Double-Edged Sword: The Impact of Devices and Screen Time on Medical Students' Health and Academic Performance

Introduction Electronic media are an integral part of university students' academic and personal lives; however, their excessive use may interfere with the cognitive functions critical for learning. Intelligence can be assessed through crystallized intelligence (Gc), which reflects accumulated knowledge, and fluid intelligence (Gf), which is associated with problem solving and adaptability. Also, neurophysiological measurements like the event-related potentials (ERPs), particularly P300, provide high temporal resolution measures of cognitive processing, allowing an assessment of attention (neurophysiological measures) and memory functions. This study hypothesizes that excessive screen time negatively impacts attention, fluid and crystallized intelligence, and academic performance in medical students. Materials and methods A total of 305 second-year medical students from a public university participated in the study (mean age: 20 years). Variables assessed included intelligence, attention, academic trajectory, and screen time. Intelligence was measured using the Shipley-2 test, and screen time was measured using a validated Screen Time Survey. For the neurophysiological measures, a subsample (n=30) underwent ERPrecording with the P300 oddball paradigm for neurophysiological analysis. Academic performance was determined from standardized physiology test scores. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (2017; IBM Corp., Armonk, New York, United States), GraphPad Prism (Dotmatics, Boston, Massachusetts, United States), and Excel (Microsoft Corporation, Redmond, New York, United States) through descriptive and inferential statistics. Results A significant relationship emerged between screen time, cognitive performance, and academic achievement. Participants reported an average daily screen exposure of 7.1 ± 4.3 hours. A negative correlation was identified between screen time and standardized test scores (r = -0.24, p < 0.001), indicating that increased screen use was associated with lower academic performance. Cognitive intelligence assessments revealed that Gf (R² = 0.848) and general cognition (R² = 0.400) were significantly affected, while Gc remained stable (R² = 0.001). Neurophysiological measures showed average P300 latencies of 358.33 ± 45.6 ms and amplitudes of 259.63 ± 61.6 μV. Shorter N100 latencies (86.7 ± 24.6 ms) correlated with better academic performance (r = -0.45, R² = 0.199). Discussion Students with greater screen time exhibited lower standardized exam scores, suggesting that excessive digital exposure may deplete the cognitive resources essential for academic tasks. The decline in fluid and general cognitive intelligence suggests a diminished capacity for problem-solving and adaptability. Neurophysiological markers indicated prolonged latencies and reduced amplitudes of key ERPs (N100, N200, and P300), reflecting impaired attentional control and working memory in students with higher screen exposure. These findings suggest that prolonged screen use contributes to slower and less efficient cognitive processing. Conclusions Excessive screen time, particularly due to recreational electronic media use, negatively affects cognitive performance and academic outcomes in medical students. The observed decline appears to be mediated by deficits in attention and working memory along with a reduction in Gf, which may impair problem-solving skills and adaptability in complex academic settings.

Introduction Electronic media are an integral part of university students’ academic and personal lives; however, their excessive use may interfere with the cognitive functions critical for learning. Intelligence can be assessed through crystallized intelligence (Gc), which reflects accumulated knowledge, and fluid intelligence (Gf), which is associated with problem solving and adaptability. Also, neurophysiological measurements like the event-related potentials (ERPs), particularly P300, provide high temporal resolution measures of cognitive processing, allowing an assessment of attention (neurophysiological measures) and memory functions. This study hypothesizes that excessive screen time negatively impacts attention, fluid and crystallized intelligence, and academic performance in medical students. Materials and methods A total of 305 second-year medical students from a public university participated in the study (mean age: 20 years). Variables assessed included intelligence, attention, academic trajectory, and screen time. Intelligence was measured using the Shipley-2 test, and screen time was measured using a validated Screen Time Survey. For the neurophysiological measures, a subsample (n=30) underwent ERP recording with the P300 oddball paradigm for neurophysiological analysis. Academic performance was determined from standardized physiology test scores. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (2017; IBM Corp., Armonk, New York, United States), GraphPad Prism (Dotmatics, Boston, Massachusetts, United States), and Excel (Microsoft Corporation, Redmond, New York, United States) through descriptive and inferential statistics. Results A significant relationship emerged between screen time, cognitive performance, and academic achievement. Participants reported an average daily screen exposure of 7.1 ± 4.3 hours. A negative correlation was identified between screen time and standardized test scores (r = -0.24, p &lt; 0.001), indicating that increased screen use was associated with lower academic performance. Cognitive intelligence assessments revealed that Gf (R² = 0.848) and general cognition (R² = 0.400) were significantly affected, while Gc remained stable (R² = 0.001). Neurophysiological measures showed average P300 latencies of 358.33 ± 45.6 ms and amplitudes of 259.63 ± 61.6 μV. Shorter N100 latencies (86.7 ± 24.6 ms) correlated with better academic performance (r = -0.45, R² = 0.199). Discussion Students with greater screen time exhibited lower standardized exam scores, suggesting that excessive digital exposure may deplete the cognitive resources essential for academic tasks. The decline in fluid and general cognitive intelligence suggests a diminished capacity for problem-solving and adaptability. Neurophysiological markers indicated prolonged latencies and reduced amplitudes of key ERPs (N100, N200, and P300), reflecting impaired attentional control and working memory in students with higher screen exposure. These findings suggest that prolonged screen use contributes to slower and less efficient cognitive processing. Conclusions Excessive screen time, particularly due to recreational electronic media use, negatively affects cognitive performance and academic outcomes in medical students. The observed decline appears to be mediated by deficits in attention and working memory along with a reduction in Gf, which may impair problem-solving skills and adaptability in complex academic settings.

