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Table 1 Characteristics of the studies included in this review (N = 70)

From: The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Name, Year, Reference

N (mean age, years)

Study Design

Measure of Sedentary Behavior

Measure of Depression and/or Anxiety Symptoms

Results

Methodolo-gical Quality Score

Allen, 2015 [23]

7818 (ages 6–10 at baseline)

C/L (screen-based SB predicting internalizing symptoms)

Parent-reported average mins/day of TV viewing and videogame playing on weekdays and weekend days

Depression and Anxiety: SDQ, emotional subscale

Female sex, null (cross-sec. and long.)

Screen-based SB *sex interaction, NS, not reported

Parental education, null (cross-sec. and long.)

Screen-based SB*parental education interaction, NS, not reported

General health rating, null (cross-sec. and long.)

Screen-based SB* general health rating interaction, NS, not reported

Pubertal status, null (cross-sec. and long.)

Screen-based SB* pubertal status interaction, NS, not reported

Household income, null (cross-sectional and longitudinal)

Screen-based SB* household income interaction, NS, not reported

Neighborhood socioeconomic status, null (cross-sectional and longitudinal)

Screen-based SB* neighborhood socioeconomic status interaction, NS, not reported

Moderate

Baer, 2012 [24]

109 (13.8)

C

Self-reported hours/day of TV viewing, recreational computer use, and videogame playing

Depression and Anxiety: SDQ, emotional subscale

TV viewing, null

(Standardized regression coefficients presented)

TV viewing:0.08 ± 0.09 (p > .05)

Computer use:0.05 ± 0.11 (p > .05)

Videogames: −0.13 ± 0.10 (p > .05)

Weak

Barcaccia, 2018 [25]

301 (17.1)

C

Self-reported average daily time spent watching TV

Depression: Beck Depression Inventory (BDI)

Anxiety: State-Trait Anxiety Inventory (STAI) Form Y

Female sex, null (dep.)

In boys: β = 0.127 (p > .05)

In girls: β = 0.384 (p > .05)

Female sex, null (anx.)

In boys: β = 0.072 (p > .05)

In girls: β = −0.046 (p > .05)

Weak

Bélair, 2018 [26]

9702 (ages 14–15)

C

Self-reported average daily time spent TV viewing, videogame playing, or watching videos

Depression and Anxiety: Ontario Child Health Study (7 items)

Female sex, null (dep. and anx.)

Screen-based SB in entire sample: OR 1.36 (95%CI 1.11–1.67)

Stratified analyses by sex NS different than estimate in entire sample, not reported

Physical activity, null (dep. and anx.)

Screen-based SB*physical activity interaction NS, not reported

Weak

Bélanger, 2011 [27]

7211 (ages 16–20)

C

Self-reported hours/day and days/week of internet use

Depression: Depressive Tendencies Scale

Female sex, null

Heavy vs. regular Internet users in boys:

RRR = 1.36 (95%CI 1.01–1.81)

Heavy vs. regular Internet users in girls:

RRR = 1.86 (95%CI 1.30–2.66)

Weak

Bickham, 2015 [28]

126 (14.0)

C/L (screen-based SB predicting depressive symptoms)

Self-reported average amount of TV viewing, computer use, videogame playing, and mobile phone use on weekends and weekdays

Depression: BDI

TV viewing, null (cross-sectional)

TV: β = −0.07 (p = .45)

Computer: β = 0.03 (p = .76)

Videogames: β = − 0.08 (p = 0.39)

Mobile phone: β = − 0.04 (p = .66)

TV viewing and mobile phone use, amplifier (longitudinal)

TV: β = 0.21 (p = .03)

Computer: β = 0.08 (p = .45)

Videogames: β = 0.004 (p = .97)

Mobile phone: β = 0.22 (p = .02)

Moderate

Brodersen, 2005 [29]

4320 (11.8)

C

Self-reported average TV viewing, computer use, and videogame playing on weekends and weekdays

Depression and Anxiety: SDQ, emotional subscale

Female sex, amplifier

In boys: β = 0.08 (p = .48)

In girls: β = 0.34 (p = .001)

Weak

Cao, 2011 [30]

5003 (13.2)

C

Self-reported average hours of TV viewing and computer use outside of school hours

Depression: Depression Self-Rating Scale for Children (DSRSC)

Anxiety: Screen for Child Anxiety Related Emotional Disorders (SCARED)

Vigorous physical activity (VPA), buffer (dep.)

High screen-based SB and low VPA: REF.

Low screen-based SB and low VPA: OR 0.66 (95%CI 0.56–0.79)

High screen-based SB and high VPA: OR 0.78 (95%CI 0.60–1.01)

Low screen-based SB and low VPA: OR 0.50 (0.41–0.62)

VPA, buffer (anx.)

High screen-based SB and low VPA: REF.

Low screen-based SB and low VPA: OR 0.72 (95%CI 0.60–0.85)

High screen-based SB and high VPA: OR 0.87 (95%CI 0.67–1.12)

Low screen-based SB and low VPA: OR 0.67 (0.41–0.62)

Strong

Casiano, 2012 [31]

9137 (ages 12–19)

C

Self-reported average hours per week of TV viewing, computer use, and videogame playing

Depression: Composite International Diagnostic Interview (CIDI)

Videogame use, buffer

TV: OR 0.94 (95%CI 0.87–1.02)

Computer: OR 1.03 (95%CI 0.96–1.10)

Videogames: OR 0.87 (95%CI 0.79–0.97)

Weak

Castillo, 2014 [32]

1508 (13.9)

C

Self-reported time spent in screen-based SB on the most recent non-school day (TV viewing, computer use, videogames, listening to music, and telephone/texting)

Depression: Kandel’s 6-item depressive symptoms scale

Female sex, null

Depression*sex interaction (p = .07)

Weak

Chen, 2009 [33]

10,347 (grade 11)

L (screen-based SB predicting depressive symptoms)

Self-reported average time watching TV and playing Internet games after school

Depression: Center for Epidemiological Studies Depression Scale (CES-D) and BDI

Internet games, buffer

TV: β = 0.00, p > 0.05

Internet games: β = −0.31, p < .01

Strong

Cho, 2017 [34]

10,261 (ages 11–17 at baseline)

L (depressive symptoms predicting screen-based SB)

Self-reported weekly hours of TV viewing, video viewing, computer games, and videogames.

