Abstract
Objective
To examine the association between parental psychological symptoms and children’s screen media behavior based on the data from a nationally representative sample.
Methods
This study included 3,974 children aged 6 to 17 years. Parental psychological symptoms were assessed using the PHQ-8 for depression and GAD-7 for anxiety. The dependent variable was children’s daily screen time, dichotomized as more than 2 h versus 2 h or less per day. Weighted logistic regression models were used to examine associations, adjusting for demographic and socioeconomic factors, and interaction analyses were conducted to explore subgroup variations.
Results
The cross-sectional study included 3,974 children aged 6 to 17 years, with 1,905 girls (47.92%) and 2,069 boys (52.08%). In total, 2,781 children (70.0%) reported daily screen time of more than 2 h. After adjusting for covariates, parental depression (OR = 1.42; 95% CI: 1.12–1.79; P = 0.004) and anxiety (OR = 1.29; 95% CI: 1.01–1.65; P = 0.04) were significantly associated with higher odds of exceeding the 2-hour threshold. Stratified analyses indicated that paternal depression was associated with stronger odds of children’s excessive screen time (OR = 1.58; 95% CI: 1.01–2.48; P = 0.04), suggesting possible differences between maternal and paternal associations on children’s media use.
Conclusion
Parental psychological symptoms were associated with increased screen time of children and adolescents, suggesting a need to explore causality and underlying mechanisms. This U.S. study found that children’s screen time is associated with age, race, income, household size, and parental health, offering insights for parental guidance and future research.
Keywords: Parental mental health, Children’s screen time, NHIS, Depression, Adolescent
Introduction
The pervasive integration of digital media into daily life has precipitated a concerning rise in screen exposure among adolescents, with contemporary youth spending unprecedented hours engaged with smartphones, video gaming platforms, computers, and television [1, 2]. With the rapid development and popularization of technology, digital media has penetrated all aspects of children’s lives, and an increasing number of children have their own electronic devices [3]. Substantial empirical evidence underscores the association between excessive screen time and multifaceted health consequences in pediatric populations, ranging from physical detriments such as diminished physical activity and elevated obesity risk to psychological impairments, including depressive symptomatology and circadian rhythm disruption [4, 5]. Electronic screen exposure has also become more diverse, resulting in children and adolescents spending more time than ever before in screen-based activities [6].
During COVID-19, there is a marked shift in the educational paradigm toward online platforms, resulting in a significant expansion of children’s daily exposure to screens [7]. A recent study showed that the average viewing time of school-age children aged 6 to 14 years is 2.77 h per day [8], and according to the report, 95% of US adolescents have access to smartphones and 45% have almost uninterrupted access to the Internet [9]. The World Health Organization recommends that children and adolescents have no more than two hours of recreational screen time per day [6]. This emerging public health challenge necessitates urgent examination of modifiable environmental determinants, particularly familial influences in mediating children’s digital engagement.
Parental factors have been identified as critical moderators, while other factors, such as lack of time, different family relationships (family structure), or presence of other siblings, may also be associated with children’s screen time. A recent nationally representative U.S. study confirmed a significant association between parental psychological problems and screen time in 9- to 10-year-old children [10]. Parental mediation strategies—encompassing rule enforcement, co-viewing practices, and provision of alternative activities—have been identified as critical moderators of screen time patterns [11]. Developmental research emphasized the temporal sensitivity of parental influence, demonstrating that the quality of parent-child communication, particularly during preadolescence, is strongly correlated with children’s television viewing time, revealing that positive parental engagement may mitigate excessive screen use [12]. Notably, nurturing parenting relationships are associated with reduced screen dependence of children across multiple media platforms [13]. However, parental capacity to manage screen time may be compromised by their own mental health challenges, particularly in the post-pandemic era [13, 14]. The COVID-19 pandemic exacerbated mental health burdens among parents, with elevated rates of clinically significant depressive and anxiety symptoms reported globally [15].
Emerging psychopathological evidence reveals a bidirectional association between parental psychological resources and digital mediation efficacy. Parents experiencing mental health challenges may have diminished psychological resources to effectively monitor their child’s behavior, reduced engagement in shared activities, or impaired ability to offer alternative activities to reduce excessive screen time [16]. Empirical findings increasingly associate parental depression and anxiety with permissive screen time practices and inadequate alternative provision [11, 16–18]. The pandemic’s psychological legacy—marked by global increases in parental depression and anxiety prevalence—heightens the urgency to understand these dynamics in contemporary contexts.
