Suicide Risk in Emerging Adulthood: Associations with Screen Time over 10 years

Who's most at risk? A person-centered approach to understanding the long-term relationship between early social media use and later depression across adolescence

INTRODUCTION

Person-centered analyses examined the relationship between social media use and depression over an 8-year period. The purpose was to examine the varying ways early social media use was associated with the development of depressive symptoms with a hypothesis that social media would not have a uniform association with depressive symptoms across adolescents.

METHODS

Participants included 488 adolescents (52% female), living in the United States, who were surveyed once a year for 8 years (beginning in 2010 when the average age for participants was 13.33 years old).

RESULTS

Longitudinal mixture regression was used to identify classes of adolescents representing unique ways their early social media use was related to the development of depressive symptoms over an 8-year period. Five classes were found representing unique ways social media use was related to depression. Findings suggest social media use does not impact all adolescents in the same way. Social media use was related to increased depression for adolescents with greater parental hostility, peer bullying, anxiety, reactivity to stressors, and lower parental media monitoring. In other instances, social media use was related to less depression or was unrelated to depression.

CONCLUSIONS

By identifying which adolescents may be most at risk from social media use, health providers, schools, and caregivers can tailor interventions to fit the needs of each adolescent.

A systematic review on passive sensing for the prediction of suicidal thoughts and behaviors

Passive sensing data from smartphones and wearables may help improve the prediction of suicidal thoughts and behaviors (STB). In this systematic review, we explored the feasibility and predictive validity of passive sensing for STB. On June 24, 2024, we systematically searched Medline, Embase, Web of Science, PubMed, and PsycINFO. Studies were eligible if they investigated the association between STB and passive sensing, or the feasibility of passive sensing in this context. From 2107 unique records, we identified eleven prediction studies, ten feasibility studies, and seven protocols. Studies indicated generally lower model performance for passive compared to active data, with three out of four studies finding no incremental value. PROBAST ratings revealed major shortcomings in methodology and reporting. Studies suggested that passive sensing is feasible in high-risk populations. In conclusion, there is limited evidence on the predictive value of passive sensing for STB. We highlight important quality characteristics for future research.

Association of screen-based activities and risk of self-harm and suicidal behaviors among young people: A systematic review and meta-analysis of longitudinal studies

Emerging evidence suggests that screen-based activities are associated with self-harm and suicidal behaviors. This study aimed to examine these associations among young people through a meta-analysis. We systematically searched EBSCO pshyARTICLES, MEDLINE (via PubMed), EMBASE, and Web of Science from their inception to April 1, 2022, and updated on May 1, 2024. Longitudinal studies reporting the association between various screen-based activities and subsequent self-harm and suicidal behaviors in young people aged 10 to 24 were included. Nineteen longitudinal studies were included in the qualitative synthesis, and 13 studies comprising 43,489 young people were included in the meta-analysis, revealing that total screen use is significantly associated with the risks of self-harm and suicidal behaviors. Cyberbullying victimization was also related to these adverse outcomes. Subgroup analyses indicated that social media use and problematic screen use are significant risk factors for self-harm and suicidal behaviors. Study quality was appraised using the Newcastle-Ottawa Scale, and potential publication bias was deemed unlikely to affect the results significantly. These findings suggest that screen-based activities should be considered in the management and intervention strategies for self-harm and suicidal behaviors in young people.

Screen exposure, mental health and emotional well-being in the adolescent population: is it time for governments to take action

During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.

The "Vicious Circle of addictive Social Media Use and Mental Health" Model

Social media use (SMU) is a significant part of many people's everyday life. Research around the globe describes an increase of addictive SMU tendencies since the COVID-19 outbreak. The present work combines available findings in the "Vicious Circle of addictive Social Media Use and Mental Health" model to explain how social media (SM) activity can contribute to the development of addictive tendencies, which consequences they have for mental health, and how to prevent them. Following the model, the interplay between the risk factors negative experiences caused by daily hassles and by unexpected global and traumatic events, SMU (dimension "quality"), and SM flow can directly contribute to addictive SMU through the "vicious circle". Time spent on SMU (dimension "quantity"), symptoms of depression and anxiety, and the personality trait narcissism contribute to the circle as moderators. Symptoms of stress, insomnia, and suicide-related outcomes are described as potential consequences of addictive SMU. Based on longitudinal intervention studies, a conscious reduction of SMU time and an increase of physical activity, as well as positive mental health and mindfulness are identified as protective factors that reduce the risk of addictive tendencies. The model contributes to a better understanding of addictive SMU. Implications of the model for future research and praxis, specifically for mental health programs and therapeutic treatment are discussed.

