The associations between screen time and mental health in children aged 0-12: A systematic review

: It is advised that children up to two years of age avoid any screen time (i.e., using digital screens), that those between the ages of two and five years should not exceed one hour per day, and that children aged five to 12 years should only have access to two hours of screen time per day. However, in the digital age, parents find it difficult to control the time their children spend on screens.

: This article aimed to systematically synthesise the evidence on the associations between screen time and mental health outcomes in children aged 0 to 12 years.

: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was defined according to the Population, Exposure, Comparator, and Outcomes (PECO) strategy, using the descriptors 'children', 'screen time' and 'mental health' when searching the databases PubMed, Scopus, and PsycINFO. Articles were included if they directly evaluated the associations between screen time and mental health, measured the results using validated instruments, included children aged 0 to 12 years, and were published since 2013. The Newcastle-Ottawa scale was used to check the methodological quality of the studies. The results were described by presenting the characteristics of the studies, the quality assessment, and the associations between screen time and mental health in longitudinal and cross-sectional studies.

: This review assessed the quality of evidence and the frequency with which different mental health problems have been investigated in relation to screen time in children. Fifty-two studies were included, with most addressing attention deficit-hyperactivity disorder (n = 19), conduct problems (n = 13), externalising symptoms (n = 9), depression (n = 11), and anxiety (n = 9). Symptoms of attention deficit-hyperactivity disorder, oppositional defiant disorder, mood symptoms, emotional and social difficulties, conduct problems, low self-esteem, and sleep disturbances were positively associated with screen time, presenting evidence considered to be of high quality.

: Although this review concluded that screen time significantly affects children's mental health, some limitations should be noted. The lack of longitudinal data made it difficult to establish a clear causal relationship in most studies, and screen time measures may have introduced a potentia memory bias, as well as relying on parental recall.

: Screen time warrants careful consideration in relation to children's mental health. Promoting off-screen activities may be crucial to reducing the risk of unfavourable mental health outcomes associated with exposure to the digital environment. Future research should focus on longitudinal studies to understand the causal relationships between children's psychosocial responses to the different purposes of screen use and the type of content to which they are exposed.