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�

Caroline A.P. Helsen	Master of Public Health
Social & Behavioral Sciences	Yale School of Public Health
2023

ARE NEWS MEDIA ORGANIZATIONS�PROTECTING YOUTH MENTAL HEALTH?
A Content Analysis Of The Top 4 News Organizations On TikTok Directed by the U.S Surgeon General Advisory on the Youth Mental Health Crisis

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BACKGROUND

RESULTS

DISCUSSION

METHODS

TABLE OF CONTENTS

01

03

02

04

“Protecting Youth Mental Health” from the Surgeon General

Adherence to Surgeon General recommendations

Limitations, Future Research, and Next Steps

Quantitative and�Qualitative Analysis

News Media & Youth Mental Health

MPH Thesis: Helsen

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BACKGROUND

01.

News Media & Youth Mental Health

MPH Thesis: Helsen

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ADVISORY�RECOMMENDATIONS

for whole-of-society efforts to protect�youth mental health¹

including news media coverage of:

Mental health and illness
Collective trauma events: weather-related disasters, pandemics, and mass violence

Background: News Media & Youth Mental Health

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NEWS ON SOCIAL MEDIA

SOCIAL MEDIA

NEWS MEDIA

THE LANDSCAPE

93% of Gen Z consumes news content on social media weekly⁸

Linked to worse mental health among youth⁷

Can contribute to mental health stigma^2,3 and viewers’ psychological distress^4,5,6

Background

News Media & Youth Mental Health | Helsen

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How are news media organizations�adhering to federal recommendations�to protect youth mental health –�

while reporting stories on mental health or illness and collective trauma events, including climate change or weather-related disasters, mass shootings, and the COVID-19 pandemic?

RESEARCH QUESTION

News Media & Youth Mental Health | Helsen

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METHODS

02.

News Media & Youth Mental Health

MPH Thesis: Helsen

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DATA SOURCE

News Coverage of:

Mental health or illness��Collective trauma:

Weather-related disasters
Climate change*
Mass shooting*
COVID-19 pandemic

Methods

News Media & Youth Mental Health | Helsen

Timeframe: Dec. 2021 - Dec. 2022

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ADVISORY RECOMMENDATIONS�mental health coverage

Avoid harmful stereotypes
Avoid demeaning language
Use person-centered language
Include stories of people seeking help (self-help)
Include stories of people seeking help (external)
Include stories of successful recovery
Direct consumers to mental health resources
Feature subject matter experts and people with personal experience
Recommendations for suicide coverage*

Background: News Media & Youth Mental Health

This list includes recommendations from the advisory regarding mental health stories. The advisory mentions stories of people seeking help (#4 and #5) including from from friends, family neighbors, or even strangers (not just mental health professionals). I separated this recommendation into self-help and external help once I started seeing a lot of news outlet videos talking about self-help.

*As for #9, there were recommendations regarding coverage of suicide. More information can be found in my thesis. Analysis of this content is not included in the presentation.

I took each recommendation from the advisory and created a corresponding question for coders to answer in a Qualtrics survey.

Source: https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

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ADVISORY RECOMMENDATIONS�collective trauma coverage

Be fact-based in reporting
Avoid language that shocks, provokes, or creates a sense of panic
Content warnings or other methods to help viewers decide if they want to engage in distressing content, particularly graphic images or videos
Give audiences context (ex. highlight uncertainties and conflicting reports)*
Offer the public ways to make a positive difference (ex. donate funds or supplies)
Include positive messages (ex. stories of hope and healing)

Background: News Media & Youth Mental Health

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Methods

News Media & Youth Mental Health | Helsen

Post metrics

Topic meets inclusion criteria

Does not meet inclusion criteria

Collective Trauma Recs (5)

Mental Health Recs (8)

Added recommendation

Inductive codes

Brief summary

Using a Qualtrics survey, we collected the post’s topic, the number of likes, and the number of comments for all videos. �

If the video met the inclusion criteria, it was coded for adherence to each recommendation. There are 5 recommendations for collective trauma content and 8 recommendations for mental health content. [Note data were collected for 3 additional recommendations regarding suicide coverage, however, those data are not reflected in this presentation].

Lastly, I added a recommendation to the study that I thought should have been included in the advisory. The added recommendation is to mention action that is being taken or can be taken to address the issue at a level beyond the individual. While this was not included in the advisory, the social-ecological model recognizes that relationships, community, and society impact public health and a sole focus on individual level behaviors and actions is insufficient.

