Title: Exploring the link between sedentary behavior and mental health outcomes in British Columbian youth during the COVID-19 pandemic.
Authors: Hasina Samji, PhD; David Long, MD; Akash Sharma, OMS II
Studies before the pandemic estimated that 8% of Canadian adolescents met the Canadian 24-Hour Movement Guidelines for limiting non-school related sedentary behavior (SB) and screen time to ≤2 hours per day. Studies have shown that increased SB in youth is related to an increase in adverse mental health outcomes (MHO), but evidence of this effect during the COVID-19 pandemic is limited. Due to COVID-19 youth may be facing increased SB resulting in increased adverse MHO. This study aims to elucidate the relationship between SB and MHO to inform future research. The study sample was derived from the Youth Development Instrument (YDI), a comprehensive self-reported survey of social and emotional development, health, and well-being of Grade 11 students piloted in participating British Columbia (BC) school districts from February 2021 to June 2021. The YDI questionnaire had a total sample size of 2350; after removing 44 outliers, 2306 participants remained for analysis. Of these, 1045 identified as female, 1152 as male, and 109 in another way or did not specify. The Mean Family Affluence Scale indicator score for the population was 9.5 ± 2.1 which indicated high affluence. Questions in the YDI pertaining to SB, physical activity (PA), depression, and anxiety were selected. SB was defined as hours of daily screen use for non-school related activities. PA was defined as weekly frequency of activities lasting at least 60 mins that increased heart rate and made the student feel out of breath. Depressive symptoms were screened via the Patient Health Questionnaire (PHQ8) and generalized anxiety via the Generalized Anxiety Disorder (GAD2) measure. Significance of linear associations was tested by linear regression, and group mean difference by t test. Statistical analysis and graphing were performed through RStudio. Depression and anxiety were common in this sample. 39.8% of students reported a PHQ8 score ≥10, and 43.2% of participants reported a GAD2 score ≥3. 86% of participants did not meet the recommended guidelines of limiting SB to 2 or fewer hours a day. SB and depressive symptoms had a highly significant association in this population (p<0.001). Students meeting SB guidelines had a mean PHQ8 of 7.4 ± 6.5, compared to a mean PHQ8 of 9.0 ± 6.8 in participants not meeting SB guidelines (p<0.001). The relationship between SB and GAD2 score was also highly significant (p<0.001). There is a significant relationship between SB and adverse MHO in a sample of BC youth during COVID-19.
A question from a judge: It looked to me like there was a HIGH degree of correlation between the GAD2 scores and the PHQ8 scores, at least indexed to physical activity. What was the Pearson product-moment correlation coefficient between these two scores, independent of the physical activity measure? It makes sense, too, because especially in youth, anxiety and depression are often comorbid.
Good evening Dr. Elliott and thank you for your question. For the YDI 2021 Dataset, the pearson correlation coefficient independent of physical activity is +0.7087 which can be interpreted as depression and anxiety in this sample of BC youth are highly correlated. This does make sense as you mention anxiety and depression in youth are often comorbid. The coefficient of determination is 0.5022, which indicates that approximately 50% of the variability in the outcome data cannot be explained by the model of GAD2 vs PHQ8 independent of physical activity.
As a judge I am wondering… a well-developed body of evidence has established the relationship between sedentary time and mental health outcomes. Your data show a similar relationship (as expected). Please discuss what your study adds to the existing literature on the topic (e.g., what do we know now that we did not know before) thanks!
Good evening Dr. Fritz and thank you for your question. The current body of evidence more strongly focuses on the effect of physical activity on mental health outcomes as compared to the effect of sedentary behavior on mental health outcomes. However, An accelerometer-based study in Canadian children and youth ages 6 to 19 (n=1608) found that children and youth spent approximately 60% of waking hours sedentary and only 9% of boys and 4% girls had 60 minutes of moderate to vigorous physical activity (MVPA) at least 6 days a week (Colley et al., 2011). Thus the effect of sedentary behaviour is also an important factor on youth mental health outcomes. Upon review of current literature, the quality of evidence related to PA and mental health outcomes in children and adolescents has been characterized as very low to low (Poitras et al., 2016). Furthermore, The quality of evidence related to SB and mental health outcomes in children and adolescents has been noted to be lower than that of PA, due to the use of predominantly cross-sectional methodology and self-report (Chaput et al., 2020). For both PA and SB, causality cannot be clearly established. Additionally, a number of research gaps are noted in the summary of evidence for the 2020 WHO guidelines on physical activity for children and adolescents (Chaput et al., 2020).
