Table 1 Cross-sectional findings
Author, Year, Country of study | Sample characteristics | Mental health measure | Sedentary behaviour measure | Findings | Quality of evidencea |
|---|---|---|---|---|---|
Arat, G (2015) [29] United States | Total = 10,563 US school attending adolescents stratified by ethnic background. 13–18 years. | Depression: assessed by one question ‘during the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?’ (Yes/No) Suicide ideation: assessed by one question ‘during the past 12 months, did you ever seriously consider attempting suicide?’ (Yes/No) | Television: assessed by one question ‘on an average school day, how many hours do you watch TV?’ | Lower odds of suicide ideation among African adolescents was associated to increased hours spent watching television (OR: 0.82, 95 % CI: 0.72–0.94, p < 0.05). No other associations were significant. | Weak |
Arbour-Nicitopoulos et al. (2012) [52] Canada | Total: 2,935 Canadian adolescents 13–20 years Mean age: 15.9y (SD:1.4) 49.0 % female | Psychological distress: General Health Questionnaire (Scores ≥3 indicated psychological distress) | Screen time: assessed using one question ‘in the last 7 days, about how many hours a day, on average, did you spend: watching TV/movies, playing video/computer games, on a computer chatting, emailing or surfing the Internet?’ Students categorised into meeting did not met Canadian guidelines of ≤ 2 h per day | Significant associations between exceeding screen time recommendations and psychological distress (OR:1.37, 95 % CI: 1.16–1.62, p < 0.001). | Moderate |
Asare & Danquah (2015) [31] Ghana | Total: 296 Ghanaian adolescents 13–18 years Mean age: 14.9y (SD:1.4y) 49.3 % female | Depressive symptoms: Child’s Depression Inventory (CDI) | Sedentary behaviour: Adolescents Sedentary Activity Questionnaire to give a daily hourly average spent sedentary. Scores of ≥4 h per day indicated high sedentary behaviour, but also treated as a continuous measure. | Significant positive relationship between sedentary behaviour and depression (r = 0.68, p < 0.001). Hourly increases in daily average sedentary behaviour was associated to a 0.20 standard deviation increase in depression (b = 0.20, p < 0.001). | Strong |
Cao et al. (2011) [32] China | Total: 5003 secondary school students from China 11–16 years 47.9 % female ≤2 h screen time per day: 3695 Mean age: 13.1 (SD: 1.0) >2 h per day: 1308 Mean age: 13.3 (SD:1.0) | Depressive symptomatology: Depression Self-rating Scale for Children (Cut-off: 15) Anxiety symptoms: Screen for Child Anxiety Related Emotional Disorders (Cut off: 23) | Screen time: open ended question participants reported how many hours per day, on average they spent on the following sedentary activities outside school hours on a usual weekday, as well as weekend day: TV viewing, computer usage. | High screen time was associated to increased odds for depressive symptoms (OR:1.52, 95 % CI: 1.31–1.76) and anxiety symptoms (OR:1.36, 95 % CI: 1.18–1.57). | Strong |
Casiano et al. (2012) [33] Canada | Total: 9137 Canadian youth 12–19 years Mean age not reported (64.9 % aged between 15 to 19y) 48.7 % female | Depressive symptoms: Composite International Diagnostic Interview (CIDI) Short Form (scores were converted to a probability of major depression and cut off of 0.90 was used) Suicide ideation: were considered positive if answered yes to question ‘Have you ever seriously considered committing suicide or taking your own life?’ and ‘Has this happened in the past 12 months?’ | Screen time: participants asked the number of hours per week that they had spent using media (including TV/video watching, video game playing, computer/Internet use) in the last three months. | Depression was less frequent in frequent video game users (OR:0.87, 95 % CI: 0.79–0.97, P < 0.05). | Moderate |
Donchi & Moore (2004) [34] Australia | Total: 336 secondary school and university students 15–21 years, 66.1 % female Secondary students: 110 regional secondary school students 15–18 years Mean age: 16.2y (SD:0.8y) University students: 226, 17–21 years Mean age: 18.6y (SD:1.1y) | Loneliness: UCLA Loneliness Scale, Wittenberg’s 10-item Emotional and Social Loneliness Scale Self-esteem: Form A of the 16-item Texas Social Behaviour Inventory | Internet use: amount of time young people spend on internet on an average day, asking to indicate in minutes time ‘on an average day’ spent on 13 items relating to internet use such as ‘visiting chat rooms’, ‘searching for things of personal interest’, ‘finding articles and references’. | None of the measures for time spent online (categorised into communication, entertainment or information-related activities) were significant predictors of well-being for male or female adolescents. | Moderate |
