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

Associations among screen time, depressive symptoms and sleep in early adolescents: A sex-disaggregated cross-lagged network analysis

BACKGROUND

Prior research has established associations among screen time, depressive symptoms, and sleep. However, the nuances of these associations, particularly regarding directionality and sex-specific differences among early adolescents, remain insufficiently understood. This study aimed to investigate sex differences in the longitudinal associations among screen time, depressive symptoms, and sleep at the symptom level during early adolescence.

METHODS

Our cohort consisted of 2987 students (1451 boys at T1; Mage = 10.52 years), who were assessed twice over six-month intervals. Sex-stratified analyses in the network associations among screen time, depressive symptoms, and sleep were examined via a cross-lagged panel network modeling approach.

RESULTS

The results revealed that depressive symptoms such as "feeling unloved" for boys and "sadness" for girls were the most central symptoms with the greatest influence on other symptoms. Furthermore, depressive symptoms such as "crying" and "loneliness" for boys and "self-hatred" and "loneliness" for girls may act as bridge symptoms, significantly forecasting excessive screen time after six months.

CONCLUSIONS

Our findings bolster the compensatory internet use theory by suggesting that screen time may function as a coping mechanism for managing depressive symptoms and sleep problems. These findings advance our comprehension of the evolving dynamics among screen time, depressive symptoms, and sleep across sexes over time. The development of targeted prevention and intervention strategies that accommodate these sex differences could be instrumental in curtailing the onset or intensification of problematic screen use among early adolescents.

Adherence to 24-h movement guidelines and its associations with dietary behavior and mental health among university students from five ASEAN countries

OBJECTIVE

Despite growing evidence linking 24-h movement behaviors to health outcomes, there is limited research examining these relationships among university students in Southeast Asia. Therefore, the purpose of this study was to examine the prevalence and associations of adherence to 24-h movement guidelines (HMG) with dietary behaviour and mental health among university students in ASEAN.

METHODS

A multi-center cross-sectional survey was conducted in 2015 included 3223 university students from five ASEAN nations-Indonesia, Malaysia, Myanmar, Thailand, and Vietnam-aged 18 to 30 years, selected by stratified random sampling. Established measures included demographics, social support, perceived stress, self-rated health status, body mass index, six dietary behaviours, eight mental health outcomes, and adherence to 24-h movement guidelines (24-HMG) was assessed based on self-reported physical activity (≥ 150 min/week), sedentary time (≤ 480 min/day), screen time (≤ 180 min/day), and sleep duration (7-9 h). The relationship between dietary behaviours, mental health indicators and meeting the 24-HMG number was investigated using logistic regression models, adjusted for relevant confounders.

RESULTS

Among 3,223 participants, 11.7% met all three 24-h movement guidelines, while 13.1% met none, and 37.6% met either one or two guidelines. Adherence to all guidelines was higher among males, participants aged 22-30 years, and those from lower-income countries (Indonesia, Myanmar, and Vietnam). Multiple logistic regression analyses, adjusted for relevant confounders, revealed that meeting more movement guidelines was associated with: Increased odds of healthy dietary behaviors (fruit and vegetable intake: Adjusted Odds Ratio-AOR: 1.96, 95% Confidence intervals-CI: 1.35-2.83; breakfast intake: AOR: 2.48, 95% CI: 1.84-3.34; meal frequency: AOR: 1.83, 95% CI: 1.36-2.45; low soft drink intake: AOR: 2.20, 95% CI: 1.54-3.14; high sugared coffee or tea intake: AOR: 0.39, 95% CI: 0.24-0.61; low fast food intake: AOR: 1.46, 95% CI: 1.08-1.96; and low snacking: AOR: 2.71, 95% CI: 2.00-3.66), and Decreased odds of mental health issues (depressive symptoms: AOR: 0.43, 95% CI: 0.26-0.70; suicidal behaviour: AOR: 0.66, 95% CI: 0.47-0.93; pathological internet use: AOR: 0.60, 95% CI: 0.45-0.81; hazardous or harmful alcohol use: AOR: 0.44, 95% CI: 0.29-0.66; illicit drug use: AOR: 0.38, 95% CI: 0.20-0.73; and had poorer sleep quality: AOR: 0.33, 95% CI: 0.16-0.68). No significant associations were found between guideline adherence and PTSD symptoms or tobacco use (p > 0.05).

