Abstract
Background
Health-related guidelines for physical activity (PA), screen time (ST), and sleep (SLP) have been combined into the 24-h movement behaviour (24-HMB) guidelines, as these behaviours collectively impact health outcomes. However, few studies have examined associations of 24-HMB with the mental health symptoms in adolescents in low- and middle-income countries. Therefore, the present study aimed to explore the individual and combined associations between meeting the 24-HMB guidelines and mental health symptoms in Brazilian adolescents.
Methods
A total of 1,151 adolescents (51% girls) participated in this cross-sectional study (age 13.5±1.0 years old). Depressive, anxiety and stress symptoms were measured using the DASS-21. PA, ST, and SLP were assessed through self-reported questionnaires. The association between individual and combined compliance with 24-HMB recommendations and mental health symptoms was analyzed using Generalized Linear Models.
Results
Not meeting the PA, ST or SLP recommendations was associated with higher depression symptoms and not meeting the ST or SLP recommendations was positively associated with higher anxiety and stress symptoms. In the combined analyses, adolescents who do not meet any recommendation were more likely to have higher depression symptoms compared with the participants who met the PA and ST (β = 1.34; 95%CI = 1.04–1.73) and those who met the PA and SLP recommendations (β = 1.41; 95%CI = 1.11–1.79). Additionally, adolescents who do not meet any recommendation were positively associated with higher anxiety (β = 1.35; 95%CI = 1.10–1.65), depression (β = 1.49; 95%CI = 1.21–1.82), and stress symptoms (β = 1.29; 95%CI = 1.07–1.55) in comparison with participants who met the ST and SLP recommendations.
Conclusions
Adolescents who met any of the 24-hour movement guidelines components had better mental health. Therefore, setting achievable goals to meet at least one of these recommendations could be considered in future public health recommendations to prevent mental health disorders in adolescents.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40359-026-04766-1.
Keywords: Physical activity, Sedentary behaviour, Screen time, Sleep, Mental health, Young people
Introduction
The prevalence of mental illnesses is a growing concern in the field of public health, being a major contributor to disability on a global scale [1], particularly affecting young people [2]. Among adolescents aged 14 to 19, anxiety and depression are the most prevalent mental disorders, with global prevalence rates of approximately 5% and 4% respectively [3]. In Brazil, a national survey indicated that over 17% of adolescents experienced mental disorders [4]. These conditions can lead to adverse impacts on adolescents’ life, including poor academic performance [5], substance misuse [6], or even suicide [7]. Therefore, it is important to identify modifiable protective factors associated with these outcomes.
Previous studies indicates that some health-related behaviours, including physical activity (PA), screen time (ST), and sleep duration (SLP), are protective factors for adolescent mental health, each demonstrating independent associations with relevant indicators [8–10]. Sufficient levels of PA can lead to a reduction of anxiety symptoms and depression [11, 12], while adequate SLP is associated with lower symptoms of anxiety, depression and stress [13, 14]. On the other hand, prolonged ST is associated with increased risk of anxiety and depression disorders [15, 16]. These behaviours have collectively being understood as co-dependents within the 24-hour cycle, collectively influencing health [17]. Therefore, a deeper insight is needed into how PA, ST and SLP interact in various combinations to affect important health indicators, including mental health [18, 19].
Recognizing that the “whole day matters”, the Canadian 24-h Movement Guidelines for Youth (5–17 years) provide evidence-based recommendations for PA, ST, and SLP. These guidelines recommend a minimum of 60 min daily of moderate to vigorous physical activity (MVPA), a maximum of 2 h per day of leisure ST, and ensuring uninterrupted sufficient SLP (9–11 h for children aged 5–13 years or 9–10 h for adolescents aged 14–17 years) [20]. Studies suggest that meeting even one component of theses 24-hour movement behaviour (24-HMB) recommendation offer protection for adolescent mental health [21, 22]. Adhering to combinations of this behaviours is associated with better mental health, with best results observed among those who meet all three recommendations [23, 24]. Despite these benefits, global adherence to the complete 24-HMB is low, with only 7.6% of children and adolescents meeting the three targets [25]. Particularly low rates of adherence were reported in South America (3.2%; 95% CI:1.3–5.2%), especially when compared to relatively higher rates among European youth (14.3%; 95% CI,10.1–18.6%) [25].
