Journal of Psychosocial Nursing and Mental Health Services

Original Article 

Physical Activity, Screen Time, and Mood Disturbance Among Chinese Adolescents During COVID-19

Suhua Xiao, BEd; Zi Yan, PhD, MPH; Li Zhao, MEd

Abstract

The purpose of the current study was to explore the physical activity and screen time status among Chinese adolescents during the coronavirus disease (COVID-19) lockdown and their association with mood disturbance and conflicts with parents. A total of 1,680 7th to 12th grade students enrolled at a large middle-high school located in Southwest China completed an online survey measuring mood states, physical activity, screen time, conflicts with parents, and body height and weight. Physical activity, particularly of at least 150 minutes' duration each week, significantly decreased the likelihood of negative mood among adolescents during lockdown. Screen time, specifically other than that spent on online study, had a negative association with mood, after controlling for the relevant variables (i.e., physical activity and body mass index). Less screen time and accumulating 150 minutes of physical activity were associated with fewer conflicts with parents. With the continuing COVID-19 pandemic, local school districts, school leaders, and health professionals should develop greater awareness of potential problems with, and engage parents in developing specific guidance on controlling, screen time and promoting physical activity in a time-sensitive manner. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Abstract

The purpose of the current study was to explore the physical activity and screen time status among Chinese adolescents during the coronavirus disease (COVID-19) lockdown and their association with mood disturbance and conflicts with parents. A total of 1,680 7th to 12th grade students enrolled at a large middle-high school located in Southwest China completed an online survey measuring mood states, physical activity, screen time, conflicts with parents, and body height and weight. Physical activity, particularly of at least 150 minutes' duration each week, significantly decreased the likelihood of negative mood among adolescents during lockdown. Screen time, specifically other than that spent on online study, had a negative association with mood, after controlling for the relevant variables (i.e., physical activity and body mass index). Less screen time and accumulating 150 minutes of physical activity were associated with fewer conflicts with parents. With the continuing COVID-19 pandemic, local school districts, school leaders, and health professionals should develop greater awareness of potential problems with, and engage parents in developing specific guidance on controlling, screen time and promoting physical activity in a time-sensitive manner. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

The global coronavirus disease (COVID-19) pandemic is the biggest threat to public health this century. As of October 30, 2020, there were approximately 45 million confirmed cases globally and 1.1 million people had died as a result of COVID-19 (World Health Organization [WHO], 2020). In addition to its global medical, economic, and social impact, COVID-19 also changed people's lifestyles worldwide.

Many countries have imposed lock-down orders and travel bans to mitigate the spread of the virus. As the center of the original outbreak, the Chinese government imposed lockdown in cities in late January 2020 (Tian et al., 2020). In addition to closing public places, such as restaurants, parks, and shopping centers, Chinese citizens were advised to stay home as much as possible (Chen, Wang et al., 2020). The results of lock-down were robust in controlling the spread of the virus. As a result, China had the outbreak under control within weeks (Azman & Luquero, 2020).

Yet, these closures have had significant social and economic consequences. During the extended school closures, children's education has been disrupted. Children and adolescents have been isolated at home. The restrictions against participating in outdoor activities include regular physical activity and exercise for adults and adolescents (Chen, Mao, et al., 2020). Isolation during lockdown also creates a strain on adolescents' mental and social development. This situation may be worse for Chinese adolescents, compared to their Western peers, as most are the single child in their household due to the single-child policy (Feng et al., 2013). In addition to the risk of obesity, long-term isolation is associated with loneliness, depression, suicide attempts, low self-esteem, and other behavioral issues (Hall-Lande et al., 2007; Kymlicka, 2018).

The effect of physical activity on mental health has been well documented. High levels of physical activity have been shown to relate to mental well-being, including less depression, anxiety, and stress among adults and children (Birkeland et al., 2009). Physical activity also buffers negative mood in adolescents. Research shows that adolescents often respond to stress with negative emotions, whereas physical activity buffers the effect of strain (Agnew, 2006). However, to maintain optimal physical and mental health, children and youth aged 5 to 17 should undertake at least 60 minutes of moderate to vigorous intensity physical activity daily (WHO, 2018). Due to the lockdown, the opportunities for children and adolescents to participate in outdoor physical activity have been significantly reduced.