Areas necessitating further investigation are:
– standardized data-processing for device-based measures.
– RCTs/prospective cohort trials using device-based measures.
– Interaction of physical activity and sedentary behaviour on mental health outcomes.
– Stratifying results by e.g. age, sex, race/ethnicity, SES, or weight status.
– Impact of different types of physical activity or sedentary behaviour
– New forms of SB including smartphone use.
– Impact of breaks in sedentary behaviour.
– Examining a broader range of mental health outcomes.
Our study seeks to add to the growing body of literature by exploring the link between sedentary behaviour and mental health outcomes through use of data from the Youth Development Instrument (YDI).
Building on the work of the Early Development Instrument (EDI) and the MDI, the YDI is a self-report questionnaire that seeks to understand the health and well-being of Grade 11 students in British Columbia (BC). This survey takes a strengths-based approach through its emphasis on developmental assets such as thriving, positive childhood experiences, and positive mental health. These assets, also known as ‘cross-cutting domains’, span the YDI’s five primary dimensions: Social and Emotional Development, Social Well-being, Learning Environment and Engagement, Physical and Mental Well-being, and Navigating the World. Each dimension is divided into several domains and subdomains that ask questions about myriad of emotions, thoughts, experiences, and habits. These five dimensions strategically identify individual and contextual resources, opportunities, and practices that foster or hinder positive youth development. At the same time, using data linkages, researchers can monitor how responses change over the life course and map out how current youth experiences effectively shape trajectories into emerging adulthood. The YDI helps produce a more elaborate, in-depth landscape of youth health and well-being to inform policies and practices that support thriving and healthy trajectories.
The YDI data for allowed for standardized data-processing, allows us to stratify based on age, sex, race/ethnicity, SES, or weight status., included new forms of sedentary behaviors such as smartphone use in questions within the self report, tracks the longitudinal relationship between SB and mental health outcomes in youth, and allowed for examination of a broader range of mental health outcomes.
Colley, R. C., Garriguet, D., Janssen, I., Craig, C. L., Clarke, J., & Tremblay, M. S. (2011). Physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 22(1), 15–23.
Chaput, J.-P., Willumsen, J., Bull, F., Chou, R., Ekelund, U., Firth, J., Jago, R., Ortega, F. B., & Katzmarzyk, P. T. (2020). 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5–17 years: Summary of the evidence. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 141. https://doi.org/10.1186/s12966-020-01037-z
Poitras, V. J., Gray, C. E., Borghese, M. M., Carson, V., Chaput, J.-P., Janssen, I., Katzmarzyk, P. T., Pate, R. R., Connor Gorber, S., Kho, M. E., Sampson, M., & Tremblay, M. S. (2016). Systematic review of the relationships between objectively measured physical activity and health indicators in school- aged children and youth. Applied Physiology, Nutrition, and Metabolism, 41(6 (Suppl. 3)), S197– S239. https://doi.org/10.1139/apnm-2015-0663
Thanks for your presentation. As a judge I am wondering if there were any specific contributions of COVID-19 to your research question. I recognize that the data was collected during the pandemic, but the factors presented (sedentary behavior and mental health) and their relationship do not seem to be explored in that context.
Good evening Dr. Salido, thank you for your question. The data was taken for the YDI and the YDI is also a population-level research tool (a description of the YDI is above in the response to Dr. Fritz’s question).
YDI researchers will link student responses to their answers on previous developmental surveys such as the Early Development Instrument and Middle Years Development Instrument, as well as to other health, education, and demographic datasets. These linkages will illustrate how students’ answers on the YDI and other surveys change over time.
This sample allowed for a cross sectional exploration of the link between sedentary behavior and mental health outcomes. Though the YDI data from this sample was collected during the pandemic, future samples will not be collected during pandemic situations which will allow us to compare the results between the current pandemic sample and future non-pandemic samples. I predict that the pandemic had many negative effects on youth lifestyle, in addition to increased sedentary behavior.
Due to the size of the sample collected, the depth of the self report questionnaire, and the longitudinal data collected from the EDI and MDI future analysis will allow us to better isolate and assess the impact of sedentary behaviour on mental health outcomes when comparing the pandemic sample group to future non-pandemic sample groups.