Trajectories of Adolescent Media Use and Their Associations With Psychotic Experiences

Importance

Adolescent media use is thought to influence mental health, but whether it is associated with psychotic experiences (PEs) is unclear.

Objective

To examine longitudinal trajectories of adolescent media use and their associations with PEs at 23 years of age.

Design, Setting, and Participants

This cohort study included participants from the Québec Longitudinal Study of Child Development (1998-2021): children who were born in Québec, Canada, and followed up annually or biennially from ages 5 months through 23 years. Data were analyzed between January 2023 and January 2024.

Exposures

Participants reported their weekly amount of television viewing, video gaming, computer use, and reading at ages 12, 13, 15, and 17 years.

Main Outcome and Measures

Lifetime occurrence of PEs was measured at 23 years of age. Covariables included sociodemographic, genetic, family, and childhood characteristics between ages 5 months and 12 years.

Results

A total of 1226 participants were included in the analyses (713 [58.2%] female, 513 [41.8%] male). For each media type, latent class mixed modeling identified 3 group-based trajectories, with subgroups following trajectories of higher use: television viewing, 128 (10.4%); video gaming, 145 (11.8%); computer use, 353 (28.8%); and reading, 140 (11.4%). Relative to lower video gaming, higher video gaming was preceded by higher levels of mental health and interpersonal problems at age 12 years. Adjusting for these risk factors mitigated the association between higher video gaming and PEs at age 23 years. The curved trajectory of computer use (189 [15.4%] participants), characterized by increasing levels of use until age 15 years followed by a decrease, was associated with higher PEs (estimated difference, +5.3%; 95% CI, +1.5% to +9.3%) relative to lower use (684 [55.8%] participants). This association remained statistically significant after covariable adjustment.

Conclusions and Relevance

This study found that longitudinal trajectories of media use during adolescence were modestly associated with PEs at age 23 years, likely reflecting the influence of shared risk factors. Understanding the environmental determinants and psychosocial functions of media use during adolescence may help better integrate digital technologies in the prevention and management of PEs.

Insufficient Sleep is Associated With Increasing Trends in Adolescent Suicidal Behaviors

PURPOSE

Youth suicide has been increasing and became a public health concern worldwide. Identifying insufficient sleep as the potential risk factor is critical to reducing suicide risk and increasing trends. This study aimed to determine whether insufficient sleep is associated with increasing trends in suicidal behaviors and disparities by sex, age, and race/ethnicity among school adolescents.

METHODS

The present study used biennial data from the US nationally representative Youth Risk Behavior Survey from 2007 to 2019. Joinpoint regression models were used to estimate biennial percent changes (BPCs) and average BPCs (ABPCs) of suicidal behaviors by sleep duration. Logistic regression models were used to examine the association between insufficient sleep and suicidal behaviors.

