The influence of sedentary behaviour on mental health among children and adolescents: A systematic review and meta-analysis of longitudinal studies

Association of sedentary time with school bullying among adolescents in 74 countries: A population-based study

BACKGROUND

Numerous studies have demonstrated the association between sedentary behavior and bullying among adolescents. However, few have explored the "dose-response" relationship between the frequency of sedentary behavior and school bullying. We aimed to evaluate the "dose-response" relationship between leisure sedentary time and school bullying among adolescents.

METHODS

We used data from the most recent Global School-based Student Health Survey (GSHS), conducted between 2009 and 2019 from 74 countries. Multivariable logistic regression analysis was employed to investigate the association between leisure sedentary time and school bullying.

RESULTS

A total of 222,172 adolescents aged 12-17 years from 74 countries were included. Overall, 29.8 % of adolescents reported having sedentary time ≥ 3 h/d, and 14.9 % reported experiencing school bullying. Compared with sedentary time < 1 h/d, increased sedentary time (except for 1-2 h/d: OR = 1.02, 95 % CI = 0.83-1.24) were associated with school bullying (3-4 h/d: OR = 1.16, 95 % CI = 1.01-1.34; ≥5 h/d: OR = 1.40, 95 % CI = 1.23-1.58).

LIMITATIONS

The data assessing school bullying and sedentary time were derived from self-reported survey questionnaires, potentially introducing recall bias.

CONCLUSIONS

School bullying is still widespread globally, and is associated with an extended period of leisure sedentary time. Efforts to reduce sedentary behavior among adolescents may potentially make a substantial impact on reducing the incidence of school bullying.

The predictive role of sedentary behavior and physical activity on adolescent depressive symptoms: A machine learning approach

OBJECTIVE

This study aims to investigate the predictive value of sedentary behavior and physical activity in adolescent depressive symptoms.

METHODS

A total of 2419 adolescent students (grades 7-12) from six administrative regions in China were surveyed. Measures included the Physical Activity Rating Scale for Children (PARS-3), a self-designed questionnaire assessing sedentary behavior among Chinese children and adolescents, and the Children's Depression Inventory (CDI). Machine learning models were trained and tested to predict depressive symptoms based on different types of sedentary behavior, physical activity, and other key variables.

RESULTS

The trained random forest model demonstrated high predictive accuracy (ACC = 90.52 %), with a precision of 92.01 %, recall of 87.95 %, and an F1 score of 0.90. Key predictors of depressive symptoms included sedentary behaviors such as multimedia learning, watching TV, classroom learning, and playing video games. Physical activity also emerged as a significant factor in predicting adolescent depressive symptoms.

CONCLUSIONS

The machine learning-based predictive model exhibited strong performance, suggesting that sedentary behavior and physical activity data can effectively predict depression symptoms in Chinese adolescents.

Transactional Associations Between Physical Activity and Depressive and Anxious Symptoms in Adolescent Girls and Boys: Considering Screen Time and Sleep Duration

The nature of the associations between physical activity and depressive and anxious symptoms, as well as the differences between adolescent girls and boys, remain poorly understood. The benefits of physical activity may depend on other lifestyle habits, including screen time and sleep duration, but the mechanisms underlying these associations have not often been explored. Thus, the present study aimed to examine (1) the bidirectional associations between physical activity and depressive and anxious symptoms during adolescence while controlling for screen time and sleep, (2) whether these associations are mediated by screen time and sleep, and (3) sex differences. The variables used were mostly self-reported by participants of the Québec Longitudinal Study of Child Development at ages 13, 15 and 17 (N = 1556). Random intercept crosslagg panel models and multigroup analyses were conducted. A high level of physical activity significantly but weakly predicted a low level of depressive symptoms from 15 to 17 in girls and boys. Physical activity was also associated with less screen time in girls aged 13 to 15, and in everyone aged 15 to 17. No associations between physical activity and anxious symptoms were found significant. The sample is more representative of White Quebec adolescents from a higher socioeconomic status, from 2011 to 2015. In conclusion, among all life habits, promotion of physical activity should be a part of prevention efforts for depression in youth, especially among older adolescents. Physical activity could also be promoted to reduce screen time in adolescents, and earlier for girls.

Symptoms of Depression, Physical Activity, and Sedentary Time: Within-Person Relations From Age 6 to 18 in a Birth Cohort

OBJECTIVE

To examine the within-person relations between objectively measured physical activity and clinically assessed symptoms of depressive disorders from childhood to late adolescence.

METHOD

Seven waves of biennially collected data from a Norwegian birth-cohort (n = 873; 53% girls) followed from age 6 to 18 years were used. Accelerometers were used to assess total physical activity, moderate-to vigorous physical activity, and sedentary time, and symptoms of depression were assessed by semi-structured psychiatric interviews. Mediators (athletic self-esteem, body image, sports participation) were captured by questionnaires. Random intercept cross-lagged panel models were estimated to test the within-person relations and their potential mediators.