Investigating the relationship between 24-HMB and mental health, considering both individual components and their combinations, is crucial for understanding how different movement behaviours profiles relate to adolescent mental health. While previous research, including two Brazilian studies, examined the association between the 24-HMB (often categorized as meeting zero, one, two, or three recommendations) and mental health outcomes in adolescents [26, 27], a specific gap remains. To the best of our knowledge, these studies did not assess the mental health implications associated with specific combinations of meeting the guidelines (e.g., meeting PA and ST, but not SLP). Thus, the purpose of the present study was to examine the individual and the combined associations between meeting the 24-HMB recommendations for PA, ST, and SLP with anxiety, depression and stress symptoms among Brazilian adolescents. It was hypothesized that adolescents who do not meet the 24-hour movement recommendations would have worse mental health symptoms.
Methods
Study design and participants
The present study is cross-sectional in design, and the study’s reporting followed the recommendations outlined in the Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE). Ethical approval was obtained from the human research ethics committee of the State University of Northern Paraná, Brazil (nº 6.566.645), and written informed consent was obtained from parents and students. Students registered in grades 7 to 9 were eligible to participate in the study. The schools were recruited through a list provided by the Regional Education Board. Since the school expressed an interest in the study, a research staff member met with the school’s representative to explain the study. Informed consent forms were distributed to students to be taken home, signed by a parent or guardian, and returned to the school. Following the receipt of parental consent, students then provided written assent at school. Regarding exclusion criteria, students with physical, cognitive or behavioural disability that may interfere with the participation in the research were excluded as well as students aged under 11 or over 16 years were excluded of the analyses.
Data collection
The entire data collection process was carried out during physical education classes in three points: March 2022; August 2023; and February 2024, in Jacarezinho, Paraná, Brazil. The data collection proceeded as follows: (1) questionnaires with personal information (sex, age, parental level of education), mental health symptoms, and lifestyle behaviours (PA, ST, and SLP); and (2) anthropometric assessments (body weight and height).
Measures
Outcome variables: mental health indicators
Depressive, anxiety and stress symptoms were evaluated by the Depression, Anxiety and Stress Scale (DASS-21). The DASS-21 comprises 21 questions divided uniformly into three subscales. Each subscale comprises 7 questions and the score of each item ranges from 0 (not at all) to 3 (almost always), where a lower score means better mental health. DASS-21 questionnaire was validated for Brazilian adolescents and presents values of reliability r = 0.86 for stress, r = 0.83 for anxiety, and r = 0.90 for depression [28].
Exposure variables
Physical activity
PA was measured by using the self-report Physical Activity Questionnaire for Adolescents (PAQ-A). The PAQ-A is a 7-day recall questionnaire that assesses the participation in different dimensions of PA. The 8 items of the questionnaire are scored between 1 ‘low’ to 5 ‘high’, and a mean score of all items constitutes the overall score. The PAQ-A was validated for Brazilian adolescents (Guedes and Guedes, 2015) [29] and presents good reproducibility (ICC: 0.68–0.88) and internal consistency (0.71 and 0.76) and moderate reliability with total PA (rho = 0.40; rho = 0.50) measured by accelerometer. Since the PAQ-A output is an arbitrary score, the cut-off value of 2.75 was adopted to classify adolescents as meeting the PA guideline, as suggested by Benítez-Torrez and colleagues [30], the value of 2.75 represents 60 min of MVPA per day assessed by accelerometer. This cut-off value has been used in previous research that assessed PA levels in adolescents [31, 32].
Screen time
Recreational ST was measured by a specific question: “Considering a typical day, how much time do you spend watching TV, playing videogame, using computer or smartphones in your free time?” Adolescents who reported up to 2 h/day of leisure ST were considered as attending the ST guideline [20].
Sleep duration
SLP was measured the following questions: “during the past month, when have you usually gone to bed at night?”; and “during the past month, when have you usually gotten up in the morning?”. From this information, the SLP was calculated in hours per day as the difference between bedtime and wake up time. Participants who reported SLP falling within the recommended range (9–11 h/night for 11–13-year-olds; or 8–10 h/night for 14–17-year-olds) were considered as attending the SLP guideline [20].
