Impact of Screen Media Activity on Children and Adolescents’ Mental & Physical Health

Many youth (individuals aged between 10 and 24 years) are spending significant time watching videos, being engrossed in games on tablets, or messaging friends as common recreational activities.

Screen media activity consumes up to 60% of teenagers after-school time, and nearly 97% of US youth have at least one electronic item in their bedroom⁽¹⁾.

The relationship between screen media activity and mental health outcomes in youth is a complex and multifaceted issue that has garnered significant attention among researchers and the public in recent years. The complexity may be due to the diverse nature of screen activities, the rapidly evolving landscape of digital media, and the differential impacts these activities may have across individuals⁽¹⁾.
 
There is a nuanced picture emerging with some evidence indicating relatively trivial effects of screen media activity on well-being and other results showing stronger associations with mental health issues such as depression or anxiety⁽²⁾.  

This article will provide a balanced review of the most recent findings within the past 3 years focused on screen media activity and mental health.

Screen Media Activity and Mental Health

Over the past decades, screen media activity research focus has recently changed from an emphasis on depression during the earlier period (1983–2016), to a greater focus on anxiety disorders (2020–2022), considering factors such as cognitive distortions, insomnia, loneliness, self-esteem, social support, and alexithymia (i.e., when a person has difficulty experiencing, identifying, and expressing emotions).

Overall, screen media activity has been associated with depressive or anxiety disorders and their symptoms, with evidence indicating that greater screen time at early ages is directionally linked to higher levels of internalizing symptoms several years later⁽³⁾.

Specific behaviors such as higher daily time spent on social media have been associated to a significant increase in the risk of depression in adolescents, more so in girls than boys, which is in agreement with another study reporting that high social media use has been found to predict more depressive symptoms, panic disorder symptoms, delinquent behaviors, and family conflict, along with lower levels of family and friend support⁽⁴⁾.

Prolonged screen time, particularly more than 1 hour per day of electronic gaming or using computers and more than 2 hours per day of watching TV, has been associated with low life satisfaction among adolescents⁽⁵⁾. 

In addition, increased time spent engaging in newer types of screen behavior, including social media, online games, and online videos, has been linked with a higher prevalence of depression⁽⁶⁾. Widespread daily use of social media (over 3 hours) has been associated with internalizing problems and co-occurring internalizing and externalizing problems⁽⁷⁾. More specifically, components of digital stress such as approval anxiety, availability stress, fear of missing out, connection overload, and online vigilance have all been linked to psychosocial distress.
 
Within the context of screen media activity, active engagement in social media was linked to subsequent anxiety symptoms in adolescents.

Additionally, heavy levels of digital screen time (i.e., 3 + hours daily) was associated with declines in well-being, particularly concerning external and prosocial functioning⁽⁸⁾.

Notably, specific uses of smartphones such as listening to music, chatting online, watching TV, and playing games have been reported to exert high to medium negative effects on succeeding mental health⁽⁹⁾.

Screen Media Activity and Sleep

There are multiple research studies indicating that greater use of screen media, including video and video game usage, were associated with decreased sleep duration, increased sleep onset latency, and heightened severity of sleep disturbance symptoms⁽¹⁰⁾.

Evidence indicates that longer engagement with entertainment content to be linked to shorter sleep duration and poorer sleep quality, consistent across all times of day of screen media activity.

Adolescents and young adults spending over two hours on smartphones per day had higher odds of sleep problems, with adolescent girls showing a significantly greater likelihood than boys⁽¹¹⁾. 

Screen Media Activity and Cognition

Research on screen media activity and cognitive functioning found both positive, no, and negative associations.

• Some data indicates youth who played video games were better prepared to allocate their attention in space and time.  There is also evidence of a small but positive relationship between gaming and measures of generalized intelligence⁽¹²⁾.
• Other research found no significant effects of media use on tasks involving switching of attentional demands to measure selective and divided attention⁽¹³⁾.
• Several studies demonstrate that media-multitasking, which refers to engaging with at least two forms of screen media activity simultaneously, is associated with negative cognitive outcomes such as reduced abilities or tendencies to filter out distractions, increased impulsivity, and lower working memory performance⁽¹⁴⁾.  
• In relation, preschoolers, greater screen time was found to statistically predict lower communication and problem-solving scores and poorer attention⁽¹⁵⁾.

These findings underline that the relationship between screen media activity and cognitive skills is complex and may vary based on factors such as screen content, youth’s surroundings, including family and friends, and personal traits/tendencies. Thus, the potential impacts of screen media activity on cognitive function in adolescents remains limited.

Screen Media Activity and Obesity

Screen media activity has also been associated with dietary habits and body mass index. There is moderate evidence for an association between increased screen media activity and higher energy intake and less healthy diets. Each additional hour of total screen time per day was prospectively associated with a 0.22 higher BMI percentile at a 1-year follow-up⁽¹⁶⁾ and in girls, much time spent on social media (≥5 h/day) was positively associated with body mass index z-score. This relationship is further supported by research linking recreational screen time, but not educational screen use, to obesity⁽¹⁷⁾.

Recent Systematic Review

A recent systematic review evaluated the current evidence on associations between mobile phones/wireless devices use and mental health outcomes in children and adolescents across 25 studies published up to 2019⁽¹⁸⁾.  

