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Pediatrics

Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
JAMA Network Open
Published Online: December 28, 2021
Original Investigation
Xuedi Li, MSc1;
Leigh M. Vanderloo, PhD1,2,3;
Charles D. G. Keown-Stoneman, PhD4,5;
Katherine Tombeau Cost, PhD6;
Alice Charach, MD, MSc6,7;
Jonathon L. Maguire, MD, MSc4,8,9;
Suneeta Monga, MD6,7;
Jennifer Crosbie, PhD6,7;
Christie Burton, PhD6;
Evdokia Anagnostou, MD8,10;
Stelios Georgiades, PhD11;
Rob Nicolson, MD12;
Elizabeth Kelley, PhD13;
Muhammad Ayub, MD14;
Daphne J. Korczak, MD, MSc6,7;
Catherine S. Birken, MD, MSc1,8
Author Affiliations
  • 1Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 2School of Occupational Therapy, Western University, London, Ontario, Canada
  • 3ParticipACTION, Toronto, Ontario, Canada
  • 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  • 5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 6Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 7Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 8Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 9Department of Pediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
  • 10Holland Bloorview Research Institute, Toronto, Ontario, Canada
  • 11Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  • 12Department of Psychiatry, Western University, London, Ontario, Canada
  • 13Department of Psychology, Queens University, Kingston, Ontario, Canada
  • 14Department of Psychiatry, Queens University, Kingston, Ontario, Canada
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Key Points

Question  What are the associations between different types of electronic screen use and mental health symptoms in Canadian children and youth during the COVID-19 pandemic?

Findings  In this longitudinal study of 4 cohorts, 2026 children with 6648 observations were included. Compared with children with lower levels of screen use, children with higher levels of screen use had significantly higher levels of mental health symptoms during the COVID-19 pandemic.

Meaning  These findings suggest that policy intervention, as well as evidence-informed social supports, may be required to promote healthful screen use and mental health in children and youth during the pandemic and beyond.

Abstract

Importance  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.

Objective  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.

Design, Setting, and Participants  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.

Main Outcomes and Measures  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.

Results  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.

Conclusions and Relevance  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.

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Adolescent Medicine Anxiety Disorders Depressive Disorders Neurology Pediatrics Psychiatry and Behavioral Health Child and Adolescent Psychiatry Coronavirus (COVID-19)
Article Information

Accepted for Publication: November 2, 2021.

Published: December 28, 2021. doi:10.1001/jamanetworkopen.2021.40875

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Li X et al. JAMA Network Open.

Corresponding Author: Xuedi Li, MSc, Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4, Canada (xuedi.li@sickkids.ca).

Author Contributions: Drs Korczak and Birken had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Li, Vanderloo, Keown-Stoneman, Charach, Maguire, Monga, Crosbie, Anagnostou, Georgiades, Korczak, Birken.

Acquisition, analysis, or interpretation of data: Li, Keown-Stoneman, Cost, Monga, Crosbie, Burton, Anagnostou, Georgiades, Nicolson, Kelley, Ayub, Korczak, Birken.

Drafting of the manuscript: Li, Vanderloo, Keown-Stoneman, Crosbie.

Critical revision of the manuscript for important intellectual content: Vanderloo, Keown-Stoneman, Cost, Charach, Maguire, Monga, Crosbie, Burton, Anagnostou, Georgiades, Nicolson, Kelley, Ayub, Korczak, Birken.

Statistical analysis: Li, Keown-Stoneman, Cost, Crosbie, Anagnostou.

Obtained funding: Keown-Stoneman, Maguire, Monga, Crosbie, Burton, Anagnostou, Georgiades, Kelley, Korczak, Birken.

Administrative, technical, or material support: Vanderloo, Keown-Stoneman, Maguire, Burton, Anagnostou, Georgiades, Ayub.

Supervision: Vanderloo, Keown-Stoneman, Maguire, Anagnostou, Georgiades, Korczak, Birken.

Conflict of Interest Disclosures: Dr Charach reported receiving grants from SickKids Hospital and Leong Centre for Healthy Children and in-kind support for all POND data from the Ontario Brain Institute during the conduct of the study. Dr Monga reported receiving grants from Cundill Centre for Youth Depression at the Centre for Addiction and Mental Health, book royalties from Springer Publishers, and grants from Canadian Institutes of Health Research outside the submitted work. Dr Anagnostou reported receiving consultation fees from Roche and Quadrant, research funding from Roche, in-kind support from AMO pharma, editorial honoraria from Wiley, and book royalties from APPI and Springer; she also holds a patent for the device Tully (formerly Anxiety Meter). Dr Nicolson reported receiving grants from Ontario Brain Institute during the conduct of the study. Dr Kelley reported receiving grants from Ontario Brain Institute, Canadian Institutes of Health Research, and the Masonic Foundation of Ontario outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by the Canadian Institutes of Health Research (grant 173092), the Centre for Brain & Mental Health at The Hospital for Sick Children, the Ontario Ministry of Health (grant 700), and the Miner’s Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness at the University of Toronto.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank all the participating families for their time and involvement in this research and are grateful to all practitioners who are currently involved in the TARGetKids! practice-based research network.

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