Binge Eating Disorder And Adolescent Screen Time
Overview
In this comprehensive study, researchers delved into the intricate dynamics surrounding screen time, mental health, and eating behaviors among adolescents in the United States. With a focus on binge eating disorder (BED), the investigation aimed to uncover whether depression symptoms play a mediating role in the prospective association between screen time and BED.
Utilizing data from the Adolescent Brain Cognitive Development (ABCD) study, which included a vast cohort of 9465 children aged 9–11 years at baseline, researchers employed a sophisticated analytical approach. They utilized a generalized structural equation model to meticulously analyze the relationship between average daily screen time at baseline and the incidence of BED at year 2. Adjustments were made for baseline BED diagnosis, alongside other pertinent covariates such as age, sex, and income level.
Crucially, the study employed mediation analysis techniques to explore the potential intermediary role of depression symptoms in this association. Through bias-corrected (BC) 95% confidence intervals, the indirect effect of baseline screen time on year 2 BED via depression symptoms was rigorously examined.
The findings shed light on the nuanced interplay between screen time, mental health indicators like depression symptoms, and the emergence of binge eating disorder among adolescents. By identifying depression symptoms as a partial mediator, the study underscores the multifaceted nature of these relationships, emphasizing the importance of holistic approaches to understanding and addressing adolescent health outcomes in the digital age.
Introduction
Over the past decade, the proliferation of digital technology has transformed the lives of adolescents, ushering in an era characterized by ubiquitous screen use. This trend has been underscored by the 2023 US Surgeon General’s Advisory, which painted a stark picture of adolescent engagement with digital platforms. The advisory revealed that a staggering 95% of adolescents aged 13–17 in the United States reported using social media platforms, with over one-third indicating near-constant usage. Even among younger children, aged 8–12, approximately 40% were found to be active on social media channels, highlighting the widespread adoption of digital screens across age groups.
However, alongside this surge in screen time, concerns have emerged regarding its potential ramifications for adolescent well-being, both mental and physical. Notably, studies have begun to shed light on the association between excessive screen time and the onset of binge eating disorder (BED) among adolescents in the US. Research has documented these links, pointing to a worrisome trend that warrants further investigation.
Also read; What are eating disorders
Central to understanding this relationship is the exploration of potential mediators, such as depression symptoms. Evidence suggests that prolonged screen time correlates with increased depression symptoms among adolescents, likely stemming from a combination of social isolation, disrupted sleep patterns, and reduced physical activity. Moreover, depression often co-occurs with BED and is considered a significant risk factor for its development.
Building upon previous analyses conducted as part of the Adolescent Brain Cognitive Development (ABCD) Study, which comprises a diverse national cohort of 9–10-year-olds, the present investigation seeks to delve deeper into these interconnections. By examining the prospective association between screen time and BED onset over a two-year period, the study aims to elucidate the role of depression symptoms as a potential mediator in this complex relationship.
The significance of this research extends beyond mere academic inquiry. By uncovering the mechanisms through which screen time impacts adolescent mental health and eating behaviors, the study holds promise for informing targeted interventions and preventive strategies. Moreover, by focusing on a critical developmental period marked by significant cognitive, emotional, and social changes, the findings have the potential to guide policies and practices aimed at promoting the holistic well-being of adolescents in the digital age.
Methods
Inclusion Criteria:
- Participants must have been enrolled in the Adolescent Brain Cognitive Development (ABCD) study.
- Participants must have been aged 9–10 years at baseline.
- Data must have been available for analysis from baseline to year 2 of the ABCD study.
- Participants must have completed the required assessments for screen time, binge eating disorder (BED), and depression symptoms at baseline, year 1, and year 2.
- Institutional review board (IRB) approval must have been obtained for the study.
- Participants or their caregivers must have provided written assent and informed consent, respectively.
Exclusion Criteria:
- Participants with missing data for screen time or covariates at baseline.
- Participants with missing data for depression symptoms at baseline and year 1.
- Participants diagnosed with BED at year 2.
- Participants who did not meet the age criteria (9–10 years) at baseline.
