Sports activity limitation during the COVID-19 pandemic in young Italian athletes: impact on mental health in children, adolescents, and young adults

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Children's physical activity and screen time are likely suboptimal during the COVID-19 pandemic, which may influence their current and future mental health. To describe the association of physical activity and screen time with mental health among US children during the pandemic. This cross-sectional survey was conducted from October 22 to November 2, 2020, among 547 parents of children aged 6 to 10 years and 535 parent-child dyads with children and adolescents (hereinafter referred to as children) aged 11 to 17 years and matched down to 500 children per cohort using US Census-based sampling frames. Children aged 11 to 17 years self-reported physical activity, screen time, and mental health, and their parents reported other measures. Parents of children aged 6 to 10 years reported all measures. All 1000 cases were further weighted to a sampling frame corresponding to US parents with children aged 6 to 17 years using propensity scores. Child physical activity, screen time, COVID-19 stressors, and demographics. Mental health using the Strengths and Difficulties Questionnaire for total difficulties and externalizing and internalizing symptoms. Among the 1000 children included in the analysis (mean [SD] age, 10.8 [3.5] years; 517 [52.6%] boys; 293 [31.6%] American Indian/Alaska Native, Asian, or Black individuals or individuals of other race; and 233 [27.8%] Hispanic/Latino individuals), 195 (20.9%) reported at least 60 minutes of physical activity every day. Children reported a mean (SD) of 3.9 (2.2) d/wk with at least 60 minutes of physical activity and 4.4 (2.5) h/d of recreational screen time. COVID-19 stressors were significantly associated with higher total difficulties for both younger (β coefficient, 0.6; 95% CI, 0.3-0.9) and older (β coefficient, 0.4; 95% CI, 0.0-0.7) groups. After accounting for COVID-19 stressors, engaging in 7 d/wk (vs 0) of physical activity was associated with fewer externalizing symptoms in younger children (β coefficient, -2.0; 95% CI, -3.4 to -0.6). For older children, engaging in 1 to 6 and 7 d/wk (vs 0) of physical activity was associated with lower total difficulties (β coefficients, -3.5 [95% CI, -5.3 to -1.8] and -3.6 [95% CI, -5.8 to -1.4], respectively), fewer externalizing symptoms (β coefficients, -1.5 [95% CI, -2.5 to -0.4] and -1.3 [95% CI, -2.6 to 0], respectively), and fewer internalizing symptoms (β coefficients, -2.1 [95% CI, -3.0 to -1.1] and -2.3 [95% CI, -3.5 to -1.1], respectively). More screen time was correlated with higher total difficulties among younger (β coefficient, 0.3; 95% CI, 0.1-0.5) and older (β coefficient, 0.4; 95% CI, 0.2-0.6) children. There were no significant differences by sex. In this cross-sectional survey study, more physical activity and less screen time were associated with better mental health for children, accounting for pandemic stressors. Children engaged in suboptimal amounts of physical activity and screen time, making this a potentially important target for intervention.

The COVID-19 pandemic has afforded the opportunity for some to improve lifestyle behaviours, while for others it has presented key challenges. Adverse changes in global lifestyle behaviours, including physical activity, sleep, and screen time can affect proximal mental health and in turn distal cardiovascular outcomes. We investigated differences in physical activity, sleep, and screen time in parents and children during early stages of the COVID-19 pandemic in Australia compared to pre-COVID-19 national data; and estimated associations between these movement behaviours with parent and child mental health. Cross-sectional baseline data from the COVID-19 Pandemic Adjustment Study (CPAS; N = 2,365) were compared to nationally representative pre-pandemic data from the Longitudinal Study of Australian Children (LSAC; N = 9,438). Participants were parents of children aged ≤ 18 years, residing in Australia. Parents provided self-report measures of mental health, physical activity and sleep quality, and reported on child mental health, physical activity and screen time. Children in CPAS had significantly more sleep problems and more weekend screen time. Their parents had significantly poorer sleep quality, despite increased weekly physical activity. Children's sleep problems were significantly associated with increased mental health problems, after accounting for socioeconomic status, physical activity, and screen time. Poorer parent sleep quality and lower levels of physical activity were significantly associated with poorer mental health. Monitoring this cohort over time will be important to examine whether changes in movement behaviour are enduring or naturally improve with the easing of restrictions; and whether these changes have lasting effects on either parent or child mental health, and in turn, future risk for CVD.

