Reciprocal Relationships between Trajectories of Depressive Symptoms and Screen Media Use during Adolescence

Longitudinal Dynamic Relationships Between Videogame Use and Symptoms of Gaming Disorder and Depression Among Chinese Children and Adolescents

Although previous studies have shown a close relationship between gaming disorder and depressive symptoms, few have measured normal videogame use, symptoms of gaming disorder, and depressive symptoms concurrently. The longitudinal dynamics between these variables remain unclear. This study used two demographic cohorts to examine the longitudinal relationship between gaming and depressive symptoms: children (n = 1513, 46.9% girls, Mage ± SD = 9.63 ± 0.58 years) and adolescents (n = 1757, 48.5% girls, Mage ± SD = 12.55 ± 0.70 years). Random intercept cross-lagged panel models (RI-CLPMs) were employed to distinguish between within- and between-person levels of gaming and depressive symptoms. The RI-CLPM results showed a stable link between symptoms of gaming disorder and depression at the between-person level for both children and adolescents. At the within-person level, among children, depressive symptoms positively predicted subsequent gaming disorder symptoms, but gaming disorder symptoms were not a significant predictor of depressive symptoms at this level. Among adolescents, there was no significant cross-lagged effect between symptoms of gaming disorder and depression at the within-person level. Additionally, there was no significant cross-lagged effect between normal videogame use and depressive symptoms in either cohort. These results highlight the different effects of normal videogame use and gaming disorder symptoms associated with depressive symptoms. The different effects on children and adolescents underscore the importance of considering the different developmental stages in the study of gaming and mental health outcomes.

Screen time, sleep, brain structural neurobiology, and sequential associations with child and adolescent psychopathology: Insights from the ABCD study

Background and Aims

The precise roles of screen media activity (SMA) and sleep problems in relation to child/adolescent psychopathology remain ambiguous. We investigated temporal relationships among sleep problems, SMA, and psychopathology and potential involvement of thalamus-prefrontal-cortex (PFC)-brainstem structural covariation.

Methods

This study utilized data from the Adolescent Brain Cognitive Development study (n = 4,641 ages 9-12) at baseline, Year1, and Year2 follow-up. Cross-Lagged Panel Models (CLPMs) investigated reciprocal predictive relationships between sleep duration/problems, SMA, and psychopathology symptoms. A potential mediating role of baseline Thalamus-PFC-brainstem covariation on SMA-externalizing relationships was examined.

Results

Participants were divided into discovery (n = 2,359, 1,054 girls) and replication (n = 2,282, 997 girls) sets. CLPMs showed 1) bidirectional associations between sleep duration and SMA in late childhood, with higher frequency SMA predicting shorter sleep duration (β = -0.10 [95%CI: -0.16, -0.03], p = 0.004) and vice versa (β = -0.11 [95%CI: -0.18, -0.05], p < 0.001); 2) externalizing symptoms at age 10-11 predicting sleep problems (β = 0.11 [95%CI: 0.04, 0.19], p = 0.002), SMA (β = 0.07 [95%CI: 0.01, 0.13], p = 0.014), and internalizing symptoms (β = 0.09 [95%CI: 0.05, 0.13], p < 0.001) at age 11-12; and 3) externalizing behavior at age 10-11 partially mediating the relationship between baseline thalamus-PFC-brainstem covariation and SMA at age 11-12 (indirect effect = 0.032 [95%CI: 0.003, 0.067], p-value = 0.030). Findings were replicable.

Conclusion

We found bi-directional SMA-sleep-duration associations in late childhood. Externalizing symptoms preceded future SMA and sleep disturbances and partially mediated relationships between structural brain covariation and SMA. The findings emphasize the need for understanding individual differences and developing and implementing integrated strategies addressing both sleep concerns and screen time to mitigate potential impacts on psychopathology.

Prospective association of screen time with binge-eating disorder among adolescents in the United States: The mediating role of depression

OBJECTIVE

Screen time has been reported to be associated with binge-eating disorder (BED) among adolescents in the US; however, potential mediators remain unclear. This study aimed to evaluate depression symptoms as a mediator of the prospective association between screen time and BED.

METHOD

We utilized data from 9465 children (aged 9-11 years at baseline) from the Adolescent Brain Cognitive Development (ABCD) study (2016-2021). A generalized structural equation model was used to examine the prospective association between average daily screen time at baseline and BED at year 2, adjusting for baseline BED diagnosis, and other potential covariates (e.g., age, sex, and income). Mediation was examined using bias-corrected (BC) 95% confidence intervals for the indirect effect of baseline screen time on year 2 BED through depression symptoms (change from baseline to year 1).

RESULTS

One hundred and one participants (42.7% male, 49.4% racial/ethnic minority) met the criteria for BED in year 2. Participants were 9.9 years of age on average at baseline, 51.3% identified as male, and 43.1% identified as a racial/ethnic minority. Adjusting for covariates, screen time was prospectively associated with BED (OR = 1.09, 95% CI [1.03, 1.14], p = .005). Depression symptoms (B = .19, BC 95% CI [0.10, 0.28]) partially mediated (9.2%) the prospective association between screen time and BED.

DISCUSSION

Among US adolescents, higher baseline screen time was prospectively associated with BED diagnosis at year 2, and this relationship was partially mediated by increased depression symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

PUBLIC SIGNIFICANCE

Among U.S. adolescents, higher screen time was prospectively associated with the incidence of BED. This association was partially mediated by the change in depressive symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

BACKGROUND

There is currently a deficit of knowledge about how to define, quantify, and measure different aspects of daily routine disruptions amid large-scale disasters like COVID-19, and which psychiatric symptoms were more related to the disruptions. This study aims to conduct a systematic review and meta-analysis on the probable positive associations between daily routine disruptions and mental disorders amid the COVID-19 pandemic and factors that moderated the associations.

METHODS

PsycINFO, Web of Science, PubMed, and MEDLINE were systematically searched up to April 2023 (PROSPERO: CRD42023356846). Independent variables included regularity, change in frequency, and change in capability of different daily routines (i.e., physical activity, diet, sleep, social activities, leisure activities, work and studies, home activities, smoking, alcohol, combined multiple routines, unspecified generic routines). Dependent variables included symptoms and/or diagnoses of mental disorders (i.e., depression, anxiety, post-traumatic stress disorder, and general psychological distress).

RESULTS

Fifty-three eligible studies (51 independent samples, 910,503 respondents) were conducted in five continents. Daily routine disruptions were positively associated with depressive symptoms (r = 0.13, 95% CI = [0.06; 0.20], p < 0.001), anxiety symptoms (r = 0.12, 95% CI = [0.06; 0.17], p < 0.001), and general psychological distress (r = 0.09, 95% CI = [0.02; 0.16], p = 0.02). The routine-symptom associations were significant for physical activity, eating, sleep, and smoking (i.e., type), routines that were defined and assessed on regularity and change in capability (i.e., definition and assessment), and routines that were not internet-based. While the positive associations remained consistent across different sociodemographics, they were stronger in geo-temporal contexts with greater pandemic severity, lower governmental economic support, and when the routine-symptom link was examined prospectively.