RESULTS

From ages 14 to 16 and 16 to 18 years, significant within-person relations were found. Decreased levels of total physical activity (PA) and moderate-to-vigorous physical activity (MVPA) predicted more symptoms of depression (PA: 14-16 years: β = -0.08; 16-18 years: β = -0.09; MVPA: 14-16 years: β = -0.10; 16-18 years: β = -0.07). These relations were not evident at earlier ages. From ages 10 to 12 and 14 to 16 years, an increased number of depressive symptoms predicted decreased levels of physical activity (PA: 10-12 years: β = -0.10; 14-16 years: β = -0.14: MVPA: 10-12 years: β = -0.10; 14-16 years: β = -0.17). We found no evidence for within-person relations between sedentary time and depressive symptoms, and no significant sex differences or mediations.

CONCLUSION

Individuals who increase their physical activity levels from middle to late adolescence are less likely to develop symptoms of depression compared to what they otherwise would. Thus, in this age period, physical activity may protect against depressive symptoms.

Adherence to 24-hour movement guidelines and associations with mental well-being: a population-based study with adolescents in Canada

BACKGROUND

Insufficient physical activity, excessive recreational screen time, and inadequate sleep pose health risks in school-aged children and adolescents. The Canadian 24-Hour Movement Guidelines for Children and Youth advocate for balanced daily movement behaviours. This population-level study in British Columbia (BC), Canada, examined the proportion of young adolescents following these guidelines and how adherence correlated with their mental well-being.

METHODS

Using cross-sectional self-report data from 26,974 grades 6-8 children (48% girls, mean age = 13.31) who had completed the Middle Years Development Instrument (MDI) in BC in 2023, we calculated the percentages of children meeting physical activity (at least 1 h daily), sleep (9 + hours for 5- to 13-year-olds, 8 + for > 13-year-olds), and screen time (no more than 2 h daily) recommendations. Eight groupings were created, indicating how many and which movement behaviour guidelines were met: none, sleep only, physical activity only, screen time only, physical activity and sleep, physical activity and screen time, sleep and screen time, and all three behaviours. Mean differences in depressive symptoms, optimism, and satisfaction with life scores across categories were estimated through sex-stratified linear mixed models, adjusting for covariates.

RESULTS

Four percent of adolescents met all recommendations, while 15% met none. Meeting some or all recommendations was associated with higher levels of optimism and satisfaction with life, and lower levels of depressive symptoms compared to meeting none. Beneficial effects were overall larger for girls, and largest for depressive symptoms among girls meeting all recommendations versus none (-1.05, 95% CI [-1.14, -0.96]).

CONCLUSIONS

Adherence to the Canadian 24-Hour Movement Guidelines was associated with higher levels of well-being, but most grades 6-8 adolescents in our study did not meet the recommendations. Given sex differences in meeting the movement behaviour recommendations, public health strategies need to consider targeted interventions aimed at improving adherence to these guidelines, particularly focusing on reducing recreational screen time and increasing physical activity.

High-level personal trainer perspective for industry practice and development in Serbia: a qualitative descriptive study

Personal trainers (PTs) play a pivotal role in promoting positive gym experiences, implementing effective weight loss strategies, and influencing healthier lifestyle choices. In Serbia, however, the absence of national accrediting bodies for standardised qualifications has led to a lack of formal recognition of exercise professionals. The views of personal training clients regarding their training practices and experiences have been explored previously. Building on this, the current study investigated the perspectives of high-level Serbian PTs, examining their professional developmental journeys, educational background, coaching philosophies, professional needs and experiences. The aim was to provide insights for educational institutions and other practitioners to adopt successful approaches that inspire lifelong exercise and promote positive lifestyle changes for increasingly sedentary populations. Using a snowball sampling method, we interviewed 12 high-level PTs, selected for their exceptional practice as recognised by their peers. The findings suggest a need for a shift from traditional, physical performance-focused approaches toward a more holistic model that incorporates psychosocial support and a care for the whole person, fostering an appreciation for the concept of physical literacy. Additionally, the study identifies critical gaps in PTs education and training, particularly concerning the lack of focus on behavior change models and inquiry-based skills essential for their future self-directed learning. These areas were highlighted as vital for continued professional development after formal qualifications are obtained. In conclusion, this research underlines the need for holistic training approaches to improve clients' physical and health outcomes. The study offers guidance to shape industry standards, foster accreditation systems, and start the debate on how best to continually support PTs during their careers. Such action is essential if the evolving personal training profession in Serbia is to be equipped with the tools needed to promote long-term client engagement and achieve the health benefits for the wider Serbian population.