Evidence suggests that participation in physical activity may support young people's current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2-5years of age), children (6-11years of age) and adolescents (12-18years of age). A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6-18years (effect size 0.173, 95% confidence interval 0.106-0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity [I2] = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. Findings from the meta-analysis suggest that physical activity interventions can improve adolescents' mental health, but additional studies are needed to confirm the effects of physical activity on children's mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.

BackgroundDeclining physical activity and increasing screen time (ST) among Chinese adolescents have become major concerns shared by scholars, while mental health issues are also on the rise. Previous studies have confirmed the association between physical activity and screen time and psychological symptoms, but it is unclear how their psychological symptoms, especially for Chinese university students who have a high proportion of psychological symptoms, and no research evidence has been found.MethodsThis study investigated physical activity, screen time, and psychological symptoms in 11,173 university students aged 19–22 years in six regions of China. A binary logistic regression analysis was used to analyze the association between moderate-to-vigorous physical activity (MVPA) and screen time and psychological symptoms. And the generalize linear model (GLM) analysis was used to further analyze the association between MVPA and screen time and psychological symptoms.ResultsThe detection rate of psychological symptoms among Chinese university students was 16.3%, with a higher percentage of female students (17.5%) than male students (14.7%). The proportion of male students (8.2%) with MVPA > 60 min/d was higher than that of female students (2.3%), and the proportion of male students (33.8%) and female students (34.5%) with screen time > 2 h/d was basically the same. The generalize linear model (GLM) analysis showed that university students with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59, 95% CI: 1.10–2.31) had the highest risk of psychological symptoms (OR = 1.59, 95% CI: 1.10–2.31) compared to university students with MVPA > 60 min/d and screen time < 1 h/d as the reference group. The risk of psychological symptoms was the highest among those with MVPA < 30 min/d and screen time > 2 h/d (OR = 1.59,95% CI: 1.10–2.31). In addition, university students with MVPA > 60 min/d and a screen time of 1–2 h/d (OR = 0.09, 95% CI: 0.03–0.25) had the lowest risk of psychological symptoms (P < 0.001). The same trend was observed for both male and female students.ConclusionChinese university students have a certain proportion of psychological symptom problems, and there is a significant between MVPA and screen time and psychological symptoms, and the same trend exists for both male and female students. Chinese university students should perform MVPA for not less than 60 min a day, and at the same time control the duration of screen time, and screen time should be controlled between 1 and 2 h a day, which has a better promotion effect on psychological health.