RESULTS

Of 73,356 adolescent students included (mean [standard deviation] age, 16.11 [1.23] years), 50.03% were female. Suicidal ideation and suicide plan among insufficient sleep group increased from 2007 to 2019 (BPC = 2.88% [95% confidence interval {CI}: 1.65%, 4.13%]; BPC = 3.42% [95% CI: 2.09%, 4.77%]), but were nonsignificant among sufficient sleep group. Trends in suicidal ideation (ABPC = 3.03% [95% CI: 1.35%, 4.73%]) and suicide plan (ABPC = 4.03% [95% CI: 2.47%, 5.62%]) among female adolescents with insufficient sleep increased, but nonsignificant among male adolescents with insufficient sleep. Suicidal ideation (ABPC = 1.73% [95% CI: 0.51%, 2.97%]) and suicide plan (ABPC = 2.31% [95% CI: 0.70%, 3.95%]) increased among younger adolescents only with insufficient sleep, whereas suicide trends by sleep duration were similar among older adolescents. Suicide plan among insufficient sleep group increased across the four racial groups, with BPC highest for the White (BPC = 3.48% [95% CI: 1.31%, 5.69%]), and lowest for the Hispanic/Latino (BPC = 1.18% [95% CI: 0.15%, 2.23%]), but were nonsignificant among sufficient sleep group except for the White (BPC = 2.83% [95% CI: 0.62%, 5.09%]).

DISCUSSION

Insufficient sleep was disproportionately associated with increasing trends in suicidal behaviors among female, younger, and non-White adolescent students. Ensuring sufficient sleep can potentially reduce suicide among school adolescents.

Positive and negative social media experiences and proximal risk for suicidal ideation in adolescents

BACKGROUND

Social media (SM) has received considerable attention as a potential risk factor for adolescent suicide. Few empirical studies, however, have examined adolescents' daily negative and positive experiences on SM and its proximal impacts on suicidal ideation (SI), particularly using intensive monitoring designs.

METHOD

Adolescents (N = 60; 14-17 years; 49% girls; 62% LGBTQ+) recruited using SM across the United States and participated in an 8-week intensive monitoring protocol. Ecological momentary assessment (three brief surveys per day) asked about negative and positive SM experiences and SI (passive and active). Multilevel modelling was used to evaluate the within-person relationships between daily SM experiences (e.g. individual fluctuations compared to a person's average) and SI, controlling for average levels of SM experiences, SM use screen time, and lifetime SI.

RESULTS

Significant within-person effects of negative and positive SM experiences were associated with days when adolescents had SI. Specifically, on days when teens endorsed more frequent negative SM experiences than usual, they were more likely to report SI. However, more positive SM experiences than usual were associated with a lower likelihood of having SI. There were no significant effects of SM use ('screen time') on SI or on the reverse associations of SI on next-day SM experiences.

CONCLUSIONS

Results indicate that SM experiences may be dynamic and modifiable risk and protective factors for SI in adolescents, whereas there is no effect of SM screen time on SI. Our results highlight that targeting negative SM experiences and augmenting the positive experiences on SM may be critical targets to improve teens' mental health and prevent suicide, rather than focusing on limiting SM screen time.

Is meeting with the 24-h movement recommendations linked with suicidality? Results from a nationwide sample of 44,734 U.S. adolescents

BACKGROUND

To our knowledge, only few studies have analyzed the relationship between meeting the 24-h movement guidelines and suicidality in adolescents. The aim of this study was twofold: first, to examine the association between meeting the 24-h movement recommendations and suicidal ideation, suicide planning, and attempted suicide in a representative sample of adolescents from the U.S.; and second, to test whether age group, sex, or race moderate these associations.

METHOD

This is a cross-sectional study including pooled data from the 2011, 2013, 2015, 2017, 2019, and 2021 high school Youth Risk Behavior Surveys (YRBS). A total sample of 44,734 participants (48.5 % females) was included. The recommendations of the 24-h movement guidelines included physical activity, screen time, and sleep duration. Suicidality was examined considering three suicide-related behaviors: suicidal ideation (yes/no), suicide planning (yes/no), and attempted suicide (at least one time or more during the past 12 months).

RESULTS

Adolescents who met all three recommendations showed a lower likelihood of suicidal ideation (odds ratio [OR] = 0.49, 95 % confidence interval [CI] 0.37 to 0.64, p < 0.001), suicide planning (OR = 0.51, 95 % CI 0.37 to 0.68, p < 0.001), and attempted suicide (OR = 0.66, 95 % CI 0.44 to 0.96, p = 0.038) than those who did not meet all the recommendations. Overall, when younger adolescents, female adolescents, and adolescents of minority races met the 24-h movement recommendations, they had lower odds of suicide-related outcomes than when they did not.