Is leisure sedentary time associated with mental health issues? Evidence from China Health and Nutrition Survey

Background

The relationship between leisure sedentary behaviors and mental health remains inconclusive. This study aims to provide evidence on leisure sedentary behaviors on mental health using longitudinal data, along with its moderating and mediating roles.

Methods

We utilized data from four waves (2006-2015) of the China Health and Nutrition Survey (CHNS), focusing on adults who completed their education, with a total sample of 23,693 observations. Leisure sedentary time, the independent variable, was measured based on self-reported data, while mental health issues were the dependent variables based on the Simplified Symptom Self-Rating Scale (SCL) and the Perceived Stress Scale (PSS-14). The primary analysis employed ordinary least squares (OLS) regression. Potential endogeneity was addressed by instrumental variable (IV) method via two-stage least squares (2SLS) regression and a continuous difference-in-differences (DID) design.

Results

Our findings indicate that high levels of sedentary time are associated adversely with mental health issues. Moderating roles show that improving health literacy and reducing sedentary time were effective in alleviating this adverse impact. Among older adults, social engagement and support from female caregivers showed greater potential to reduce the detrimental mental health impact of leisure sedentary time. Furthermore, obesity serve as its mediating role.

Conclusion

This study highlights the potential adverse impact of increased leisure sedentary time on mental health among Chinese population. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with mental health issues.

Movement Mediates the Relationship Between Socioeconomic Position and Socioemotional Outcomes in Youth

BACKGROUND

Youth from lower socioeconomic positions tend to have poorer socioemotional outcomes, be less physically active, have poorer sleep, and engage in more screen time than their peers from higher socioeconomic positions. The objective of this study was to test the hypothesis that movement behaviors (ie, physical activity, sedentary behavior, and sleep) and changes in combinations of movement behaviors over time (movement trajectories) mediate the relationship between socioeconomic position and socioemotional outcomes in youth.

METHODS

This study used socioeconomic position data, scores from Strengths and Difficulties Questionnaires, and time-use diaries from 980 females and 1014 males (2% Australian Indigenous) aged 10-14 from the Longitudinal Study of Australian Children from 2014 to 2018.

RESULTS

Movement trajectories did not mediate the relationship between socioeconomic position and socioemotional outcomes. Least absolute shrinkage and selection operator-based mediation analyses found males from lower socioeconomic positions participated in less moderate- to vigorous-intensity physical activity than their peers from high socioeconomic positions, partially explaining (7%) more peer problems. Youth from lower socioeconomic positions participated in more recreational screen activities than their peers from higher socioeconomic positions, partially explaining (1%-3%) worse total socioemotional outcomes and conduct (females) and emotional problems (males).

CONCLUSIONS

Future qualitative research should be considered to identify the best ways for youth from lower socioeconomic positions to decrease screen time and increase opportunities to participate in moderate- to vigorous-intensity physical activity in the community, at school, and at home. Other mediators explaining differences in socioemotional outcomes should be explored.

Screen time and allostatic load among youth: findings from the National Health and Nutrition Examination Survey, 2015-2018

BACKGROUND

More screen time (ST) is associated with dysregulation of the individual biological systems (cardiovascular, immune, metabolic, and neuroendocrine) involved in the stress response in youth. However, its relationship with allostatic load (AL), a measure of the cumulative physiological stress response, is unclear in youth.

PURPOSE

To investigate the associations between ST types and AL outcomes in youth and to explore sociodemographic and behavioral moderators of these relationships.

METHODS

Cross-sectional data were from 1053 US youth aged 12-17 years (Mage = 14.20; 54% male; 21% Hispanic) in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). ST was assessed as watching TV/videos and computer use/playing computer games. AL was measured using 7 biomarkers across 3 systems: cardiovascular (systolic and diastolic blood pressure, heart rate), immune (C-reactive protein), and metabolic (body mass index, glycohemoglobin, and high-density lipoprotein). Weighted multivariable regression models assessed whether ST predicted AL composite and subsystem (cardiovascular, immune, and metabolic) scores. Moderation by age, sex, income, race/ethnicity, and physical activity was explored.

RESULTS

A 1-hour/day increase in watching TV/videos was associated with a 4% increase in mean AL composite score (incident rate ratio = 1.040; 95% CI = 1.008, 1.073; P = .015), while computer use/gaming showed no significant associations (P's > .05). Age moderated the TV/videos-AL cardiovascular association (P = .009), with older youth having higher AL cardiovascular scores.

CONCLUSIONS

More time spent watching TV/videos was associated with higher cumulative physiological stress in youth. Prospective studies are needed to determine causal pathways and potential intervention targets in youth.

