Annotated bibliography: Screen time and its impact on young people’s mental health.

Annotated bibliography


Babic, M. J., Morgan, P. J., Plotnikoff, R. C., Lonsdale, C., & Eather, N. (2015). Skinner, Geoff; Baker, Amanda L.; Pollock, Emma; Lubans, David R. “Rationale and study protocol for ‘Switch-off 4 Healthy Minds'(S4HM): a cluster randomized controlled trial to reduce recreational screen time in adolescents”. Originally published in Contemporary Clinical Trials Vol. 40, p. 150-158 (2015). Clinical Trials, 40, 150-158.

This paper describes a school-based strategy trialled in New South Wales to reduce screen time for adolescents in response to the known adverse effects high screen time can have on their mental and physical health. It uses self-determination theory and involves educating both the adolescent and their parents. Prompts were sent to the young via the social media platform of their choice and newsletters were sent to parents to raise awareness of screen time and its dangers. There wasn’t much detail in the paper about the interventions that would be employed in implementing the strategy.

Chassiakos, Y. L. R., Radesky, J., Christakis, D., Moreno, M. A., & Cross, C. (2016). Children and adolescents and digital media. Pediatrics, 138(5), e20162593.

This report provides a summary of the benefits and risks of childhood exposure to digital media. Social media can have beneficial effects to the mental health of LGBTIQ teenagers if they use it to engage with supportive communities. Similarly, individuals with mental illness may also benefit when using social media to share stories with others experiencing similar challenges. However, this can also leave them open to exposure, misinformation, negativity and hostility. Examples of digital media which may have adverse effects on the mental health of young people are pro-anorexia sites. Exposure to risky behaviour in media has been proven to increase teenage uptake of the behaviour and this exposure can be difficult to police on digital devices by parents. Social media has been shown to have both positive and negative effects on young people’s mental health. Used in moderation it can enhance their feelings of social connectedness. Passive use of social media or following attractive celebrities can increase depression and lower self-esteem, whereas engaging actively with family and friends has the opposite effect.

Gunnell, K. E., Flament, M. F., Buchholz, A., Henderson, K. A., Obeid, N., Schubert, N., & Goldfield, G. S. (2016). Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence. Preventive Medicine, 88, 147-152.

This study was performed to establish relationships between low levels of physical activity, high screen time, depression and anxiety in adolescents. It took place over 11 years and took the form of four time specific questionnaires covering the ages from 10-21 years old (n= 1160, mean age = 13.54 years).  The results were controlled for variables such as gender, ethnicity, location and educational level of parents. A decrease in physical activity and increase in screen time, depression and anxiety over time was observed. Initial high anxiety was associated with higher screen time and lower physical activity independent of symptoms of depression. Higher initial levels of depression were also associated with higher screen time and predicted greater decreases in physical activity over time.  Limitations include the data collected was self-reported, type of screen time and type of physical activity was not identified and there was a high rate of attrition.

Hoare, E., Milton, K., Foster, C., & Allender, S. (2016). The associations between sedentary behaviour and mental health among adolescents: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 108.

This systematic review examined 32 papers, all of which reported the use of screen time for leisure amongst adolescents and two thirds identified depressive symptoms. Adolescence is a significant risk period for the development of mental health disorders and it is also a period when lifestyle behaviours are developed which can impact on mental health into adulthood. Depressive symptoms and length of  screen time for leisure use were consistently linked in the evidence. There was moderate evidence for an association between length of screen time and low self-esteem. More than 2-3 hours of screen time per day in adolescents is linked to poorer mental health status. It identified that the link may be in part due to the sedentary nature of screen time, as physical activity has been found to have a positive effect on mental health. Adolescents with poor mental health may lack motivation to exercise and instead opt for screen based activities. Young people who lead sedentary lifestyles are more likely to suffer from obesity, which can lead to stigmatisation and bullying resulting in adverse effects on their mental health.

Maras, D., Flament, M. F., Murray, M., Buchholz, A., Henderson, K. A., Obeid, N., & Goldfield, G. S. (2015). Screen time is associated with depression and anxiety in Canadian youth. Preventive Medicine, 73, 133-138.

Increased screen time has been linked to low physical activity and obesity in youth, factors that have been linked to an increase in depression and anxiety. The study aimed to examine the relationship between length of screen time and anxiety and depression in young people using a large community sample of Canadian adolescents (n=2482). They found that depression was associated with any type of screen behaviour except watching the TV, whereas anxiety was only associated with gaming. This is consistent with other large-scale studies including studies from the USA and Australia. They offer several explanations for this including social isolation and cyberbullying.  A limitation of the study was that they couldn’t conclude whether it was increased screen time that caused the depression and anxiety or whether the opposite was true that people with depression and anxiety spent more time on their electronic devices.

Przybylski, A. K., & Weinstein, N. (2017). A large-scale test of the Goldilocks Hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychological Science, 28(2), 204-215.

