Cohort study of the correlation between screen time and emotional problems in primary school students across the COVID-19 pandemic

doi:10.11852/zgetbjzz2023-0567

Abstract

Abstract: Objective To investigate the screen time of primary school students in Shenzhen during the COVID-19 outbreak, and to analyze the association between the screen time and emotional problems of primary school students. Methods A cohort study design was designed. Students from two primary schools in Shenzhen completed questionnaire survey in 2019 and 2021, including screen time, Morning and Evening Questionnaire-5(MEQ-5), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD-7). The paired t-test was used to analyze the differences in screen use of primary school students before and during the middle period of COVID-19, and Logistic regression was used to analyze the impact of screen time on emotion. Results The differences in computer time on weekdays, TV time on weekdays, cell phone time on weekdays, computer time on holidays, and TV time on holidays were not statistically significant compared with the pre- and mid-epidemic periods among primary school students in Shenzhen (P>0.05), but the proportion of cell phone use ≥2h/d on holidays in mid-epidemic period was significantly higher than that of pre-epidemic period(χ²=4.785, P<0.05). Protective factors for depression among elementary school students in the pre-epidemic period included cell phone time ≥2h/d on weekdays(OR=0.258, 95% CI: 0.133 - 0.500), and protective factors for anxiety included cell phone time≥2h/d on weekdays(OR=0.436, 95% CI: 0.206 - 0.923) and weekday TV time ≥2h/d (OR= 0.377, 95%CI: 0.180 - 0.790); protective factors for depression among elementary school students in mid-epidemic period were TV time ≥2h/d on weekdays(OR=0.424, 95% CI: 0.202 - 0.890) and cell phone time ≥2h/d on holidays(OR=0.308, 95% CI: 0.162 - 0.585), and sleep rhythms for early morning type was a risk factor for depression among elementary school students in mid-epidemic period (OR=5.817, 95%CI:1.790 - 18.898), and a protective factor for anxiety among elementary school students inmid-epidemic period was cell phone use ≥2h/d on weekdays(OR=0.388, 95% CI:0.179 - 0.842). Conclusion Primary school students in Shenzhen spend more time using mobile phones during holidays in mid-epidemic period than pre-epidemic period, and appropriate screen time could alleviate anxiety and depression in primary school students.

Key words: COVID-19, screen time, emotion, primary school students, mental health

摘要： 目的了解新型冠状病毒肺炎(简称新冠)疫情期间深圳市小学生屏幕使用情况,分析屏幕使用时间对小学生情绪问题的影响。方法采用队列研究设计,于2019年和2021年对深圳市两所小学同一批学生进行问卷调查,包括屏幕使用时间、清晨型-夜晚型量表(MEQ-5)及焦虑抑郁量表。采用配对t检验分析新冠疫情前和中期小学生屏幕使用情况的差异,采用Logistic回归分析屏幕使用时间对于情绪的影响。结果深圳市小学生疫情前和中期相比,工作日使用电脑时间,工作日电视时间,工作日使用手机时间,节假日使用电脑时间以及节假日电视时间差异无统计学意义(P>0.05),但疫情中期节假日使用手机≥2h/d 的比例高于疫情前,差异有统计学意义(χ²=4.785,P<0.05)。疫情前小学生抑郁的保护因素为工作日使用手机时间≥2h/d(OR=0.258,95%CI:0.133~0.500),焦虑的保护因素为工作日使用手机时间≥2h/d(OR=0.436,95%CI: 0.206~0.923)和工作日使用电视时间≥2h/d(OR=0.377,95%CI: 0.180~0.790);疫情中期小学生抑郁的保护因素有工作日使用电视时间≥2h/d(OR=0.424,95%CI: 0.202~0.890)和节假日使用手机时间≥2h/d(OR=0.308,95%CI: 0.162~0.585), 睡眠节律为清晨型是疫情中期小学生抑郁的危险因素(OR=5.817,95%CI: 1.790~18.898);疫情中期小学生焦虑的保护因素为工作日使用手机时间≥2h/d(OR=0.388,95%CI: 0.179~0.842)。结论与疫情前相比,深圳市小学生疫情中期节假日使用手机的时间增加,且适当的屏幕使用可缓解小学生焦虑抑郁情况。

关键词: 新型冠状病毒肺炎, 屏幕使用时间, 情绪, 小学生, 心理健康

CLC Number:

R179

HAN Yaohui, DONG Fang, SUN Xiaoya, LI Lihong, YANG Weiting, LIN Yin. Cohort study of the correlation between screen time and emotional problems in primary school students across the COVID-19 pandemic[J]. Chinese Journal of Child Health Care, 2023, 31(12): 1314-1319.