CONCLUSIONS

This is the first study to look at the prevalence, correlates, and relationships between 24-HMG adherence and dietary behaviour and mental health outcomes among university students in ASEAN. This pioneering study among ASEAN university students demonstrates that adherence to 24-h movement guidelines is associated with better dietary behaviours and mental health outcomes in a dose-response manner. Future university health policies should incorporate 24-h movement guidelines into existing health promotion strategies, particularly in resource-limited settings.

Socioeconomic differences in adolescent health behaviors and their effect on inequalities in adult depressed mood: findings from a 27-year longitudinal study

BACKGROUND

Health behaviors have been posited to partly explain the association between socioeconomic status (SES) and health (i.e., the behavioral explanation of health inequalities), yet few studies have examined whether health behaviors serve as pathways from adolescent SES to adult depressive symptoms. This study aimed to explore the effects of adolescent health behaviors on adult depressed mood using the adolescent pathway model (APM).

METHODS

Our sample consisted of n = 1109 Norwegians [45.5% female], who were surveyed from ages 13 to 40 across ten time points. Using linear regression analyses, we examined (1) the association between parental SES [household income and parental education] and adolescent health behaviors [breakfast regularity, leisure time physical activity (LTPA), difficulties falling asleep, alcohol consumption, and smoking], and (2) the associations between adolescent health behaviors and adult depressed mood, and whether these were moderated by indicators of parental SES. We also assessed how health behaviors are associated with social inequality in adult depressed mood. In this context, social inequality was defined as the covariance between adult SES (i.e., income and education) and adult depressed mood.

RESULTS

Higher household income predicted higher levels of LTPA, and higher parental education predicted greater breakfast regularity. None of the health behaviors were associated with adult depressed mood, nor did they show moderation by SES. Adolescent health behaviors did not independently account for social inequality in adult depressed mood.

CONCLUSIONS

The study suggests minimal socioeconomic differences in adolescent health behaviors, which do not significantly account for social inequalities in adult depressed mood. This offers limited support for the behavioral explanation of health inequalities within the framework of the APM. However, adolescent depressed mood emerges as the strongest predictor of adult depressed mood, highlighting its importance as a key focus for early intervention efforts.

From social media to artificial intelligence: improving research on digital harms in youth

In this Personal View, we critically evaluate the limitations and underlying challenges of existing research into the negative mental health consequences of internet-mediated technologies on young people. We argue that identifying and proactively addressing consistent shortcomings is the most effective method for building an accurate evidence base for the forthcoming influx of research on the effects of artificial intelligence (AI) on children and adolescents. Basic research, advice for caregivers, and evidence for policy makers should tackle the challenges that led to the misunderstanding of social media harms. The Personal View has four sections: first, we conducted a critical appraisal of recent reviews regarding effects of technology on children and adolescents' mental health, aimed at identifying limitations in the evidence base; second, we discuss what we think are the most pressing methodological challenges underlying those limitations; third, we propose effective ways to address these limitations, building on robust methodology, with reference to emerging applications in the study of AI and children and adolescents' wellbeing; and lastly, we articulate steps for conceptualising and rigorously studying the ever-shifting sociotechnological landscape of digital childhood and adolescence. We outline how the most effective approach to understanding how young people shape, and are shaped by, emerging technologies, is by identifying and directly addressing specific challenges. We present an approach grounded in interpreting findings through a coherent and collaborative evidence-based framework in a measured, incremental, and informative way.

StandUPTV: A full-factorial optimization trial to reduce sedentary screen time among adults

Background

Using the multiphase optimization strategy (MOST) framework, we aimed to identify a feasible, acceptable and optimized set of mHealth-delivered behavioral strategies for reducing recreational sedentary screen time (rSST) by at least 60 min/day.

Methods

Eligible participants were 23-64 years old and had high rSST (> 3 h/day). We used a full factorial (23) design in which participants received a "core" mHealth application and were randomized to combinations of three components (on vs. off): LOCKOUT: rSST electronically restricted; TEXT: rSST reduction prompts; and EARN: rSST through physical activity. rSST was assessed at baseline and at 8 and 16 weeks of age via an integrated measure of sedentary time and screen time. We used a linear mixed effect model to test the change in rSST for the three intervention components and their interactions.

