Association of Changes of lifestyle behaviors before and during the COVID-19 pandemic with mental health: a longitudinal study in children and adolescents

Background We examined the prospective associations of changes in lifestyle behaviors before/during the COVID-19 pandemic, namely physical activity and screen time, with mental health. Furthermore, the impacts of physical activity and screen time on mental health during the pandemic were examined cross-sectionally. Methods A two-wave longitudinal study was conducted among 2423 children and adolescents in Shanghai, China. Lifestyle behavior variables (physical activity and screen time) and psychological variables (depressive symptoms, anxiety, and stress) were measured using a self-reported questionnaire in January and March 2020. A series of multivariable logistic regressions were performed to examine the associations between changes in lifestyle behaviors in two waves and psychological problems. The combined associations of physical activity and screen time with psychological problems were also explored using the second wave data. Results Compared to students with persistently short screen time before and during the COVID-19 pandemic, those with prolonged screen time (OR = 1 center dot 36 for depression, OR = 1 center dot 48 for anxiety) and those with persistently long screen time (OR = 1 center dot 70 for depression, OR = 2 center dot 13 for anxiety) reported a higher risk of psychological symptoms. The association between changes in physical activity and psychological symptoms was not statistically significant after adjustment for demographic factors, socioeconomic status, and screen time. During the COVID-19 pandemic, engaging in longer screen time (OR = 1 center dot 44 for depression, OR = 1 center dot 55 for anxiety) was associated with worsened psychological conditions, while engaging in increased physical activity (OR = 0 center dot 58 for depression, OR = 0 center dot 66 for anxiety) was associated with better psychological conditions. Conclusions Our study suggests that promoting physical activity and limiting leisure screen time during the COVID-19 pandemic are important to prevent and mitigate psychological problems in children and adolescents. Therefore, effective interventions targeting lifestyle behaviors are needed to protect children and adolescents' physical and mental health.