Associations between adherence to 24-hour movement guidelines with depression, anxiety, and loneliness among Chinese adolescents

Abstract

Purpose: While growing evidence suggests a link between meeting 24-hour movement guidelines and adolescent mental health, further investigation is needed to clarify this association. This cross-sectional study aimed to examine how adherence to single and combined 24-hour movement guidelines relates to depression, anxiety, and loneliness in adolescents, while exploring variations across sex and age.

Methods: A total of 15,344 adolescents aged 10-18 years in Shanghai were selected using multi-stage stratified cluster random sampling in 2021. Data on movement behavior and mental health problems were collected through self-reported questionnaires. Logistic regression was used to assess the associations and stratified analyses were performed for sex and age groups. The STROBE checklist for observational research was adopted for reporting.

Results: Only 2.7 % of our sample of Chinese adolescents met all three 24-hour movement behavior recommendations. Compared to not meeting any recommendations, meeting one or more recommendations was significantly associated with a lower risk of depression, anxiety, and loneliness (p < 0.001 for all), showing a dose-response gradient (p < 0.001 for all). Meeting both screen time and sleep recommendations showed near-equivalent protection against depression (OR = 0.47, 95%CI 0.37-0.61) to meeting all three recommendations (OR = 0.46, 95%CI 0.32-0.64). Meeting the guidelines appeared to have a stronger protective effect on the mental health of girls and younger adolescents than boys and older adolescents.

Conclusions: Meeting 24-hour movement guidelines, particularly screen time and sleep recommendations, was associated with a reduced risk of depression, anxiety, and loneliness in adolescents. These findings highlight the importance of integrating 24-hour movement guidelines into public health initiatives, such as school-based policies promoting balanced schedules and parental guidance on recreational screen use.

Keywords: Mental health; Movement behaviors; Physical activity; Sedentary behavior; Sleep.