Depression: Modified CES-D

Socioeconomic Neighborhood Environment, null

Depressive symptom*poverty interaction NS, not reported

Depressive symptom*education interaction NS, not reported

Depressive symptom*Race/ethnicity composition interaction NS, not reported

Weak

Dennison-Farris, 2017 [35]

121 (10.5)

C

Self-reported average daily hours of TV viewing, computer use, videogame playing, and tablet use on weekdays and weekend days

Depression: Children’s Depression Inventory (CDI)

Tablet, amplifier (on weekdays only)

On weekdays

TV: β = 0.01 (p = .65)

Computer: β = 0.03 (p = .06)

Videogames: β = 0.01 (p = .66)

Tablet: β = 0.03 (p = .03)

Tablet, null (on weekend days only)

On weekend days

TV: β = 0.04 (p = .01)

Computer: β = 0.04 (p = .02)

Videogames: β = 0.03 (p = .03)

Tablet: β = 0.03 (p = .04)

Weak

Desai, 2010 [36]

4028 (ages 14–18)

C

Self-reported average time playing video or computer games in the previous week

Depression: self-reports of being sad or hopeless for 2 weeks or more during the previous year

Female sex, buffer

Depressive symptom*sex interaction (p = .01)

In boys: OR 1.15 (p = .35)

In girls: OR 0.72 (p = .002)

Weak

Do, 2013 [37]

136,589 (ages 13–18)

C

Self-reported average daily minutes of Internet use (non-study purposes) over the last 30 days

Depression: self-reports of sadness/despair or suicidal ideation

Longer sleep duration, null

Internet*sleep duration interaction NS, not reported

Weak

Durkin, 2002 [38]

1304 (16.0)

C

Self-reported of average computer game use

Depression: 4-item scale (measure not reported)

Female sex, null

Screen-based SB*sex interaction NS, not reported

Weak

Fulkerson, 2004 [39]

4734 (14.8)

C

Self-reported average TV viewing on weekends and weekdays

Depression: Kandel and Davies 6-item depressive mood scale

Female sex, amplifier (on weekdays and weekend days)

On weekdays

Mean hours of screen-based SB in boys: Low dep = 4.7 h vs. moderate dep. = 4.8 h vs high dep. = 4.8 h (p = .665)

Mean hours of screen-based SB in girls: Low dep. = 4.3 h vs. moderate dep. = 4.7 h vs. high dep. = 4.5 h (p < .001)

On weekend days

Mean hours of screen-based SB in boys: Low dep = 4.7 h vs. moderate dep. = 4.7 h vs. high dep. = 4.7 h (p = .705)

Mean hours of screen-based SB in girls: Low dep. = 4.3 h vs. moderate dep. = 4.6 h vs. high dep. = 4.3 h (p < .001)

Weak

Godinho, 2014 [40]

1680 (aged 13)

C

Self-reported average TV viewing and computer use on weekends and weekdays

Depression: BDI-II

Female sex and computer use, amplifier

TV (in boys): OR 1.17 (95%CI 0.64–2.14)

TV (in girls): NS, not reported

Computer (in boys): OR 1.02 (95%CI 0.55–1.89)

Computer (in girls): OR 1.71 (95%CI 1.11–2.61)

Moderate

Goldfield, 2016 [41]

358 (15.6)

C

Self-reported average daily hours TV viewing, computer use, and playing inactive videogames

Depression: CDI

Female sex, null

Total screen-based SB*sex interaction (p = .751)

TV*sex interaction (p = .276)

Computer*sex interaction (p = .623)

Videogame*sex interaction (p = .335)

TV Viewing, buffer

TV: β = 0.11 (p > .05)

Computer: β = 0.18 (p = .006)

Videogames: β = 0.13 (p = .05)

Weak

Gopinath, 2012 [42]

1094 (17.3) (C) 775 (17.3) (L)

C/L (screen-based SB predicting internalizing symptoms)

Self-reported average daily hours TV viewing, computer use, videogame playing

Depression and Anxiety: Pediatric Quality of Life Inventory (PedsQL), emotional subscale

TV viewing, null (dep. and anx.) (cross-sectional)

TV Viewing: β = −2.4, p = .01

Computer: β = − 2.3, p = .004

Videogames: β = −3.2, p = .01

TV viewing, buffer (dep. and anx.)

(longitudinal)

Low TV viewing mean score = 76.17

Moderate TV Viewing mean score = 73.78

High TV viewing mean score = 71.31

(p-trend = .10)

Low total screen time mean score = 75.31

Moderate total screen time mean score = 76.92

High total screen time mean score = 66.98

(p-trend = .01)

Moderate

Griffiths, 2010 [43]

13,470 (5.2)

C

Mother-report of child’s average hours of TV/videos/DVD, computer use, and electronic game use

Depression and Anxiety: SDQ, emotional subscale

Female sex, amplifier (dep. and anx.)

In boys: β = − 0.03, p = .77

In girls: β = 0.09, p = .03

Moderate

Grontved, 2015 [44]

435 (aged 15 at baseline)

L (screen-based SB predicting depressive symptoms)

Self-reported leisure time TV viewing and computer use

Depression: Major Depression Inventory (MDI)

Female sex, null

TV*sex interaction (p = .89)

Computer*sex interaction (p = .18)

TV Viewing, amplifier

TV: β = 1.24 (p < .001)

Computer: β = −.06 (p = .91)

Weak

Hamer, 2016 [45]

2038 (16.0)

L (screen-based SB predicting internalizing symptoms)

Self-reported time spent TV viewing, watching videos, and computer use “after school yesterday”

Depression and Anxiety: 9-item Malaise Inventory

Female sex, null (dep. and anx.)