Digital screen use is highly prevalent among adolescents, most of whom use smartphones, tablets, games consoles, computers and televisions daily. WHO guidelines for physical activity and sedentary behaviour recommend that school-age children and adolescents limit such recreational screen time, while a more definitive recommendation of up to 2 hours/day recreational screen time is provided in Canada, Australia and New Zealand. Compliance with this recommendation is typically low (eg 23% among UK adolescents)1 with 4–5+ hours/day screen use commonplace.2 A widely held view is that excessive screen time is detrimental to adolescents’ health and well-being. Screen time is unfavourably associated with sleep duration and quality, weight status, cardiometabolic risk, physical fitness, mental health and health-related quality of life.3 The magnitude of associations does though vary depending on the specific type of screen in question and the amount of time that adolescents engage with it. The potential negative health and well-being implications of screen time for adolescents may be further exacerbated by the consistently observed decline in physical activity and increase in sedentariness through the teen years. Maturational development drives physical changes that may contribute to reduced motivation for physical activity, particularly among girls, which may be compounded by societal norms and expectations related to physical appearance and accepted behaviours. Furthermore, sedentary and activity habits formed during adolescence can strongly predict those in adulthood. As a consequence, adolescence has been described as a ‘risk factor’ for physical inactivity with adolescent girls at heightened risk.4 The ubiquity of screen-based devices and their prevalence among teenagers only adds to this risk. iPhones and Android smartphones have only been around since 2007 and 2008, respectively, but they and other devices like games consoles, tablets, computers and televisions are now owned and used daily by adolescents across most parts of the world. Devices are central to the lives of adolescent girls and boys with social media, on-demand streaming, interactive gaming and other digital activities firmly embedded in teenagers’ routines. In this issue, Harrington and colleagues5 describe English adolescent girls’ screen use and associations with lifestyle behaviours and psychosocial health. The authors focused on concurrent use of multiple screen-based devices in over 800 adolescent girls who self-reported which screen-devices they used simultaneously during four discrete time periods (after-school, evenings, in bed at night and at weekends). Smartphones were most frequently used at all time periods, followed by televisions and tablets. Between 59% and 68% of girls used concurrent combinations of smartphones, televisions and tablets after school, in the evenings and at weekends, with over one-third using at least two screens in bed at night. At weekends, girls who used three screens simultaneously did 22 min/day less moderate-to-vigorous physical activity (MVPA) overall, 25 min/day less weekend MVPA, and spent an additional 1.5 hours/day in weekend sedentary time than girls who used no screens. Those using two screens concurrently in bed spent around 9 minutes less engaged in MVPA at the weekends, while evening screen use was associated with lower MVPA after-school and in the evening. After-school concurrent screen use was associated with higher body mass index and shorter weekday sleep duration, but interestingly, there were no significant differences in sleep related to bedtime screen use. Harrington and colleague's novel study demonstrates that during discretionary leisure time it is common for adolescent girls to ‘screen-stack’ with at least two devices. This is an important observation for researchers because usually data on simultaneous device use is not gathered, which limits efforts to understand adolescents’ screen behaviours and the potentials implications for health and well-being. The cross-sectional results indicate that concurrent screen use was negatively associated with healthy lifestyle factors like physical activity and sleep, and positively related to sedentary time and body mass index. The study findings raise the question of whether screen time displaces ‘healthy’ behaviours like physical activity, particularly after-school and at weekends when adolescent girls (and boys) have most choice about how they spend their time. While on the face of it this supposition may seem reasonable, the relationship between screen time and physical activity is more nuanced, depending on the type of screen behaviour and mode of physical activity. For example, in a recent analysis of adolescent behaviours during the Covid pandemic, it was found that screen time and habitual physical activity increased, but these changes coincided with a drop in structured sport participation, suggesting that screens do not necessarily compete with all physically active behaviours.6 Conversely, adolescent girls using social media for >2 hours/day are less likely to achieve physical activity and sedentary time guidelines.7 Use of screens for social media is highly prevalent in teen girls and is a significant means of social interaction. During the Covid pandemic, the potential value of screens to offset the limited opportunities for face-to-face peer contact and interaction has doubtless been beneficial in supporting adolescent girls’ social functioning and well-being. Thus, the view that screen use is detrimental to adolescents’ health and well-being is an oversimplification. Although much of the research to date tends to highlight the negative influence of screens, this partly relates to how ‘screen time’ has been defined (ie as television viewing in earlier studies or as total screen time), which screen behaviours were studied, and the contexts for these behaviours. This is illustrated by a large study of Australian adolescents, which found that time spent by girls and boys in passive screen use (ie television) was negatively associated with physical and mental health outcomes, but that educational (ie homework) and interactive (ie video gaming) screen use were positively associated with school achievement. However, when interactive screen time was analysed in relation to physical and mental health, the associations were unfavourable.8 Thus, the interplay between screen type, the context of its use, and the health and well-being outcomes under consideration all need to be accounted when thinking about the role, benefits, and risks of adolescent screen use. Notably, the effect sizes for these associations were very small suggesting that the impact of screen use on adolescents’ health and well-being may be less of an issue than some believe. In circumstances where adolescents’ screen use may impinge on more healthy lifestyle activities, strategies which ironically embrace and integrate screens (eg smartphone apps, social media groups) have potential to support positive behaviour change, for being physically active and helping teens to ‘power-down’ their devices. As screen time is associated with device availability (particularly in bedrooms),9 time spent in bedrooms and being alone after school,10 then families concerned about adolescents’ screen use could agree ways that limit home screen use at specific times of the day to enable better balance with other activities. Adolescents’ use of digital screens is here to stay, and it is incumbent on researchers, health professionals, practitioners and parents with an interest in adolescent health and well-being to be aware of the potential risks and also benefits of screen use. Improving understanding of adolescents’ screen use and promoting active behaviours that are accessible, developmentally appropriate and enjoyable and which can harness the appeal and familiarity of digital screens may be more fruitful endeavours than solely investing effort into limiting screen time. None.

