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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

Article Information and Disclosures

Xuedi Li, MSc¹;

Leigh M. Vanderloo, PhD^1,2,3;

Charles D. G. Keown-Stoneman, PhD^4,5;

Katherine Tombeau Cost, PhD⁶;

Alice Charach, MD, MSc^6,7;

Jonathon L. Maguire, MD, MSc^4,8,9;

Suneeta Monga, MD^6,7;

Jennifer Crosbie, PhD^6,7;

Christie Burton, PhD⁶;

Evdokia Anagnostou, MD^8,10;

Stelios Georgiades, PhD¹¹;

Rob Nicolson, MD¹²;

Elizabeth Kelley, PhD¹³;

Muhammad Ayub, MD¹⁴;

Daphne J. Korczak, MD, MSc^6,7;

Catherine S. Birken, MD, MSc^1,8

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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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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.