A prospective study of screen time in adolescence and depression symptoms in young adulthood

Association of Fast-Food Intake with Depressive and Anxiety Symptoms among Young Adults: A Pilot Study

Background: High intake of fast food has been linked to increased risks of both depressive and anxiety disorders. However, associations between individual fast-food items and depressive/anxiety disorders are rarely examined. Method: Using cross-sectional survey the association between common fast-food items and depressive/anxiety symptoms among 142 young Hong Kong adults aged 18-27 years old was examined. A qualitative food frequency questionnaire was employed to measure the intake frequency of 22 common fast-food items found in Hong Kong. Occurrence of significant depressive and anxiety symptoms was measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Primary measures were multivariate-adjusted odds ratios for occurrence of depressive and anxiety symptoms compared with the low intake frequency group for common fast-food items. Results: Our observations suggest that frequent intake of high-fat, -sugar, and -sodium fast-foods increased depressive symptoms, while frequent high-fat fast-food intake was associated with anxiety symptoms. However, frequent intake of sugar-free beverages reduced the risk of depressive symptoms. Conclusions: Habitual intake of certain fast foods were related to depressive/anxiety symptoms in young adults.

Trajectories of Problem Behaviors and Information Technology Use Among Adolescents: A Latent Growth Model Using the Korean Children and Youth Panel Survey

We investigated the association between computer and mobile phone online activities and adolescents' problem behaviors (e.g., depressive symptoms, withdrawal, somatic complaints, attention deficit, and aggression) using data from the Korean Children and Youth Panel Survey and latent growth model analysis. The results demonstrated that text-related activities lowered withdrawal and attention deficit. Higher use of online communities or personal websites was associated with higher depressive symptoms, withdrawal, somatic symptoms, and aggression. Online gaming increased both attention deficit' initial value and its decrease rate. Taking photos decreased withdrawal. Watching videos increased depressive symptoms, withdrawal, and attention deficit. Listening to music lowered attention deficit' initial value and somatic symptoms' decrease rate. Accessing adult websites increased attention deficit and aggression. Educational information searches reduced attention deficit and aggression. Online transactions increased somatic symptoms. This study indicates that adolescents' problem behaviors may appear differently depending on the type of information technology use.

Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study

BACKGROUND

Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population-a demographic with high screen use-and in low- and middle-income country settings are limited.

OBJECTIVE

This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being.

METHODS

This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables.

RESULTS

The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection.

CONCLUSIONS

Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/39707.

Analysis of the associations between moderate-to-vigorous physical activity and screen time on psychological symptoms among university students: a cross-sectional survey based on six geographic regions in China

BACKGROUND

Declining physical activity and increasing screen time (ST) among Chinese adolescents have become major concerns shared by scholars, while mental health issues are also on the rise. Previous studies have confirmed the association between physical activity and screen time and psychological symptoms, but it is unclear how their psychological symptoms, especially for Chinese university students who have a high proportion of psychological symptoms, and no research evidence has been found.

METHODS

This study investigated physical activity, screen time, and psychological symptoms in 11,173 university students aged 19-22 years in six regions of China. A binary logistic regression analysis was used to analyze the association between moderate-to-vigorous physical activity (MVPA) and screen time and psychological symptoms. And the generalize linear model (GLM) analysis was used to further analyze the association between MVPA and screen time and psychological symptoms.

RESULTS

The detection rate of psychological symptoms among Chinese university students was 16.3%, with a higher percentage of female students (17.5%) than male students (14.7%). The proportion of male students (8.2%) with MVPA > 60 min/d was higher than that of female students (2.3%), and the proportion of male students (33.8%) and female students (34.5%) with screen time > 2 h/d was basically the same. The generalize linear model (GLM) analysis showed that university students with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59, 95% CI: 1.10-2.31) had the highest risk of psychological symptoms (OR = 1.59, 95% CI: 1.10-2.31) compared to university students with MVPA > 60 min/d and screen time < 1 h/d as the reference group. The risk of psychological symptoms was the highest among those with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59,95% CI: 1.10-2.31). In addition, university students with MVPA > 60 min/d and a screen time of 1-2 h/d (OR = 0.09, 95% CI: 0.03-0.25) had the lowest risk of psychological symptoms (P < 0.001). The same trend was observed for both male and female students.

CONCLUSION

Chinese university students have a certain proportion of psychological symptom problems, and there is a significant between MVPA and screen time and psychological symptoms, and the same trend exists for both male and female students. Chinese university students should perform MVPA for not less than 60 min a day, and at the same time control the duration of screen time, and screen time should be controlled between 1 and 2 h a day, which has a better promotion effect on psychological health.

Prevalence of major depressive disorder and its determinants among young married women and unmarried girls: Findings from the second round of UDAYA survey

INTRODUCTION

Depression is a prevalent and debilitating mental illness affecting young women worldwide. This study aimed to identify psychosocial determinants of major depressive disorder (MDD) among young women in Bihar and Uttar Pradesh, India.

METHODS

Data from "Understanding the Lives of Adolescents and Young Adults" (UDAYA) study (2018-19) for young women aged 12-23 years, both married and unmarried was used for this paper. MDD was evaluated using the Patient Health Questionnaire PHQ-9 with a cut-off score of ≤10. The determinants of MDD were identified through multilevel binary logistic regression analysis.

RESULTS

The prevalence of MDD was 13.6% (95% CL 12.2-15.2) and 5.1% (95% CL 4.2-6.1) for young married women and unmarried girls, respectively. Among the young married women, community-level variables like dowry-related humiliation (1.74, 95% CI 1.15-2.64), and sexual assaults (2.15, 95% CI 1.24-3.73) were significantly associated with MDD. For unmarried girls, reporting of family violence <10% of participants (0.45, 95% CI 0.24-0.85), family violence (≥10% of participants) % (0.35 95% CI 0.19-0.68) and interpartner violence (>25% of participants) (0.42; 95% CI 0.23-0.74) remain significant predictors of MDD. At individual level, for both the groups, age, participation in decision making (on education), social capital (currently attending school/educational course and number of friends), self-efficacy, telephonic harassment, and physical activity were associated with MDD. Wealth index, job seeking, participation in decision making (on health-seeking), parental interactions and physical abuse (for unmarried girls only) and education, reported last sexual intercourse, pressure from the in-laws' to conceive (for young married women only) were associated with MDD.

CONCLUSIONS

For young married women, community level targeted interventions should focus on the social ecology to foster a sense of safe community environment. For unmarried girls, additionally, interventions should aim to optimize their family environment for effective mental health outcomes.