CONCLUSIONS

This is one of the first meta-analytic evidence to show the positive association between daily routine disruptions and symptoms of mental disorders among large populations as COVID-19 dynamically unfolded across different geo-temporal contexts. Our findings highlight the priority of behavioral adjustment for enhancing population mental health in future large-scale disasters like COVID-19.

Association between screen time and physical activity on mental health among preschoolers: a cross-sectional study from Southwest China

BACKGROUND

Screen time and physical activity behaviors undergo development during early childhood and impact mental health. However, there is limited knowledge regarding the associations between physical activity, screen time, and mental health problems (MHP) in preschoolers. This study examines these associations using a large sample size and brief measures.

METHODS

A multistage cluster stratified sampling method was used to conduct an observational cross-sectional study of 19,015 Chinese preschoolers in 2020. Information on physical activity, and screen time was collected by a self-administered questionnaire; MHP was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). Logistic regression models were used to obtain the odds ratios (ORs) and 95% confidence intervals (95% CIs) of preschoolers' MHP associated with screen time, total physical activities, moderate to vigorous physical activity (MVPA), and outdoor physical activities.

RESULTS

A total of 19,015 participants from the 19,548 recruited population were included in the analyses (missing rate: 2.73%), 52.60% were boys. 64.01%, 57.96%, 35.98%, and 82.64% of preschoolers were reported to meet total physical activities, MVPA, and outdoor activities with screen time recommendations level. The results of multivariable-adjusted ORs (95% CIs) of preschoolers' MHP for comparisons of different levels of screen time (< 2 h/day, 2-4 h/day,≥4 h/day) show that screen time positively associated with MHP after adjusting for confounders (P < 0.05), but the association was not significant among girls with screen time ≥ 4 h/day. In addition, increased engagement in physical activity was reversely linked to MHP (P < 0.05). A stronger association between MHP and MVPA was observed in boys, however, this association was weakened when the total time spent engaging in MVPA exceeded two hours per day (P < 0.05).

CONCLUSION

Less physical activity and more screen time positively relate to MHP, but the relationship differs by type of physical activity, total time, and gender. These findings provide novel insights and evidence supporting for guidelines on physical activity, screen time, and improvement of mental health for preschoolers.

Physical activity, recreational screen time, and depressive symptoms among Chinese children and adolescents: a three-wave cross-lagged study during the COVID-19 pandemic

BACKGROUND

Longitudinal evidence is lacking on the interplay between lifestyle behaviors and depressive symptoms, especially in the context of the COVID-19 pandemic. This study investigated the changes in physical activity and recreational screen time during the pandemic, along with their reciprocal associations with depressive symptoms among children and adolescents.

METHODS

The public health emergency due to the pandemic started in January 2023 and lasted for two months in Shanghai, China. A three-wave longitudinal study was conducted among 1,666 children and adolescents (6-18 years) in January, March, and July 2023. Moderate-to-vigorous intensity physical activity (MVPA), recreational screen time, and depressive symptoms were measured using self-reported questionnaires. Random-intercept cross-lagged panel models were constructed to examine the bidirectional associations between physical activity and recreational screen time with depressive symptoms.

RESULTS

Children and adolescents experienced a significant decrease in MVPA and a substantial increase in recreational screen time during the pandemic, which failed to return to pre-pandemic levels post-pandemic. Pre-pandemic MVPA was negatively associated with subsequent depressive symptoms (β = -0.147). Conversely, pre-pandemic depressive symptoms were positively associated with subsequent recreational screen time (β = 0.085), which in turn predicted heightened post-pandemic depressive symptoms (β = 0.076). When stratified by age, significant associations were found in adolescents but not children.

CONCLUSIONS

Sustained unhealthy changes in physical activity and recreational screen time were observed during the COVID-19 pandemic among children and adolescents. This study elucidates a potential reciprocal relationship between lifestyle behaviors and mental well-being. Effective interventions are emphasized to counter the negative impacts of insufficient physical activity and excessive screen use on the mental health of children and adolescents.

Associations between digital media use and psychotic experiences in young adults of Quebec, Canada: a longitudinal study

PURPOSE

Digital media use has been associated with psychotic experiences in youth from the community, but the direction of association remains unclear. We aimed to examine between- and within-person associations of digital media use and psychotic experiences in youth.

METHODS

The sample included 425 participants aged 18-25 years (82.5% female) from the community, followed between May 2021 and January 2022 over 3 time points-of which 263 participants (61.9%) completed at least 2. Digital media use was self-reported as time spent daily on TV and streaming platforms, social media, and video games over the past 3 months. Psychotic experiences in the past 3 months were measured with the 15-item Community Assessment of Psychic Experiences. Associations between digital media use and psychotic experiences were estimated using a random-intercept cross-lagged panel model.

RESULTS

On average, individuals who reported greater digital media use also reported higher levels of psychotic experiences (r = 0.34, 95% CI 0.15, 0.53). However, a person's variation in digital media use, relative to their personal average, was not significantly associated with subsequent variations in their levels of psychotic experiences, or vice-versa. Results were similar across TV/streaming, social media and video game use, and after adjusting for age, sex, education, sleep, physical activity, and cannabis use.

CONCLUSION

Individuals with a tendency for higher levels of digital media use also had a tendency for higher levels of psychotic experiences. Understanding this association may help personalize mental health interventions for people with psychotic experiences, which may be offered digitally to promote their accessibility.

Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions

Loneliness affects the quality of life of people all around the world. Loneliness is also shown to be directly associated with mental health issues and is often the cause of mental health problems. It is also shown to increase the risk of heart diseases and other physical illnesses. Loneliness is studied both from the social and medical sciences perspectives. There are also interventions on the basis of health informatics, information and communication technologies (ICTs), social media, and other technological solutions. In the literature, loneliness is studied from various angles and perspectives ranging from biological to socioeconomical and through anthropological understandings of technology. From the ICT and technological sides, there are multiple reviews studying the effectiveness of intervention strategies and solutions. However, there is a lack of a comprehensive review on loneliness that engulfs the psychological, social, and technological studies of loneliness. From the perspective of loneliness informatics (ie, the application of health informatics practices and tools), it is important to understand the psychological and biological basis of loneliness. When it comes to technological interventions to fight off loneliness, the majority of interventions focus on older people. While loneliness is highest among older people, theoretical and demographical studies of loneliness give a U-shaped distribution age-wise to loneliness; that is, younger people and older people are the demographics most affected by loneliness. But the strategies and interventions designed for older people cannot be directly applied to younger people. We present the dynamics of loneliness in younger people and also provide an overview of the technological interventions for loneliness in younger people. This paper presents an approach wherein the studies carried out from the perspectives of digital health and informatics are discussed in detail. A comprehensive overview of the understanding of loneliness and the study of the overall field of tools and strategies of loneliness informatics was carried out. The need to study loneliness in younger people is addressed and particular digital solutions and interventions developed for younger people are presented. This paper can be used to overcome the challenges of technological gaps in the studies and strategies developed for loneliness. The findings of this study show that the majority of interventions and reviews are focused on older people, with ICT-based and social media-based interventions showing promise for countering the effects of loneliness. There are new technologies, such as conversational agents and robots, which are tailored to the particular needs of younger people. This literature review suggests that the digital solutions developed to overcome loneliness can benefit people, and younger people in particular, more if they are made interactive in order to retain users.