Durkin & Barber (2002) [35] United States | Total: 1304 10th grade secondary school students in 1988 Mean age: 16y (SD not reported) Gender descriptive not reported | Depressed mood: measured with a four-item scale with sample item ‘how often do you feel unhappy, sad, or depressed?’ Self esteem: measured with three items with sample item ‘how often do you feel satisfied with yourself the way you are?’ Responses for both items ranged from 1 (never) to 7 (daily). A mean score was computed. No other details. | Computer game use: measured with two questions about computer use, first asked whether the participant ever used a computer (Yes/No), if response yes then asked how often they used a computer to play games, responses ranged from 1 (never) to 7 (daily). Participants categorised into; none (those who did not use computers at all, as well as those who used computers but never for computer games), low (those who checked 2–5 for frequency of computer use for games) and high (6 or 7 for frequency of computer game play). | Depressed mood varied significantly by computer game use (F(2,1014) = 4.19, p < 0.05) with the low use group reporting significantly less depressed mood than the high use group and their peers who did not use computer games. Self-esteem differences by computer game use favoured the low play group over the non players (F(2,1014) = 4.00, p < 0.05), neither group differed significantly from the high players. | Weak |
Fang et al. (2014) [36] Canada | Total: 152 Canadian Chinese youth 17–24 years, 43.4 % females Mean age not reported 103 aged 17–18 years (67.8 %) 49 aged 19–24 years (32.2 %) | Depressed mood: 5 items from the General Health Questionnaire. Summed scores ranged from 0 to 15 and higher scores reflected higher level of depressed mood. Stress: was measured by one item taken from Perceived Stress Scale, participants were asked to indicate on average their level of stress from 0 (not stressed at all) to 10 (very stressful). Suicide ideation: two items from Ontario Student Drug Use and Health Survey, one example ‘in the past 12 months, did you seriously think about committing suicide or taking your own life?’ Scores ranged from 0–2 (no further description provided) where higher scores indicated a greater level of suicide ideation. | Screen time: total number of hours spent per day on the computer and TV, then two further categories; time spent for school and non school related reasons in the past 7 days | Total amount of time spent in screen time was positively associated with perceived stress (β = 0.32, p < 0.01). When youth spent more time for non-school related reasons they were more likely to be depressed (β = 0.32, p < 0.05). Those who spent more screen time on school related activities experienced higher stress (β = 0.42, p < 0.0001). | Weak |
Gross (2004) [37] United States | Total: 261 7th and 10th grade Californian secondary school students 61.7 % female Mean age of 7th graders: 12y (SD:0.4y) Mean age of 10th graders: 15y (SD:0.6y) | Participants completed daily reports before going to sleep at night for 3 days (7th graders) or 4 days (10th graders) Depressive symptoms: Child Depression Inventory Loneliness: UCLA Loneliness scale (‘in school’ was added to enable assessment of loneliness at school specifically) Social anxiety: combining items form two subscales of the Social Anxiety Scale for Adolescents produced a total social anxiety index where higher scores indicated increased levels of social anxiety. | Sedentary behaviours: Participants asked to estimate how much time they spent talking on the phone, watching TV and using the Internet | No association between average daily time online and any mental health measure (all p values > 0.1). | Moderate |
Herman et al. (2015) [38] Canada | Total: 7725 Canadian adolescents 12–17 years Mean age not reported 49 % female | Self-rated mental health: one item ‘would you say your mental health in general is excellent, very good, fair or poor?’ Responses were dichotomised to estimate the probability of rating one’s health sub-optimally (good, fair, poor) versus optimally (excellent or very good) | Screen time was assessed via questions; ‘in a typical week in the past 3 months, how much time did you spend on a computer, including playing computer games and using the internet? (not including time spent at work or at school), playing video games, watching TV or videos?’ Responses were summed to give a pre-categorised total weekly screen time from which an upper cut off of 14 h per week was used to denote 2 h/day. | Adolescents exceeding screen time guidelines were 30–50 % more likely to rate their mental health sub-optimally compared to those who met guidelines (males OR:1.34 95 % CI 1.11–1.62, females OR: 1.52 95 % CI: 1.28–1.80). | Strong |