Results

A total of 82% of the randomized participants (N = 110) were female, with a mean ± SD age of 41 ± 11.7 y and a BMI of 29.7 ± 7.8 kg/m2, and their mean (95% CI) rSST was 184.7 (172.8, 196.5) min/day at baseline. The expected difference (baseline vs 16 weeks) in rSST was greatest for the intervention versions with a core, LOCKOUT, TEXT, & EARN (-125.7 [-172.0, -79.3] min/day) at the "on" level. The participants were satisfied with the study and found the app helpful in reducing rSST (> 94%). Technical issues resulted in 20% being somewhat dissatisfied with the app.

Conclusions

We identified several promising intervention versions that exceeded our optimization objective. The intervention version that included core, LOCKOUT, TEXT, & EARN components "on" was efficacious, feasible and acceptable and should be used to test the effect of rSST reductions on health outcomes.

Trial registration

(clinicaltrials.gov NCT04464993).

Screen exposure, mental health and emotional well-being in the adolescent population: is it time for governments to take action

During the last decade, a multitude of epidemiological studies with different designs have been published assessing the association between the use of digital media and psychological well-being, including the incidence of mental disorders and suicidal behaviours. Particularly, available research has very often focused on smartphone use in teenagers, with highly addictive potential, coining the term 'problematic smartphone use' and developing specific scales to measure the addictive or problematic use of smartphones. Available studies, despite some methodological limitations and gaps in knowledge, suggest that higher screen time is associated with impaired psychological well-being, lower self-esteem, higher levels of body dissatisfaction, higher incidence of eating disorders, poorer sleeping outcomes and higher odds of depressive symptoms in adolescents. Moreover, a significant association has also been found between screen time and higher suicide risk. Finally, problematic pornography has been shown to be highly prevalent and it is a strong cause of concern to many public health departments and national governments because it might be eventually associated with aggressive sexual behaviours.

Prevalence, subtypes, and risk factors of adverse childhood experiences among Chinese residents: a multicenter cross-sectional study

Background

Addressing the long-term physical and mental health impacts of adverse childhood experiences (ACEs) remains a significant public health challenge. Additionally, ACEs can contribute to intergenerational transmission, affecting future generations. While previous studies have primarily focused on children and adolescents, there is limited data on ACE subtypes and influencing factors among the general adult population, particularly in China. This study aims to explore the prevalence, subtypes, and factors influencing ACEs among Chinese adults.

Method

A total of 1,932 Chinese residents from southwest China (Sichuan, Yunnan, Guizhou provinces, and Chongqing Municipality) participated in the study, consisting of 867 men (44.9%) and 1,065 women (55.1%). Latent class analysis (LCA) was used to identify ACE clusters, and regression analysis examined associations between ACE clusters and demographic factors, physical illness, and mental health outcomes.

Results

The findings revealed that 28.7% of participants had experienced at least one ACE, while 13.2% had experienced three or more ACEs. Three distinct ACE clusters were identified: a low ACE group, a high emotional and physical abuse/family dysfunction group, and a high ACE/sexual abuse group. Regression analysis showed significant associations between childhood adversity and demographic factors (age, education, birthplace), as well as physical and mental health outcomes (anxiety, depression). ANOVA further confirmed significant differences in depression and anxiety scores across the clusters.

Conclusion

These findings offer critical insights for developing targeted public health interventions. Policymakers should consider strategies to reduce childhood ACEs and mitigate their long-term consequences, with particular attention to high-risk groups.

Sleep Disturbances and Depression Levels among General Indonesian Population: A National Survey

Background

The correlation between sleep disturbance and depression is widely recognized in developed countries but relevant evidence is lacking in developing countries.

Objective

This study aims to assess the correlation between sleep disturbance and depression levels among the general Indonesian population.

Methods

This national cross-sectional survey was conducted using the Indonesian Family Life Survey. Sleep disturbance was assessed based on the questions related to sleeping experience. Depression levels were assessed with a modified Center for Epidemiologic Studies-Depression scale. Sociodemographic factors as confounders were obtained from the self-reported data. Logistic regression was performed after adjusting for confounders.

Results

A total of 22,024 respondents were included. Respondents with severe, moderate, and mild sleep disturbance were associated with depression compared to those with none or slight sleep disturbance.

Conclusions

Respondents with sleep disturbance had a higher possibility of experiencing depression. Screening of sleep quality among the general population is important to reduce the risk of depression.

