Abstract
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. 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. 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. 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. 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. 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.
Highlights
IntroductionThe COVID-19 pandemic has resulted in major changes in the daily routines of children, primarily because of the imposed public health measures related to distancing, isolation, and school closures (see eAppendix 1 in the Supplement for COVID-19 public health measures and daily cases in Ontario, Canada).[1,2] Children and youth reported higher levels of electronic screen use during the pandemic compared with prepandemic levels.[3,4,5,6,7,8] Our group reported that children’s adherence to COVID-19 public health measures was associated with higher screen use among young children in Ontario.[9]Research[10,11,12] conducted before the pandemic consistently showed that high levels of screen use are associated with depression, anxiety, conduct disorders, and attention problems in children and youth, causality cannot be concluded
In younger children, higher TV or digital media time was associated with higher levels of conduct problems and hyperactivity/inattention (β, 0.07 [95% CI, 0.006-0.14]; P = .04)
In older children and youth, 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
Summary
The COVID-19 pandemic has resulted in major changes in the daily routines of children, primarily because of the imposed public health measures related to distancing, isolation, and school closures (see eAppendix 1 in the Supplement for COVID-19 public health measures and daily cases in Ontario, Canada).[1,2] Children and youth reported higher levels of electronic screen use during the pandemic compared with prepandemic levels.[3,4,5,6,7,8] Our group reported that children’s adherence to COVID-19 public health measures was associated with higher screen use among young children in Ontario.[9]Research[10,11,12] conducted before the pandemic consistently showed that high levels of screen use are associated with depression, anxiety, conduct disorders, and attention problems in children and youth, causality cannot be concluded. The COVID-19 pandemic has resulted in major changes in the daily routines of children, primarily because of the imposed public health measures related to distancing, isolation, and school closures (see eAppendix 1 in the Supplement for COVID-19 public health measures and daily cases in Ontario, Canada).[1,2] Children and youth reported higher levels of electronic screen use during the pandemic compared with prepandemic levels.[3,4,5,6,7,8] Our group reported that children’s adherence to COVID-19 public health measures was associated with higher screen use among young children in Ontario.[9]. Research[13] by our group provided evidence that stress due to social isolation was associated with deterioration in multiple mental health domains during COVID-19. In addition to high screen use and social isolation, the worsening of child mental health could be related to the displacement of sleep, physical exercise, and other prosocial activities, which were disrupted during the pandemic.[3,5,14] The exposure to online bullying, stressful news, and harmful advertisements during screen use could contribute to poor child mental health during the pandemic.[15]
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