The associations between screen time and mental health in adolescents: a systematic review

From temperament to YouTube: exploring the link between childhood temperament, YouTube usage patterns, and emotional/behavioral problems among children

BACKGROUND

YouTube is a widely used video sharing and social networking platform among children and adolescents. However, research on YouTube usage among this population remains scarce. Specifically, studies on factors that influence children and adolescents' usage are clinically significant but largely lacking. Additionally, few studies have examined the association between usage and emotional/behavioral problems, which is fundamental to smartphone research. Therefore, this study explored the relationship between early childhood temperament, subsequent YouTube usage patterns, and emotional/behavioral problems.

METHODS

The Kids Cohort for Understanding Internet Addiction Risk Factors in Early Childhood (K-CURE) is the first long-term prospective cohort study in Korea aimed at understanding the long-term effects of media exposure on young children. The study included 195 children aged 8-11 years enrolled in the K-CURE study. Caregivers, predominantly mothers, who voluntarily participated during their visits to community centers for children's mental health in Korea's major cities, completed a detailed self-administered survey. Childhood temperament was measured in 2018 when the children were 5-8 years old. Subsequent YouTube usage patterns and emotional/behavioral problems were assessed in 2021. Data were analyzed using frequency analysis, correlation analysis, and multiple linear regression.

RESULTS

The study found that 21.0% of children started using YouTube before age 4, with the most common onset age being 8-9 years (30.3%). These children used YouTube on average 4.8 days per week for 68.5 min per day. Early childhood persistence was negatively associated with the subsequent YouTube usage duration, and the age at first YouTube use was negatively correlated with subsequent usage frequency. Furthermore, a younger age at first YouTube use and higher usage frequency were significantly associated with increased emotional/behavioral problems.

CONCLUSIONS

In the YouTube environment, where content is automatically recommended based on user preferences, traits related to usage patterns may be associated with persistence, which is linked to self-regulation. Considering the current trend where children use smartphones, contents frequently for very short durations, our findings highlight the importance of self-regulation in the media usage of children who are still developing. Additionally, our results provide fundamental information for future YouTube studies and illustrate similarities and differences between smartphone and YouTube research.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

PUBLIC SIGNIFICANCE

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

Childhood internalizing, externalizing and attention symptoms predict changes in social and nonsocial screen time

BACKGROUND

While accumulating research has tested the hypothesis that screen time causes psychiatric symptoms in children, less attention has been paid to the hypothesis that children with psychiatric symptoms change their patterns of screen time and digital media use. We aimed to test whether children with psychiatric symptoms subsequently change their patterns of screen time and digital media use.

METHODS

N = 9,066 children primarily aged 9-10 in the Adolescent Brain Cognitive Development Study at baseline and 1-year later. Psychiatric symptoms included internalizing, attention, and externalizing symptoms. Screen time was measured as ordinally defined weekday and weekend time on social and nonsocial [e.g., YouTube] digital media). Models assessed psychiatric symptoms as predictors of screen time, and screen time as predictors of psychiatric symptoms, controlled for baseline measures of each, sex, age, race/ethnicity, and income.

RESULTS

Children with psychiatric symptoms spent more time on non-social media one year later compared with peers. Considering total psychiatric problems, clinical levels of problems predicted higher levels of weekday (OR = 1.22, 95% CI 1.22-1.23) and weekend (OR = 1.10, 95% CI 1.09-1.11) nonsocial screen time. For nearly all analyses of psychiatric symptoms predicting screen time, associations were highest for a non-social screen time outcome rather than a social screen time outcome (Highest OR = 1.65, 95% CI 1.63-1.67, clinical rule breaking predicting weekday nonsocial screen time). Comparable magnitude associations were observed for social and nonsocial media use predicting future psychiatric symptoms, suggesting bidirectionality.

CONCLUSION

Children with psychiatric symptoms have different subsequent media use patterns, including higher rates of subsequent nonsocial engagement. Ensuring that ongoing data collection and analysis efforts attend to temporality and transitions in the relation between media use and psychiatric symptoms will accelerate progress in the field.

SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study

During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents' health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information.

A cross-sectional study on personal values of medical students: the differences from their instructors, their associations with mental wellbeing, and the influences of gender

BACKGROUND

Personal values of Thai medical students have been observed to be diverging from those of their seniors, but the differences remain uncharacterized. Despite its potential association with mental wellbeing, the issue remain unexplored in the population. This study aimed to explore (1) the difference in personal values between medical students and instructors and (2) the association between student's value adherence to mental well-being and the interaction by gender.

METHODS

An online survey was performed in 2022. Participants rated their adherence to five groups of values, namely, Self-Direction, Hedonism, Achievement & Power, Universalism & Benevolence, and Tradition. Participants also rated their mental wellbeing. Comparisons were made between the personal values of students and instructors. The association between the personal values of students and their mental wellbeing and the interaction between values and gender were analyzed in linear regression.