Association of types of on-screen content with mental health problems among Chinese adolescents

Excessive screen time was associated with mental health problems, yet whether the associations differ by screen content types remain unknown. Here, we conducted a cross-sectional study of adolescents from 156 junior and high school to investigate the association of types of on-screen content with mental health problems in China. The exposure variable was screen exposure, measured by the self-reported questionnaire. Symptoms of depression and anxiety were assessed by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. Suicide-related behavior was adapted from the Centers for Disease Control's Youth Risk Behavior Surveillance. Generalized linear models and network analysis were performed. Of the 15,194 adolescents included in the final analysis, 8,019 were males and mean (SD) age was 14.50 (1.68) years. 34.6% of adolescents had an average screen time of ≥ 4 h/day on weekends. The most frequently used screen contents (≥ 4 h/d) were electronic games (9.1%), followed by short video (6.6%). Learning online had strong associations with depression (OR = 2.03, 95%CI: 1.29-3.11, P = 0.002) and anxiety (OR = 2.05, 95%CI: 1.24-3.27, P = 0.004) symptoms. The associations between on-screen content and mental health varied. The strongest edges linked to screen content types were edge between "Electronic games" and "Anhedonia" in the network model. "Control worry" was the most central nodes, followed by "Irritable" and "Worry A Lot". Findings suggested that both screen time and different types of screen content were associated with mental health problems among adolescents. Limiting screen exposure and developing effective interventions to improve mental health should be a priority.

Development of the psychopathological vulnerability index for screening at-risk youths: a Rasch model approach

Accumulating research on mental health emphasizes the general factor of psychopathology (p-factor) that unites various mental health issues. This study develops a psychopathological vulnerability assessment for youths, evaluating its psychometric properties and clinical utility. An umbrella review conceptualized multifactor psychopathological vulnerability, leading to a 57-item pool. A total of 11,224 individuals participated in this study. The resulting 22-item psychopathological vulnerability index (PVI) fitted the unidimensional Rasch model, demonstrating a person separation reliability of 0.78 and a Cronbach's alpha of 0.84. Cut-off points of 11 and 5, derived from latent class analysis, were used to distinguish vulnerable and high-protection populations. The PVI's concurrent and predictive hit rates ranged from 36.00% to 53.57% in clinical samples. The PVI concretized the vulnerability-stress model for identifying at-risk youths and may facilitate universal interventions by integrating the theoretical foundations of bifactor S-1 models with key symptoms from network models for theoretically grounded approaches.

Screen time trajectories and psychosocial well-being among Chinese adolescents: a longitudinal study

BACKGROUND

While the association between screen time (ST) and psychosocial well-being has been extensively examined, limited studies have investigated the dynamic patterns of ST, and their impact on subsequent psychosocial well-being among adolescents. Therefore, this longitudinal study aimed to examine the association between ST trajectories and the subsequent psychosocial well-being among Chinese adolescents.

METHODS

Data were drawn from the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research (Registration No. ChiCTR1900022032). The final analysis included 1480 participants who completed baseline and two follow-up surveys. Standardized measures were employed to assess ST and multiple psychosocial well-being, including depressive symptoms, anxiety, externalizing problems, and coping style. Group-based trajectory modeling and generalized linear mixed models were performed.

RESULTS

Over the two-year follow-up period, two distinct ST trajectories emerged: continued high (298 [20.1%]) and continued low (1182 [79.9%]). Compared with those in the continued low ST group, adolescents in the continued high group exhibited a higher likelihood of presenting depressive symptoms (β = 0.97, 95% CI = 0.43 ~ 1.50), anxiety symptoms (β = 0.29, 95% CI = 0.05 ~ 0.53), and emotional problems (β = 0.35, 95% CI = 0.22 ~ 0.48), and were less likely to demonstrate prosocial behavior or employ positive coping style. The stratified analysis demonstrated that the aforementioned associations only existed among female adolescents.

CONCLUSIONS

Persistent high exposure to ST was associated with an increased odds of emotional problems and a decreased probability of engaging in prosocial behavior and positive coping style, with particularly noteworthy effects observed among female adolescents. These findings underscore the importance of reducing ST exposure to improve the psychological well-being of adolescents.

Evaluating the impact of rock climbing on mental health and emotional well-being in adolescents

Background

Rock climbing (RC) has gained attention as a therapeutic tool in psychiatric settings that merges physical exertion with mental engagement. It has potential to enhance mental health, through improved self-efficacy and social interaction, making it a novel intervention for addressing anxiety, depression, and behavioral issues in adolescents. This study aimed to investigate the effects of RC as a physical activity on anxiety, depression, and emotional and behavioral problems in adolescents.

Methods

The current study included 57 athletes aged 14.5 ± 1.7 years and 91 adolescents aged 13.6 ± 1.2 years, matched for age and gender, who were not professionally involved in sport. In addition to the socio-demographic form, a detailed psychiatric assessment was carried out by the child psychiatrist; using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL) to detect psychiatric conditions. The Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) and the Strengths and Difficulties Questionnaire (SDQ) were also administered to the adolescents in the study.

