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Table of Contents
Year : 2021  |  Volume : 3  |  Issue : 2  |  Page : 77-86

Psychological Trauma Through Mass Media: Implications for a Current “Pandemic-Infodemic” Situation (A Narrative Review)

1 Department of Psychology, Saint-Petersburg State University; V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint-Petersburg, Russian Federation
2 Department of Social Work, Coburg University of Applied Sciences, Coburg, Germany

Date of Submission21-Dec-2020
Date of Acceptance21-Jun-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Prof. Vsevolod Anatolievitch Rozanov
Department of Psychology, Saint-Petersburg State University, Makarov Embankment, 6, Saint-Petersburg; V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhterev Str., 3, Saint-Petersburg, Russian Federation

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wsp.wsp_90_20

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There is evidence from earlier studies that the probability to be traumatized by pictures of disasters is associated with a high level of exposure, the traumatic significance of the pictured event, prior exposure to similar real-life events, and personality variables. Preexisting symptoms of posttraumatic stress disorder, depression, and anxiety are predictors of the higher impact of mass media (MM) and social media (SM) contributing to a vicious cycle. We aimed to discuss mechanisms through which MM and SM may cause massive indirect traumatization of populations and that may be relevant for the psychosocial conditions that emerged during COVID-19 pandemic news bombardment. The current pandemic is an example of a serious and deadly disease with extremely enhanced representation in the MM and SM and high rates of unverified, false, and sometimes apocalyptic information. Both mass as well as social medial tendencies to select their news according to their controversial and often negatively affective load contribute to this. This phenomenon is characterized as “infodemic” – a situation that may have profound consequences for mental health due to undermining feelings of personal safety, corroding social cohesion, and inducing conflicts and bitterness. Pandemic-infodemic situation has shown that complicated but inevitable turn to higher transparency including ethically motivated restrictions of anonymity and the contents of the web measures that, however, have to be sensitively balanced with the demands guaranteeing the freedom of opinion, the freedom of speech and the avoidance of censorship. In general, there is a need for complex solutions, difficult decisions, and intricate balances.

Keywords: Disasters, infodemic, mass media, pandemic, psychological trauma, psychosocial variables, social media

How to cite this article:
Rozanov VA, Rutz W. Psychological Trauma Through Mass Media: Implications for a Current “Pandemic-Infodemic” Situation (A Narrative Review). World Soc Psychiatry 2021;3:77-86

How to cite this URL:
Rozanov VA, Rutz W. Psychological Trauma Through Mass Media: Implications for a Current “Pandemic-Infodemic” Situation (A Narrative Review). World Soc Psychiatry [serial online] 2021 [cited 2023 May 31];3:77-86. Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/2/77/324993

  Introduction Top

It has been already predicted that the adverse public health effects of the recent COVID-19 pandemic may be seriously aggravated by different sources of information, both official ones, like public TV and newspapers, and unofficial, like social media (SM).[1] Such predictions are based on observations from previous information campaigns associated with the Ebola outbreak – in spite of the fact that US populations were almost unaffected by the disease, the increased media coverage caused quite distinct distress, anxiety, and impaired functioning.[2] COVID-19 pandemic has impacted all nations and countries, it is causing anxiety, fears, psychological distress, sleep disturbances, depression, and the exacerbation of addictions and other psychiatric disorders in all populations.[3] The current situation, however, is not only pandemic but also “infodemic,” with not only understandable fears to catch the infection and grave expectations of future economic decline, but also with extreme media coverage, an avalanche of fake news, a propagation of useless medicines, and deliberate disinformation.[4] All this is the result of the dramatic development of digital technologies, as well as the ubiquity of the internet and its pervasive character.

