Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study

Influence of circadian rhythm and sleep schedules on depressive symptoms among adolescents in China

Circadian rhythm (24-hour period of physiological and behavioral changes) is the basis of the overall health, including mood and health. This study aimed to explore the influence of circadian rhythm and sleep schedules on depressive symptoms in Chinese adolescents. In this cross-sectional study, 841 middle school students were recruited and divided into two groups (depressive group, DG, n = 210, and control group, n = 631) depending on the total score of The Center for Epidemiological Studies Depression Scale for Children (CES-DC). The circadian rhythm and sleep quality among adolescents were evaluated by using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and Self-rating scale of Sleep (SRSS) scales. Furthermore, correlation analysis and logistic regression analysis were used to determine the effects of demographic factors, sleeping arrangement, sleep quality, and circadian rhythm on depressive symptoms. The DG group's CES-DC, BRIAN and SRSS scores were significantly higher than the control group's. Higher scores of BRIAN and SRSS were risk factors for depressive symptoms in Chinese adolescents. Attending a day school and waking up later on weekends may be weak protective factors. Our results suggest that circadian rhythm disturbance, sleep quality, and sleeping arrangement have a significant influence on depressive symptoms among adolescents in China.

Associations Between Changes in 24-Hour Movement Behaviors in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review and Mediation-Based Meta-Analysis

BACKGROUND

Although 24-hour movement behaviors are known to be interconnected, limited knowledge exists about whether change in one behavior during the COVID-19 pandemic (eg, increased screen time) was associated with change in another (eg, reduced physical activity or sleep). This review estimates mediational associations between changes in children's physical activity, screen time, and sleep during the COVID-19 pandemic.

METHODS

We included studies published between January 1, 2020 and June 27, 2022, in the PubMed/MEDLINE, Embase, PsycINFO, SPORTDiscus, and Web of Science databases. Summary data were extracted from included studies and analyzed with random-effects meta-regression.

RESULTS

This review included 26 studies representing 18,959 children across 18 mid-high-income countries (53% male; mean age, 11.5 [2.9] y). There was very good evidence of decreased total daily physical activity (factor change, 0.62; 90% CI, 0.47-0.81) and strong evidence of increased screen time (1.56; 90% CI, 1.38-1.77). There was very good evidence of decreased moderate to vigorous physical activity (0.75; 90% CI, 0.62-0.90) and weak evidence of increased sleep (1.02; 90% CI, 1.00-1.04). Mediational analysis revealed strong evidence that most of the reduction in total daily physical activity from before, to during, the pandemic was associated with increased screen time (0.53; 90% CI, 0.42-0.67). We observed no further mediational associations.

CONCLUSION

Increased reliance on and use of screen-based devices during the COVID-19 pandemic can be linked with reduced child and adolescent physical activity. This finding links COVID-related restrictions to potential displacement effects within child and adolescent 24-hour movement behavior.

Are social pressure, bullying and low social support associated with depressive symptoms, self-harm and self-directed violence among adolescents? A cross-sectional study using a structural equation modeling approach

BACKGROUND

More in-depth evidence about the complex relationships between different risk factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing social pressure, bullying, and low social support on mental health problems in adolescence.

METHODS

A school-based cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, social pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts.

RESULTS

Poor family economy and low parental education were associated with high pressure, low parental support and depressive symptoms in males and females. Moreover, poor family economy was associated with bullying perpetration and bullying victimization among males and females, and cyberbullying victimization among females, but not males. Low parental education was associated with bullying victimization among males, but not females. Further, high social pressure was associated with depressive symptoms among males and females, whereas high social pressure was linked to self-harm and suicide thoughts among females, but not males. Bullying victimization and cyberbullying victimization were associated with depressive symptoms, self-harm, and suicide thoughts among males and females. Bullying victimization was associated with depressive symptoms among males, but not females, whereas bullying perpetration was linked to self-harm and suicide thoughts among females, but not males. Low parental support was associated with bullying perpetration, bullying victimization, depressive symptoms, self-harm and suicide thoughts among males and females, whereas low parental support was associated with high social pressure among females, but not males. Low teacher support was associated with high social pressure and depressive symptoms. Low support from friends was associated with bullying victimization, depressive symptoms and suicide thoughts among males and females, whereas low support from friends was linked to self-harm among males, but not females. Finally, results showed that depressive symptoms were associated with self-harm and suicide thoughts among males and females.

CONCLUSION

Low socioeconomic status, social pressure, bullying and low social support were directly and indirectly associated with depressive symptoms and self-directed violence among Norwegian adolescents.

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

The role of sleep in prospective associations between parent reported youth screen media activity and behavioral health

BACKGROUND

Screen media activity (SMA) can negatively affect youth behavioral health. Sleep may mediate this association but has not been previously explored. We examined whether sleep mediated the association between SMA and youth behavioral health among a community sample.

METHOD

Parents completed questions about their child (N = 564) ages 3-17 at Wave 1, Wave 2 (4-8 months later), and Wave 3 (12 months later). Path analyses were conducted to examine links between Wave 1 SMA and Wave 3 behavioral health problems (i.e., internalizing, externalizing, attention, peer problems) through Wave 2 sleep disturbance and duration.