Despite progress in understanding television-specific viewing patterns [19], critical knowledge gaps persist regarding modern digital ecosystems. Current literature inadequately addresses: (1) differential impacts across diverse screen modalities (e.g., social media vs. gaming platforms) [20, 21], (2) developmental variations in susceptibility across childhood and adolescence, and (3) gender-dimorphic patterns in parental mediation effectiveness [14, 22]. Furthermore, the pandemic-induced transformation of family digital practices necessitates updated epidemiological evidence to inform post-COVID intervention strategies.
Therefore, using the nationally representative 2022 National Health Interview Survey (NHIS) data, this study aimed to extend prior work by: (1) providing a post-COVID-19 assessment of associations between parental psychological symptoms and children’s screen time; (2) comparing the associations of maternal and paternal depression and anxiety with children’s screen time; and (3) examining whether these associations vary across ages 6–17, with particular attention to adolescents in subgroup analyses. We hypothesized that parental psychological distress would be associated with higher odds of excessive screen time in children, and that these associations would differ by parental sex as well as by the child’s age and sex.
Methods
Participants
The National Health Interview Survey (NHIS) was a nationally representative household survey of the U.S. civilian noninstitutionalized population. It was conducted continuously throughout the year by the National Center for Health Statistics (NCHS) [23]. Interviews were typically performed in respondents’ homes, with follow-ups completed via telephone [19]. Information about the Sample Child was collected from a parent or caregiver responsible for the child’s healthcare.
The study utilized data from the 2022 NHIS Sample Child and Adult file, which initially included 6,261 parent-child pairs. We excluded 2,275 pairs with missing data on children’s variables (age, sex, race/ethnicity, region, urban-rural classification, number of children in the household, family structure, family income, and screen time). From the remaining 3,986 pairs, we further excluded 12 pairs with missing data on the parental psychological symptom variables (PHQ-8 or GAD-7). The final analytic sample comprised 3,974 parent-child pairs with complete data for all variables used in this analysis. All analyses incorporated the complex survey design elements provided by NHIS to account for the unequal probability of selection and non-response. This weighting procedure is the primary method recommended by NHIS for producing nationally representative estimates and mitigating potential bias from non-response.
The NHIS protocol was approved by the Research Ethics Review Board of the NCHS and the U.S. Office of Management and Budget. Secondary analysis of de-identified, publicly available data did not require additional IRB review.
Children’s screen time
Children’s screen time was assessed through a single question posed to parents or caregivers: “On most weekdays, does the child spend more than 2 hours a day in front of a TV, computer, cellphone, or other electronic device for watching programs, playing games, accessing the internet, or using social media?” Notably, no additional questions related to screen time were included in the NHIS interview for this wave. This single-item assessment reflects the NHIS’s focus on broad, population-representative screening rather than granular, modality-specific measurement of screen use. Children aged 6 to 17 years are considered to have excessive screen time when they spend more than two hours a day [3, 6, 8].
Assessment of psychological symptoms assessment
NHIS evaluated the psychological symptoms of the primary caregiver using two validated instruments: the Patient Health Questionnaire-8 (PHQ-8) and the General Anxiety Disorder-7 (GAD-7) [21, 24]. The PHQ-8 is a widely used tool for assessing depressive symptoms, while the GAD-7 specifically designed to screen for symptoms of generalized anxiety disorder within the past two weeks and to assess severity in both clinical and general populations [25].
For both the GAD-7 and PHQ-8, response options were identical: (1) not at all; (2) a few days; (3) more than half the time; and (4) almost every day. Each response category corresponded to a score of 0–3, with total scores ranging from 0 to 21 (GAD-7) and 0–24 (PHQ-8) [26]. Variables categorizing the total score into four categories of depressive and anxiety symptom severity (i.e., none or minimal, mild, moderate, and severe) were made available to data users (see main record below). Parental depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8, range 0–24), and anxiety symptoms were measured using the Generalized Anxiety Disorder-7 scale (GAD-7, range 0–21). Following established cut-offs, both scales were categorized into four severity levels: none/minimal (0–4), mild [5–9], moderate [10–14], and severe (≥ 15) [21]. For both the GAD-7 and PHQ-8, a total score of ≥ 10 was considered indicative of a potentially clinically significant disorder. However, these categorizations were subsequently converted into binary variables to indicate the presence or absence of symptoms, with “none/minimal/mild” grouped as one category, while “moderate” and “severe” symptoms were combined as the second category. This approach allowed for a more streamlined analysis while retaining the essential information on symptom severity.