Reduced physical activity is associated with increased screen time among children and adolescents (Hands et al., 2011), which in turn escalates the risk of obesity, negative mood, and other behavioral problems among adolescents (Twenge et al., 2018). School closures and adherence to advice on social distancing increase the time adolescents spend online and reduce their in-person social interactions, particularly with their peers. Previous studies have shown that face-to-face communication provides more emotional closeness than electronic communication (Sherman et al., 2013), and is thus a protective factor against loneliness and other negative emotions (Kross et al., 2013). Therefore, the risk of negative mood among adolescents may be heightened as a result of increased time spent online during lockdown. Given the psychological benefits of physical activity and the risks of screen time, it is reasonable to think that during lockdown physical activity among adolescents, particularly indoor physical activity, may contribute to improved mood states, whereas more screen time leads to worse mood states.

Lockdown also influenced parent–child relationships in many ways. First, during lockdown, children and adolescents spent more time online, potentially reducing their closeness to their parents (Sherman et al., 2013). According to Cues-Filtered-Out theory, lack of nonverbal communication through screen-based media could lead to impersonal communication (Walther & Parks, 2002) and hinder the development of communication skills and understanding of emotional cues among children and adolescents (Uhls et al., 2014). In addition, negative mood, such as anxiety and stress, and long-term separation from their social network resulting from lockdown may increase family tension and the likelihood of conflict between family members (Sigfusdottir et al., 2011). A recent survey shows that the relationship between adolescents and parents worsened during lockdown in China (Lin, 2020).

Physical activity has been reported to promote energy and positive mood (McPhie & Rawana, 2015), and hence may buffer the effects of family conflict among adolescents (Sigfusdottir et al., 2011). It is also reasonable to expect that at least some, if not most, of the physical activity performed by adolescents during lockdown was with their parents. Previous research has also shown that physical activity increases bonding between family members and facilitates family cohesion (Lehto et al., 2012). Thus, adolescents who engage in more physical activity may experience fewer conflicts with their parents during lockdown.

To date, it is still unclear how long the COVID-19 pandemic will last. Scientists have predicted that it will result in long-term transformation in our daily lives (World Economic Forum, 2020). Working and studying from home may become a routine for many adults and adolescents around the world. Therefore, more studies on how this lifestyle change may impact adolescents and their families are needed. More importantly, it is essential to explore the role of possible means of promoting physical and mental well-being, such as physical activity, during the imposition of social distancing. Hence, the current study's primary goal is to understand Chinese adolescents' mood and physical activity during lockdown. We also had the following research hypotheses (H):

H1: More screen time and less physical activity predict higher mood disturbance during lockdown.

H2: More screen time and less physical activity are associated with more conflicts with parents during lockdown.

Method

Participants

The study was part of an anonymous survey that was approved by a large middle-high school located in Southwest China and distributed to students and their parents during lockdown in early April 2020. A total of 1,680 students took the survey (males, n = 862; females, n = 818) (Table 1). The average body mass index (BMI) of participants was 17.10 kg/m2 (males = 17.12 kg/m2, females = 17.09 kg/m2).

Participant Demographics, Screen Time, and Physical Activity (N = 1,680)

Table 1:

Participant Demographics, Screen Time, and Physical Activity (N = 1,680)

Measures

Mood State. The Chinese version of the Profile of Mood States short form (POMS) (Zhu, 1995) was adopted to measure students' mood states. The POMS short-form measures the same six scales as the long-form: tension, depression, anger, fatigue, confusion, and vigor. The total mood disturbance (TMD) score was computed by adding an individual's scores on tension, depression, anger, fatigue, confusion, and subtracting the score for vigor. A higher score indicates higher mood disturbance. Previous studies have tested the reliability (range = 0.76 to 0.95) and validity of this scale among various populations, including adolescents (Chen et al., 2002).