A scoping review of social media in child, adolescents and young adults: research findings in depression, anxiety and other clinical challenges

BACKGROUND

Social media and other technologies are reshaping communication and health.

AIMS

This review addresses the relationship between social media use, behavioural health conditions and psychological well-being for youth aged <25 years.

METHOD

A scoping review of 11 literature databases from 2000 to 2020 explored research studies in youth in five areas: clinical depression and anxiety, quantitative use, social media mode, engagement and qualitative dimensions and health and well-being.

RESULTS

Out of 2820 potential literature references, 140 met the inclusion criteria. The foci were clinical depression and anxiety disorders (n = 78), clinical challenges (e.g. suicidal ideation, cyberbullying) (n = 34) and psychological well-being (n = 28). Most studies focused on Facebook, Twitter, Instagram and YouTube. Few studies are longitudinal in design (n = 26), had comparison groups (n = 27), were randomised controlled trials (n = 3) or used structured assessments (n = 4). Few focused on different youth and sociodemographic populations, particularly for low-income, equity-seeking and deserving populations. Studies examined association (n = 120; 85.7%), mediating (n = 16; 11.4%) and causal (n = 4; 2.9%) relationships. Prospective, longitudinal studies of depression and anxiety appear to indicate that shorter use (≤3 h/day) and purposeful engagement is associated with better mood and psychological well-being. Depression may predict social media use and reduce perception of support. Findings provide families, teachers and providers ways to engage youth.

CONCLUSIONS

Research opportunities include clinical outcomes from functional perspective on a health continuum, diverse youth and sociodemographic populations, methodology, intervention and privacy issues. More longitudinal studies, comparison designs and effectiveness approaches are also needed. Health systems face clinical, training and professional development challenges.

Time Spent on Mobile Apps Matters: A Latent Class Analysis of Patterns of Smartphone Use among Adolescents

The aims of the present study are: (1) to determine classes of adolescents with homogeneous patterns of smartphone or social media use; and (2) to examine the level of distress across the empirically derived profiles. Three hundred and forty adolescents (Mage = 15.61, SD = 1.19; 38.2% females) participated in a cross-sectional survey. Participants provided objective trace data on time spent on smartphones and applications, as well as self-reported social media addiction, social media use intensity, online social comparison, emotion dysregulation, and psychological distress. Latent class analysis (LCA) with total smartphone use categorized participants into three classes. Participants in Class 3 (19%) showed a more impaired functioning profile, with a tendency towards social media addiction and greater levels of distress. LCAs with the amount of time devoted to specific applications are more heterogeneous, and results showed that heavy use of social media apps was not consistently connected to the most impaired psychosocial profiles. Although the amount of mobile screen time can be a characteristic of problematic users, the link between social media usage and an adolescent's psychological characteristics is mixed. More research is needed to explore the interplay between mobile screen time and social media usage among adolescents.

Analysis of Social Media Use, Mental Health, and Gender Identity Among US Youths

Importance

Mental health among children and adolescents is a critical public health issue, and transgender and gender nonbinary youths are at an even greater risk. Social media has been consistently associated with youth mental health, but little is known about how gender identity interacts with this association.

Objective

To use a risk and resilience approach to examine the association between social media use and mental health among transgender, gender nonbinary, and cisgender youths.

Design, Setting, and Participants

This cross-sectional study analyzed data collected from an online survey between May and August 2021. Participants included a random sample of US youths; eligibility requirements included being aged 10 to 17 years and residing in the US. Statistical analysis was performed from February to April 2022.

Main Outcomes and Measures

Social media use (time, type of use, favorite site, social comparisons, mindfulness, taking intentional breaks, cleaning and curating feeds, problematic use, and media literacy programs at their school) and mental health (depression, emotional problems, conduct problems, and body image) as main outcomes.

Results

Participants included 1231 youths aged 10 to 17 years from a national quota sample from the United States; 675 (54.8%) identified as cisgender female, 479 (38.9%) as cisgender male, and 77 (6.3%) as transgender, gender nonbinary, or other; 4 (0.3%) identified as American Indian or Alaska Native, 111 (9.0%) as Asian, 185 (15.0%) as Black, 186 (15.1%) as Hispanic or Latinx, 1 (0.1%) as Pacific Islander, 703 (57.1%) as White, and 41 (3.3%) as mixed and/or another race or ethnicity. Gender identity moderated both the strength and the direction of multiple associations between social media practices and mental health: active social media use (eg, emotional problems: B = 1.82; 95% CI, 0.16 to 3.49; P = .03), cleaning and/or curating social media feeds (eg, depression: B = -0.91; 95% CI, -1.98 to -0.09; P = .03), and taking intentional breaks (eg, depression: B = 1.03; 95% CI, 0.14 to 1.92; P = .02).

Conclusions and Relevance

In this cross-sectional study of gender identity, social media, and mental health, gender identity was associated with youths' experiences of social media in ways that may have distinct implications for mental health. These results suggest that research about social media effects on youths should attend to gender identity; directing children and adolescents to spend less time on social media may backfire for those transgender and gender nonbinary youths who are intentional about creating safe spaces on social media that may not exist in their offline world.

Screen use before sleep and emotional problems among adolescents: Preliminary evidence of mediating effect of chronotype and social jetlag

BACKGROUND

Screen use before sleep is shown to be positively related to emotional problems. However, whether this relationship was mediated by circadian phenotypes (i.e., chronotype and social jetlag) remains unclear.

METHODS

Data from two independent adolescent surveys among 2685 and 1368 adolescents, respectively, were used. Adolescents reported screen use before sleep (yes/no and screen time), chronotype, social jetlag, and emotional problems using questionnaires. Serial mediation analyses were performed.

RESULTS

Adolescents who reported screen use before sleep showed later chronotype and greater social jetlag, which was further associated with a higher level of emotional problems. Such relationships held for screen use as a yes/no variable and screen time. The serial indirect effect of chronotype and social jetlag accounted for 6.2%-16.7% of the total effect of screen use before sleep on emotional problems.

LIMITATIONS

The use of a cross-sectional design did not allow the establishment of causal links between the variables. All data were self-reported by adolescents, and might be subject to report bias and recall bias.

