Mental Health and Childhood Obesity

Replacing Screen Time with Daily Activity to Improve Mental Health in Adolescents

Samuel Allen

University of Missouri-Kansas City

N5555 Nursing research

Dr. Lindholm

07/17/2022

Abstract

Exposure to screen media has been associated with the development of mental health problems. Screen use is higher among children and adolescents with sedentary lifestyles, who are also most likely to be obese. Screen time exposes children and adolescents to other intermediate factors that lead to the development of mental health problems including obesity, due to poor eating habits, and lack of physical activity. Children with high exposure to screen media are more likely to develop serious mental health problems that affect their physical functioning as well as academic performance. The purpose of this evidence-based scholarly paper is to establish whether replacing screen time with 30-minute exercise could improve overall mental health in adolescents compared with adolescents with a sedentary lifestyle. This paper utilizes a quasi-experimental study design to measure the effect of the intervention on the participant’s mental health. The participants of the project will include adolescents with high exposure to screen media who have been diagnosed with a mental health problem to determine the effect of the intervention on mental wellbeing. Replacing screen time with 30-minute activity is expected to lower the symptoms of mental health problems. The findings of the project would be used to help adolescents with mental health problems and also address other issues associated with a sedentary lifestyle such as childhood obesity.

Keywords: screen time, screen media, mental health, physical activity, adolescents

Replacing Screen Time with Daily Activity to Improve Mental Health in Adolescents

Significance of the Topic

           Screen media has been closely associated with mental health problems, behavioral problems, lower self-esteem, and lower health-related quality of life. Childhood obesity is a major health concern among adolescents with a sedentary lifestyle that increases the risk of developing serious mental health problems at a younger age. Current evidence associates screen media exposure with the development of childhood obesity, which affects children’s physical health, as well as emotional and social well-being (Stiglic & Viner, 2018). Studies have established that obese children are more likely to be affected by multiple psychological problems than their healthy peers, which could be worsened by stigma, bullying, and teasing, and seriously impact the performance of their physical and emotional health. The association between screen time and mental health has been extensively studied. Due to the technological developments taking place in the modern world, the exposure of children to screen media is increasing. With the increasing use of digital media by children and adolescents, the risk of developing mental or behavioral disorders is also increasing, which creates the need for interventions to address the issue in primary settings. Mental health problems in children with increased screen media use include unhealthy diet, sedentary lifestyle, sleep deprivation as well as other physiological and psychological factors (Sampasa-Kanyinga et al., 2020; Davison et al., 2022). The diversity considerations that would be considered in the target population include the socioeconomic status of the family, race or ethnicity, and age. The use of a diverse sample would increase the applicability of the findings to the general population.

Problem and Purpose Statements

Sagar and Gupta (2018) explained that childhood obesity is a threat to mental health in adolescents and children. Although not all obese children develop mental health problems, some specific groups of children and adolescents such as children with chronic and severe obesity and clinically obese groups, and adolescent females were found to be at a high risk of developing multiple psychiatric problems. Screen time is a significant factor that contributes to obesity in children due to increased food intake when viewing, intake of low-nutrient beverages and foods and foods with high calories, and sleep deprivation (Robinson et al., 2017). Screen media exposure increases children’s exposure to the marketing of unhealthy foods and beverages that influences their consumption habits, purchase behavior, and their food preferences. 

The purpose of this evidence-based scholarly is to establish whether replacing screen time with physical activity would improve the overall mental health of children and adolescents. Physical activity is associated with the improvement of mental health outcomes and could help obese children by reducing their weight. Weight reduction is one of the strategies used to tackle obesity, which is mostly associated with a sedentary lifestyle. Increased screen time promotes a sedentary lifestyle which increases the risk of obesity. There is a need to identify interventions to address the mental health challenges that face obese adolescents. The findings of the study will be used to assist obese adolescents with increased exposure to screen media by increasing their activity level and reducing their screen time.  

Facilitators and Barriers

           The success of the project will be influenced by both facilitators and barriers. The main facilitators of the project include knowledge in evidence-based practice, availability of existing literature on the topic in peer-reviewed journals available in various nursing and medical databases that can be accessed through the university library, well-designed research protocols, resources, time, and academic training. The barriers include lack of adequate human resources, time constraints, resource shortages, and the high cost of the project. 

Review of Evidence

PICOT

           The primary PICOT statement is "in adolescents ages 10-16, how does replacing screen time with 30 minutes of activity daily compared to children with sedentary lifestyle behaviors improve their overall mental health in a 3-month period?"

Search 

           The database used to search for evidence was PubMed available through the university library. The search terms and phrases used in the search process were derived from the PICOT question. These included adolescents, screen time, physical activity, sedentary lifestyle, screen media, and mental health. The initial search produced 678 articles, which were too many to identify the relevant ones. Therefore, some refinement decisions were applied to narrow down the search results. These included using Boolean operators “OR” and “AND” and additional filters such as limiting the publication date to the last five years, and selecting articles with full text available in PDF. 

The final search results included 31 articles after refining the search strategies, out of which 15 articles were found to be the most relevant to the study. Among the articles, there were 11 quantitative single-study articles, 4 systematic reviews, and no qualitative single-study article was selected. The articles selected provided relevant evidence for the evidence-based project. The evidence provided in the articles was critically analyzed and appraised before the articles were selected for use in the project. 

