Reciprocal associations between depression and screen-based sedentary behaviors in adolescents differ by depressive symptom dimension and screen-type

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

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.

Associations Between Moderate to Vigorous Physical Activity, Sedentary Behavior, and Depressive Symptomatology in Adolescents: A Prospective Observational Cohort Study

BACKGROUND

More moderate to vigorous physical activity (MVPA) and less time in sedentary behavior (SB) may protect against poor mental health in adolescence. Depressive symptomatology may also influence adolescents' own MVPA and SB. The aim of this study was to examine the bidirectional relationship between adolescent MVPA, SB, and depressive symptomatology using a longitudinal approach.

METHODS

Adolescents (10-16 y) were recruited for a prospective observational cohort. Depressive symptomatology was measured using the Short Mood and Feelings Questionnaire. Accelerometry was used to measure MVPA and SB. Adolescents were classified by meeting the MVPA guideline (≥60 min/d) and quartiles of SB time, with the lowest amount of time in SB compared to others. Bidirectional associations between MVPA, SB, and depressive symptomatology were assessed using mixed-effects regression models.

RESULTS

At baseline, adolescents (n = 205) were 12.5 (2.0) years, 54.6% women, 59.1% White, and 34.6% African American. In unadjusted models, adolescents with less baseline time in SB had lower follow-up Short Mood and Feelings Questionnaire scores, and fewer were classified as depressed at follow-up compared to others. After adjustment, adolescents with less baseline time in SB had lower depressive symptomatology at follow-up.

CONCLUSIONS

Limiting time spent in SB in adolescence may improve future mental health.

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-Varying Associations Between Device-Based and Ecological Momentary Assessment-Reported Sedentary Behaviors and the Concurrent Affective States Among Adolescents: Proof-of-Concept Study

BACKGROUND

Previous studies on affective state-sedentary behavior (SB) associations have not accounted for their potentially time-varying nature and have used inconsistent SB measurement modalities. We investigated whether the strength of the associations between affective states and SB varied as a function of the time of day and by SB measurement modality (device-measured SB vs ecological momentary assessment-reported screen-based SB) in youth.

OBJECTIVE

This study aimed to establish a proof of concept that SB-affective state associations may not be static during the day. In addition, we aimed to inform the methodology of future work, which may need to model associations as functions of the time of day and carefully consider how SB is operationalized or measured.

METHODS

A total of 15 adolescents (age: mean 13.07, SD 1.03 years; 10/15, 67% female; 6/15, 40% Hispanic; 10/15, 67% healthy weight) wore thigh-mounted activPAL accelerometers and simultaneously reported their screen-based SBs and concurrent positive and negative affective states via ecological momentary assessment for 7 to 14 days (N=636 occasions). Time-varying effect models (varying slopes) examined how each measure of SB was associated with concurrent affective states from 7 AM to 8 PM.

RESULTS

Time-varying effect model plots revealed that these associations varied in strength throughout the day. Specifically, device-based SB was related to greater concurrent negative affect only after approximately 5 PM and was unrelated to concurrent positive affect. Screen-based SB was related to greater concurrent negative affect only from 7 AM to approximately 9 AM. This was also related to greater concurrent positive affect from 7 AM to approximately 9:30 AM and from approximately 3 PM to approximately 7 PM.

CONCLUSIONS

We provide preliminary evidence to suggest that future confirmatory studies investigating the SB-affective state relationship should consider the time-varying nature of these associations and SB measurement modality. There may be critical time windows when specific types of SBs co-occur with affect, suggesting that interventions may need tailoring to the time of day and type of SB if future studies using similar methodologies can replicate our findings.

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.

Unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents

BACKGROUND

It is well known that some lifestyle-related behaviors are related to depressive symptoms, but the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents are still controversial.

AIMS

The aims of this study were to examine the unique and cumulative effects of lifestyle-related behaviors on depressive symptoms among Chinese adolescents, and explored the potential influences of gender difference on these associations.

METHODS

We conducted a cross-sectional study among 3967 Chinese adolescents aged 11 to 19 from Jilin, China during September and October of 2018. Students reported their lifestyle factors including sleep duration, time spent on computer, time spent on television, time spent on homework, eating breakfast, smoking, drinking, physical activity, and outdoor activity. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

The prevalence of depressive symptoms was 28.2% among Chinese adolescents. Multivariate logistic regression analysis revealed that sleep duration <8 hour/day, time spent on homework ⩾3 hour/day, skipping breakfast, alcohol use, physical activity <3 days/week, and outdoor activity <2 hour/day were positively associated with depressive symptoms in both girls and boys. Time spent on computer ⩾2 hour/day was an independent risk predictor for depressive symptoms in males, while smoking only showed higher risk of depressive symptoms in females. There was an additive relationship between the lifestyle risk index scores and the risk of depressive symptoms for both genders, the relationship being strongest among females.