The Journal of Adolescent Health's current supplement presents the work of a highly active team of researchers who are focusing on developing a strong body of evidence around child and adolescent mental health in Sub-Saharan Africa. The supplement lays out scholarship generated through years of partnership between researchers based in the United States—some of whom are from Sub-Saharan context, specifically Uganda—in connecting applied social work, community mental health for children and adolescents, and family development. The work comprises a series of articles embedded within several National Institutes of Health–funded grants by authors based in the United States in partnership with various academic and nongovernmental organizations in Uganda and Ghana. A rich collection of information and ideas around HIV-associated physical health, psychosocial, and educational challenges across child and adolescent populations are presented. Mental health outcomes and aspects of community and family cohesion, as well as health, are assessed via multimodal interventions. The strength of this group's work is the focus on poverty and ameliorating adversities through structured economic and psychosocial empowerment. The article entitled "The post-intervention impact of Amaka Amasanyufu on behavioral and mental health functioning of children and adolescents in low-resource communities in Uganda: analysis of a cluster-randomized trial from the SMART Africa-Uganda study (2016–2022)", led by Ssewamala et al., presents improvements in depressive symptoms, self-concept, and externalizing behaviors in a school-based multiple family group (MFG) intervention tested in a three-arm cluster randomized controlled trial delivered by parent, peers, or community health workers versus control condition [[1]Ssewamala F.M. Brathwaite R. Bahar O.S. et al.The post-intervention impact of Amaka Amasanyufu on behavioral and mental health functioning of children and adolescents in low-resource communities in Uganda: Analysis of a cluster-randomized trial from the SMART Africa-Uganda study (2016-2022).J Adolesc Health. 2023; : S3-S10Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Another articles led by Nabayinda et al. explored "The relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in Southern Uganda" and found that family cohesion was a protection against depression [[2]Nabayinda J. Kizito S. Ssentumbwe V. et al.The relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in Southern Uganda.J Adolesc Health. 2023; : S11-S17Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. Both articles were built on the same SMART Africa cluster randomized controlled trial. Nabunya et al., in the article "Stigma by Association, Parenting Stress and the Mental Health of Caregivers of Adolescents Living with HIV in Uganda", find that HIV-associated stigma in caregivers of adolescents is associated with poor caregiver mental health and parenting stress [[3]Nabunya P. Namuwonge F. Bahar O.S. et al.Stigma by association, parenting stress and the mental health of caregivers of adolescents living with HIV in Uganda.J Adolesc Health. 2023; : S18-S23Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Byansi et al. extend the focus on adolescents in Uganda in their article "Patterns of and factors associated with mental health service utilization among school-going adolescent girls in southwestern Uganda: A latent class analysis", reporting on latent class analysis findings testing MFG on adolescent girls [[4]Byansi W. Ssewamala F.M. Neilands T.B. et al.Patterns of and factors associated with mental health service utilization among school-going adolescent girls in southwestern Uganda: A latent class analysis.J Adolesc Health. 2023; : S24-S32Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Patterns in attendance of sessions and family demographic factors were associated with improved mental health service utilization. Implications for implementation of intervention are drawn from the approach taken in the article "Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: analysis of a cluster randomized controlled trial (Suubi4Her)" [[5]Filiatreau L.M. Tutlam N.T. Brathwaite R. et al.Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: Analysis of a cluster randomized controlled trial (Suubi4Her).J Adolesc Health. 2023; : S33-S40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. Filiatreau et al. present findings of another trial testing youth development account intervention with MFG in a three-arm study, with results suggesting that economic empowerment when augmented with culturally engaged psychotherapy is more efficacious [[5]Filiatreau L.M. Tutlam N.T. Brathwaite R. et al.Effects of a combination economic empowerment and family strengthening intervention on psychosocial well-being among Ugandan adolescent girls: Analysis of a cluster randomized controlled trial (Suubi4Her).J Adolesc Health. 