title: The associations between sedentary behaviour and mental health among adolescents: a systematic review.
abstract: With technological developments and modernised sedentary lifestyles has come an increase in diseases associated with inactivity such as obesity and other non-communicable diseases. Emerging evidence suggests that time spent sedentary may also interact with mental health. This systematic review examined the associations between sedentary behaviour and mental health problems among adolescents.
  
  
  
  This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and applied a quality assessment tool for quantitative studies to identity best available evidence. Following stringent search strategy of the databases; Cumulative Index to Nursing and Allied Health Literature, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsychARTICLES and PsycINFO, we identified 32 articles eligible for review.
  
  
  
  All studies reported leisure screen time among adolescents, and two thirds of identified studies examined depressive symptomatology. Other mental health measures were; anxiety symptoms, self-esteem, suicide ideation, loneliness, stress, and psychological distress. Strong consistent evidence was found for the relationship between both depressive symptomatology and psychological distress, and time spent using screens for leisure. Moderate evidence supported the relationship between low self-esteem and screen use. Poorer mental health status was found among adolescents using screen time more than 2-3 h per day, and gender differences exist. Essential information was missing for quality of evidence including heterogeneity in mental health and screen time-based measures, and self-report data collection methods.
  
  
  
  The findings are of particular significance given the global public health concern of lifestyle-attributed diseases and the possibility for novel approaches to mental health. Future research should examine the psychological impact of reducing time spent using screens for leisure among adolescents, whilst accounting for possible confounding factors such as physical activity and dietary behaviours. It is critical that the reciprocal relationship between lifestyle behaviours and mental health is represented in both the psychiatric and public health forum.
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, 1 Gheringhap Street, Geelong, 3220, Victoria, Australia. erin.hoare@deakin.edu.au.
authors.forename: Erin
authors.initials: E
authors.lastname: Hoare
authors.affiliation: British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Milton
authors.affiliation: British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Foster
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, 1 Gheringhap Street, Geelong, 3220, Victoria, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
mesh_terms: D000293:Adolescent; D003201:Computers; D003863:Depression / Q000209:etiology; D015444:Exercise; D005260:Female; D006801:Humans; D020407:Internet; D007899:Leisure Activities; D008297:Male; D008603:Mental Health; D057185:Sedentary Behavior; D012649:Self Concept; D013315:Stress, Psychological / Q000209:etiology; D013690:Television; D018910:Video Games
keywords: Adolescents; Mental health; Screen time; Sedentary behaviour