RESULTS

Compared to instructors, students rated higher on Universalism & Benevolence, marginally higher on Hedonism, and lower on Tradition. Students' ratings on Self-Direction, Universalism & Benevolence, and Tradition predicted better mental wellbeing. Their rating on Hedonism predicted poorer mental wellbeing, the effect of which was marginally stronger in males. Ratings on Achievement & Power marginally predicted poorer mental wellbeing in females.

CONCLUSION

Difference in personal values between medical students and instructors have been observed. Some of these values hold potentials over student's mental wellbeing. Curricular and medical school environmental accommodation for the changes in the characters of learners may be necessary to mitigate the adverse effects on their mental wellbeing and foster development of desirable professional characteristics.

[Digital media use and mental health in adolescents-a narrative review]

The opportunities and hazards of digital media, especially with regard to children and adolescents, are currently the subject of frequent family, school, and social debates.Digital platforms can support the accomplishment of adolescent developmental tasks through gaming and social exchange as well as communication and contact promotion, learning, and health promotion, and are widely used for entertainment. In Germany, almost all adolescents own a smartphone. During the COVID-19 pandemic, an intensification of the use of digital games, social media, and streaming offers by adolescents was observed. Exposure to age-uncensored content such as the depiction of violence, extreme political views, and conspiracy theories, as well as personal attacks through cyberbullying, unfiltered initiation of contact including cybergrooming, dysfunctional role models, and addiction-promoting aspects are associated with mental health risks.Cyberbullying affects about 5% of children and adolescents in Germany. A bidirectional relationship with mental health could be shown. The gaming disorder is the first digital media use disorder (DMUD) that has been included in the ICD-11 and thus internationally recognized as a mental illness. Adolescents are affected disproportionately often and experience impairments in their mental development and levels of functioning.Services are available to promote adolescent media literacy, and their expansion, structured application, and evaluation are needed. Evidence-based prevention and treatment options for DMUD are currently largely lacking. Their development, review, and dissemination should be further supported.

Comparison of the Mental Disorders Among Families of ISIS Captives Residing in Sulaymaniyah With the Native Population in 2023: A Cross-sectional Study

BACKGROUND

This study aimed to compare the level of mental disorders among families of ISIS captives residing in Sulaymaniyah with the native population in 2023.

METHODS

In the present descriptive-analytical cross-sectional study, a total of 383 ISIS captives by census aged 18-60 years were selected, along with an equal number of matched native individuals from Sulaymaniyah in terms of demographic characteristics. The data collection tool was the SCL-90 questionnaire. The 90-R-SCL interview and test were used to assess the level of symptoms related to mental disorders.

RESULTS

The results showed statistically significant differences between ISIS captives and the native population in terms of the total psychological disorder mean score (2.54±0.30 vs. 1.52±0.16; P<0.001), Global Severity Index (GSI) (253.40±32.82 vs. 137.03±14.74; P<0.001) and the mean scores of the dimensions of psychological disorder including: physical complaint (2.52±0.45 vs. 1.67±0.54; P<0.001), obsessive compulsive disorder (2.51±0.43 vs. 1.50±0.44; P<0.001), disorder in interpersonal relationships (2.55±0.44 vs. 19.10±0.29; P<0.001), depressive disorder (2.60±0.41 vs. 1.60±0.55; P<0.001), anxiety disorder (2.50±0.41 vs. 12.10±0.29; P<0.001), aggression disorder (2.55±0.49 vs. 19.10±0.40; P<0.001), morbid fear disorder (2.55±0.45 vs. 1.48±0.45; P<0.001), paranoid ideation disorder (2.49±0.55 vs. 1.39±0.40; P<0.001), and psychotic disorder (2.47±0.43 vs. 1.52±0.57; P<0.001).

CONCLUSION

The findings of this study suggest that ISIS captives suffer from multiple psychological disorders, and the presence of more severe mental disorders among this population necessitates comprehensive psychiatric and psychological services for them.

Promoting mental health in esports

There is growing recognition of the demands and health challenges experienced by esports athletes. The purpose of this perspective paper is to draw specific attention to the mental health of competitive gamers and spur on both future research and applied initiatives focussing on this important but under-addressed topic. We will briefly discuss the prevalence of mental health concerns, domain-specific stressors, and the need for comprehensive mental health support systems tailored to the esports context. It is our hope that, with this perspective paper, we can help set a new research agenda addressing mental health in esports.

The influence of screen time on behaviour and emotional problems among adolescents: A comparison study of the pre-, peak, and post-peak periods of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has brought drastic changes globally in the past three years, one of which is an increase in the use of digital media or electronic devices. Previous studies have shown that long screen time may stimulate the neurobiological system, resulting in various behavioural and emotional problems; however, there is insufficient population-based evidence. This study aimed to investigate the influence of screen time on behavioural and emotional problems in Indonesian adolescents at three time points: the pre-, peak, and post-peak periods of COVID-19. Data were collected using an online community mental health survey. This survey incorporated the Youth Screen Time Survey to gauge screen time and the adolescent version of the Strengths and Difficulties Questionnaire to assess emotional, conduct, and prosocial behaviour problems. The participants were adolescents in secondary and senior high schools, with 337, 423, and 1,096 participants from the pre-, peak-, and post-pandemic periods, respectively, included in the analysis. Daily average screen time was compared, followed by the calculation of odds ratios for screen time and mental health problems during the different periods. The results demonstrated significant differences in adolescents' total daily average screen time between the different pandemic periods. Decreased screen time was associated with reduced emotional, conduct, and prosocial behaviour problems, especially during the peak period. Thus, psychoeducation on screen time in adolescents should be considered as a point of interest for mental well-being interventions.