This information bombardment is falling on a well-prepared soil. Exposure to traumatic events has become rather prevalent in the modern world – survey of about 70,000 adults from 24 countries has revealed that 70.4% of the respondents had experienced at least one type of a traumatic event during entire life.[5] In the US traumatic events are experienced by about 90% of respondents and multiple types of events are the norm.[6] The negative long-lasting psychiatric consequences of such events are understood today in terms of posttraumatic stress disorder (full-scale PTSD, complex PTSD or separate symptoms manifestation). The construct of PTSD appeared in 1980 as an effort to understand and generalize mental health problems and psychopathologies of about 3 million Vietnam War veterans in the 70s.[7] Today, the lifetime prevalence of PTSD in the general population is ranging from 2.3% to 19.5% around the world in peacetime, reaching 50% in groups affected by natural and technogenic disasters, military conflicts, or terrorist attacks.[8],[9] Another overlapping construct is that of a psychological trauma – a condition with less clear diagnostic criteria, widely applied to explain psychological consequences of any crisis, disaster, personal or collective. One of the strongest predictors of both conditions is the feeling of helplessness in the face of dramatic, shocking or frightening event that undermine the feeling of control over one's life and personal integrity.[10]

In this overview, we aim to explore how technological, vivid, naturalistic, and ubiquitous live-streaming of disasters from TVs and billions of smartphones may cause psychiatric consequences similar to those induced by real disasters and if lessons learned from such studies may be relevant to the modern pandemic situation.

  How Mass Media Induce Psychological Trauma or Posttraumatic Stress Disorder and who is the Most Vulnerable? Top

General explanations of the indirect traumatization

The fact that a vivid display of a traumatic event, both of natural disasters such as earthquake, tsunami, hurricane, or terroristic acts and shooting with many victims, can cause traumatic experiences in the audience similar to the experiences of witnessing the event in reality, was reported many times.[11],[12],[13] Several hypotheses exist to explain why media reporting and streaming may become traumatizing per se on a personal level the effect seems most probable when the perception of the report is accompanied by a realization that this could happen to the spectator himself or to his/her relatives and loved people. This may be due to higher personal sensitivity or simply due to a proximity to the event (next of kin, the same city, etc.). Another probability is that individual TV-watching habits or addictive involvement in the Internet and SM can enhance the effect. Quite possible indirect exposure may impact mostly those who are already traumatized and/or have mental health problems or are specifically vulnerable to psychosocial stress. Moreover, some demographic groups (age, gender) may be more easily traumatized than others.

Most prominent historical examples and first evaluations

Objective data are provided primarily by studies conducted in the U.S., where two widely visualized terroristic acts have been studied from this point of view – the September 9, 2001 (known as 9/11 attack), and Boston Marathon Bombing. Evidence was obtained that PTSD symptoms could be found not only in those, who were directly witnessing the event, but also among much wider auditorium of TV-viewers. Geographical proximity to the site of the event and hours of TV watching appeared to be important predictors of indirect trauma.[11],[12],[13],[14],[15] Symptoms were associated with female sex, low income, poor education, poor social support, and prior psychotropic drug use.[16] In some studies respondents leaving rather far from New York and exposed only by TV had even twice more dreams containing features related to the 9/11 attack shortly after it happened.[17]

Time course and persistence of the symptoms

Indirect trauma may be exacerbated over time. In a longitudinal observation, it was found that early 9/11-and Iraq war-related TV exposure and the frequency of exposure to war images predicted increased PTSD symptoms and physical health impairment in 2–3 years after 9/11.[18] It should be mentioned that the terroristic act in New York on the September 11, 2001 was an event that made “people stay glued to the television not able take their eyes off the screen for fear of missing something.”[19] The national survey has found that on the day of the attack adults watched a mean of 8.1 h of television coverage, and their children watched a mean of 3.0 h.[20]

Sensitization and cumulative effects

The 9/11 event became a catalysator for higher general level of anxiety in the population and for stronger impact of events, which followed. In a study of acts of bioterrorism (anthrax envelopes posting) it was found that in people who were informed by television, the level of initial media exposure was a powerful predictor of distress, whereas the subsequent media exposure predicted fearful outlook over time.[21] Studies dedicated to another widely pictured terroristic act in the U.S. – the Boston Marathon bombing – in a month after the event found acute stress symptom scores in Boston comparable to New York, but lower nationwide. After controlling for mental health, demographic data, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with even higher acute stress than direct exposure to the bombings.[22] Thus, by spreading negative information beyond the directly affected communities, MM are impacting mostly those who were previously traumatized by previous disastrous experiences.[22] Both a direct contact with the event and a live-media-based exposure can sensitize spectators to the negative impact of subsequent events, producing a cumulative effect, especially in communities previously exposed to disasters.[23]