Excessive screen time and the growing influence of digital technologies have raised concerns about their impact on children's physical health, academic performance, and social behaviour. Parenting styles and parent-child relationships further modulate these outcomes. This scoping review examines the impact of excessive digital screen time and social media addiction on parenting styles, the parent-child relationship and child behaviour. This scoping review was conducted following the Joanna Briggs Institute guidelines, including a quality appraisal checklist for observational studies. We utilized the Arksey and O’Malley framework to report the methodology and results, and applied the PAGER framework to enhance the quality of the findings. Systematic searches were conducted across national and international databases. Original studies conducted in India and published in English between January 2012 and August 2024 were included in the review. Qualitative synthesis was adopted to describe outcomes. A total of 25 studies were included, involving 28,366 participants from urban and rural India. Excessive digital screen time and social media addiction influence parenting styles, leading to shifts in parent-child relationships. Specifically, authoritarian parenting behaviours were observed more frequently. Additionally, excessive screen exposure was associated with adverse physical health outcomes, including eye strain, backache, headaches, and obesity, along with mental health challenges such as depression, anxiety, and stress. Excessive social media use adversely affects children's mental health and academic performance, while parenting styles significantly influence these outcomes. Promoting balanced media use and nurturing parent-child relationships can mitigate these impacts and foster positive development.

Objective: To explore the relationship between academic and recreational screen time and physical activity levels among medical students in Pakistan, taking into account demographic and lifestyle factors. Study Design: Cross-sectional study Place and Duration of Study: The study was conducted at Liaquat National Hospital and Nishtar Medical University from October 2024 to March 2025. Subjects and Methods: A stratified random sample of 374 medical students was selected, and data were collected through a structured questionnaire that assessed screen time and physical activity using the International Physical Activity Questionnaire (IPAQ). Statistical analyses, including Chi-square tests and binary logistic regression performed using SPSS version 23, with a significance threshold set at p ≤ 0.05. Results: The participants reported an average academic screen time of 2.43 ± 1.39 hours per day and recreational screen time of 3.58 ± 1.48 hours per day. Recreational screen time negatively impacted academic performance for 59.9% of students, with only 5.6% engaging in physical activities concurrently. Physical activity levels were low among 65% of participants. Barriers to physical activity included a lack of motivation (47.9%) and academic commitments (35.6%). Male students and those over the age of 20 exhibited higher levels of physical activity. Excessive academic screen time was strongly associated with low physical activity (p &lt; 0.001). Conclusion: Medical students in Pakistan demonstrate low levels of physical activity, which are further exacerbated by excessive screen time, particularly for academic purposes. Interventions aimed at promoting balanced screen use and encouraging physical activity are essential.

