Adolescent mental health issues have been increasing globally, with one in seven youth experiencing mental health disorders. While social connectedness traditionally serves as a protective factor, the widespread adoption of online platforms has fundamentally transformed how adolescents build and maintain social relationships. This systematic review aimed to synthesize existing literature on the relationship between online social connections and mental health among adolescents aged 10–18 years. The review specifically examined how the structure, function, and quality of online interactions influence mental health outcomes, guided by the U.S. Surgeon General’s framework on social connection. A systematic search was conducted in January 2024 using PsycINFO, MEDLINE, PubMed, and Web of Science databases. Studies were included if they measured mental health outcomes, assessed online social connection, analyzed relationships between these variables, and focused on adolescents ages 10–18 years. From an initial search of 3,745 articles, 23 met inclusion criteria after screening. The review revealed complex, bidirectional relationships between online social connections and adolescent mental health. Online-only friendships demonstrated a protective function, particularly for vulnerable youth experiencing suicidal ideation. Social capital in online contexts significantly influenced well-being, with higher online social capital associated with positive outcomes, especially in gaming environments. Gender differences emerged in social media effects, with passive use negatively impacting girls. Online social connections present both opportunities and risks for adolescent mental health. While digital platforms can provide valuable support and self-expression opportunities, particularly for vulnerable youth, they also carry risks related to social comparison and inadequate support.
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