This study tested the Goldilocks Hypothesis for screen time in adolescents to try and ascertain the optimum amount of screen time that would benefit development without adversely affecting mental health. They studied 120115 British adolescents. They found the relationship between screen time and mental health was non-linear and a moderate time spent on screens was not harmful and may even have positive effects on wellbeing. There were differences in effect depending on the screen type, the type of activity, the day or time used and the level of engagement in the activity. They recommend studying the functionality of screen time against other daily pursuits in order to get a fuller understanding. Overall they concluded that moderate technology use was not intrinsically harmful and may prove beneficial in an increasingly digital world.

Saquib, N., Saquib, J., Wahid, A., Ahmed, A. A., Dhuhayr, H. E., Zaghloul, M. S., … & Al-Mazrou, A. (2017). Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia. Addictive Behaviors Reports, 6, 112-117.

This study was conducted using a self-reported survey distributed to 276 students in expatriate schools in Saudi Arabia. The researchers use DSM-V criteria to diagnosed video game addiction and it was compared with other variables including screen time and psychological distress. The mean age of the participants was 15.3 years and nearly 75% reported screen time greater than 2 hours and 20% reported sleeping less than 5 hours a night. Those addicted to video games encompassed 15.8% of the sample and they were more likely to be boys, have higher screen time and less sleep. Addiction to video games was strongly related to psychological distress, as was screen time greater than 2 hours a day.  Psychological distress was also related to gender, with girls being more likely to experience it and inversely to sleep patterns. This study didn’t find any link between physical activity or BMI and psychological distress. The study concludes that screen time has an independent association with psychological distress even when other variables are taken into consideration.

Straatmann, V. S., Oliveira, A. J., Rostila, M., & Lopes, C. S. (2016). Changes in physical activity and screen time related to psychological well-being in early adolescence: findings from longitudinal study ELANA. BMC Public Health, 16(1), 977.

In this study, data was analysed from 526 adolescents in Brazil, assessing physical activity, screen time and psychological distress using a questionnaire. Psychological distress was associated with exceeding the recommended screen time of 4 hours per day in girls, although they questioned whether there was a negative causality impacting on this that is the psychological distress caused them to withdraw and spend more time on screen based activities. For boys, psychological distress was associated with a reduction in physical activity in this study. The study was limited in that the data collected was self-reported.

Trinh, L., Wong, B., & Faulkner, G. E. (2015). The independent and interactive associations of screen time and physical activity on mental health, school connectedness and academic achievement among a population-based sample of youth. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 17.

The study aimed to establish the effects high screen time and physical activity had independently and together on the mental health of young people. Data was collected from 2660 adolescents using a survey. It found that high screen time is consistently associated with poorer mental health independent of the amount of physical activity. However, there may be reverse causality where depressed youth seek social isolation or comfort in their digital devices. The study also found that high screen time was associated with low self-esteem, which did not improve with physical activity.  Higher screen time was associated with lower physical activity. It concluded that screen time and physical activity had both independent and interactive effects on the mental health of young people. A limitation in the study was that the data was self-reported.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2017). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 2167702617723376.

There was an increase in teenage depression and suicide in the USA between 2010 and 2015, which corresponded with the increased use of smartphones and other digital devices. This study analysed the data from two national surveys of high school students in the USA to establish if there was a link between screen time and depression and suicide.  There were 388275 respondents to the surveys, who completed them retrospectively. The study found a positive correlation between screen time and depression and suicide especially amongst females. No significant variation occurred in other variables such as socioeconomic status. Exercise and face-to-face social interaction negatively correlated with depression and suicide, but increased screen time was often associated with low physical activity and social interaction. Lack of sleep has also been identified in other studies as being linked to increased screen time and as a risk factor for depression and suicide. The study was unable to establish if screen time was the sole cause of increased incidence of depression and suicide, the joint cause or if the cause was one of the other factors. Another limitation was the surveys were completed retrospectively rather than in real time, which may have affected the answers given.

Wu, X., Tao, S., Zhang, Y., Zhang, S., & Tao, F. (2015). Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One, 10(3), e0119607.

High screen time and low physical activity have been shown to interact to cause psychological problems. The study has suggested that high screen time is associated with a higher incidence of depression, anxiety, psychopathological symptoms and poor sleep quality. It is also associated with reduced physical activity. Physical activity has been shown to reduce symptoms of depression, anxiety and other mental health problems. The results of this study suggest that high screen time and low physical activity both increase psychological stress independently and synergistically. A limitation of the study is that it assessed self-reported symptoms and not clinically diagnosed disorders.

Wu, X., Tao, S., Zhang, S., Zhang, Y., Chen, K., Yang, Y., … & Tao, F. (2016). Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open, 6(11), e011533.

This study examined the association between screen time and mental health in a group of Chinese university students (n=2521, mean age=18.43 years). Nearly all of the participants reported screen time of more than 2 hours per day. They found consistent associations with screen time and anxiety, depression or other psychopathology. The associations also remained after adjustments for other variables. Due to the small effects size it is unclear to what degree screen time effects mental health outcomes. The limitations of the study include that the data collected was self-reported and it doesn’t differentiate between different screen uses.

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