RESULTS

SMA was significantly associated with greater sleep disturbance, β = .11, 95% CI [.01, .21] and shorter sleep duration, β = -.16 [-.25, -.06], and greater sleep disturbance was associated with worse youth behavioral health across internalizing, β = .14 [.04, .24], externalizing, B = .23 [.12, .33], attention, β = .24 [.15, .34], and peer problems, β = .25 [.15, .35]. Longer sleep duration was associated with more externalizing, β = .13 [.04, .21], and attention problems, β = .12 [.02, .22], and fewer peer problems, β = -.09 [-.17, -.01], but not with internalizing problems. Lastly, there was a direct effect of SMA on peer problems, β = -.15 [-.23, -.06] such that higher SMA that does not impact sleep may have a positive impact on reducing peer problems.

CONCLUSIONS

Sleep (i.e., disturbances and shorter duration) may partially account for the small associations observed between SMA and worse behavioral health in youth. To continue expanding our understanding, future research should utilize more diverse representative samples, use objective measures of SMA and sleep, and examine other relevant aspects of SMA, including content, device type, and timing of use.

Association of Screen Time with Anxiety and Depressive Symptoms in College Students During COVID-19 Outbreak in Shanghai: Mediation Role of Sleep Quality

The study aimed to investigate the associations between different types of screen time (ST) and anxiety and depressive symptoms in college students during the Coronavirus disease 2019 (COVID-19) outbreak in Shanghai, China; the potential mediation role of sleep quality was also examined. A total of 1,550 college students completed an online survey in May 2022. ST, Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, Pittsburgh Sleep Quality Index (PSQI) score, and physical activity were self-reported. Multiple linear regression and mediation analysis were conducted. The results showed that more time spent in TV/movie viewing (>2 h/day) and recreational reading (>1 h/day) was associated with higher levels of anxiety, while more time spent in online social media (>2 h/day) was associated with a higher level of depressive symptoms. In contrast, time spent in online social media (1-2 h/day) was associated with a lower level of anxiety. Meanwhile, recreational reading (2-3 h/day) had a significant indirect effect on anxiety and depressive symptoms through sleep quality. During the COVID-19 outbreak, the associations of ST with anxiety and depressive symptoms varied by the type of screen viewing in college students. The associations of slightly excessive time spent on recreational reading with higher levels of anxiety and depressive symptoms were partially mediated by sleep quality.

Homework, sleep insufficiency and adolescent neurobehavioral problems: Shanghai Adolescent Cohort

BACKGROUND

The prospective associations between homework burdens and adolescent neurobehavioral problems, and whether sleep-durations mediated and sex modified such associations remained unclear.

METHODS

Using Shanghai-Adolescent-Cohort study, 609 middle-school students were recruited and investigations took place at Grade 6, 7 and 9. Information on homework burdens (defined by homework completion-time and self-perceived homework difficulty), bedtime/wake-up-time and neurobehavioral problems was collected. Two patterns of comprehensive homework burdens ('high' vs. 'low') were identified by latent-class-analysis and two distinct neurobehavioral trajectories ('increased-risk' vs. 'low-risk') were formed by latent-class-mixture-modeling.

RESULTS

Among the 6th-9th graders, the prevalence-rates of sleep-insufficiency and late-bedtime ranged from 44.0 %-55.0 % and 40.3 %-91.6 %, respectively. High homework burdens were concurrently associated with increased-risks of neurobehavioral problems (IRRs: 1.345-1.688, P < 0.05) at each grade, and such associations were mediated by reduced sleep durations (IRRs for indirect-effects: 1.105-1.251, P < 0.05). High homework burden at the 6th-grade (ORs: 2.014-2.168, P < 0.05) or high long-term (grade 6-9) homework burden (ORs: 1.876-1.925, P < 0.05) significantly predicted increased-risk trajectories of anxiety/depression and total-problems, with stronger associations among girls than among boys. The longitudinal associations between long-term homework burdens and increased-risk trajectories of neurobehavioral problems were mediated by reduced sleep-durations (ORs for indirect-effects: 1.189-1.278, P < 0.05), with stronger mediation-effects among girls.

LIMITATIONS

This study was restricted to Shanghai adolescents.

CONCLUSIONS

High homework burden had both short-term and long-term associations with adolescent neurobehavioral problems, with stronger associations among girls, and sleep-insufficiency may mediate such associations in a sex-specific manner. Approaches targeting appropriate homework-load/difficulty and sleep restoration may help prevent adolescent neurobehavioral problems.

Family resilience and neighborhood factors affect the association between digital media use and mental health among children: does sleep mediate the association?

The associations between digital media use and mental well-being among children and adolescents have been inconclusive. We examined (i) the associations between digital media use and mental health outcomes, anxiety, depression, and ADHD, (ii) whether family resilience and neighborhood factors attenuate the associations, and (iii) whether sleep mediates these associations. We used the National Survey of Children's Health data from 2019 to 2020. A total of 45,989 children's (6-17 years) data were analyzed in this study. Multivariate logistic regression was used to assess the associations between digital media use and anxiety, depression, and ADHD. Path models and Paramed command in STATA were used to test the role of sleep as a mediator of these associations. The prevalence of heavy digital media users (who spent 4 or more hours per day) among the analytic sample was 30.52%, whereas anxiety was 13.81%, depression was 5.93%, and ADHD was 12.41%. Children in the heavy media user group had 63% increased odds of anxiety (95% CI: 1.32-2.01) and 99% increased odds of depression (95% CI: 1.35-2.94) after adjusting for sociodemographic factors, compared to the children in light media user group (who spent < 2 h per day), and these relations were significant at 0.01 level. However, family resilience and community factors significantly attenuated the effect of digital media use on anxiety and depression. Sleep did not mediate the associations between digital media use and anxiety or depression.   Conclusions: Family resilience and neighborhood factors protect against the harmful effects of digital media use. Further research is needed to examine the relationships of media contents, the presence of electronic devices in bedrooms, and sleep quality with mental health. What is Known: • Spending long hours on digital media may adversely affect children and adolescents' health and development. However, the mediating role of sleep in the association between digital media use and mental health outcomes is inconclusive. What is New: • Digital media use has detrimental effects on anxiety and depression. However, family resilience and neighborhood factors attenuated the association. The study highlights the importance of positive family functioning and neighborhood conditions reducing the harmful effects of digital media use.