CONCLUSIONS

These findings contributed to the existing literature by examining the mediating effect of chronotype and social jetlag in the relationship between screen use before sleep and emotional problems from a circadian rhythm perspective. Healthy media use habits and interventions targeting circadian characteristics may work towards promoting emotional health in adolescents.

Is adolescent internet use a risk factor for the development of depression symptoms or vice-versa?

BACKGROUND

The extent to which digital media use by adolescents contributes to poor mental health, or vice-versa, remains unclear. The purpose of the present study is to clarify the strength and direction of associations between adolescent internet use and the development of depression symptoms using a longitudinal modeling approach. We also examine whether associations differ for boys and girls.

METHODS

Data are drawn from (N = 1547) participants followed for the Quebec longitudinal Study of Child Development (QLSCD 1998-2020). Youth self-reported internet use in terms of the average hours of use per week at the ages of 13, 15, and 17. Youth also self-reported depression symptoms at the same ages.

RESULTS

After testing sex-invariance, random intercepts cross-lagged panel models stratified by sex, revealed that internet use by girls was associated with significant within-person (time-varying) change in depression symptoms. Girl's internet use at age 13 was associated with increased depression symptoms at age 15 (ß = 0.12) and internet use at age 15 increased depression at age 17 (ß = 0.10). For boys, internet use was not associated with significant time varying change in depression symptoms.

CONCLUSIONS

The present findings support the hypothesis that internet use by adolescents can represent a significant risk factor for the development of depressive symptoms, particularly in girls.

Longitudinal Effects of Screen Time on Depressive Symptoms among Swedish Adolescents: The Moderating and Mediating Role of Coping Engagement Behavior

Studies suggest that hourly digital screen time increases adolescents' depressive symptoms and emotional regulation difficulties. However, causal mechanisms behind such associations remain unclear. We hypothesized that problem-focused and/or emotion-focused engagement coping moderates and possibly mediates this association over time. Questionnaire data were collected in three waves from a representative sample of Swedish adolescents (0, 3 and 12 months; n = 4793; 51% boys; 99% aged 13-15). Generalized Estimating Equations estimated the main effects and moderation effects, and structural regression estimated the mediation pathways. The results showed that problem-focused coping had a main effect on future depression (b = 0.030; p < 0.001) and moderated the effect of screen time (b = 0.009; p < 0.01). The effect size of this moderation was maximum 3.4 BDI-II scores. The mediation results corroborated the finding that future depression was only indirectly correlated with baseline screen time, conditional upon intermittent problem-coping interference (C'-path: Std. beta = 0.001; p = 0.018). The data did not support direct effects, emotion-focused coping effects, or reversed causality. We conclude that hourly screen time can increase depressive symptoms in adolescent populations through interferences with problem-focused coping and other emotional regulation behaviors. Preventive programs could target coping interferences to improve public health. We discuss psychological models of why screen time may interfere with coping, including displacement effects and echo chamber phenomena.

Factors influencing smart device addiction among preschool children: An extended protection-risk model perspective

Today, users of smart devices are from increasingly younger generations, and their use is very common among preschoolers. The problem of smart device addiction in preschool children has attracted widespread attention, due to which this study explores the influencing factors in children aged 2-5 years. Based on the protection-risk model, 236 Chinese parents were surveyed, and the data was analyzed using partial least squares structural equation modeling. The findings show that parental emotion regulation significantly and negatively influences children's depression and social withdrawal symptoms, whereas it has a significant and positive influence on parental self-control as well as outdoor intention. Also, children's depression and social withdrawal symptoms have a significant and positive influence on their smart device addiction, whereas parental self-control and outdoor intentions have no significant influence on it. Moreover, children's social withdrawal and depression have a mediating effect between parental emotion regulation and children's smart device addiction, but parental self-control and outdoor intention have no mediating effect between the two. This study identifies the factors influencing children's smart device addiction from a new perspective, providing theoretical support to address this problem of addiction.

Time to Think "Meta": A Critical Viewpoint on the Risks and Benefits of Virtual Worlds for Mental Health

The metaverse is gaining traction in the general population and has become a priority of the technological industry. Defined as persistent virtual worlds that exist in virtual or augmented reality, the metaverse proposes to afford a range of activities of daily life, from socializing and relaxing to gaming, shopping, and working. Because of its scope, its projected popularity, and its immersivity, the metaverse may pose unique opportunities and risks for mental health. In this viewpoint article, we integrate existing evidence on the mental health impacts of video games, social media, and virtual reality to anticipate how the metaverse could influence mental health. We outline 2 categories of mechanisms related to mental health: experiences or behaviors afforded by the metaverse and experiences or behaviors displaced by it. The metaverse may benefit mental health by affording control (over an avatar and its virtual environment), cognitive activation, physical activity, social connections, and a sense of autonomy and competence. However, repetitive rewarding experiences may lead to addiction-like behaviors, and high engagement in virtual worlds may facilitate and perpetuate the avoidance of challenges in the offline environment. Further, time spent in virtual worlds may displace (reduce) other determinants of mental health, such as sleep rhythms and offline social capital. Importantly, individuals will differ in their uses of and psychological responses to the metaverse, resulting in heterogeneous impacts on their mental health. Their technological motivations, developmental stage, sociodemographic context, and prior mental health problems are some of the factors that may modify and frame the positive and negative effects of the metaverse on their mental health. In conclusion, as the metaverse is being scaffolded by the industry and by its users, there is a window of opportunity for researchers, clinicians, and people with lived experience to coproduce knowledge on its possible impacts on mental health and illness, with the hope of influencing policy-making, technological development, and counseling of patients.

Smartphone use and well-being in Pakistan: Comparing the effect of self-reported and actual smartphone use

Objective

Past work has shown that smartphone use has negative effects on well-being. Yet, most evidence relies on self-reported measures of smartphone use and comes from Western democracies. We examined the relationship between both self-reported and actual smartphone use and well-being in Pakistan, a country that is under-researched in the Global South. Additionally, we investigated the moderating effect of the fear of missing out (FoMO).

Methods

We conducted an online survey among 427 Pakistani citizens. Participants reported their smartphone use and well-being (i.e., levels of depression, loneliness, and life satisfaction). At the end of the survey, participants were asked to upload screenshots of their respective 'Screen Time' (for iOS) or 'Digital Well-being' (for Android) apps, which we used to measure their actual smartphone use.

Results

We found a moderate association between self-reported and actual smartphone use (r = .36); on average, participants underreported their daily smartphone use by 11 min. Actual smartphone use was negatively associated with well-being, while self-reported use showed no statistically significant association. FoMO was positively associated with actual smartphone use but not with self-reported use. Finally, FoMO moderated the relationship between self-reported use and well-being.

Conclusion

Our findings show that the relationship between smartphone use and well-being depends on how smartphone use is measured and is moderated by FoMO. Moreover, we find that mobile data donation is viable in Pakistan, which should encourage future research to use it as a complement to self-reported media use more often.