Control variables
Adolescents were asked about their age, sex, and parent education level. Body mass was measured using a portable digital scale (Welmy®, Santa Bárbara do Oeste, São Paulo, Brazil) to the nearest 0.1 kg, and participants were in light clothing without shoes and body height was measured using a portable stadiometer (Welmy®, Santa Bárbara do Oeste, São Paulo, Brazil). BMI was calculated by the equation [BMI=weight (kg)/height (m2)] and adolescents were classified according to age and sex-adjusted cut-off points [33].
Statistical analyses
Data normality was verified using the Kolmogorov-Smirnov Test. The sample´s characteristics were described in means and standard deviations. One-Way ANOVA test was used to compare inter-group values, a bias corrected and accelerated (BCa) bootstrap method with 1000 samples was used for continuous variables. The association between individual and combined compliance with 24-HMB recommendations and mental health symptoms was analyzed using Generalized Linear Models. For the combined analyses, 24-HMB were combined into one of the following categories (1. Meeting PA + ST recommendations; 2. Meeting PA + SLP recommendations; 3. Meeting ST + SLP recommendations; 4. Meting all three 24-HMB recommendations; and 5. Meeting none). All models were adjusted by covariates age, sex, BMI percentile, and year of data collection. The data are presented as crude and adjusted regression coefficients. Statistical analyses were performed using the SPSS version 25.0 and the level of significance was set at 5%.
Results
Descriptive characteristics of the sample are presented in Table 1. A total of 1,177 adolescents were assessed, and 26 were excluded (over 16 years old). Of the 1,151 participants, 344 were from 2022 wave, 424 from 2023 wave, and 383 from 2024 wave. Significant differences in mental health symptoms were observed based on the number of 24-HMB recommendations met by participants. Adolescents who did not meet any of the recommendations presented highest scores of anxiety (11.5 ± 10.6), depression (13.9 ± 12.1), and stress symptoms (15.6 ± 11.4). Figure 1 (Venn diagram) displays the proportion of participants meeting different combinations of 24-HMB international recommendations. Overall, 2.5% of the participants met the three 24-HMB recommendations, while 44.5% did not meet any. Adherence was highest for the SLP recommendation (32.2%) and lowest for the PA recommendation (21.5%).
Table 1.
Characteristics of the study participants. Overall and by number of compliances to 24-HMB international recommendations
| Characteristics | Overall (n = 1,151) | Number of adhering to 24-hour movement recommendations | ||||
|---|---|---|---|---|---|---|
| Meeting none (n = 455) | Meeting one recommendation (n = 404) | Meeting two recommendations (n = 137) | Meeting all (n = 26) | p value | ||
| Age, years, mean (SD) | 13.5 (1.0) | 13.3 (0.91) | 13.4 (1) | 13.4 (1) | 13.4 (1.1) | 0.365 |
| Sex, n (%) | ||||||
| Boys | 564 (49) | 157 (39.3) | 211 (52.2) | 89 (65) | 17 (65.4) | |
| Girls | 587 (51) | 242 (60.7) | 193 (47.8) | 48 (35) | 9 (34.6) | |
| College complete, n (%) | ||||||
| Mother | 129 (22.7) | 47 (22.4) | 43 (21.4) | 17 (23.6) | 5 (29.4) | |
| Father | 84 (15.6) | 30 (14.8) | 34 (17.9) | 8 (11.8) | 2 (11.8) | |
| Height, cm, mean (SD) | 159.4 (10) | 158.8 (8.9) | 159.7 (9.8) | 159.9 (12.7) | 157.9 (7.6) | 0.597 |
| Weight, kg, mean (SD) | 54.4 (14.9) | 55.1 (15.2) | 54.0 (14.2) | 53.4 (14.2) | 50.5 (12.8) | 0.355 |
| BMI, kg/m2, mean (SD) | 21.4 (6.9) | 21.6 (5.2) | 21.1 (7) | 21.4 (8.4) | 20.0 (3.9) | 0.607 |
| Nutritional status, n (%) | ||||||
| Underweight | 43 (4.4) | 9 (2.5) | 20 (5.8) | 4 (3.3) | 2 (8.7) | |
| Eutrophic | 641 (67.3) | 236 (66.9) | 228 (66.1) | 87 (71.3) | 15 (65.2) | |
