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Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? : a 12-country study

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Abstract
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 +/- 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) Health Behaviour in School-aged Children 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.
Keywords
mental health, adolescents, sleep, AGE-OF-ONSET, EUROPEAN ADOLESCENTS, DEPRESSIVE SYMPTOMS, CHILDREN, STRESS, METAANALYSIS, DISORDERS, EXERCISE, VALIDITY, BEHAVIOR

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MLA
Vandendriessche, Anneke, et al. “Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? : A 12-Country Study.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 16, no. 6, 2019.
APA
Vandendriessche, A., Ghekiere, A., Van Cauwenberg, J., De Clercq, B., Dhondt, K., DeSmet, A., … Deforche, B. (2019). Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? : a 12-country study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 16(6).
Chicago author-date
Vandendriessche, Anneke, Ariane Ghekiere, Jelle Van Cauwenberg, Bart De Clercq, Karlien Dhondt, Ann DeSmet, Jorma Tynjälä, Maïté Verloigne, and Benedicte Deforche. 2019. “Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? : A 12-Country Study.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 16 (6).
Chicago author-date (all authors)
Vandendriessche, Anneke, Ariane Ghekiere, Jelle Van Cauwenberg, Bart De Clercq, Karlien Dhondt, Ann DeSmet, Jorma Tynjälä, Maïté Verloigne, and Benedicte Deforche. 2019. “Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? : A 12-Country Study.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 16 (6).
Vancouver
1.
Vandendriessche A, Ghekiere A, Van Cauwenberg J, De Clercq B, Dhondt K, DeSmet A, et al. Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? : a 12-country study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. 2019;16(6).
IEEE
[1]
A. Vandendriessche et al., “Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? : a 12-country study,” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 16, no. 6, 2019.
@article{8609337,
  abstract     = {This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 +/- 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) Health Behaviour in School-aged Children 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.},
  articleno    = {1072},
  author       = {Vandendriessche, Anneke and Ghekiere, Ariane and Van Cauwenberg, Jelle and De Clercq, Bart and Dhondt, Karlien and DeSmet, Ann and Tynjälä, Jorma and Verloigne, Maïté and Deforche, Benedicte},
  issn         = {1660-4601},
  journal      = {INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH},
  keywords     = {mental health,adolescents,sleep,AGE-OF-ONSET,EUROPEAN ADOLESCENTS,DEPRESSIVE SYMPTOMS,CHILDREN,STRESS,METAANALYSIS,DISORDERS,EXERCISE,VALIDITY,BEHAVIOR},
  language     = {eng},
  number       = {6},
  pages        = {15},
  title        = {Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? : a 12-country study},
  url          = {http://dx.doi.org/10.3390/ijerph16061072},
  volume       = {16},
  year         = {2019},
}

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