Hökby Sebastian, Alvarsson Jesper, Westerlund Joakim, Carli Vladimir, Hadlaczky Gergö
National Centre for Suicide Research and Prevention, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
National Centre for Suicide Research and Prevention, Center for Health Economics, Informatics and Healthcare Research; Stockholm Health Care Services, Stockholm, Sweden.
PLOS Glob Public Health. 2025 Apr 2;5(4):e0004262. doi: 10.1371/journal.pgph.0004262. eCollection 2025.
Recently the Swedish Public Health Agency published recommendations of a maximum of two-to-three hours of daily leisure screen time for adolescents aged 13-18, partly to promote better sleep (2024-Sep-02). Biologically and socially, adolescence is characterized by belated sleep times, and depressive effects of screen time can arise through sleep displacements. Theorized links between screen time, sleep, and depression, merited examination of four sleep mediators to determine their relative importance and determine which of them mediate future depression. Hypotheses were preregistered. Three-wave psychometric health data were collected from healthy Swedish students (N = 4810; 51% Boys; ages 12-16; N = 55 schools; n = 20 of 26 Stockholm municipalities). Multiple imputation bias-corrected missing data. Gender-wise Structural Equation Modelling tested four sleep facets as competing mediators (quality, duration, chronotype, social jetlag). The primary model result included the three first mediators to achieve acceptable fit indices (RMSEA = 0.02; SRMR = 0.03; CFI = 0.95; TLI = 0.94). Screen time deteriorated sleep within three months and effect sizes varied between mediators (Beta weights ranged: 0.14-0.30) but less between genders. Among boys, screen time at baseline had a direct adverse effect on depression after twelve months (Beta = 0.02; p <0.038). Among girls, the depressive effect was mediated through sleep quality, duration, and chronotype (57, 38, 45% mediation). Social jetlag remained non-significant. This study supports a modernized 'screen-sleep-displacement theory'. It empirically demonstrates that screen-sleep displacements impact several aspects of sleep simultaneously. Displacements led to elevated depressive symptoms among girls but not boys. Boys may be more prone to externalizing symptoms due to sleep loss. Results could mirror potentially beneficial public health effects of national screen time recommendations.
最近，瑞典公共卫生机构发布了针对13至18岁青少年的建议，即每天休闲屏幕使用时间最多为两到三小时，部分原因是为了促进更好的睡眠（2024年9月2日）。从生物学和社会学角度来看，青少年的特点是睡眠时间较晚，屏幕使用时间的抑郁效应可能通过睡眠替代而产生。屏幕使用时间、睡眠和抑郁之间的理论联系，值得对四种睡眠调节因素进行研究，以确定它们的相对重要性，并确定其中哪些因素介导未来的抑郁。假设已预先登记。从健康的瑞典学生中收集了三波心理测量健康数据（N = 4810；51%为男孩；年龄12 - 16岁；N = 55所学校；来自斯德哥尔摩26个市中的20个市）。采用多重插补偏差校正缺失数据。按性别进行的结构方程模型测试了四个睡眠方面作为竞争调节因素（质量、时长、生物钟类型、社会时差）。主要模型结果包括前三个调节因素，以实现可接受的拟合指数（RMSEA = 0.02；SRMR = 0.03；CFI = 0.95；TLI = 0.94）。屏幕使用时间在三个月内会使睡眠质量下降，效应大小在调节因素之间有所不同（标准化回归系数范围：0.14 - 0.30），但在性别之间差异较小。在男孩中，基线时的屏幕使用时间在十二个月后对抑郁有直接的不利影响（标准化回归系数 = 0.02；p <0.038）。在女孩中，抑郁效应是通过睡眠质量、时长和生物钟类型介导的（中介效应分别为57%、38%、45%）。社会时差仍然不显著。本研究支持一种现代化的“屏幕 - 睡眠替代理论”。它通过实证表明，屏幕 - 睡眠替代同时影响睡眠的多个方面。替代导致女孩出现抑郁症状增加，但男孩没有。男孩可能因睡眠不足更容易出现外化症状。研究结果可能反映出国家屏幕使用时间建议对公共卫生的潜在有益影响。