Assessment of covariates
In our analyses, we accounted for covariates including children’s age, sex, race/ethnicity, region, urban-rural classification, number of children in the household, family structure, and family income. Family income was categorized based on the ratio of family income to the federal poverty level (FPL) into four categories: less than 1.0 (below poverty), 1.0 to 1.9 (near poverty), 2.0 to 3.9 (middle income), and 4.0 or higher (high income). Additionally, the caregiver was coded as 1 (mother), 2 (father), or 3 (other family member). Fathers and mothers were not included in the same model, and only one caregiver per household was interviewed. Instead, stratified analyses were conducted separately by caregiver type (mother vs. father). We further examined whether the association between screen time and parental psychological symptoms varied by age of the child, sex of the child, and race/ethnicity of the child.
Statistical methods
Descriptive statistics, including frequencies and percentages, were used to characterize screen time categories, parental depression and anxiety symptoms (based on PHQ-8 and GAD-7 cut-offs), and other characteristics. Chi-square tests were conducted to compare factors associated with varying screen time outcomes. Binary logistic regression models were applied to estimate the association between screen time and parental psychological health. Model 1: Crude model adjusted for no confounders; Model 2: Model plus age of the child, sex of the child, and race/ethnicity of the child; Model 3: Model 2 plus region, urban-rural classification, and family income. Additionally, stratified analyses were performed to assess whether the associations differed by caregiver type. In Model 3, interaction terms were incorporated to examine potential variations across age, race/ethnicity, and family characteristics. Specifically, multiplicative interaction terms between each stratifying variable (age, race/ethnicity, and family) were included to explore whether they varied across these subgroups. However, given the theoretical relevance of caregiver type and its potential policy implications, we proceeded with stratified analyses to provide a more nuanced understanding of possible subgroup differences, even though the interaction was not statistically significant.
All statistical analyses were performed using the survey module in SAS software version 9.4 (SAS Institute Inc., Cary, NC, USA). A two-sided p-value of less than 0.05 was considered statistically significant.
Results
The analytic sample included 3,974 children (mean age 10.32 years; 52.15% male). Children exceeding the recommended 2-hour daily screen time threshold (69.98%) were significantly different from those with lower screen use in terms of age, race/ethnicity, family income, family structure, number of children in the family, and parental psychological symptoms (all P < 0.05) (Table 1). Higher odds of excessive screen time were observed among adolescents aged 12–17 years compared to younger children (80.68% vs. 59.06%; P < 0.001).
Table 1.
Characteristics of all participants aged 6–17 years according to screen time in NHIS, 2022 (N = 3974)
| Characteristics | Screen time | P value | |
|---|---|---|---|
| <2h, n (Weighted %) n (weight | ≥2h, n (Weighted %) | ||
| Overall | 1192 (30.02) | 2781 (69.98) | |
| Age of the child | <0.001* | ||
| 6–12 | 792 (40.94) | 1080 (59.06) | |
| 12–17 | 401 (19.32) | 1701 (80.68) | |
| Sex of the child | 0.223 | ||
| male | 607 (29.11) | 1462 (70.89) | |
| female | 586 (31.22) | 1319 (68.78) | |
| Race/Ethnicity of the child | < 0.001* | ||