The effects of a combined physical activity and health education program on health knowledge and well-being of socially vulnerable children

The purpose of the present study was to evaluate the effects of the football-based health education program "11 for Health" on health knowledge and well-being in the setting of a 10-week residential stay in a Danish charity home for socially vulnerable children. Six hundred and fourteen children participated in the study, of which 305 took part in the standard program plus "11 for Health" (SG+: 12.4 ± 1.4 (mean ± SD) years) and 309 took part in the standard program (SG: 12.4 ± 1.6 years). We used a crossover design over two full years. The study examined changes in health knowledge and well-being through questionnaires. Overall health knowledge increased more in SG+ than SG over 10 weeks (6.6 vs. 3.4%, p < 0.05). The overall well-being scores were markedly improved (p < 0.05) by 4.54 ± 7.17 AU in SG+ and 4.51 ± 7.16 AU in SG, with no between-group differences. Specific improvements (p < 0.05) were seen in all well-being subcategories, raising the well-being scores to the national average. In conclusion, a 10-week stay at a Danish charity home, the Christmas Seal Home, markedly affected health knowledge and well-being of socially vulnerable children. When the football-based health education program-11 for Health-was added, there were additional positive effects on health knowledge.

Investigating Facilitators and Barriers for Active Breaks among Secondary School Students: Formative Evaluation of Teachers and Students

Physical activity in the form of "active breaks" can be combined with academic instruction in primary school. However, few studies have examined the feasibility of conducting active breaks in secondary school. To address this gap, we conducted focus groups (FGs) regarding the implementation of an active breaks (ABs) protocol with 20 teachers and 10 secondary school students. Barriers/facilitators toward the implementation of ABs were classified using grounded theory inductive methods framed by the socio-ecological model. Individual-level factors were instrumental for both teachers and students. Teachers highlighted personal fears and concerns regarding using ABs, while students reported fears related to peer behaviour during the activity. Both teachers and students agreed that ABs can improve cognitive skills and time-on-task behaviour. Teachers articulated concerns related to student behaviour during ABs including possible social exclusion and injury. Students felt that ABs might affect classroom management and interfere with maintaining students' academic focus. Teachers underscored that ABs required social support from the administration and colleagues. Students felt that ABs could support teachers' instructional focus and provide them with an energy respite. Collectively, the FGs suggested that environmental limitations could hinder the implementation of ABs. Involving teacher and student feedback during the codesign phase can rationally inform the design of school-based ABs.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students' daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.

METHODS

This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.

RESULTS

Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.

CONCLUSION

During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.

Internet use and depressive symptoms among Chinese older adults: Two sides of internet use

Objective

To explore the relationship between internet use which includes time spent on the internet, internet skills, types of online activities, and depressive symptoms in older adults.

Methods

We used 2020 China Family Panel Studies (CFPS) data with 3,171 older adults aged 60 years. Depression symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D), and internet use was measured by time spent on the internet, internet skills, and types of online activities. Multiple linear regression models were used to explore the relationship between internet use and depressive symptoms in older adults.

Results

Longer time spent on the internet was associated with higher scores of depressive symptoms (β = 0.14). Higher internet skills were associated with lower scores of depressive symptoms (β = −0.42). Watching short-form videos (β = 1.34) was associated with higher depressive symptom scores, and the use of the WeChat function (β = −0.96) was associated with lower depressive symptom scores, while online games and online shopping were not significant.

Conclusion

The effect of internet use on depressive symptoms in older adults is a double-edged sword. Controlling the time spent on the internet, improving internet skills, and guiding specific a type of online activities in older adults can improve depressive symptoms through rational use.

Cross-Sectional Analysis of Family Factors Associated with Lifestyle Habits in a Sample of Italian Primary School Children: The I-MOVE Project

The acquisition of healthy dietary and exercise habits during childhood is essential for maintaining these behaviors during adulthood. In early childhood, parents have a profound influence on a child's lifestyle pursuits, serving as both role models and decision-makers. The present study examines family factors as potential contributors to healthy lifestyle habits and their child's overall diet quality among a sample of primary school children. A secondary aim is to evaluate several aspects of diet quality using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I). This cross-sectional study involved 106 children enrolled in a primary school located in Imola, Italy. Data were collected from October to December 2019 using an interactive tool used to assess parent characteristics, children's lifestyle, food frequency (ZOOM-8 questionnaire), and actigraph accelerometers to capture children's physical activity and sedentary behavior. Adherence to the Mediterranean Diet (expressed by KIDMED Index) was positively associated with fathers' educational level, parental sport participation, and the parent's overall nutritional knowledge. Higher mothers' educational level was inversely associated with children's leisure screen time. Parents' nutritional knowledge was positively related to children's average daily minutes of organized sport activities. The better score for DQI-I was for consumption adequacy, followed by variety and moderation. The lowest score was for overall balance. The present study reinforces the importance of family factors in young children's lifestyle choices, particularly their dietary, leisure time, and exercise habits.

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.

The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents

OBJECTIVE

The Canadian 24-hour movement guidelines for children and youth recommend a minimum of 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and 8-11 h/night of sleep depending on age. The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health.

METHODS

This study used data from the 2017 (n = 5739) and 2019 (n = 6960) cycles of the Ontario Student Drug Use and Health Survey (OSDUHS), a biennially repeated cross-sectional study of Ontario students in grades 7 through 12. Multivariable ordered logistic regression models were adjusted for age, gender, ethnoracial background, subjective socio-economic status, and body mass index z-scores.

RESULTS

Similar patterns were seen in the 2017 and 2019 samples. Compared with meeting none of the recommendations, meeting different combinations of recommendations in the 2019 sample was associated with positive self-rated physical and mental health. A dose-response gradient between the number of recommendations met and self-rated physical (p < 0.001) and mental (p < 0.001) health was observed, with meeting one (AOR: 1.82; 95% CI: 1.58-2.09), two (AOR: 3.54; 95% CI: 2.98-4.22), or three recommendations (AOR: 6.34; 95% CI: 4.46-9.02) being increasingly associated with positive self-rated physical health compared with meeting none; and meeting one (AOR: 1.51; 95% CI: 1.33-1.71), two (AOR: 2.70; 95% CI: 2.31-3.17), or three recommendations (AOR: 3.58; 95% CI: 2.57-4.98) being increasingly associated with positive self-rated mental health compared with meeting none.

CONCLUSION

Meeting the 24-hour movement guidelines is associated with better self-rated physical and mental health among adolescents.