A Narrative Review of Screen Time and Wellbeing among Adolescents before and during the COVID-19 Pandemic: Implications for the Future

The COVID-19 pandemic has disrupted the lives of many. In particular, during the height of the pandemic, many experienced lockdowns, which in turn increased screen time drastically. While the pandemic has been declared an endemic and most activities have been reinstated, there appears to still be elevated screen time among adolescents due to poor habits formed during the pandemic lockdowns. This paper explores the factors by which screen time affects well-being among adolescents and how the pandemic may have influenced some of these factors. For example, beyond having greater screen time, many adolescents have also reduced their physical activities and picked up poor sleeping habits. These findings highlight the importance of having integrated activity guidelines that go beyond limiting adolescents' daily screen time. It is important to affirm that beyond ensuring that adolescents limit their daily screen time, they are also meeting physical activity and sleep guidelines so that they achieve a holistic sense of wellbeing.

The association between social capital indicators and psychological distress in Catalan adolescents

According to the WHO, globally, one in seven adolescents experiences a mental disorder, being in a detrimental situation toward educational achievement, social cohesion, future health and life chances. Calls to identify risk and resilience factors to develop effective preventive actions have been made. Following a systemic approach, we conducted a cross-sectional study on the relationship between social capital and psychological distress in a sample of Catalan adolescents in Barcelona, taking into account a range of other relevant aspects at different levels influencing mental health, including gender, age, migrant status, family background, lifestyle factors, body mass index, and self-rated health. Data were collected through validated questionnaires in December 2016 from 646 of 14- to 18-year-old adolescents from three public and private high schools in Barcelona (Spain). Data analysis included descriptive analysis, a correlational study and logistic regression to obtain the odds ratio for social capital indicators to be associated with psychological distress. Our results suggest that reporting higher levels of family support and higher levels of teacher-student trust reduce the likelihood of suffering psychological distress. Higher levels of neighborhood informal control were associated with mental health, but a possible detrimental effect cannot be ruled out. Being a girl, reporting low self-rated health or higher media use was also associated with higher likelihood of psychological distress. Current results may encourage interventions that focus on social capital as a means to reduce psychological distress and foster well-being in youth.

Sleep health and its related influencing factors in primary and middle school students in Fuzhou: A large multi-center cross-sectional study

Background

This current study set out to investigate the status of sleep health in 7–20-year-old students in Fuzhou and explore the related influencing factors of sleep health.

Methods

A total of 38,467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May to June 2019, in 18 primary schools and 18 middle schools from nine districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill out a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, sleep-related lifestyle behaviors, and electronic-products usage). Multiple linear regression was carried out to analyze data.

Results

Of the total 40,888 questionnaires we released, 38,467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85 ± 3.1, including 20,013 boys and 18,454 girls. The multiple linear regression analysis identified factors associated with sleep health (p < 0.05): Boy (coef = 0.073, 95% CI: 0.030–0.115), age (coef = 1.797, 95% CI: 0.224–0.243), key school (coef = 2.069, 95% CI: 0.105–0.193), urban (coef = 0.096, 95% CI: 0.054–0.139), excessive daytime sleepiness (coef = 0.535, 95% CI: 0.432–0.639), unhealthy sleep habits (coef = 0.363, 95% CI: 0.307–0.419), eating before sleep (coef = 0.578, 95% CI: 0.527–0.630), using electronic products in bedroom (coef = 0.074, 95% CI: 0.028–0.121), screen time per day during school (coef = 0.260, 95% CI: 0.235–0.284), frequency of using electronics 30 min before bedtime (coef = 0.150, 95% CI: 0.134–0.166), strained relationship with parents (coef = 0.361, 95% CI: 0.270–0.452), strained relationship with peers (coef = 0.267, 95% CI: 0.171–0.363), excessive homework or learning (coef = 0.189, 95% CI: 0.141–0.237), time for doing homework (coef = 0.266, 95% CI: 0.245–0.287), and mood swings frequently (coef = 1.174, 95% CI: 1.127–1.221) negatively impact sleep health. Sleep alone (coef = −0.204, 95% CI: −0.262–0.147) were the risk factors for sleep health. Furthermore, frequent mood swings was considered the most influential factor on overall variables.

Conclusions

Sleep health is associated with factors covered sociodemographic characteristics, family sleep habits, and routine activities before bedtime. Multiple measures should be taken to improve sleep quality in a targeted manner.