Screen-based SB*sex interaction NS, not reported

Moderate

Hayward, 2016 [46]

3295 (15.1)

C

Self-reported screen-based SB from single item on Core Indicators and Measures of Youth Health Survey

Depression: Short Mood and Feelings Questionnaire (MFQ)

Female sex, buffer

In boys: OR 0.98 (95%CI 0.93–1.03)

In girls: OR 0.95 (95%CI 0.91–0.98)

Moderate

Hinkley, 2014 [47]

3604 (4.3)

L (screen-based SB predicting internalizing symptoms)

Parent-reported average daily hours of TV viewing and e-game/computer use on weekdays and weekend days

Depression and Anxiety: SDQ, emotional subscale

Female sex and TV viewing, null (dep. and anx.) (on weekdays and weekend days)

On weekdays

TV viewing in boys: OR 1.2 (95% CI 0.9–1.5)

TV viewing in girls: OR 1.3 (95%CI 1.0–1.7)

Computer use in boys: OR 1.3 (95%CI 0.8–2.1)

Computer use in girls: OR 2.0 (95%CI 1.0–4.0)

On weekend days

TV viewing in boys: OR 1.0 (95% CI 0.8–1.3)

TV viewing in girls: OR 1.3 (95% CI 1.0–1.6)

Computer use in boys: OR 1.0 (95%CI 0.7–1.4)

Computer use in girls: OR 1.1 (95%CI 0.7–1.8)

Moderate

Hoare, 2014 [48]

800 (13.1)

C

Self-reported average daily hours of TV viewing, computer use, and videogame playing

Depression: SMFQ

Female sex, null

In boys: OR 1.22 (p = .01)

In girls: OR 1.12 (p = .02)

Weak

Holtz, 2011 [49]

205 (12.7)

C

Self-reported average daily hours of Internet use (for communication, informational purposes, and online gaming)

Depression and Anxiety: German version of the Youth Self Report (YSR), internalizing subscale

Parental communication, null (dep. and anx.)

Parent communication*Internet use interaction NS (Wald χ2 < 0.6)

Weak

Houghton, 2018 [50]

1749 (ages 10–17)

L (bi-directional)

Self-reported screen-based SB (TV viewing, web, gaming, and social media) via Screen Based Media Use Scale

Depression: CDI 2

Female sex, buffer

Social media, amplifier

TV viewing in boys: β = 0.108 (p = .058) (depressive symptoms predicting TV viewing)

β = 0.057 (p = .290) (TV viewing predicting depressive symptoms)

Web use in boys: β = 0.058 (p = .246) (depressive symptoms predicting web use)

β = 0.115 (p = .028) (web use predicting depressive symptoms)

Gaming in boys: β = 0.045 (p = .338) (depressive symptoms predicting gaming)

β = 0.040 (p = .451) (gaming predicting depressive symptoms)

Social media in boys: β = 0.163 (p = .002) (depressive symptoms predicting social media)

β = 0.150 (p = .002) (social media predicting depressive symptoms)

TV viewing in girls: β = 0.033 (p = .563) (depressive symptoms predicting TV viewing)

β = 0.072 (p = .212) (TV viewing predicting depressive symptoms)

Web use in girls: β = − 0.022 (p = .707) (depressive symptoms predicting web use)

β = 0.070 (p = .211) (web use predicting depressive symptoms)

Gaming in girls: β = 0.038 (p = .404) (depressive symptoms predicting gaming)

β = 0.050 (p = .302) (gaming predicting depressive symptoms)

Social media in girls: β = − 0.061 (p = .238) (depressive symptoms social media)

β = − 0.083 (p = .104) (social media predicting depressive symptoms)

Mid-adolescence, amplifier

In boys (early): β = 0.032 (p = .757) (depressive symptoms predicting total screen-based SB)

β = 0.361 (p = .241) (total screen-based SB predicting depressive symptoms)

In girls (early): β = − 0.054 (p = .555) (depressive symptoms predicting total screen-based SB)

β = 0.002 (p = .986) (total screen-based SB predicting depressive symptoms)

In boys (mid): β = 0.068 (p = .501) (depressive symptoms predicting total screen-based SB)

β = 0.272 (p < .001) (total screen-based SB predicting depressive symptoms)

In girls (mid): β = 0.217 (p = .107) (depressive symptoms predicting total screen-based SB)

β = 0.253 (p = .024) (total screen-based SB predicting depressive symptoms)

In boys (late): β = − 0.009 (p = .955) (depressive symptoms predicting total screen-based SB)

β = 0.107 (p = .518) (total screen-based SB predicting depressive symptoms)

In girls (late): β = 0.026 (p = .857) (depressive symptoms predicting total screen-based SB)

β = 0.187 (p = .302) (total screen-based SB predicting depressive symptoms)

Moderate

Hrafnkelsdottir, 2018 [51]

244 (15.8)

C

Self-reported average daily hours of TV viewing, computer use, and videogame playing on weekends and weekdays

Depression and Anxiety: Symptom Checklist 90 (SCL-90) depression and anxiety subscales

VPA, buffer (dep.)

Low VPA and high screen-based SB: REF.

High VPA and low screen-based SB: RR = 0.06 (95%CI 0.01–0.41)

VPA, buffer (anx.)

Low VPA and high screen-based SB: REF.