Association of screen exposure with psychosocial problems in primary school students

INTRODUCTION

This study aimed to investigate the current status of screen exposure and the factors related to screen exposure in primary school students and explore the relationship between screen exposure and psychosocial problems, which may provide evidence for the scientific use of electronic products and psychological interventions used in these children.

METHODS

The parents of 811 primary school students aged 6-12 years received a questionnaire survey in Beijing between January 13 and January 16, 2022. The demographic data and daily screen exposure time were collected, and the Strengths and Difficulties Questionnaire (SDQ) about their children was administered online.

RESULTS

In 793 students, the average daily screen exposure of <2 h and ≥2 h was noted in 75.0% and 25% of patients, respectively. The mobile phone was the main medium for screen exposure (40.9%). The family's economic level, parental relationship, and main supervisor were related to screen exposure time (χ ² = 44.8,14.5 and 12.4, P < 0.05). A low family economic level with a monthly income not meeting the basic living needs, poor parental relationship, and an elderly person responsible for supervision were related to increased screen exposure time. The abnormal emotional and behavioral symptoms, conduct problems, hyperactivity inattention, peer communication, prosocial behaviors, and a total difficulties score were found in 11.6%, 9.8%, 15.3%, 22.1%, 6.8%, and 13.4% of children, respectively. Excessive screen exposure was related to peer interaction and prosocial behaviors (χ ²= 12.18 and 7.76, P < 0.05). The children with excessive screen exposure were more likely to have abnormal peer interaction (χ ²= 12.09, P = 0.001) and prosocial behaviors (χ ²= 7.76, P = 0.005). Excessive screen exposure was a risk factor for peer interaction problems (P < 0.05).

DISCUSSION

In conclusion, the detection rate of excessive screen exposure is higher in primary school students, which is related to the family's economic level, parental relationship, and main supervisor. Excessive screen exposure is harmful to the psychosocial health of these children, which is characterized by abnormal peer intercommunion and prosocial behaviors. More attention should be paid to screen exposure time in primary school students.

Adolescent screen time: associations with school stress and school satisfaction across 38 countries

This study examined associations of watching television, electronic games, computer uses with school stress, and satisfaction among adolescents. Nationally representative data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey were analysed. School stress and school satisfaction were each assessed using a 4-point self-reported item and then dichotomised. Participants reported discretional time spent on different screen-based activities. Of the 191,786 participants (age 13.6 [1.6] years; 51% girls), 35% reported high levels of school stress, while 30% reported high satisfaction with their school. Multilevel multivariable logistic regression modelling showed that adolescents reporting watching television > 4 h/day (≤ 1 h/day as reference) had 31% higher odds of school stress (OR 1.31; 95% CI: 1.27-1.35) and 36% less odds of school satisfaction (OR 0.64; 95% CI: 0.62-0.67). Prolonged electronic gaming (> 4 h/day) increased the odds of school stress by 26% (OR 1.26; 95% CI: 1.22-1.30) and decreased the odds of school satisfaction by 37% (OR 0.63; 95% CI: 0.61-0.65). Adolescents with prolonged computer use had 46% higher odds of school stress (OR 1.46; 95% CI: 1.42-1.50) and 39% lower odds of school satisfaction (OR 0.61; 95% CI: 0.59-0.63). Association estimates were more evident among younger adolescents than their older counterparts with no apparent gender differences.

CONCLUSION

Prolonged screen use, irrespective of type, was positively associated with school stress and inversely associated with school satisfaction with high computer use showing the highest adverse associations. Prospective research is needed to understand directionality and mechanisms of these relationships.

WHAT IS KNOWN

• Screen-based activities are adversely associated with various health and wellbeing indicators in adolescents.. • The relation between screen time and school-related outcomes is yet to understand fully.

WHAT IS NEW

• Prolonged screen time is associated with increased school stress and decreased school satisfaction in adolescents. • Computer use showed higher adverse associations than watching television or playing electronic games.

Screen time and depression risk: A meta-analysis of cohort studies

BACKGROUND

The impact of screen time on mental health, including depression, has attracted increasing attention from not only children and adolescents but also the elderly. Thus, we conducted a meta-analysis of cohort studies to evaluate the association between screen time and depression risk.

METHODS

The PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched for cohort studies up to May 2022, and the reference lists of the included studies were also retrieved. A random-effect model was used to estimate the combined effect size. Heterogeneity was assessed with the I ² statistic. Potential publication bias was evaluated using a funnel plot and Begg's and Egger's tests.

RESULTS

The final analysis included 18 cohort studies with a combined total of 241,398 participants. The pooled risk ratio (RR) was 1.10 (95% confidence interval: 1.05-1.14), with significant heterogeneity (I ² = 82.7%, P < 0.001). The results of subgroup analyses showed that the pooled RRs varied according to geographic locations, gender, age group, screen time in the control group, depression at the baseline, and whether the study was conducted during the COVID-19 pandemic. No obvious evidence of publication bias was found.

CONCLUSION

This study indicates that screen time is a predictor of depressive symptoms. The effects of screen time on depression risk may vary based on the participant's age, gender, location, and screen time duration. The findings could have important implications for the prevention of depression.

Electronic Games, Television, and Psychological Wellbeing of Adolescents: Mediating Role of Sleep and Physical Activity

This study investigated the associations between two common recreational screen activities and the psychological wellbeing of adolescents, and whether this association was mediated by sleep duration or physical activity frequency. This study used nationally representative cross-sectional survey data from 2946 adolescents (mean age 16.9 [0.38] years; 49% female) in the Longitudinal Study of Australian Children (LSAC). Adolescents provided information on daily time spent for each of the following: playing electronic games and watching television, time of sleep onset and wakeup, and number of days/week doing ≥60 min/day of physical activity. Psychological wellbeing was assessed by the Strengths and Difficulties Questionnaire (SDQ). Generalized estimating equations were used to examine the associations, and a contemporary multiple mediation analysis was used to examine the mediation effects. One fifth (20%) of adolescents were categorized as having poor wellbeing (SDQ total ≥17) with a significant sex difference (males: 16%; females: 24%; p < 0.001). Playing electronic games was inversely associated with psychological wellbeing for both male and female adolescents (p < 0.001). Watching television was inversely associated with psychological wellbeing for female adolescents (p < 0.001). Sleep duration and physical activity frequency were found to partially mediate the relationships between playing electronic games and the psychological wellbeing of male and female adolescents. Physical activity frequency partially mediated the association between television watching and wellbeing among female adolescents. Longitudinal studies are required to determine the causal pathway between screen-based activities and the wellbeing of adolescents, and to inform intervention strategies.

