Leisure-time sedentary behavior and psychosocial distress among intermediate-school adolescents in Saudi Arabia: a cross-sectional study

Background Leisure-time sedentary behavior is strongly linked to poorer psychosocial wellbeing among adolescents. In Saudi Arabia, however, where adolescents have among the highest reported levels of screen-based media use, this association is notably under-researched. To address this gap in the literature, the current study investigated the association between leisure-time sedentary behavior and psychosocial wellbeing using the metrics of loneliness and anxiety-related sleep disturbance among Saudi intermediate-school adolescents. Methods Adopting a cross-sectional research design, a stratified multi-stage sample of Saudi adolescents ( N = 5,895; grades 7–9) was recruited from 40 public intermediate schools across five Saudi cities in 2019 using a modified Global School-based Student Health Survey (GSHS). Leisure-time sedentary behavior (a single self-report sitting/screen-time item) was dichotomized at ≥3 h/day (“high”). Loneliness and anxiety-related sleep disturbance were assessed individually and as a composite distress score (two items, 0–3 each, summed; distress = score ≥3). Logistic regression, adjusted for age, sex, nationality, city, physical activity, and sleep duration, estimated adjusted odds ratios (aOR), with standard errors clustered by school ( N = 40) to account for students being sampled within, rather than independently of, schools. Results Just over half (52.2%) reported high sedentary behavior (≥3 h/day), which was significantly associated with composite psychological distress (aOR 1.55, 95% CI 1.33–1.80), loneliness (aOR 1.37, 95% CI 1.19–1.58), and anxiety-related sleep disturbance (aOR 1.64, 95% CI 1.38–1.94); crude and adjusted estimates were similar. An exploratory dose–response analysis showed a pattern visually consistent with a threshold, with odds rising significantly only beyond 6–7 h/day; the significant ≥3 h/day association was likely driven by this highest-exposure subgroup. Distress similarly increased with age from 14 onwards, and girls were approximately twice as likely to report distress as boys (aOR 2.09). Conclusion High leisure-time sedentary behavior was independently associated with loneliness and anxiety-related sleep disturbance among the sampled Saudi intermediate-school adolescents, particularly at the highest exposure levels. As the design was cross-sectional, these findings describe an association, not causation; longitudinal and intervention studies are needed to establish direction and to test whether reducing sedentary behavior improves psychosocial outcomes in this population.