| Hispanic | 278 (26.56) | 740 (73.44) | |
| Non-Hispanic White only | 645 (33.40) | 1357 (66.60) | |
| Non-Hispanic Black/African American only | 92 (21.01) | 302 (78.99) | |
| Non-Hispanic Asian only | 178 (33.80) | 382 (66.20) | |
| Highest education level of household | 0.103 | ||
| Less than high school | 75 (33.54) | 168 (66.46) | |
| High School | 157 (25.81) | 446 (74.19) | |
| College or higher | 961 (30.73) | 2167 (69.27) | |
| Family Income | 0.017* | ||
| <1.0 | 130 (31.69) | 294 (68.31) | |
| 1.0–1.9.0.9 | 202 (25.46) | 594 (74.54) | |
| 2.0–3.9.0.9 | 350 (29.35) | 821 (70.65) | |
| 4.0 or higher | 511 (33.37) | 1072 (66.63) | |
| Region | 0.253 | ||
| Northeast | 190 (30.66) | 426 (69.34) | |
| Midwest | 258 (33.43) | 557 (66.57) | |
| South | 421 (27.92) | 1074 (72.08) | |
| West | 324 (30.37) | 724 (69.63) | |
| Urban-Rural Classification | 0.057 | ||
| Large central metro | 379 (30.89) | 795 (69.11) | |
| Large fringe metro | 325 (31.64) | 732 (68.36) | |
| Medium and small metro | 301 (26.32) | 895 (73.68) | |
| Nonmetropolitan | 188 (33.50) | 359 (66.50) | |
| Number of children in family | < 0.001* | ||
| 1 child | 413 (24.82) | 1161 (75.18) | |
| 2 and 2+ child | 780 (31.60) | 1620 (68.40) | |
| Family structure | < 0.001* | ||
| single-parent raising | 269 (23.94) | 778 (76.06) | |
| dual-parent raising | 924 (31.44) | 2003 (68.56) | |
| Depression severity according to PHQ-8 | < 0.001* | ||
| none/minimal/mild (PHQ-8 < 10) | 1010 (31.51) | 2197 (68.49) | |
| moderate/severe (PHQ-8≥10) | 183 (23.93) | 584 (76.07) | |
| Anxiety severity according to GAD-7 | 0.038* | ||
| none/minimal/mild (GAD-7 < 10) | 998 (30.95) | 2260 (69.05) | |
| moderate/severe (GAD-7≥10) | 195 (26.10) | 521 (73.90) | |
Abbreviation: GAD-7 General Anxiety Disorder-7, NHIS National Health Interview Survey, PHQ-8 Patient Health Questionnaire-8
Data are presented as frequencies (weighted percentages) for all binary variables
Data source: NHIS National Health Interview Survey, 2022
Family income categories correspond to multiples of the U.S. Federal Poverty Level (FPL): < 1.0 = below poverty; 1.0–1.9.0.9 = near poverty; 2.0–3.9.0.9 = middle income; 4.0 or higher = high income
Depression severity was categorized using the Patient Health Questionnaire-8 (PHQ-8): scores <10 indicated none/minimal/mild symptoms, and scores ≥10 indicated moderate/severe symptoms
Anxiety severity was categorized using the Generalized Anxiety Disorder-7 (GAD-7): scores <10 indicated none/minimal/mild symptoms, and scores ≥10 indicated moderate/severe symptoms
Note: *p<0.05
Higher rates of moderate/severe depressive symptoms (76.07% vs. 68.49%, P < 0.001) and anxiety symptoms (73.90% vs. 69.05%, P = 0.04) were reported by parents of children with ≥ 2 h of daily screen time compared to those with screen time < 2 h. Additionally, an association was observed: children whose parents reported moderate/severe psychological symptoms had a higher likelihood of having ≥ 2 h of daily screen time, compared with children whose parents had no or minimal symptoms (Table 1).
After adjusting for covariates, including age, sex, race/ethnicity, family education level, family income, and urban-rural classification, Children whose parents had moderate/severe depressive symptoms (PHQ-8 ≥ 10) had 42% higher odds of exceeding 2 h of daily screen time (OR 1.42; 95% CI 1.12–1.79; P = 0.004) compared with children whose parents had no depressive symptoms, while parental anxiety (GAD-7 ≥ 10) was associated with 29% increased odds (OR 1.29; 95% CI 1.01–1.65; P = 0.04) compared with children whose parents had no anxiety symptoms (Table 2).
Table 2.