Genetically Proxied Diurnal Preference, Sleep Timing, and Risk of Major Depressive Disorder

Importance

Morning diurnal preference is associated with reduced risk of major depressive disorder (MDD); however, causality in this association is uncertain.

Objective

To examine the association of genetically proxied morning diurnal preference with depression risk using mendelian randomization.

Design, Setting, and Participants

This 2-sample mendelian randomization study used summary-level genetic associations with diurnal preference and MDD. Up to 340 genetic loci associated with diurnal preference in a meta-analysis of the UK Biobank and 23andMe cohorts were considered as genetic proxies for diurnal preference. The effect size of these variants was scaled using genetic associations with accelerometer-based measurement of sleep midpoint. Genetic associations with MDD were obtained from a meta-analysis of genome-wide association studies data from the Psychiatric Genomics Consortium and UK Biobank. The inverse-variance weighted method was used to estimate the association of genetically proxied morning diurnal preference, corresponding to a 1-hour earlier sleep midpoint, with MDD risk.

Exposures

Morning diurnal preference scaled to a 1-hour earlier, objectively measured sleep midpoint.

Main Outcomes and Measures

Risk of MDD, including self-reported and clinically diagnosed cases, as ascertained in meta-analyses of genome-wide association studies.

Results

A total of 697 828 individuals (all of European ancestry) were in the UK Biobank and 23andMe cohorts; 85 502 in the UK Biobank had measurements of the sleep midpoint. A further 170 756 individuals with MDD and 329 443 control participants (all of European ancestry) were in the Psychiatric Genomics Consortium and UK Biobank data. Genetically proxied earlier diurnal preference was associated with a 23% lower risk of depression (odds ratio [OR] per 1-hour earlier sleep midpoint, 0.77 [95% CI, 0.63-0.94]; P = .01). This association was similar when restricting analysis to individuals with MDD as stringently defined by the Psychiatric Genomics Consortium (OR, 0.73 [95% CI, 0.54-1.00]; P = .05) but not statistically significant when defined by hospital-based billing codes in the UK Biobank (OR, 0.64 [95% CI, 0.39-1.06]; P = .08). Sensitivity analyses examining potential bias due to pleiotropy or reverse causality showed similar findings (eg, intercept [SE], 0.00 [0.001]; P = .66 by Egger intercept test).

Conclusions and Relevance

The results of this mendelian randomization study support a protective association of earlier diurnal preference with risk of MDD and provide estimates contextualized to an objective sleep timing measure. Further investigation in the form of randomized clinical trials may be warranted.

Associations Among Screen Time, Sleep Duration and Depressive Symptoms Among Chinese Adolescents

OBJECTIVES

Relatively few studies have explored the inter-relationship between screen time (ST), sleep duration and depressive symptoms. The study herein sought to determine (1) the relationships between ST, sleep duration and depressive symptoms among Chinese adolescents; (2) whether sleep duration mediates the relationships between ST and depressive symptoms.

METHODS

1^st grade students (n=1,976) from ten high schools in Guangzhou, China were invited through cluster sampling between January and April 2019. Self-reported ST with electronic devices and Internet, sleep duration, and The Center for Epidemiology Scale for Depression (CES-D) score were collected. Generalized mixed linear models and mediation analyses were conducted.

RESULTS

There were 1,956 self-reported questionnaires received (response rate: 98.99%). Approximately 25% (471/1,929 for Internet use, 399/1,928 for electronic device) of the total sample reported ST >2 hours/day. Approximately 8.9% (169/1,894) reported a CES-D score >28. Longer ST with electronic devices (estimate=0.52, 95%CI: 0.24~0.80), Internet usage (estimate=0.82, 95%CI: 0.53~1.11) were positively associated with depressive symptoms, while less sleep (estimate=-1.85, 95%CI: -2.27~-1.43) was negatively associated with depressive symptoms. There is significant indirect effect of electronic device usage on depressive symptoms through sleep duration (indirect effect=0.08, 95%CI: 0.01~0.15).

LIMITATIONS

This study only included school students from Guangzhou. Causal relationship cannot be inferred by this cross-sectional design.

CONCLUSIONS

ST and sleep duration were significantly associated with depressive symptoms severity. The indirect effect of sleep duration suggests a possible mechanism of the association between ST and depressive symptoms. Future interventions to manage depressive symptoms should target sleep time and decrease ST among adolescents.

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.

Factors Affecting Adolescents' Screen Viewing Duration: A Social Cognitive Approach Based on the Family Life, Activity, Sun, Health and Eating (FLASHE) Survey

The pervasiveness of prolonged screen viewing (SV) in adolescence is of significant concern given its well-documented implications with various health outcomes. Based on Social Cognitive Theory (SCT), this study explored how a wide range of individual, environmental, and behavioral factors correlate with adolescents' SV duration. The study used adolescents' self-reported data from the cross-sectional Family Life, Activity, Sun, Health and Eating (FLASHE) study implemented by the National Cancer Institute (NCI). Findings indicated that adolescents' SV duration were different across various age and ethnic groups. It was positively associated with emotion regulation and negatively connected with self-efficacy in limiting screen time. Compared to un-authoritative parenting style, authoritative parenting had an advantage in curbing adolescents' screen use. General media susceptibility strongly correlated with SV duration. Perception of peers' behaviors (descriptive norm) and how peers would react adversely (injunctive norm) were both connected with SV duration. SV duration was negatively connected with physical activity whereas positively linked with sedentary behavior. Theoretical and practical implications were outlined, as well as limitations and directions for future research.

Cannabis Use, Screen Time, and Internalizing Symptoms among Canadian Youth: Testing Mediation Pathways

Background: Existing research suggests positive correlations between screen time sedentary behaviors (STSB) and substance use, including cannabis use, among youth. However, little research has examined what factors mediate these relationships.Methods: This study examined mediating pathways among STSB, internalizing symptoms (IS), and cannabis use in a linked longitudinal sample of 28 269 Canadian youth who participated in the COMPASS study over a two-year period (2017/18 to 2018/19). Structural equation modeling examined two main hypotheses cross-sectionally and over time: 1) if IS mediated associations between STSB and cannabis use frequency, and 2) if STSB mediated associations between IS and cannabis use frequency. Results: Results demonstrated significant partial mediation effects for both hypotheses. For example, indirect effects indicated that IS mediated the association between STSB and cannabis use both cross sectionally (95% CI: 0.021, 0.029) and longitudinally (95% CI: 0.006, 0.010). STSB also mediated associations between IS and cannabis use cross sectionally (95% CI: 0.015, 0.023) and longitudinally (95% CI: 0.010, 0.014). This study demonstrated that the associations between STSB, internalizing symptoms and cannabis use are complex, involving mediation in both directions.Discussion: These findings can be used to inform public health initiatives that aim to take a comprehensive approach to addressing negative health behaviors and outcomes, as it is clear that the multi-directional relationships between STSB and mental health may in-turn impact other health behaviors. Future research should continue to examine mediating factors between STSB and substance use among youth, including exploration of associations with other substances.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922455 .

