarification page about the research, such as the objectives, the risks and the benefits, in addition to requesting authorization to use the data.

Initially, the results of the closed questions (multiple choice) were tabulated and presented in graphs, using simple statistics, presenting frequency distribution. After being organized and described, the open questions (discursive) allowed establishing analysis categories, which were discussed from the perspective of the relevant theoretical framework.

The research met all ethical issues according to Resolutions No. 466/12 and No. 510/16 of the National Health Council (Conselho Nacional de Saúde, CNS) and was approved by the Research Ethics Committee (Comitê de Ética e Pesquisa, CEP) of the State University of Rio Grande do Norte (Universidade do Estado do Rio Grande do Norte, UERN) on March 15^th, 2019 with Opinion Number: 3,202,624 and CAAE number: 06892818.6.0000.5294.

RESULTS

Among the 71 adolescents who participated in the research, 61% (n=43) were female and 39% (n=28) were male. The majority, 44% (n=31), were aged between 12 and 14 years old, 42% (n=30) were between 15 and 17 years old, and 14% (n=10) were over 18 years old. Regarding the school level, 11% (n=8) were in 8^thgrade of Elementary School, 39% (n=28) in 9^thgrade of Elementary School, 14% (n=10) were in 1^styear of High School, 9% (n=6) in 2^ndyear of High School, and 27% (n=19) in 3^rdyear of High School.

Regarding the monthly income of the head of the house, 42% (n=30) answered that it was 1 minimum wage, 40% (n=28) reported that it was 2 wages and only 1% (n=1) stated having an income above 5 minimum wages. The main city of residence was the municipality of Pau dos Ferros-RN, with 38% (n=38) of the adolescents, followed by Natal-RN, with 5% (n=5).

Regarding the use of the social networks, 100% of the respondents reported using them frequently, with 93% (n=66) stating that they accessed them more than 5 days, for a daily time of more than 8 hours (35%, n=25), and only 5% (n=4) reported accessing for up to 1 hour a day.

In relation to the number of social networks, 27% (n=19) stated taking part in 3 social networks and only 3% (n=2) reported having only one social network, with WhatsApp and Instagram being the most used, as shown in Graph 1.

Graph 1:  Which social media do you use most? Pau dos Ferros, RN, Brazil. 2019. 

Regarding the means to access the social networks, 52% (n=58) stated that they used them through mobile devices and 29% (n=32), from computers. In relation to the purpose of this use, 37% (n=56) of the participants reported that it was for leisure/entertainment, 32% (n=49) for communication, 24% (n=36) for schoolwork, and 7% (n=11) answered “others”. In relation to establishing relationships through the Internet, 69% (n=49) of the participants answered that it is possible, as can be seen in Graph 2.

Graph 2:  Do you believe that relationships can be established through the social networks? Pau dos Ferros, RN, Brazil. 2019. 

In the question referring to the advantages of having a profile on a social network, according to the participants, information exchange is easy and quick, with 47% (n=51), followed by new friendships (24%, n=26), monitoring of updates (22%, n=24), and even 6% (n=6) of the participants stated that there were others, such as using accounts for online games, for studies and school work, as well as following artists' news. In this question, the participants were also able to choose more than one option. In relation to the risks of using social networks, the participants mentioned the disclosure of personal data and invasion of privacy, as shown in Graph 3.

Graph 3:  What do you believe is the biggest risk in using social networks? Pau dos Ferros, RN, Brazil. 2019. 

When asked about some situations that have already happened on social networks, the participants claimed to have received messages with inappropriate content, as can be seen in Graph 4.

Graph 4:  Has any of these situations ever happened to you? Pau dos Ferros, RN, Brazil. 2019. 

The participants were also asked if they thought it was important to have a cell phone, obtaining 97% of affirmative answers. And when asked about its purpose, they stated that they like to access the social networks and talk with friends, with 34% (n=62) each, and only 6% (n=10) stated that it would be another topic, such as news, medical matters, games, memes, DIY, videos and music, and studies.

From the answers obtained in the open questions, fifty-four key expressions were extracted, which were grouped into twenty-nine central ideas, whose representations were divided into three categories, namely: (1) Adolescents' feelings about the situations experienced in the social networks. The main feelings recorded were “Embarrassment” (27%) and “Discomfort Insecurity” (25%); (2) Influence and contributions of the social networks on the adolescents' lives. The influences and contributions detected were “Studies/Updates” (29.5%), “Communication/New Friends” (26.7%), and “Dreary, boring and bad life without the Internet” (18%); and (3) The consequences of the social networks for the mental health of adolescents. The main consequences for mental health resulting from the use of social networks were “Invasion of privacy/Disclosure of data” (20.5%), “Addiction” (19.3%) and “Confusions/Fights/Cyberbullying” (17.8%).