High VPA and low screen-based SB: RR = 0.16 (95%CI 0.06–0.45)

Weak

Hume, 2011 [52]

155 (14.4)

C/L (bi-directional)

Self-reported average TV viewing

Depression: CES-D

Female sex, null (cross-sectional)

In boys: NS, not reported

In girls: NS, not reported

Female sex, null (long., screen-based SB predicting depressive symptoms)

In boys: NS, not reported

In girls: NS, not reported

Female sex, amplifier (long., depressive symptoms predicting screen-based SB)

In boys: β = −4.29 (p > .05)

In girls: β = 3.53 (p < .001)

Moderate

Iannotti, 2013 [53]

9058 (13.9)

C

Self-reported average daily hours of TV viewing, computer use, and videogame playing on weekends and weekdays

Depression: Scale not reported, 6 screening questions (sadness, irritability, hopelessness, change in appetite, change in sleeping, and problems concentrating)

Female sex, null

Healthful boys (low screen-based SB): mean depression score = 2.11

Unhealthful boys (high screen-based SB): mean depression score = 2.35

Typical boys (moderate screen-based SB): mean depression score = 2.17

(each group sig. Different from one another at p < .05 level)

Healthful girls (low screen-based SB): mean depression score = 2.40

Unhealthful girls (high screen-based SB): mean depression score = 2.76

Typical girls (moderate screen-based SB): mean depression score = 2.64

(each group sig. Different from one another at p < .05 level)

Strong

Katon, 2010 [54]

2274 (13–17)

C

Self-reported average time TV viewing and computer use

Depression: Patient Health Questionnaire (PHQ-2)

Computer use, amplifier

Mean hours of TV viewing: Low dep. = 1.7 vs. high dep. = 1.7 (p > .05)

Mean hours of computer use: Low dep. = 1.6 vs. high dep. = 1.9 (p < .01)

Weak

Khan, 2017 [55]

505 (14.3)

C

Self-reported average daily TV viewing, DVD viewing, computer use, and social media on weekdays and weekend days

Depression: CES-D 10

MVPA, buffer

In sedentary participants meeting the MVPA guidelines: REF.

In sedentary participants not meeting the MVPA guidelines: OR 2.37 (95%CI 1.23–4.59)

Weak

Kim, 2012 [56]

75,066 (grades 7–12)

C

Self-reported internet use for non-educational purposes

Depression: depression rate via the Korea Youth Risk Behavior Web-based Survey

Female sex, amplifier

No internet users in boys: OR 1.21 (95%CI 1.13–1.30)

Occasional internet users in boys: REF.

Moderate internet users in boys: OR 1.11 (95%CI 1.02–1.21)

Heavy internet users in boys: OR 1.33 (95%CI 1.12–1.59)

No internet users in girls: OR 1.15 (95%CI 1.06–1.25)

Occasional internet users in girls: REF.

Moderate internet users in girls: OR 1.33 (95%CI 1.20–1.47)

Heavy internet users in girls: OR 1.87 (95%CI 1.43–2.46)

Weak

Kim, 2016 [57]

2198 (middle schoolers)

L (screen-based SB predicting depressive symptoms)

Self-reported daily average hours of videogame playing

Depression: CESD-R

High neighborhood divorce rate, buffer

Screen-based SB*divorce interaction β = −0.171 (p < .05)

Neighborhood population size, null

Screen-based SB*population size interaction β = 0.003 (p > .05)

Neighborhood education level, null

Screen-based SB*education interaction β = − 0.006 (p > .05)

Strong

Kleppang, 2019 [58]

3223 (ages 15–16)

C

Self-reported average daily hours of TV viewing, computer use, and videogame playing

Depression and Anxiety: Hopkins Symptom Checklist-10 (HSCL-10)

Female sex, null

Sex*screen-based SB interaction NS, not reported

Year of investigation, null

Year*screen-based SB interaction NS, not reported

Moderate

Krejci, 2011 [59]

599 (3.8) (Japanese) 497 (4.6) (Czech)

C

Parent-reported average use of videogames

Depression: Morningness-eveningness questionnaire (MEQ) and original sleep habit questionnaire

Japanese origin, buffer

In Japanese children: χ2-value = 14.17 (p = .028)

In Czech children: χ2-value = 5.83 (p = 0.757)

Weak

Kremer, 2013 [60]

8029 (11.5)

C

Self-reported screen-based SB via the Communities That Care Youth Survey (TV viewing, computer use, and videogame playing)

Depression: Short MFQ

Female sex, null

Screen-based SB*sex interaction p = .91

Younger age, amplifier

Screen-based SB*age interaction p = .04

In older participants: Conditional OR 0.64

In younger participants: Conditional OR 0.88

Physical activity (PA), null

Screen-based SB*PA interaction p = .92

Moderate

Lemola, 2015 [61]

362 (14.8)

C

Self-reported average use of TV viewing, videogame playing, phone use/texting, and Internet use before going to sleep

Depression: six items from the CES-D (German version)

Age, null

SB*age interaction p > .10

TV viewing and phone/texting, buffer

TV: NS, not reported

Videogames: β = 0.15, p = .005

Phone/texting: NS, not reported

Internet use: β = 0.19, p < .001

Weak

Liu, 2016 [62]

13,369 (15.2)

C

Self-reported TV viewing and computer/videogame use via the Youth Risk Behavior Survey (YRBS)

Depression: CES-D

Anxiety: Multidimensional Anxiety Scale for Children (MASC)

Female sex and computer/videogames, amplifier (dep.)

TV in boys: OR 1.33 (95%CI 1.02–1.73)

TV in girls: OR 1.62 (95% CI 1.19–2.21)

Computer/videogames in boys: OR 1.61 (95%CI 1.28–2.03)

Computer/videogames in girls: OR 1.96 (95%CI 1.42–2.71)

Female sex, null

Computer/videogames, amplifier (anx.)

TV in boys: OR 1.43 (95%CI 1.05–1.95)

TV in girls: OR 1.51 (95%CI 0.96–2.38)

Computer/videogames in boys: OR 1.40 (95%CI 1.06–1.86)

Computer/videogames in girls: OR 1.78 (95%CI 1.09–2.89)

Weak

Maras, 2015 [63]

2482 (14.1)

C

The Leisure-Time Sedentary Activities Questionnaire (TV viewing, computer use, and videogame playing)

Depression: CDI Anxiety: MASC-10

TV viewing, buffer (dep.)

TV: β = 0.03, p > .05

Computer: β = 0.17, p < .001

Videogames: β = 0.13, p < .001

Videogames, amplifier (anx.)

TV: β = 0.03, p > .05

Computer: β = −0.03, p > .05

Videogames: β = 0.11, p < .001

Weak

Mathers, 2009 [64]

925 (16.1)

C

Multimedia Activity Recall for Children and Adolescents (MARCA) (TV viewing, computer use, videogame playing, and telephone/texting)

Depression and Anxiety: Kessler-10

Videogame playing, amplifier (dep. and anx.)