Physical Activity Participation. Physical activity was measured by the Leisure-Time Exercise Questions (Godin, 2011). This measure estimated students' participation in weekly physical activity during the stay-home period in a range of mild (e.g., easy walking), moderate (e.g., fast walking), and strenuous (e.g., running) forms. Based on this information, exercise metabolic (MET) units were calculated according to the following formula: [(Mild × 3) + (Moderate × 5) + (Strenuous × 9)]. Previous research has reported a high test–retest reliability over a 2-week period (r = 0.75 to 0.82) (Reed & Phillips, 2005) and good validity (Amireault & Godin, 2015). Participants were also asked whether they had undertaken at least 150 minutes of physical activity each week. Finally, participants were asked to choose the frequency of the physical activity in which they had participated during the previous month.

Screen Time. As most of the school offered online courses during lockdown, students were asked to indicate the number of hours they spent on online study daily, as well as other screen time usage.

Conflicts With Parents. The number of conflicts with parents was used as a proxy for relationships with parents during lockdown, using a single question: “Approximately how many times have you had conflicts with your parents (e.g., arguments, emotional and physical violence) during the past 7 days?”

Demographic Factors. Age, gender, grade, and self-reported height and body weight were also measured.

Procedure

A description of the survey and the survey link were sent to students in grades 7 to 12 and their parents in the middle-high school via WeChat, a popular social media application (app) in China. Different WeChat groups were organized by grades and classes. Students and their parents had the chance to read the study introduction and consent statements and to ask questions before providing their consent.

Data Analysis

All data were entered, coded, and analyzed using SPSS 26.0. Mood disturbance score, physical activity score, types of physical activity, online study time, and other screen time were reported descriptively. Hierarchical regression analyses were performed to explore factors that predicted mood disturbance and relationships with parents.

Results

Physical Activity

A total of 69.5% (males = 72.4%; females = 66.4%) of participants undertook at least 150 minutes of physical activity each week during lockdown. Male students had significantly higher physical activity scores than females (t[1,578] = 2.40, p < 0.05). Students in lower grades were also more physically active than those in higher grades (F[5, 1,674 = 3.21, p < 0.01). Specifically, 7th grade students had a higher physical activity score than 10th (p < 0.05) and 11th (p < 0.01) grade students; 8th grade students were more active than 11th grade students (p < 0.01); and 9th grade students were more active than 11th grade students (p < 0.01). Table 2 shows that the most frequent physical activity was indoor stretch, followed by indoor resistance training, outdoor walking, and jump rope. Most activities that involved more than one person, such as badminton, basketball, and table tennis, were not popular.

Mode and Median of Participation in Physical Activity During Previous 7 Days

Table 2:

Mode and Median of Participation in Physical Activity During Previous 7 Days

Screen Time

Male students on average spent 5.2 hours on online study and 2.38 hours on other screen time daily, whereas female students spent 5.29 hours on online study and 2.56 hours on other screen time. No gender differences in study hours or other screen time were found.

Analysis of variance identified significant differences in online study hours among different grades (F[5, 1,674] = 12.64, p < 0.001). The post-hoc test revealed that 7th grade students studied significantly less than 10th (p < 0.01) and 11th (p < 0.001) grade students; 8th grade students studied less than 9th (p < 0.05), 10th (p < 0.001), and 11th (p < 0.001) grade students; 9th grade students studied less than 11th grade students (p < 0.01); and 11th grade students studied more than 12th grade students (p < 0.01).

There were also differences among grades in screen time other than online studies (F[(5, 1,674] = 22.03, p < 0.001). Seventh grade students had significantly fewer screen hours than 8th (p < 0.01), 9th (p < 0.001), 10th (p < 0.001), 11th (p < 0.001), and 12th (p < 0.01) grade students; and 8th grade students had fewer hours than 9th, 10th, 11th (all p < 0.001), and 12th (p < 0.05) grade students.

Mood Disturbance

Female students had significantly higher mood disturbance scores (t[1,678] = −3.26, p < 0.01). Mood disturbance score also differed among grades (F[5, 1,674] = 6.82, p < 0.001). Twelfth grade students had a significantly higher score than all other grades (all p < 0.001); 11th grade students had a higher score than 7th and 8th grade students (both p < 0.05); 10th grade had a higher score than 7th (p < 0.001) and 8th (p < 0.05) grade students.