2023; : S33-S40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. "A Structural Equation Model of the Impact of a family-based economic intervention on ART Adherence among adolescents living with HIV in Uganda" reports findings of an older trial that tests a variety of financial strengthening strategies and finds that these improve treatment adherence and mental health outcomes in young girls [[6]Kizito S. Nabayinda J. Neilands T.B. et al.A Structural Equation Model of the Impact of a family-based economic intervention on ART Adherence among adolescents living with HIV in Uganda.J Adolesc Health. 2023; : S41-S50Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. In the article "The Impact of Family Economic Empowerment Intervention on Psychological Difficulties and Prosocial Behavior among AIDS-orphaned children in southern Uganda", deeper insights are offered around mental health programming infused with family-based economic empowerment for younger orphaned children [[7]Tutlam N.T. Filiatreau L.M. Byansi W. et al.The impact of family economic empowerment intervention on psychological Difficulties and prosocial behavior among AIDS-orphaned children in southern Uganda.J Adolesc Health. 2023; : S51-S58Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. It appears from this article that even small steps toward strengthening routine care and provision of services goes a long way in improving child outcomes. The final article focuses on Ghana and uses the World Health Organization school health survey to identify "Correlates of Suicide Among Middle and High School Students in Ghana" [[8]Azasu E.K. Joe S. Correlates of suicide among Middle and high school Students in Ghana.J Adolesc Health. 2023; : S59-S63Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. The resulting younger age of onset of suicide and disaggregation of various suicide behaviors provide an impetus toward research that addresses suicide risk factors, treatment, and mental health promotion for children and adolescents. The articles make a compelling case around strengthening economic empowerment by directly providing economic incentives to support vulnerable populations and high-risk children and youth. The themes that require more attention with time include addressing more contextualized mental health constructs such as triggers and idioms of distress, understanding child and adolescent development from African cultural perspective, disentangling intersectional stigma and its impact on caregiver and child mental health, and grasping the significance of the adversities these communities and children face by reflecting on economic vulnerabilities and stressors more closely. A system-level appraisal of how these economic strengthening approaches are independently evaluated and evaluation by partners from economic and social development sectors of the Ugandan government or civil society would be important next steps. There is room to report on implementation outcomes that focus on the process of developing these integrated interventions and whether mental health and economic empowerment approaches need a different strategy, community, or youth engagement framework. As a guest editor, my commentary here is to buttress the importance of such well-funded, well-aligned scholarship in Africa and also to highlight that South-to-South partnerships are not only about US-funded research from largely northern partners. It should also become a venture where Southern countries (often "sites of intervention and need") deliberate and build joint priorities, co-create solutions that are relevant to them, and frame research articles in a manner that reflects how multistakeholder priorities were identified and addressed. The title of South-to-South partnerships could be a misnomer when most of the key authors are from limited northern institutions. Southern researchers working within the global north is not the only model for south-south partnerships. Most of these articles are led by individuals based in global North, including senior, first, and second authors. That is where a sea-change is needed. Building capacity to publish more articles within research teams and for improved representation would also serve accomplished teams that are generating enormous evidence-based research in these constrained geographies. How young people will respond to such complex interventions, and if these are designed, vetted, and improved by their feedback, has become a big theme in global health. While developing strong, outcome-informed evidence, we need process indicators. Multilevel community, economic, and family-level analyses that speak to multidimensional and interconnected social determinants would be other opportunities to consider. My hope would be to see more attention to these areas of framing and partnerships. It will be important for funders, publishers, and global health consortiums to ask for a score card on inclusivity, equity, representativeness, and a focused direction toward addressing social determinants of child and adolescent mental health.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

