Association of types of on-screen content with mental health problems among Chinese adolescents.

Excessive screen time was associated with mental health problems, yet whether the associations differ by screen content types remain unknown. Here, we conducted a cross-sectional study of adolescents from 156 junior and high school to investigate the association of types of on-screen content with mental health problems in China. The exposure variable was screen exposure, measured by the self-reported questionnaire. Symptoms of depression and anxiety were assessed by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. Suicide-related behavior was adapted from the Centers for Disease Control's Youth Risk Behavior Surveillance. Generalized linear models and network analysis were performed. Of the 15,194 adolescents included in the final analysis, 8,019 were males and mean (SD) age was 14.50 (1.68) years. 34.6% of adolescents had an average screen time of ≥ 4 h/day on weekends. The most frequently used screen contents (≥ 4 h/d) were electronic games (9.1%), followed by short video (6.6%). Learning online had strong associations with depression (OR = 2.03, 95%CI: 1.29-3.11, P = 0.002) and anxiety (OR = 2.05, 95%CI: 1.24-3.27, P = 0.004) symptoms. The associations between on-screen content and mental health varied. The strongest edges linked to screen content types were edge between "Electronic games" and "Anhedonia" in the network model. "Control worry" was the most central nodes, followed by "Irritable" and "Worry A Lot". Findings suggested that both screen time and different types of screen content were associated with mental health problems among adolescents. Limiting screen exposure and developing effective interventions to improve mental health should be a priority.