The Association Between Youth Screentime, Suicide Behaviors, and Protective and Risk Factors in a United States...

Adolescent screentime and suicide rates increased during the coronavirus disease 2019 (COVID-19) pandemic. This study assesses whether specific risk and protective factors moderate the relationship between screentime and suicide outcomes in a post-COVID-19, nationally-representative sample of US adolescents. Data are from the Center for Disease Control and Prevention's 2021 Youth Risk Behavior Survey (n = 17,232). Weighted logistical ANCOVAs tested relationships between screentime (low [≤2 h/day], medium [3-4 h/day], high [≥5 h/day]) and suicide (suicidal ideation [SI], plan, attempt), interactions of screentime and risk/protective factors (feeling sad, being bullied/cyberbullied, feeling close to people at school, sleep, and exercise), and the relationship between screentime and suicide behaviors, adjusting for significant risk/protective factors. Compared to low screentime, high screentime was associated with higher odds of all suicide behaviors (aORs = 1.30-1.96; 95% CI from 1.02 to 2.35), while medium screentime's effect varied by behavior (SI: aOR = 1.19; 95% CI 1.02-1.38; Plan: aOR = 1.09; 95% CI 0.92-1.29; Attempt: aOR = 0.80; 95% CI 0.65-0.98). After adjusting for combined risk factors, high screentime remained significantly associated with SI and plan (aORs = 1.39-1.62; 95% CI from 1.12 to 1.97) but not attempt (aOR = 1.10; 95% CI 0.85-1.41). In combined models, feeling close to people at school was significantly protective against SI for all levels of screentime (aORs 0.43-0.59; 95% CI from 0.35 to 0.70), and sleep was protective for SI and plan (aORs 0.59-0.60; 95% CI from 0.45 to 0.78). Among US adolescents, high screentime is a significant risk factor for suicidal ideation and plan, above and beyond other known risk factors. Findings underscore school connectedness and adequate sleep as potential areas for intervention alongside guidance on high daily screentime.