DISCUSSION

The study results corroborate the Brazilian Media Survey (Pesquisa Brasileira de Mídias, BMS), which found that most of the adolescents use the Internet seven days a week, since the vast majority of young people have Internet access in their homes, using cell phones and computers¹⁰.

These devices also offer a form of entertainment and social stimulation, also providing an “integration” between people. In general, cell phones have become constant companions of the adolescents, serving, in a social context, to include and exclude friends, organize, improve and relive experiences, as well as to redefine the social space³.

Internet use is multiple and is directly related to the interest of young people when navigating this space, given that, although communication appears as an important activity performed, research and leisure also stand out,¹¹ in addition to being an environment used to make new friends and seek love relationships¹².

Currently, the social networks occupy an important space in the lives of young people and influence the construction of their identities and behaviors, as contemporary society has assumed a dynamic of carrying out activities in a solitary way, hindering social interaction and compromising the establishment of love relationships constructed socially and offline¹³. Thus inducing the increased demand for online relationships built and awakened from dating apps, which also increase sexual risk behaviors, such as unprotected sex, multiple partners and sexual violence, mostly developed by young individuals^12,14.

The development of virtual relationships, although highly sought after, is not credible by 69% of the research participants, who believe that online relationships are weaker and more superficial. A number of studies^15-16 show the propensity of the subjects, mainly men, to seek casual sex and not for serious relationships, causing a high degree of frustration in people due to unmet expectations and divergent intentions.

Adolescents are increasingly immersed in the technological universe, making this a primordial environment for relationships via social networks and, therefore, considering them as an indispensable tool for modern life.¹¹ They are also important consumers of trends, among them, they intensively use social media as a means of communication and new information, and these, in turn, seem to exert an important influence on various aspects of their lives⁵, in addition to using them for educational purposes.

This becomes important during this period, since belonging to groups of people not only provides support but also assists in the construction of identity. Presence in the virtual world has become essential for individuals to be socially included.¹⁷ However, the need to meet the beauty and life standards imposed by society has increased, causing intense dissatisfaction with their body image, reinforcing patterns of narcissistic behavior and consumerism⁵.

The excessive and ungoverned use of social media can develop dependence and a high need for acceptance on young people, hindering self-knowledge and the construction of healthy social practices,¹⁸ which can cause family conflicts, difficulties in, in social interaction and in dialog, as well as anxiety disorders and attention deficit¹⁹.

The continuous and intense use of technological updates and social networks can lead to addiction and dependence on the part of their users, as young people claim to use social networks in their homes, at school and in various places to interact virtually, distancing themselves from the context around them, reflecting on problems in the social, personal and educational spheres, also interfering in the student's learning performance, as well as in other aspects of daily life¹¹.

In addition to developing some risks, such as cyberbullying, depression, suicide, mood and behavior changes and affective vulnerability, among other various emotional and mental problems; they favor the emergence of psychological problems, such as: shyness, panic, social phobia, social isolation and affective disorder, as this stage initiates the process of affective relationships, which are always undergoing changes, making adolescents insecure²⁰.

Cyberbullying favors the emergence of disorders, such as academic and psychosocial problems, depression, low self-esteem and externalized hostility, among others. The types of cyberbullying related to episodes in which the aggressor was an adult, publication of a photograph of the child or adolescent, and episodes accompanied by aggressive offline contacts, such as receiving a phone call or when the aggressor went to the victim's home, are related to a three-fold risk of emotional distress; reporting that nearly 68.5% of the adolescents experienced some negative emotions, such as anger, upset, worry, stress, fear and "depressive feelings", while 24.5% them do not worry about the incidents⁴.

The study²¹ showed that the probability of a suicide attempt was up to two times higher among victims and aggressors, when compared to those who were not involved in cyberbullying. This is due to emotional stress and to the emergence of negative emotions such as anger, fear and depression due to stress and social anxiety, which can lead to drug use and depressive symptoms, emphasizing that situations leading to psychological discomfort can induce suicidal thoughts and even suicide².

