Physical Activity or Organized Sport, Which Is Better for Depression? A Perspective on Attributable Healthcare Costs in Chinese Children and Adolescents

Background: Depression is a growing public health concern among Chinese children and adolescents, with substantial healthcare costs. Physical activity (PA) and organized sport are modifiable behaviours protective against depression. This study, therefore, estimated the healthcare costs of depression attributable to insufficient PA and organized sport participation. Methods: A cost-of-illness approach with population attributable fraction (PAF) was applied. Relative risks were derived from longitudinal evidence, prevalence estimates from national Chinese surveys, and depression case numbers from the Global Burden of Disease 2021. Direct healthcare costs were extrapolated from European Union estimates, adjusted to 2024 US dollars (USD), and Chinese expenditure. Sex-stratified analyses were conducted. Results: Estimated depression-related healthcare costs attributable to insufficient PA were approximately 81 million USD, compared with around 84 million USD attributable to insufficient organized sport participation. At the population level, the economic burden attributable to insufficient PA and organized sport was of a similar order of magnitude. Among boys, costs attributable to insufficient organized sport participation (approximately 57 million USD) exceeded those attributable to insufficient PA (around 39 million USD), whereas among girls, costs attributable to insufficient PA (approximately 42 million USD) were higher than those related to organized sport (around 27 million USD). These sex-specific patterns were consistent across sensitivity analyses examining uncertainty in key model parameters. Conclusions: Both insufficient PA and organized sport contribute substantially to depression-related healthcare costs, with sex-specific differences. Policies should prioritise promoting overall PA in girls and organized sport in boys to reduce depression burden and associated expenditures. The magnitude of these attributable costs indicates an economically meaningful burden that is potentially modifiable through behavioural interventions.