The current study examines the association between TikTok use and psychological well-being, including mood, self-esteem, body image concerns, and mental health distress. A central aim of the study is to investigate psychological distress in relation to both the amount of time spent on TikTok and exposure to mental health-related content on the platform.

Recently, increasing concern has emerged regarding a teen mental health crisis ([5]). Evidence suggests that rates of depressive symptoms—and, more concerningly, suicidality—have increased among adolescents, particularly among females ([20]). Initially, researchers believed that these trends primarily reflected reduced social contact and social isolation during the COVID-19 pandemic ([26]). However, levels of psychological distress did not substantially decline after the pandemic subsided. One potential contributing factor is increasing use of social media, particularly among adolescent females ([42]).

A substantial body of literature has examined the relationship between social media use and psychological well-being ([19]). Although findings have not always been consistent, research generally suggests a positive association between time spent on social media and symptoms of psychological distress, depressive mood, anxiety, and body image dissatisfaction ([41]). These effects may be particularly pronounced among girls and young women.

Although prior studies have examined associations between TikTok use, self-esteem, depressed and anxious mood, and body image concerns among college-age women, relatively limited data are available regarding the use of TikTok specifically for accessing mental health-related content and the types of conditions most frequently viewed or discussed.

TikTok currently has an estimated 1.7 billion users worldwide, with adolescent and young adult women representing one of its largest demographic groups. Originally developed as a platform emphasizing creativity through music, dance, and short entertainment videos, TikTok has increasingly been implicated in discussions surrounding adolescent mental health problems ([4]; [7]).

A major concern is TikTok’s “For You” algorithm, which uses current and past viewing patterns to serve increasingly similar content to users. As a result, an adolescent experiencing transient sadness or anxiety may repeatedly encounter videos describing symptoms of depression, anxiety disorders, eating disorders, or other psychiatric conditions ([8]). Similar processes may occur for conditions such as mild autism spectrum disorder or Attention-Deficit/Hyperactivity Disorder ([12]).

More recently, attention has focused on the possibility of social contagion of psychiatric symptoms via social media platforms. Rather than being viewed solely as stigmatizing, some mental health conditions may become normalized, socially reinforced, or even presented in ways that enhance social status online ([13]).

Foulkes and colleagues suggest that part of the apparent increase in adolescents’ mental health symptoms may reflect the positive or celebrity-like portrayal of psychiatric conditions on social media. Increasingly, mental health concerns portrayed on TikTok are not always framed as conditions requiring professional treatment. Instead, they may be presented as positive, unique personality traits or characteristics that make individuals appear distinctive ([18]).

Although earlier platforms such as Tumblr and Instagram contributed to the rise of self-diagnosis, TikTok appears to have amplified this trend because of its highly personalized algorithm and short-form video format.

Despite the benefits of raising mental health awareness on social media, some psychologists have expressed concern that social media may portray conditions inaccurately and that psychiatric terminology is often used casually or imprecisely online, potentially trivializing the experiences of individuals with formally diagnosed conditions ([13]). For example, diagnostic labels such as “bipolar” may be used loosely to describe normal mood changes.

One frequently cited example of possible social contagion involves Tourette-like symptoms with relatively sudden onset, often involving prominent upper-body tics ([14]). In classic Tourette syndrome, motor tics typically precede vocal tics, and fewer than 15% of individuals demonstrate severe vocal symptoms ([14]).

Another example involves Dissociative Identity Disorder, a relatively rare condition with an estimated prevalence of approximately 1%, which has gained increased visibility on TikTok. [18] suggest that rare disorders may become especially popular online because they emphasize individuality and uniqueness.

[23] also identifies Attention-Deficit/Hyperactivity Disorder, Borderline Personality Disorder, and autism spectrum disorder as conditions frequently represented in TikTok-related content. [23] describes some of these online presentations as “performative sick role content” and argues that certain displays may resemble malingering or factitious disorder. Researchers have also expressed concern that social contagion processes may contribute to the spread of conversion-like symptoms and other functional neurological presentations.