Predictors of Mood Disturbance

Nested regression analyses were performed to explore the factors that contributed to mood disturbance among participants (Table 3). Females had significantly higher mood disturbance scores across four models. A higher grade was associated with a higher mood disturbance score in Models 1, 2, and 3, but not after adding the variable of at least 150 minutes of physical activity each week. Online study time was not associated with mood disturbance, but other screen time was associated with mood disturbance. An additional 1 hour of screen time that was not online study was associated with an increase of 1.6 to 1.8 points in participants' mood disturbance scores. In Model 3, adding physical activity participation was significantly associated with a lower mood disturbance score; however, in Model 4, doing at least 150 minutes of physical activity each week significantly predicted a lower mood disturbance score by 10 points, which outweighed the effect of the physical activity participating score.

Hierarchical Regression Analysis on Mood Disturbance

Table 3:

Hierarchical Regression Analysis on Mood Disturbance

Predictors of Conflicts With Parents

Similar analyses were performed on the frequency of conflicts with parents (Table 4). Gender was not associated with conflicts with parents in any model. A higher grade was associated with fewer conflicts with parents in all four models; more online study time and other screen time predicted more conflict with parents. In Model 3, physical activity participation did not predict conflict with parents. However, after controlling other variables, undertaking at least 150 minutes of physical activity each week predicted fewer conflicts with parents (Model 4).

Hierarchical Regression Analysis on Conflicts With Parents

Table 4:

Hierarchical Regression Analysis on Conflicts With Parents

Discussion

The current study provided a brief insight into physical activity, screen time, and mood disturbance among adolescents during the COVID-19 lockdown in Southwest China. Female students had significantly higher mood disturbance than male students, which is consistent with previous studies that females in general experience higher mood disturbance than males (Merikangas et al., 2010). In the United States, the prevalence of mental disorder among female adolescents was found to be twice as high as male adolescents (Merikangas et al., 2010). The finding that students in higher grades had more mood disturbance than lower grades also confirms previous research (Merikangas et al., 2010). However, the effect of grade faded when considering participation in physical activity. Physical activity, particularly of at least 150 minutes' duration each week, played a significant role in decreasing the likelihood of negative mood among adolescents during lockdown. This result was consistent with prior research that physical activity buffers negative mood stemming from social strain (Agnew, 2006).

In addition to providing evidence of the positive impact of physical activity, the study also confirmed that screen time, specifically screen time other than online study, had a negative association with mood, controlling for relevant variables (i.e., physical activity and BMI). Previous studies have confirmed that screen time not only leads to reduced physical activity participation (Kremer et al., 2014; Maras et al., 2015), but is also directly associated with anxiety and depression among adolescents in China and Western countries (Cao et al., 2011; Maras, et al., 2015). However, there is little research on the relationship between specific types of screen behavior and mood. Investigation of such a question is important, given that online study is expected to be more prevalent if the epidemic continues. Whether screen behavior such as online study would generate a negative impact on mood needs further research.

The most recent guideline on online study during lockdown published by the National Health Commission of the People's Republic of China (2020) suggests that middle-high school students should be exposed to no more than 4 hours of online study and 1 hour of other screen time each day during lockdown to prevent myopia. The results of this study indicate that middle school students spent more than the recommended time on online study and other screen time. This finding raises health concerns in addition to myopia. Local school districts, school leaders, and health professionals should be more aware of the hazards of insufficient physical activity and excessive screen time exposure and actively engage parents in protecting children and adolescents from these various health concerns during lockdown.

Online study time and other screen time were associated with more conflicts with parents. Although the physical activity score did not predict fewer conflicts, undertaking at least 150 minutes of physical activity each week predicted fewer conflicts with parents. Although lockdown provided an opportunity for families to spend more time together, it also challenged family members to explore new approaches to care for, respect, and interact with each other under the same roof. Physical activity, undertaken either alone or with parents, generates a positive mood, which facilitates a constructive relationship between adolescents and parents. Screen time, on the other hand, may create negative mood, which facilitates conflict between adolescents and parents. However, it is still unclear how screen time or physical activity influence or are influenced by adolescents' relationships with their parents. Nevertheless, it seems that reducing screen time and increasing physical activity are feasible approaches to facilitate relationships between adolescents and their parents.