| Overweight | 127 (15.2) | 44 (12.5) | 52 (15.1) | 12 (8.8) | 3 (13.0) | |
| Obese | 147 (15.2) | 64 (18.1) | 45 (13.0) | 19 (13.9) | 3 (13.0) | |
| PA, *score, mean (SD) | 2.6 (0.93) | 2.25 (0.64) | 2.74 (0.95) | 3.1 (1.0) | 3.9 (0.41) | 0.000 |
| ST, hours/day, mean (SD) | 3.8 (2.3) | 5.1 (1.8) | 3.47 (2.2) | 1.8 (1.5) | 0.88 (0.60) | 0.000 |
| SLP, hours/day, mean (SD) | 8.0 (1.5) | 7.2 (1.3) | 8.4 (1.4) | 9.2 (1.1) | 9.4 (0.85) | 0.000 |
| Anxiety, score 0–21, mean (SD) | 9.9 (10) | 11.5 (10.6) | 9.3 (9.7) | 7.2 (8.3) | 7.6 (7.7) | 0.000 |
| Depression, score 0–21, mean (SD) | 11.2 (11.1) | 13.9 (12.1) | 9.9 (10.3) | 7.5 (7.8) | 7.9 (8.2) | 0.000 |
| Stress, score 0–21, mean (SD) | 13.1 (10.9) | 15.6 (11.4) | 11.8 (10.2) | 10.1 (9.2) | 13.3 (10.1) | 0.000 |
Abbreviations: SD Standard deviation, n Number of subjects, cm centimeters, kg kilograms, BMI Body mass index, PA Physical activity, ST Screen time, SLP Sleep duration
* Higher scores indicate higher levels of PA
Fig. 1.
Prevalence of adolescents who meet the physical activity, screen time, sleep duration recommendations, and their combinations (n = 1,151)
Results of regression analyses examining the individual associations between meeting PA, ST, or SLP recommendation with mental health symptoms are outlined in Table 2. Not meeting the PA recommendation was associated with higher depression symptoms (β = 1.18; 95%CI = 1.02–1.36), while not meeting the ST recommendation was associated with higher anxiety (β = 1.20; 95%CI = 1.05–1.38), depression (β = 1.19; 95%CI = 1.04–1.37), and stress symptoms (β = 1.21; 95%CI = 1.08–1.37). Not meeting the SLP recommendation was associated with higher depression (β = 1.26; 95%CI = 1.12–1.42) and stress symptoms (β = 1.12; 95%CI = 1.01–1.24). Table 3 displays the adjusted associations between combinations of meeting 24-HMB recommendations and mental health symptoms. Adolescents meeting none of the recommendations had higher depression symptoms (β = 1.34; 95%CI = 1.04–1.73) compared to those who met the PA + ST recommendations. Similarly, adolescents meeting none of the recommendations had higher depression symptoms (β = 1.41; 95%CI = 1.11–1.79) compared to those who met the PA + SLP recommendations. Additionally, adolescents who do not meet any recommendation had higher anxiety (β = 1.35; 95%CI = 1.10–1.65), depression (β = 1.49; 95%CI = 1.21–1.82), and stress symptoms (β = 1.29; 95%CI = 1.07–1.55) compared to those who met the ST + SLP recommendations.
Table 2.
Individual associations between meeting the movement behaviour recommendation and mental health symptoms
| Anxiety | Depression | Stress | ||||
|---|---|---|---|---|---|---|
| Unadjusted β (95% CI) |
Adjusted β (95% CI) |
Unadjusted β (95% CI) |
Adjusted β (95% CI) |
Unadjusted β (95% CI) |
Adjusted β (95% CI) |
|
| Meeting PA | ||||||
| Yes≠ | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| No∞ | 1.19 (1.03–1.38) | 0.98 (0.85–1.12) | 1.43 (1.25–1.64) | 1.18 (1.02–1.36) | 1.18 (1.04–1.33) | 0.99 (0.88–1.11) |
| Meeting ST | ||||||
| Yes≠ | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| No∞ | 1.30 (1.14–1.49) | 1.20 (1.05–1.38) | 1.29 (1.13–1.47) | 1.19 (1.04–1.37) | 1.30 (1.16–1.45) | 1.21 (1.08–1.37) |
| Meeting SLP | ||||||
| Yes≠ | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| No∞ | 1.14 (1.00-1.29) | 1.11 (0.98–1.25) | 1.27 (1.12–1.43) | 1.26 (1.12–1.42) | 1.15 (1.03–1.27) | 1.12 (1.01–1.24) |
95% CI 95% confidence intervals, Ref Reference group. Adjusted by sex, age, BMI percentile, and year of assessment. PA Physical activity, ST Screen time, SLP Sleep duration
≠Adolescents who met the specific movement behaviour recommendation
∞Adolescents who do not meet the specific movement behaviour recommendation
Statistical significance: highlighted in bold at p < 0.05
Table 3.