The increase in self-diagnosis of mental health problems has been cited as one factor contributing to the apparent rise in mental health conditions among adolescents and young adults. Self-diagnosis occurs when an individual concludes that they meet criteria for a psychiatric condition without undergoing a professional assessment ([33]).

[2] found that even among youth seeking professional mental health services, more than 70% had already diagnosed themselves prior to evaluation and reported that social media engagement contributed to their self-diagnosis.

Qualitative research has also found that many young people view self-diagnosis as acceptable when it provides a framework for understanding and legitimizing emotional experiences. At the same time, participants generally did not support the use of psychiatric labels as a means of avoiding personal responsibility ([2]).

As mentioned above, some researchers have suggested that self-diagnosis and online self-presentation as mentally ill may function as strategies for enhancing self-worth, obtaining social recognition, or improving short-term mood states ([18]).

Social comparison has been identified as one of the key mechanisms linking social media use to depressive symptoms and body image dissatisfaction. Upward social comparison occurs when individuals compare themselves to peers whom they perceive as more attractive, successful, or socially desirable.

Social media platforms frequently present highly curated and idealized depictions of daily life, increasing the likelihood of upward social comparison. This process has been associated with envy, jealousy, irritability, anxiety, and depressive symptoms ([27]). Research has also shown that individuals who compare their physical appearance to celebrities, influencers, or peers perceived as more attractive are more likely to experience body dissatisfaction and develop depressive symptoms ([6]).

Another proposed mechanism is cognitive overload ([44]). Because social media users are exposed to large amounts of emotionally salient information while managing interpersonal interactions, excessive social media engagement may overwhelm cognitive and emotional resources. Cognitive overload theory suggests that this process may contribute to fatigue, stress, and dysphoric mood ([21]; [44]).

[44], for example, found that social media use among college students was positively associated with both cognitive overload and depressive symptoms, and that cognitive overload partially mediated the relationship between social media use and depression.

The current study explored the level of engagement with TikTok, including the amount of time participants spent viewing mental health-related content, particularly material related to depression and anxiety.

A secondary purpose of the study was to examine the association between TikTok use and symptoms of depression and anxiety, self-esteem, and body image discrepancy. Although previous studies have identified associations between social media use and these psychological variables, findings have not always been consistent, and relatively few studies have focused specifically on TikTok.

Because social media use is often episodic and emotionally reactive, the current study used the briefer version ([9]) of the Profile of Mood States ([24]; [35]) to assess short-term aversive emotional states.

Overall, the study seeks to clarify the relationship between TikTok engagement, exposure to mental health-related content, social comparison processes, and psychological well-being among young adult women.

Participants were recruited through Prolific, an online research platform used for behavioral science studies that matches participant profiles to studies for which they are qualified. The eligibility criteria specified that women must be currently enrolled in a higher education institution. Prolific reports a proprietary method for detecting fraudulent responses and ensuring data quality ([28]).

The sample consisted of 151 college-aged women ranging in age from 18 to 27 years (M = 22.56, SD = 1.90). The sample was racially diverse. Participants identified as Black/African American (49.0%, n = 77), White (34.4%, n = 54), Asian (3.8%, n = 6), Multiracial (3.8%, n = 6), Hispanic/Latina (2.5%, n = 4), and Middle Eastern (2.5%, n = 4).

Most participants were undergraduate students (55.4%, n = 87). Additional participants reported enrolment in a master’s program (31.8%, n = 50), doctoral program (1.3%, n = 2), vocational or trade school (1.3%, n = 2), or community college (1.9%, n = 3).

Regarding mental health status, 31.8% (n = 50) reported having received a formal mental health diagnosis, 18.5% (n = 29) reported being self-diagnosed or suspecting that they had a mental health condition, and 45.9% (n = 72) reported no diagnosis.

2.2.1. TikTok Usage Questionnaire

Participants responded to the following questions regarding their TikTok use by selecting one of the provided response options.

1) Length of TikTok Use

Participants indicated how long they had been using TikTok. Response options ranged from less than 6 months to more than 5 years.

2) Average Daily Time Spent on TikTok

Participants estimated the average number of minutes per day they spent on TikTok. Response options ranged from less than 30 minutes to more than 300 minutes per day.