LIMITATIONS

This is a cross-sectional study using self-reported data. It is not possible to establish cause-and-effect relationships, and the results could be influenced by some biases.

CONCLUSION

This study suggests that meeting the 24-h movement recommendations could play a relevant role in the prevention of suicidal ideation, planning suicide, and attempted suicide in a nationwide sample from the U.S. adolescents.

Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States

Aim

Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents.

Methods

Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality.

Results

A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight.

Conclusion

Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.

Trajectories of Screen Time across Adolescence and Their Associations with Adulthood Mental Health and Behavioral Outcomes

Excessive screen time among adolescents is discussed as a significant public health concern. Identifying adolescent longitudinal patterns of time spent on regularly-used media screens and understanding their young adulthood mental health and behavioral issue correlates may help inform strategies for improving these outcomes. This study aimed to characterize joint developmental patterns of time spent on videogames, surfing/chatting the Internet, and TV/DVDs during adolescence (at ages 11, 13, 15, 17) and their associations with mental health (i.e., depression, anxiety, suicidal ideation, and self-injury) and behavioral issues (i.e., substance use, delinquency, aggression) in early adulthood (at age 20). A parallel-process latent class growth analysis was used to model data from a diverse community-ascertained sample of youth in Zurich, Switzerland (n = 1521; 51.7% males). Results suggested that a five-class model best fitted the data: (1) low-screen use, 37.6%; (2) increasing chatting/surfing, 24.0%; (3) moderate-screen use, 18.6%; (4) early-adolescence screen use, 9.9%; and (5) increasing videogame and chatting/surfing, 9.9%. After adjusting for baseline levels of outcomes (primarily at age 11), the trajectory groups differed in their associations with adulthood outcomes of mental health and behavioral problems, indicating the importance of problematic screen usage patterns in predicting these outcomes. Future research to test the directionality of these associations will be important. These findings suggest which patterns of screen use may be a marker for later mental health and behavioral issues in different domains.

Screen time and suicidal behaviors among U.S. children 9-11 years old: A prospective cohort study

Suicide is a leading cause of death among adolescents. Emerging literature has described relationships between excessive screen time and suicidal behaviors, though findings have been mixed. The objective of this study is to determine the prospective associations between screen time and suicidal behaviors two-years later in a national (U.S.) cohort of 9-11-year-old-children. We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,633). Logistic regression analyses were estimated to determine the associations between baseline self-reported screen time (exposure) and suicidal behaviors (outcome) based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at two-year-follow-up. Participants reported an average of 4.0 h of total screen time per day at baseline. At two-year-follow-up, 1.38% of the sample reported at least one suicidal behavior. Each additional hour of total screen time was prospectively associated with 1.09 higher odds of suicidal behaviors at 2-year-follow-up (95% CI 1.03-1.14), after adjusting for covariates. For specific screen time modalities, each additional hour of texting (aOR 1.36, 95% CI 1.06-1.74), video chatting (aOR 1.30, 95% CI 1.03-1.65), watching videos (aOR 1.21, 95% CI 1.04-1.39), and playing video games (aOR 1.18, 95% CI 1.01-1.38) was associated with higher odds of subsequent suicidal behaviors. Higher screen time is associated with higher odds of reporting suicidal behaviors at two-year-follow-up. Future research should seek to identify how specific screen time experiences may influence suicidal behaviors.

Child and family factors associated with child mental health and well-being during COVID-19

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children's mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother-child dyads (child age 9-11) from the All Our Families cohort. Mothers reported on the child's pre-pandemic mental health at age 8 (2017-2019) and during COVID-19 (May-July 2020), the family's financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July-August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B - 0.16; 95% CI - 0.22 to - 0.09), child sleep (B - 0.11; 95% CI - 0.19 to - 0.04), and child screen time (B 0.11; 95% CI 0.04-0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B - 0.26; 95% CI - 0.32 to - 0.21) and screen time (B 0.09; 95% CI 0.02-0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28-0.39) predicted child COVID-19 happiness. Fostering parent-child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.

