The role of Somatization as a clinical marker of Depressive Symptoms and Suicidal Risk associated with Social Media use in Adolescents

Purpose Adolescent mental health disorders are increasing worldwide, and suicidal ideation represents a major public health concern. Social media use is a pervasive component of adolescents’ daily lives and may influence psychological well-being through complex behavioral and emotional mechanisms. This study investigated whether patterns of social media engagement and perceived online self-expression are associated with depressive symptoms, somatic complaints, and suicidal ideation in adolescents. Methods A survey was conducted among 1,364 adolescents aged 11–19 years recruited from six schools. Participants completed questionnaires assessing social media use patterns, depressive symptoms (Children’s Depression Inventory-2), and emotional–behavioral problems including somatization and suicidal ideation (Child Behavior Checklist). Correlation analyses, multiple regression models, and sequential mediation analyses were performed to examine direct and indirect associations among variables. Results Daily social media use was reported by 96% of participants, with 20% spending more than four hours per day online. Clinically relevant depressive symptoms were observed in approximately 12% of adolescents, while 9% reported recurrent suicidal ideation. Greater time spent on social media was significantly associated with higher levels of depressive symptoms, somatic complaints, and suicidal ideation. Adolescents reporting greater ease in online self-expression showed increased psychological vulnerability. Sequential mediation analysis indicated that perceived online self-expression was indirectly associated with suicidal ideation through increased time spent online, depressive symptoms, and somatization. Gender-stratified analyses revealed stronger sequential effects in females, whereas in males suicidal ideation was primarily mediated by depressive and somatic symptoms. Conclusions Problematic patterns of social media engagement may represent clinically relevant psychosocial risk markers in adolescents. Somatic symptoms appear to function as a clinical bridge between maladaptive digital behaviors and suicidal vulnerability. Pediatricians should consider screening for digital habits when adolescents present with depressive symptoms and medically unexplained somatic complaints, as early identification of at-risk youths may improve preventive interventions.