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Interaction effect of screen time and sugar-sweetened beverages with depressive symptoms in adolescents: evidence from a large sample-based survey in China

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Abstract

Excessive screen time and the consumption of sugar-sweetened beverages are found to be independent predictors of depressive symptoms. However, the potential interaction effect of screen time and sugar-sweetened beverages, that is, whether one exposure factor strengthens the association of another with depressive symptoms, remains unclear. A large-scale adolescent health surveillance survey was conducted in 27 schools in eight regions across China. A total of 22,868 students were recruited to complete an eligible questionnaire to provide details of their screen time and sugar-sweetened beverage consumption. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Multiplicative and additive interaction models were performed to estimate the interaction effects of screen time and sugar-sweetened beverages on depressive symptoms, and whether the relationship varied by age group was also examined. The multivariate logistic regression model showed that even if the confounding factors were controlled, screen time and sugar-sweetened beverages were still risk factors for depressive symptoms in adolescents. Interaction models indicated that screen time and sugar-sweetened beverages in combination were related to greater odds of depressive symptoms. Compared with late adolescents, early adolescents had a higher probability of depressive symptoms when exposed to the joint effects. Our study may hopefully deepen the understanding of the association between screen time and sugar-sweetened beverages and depressive symptoms. Future research should further explore how and why screen time and sugar-sweetened beverages affect individuals more profoundly in early adolescence than in late adolescence and how to mitigate this.

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Acknowledgements

We would like to acknowledge all school action teams, the staff and students from the participating schools, and our co-operators, including Shenzhen Center for Disease Control and Prevention, Jiangxi province Center for Disease Control and Prevention, Xuzhou primary and middle school health care center, Shenyang Yuhong primary and middle school health care center, Shenyang Sujiatun primary and middle school health care center, for assistance in data collection.

Funding

Funding for the project was provided by National Natural Science Foundation of China (82073576) and the Support Programme for University Outstanding Youth Talent of Anhui Province (gxyq2022011). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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  1. Zhengge Jin, Wan Xiao and Yi Zhang contributed equally to this article.

Authors and Affiliations

  1. Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China

    Zhengge Jin

  2. Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China

    Zhengge Jin, Wan Xiao, Yi Zhang, Fan Rong, Weiqiang Yu, Ying Sun, Fangbiao Tao & Yuhui Wan

  3. Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China

    Zhengge Jin, Wan Xiao, Yi Zhang, Fan Rong, Weiqiang Yu, Ying Sun, Fangbiao Tao & Yuhui Wan

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ZJ was involved in data entry, statistical analysis and interpretation, and writing of the manuscript. WX and YZ were involved in data entry, statistical analysis and revising the manuscript. FR and WY assisted in data entry, statistical analysis. YS assisted in the development of the study methodology and revising the manuscript. FT, YW were involved in developing the research question and study methodology, providing assistance and guidance in the interpretation of the study data, and revising the manuscript. All authors approved the final version of the submitted manuscript.

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Jin, Z., Xiao, W., Zhang, Y. et al. Interaction effect of screen time and sugar-sweetened beverages with depressive symptoms in adolescents: evidence from a large sample-based survey in China. Eur Child Adolesc Psychiatry (2024). https://doi.org/10.1007/s00787-024-02414-w

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