Digital screen time and suicidality during high school: How important is cyberbullying? A mediation analysis using the youth risk behavioral surveillance survey, 2011-2019

Elevated digital screen time (i.e., 2+ hours per day) is associated with suicidal ideations, planning, and attempts during adolescence. Recent studies suggest quality, rather than duration, of digital screen time is most impactful on adolescent mental health. We investigate the role of cyberbullying victimization on the relationship between elevated digital screen time and risk factors for completed suicide. We pooled five years of biennial Youth Risk Behavioral Surveillance (YRBS) survey data (2011-2019). Participants were n = 73,011 high school students in the United States (US). Elevated digital screen time reflected spending 3 h (or more) per day on leisure, digital media. Outcome variables were: (1) feeling sad/hopeless; (2) suicidal ideation; (3) suicidal planning; and (4) suicide attempt. Structural equation models (SEMs) tested the mediating effects of self-reported online bullying victimization (i.e., cyberbullying) on the effect of elevated digital screen time on suicidality. We controlled for age, sex, race/ethnicity, and survey year. Subsample analyses stratified by sex were also conducted. Overall, 40.5% of high school students reported elevated digital screen time and 15.4% reported cyberbullying. Cyberbullying mediated a substantial proportion of the relationship between digital screen time and feeling sad/hopeless (16%), suicidal ideation (18%), planned suicide attempt (18%), and past suicide attempt (26%), among high school students, controlling for covariates. Similar mediating effects were observed in models stratified by sex. Findings reinforce prior research demonstrating that the quality of leisure, digital media strongly influences the relationship between digital screen time and mental health during adolescence. Findings need replication via longitudinal designs.

Interaction effects of screen time and fast-food consumption on suicidal behaviours: Evidence from a nationwide survey among Chinese adolescents

BACKGROUND

Although screen time and fast-food consumption have been linked to suicidal behaviours, it is unclear whether their combined effects are associated with suicidal behaviours among adolescents.

METHODS

A sample of 16,853 Chinese adolescents answered a standard questionnaire on screen time, fast-food consumption, and suicidal behaviours. A binomial logistic regression model was used to analyse the association between the three. An interaction model was used to examine the interaction effects of screen time and fast-food consumption on suicidal behaviours in adolescents.

RESULTS

There were positive correlations between screen time, fast-food consumption, and suicidal behaviours, even after adjusting for confounding factors. Interaction analyses indicated that increased screen time on weekdays and fast-food consumption were associated with suicidal ideation. The relative excess risk of interaction, attributable proportions, and synergy index of interaction were 0.41, 0.15, and 1.32, respectively. Increased screen time on weekends and fast-food consumption were associated with suicidal ideation. The relative excess risk of interaction, attributable proportions, and synergy index of interaction were 0.37, 0.14, and 1.27, respectively. Similar additive interaction effects were exhibited in increased screen time and fast-food consumption on suicidal planning. Positive additive interaction effects were observed in increased screen time on weekdays and fast-food consumption on suicide attempts.

LIMITATIONS

A cross-sectional study design was used; therefore, causal associations remain unclear.

CONCLUSIONS

Screen time and fast-food consumption are cross-sectionally associated with suicidal behaviours among Chinese adolescents. Strategies should be considered to reduce screen time and fast-food consumption among adolescents.

Social media use, mental health, and suicide-related outcomes in Russian women: A cross-sectional comparison between two age groups

BACKGROUND

Women who belong to the age group "emerging adulthood" (18 to 29 years) are vulnerable to mental health issues and suicide-related outcomes.

OBJECTIVES

This study investigated potential predictors of suicide-related outcomes in females emerging adulthood and compared them to older women.

DESIGN AND METHODS

Data of 2537 women from Russia (group "18 to 29 years": n = 1123; group "> 29 years": n = 1414) on lifetime suicide-related outcomes, (problematic) social media use, daily stress, depression and anxiety symptoms, and positive mental health were assessed via online cross-sectional surveys.

