Social media in early psychosis and first episode: A systematic review

OBJECTIVES: Over the past two decades social media use has expanded rapidly raising increasing concerns regarding its impact on the mental health of young and vulnerable populations. This systematic review aims to synthesize current evidence on the association between social media use and emergence of psychotic symptoms in transition processes toward psychosis. METHODS: Searches were conducted in PubMed and Google Scholar databases. Of the 436 records identified, nine studies met inclusion criteria. RESULTS: The reviewed literature highlighted a complex and heterogeneous relationship between social media use and psychosis risk. Social media exposure may function as an environmental stressor for individuals at a clinically high risk for psychosis, particularly depending on patterns of use, subjective meaning, and contextual factors. Reported mechanisms included social stress, exposure to misinformation, heightened interpersonal sensitivity, as well as potentially protective effects such as access to social support and normalization of experiences. Rather than reflecting individual deficits, vulnerability appeared to arise from dynamic interactions between social media environments and pre-existing psychological, social, and biological risk factors. CONCLUSIONS: These findings raise important questions regarding how digital social environments interact with processes of self-concept, social cognition, and stress regulation during critical developmental periods. However, conclusions remain limited by the predominance of correlational designs and the scarcity of longitudinal and qualitative research. Future studies should prioritize in-depth exploration of subjective digital experiences and longitudinal approaches to clarify causal pathways and to distinguish adaptive from stressful patterns of social media use in clinical high-risk populations.