Association of parents’ depression (PHQ) and anxiety (GAD) with screen time in US children and adolescents aged 6–17 years in NHIS 2022 (N = 3974)
| Variables | OR (95%CI) | P value | ||
|---|---|---|---|---|
| None/Minimal/Mild | Moderate/Severe | |||
| Screen Time (≥ 2 h) | ||||
|
Depression severity according to PHQ-8 (PHQ-8 < 10) [n (%)] | ||||
| Cases/total | 183/1193 | 584/2781 | ||
| Model 1 | Reference | 1.46 (1.17,1.83) | < 0.001* | |
| Model 2 | Reference | 1.45 (1.15,1.84) | 0.002* | |
| Model 3 | Reference | 1.42 (1.12,1.79) | 0.004* | |
|
Anxiety severity according to GAD-7 (GAD-7 < 10) [n (%)] | ||||
| Cases/total | 195/1193 | 521/2781 | ||
| Model 1 | Reference | 1.27 (1.01,1.59) | 0.039* | |
| Model 2 | Reference | 1.29 (1.02,1.65) | 0.037* | |
| Model 3 | Reference | 1.29 (1.01,1.65) | 0.043* | |
CI confidence interval, GAD-7 General Anxiety Disorder-7, NHIS National Health Interview Survey, OR odds ratio, PHQ-8 Patient Health Questionnaire-8
Data source: NHIS National Health Interview Survey, 2022
*p<0.05
Model 1: Crude model adjusted for no confounders
Model 2: Model plus age of the child, sex of the child, and race/ethnicity of the child
Model 3: Model 2 plus region, urban-rural classification, and family income
Reference group for parental psychological symptoms: Participants with PHQ-8 score < 10 (none/minimal/mild depressive symptoms) or GAD-7 score < 10 (none/minimal/mild anxiety symptoms)
The interaction terms were not statistically significant, suggesting that the associations between screen time and parental psychological symptoms did not differ by child’s age, sex, and race/ethnicity. Stronger associations between paternal depression and screen time were observed (OR 1.58; 95% CI 1.01–2.48; P = 0.04) compared to maternal depression. A more pronounced association between parental depression and screen time was observed in adolescents aged 12–17 years (OR 1.71; 95% CI 1.14–2.57; P = 0.01) compared to younger children (Table 3).
Table 3.
Stratified analysis of the association of parents’ depression (PHQ) and anxiety (GAD) with screen time in US children and adolescents aged 6–17 years in NHIS 2022
| Variables | PHQ-8 | GAD-7 | |||||
|---|---|---|---|---|---|---|---|
| Lower than 2 h/Total participants | OR (95%CI) | Pvalue | P-value for interaction | OR (95%CI) | P value | P-value for interaction | |
| Age, y | |||||||
| 6–12 | 792/1872 | 1.27 (0.94,1.70) | 0.115 | 0.185 | 1.28 (0.94,1.73) | 0.112 | 0.715 |
| 12–17 | 401/2102 | 1.71 (1.14,2.57) | 0.010* | 1.33 (0.91,1.96) | 0.142 | ||
| Sex | |||||||
| male | 607/2069 | 1.46 (1.08,1.97) | 0.013* | 0.984 | 1.25 (0.93,1.68) | 0.140 | 0.548 |
| female | 586/1905 | 1.40 (0.99,1.97) | 0.057 | 1.39 (0.96,2.03) | 0.085 | ||
| Family | |||||||
| mother | 647/2056 | 1.31 (0.96,1.81) | 0.094 | 0.133 | 1.13 (0.82,1.55) | 0.461 | 0.066 |
| father | 407/1337 | 1.58 (1.01,2.48) | 0.044* | 1.55 (0.93,2.60) | 0.096 | ||
| others | 139/581 | 1.67 (0.90,3.10) | 0.101 | 1.79 (0.97,3.31) | 0.063 | ||
CI confidence interval, GAD-7 General Anxiety Disorder-7, NHIS National Health Interview Survey, OR odds ratio, PHQ-8 Patient Health Questionnaire-8
Data source: NHIS National Health Interview Survey, 2022
*p<0.05
Multivariable model adjusted for age of the child, sex of the child, race/ethnicity of the child, region, urban-rural classification, and family income
Reference group for parental psychological symptoms: Participants with PHQ-8 score < 10 (none/minimal/mild depressive symptoms) or GAD-7 score < 10 (none/minimal/mild anxiety symptoms)
Discussion
Our study, based on a nationally representative sample of U.S. children, revealed significant positive associations between parental anxiety and depression symptoms and children’s screen time. It highlighted those parental psychological symptoms, especially depression, that are associated with children’s screen-using behaviors. This association remained significant even after adjusting for confounding factors.