A qualitative study on negative experiences of social media use and harm reduction strategies among youths in a multi-ethnic Asian society

PURPOSE

This study aimed to expand and inform the emerging body of research on the negative experiences of social media use among youths and how youths deal with them, in an Asian setting, using a qualitative approach.

METHODS

Data were collected using 11 focus group discussions (FGDs) and 25 semi-structured interviews (SIs) among youths aged 15 to 24 years residing in Singapore who were recruited via purposive sampling. Data were analysed using thematic analysis.

RESULTS

The salient negative effects mentioned by participants include the development of negative reactions and feelings from upward comparisons with others (e.g., others' achievements and lifestyle), receiving hurtful comments, exposure to controversial content (e.g., political events and social movements), as well as the perpetuation of negative feelings, behaviours, and sentiments (e.g., rumination, unhealthy eating behaviour, and self-harm). Participants also described strategies which they have employed or deemed to be useful in mitigating the negative effects of social media use. These include filtering content and users, taking breaks from social media, cognitive reframing, and self-affirmation, where they identify and change stress-inducing patterns of thinking by setting realistic social, physical, and lifestyle expectations for themselves, and focusing on self-development.

CONCLUSION

The current results highlight that while youths experience negative effects of social media use, they have high media literacy and have employed strategies that appear to mitigate the negative effects of social media use. The findings can inform various stakeholders involved in helping youths navigate the harms of social media use or provide directions for intervention studies aimed at reducing the harms of social media use.

Drivers and Consequences of Short-Form Video (SFV) Addiction amongst Adolescents in China: Stress-Coping Theory Perspective

As a hedonic technology, short-form videos (SFVs) have attracted numerous users. However, one related problem that merits research is SFV addiction, especially among adolescents due to their immature self-control abilities. Although recent research has discussed the formation process of SFV addiction from psychological needs and the SFV features perspective, scarce attention has been paid to investigating the relationship between stress and SFV addiction, as well as the relationship between SFV addiction and its consequences. Therefore, the purpose of this study is to examine whether school burnout (school stress), social phobia (social stress), and parental phubbing (family stress) trigger SFV addiction based on stress-coping theory and, furthermore, whether SFV addiction leads to low levels of happiness (psychological consequence), parent-child relationship quality (relational consequence), and perseverance (behavioral consequence) among adolescents. The proposed model was tested based on data collected from 242 adolescents from across China under the age of 18 with the experience watching SFVs. A covariance-based structural equation modeling (CB-SEM) method was used for data analysis. The results showed that school burnout and social phobia significantly triggered SFV addiction, which later negatively and significantly influenced adolescents' happiness, parent-child relationship quality, and perseverance. The study also found that SFV addiction served as a mediator between the drivers and consequences of SFV addiction. This study provides several theoretical implications. First, this study is one of the first to explain adolescents' SFV addiction from stress-coping perspective, thereby enriching research in the field of SFV addiction. Second, prior research has rarely discussed the impacts of stresses from various environments on addiction behavior in a single study. Therefore, this study contributes to the knowledge of stress-related research in an SFV addiction context. Finally, our study enhances our understanding of the impact of SFV addiction on its consequences, in both an SFV research context and a social media research context.

Does Objectively Measured Social-Media or Smartphone Use Predict Depression, Anxiety, or Social Isolation Among Young Adults?

Despite a plethora of research, the link between digital technology use and psychological distress among young adults remains inconclusive. Findings in this area are typically undermined by methodological limitations related to measurement, study design, and statistical analysis. Addressing these limitations, we examined the prospective, within-person associations between three aspects of objectively-measured digital technology use (smartphone use duration and frequency; social media use duration) and three aspects of psychological distress (depression, anxiety, and social isolation) among a sample of young adults (N = 384). Across 81 different model specifications, we found that most within-person prospective effects between digital technology use and psychological distress were statistically non-significant and all were very small-even the largest effects were unlikely to register a meaningful impact on a person's psychological distress. In post hoc subgroup analyses, we found scant evidence for the claim that digital technology use is more harmful for women and/or younger people.

Patterns of Objectively Measured Sedentary Time and Emotional Disorder Symptoms Among Youth

OBJECTIVE

We examined the within-person longitudinal and bidirectional associations between patterns of sedentary time accumulation [alpha (sedentary bout duration/length), sedentary breaks (number of breaks in sedentary bouts)], and symptoms of major depressive disorder and generalized anxiety disorder.

METHODS

Children [N = 167, 10.1(0.9) years old, 54.5% female, 59.3% Hispanic, 35.9% overweight/obese at baseline] participated in a 3-year longitudinal study that consisted of assessments of sedentary time, and depressive and anxiety symptoms. At each assessment, participants wore accelerometers and completed the Revised Child Anxiety and Depression Scale. Separate random intercept cross-lagged panel models estimated the within-person longitudinal and bidirectional associations between alpha, sedentary breaks, and symptoms of major depressive disorder and generalized anxiety disorder across chronological age intervals.

RESULTS

Having greater than one's own usual depressive symptoms at age 11 was associated with fewer sedentary breaks 1 year later. Having greater than one's own usual generalized anxiety symptoms at age 11 was associated with longer sedentary bouts and fewer sedentary breaks 1 year later. In contrast, having greater than one's own usual sedentary breaks at age 10 was associated with fewer generalized anxiety symptoms 1 year later. All other associations, including at younger ages, were null.

CONCLUSION

Deviations from one's usual levels of depressive or anxiety symptoms may be important for how sedentary time is subsequently accumulated. Intraindividual processes appear to be at play, therefore more within-person research is needed. Intervention strategies for promoting a healthier accumulation of sedentary time may consider targeting occasions when depressive and anxiety symptoms are greater than usual.

Time spent playing video games is unlikely to impact well-being

Video games are a massively popular form of entertainment, socializing, cooperation and competition. Games' ubiquity fuels fears that they cause poor mental health, and major health bodies and national governments have made far-reaching policy decisions to address games' potential risks, despite lacking adequate supporting data. The concern-evidence mismatch underscores that we know too little about games' impacts on well-being. We addressed this disconnect by linking six weeks of 38 935 players' objective game-behaviour data, provided by seven global game publishers, with three waves of their self-reported well-being that we collected. We found little to no evidence for a causal connection between game play and well-being. However, results suggested that motivations play a role in players' well-being. For good or ill, the average effects of time spent playing video games on players' well-being are probably very small, and further industry data are required to determine potential risks and supportive factors to health.

The influence of sedentary behaviour on mental health among children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Systematic reviews that have examined associations between sedentary behaviour (SB) and mental health among children and adolescents are mainly based on cross-sectional investigations. There is a lack of evidence for a prospective relationship between SB and mental health in children and adolescents. This systematic review synthesized longitudinal studies that examined prospective associations between SB and mental health among children and adolescents.