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was β = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

<h3>Context</h3> The adolescent patient population often suffers consequences from social media consumption, to include cyber-bullying, poor mental health, sleep disturbances, decline in academic performance, and body dissatisfaction. Screen time will be compared to prevalence of poor mental health in this study. <h3>Objective</h3> No consensus exists for what constitutes a healthy amount of screen time or social media consumption. This study examines the effects of screen time on adolescents, offering support for interventions at school and family unit levels. <h3>Study Design and Analysis</h3> A retrospective cross-sectional analysis of the CDC’s 2011 and 2021 Youth Risk Behavior Survey (YRBS) was completed. The primary study question was to learn associations of excess screen time, poor sleep quantity, and their downstream effects. <h3>Setting or Dataset</h3> The YRBS has been administered bi-annually across the United States since 1991. The 2021 and 2011 surveys were administered to 17,232 and 15,425 students, respectively. <h3>Population Studied</h3> Males and females in grades 9 through 12 in public and private schools in the United States. <h3>Intervention/Instrument</h3> The CDC’s YRBS is a strong data source for understanding nationwide adolescent behaviors, outcomes, and leading causes of death and disability among high schoolers in the United States. <h3>Outcome Measures</h3> Prevalence of poor sleep quantity, difficulty concentrating, poor mental health, and desire to lose weight associated with excess screen time. Prevalence of difficulty concentrating, poor mental health, and desire to lose weight associated with poor sleep quantity. <h3>Results</h3> Inadequate sleep increased the risk of poor mental health, difficulty concentrating, and desire to lose weight. Excess screen time increased the risk of getting inadequate sleep, having poor mental health, and difficulty concentrating. Female students were more likely to desire to lose weight. Male students were more likely to desire to gain weight. Being female and having inadequate sleep both increased the risk of the desire to lose weight. Excess screen time is a greater risk for poor mental health than having inadequate sleep. Inadequate sleep is a greater risk for difficulty concentrating than excess screen time. <h3>Conclusions</h3> Relationships between screen time, sleep, and behavioral outcomes warrant a change in policy or education surrounding screen time. Primary care providers may have the greatest impact in implementing such education at well-child visits.

This study aims to identify factors associated with excessive screen time among preschoolers in Lima, Peru. Cross-sectional analysis from a 2019 panel study in Lima, Peru, was conducted focusing on women, aged 18 and above, who are mothers of 3- to 5-year-olds in mid-high and mid-low districts. There were two outcome variables: excessive TV and excessive electronic devices screen time, defined as ≥ 1 h of screen exposure for each one. Explored factors included the mother's age, education and wealth index and the children's age, sex, physical activity, day care attendance and ultra-processed food consumption. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between associated factors and excessive screen time using the GLM Poisson of with a logarithmic link. Excessive TV screen time and electronic devices prevalence was 74% and 36.9%, respectively. For TV screen time, a high wealth index (aPR 1.13; 95%CI: 1.03-1.23) and children's age (aPR 1.18; 95%CI: 1.08-1.29 for 4 years, PR = 1.17; 95%CI: 1.07-1.28 for 5 years) were significant. For electronic devices, significant associations included mothers with more than 3 children (aPR 0.77; 95%CI: 0.62-0.96), being single (aPR 1.27; 95%CI: 1.01-1.58) and a high wealth index (aPR 1.38; 95%CI: 1.13-1.68). Furthermore, significant associations were found between excessive electronic device screen time and consumption of candies and chocolates (aPR 1.38; 95%CI: 1.08-1.77). Seven out of 10 preschool children exceeded the recommended television screen time. Certain characteristics of the children, their mothers and the family's socio-economic situation are related to excessive television screen time and excessive electronic device screen time.

Digital media use has expanded rapidly among medical students, raising concerns about its impact on cognitive function and academic achievement. However, specific links between screen time and distinct facets of cognition (such as fluid vs. crystallized intelligence), as well as their combined impact on academic performance, remain underexplored in medical education. This study explored how digital screen time and related behaviors are associated with different dimensions of intelligence (fluid and crystallized), attention, and academic performance in second-year medical students, using a network analysis approach. A cross-sectional sample of 305 second year medical students from the Faculty of Medicine, UNAM, recruited during the 2023 academic year, completed standardized assessments: the Shipley-2 test for crystallized (Gc) and fluid intelligence (Gf), the Youth Screen Time Survey, and official academic records (standardized Physiology course exam scores). Network analysis was implemented through the igraph package in R to identify structural relationships among 34 variables representing cognitive, behavioral, and academic domains. The network analysis identified six clusters of interrelated variables, revealing distinct groupings linking digital behavior, cognitive abilities, and academic outcomes. Key variables with the highest connectivity (centrality) were the number of failed courses, total screen time, and age, indicating these factors are most influential in the network. Notably, text messaging and short-form video use (e.g., TikTok) emerged as bridge nodes connecting digital media use to academic performance. Higher screen time was associated with lower academic performance (r ≈ -0.24) and reduced fluid intelligence, while crystallized intelligence appeared relatively unaffected. Excessive digital exposure was associated with weaker cognitive efficiency and academic performance in this cross-sectional sample. These findings underscore the need for balanced digital habits to support attention, learning, and problem-solving capacity in medical students.