Senseless violence and self-selection

One of the terrifying types of events widely spread by TV and other MM is the mass shooting that periodically happens in colleges and universities of U.S. and that recently has occurred in other parts of the world. Such killings aimed at random victims are perceived as “senseless violence”– a phenomenon that puzzles and petrifies onlookers and survivors[24],[25] and often bears features of an extended suicide. A study dedicated to Virginia Tech shooting in 2007 has revealed that in a remote students' sample a greater exposure to news about the event resulted in a variety of stress-responses and adverse psychological outcomes including fears and feeling of safety loss.[26] Lowe and Galea have reviewed studies of mass shooting in colleges and universities and have pointed that mental health consequences of indirect exposure could be partly the result of “self-selection” and “reverse causation,” i.e. that participants with more severe preexisting symptoms might be more likely to approach media exposure.[27] High-level media consumption of picturing of the disastrous event was a risk factor especially in individuals lacking social support or having mental health problems and preexisting symptoms of PTSD.[16] Busso et al. aimed to evaluate the interplay between media exposure, preexisting psychopathology, autonomic nervous system (ANS) reactivity, and prior violence exposure. It was found that a low media exposure to Boston marathon bombing predicted symptoms of PTSD mostly in students with high sympathetic reactivity, while high exposure was less dependent on ANS reactivity. On the other hand, there was an association with prior early life traumatic exposure and indirect traumatizing effect.[28]

Community sensitization and different factors interplay

All above-mentioned studies provide evidence that the traumatizing effect of a MM portrayal of mass violence is quite real. A recent meta-analysis of 18 studies comprising an overall sample of 1.634 persons confirmed that media exposure to disasters and large-scale violence is followed by adverse psychological outcomes, anxiety being the most well confirmed reaction.[29] Community sensitization, i.e. belonging to a region and a population that had recently been exposed to a certain type of disaster or violence portrayed by the media appeared to be an important factor.[29] Thus, not only factors belonging to the event itself, such as severity, intensity of representation in MM, traumatizing potential, psychological meaning for the population– but also personal factors such as belonging to sensitized group, having a background of severe stressful events in the earlier life must be taken into consideration.

  Further Development of Models and Mechanisms of Media-Induced Psychological Traumata Top

Fear conditioning and extinction model

An excessive utilization of MM and SM is associated with many different pathologies, including obesity due to high-calorie intake and sedentary lifestyles, anorexia in women caused by promotion of specific beauty standards, anxiety, depression, and sleeping disorders in teenagers and older people due to constant being online, etc.[30],[31],[32] The possibility for a massive traumatization through vivid representations of disasters complements this list. The development of PTSD symptoms during an indirect exposure to disasters and terrorism may be explained using Pavlovian fear conditioning and extinction model.[33] Psychological studies provide evidence that about 20% of people have a biologically based higher sensitivity to emotional stimuli and graphic contents, which is associated with an enhanced activity in brain regions involved in awareness, the integration of sensory information, empathy and action planning.[34] From the point of a Pavlovian concept, the amount of reinforcements (evaluated as the number of hours of TV watched or gadgets screen time) should be the main driver of negative outcomes. Most of the studies confirm that a high level of indirect exposure predicts higher psychological trauma symptoms.[15],[18] Fear and other consequences of the trauma may extinct over time, but if they are reinforced again by another frightening event, a new cycle of emotions and mental health problems can start, ultimately resulting in more severe PTSD symptomatology, depression or anxiety.[33]

