Association of screen time-based sedentary behavior and the risk of depression in children and adolescents: Dose-response meta-analysis

Purpose: We aimed to find the association between screen time (ST)-based sedentary behavior and depression in children and adolescents. Methods: PubMed, Embase, and Web of science database were searched to find eligible studies until April 25, 2021. Data extraction was conducted by two investigators independently, followed by quality assessment for included studies. Odd ration (OR) and 95% confidence intervals (CI) were regarded as effect size index. Heterogeneity test was conducted using Cochran' s Q test and I-2 test. Least squares trend estimation method was used for dose-response meta-analysis. All statistical analyses were conducted using Stata12.0 software. Results: Totally 22 articles containing 197,673 cases were included. The pooled results displayed that there was a significant positive correlation between ST and depression [OR (95%CI) = 1.24 (1.11, 1.38), P < 0.001]. Similar results were observed for watching television (TV), computer use (CU), computer game (CG)/video game (VG) and internet use (IU)/mobile phone (MP) time. Dose-response meta-analysis showed that take 1 hour/day as control, the risk of depression went down and then went up as sedentary time increased for ST (P > 0.05). The risk of depression was significantly increased when TV time beyond 4.5 hours/day (P < 0.05), or CU time beyond 0.5 hours/day (P < 0.05), or CG/VG time beyond 2 hours/day (P < 0.05), or IU/MP time beyond 0.5 hours/day (P < 0.05). Conclusions: ST-based sedentary behavior was associated with the risk of depression in a non-linear dose-response manner for children and adolescents.