Hoare et al. (2014) [39] Australia | Total: 800 Australian secondary students 11–14 years Mean age: 13.1y (SD:0.6y) 55 % female | Depressive symptoms: Short Mood and Feelings Questionnaire Cut off of 10 indicated depressive symptomatology presence | Leisure time screen based behaviour: items relating to TV viewing (including videos and DVDs) and three related to playing video games and using the computer (other than for homework), on a single school day, and Saturday and Sunday, then calculated to provide a daily estimate. Dichotomised into met or exceeded Australian guidelines of 2 h or less per day. | Screen time was associated to presence of depressive symptomatology in males (OR:1.22 SE:0.10, p = 0.01) and females (OR:1.12 SE:0.06, p = 0.02). | Moderate |
Jackson et al. (2010) [40] United States | 500 American youth Mean age: 12.2y (SD not reported) 53 % female 11–16 years | Self-esteem: Rosenberg self-esteem scale | Internet, videogame and mobile phone use: how often do they use above 1 = do not use at all, 2 = about once a mnth, 3 = a few times a month, 4 = a few times a week, 5 = everyday for less than 1 h, 6 = everyday for 1–3 h, 7 = everyday for more than three hours. | Adolescents who played videogames more had lower self-esteem than did adolescents who played less frequently (p < 0.05) | Moderate |
Katon et al. (2010) United States | Total: 2291 American adolescents 13–17 years 1993 without depressive symptoms Mean age: 15.3y (SD:1.3y) 47.8 % female 281 with depressive symptoms Mean age: 15.5 (SD:1.3y) 61.2 % female | Depressive symptoms: Patient Health Questionnaire two item depression scale Cut-off score ≥3 indicated depressive symptoms | Screen time: two questions on hours and minutes spent on a computer and TV watching. | Adolescents with depressive symptoms reported a significantly (p < 0.001) higher amount of average time daily using computer (mean: 1.9 SD:1.7) compared to those without depressive symptoms (mean:1.6 SD:1.4) | Moderate |
Kremer et al. (2014) [42] Australia | Total: 8029 Australian young people 10-14 years Mean age: 11.5y (SD:0.8) 52 % female | Depressive symptoms: Short Mood and Feelings Questionnaire Cut off: ≥8 indicated depressive symptoms presence | Screen time: participants reported time spent watching TV and on a computer or playing video games for leisure separately for weekdays and weekend days (‘On school days/weekend days for how many hours do you usually watch TV?’, ‘On school days/weekend days for how many hours do you usually spend on a computer or playing video games such as gamecube, xbox, PS2, PSP, GBA etc.?’; 1 = none; 6 = more than 6 h). | Adolescents who were asymptomatic had a greater proportion who met screen time recommendations compared to those with depressive symptoms (p < 0.001). A significant age group x screen time effect was observed (OR:0.77 95 % CI:0.59–0.99, p < 0.04) indicating the effect of meeting scree time recommendations on depressive symptoms was moderated by the age of the respondent. | Strong |
Maras et al. (2015) [43] Canada | Total: 2482 English speaking grade 7 to 12 57.7 % female | Depressive symptoms: Children’s Depression Inventory Anxiety symptoms: Multidimensional Anxiety scale for Children-10. | Screen time: hours per day of TV, video games, and computer was assessed using the Leisure-Time Sedentary Activities Questionnaire, developed by investigators. | Duration of screen time was associated with severity of depression (β = 0.23, p <0.001) and anxiety (β = 0.07, p < 0.01). Video game playing (β = 0.13, p <0.001) and computer use (β = 0.17, p < 0.001) but not TV viewing were associated with more severe depressive symptoms. Video game playing (β = 0.11, p < 0.001) was associated with severity of anxiety. | Moderate |
Mathers et al. (2009) [44] Australia | Total: 925 adolescents Mean age: 16.1y (SD: 1.2y) 13–19 years, 49.6 % female | Psychological distress: Kessler 10 | Screen time: duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity recall for Children and Adolescents computerized time-use diary | Adolescents who reported high level of video game use were more likely to report high/very high levels of psychological distress (OR: 1.79 95 % CI: 1.17–2.73, p = 0.007) compared to those who did not play games. There was a favourable association between low (OR: 0.58 95 % CI: 0.37–0.91, p = 0.02) and high (OR: 0.61 95 % CI: 0.38–0.96, p < 0.03) computer use and psychological distress compared to no computer use. | Strong |
