Dose-response association of screen time-based sedentary behaviour in children and adolescents and depression: a meta-analysis of observational studies

Abstract

Background: Depression represents a growing public health burden. Understanding how screen time (ST) in juveniles may be associated with risk of depression is critical for the development of prevention and intervention strategies. Findings from studies addressing this question thus far have been inconsistent. Therefore, we conducted a comprehensive systematic review and meta-analysis of data related to this question.

Methods: The meta-analysis was conducted in accordance with the PRISMA guideline. We searched the electronic databases of PubMed, Web of Science and EBSCO systematically (up to 6 May 2015). OR was adopted as the pooled measurement of association between ST and depression risk. Dose-response was estimated by a generalised least squares trend estimation.

Results: Twelve cross-sectional studies and four longitudinal studies (including 1 cohort study) involving a total of 127 714 participants were included. Overall, higher ST in preadolescent children and adolescents was significantly associated with a higher risk of depression (OR=1.12; 95% CI 1.03 to 1.22). Screen type, age, population and reference category acted as significant moderators. Compared with the reference group who had no ST, there was a non-linear dose-response association of ST with a decreasing risk of depression at ST<2 h/day, with the lowest risk being observed for 1 h/day (OR=0.88; 95% CI 0.84 to 0.93).

Conclusions: Our meta-analysis suggests that ST in children and adolescents is associated with depression risk in a non-linear dose-response manner.

Keywords: Adolescent; Depression; Physical activity; Psychology; Sedentary.

Figure 1

Flow chart of article screening process.

Figure 2

Forest plot of the association between depression risk and screen time (hours/day) in children and adolescents by study design. OR of depression risk for higher daily screen time compared with reference groups and corresponding 95% CI (F, female; M, male).

Figure 3

The dose–response relationship for the association between screen time in children and adolescents and risk of depression (solid line) as estimated by a generalised least squares trend estimation. Screen time was modelled with a restricted cubic spline in a two-stage random-effects dose–response model. The ORs are plotted on the log scale. Dashed lines represent the 95% CIs for the spline model. No screen time served as the referent category.

Figure 4

Forest plot of the association between depression risk and screen time (hours/day) in children and adolescents by screen type. OR of depression risk for higher daily screen time compared with reference groups and corresponding 95% CI (F, female; CU, computer/internet use; M, male; TV, television; VG/CG, video games/computer games).