Screen Time and Child Behavioral Disorders During COVID‑19 Pandemic: A Systematic Review
Abstract
Background: The extensive use of various electronic games and communication devices, particularly among children and adolescents, has raised concerns, particularly during the COVID‑19 pandemic. This study investigated the link between screen time and internalizing disorders, such as anxiety and depression, among individuals aged ≤18 during the global COVID‑19 pandemic. Methods: This systematic review aims to summarize scientific publications from 2019 to early 2022 by searching databases, including the Cochrane Library, PubMed, Web of Science, Scopus, and PsycINFO, to identify suitable studies. In each paper, we searched the following keywords and their synonyms: screen, child, high school, middle school, and psychiatric disorders. The quality of the selected papers was evaluated using a checklist recommended by the National Institutes of Health (NIH) for observational cohort studies. Results: Out of 986 reports identified, we included 12 papers with 14,483 participants. The study revealed a negative correlation between screen time (TV, computer, video games, and mobile phones) and behavioral outcomes. Smartphones were the most frequently used devices, with video games being more prevalent among older participants for education, communication, and entertainment purposes. The prevalence of depression ranged between 10% and 25%. Furthermore, anxiety and depression were identified as predictors of increased screen usage. Some results displayed variation based on the type of screen exposure, the questionnaires used, and the age of the participants. Conclusions: The findings imply an indirect association between increased screen time and depression and anxiety. It is crucial to consider limitations on screen time exposure and parental supervision as measures to prevent certain mental disorders.
International Journal of Preventive Medicine 15():9, February 2024. | DOI: 10.4103/ijpvm.ijpvm_78_23
Corresponding Author: Dr. Seyede Shahrbanoo Daniali
E‑mail: sh_daniali@yahoo.com
You can also search for this author in: PubMed Google Scholar
Keywords
Full Text:
PDFReferences
WHO. Coronavirus disease (COVID‑19): Situation report, 206.
Geneva: World Health Organization; 2020. [Last accessed on
Aug 13].
Zhang X, Luo W, Zhu J. Top‑down and bottom‑up lockdown:
Evidence from COVID‑19 prevention and control in China.
J Chin Polit Sci 2021;26:189‑211.
Doering S, Larsson H, Halldner L, Gillberg C, Kuja‑Halkola R,
Lundström S. Internalizing symptoms in adolescence are
modestly affected by symptoms of anxiety, depression, and
neurodevelopmental disorders in childhood. BMC Psychiatry
;22:233.
Chen H, Cohen P, Kasen S, Johnson JG, Berenson K, Gordon K.
Impact of adolescent mental disorders and physical illnesses
on quality of life 17 years later. Arch Pediatr Adolesc Med
;160:93‑9.
Zahn–Waxler C, Klimes–Dougan B, Slattery MJ. Internalizing
problems of childhood and adolescence: Prospects, pitfalls,
and progress in understanding the development of anxiety and
depression. Dev Psychopathol 2000;12:443‑66.
Tremblay MS, Carson V, Chaput J‑P, Connor Gorber S, Dinh T,
Duggan M, et al. Canadian 24‑hour movement guidelines for
children and youth: An integration of physical activity, sedentary
behaviour, and sleep. Appl Physiol Nutr Metab 2016;41:S311‑27.
McWilliams C, Ball SC, Benjamin SE, Hales D, Vaughn A,
Ward DSJP. Best‑practice guidelines for physical activity at child care. Pediatrics 2009;124:1650‑9.
Mustafa N. Impact of the 2019–20 coronavirus pandemic on
education. Int J Health Prefer Res 2020;4:25‑30.
Sun Y, Li Y, Bao Y, Meng S, Sun Y, Schumann G, et al. Brief
report: Increased addictive internet and substance use behavior
during the COVID‐19 pandemic in China. Am J Addict
;29:268‑70.
Olive LS, Sciberras E, Berkowitz TS, Hoare E, Telford RM,
O’Neil A, et al. Child and parent physical activity, sleep, and
screen time during COVID‑19 and associations with mental
health: Implications for future psycho‑cardiological disease?
Front Psychiatry 2022;12:774858.
Chen IH, Chen C‑Y, Pakpour AH, Griffiths MD, Lin C‑Y, Li
X‑D, et al. Problematic internet‑related behaviors mediate
the associations between levels of internet engagement and
distress among schoolchildren during COVID‑19 lockdown:
A longitudinal structural equation modeling study. J Behav
Addict 2021;10:135‑48.
Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD,
Pakpour AH. The fear of COVID‑19 scale: Development and
initial validation. Int J Ment Health Addict 2022;20:1537‑45.
Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and
sleep quality in individuals who self‑isolated for 14 days during
the Coronavirus Disease 2019 (COVID‑19) outbreak in January
in China. Med Sci Monit 2020;26:e923921.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate
psychological responses and associated factors during the initial
stage of the 2019 Coronavirus Disease (COVID‑19) epidemic
among the general population in China. Int J Environ Res Public
Health 2020;17:1729.