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.

Are one-year changes in adherence to the 24-hour movement guidelines associated with flourishing among Canadian youth?

Movement behaviours (e.g., physical inactivity, short sleep duration, high screen time) are associated with mental illness but less is known about the relationship between health behaviours and positive mental health constructs such as flourishing. This study examines if changes in adherence to the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth (moderate-to-vigorous physical activity (MVPA), total screen time (ST), sleep) are associated with changes in youth flourishing over one year. Students (N = 2292) were recruited from 12 secondary schools in Canada participating in the COMPASS study. Conditional change models were used to analyze two waves of longitudinal questionnaire data from 2016-17 to 2017-18. One-year change in adherence to the MVPA, ST, and sleep duration guidelines were modeled as predictors of flourishing adjusting for covariates. Models were stratified by sex. For males only, meeting MVPA guidelines both years was associated with higher flourishing compared to males not meeting guidelines (Est:0.87, SE:0.36, p = .01). Reducing ST was associated with higher flourishing for males only relative to other males who continued to exceed the ST guidelines (Est:2.23, SE:1.04, p < .03). Longer sleep duration had the most consistent association with greater flourishing among females (Est:1.02, SE:0.3, p < .001) and males (Est:0.93, SE:0.34, p < .006), highlighting sleep as a public health priority in the context of 24-hour movement behaviours. These findings contribute to increasing calls for research examining positive mental health constructs independent of mental illness.

Are one-year changes in adherence to the 24-hour movement guidelines associated with depressive symptoms among youth?

Background

There remains a need for prospective research examining movement behaviours in the prevention and management of mental illness. This study examined whether changes in adherence to the 24-h Movement Guidelines (moderate-to-vigorous physical activity [MVPA], sleep duration, screen time) were associated with depression symptoms among youth.

Methods

Conditional change models were used to analyze two waves of longitudinal questionnaire data (2016/17, 2017/18) from students in grades 9–12 (N = 2292) attending 12 schools in Ontario and British Columbia, Canada, as part of the COMPASS study. One-year change in adherence to the MVPA, screen time, and sleep duration guidelines were modeled as predictors of depressive symptoms, adjusting for covariates and prior year depressive symptoms. Models were stratified by sex.

Results

Continued adherence to sleep guidelines and transitioning from inadequate to sufficient sleep were associated with lower depressive symptoms than continued nonadherence, and continued adherence was associated with lower depression than transitioning from sufficient to short sleep. For screen time, transitioning from exceeding guidelines to guideline adherence was associated with lower depressive symptoms than continued nonadherence. MVPA guideline adherence was not associated with depression scores, when controlling for sleep and screen time guideline adherence change and covariates. When combined, meeting additional guidelines than the year prior was associated with lower depressive symptoms among females only.

Conclusions

Adherence to the sleep guidelines emerged as the most consistent predictor of depression symptoms. Promoting adherence to the Movement Guidelines, particularly sleep, should be considered priorities for youth mental health at a population level.

The development of a questionnaire to assess leisure time screen-based media use and its proximal correlates in children (SCREENS-Q)

Background

The screen-media landscape has changed drastically during the last decade with wide-scale ownership and use of new portable touchscreen-based devices plausibly causing changes in the volume of screen media use and the way children and young people entertain themselves and communicate with friends and family members. This rapid development is not sufficiently mirrored in available tools for measuring children’s screen media use. The aim of this study was to develop and evaluate a parent-reported standardized questionnaire to assess 6–10-year old children’s multiple screen media use and habits, their screen media environment, and its plausible proximal correlates based on a suggested socio-ecological model.

Methods

An iterative process was conducted developing the SCREENS questionnaire. Informed by the literature, media experts and end-users, a conceptual framework was made to guide the development of the questionnaire. Parents and media experts evaluated face and content validity. Pilot and field testing in the target group was conducted to assess test-retest reliability using Kappa statistics and intraclass correlation coefficients (ICC). Construct validity of relevant items was assessed using pairwise non-parametric correlations (Spearman’s). The SCREENS questionnaire is based on a multidimensional and formative model.

Results

The SCREENS questionnaire covers six domains validated to be important factors of screen media use in children and comprises 19 questions and 92 items. Test-retest reliability (n = 37 parents) for continuous variables was moderate to substantial with ICC’s ranging from 0.67 to 0.90. For relevant nominal and ordinal data, kappa values were all above 0.50 with more than 80% of the values above 0.61 indicating good test-retest reliability. Internal consistency between two different time use variables (from n = 243) showed good correlations with rho ranging from 0.59 to 0.66. Response-time was within 15 min for all participants.

Conclusions

SCREENS-Q is a comprehensive tool to assess children’s screen media habits, the screen media environment and possible related correlates. It is a feasible questionnaire with multiple validated constructs and moderate to substantial test-retest reliability of all evaluated items. The SCREENS-Q is a promising tool to investigate children screen media use.

The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Background

To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.

Methods

Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.

Results

Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.

Conclusions

Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.

Sedentary behaviors and risk of depression: a meta-analysis of prospective studies

Epidemiological evidence on the association between sedentary behaviors and the risk of depression is inconsistent. We conducted a meta-analysis of prospective studies to identify the impact of sedentary behaviors on the risk of depression. We systematically searched in the PubMed and Embase databases to June 2019 for prospective cohort studies investigating sedentary behaviors in relation to the risk of depression. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effect meta-analysis. In addition, meta-regression analyses, subgroup analyses, and sensitivity analyses were performed to explore the potential sources of heterogeneity. Twelve prospective studies involving 128,553 participants were identified. A significantly positive association between sedentary behavior and the risk of depression was observed (RR = 1.10, 95% CI 1.03-1.19, I2 = 60.6%, P < 0.01). Subgroup analyses revealed that watching television was positively associated with the risk of depression (RR = 1.18, 95% CI 1.07-1.30), whereas using a computer was not (RR = 0.99, 95% CI 0.79-1.23). Mentally passive sedentary behaviors could increase the risk of depression (RR = 1.17, 95% CI 1.08-1.27), whereas the effect of mentally active sedentary behaviors were non-significant (RR = 0.98, 95% CI 0.83-1.15). Sedentary behaviors were positively related to depression defined by clinical diagnosis (RR = 1.08, 95% CI 1.03, 1.14), whereas the associations were statistically non-significant when depression was evaluated by the CES-D and the Prime-MD screening. The present study suggests that mentally passive sedentary behaviors, such as watching television, could increase the risk of depression. Interventions that reduce mentally passive sedentary behaviors may prevent depression.