The participants reported that they know people who had their image exposed and that several problems occurred later, as well as they stated that many peers use the social networks to provoke people they do not like, thus being possible to show that social networks can promote situations of embarrassment for the participants, as well as other reactions and social conflicts, such as discomfort and insecurity, among others²².

In Brazil, cybercrimes are becoming routine, the most common being slander, insults, defamation, revealing third-party secrets, disclosing intimate material such as photographs and documents, obscene acts, apology for crime, prejudice/racism and pedophilia. Users of the Internet and of the social networks often disclose personal data on these networks, making confidential information accessible that could be misused, for example, by identity thieves and other malicious parties²³.

Therefore, it can be noticed that the use of social media has consequences for the mental health of these adolescents, such as compulsive use, in which there are difficulties in controlling use, extreme dependence and psychological, social and biological problems, such as: alienation, anxiety, intolerance, isolation, individualism, depression and, in more extreme cases, suicide, causing difficulties in concentration and aggression.

However, there are many benefits involved in the ideal use of the social networks, such as increasing information diversity, for use in the school environment and in groups of friends, favoring indirect contact with people with matters of their interest²⁴.

In the social networks, mainly through photographs, young people seek to express themselves in order to build an image of themselves for the others. Thus, it is quite common for them to disseminate/post photographs with different contents, carrying out identity experiments on their profiles, emphasizing or hiding some of their characteristics, bearing in mind that shy individuals also gain from social media, as they can improve sociability with the help of the network.^24,25

As there is a large concentration of people in the social networks, these forms of communication needed to adapt to the new demands that emerge every day. Thus, social networks have become platforms in which they disseminate their contents and, in this way, it is possible to stay informed about the most diverse subject matters, such as diverse news, educational issues, etc.

Computer-mediated communication offers certain anonymity as it allows people to feel less inhibited and express themselves in a way that they would not feel comforTable in person, whether because of shyness, appearance, sexuality and age³. Thus, these adolescents can develop a more "open" relationship. This online disinhibition allows for a reduction in social presence, as it allows the members to choose the extent to which they want to be identified, and to express only their most desirable characteristics and, in this way, they are able to feel comforTable enough to reveal personal details that they normally would not disclose in a face to face conversation.

It is necessary to make young individuals seek to understand the extent of the harms they cause to themselves and how important real interaction with the other is. It is worth emphasizing the role of Primary Health Care (PHC) in being a transforming and stimulating means of new social practices, in addition to being the care level that works with the prevention of vicious practices and suicidal behavior,² emphasizing the role of the Family Health Support Center (Núcleo de Apoio à Saúde da Família, NASF) in strengthening the mental health of adolescents through group work promoted by psychologists, whether in health units, communities or schools¹¹.

Making the adolescent see the problem and try to solve it can improve self-esteem and, consequently, the search for solutions. Hence the importance of health professionals, performing therapeutic listening, creating a climate of trust, better understanding, allowing for a good connection between people, and thus intervening more effectively in the complaints of these adolescents.

As a member and coordinator of a multidisciplinary team, the Nurse plays an important role in the care for the mental health of adolescents, so that it occurs in a holistic manner and in all health care spaces, contributing to reducing the number of mental illness cases among young individuals².

A limitation of the study is the data collection time and strategy, which was reduced, thus not allowing for a general overview of the country, only of some locations, since the data obtained could have shown another reality. Strategies are needed to gain greater participation in online research studies. In addition to that, the socioeconomic and cultural reality needs to be analyzed, as the experiences of adolescence are diverse and influenced by other social determinants of health not presented in this study.

This research contributes to the nursing and health work process, as knowing the main characteristics and habits of these adolescents will enable new ways to intervene in health needs. Thus, there is a need for educational, interdisciplinary and intersectoral work, as the issue of the social networks and their influence on health permeates other economic, social, political and health issues. It becomes indispensable to implement public policies with a health promotion character aimed at the interests of children and adolescents.

FINAL CONSIDERATIONS

The research objectives were achieved, as the perception of adolescents about the use of the social networks and the influence on mental health was identified. The participants use them frequently, participating in three social networks, with WhatsApp and Instagram being the most used. The greatest risks of use for mental health are disclosure of personal data/invasion of privacy and addiction, with embarrassment being the main feeling involved.

It is suggested that new studies be carried out to better clarify how the Internet and the social networks affect the lives of adolescents and society in general, as the use of networks is growing and has resulted in new forms of illness, as well as the conduction of studies that evaluate effective intervention programs, considering the school, health services and other sectors of the community.