An Explanatory Model of the Relationships between Physical Activity, Social Support and Screen Time among Adolescents

Effective physical activity studies are necessary to understand how factors involved in physical activity mediate behaviour. Therefore, more reliable explanatory models can be generated in order to design effective actions to promote physical activity. The study had two aims: (1) to develop an explanatory model to identify and establish the relationships between physical activity, social support and screen time among adolescents; and (2) to contrast the explanatory structural model by means of a multi-group analysis according to sex. The study design was cross-sectional with descriptive and correlational analysis. The research was carried out with a representative sample of adolescents from the province of Soria (mean age 14.06 ± 1.27 years). The instruments used were: Four by One-Day Physical Activity Questionnaire, Parent Support Scale and Peer Support Scale. The results show that social support had a negative relationship with screen time (r = −0.178; p ≤ 0.001); males had a positive relationship between physical activity and screen time (r = 0.118; p ≤ 0.05); and peer support had more influence on social support than parental support. In conclusion, the proposed model was effective in triangulating the relationships between physical activity, social support and screen time in a novel way, while allowing us to discriminate these results according to participants’ sex.

The impact of screen time changes on anxiety during the COVID-19 pandemic: sleep and physical activity as mediators

Under the burden caused by COVID-19 and rapid lifestyle changes, many people increased their screen time due to psychological needs and social requirements. The current study investigated the relationship between screen time changes and anxiety symptoms during the pandemic of COVID-19. Furthermore, we examined whether sleep and physical activity would mediate the association between screen time changes and anxiety. The self-developed questionnaire was delivered online to collect people's changes in anxiety, sleep patterns, and screen time during COVID-19. 970 participants (74.4% female) with an average age of 23 years were involved in this study. After adjusting demographic variables, the ordinal logistic regression analyses revealed that a significant increase in screen time was linked with anxiety. Slightly increased screen time, slightly and significantly decreased screen time did not predict anxiety symptoms during the pandemic. The level of anxiety was significantly higher among respondents who reported decreased sleep quality. Sleep quality directly mediated the association between screen time changes and anxiety, while sleep latency did not. The longer sleep latency caused by increased screen time would amplify anxiety by affecting sleep quality. In addition, the relationship between screen time changes and anxiety was also mediated by physical activity. We concluded that the fluctuation of screen time in a modest range does not affect the anxiety level substantially. The significantly increased screen time would contribute to poor sleep (including longer sleep latency and worse sleep quality) and lack of physical activity, which would lead to higher levels of anxiety.

Personal, social, and environmental correlates of physical activity and sport participation in an adolescent Turkish population

Background

Benefits of physical activity has been shown for adolescents; however, there is a decline trend in number of adolescents meeting current WHO recommendations. This trend underlines the importance of identifying factors associated with adolescents’ physical activity level (PAL) with considerations of regional and cultural differences to plan and implement effective policies. Therefore, the aim of this study was to determine personal, ecological, and social factors associated with PAL and sport participation in Turkish adolescents aged 11–14 years. A cross-sectional study was conducted by including 996 adolescents aged between 11 and 14 years from 39 secondary schools in İstanbul, Turkey. Logistic regression analyses performed to identify the significant personal (age, gender, sleep time, screen time, BMIz score, having siblings), ecological (presence of playground, type of school transportation), and social (family income, engaging a physical activity with family, and preferred activity at school breaks) predictors of PAL and sport participation.

Results

Adolescents who were active during break time at school (p < 0.001), engaging a physical activity with family (p < 0.001), and did not have a sibling (p = 0.029) were more likely to be physically active. Adolescents behaved active during break time at school (p < 0.001), had a playground at home (p < 0.001), spending time with family for physical activity (p < 0.001), and did not have a sibling (p = 0.021) were more likely to participate in a sport activity.

Conclusions

Predictors of PAL in this study indicates the need to promote active break time in school, increased physical activity time with family, and to design environmental policies to increase number of playgrounds.

Screen Time Effect on Insomnia, Depression, or Anxiety Symptoms and Physical Activity of School Students During COVID-19 Lockdown in Lebanon: A Cross Sectional Study

Background and Objective Our aim is to investigate the impact of COVID-19 on screen time among Lebanese high school students (grades 9–12).Methods An anonymous online questionnaire was distributed among 510 school students from different governorates in Lebanon; this included questions regarding screen time, food habits, and physical activity. Psychological symptoms were assessed using the Generalized Anxiety Disorder-7 items and Patient Health Questionnaire-9 items. Effects of screen time on sleep was evaluated using the Insomnia Severity Index and Bedtime Procrastination Scale.Results Female students reported higher depression (p = 0.018) and anxiety (p = 0.023) than male students; however, there was no difference in their sleep. Insomnia, depression, and anxiety were highest among phone users. A screen time of more than 7 hours per day was significantly associated with higher depression (67.9%), anxiety (61.6%), insomnia (82.1%), and bedtime procrastination. It also indicated a shift toward a less healthy diet and light exercise.Conclusions Seven hours of screen was found to develop depression and anxiety, exercising less, eating a less healthy diet, and experiencing disturbed sleep among school adolescents.

Participatory Development and Pilot Testing of an Adolescent Health Promotion Chatbot

Background: The use of chatbots may increase engagement with digital behavior change interventions in youth by providing human-like interaction. Following a Person-Based Approach (PBA), integrating user preferences in digital tool development is crucial for engagement, whereas information on youth preferences for health chatbots is currently limited.

Objective: The aim of this study was to gain an in-depth understanding of adolescents' expectations and preferences for health chatbots and describe the systematic development of a health promotion chatbot.