3) Frequency of Checking TikTok

Participants reported how frequently they checked TikTok. Response options ranged from multiple times per hour to less than once per week.

4) Exposure to Mental Health-Related Content

Participants estimated the percentage of TikTok content with which they interacted (e.g., liked, commented on, shared, or watched) that related to mental health or emotional topics. Response options ranged from 0% - 10% to 91%or greater.

Examples of mental health-related content included anxiety, depression, therapy, trauma, relationships, emotional struggles, coping mechanisms, mental health awareness, self-help, and emotional support.

5) Types of Mental Health Content Encountered

Participants identified the types of mental health or emotional content they most frequently encountered on TikTok by selecting all applicable options. Eleven categories were provided, including anxiety, depression, post-traumatic stress disorder (PTSD), and Attention-Deficit/Hyperactivity Disorder (ADHD)/neurodivergence.

6) Engagement With Mental Health Content

Participants described their level of engagement with mental health-related content on TikTok. Response options ranged from actively seeking out this content to rarely encountering it.

2.2.2. Rosenberg Self-Esteem Scale

The Rosenberg Self-Esteem Scale (RSES; [32]) was used to assess global self-worth and self-acceptance. The RSES consists of 10 items rated on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree), with five items reverse scored. Although some researchers have proposed a two-factor structure separating positively and negatively worded items ([10]), the scale is most commonly treated as a unidimensional measure of global self-esteem.

The RSES has demonstrated strong psychometric properties across diverse populations. Internal consistency reliability coefficients typically range from .88 to .95 ([38]), and test-retest reliability over two-week intervals has ranged from .85 to .88 ([30]). Evidence supporting construct validity includes significant associations with related constructs such as depression (r = −.54) and life satisfaction (r = .47), as well as factorial invariance across gender, age, and ethnic groups ([34]).

2.2.3. Profile of Mood States-Short Form

The Profile of Mood States-Short Form (POMS-SF; [36]) was used to assess transient mood states and psychological distress over a specified time interval. The measure consists of 37 adjectives rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely), indicating the extent to which each adjective described the respondent during the previous week.

The POMS-SF yields scores on six subscales: Tension-Anxiety, Anger-Hostility, Depression-Dejection, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment. In addition, a Total Mood Disturbance score can be calculated by summing the five negative mood subscales and subtracting the Vigor-Activity score. Example items include adjectives such as “tense,” “angry,” “unhappy,” “lively,” “worn out,” and “confused” ([25]).

The POMS-SF has demonstrated strong psychometric properties across both clinical and nonclinical populations. [9], in a sample of approximately 600 participants, reported Cronbach’s alpha coefficients ranging from .76 to .95 across subscales, with most coefficients exceeding .90.

2.2.4. Stunkard Figure Rating Scale

The Stunkard Figure Rating Scale (FRS; [39]) was used to assess body image perception and body dissatisfaction. The FRS is a widely used pictorial measure consisting of nine silhouette figures that range from very thin to obese. The measure was developed to provide a rapid assessment of body image while minimizing literacy demands and has become one of the most frequently used instruments in body image research ([40]).

Participants are asked to identify the figure that best represents their current body size and the figure that represents their ideal body size. Body dissatisfaction is calculated as the discrepancy between current and ideal body figure selections, with larger discrepancies reflecting greater body image dissatisfaction or disturbance ([15]).

The FRS has demonstrated acceptable psychometric properties, including good test-retest reliability and convergent validity with other measures of body image dissatisfaction and eating pathology.

The FRS has demonstrated good test-retest reliability over a two-week period (r = .89).

Participants were recruited through Prolific, an online participant recruitment platform. After accessing the study link, participants were presented with an informed consent form describing the purposes of the study, research procedures, potential risks and benefits, confidentiality protections, and the voluntary nature of participation.

Because the survey was administered online, implied consent procedures were used. Participants were informed that continuing with the survey indicated consent to participate, whereas closing the browser window or discontinuing the survey indicated a decision not to participate.

Prior to implementation, the study protocol was assessed and approved by the Lake Superior State University Institutional Review.