Chen CY, Chen IH, Hou WL, Potenza MN, O’Brien KS,
Lin CY, et al. The relationship between children’s problematic
internet‑related behaviors and psychological distress during the
onset of the COVID‑19 pandemic: A longitudinal study. J Addict
Med 2022;16:e73‑80.
Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental
health status among children in home confinement during the
coronavirus disease 2019 outbreak in Hubei Province, China.
JAMA Pediatr 2020;174:898‑900.
Lewis R, Roden LC, Scheuermaier K, Gomez‑Olive FX,
Rae DE, Iacovides S, et al. The impact of sleep, physical activity
and sedentary behaviour on symptoms of depression and anxiety
before and during the COVID‑19 pandemic in a sample of South
African participants. Sci Rep 2021;11:1‑11.
Merrill RM. Mental health conditions according to stress and
sleep disorders. Int J Environ Res Public Health 2022;19:7957.
Elson M, Ferguson CJ, Gregerson M, Hogg JL, Ivory J,
Klisanin D, et al. Do policy statements on media effects
faithfully represent the science? Adv Methods Pract Psychol Sci
;2:12‑25.
Kaye LK, Orben A, Ellis DA, Hunter SC, Houghton S. The
conceptual and methodological mayhem of “Screen Time”. Int J
Environ Res Public Health 2020;17:3661.
Vickers NJ. Animal communication: When I’m calling you, will
you answer too? Curr Biol 2017;27:R713‑5.
Jeffery CP. Parenting in the digital age: Between socio‑biological
and socio‑technological development. New Media Soc
;23:1045‑62.
Gür D, Türel YK. Parenting in the digital age: Attitudes, controls
and limitations regarding children’s use of ICT. Comput Educ
;183:104504.
Omar SZ, Daud A, Hassan MS, Bolong J, Teimmouri M.
Children internet usage: Opportunities for self development.
Procedia Soc Behav Sci 2014;155:75‑80.
Shen C‑X, Liu R‑D, Wang D. Why are children attracted to
the Internet? The role of need satisfaction perceived online
and perceived in daily real life. Comput Human Behav
;29:185‑92.
Genevieve Marie J. Internet use and child development:
Validation of the ecological techno‑subsystem. J Biochem
Technol 2010;13:176‑85.
Kamaşak T, Topbaş M, Ozen N, Esenülkü G, Yıldız N, Şahin S,
et al. An investigation of changing attitudes and behaviors and
problematic internet use in children aged 8 to 17 years during
the COVID‑19 pandemic. Clin Pediatr (Phila) 2021;61:194‑205.
Odgers CL, Jensen MR. Annual research review: Adolescent
mental health in the digital age: Facts, fears, and future
directions. J Child Psychol Psychiatry 2020;61:336‑48.
Browne D, Thompson DA, Madigan S. Digital media use in
children: Clinical vs Scientific responsibilities. JAMA Pediatr
;174:111‑2.
Wang L, Chen L, Jia F, Shi X, Zhang Y, Li F, et al. Risk
factors and prediction nomogram model for psychosocial and
behavioural problems among children and adolescents during
the COVID‑19 pandemic: A national multicentre study: Risk
Factors of Childhood Psychosocial Problems. J Affect Disord
;294:128‑36.
Monteiro R, Rocha NB, Fernandes S. Are emotional and
behavioral problems of infants and children aged younger than
years related to screen time exposure during the coronavirus
disease 2019 confinement? an exploratory study in Portugal.
Front Psychol 2021;12:590279.
Li X, Vanderloo LM, Keown‑Stoneman CD, Cost KT,
Charach A, Maguire JL, et al. Screen use and mental health
symptoms in Canadian children and youth during the COVID‑19
pandemic. JAMA Netw Open 2021;4:e2140875.
Ueno C, Yamamoto S. The relationship between behavioral
problems and screen time in children during COVID‑19 school
closures in Japan. Scand J Child Adolesc Psychiatr Psychol
;10:1‑8.
McArthur BA, Racine N, McDonald S, Tough S, Madigan S. Child
and family factors associated with child mental health and well‑being
during COVID‑19. Eur Child Adolesc Psychiatry 2023;32:223‑33.
Duan L, Shao XJ, Wang Y, Huang YL, Miao JX, Yang XP,
et al. An investigation of mental health status of children and
adolescents in China during the outbreak of COVID‑19. J Affect
Disord 2020;275:112‑8.
Drouin M, McDaniel BT, Pater J, Toscos T. How parents and
their children used social media and technology at the beginning
of the COVID‑19 pandemic and associations with anxiety.
Cyberpsychol Behav Soc Netw 2020;23:727‑36.
Teng Z, Pontes HM, Nie Q, Griffiths MD, Guo C. Depression
and anxiety symptoms associated with internet gaming disorder
before and during the COVID‑19 pandemic: A longitudinal
study. J Behav Addict 2021;10:169‑80.