Messias et al. (2011) [45] United States | Total: 29,941 American adolescents 14–18 years 13,817 adolescents from 2007 Mean age: 16.1y (SD:1.2y) 49.7 % female 16,124 adolescents 2009 Mean age:16.1y (SD:1.2y) 47.9 % female | Sadness: ‘during the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?’ Suicidality: ‘during the past 12 months, did you ever seriously consider attempting suicide?’ ‘during the past 12 months, did you make a plan about how you would attempt suicide?’ ‘During the past 12 months how many times did you actually attempt suicide?’ ‘If you attempted suicide during the past 12 month, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse?’ | Screen time: on an average school day, how many hours do you play video or computer games or use a computer for something that is not school work? 7 answers were possible ranging from ‘I do not play video or computer games or use a computer for something that is not school work’ to ‘5 or more hours per day’. | Those reporting moderate game/internet use (1 h or less daily) are significantly less likely to report sadness compared to those reporting no use at all, but no statistics available. Those with video game use between 2–3 h were not different from those reporting no video game use. Those reporting 5 h or more were more likely to experience sadness than those reporting no use. Compared to those reporting no video game use/internet those reporting 5 h or more were more likely to have experienced suicide ideation and made suicidal plans in both 2007 group (ideation OR:1.4 95 % CI: 1.1–1.8; planning OR:1.8 95 % CI: 1.3–2.3), and 2009 group (ideation OR:1.7 95 % CI: 1.3–2.1; planning OR:1.5 95 % CI: 1.1–1.9). All p < 0.05. | Moderate |
Nihill et al. (2013) [46] Australia | Total: 357 females from 12 secondary schools in New South Wales Mena age: 13.2y (SD:0.5y) 100 % female | Self-esteem: self esteem subscale from Marsh’s Physical Self-Description Questionnaire Example item ‘overall, most things I do turn out well’. | Sedentary behaviour: Adolescent Sedentary Activity Questionnaire included amount of time outside school spent in various sedentary behaviours including watching TV/videos/DVDs, using computers for school and non-school purposes, studying, reading, sitting with friends, using the telephone, listening to or playing music, motorized travel, hobbies and crafts. Screen time: assessed by one item asking how much time was spent watching TV, videos, DVDs and using the computer for non-school purposes. | Significant inverse associations between time spent watching DVDs (B:-0.00304 95 % CI:-0.00542 to -0.00067, p < 0.05), playing computer games (B:-0.00171, 95 % CI:-0.00299 to -0.00043, p < 0.05), and total screen time (B:-0.00084, 95 % CI : -0.00157 to -0.00012, p < 0.05) and self-esteem. | Moderate |
Pantic et al. (2012) [47] Serbia | Total: 160 high school students Mean age: 18.02y (SD:0.29) 68.1 % female | Depression: Beck Depression Inventory-II-II Cut off: 0–9 minimal depression, 10–18 mild depression, 19–29 moderate depression and 30–63 severe depression. | Screen time: item asked self-report daily average time spent on watching TV, and time spent on social networking sites. | Significant correlation between depression score and time spent on social networking sites (R = 0.15, p < 0.05). No correlation was found between TV viewing and depression. | Moderate |
Park (2009) [48] South Korea | Total: 3449 Korean second year middle students Mean age and gender not reported. | Depressive symptoms: based on 6 questions examining symptoms listed in the DSM-4 | Internet use: 4 items asking how frequent a respondent used the Internet for chat room or messenger, email, club activities, bulletin board. | Increased risk for depressive symptoms was positively associated with greater use of the internet (OR:1.207 95 % CI:1.043–1.398, p < 0.05). | Strong |