RESULTS

The younger group spent significantly more time on social media use than the older group. It had significantly higher levels of daily stress, problematic social media use, depression and anxiety symptoms, and suicide-related outcomes. The older group showed significantly higher levels of positive mental health. Only in the younger group, problematic social media use significantly mediated the relationship between daily stress and suicide-related outcomes in a moderated mediation analysis. Positive mental health significantly moderated the association between problematic social media use and suicide-related outcomes. Specifically, the higher the positive mental health level, the less close the link between both variables.

CONCLUSION

The current results reveal that young women in Russia could be at enhanced risk for daily stress, problematic social media use, and low levels of mental health. The interaction between these variables could foster suicide-related outcomes. Public governmental communication in Russia should call attention to potential negative impact of intensive social media use.

Trajectories of 24-h movement guidelines from middle adolescence to adulthood on depression and suicidal ideation: a 22-year follow-up study

Background:

The 24-h movement guidelines for youth and adults recommend the specific duration of physical activity, sedentary time, and sleep duration to ensure optimal health, but little is known about its relationship to mental health indicators. The aim of the study was to explore the association between 24-h movement guidelines in adolescence and its trajectories from middle adolescence (12–17 years old) to adulthood (33–39 years old) with depression and suicidal ideation in adulthood.

Methods:

This prospective cohort study included individuals who participated in Waves I (1994–1995) and V (2016–2018) of the National Longitudinal Study of Adolescent Health (Add Health) in the United States. Physical activity, screen time and sleep duration were measured using questionnaires. Adults were categorized as having depression if they had a self-reported history of depression and/or prescription medication-use for depression in the previous four weeks. Suicidal ideation was assessed by a self-reported single question in both waves. Poisson regression analyses were used to estimate the incidence rate ratio (IRR) of depression and suicidal ideation at adulthood, according to meeting specific and combinations of 24-h movement guidelines at Wave I and its trajectories from adolescence to adulthood.

Results:

The study included 7,069 individuals (56.8% women). Adolescents who met physical activity guidelines and all three guidelines at middle adolescence had lower risk of depression (IRR = 0.84, 95%CI 0.72 to 0.98) and suicidal ideation (IRR = 0.74, 95%CI 0.55 to 0.99) at adulthood than those who did not meet any of these guidelines, respectively. Individuals who met the guidelines for screen time and all three guidelines in both adolescence and adulthood had lower risk of depression (screen time, IRR = 0.87, 95% CI 0.72 to 0.98; all three, IRR = 0.37, 95% CI 0.15 to 0.92) and suicidal ideation (screen time, IRR = 0.74, 95% CI 0.51 to 0.97; all three, IRR = 0.12, 95% CI 0.06 to 0.33) than those who never met the guidelines. Additionally, individuals who did not meet all three guidelines in adolescence but met the guidelines in adulthood had lower risk of suicidal ideation than those who never met the guidelines (IRR = 0.81, 95%CI 0.45 to 0.89).

Conclusion:

Our findings highlight the importance of promoting and maintaining adherence to the 24-h movement guidelines from middle adolescence to adulthood to prevent mental health problems. However, our findings must be interpreted carefully due to declared limitations, e.g., the self-reported assessments which are subject to sources of error and bias or that the dataset used to gauge meeting a guidelines (1994–1996) was made later (2016).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01367-0.

Youths' attitudes toward open discussion of suicide, preferred contexts, and the impact of Internet use: An exploratory sequential mixed-methods study in Hong Kong

BACKGROUND

Although the necessity and benefits of having the open and public discussion about suicide have been recognized, youths' opinions regarding such discussion remain unknown.

AIMS

To explore youths' attitudes toward open suicide discussion, particularly concerning their preference of discussion contexts and impacts of Internet use.

METHOD

This exploratory sequential mixed-methods study targeted Hong Kong youths aged 15 to 19. A total of six focus groups and 12 individual interviews were held (N = 40). Topics included adolescents' views of open suicide discussion, concerns, perceived benefits, and preferred contexts. The questionnaire survey (N = 1,676) was conducted subsequently to investigate the prevalence of youths' perspectives on public discussion of suicide and relationships with discussion contexts, use of social media platforms, and motivations of online expression.