Do movement behaviours influence the association between early menarche and depression symptoms among Brazilian adolescents?

Early menarche has been associated with adverse health outcomes, such as depressive symptoms. Discovering effect modifiers across these conditions in the pediatric population is a constant challenge. We tested whether movement behaviours modified the effect of the association between early menarche and depression symptoms among adolescents. This cross-sectional study included 2031 females aged 15-19 years across all Brazilian geographic regions. Data were collected using a self-administered questionnaire; 30.5% (n = 620) reported having experienced menarche before age 12 years (i.e., early menarche). We used the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Accruing any moderate-vigorous physical activity during leisure time, limited recreational screen time, and having good sleep quality were the exposures investigated. Adolescents who experienced early menarche and met one (B: -4.45, 95% CI: (-5.38, -3.51)), two (B: -6.07 (-7.02, -5.12)), or three (B: -6.49 (-7.76, -5.21)), and adolescents who experienced not early menarche and met one (B: -5.33 (-6.20; -4.46)), two (B: -6.12 (-6.99; -5.24)), or three (B: -6.27 (-7.30; -5.24)) of the movement behaviour targets had lower PHQ-9 scores for depression symptoms than adolescents who experienced early menarche and did not meet any of the movement behaviours. The disparities in depressive symptoms among the adolescents (early menarche vs. not early menarche) who adhered to all three target behaviours were not statistically significant (B: 0.41 (-0.19; 1.01)). Adherence to movement behaviours modified the effect of the association between early menarche and depression symptoms.

The association of adherence to 24-hour movement guidelines with frailty and mortality: cross-sectional and longitudinal analyses of NHANES data

BACKGROUND

Adherence to the Canadian 24-Hour Movement Guidelines (24 H-MG) has been associated with a reduced risk of developing various chronic conditions. However, its association with frailty and all-cause mortality has not been investigated. Therefore, our primary and secondary objective was to investigate the association between adherence to the 24 H-MG and frailty and mortality, respectively.

METHODS

This study included 2739 individuals (age = 50.6 ± 18.1 years; male = 1370 (50.0%)) from the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Frailty was quantified with a 46-item frailty index and analyzed cross-sectionally using linear regression. All-cause mortality data were obtained from the National Death Index and was analyzed prospectively over 10 years using Cox regression. The primary exposure variable was six individual and combined 24 H-MG components including the moderated-to-vigorous physical activity, light physical activity, sedentary time, recreational screen time, sleep, and strength training guidelines. All analyses were stratified into two age groups (younger: 20-64 and older adults 65 + years).

RESULTS

Our cross-sectional analyses demonstrated an inverse dose-response relationship between the number of individual 24 H-MG components met and frailty level in adults aged 20-64 (β = -0.439 (95% C.I. = -0.551:-0.328)) and 65+ (β = -0.322 (95% C.I. = -0.490:-0.154)). Of the individual guideline components, following the moderate-to-vigorous physical activity (MVPA) guideline in individuals aged 20-64 and the recreational screen time guideline in adults aged 65 + was associated with lower frailty (p < 0.001). There was no clear prospective relationship between adherence to the combined 24 H-MG and mortality. Of the individual guideline components, only meeting the MVPA guideline component in the 65 + group was prospectively associated with reduced mortality risk (HR = 0.48 (95% C.I. = 0.25-0.93)).

CONCLUSION

Adherence to the Canadian 24 H-MG may be protective against frailty. Increasing MVPA and decreasing recreational screen time may be important behaviors to consider for frailty prevention and should be investigated further.

The association between screen time exposure and myopia in children and adolescents: a meta-analysis

OBJECTIVE

This study aimed to systematically review epidemiological evidence on associations between screen time exposure and myopia in children and adolescents, and to quantitatively evaluate summary effect estimates from existing literature.

METHOD

There were three online databases including PubMed, Embase, and Web of Science, for epidemiological studies on screen time exposure and myopia published before June 1, 2023. The risk of bias was assessed by the Newcastle Ottawa Scale (NOS) checklist. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the correlation between screen time exposure and myopia using random or fixed-effect models by exposure type (categorical/continuous). We also performed subgroup analysis by screen device type, study quality, geographic region, and research period.