- Participants who did not provide written assent or informed consent.
- Data from sites where IRB approval was not obtained were excluded from the analysis.
These criteria were applied to ensure the integrity and validity of the data analyzed in the study, as well as to comply with ethical standards regarding participant consent and IRB approval.
Analysis
Baseline characteristics were analyzed for differences according to the diagnosis of binge eating disorder (BED) at year 2 using Student’s t-tests and chi-square tests. Generalized structural equation models (GSEMs) with maximum likelihood estimation were employed to evaluate the prospective associations between average daily screen time at baseline, depression symptoms from baseline to year 1, and BED at year 2. The models were adjusted for various covariates including age, sex, race, household income, highest parental education, study site, BED diagnosis at baseline, date of BED diagnoses, food insecurity, and adverse childhood experiences (ACEs).
The association between baseline screen time and the change in depression symptoms from baseline to year 1 was also assessed. Covariate adjustment was not applied to this aspect of the model to avoid potentially influencing the estimators. Additionally, the change in depression symptoms was examined as a mediator of the relationship between baseline screen time and year 2 BED.
Statistical significance was determined using a p-value threshold of < 0.05. Bias-corrected (BC) 95% confidence intervals (CIs) for the indirect effect were generated using 5000 bootstrap samples, with significance indicated by CI values not crossing zero. Effect sizes for the associations between screen time, change in depression symptoms, and BED were calculated using standardized values. To ensure comparability, screen time and the change in depression symptoms were normalized by subtracting the means and dividing by the standard deviations before applying the generalized structural equation models.
All analyses were conducted using Stata 18 software, with propensity weights based on the specific study design utilized to account for potential confounding factors.
Results
The study included 9465 children aged 9–11 years at baseline, among whom 101 children met the criteria for binge eating disorder (BED) in year 2. Adolescents with BED exhibited higher average daily screen time at baseline and a greater change in depression symptoms from baseline to year 1 compared to those without BED (p < .001).
Prospective associations were examined between average daily screen time at baseline, increased depression symptoms from baseline to year 1, and BED diagnosis at year 2. After adjusting for covariates, higher baseline screen time was significantly associated with a 9% increase in the odds of BED diagnosis at year 2 (OR=1.09, 95% CI 1.03, 1.14, p = .005). Similarly, increased depression symptoms from baseline to year 1 were significantly associated with a 21% increase in the odds of BED diagnosis at year 2 (OR=1.21, 95% CI 1.11, 1.32, p < .001).
Furthermore, higher baseline screen time was significantly associated with increased depression symptoms from baseline to year 1 (B = .04, 95% CI .03, .05, p < .001).
Mediation analysis revealed a significant indirect effect of baseline screen time on BED at year 2, suggesting that increased depression symptoms partially mediated the relationship between baseline screen time and BED in year 2. However, there was also a significant direct effect between baseline screen time and BED at year 2, indicating that the association was not entirely explained by increasing screen time. The contribution of depression symptoms as a mediator of the association between screen time and BED was calculated to be 9.2% (95% CI 1.9%, 16.5%, p = .013), indicating partial mediation.
Conclusion
This national longitudinal study conducted in the United States investigated the relationship between screen time, depression symptoms, and the incidence of binge eating disorder (BED) among adolescents. The study found that higher screen time was prospectively associated with an increase in depression symptoms and a higher incidence of BED. Furthermore, the association between screen time and BED incidence was found to be partially mediated by increased depression symptoms.
These findings suggest that interventions aimed at reducing excessive screen time among adolescents may have multiple benefits, including reducing the risk of depression and BED. It is proposed that such interventions could involve educating both parents and adolescents about the adverse mental and physical health effects of excessive screen time. Additionally, healthcare providers may consider incorporating screening for screen time, depression symptoms, and binge eating into routine assessments for adolescents.
Moreover, since increased depression symptoms not only partially mediated the association between screen time and BED but also emerged as a significant predictor of BED independently, the study suggests that future research should explore other psychosocial and behavioral variables that may contribute to the relationship between screen time and BED in adolescents.
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