Our results were broadly consistent with prior studies linking parental mental-health symptoms with parenting behaviors and family dynamics that have been associated with children’s screen time. A recent nationally representative U.S. study confirmed a significant association between parental psychological problems and screen time in 9- to 10-year-old children [10]. A study conducted by a research team in Shanghai, China, during the COVID-19 pandemic found a significant association between higher levels of maternal anxiety/depression and an increased risk of cell phone/iPad overuse among preschool and elementary school children [27]. A Korean study similarly reported associations between parental depression and children’s TV/tablet use and behavioral problems, reinforcing the relevance of parental mental health to children’s screen behaviors [28].
From an intervention and prevention perspective, it is relevant that parental behavior is a potential influence. Prior literature suggests that parental mental health problems may increase the likelihood of family conflict [16, 18], which, in turn, is associated with children spending more time looking at screens [11, 29]. Studies have also shown that when parents set limits and rules on the amount of time their children spend looking at screens, children tend to spend less time on screens and watching TV with their parents [29–31]. When parents experience mental health issues, children are more likely to experience stress, which might be associated with the direct and indirect transmission of parental stress [32, 33]. In interpreting the differences observed between maternal and paternal psychological symptoms, it is also important to consider that these patterns may partly reflect differences in household roles, such as whether mothers or fathers serve as the primary caregiver, rather than differences in psychological influence alone. Moreover, children may turn to their parents for solace during times of crisis, and scholarly literature underscores the importance of parental self-care in promoting not only their own well-being but also that of their children [34]. Children’s internalized problems, such as depression and anxiety, can stem from their parents’ struggles with psychological or emotional issues, which may hinder their ability to provide adequate guidance and emotional support [32, 35], ultimately leading to increased screen time for children. Moreover, lower levels of family closeness and higher levels of conflict were linked to greater maternal depression/anxiety and a higher risk of electronic device overuse. These findings suggest that psychological issues within the family—particularly symptoms of depression and anxiety in parents—are associated with increased levels of child-screen interaction. Marital problems, in particular, may be especially sensitive to the presence of parental depressive symptoms [18]. This phenomenon could be related to differences in family dynamics, such as time management practices, supervision levels, and individual children’s entertainment preferences. For subsequent understanding, externalizing problems refer to outward-directed behaviors (e.g., aggression, hyperactivity/ADHD, rule-breaking), whereas internalizing problems refer to inward-directed symptoms (e.g., depression, anxiety, somatic complaints) [36]. Previous studies have found that children are more likely to use media content that involves violence, sexual acts, substance use, or other adult-related content if their parents have internalizing problems [10]. These findings underscore content-specific differences in media exposure associated with parental mental health [10].
These results emphasize the profound association of familial environments with children’s screen time, which may operate through changes in family norms, emotional support systems, and behavioral modeling. Additionally, A cross-sectional survey in China found that greater parental screen time (notably paternal) and lack of household screen rules were independently associated with longer preschooler screen time [37, 38]. Furthermore, a recent study suggests that lower father-child attachment is associated with increased children’s screen time [39]. This finding broadly aligns with the results of our stratified analyses, although the literature does not primarily explore the association between parental psychological problems and children’s screen time. Nevertheless, this could be one possible explanation for our findings.
Additionally, research has shown that age has a significant impact on children’s screen time, with notable differences between the 6–12 and 12–18 age groups, the latter of which spends more time on screens, consistent with previous research findings [40, 41]. This pattern may reflect expanding educational and recreational use of devices with age. During the COVID-19 pandemic [11], especially among children aged 6 and above, with online instruction potentially exacerbating this trend [27].
Racial and ethnic differences in screen time were also observed. Non-Hispanic white and Hispanic children demonstrated longer screen time compared to their non-Hispanic black peers. This finding contrasts with earlier data from the 2012 NHANES and the NHANES National Youth Health Survey, which reported that non-Hispanic black youth spent less time watching TV compared to their non-Hispanic white and Hispanic peers [42]. This discrepancy may be attributed to cultural, educational, and media consumption differences. Family income level emerged as another significant factor influencing children’s screen time. Children from low-income families were more likely to have prolonged screen exposure, potentially may be related to limitations in family resources, parental work schedules, and media device accessibility [39, 43, 44]. On the other hand, children from higher-income families tended to have better-regulated screen time, which might be associated with greater availability of extracurricular activities. Family structure also plays a role in shaping children’s screen time habits. Children from single-parent or multi-child families tend to spend more time on screens compared to those from dual-parent or single-child families. Our findings suggest that non-only-child families are at greater risk for excessive screen exposure, as parents’ attention and resources are divided among multiple children, which may reduce their ability to supervise children’s screen time effectively. Unsupervised environments can encourage sedentary behaviors associated with longer screen use [45]. Moreover, research has found that children who spend more time alone are at higher risk for screen-related sedentary behaviors [46, 47]. This is consistent with studies that report higher levels of media addiction in children who spend more time alone, such as a survey in Korea [47]. However, a systematic review on children under 7 years old did not find conclusive evidence that the number of siblings directly affects screen exposure [48].