Role of preexisting psychopathologies and vicious cycle model

Another explanation is based on the idea of exacerbation of preexisting mental health problems under massive MM or SM influence. Indeed, psychiatric patients depending on the diagnostic groups, appeared to be more vulnerable to news regarding 9/11 attack as compared with controls.[35] All types of mental health effects induced by disaster media coverage (PTSD-caseness, stress reactions, posttraumatic symptoms, depression, anxiety and substance use) were mostly prominent in individuals with preexisting depression, anxiety or PTSD.[33] Some studies are trying to prove that real-life traumatization could be augmented by TV exposure to another disastrous event by inducing a vicious cycle.[36] For instance, Pfefferbaum et al. showed that surviving a prior terrorist incident (the Oklahoma City bombing in 1995) and developing a PTSD predisposes individuals to adverse reactions to a later media coverage of another terrorist attack (9/11 event in 2001).[37] Given that the media coverage of disasters is growing overall, a repeated MM exposure leading to re-activation of traumatic experiences may be one of the reasons for increasing PTSD symptoms in the whole population.[38] Pertinent distress and anxiety can cause behavioral patterns increasing trauma-related media consumption, for instance searching the web for specific information that, in turn, may promote increased distress. This hypothesis was tested in a 3-year longitudinal study following the 2013 Boston Marathon bombings and the 2016 Orlando Pulse nightclub massacre using a national U. S. sample of 4165 respondents. It appeared that the bombing-related media exposure predicted posttraumatic stress symptoms (PTSS) 6 months later, which predicted worries about future negative events 2 years after the bombings, which in turn predicted increased media consumption and acute stress following the Pulse nightclub massacre 1 year later. Thus, trauma-related media exposure perpetuates a cycle of high distress and increased media use.[39]

Desensitization model

On the other hand, such development is inherent only to vulnerable personalities, while most people experience desensitization. Desensitization results in perceiving news about another mass shooting or terroristic act with lower emotionality, even if they happen in a closer neighborhood. Such adjustment to televised scenes of violence, especially in young people, replaces the emotional distress by numbness leading to lowering anxiety and depression.[40] Furthermore, professional approach may lead to detached response. One study has assessed 81 employed journalists, who presumably may be at higher risk due to their professional exposure to videos with violent events and disasters. Although nearly 80% of the sample reported recurring intrusive memories about the events watched, the overall PTSD symptoms in this sample were low. However, participants with a prior trauma, higher work-place stress, and a greater exposure to video footage tended to show more severe symptoms.[41]

Anticipated traumatic response model

Traumatization is more probable in populations and societies cultivating high expectations of well-being and experiencing long-lasting safety, while communities with a low level of safety and a highly persistent degree of violence and danger presumably may have higher thresholds and suffer less. On the other hand, one should consider more complex effects, for instance the possibility of anticipated traumatic response (ATR). ATR depicts future-focused distress and safety concerns stemming from exposure to threat-related media and/or social discussions. It is associated with negative affect, depression, anxiety, stress, neuroticism, and repetitive negative thinking.[42] This construct (”thoughts about reduced safety and security for oneself and others due to concern that events similar to those reported may be experienced personally in the future”) has some overlapping features with PTSD. However, in contrast to PTSD, it is not induced by previously experienced events but is turned towards future anxiety.[42]

  The Role of Age – Indirect Exposure of Children Top

Higher vulnerability of children and adolescents

Developing brain is more susceptible to conditioning and learning, and youngsters may have a higher emotional liability. Studies show that children in all cultures are much more susceptible to traumatic experiences.[43],[44] The prevalence of PTSD is usually substantially higher in children and adolescents than among adults, reaching an extremely high rate of 60%–70% in some specific environments, like war zones.[9],[45],[46] Moreover, children seem to be especially sensitive to the picturesque graphic contents produced by modern MM and SM and may be more prone not only to reexperiencing, but also to reproducing emotions and aggressive behaviors in response to video content.[47],[48] Thus, it is no surprise that terrorism on TV affects youth stronger that older people, as reviewed recently.[49] Higher vulnerability of children is confirmed after indirect exposure for the most studied event – the 9/11 attack,[50] and each subsequent exposure has more impact. In U. S. children with PTSS due to an extensive exposure to news of hurricane Katrina were especially sensitive to disaster television coverage of the following hurricane Gustav.[36]