Inductive codes were recorded for each video as well as a brief summary of what the video was about

The team piloted coding and reached a satisfactory agreement rate. After all the data were collected, I double coded all mental health content and then, due to time constraints, I randomly sampled the collective trauma content to check the agreement rate.

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Details:

Pilot coding > 24 videos > 90.3% agreement rate not including irrefutable codes.
I double coded all mental health videos. Of the collective trauma event content, 5.0% (n=45) were randomly sampled and double coded. The agreement rate was 94.4%.

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RESULTS

03.

News Media & Youth Mental Health

MPH Thesis: Helsen

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5,344

total videos

Results: Performance by Outlet

News Media & Youth Mental Health | Helsen

met inclusion criteria

950 (18%)

Recommendation adherence rate by outlet (median)

OVERALL

ABC News

CBS News

NBC News

Daily Wire

19.5%

34.6%

14.3%

9.8%

7.7%

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Results: Performance by Exposure Type

News Media & Youth Mental Health | Helsen

Recommendation adherence rate by exposure type (median)

COVID-19

Climate change*

Mental health

Mass shooting

Weather Disasters*

35.7%

21.5%

18.6%

15.4%

12.5%

OVERALL

19.5%

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Results: Performance by Recommendation

News Media & Youth Mental Health | Helsen

Mental Health

Do not include harmful stereotypes about mental illness

Do not include�demeaning language

…

Share mental health resources

Stories of successful recovery

Example (negative | positive)

84%

66%

10%

8%

Self-care and inner-strength as�the only components of recovery

“Sociopathic liar”�“psycho” “crazy”�

…

988

Self-help; therapy; faith; mostly celebrities*

This slide shows the top two and bottom two recommendations adhered to for mental health content (n=62).

One harmful stereotype was portraying self-care and inner-strength for recovery without conveying external factors such as treatment or community. This included coverage of substance use disorder. �

Most of the examples of demeaning language came from Daily Wire and involved a non-medical-professional labeling someone as “crazy” or a “psychopath” or a “sociopathic liar” based on one action or opinion.

While few videos shared mental health resources (10%) or stories of successful recovery (8%), I did highlight some examples. The resource shared most frequently was the National Suicide Prevention Hotline (the full 10 digit number) and the recently shortened hotline number 988. Only one video mentioned the 988lifeline.org website and text message number. One video mentioned the SAMHSA Helpline.�

*Stories mostly featured celebrities, which may or may not be a good thing for youth mental health. They may serve as role models. Or their stories may not be as relatable as non-celebrity individuals.

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Results: Performance by Recommendation

News Media & Youth Mental Health | Helsen

Collective Trauma

Most adhered to: fact-based; no shocking+ language

Least adhered to: ways to make a positive difference; content warnings

For collective trauma content, the recommendations most adhered to were: (1) Fact-based reporting and (2) No language that shocks, provokes, or creates a sense of panic�

The recommendations least adhered to were: (1) Ways the public can make a positive difference and (2) Content warnings on distressing content.

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From left to right:

Most weather disaster content was fact-based and had no shocking language. While this may seem positive, the vast majority of this content depicts life-threatening circumstances with no positive messages.
For Climate change content: [was better than I expected, though still had low adherence rates]. This video covered global inequities and several other videos talked not only individual-level action but systemic action as well
For COVID: Overall, the content conveyed a severe situation (surges, death counts) with inadequate resources (strained hospitals, lack of tests)
For Mass shooting content: definitions of distressing content typically include blood and injuries. This study included depictions of chaos on the scene. Only 1 video out of 171 had a content warning. Only three videos mentioned the bipartisan gun safety bill passing and being signed into law (which is an example of a positive message).

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DISCUSSION

04.

News Media & Youth Mental Health

MPH Thesis: Helsen

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Limitations

Some Surgeon General recommendations were not well-defined
Gen Z is on TikTok, but what news media content are they actually seeing?
The mass shooting definition excludes potentially relevant content

Discussion

News Media & Youth Mental Health | Helsen

Future Research

Further analysis of engagement on distressing versus non-distressing content
Examine additional types of collective trauma events
Compare the U.S. with other countries
Track legacy media versus emerging media performance

1. For limitations, since some recommendations were not well defined, I created a definition. For example what is language that shocks provokes or creates a sense of panic? I used a restrictive definition so data may be underestimates.�

2. Gen Z is on TikTok at high rates, but what news media content are they actually seeing? Other studies could enroll youth and have them track news media they see on TikTok. Once there’s a verified set of videos, analysis can be done on that data set. Or more insight into TikTok’s algorithm could refine future study methods.