Background and Aim. Final-year medical sciences students are exposed to sustained academic and clinical demands that predispose them to multidimensional mental fatigue, including sleep deprivation, burnout, perceived workload and sustained attention deficits. Although these dimensions have frequently been examined in isolation, there remains insufficient integrated evidence on how they differentially predict specific academic performance outcomes within a unified analytical framework, particularly in the Lithuanian higher education context. The aim of this study was to examine the predictive relationships between dimensions of mental fatigue and academic performance outcomes among final-year medical students in Lithuania. Methods. A quantitative cross-sectional survey design was employed. Data were collected from 150 final-year health sciences students across selected Lithuanian universities using structured Likert-scale questionnaires measuring four dimensions of mental fatigue and four academic performance indicators. Descriptive statistics and simple linear regression models were conducted using SPSS (Version 27) to test the proposed hypotheses at a significance level of p &lt; 0.05. Results. All four dimensions of mental fatigue demonstrated significant negative associations with their respective academic outcomes. Sleep deprivation significantly predicted reduced class participation; burnout was negatively associated with examination performance; perceived workload significantly predicted lower GPA; and sustained attention deficits were significantly related to reduced assignment completion. The regression models indicated moderate explanatory power, confirming that increased mental fatigue corresponds with measurable declines in academic functioning. Conclusions. Multidimensional mental fatigue significantly predicts academic performance among final-year health sciences students. Institutional strategies aimed at sleep regulation, burnout mitigation, workload optimisation, and attentional support may enhance academic engagement and overall performance outcomes within this population. Keywords: Mental fatigue; sleep deprivation; burnout; academic performance; health sciences students

Background: Myopia, or nearsightedness, is increasingly prevalent among students, largely due to prolonged screen time, near work (visually demanding activities performed at a short distance (typically less than 40 cm)), and reduced outdoor activity. Medical students, in particular, are at higher risk due to academic pressure and digital exposure, affecting their vision, performance, and well-being. Early detection and prevention are essential. This study investigates the prevalence, risk factors (genetics, near work, screen use, outdoor activity), and impact of myopia on daily life and academics to support awareness and better eye care practices.Methodology: This cross-sectional study was conducted among undergraduate medical students in three tertiary care hospitals in Andhra Pradesh, India, over four months (August-December 2024). Using probability proportional to size sampling (PPSS), 1,506 students across different academic years were selected. Eligible participants were enrolled students who consented to participate, while those with hypermetropia or severe ocular conditions were excluded. Data were collected via a structured questionnaire covering demographics, myopia history, lifestyle habits, and academic performance, as well visual discomfort, psychological well-being, and myopia correction practices. Ethical approval was obtained, confidentiality was maintained, and pre-testing ensured data accuracy. Descriptive analysis determined myopia prevalence, and chi-squared tests were used to assess associations with genetics, screen time, sleep patterns, and academic performance.Results: The overall prevalence of myopia among the medical students was 947 (61.55%), with significant associations between demographic and lifestyle factors. The highest prevalence was in the 20-22 age group (412, 62.24%) and the lowest in the 23-25 group (23, 48.94%), though the difference was not statistically significant (χ² = 5.23, p = 0.51). A total of 597 (65.19%) female students had a significantly higher prevalence than male students (322, 54.58%) (χ² = 17.38, p < 0.001). Myopia prevalence varied by academic year (χ² = 743.7, p < 0.001), peaking in third-year students (244, 70.11%) and lowest in fourth-year students (161, 46.55%). Family history was a strong predictor (χ² = 103.07, p < 0.001), with a higher prevalence among those with genetic predisposition (83.57%). Early onset (ages 5-10 years) was associated with greater severity (χ² = 248.03, p < 0.001), with 58 (51.33%) developing moderate and 25 (22.12%) high myopia. The associations with near work (χ² = 15.14, p = 0.08), screen time (χ² = 12.09, p = 0.2), and sleep patterns (χ² = 4.4, p = 0.88) were weak. Psychological distress was correlated with severity (χ² = 28.26, p < 0.05), and 50% of the high myopes reported severe limitations in daily activities.Conclusion: This study highlights the high prevalence of myopia among medical students in Andhra Pradesh, linking it to lifestyle factors, such as prolonged near work, excessive screen time, and limited outdoor activity. Female students, particularly in their first year, were a higher risk. These findings emphasizes the importance of early detection through regular eye check-ups and lifestyle adjustments to slow myopia progression. Additionally, this study underscores the impact of myopia on academics, daily life, and mental well-being, reinforcing the need for targeted vision-care strategies and preventive measures in academic settings.

