SCAMP Wave 2

Mental illness commonly emerges during adolescence, but the reasons for this are not well understood. Adolescence is a period of great change in family, school, and peer relationships, use of mobile phones/social media (i.e. digital technology use), cognition (i.e. how people think, make decisions and process information), puberty hormones, and physical activity. Previous research has shown links between overuse of digital technology and poor mental health. However, this link could be explained by various factors, such as cognition, puberty hormones, how much physical activity people do, or obesity. There is currently little scientific evidence on which factors are responsible and how they might all interact with one another. It is likely that mental health varies according to an individual's genes, gender, wealth, social class and ethnicity, and it is important to understand this variation to identify groups in the population who may be more susceptible to the negative impacts of digital technology use.

The Study of Cognition, Adolescents and Mobile Phones (SCAMP) is the largest long-term study of digital technology use and cognition in adolescence. It is currently the only study that can answer detailed research questions about how digital technology used by adolescents in today's digital era may affect their mental health as they move into adulthood. We previously collected data from ~6,600 SCAMP study participants ages 11-15 about how they use digital devices, their cognition, physical and mental health, and lifestyle (e.g. smoking and diet), together with urine and saliva samples (to measure e.g. puberty hormone levels), and physical measurements e.g. height and weight.

Here, we plan to collect data, samples (urine and saliva), and physical measurements from SCAMP participants at ages 17/18 at a face-to-face session, and we will ask SCAMP participants to download an app so that we can continue to collect data remotely for 3-4 years, including after participants have left school. We will ask participants to wear a fitness tracker wristband for up to 2 months so that we can collect accurate data on physical activity. We will also link to participants' routinely collected health and educational records if they permit this. The proposed waves of data collection will allow continued and more in-depth assessment of participants' mental health, cognition, digital technology use, lifestyle, and physical health during the time period when they move from adolescence into adulthood. We will analyse genetics from biological samples provided by participants to obtain data on genetic variation. We will use these data to investigate research questions such as: 1) is the relationship between overuse of digital technology and poor mental health explained by lack of physical activity, or obesity?; 2) does cognitive development and puberty during adolescence explain relationships between digital technology use and mental health?; and 3) are some people more susceptible to the impacts of digital technology use on mental health than others, due to their genes?

This research will address current gaps in scientific knowledge about links between digital technology use and mental health. It may allow us to identify specific aspects of digital technology use that increase an individual's risk of poor mental health, or specific aspects of lifestyle that are "protective" and boost mental wellbeing. Our proposal has high policy relevance, both nationally and internationally, at government and education levels for action to prevent mental illness in early life. Supported by co-design from stakeholders, we aim to ensure that our research findings inform the development of future evidence-based policies and interventions for mental health to enhance quality of life for young people and provide long-term economic benefits to society.

Mental illness commonly emerges in adolescence. Excessive use of digital technology (e.g. social media) is associated with poor mental health, but underlying mechanisms are not established. The Study of Cognition, Adolescents and Mobile Phones (SCAMP) is a prospective cohort uniquely placed to investigate the multifactorial pathways by which the contemporary digital environment may affect mental health during adolescence. The programme aims are: 1) to investigate direct and indirect mechanistic pathways and genetic risk factors to better understand how digital environments might affect mental health from adolescence to adulthood; 2) to enhance SCAMP as a major national/international resource for research into adolescent mental and physical health. We will do this via face-to-face follow-up of SCAMP participants 6 years post baseline at age 17/18 years; followed by 3-4 years of remote follow-up via an app; and ongoing linkage to routine health/educational records. We will collect repeat and new measures of mental health, cognition, technology use and potential confounders, plus biosamples and anthropometry. Objective data on digital technology use and physical activity will also be collected via the app and a fitness tracker. Participant DNA from biosamples will be genotyped. We will use these data to investigate the roles of physical inactivity, adiposity, cognitive development, puberty hormones and genetic risk factors in the pathways linking adolescents' digital technology use to mental health. Supported by co-design from stakeholders, this research may identify specific high-risk digital technology activities and/or high-risk population groups, thus informing development of evidence-based targeted risk reduction strategies and behavioural health promotion policies.

The primary beneficiaries of this research will be children, adolescents and young adults. Many young people experience challenges to their mental health and wellbeing; the majority of which can persist into adulthood. The impact of these challenges is extensive, with consequences for educational, social and economic outcomes; as well as poor health behaviours that further impact on mental and physical health. This research will advance the evidence base regarding the relationship between the digital environment and mental health in young people. Specifically, it will investigate the potential mechanistic pathways underlying any observed relationships, and interactions with genetic risk factors, gender, socioeconomic status and ethnicity. This will allow identification of specific digital technology activities and environments that may lead to increased risk for poor mental health and cognitive outcomes and/or specific groups at high-risk of negative impacts of digital technology, enabling targeted risk reduction strategies by policy makers across a range of sectors, including public health and education. The enhanced evidence base may also allow technology companies to develop more socially responsible digital technologies, to promote wellbeing. This may improve mental health and quality of life for children and young people, with substantial health, social, and economic benefits across the life-course.

Public health policy-makers, and youth mental health organisations/charities, both nationally and internationally, will benefit from the research via the evidence base it will provide on potential health impacts of digital technology, which will allow development of guidance for children and adolescents' healthy use of digital technology. It will inform policy debate on the complex interplay between social, behavioural, technological, environmental and biological factors potentially influencing physical and mental health, wellbeing, obesity, and cognition during the important transition period from adolescence to early adulthood. Ultimately, this will help to shape preventative strategies through behavioural health promotion and education policies.

Parents will benefit from a strengthened evidence base regarding digital technology use and any subsequent revisions to public health guidance, which will allow them to make informed choices and better advise their children on digital technology use. Moreover, they will be able to better identify mentally vulnerable adolescents earlier to potentially prevent life-long mental illness and understand/discuss with their children the pathways to mental health resilience.

Education policy-makers and practitioners will benefit from a clearer understanding of the inter-relationships between cognitive development, mental health and educational outcomes in adolescents and young adults. This in turn may inform school/higher education policies to support best practice in mental health and wellbeing provision and digital technology use, which overall may improve educational achievement with long-term economic benefits to society.

The UK health service may also benefit. Strengthening the evidence base to identify risk factors for mental health vulnerability and resilience will reduce the burden on the NHS and the huge healthcare cost involved.

Longer term, any population-level improvements in mental health arising from policy or behaviour changes informed by this work have potential to benefit UK employers, businesses and the wider UK economy via reduced direct (e.g. social services) and indirect (e.g. lost production due to sickness absence/early retirement) costs of poor mental health, and improved quality of life, social mobility, and income. The UK's total annual cost on mental health disorders was approximately £94 billion in 2015.

Since digital technology is ubiquitous, this research will potentially be beneficial for the 5 billion mobile phone users worldwide.