Elsevier

Preventive Medicine

Volume 88, July 2016, Pages 147-152
Preventive Medicine

Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence

https://doi.org/10.1016/j.ypmed.2016.04.002Get rights and content

Highlights

  • Physical activity decreased over time.

  • Screen time and symptoms of anxiety and depression increased over time.

  • Initially higher screen time covaries with initially higher depression and anxiety.

  • Initial depression symptoms predict greater declines in physical activity over time

  • Increases in screen time covary with increases in anxiety.

Abstract

More physical activity (PA) and less screen time (ST) are positively associated with mental health in adolescents; however, research is limited by short-term designs and the exclusion of ST when examining PA. We examined: (a) changes in PA, ST, symptoms of depression, and symptoms of anxiety over four assessments spanning 11 years, and (b) bidirectional relationships between initial PA, ST, and symptoms of depression and anxiety as predictors of change in each other during adolescence. Between 2006 and 2010, participants from Ottawa Canada (Time1; N = 1160, Mean age = 13.54 years) completed questionnaires at four points covering the ages from 10 to 21 years. Latent growth modeling was used. PA decreased over time whereas ST and symptoms of depression and anxiety increased over time. Controlling for sex, ethnicity, school location, zBMI, birth year, and parents' education, initially higher anxiety was associated with initially higher ST (covariance = .88, p < .05) and initially lower PA (covariance =  6.84, p = .07) independent of initial symptoms of depression. Higher initial depression was associated with higher initial ST (covariance = 2.55, p < .05). Increases in anxiety were associated with increases in ST (covariance = .07, p = .06) and increases in depression (covariance = .41, p < .05). Examining bidirectional relationships, higher initial symptoms of depression predicted greater decreases in PA (b = −.28, p < .05). No other significant findings between initial PA, ST, anxiety, or depression were found as predictors of change in each other. Interventions targeting depression around age 13 may be useful to prevent further declines in PA. Similarly, interventions to reduce ST may be beneficial for concurrent reductions in symptoms of depression and anxiety, irrespective of PA.

Introduction

Mental health disorders are a leading cause of disability (Merikangas et al., 2009) and typically develop in childhood or adolescence (Kessler et al., 2007). Anxiety and depression are among the most common mental disorders in youth (Merikangas et al., 2009) with increasing incidence during adolescence (Leadbeater et al., 2012). With prevalence rates of symptoms of depression in childhood ranging from 21 to 50% (Merikangas, 2002) and similar rates for anxiety disorders (Merikangas, 2002) more research is needed to understand the trajectory of psychopathology and factors that predict changes in symptoms of depression and anxiety such that targeted interventions can be developed to aid prevention and treatment.

Two factors that have links with mental health are physical activity (PA) and screen time (ST) (Maras et al., 2015, Goldfield et al., 2016). However, the relationship between PA, ST, and mental disorders and their symptoms is complex. On the one hand, increasing PA and reducing ST can alleviate or prevent symptoms of mental health disorders such as anxiety and depression (Maras et al., 2015, Goldfield et al., 2016, Herman et al., 2015, Biddle and Asare, 2011). On the other hand, mental disorders can lead to disengagement in PA and increased engagement in ST (Jerstad et al., 2010, Lindwall et al., 2011, Azevedo Da Silva et al., 2012, Roshanaei-Moghaddam et al., 2009). Longitudinal research examining ST, PA, and symptoms of depression and anxiety in adolescents is sparse and preliminary findings are contradictory. Investigators have demonstrated that changes in PA and ST over time are predictive of depression (Motl et al., 2004, Primack et al., 2009, Sund et al., 2010) whereas others have found no association (Hume et al., 2011, Brunet et al., 2013). Moreover, researchers have not always controlled for ST (Motl et al., 2004) when examining the relationships between PA and symptoms of depression and/or anxiety, or for PA when examining the relationships with ST (Primack et al., 2009). This is an important methodological limitation given the evidence that sedentary behaviors and PA have distinct relationships with physical and mental health outcomes (Tremblay et al., 2010). Given these independent relationships, the psychological benefits of focusing on one lifestyle behavior (i.e., PA) may be offset by ignoring the other (i.e., ST). Finally, although there is emerging evidence that the relationship between PA and mental disorders may be bidirectional, much of the research examining directionality has been conducted among adults (Lindwall et al., 2011, Azevedo Da Silva et al., 2012, Steinmo et al., 2014, Ku et al., 2012) and did not include ST despite its independent relationship with mental health (Maras et al., 2015, Herman et al., 2015, Goldfield et al., 2015).