The role of family, parental habits and mental health

Children's direct and indirect traumatization is influenced by family variables, which include both TV-viewing practices and the reactions of parents. The last are based on their own preferences and eventual psychopathologies.[51] A lower socioeconomic status of the family, a lower educational status of parents, high parental stress and poor coping ability appeared to be strongest risk factors for adverse psychological effects in their children.[52] Duarte and colleagues have assessed more than 8000 NYC young students categorizing them as having a direct exposure through a family member or an indirect exposure to the 9/11 attack through different types of MM. It was found that a greater probability of PTSD in adolescents 6 months after the event was associated with greater use of television, radio, and print media among those with no direct or family exposure. An intense use of media among those with direct or family exposure was not associated with an increase of PTSS.[53] Otto et al. assessed PTSS in 166 children and 84 mothers without direct exposure to the 9/11 attack including 2–6 years old children who had been assessed for the presence of temperamental behavioral inhibition.[54] Younger age, identification with victims of the attack, and the amount of television viewing predicted an increased risk. The parents' depression was associated with higher PTSS, while a higher level of family support predicted a lower risk of PTSS. Behavioral inhibition (lower intensity of reactions of children to novel events, people, and objects) was linked to lower rates of PTSS.[54]

Other significant figures and coping styles role

In primary and secondary school environments, the reaction of significant people (teachers and caretakers) also may mediate indirect effects in young students. In a study from China following the devastating Sichuan Earthquake, the PTSS, perceptions and emotional reactions were measured 1 and 6 months after the event in more than 3500 students exposed to visualizations of the earthquake.[55] Those children, who were frequently exposed to a distressful imagery and had experienced at least two types of negative life events, as well as those, who perceived their teachers as distressed due to the earthquake and who were emotionally disturbed due to the earthquake were at higher risk of probable PTSD at 6-month follow-up. The authors conclude that parents and teachers should be aware of the negative impacts of disaster-related media exposure on adolescents' psychological health, especially in the context of repetitive exposure.[55] Remarkably, similar results were obtained in a group of Israeli adolescents living in a war zone. In this group, an interaction between real-life, TV exposures and mediating role of parents was found, however only in case of a low real-life exposure parents as intermediaries did buffer the effect of television exposure on general distress.[56] In an older sample of Israeli university students, a more frequent media exposure of terror attacks was positively related to higher levels of distress and PTSS. A higher degree of general coping resources levels was related to lower levels of PTSS, whereas greater use of avoidance behavior was related to higher distress.[57] In a sample of Japanese university students higher posttraumatic psychopathology after media exposure to 2011 earthquake and tsunami correlated with avoidance and hyperarousal.[58] Thus, certain counterproductive coping styles may serve additional risk factors for MM traumatization.

  The Role of Age – Indirect Exposure of Older People Top

Studies on indirect traumatization in older age by MM are rare. In a sample of Israeli adults, the negative effects of constant news broadcasting on psychological well-being were increasing with age,[59] while in Dutch adults higher age did not predict unpleasant emotional reactions to broadcasting negative news.[60] In a study of anthrax envelopes attacks, however, older adults were found to consume more disaster media coverage than younger adults.[21] In South Korea, it was shown that SM are responsible for increasing risk perceptions of the MERS epidemic and this effect was positively associated with age.[61]

  Modern Social Media and Psychological Trauma Top

Social media and messengers as a source of indirect psychosocial impact

Modern mankind is more and more linked to Internet and SM. Billions of people cannot any longer imagine their lives without the possibility to exchange information (messages, pictures, and videos) in a real-time manner through a variety of free-of-charge messengers and accounts in the SM. All around the world an increasing use of SM is normal to the youngest, who are watching streams on YouTube instead of TV. An excessive use and increasing dependency of SM (Facebook as well as national platforms) can be a source of frustration, depression and social anxiety.[62],[63],[64] These novel information sources have all characteristics of mass media (MM), for instance, some bloggers may have millions of followers. First studies dedicated to the traumatizing effects of SM come from the USA. It was reported that children, who saw images of death or injury in the internet reports, had more PTSS in comparison with those who were mostly watching television.[65] The traumatizing effect of new types of media is associated with younger age and prior direct exposure to collective trauma.[66] There is an evidence that networking platforms may be a source of massive emotional contagion, both positive and negative.[67],[68] In one of the studies focusing on the role of Twitter in distributing negative emotions and anxiety messages authors observed an increase of negative emotional expressions shortly after violence in U. S. college campuses among the sampled followers of the event.[69] In another study researchers have analyzed 1.16 million tweets, representing 25,894 users from San Bernardino, CA, which survived a terrorist attack in 2015, and a matched control community (Stockton, CA). A linguistic analysis has revealed that negative emotions significantly increased by 6.2% in San Bernardino on the day of the attack and remained elevated for 5 days; while no elevation was observed in a control sample.[70]