RESULTS

We searched 7,571 records from three databases and identified 19 eligible studies, including 14 high-quality studies and 5 moderate-quality studies. Meta-analyses suggested that there was a statistically significant correlation between screen time (high vs. low) and myopia. The pooled ORs with 95%CIs were respectively 2.24 (1.47-3.42) for cross-sectional studies, and 2.39 (2.07-2.76) for cohort studies. We also found a significant association between continuous exposure to screen time (per 1 h/d increase) and myopia in cohort studies. The pooled ORs with 95%CIs were 1.07 (1.01-1.13). In subgroup analysis stratified by screen device type in cross-sectional studies, screen time exposures from computers (categorical: OR = 8.19, 95%CI: 4.78-14.04; continuous: OR = 1.22, 95%CI: 1.10-1.35) and televisions (categorical: OR = 1.46, 95%CI: 1.02-2.10) were associated with myopia, while smartphones were not. Although publication bias was detected, the pooled results did not show significant changes after adjustment using the trim and fill method.

CONCLUSION

Our findings support that screen time exposure was significantly associated with myopia in children and adolescents. Notably, screen time exposure from computers may have the most significant impact on myopia.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

PUBLIC SIGNIFICANCE

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

Gender Differences in the Association Between Screen Time and Depression

Introduction

Previous research has shown that screen time is associated with depression, especially in children. Some evidence further suggests that the association may be stronger in women than in men, although findings are inconclusive. This cross-sectional study examines the association between screen time and depression in representative U.S. adults, stratified by gender.

Methods

This study used data from the 2015-2016 National Health and Nutrition Examination Survey; analysis was conducted in 2023. Screen time was partitioned into 3 categories-0-2 hours, 3-4 hours, and >4 hours-and included TV and computer time. Depression was defined as a Patient Health Questionnaire score ≥10. TV time and computer time were also analyzed as separate exposures. A multivariable logistic regression model examined the association between screen time and depression.

Results

Results showed that there was a significant interaction between gender and screen time. An association between the highest screen time exposure group and depression was observed for women (>4 hours per day: OR=3.09; 95% CI=1.68, 5.70). The type of screen time affected the relationship, with TV showing a stronger association than computer time. There were no significant associations in men across all exposure groups.

Conclusions

Further research is needed to determine whether higher levels of screen time, especially TV, may be a depression risk marker for women but not men.

Race/Ethnicity Inequities in the Association Between Movement Behaviors and Suicidal Thoughts/Ideation Among Adolescents

OBJECTIVE

We aimed to analyze the associations between movement behaviors (physical activity, screen time, and sleep), independently and jointly, and suicidal thoughts/ideation among Brazilian adolescents according to race/ethnicity.

METHODS

This cross-sectional study surveyed 4,081 adolescents aged 15-19 years (49.9% females) across all Brazilian geographic regions. Data were collected using a self-administered questionnaire. Within the sample, 31.0% (n = 1,264) self-reported as White and 69.0% (n = 2,817) as Black. Adolescents who declared one or more times/week suicidal thoughts/ideation were considered as a risk group. Accruing moderate-to-vigorous physical activity during leisure time, reduced recreational screen time, and good sleep quality were the exposures investigated. We evaluated both additive and multiplicative interactions between race/ethnicity and movement behaviors. Binary logistic regression was used to estimate the odds ratio (OR), marginal means effects, and 95% confidence intervals (95% CIs).

RESULTS

Black adolescents who met 1 (OR: 0.34; [95% CI: 0.22-0.52]), 2 (OR: 0.17 [0.11-0.27]), or 3 (OR: 0.13 [0.07-0.26]), and White adolescents who met 1 (OR: 0.35 [0.21-0.57]), 2 (OR: 0.14 [0.08-0.26]), or 3 (OR: 0.11 [0.04-0.31]) of the movement behavior targets had lower odds of suicidal thoughts/ideation than Black adolescents who did not meet any of the movement behavior targets. Black adolescents who did not meet any of the movement behavior targets had higher suicidal thoughts/ideation odds than the other adolescent's groups.

CONCLUSIONS

We identified an inverse association between meeting individuals and combinations of movement behavior targets with suicidal thoughts/ideation. Among Black adolescents who did not meet any targets, these associations were more evident.

Lifestyle, meal times, and sleep patterns changes in higher education professors during COVID-19: Association with non-communicable chronic diseases

BACKGROUND

In response to the COVID-19 pandemic, educational institutions had to swiftly adapt and transition to remote teaching in order to maintain academic activities. However, these changes presented a number of challenges for professors, which could have negative effects on their health.

