A Cross-sectional Study of the Association Between Physical Activity and Depressive Symptoms Among Adolescents in Southwest China Stratified by Parental Absence: the Mediating Role of Insomnia and the Moderating Role of Resilience

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Sep 11

PMID 39260839

Authors

Ming Zhang

Jianjun Jiang

Wei Peng

Ruixi Yang

Qijiao Liu

Shiying Li

Yuchen Li

Qiaolan Liu

Affiliations

Soon will be listed here.

Abstract

Objectives: This study explored the mechanisms by which physical activity was associated with depressive symptoms in multi-ethnic (Han, Yi and Tibetan) adolescents in southwest China. The mediating role of insomnia in the association of physical activity with depressive symptoms, the moderating role of resilience in this mediation model and the moderating role of parental absence in the moderated mediation model were also examined.

Design: A cross-sectional survey.

Setting: In southwest China (Sichuan Province and Tibet Autonomous Region).

Participants: 3195 adolescents from a school-based survey conducted between April and October 2020.

Methods: There were 3143 valid samples in this study (47.2% males with mean age=12.88±1.68 years). Structural equation models were developed to estimate the direct and mediating effect, and the moderating effect. Multigroup comparison was performed to examine the differences and similarities of the moderated mediation model across three parental absence subgroups: (1) both parents present, (2) one parent absent and (3) both parents absent.

Results: As hypothesised, physical activity was significantly and positively associated with the reduction of depressive symptoms in adolescents. Insomnia partially mediated the effect of physical activity on depressive symptoms. In addition, resilience moderated the direct and indirect effects of physical activity (through insomnia) on depressive symptoms. Finally, the multigroup comparison indicated the moderating effect of parental absence on the moderated mediation model.

Conclusions: Physical activity was associated with alleviating insomnia symptoms among adolescents, thus correlating with the improvement of their depressive symptoms. Resilience was associated with enhancing the beneficial effects of physical activity, further improving depressive symptoms among adolescents, especially those with both absent parents. It is evident that physical activity interventions should be further incorporated into public health programmes to foster the physical and mental health of left-behind adolescents in southwest China.

Citing Articles

The effects of interactive video games combined with LEGO game therapy on social anxiety in rural left-behind children.

Peng D, Wu X, Yang Y, Li X, Shu A, Liang J Front Psychol. 2025; 15:1423755.

PMID: 39759419 PMC: 11696536. DOI: 10.3389/fpsyg.2024.1423755.

References

Hartescu I, Morgan K, Stevinson C . Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015; 24(5):526-34. DOI: 10.1111/jsr.12297. View

Lai S, Zhou J, Xu X, Li S, Ji Y, Yang S . Subjective well-being among AIDS orphans in southwest China: the role of school connectedness, peer support, and resilience. BMC Psychiatry. 2022; 22(1):197. PMC: 8933895. DOI: 10.1186/s12888-022-03833-2. View

Feiss R, Dolinger S, Merritt M, Reiche E, Martin K, Yanes J . A Systematic Review and Meta-Analysis of School-Based Stress, Anxiety, and Depression Prevention Programs for Adolescents. J Youth Adolesc. 2019; 48(9):1668-1685. PMC: 7548227. DOI: 10.1007/s10964-019-01085-0. View

McMahon E, Corcoran P, ORegan G, Keeley H, Cannon M, Carli V . Physical activity in European adolescents and associations with anxiety, depression and well-being. Eur Child Adolesc Psychiatry. 2016; 26(1):111-122. DOI: 10.1007/s00787-016-0875-9. View

Masten A . Invited commentary: Resilience and positive youth development frameworks in developmental science. J Youth Adolesc. 2014; 43(6):1018-24. DOI: 10.1007/s10964-014-0118-7. View

Thapar A, Collishaw S, Pine D, Thapar A . Depression in adolescence. Lancet. 2012; 379(9820):1056-67. PMC: 3488279. DOI: 10.1016/S0140-6736(11)60871-4. View

Dworak M, Wiater A, Alfer D, Stephan E, Hollmann W, Struder H . Increased slow wave sleep and reduced stage 2 sleep in children depending on exercise intensity. Sleep Med. 2007; 9(3):266-72. DOI: 10.1016/j.sleep.2007.04.017. View

Tugade M, Fredrickson B . Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004; 86(2):320-33. PMC: 3132556. DOI: 10.1037/0022-3514.86.2.320. View

Bailey A, Hetrick S, ROSENBAUM S, Purcell R, Parker A . Treating depression with physical activity in adolescents and young adults: a systematic review and meta-analysis of randomised controlled trials. Psychol Med. 2017; 48(7):1068-1083. DOI: 10.1017/S0033291717002653. View

10.

Ho F, Louie L, Wong W, Chan K, Tiwari A, Chow C . A Sports-Based Youth Development Program, Teen Mental Health, and Physical Fitness: An RCT. Pediatrics. 2017; 140(4). DOI: 10.1542/peds.2017-1543. View

11.

Inoue Y, Fukunaga A, Stickley A, Yazawa A, Pham T, Nguyen C . Association between parental absence during childhood and depressive symptoms in adulthood in rural Vietnam. J Affect Disord. 2022; 311:479-485. DOI: 10.1016/j.jad.2022.05.102. View

12.

Chmelik F, Fromel K, Groffik D, Safar M, Mitas J . Does Vigorous Physical Activity Contribute to Adolescent Life Satisfaction?. Int J Environ Res Public Health. 2021; 18(5). PMC: 7956582. DOI: 10.3390/ijerph18052236. View

13.

Bull F, Al-Ansari S, Biddle S, Borodulin K, Buman M, Cardon G . World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54(24):1451-1462. PMC: 7719906. DOI: 10.1136/bjsports-2020-102955. View

14.

Podsakoff P, Mackenzie S, Lee J, Podsakoff N . Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003; 88(5):879-903. DOI: 10.1037/0021-9010.88.5.879. View

15.

Piercy K, Troiano R, Ballard R, Carlson S, Fulton J, Galuska D . The Physical Activity Guidelines for Americans. JAMA. 2018; 320(19):2020-2028. PMC: 9582631. DOI: 10.1001/jama.2018.14854. View

16.

Dunn V, Goodyer I . Longitudinal investigation into childhood- and adolescence-onset depression: psychiatric outcome in early adulthood. Br J Psychiatry. 2006; 188:216-22. DOI: 10.1192/bjp.188.3.216. View

17.

Rice F, Riglin L, Lomax T, Souter E, Potter R, Smith D . Adolescent and adult differences in major depression symptom profiles. J Affect Disord. 2018; 243:175-181. DOI: 10.1016/j.jad.2018.09.015. View

18.

Evans G, Li D, Whipple S . Cumulative risk and child development. Psychol Bull. 2013; 139(6):1342-96. DOI: 10.1037/a0031808. View

19.

Mao M, Zang L, Zhang H . The Effects of Parental Absence on Children Development: Evidence from Left-Behind Children in China. Int J Environ Res Public Health. 2020; 17(18). PMC: 7559575. DOI: 10.3390/ijerph17186770. View

20.

Li X, Coid J, Tang W, Lv Q, Zhang Y, Yu H . Sustained effects of left-behind experience during childhood on mental health in Chinese university undergraduates. Eur Child Adolesc Psychiatry. 2020; 30(12):1949-1957. DOI: 10.1007/s00787-020-01666-6. View