Adolescents' screen time, sleep and mental health: literature review
Systematic review summarising the published experimental and longitudinal evidence on adolescent screen time, sleep and mental health.
Appendix Table F: Summary of findings on the relationship between mobile device screen use and mental health mediated by the impact of screen use on sleep
Reference |
Study characteristics |
Sample characteristics |
Exposure/Intervention Description |
Outcome description |
Findings CI=confidence interval SES=socioeconomic status |
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Night-time mobile phone use |
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Vernon 2018 |
Australia Longitudinal cohort study Follow-up: 1 year |
N=1101 Age: 13-16 years Baseline mean age: 13.5 years Sex: 57% female Ethnicity: 56.9%Caucasian, 7.1% Asian, 2% Aboriginal or Torres Strait Islander, 21.9% other Other: 44% from lower SES |
Night-Time Mobile Phone Use: Students were asked if they had a mobile phone and if they answered yes they were then asked, "At what time of the night do you usually send or receive messages and/or phone calls?" 6 response options: never text or phone after lights out; immediately after lights out; 10–11 p.m.; 11 p.m.–12 a.m.; 12–1 a.m.; 1–2 a.m.; 2–6 a.m.; at any time of the night. Coded on 6-point scale (0-5) as 0 = no mobile phone, 1 = never text or phone after lights out, 2 = immediately after lights out, 3 = before midnight, 4 = after midnight, and 5 = at any time of the night |
Depressed mood: questionnaire based on the mean of five items designed to tap emotional well-being, originally from the Michigan Study of Adolescent Life Transitions. Items included: "How often do you feel there is nothing nice you can look forward to; feel unhappy, sad, or depressed?" Responses ranged from 1 (never) to 6 (daily). Higher scores = worse outcome |
Latent Growth Curve Mediation Models (Mediator: sleep quality; Covariate: bedtime, gender, SES) Indirect effect intercept: B=0.29 (95%CI 0.10 to 1.75) ß=0.44 |
Externalising behaviour: Questionnaire comprising the mean of seven items, included: "In the past 6 months how often have you skipped school without parent permission?; how often have you gotten in a physical fight with another person?" The items were measured on an 8-point scale from 1 (none) to 8 (31 or more times), Higher scores = worse outcome |
Latent Growth Curve Mediation Models (Mediator: sleep quality; Covariate: bedtime, gender, SES) Indirect effect intercept: B=0.08 (95%CI 0.01 to 1.34) ß=0.12 |
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Self-esteem: Questionnaire based on the mean for three items and included: "How often do you feel satisfied with who you are?" Items were measured on a 6-point scale from 1 (never) to 6 (daily). The items were reverse coded with higher scores = low self-esteem. |
Latent Growth Curve Mediation Models (Mediator: sleep quality; Covariate: bedtime, gender, SES) Indirect effect intercept: B=0.13 (95%CI 0.04 to 0.73) ß=0.15 |
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Coping: Single-item question: "How often do you feel that you are capable of coping with most of your problems?" Responses ranged from 1 (never) to 6 (daily). The item was reverse coded with higher scores = poor coping ability |
Latent Growth Curve Mediation Models (Mediator: sleep quality; Covariate: bedtime, gender, SES) Indirect effect intercept: B=0.16 (95%CI 0.06 to 1.07) ß=0.19 |
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Social media use |
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Vernon 2017 |
Australia Longitudinal cohort study Follow-up: 2 years |
N=874 Age: range not reported Baseline mean age: 14.4 years (SD not reported) Sex: 59% female Ethnicity: 57.2% were Caucasian, 7.2% Asian, and 1.6% Aboriginal or Torres Strait Islander, 23.3% other |
Social media use assessed using the problematic use of social networking scale consisting of 4 items. Items measured the degree to which adolescents invest emotionally in social networking
Possible responses ranged from 0 (no social media profile) to 1 (completely disagree) and 5 (completely agree). |
Depressed mood: See Vernon 2018 |
Latent Growth Curve Mediation Models (Mediator: sleep disruptions; Covariate: gender, SES, pubertal timing) Indirect effect intercept: B = 0.181 (95%CI 0.132 to 0.244) |
Externalising behaviour: See Vernon 2018 |
Latent Growth Curve Mediation Models (Mediator: sleep disruptions; Covariate: gender, SES, pubertal timing) Indirect effect intercept: B = 0.037 (95%CI 0.019 to 0.060) |
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Smartphone application |
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Werner-Seidler 2019 |
Australia pilot study (single arm pre-post intervention design) Follow-up: 6 weeks |
N=50 (baseline) Age: 12 to 16 years Baseline mean age: 13.71 (SD 1.35) Sex: 66% female Other: With mild insomnia; 94% born in Australia |
Sleep Ninja App aiming to teach users about the importance of consistent sleep and wake times, and recommended bedtimes. The structure of the Sleep Ninja app includes six training lessons, a sleep tracking function, recommended bedtimes based on sleep guidelines, reminders to start a wind-down routine each night, a series of sleep tips and general information about sleep. Training sessions were delivered through a chat-bot format where the sleep ninja essentially acts as a sleep coach. Training sessions took approximately 5–10 min to complete. Intervention duration: 6 weeks (locked sessions thereafter) |
Depressive symptoms: Patient Health Questionnaire-Adolescent Version (PHQ-A), asked about symptoms in preceding 2 weeks. Items scored on a 4-point scale, summed together to form a total depression score ranging from 0 to 24. 0–9 = minimal symptoms, 10–14 = mild symptoms, 15–19 = moderate symptoms, 20–24 = severe depression |
Multilevel modelling, random effects β=−2.60, p<0.001 Cohen's d =0.36 |
Anxiety: Generalised Anxiety Disorder 7-item scale (GAD-7), items scored on a scale from 0 (not at all) to 3 (nearly every day). Total score ranging from 0 to 21: 0–4 = minimal anxiety, 5–9 = mild anxiety, 10–14= moderate anxiety, 15–21 = severe anxiety |
Multilevel modelling, random effects β=−2.56, p<0.001 Cohen's d =0.41 |
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