Screen time and addictive use of gaming and social media in relation to health outcomes

Introduction

This study examined associations between screen time and addictive use (i.e., heavy involvement and negative consequences) of gaming and social media, and their independent effects on health outcomes.

Methods

Survey data were collected from 2,265 participants (mean age = 21.57). Internet Gaming Disorder (IGD) and Social Media Disorder (SMD) were measured with the Gaming and Social Media Questionnaire (GSMQ-9), with separate measures for heavy involvement and negative consequences. Screen time was measured by weekly hours of gaming and social media. Assessed health outcomes were psychological problems, low self-concept, social problems, sleep problems, and sleep time.

Results

Screen time and addictive use were significantly associated for both gaming and social media, with associations being stronger for symptoms of heavy involvement compared to symptoms of negative consequences. However, despite significant associations, a substantial proportion of the participants with a high screen time did not meet any or just one symptom of addiction. More importantly, it was primarily negative consequences that had independent effects on health outcomes, except for sleep. High levels of heavy involvement in gaming, were even related to lower, not higher, levels of psychological problems.

Conclusion

The present findings study show that screen time is a poor indicator of addictive use of gaming and social media. Given that it was primarily negative consequences of gaming or social media that had effects on health outcomes, our study also emphasizes the need to distinguish between different types of addictive use and to further examine the diagnostic validity of the nine IGD symptom criteria.

Mediating effect of sleep in the association between social media use and mental health among French adolescents during the COVID-19 sanitary crisis

OBJECTIVE/BACKGROUND

Social media use could have deleterious effects on mental health through short sleep duration and poor sleep quality among adolescents. This study aimed to investigate the mediating role of both sleep duration and sleep quality in the association between social media use and mental health among adolescents.

PATIENTS/METHODS

We used cross-sectional data collected from adolescents in the EXIST pilot project conducted during COVID-19 pandemic. Adolescents self-reported wellbeing (WEMWBS), anxiety and depression (HADS) as mental health outcomes. We used ad-hoc questionnaires to assess social media use during weekdays and weekend days, and sleep duration and quality. Mediation analyses were carried out following Baron and Kenny's method, using adjusted linear regression models.

RESULTS

A total of 340 adolescents (13.5 ± 0.6 years, 45.3 % girls) were included. Greater social media use, poorer sleep quality, and shorter sleep duration were associated with poorer mental health. Greater social media use was associated with poorer sleep quality only during the weekend days. The total effect of social media use during weekend days on anxiety (β = 2.54; 95%CI [-1.59; 6.68]) was significantly conveyed through sleep quality (β = 1.22; 95%CI [0.17; 2.62]; mediated proportion = 48.0 %) and duration (mediated proportion = 46.8 %). Mediated proportions ranged from 12.5 % to 20.6 % for wellbeing and depression. Mediating effects were not evident during weekdays.

CONCLUSIONS

Sleep duration and quality mediated the association between social media use and mental health among adolescents during weekend days but not weekdays. Our findings highlight the importance of promoting healthy social media habits, especially during periods of increased reliance on digital platforms, such as COVID-19 pandemic.

Screen media activity in youth: A critical review of mental health and neuroscience findings

This review has two primary objectives: (1) to offer a balanced examination of recent findings on the relationship between screen media activity (SMA) in young individuals and outcomes such as sleep patterns, mood disturbances, anxiety-related concerns, and cognitive processes; and (2) to introduce a novel multi-level system model that integrates these findings, resolves contradictions in the literature, and guides future studies in examining key covariates affecting the SMA-mental health relationship. Key findings include: (1) Several meta-analyses reveal a significant association between SMA and mental health issues, particularly anxiety and depression, including specific negative effects linked to prolonged screen time; (2) substantial evidence indicates that SMA has both immediate and long-term impacts on sleep duration and quality; (3) the relationship between SMA and cognitive functioning is complex, with mixed findings showing both positive and negative associations; and (4) the multifaceted relationship between SMA and various aspects of adolescent life is influenced by a wide range of environmental and contextual factors. SMA in youth is best understood within a complex system encompassing individual, caregiver, school, peer, and environmental factors, as framed by Bronfenbrenner's ecological systems theory, which identifies five interrelated systems (microsystem, mesosystem, exosystem, macrosystem, and chronosystem) that influence development across both proximal and distal levels of the environment. This model provides a framework for future research to examine these interactions, considering moderating factors, and to develop targeted interventions that can mitigate potential adverse effects of SMA on mental well-being.

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

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