Elsevier

Preventive Medicine

Volume 76, July 2015, Pages 48-57
Preventive Medicine

Review
Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review

https://doi.org/10.1016/j.ypmed.2015.03.026Get rights and content

Highlights

  • Screen time was associated with more ADHD symptoms and internalizing problems.

  • Screen time was associated with less psychological well-being and quality of life.

  • Synthesis for depressive symptoms and self-esteem revealed inconsistent results.

  • No clear conclusion could be drawn about causality.

  • Future research needs to examine moderating and mediating variables.

Abstract

Objective

The presented systematic review aims at giving a comprehensive overview of studies assessing the relationship between sedentary behavior and indicators of mental health in school-aged children and adolescents.

Methods

Six online databases (MEDLINE, EMBASE, PsycINFO, PsycARTICLES, CINAHL and SPORTDiscus) as well as personal libraries and reference lists of existing literature were searched for eligible studies.

Results

Ninety-one studies met all inclusion criteria. There was strong evidence that high levels of screen time were associated with more hyperactivity/inattention problems and internalizing problems as well as with less psychological well-being and perceived quality of life. Concerning depressive symptoms, self-esteem, eating disorder symptoms, and anxiety symptoms, no clear conclusion could be drawn. But, taking quality assessment into account, self-esteem was negatively associated with sedentary behavior, i.e. high levels of time engaging in screen-based sedentary behavior were linked to lower scores in self-esteem.

Conclusions

Overall, the association between sedentary behavior and mental health indicators was rather indeterminate. Future studies of high quality and with an objective measure of sedentary behavior will be necessary to further examine this association as well as to investigate longitudinal relationships and the direction of causality. Furthermore, more studies are needed to identify moderating and mediating variables.

Introduction

Considering the importance of electronic entertainment such as TV, video games or computers and inactive modes of transportation in developed societies, the investigation of adverse effects of an increasing sedentary lifestyle has become a new public health issue. About 10 years ago, the term sedentary behavior (SB) was often used to describe a lack of physical activity including also activities of low intensity (Pate et al., 2008). But in contrast to physical inactivity, SB is defined more appropriately as a distinct behavioral category comprising exclusively activities that do not substantially increase energy expenditure compared to resting level (Sedentary Behaviour Research Network, 2012, Pate et al., 2008). In the past few years, the amount of time spent in SB has emerged as an important and independent risk factor for children's and adolescents' physical health, additionally to the level of physical activity. Higher levels of SB, especially screen-based, were linked to higher risk for overweight and abdominal adiposity (Mitchell et al., 2013, Byun et al., 2012), decreased cardiorespiratory fitness (Mitchell et al., 2012, Santos et al., 2014) and increased cardio-metabolic health-risk (Carson and Janssen, 2011a, Byun et al., 2012, Ekelund et al., 2006). Less is known about the association between SB and mental health in youth even though beneficial impacts of physical activity and fitness on mental health are well established (World Health Organization, 2010, Biddle and Asare, 2011, Ahn and Fedewa, 2011a), including lower levels of depression (Rieck et al., 2013, Wiles et al., 2012), higher self-esteem (Strauss et al., 2001) and lower levels of subjective stress (Norris et al., 1992). As stated in a recent report of the World Health Organization (WHO), about 20% of adolescents experience a mental health problem in any given year (World Health Organization, 2012). Moreover, the first signs of most mental disorders occur in childhood and adolescence and persist into adulthood (Kessler et al., 2005, Belfer, 2008). Therefore, maintaining and improving mental health among children and adolescents are of considerable public health relevance (Patel et al., 2007).

To the authors' present knowledge, there are two systematic reviews examining the association between SB and mental health in childhood and/or adolescence. Tremblay et al. (2011) determined the relationship between SB and self-esteem (among other physical health indicators) in young people aged 5 to 17 years. As a common finding of the 14 included primary studies, they reported an inverse association. Adolescents spending a lot of time sedentary, especially with screen-based activities, were more likely to report lower levels of self-esteem. Even though Tremblay et al. included studies with a wide range of age and different sedentary activities, their review was limited to self-esteem as only one indicator of mental health. Another review by Costigan et al. (2013) examined the relationship between screen-based SB and health indicators in adolescent girls. With regard to psychosocial health, the authors identified six studies which found screen-based SB to be negatively associated with psychological well-being and positively with depression. Costigan et al. limited their review to adolescent girls and considered only time spent with screen-based SB.

In consideration of the high prevalence of sedentary lifestyles in modern societies and the growing body of research dealing with adverse mental health effects of SB, the present systematic review aims at giving a comprehensive overview of the existing literature. It follows an extended systematic approach that integrates different aspects and strengths of these previous reviews, namely (1) a wide range of age, (2) both genders, (3) all types of SB, and (4) different mental health outcomes.

Section snippets

Methods

The presented systematic review is in compliance with the PRISMA Statement (Liberati et al., 2009).

Overview of studies

After all duplicates were removed a total of 5272 studies were identified through searching electronic databases. Additional 10 studies were added from reference lists or the author's personal literature database. In Figure 1, a detailed flow chart of primary studies is presented. Screening titles and abstracts of these articles led to the exclusion of 5085 studies, i.e. full texts of 187 studies were obtained. Ninety-six articles were excluded. The most frequent reasons for exclusion were: 1)

Discussion

The presented systematic review aimed to provide a comprehensive summary of the existing literature assessing the association between sedentary behavior (SB) and indicators of mental health in childhood and adolescence. There was strong evidence that high levels of screen time were associated with more hyperactivity/inattention problems as well as internalizing problems, and with less psychological well-being and perceived quality of life. Concerning depressive symptoms, self-esteem, eating

Conflict of interest statement

There are no competing interests.

Acknowledgments

This work was supported by German Cancer Aid (Grant number: 110012).

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