Robinson et al. (2011) [49] Australia | Total: 1860 Australian adolescents Mean age:14.01y (SD:0.20) 46.9 % female | Mental health: Parent reported Child Behaviour Checklist for Ages 4–18 which provided continuous scores from which quartiles represented level of mental health. | Screen time: participant were asked about their television/video viewing habits and computer use which was categorised into less than two hours per day, 2–4 h per day and more than 4 h per day. | Compared to less than two hours per day, adolescents using screen time 2–4 h per day (β:1.88 95 % CI:0.40–3.36, p < 0.05) and those who reported 4 or more hours per day (β:2.80, 95 % CI:1.24–4.36, p < 0.005) reported higher mental health scores indicating poorer mental health status. | Strong |
Trinh et al. (2015) [50] Canada | Total: 2,660 Ontario, Canadian youth Mean age: 15.8y (SD:1.3y) 52.5 % female | Psychological distress: was measured by the General Health Questionnaire to assess symptoms of anxiety, social dysfunction, and self-esteem. Experiencing at least three of the 12 symptoms indicated elevated psychological distress. Depressive symptoms: were assessed using four items adapted from the Centre for Epidemiologic Studies Depression [76]. Having depressive symptomatology was defined as reporting ‘often’ or ‘always’ on all four symptoms. Higher scores indicated higher depressive symptomatology. Self-esteem: assessed using six items adapted from the Rosenberg Self-Esteem scale, higher scores indicated lower self-esteem. | Screen time: assessed with one question ‘in the last 7 days, about how many hours a day, on average, did you spend watching TV/movies, playing video/computer games, on a computer chatting, emailing or surfing the internet?’ Responses; none, less than one hour, 1–2 h, 3–4 h, 5–6 h a day and 7 or more hours a day. Dichotomised into not meeting (more than 2 h a day) or meeting (two hours or less). | Exceeding screen time recommendations was significantly related to; psychological distress (OR:2.01, 95 % CI:1.40–2.89, p < 0.05), low self-esteem (OR:1.32, 95 % CI:1.17–1.49, p < 0.05), depressive symptoms (OR:1.92, 95 % CI:1.05–3.54, p < 0.05). In males, higher screen time was associated to psychological distress (OR:2.40, 95 % CI:1.63–3.54, p < 0.05), low self-esteem (OR:1.31, 95 % CI:1.13–1.53, p < 0.05), and depressive symptoms (OR:2.82, 95 % CI = 1.09–7.30, p < 0.05). In females, higher screen time was associated with low self-esteem (OR:1.30, 95 % CI:1.10–1.53, p < 0.05). | Strong |
Ybarra et al. (2005) [56] United States | Total: 1501 American youth 10–17 years Mean age: 14.1y (SD:1.9y) 47.3 % female | Depressive symptomatology: youth were asked about the presence (yes/no) of each of the nine symptoms of depressive disorder based on DSM-IV [77]. Three categories: DSM-IV-like major depressive symptomatology (five or more symptoms), minor depressive symptomatology (3–4 symptoms) and mild or no depressive symptomatology (fewer than three symptoms). | Internet use: asked to estimate the average number of hours per day he or she used the Internet on a typical day of internet use (1–10+ hours). Participants were asked to estimate the average number of days he or she went online in a typical week. | Among females, compared to mild/no depressive symptomatology, using the internet for 3 or more hours per day was related to increased odds of major like depressive symptomatology (OR:3.57 95 % CI:1.70-7.50, p < 0.001), and for minor depressive symptomatology (OR:2.19 95 % CI: 1.20–4.01, p < 0.01). No significant findings for males. | Moderate |
Young et al. (2013) [30] South Korea | Total: 136,589 South Korean secondary school students 13–18 years Mean age not reported. 47.7 % female | Depressive symptoms: response to ‘during the past 12 months, did you ever feel intense sadness or despair that lasted more than two weeks, and that interfered with your life?’ (yes/no) Suicide ideation: response to ‘during the past 12 months, did you ever seriously consider attempting suicide?’ (yes/no) | Internet use: assessed by ‘how many minutes did you spend using the Internet (for non-study purposes) on average each day for the last 30 days?’ Total amount of time for internet use per week was calculated to capture the average daily amount of time for Internet use. | Compared to 0–17 mins average per day of internet use, an increase of internet use up to 124 mins daily average (OR:-0.07 95 % CI:-0.12 to -0.02, p < 0.01), reduced the likelihoods of reporting depressive symptoms and suicide ideation, only showing reverse trends 129 mins daily average per day and beyond, with significance at 184–630 mins daily average (OR:0.19 95 % CI:0.14–0.24, p < 0.01). Similar patterns observed in suicide ideation. Up to 124 min reduced likelihood of suicide ideation (OR:-0.08, 95 % CI:-0.15 to -0.02, p < 0.01), and beyond average 129 min per day increased likelihood of suicide ideation (OR:0.06 95 % CI:0.00-0.12). | Strong |