Results

In the comparative analysis of the RCADS-CV outcomes between the athlete and control groups, the athletes demonstrated notably lower scores for both Separation Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD), yielding p-values of < 0.001 and 0.031, respectively. Although the mean scores for social phobia, OCD, panic disorder, and MDD were lower in the athlete group, the differences were not statistically significant (p > 0.05). In the correlation analysis, a moderately significant correlation was found between the duration of doing sport and the scale scores for SAD (p:0.010), OCD (p:0.014), and panic disorder (p:0.016). There was no significant difference between groups in terms of SDQ scores.

Conclusion

These results suggest that RC, through its unique combination of physical exertion and mental focus, may offer protective benefits against certain anxiety disorders among adolescents. Further studies should be conducted to explore the potential use of RC as a preventive program for both healthy adolescents, as well as those with psychiatric disorder.

A Scoping Review of Acute Sedentary Behaviour Studies of People with Spinal Cord Injury

People with a spinal cord injury (SCI) report less physical activity than other populations and may engage in more sedentary behaviour (SB), especially sitting time. SB negatively impacts physiological and psychosocial outcomes in the general population, yet minimal research has explored the effects in people with SCI. The goal of this scoping review was to catalogue and describe the effects of acute SB among people with SCI. We searched four databases before February 2024 for studies in which people with any SCI sat, laid, or reclined for more than one hour in a day, and any physiological, psychological, or behavioural (i.e., SB time) outcome was measured. In total, 2021 abstracts were screened, and eight studies were included (n = 172 participants). The studies were characterized by varied definitions, manipulations, and measures of SB. Most measured outcomes were physiological (e.g., metabolic, blood pressure), followed by behavioural (e.g., SB time) and psychological (e.g., well-being, affect). When SB was interrupted, only postprandial glucose and affect improved. Based on two studies, participants engaged in 1.6 to 12.2 h of SB per day. Average uninterrupted wheelchair sitting bouts lasted 2.3 h. Based on the very limited body of research, it is impossible to draw any conclusions regarding the nature, extent, or impact of SB in people with SCI. There is much work to carry out to define SB, test its effects, and determine if and how people with SCI should reduce and interrupt SB.

Can the sports apps using play an intervening role in the process of college students' exercise motivation affecting mental health by exercise adherence?

The continuous increase in college students' use of the Internet and their mental health problems caused by a sedentary lifestyle, lack of exercise, and obesity have gradually attracted researchers' attention. There is still more work to be done to understand "how" and "under what circumstances" exercise motivation effects mental health, despite the fact that many of these studies have demonstrated that it has a significant impact on it. Four hundred forty-three college students in China were selected to participate in this study in order to explore the impact of exercise motivation on mental health. The mediating role of exercise adherence and the moderating role of sports apps using in this relationship. The results show that exercise motivation has a significant positive impact on college students' mental health; exercise adherence partially mediates the relationship between exercise motivation and mental health; and the relationship between exercise motivation and exercise adherence is moderated by sports apps using. Specifically, the relationship between exercise motivation and exercise adherence is stronger for college students with high sports apps using. This study is based on the Internet using to promote physical exercise to college students, thereby alleviating their psychological problems caused by a sedentary lifestyle, lack of exercise, and obesity in the Internet era. New ideas are also provided for intervention in college students' mental health.

Instrumented measures of sedentary behavior and physical activity are associated with depression among children and adolescents: a systematic review and dose-response meta-analysis of observational studies

Background

Higher sedentary behavior (SB) and lower physical activity (PA) are associated with negative physical and mental health outcomes. SB and PA can be objectively assessed using inertial sensors to evaluate body movements. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and depression among children and adolescents using a systematic review and meta-analysis of observational studies.

Methods

An electronic search was conducted on six databases up to May 12, 2024. A dose-response meta-analysis was conducted to determine the association between i-SB and i-PA and depression, expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Five cross-sectional and 11 longitudinal studies comprising 26,109 participants met the inclusion criteria. Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled ORs of 1.05 (95% CI 0.94-1.16). Comparing the least active with the most active groups of participants resulted in pooled ORs of 0.93 (95% CI 0.84-1.07), 0.89 (95% CI 0.79-1.00), 0.83 (95% CI 0.66-0.99), and 0.73 (95% CI 0.58-0.89) for light, moderate-to-vigorous (MV), vigorous, and total PA, respectively. Robust error meta-regression analyses showed clear dose-response relationships between i-SB and i-MVPA and depression.

Conclusion

Both i-SB and i-PA were significantly associated with risk of depression in children and adolescents, which may become non-significant after mutual adjustment for i-PA and i-SB.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=546666], identifier [CRD42024546666].