Computer use, buffer (dep. and anx.)

TV: OR 1.03 (95%CI 0.62–1.70)

Computer: OR 0.61 (95%CI 0.38–0.96)

Videogames: OR 1.79 (95%CI 1.17–2.73)

Telephone/texting: OR 1.13 (95%CI 0.74–1.74)

Weak

McHale, 2009 [65]

469 youth (12.8 & 15.7)

C

Self-reported TV viewing

Depression: CES-D

Low parental education values, amplifier

TV in those with parents with high education values: NS, not stated

TV in those with parents with low education values:

λ = −.002 (p < .05)

Parental cultural orientations, null

TV viewing*cultural orientations interaction NS, not reported

Weak

McVeigh, 2016 [4]

2411 (aged 1 at baseline)

L (screen-based SB predicting internalizing symptoms)

Parent-reported and self-reported TV viewing

Depression and Anxiety: Depression Anxiety Stress Scales (DASS-21)

Female sex, null (dep. and anx.)

In boys: RR 1.00 (95%CI 0.72–1.38) (dep. and anx.)

In girls: RR 1.09 (95%CI 0.87–1.36) (dep. and anx.)

Moderate

Mistry, 2007 [66]

2707 (ages 30–33 months at baseline)

L (screen-based SB predicting internalizing symptoms)

Parent-reported TV viewing

Depression and Anxiety: Child Behavior Checklist (CBCL) internalizing subscale

Household income, null (dep. and anx.)

Screen-based SB*household income interaction NS, not reported

Parental involvement, null (dep. and anx.)

Screen-based SB*parental involvement interaction NS, not reported

Moderate

Mundy, 2017 [67]

876 (9.0)

C

Parent-reported average weekly time spent in TV viewing, computer use, and videogame playing

Depression and Anxiety: SDQ, emotional subscale

Videogame playing, amplifier (dep. and anx.)

Female sex, buffer (dep. and anx.)

TV in boys: OR 1.00 (95%CI 0.96–1.03)

TV in girls: OR 1.02 (95%CI 0.99–1.05)

Computer in boys: OR 0.98 (95%CI 0.94–1.02)

Computer in girls: OR 1.04 (95%CI 0.99–1.08)

Videogames in boys: 1.07 (95%CI 1.04–1.11)

Videogames in girls: 1.03 (95%CI 0.98–1.08)

Weak

Nakamura, 2012 [68]

3464 (10.1)

C

Self-reported average daily TV viewing, computer use, and videogame playing

Depression: single-item on subjective health complaint scale

TV Viewing, buffer

TV: NS, not reported

Computer: effect estimate not reported-positive association (p < .001)

Videogames: effect estimate not reported-positive association, (p = .001)

Weak

Ohannessian, 2009 [69]

328 (15.0)

C/L (screen-based SB predicting internalizing symptoms)

Self-reported average daily TV viewing, emailing/IM-ing/surfing the web, videogame playing, and text messaging

Depression: CES-DC

Anxiety: SCARED

Female sex, amplifier (dep.)

Surfing the web, null (dep.)

Screen-based SB*sex interaction (p < .05) (TV viewing)

TV: NS, not reported

Surfing the web: NS, not reported (cross-sec. and long.)

Videogames: NS, not reported (cross-sec. and long.)

Texting: NS, not reported (cross-sec. and long.)

Parental alcoholism, null (dep.)

Parental alcoholism* screen-based SB interaction NS, not reported

Female sex, amplifier (anx.)

Screen-based SB*sex interaction (p < .05) (TV viewing and videogames)

Surfing the web, amplifier (anx.)

TV: NS, not reported (cross-sec. and long.)

Surfing the web: F (7,154) = 6.02 (p < .05) (long. only)

Videogames: NS, not reported (cross-sec. and long.)

Texting: NS, not reported (cross-sec. and long.)

Parental alcoholism, amplifier (anx.)

Parental alcoholism*surfing the web interaction (p < .05) (cross-sec. and long.)

Parental alcoholism*sex*videogame interaction (p < .05) (cross-sec.)

Weak

Ohannessian, 2018 [70]

441 (17.1)

L (screen-based SB predicting anxiety symptoms)

Self-reported average daily videogame playing

Anxiety: SCARED

Female sex and playing with others (social context), amplifiers

Videogame*sex interaction p < .001

Videogame*sex*social context interaction p < .01

Weak

Parkes, 2013 [71]

11,014 (age 5 at baseline)

L (screen-based SB predicting internalizing symptoms)

Parent-reported average daily hours of TV viewing and computer/videogame playing

Depression and Anxiety: SDQ, emotional subscale

Female sex, null (dep. and anx.)

Screen-based SB*sex interaction p > .05 (TV viewing and computer/videogames)

TV Viewing, null (dep. and anx.)

TV 0 h daily: β = −0.05 (p = .66)

TV < 1 h daily: REF.

TV 1–3 h daily: β = 0.02 (p = .64)

TV > 3 h daily: β = 0.01 (p = .91)

Computer/videogames 0 h daily: β = 0.07 (p = .09)

Computer/videogames < 1 h daily: REF.

Computer/ videogames 1–3 h daily: β = 0.03 (p = .48)

Computer/videogames > 3 h daily: β = 0.26 (p = .11)

Moderate

Poulain, 2018 [72]

527 (3.8)

L (bi-directional)

Parent-reported average hours of TV viewing, videogames, computer use, and mobile phone use

Depression and Anxiety: SDQ, emotional subscale

Female sex, null (dep. and anx., bi-directionally)

Screen-based SB*sex interaction p > .05

Age, null (dep. and anx., bi-directionally)

Screen-based SB*age interaction p > .05

Socioeconomic status, null (dep. and anx., bi-directionally)

Screen-based SB*socioeconomic status interaction p > .05

TV viewing, null (dep. and anx., bi-directionally)

Screen-based SB predicting internalizing symptoms

TV: OR 0.63 (95%CI 0.35–1.12)

Computer: OR 0.98 (95%CI 0.35–2.77)

