Abstract
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) “Health Behaviour in School-aged Children” 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents’ psychological symptoms. Future interventions improving adolescents’ mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.
Highlights
The prevalence of mental health problems among adolescents (i.e., 12–18-year-olds) is alarming: an average of 20% of European adolescents suffer from developmental, behavioral, or emotionalInt
This study showed that more school pressure, fewer days of engaging in sufficient physical activity, and higher levels of screen time were associated with more psychological symptoms in European adolescents
Our results are in line with a previous study, in which better sleep quantity and quality were related to a better mental health status in adolescents [32,33]
Summary
The prevalence of mental health problems among adolescents (i.e., 12–18-year-olds) is alarming: an average of 20% of European adolescents suffer from developmental, behavioral, or emotionalInt. The prevalence of mental health problems among adolescents (i.e., 12–18-year-olds) is alarming: an average of 20% of European adolescents suffer from developmental, behavioral, or emotional. Res. Public Health 2019, 16, 1072; doi:10.3390/ijerph16061072 www.mdpi.com/journal/ijerph. Res. Public Health 2019, 16, 1072 problems, and about 12.5% have a clinically diagnosed mental disorder [1,2]. The prevalence of major depression among adolescents in Europe ranges between 7.1% and 19.4% [3]. Poor mental health in adolescence tracks into adulthood [4]. Given the high prevalence of mental health problems in European adolescents, the prevention of these problems is an important public health issue
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