Exploring Problematic TikTok Use and Mental Health Issues: A Systematic Review of Empirical Studies

TikTok’s global rise since 2017 and its highly engaging, algorithm-driven short-video format have spurred concerns about excessive and problematic use. The platform’s design (For You Page, endless scroll, personalized feeds) may foster prolonged engagement and addictive-like behaviors, particularly among adolescents and young adults. This review addresses the research question: what is the prevalence of problematic TikTok use and how is it associated with mental health outcomes? The purpose is to synthesize empirical evidence on prevalence, risk factors, usage patterns/trends, and mental health correlates (eg, anxiety, depression, stress), and to inform clinical identification and intervention strategies. The study highlights the importance of understanding TikTok’s unique engagement mechanisms and their implications for vulnerable populations.

Prior work suggests TikTok’s immersive design (eg, personalized FYP, short-form video streams, endless scroll) increases screen time and supports addictive tendencies by meeting psychological needs like self-expression and escapism (Montag et al.). Studies have linked algorithmic reinforcement to flow experiences (enjoyment, concentration, time distortion), which mediate addictive behaviors in adolescents (Qin et al.). Comparative analyses indicate TikTok drives stronger engagement than platforms like Instagram or Facebook, and emotional investment in likes/followers is associated with problematic social media use and depression (Hendrikse & Limniou). Research also documents associations between TikTok use and body image concerns, social comparison, and exposure to potentially harmful content (eg, substances), while acknowledging some positive, recovery-oriented content. During COVID-19, increased TikTok use served as coping and social connection but elevated risks for problematic consumption. Collectively, the literature underlines unique addictive potential relative to other social media due to algorithmic personalization, novelty, and reward mechanisms.

Design: Systematic review conducted per PRISMA 2020 guidelines. Protocol registered on OSF (https://osf.io/cjf97). Search Strategy: Comprehensive searches in PubMed, Embase, Scopus, Web of Science, and PsycINFO through July 10, 2024. Iteratively refined Boolean queries using terms such as TikTok, TikTok addiction, problematic TikTok use, short video addiction, TikTok use disorder, social media addiction, mental health, psychological traits, usage patterns, demographic factors, technology use, compulsive use, behavioral addiction. No language restrictions; manual reference screening performed. Study Selection: Records managed in EndNote X9; duplicates removed. Two reviewers independently screened titles/abstracts against inclusion/exclusion criteria, with full-text review and consensus resolution; third reviewer consulted as needed. Inclusion: Empirical studies focusing on TikTok addiction/problematic use; peer-reviewed; cross-sectional, longitudinal, qualitative, mixed-methods; clear objectives/methods/outcomes related to TikTok use. Exclusion: Non-empirical (reviews, editorials, commentaries, theoretical papers), general social media without TikTok emphasis, content-only analyses, grey literature, conference abstracts, and non–peer-reviewed articles. PRISMA: Identified 1,513 records; 85 duplicates removed; 1,428 screened; 1,311 excluded; 117 sought for retrieval and assessed; 91 excluded (33 non-empirical, 30 grey/non-peer-reviewed, 28 not focused on TikTok); 26 included. Data Extraction: Standardized form captured authors/year, title, domain, country, sample characteristics, objectives, design, interventions, risk factors, prevalence rates, usage patterns/trends, statistical measures, outcomes, key findings. Quality Assessment: Applied JBI for cross-sectional studies, CASP for qualitative studies, MMAT for mixed methods, Cochrane RoB 2 for randomized/experimental studies, and NOS for longitudinal designs. Two reviewers independently assessed quality; disagreements resolved by consensus/third reviewer. Data Synthesis: Narrative synthesis and thematic analysis of prevalence, demographics, and mental health factors. Quantitative data summarized with descriptive statistics; comparisons across studies to derive broader conclusions. Software: IBM SPSS Statistics v28. Ethics/Funding: Secondary analysis only; ethical approval not required; no external funding; authors declared no conflicts of interest.

