Leisure screen time, internet gaming disorder, and mental health among Chinese adolescents: a large-scale cross-sectional study (Preprint)

BACKGROUND A non-trivial proportion of adolescents are spending significant leisure time on screen media activities that could accelerate the onset of mental disorders, but existing evidence from this vulnerable population has been limited. OBJECTIVE Our study aimed to investigate the independent and joint associations of leisure screen time (LST) and internet gaming disorder (IGD) with an array of mental health conditions among Chinese adolescents. METHODS A cross-sectional survey was conducted involving 13,240 adolescents from 20 primary and secondary schools in Pidu District, Sichuan Province, China. LST was assessed through self-reported questionnaires, capturing daily LST on typical weekdays and weekends. IGD was evaluated using IGDS9-SF (the Internet Gaming Disorder Scale-9 Item Short Form). Mental health outcomes included overall mental health status and its five major components: psychological distress, depression, paranoia, insomnia, and suicidal ideation, all assessed through standardized adolescent-specific rating scales. RESULTS The prevalence of excessive LST (≥ 2h/day), IGD, and mental health disorders (any of the five) among participants was 48.2%, 1.4%, and 55.8%, respectively. Excessive LST (OR = 1.18, 95%CIs = 1.09-1.27) and the presence of IGD (OR = 6.58, 95%CIs = 5.02-8.62) were independently and significantly associated with poor mental health conditions. The effect size was stronger for IGD than LST. Moreover, the risk of mental health disorders increased markedly as LST increased, with a linear trend (Ptrend < 0.001). When considered jointly, adolescents who exhibited both excessive LST and the presence of IGD demonstrated the highest risk of developing mental health disorders (OR = 7.35, 95%CIs = 5.29-10.22). No significant LST-IGD interaction, either on the additive or multiplicative scale, was identified. CONCLUSIONS Excessive LST and IGD are both associated with a range of mental health disorders in adolescents. However, longitudinal studies are needed to better understand the long-term effects of excessive LST and IGD on adolescent mental health in future. Moreover, management guidelines focusing on leisure screen behaviors among adolescents should be regularly updated to coordinate with rapid technological advancements.