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Interpersonal conflicts, social media use and depression associated with protests

Nature Medicine volume 32, pages 224–230 (2026)Cite this article

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Abstract

Globally, the number of social protests has increased in the 21st century, and these have been associated with mental health consequences. Here we examined how interpersonal conflicts and social media use are associated with depression in a 15-year prospective cohort of 1,044–17,000 adults, assessed at 23 time points before, during and after two major protests in Hong Kong. During the 2019 social unrest, 32.4% of participants reported conflicts with family, friends, colleagues or strangers, higher than during the 2014 Occupy Central period (11.6–27.5%) and the following year (6.0–10.3%). Interpersonal conflicts were associated with depressive outcomes, with long-term associations persisting over 13 years (odds ratio (OR) = 1.49, 95% CI = 1.12–1.97). During the 2019 social unrest, almost half of adults spent ≥1 h per day on politics-related content on social media (47.4%), television (46.5%) and newspapers and radio (42.1%). Only heavy social media use (≥2 h per day) was positively associated with interpersonal conflicts and depression. Our findings suggest that protests are associated with depression in the long term as a result of sustained interpersonal conflicts, while heavy social media use may contribute to the association. To mitigate this impact, it is vital to provide social support to improve mental health of the affected individuals.

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Fig. 1: Directed acyclic graph and study objectives regarding interpersonal sociopolitical conflicts, social media use and depression.
Fig. 2: Trends in interpersonal sociopolitical conflicts in Hong Kong adults, 2009–2023.
Fig. 3: Adjusted interpersonal sociopolitical conflicts during major protests by use of social and traditional media, 2014–2019.

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Data availability

To protect participants’ privacy, de-identified individual participant data are available under restricted access, as approved by the Institutional Review Board. Data access is limited to the Institutional Review Board for ethics review purposes and to authorized researchers for noncommercial academic use. Researchers must submit a detailed research proposal for collaboration, which will be reviewed by the FAMILY Cohort Research Committee on the basis of scientific merit, ethical review and regulatory requirements. Access will be granted only after the proposal is approved and a signed undertaking on data transfer and access is received. Limited access to the data is also allowed for auditing and validation of this study, which requires a letter of intent outlining the intended purposes of data use. Data will be available for a period of 5 years after publication. Researchers interested in accessing the data should submit their requests to the FAMILY Cohort Research Committee through email at familyco@hku.hk. All requests will be reviewed and processed within 1 month. For additional information, please visit the FAMILY Cohort website at https://www.familycohort.sph.hku.hk/database.

Code availability

The codes used for analyses in this study can be found at https://github.com/jianshi3/Interpersonal-Conflicts-Social-Media-Use-and-Depression-Study.git.

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Acknowledgements

The authors thank S.-H. Lin for expert advice, and C. Yau, H. W. Wong, E. Wong, A. Au, K. Tam, C. K. M. Ng and M. Chow for technical support. The authors would also like to thank the funders, including the Hong Kong Jockey Club Charities Trust, the Research Grants Council of the Hong Kong Special Administrative Region of the People’s Republic of China (awards HKU 17609818 and HKU 17609923 to M.Y.N.), and the Government of the Hong Kong Special Administrative Region of the People’s Republic of China (awards COVID19F04, COVID19F11 and one additional grant to M.Y.N.), for providing financial support. J.S., R.C., X.X., F.P.F., K.N. and M.Y.N. had access to and verified data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Author notes

  1. These authors contributed equally: Jian Shi, Candi M. C. Leung.

Authors and Affiliations

  1. School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Jian Shi

  2. School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Jian Shi, Candi M. C. Leung, Roujia Chen, Xiao Xiao, Francis P. Flores, Tiffany S. W. Ma, Solomon B. K. Wong, Corine S. M. Wong, Yoona Kim, Gabriel M. Leung & Michael Y. Ni

  3. Research Division, Institute of Mental Health, Singapore, Singapore

    Ke Ning

  4. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Ichiro Kawachi

  5. Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China

    Gabriel M. Leung

  6. The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China

    Michael Y. Ni

  7. Urban Systems Institute, The University of Hong Kong, Hong Kong, China

    Michael Y. Ni

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Contributions

M.Y.N. conceived the study. M.Y.N. and J.S. designed the study. J.S., C.M.C.L., C.S.M.W., K.N. and M.Y.N. carried out the study. J.S., C.M.C.L., T.S.W.M., R.C. and S.B.K.W. conducted the literature review. J.S., R.C., X.X., F.P.F., K.N. and M.Y.N. analyzed the data. M.Y.N., J.S. and C.M.C.L. wrote the manuscript. M.Y.N. obtained funding. All authors interpreted the data, critically revised the manuscript and approved the final version.