Preliminary Effectiveness of a One-Week Summer Day Camp for Improving Children's Health Behaviors and Psychosocial Well-Being Outcomes

PURPOSE

Summer day camp offers children opportunities to grow knowledge and skills, be physically active, and have fun. Compared to healthy children, at-risk children (i.e., overweight, or with obesity and chronic health conditions) typically display less optimal health behaviors and psychosocial well-being, especially during summer months. This study examined the preliminary effectiveness of an American-Diabetes-Association-sponsored summer day camp at improving children's health behaviors (i.e., physical activity, screen time, diet, sleep) and psychosocial well-being outcomes (i.e., quality of life [QoL], enjoyment, weight-related self-efficacy).

METHOD

The sample consisted of 39 participants, including 19 boys and 20 girls, with majority being overweight (n = 4 or 10%) or with obesity (n = 26 or 67%), who attended the day camp for one week.

RESULTS

Significant improvements were observed in screen time, quality of life, and physical function. The results further showed significant time by gender interaction effect for overall QoL (p < 0.05, ηp2 = 0.15), physical health (a dimension of QoL; p < 0.05, ηp2 = 0.18), and significant time by household income for the psychosocial health (another dimension of QoL), favoring boys and those from higher income families.

DISCUSSION

The findings indicate a positive preliminary effectiveness of the summer camp at reducing children's screen time and improving their QoL, especially in boys and those from higher-income families. Future research should focus on health disparities and expansion of this camp for the potential of longer-term and more robust effects related to wellness, nutrition literacy, physical activity promotion, and obesity prevention.

Exploring the longitudinal impacts of academic stress and lifestyle factors among Chinese students

Background

Several cross-sectional and longitudinal investigations have demonstrated a robust association between academic stress, physical activity, mental health history, and time management skills. However, the existing literature exhibits inconsistencies in the relationship between academic stress and its predictive effects on physical activity and mental health history. In addition, there is a scarcity of scholarly research that concentrates on the significance of time management skills within this particular context. Furthermore, limited research has investigated these variables' longitudinal associations and causal pathways. Therefore, the present research explores the longitudinal relationships among academic stress, physical activity, mental health history, and time management skills among university students.

Methods

The data were gathered from Wuhan University, China, employing a two-wave longitudinal survey methodology with an annual interval. A cohort of 980 university-level students engaged in the completion of questionnaires, which encompassed measures of academic stress via the Educational Stress Scale for Adolescents (ESSA), physical activity ascertained through Cho's five-item questionnaire, mental health history assessed by the Kessler Psychological Distress Scale, and time management skills evaluated using the Time Management Behaviour Scale (TMBS). Subsequently, a cross-lagged path model was utilised to examine the prospective associations among these constructs.

Results

The outcomes of the cross-lagged path analysis indicated the presence of significant bidirectional relationships between academic stress and physical activity, mental health history, and time management skills. In addition, bidirectional interconnections existed between physical activity and mental health history. Furthermore, unilateral correlations were detected between physical activity and time management skills.

Conclusions

These findings underscore the importance of an integrated approach to student health initiatives and highlight the need for comprehensive support systems that address student well-being's psychological and physical aspects.

The impact of the world's first regulatory, multi-setting intervention on sedentary behaviour among children and adolescents (ENERGISE): a natural experiment evaluation

BACKGROUND

Regulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world's first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils.

METHODS

With a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal (n = 7,054, matched individuals, primary analysis) and repeated cross-sectional (n = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status.

RESULTS

Longitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings.

CONCLUSIONS

This regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere.

Substitutions of physical activity and sedentary behavior with negative emotions and sex difference among college students

BACKGROUND

A growing number of studies have found that physical activity (PA) benefits mental health, and sedentary behavior (SB) increases the risk of psychological symptoms, but it remains unclear whether substituting the duration of different activities may affect the association, and whether sex difference exists among college students.

METHODS

A longitudinal survey was conducted in three colleges in Anhui province, China. A total of 8049 participants validly answered the questionnaire, which included demographic variables, PA, SB and negative emotions (depressive, anxiety, and stress symptoms).

RESULTS

Substituting 30 min per day of SB with equivalent walking was associated with lower scores of depressive symptoms. Stress symptoms were reduced when SB was substituted by moderate intensity PA (MPA) and walking. Substituting 30 min per day of MPA in place of walking and SB was associated with an amelioration of depressive and stress symptoms in females, and a reallocation of 30 min walking was associated with lower depressive and stress symptom scores when SB was replaced in males.

CONCLUSIONS

Replacing SB with walking and MPA ameliorates the depressive and stress symptoms in young adults. The results suggest a reallocation of time from SB or walking to MPA in females while from SB to walking in males may markedly reduce the depressive and stress symptoms in college population.