Individual and combined associations between not meet any movement behaviour recommendation and mental health symptoms
| Anxiety | Depression | Stress | ||||
|---|---|---|---|---|---|---|
| Unadjusted β (95% CI) |
Adjusted β (95% CI) |
Unadjusted β (95% CI) |
Adjusted β (95% CI) | Unadjusted β (95% CI) |
Adjusted β (95% CI) |
|
| Only PA | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.31 (1.13–1.52) | 1.07 (0.91–1.25) | 1.63 (1.40–1.89) | 1.33 (1.14–1.56) | 1.31 (1.15–1.50) | 1.13 (0.98–1.29) |
| Only ST | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.38 (1.20–1.60) | 1.25 (1.08–1.45) | 1.46 (1.26–1.69) | 1.34 (1.16–1.56) | 1.42 (1.24–1.61) | 1.32 (1.15–1.50) |
| Only SLP | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.25 (1.09–1.43) | 1.17 (1.02–1.34) | 1.43 (1.24–1.63) | 1.39 (1.21–1.60) | 1.28 (1.13–1.45) | 1.22 (1.08–1.38) |
| PA + ST | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.59 (1.25–2.02) | 1.11 (0.87–1.43) | 1.80 (1.41–2.28) | 1.34 (1.04–1.73) | 1.44 (1.16–1.79) | 1.11 (0.89–1.38) |
| PA + SLP | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.31 (1.04–1.64) | 1.04 (0.82–1.32) | 1.73 (1.38–2.18) | 1.41 (1.11–1.79) | 1.19 (0.97–1.46) | 0.98 (0.80–1.21) |
| ST + SLP | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.46 (1.19–1.79) | 1.35 (1.10–1.65) | 1.55 (1.26–1.90) | 1.49 (1.21–1.82) | 1.39 (1.16–1.68) | 1.29 (1.07–1.55) |
| PA + ST + SLP | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| None∞ | 1.47 (1.04–2.08) | 1.11 (0.75–1.62) | 1.71 (1.20–2.44) | 1.36 (0.98–1.88) | 1.17 (0.89–1.54) | 0.92 (0.68–1.25) |
95% CI: 95% confidence intervals. Reference group. PA, physical activity; ST, screen time; SLP, sleep duration
Adjusted by sex, age, BMI percentile, and year of assessment
∞Adolescents who do not meet any movement behaviour recommendation
Statistical significance: highlighted in bold at p < 0.05
Discussion
This study aimed to examine the associations of meeting the individual and combined 24-HMB recommendations with mental health symptoms in a sample of Brazilian adolescents. We found significant associations between not meeting the PA, ST, or SLP recommendations with higher mental health symptoms. Likewise, in the combined analyzes, participants who do not meet any recommendation revealed higher depression symptoms compared with participants who meet the PA + ST or PA + SLP recommendations. Additionally, adolescents who met none of the recommendations had higher anxiety, depression and stress symptoms when compared with participants who met the ST + SLP recommendations, supporting our hypotheses.
Results of the present study are consistent with those from previous studies indicating that meeting the PA, ST, and SLP recommendations is associated with better mental health in adolescents [24, 34, 35]. Nevertheless, our study differs from preceding studies by exploring specific combinations of attending the 24-HMB guidelines instead of the accumulation of them [27, 36, 37], especially among Brazilian adolescents. Using an integrated approach, which incorporates all or part of the movement behaviours and how they interact with each other within a 24 hour period will result in a greater impact on health-related outcomes, performing a combined and specific analysis between parameters is, in fact, more appropriate [38].