METHODS

We conducted computer searches for English language literature from electronic databases of PubMed, Embase, PsycInfo and Google scholar, and manually screened the references of existing relevant studies to select studies for the synthesis. We included observational longitudinal studies that assessed the association between SB and mental health among children and adolescents. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

In total, 58 longitudinal studies met the inclusion criteria and were synthesized in the review. We found that higher SB among children and adolescents was associated with increased depression, anxiety and other mental health problems later in life. A dose-response association between SB and mental health was observed, suggesting that children and adolescents who spend more time on SB may have a higher risk of developing poorer mental health later.

CONCLUSIONS

The findings in the present study suggest that intervention programs targeting reducing SB may benefit to the prevention of poor mental health among children and adolescents. Future intervention studies especially randomized controlled trials are needed to elucidate a causal relationship between SB and mental health among children and adolescents.

Screen Time and Mental Health Among Adolescents: Implications of the Rise in Digital Environment in South Africa

The rise in use of digital technology among adolescents is unquestionable, with few studies having explored the effect of screen time on mental or behavior challenges in sub-Saharan Africa. We investigated the extent of screen time and its associations with mental/behavior challenges in South Africa. A multisite study was conducted among adolescents aged 15 to 17 years from three government schools in KwaZulu-Natal Province, South Africa. Measures included depressive symptoms (using Patient Health Questionnaire-9), behavioral problems (using Strengths and Difficulties Questionnaire), and screen time (using Children's Leisure Activities Study Survey). The prevalence of severe depressive symptoms, conduct features, and negative prosocial behavior was 11.2% (n = 20), 13.6% (n = 25), and 4.9% (n = 9), respectively. The mean screen time was 2.1 h/d (SD = 2.4) during weekday and 4.7 h/d (SD = 5.5) during weekend. Weekend screen time was significantly associated with a greater likelihood of severe depression and conduct challenges, based on multivariable regression. We also found that greater weekend cell phone use was significantly associated with lower prosocial behavior. No role of weekday screen time was detected in this study. Parents or legal guardians need to be aware of their children's weekend screen time, including cell phones, as access to digital devices becomes more ubiquitous in resource-limited settings.

Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review

Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.

Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review

INTRODUCTION

Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents.

METHODS

Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review.

RESULTS

Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist.

DISCUSSION

Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.

Dynamics of adolescents' smartphone use and well-being are positive but ephemeral

Well-being and smartphone use are thought to influence each other. However, previous studies mainly focused on one direction (looking at the effects of smartphone use on well-being) and considered between-person effects, with self-reported measures of smartphone use. By using 2548 assessments of well-being and trace data of smartphone use collected for 45 consecutive days in 82 adolescent participants (Mage = 13.47, SDage = 1.62, 54% females), the present study disentangled the reciprocal and individual dynamics of well-being and smartphone use. Hierarchical Bayesian Continuous Time Dynamic Models were used to estimate how a change in frequency and duration of smartphone use predicted a later change in well-being, and vice versa. Results revealed that (i) when participants used the smartphone frequently and for a longer period, they also reported higher levels of well-being; (ii) well-being positively predicted subsequent duration of smartphone use; (iii) usage patterns and system dynamics showed heterogeneity, with many subjects showing reciprocal effects close to zero; finally, (iv) changes in well-being tend to persist longer than changes in the frequency and duration of smartphone use.

No effect of different types of media on well-being

It is often assumed that traditional forms of media such as books enhance well-being, whereas new media do not. However, we lack evidence for such claims and media research is mainly focused on how much time people spend with a medium, but not whether someone used a medium or not. We explored the effect of media use during one week on well-being at the end of the week, differentiating time spent with a medium and use versus nonuse, over a wide range of different media types: music, TV, films, video games, (e-)books, (digital) magazines, and audiobooks. Results from a six-week longitudinal study representative of the UK population 16 years and older (N = 2159) showed that effects were generally small; between-person relations but rarely within-person effects; mostly for use versus nonuse and not time spent with a medium; and on affective well-being, not life satisfaction.

Difficulties in Establishing "Truth" Conditions in the Assessment of Addictive Smartphone Use in Young Adults

The smartphone revolution has placed powerful, multipurpose devices in the hands of youth across the globe, prompting worries about the potential negative consequences of these technologies on mental health. Many assessment tools have been created, seeking to classify individuals into problematic and non-problematic smartphone users. These are identified using a cutoff value: a threshold, within the scale range, at which higher scores are expected to be associated with negative outcomes. Lacking a clinical assessment of individuals, the establishment of this threshold is challenging. We illustrate this difficulty by calculating cutoff values for the Short Version of the Smartphone Addiction Scale (SAS-SV) in 13 Spanish-speaking samples in 11 countries, using common procedures (i.e., reliability, validity, ROC methodology). After showing that results can be very heterogeneous (i.e., they lead to diverse cutoff points and rates of addiction) depending on the decisions made by the researchers, we call for caution in the use of these classifications, particularly when researchers lack a clinical definition of true addiction-as is the case with most available scales in the field of behavioral addictions-which can cause an unnecessary public health alert.

Internet Addiction and Emotional and Behavioral Maladjustment in Mainland Chinese Adolescents: Cross-Lagged Panel Analyses

Adolescence is a developmental stage when adolescents are vulnerable to addictive behaviors, such as Internet addiction (IA), which refers to pathological use of the Internet. Although there are views proposing that the links between IA and adolescent problem behavior may be bidirectional in nature, few studies have examined the reciprocal relationships between IA and other maladjustment indicators, and even fewer studies have simultaneously employed both emotional and behavioral maladjustment indicators in a single study. To address the above research gaps, the present study investigated how IA is associated with both depression and delinquency among Chinese adolescents. Two waves of data were collected at two consecutive years, respectively, with 1year apart, from 3,010 students (Mean age=13.16, SD=0.81; 57.48% boys) in four junior high schools in mainland China. These students completed the same questionnaire containing measures of IA, depression, and delinquency at each wave. The proposed cross-lagged panel model fitted the data very well, and there were significant positive reciprocal effects between IA and depression as well as delinquency after controlling for background socio-demographic factors. Gender differences were also observed in multi-group comparisons. Specifically, IA showed a stronger longitudinal impact on delinquency among boys than among girls. While depression significantly predicted IA in 1year among boys, such a prediction was not significant among girls. These findings delineate the bidirectionality of the associations between IA and emotional and behavioral maladjustment indexed by depression and delinquency, respectively. The findings also suggest that researchers and practitioners have to take gender differences as well as different developmental indicators in understanding the bidirectional influences between IA and adolescent behavioral and emotional development.