Social media as a source of emotional contagion

In Europe several studies also have tried to evaluate the role of social networks and media in distribution of stress and emotional reactions. In the example of the terrorist event in Woolwich, London in 2013 it was shown that sentiments expressed in the tweets predict both the size and survival of information flows in this network, in other words, the more excited are the Tweeter messages, the longer and wider they are retweeted.[71] A study dedicated to Paris 2015 terroristic attack (shootings in several restaurants and Bataclan night club massacre), revealed that massive SM communications interacting with a dysfunctional regulation of emotions in young adults lead to enhanced anxiety, depression, somatization symptoms and cognitive alterations.[72] Interestingly, there was no association between traditional media consumption and websites browsing and psychopathological symptoms. Authors support the emotional contagion hypothesis, which implies that substantial time spent in social networks may lead to an in between-person circulation of negative emotional states, resulting in mental health disturbances, that may be independent of a prior childhood trauma or present trauma exposure.[72] Some studies in France measured different media use, posttraumatic stress, and sleep patterns showed, that those with moderate or high SM use reported higher PTSS than those reporting no use.[73],[74] Interestingly, insomnia was associated with both traditional and SM use, while associations between SM and insomnia were independent of traditional media use.[73] The authors conclude that in the context of persistent terrorist threats, the effect of media consumption on psychopathological outcomes becomes a serious issue and that interventions targeted at SM may be particularly important following mass trauma.[73],[74]

Social media may be both for good and for evil

The impact of the most recent acts of terror in Europe (Paris in 2015, Brussels in 2016, Manchester arena accident in 2017), as well as USA mass shootings, which usually includes about a dozen of events per year[74],[75],[76],[77] seems to be more strongly associated with twitter, Facebook, and other SM, given the growing segment that these sources of information have captured recently.[78] Existing studies testify that these instruments may as deleterious as traditional TV, and possibly may have even bigger impact in the modern world, where trust in official sources is falling. Moreover, the socially deprived communities experience double disadvantage – sending fewer tweets but expressing more negative emotions.[78] On the other hand, the use of Twitter and other social networks in response to terror may also be positive by establishing immediate channels of communication between citizens, emergency services, governmental structures and by providing social and other types of support.[79],[80] Possibly due ambiguous roles of SM in a recent meta-analysis authors could not make a definite conclusion regarding negative or positive effect of SM on depression and anxiety.[81] Decisive may be what kind of society people want to live in and how they perceive the role of SM.

  The Psychological Impact of Mass Media and Social Media during COVID-19 Pandemic Top

Unprecedented information flow

From the beginning of the pandemic, the avalanche of frightening information, different ideas of treatment that soon appeared noneffective, pictures of suffering patients on respiratory devices, helpless and desperate relatives and disoriented health care officials, controversial discussions of virological and epidemiological experts, morbidity and mortality cases plots, pictures of feverish preparations for mass burials, comparisons of national strategies aimed to decrease morbidity and mortality formed an atmosphere of helplessness and unpredictability. In the first phase, people were increasingly seeking information watching TV news, browsing the web, and communicating in SM. In US, total digital visits were up 425% in March 9–15 versus January 6–12, and the week of March 9–15 was up 79% over the week prior. For mobile web, visits were up 671% March 9–15 versus January 6–12.[82] False news, conspiracy theories, magical cures, stories of known persons infected were being shared at an alarming rate, mostly via the SM, with the potential to increase anxiety and stress.[83] Under such conditions rumors and disinformation are spreading easily and readily, but never before the mechanism of spreading was so technologically effective. Maybe for the first time in the history of mankind, humanity appeared in a situation that could be characterized as “infodemic.” The reason is of course internet and electronic media that has been developed in the whole world to an extremely high level, leaving no place on the planet to be not connected. It may be also noted that during the Spanish flu pandemic roughly 100 years ago the extend of the disease was deliberately hidden by the governments due to the military situation. Thus, both necessary information but also disinformation during the current COVID-19 pandemic has posed a set of challenges not encountered before.

