Screen Time on School Days and Risks for Psychiatric Symptoms and Self-Harm in Mainland Chinese Adolescents

Objective: To investigate associations of television and of video game or non-educational computer use (VG/CU) exposure volumes in a typical school day with psychiatric symptoms and suicidal ideation/self-injurious behavior (self-harm), in mainland Chinese adolescents.

Methods: Secondary school pupils (N = 13,659; mean age: 15.18 ± 1.89) from 10 urban areas sampled from different regions of mainland China were recruited. The subjects were divided into the following four screen exposure volume groups for television and VG/CU respectively based on a self-administered questionnaire: 0 h/day, >0 to ≤1 h/day, >1 to ≤2 h/day, and >2 h/day. Demographic and psychiatric symptoms were recorded for each respondent. Odds ratios (ORs) and 95% confidence intervals (CIs) for several types of psychological problems and self-harm were calculated.

Results: More than 2 h per school day television watching was associated with higher risk of depression in both boys (OR = 1.33, 95%CI: 1.02-1.73) and girls (OR = 1.62, 95%CI: 1.19-2.21), of anxiety in boys (OR = 1.43, 95%CI: 1.05-1.95), of general emotional, behavioral, and social problems (GEBSPs; OR = 1.55, 95%CI: 1.01-2.39), and of oppositional defiant problems (OR = 1.65, 95% CI: 1.09-2.50) in girls, compared with no television exposure. Conversely, television exposure of no more than 1 h per school day was associated with lower self-harm risk in boys (OR = 0.81, 95%CI: 0.67-0.99) compared with no television exposure. High school day VG/CU time (>2 h) compared with no VG/CU were associated with higher risks of anxiety (OR = 1.40, 95%CI: 1.06-1.86) and of attention deficit/hyperactivity problems (ADHPs; OR = 1.56, 95%CI: 1.02-2.38) in boys. And any school day VG/CU exposure was associated with higher risks of self-harm and all other psychiatric problems in boys and all psychiatric problems (including anxiety and ADHPs) in girls (ORs, 1.44-3.69), compared to no VG/CU exposure.

Conclusion: For secondary school students, associations of psychiatric problems and self-harm were more strongly associated with exposure to VG/CU than with exposure to television. The findings suggest that VG/CU and television exposure on weekdays should be considered in psychiatric interventions for adolescents.