Objective: 1. To investigate smartphone use and severity of addiction, anxiety and depression. 2. To find out the relationship between smartphone use with addiction, anxiety and depression. Study Design: Cross-sectional study. Setting: At MBBS and Allied (DPT, Pharmaceutical Sciences, Public Health &amp; Nursing) Departments of Peoples University of Health Sciences for Women, Shaheed Benazirabad, Pakistan. Period: from August 2023 to January 2024. Methods: Among undergraduate medical students aged 18 to 25 the study's sample size was 350, and a multistage random sampling technique was used to select the participants from the Peoples University of Medical and Health Sciences for Women. After approval by the institution, data were collected from the medical students using validated tools, including smartphone addiction (SAS scale), depression (PHQ-9), and anxiety (GAD-7). The data were analyzed using SPSS software version 25. A chi-square test was used to identify the association between smartphone usage and addiction, depression, and anxiety, and a p-value of &lt;0.05 was considered statistically significant. Results: The findings revealed that half the students (49.7%) spent more than 6 hours per day on their mobile screens. (49.1%) of medical students reported having a high prevalence of smartphone addiction, (48.6%) reported having moderate to severe depression, and (55.8%) reported having moderate to severe anxiety. Addiction, depression, and anxiety scores were higher among the excessive smartphone use group than in the low smartphone users. A statistically positive association was found between smartphone usage and the addiction level, depression level, and anxiety level scores. Conclusion: This study highlights the overdependence on smartphones among medical students and the positive association between smartphone usage and mental health outcomes like addiction, anxiety and depression among PUMHSW medical students in Pakistan. Excessive screen time can impact students' academic performance, sleep quality, and eating behaviors.

Background: Sleep disturbance is an important issue among medical students and high stress including the pressure of maintaining grades might affect the quality of sleep among students. Objective: To determine the effects of sleep quality on medical and dental students' cardiovascular system, academic performance, and anxiety at Peshawar Medical and Dental College. Methodology: The Riphah International University and Prime Foundation Pakistan Institutional Review Board approved a cross-sectional research for their respective institutions. Interrogation of randomly chosen individuals was conducted using the Pittsburgh Sleep Quality Index (PSQI), as well as physiological data. The data were entered and analyzed using SPSS-25. Result: In our research, out of 600 individuals, 286 (46.7%) had excellent sleep quality (PSQI score less than 5) and 314 (52.3%) had poor sleep quality (PSQI score larger than 5). (PSQI score greater than 5). Among medical students, there was a statistically significant link between sleep quality and physiologic parameters, academic performance, and anxiety score; heart rate (p0.05), systolic blood pressure (p0.05), diastolic blood pressure (p0.01), and academic performance (p0.05) were all linked. Conclusion: Academic performance, heart rate, and blood pressure were shown to be significantly correlated with sleep quality in dentistry and medical students; however sleep quality was not found to be significantly correlated with anxiety scores. Keywords: Effects, Sleep Quality, Cardiovascular System, Anxiety, Academic Performance

