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Table 1 Cross-sectional findings

From: The associations between sedentary behaviour and mental health among adolescents: a systematic review

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
  1. β standardised beta coefficient; B unstandardized beta coefficient; CI confidence interval; F analysis of variance; OR odds ratio; R correlation coefficient; SD standard deviation; SE standard error; y years
  2. a Quality of evidence based on assessment tool for quantitative studies [26] including selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop outs, intervention integrity, and analysis. Strong quality of evidence = if three or more components scored strong. Moderate quality of evidence = if less than three components were strong with no more than one weak score. Weak quality of evidence = if two or more components scored weak