1. Children with higher levels of screen time had significantly higher levels of mental health symptoms, with different forms of screen use associated with distinct psychological symptoms, suggesting that not all screen use is equal.
2. These findings may help inform public health guidelines and policies that consider different forms of screen use in the prevention of mental health disorders in children during the pandemic and beyond.
Evidence Rating Level: 2 (Good)
Study Rundown: The restrictions brought on by the COVID-19 pandemic has undoubtedly increased screen use in children and youth, serving as an essential platform for their learning, entertainment, social interactions, and leisure. However, longitudinal data on the mental health effects of increased screen time through its various forms is lacking. This cohort study assessed whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19. The main outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention assessed using validated standardized tools. Among 2026 children with 6648 total observations, children with higher levels of screen time had significantly higher levels of mental health symptoms, with various forms of screen use associated with distinct psychological symptoms, suggesting that not all screen use is equal. A limitation of this study was the predominance of children of European ancestry included in the study cohort, owing to different socioeconomic and cultural demographics and thus, limiting the generalizability of the findings to the general population.
In-Depth [prospective cohort]: This longitudinal cohort study included 2026 children from the province of Ontario, Canada with 6648 total observations between May 2020 and April 2021. Children were 2 to 18 years old divided across 4 cohorts: 2 community cohorts and 2 clinically referred cohorts, where parents completed questionnaires about their children’s health behaviors and mental health symptoms during COVID-19. In younger children (mean [SD] age, 5.9 [2.5] years; 275 [51.7%] male), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: β, 0.22 [95%CI, 0.10-0.35]; P < .001; age ≥4 years: β, 0.07 [95%CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (β, 0.07 [95%CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 [56.5%] male), higher TV or digital media consumption was associated with higher levels of depression, anxiety, and inattention. In particular, increased video game time was associated with higher levels of depression, irritability, inattention, and hyperactivity and increased electronic learning time was associated with higher levels of depression and anxiety.
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