Association Between Screen Time, Fast Foods, Sugar-Sweetened Beverages and Depressive Symptoms in Chinese Adolescents

OBJECTIVE

Although previous studies have shown that screen time (ST), fast foods (FFs) and sugar-sweetened beverages (SSBs) consumption are associated with depressive symptoms in adolescents, research on these associations in Chinese adolescents is scarce. This study aimed to examine the association between ST, FFs, SSBs and depressive symptoms in Chinese adolescents, and explore the mediating effects of FFs and SSBs in the association between ST and depressive symptoms.

METHODS

This school-based nationwide survey was carried out among 14,500 students in four provinces of China. The Children's Depression Inventory was used to assess the participants' depressive symptoms. ST, FFs and SSBs consumption was measured by a self-reported questionnaire. The Bayesian multiple mediation model was used to analyze the mediation effect.

RESULTS

ST, FFs and SSBs, were more likely to be associated with depressive symptoms, and ORs (95%CI) was 1.075 (1.036-1.116), 1.062 (1.046-1.078) and 1.140 (1.115-1.166), after we adjusted for sociodemographic variables. Additionally, in Bayesian multiple mediation model, direct effect, mediating effect, total effect, the ratio of mediating effect to total effect was 0.125, 0.034, 0.159, and 0.214, respectively. All path coefficients of the three mediation paths are statistically significant (p < 0.05).

CONCLUSIONS

Our study demonstrates that ST, FFs and SSBs consumption are associated with depressive symptoms in Chinese adolescents. It is likely that FFs and SSBs partially mediate the association between ST and depressive symptoms by chain-mediating effects.

The Effect of Screen Viewing Duration and Self-Efficacy in Limiting Screen Viewing on Loneliness in Adolescent-Parent Dyads: An Application of the Actor-Partner Interdependence Model

PURPOSE

To examine the influence of parents' screen viewing (SV) duration and self-efficacy in limiting SV on their adolescents' loneliness, and to explore the influence of adolescents' SV duration and self-efficacy in limiting SV on parents' loneliness.

DESIGN AND METHODS

A cross-sectional survey with 1573 adolescent-parent dyads from the Family Life, Activity, Sun, Health, and Eating Study were included in this study. The actor-partner interdependence models were used to examine the effect of each dyadic partner's SV duration and self-efficacy in limiting SV on their own and their dyadic partner's loneliness within adolescent-parent dyads.

RESULTS

There were no significant actor and partner effects of SV duration on loneliness for both parents and adolescents (all p_s > 0.05). Adolescents' self-efficacy in limiting SV was associated with less loneliness of their own (adolescents' actor effect: β = -0.35, SE = 0.04, p < .01) and that of their parents (adolescents' partner effect: β = -0.15, SE = 0.04, p = .001). Parents' self-efficacy in limiting SV was negatively associated with their own loneliness (parents' actor effect: β = -0.25, SE = 0.05, p < .01), but not with their adolescents' loneliness (parents' partner effect: β = -0.06, SE = 0.05, p = .189).

CONCLUSIONS

Adolescents' own self-efficacy in limiting SV has a significant impact on their parents' loneliness. Parents' self-efficacy in limiting SV, however, did not influence their adolescents' loneliness.

PRACTICE IMPLICATIONS

Our results highlight the importance of providers screening for loneliness as part of the plan of care for adolescents and parents who might have excessive SV, with close attention given to those who possess less self-efficacy in controlling their SV.

Sleep mediates the association between adolescent screen time and depressive symptoms

OBJECTIVE

This study examined the associations between four types of screen-based activities and depressive symptoms among adolescents. We further investigated whether sleep characteristics (ie, insomnia symptoms and sleep duration) mediate these associations.

METHODS

Data come from 2865 U.S. adolescents (mean age = 15.53, SD = 0.73, 51.8% male) in the age 15 follow-up of the Fragile Families and Child Wellbeing Study. Adolescents completed surveys regarding sleep duration and insomnia symptoms, typical daily duration of four screen activities (social messaging, web surfing, TV/movie watching, and gaming), and depressive symptoms. We constructed a multiple mediation model to elucidate the associations between age 15 screen time, sleep and depressive symptoms, while adjusting for age 9 depressive symptoms.

RESULTS

Structural Equation Modeling analyses revealed that the association between screen time and depressive symptoms is partially or fully mediated by sleep. For social messaging, web surfing and TV/movie watching, the three sleep variables fully mediated the positive association between screen time and depressive symptoms. For gaming, the three sleep variables acted as partial mediators in the model, accounting for 38.5% of the association between gaming and depressive symptoms.

CONCLUSIONS

Our results highlight both screen-based activities and sleep behaviors as potential intervention targets to reduce depressive symptoms among adolescents.

Use of Electronic Entertainment and Communication Devices Among a Saudi Pediatric Population: Cross-Sectional Study

BACKGROUND

Excessive use of various electronic entertainment and communication devices, particularly among children, has been associated with increased behavioral problems. Despite children's escalating use of these devices, parents' awareness about the impact thereof is still lacking.

OBJECTIVE

The objective of this study was to assess the use of electronic entertainment and communication devices among children attending a health care facility in Jeddah, Saudi Arabia, as well as the parental impression regarding the impact of electronic devices use on the behavior of their child.

METHODS

A focused 15-item questionnaire was designed for this cross-sectional study involving mothers of children attending the Well Baby Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from July 1, 2016 to November 30, 2016.

RESULTS

This study included 190 mothers. The mean ages of the children, mothers, and fathers were 7.3 (SD 3.5), 35 (SD 6.5), and 43 (SD 8.3) years, respectively. Most children were of Saudi Arabian nationality (106/190, 55.8%). The most used device in this study was television (154/190, 81.0%), followed by mobile phones (134/190, 70.5%), and tablets (116/190, 61.0%). Computers were the least used device in this study (59/190, 31.0%). In total, 24.7% (47/190) of children in this study used electronic entertainment and communication devices for more than 4 hours per day. Most mothers (129/190, 67.9%) felt that their child spends too much time on electronic devices. Hyperactivity or behavioral problems were reported by 20.0% (38/190) of mothers in this study. Children spending longer hours on electronic devices were much more likely to be perceived to suffer from hyperactivity or behavioral problems (P=.01).