The strength of this study lies in the use of the National Health Interview Survey (NHIS), which provided reliable and representative data with a high response rate [19], making it particularly well-suited for examining the association between parental psychological symptoms and children’s screen time. Given the limited availability of large-sample studies on this topic, our research was particularly valuable. Our findings were consistent with existing trends and highlighted the role of parental psychological challenges in shaping children’s screen habits [10], underscoring the importance of paternal and maternal association.
However, there were several limitations. First, the cross-sectional design limited our ability to establish causality and track changes over time. Second, self-reported data might introduce recall and information bias, and small subgroup sizes could reduce statistical power. Inadequate control over confounding factors and errors in self-reporting or measurement tools might also lead to biased results. For example, parents may not always accurately report their child’s screen time, especially for older children. Third, only one caregiver per household was interviewed in the NHIS. As a result, it is possible that the same caregiver reported both their own psychological symptoms and their child’s screen time, introducing shared method variance. Moreover, because mothers and fathers were sampled from different households, this design limitation restricts the causal interpretation of differences across parental sex. Additionally, a single item to assess screen time, with a 2-hour cut-off, lacks distinction between modalities of screen time, which is a limitation.
Future studies should aim to increase sample sizes, improve confounder control, and distinguish between different types of screen use, especially as these thresholds may vary for different age groups of children, conducting sensitivity analyses to determine more appropriate cut-offs, as their associations with child health outcomes may vary. Longitudinal studies are needed to explore the long-term impact of parental mental health on children’s screen behaviors. Interventions should focus on family education and media literacy, especially for different racial, economic, and structural groups. Overall, our study highlighted the important role of family environments and parental mental health in influencing children’s screen time and called for further research in this area.
Conclusion
In conclusion, this study demonstrated a significant association between parental psychological symptoms—particularly depression—and odds of more than 2 h of screen time among children. The family environment, as the primary context for children’s growth and development, was identified as a critical determinant of screen-related behaviors. Our findings highlight the importance of addressing parental psychological symptoms as a potential factor associated with excessive screen use in children. Future interventions aimed at reducing screen time should prioritize strategies to support parental mental health, with a specific focus on mitigating depressive symptoms, alongside fostering healthy family dynamics.
Acknowledgements
The authors would like to acknowledge the support of all team members and staff at the National Center for Health Statistics.
Abbreviations
- CI
Confidence interval
- GAD-7
General anxiety disorder-7
- NCHS
National center for health statistics
- NHIS
National health interview survey
- OR
Odds ratio
- PHQ-8
Patient health questionnaire-8
Authors’ contributions
The study design was conceived by WY and SQ. SQ downloaded and processed the data, conducted the statistical analyses, wrote and edited the manuscript. XZ and MY provided methodological guidance on statistical analyses. WY, YC, SC, GL, YL, and YW were involved in the interpretation of the results, revision of the manuscript, and finalization of the manuscript. All authors reviewed and approved the final version of the manuscript.
Funding
This work was supported by the Department of Science and Technology of Guangdong Province, China (Grant No. 2021A1515110536).
Data availability
The datasets analyzed during the current study are available at the NHIS online website: [https://www.cdc.gov/nchs/nhis/index.html](https:/www.cdc.gov/nchs/nhis/index.html).
Declarations
Ethics approval and consent to participate
The NHIS protocols were approved by the National Center for Health Statistics research ethics review board. Written informed consent was obtained for all participants. The Guangdong Pharmaceutical University Academic Review Board determined the study was exempt from approval because of the use of deidentified data.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets analyzed during the current study are available at the NHIS online website: [https://www.cdc.gov/nchs/nhis/index.html](https:/www.cdc.gov/nchs/nhis/index.html).