Videogames: OR 0.47 (95%CI 0.09–2.34)

Mobile phone: OR 0.68 (95%CI 0.17–2.68)

Internalizing symptoms predicting screen-based SB

TV: OR 0.96 (95%CI 0.80–1.16)

Computer: OR 0.96 (95%CI 0.78–1.18)

Videogames: OR 1.10 (95%CI 0.87–1.39)

Mobile phone: OR 0.87 (95%CI 0.66–1.15)

Moderate

Primack, 2009 [73]

4142 (21.8 at follow-up)

L (screen-based SB predicting depressive symptoms)

Self-reported average hours of TV viewing, video viewing, and videogames

Depression: CES-D

Female sex, buffer

Screen-based SB*sex interaction OR 0.93 (95%CI 0.88–0.99)

TV viewing, amplifier

TV: OR 1.08 (95%CI 1.01–1.06)

Videos: OR 1.03 (95%CI 0.86–1.25)

Videogames: OR 1.04 (95%CI 0.89–1.22)

Strong

Primack, 2011 [74]

106 (12.7)

C

Self-reported media use (TV viewing, videogames, and computer use)

Depression: DSM-III or DSM-IV diagnostic criteria for major depressive disorder

Female sex, null

Screen-based SB*sex interaction term NS, not reported

Age, null

Screen-based SB*age interaction term NS, not reported

TV viewing, null

TV: OR 1.2 (95%CI 0.8–1.7)

Computer: OR 1.1 (95%CI 0.7–1.6)

Videogames: OR 1.3 (95% CI 0.8–2.1)

Weak

Robinson, 2011 [75]

1860 (14.0)

C

Self-reported average daily hours of TV viewing and computer use

Depression and Anxiety: CBCL (internalizing subscale)

Female sex, null

Screen-based SB*sex interaction NS, not reported

Weak

Romer, 2013 [76]

719 (ages 12–24)

L (screen-based SB predicting depressive symptoms)

Self-reported average time TV viewing, computer use, and videogames

Depression: Youth Risk Behavior Survey (2 items, reports of sadness or hopelessness)

Younger age, null

Screen-based SB*age interaction NS, not reported

TV viewing, buffer

TV: NS, not reported

Computer: β = 0.12 (p = .039)

Videogames: β = 0.14 (p = .001)

Weak

Rottenberg, 2014 [77]

363 (15.8–17.0)

L (depression predicting screen-based SB)

Self-reported TV viewing and computer use via YRBS

Depression: Interview Schedule for Children and Adolescents Diagnostic Version (ISCA-D)

TV viewing, null

TV: OR 1.53 (95%CI 1.19–1.95)

Computer: OR 1.31 (95%CI 1.05–1.62)

Moderate

Schmitz, 2002 [78]

3798 (12.8)

L (depressive symptoms predicting screen-based SB)

Self-reported average time of TV viewing and playing videogames

Depression: CES-D

Female sex, null

In boys: mean sed. Score amongst those with most depressive symptoms = 12.66 (95%CI 12.24–13.08) (p < .01)

In girls: mean sed. Score amongst those with most depressive symptoms = 10.28 (95%CI 9.99–10.58) (p < .01)

Moderate

Schreck, 2016 [79]

178 (11.3)

C

Parent-reported average time spent TV viewing, using the computer, and playing videogames

Depression: CBCL, withdrawn/depressed subscale

Female sex, null

In boys: β = 0.05 (p > .05)

In girls: β = 0.05 (p > .05)

Weak

Selfhout, 2009 [80]

307 (15.5)

L (screen-based SB predicting internalizing symptoms)

Self-reported average time spent instant messaging or surfing the web

Depression: CDI

Anxiety: SCARED

Female sex, null (dep. and anx.)

screen-based SB*sex interaction p > .05 (instant messaging and surfing the web)

Low perceived friendship quality (surfing the web), amplifier (dep. and anx.)

Low perceived friendship quality (instant messaging), buffer (dep. only)

Screen-based SB*friendship quality interaction β = − 0.23 (p < .01) (dep.) (instant messaging)

Screen-based SB*friendship quality interaction β = 0.20 (p < .01) (dep.) (surfing the web)

Screen-based SB*friendship quality interaction β = .03 (p > .05) (anx.) (instant messaging)

Screen-based SB*friendship quality interaction β = .13 (p < .01) (anx.) (surfing the web)

High instant messaging and low friendship quality: β = − 0.27 (p < .01) vs. high instant messaging and high friendship quality: β = 0.02 (p > .05) (dep.)

High surfing the web and low friendship quality: β = 0.33 (p < .01) vs. high surfing the web and high friendship quality: β = 0.05 (p > .05) (dep.)

High surfing the web and low friendship quality: β = 0.22 (p < .01) vs. high surfing the web and high friendship quality: β = 0.03 (p > .05) (anx.)

Female sex and low perceived friendship quality, null (dep. and anx.)

Screen-based SB*sex*friendship quality interaction p > .05 (instant messaging and surfing the web)

Moderate

Singer, 1998 [81]

2245 (11.0)

C

Self-reported daily average time watching TV

Depression and Anxiety: Trauma Symptom Checklist for Children (TSCC), depression and anxiety subscales

Female sex, amplifier (dep.)

Depression rate in boys: low TV = 7.0%, high TV = 10.6% (p > .05)

Depression rate in girls: low TV = 5.8%, high TV = 17.8% (p < .01)

Female sex, null (anx.)