Below are the findings:

• They found evidence to suggest that greater use of mobile phones/wireless devices may be associated with poorer mental health in children and adolescents, but that the strength of the associations vary partly depending on the time and nature of mobile phones/wireless devices usage.
• Secondly, evidence suggests that bedtime mobile phones/wireless devices duration or frequency of use is associated with worse mental health.
• Third, based on limited available research, there is no evidence supporting a direct impact of radiofrequency electromagnetic fields on mental health.
• Finally, more research is needed to clarify whether the different uses of mobile phones/wireless devices have distinct impacts on specific psychopathology.  General use of mobile phones/wireless devices might be associated with externalizing symptoms in children and adolescents⁽¹⁸⁾.

Summary

In summary, evidence supports a negative impact of general mobile phones/wireless devices use on externalizing symptoms in children and early adolescents, while findings on internalizing symptoms are less consistent.

Sleep disturbance due to mobile phones/wireless devices use appears to influence mental health outcomes but the specific role of sleep remains to be clarified. There are some main gaps that need to be addressed such as the need to dissect effects based on different types of mobile phones/wireless devices use and in relation to specific population characteristics.

Despite the fears held around wireless technologies, at this stage there is not enough evidence supporting a causal negative relationship between mobile phones/wireless devices use and children and adolescent’s mental health to justify particular public health interventions.

Even if the current research doesn't always offer concrete black-and-white answers, common sense would tell us that excessive screen time can have real implications for children’s mental and physical well-being.

After all, kids need social interaction and exercise, and sitting in front of a screen doesn't provide either.

There’s another factor influencing mental health that’s often overlooked—where we live. Urban environments, with their fast pace and constant sensory overload, also play a critical role in shaping our brains.

If you're interested to know how our surroundings are rewiring our brains, and what that means for both adults and children, you can read our next post, 'Our Brains in the City: The Neurobiological Effects of Urbanization', where we examine the research surrounding how city living affects mental health in ways you might not expect here.

References:
    1.    Paulus MP, Zhao Y, Potenza MN, et al: Screen media activity in youth: A critical review of mental health and neuroscience findings. J Mood Anxiety Disord 3, 2023
    2.    Roberston L, Twenge JM, Joiner TE, et al: Associations between screen time and internalizing disorder diagnoses among 9- to 10-year-olds. J Affect Disord 311:530-537, 2022
    3.    Neville RD, McArthur BA, Eirich R, et al: Bidirectional associations between screen time and children's externalizing and internalizing behaviors. J Child Psychol Psychiatry 62:1475-1484, 2021
    4.    Vannucci A, McCauley Ohannessian C: Social Media Use Subgroups Differentially Predict Psychosocial Well-Being During Early Adolescence. J Youth Adolesc 48:1469-1493, 2019
    5.    Khan A, Moni MA, Khan SR, et al: Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries. Scand J Public Health 51:918-925, 2023
    6.    Kidokoro T, Shikano A, Tanaka R, et al: Different Types of Screen Behavior and Depression in Children and Adolescents. Front Pediatr 9:822603, 2021
    7.    Riehm KE, Feder KA, Tormohlen KN, et al: Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry 76:1266-1273, 2019
    8.    Bohnert M, Gracia P: Digital use and socioeconomic inequalities in adolescent well-being: Longitudinal evidence on socioemotional and educational outcomes. J Adolesc 95:1179-1194, 2023
    9.    Huang S, Lai X, Li Y, et al: Beyond Screen Time: The Different Longitudinal Relations between Adolescents' Smartphone Use Content and Their Mental Health. Children (Basel) 10, 2023
    10.    Hisler GC, Hasler BP, Franzen PL, et al: Screen media use and sleep disturbance symptom severity in children. Sleep Health 6:731-742, 2020
    11.    Maurya C, Muhammad T, Maurya P, et al: The association of smartphone screen time with sleep problems among adolescents and young adults: cross-sectional findings from India. BMC Public Health 22:1686, 2022
    12.    Sauce B, Liebherr M, Judd N, et al: The impact of digital media on children's intelligence while controlling for genetic differences in cognition and socioeconomic background. Sci Rep 12:7720, 2022
    13.    Liebherr M, Kohler M, Brailovskaia J, et al: Screen Time and Attention Subdomains in Children Aged 6 to 10 Years. Children (Basel) 9, 2022
    14.    Madore KP, Khazenzon AM, Backes CW, et al: Memory failure predicted by attention lapsing and media multitasking. Nature 587:87-91, 2020
    15.    Axelsson EL, Purcell K, Asis A, et al: Preschoolers' engagement with screen content and associations with sleep and cognitive development. Acta Psychol (Amst) 230:103762, 2022
    16.    Nagata JM, Iyer P, Chu J, et al: Contemporary screen time usage among children 9-10-years-old is associated with higher body mass index percentile at 1-year follow-up: A prospective cohort study. Pediatr Obes 16:e12827, 2021
    17.    Liu Y, Sun X, Zhang E, et al: Association between Types of Screen Time and Weight Status during the COVID-19 Pandemic: A Longitudinal Study in Children and Adolescents. Nutrients 15, 2023
    18.    Girela-Serrano BM, Spiers ADV, Ruotong L, et al: Impact of mobile phones and wireless devices use on children and adolescents' mental health: a systematic review. Eur Child Adolesc Psychiatry 33:1621-1651, 2024