Corresponding author

Correspondence to Michael Y. Ni.

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Competing interests

The establishment of the original cohort was supported by the Hong Kong Jockey Club Charities Trust from 2007 to 2014. The research was supported by Research Grants Council (Projects HKU 17609818, HKU 17609923), Health Bureau (Projects COVID19F04, COVID19F11) and the Government of the Hong Kong Special Administrative Region. All grants from the Government of the Hong Kong Special Administrative Region were provided for the real-time monitoring of psychobehavioral responses to the pandemic in Hong Kong and supported data collection for this study during the COVID-19 pandemic. The funders, including the Government of the Hong Kong Special Administrative Region, had no role in any aspects of the submitted work, including the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. C.S.M.W. reports a research grant from the Government of the Hong Kong Special Administrative Region, outside of the submitted work. G.M.L. was formerly the Under Secretary for Food and Health from 2008 to 2011, and Director of the Office of the Chief Executive, the Government of Hong Kong Special Administrative Region, from 2011 to 2012. He also served in unpaid roles on various commissions and committees of the Government of the Hong Kong Special Administrative Region, including his service as a nonofficial member of the Youth Development Commission, a member of the COVID-19 Expert Advisory Panel and a nonofficial member of the Steering Committee on Primary Healthcare Development. All declared roles of G.M.L. are outside of the submitted work. M.Y.N. declares research grants from the Government of the Hong Kong Special Administrative Region for the real-time monitoring of psychobehavioral responses to the COVID-19 pandemic in Hong Kong, as well as for other studies unrelated to the submitted work. The other authors declare no competing interests.

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Extended data

Extended Data Fig. 1 Trends in levels of interpersonal sociopolitical conflicts in Hong Kong adults, 2009–2023.

Bars represent weighted mean levels of conflicts with 95% confidence intervals. The analyzed sample sizes of waves 1 and 2 (aged 18 years or above) were 17,000 and 12,896, respectively. All participants of waves 3 to 23 were included, with the respective sample sizes presented in Extended Data Fig. 3. Inverse probability of censoring weighting and raking were applied.

Extended Data Fig. 2 Association of cumulative interpersonal sociopolitical conflicts and probable depression by sociodemographic groups, 2014–2019.

The forest plot shows estimated odds ratios of probable depression in 2019 (wave 9) with 95% confidence intervals. The odds ratios of probable depression were obtained through marginal structural models adjusting for baseline sociodemographics, past history of exposure (that is, sociopolitical conflicts with family members or friends and colleagues), probable depression, family support, time spent on social media and online for sociopolitical news during protests, protest participation, and prior levels of other types of sociopolitical conflicts (that is, adjusted for prior sociopolitical conflicts with friends and colleagues in the model examining association between intrafamilial sociopolitical conflicts and probable depression). Weights were truncated at 1st and 99th percentiles. Cumulative interpersonal sociopolitical conflicts were defined as the mean score of the conflicts from 2014 to 2019 (waves 3 to 8).

Extended Data Fig. 3 Sampling and retention of participants of the FAMILY Cohort, 2009–2023.

An asterisk (*) indicates that sample size of the random core of wave 1 is 19,533 participants aged 10 years or above. A dagger (†) indicates that sample size of the random core of wave 2 is 14,536 participants aged 10 years or above. A crossed dagger (‡) indicates replenishment of random samples from wave 2. The symbol ‘§’ denotes cooperation rates.

Extended Data Fig. 4 Causal diagram for relationships over time between interpersonal sociopolitical conflicts and depression.

C1 denotes baseline covariates, including sex, age, educational attainment, marital status, employment status, monthly household income, family support, sociopolitical conflicts with family members, and probable depression or depressive symptoms at wave 1. Ln denotes time-varying confounding variables, including probable depression or depressive symptoms, interpersonal sociopolitical conflicts, family support, time spent on social media and online for sociopolitical news, political participation, COVID-19-related sources of stress, and anxiety levels during COVID-19 at wave n. An denotes the time-varying exposure (for example, sociopolitical conflicts with family members or those with friends and colleagues) at wave n. Y denotes the outcome of interest, final probable depression or depressive symptoms. Covariates were selected a priori based on the literature review on potential determinants of the exposure and outcome.

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Shi, J., Leung, C.M.C., Chen, R. et al. Interpersonal conflicts, social media use and depression associated with protests. Nat Med 32, 224–230 (2026). https://doi.org/10.1038/s41591-025-04145-0

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