Therefore, the objectives of this study in a community-based sample of adolescents were to examine (1) if and how PA, ST, symptoms of depression, and symptoms of anxiety changed over time during adolescence, and (2) if initial PA and ST predicted change in symptoms of depression and symptoms of anxiety and/or if initial symptoms of depression and initial symptoms of anxiety predicted changes in PA and ST. We hypothesized that PA would decrease whereas ST, symptoms of depression, and symptoms of anxiety would increase over time. Second, we hypothesized that higher initial PA and lower initial ST would predict reductions in symptoms of depression and symptoms of anxiety over time whereas higher initial symptoms of depression and anxiety would predict decreases in PA and increases in ST over time.

Section snippets

Participants and procedure

These data are part of a larger study entitled the Research on Eating and Adolescent Lifestyles (REAL) study (see (Flament et al., 2015) and online supplement). The study was approved through two hospital research ethics boards and relevant school board authorities. Briefly, beginning between 2006 and 2010 students (N = 1208) from grades 7 and 9 consented to participate in a longitudinal component of the REAL study, which involved repeated assessments at 1 to 2 year intervals up to 7 years (average

Demographic and anthropometric characteristics

These included school, grade, and self-reported sex, birthdate, parents' education level, and ethnic background. Exact age at each time point was calculated. Objective measures of height and weight were collected with a Portable Stadiometre (Quick Medical Equipment and Supplies, U. S. A.) and a UC-321 Digital Weighing scale (Quick Medical Equipment and Supplied, U. S. A.). Body mass index (BMI) at Time 1 was calculated (kg/m2). Sex and age standardized BMI (zBMI) was calculated (World Health

Statistical analyses

Latent growth modeling (LGM) was conducted using Mplus 7.3 with robust full information maximum likelihood estimation to account for possible non-normality and missing data. For each variable (PA, ST, symptoms of depression, and symptoms of anxiety), LGM was used to create two random latent variables that represent an intercept (baseline) and slope (change), and each individual was allowed to vary from the mean intercept and slope. Because the data were not collected at equal intervals, the

Patterns of change

Descriptive statistics for the main variables are reported in Table 1. Independent analyses of each variable indicated that PA, ST, symptoms of depression, and symptoms of anxiety were changing steadily (i.e., linearly) over time. There were no significant accelerations or decelerations in the rates of change (i.e., quadratic trend) in any variables. Means, variances, and covariances from the LGM with all variables analyzed simultaneously are presented in Table 2. Examining the mean slope

Discussion

Over a developmental period during adolescence, we examined the independent roles of initial PA, ST, symptoms of depression, and symptoms of anxiety as bidirectional predictors of change in symptoms of depression, symptoms of anxiety, PA, and ST, respectively. Results were based on 4 measurement points spanning 11 years in a large sample of 1160 adolescents from ages 10 to 21 years. To the best of our knowledge, this is the first longitudinal investigation that has examined directionality and the

Conclusion

Generally, we found that symptoms of depression and symptoms of anxiety are independently related to ST and PA (cross-sectionally and longitudinally), yet only higher symptoms of depression at age 13.54 years predicted a reduced trajectory of PA over time. Other than the one bidirectional finding, our results are promising because they indicate that baseline levels of PA and ST, and symptoms of anxiety at age 13.54 years are not indicative of changes in symptoms of depression or anxiety, and

Conflict of interest statement

No authors have financial relationships relevant to this article to disclose. The authors declare that there are no conflicts of interest.

Acknowledgments

This study has been funded by the Ontario Centre of Excellence for Child and Youth Mental Health at CHEO (# RG627), the University of Ottawa Medical Research Fund (# 03-2009), and the Children's Hospital of Eastern Ontario Research Institute (RI 11-19). The first author is a Junior Scientist supported by grants from the Lawson Foundation and the Children's Hospital of Eastern Ontario Foundation. We extend our sincere thanks to the three school boards and the schools who generously contributed

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