Anxiety rate in boys: low TV = 5.5%, high TV = 12.4% (p < .01)

Anxiety rate in girls: low TV = 7.0%, high TV = 15.3% (p < .01)

Weak

Straker, 2013 [82]

643 (14.0)

C

MARCA

Depression: BDI

Depression and Anxiety: CBCL, internalizing subscale

Female sex, buffer (dep., BDI)

Computer (instrumental) in boys: median (IQR) = 3.0 (4.0) vs. computer (for games): median (IQR) = 4.0 (7.0) vs. videogames: median (IQR) = 4.0 (7.0) (p = .046)

Computer (instrumental) in girls: median (IQR) = 5.0 (8.0) vs. computer (for games): median (IQR) = 5.0 (9.0) vs. videogames: Not reported (p = .995)

Female sex, null (dep. and anx., CBCL)

Computer (instrumental) in boys: median (IQR) = 7.4 (5.0) vs. computer (for games): median (IQR) = 10.0 (6.8) vs. videogames: median (IQR) = 9.1 (6.1) (p = .071)

Computer (instrumental) in girls: median (IQR) = 10.2 (6.5) vs. computer (for games): median (IQR) = 10.2 (6.6) vs. videogames: Not reported (p = .950)

Weak

Suchert, 2015 [16]

1296 (13.7)

C

Self-reported time spent TV viewing, computer use, videogames, and mobile phone on the most recent school day and the most recent Sunday

Depression: CES-D (depressed affect subscale)

Female sex, amplifier

In boys: β = −0.024 (p = .552)

In girls: β = 0.094 (p = .032)

Moderate

Trinh, 2015 [83]

2660 (15.8)

C

Self-reported daily average time spent TV viewing, computer use, and videogame playing

Depression: CES-D (4 items: sad, lonely, depressed, crying)

Female sex, buffer

In boys: OR 2.82 (95%CI 1.09–7.30)

In girls: OR 1.65 (95%CI 0.87–3.16)

PA, null

Screen-based SB*PA interaction NS, not reported

Weak

Twenge, 2018 [84]

388,275 (grades 8–10)

C

Self-reported average daily time spent TV viewing, social media use, and internet use for news

Depression: 6 items from the Bentler Medical and Psychological Functioning Inventory, depression subscale

Social Media and Female sex, amplifier

TV in boys: r = 0.02 (p < .05)

Internet for news in boys: r = −0.02 (p > .05)

Social media in boys: r = 0.01 (p > .05)

TV in girls: r = 0.03 (p < .001)

Internet for news in girls: r = 0.01 (p > .05)

Social media in girls: r = 0.06 (p < .001)

Low in-person social interaction, amplifier

Social media*social interaction p < .001

Social media among those with low in-person social interaction: F(1, 9765) = 185.35 (p < .001)

Social media among those with high in-person social interaction: F(1, 11,271) = 2.21 (p = .14)

Weak

Whiteley, 2011 [85]

1518 (15.3)

C

Self-reported average weekly computer use and mobile phone use

Depression: CES-D8

Computer use, null

Computer: β = 0.01 (p = .777)

Mobile phone: β = 0.001 (p = .980)

Weak

Wu, 2017 [86]

4875 (ages 10–11)

L (screen-based SB predicting depression and anxiety)

Self-reported average daily time spent TV viewing, computer use, and videogame playing

Depression and Anxiety: Clinical diagnoses defined by the International Classification of Diseases, Ninth Revision, Clinical Modification or Tenth Revision

TV viewing, buffer (dep. and anx.)

TV < 1 h/day, REF.

TV 1–2 h/day, IRR 0.98 (95CI 0.74–1.29)

TV 3–4 h/day, IRR 0.93 (95%CI 0.71–1.23)

TV 5h hours/day, IRR 0.77 (95%CI 0.56–1.06)

Computer/videogames < 1 h/day, REF.

Computer/videogames 1–2 h/day, IRR 1.56 (95%CI 1.26–1.93)

Computer/videogames 3–4 h/day, IRR 1.42 (95%CI 1.06–1.91)

Computer/videogames 5h hours/day, IRR 1.67 (95%CI 1.10–2.54)

Moderate

Wu, 2018 [87]

4861 (ages 10–11)

L (screen-based SB predicting depression and anxiety)

Self-reported average daily time spent TV viewing, computer use, and videogame playing

Depression and Anxiety: Clinical diagnoses defined by the International Classification of Diseases, Ninth Revision, Clinical Modification or Tenth Revision

Female sex, amplifier (dep. and anx.)

TV in boys: < 1 h/day, REF.

1, 2 hours/day, HR 1.09 (95%CI 0.78–1.53)

3–4 h/day, HR 1.12 (95% CI 0.79–1.60)

5h hours/day, HR 1.06 (95%CI 0.72–1.57)

TV in girls: < 1 h/day, REF.

1, 2 hours/day, HR 0.80 (95%CI 0.63–1.00) (p < .05)

3–4 h/day, HR 0.81 (95%CI 0.63–1.04)

5h hours/day, HR 0.85 (95%CI 0.63–1.16)

Computer/videogames in boys: < 1 h/day, REF.

1, 2 hours/day, HR 1.43 (95%CI 1.13–1.81)

3–4 h/day, HR 1.23 (95%CI 0.89–1.69)

5h hours/day, HR 1.35 (95%CI 0.93–1.96)

Computer/videogames in girls: < 1 h/day, REF.

1, 2 hours/day, HR 1.18 (95%CI 1.00–1.42) (p < .05)

3–4 h/day, HR 1.31 (95%CI 1.00–1.74) (p < .05)

5h hours/day, HR 1.04 (95%CI 0.61–1.79)

TV viewing, buffer (dep. and anx.)

TV (entire sample): < 1 h/day, REF.

1, 2 hours/day, HR 0.89 (95%CI 0.74–1.08)

3–4 h/day, HR 0.91 (95%CI 0.74–1.11)

5h hours/day, HR 0.91 (95%CI 0.72–1.16)

Computer/videogames (entire sample):

< 1 h/day, REF.

1, 2 hours/day, HR 1.27 (95%CI 1.11–1.47)

3–4 h/day, HR 1.25 (95%CI 1.02–1.55)

5h hours/day, HR 1.23 (95%CI 0.92–1.64)

Moderate

Yan, 2017 [88]

2625 (15.1)

C

Self-reported average daily time spent TV viewing, videogame playing, studying on electronic devices, using social networking sites, or watching videos on school days and non-school days

Anxiety: The Middle School Student Mental Health Scale

TV viewing, buffer (school days)

TV: Never, REF.

< 1 h/day, β = − 0.023 (p = .210)

2–4 h/day, β = − 0.094 (p = .047)

4h hours/day, β = − 0.082 (p = .408)

Videogames: Never, REF.