Objective studies on the indirect effects of mass media and social media in the pandemic

Recently the media exposure has lowered, but remains still high, with spikes of information when new waves or new variants of the virus emerge. By now several publications have already provided first results on the possible role of MM and SM in mass traumatization during COVID-19 pandemic. High rates of symptoms of anxiety (6.33%–50.9%), depression (14.6%–48.3%), PTSD (7%–53.8%), psychological distress (34.43%–38%), and physiological stress (8.1%–81.9%) are reported in the general population during the COVID-19 pandemic in China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark. Risk factors associated with distress measures include female gender, younger age (≤40 years), presence of chronic/psychiatric illnesses, unemployment, student status, and frequent exposure to SM/news concerning COVID-19.[84] An online study from China of 1118 people has revealed that different types of media (official, commercial, social, and overseas media) in the current situation of pandemic caused vicarious traumatization (reaction to overwhelming reports and vivid visual materials about trauma survivors) to different degrees, commercial media being most traumatic.[85] In another study it was shown that the use of “new” rather than traditional media was significantly associated with more depression, anxiety, and stress. Viewing stressful content (i.e. severity of the outbreak, reports from hospital) was associated with more negative affect and depression. On the other hand, presenting heroic acts, knowledgeable speeches from experts, and objective information about the disease and possibilities of prevention was positively associated with less depression.[86] COVID-19 anxiety was strongly associated with problematic smartphones use and addiction.[87] The authors advocate for a restricted use of novel media and measures to prevent problematic smartphone use in young people.[86],[87] An extremely high exposure to SM (more than 80% of 4872 Chinese respondents in February 2020) was associated with higher depression and combination of depression and anxiety.[88] Authors advocate for more attention from the government to mental health problems, especially depression and anxiety among general population and to combating infodemic.[88]

Studies from other countries provide quite similar evidence. For instance, in Iraqi Kurdistan, a study involving 516 SM-users reported that there was a significant positive statistical correlation between self-reported SM use (mostly Facebook) and the spread of panic feelings related to COVID-19. Authors consider that SM has played a key role in spreading anxiety about the COVID-19 outbreak.[89] In Brazil, authors also consider that SM platforms have been a key factor in the dissemination of traumatizing information and advocate a more responsible use of these tools to enhance advantages and diminish disadvantages associated with them.[90]

Pandemic pointed on the problems in the modern information environment that affect mental health

In a current situation, billions of web-resources and private users have received a chance to distribute any type of content often loosing ethical restrictions in a global competition. One of the recent features in this domain are deliberately constructed fake news, either “for fun,” as a sarcasm or satire, or as an attempt to hyperbolize disasters and threats, to undermine the trust in the “official data” and to destroy a community cohesion by inducing conflicts between groups or between citizens and the official structures.[91] That turns increasingly into a serious problem – huge efforts are needed to disconfirm fake news, as people are more prone to believe in negative than in positive information.[92] Furthermore, MM tend to selectively report negative events characterized by discontinuity, high quantity, local implication as well as leading to indignation by breaking moral and other norms, ethical principles, or political correctness.[93] The sensitivity to media is based on media behaviors and qualities from one side, and viewer (consumer) reactions, emotional and behavioral patterns from another side, as well as on interaction between these variables. For, instance, numerous studies have already characterized a new type of addiction – SM dependence.[94],[95] It is associated with elevated anxiety, depression, other types of dependencies (Internet-addiction, gambling, problematic smartphone use, eating behavior disturbances) and phobias (fear of missing out, fear of losing a smartphone, etc.). Individuals with higher level of anxiety and depression in a state of frustration more often turn to SM in attempts to lower their anxiety.[94],[95] Consequently, their addiction may become an extra factor enhancing their media consumption and increasing their risk. If the content is associated with disaster picturing, victims' messages, and other peoples' stressful and anxious comments (which is most probable in a collective condition of fear and negative expectations), it may cause more indirect traumatization. It is relevant for the current pandemic situation, when billions of worried citizens under quarantine, whose plans for future were ruined, forcefully deprived of their usual working activities, were stuck in their homes monitoring different types of web-sites and sharing their anxious and depressive messages in SM. Some authors have very aptly coined it as “digital stress and digital burnout.”[96]