Synthesis of the Evidence 

           After analyzing the evidence from the 15 articles selected for the evidence-based project, the following themes were developed including the association between physical activity and mental health problems, the association between screen time and mental wellbeing, the mediators of the impact of screen media use, and physical activity on mental health, and the effect of replacing screen time with physical activity on mental health symptoms. The themes are discussed below in a series of sub-topics that represent each of the themes. The evidence supporting the various sub-topics is analyzed and integrated into the evidence-based intervention.

The Association Between Physical Activity and Mental Health Symptoms

Davison et al. (2022) established that increased frequency of physical activity improved the mental well-being of adolescents aged between 13 and 16 years old. Wang et al. (2022) found that an aerobic exercise lasting 30 minutes, carried out 4 times per week for 6 weeks significantly improved depressive symptoms among adolescents. Similar findings were reported when adolescents participated in 75-120 minutes of aerobic exercise, 3 times per week for 8 weeks (Wang et al., 2022). Tandon et al. (2021) identified suggested that physical activity led to a decrease in the number of symptoms of mental health disorders in children. However, other studies found no strong evidence supporting the effect of physical activity on mental well-being in adolescents (Bell et al., 2019). Nevertheless, the authors suggested that physical activity could lead to the improvement of emotional problems, which could reduce depressive and anxiety symptoms. However, the positive association between physical activity and improvement of mental health outcomes indicates that physical activity can be used as an intervention to address the issue of mental health problems in adolescents.

The Association Between Screen Time and Mental Wellbeing 

Davison et al. (2022) found that prolonged use of social media led to lower mental health and well-being in adolescents. Similar findings were shared by Twenge and Campbell (2018) who revealed that more than one hour of screen time per day led to lower psychological wellbeing, which was characterized by lower emotional stability, distractibility, lower self-control, and less curiosity. Tang et al. (2021) stated that there was limited evidence that associated screen time with depressive symptoms. Nagata et al. (2022) suggested that poorer mental health was associated with high screen use. Twenge and Campbell (2018) associated screen time and lower psychological well-being. Another study associated higher screen time with an increased likelihood of developing severe depression and lower prosocial behavior (Ranjit et al., 2022). 

Sampasa-Kanyinga et al. (2020) explained that excessive screen time may have direct or indirect effects on mental health, by directly affecting interpersonal relationships and emotional stability, or indirectly influencing intermediate factors such as eating behaviors, sleep, or body weight. Stiglic and Viner (2018) found that screen time was significantly associated with obesity and depressive symptoms. The evidence from the articles indicated that higher screen time could lead to mental health problems. However, some studies did not establish the direction of the association between screen time and mental health problems. The positive association between screen time and mental health symptoms indicates that adolescents’ mental health could be improved by reducing screen time.

Mediators of the Impact of Screen Media Use and Physical Activity on Mental Health

There are some factors that influence the association between both physical activity and screen media use and mental health such as age, duration, devices used, and gender. Tandon et al. (2021) identified an association between increased screen time and more symptoms of mental health problems in both younger and older children. Twenge and Campbell (2018) identified the duration of screen use as a significant factor that influenced psychological wellbeing since high screen use was associated with more than twice the likelihood of depression diagnosis, while the effect of moderate screen use did not differ with no use in participants’ wellbeing. Also, older adolescents had lower psychological well-being due to screen use than younger children (Twenge & Campbell, 2018). Tang et al. (2021) found that devices influenced the association between screen time and symptoms of depression among adolescents. On the aspect of sex, Davison et al. (2022) found that females had significantly lower mental health well-being scores than males after participating in the same level of physical activity. The mediating factors should be considered to get the accurate effect of the intervention. If the factors are not controlled, they could influence the outcome of the intervention and produce inaccurate results.

The Impact of Replacing Screen Time with Physical Activity

           Current evidence suggests that replacing screen time with physical activity is associated with the improvement of mental health. In one of the studies, Kandola et al. (2022) found that replacing one hour of total screen time with exercise reduced emotional problems, but there was no change if only one video game was replaced with individual exercise. The researchers established that replacing screen time with exercise could lead to a reduction in emotional distress in adolescents, which could have a protective effect on mental health. Tandon et al. (2021) found that less screen time and more physical activity led to improvement of mental health in children while considering the effect of other stressors. Zhang et al. (2020) found less than 2 hours of screen time and more than 30 minutes of exercise per day were associated with higher psychological wellbeing. In another study,

Hrafnkelsdottir et al. (2018) associated less screen time and a higher frequency of vigorous physical activity (at least 4 times a week) with reduced depression, life dissatisfaction, low self-esteem, and anxiety symptoms. The evidence from the articles suggests that replacing or reducing screen time and increasing physical activity could lead to better mental health outcomes.

References

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Bell, S. L., Audrey, S., Gunnell, D., Cooper, A., & Campbell, R. (2019). The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 1-12. https://doi.org/10.1186/s12966-019-0901-7

Davison, J., Bunting, B., Connolly, P., Lloyd, K., Dunne, L., & Stewart-Knox, B. (2022). Less screen time, more frequent fruit and vegetable intake and physical activity are associated with greater mental wellbeing in adolescents. Child Indicators Research, 1-23. https://doi.org/10.1007/s12187-022-09924-6

Engberg, E., Hietajärvi, L., Maksniemi, E., Lahti, J., Lonka, K., Salmela-Aro, K., & Viljakainen, H. (2022). The longitudinal associations between mental health indicators and digital media use and physical activity during adolescence: A latent class approach. Mental health and physical activity, 22, 100448. https://doi.org/10.1016/j.mhpa.2022.100448R

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