Not just time: Multidimensional patterns of screen use and adolescent well-being in nine countries and regions

Although major scholars and policy institutions have long advocated limiting adolescents' screen time to reduce potential health risks, evidence remains insufficient regarding whether such restrictions may overlook the potential benefits of screen use. The present study aimed to comprehensively capture the associations between multiple features of screen engagement and diverse health indicators among adolescents using a large cross-nations dataset. Participants included 57,279 fifteen-year-old adolescents (50.6% female) from nine countries or regions. Regression analyses and latent profile analysis (LPA) were conducted to examine how different characteristics of screen use-specifically content, mode, and context-were related to somatic symptoms, psychological symptoms, and life satisfaction. Results showed that all types of screen use were consistently associated with more somatic symptoms. However, associations with psychological symptoms and life satisfaction were more mixed. Four distinct subgroups of adolescents were identified: Low users (58.28%), Moderate users (22.13%), Heavy users (6.18%), and High-social but low-functional users (13.41%). While Heavy users reported the highest levels of both somatic and psychological symptoms, they also exhibited the highest life satisfaction. Notably, High-social but low-functional users showed elevated somatic and psychological symptoms and the lowest life satisfaction. These findings underscore the heterogeneity of adolescent screen-use behaviors and suggest that a nuanced understanding of screen-use characteristics is essential for interpreting their health implications. Merely restricting screen time may not yield optimal health outcomes for adolescents.