Dose-Response Associations Between Screen-Based Digital Media Use and Anxiety in Children and Adolescents: A...

Screen-based digital media use is widespread in childhood and adolescence, but its association with anxiety and dose-response relationship remain uncertain. We systematically reviewed observational studies of participants aged 6-19 years reporting time- or frequency-based screen exposure and anxiety-specific outcomes. PubMed/MEDLINE, Web of Science Core Collection, Scopus, and CNKI were searched through September 2026. Study quality was assessed using the AHRQ checklist or Newcastle-Ottawa Scale. Eligible estimates were synthesized using three-level random-effects meta-analysis and restricted cubic splines. Fifty-seven reports were retained. The primary adjusted dataset included 79 odds-ratio effects from 17 independent studies (pooled OR 1.40, 95% CI 1.26-1.54; I² = 51.7%). Screen type significantly moderated the association after Holm correction. The dose-response analysis included seven independent studies; the linear component was significant (p = 0.039), whereas nonlinearity was not supported (p = 0.132; wild-cluster p = 0.163). Evidence was predominantly observational and cross-sectional, and dose-response data were limited. Greater screen exposure was associated with higher odds of anxiety, supporting a graded pattern without a discrete threshold. Because the evidence was predominantly observational and cross-sectional, this exposure-response gradient should be interpreted as an association rather than evidence that greater screen use causes anxiety; reverse and reciprocal pathways remain possible. This review was not registered and was funded by two Jiangsu Provincial Education Science Planning projects.