PurposeThis study aimed to investigate the associations between adverse childhood experiences (ACEs) and excessive recreational screen time. MethodsUsing data from the UK Millennium Cohort Study, we examined the associations of prospectively collected individual ACEs, ACE scores, and poverty with excessive recreational screen time (>4 hours) across different media types. We ran further analyses to investigate sex differences in the associations of ACEs with excessive screen time. The robustness of these associations were tested by controlling for sociodemographic factors. ResultsAmong the included 11,439 adolescents (49.9% boys), those who experienced three or more ACEs were more likely to partake in excessive screen time compared to those with no ACEs after adjusting for covariates. This included recreational internet time at age 14, television time at age 14, electronic game time at ages 14 and 17, and social networking time at ages 14 and 17. We found similar associations between individual ACEs and excessive screen time. For example, parental mental health problems were associated with excessive recreational internet time (odds ratio [OR]: 1.28; 95% confidence interval [CI]: 1.15, 1.42), excessive television time (OR: 1.14; 95% CI: 1.01, 1.28), and excessive electronic game time (OR: 1.34; 95% CI: 1.16, 1.56) at age 14. Boys showed stronger associations between certain ACEs and excessive screen time compared to girls. DiscussionACEs and poverty are associated with adolescents' later excessive recreational screen time, including excessive time spent on television watching, electronic games, and social networking.

Background/Objectives: Adolescents’ screen time has increased alongside rising rates of depression and suicidal ideation and behavior. This study examined associations between excessive screen time and mental health among U.S. high school students, and explored whether social image factors (overweight perception, sports team participation, and academic performance) mitigate these associations. Methods: We analyzed data from the 2019 Youth Risk Behavior Surveillance System (YRBSS) (N = 13,677). Screen time was categorized as <2, 2–3, ≥4 h per day for television watching and digital device use (excluding school-related use). Multivariate logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations between screen time and mental health outcomes, adjusting for demographic and social image factors. Results: Overall, 31.7% of students reported using digital devices for ≥4 h per day, compared with 10.2% who watched television for ≥4 h per day. Using digital devices for ≥4 h per day was significantly associated with difficulty concentrating (AOR = 1.68), insufficient sleep (AOR = 1.43), feeling sad or hopeless (AOR = 1.86), and suicidal ideation (AOR = 1.69 for considering suicide; AOR = 1.77 for planning suicide) compared with using digital devices for <2 h per day, after adjusting for demographic and social image factors. Significant associations between television viewing and mental health outcomes appeared to be largely explained by social image factors. Female students and certain racial/ethnic groups were more likely to report mental health difficulties. Students with a positive social image reported lower odds of poor mental health outcomes and excessive screen time. Conclusions: Excessive digital device use is associated with poor mental health and suicidal ideation among high school students, with female students particularly vulnerable. Social image factors were also associated with screen time and mental health outcomes. Interventions that promote school engagement, sports team participation, and a positive social image may help mitigate the adverse effects of excessive screen time.

ObjectiveWe examined whether excessive screen time (ST) is associated with emotional and behavioral problems (EBPs) in young school children mediated by sleep disturbance.MethodsThis was a cross-sectional survey of 3883 children aged 7–9 years at 18 primary schools in Shenzhen. Data on children’s ST on weekdays and weekends as well as household environment, parental ST, and parental accompaniment time were collected. Sleep disturbance and EBPs were assessed with the Sleep Disturbance Scale for Children and the Strengths and Difficulties Questionnaire (SDQ), respectively. Odds ratios (ORs) and 95% confidence intervals (CIs), the average causal mediation effects and the average direct effects were estimated.ResultsOverall, 15.7% of children had ST in excess of the recommended 2 hr/day, and 24.1% of parents reported that their child had a sleep disturbance. The total SDQ score was higher for children with than without ST ≥ 2 hr/day and sleep disturbance (P<0.001). After adjustment for potential confounders, children with ST ≥ 2 hours/day had increased odds of sleep disturbances (OR 1.99, 95% CI 1.65–2.33). The odds of EBPs were increased for children with ST ≥ 2 hr/day (OR 1.34, 95% CI 1.11–1.64) and sleep disturbance (OR 2.77, 95% CI 2.23–3.22). Mediation analysis indicated that sleep disturbance partially explained the association between ST and EBPs (all effects statistically significant, P < 0.001).ConclusionExcessive ST was significantly associated with EBPs and may be mediated by sleep disturbance. Reducing children’s ST and encouraging good sleep practices may enhance mental health.