• Included 26 empirical studies with 11,462 participants across 14 countries; majority from Asia (68.8%), with China contributing 45.5% of participants. - Study designs: 73.1% cross-sectional (n=19), 7.7% longitudinal (n=2), 7.7% mixed methods (n=2), 3.8% experimental (n=1), 7.7% qualitative (n=2). - Pooled prevalence of TikTok use: 80.19% (8,141/10,154). Highest usage among ages 18–29; notably higher among females and lower socioeconomic groups. - Short-term experimental exposure (20 minutes) increased depression by 12% and anxiety by 15% (Barry et al.). TikTok use reduced stress/boredom but lowered feelings of connectedness; regular use correlated with higher FOMO and loneliness. - Psychological correlates of problematic use: loneliness, boredom, low self-esteem, neuroticism, procrastination, depressive tendencies. Distress intolerance mediated links between depression/social anxiety and problematic use (Yao et al.). - Personality and demographics: TikTok Use Disorder correlated positively with neuroticism and depressive symptoms, negatively with age; more prevalent among females; low conscientiousness associated with higher TTUD tendencies (Montag & Markett). - Behavioral mechanisms: enjoyment → concentration → time distortion predicted problematic use; active parental mediation mitigated concentration’s effect on problematic use (Qin et al.). Obsession, escapism, and lack of control emerged as core dimensions of problematic use (Günlü et al.). - Usage patterns: High daily engagement common; female students showed higher addiction levels than males; lower SES linked to more frequent use; users often spent more than 2–3 hours/day; many reported use for entertainment, social connection, and escapism. - Mental health outcomes: Problematic TikTok use associated with increased depression and anxiety across multiple studies; procrastination partially mediated the relationship between problematic use and depression (Rogowska & Cincio). Social comparisons mediated TikTok use’s link to depression (Astuti et al.). - Risk behaviors during COVID-19: Weekly TikTok use associated with hazardous alcohol consumption and problem gambling (Savolainen & Oksanen). - Body image and social comparison: TikTok users had higher social comparison and lower body image scores than non-users (Auf et al.). - Neuroimaging: Personalized TikTok videos activated reward-related regions (DMN and VTA), indicating higher perceived value, attention, and reduced self-control (Su et al.). - Quality appraisal: Many cross-sectional studies met all JBI criteria; some had moderate/high risk due to lack of objective measures and confounding control. Longitudinal NOS scores: 6/9 (Savolainen & Oksanen) and 8/10 (Yao et al.). Mixed methods studies met many criteria but did not address divergences between components.

Findings across diverse empirical studies support the review’s objective: problematic TikTok use is common and associated with adverse mental health outcomes, especially among younger users and those with pre-existing vulnerabilities. TikTok’s design—algorithmic personalization, endless scroll, novelty, and social validation—facilitates immersive engagement that can promote flow states (enjoyment, concentration, time distortion) and compulsive use. These mechanisms, combined with psychological risk factors (neuroticism, distress intolerance, low self-esteem, procrastination), elucidate why certain users develop problematic patterns. The evidence suggests increased anxiety/depression with frequent use and links with social comparison, body image concerns, and risky behaviors (alcohol/gambling). COVID-19 amplified engagement, positioning TikTok as both a coping tool and a risk factor for problematic use. Compared with other platforms, TikTok appears uniquely potent in driving emotional investment and prolonged use, which may explain higher problematic social media scores observed. While misinformation and negative mental health content are concerns, positive recovery-oriented content demonstrates dual potential. These results underscore the relevance for clinicians, educators, and policymakers: prioritize digital/media literacy, parental/caregiver mediation, and usage parameters to mitigate harms, while recognizing platform-specific risks.

This systematic review consolidates evidence from 26 studies (11,462 participants) indicating that problematic TikTok use is associated with increased anxiety, depression, procrastination, and adverse psychosocial outcomes. Risk is heightened among younger users, females, those with lower socioeconomic status, and individuals with higher neuroticism or lower conscientiousness. Platform design features and algorithmic personalization contribute to compulsive engagement via flow states and reward circuitry. The review recommends integrating digital literacy into curricula, caregiver-guided mediation, and clear usage parameters to manage screen time in youth. To strengthen causal inference and inform interventions, future work should prioritize longitudinal and interventional studies, explore dose-response relationships, and address confounding and cultural generalizability.

• Predominance of self-reported measures increases risks of social desirability and recall bias; objective digital-tracking data are needed. - Many cross-sectional designs limit causal inference; longitudinal and interventional studies are required to assess temporal dynamics. - Generalizability concerns due to geographic concentration (notably Asia/China) and culturally specific samples; broader, representative, cross-cultural studies are needed. - Some studies lacked objective measurement criteria and did not address confounding factors, increasing risk of bias. - Mixed methods studies often did not reconcile divergences between quantitative and qualitative findings. - Potential moral panic and parental attitudes may bias research narratives around “addiction,” particularly in certain regions. - Lack of dose-response investigations hinders understanding of how increasing exposure affects mental health outcomes. - Longitudinal studies may suffer from dropouts and incomplete follow-up, affecting result validity. - Correlation versus causation: individuals with pre-existing mental health issues may engage more with TikTok as coping, complicating attribution.