Methods: Three studies in three different stages of PBA were conducted: (1) a qualitative focus group study (n = 36), (2) log data analysis during pretesting (n = 6), and (3) a mixed-method pilot testing (n = 73).

Results: Confidentiality, connection to youth culture, and preferences when referring to other sources were important aspects for youth in chatbots. Youth also wanted a chatbot to provide small talk and broader support (e.g., technical support with the tool) rather than specifically in relation to health behaviors. Despite the meticulous approach of PBA, user engagement with the developed chatbot was modest.

Conclusion: This study highlights that conducting formative research at different stages is an added value and that adolescents have different chatbot preferences than adults. Further improvement to build an engaging chatbot for youth may stem from using living databases.

Interactive Effects of Neighborhood Safety and Screen Time on Adolescent Internalizing Symptoms

OBJECTIVE

Perceptions of less neighborhood safety and higher levels of screen time are independently linked to adolescent anxiety and depression. Furthermore, residing in a neighborhood perceived as less safe is associated with engaging in higher levels of screen time. Screen time may act as a potential mechanism by which the effects of neighborhood safety on internalizing symptoms differ. Yet, research has not investigated whether the relationship between neighborhood safety and psychosocial adjustment varies at high and low levels of screen time. Therefore, this study examined the interaction between perceived neighborhood safety and screen time on adolescent internalizing symptoms (i.e., anxiety and depressive symptoms).

METHOD

A total of 184 adolescents (53% female; mean age = 17.09, SD = 1.07) were recruited from an ongoing longitudinal study of adolescent drivers. Participants reported their perceptions of neighborhood safety, screen use, anxiety and depressive symptoms, and demographic characteristics. The independent and interactive contributions of neighborhood safety and screen time predicting anxiety and depressive symptoms in adolescents were tested with hierarchical linear regressions.

RESULTS

Perceptions of less neighborhood safety and higher levels of screen time each uniquely predicted adolescent anxiety and depressive symptoms. The relationship between living in a neighborhood perceived as less safe and anxiety symptoms was stronger for youth with high levels of screen time.

CONCLUSION

The findings suggest that youth residing in less safe neighborhoods may have higher levels of anxiety symptoms, and this anxiety symptomology is higher at high levels of screen time.

Use of Technology and Its Association With Academic Performance and Life Satisfaction Among Children and Adolescents

Introduction: In the last years, there has been a rise in the use of technology among children and adolescents, which has led to a greater concern about its impact on their socioemotional and cognitive development. Aims: To explore the time spent using technology, the risk perception of its use by students, and the association between frequency of technology use and life satisfaction and academic performance among children and adolescents in Chile. Additionally, we explored the mediating effect of sleep deprivation on these outcomes. Methods: This is a cross-sectional study, where 2,440 students (9-12 years old) from 13 schools participated. Data was collected using an online survey answered by students during school hours. The association analyses were performed using multivariable regression models considering life satisfaction and academic performance as dependent variables. Additionally, mediating analyses were conducted using structural equation modeling. Results: Time watching television and using cellphones were similar on weekdays, and playing video games was the most frequent activity during weekends. A 42.1% of students reported playing online video games with strangers, and 12.7% had sleep deprivation. Lower self-reported academic performance was associated with cyberbullying victimization, sleep deprivation, being hacked, exposure to violent content, time spent using cell phones during weekdays and weekends, and playing video games during weekdays. Students who perceived that playing video games after 9 pm affected their sleep had a higher academic performance. There was a clear mediating effect of sleep deprivation in the relationship between time spent using a cellphone during weekdays and weekends and playing video games during weekdays and GPA. Conclusions: Time spent using technological devices was not associated with life satisfaction; however, the time spent using cell phones and playing video games was related to lower self-reported academic performance, mediated by sleep deprivation. Future research may focus on a better understanding of the mechanisms involved in the effect of technology use on sleep routines among adolescents and potential interventions to reduce its impact on academic performance.

Electronic media use and sleep in children and adolescents in western countries: a systematic review

Background

Sleep is essential for child and adolescent health and well-being. There is an increasing interest in whether electronic media use affects children and young adolescents’ sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that research continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media use related to sleep among 0–15-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ 15 years, and intervention, cohort, or cross-sectional studies from western countries. Methodological quality was rated using the Quality Assessment Tool for Quantitative Studies by two independent reviewers. Data was extracted using a standardized data extraction form. Synthesis was done by summarizing results across studies by age groups of 0–5, 6–12, and 13–15 years within four sleep domains: Bedtime and sleep onset; Sleep quality; Sleep duration; Daytime tiredness.

Results

The search identified 10,719 unique studies, of which 109 fulfilled inclusion and exclusion criteria and were assessed for methodological quality. In total, 49 studies were included in the review. The study designs were randomized controlled trials (n = 3), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (n = 29). Evidence for an association between electronic media use and sleep duration was identified, with stronger evidence for 6–15-years-olds than 0–5-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. However, for 6–12-year-old children, there was evidence for associations of electronic media use with delayed bedtime and poor sleep quality. For 13–15-year-olds, there was evidence for associations between screen time and problems falling asleep, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media use was generally associated with shorter sleep duration in children and adolescents. Studies with stronger research design and of higher quality are needed to draw solid conclusions about electronic media’s impact on other sleep outcomes. Public awareness and interventions could be promoted about the potential negative impact on children’s sleep of electronic media devices that are used excessively and close to bedtime.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11640-9.

