ReviewSedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review
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).
References (128)
- et al.
Does the camera add 10 pounds? Media use, perceived importance of appearance, and weight concerns among teenage girls
J. Adolesc. Health
(2000) - et al.
Screen time, physical activity and mental health among urban adolescents in China
Prev. Med.
(2011) - et al.
The health indicators associated with screen-based sedentary behavior among adolescent girls: A systematic review
J. Adolesc. Health
(2013) - et al.
Game on… girls: Associations between co-playing video games and adolescent behavioral and family outcomes
J. Adolesc. Health
(2011) - et al.
The associations between self-reported sleep duration and adolescent health outcomes: What is the role of time spent on Internet use?
Sleep Med.
(2013) - et al.
Not so doomed: Computer game play and positive adolescent development
J. Appl. Dev. Psychol.
(2002) The influence of television and video game use on attention and school problems: A multivariate analysis with other risk factors controlled
J. Psychiatr. Res.
(2011)- et al.
Locus of control, television viewing, and eating disorder symptomatology in young females
J. Adolesc.
(2002) - et al.
Depressive symptoms and adolescent eating and health behaviors: A multifaceted view in a population-based sample
Prev. Med.
(2004) - et al.
Internet use and video gaming predict problem behavior in early adolescence
J. Adolesc.
(2011)
Self-concept, self-esteem, gender, race, and information technology use
Comput. Hum. Behav.
Depressive symptoms in adolescence: The association with multiple health risk behaviors
Gen. Hosp. Psychiatry
The nonlinear association between Internet using time for non-educational purposes and adolescent health
J. Prev. Med. Public Health
Associations between sedentary behavior and self-esteem in adolescent girls from schools in low-income communities
Ment. Health Phys. Act.
The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population
J. Psychosom. Res.
Mental health of young people: A global public-health challenge
Lancet
Associations between media use and health in US children
Acad. Pediatr.
A meta-analysis of the relationship between children's physical activity and mental health
J. Pediatr. Psychol.
A meta-analysis of the relationship between children's physical activity and mental health
J. Pediatr. Psychol.
Correlates of video games playing among adolescents in an Islamic country
BMC Public Health
Association of depression with body mass index, sedentary behavior, and maladaptive eating attitudes and behaviors in 11 to 13-year old children
Eat. Weight Disord.
Child and adolescent mental disorders: The magnitude of the problem across the globe
J. Child Psychol. Psychiatry
Pediatric obesity and depression: A cross-sectional analysis of absolute BMI as it relates to children's depression index scores in obese 7- to 17-year-old children
Clin. Pediatr.
Physical activity and mental health in children and adolescents: A review of reviews
Br. J. Sports Med.
Is television viewing a suitable marker of sedentary behavior in young people?
Ann. Behav. Med.
Predictors of quality of life in children
J. Hum. Sport Exerc.
The mirror of television: A comparison of Black and White adolescents' body image
J. Commun.
Sociodemographic, developmental, environmental, and psychological correlates of physical activity and sedentary behavior at age 11 to 12
Ann. Behav. Med.
Associations between screen-based sedentary behavior and cardiovascular disease risk factors in Korean youth
J. Korean Med. Sci.
The mass media exposure and disordered eating behaviours in Spanish secondary students
Eur. Eat. Disord. Rev.
Volume, patterns, and types of sedentary behavior and cardio-metabolic health in children and adolescents: A cross-sectional study
BMC Public Health
Volume, patterns, and types of sedentary behavior and cardio-metabolic health in children and adolescents: A cross-sectional study
BMC Public Health
Systematic reviews: CRD's guidance for undertaking reviews in health care
A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents
Ann. Gen. Psychiatry
After-school time use in Taiwan: Effects on educational achievement and well-being
Adolescence
Associations of lifestyle factors with quality of life (QOL) in Japanese children: A 3-year follow-up of the Toyama Birth Cohort Study
Child Care Health Dev.
The relationship between TV/computer time and adolescents' health-promoting behavior: A secondary data analysis
J. Nurs. Res.
Early television exposure and subsequent attentional problems in children
Pediatrics
Investigation of the relationship between social isolation, self-esteem, aggression and computer game play in Japanese adolescents
Asian J. Soc. Psychol.
Negative correlates of computer game play in adolescents
Br. J. Psychol.
Media use and children's perceptions of societal threat and personal vulnerability
J. Clin. Child Adolesc. Psychol.
Health behaviors and health-related quality of life among middle school children in Southern Appalachia: data from the winning with wellness project
J. Pediatr. Psychol.
Videogames, television violence, and aggression in teenagers
J. Commun.
Sedentary behavior in adolescents: The 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study
Cad. Saúde Pública
TV viewing and physical activity are independently associated with metabolic risk in children: The European Youth Heart Study
PLoS Med.
Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents
JAMA
Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents
Eur. Child Adolesc. Psychiatry
Explaining the relationship between media exposure and early adolescents' body image perceptions
J. Med. Psychol.
Videogames, aggression, and self-esteem: A survey
Soc. Behav. Personal.
Use of active video games to increase physical activity in children: A (virtual) reality?
Pediatr. Exerc. Sci.
Cited by (204)
Combinations of physical activity, screen time and sleep, and their association with subjective wellbeing in children
2023, Complementary Therapies in Clinical PracticeScreen use before sleep and emotional problems among adolescents: Preliminary evidence of mediating effect of chronotype and social jetlag
2023, Journal of Affective DisordersExercise, physical activity, and mental health
2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3Screen media technology and ADHD in children and adolescents: Potential perils and emerging opportunities
2023, Encyclopedia of Child and Adolescent Health, First EditionSedentary behavior
2023, Encyclopedia of Child and Adolescent Health, First Edition