title: Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review.
abstract: OBJECTIVE
  The presented systematic review aims at giving a comprehensive overview of studies assessing the relationship between sedentary behavior and indicators of mental health in school-aged children and adolescents.
  
  
  METHODS
  Six online databases (MEDLINE, EMBASE, PsycINFO, PsycARTICLES, CINAHL and SPORTDiscus) as well as personal libraries and reference lists of existing literature were searched for eligible studies.
  
  
  RESULTS
  Ninety-one studies met all inclusion criteria. There was strong evidence that high levels of screen time were associated with more hyperactivity/inattention problems and internalizing problems as well as with less psychological well-being and perceived quality of life. Concerning depressive symptoms, self-esteem, eating disorder symptoms, and anxiety symptoms, no clear conclusion could be drawn. But, taking quality assessment into account, self-esteem was negatively associated with sedentary behavior, i.e. high levels of time engaging in screen-based sedentary behavior were linked to lower scores in self-esteem.
  
  
  CONCLUSIONS
  Overall, the association between sedentary behavior and mental health indicators was rather indeterminate. Future studies of high quality and with an objective measure of sedentary behavior will be necessary to further examine this association as well as to investigate longitudinal relationships and the direction of causality. Furthermore, more studies are needed to identify moderating and mediating variables.
authors.affiliation: Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany. Electronic address: suchert@ift-nord.de.
authors.forename: Vivien
authors.initials: V
authors.lastname: Suchert
authors.affiliation: Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Hanewinkel
authors.affiliation: Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Isensee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003201:Computers / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D000297:Psychology, Adolescent; D002666:Psychology, Child; D057185:Sedentary Behavior; D012649:Self Concept; D013690:Television / Q000706:statistics & numerical data
keywords: Adolescent; Child; Mental health; Sedentary lifestyle; Systematic review