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.

The Associations between Sleep Duration, Academic Pressure, and Depressive Symptoms among Chinese Adolescents: Results from China Family Panel Studies

Depressive symptoms are a common mental health problem among adolescents, which may affect their physical and mental health development and impose heavy burdens on individual families and society. This study aimed to examine the associations between sleep duration, academic pressure, and depressive symptoms among Chinese adolescents and to construct the mediation model to explore the mediating effect of sleep duration. The data are from the China Family Panel Studies (CFPS). Methodologically, the aforementioned associations were explored by constructing a structural equation model and applying multivariate multilevel logistic regression. In this study, we found that approximately 6.49% of the 3724 Chinese adolescents had depressive symptoms. Sleep duration of <6 h/night (OR = 2.39, 95%CI = 1.33-4.32) and high/maximum academic pressure (high: OR = 1.43, 95%CI = 1.02-1.99; maximum: OR = 2.43, 95%CI = 1.58-3.73) were both associated with an increased risk of depressive symptoms in adolescents. Meanwhile, the multiplicative interaction between sleep duration and academic pressure was significantly associated with depressive symptoms in adolescents (p < 0.001). The sleep duration played a partial mediating role in the relationship between academic pressure and depressive symptoms (a*b = 0.006, 95%BootCI = 0.001-0.012). Our study highlights that it is essential to mitigate the academic pressure of adolescents to increase their sleep duration and further reduce the occurrence of depressive symptoms by adopting corresponding preventive measures.

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

OBJECTIVE/BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Disentangling individual, school, and neighborhood effects on screen time among adolescents and young adults in the United States

OBJECTIVES

To examine the association between individual, neighborhood, and school-level influences on individual screen time among adolescents and young adults (AYAs) in the National Longitudinal Study of Adolescent to Adult Health.

METHODS

We classified screen time continuously as self-reported total hours per week of television, videos, and video/computer games at baseline and categorical as extended screen time (≥14 h per week). We fit cross-classified multilevel models (CCMM) to examine to examine the individual-, school- and neighborhood-level demographic and socioeconomic factors associated with screen time. Models were fit using MLwiN with Bayesian estimation procedures.

RESULTS

AYAs reported an average of 22.8 (SD = 19.4) and 21.9 (SD = 20.3) hours of screen time, respectively. At the individual level, younger age, male sex, Black/multiracial race, receipt of public assistance, and lower parental education were associated with higher screen time. At the school level, being out of session (i.e., school and national holidays including summer), having a higher proportion of non-White students, and having a lower proportion of parents with a college education were associated with higher individual screen time.

CONCLUSIONS

We found that individual-level factors most influence youth screen time, with smaller contributions from school factors.

A bio-ecological framing of evidence on the determinants of adolescent mental health - A scoping review of the international Health Behaviour in School-Aged Children (HBSC) study 1983-2020

This paper extracts, organises and summarises findings on adolescent mental health from a major international population study of young people using a scoping review methodology and applying a bio-ecological framework. Population data has been collected from more than 1.5 million adolescents over 37 years by the Health Behaviour in School-Aged Children: WHO Cross-National (HBSC) Study. The paper reviews the contribution that this long standing study has made to our understanding of the individual, developmental, social, economic, cultural determinants of adolescent mental health by organising the findings of 104 empirical papers that met inclusion criteria, into individual, microsystem, mesosystem and macrosystem levels of the framework. Of these selected papers, 68 were based on national data and the other 36 were based on international data, from varying numbers of countries. Each paper was allocated to a system level in the bio-ecological framework according to the level of its primary focus. The majority (51 papers) investigate individual level determinants. A further 28 concentrate primarily on the microsystem level, 6 on the mesosystem level, and 29 on the macrosystem level. The paper identifies where there is evidence on the determinants of mental health, summarises what we have learned, and highlights research gaps. Implications for the future development of this population health study are discussed in terms of how it may continue to illuminate our understanding of adolescent mental health in a changing world and where new directions are required.

Screen time and autistic-like behaviors among preschool children in China

Screen time is becoming increasingly common in daily life. Early and excessive screen use has raised growing concerns for children's neuropsychological development. The purpose of this study was to evaluate the association between exposure to screen time in early life and the presence of autistic-like behaviors among preschool children. 29,461 child-caregiver dyads at kindergartens in Longhua New District of Shenzhen, China, were enrolled in this cross-sectional study. Information concerning socio-demographic characteristics, frequency and duration of children's electronic screen exposure for each year since birth, and autistic-like behaviors (measured by the Autism Behavior Checklist) were collected using a self-administered structured questionnaire completed by the primary caregivers. A series of logistic regression models assessed the association between screen time and autistic-like behaviors. Results indicated that younger initial age, longer daily screen time and longer cumulative years of screen exposure since birth were associated with the presence of autistic-like behaviors at preschool age. The risk was enhanced with the increase of both daily screen time and cumulative years of screen exposure during preschool period. Moreover, the cross-over analysis indicated that the first three years following birth might be a sensitive period for children when screen exposure increases the risk of experiencing autistic-like behaviors. In conclusion, our study implied that screen exposure in early life might increase the occurrence of autistic-like behaviors among preschoolers. These findings support the need for early interventions into preschoolers' screen use, however longitudinal studies are necessary to further confirm the causal relationship between early screen time and the incidence of later autistic-like behaviors among preschool children.

Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities

Research into early screen exposure has raised growing concerns about its impact upon children’s neuropsychological well-being. However, possible pathways remain unclear. This study therefore aimed not only to evaluate the association between screen exposure during the ages of 0–3 years and preschoolers’ autistic-like behaviors, but also the mediating roles of the frequency of caregiver-child interaction, sleep duration and level of participation in outdoor activities. Based on the 2017 survey of the Longhua Child Cohort Study, data of 29,595 child-caregiver dyads were obtained via a caregiver-reported questionnaire, with the data from 29,461 dyads included in the data analysis. Multiple linear and logistic regression models were employed to estimate the associations between screen exposure, caregiver-child interaction, sleep duration, outdoor activities, and children’s autistic-like behaviors. The results indicated that screen exposure during 0–3 years of age was associated with the presence of autistic-like behaviors at preschool age, and the strength of the association was enhanced with the increase of average daily screen time (Odds Ratios (ORs) ranging from 1.358 to 4.026). The frequency of caregiver-child interaction and sleep duration mediated 5.32% and 1.19% of the variance of the association respectively, but outdoor activities did not mediate the association. Our findings indicate that preschoolers who are exposed to screens at aged 0–3 years might have an increased risk of autistic-like behaviors, and that, the frequency of caregiver-child interaction and sleep duration might function as potential mediators of this association.

Insufficient sleep duration in association with self-reported pain and corresponding medicine use among adolescents: a cross-sectional population-based study in Latvia

OBJECTIVES

Pain among adolescents is prevalent that may negatively affect adolescents' general well-being of which sleep is an important domain. This study aims to explore the associations between weekly pain and medicine use for relevant pain and insufficient sleep duration among 11-, 13- and 15-year-old adolescents in Latvia by assessing the moderation effect of gender and age.

METHODS

Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n = 4412; 49.6% boys) were used. Logistic regression was applied to analyse the odds of insufficient sleep (< 7 h) on schooldays and weekends in association with weekly headache, stomach ache or backache and corresponding medicine use when testing the interaction effect of adolescents' gender and age.

RESULTS

The experience of weekly pain with or without medicine use significantly increased the odds of insufficient sleep compared to adolescents with pain less than weekly, while controlling for gender and age. The interaction effect of gender and age on the studied associations was not significant.

CONCLUSIONS

Weekly pain among adolescents is a significant risk factor for insufficient sleep duration, regardless of adolescents' gender and age.

Adolescents' sleep quality in relation to peer, family and school factors: findings from the 2017/2018 HBSC study in Flanders

PURPOSE

While a multitude of studies focused on biological and behavioral determinants of adolescents' sleep quality, a paucity of research examined the impact of social factors. The current study therefore examines the relationship between adolescents' sleep quality and peer, family and school factors.

METHODS

Data of Flemish participants in the 2017/2018 Health Behavior in School-aged Children survey (HBSC) were used, which is representative of the adolescent population (11-18 years) in Flanders. Adolescents' sleep quality was linked to individual-level data on peer relationships (i.e., peer support), family relationships (i.e., family support, perceived family wealth, caregiving responsibilities) and school relationships (i.e., teacher support, school support, school pressure) and contextual-level data on the school culture. Three-level multilevel models were fitted to account for the clustering of individuals (N = 8153) within classes (N = 769) and classes within schools (N = 177).

RESULTS

The individual-level results indicated that adolescents' sleep quality was positively related to family support, teacher support, student support and perceived family wealth. In contrast, adolescents' sleep quality was negatively related to caregiving responsibilities and school pressure. In addition, the contextual-level results pointed out that adolescents tended to report better sleep quality in less-demanding schools.

CONCLUSION

These findings highlight the need to consider social factors in promoting better sleep in adolescence.

Self-reported psychological problems amongst undergraduate dental students: A pilot study in seven European countries

AIM

To map psychological problems amongst undergraduate dental students with a focus on different time points in clinical work in seven Eastern European and Scandinavian countries.

MATERIALS AND METHODS

A total of 1063 3rd- and 5th-year dental students (response rate 70%) participated in this pilot study and completed a pre-tested, structured questionnaire, which collected information on sociodemographic characteristics and self-reported psychological problems. Data were analysed by bivariate and multivariate methods.

RESULTS

The majority of participants were female and were younger than male participants. Most participants, though more females than males, agreed that the clinical work of dentistry was psychologically difficult. Almost half of participants felt nervous before working with patients (N = 506, 48%) and experienced a lot of stress whilst working with patients (N = 488, 46%); almost one-third (N = 287, 27%) felt anxious/worried after working with patients. Being a 3rd- and 4th-year student (vs 5th-year) reduced the odds for anxiety after working with patients; being a 3rd-year student (vs 5th-year) increased the odds for stress whilst working with patients. Studying in countries other than Norway reduced the odds for stress whilst working with patients. Less than good self-perceived health, presence of psychological health complaints before starting dental education, female gender and lack of physical activity increased the odds for psychological problems.

CONCLUSION

A high number of undergraduate dental students reported psychological problems in connection with clinical work. It is unlikely that "one size fits all"; therefore, further qualitative investigations on stressors in clinical learning environments should be done in order to design tailor-made supportive strategies.

Physical exercise, mental health problems, and suicide attempts in university students

BACKGROUND

Physical inactivity and mental health problems are both major public health concerns worldwide. Although several studies have demonstrated the health benefits of regular physical exercise, few epidemiological studies have investigated the nature of the association between different aspects of physical exercise and mental health, and little is known regarding the possible link to suicidality.