Contemporary models of the indirect effects of the mass media and social media and pandemic

Recently several other theories have been discussed in this context.[97] One is the uncertainty management theory, which gives still more explanations to the vicious cycles created by media. Apparently, the MM strategy to add anxiousness and hype to the coverage of an event may create still higher attention, but also initiate uncertainty. It motivates individuals to seek out more information from the same or other media sources to decrease this unpredictability. Another theory assumes that the disaster coverage of the media might lead readers and audiences to perceive the world to be a more disastrous place than it is. This concept, called cultivation theory, can explain long-lasting effects of media coverage that predisposes an acceptance of stressful information.[97] In the current pandemic situation media seem to have achieved this goal. On the other hand, the world really appeared more dangerous than it was perceived! It is questionable if understanding the fragility of the human population will influence MM and especially SM to behave more responsibly. However, there are many examples during pandemic showing that balancing disturbing information by supportive messages, focused on successful recovery, efficient methods of treatment and finally, on possible vaccination is helpful. There is also huge flow of supportive content in SM, examples of social support, psychological aid, humorous messages, images, and videos. The use of SM for anxiousness or for coping depends on the mental health resiliency.[98] Moreover, even negative collective emotions distributed by SM after a disaster may lead to higher solidarity, revealing the social resilience of a community.[99]

  Conclusion and Ideas for Further Studies and Prevention Top

Apparently, the vulnerability of the human condition, the humanistic background and the socio-political implications of different supportive strategies becomes increasingly important in the present situation of new communicative technologies, information overload and pandemic-related morbidity, mortality, and unpredictability. Modern technological advances are not only a marker of a progress, but bear a risk undermining human beings' resilience and resistance to mental health disturbances, dysfunctions, and decompensations. The current pandemic is an example of a serious and deadly disease with an extremely enhanced representation in the MM and social networks. This is an unprecedented situation that becomes a challenge to the whole humanity.

It seems necessary to outline generally some main pathways and kings' roads to prevention of an infodemic imbalance and a stressful information overload. They may include (1) Early educational crisis interventions in the general population, encouraging a more controlled, informed and skeptical style of MM consumption; (2) Better social support, earlier recognition and better primary prevention and follow up treatment of mental disturbances; (3) Teaching young parents positive practices of monitoring their children's exposure to TV, selection and control of television content as well as limitations of their access to mobile phones and gadgets. (4) Concerning adolescents and young adults, there is an urgent need of promoting personal growth, self-actualization and intrinsic life goals development instead of hedonistic habits and pursuing unrealistic goals of immediate need satisfaction as they are facilitated by too intensive use of modern digital communication devices; (5) There is also a need of a new set of ethical decisions regarding the role of MM and the use of modern digital social communication tools; (6) There is a need of a complicated but inevitable turn to higher transparency including ethically motivated restrictions of anonymity and the contents of the web measures that, however, have to be sensitively balanced with the demands guaranteeing the freedom of opinion, the freedom of speech and the avoidance of censorship, which is necessary in order to keep alive the free and pluralistic democratic society we all want to live in.

In general, there is a need for complex solutions, difficult decisions and intricate balances ahead of us. Whether this will lead to an era of increased censorship or a new state of “freedom under responsibility” is up to all of us.

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Conflicts of interest

There are no conflicts of interest.

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