ObjectivesTo examine the associations of screen time, homework and reading duration, sleep duration, social jetlag with mental health in children and adolescents, as well as its gender differences.MethodsFrom December 2023 to April 2024, a total of 62 395 children and adolescents were selected from 51 schools in 17 cities of China by stratified cluster sampling. Screen time, homework and reading duration, sleep duration, and social jetlag were calculated by answering the questions about watching TV time, playing smartphones time, doing homework time, reading extracurricular books time, bedtime, wake-up time, and nap time during weekdays and weekends. Mental health was assessed by the Revised Mental Health Inventory-5 (MHI-5). The generalized linear model was used to determine the association between screen time, homework and reading duration, sleep duration, social jetlag, and mental health in children and adolescents.ResultsThe generalized linear model results showed that longer watching TV time, longer playing smartphones time, longer homework time, and greater social jetlag were correlated with poorer mental health in children and adolescents, while longer nighttime sleep duration, and longer daytime nap duration were correlated with better mental health. Moreover, in primary school and junior high school, we found that this association was stronger during the weekdays. However, in senior high school, this association was stronger during the weekends. After according to gender stratified, we found that the strength of this association was different in boys and girls at different study phases. Furthermore, our findings also revealed a significant quadratic relationship, indicating the association of better mental health with an optimal amount of sleep duration.ConclusionsThere was a significant association between screen time, homework and reading duration, sleep duration, social jetlag, and mental health in children and adolescents. This study has the potential to offer useful insights for the prevention and control of mental health issues in children and adolescents.

BackgroundWe examined the prospective associations of changes in lifestyle behaviors before/during the COVID-19 pandemic, namely physical activity and screen time, with mental health. Furthermore, the impacts of physical activity and screen time on mental health during the pandemic were examined cross-sectionally.MethodsA two-wave longitudinal study was conducted among 2423 children and adolescents in Shanghai, China. Lifestyle behavior variables (physical activity and screen time) and psychological variables (depressive symptoms, anxiety, and stress) were measured using a self-reported questionnaire in January and March 2020. A series of multivariable logistic regressions were performed to examine the associations between changes in lifestyle behaviors in two waves and psychological problems. The combined associations of physical activity and screen time with psychological problems were also explored using the second wave data.ResultsCompared to students with persistently short screen time before and during the COVID-19 pandemic, those with prolonged screen time (OR = 1·36 for depression, OR = 1·48 for anxiety) and those with persistently long screen time (OR = 1·70 for depression, OR = 2·13 for anxiety) reported a higher risk of psychological symptoms. The association between changes in physical activity and psychological symptoms was not statistically significant after adjustment for demographic factors, socioeconomic status, and screen time. During the COVID-19 pandemic, engaging in longer screen time (OR = 1·44 for depression, OR = 1·55 for anxiety) was associated with worsened psychological conditions, while engaging in increased physical activity (OR = 0·58 for depression, OR = 0·66 for anxiety) was associated with better psychological conditions.ConclusionsOur study suggests that promoting physical activity and limiting leisure screen time during the COVID-19 pandemic are important to prevent and mitigate psychological problems in children and adolescents. Therefore, effective interventions targeting lifestyle behaviors are needed to protect children and adolescents’ physical and mental health.