STUDY AIM

To examine the association between frequency, intensity, and duration of physical exercise and mental health problems, and to explore whether low levels of physical activity is related to self-harm and suicide attempts among college and university students.

METHODS

We employed data from the SHoT2018-study, a national health survey for higher education in Norway, in which 50,054 students aged 18-35 years participated. Physical exercise was assessed with three questions (frequency, intensity, and duration). Mental health problems were assessed with both a screening tool assessing psychological distress (Hopkins Symptom Checklist-25; HSCL-25) and self-reported depressive disorder (using a pre-defined list of conditions). Suicide attempts and self-harm were assessed with two items from the Adult Psychiatric Morbidity Survey.

RESULTS

Physical exercise was negatively associated with all measures of mental health problems and suicidality in a dose-response manner. The strongest effect-sizes were observed for frequency of physical exercise. Women with low levels of physical activity had a near three-fold increased odds of both scoring high on the HSCL-25, and self-reported depression, compared to women exercising almost every day. Even stronger effect-sizes were observed for men (ORs ranging from 3.5 to 4.8). Also, physical exercise duration and intensity were significantly associated with mental health problems, but with generally smaller ORs. Similarly, graded associations were also observed when examining the link to self-harm and suicide attempts (ORs ranging from 1.9 to 2.5).

CONCLUSION

Given the demonstrated dose-response association between inactivity and both poor mental health, self-harm, and suicidal attempt, there is a need to facilitate college students to become more physically active. This is a shared responsibility that resides both on a political level and on the post-secondary institutions. The cross-sectional nature of the study means that one should be careful to draw firm conclusion about the direction of causality.

Effects of Job Stressors, Stress Response, and Sleep Disturbance on Presenteeism in Office Workers

BACKGROUND

Occupational mental health, work environment, sleep health, presenteeism, and loss of work productivity caused by health problems are all public health concerns. Although sleep affects mental health and presenteeism, the associations between sleep disturbance, job stressors, stress responses, and presenteeism have remained unclear. We hypothesized that job stressors affect the presenteeism of office workers through sleep disturbance and analyzed the association among these factors.

SUBJECTS AND METHODS

In 2017, a cross-sectional survey of adult office workers was performed. A total of 2899 subjects who provided written consent were included in the analysis. The survey collected demographic information, as well as the Work Limitation Questionnaire (WLQ), Pittsburgh Sleep Quality Index (PSQI), and Brief Job Stress Questionnaire (BJSQ). Associations between each of the variables were analyzed by path analysis (covariance structure analysis). This study was approved by the Ethics Committee of Tokyo Medical University.

RESULTS

The path analysis demonstrated that job stressors, psychological and physical stress response (PPSR) in the BJSQ, and sleep disturbance in the PSQI had direct effects on presenteeism in the WLQ. Both job stressors and social support in the BJSQ indirectly affected presenteeism through effects on sleep disturbance and PPSR. Sleep disturbance indirectly affected presenteeism via PPSR. This model accounted for the variation of presenteeism (R ² = 0.322).

CONCLUSION

In the workplace, job stressors and low social support increase presenteeism through psychological and physical stress responses, as well as sleep disturbance. Evaluating and resolving work problems and sleep disturbance would hence be beneficial from the aspects of public health and socioeconomics.

Screen time and problem behaviors in children: exploring the mediating role of sleep duration

Background

Previous research examining the relationship between screen time (ST) and psychological health outcomes have primarily focused on one type of ST (i.e., television), while little research has considered other types of screens (e.g., videos, movies, social media), screen content (e.g., violent video games), or potential mediating variables. Therefore, the purpose of the present study was to assess ST types and content and their association with problem behaviors, and to determine whether these relationships were mediated by sleep duration.

Methods

Parents and children provided cross-sectional baseline data (2016–18) as part of the Adolescent Brain Cognitive Development study, a broadly US representative sample of 11,875 children aged 9 to 10 years. Parents self-reported their children’s emotional and behavioral syndromes via the Child Behavior Checklist and sleep duration using one item from the Parent Sleep Disturbance Scale. Children self-reported their ST behavior, which comprised ST types (television/movies, videos, video games, and social media) and content (mature-rated video games and R-rated movies).

Results

Time spent in various ST types was positively associated with problem behaviors: watching television/movies was associated with a 5.9% increase in rule-breaking behavior (incidence rate ratio [IRR] = 1.059), 5% increase in social problems (IRR = 1.050), 4% increase in aggressive behavior (IRR = 1.040), and 3.7% increase in thought problems (IRR = 1.037). Greater time spent playing mature-rated video games was associated with greater somatic complaints (IRR = 1.041), aggressive behavior (IRR = 1.039), and reduced sleep duration (IRR = .938). Sleep duration mediated the relationship between ST (type and content) and problem behaviors, albeit the effect sizes were small. The largest effects were observed between sleep duration and all problem behaviors, with greater sleep duration predicting an 8.8–16.6% decrease in problem behaviors (IRRs ranging from .834 to .905).

Conclusion

Greater time spent in ST behavior was associated with greater problem behaviors among children. There was strong evidence that longer sleep duration was associated with reduced problem behaviors. While sleep duration mediated the effects of ST on problem behaviors, other potential mediating variables need to be investigated in future research.