CONCLUSIONS

Parental awareness is necessary to counteract the harmful effects of using electronic devices for a prolonged period. Parents require help to cope with this problem effectively.

Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12-15 years from 30 low- and middle-income countries

BACKGROUND

Depression is common and burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective of depression. However, the impact of sedentary behavior (SB) on depression is relatively under-researched especially in low- and middle-income countries (LMICs). In this cross-sectional study, we explored the association between SB and depressive symptoms in adolescents from 30 LMICs, controlling for confounders including physical activity.

METHOD

Data from the Global school-based Student Health Survey were analyzed in 67,077 adolescents [mean (SD) age 13.8 (0.9) years; 50.6% girls). Self-report measures assessed depressive symptoms during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken.

RESULTS

The prevalence of depressive symptoms and ≥ 3 h/day of SB were 28.7 and 30.6%, respectively. There was a linear increase in the prevalence of depressive symptoms with increasing sedentary time beyond ≥3 h/day (vs. < 1 h/day). Among boys, 1-2 h/day of SB was associated with lower odds for depression (vs. < 1 h/day). Countrywide meta-analysis demonstrated that spending ≥3 h/day versus < 3 h/day was associated with a 20% increased odds for depressive symptoms (OR = 1.20; 95% CI = 1.16-1.24) with low between-country heterogeneity (I2 = 27.6%).

CONCLUSION

Our data indicate that being sedentary for ≥3 h/day is associated with increased odds for depressive symptoms in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to limit the time spent being sedentary in adolescents.

Prognostic value of exercise capacity among patients with treated depression: The Henry Ford Exercise Testing (FIT) Project

BACKGROUND

Exercise capacity is associated with survival in the general population. Whether this applies to patients with treated depression is not clear.

HYPOTHESIS

High exercise capacity remains associated with lower risk of all-cause mortality (ACM) and nonfatal myocardial infraction (MI) among patients with treated depression.

METHODS

We included 5128 patients on antidepressant medications who completed a clinically indicated exercise stress test between 1991 and 2009. Patients were followed for a median duration of 9.4 years for ACM and 4.5 years for MI. Exercise capacity was estimated in metabolic equivalents of tasks (METs). Cox proportional hazards regression models were used.

RESULTS

Patients with treated depression who achieved ≥12 METs (vs those achieving <6 METs) were younger (age 46 ± 9 vs 61 ± 12 years), more often male (60% vs 23%), less often black (10% vs 27%), and less likely to be hypertensive (51% vs 86%), have DM (9% vs 38%), or be obese (11% vs 36%) or dyslipidemic (45% vs 54%). In the fully adjusted Cox proportional hazard regression model, exercise capacity was associated with a lower ACM (HR per 1-MET increase in exercise capacity: 0.82, 95% CI: 0.79-0.85, P < 0.001) and nonfatal MI (HR: 0.92, 95% CI: 0.87-0.97, P = 0.004).

CONCLUSIONS

Exercise capacity had an inverse association with both ACM and nonfatal MI in patients with treated depression, independent of cardiovascular risk factors. These results highlight the potential impact of assessing exercise capacity to identify risk, as well as promoting an active lifestyle among treated depression patients.

Sedentary Behaviors and Cardiometabolic Risk: An Isotemporal Substitution Analysis

Evidence suggests that time spent engaging in sedentary behaviors is associated with a greater risk of adverse cardiometabolic outcomes. We investigated the cross-sectional associations of 6 unique sedentary tasks (watching television, using the computer, completing paperwork, reading, talking on the telephone, and sitting in a car) with cardiometabolic risk factors, and also examined the effect of replacing one type of sedentary behavior with another on the level of cardiometabolic risk. Participants consisted of 3,211 individuals from the Coronary Artery Risk Development in Young Adults Study who visited the clinic between 2010 and 2011. Linear regression models examined the independent and joint associations of sedentary tasks with a composite cardiometabolic risk score, as well as with individual cardiometabolic risk factors (waist circumference, blood pressure, fasting glucose, insulin, triglycerides, and high density lipoprotein cholesterol) after adjusting for physical activity and other covariates. Replacing 2 hours of television viewing with 2 hours spent performing any other sedentary activity was associated with a lower cardiometabolic risk score of 0.06-0.09 standard deviations (all 95% confidence intervals: -0.13, -0.02). No other replacements of one type of sedentary task for another were significant. Study findings indicate that television viewing has a more adverse association with cardiometabolic risk factors than other sedentary behaviors.

The importance of health behaviours in childhood for the development of internalizing disorders during adolescence

Background

Poor mental health constitutes a considerable global public health burden with approximately half of all cases of poor mental health having their onset before the age of 14 years. The identification of modifiable risk factors early in life is therefore essential to prevention, however, there are presently very few longitudinal studies on health behaviours for mental health to inform public health decision makers and to justify preventive action. We examined the importance of diet quality, physical activity (PA) and sedentary behaviours in childhood for internalizing disorder throughout adolescence.

Methods

We linked data from a population-based lifestyle survey among 10 and 11 year old grade five students in the Canadian province of Nova Scotia with physician diagnoses of internalizing disorders from administrative health records. We applied negative binomial regressions to examine the associations of health behaviours with the number of health care provider contacts with a diagnosis of internalizing disorder.

Results

Of the 4875 students, 23.9% had one or more diagnoses for internalizing disorder between the age of 10 or 11 years and 18 years. The number of health care provider contacts with a diagnosis of internalizing disorder was statistically significant higher among students with less variety in their diets, and among students who reported less PA and more time using computers and video games. The number of health care provider contacts was also higher for girls, and for students with low self-esteem and from low-income households.

Conclusions

These findings suggest that diets and active lifestyles in childhood affect mental health during adolescence, and imply that succxessful health promotion programs targeting children’s diets and activity will contribute to the prevention of mental health disorders in addition to the prevention of chronic diseases later in life.

Electronic supplementary material

The online version of this article (10.1186/s40359-017-0208-x) contains supplementary material, which is available to authorized users.

Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study

PURPOSE

Studies among youth suggest that physical inactivity, sedentary behaviors, and poor diet quality are associated with poor mental health. Few population-based studies have investigated these relationships longitudinally. We examined the association between physical activity, sedentary behaviors, and diet quality in childhood and the incidence of internalizing and externalizing disorders throughout adolescence.

