July 12, 2024

expert reaction to secondary analysis of an RCT on screen media use and mental health of children and adolescents

A study published in JAMA Network Open looks at the impact of a screen time intervention on the mental health of children. 

Prof Ben Carter, Professor of Medical Statistics at King’s College London said:

“This study was one of the first to show that a screentime reduction strategy evaluated in a randomised controlled trial found a reduction in some mental health symptoms after just two weeks. One weakness was the study measurement of screentime included a wide degree of screens (including watching tv), a further weakness was that some of the analyses may have been underpowered.

“Further research is needed to understand the mechanism of what part of the strategy led to the reduction, as well as to understand the proportion of children and adolescents that would like help in cutting down their usage.”

(this comment comes via the Pilot SMC for Ireland) Dr Kristin Hadfield, Assistant Professor, Psychology, Trinity College Dublin, said:

“There is a lot of concern about the impacts of ‘screen time’ on children and adolescents, but most of the studies are correlational and so can’t tell us whether more screen time causes worse child mental health. Screen time is a very vague concept, with major differences in effects depending on what someone is actually doing on their phone, computer, tablet, etc. This paper provides experimental evidence about the effects of a screen time intervention on children’s mental health, which is a major advancement. They find that the SCREENS intervention seems to reduce total mental health difficulties, as well as specifically internalising and externalising problems, while increasing prosocial behaviour. A few things are worth noting, however: first, they identified 408 families who said they would want to do the intervention, but only 89 actually did it despite a payment of €70 being offered, which suggests that many families did not find this intervention workable, and may have resulted in a relatively ‘unusual’ group taking part. Second, parents knew their family was taking part in the intervention and they were the ones who reported on the child’s mental health issues; parents who took part in the intervention, in keeping with the common understanding that screen time is bad for children, may have responded more positively on the SDQ because they knew that better mental health would be expected from taking part in the intervention. Finally, while the intervention was pre-registered, only the SDQ Total Difficulties score was included as a secondary outcome, yet here they look within that score at internalising and externalising symptom scores, as well as at the prosocial scale of the SDQ; none of which was pre-registered, and so should be considered with caution. 

“This is a good step in understanding how screen time is related to child and adolescent mental health. However, we should be careful about over-interpreting a relatively small study as considerably more experimental research would be needed to understand how, to what extent, and for whom screen time impacts mental health.

“People often think of screen time as bad, but it really depends what the child is doing on the screen. Very few people would view it as a negative if a child was video calling their grandparent, watching a documentary, or learning how to code, and we wouldn’t expect any of these things to negatively impact a child’s mental health. A greater focus in research and intervention on what children are doing on computers, phones, and tablets would be more valuable than just counting the time they spend on these.”

‘Screen Media Use and Mental Health of Children and Adolescents, A Secondary Analysis of a Randomized Clinical Trial’ by Jesper Schmidt-Persson et al. was published in JAMA Network Open at 16:00 UK time on Friday 12^th July.

DOI: 10.1001/jamanetworkopen.2024.19881

Declared interests

Prof Ben Carter: No COI

Dr Kristin Hadfield: No COI