OBJECTIVE

To analyze the association between changes in dietary and sleep habits, physical activity level, and sedentary behavior with the development of non-communicable diseases (NCDs) among Brazilian higher education professors during the pandemic period.

METHODS

This is a cross-sectional and retrospective study conducted using an online form. Generalized linear models, adjusted for age, sex, and body mass index, were used to verify the difference between pre-pandemic and pandemic periods. Logistic regression models were used to predict the odds ratio (OR) for the development of NCDs according to physical activity time, sedentary behavior time, dietary and sleep patterns.

RESULTS

A total of 936 professors residing across Brazil participated in the survey. The duration of sedentary behavior increased, sleep duration slightly decreased, and meal times shifted to earlier during the pandemic. A total of 22.9%of the participants reported the diagnosis of some NCDs during this period. Physical activity practice was associated with a lower risk of diseases during the pandemic, regardless of the intensity performed. On the other hand, late eating habits and excessive food consumption during the pandemic were associated with a higher risk.

CONCLUSION

The results provide data that can help in the development of public policies that promote health actions to minimize the consequences associated with the pandemic period.

The association between screen time and depression symptoms severity among adults with diabetes: A cross-sectional study

OBJECTIVE

To investigate the association between time spent on screen-based sedentary behavior (SBSB) and depression symptom severity (DSS) among adults with type 2 diabetes.

METHODS

A cross-sectional study employing secondary data collected by Qatar Biobank (QBB) on 2386 adults with type 2 diabetes aged ≥ 18 years. Self-reported data on DSS measured using the Patient Health Quationnaire-9 and daily time spent on SBSB per week was used.

RESULTS

After adjusting for covariates, including physical activity and sleep duration, subjects who spent 2-4 h or > 4 h a day on SBSB watching TV or other devices other than computers during weekdays had increased odds of higher DSS than subjects who spent < 1 h by 44% (95% Confidence interval (CI) 13-83%) and 52% (95% CI 17-96%), respectively. Subjects who spent > 4 h a day on SBSB using computers during weekdays had increased odds of higher DSS by 115% (95% CI 56-196%) than subjects who spent < 1 h. Similar associations were observed between time spent on SBSB using the mentioned devices during weekends and DSS.

CONCLUSION

Increase in time spent on SBSB is independently associated with increased DSS among adults with type 2 diabetes regardless of the equipment used or timing of the week.

Reduced suicidality after electroconvulsive therapy is linked to increased frontal brain activity in depressed patients: a resting-state fMRI study

Objective

Suicidality is commonly observed in patients with depressive episodes, and electroconvulsive therapy (ECT) has been found to be effective in treating these patients. However, the role of ECT in suicidality remains unclear. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the changes in brain function before and after ECT in depressed patients with suicidality.

Methods

In total, 26 depressed patients with suicidality underwent rs-fMRI at baseline and after 8-12 sessions of ECT. In addition, 32 healthy controls (HCs) matched for age, gender, and educational level underwent rs-fMRI once. The amplitude of low-frequency fluctuations (ALFF), the fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were measured to evaluate whole brain function. Differences between the groups and time points (before and after ECT) were compared. Clinical symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and Beck Scale for Suicide Ideation (BSSI).

Results

At baseline, patients exhibited decreased ALFF in the right postcentral and precentral gyrus and decreased fALFF in the right supramarginal and postcentral gyrus, left superior frontal gyrus (SFG), as well as the superior and middle temporal gyrus compared to HCs. Patients also had lower ReHo in the left amygdala, anterior cingulate, and postcentral gyrus, and in the right thalamus, insula, and postcentral gyrus. They also exhibited higher ALFF in the bilateral temporal gyrus and insula as well as higher fALFF in the cerebellum. Following ECT, fALFF in the left SFG and orbital frontal cortex (OFC) significantly increased and was inversely correlated with the reduction of BSSI scores (r = -0.416, p = 0.048), whereas no correlation was found with changes in HAMD-17scores.

Conclusion

Our findings suggest that the left SFG and OFC may play a key role in the mechanism of ECT for suicidality. The decrease of fALFF in the left SFG and OFC may represent a potential mechanism through which ECT effectively treats suicidality in depressed patients.