Emerging research suggests that the prevalence of child and adolescent mental health problems has increased considerably during the COVID-19 crisis. However, there have been few longitudinal studies on children’s mental health issues according to their social determinants in this context, especially in Europe. Our aim was to investigate the association between family socioeconomic status (SES) and children' mental health during the period of school closure due to COVID-19. Longitudinal data came from 4575 children aged 8–9 years old in 2020 and participating in the ELFE population-based birth cohort that focuses on children’s health, development and socialization. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when children were (a) 5 years of age and (b) 9 years of age, which corresponded to the period of school closure due to the COVID-19 pandemic in France. We retrieved data from the ELFE cohort collected on children from birth to age 5 years (birth, 1 year, 2 years, 3,5 years and 5 years). Socioeconomic status (SES) was measured based on information obtained when the child was 5 years old. Data were analyzed using multinomial logistic regression models. Children’s elevated levels of symptoms of Attention-deficit/Hyperactivity disorder (ADHD) during the period of school closure were significantly associated with prior low family SES (aOR 1.26, 95% CI 1.08–1.48). Children’s elevated symptoms of hyperactivity/inattention and of emotional symptoms were associated with decline in income during the COVID crisis (respectively, aOR 1.38, 95% CI 1.16–1.63 and aOR 1.23, 95% CI 1.01–1.51). Moreover, when testing interactions, a low prior SES was significantly associated with a higher risk of emotional symptoms aOR 1.54 (1.07–2.21), only for children whose families experienced a decline in income, while gender, parental separation and prior mental health difficulties were not associated. This study underlines the impact of the financial crisis related to the COVID-19 epidemic on children’s mental health. Both pre-existing family SES before lockdown and more proximal financial difficulties during the COVID crisis were negatively associated with children’s psychological difficulties during the period of school closure. The pandemic appears to exacerbate mental health problems in deprived children whose families suffer from financial difficulties.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-022-02010-w.

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Children and adolescents with neurodevelopmental disorders experience mental health issues and are encouraged to be brought together in real-life treatment. However, physical activity, which is a promising method for boosting mental health, has only been examined in children and adolescents with certain types of neurodevelopmental disorders. To examine the association of physical activity interventions with mental health (ie, cognitive function, psychological well-being, internalizing, and externalizing problems) in children and adolescents with neurodevelopmental disorders and to identify possible moderators. Studies were searched from inception to May 2023 through Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC. Randomized clinical trials or nonrandomized designs applying physical activity interventions and reporting at least 1 mental health outcome in children and adolescents aged 5 to 17 years with neurodevelopmental disorders were included. Two independent reviewers selected and assessed the studies. Random multilevel meta-analysis using Hedges g was performed. Data extraction and risk-of-bias assessment were conducted by multiple reviewers. Heterogeneity, publication bias, sensitivity analysis, and moderator analysis were examined to substantiate the results. The main outcomes were mental health related to cognitive function, psychological well-being, internalizing, or externalizing problems measured by neurocognitive tasks or subjective questionnaires. A total of 76 studies involving 3007 participants were included in systematic review, 59 of which were used for meta-analysis. The findings indicated that physical activity interventions were associated with significant benefits for overall mental health (g, 0.67; 95% CI, 0.50-0.85), cognitive function (g, 0.74; 95% CI, 0.53-0.95), psychological well-being (g, 0.56; 95% CI, 0.16-0.96), internalizing (g, 0.72; 95% CI, 0.34-1.10), and externalizing problems (g, 0.58; 95% CI, 0.28-0.89). Moderators were also identified: frequency, total sessions, and total duration for overall mental health; total sessions, and total duration for cognitive function; session duration and frequency for psychological well-being; physical activity type for internalizing problems; and session duration for externalizing problems. Moderator analyses showed that type of neurodevelopmental disorder did not modify the associations between physical activity and overall mental health or its subgroups. The findings in this study suggest that children and adolescents with different types of neurodevelopmental disorders may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Child mental health services in England: a continuing crisis