Digital media use and suicidal behavior in U.S. adolescents, 2009-2017

U.S. adolescent suicidal behavior and digital media use prevalence have contemporaneously increased this decade in population-level ecological analyses. The purpose of this study was to determine whether these two trends are directly associated by using multi-year person-level data to test whether the association of year with suicidal behavior was mediated by digital media use. Data were from the Youth Risk Behavior Surveillance System (2009-2017), a nationally-representative biennial cross-sectional self-report survey of U.S. students (N = 72,942). Mediation analysis was used to estimate the proportion of cross-year changes in suicidal behavior that were mediated by concurrent changes in leisure-time digital media use. Past-year suicidal behavior in 2011 (19.6%), 2013 (20.4%), 2015 (21.7%), and 2017 (20.5%) increased relative to 2009 (17.1%). Hours of daily digital media use in 2011 (mean[SD] = 2.65[1.86]), 2013 (mean[SD] = 3.02[2.08]), 2015 (mean[SD] = 2.97[2.12]), and 2017 (mean[SD] = 3.01[2.18) increased vs. 2009 (mean[SD] = 2.31[1.81]). The association of survey year with suicidal behavior was mediated by digital media use-20.5%(95%CI = 16.2, 24.8), 34.3%(95%CI = 24.5, 44.1), 22.8%(95%CI = 17.3, 28.0), and 41.4%(95%CI = 33.9, 49.5) of cross-year suicidal behavior prevalence increases (vs. 2009) for 2011, 2013, 2015, and 2017, respectively, were mediated by concurrent digital media use increases. Therefore, small proportions of the 2009-2017 increases in U.S. adolescent suicidal behavior are associated with concurrent increasing digital media use trends. Further exploration of these trends is warranted.

Gender moderates the relationship between media use and sleep quality

With high screen time and poor sleep commonly reported in adolescents, it is important to more fully understand how screen time impacts sleep. Despite similar overall screen times, male and female media preferences and usages differ, making it critical to determine if different domains of screen time differentially affect sleep quality. The present study examined whether differing amounts and domains of screen-based media vary in impact on sleep quality of 16-year-old male and female adolescents over a 3-month period. A total of 98 adolescents (mean [SD] age 16.27 [0.29] years; 51% female) completed two online surveys spaced 3 months apart and comprised of well-validated self-reported measures of sleep quality, media usage, and depressive symptoms. The various domains of media were categorised into screen-based media with little-to-no peer-to-peer interaction involved (video-only) and screen-based media with interaction a predominant component to the usage (peer-to-peer interaction-involved). Self-reported sleep quality decreased across the 3-month study period. Gender moderated the effect of interactive screen time on sleep quality 3 months later, with interactive screen time associated with better sleep quality in males, but remaining poorer in females. Screen time competes with sleep time and may do so differentially depending on the media domain. Compared to females, interactive components of screen time may lessen worsening sleep quality over time in males. Understanding the relationships among screen time, its content, age, and gender may inform guidelines for educators, parents, and adolescents to help improve sleep quality of adolescents.

The impact of digital technology use on adolescent well-being

This review provides an overview of the literature regarding digital technology use and adolescent well-being. Overall, findings imply that the general effects are on the negative end of the spectrum but very small. Effects differ depending on the type of use: whereas procrastination and passive use are related to more negative effects, social and active use are related to more positive effects. Digital technology use has stronger effects on short-term markers of hedonic well-being (eg, negative affect) than long-term measures of eudaimonic well-being (eg, life satisfaction). Although adolescents are more vulnerable, effects are comparable for both adolescents and adults. It appears that both low and excessive use are related to decreased well-being, whereas moderate use is related to increased well-being. The current research still has many limitations: High-quality studies with large-scale samples, objective measures of digital technology use, and experience sampling of well-being are missing.
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The Strengths Use Scale: Psychometric Properties, Longitudinal Invariance and Criterion Validity

Strengths use is an essential personal resource to consider when designing higher-educational programs and interventions. Strengths use is associated with positive outcomes for both the student (e.g., study engagement) and the university (e.g., academic throughput/performance). The Strengths Use Scale (SUS) has become a popular psychometric instrument to measure strengths use in educational settings, yet its use has been subjected to limited psychometric scrutiny outside of the U.S. Further, its longitudinal stability has not yet been established. Given the wide use of this instrument, the goals of this study were to investigate (a) longitudinal factorial validity and the internal consistency of the scale, (b) its equivalence over time, and (c) criterion validity through its relationship with study engagement over time. Data were gathered at two-time points, 3 months apart, from a sample of students in the Netherlands (n = 360). Longitudinal confirmatory factor analyses showed support for a two-factor model for overall strengths use, comprised of Affinity for Strengths and Strengths Use Behaviors. The SUS demonstrated high levels of internal consistency at both the lower- and upper bound limits at both time points. Further, strict longitudinal measurement invariance was established, which confirmed the instrument's temporal stability. Finally, criterion validity was established through relating strengths use to study engagement at different time stamps. These findings support the use of the SUS in practice to measure strengths use and to track the effectiveness of strengths use interventions within the higher education sector.

Social media use and emotional and behavioural outcomes in adolescence: Evidence from British longitudinal data

We investigate the relationship between social media use and emotional and behavioural outcomes in adolescence using data from a large and detailed longitudinal study of teenagers from the UK. We use individual fixed effects, propensity score matching and treatment effects with Inverse Probability Weighted Regression Adjustment, controlling for a rich set of children's and family's characteristics and using comprehensive sensitivity analyses and tests to assess the potential role of unobserved variables. Our results show that prolonged use of social media (more than 4 hours per day) is significantly associated with poor emotional health and increased behavioural difficulties, and in particular decreased perception of self-value and increased incidence of hyperactivity, inattention and conduct problems. However, limited use of social media (less than 3 h per day) compared to no use has some moderate association with positive peer relationships.

Sleep duration does not mediate the association between screen time and adolescent depression and anxiety: findings from the 2018 National Survey of Children's Health

OBJECTIVE/BACKGROUND

Adolescence is a crucial time period in which individuals are at high risk for depression and anxiety. Associations between screen time and adolescent depression and anxiety have been inconclusive. We examined 1) the associations of screen time with adolescent depression and anxiety and 2) whether sleep duration mediates these relationships.

METHODS

This study utilized data from the 2018 US. National Survey of Children's Health, a large cross-sectional population representative dataset with parent/caregiver responses. Multivariable logistic regression was used to estimate the associations between screen time and depression and anxiety in separate models. Path models were used to test the mediating role of sleep duration. Confounders, as sex, age, and sociodemographic variables were included in our adjusted models.

RESULTS

Data of 10,907 adolescents aged 13 to 17 were included in this study. The average screen time was 3.76 h daily. Compared to no screen time, adolescents who used over 4 h of screen time per day had higher odds of depression (OR = 2.23, 95% CI:1.27-3.91) and anxiety (OR = 1.85, 95% CI: 1.26-2.72). Sleep duration did not mediate the associations between screen time and depression and anxiety.

CONCLUSIONS

Further research is necessary to examine the associations of screen time content with depression and anxiety, as well as the effects of sleep quality in conjunction with sleep duration on the relationships of screen time and depression and anxiety.

Increases in youth mental health services in Australia: Have they had an impact on youth population mental health?