Limitations

There are several limitations to the study. First, the data were from a single city in Southwest China, which may not be representative of other locations in China. Given that different regions and areas within China were at different levels of risk during the COVID-19 crisis, residents, including adolescents, may respond with different behaviors. For example, residents in lower-risk areas are more likely to go outdoors for physical activity whereas those at higher risk are less likely to do so. Second, although data on screen time, mood states, physical activity, and other variables were collected, lack of pre-pandemic data makes it impossible to make pre- and post-lockdown comparisons. Third, measures such as physical activity and screen time were self-reported, which may not be accurate and may also be subject to social desirability bias.

Conclusion

COVID-19 is the biggest public health challenge that humans have had to face in the current century. Although traditional face-to-face interactions have been challenged during the crisis, we have to explore new lifestyles that facilitate our children's positive physical, mental, and social development. The most important indication from the current study is that promoting physical activity and decreasing screen time among adolescents during school closure is an effective way to minimize negative mood and conflicts with parents. However, few health guidelines have been issued to the public, including adolescents, as to what they should do in terms of maintaining regular physical activity (Chen, Mao, et al., 2020). While the virus continues, specific guidance on how to control screen time and promote physical activity should be developed and promoted in a time-sensitive manner.

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Participant Demographics, Screen Time, and Physical Activity (N = 1,680)

DemographicnMean (SD) (Range)
Online Study Time (h/day)Other Screen Time (h/day)Physical Activity ScoreaTMDb
Gender
  Male8625.20 (3.06)2.38 (2.41)69.73 (71.13)16.31 (26.18)
  Female8185.29 (2.67)2.56 (2.52)61.44 (65.70)20.52 (26.74)
Grade
  7th6094.96 (2.71)1.81 (1.82)70.15 (65.55)15.24 (25.38)
  8th3864.69 (2.54)2.24 (2.29)70.29 (67.53)16.86 (25.23)
  9th1165.44 (2.88)3.37 (2.97)70.31 (83.83)18.82 (24.12)
  10th2715.67 (2.98)3.25 (2.70)59.63 (73.29)22.04 (25.57)
  11th2536.30 (3.27)3.00 (2.90)52.05 (62.80)21.21 (28.98)
  12th454.91 (3.06)3.08 (3.38)65.37 (70.57)34.04 (38.78)

Mode and Median of Participation in Physical Activity During Previous 7 Days

Physical ActivityModeMedian
Indoor stretch>74
Indoor resistance training03
Outdoor walking03
Jump rope03
Indoor run01
Outdoor run01

Hierarchical Regression Analysis on Mood Disturbance

VariableModel 1Model 2Model 3Model 4
Female4.42**4.10**3.82**3.42**
Grade1.94***1.25**1.12**0.71
Online study time0.260.350.43
Other screen time1.79***1.76***1.6***
Physical activity score−0.03***−0.01
Participating in ≥150−10.98***
minutes of physical activity
R2 (%)2.14.95.78.8
Change of R2 (%)2.80.83.1

Hierarchical Regression Analysis on Conflicts With Parents

VariableModel 1Model 2Model 3Model 4
Femalea0.040.030.030.02
Grade−0.11***−0.13***−0.13***−0.14***
Online study time0.02*0.02*0.02*
Other screen time0.06***0.06***0.06**
Physical activity score0.0010.001
Participating in ≥150 minutes of physical activity−0.21***
R2 (%)2.34.54.75.3
Change of R2 (%)2.20.20.6
Authors

Ms. Xiao is Director, and Ms. Zhao is Lecturer, Physical Education Department, Physical Education Teaching and Research Center of Nankai Secondary School, Chongqing, China; and Dr. Yan is Associate Professor, School of Health Sciences, Merrimack College, North Andover, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Zi Yan, PhD, MPH, Associate Professor, School of Health Sciences, Merrimack College, 315 Turnpike Street, North Andover, MA 01845; email: yanz@merrimack.edu.

Received: July 02, 2020
Accepted: August 27, 2020
Posted Online: November 12, 2020

10.3928/02793695-20201104-04

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