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.

Path of Physical Exercise's Impact on Deviant Behavior Among Chinese Adolescents

Purpose

Physical exercise is an important predictor of deviant behavior in adolescents; however, the paths and mechanisms underlying this relationship remain understudied.

Patients and Methods

This cross-sectional study used education tracking data of 8725 Chinese adolescents (4453 males, 4240 females, average age 14 ± 0.73) to construct a chain mediation model to explore whether sleep quality and mental health mediated the relationship between physical exercise and adolescent deviant behavior.

Results

The results show that physical exercise cannot directly predict adolescent deviant behavior; however, it can indirectly affect deviant behavior through the mediating effect of sleep quality and mental health as well as the chain mediating benefit of "sleep quality-mental health".

Conclusion

Sleep quality and mental health are important internal factors of physical exercise that inhibit deviant adolescent behavior. The lack of physical activity and poor sleep quality should be prioritized in interventions regarding deviant behavior among Chinese adolescents.

Associations between 24-h movement behaviors and indicators of mental health and well-being across the lifespan: a systematic review

Researchers have adopted a variety of analytical techniques to examine the collective influence of 24-h movement behaviors (i.e., physical activity, sedentary behaviors, sleep) on mental health, but efforts to synthesize this growing body of literature have been limited to studies of children and youth. This systematic review investigated how combinations of 24-h movement behaviors relate to indicators of mental ill-being and well-being across the lifespan. A systematic search of MEDLINE, PsycINFO, Embase, and SPORTDiscus was conducted. Studies were included if they reported all three movement behaviors; an indicator of mental ill-being or well-being; and were published in English after January 2009. Samples of both clinical and non-clinical populations were included. A total of 73 studies (n = 58 cross-sectional; n = 15 longitudinal) met our inclusion criteria, of which 47 investigated children/youth and 26 investigated adults. Seven analytical approaches were used: guideline adherence (total and specific combinations), movement compositions, isotemporal substitution, profile/cluster analyses, the Goldilocks method and rest-activity rhythmicity. More associations were reported for indicators of mental ill-being (n = 127 for children/youth; n = 53 for adults) than well-being (n = 54 for children/youth; n = 26 for adults). Across the lifespan, favorable benefits were most consistently observed for indicators of mental well-being and ill-being when all three components of the 24-h movement guidelines were met. Movement compositions were more often associated with indicators of mental health for children and youth than adults. Beneficial associations were consistently observed for indicators of mental health when sedentary behavior was replaced with sleep or physical activity. Other analytic approaches indicated that engaging in healthier and more consistent patterns of movement behaviors (emphasizing adequate sleep, maximizing physical activity, minimizing sedentary behaviors) were associated with better mental health. Favorable associations were reported less often in longitudinal studies. Collectively, these findings provide further support for adopting an integrative whole day approach to promote mental well-being and prevent and manage mental ill-being over the status quo of focusing on these behaviors in isolation. This literature, however, is still emerging-for adults in particular-and more longitudinal work is required to make stronger inferences.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Associations between healthy lifestyle behavioral patterns and mental health problems: A latent class analysis of 161,744 Chinese young adults

BACKGROUND

Youth mental health problems are a public health priority. Multiple healthy lifestyle behaviors may cluster into healthy lifestyle behavioral patterns (HLBPs) that increase mental health risks in adolescents and older adults, but little is known regarding young adults. This study aimed to explore the associations between cluster HLBPs and mental health problems in young adults.

METHODS

We selected 161,744 young adults aged 20-39 as participants from the database of a Chinese general hospital health management center for the years 2015-2020. The latent class analysis was used to identify HLBPs.

RESULTS

A total of 15.0 % of young adults have at least one mental health problem. Five clusters of HLBPs were identified, characterized as low-risk class (1.6 %), moderate-risk class 1 (12.0 %), moderate-risk class 2 (2.1 %), moderate-risk class 3 (56.8 %), and high-risk class (27.4 %). The odds ratios (ORs) for young adults with two mental health problems increased with the risk grade of HLBPs, while the ORs for young adults with one or three mental health problems ranged from high to low according to the risk grade of HLBPs: high-risk class, moderate-risk class 2, moderate-risk class 3, moderate-risk class 1.

LIMITATIONS

Cross-sectional design and no causal conclusions could be drawn.

CONCLUSION

Young adults demonstrated a cluster phenomenon of healthy lifestyle behaviors and significant associations between HLBPs and mental health problems. Young adults with a higher risk grade for HLBPs were more likely to have mental health problems. Different HLBPs should be taken into account when implementing mental health interventions.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Linking sedentary behavior and mental distress in higher education: a cross-sectional study

Background

Sedentary behavior among university students could negatively affect their mental health.