METHODS

We linked health behavior survey data from 2003 among 10- to 11-year-old children across Nova Scotia, Canada, with administrative health care data from 2003 to 2011. Students' diet quality was assessed using the Harvard Food Frequency Questionnaire. Physical activity and sedentary behaviors were self-reported, and internalizing and externalizing disorders were diagnosed by a physician. We applied Cox regression to examine the associations of the health behaviors with the incidence of internalizing and externalizing disorders between 2003 and 2011.

RESULTS

Of the 4861 participating students, 23.7% and 9.4% had a diagnosis of internalizing and externalizing disorders, respectively. The incidences of internalizing and externalizing disorders were higher among students who were less physically active and spent more time using computers and video games.

CONCLUSIONS

These findings suggest that promoting an active lifestyle in childhood may contribute to the prevention of both internalizing and externalizing disorders during adolescence.

Association between screen time and depression among US adults

Epidemiological surveys conducted in general populations have found that the prevalence of depression is about 9% in the United States. World Health Organization has projected that depression will be leading cause of disease burden by the year 2030. Growing evidence suggests that sedentary lifestyle is an important risk factor of depression among adults. The relationship between television watching/computer use and depression in US adults is still unknown. The objective of this study was to assess the relationship between television watching/computer use and depression. This is a cross-sectional study that used the secondary data from the National Health and Nutritional Examination Survey (NHANES) (2011/2012). Participants were 3201 US adults who were 20 years or more. Self-reported Patient Health Questionnaire-9 [PHQ-9] was used to classify depression level; self-reported hours of watching TV and use of computer/day, and demographic information were obtained from NHANES data set. SAS®9.4was used to perform all statistical analyses and final model selection procedure. Depression was found to be significantly higher among female. Results showed that moderate or severe depression level was associated with higher time spent on TV watching and use of computer (> 6 h/day) (adjusted odds ratio: 2.3, 95% CI: 1.602–3.442). Duration of screen time was significantly associated when all covariates were adjusted. TV watching and computer use can predict the depression level among adults. Prospective studies and measurement of factors such as: work place sitting, social relationship, and family history of depression are warranted.

•

Assess the relationship between television watching/computer use and depression

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Depression was found to be significantly higher among female.

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Moderate or severe depression level was associated with higher screen time.

Socio-Demographic, Social-Cognitive, Health-Related and Physical Environmental Variables Associated with Context-Specific Sitting Time in Belgian Adolescents: A One-Year Follow-Up Study

INTRODUCTION

More knowledge is warranted about multilevel ecological variables associated with context-specific sitting time among adolescents. The present study explored cross-sectional and longitudinal associations of ecological domains of sedentary behaviour, including socio-demographic, social-cognitive, health-related and physical-environmental variables with sitting during TV viewing, computer use, electronic gaming and motorized transport among adolescents.

METHODS

For this longitudinal study, a sample of Belgian adolescents completed questionnaires at school on context-specific sitting time and associated ecological variables. At baseline, complete data were gathered from 513 adolescents (15.0±1.7 years). At one-year follow-up, complete data of 340 participants were available (retention rate: 66.3%). Multilevel linear regression analyses were conducted to explore cross-sectional correlates (baseline variables) and longitudinal predictors (change scores variables) of context-specific sitting time.

RESULTS

Social-cognitive correlates/predictors were most frequently associated with context-specific sitting time. Longitudinal analyses revealed that increases over time in considering it pleasant to watch TV (p < .001), in perceiving TV watching as a way to relax (p < .05), in TV time of parents/care givers (p < .01) and in TV time of siblings (p < .001) were associated with more sitting during TV viewing at follow-up. Increases over time in considering it pleasant to use a computer in leisure time (p < .01) and in the computer time of siblings (p < .001) were associated with more sitting during computer use at follow-up. None of the changes in potential predictors were significantly related to changes in sitting during motorized transport or during electronic gaming.

CONCLUSIONS

Future intervention studies aiming to decrease TV viewing and computer use should acknowledge the importance of the behaviour of siblings and the pleasure adolescents experience during these screen-related behaviours. In addition, more time parents or care givers spent sitting may lead to more sitting during TV viewing of the adolescents, so that a family-based approach may be preferable for interventions. Experimental study designs are warranted to confirm the present findings.

Impact of screen time on mental health problems progression in youth: a 1-year follow-up study

OBJECTIVES

We examined the relationships between screen time (ST) and mental health problems and also increment of ST and progression of mental health problems in a college-based sample of Chinese youth.

METHODS

We assessed 2521 Chinese college freshmen from October 2013 to December 2014. At baseline, the mean age of participants was 18.43 years (SD 0.96 years), and 1215 (48.2%) participants reported ST >2 h/day. We estimated multivariable-adjusted ORs by using logistic regression models for the risk of developing mental health problems (anxiety, depression and psychopathological symptoms) and/or progression of these problems, according to baseline ST exposure and changes in exposure at follow-up.

RESULTS

At baseline, when ST >2 h/day was compared with ST ≤2 h/day, the OR was 1.38 (95% CI 1.15 to 1.65) for anxiety, 1.55 (95% CI 1.25 to 1.93) for depression and 1.49 (95% CI 1.22 to 1.83) for psychopathological symptoms. The results remained unchanged for depressive and psychopathological symptoms but not for anxiety, after additional adjustment for sex, age, residential background, body mass index, perceived family economy, sleep quality, smoking, alcohol intake, exercise after school and physical activity. When participants who had increased their ST exposure to >2 h/day were compared with those with no change and ST ≤2 h/day, the OR was 1.78 (95% CI 1.12 to 2.83) for anxiety, 1.92 (95% CI 1.23 to 2.83) for depression and 1.93 (95% CI 1.16 to 3.21) for psychopathological symptoms. These associations also remained after additional adjustment.

CONCLUSIONS

The overall effects are consistent yet small for ST/ST increment on mental health problems and its progression. Given the small effect size of the current results, it remains unclear the degree to which ST is a practically significant risk factor for mental health outcomes. Future studies of high quality are necessary to further examine this association and the direction of causality.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.

Intervention to reduce recreational screen-time in adolescents: Outcomes and mediators from the 'Switch-Off 4 Healthy Minds' (S4HM) cluster randomized controlled trial

INTRODUCTION

The primary objective was to evaluate the impact of the 'Switch-off 4 Healthy Minds' (S4HM) intervention on recreational screen-time in adolescents.

METHODS

Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e., >2h/day). In total, 322 adolescents (mean age=14.4±0.6years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test.

RESULTS

At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-50min/day versus -29min, p<0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean=-21.3min/day, p=0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found.

CONCLUSIONS

Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time.

TRIAL REGISTRATION

ACTRN12614000163606.