Tandon PS, Zhou C, Johnson AM, Gonzalez ES, Kroshus E.
Association of children’s physical activity and screen time with
mental health during the COVID‑19 pandemic. JAMA Netw
Open 2021;4:e2127892.
Li XD, Vanderloo LM, Keown‑Stoneman CDG, Cost KT,
Charach A, Maguire JL, et al. Screen use and mental health
symptoms in Canadian children and youth during the COVID‑19
pandemic. JAMA Network Open 2021;4:e2140875.
Fawaz M, Samaha, A E‑learning: Depression, anxiety, and stress
symptomatology among Lebanese university students during
COVID‑19 quarantine. Nurs Forum 2021;56:52–7.
Yousef S, Eapen V, Zoubeidi T, Mabrouk A. Behavioral
correlation with television watching and videogame playing
among children in the United Arab Emirates. Int J Psychiatry
Clin Pract 2014;18:203‑7.
Cash H, Rae CD, Steel AH, Winkler A. Internet addiction:
A brief summary of research and practice. Curr Psychiatry Rev
;8:292‑8.
Pantic I. Online social networking and mental health.
Cyberpsychol Behav Soc Netw 2014;17:652‑7.
Suchert V, Hanewinkel R, Isensee B. Sedentary behavior
and indicators of mental health in school‑aged children and
adolescents: A systematic review. Prev Med 2015;76:48‑57.
Liu Q, Zhou Y, Xie XY, Xue Q, Zhu KH, Wan ZH, et al. The
prevalence of behavioral problems among school‑aged children
in home quarantine during the COVID‑19 pandemic in China.
J Affect Disord 2021;279:412‑6.
Babic MJ, Smith JJ, Morgan PJ, Eather N, Plotnikoff RC,
Lubans DR. Longitudinal associations between changes in
screen‑time and mental health outcomes in adolescents. Ment
Health Phys Act 2017;12:124‑31.
Gupta P, Shah D, Bedi N, Galagali P, Dalwai S, Agrawal S,
et al. Indian Academy of Pediatrics Guidelines on screen time
and digital wellness in infants, children and adolescents. Indian
Pediatr 2022;59:235‑44.
Elhai JD, McKay D, Yang H, Minaya C, Montag C,
Asmundson GJ. Health anxiety related to problematic
smartphone use and gaming disorder severity during COVID-19:
Fear of missing out as a mediator. Hum Behav Emerg Technol
;3:137‑46.
Yuan G, Elhai JD, Hall B. The influence of depressive
symptoms and fear of missing out on severity of problematic
smartphone use and Internet gaming disorder among Chinese
young adults: A three‑wave mediation model. Addict Behav
;112:106648.
Wang C‑Y, Wu Y‑C, Su C‑H, Lin P‑C, Ko C‑H, Yen J‑Y.
Association between Internet gaming disorder and generalized
anxiety disorder. J Behav Addict 2017;6:564‑71.
King DL, Delfabbro PH, Billieux J, Potenza MN. Problematic
online gaming and the COVID‑19 pandemic. J Behav Addict
;9:184‑6.
Fitzpatrick KM, Harris C, Drawve G. Living in the midst of
fear: Depressive symptomatology among US adults during the
COVID-19 pandemic. Depress Anxiety 2020;37:957‑64.
Kondo Y, Tanabe T, Kobayashi‑Miura M, Amano H,
Yamaguchi N, Kamura M, et al. Association between feeling
upon awakening and use of information technology devices in
Japanese children. J Epidemiol 2012;22:12‑20.
Subki AH, Alsallum MS, Alnefaie MN, Alkahtani AM,
Almagamsi SA, Alshehri ZS, et al. Pediatric motor stereotypies:
An updated review. J Pediatr Neuroradiol 2017;15:151‑6.
Elhai JD, Levine JC, Hall BJ. The relationship between anxiety
symptom severity and problematic smartphone use: A review
of the literature and conceptual frameworks. J Anxiety Disord
;62:45‑52.
Lee Y‑S, Joo JH, Shin J, Nam CM, Park E‑C. Association
between smartphone overdependence and generalized
anxiety disorder among Korean adolescents. J Affect Disord
;321:108‑13.
Sanders T, Parker PD, del Pozo‑Cruz B, Noetel M, Lonsdale C.
Type of screen time moderates effects on outcomes in 4013
children: Evidence from the longitudinal study of Australian
children. Int J Behav Nutr Phys Act 2019;16:1‑10.
K. WB. Using social media to our advantage: Alleviating anxiety
during a pandemic. Cyberpsychol Behav Soc Netw 2020;23:197‑8.
Marques de Miranda D, da Silva Athanasio B, Sena Oliveira AC,
Simoes‑e‑Silva AC. How is COVID‑19 pandemic impacting
mental health of children and adolescents? Int J Disaster Risk
Reduct 2020;51:101845.