Objective

The aim of this study was to examine the relationship of mental health (anxiety and depression) and sedentary behavior between gender in Health Degrees at the University of Zaragoza.

Design

Cross-sectional descriptive study.

Participants

Sample of 257 University students who completed an online questionnaire.

Methods

Sedentary behavior was assessed with the SBQ questionnaire. Anxiety and depression were assessed with the GADS questionnaire. The Mann-Whitney U test and multiple linear regression models were used.

Results

In comparison to men, female students with symptoms of anxiety spend more time in total engaged in sedentary behaviors (10.56 ± 4.83) vs. (7.8 ± 3.28; p < 0.001) and mentally-passive sedentary activities [2.24 (1.57) vs. 1.15 (0.90; p < 0.005)]. Female students at risk of depression also spend more hours engaged in mentally-passive sedentary behaviors in comparison to men (8.28 ± 50.70 vs. 1.27 ± 1.02; p = 0.009).

Conclusion

Female students at risk of anxiety and/or depression spend more time engaged in sedentary activities in comparison to male students. The risk of anxiety and depression is associated with the total number of hours a day spent engaged in sedentary behaviors and with mentally passive behaviors, but not mentally active behaviors.

Longitudinal associations between different types of screen use and depression and anxiety symptoms in adolescents

Background

Evidence examining the longitudinal associations between different types of screen behaviours and mental health among adolescents is limited. The present study examined the association between five types of screen behaviours and symptoms of anxiety and depression one year later. This study also assessed how changes in screen time were associated with changes in anxiety and depressive symptoms and whether the observed relationships were moderated by sex.

Methods

Longitudinal data of 17,174 students in grades 9-12 (53.5% females; mean age: 15.1 ± 0.9 years) attending high schools in Canada from two waves (year 6: 2017/18, year 7: 2018/19) of the COMPASS study were analyzed. Leisure screen time and mental health measures were self-reported. To test if the associations between screen time and anxiety, and depression vary by sex, two-way interactions were examined for sex. Analyses accounted for school clustering, race/ethnicity, sex, age, income, body mass index z-score, and previous year anxiety and depression symptoms.

Results

There were significant longitudinal associations between time spent on each type of screen and subsequent anxiety and depression symptoms. The strength of the associations varied by type of screen behaviour. Interaction analysis indicated a sex difference for television viewing and anxiety and depression symptoms, and internet surfing and anxiety symptoms. A dose-response relationship was observed between phone talking and anxiety symptoms. Beta estimates indicated that an increase in screen duration was associated with a further increase in anxiety and depression symptoms.

Conclusion

Higher screen time was longitudinally associated with higher anxiety and depression symptoms at one-year follow-up in adolescents. Time-change associations between screen usage and depressive and anxiety symptoms were observed. Also, associations differed based on sex and screen type, whereby greater increases in screen use predicted greater emotional distress. Findings from this prospective analysis suggest that screen time is an important determinant of anxiety and depressive symptoms among adolescents. Future studies are recommended to help inform programs promoting screen time reduction with a goal to enhance adolescents' mental health.

Multiple health risk behaviors, including high consumption of ultra-processed foods and their implications for mental health during the COVID-19 pandemic

Background and aim

The growing increase in diet- and behavior-related illnesses has drawn the attention of many epidemiologists who attribute such changes to the epidemiological and nutritional transition. Thus, this study aims to evaluate the association between the combined occurrence of health risk behaviors, such as sedentary lifestyles, high weekly consumption of ultra-processed foods (UPFs), and non-daily consumption of fruits and vegetables, and symptoms of anxiety or depression in adults.

Methods

This is a cross-sectional study based on an epidemiological survey in two Brazilian cities. The outcome, anxiety, and depression symptoms were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Food consumption was assessed using a qualitative food frequency questionnaire (FFQ) with reference to consumption in the last 3 months and categorized into the consumption of fruits and vegetables and the consumption of UPFs according to the NOVA classification. Sedentary behavior was assessed by considering the amount of sitting or reclining time per day reported by participants and categorized as less than 9 h of sitting or reclining and 9 h or more. For the analysis, adjusted Poisson regression (PR) was used to estimate the prevalence ratio and the 95% confidence interval (CI).

Results

Those with the health risk behaviors, non-daily consumption of fruits and vegetables, and high consumption of UPFs had a 2.6 higher prevalence ratio for symptoms of mental disorder (PR: 2.6 and 95%CI: 1.1–6.5), as well as those with all three health risk behaviors, had a 2.8 higher prevalence ratio for symptoms of mental disorder (PR: 2.8 and 95%CI: 1.3–6.1).

Conclusion

This study revealed that the existence of a combination of two and three health risk behaviors led to a higher prevalence of symptoms of anxiety or depression.

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

Background:

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

Methods:

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

Results:

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

Conclusion:

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

Supplementary Information

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

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.