{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:04:06Z","timestamp":1790622246913,"version":"4.1.0"},"reference-count":44,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"unspecified","delay-in-days":88,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study aimed to assess the levels and patterns of social media use among Saudi adolescents and middle-aged adults, evaluate associations with self-esteem and identify which usage modalities (image-based, comparison-based, belief-based, consumption-based) are differentially linked to low self-esteem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional online survey was conducted among 600 Saudi participants aged 14\u201350 years. The questionnaire included demographic and lifestyle items, medical history, the Rosenberg Self-Esteem Scale (RSES) and the Social Media Use Scale (SMUS). Logistic regression models assessed predictors of low self-esteem and comparison-based use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants reported high social media engagement, with 68.5% using it over 4\u2009hours per day. Comparison-based and consumption-based modalities were most frequent. Low self-esteem was observed in 16.2% of participants and independently predicted by younger age (OR=0.96, 95%\u2009CI 0.92 to 0.99), low socioeconomic status (OR=3.00, 1.45 to 6.19), mental health history (OR=2.02, 1.15 to 3.53), unhealthy diet (OR=2.10, 1.01 to 4.34) and high comparison-based use (OR=4.93, 2.58 to 9.43). Moderate and high Snapchat use were associated with lower odds of low self-esteem. Comparison-based use was further associated with unhealthy diet, low spirituality, thyroid disorders and &gt;8\u2009hours of daily use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Comparison-based social media use is a strong and independent predictor of low self-esteem, underscoring the importance of analysing usage patterns over mere frequency or platform type. These findings support the need for targeted interventions focusing on at-risk modalities of social media engagement. The results hold implications for youth-focused digital literacy, mental health prevention strategies and culturally informed psychosocial support in the Saudi context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005365","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:45:21Z","timestamp":1790621121000},"page":"e005365","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Social media use modalities and self-esteem among Saudi youth and middle-aged adults: a community-based cross-sectional study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3747-3939","authenticated-orcid":false,"given":"Sami S","family":"Alharthi","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Medicine, Taif University, Kingdom of Saudi Arabia, Taif University, Taif, Makkah Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatim Y","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, Qassim University, Buraydah, Al Qassim, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz A","family":"Qrmli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, University of Tabouk, Tabuk, Tabuk Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid H","family":"Yousef","sequence":"additional","affiliation":[{"name":"Behavioral And Developmental Disorder Center, Taif Health Cluster, Saudi Arabia Ministry of Health Taif, Taif, Makkah Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz M","family":"Abudasser","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, King Khalid University, Abha, Aseer Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4998-7643","authenticated-orcid":false,"given":"Sobhia N","family":"Abanmi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal K","family":"Almutairi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lujain B","family":"Albarkheel","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel S","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaden B","family":"Almutairi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manar M","family":"Almania","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghadah M","family":"Almutairi","sequence":"additional","affiliation":[{"name":"College of Medicine, Majmaah University, Al Majmaah, Riyadh Province, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092811451468000_4.3.e005365.1","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2020.01949","article-title":"Social Media Use and Mental Health and Well-Being Among Adolescents - 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