3. As for the third limitation, coverage of thwarted attempts or events where less than four people died like the UVa bus shooting or events where there were several injuries but no deaths such as the NYC subway shooting were excluded.

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I did collect and report engagement data in my thesis. Future research could see if there are any significant differences in likes or comments on distressing versus non-distressing content.

Studies can also examine other types of collective trauma events such as war or economic recessions; compare US outlets with other countries’ outlets; and track performance of legacy media like ABC NBC etc. versus emerging media like Daily Wire and other market entrants.

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ADVOCACY ORGS

U.S. SURGEON GENERAL

NEWS OUTLETS

Raise awareness among producers

Share resources

Track and publish performance

Monitor emerging media outlets

Add

Clarify

Publicize

Act urgently: Prioritize mass shooting content

Repeat what you’re doing well and revise what falls short

Be innovative: Maintain or increase content engagement AND develop authentic connections to the brand

Discussion

News Media & Youth Mental Health | Helsen

NEXT STEP:

disseminate findings and recommended actions

Next, I will create one pagers summarizing the findings and my recommendations and send them to relevant stakeholders.

When I was forming my plan, I connected with someone at the SG’s office who helped put together the report. The recommendations I’ll share with him are: (1) add a recommendation for news coverage to include ways to address the issue beyond the individual level. Not only donate supplies, but what community-level and structural-level solutions are proposed or underway (2) clarify definitions for “distressing content” and “language that shocks provokes or creates a sense of panic” (3) publicize the advisory to news media and advocacy orgs. Since the Administration is also focused on health misinformation shared via news and social media…
…advocacy orgs also need to play a role in raising awareness of the recommendations among producers. They should also share examples of what successful recovery looks like in mental illness and resources in addition to 988. Additional pressure can be put on news outlets to improve their content if their adherence to these guidelines are tracked and shared publicly
News outlets may choose to prioritize mass shooting content because it has the highest engagement rate and has lower adherence rates. My thesis includes specific examples of where improvements are needed across all content types. Lastly, distressing content may receive more reactions but I’m skeptical it will capture youth audiences in the long run as they become more aware of how distressing news can impact mental health. News outlets should be more innovative in how they increase youth engagement and develop authentic connections to the brand.

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THANK YOU!

linkedin.com/in/caroline-helsen/

caroline.helsen@yale.edu

Primary Advisor: Sarah Lowe, PhD

Secondary Advisor: Jonathan Purtle, DrPH, MSc

Coding Team: Dara Gleeson, Hannah Scott, Rhayna Poulin, and Victoria McClare

CREDITS: This presentation template was created by Slidesgo, including icons�by Flaticon, and infographics & images by Freepik and illustrations

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References

U.S. Surgeon General. Surgeon General Youth Mental Health Advisory. HHS. Published December 7, 2021. Accessed March 17, 2023. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health- advisory.pdf
Klin A, Lemish D. Mental Disorders Stigma in the Media: Review of Studies on Production, Content, and Influences. J Health Commun. 2008;13(5):434-449. doi:10.1080/10810730802198813
Heflinger CA, Hinshaw SP. Stigma in Child and Adolescent Mental Health Services Research: Understanding Professional and Institutional Stigmatization of Youth with Mental Health Problems and their Families. Adm Policy Ment Health Ment Health Serv Res. 2010;37(1):61-70. doi:10.1007/s10488-010-0294-z
Ohnuma A, Narita Z, Tachimori H, et al. Associations between media exposure and mental health among children and parents after the Great East Japan Earthquake. Eur J Psychotraumatology. 2023;14(1):2163127. doi:10.1080/20008066.2022.2163127
Su Z, McDonnell D, Wen J, et al. Mental health consequences of COVID-19 media coverage: the need for effective crisis communication practices. Glob Health. 2021;17(1):4. doi:10.1186/s12992-020-00654-4
Thompson, Rebecca R. Media exposure to mass violence events can fuel a cycle of distress | Science Advances. Published April 17, 2019. Accessed March 19, 2023. https://www.science.org/doi/10.1126/sciadv.aav3502
Alonzo R, Hussain J, Stranges S, Anderson KK. Interplay between social media use, sleep quality, and mental health in youth: A systematic review. Sleep Med Rev. 2021 Apr;56:101414. doi: 10.1016/j.smrv.2020.101414. Epub 2020 Dec 10. PMID: 33385767.
Project TMI. The news consumption habits of 16- to 40-year-olds. American Press Institute. Published August 31, 2022. Accessed March 16, 2023. https://www.americanpressinstitute.org/publications/reports/survey- research/the-news-consumption-habits-of-16-to-40-year-olds/