CONCLUSION

The important role of lifestyle factors should be taking into consideration when create intervention programs to prevent and reduce depressive symptoms among adolescents. In addition, preventive interventions may need to focus on gender-informed approaches when targeting multiple lifestyle factors.

The relationships between screen time and mental health problems among Chinese adults

BACKGROUND

This study aimed to examine the specific relationships between screen time and various mental health problems among community-dwelling adults in China.

METHODS

Self-reports of weekday and weekend screen time (TV, computer use and cell phone/tablet use), symptoms of PTSD, depression, and ADHD, and psychotic-like experiences (PLEs) were completed by 7121 Chinese adults. Logistic regression was used to examine specific relationships between screen time and mental health problems with demographics, physical activity, drinking, smoking, and sleep duration as covariates.

RESULTS

On weekdays, the participants spending at least 3 h on watching TV, computer use and cell phone/tablet use respectively accounted for 6.8%, 15.9% and 45.9%. On weekends, the proportions were 15.5%, 12.1% and 50.0%. Computer use on weekends was associated with higher risk of PTSD (OR = 1.81); cell phone/tablet use on weekdays and weekends was related to increased depression (OR = 1.38, OR = 1.28, respectively), while only computer use on weekends was related to depression (OR = 1.33); cell phone/tablet use both on weekdays and weekends was also connected to ADHD (OR = 1.56, OR = 1.48, respectively); on weekdays and weekends, more time TV viewing (OR = 1.76-1.79, OR = 1.46-1.71, respectively) and less cell phone/tablet use (OR = 0.66, OR = 0.65, respectively) were associated with higher numbers of PLEs.

CONCLUSIONS

The relationships between different types of screen time and mental health problems are variant. Future longitudinal studies should subdivide screen time on the basis of content and explore the specific causal relationship between screen time and mental health problems.

The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren

Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8-10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.

Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic

Research on the combined role of 24-hour movement behaviors (sleep, sedentary behavior [SB], and physical activity) in adult mental health, though important, is in its infancy. In the context of Canadian 24-hour movement guidelines integrating quantitative recommendations for sleep, SB, and moderate-to-vigorous physical activity (MVPA), this study aimed to examine the associations between meeting guidelines and mental health among college students. The study used a cross-sectional sample of 1846 Chinese college students surveyed online in August 2020. Through network analysis and multivariate analysis of covariance, the individual and combined associations between meeting 24-hour movement guidelines and the levels of depression and anxiety after adjusting sociodemographic factors were analyzed. Results indicated that meeting the sleep guideline had stronger associations with depression and anxiety than meeting the SB or MVPA guideline. Specifically, compared to meeting no guidelines, meeting the sleep guideline (alone or in combination with other guidelines) was associated with significantly lower levels of depression and anxiety; meeting both SB and MVPA guidelines was also associated with a significantly lower level of depression. Hence, meeting more guidelines, especially adhering to a healthy sleep routine, may play an important role in promoting the mental health of young adults.

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.

Health Behavior, Health-Related Quality of Life, and Mental Health Among Canadian Children: A Population-Based Cohort Study

Objective: Studies that have reported the associations of diet quality, physical activity (PA), sedentary behavior (SB), and health-related quality of life (HRQoL) with mental health among children and adolescents are predominantly cross-sectional in design. Very few studies have examined the longitudinal relationship of mental health with health behavior and HRQoL among children. This study aimed to investigate the associations of diet quality, PA, SB, and HRQoL among children with mental health disorders throughout childhood.

Methods: We linked data from grade five students aged primarily 10 and 11 years who participated in the Raising Healthy Eating and Active Living (REAL) Kids Alberta survey in 2012 in the Canadian province of Alberta with their administrative health care data from birth to 2012. Mental health outcomes included internalizing disorder and attention deficit and hyperactivity disorder (ADHD) defined by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or Tenth Revision, Canadian version (ICD-10-CA). The HRQoL was measured by the EQ-5D-Y, a five-dimensional descriptive system for children and youth. We applied negative binomial regressions to examine the associations between health behaviors, HRQoL, and mental health.

Results: Of the 1,352 participating students, 12.31 and 8.32% had a diagnosis of internalizing disorders and ADHDs, respectively, during childhood from birth to the ages of 10–11 years. Students in the highest tertile for diet quality, relative to the lowest tertile, were 56% less likely to have diagnoses of internalizing disorders (incidence rate ratio, IRR = 0.44, 95% CI = 0.23–0.85). Students engaged in less PA (vs. more PA) were more likely to be diagnosed for internalizing disorders (IRR = 1.98, 95% CI = 1.19–3.30). Poorer diet quality, low PA, excessive use of computers/video games, and watching TV were significantly associated with more diagnoses of ADHDs. Children who experienced some or a lot of problems in “feeling worried, sad, or unhappy” and “having pain or discomfort” were more likely to receive diagnoses of internalizing disorders and ADHDs, respectively.

Conclusions: These observed associations suggest that health promotion programs targeting promoting diet quality, PA, and HRQoL and reducing SB among children may contribute to improving mental health.