RESULTS

Qualitative findings revealed three types of attitudes toward open suicide discussion: reluctance, support, and indifference. Major barriers included cultural norms, topic sensitivity, privacy concerns, contagion effect, fear of embarrassment, and unpleasant experiences in school programs. Results of quantitative analyses showed that reluctance was the dominant attitude among adolescents, and taboo was the top concern. Variations in youths' attitudes were related to gender, school academic banding, and suicide-related experiences. Notably, adolescents who had been exposed to suicide messages in contexts of peer networks and online platforms were more likely to endorse open suicide discussion. In addition, an increased likelihood of engaging in public suicide discussion was associated with the use of Instagram, WhatsApp, and Snapchat, and the motive of 'expressing emotions and opinions' online.

CONCLUSIONS

Our results indicated a prevalent rejection among adolescents toward open suicide discussion, suggesting the issue of stigma, the need for tailored programs, the value of appropriate contexts, and the impact of Internet use. These findings may facilitate the development of school-based suicide prevention initiatives and the efficacy of online services for suicide-related communication.

Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic

Despite an overall decrease in utilization of emergency departments during COVID-19 (Hartnett et al. in MMWR Morb Mortal Wkly Rep. 69(23):699-704, 2020), US pediatric emergency departments experienced an increase in mental health visits for children and adolescents (Leeb et al. in MMWR Morb Mortal Wkly Rep. 69(45):1675-80, 2020). Simultaneously, individuals with eating disorders reported increasing symptomology (Termorshuizen et al. in Int J Eat Disord. 53(11):1780-90, 2020). This study compares Emergency Department utilization at a pediatric quaternary-level care center by patients with eating disorders during the pandemic (March-Dec 2020) vs March-Dec 2019. We hypothesize that there was an increase in presentation of patients with eating disorders. An Informatics for Integrating Biology and the Bedside query of the electronic medical record system identified patients with eating disorder diagnoses per ICD9/ICD10 codes aged 6-23 who presented to the Emergency Department between March 1^st and December 31^st of 2020 and 2019. Subsequent retrospective chart review was carried out. Patients were excluded from analysis if the presenting problem was not directly related to the eating disorder. During March-Dec 2019, 0.581% percent of all patients presented to the Emergency Department due to an eating disorder. During the same time frame in 2020, however, that percentage increased to 1.265%. Statistical significance was corrected using a Benjamini-Hochberg analysis. Despite a 66.5% decline in overall visits to the Emergency Department, the percentage of patients presenting with eating disorders doubled during the pandemic. During the pandemic, the total time spent awaiting placement significantly increased, and the number of patients identifying as transgender and/or nonbinary increased. Our data support the hypothesis that eating disorder presentation increased during the pandemic.

Teens, screens and quarantine; the relationship between adolescent media use and mental health prior to and during COVID-19

This study examines associations between media use and mental health for adolescents prior to and during the COVID-19 pandemic. Using two separate datasets that sampled adolescents (8th, 10th, and 12th graders) in 2018 (n = 31,825) and 2020 (n = 1,523), mental health (hopelessness and happiness), media use (time spent using a variety of media), and personal health habits (sleep) were assessed. Overall, we found that there were significant differences by year in adolescent hopelessness, with adolescents reporting less hopelessness in 2020 (during COVID-19) than in 2018 (pre COVID-19). There were not ​practical significant differences in adolescent happiness and loneliness. Adolescents also reported getting more sleep in our 2020 sample than the 2018 sample. Adolescents in 2020 spent significantly more time watching movies and video chatting, but less time texting and on social media than adolescents in 2018. Finally, we found that time spent video chatting and sleep had a different relationship with various aspects of mental health (happiness, hopelessness, or loneliness) in 2018 vs. 2020.