< 1 h/day, β = − 0.027 (p = .199)

2–4 h/day, β = − 0.018 (p = .664)

4h hours/day, β = − 0.167 (p = .058)

Studying on electronic devices: Never, REF.

< 1 h/day, β = 0.012 (p = .542)

2–4 h/day, β = 0.062 (p = .036)

4h hours/day, β = 0.190 (p = .002)

Social networking sites: Never, REF.

< 1 h/day, β = 0.037 (p = .078)

2–4 h/day, β = 0.085 (p = .01)

4h hours/day, β = 0.106 (p = .025)

Videos: Never, REF.

< 1 h/day, β = 0.009 (p = .661)

2–4 h/day, β = 0.001 (p = .970)

4h hours/day, β = 0.013 (p = .846)

Social networking sites, amplifier (non-school days)

TV: Never, REF.

< 1 h/day, β = − 0.033 (p = .131)

2–4 h/day, β = − 0.031 (p = .129)

4h hours/day, β = 0.034 (p = .208)

Videogames: Never, REF.

< 1 h/day, β = − 0.033 (p = .118)

2–4 h/day, β = − 0.028 (p = .192)

4h hours/day, β = − 0.010 (p = .711)

Studying on electronic devices: Never, REF.

< 1 h/day, β = 0.052 (p = .059)

2–4 h/day, β = 0.041 (p = .135)

4h hours/day, β = 0.060 (p = .055)

Social networking sites: Never, REF.

< 1 h/day, β = 0.072 (p = .009)

2–4 h/day, β = 0.087 (p = .002)

4h hours/day, β = 0.087 (p = .005)

Videos: Never, REF.

< 1 h/day, β = 0.001 (p = .975)

2–4 h/day, β = 0.001 (p = .964)

4h hours/day, β = 0.049 (p = .106)

Weak

Yang, 2013 [89]

10,829 (ages 10–12)

C

Self-reported average daily TV viewing and computer use (Internet games, non-Internet games, Internet for chatting, and “other” computer use)

Depression: select items from the SCL-90

Female sex and TV viewing, amplifiers (sad or little interest in doing things)

TV in boys: OR 2.13 (95%CI 1.61–2.82)

TV in girls: OR 3.54 (95%CI 2.59–4.85)

Internet games in boys: OR 2.20 (95%CI 1.65–2.93)

Internet games in girls: OR 2.85 (95%CI 1.70–4.78)

Non-internet games in boys: OR 1.87 (95%CI 1.36–2.58)

Non-internet games in girls: OR 2.25 (95%CI 1.28–3.97)

Internet for chatting in boys: OR 2.0 (95%CI 1.42–2.84)

Internet chatting in girls: OR 2.88 (95%CI 1.99–4.16)

“Other” computer use in boys: OR 1.85 (95%CI 1.22–2.81)

“Other” computer use in girls: OR 2.63 (95%CI 1.44–4.82)

Female sex and Internet games, amplifiers (cried easily or wanted to cry)

TV in boys: OR 2.37 (95%CI 1.66–3.40)

TV in girls: OR 2.29 (95%CI 1.68–3.13)

Internet games in boys: OR 1.79 (95%CI 1.20–2.65)

Internet games in girls: OR 3.16 (95%CI 1.94–5.15)

Non-internet games in boys: OR 1.82 (95%CI 1.19–2.79)

Non-internet games in girls: OR 2.19 (95%CI 1.27–3.75)

Internet for chatting in boys: OR 2.05 (95%CI 1.32–3.17)

Internet chatting in girls: OR 2.60 (95%CI 1.83–3.69)

“Other” computer use in boys: OR 2.67 (95%CI 1.64–4.36)

“Other” computer use in girls: OR 2.91 (95%CI 1.63–5.17)

Female sex and other computer use, amplifiers (sad or blue)

TV in boys: OR 2.61 (95% 1.85–3.68)

TV in girls: OR 2.52 (95%CI 1.79–3.55)

Internet games in boys: OR 2.23 (95%CI 1.55–3.22)

Internet games in girls: OR 2.76 (95%CI 1.62–4.68)

Non-internet games in boys: OR 1.97 (95%CI 1.30–2.98)

Non-internet games in girls: OR 2.70 (95%CI 1.52–4.78)

Internet for chatting in boys: OR 2.26 (95%CI 1.48–3.46)

Internet chatting in girls: OR 3.31 (95%CI 2.29–4.80)

“Other” computer use in boys: OR 2.64 (95%CI 1.63–4.27)

“Other” computer use in girls: OR 3.88 (95%CI 2.16–6.97)

Female sex and time on Internet for chatting, amplifiers (hopeless about future)

TV in boys: OR 2.91 (95% 2.09–4.06)

TV in girls: OR 3.06 (95%CI 2.09–4.47)

Internet games in boys: OR 2.70 (95%CI 1.90–3.83)

Internet games in girls: OR 4.48 (95%CI 2.57–7.79)

Non-internet games in boys: OR 3.13 (95%CI 2.18–4.47)

Non-internet games in girls: OR 3.57 (95%CI 1.94–6.56)

Internet for chatting in boys: OR 3.01 (95%CI 2.05–4.41)

Internet chatting in girls: OR 5.41 (95%CI 3.68–7.96)

“Other” computer use in boys: OR 2.92 (95%CI 1.84–4.63)

“Other” computer use in girls: OR 4.89 (95%CI 2.62–9.12)

Weak

Ybarra, 2005 [90]

1501 (14.1)

C

Self-reported amount of general internet use

Depression: DSM-IV symptomology (major depression vs. minor depression vs, mild/no depression)

Female sex, amplifier

In boys: Conditional OR 2.04 (0.90–4.65) (p = .09)

In girls: Conditional OR 3.57 (95%CI 1.70–7.50) (p < .001)

Strong

  1. Note: C Cross-sectional, L Longitudinal, NS nonsignificant, SB sedentary behavior, OR odds ratio, HR hazard ratio, IRR incidence rate ratio