. 2021 Dec 1;4(12):e2140875.

doi: 10.1001/jamanetworkopen.2021.40875.

Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

Xuedi Li¹, Leigh M Vanderloo^{1

2

3}, Charles D G Keown-Stoneman^{4

5}, Katherine Tombeau Cost⁶, Alice Charach^{6

7}, Jonathon L Maguire^{4

8

9}, Suneeta Monga^{6

7}, Jennifer Crosbie^{6

7}, Christie Burton⁶, Evdokia Anagnostou^{8

10}, Stelios Georgiades¹¹, Rob Nicolson¹², Elizabeth Kelley¹³, Muhammad Ayub¹⁴, Daphne J Korczak^{6

7}, Catherine S Birken^{1

8}

Affiliations

¹ Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
² School of Occupational Therapy, Western University, London, Ontario, Canada.
³ ParticipACTION, Toronto, Ontario, Canada.
⁴ Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.
¹⁰ Holland Bloorview Research Institute, Toronto, Ontario, Canada.
¹¹ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
¹² Department of Psychiatry, Western University, London, Ontario, Canada.
¹³ Department of Psychology, Queens University, Kingston, Ontario, Canada.
¹⁴ Department of Psychiatry, Queens University, Kingston, Ontario, Canada.

PMID: 34962557
PMCID: PMC8715351
DOI: 10.1001/jamanetworkopen.2021.40875

Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

Xuedi Li et al. JAMA Netw Open. 2021.

. 2021 Dec 1;4(12):e2140875.

doi: 10.1001/jamanetworkopen.2021.40875.

Authors

Affiliations

¹ Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
² School of Occupational Therapy, Western University, London, Ontario, Canada.
³ ParticipACTION, Toronto, Ontario, Canada.
⁴ Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada.
¹⁰ Holland Bloorview Research Institute, Toronto, Ontario, Canada.
¹¹ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
¹² Department of Psychiatry, Western University, London, Ontario, Canada.
¹³ Department of Psychology, Queens University, Kingston, Ontario, Canada.
¹⁴ Department of Psychiatry, Queens University, Kingston, Ontario, Canada.

PMID: 34962557
PMCID: PMC8715351
DOI: 10.1001/jamanetworkopen.2021.40875

Abstract

Importance: Longitudinal research on specific forms of electronic screen use and mental health symptoms in children and youth during COVID-19 is minimal. Understanding the association may help develop policies and interventions targeting specific screen activities to promote healthful screen use and mental health in children and youth.

Objective: To determine whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19.

Design, setting, and participants: A longitudinal cohort study with repeated measures of exposures and outcomes was conducted in children and youth aged 2 to 18 years in Ontario, Canada, between May 2020 and April 2021 across 4 cohorts of children or youth: 2 community cohorts and 2 clinically referred cohorts. Parents were asked to complete repeated questionnaires about their children's health behaviors and mental health symptoms during COVID-19.

Main outcomes and measures: The exposure variables were children's daily TV or digital media time, video game time, electronic-learning time, and video-chatting time. The mental health outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention using validated standardized tools.

Results: This study included 2026 children with 6648 observations. In younger children (mean [SD] age, 5.9 [2.5] years; 275 male participants [51.7%]), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: β, 0.22 [95% CI, 0.10-0.35]; P < .001; age ≥4 years: β, 0.07 [95% CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (β, 0.07 [95% CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 male participants [56.5%]), higher levels of TV or digital media time were associated with higher levels of depression, anxiety, and inattention; higher levels of video game time were associated with higher levels of depression, irritability, inattention, and hyperactivity. Higher levels of electronic learning time were associated with higher levels of depression and anxiety.

Conclusions and relevance: In this cohort study, higher levels of screen use were associated poor mental health of children and youth during the COVID-19 pandemic. These findings suggest that policy intervention as well as evidence-informed social supports are needed to promote healthful screen use and mental health in children and youth during the pandemic and beyond.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Charach reported receiving grants from SickKids Hospital and Leong Centre for Healthy Children and in-kind support for all POND data from the Ontario Brain Institute during the conduct of the study. Dr Monga reported receiving grants from Cundill Centre for Youth Depression at the Centre for Addiction and Mental Health, book royalties from Springer Publishers, and grants from Canadian Institutes of Health Research outside the submitted work. Dr Anagnostou reported receiving consultation fees from Roche and Quadrant, research funding from Roche, in-kind support from AMO pharma, editorial honoraria from Wiley, and book royalties from APPI and Springer; she also holds a patent for the device Tully (formerly Anxiety Meter). Dr Nicolson reported receiving grants from Ontario Brain Institute during the conduct of the study. Dr Kelley reported receiving grants from Ontario Brain Institute, Canadian Institutes of Health Research, and the Masonic Foundation of Ontario outside the submitted work. No other disclosures were reported.

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Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

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Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

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