Less physical activity and more screen time is associated with poorer mental health in children and adolescents

1. In children and adolescents, meeting the 60 min/day physical activity recommendation and having less screen time were associated with fewer mental health difficulties.

2. More mental health difficulties in children and adolescents were detected during this survey conducted during the SARS-CoV2 (COVID-19) pandemic than pre-pandemic studies.

Evidence Rating Level: 3 (Average)

Study Rundown: The SARS-CoV2 (COVID-19) pandemic disrupted many children’s lives, which may have consequences on mental health. The pandemic decreased physical activity by disrupting organized sports and extracurriculars and increased screen time for education and recreation. Most studies on physical activity and screen time affecting mental health are conducted on adults and no studies have reported these effects during the COVID-19 pandemic. This survey identified a United States (US) nationally representative sample of 500 parents of children (aged 6-10) and 500 parent-adolescent (aged 11-17) pairs. Parents or adolescents completed a cross-sectional survey on the number of days meeting the recommended 60 mins/day of physical activity, non-academic screen time, and mental health. Participants completed an average of 3.9±2.2 days/week of 60 mins/day of physical activity, with 20% completing the recommendation every day and about 10% never meeting it. Participants were at screens for 4.4±2.5 hours/day. COVID-19 was associated with more mental health difficulties in children and adolescents. Children and adolescents who always met the physical activity recommendations, as well as adolescents who sometimes met these recommendations, had fewer mental health difficulties compared children or adolescents who never did. Greater screen time was associated with more mental health difficulties in children and adolescents. A strength of this study is its large, nationally representative sample based on US-census data. Surveys like this study completed are prone to recall and social desirability bias, which may have falsely increased physical activity and decreased screen time reporting. As a cross-sectional study, this study could not discern if mental health disorders reported began before or during the pandemic; though the rates of mental health disorders were higher in this sample compared to pre-pandemic studies, no measures were in place to identify if that was part of this population surveyed or due to the pandemic increasing rates of mental illness. Similarly, this cross-sectional survey could not assess any change in health behaviours or infer causality due to the pandemic. This cross-sectional study was conducted in late October 2020, when the rate of COVID-19 transmission was variable across the US as were the lockdown requirements.

Click to read the study in JAMA Network Open

Relevant Reading: Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and Adolescents: A Systematic Review

In-Depth [cross-sectional study]: YouGov conducted a cross-sectional survey of 547 parents of children and 535 parent-adolescent pairs. 500 respondents in each cohort were matched to data from Census–based sampling to represent the age, race, educational level, as well as sex in the adolescent group, of the US. Parents reported family demographics (child and parent age, sex, ethnicity, and parents location of birth and educational attainment) and the effects of COVID. Parents reported their child’s number of days meeting the 60 minutes/day of recommended physical activity, screen time, and mental health via the Youth Risk Behavior Surveillance Survey and Strength and Difficulties Questionnaire (SDQ). Adolescents self-reported these measures using self-report versions of the same surveys. The average child/adolescent participant was 10.8±3.5 years old, 52.6% were boys, 31.6% were American Indian/Alaska Native, Asian, Black, or another race and 27.8% were Hispanic/Latino. 50.6% of participants attended school virtually, 22.2% attended in-person and 27.2% attended in some hybrid form. 24.4% of the parents were born outside of the US and 37.6% had an education less than a high school diploma. On average, children/adolescents met the recommended 60 mins/day of physical activity 3.9±2.2 days/week. 20.9% of participants did 60 mins/day of physical activity every day of the week, while 8.4% never met the recommendation. On average, children/adolescents had 4.4±2.5 hours/day of recreational screen time. Mental health disorders in the children/adolescent sample included: 13.7% with anxiety, 10.4% with depression, 15.0% with ADHD, and 11.4% with a behavioral problem (SDQ = 11.9±7.1/20, where higher scores represent greater psychopathology). The pandemic time was associated in children with higher mental health difficulties on the SDQ (β coefficient = 0.6, 95% CI = 0.3-0.9), including on internalizing (made up of the emotional and peer SDQ subscales) (β coefficient = 0.3, 95% CI = 0.2-0.5) and externalizing (made up of the behavioral and hyperactivity SDQ subscales) (β coefficient = 0.3, 95% CI = 0.1-0.5). Similarly, the pandemic time was associated in adolescents with higher mental health difficulties on the SDQ (β coefficient = 0.4, 95% CI = 0.0-0.7), including on externalizing (β coefficient = 0.3; 95% CI = 0.1-0.5), but not internalizing. Children who always met the physical activity recommendations were associated with lower difficulties (β coefficient = -2.4, 95% CI = -4.6−-0.2) compared children who never met these recommendations. By contrast, children who sometimes met these recommendations did not see these mental health benefits. However, for adolescents, sometimes meeting these recommendations was associated with lower difficulties (β coefficients = -3.5, 95% CI = -5.3−-1.8). Higher screen time was associated with higher SDQ difficulties in children (β coefficients = 0.3, 95% CI = 0.1-0.5) and adolescents (β coefficients = 0.4, 95% CI = 0.2-0.6).

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