Investigating the impact of active and passive social media behaviors on mental health—including self-esteem, anxiety, and belonging—this study presents an integrative review of 18 peer-reviewed articles. We uncover that while passive engagement, often stemming from social comparison and dysfunctional cognition, consistently correlates with increased anxiety, depression, and body dissatisfaction in vulnerable groups, active engagement driven by authentic interaction tends to boost self-esteem and emotional well-being. Crucially, our findings challenge the simplistic active–passive dichotomy, demonstrating that the psychological outcomes are mediated by interdependent variables such as emotional intent, cognitive profiles, and the inherent design architecture of social media platforms. This highlights the necessity for more refined behavioral models and suggests avenues for future mixed-methods, longitudinal, and intervention-focused research to cultivate healthier digital interactions. Ultimately, this work deepens the understanding of digital well-being and highlights the importance of considering the psychological and social factors that mediate social media use. It provides a foundation for the creation of more ethically conscious and psychologically beneficial social media interfaces, enabling designers to build platforms that mitigate adverse psychological impacts and foster emotionally sustainable online environments.