The Association of Soft Drink Consumption and the 24-Hour Movement Guidelines with Suicidality among Adolescents of the United States

Background: Evidence is lacking for the association of the behaviors of the 24 h movement guidelines including sleep duration, physical activity, screen time, and soft drink consumption with suicidality among adolescents. Methods: Data were extracted from a national representative sample of Youth Risk Behavior Surveys (YRBS) in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of the recommendations of the 24 h movement guidelines and soft drink consumption with suicidality. Results: The total prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment was higher among adolescents who did not meet all the recommendations in the 24 h movement guidelines and had a higher level of soft drink consumption. Totally, not meeting all the recommendations of the 24 h movement guidelines was significantly associated with an increased risk of suicidal ideation (OR: 1.69, 95% CI: 1.30–2.19) and suicide plan (OR: 1.76, 95% CI: 1.34–2.33) compared with adolescents who meet all the recommendations. Soft drink consumption of ≥3 times/day was associated with an increased risk of suicidality including suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment, regardless of sex. Soft drink consumption of ≥3 times/day was significantly associated with an increased risk of suicide attempt and suicide attempt with medical treatment, regardless of whether the recommendations of physical activity, screen time, and sleep duration were met. Conclusion: Age-appropriate sleep duration, no more than 2 h of screen time per day, at least 1 h of physical activity per day as contained in the 24 h movement guidelines and less than one soft drink consumption per day are good targets to prevent involvement in suicidality. More actions for intervening in the movement and dietary behaviors among adolescents are needed to maintain physical and mental health.

Youth, Social Media, and Telehealth: How COVID-19 Changed Our Interactions

Adolescents and young adults (AYA) use social media more than any other generation, including to learn about their health. The coronavirus disease 2019 pandemic further accelerated both health harming and health benefits of technology use. Also, during this time, medical professionals moved more quickly to virtual visits, changing AYA, family, and provider interactions and expectations. Remote health care, broader technology use, and improved youth engagement have the potential to address long-standing barriers to health equity. Telehealth disadvantages still exist, however, especially for those with decreased access. Recent rapid changes have not allowed for sufficient study to address optimizing the experience, effectiveness, and utilization of remote health care. Fortunately, because of their expansive engagement with social media and technology, AYA are paving the way toward a digital health future. Health professionals are encouraged to improve their virtual and social media interactions with AYA patients, while finding ways to improve health equity. [Pediatr Ann. 2022;51(4):e161-e166.].

Impact of the COVID-19 pandemic on children's mental health: A systematic review

BACKGROUND

The outbreak of COVID-19 in December 2019 has caused unprecedented disruption to the structure of children's daily lives due to school closures, online learning, strict social distancing measures, limited access to outdoor activities and many other restrictions. Since children are more susceptible to stress than adults and there is a growing concern about the potential debilitating consequences of COVID-19 for children's mental health, the present review aims to provide empirical evidence on the groups who are most at risk of mental health problems and uncover the risk and protective factors of children's mental health.

METHODS

A systematic search was performed, in accordance with PRISMA guidelines, in the electronic databases Web of Science (including SSCI and A&HI) and EBSCOhost (including ERIC, MEDLINE and APA PsycArticles and APA PsycINFO), for any empirical studies published between January 2020 and February 2022 that focused on children ≤ 12 years old.

RESULTS

An initial search identified 2,133 studies. A total of 30 studies fulfilled the inclusion criteria and were analyzed. The evidence showed that many children were affected by the COVID-19 pandemic and experienced internalizing and externalizing behaviors. Worsened child mental health outcomes reflected socioeconomic inequalities as most at-risk children had parents with low educational attainment, were from families of low socioeconomic status and lived in small homes. Key risk factors were identified, including unhealthy lifestyle behaviors (extended screen time, sleep disturbances and less physical activity), increased pandemic-related stressors among parents and deteriorated mental health of parents, which were directly or indirectly associated with the pandemic safety measures, such as home confinement or social distancing. Protective factors including parents' resilience, positive parent-child relationship and school connectedness in relation to children's mental health were reported.

CONCLUSION

The overall results highlight the urgent need for the implementation of tailor-made interventions for children with signs of internalizing and externalizing behaviors. Health promotion and prevention strategies by the government to maintain the mental health of children, particularly those from lower SES families who are at higher risk of worsened mental health are essential for post-pandemic policies.