韩耀辉, 东方, 孙晓娅, 李丽红, 杨伟亭, 林鄞. 小学生跨新型冠状病毒肺炎疫情期间屏幕使用时间与情绪相关性的队列研究[J]. 中国儿童保健杂志, 2023, 31(12): 1314-1319.

References

[1] Magee CA, Lee JK, Vella SA.Bidirectional relationships between sleep duration and screen time in early childhood[J].JAMA Pediatr,2014,168(5):465-470.
[2] Tamana SK, Ezeugwu V, Chikuma J,et al.Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study[J].PLoS One, 2019, 14(4):e0213995.
[3] Ngamije J. The impact of Internet use during COVID-19 lockdown in Rwanda: A potential public health threat[J].J Addict Dis, 2021,39(3):417-420.
[4] Gwon SH, Jeong S. Concept analysis of impressionability among adolescents and young adults[J].Nurs Open, 2018, 5(4):601-610.
[5] Parmar D, Tabler J, Okumura M, et al. Investigating protective factors associated with mental health outcomes in sexual minority youth[J].J Adolesc Health, 2022, 70(3):470-477.
[6] Otto C, Reiss F, Voss C, et al. Mental health and well-being from childhood to adulthood: Design, methods and results of the 11-year follow-up of the BELLA study[J].Eur Child Adolesc Psy, 2021, 30(10):1559-1577.
[7] Khouja JN, Munafò MR,Tilling K, et al. Is screen time associated with anxiety or depression in young people? Results from a UK birth cohort[J].BMC Public Health, 2019,19(1):82.
[8] Orben A, Przybylski AK. Screens, teens, and psychological well-being: Evidence from three time-use-diary studies[J]. Psychol Sci, 2019, 30(5):682-696.
[9] Odgers C. Smartphones are bad for some teens, not all[J].Nature, 2018, 554(7693):432-434.
[10] Adan A, Almirall H.Horne & Stberg Morningness-eveningness Questionnaire: A reduced scale[J].Pers Indiv Differ, 1991, 12(3):241-253.
[11] Stiglic N, Viner RM. Effects of screen time on the health and well-being of children and adolescents:A systematic review of reviews[J].BMJ Open, 2019, 9(1):e023191.
[12] Zink J, Belcher BR, Kechter A, et al. Reciprocal associations between screen time and emotional disorder symptoms during adolescence[J].Prev Med Rep, 2019, 13:281-288.
[13] Berg VD, Julia F, Kivela, et al. Chronotype and depressive symptoms in students: An investigation of possible mechanisms[J].Chronobiol Int, 2018, 35(9):1248-1261.
[14] Sun W, Kwok N, Chan N,et al. Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children[J].J Clin Sleep Med, 2021, 17(10):2107-2114.
[15] Xiang M, Zhang ZR, Kuwahara K, et al. Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected[J].Prog Cardiovasc Dis, 2020, 63(4):531-532.
[16] Pietrobelli A, Pecoraro L, Ferruzzi A,et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study[J].Obesity, 2020, 28(8):1382-1385.
[17] Jiao WY, Wang LN, Liu J, et al. Behavioral and emotional disorders in children during the COVID-19 epidemic[J]. J Pediatr, 2020, 221:264-266.
[18] Loades ME, Chatburn E, Higson-Sweeney N,et al. Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19[J].J Am Acad Child Psy, 2020, 59(11):1218-1239.
[19] Zink J, Belcher BR, Imm K, et al. The relationship between screen-based sedentarybehaviors and symptoms of depression and anxiety in youth: A systematic review of moderating variables[J].BMC Public Health, 2020, 20(1):472.
[20] Oswald TK, Rumbold AR, Kedzior SGE,et al. Psychological impacts of "screen time" and "green time" for children and adolescents: A systematic scoping review[J].PLoS One, 2020, 15(9):e0237725.
[21] Fang H, Tu S, Sheng JF, et al. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment[J].J Cell Mol Med, 2019, 23(4):2324-2332.
[22] Neuman SB.Assessing children's inferencing strategies[J].Context Clues,1989:24.
[23] Parkes A, Sweeting H, Wight D, et al. Do television and electronic games predict children's psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study[J].Arch Dis Child, 2013, 98(5):341-348.
[24] Adhikari B. Use of screen media and mental health: Effects on adolescents and pre-adolescents[J].JAMA, 2021, 59(241):962-964.
[25] Shah SGS, Nogueras D, Woerden HCV,et al. The COVID-19pandemic: A pandemic of lockdown loneliness and the role of digital technology[J].J Med Internet Res, 2020, 22(11):e22287.