BACKGROUND

Mental disorders often have their first onset during youth, which justifies targeting treatment services at this age group. Australia has had a substantial increase in youth mental health services since the introduction of the Medicare Better Access scheme and headspace services in 2006-2007. This paper examines trends in the mental health of Australian youth before and after this time using available national and state datasets.

METHODS

The following data were examined for age groups available in the age range of 12-25 years: use of mental health services per 100,000 population provided under Medicare by GPs, psychiatrists, clinical psychologists, other psychologists and allied health professionals; per capita accessing of headspace services; and prevalence of high and very high psychological distress (using the K10) in youth age groups in the National Health Survey, the Victorian Population Health Survey and the New South Wales Population Health Survey between 2001 and 2018.

RESULTS

There has been a large increase in use of mental health services since the introduction of Better Access and headspace. No significant improvement in youth mental health was evident following the introduction of these schemes. Rather, there appeared to be a worsening of youth mental health from around 2015 onwards.

CONCLUSION

Despite a large increase in the provision of mental health services to Australian youth, there has not been a detectable reduction in the prevalence of psychological distress. There may be other factors that have worsened youth mental health in recent years.

Social Media and Mental Health Among Early Adolescents in Sweden: A Longitudinal Study With 2-Year Follow-Up (KUPOL Study)

PURPOSE

The aim of this study is to assess the longitudinal associations between the frequency of social media use and symptoms of mental ill-health among Swedish adolescents.

METHODS

Data came from KUPOL, a Swedish school-based longitudinal cohort accrued in 101 participating schools in 8 regions of Sweden. The study sample consisted of 3,501 adolescents in grade 8 (14-15 years, 51.5%, n = 1,765 girls) followed for 2 consecutive years. Daily social media use was measured as weighted average of self-reported use in weekdays and weekend days. Mental health was measured with the Strength and Difficulties Questionnaire (SDQ). A Random-Intercept Cross-Lagged Panel Model was applied to distinguish between-person from within-person associations between social media use and symptoms of mental ill-health.

RESULTS

Median SDQ score at baseline was 9 (interquartile range [IQR] 6-14). Median social media use was 1.7 hours at baseline (interquartile range .6-3.0) and increased over the 3-year period. Adolescents with more social media use also reported higher SDQ scores, B (95% confidence interval [CI]) = 2.40 (2.03-2.77). On a within-person level, no cross-lagged associations were found between changes in social media use and subsequent changes in symptoms of mental ill-health after 1 year, B (95% CI) = .02 (-.12 to .16) or vice versa B (95% CI) = .00 (-.02 to .02). Weak cross-sectional associations were found between changes in social media use and concurrent changes in symptoms of mental ill-health, B (95% CI) = .24 (.00-.48).

CONCLUSIONS

Adolescents with higher use of social media report more symptoms of mental health problems, but there is no evidence for a longitudinal association between increased use and mental health problems. This suggests that social media may be rather an indicator than a risk factor for symptoms of mental ill-health.

Social media 'addiction': The absence of an attentional bias to social media stimuli

BACKGROUND AND AIMS

Social media use has become a ubiquitous part of society, with 3.8 billion users worldwide. While research has shown that there are positive aspects to social media engagement (e.g. feelings of social connectedness and wellbeing), much of the focus has been on the negative mental health outcomes which are associated with excessive use (e.g. higher levels of depression/anxiety). While the evidence to support such negative associations is mixed, there is a growing debate within the literature as to whether excessive levels of social media use should become a clinically defined addictive behaviour.

METHODS

Here we assess whether one hallmark of addiction, the priority processing of addiction related stimuli known as an 'attentional bias', is evident in a group of social media users (N = 100). Using mock iPhone displays, we test whether social media stimuli preferentially capture users' attention and whether the level of bias can be predicted by platform use (self-report, objective smartphone usage data), and whether it is associated with scores on established measures of social media engagement (SMES) and social media 'addiction' severity scales (BSNAS, SMAQ).

RESULTS

Our findings do not provide support for a social media specific attentional bias. While there was a large range of individual differences in our measures of use, engagement, and 'addictive' severity, these were not predictive of, or associated with, individual differences in the magnitude of attentional capture by social media stimuli.

CONCLUSIONS

More research is required before social media use can be definitively placed within an addiction framework.

The relationship between screen time and mental health in young people: A systematic review of longitudinal studies

An increase in time spent on screen-based technologies has been suggested to underlie recent increases in mental health problems among young people. However, this hypothesis has primarily been based on the findings of cross-sectional studies. The aim of the current review was to provide a comprehensive overview of longitudinal studies examining the relationship between screen time and internalising mental health symptoms. PsycINFO, PubMed/Medline and EMBASE were systematically searched for articles published up to August 2020. Thirty-five studies, with sample sizes ranging from 126 to 12,866 participants, met inclusion criteria. The association between screen time and subsequent depressive symptoms was found to be small to very small in size. There was limited evidence of any reverse association between depressive symptoms and subsequent screen time. The association between screen time and depressive symptoms varied between different devices and uses. In contrast to depressive symptoms, evidence to support longitudinal associations between screen time and other internalising mental health symptoms, including anxiety, self-esteem, and general internalising problems, was lacking. Together, these results suggest that the impact of increased screen time on the prevalence of mental health problems among young people is likely to be negligible or small. Further longitudinal studies that examine screen content and motivations underlying screen use are required to better discern any relationship between screen time and internalising mental health symptoms.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.

Psychological Correlates of Sedentary Screen Time Behaviour Among Children and Adolescents: a Narrative Review

PURPOSE OF REVIEW

The aims of this narrative review were to (1) synthesise the literature on the relationship between screen time and important mental health outcomes and (2) examine the underpinning factors that can influence this association.

RECENT FINDINGS

Paralleling the rise of mental health issues in children and adolescents is the ubiquitous overuse of screens, but it is unclear how screen time is related to important mental health outcomes and whether this association differs by gender, age and screen type.

METHODS

Medline/PubMed, PsychINFO and Google Scholar databases were searched on December 2019 for articles published mainly in the last 5 years. The search focused on two main concepts: (i) screen time and (ii) mental health outcomes including anxiety, depression, psychological and psychosocial well-being and body image concerns.

RESULTS

Sixty studies were included in the review. Higher levels of screen time were associated with more severe depressive symptoms. We found moderate evidence for an association between screen time and poor psychological well-being and body dissatisfaction especially among females. Relationships between screen time and anxiety were inconsistent and somewhat gender specific. Social media use was consistently associated with poorer mental health. Higher levels of screen time are generally associated with poorer mental health outcomes, but associations are influenced by screen type, gender and age. Practitioners, parents, policy makers and researchers should collectively identify and evaluate strategies to reduce screen time, or to use screens more adaptively, as a means of promoting better mental health among children and adolescents.

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders

OBJECTIVES

To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders.

METHODS

Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17 years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents.

RESULT

Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2 h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance.

CONCLUSIONS

Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.