Higher depressive symptoms were found in adolescents who do not meet the PA recommendation. The associations between PA on adolescents´ mental health may be explained by neurobiological and psychosocial factors [39–41]. More specifically, regular PA may help to reduce cortisol secretion in response to stress as the body adapts to the stress of physical exercise [42]. This effect might help balance cortisol levels, resulting in an anti-stress response in the body [42]. In addition, these mechanisms are also associated with the increased depressive symptoms and anxiety disorders, since increased cortisol is related to the inhibition of the production of neurotransmitters, such as serotonin and dopamine [39, 40, 42]. Furthermore, engaging in PA has the potential to improve well-being via a range of psychosocial factors, since PA provides an opportunity for social interaction, distraction from negative and worrying thoughts, and might leads to improvements in appearance self-perceptions [41, 43]. On the other hand, it is also possible that depressive symptoms, such as lack of energy, low motivation, social isolation, and anhedonia may inhibit involvement in PA, and consequently, individuals with higher depressive symptoms may not meet the PA recommendations, suggesting that a bidirectional relationship may exist between PA and depression [44, 45].
Regarding ST, our findings demonstrated that adolescents who did not meet this component had higher anxiety, depression, and stress symptoms. Previous studies indicated strong evidence for the relationship between ST for leisure and poorer mental health among adolescents [8, 46]. The ST negatively affects mental health because it displaces time participating in healthier activities (displacement hypothesis theory) [15] and in interpersonal interactions, leading to social isolation and increasing the dependency on social media [47]. Furthermore, the content watched on social media may leads to decreased body satisfaction, in turn resulting in more severe symptoms of depression (upward social comparison theory) [15], as well as the fast-paced media may affects the cognitive and emotional reactions of young people [48]. Although a recent prospective study showed that higher ST was associated with higher anxiety and depression symptoms at one-year follow-up [49], there remains the possibility of reverse causality. Existing depression or loneliness may drive increased, escapist screen usage, creating a cycle fueled by sleep disruption, social comparison, and cyberbullying. Additionally, adolescents experiencing mental health symptoms derive less pleasure from in-person social interactions and have increased sensitivity to social rejection, which often leads to more frequent social media use [50].
Concerning the SLP, sleep deprivation or even interruption negatively affects the behaviour of melatonin, which in turn directly impacts the regulation of cortisol levels, resulting in chronically high levels of stress [39]. Considering that cortisol levels can negatively affect mental health, ST and consequently its effect on SLP can also modulate outcomes related to depressive symptoms and anxiety disorders. Another potential mechanism that might explain the interaction between SLP and mental health is brain factor, as the prefrontal cortex plays a critical role for many psychiatric disorders. SLP duration influences the prefrontal areas, and poor SLP may promote dysfunction in the region and consequently result in mental illness. Therefore, it could be hypothesized that prefrontal cortex functioning could help to explain the associations between SLP and mental disorders [51]. Furthermore, as noted for PA and ST, evidence supports a bidirectional relationship between SLP, including both duration and quality, and mental health in adolescents. Adolescents with poor mental health, such as those experiencing anxiety, depression, or high stress, are more likely to encounter SLP problems. These issues often include insufficient sleep duration, prolonged sleep latency, sleep disturbance, and sleep-wake problems [52, 53].
Analyzing the joint associations, our findings indicated that meeting different combinations of 24-HMB recommendations were associated with better mental health. Adolescents who do not meet any guidelines revealed higher depressive, anxiety, and stress symptoms. Similarly, Luo et al. [24] found that adolescents (grade 8 - age 14.53 ± 0.69 years) who met ST + SLP had lower prevalence of depression (21.1% and 19.5%, respectively) and anxiety (22.4% and 21.2%, respectively). Furthermore, adolescents who met ST + SLP recommendations had 54% reduced chance of experiencing symptoms of depression and 43% reduced chance of experiencing symptoms of anxiety compared to the group who did not meet any recommendations.
Regarding the joint associations of PA + SLP and PA + ST of the current study, adolescents who did not meet any recommendation showed higher depression symptoms. These findings are consistent with Sampasa-Kanyanga et al. [35] who found that meeting PA + SLP and PA + ST may have a significant role in preventing self-reported mental disorders compared to not meeting any recommendation. The present study did not find statistically significant associations between adherence to all 24-HMB recommendations and higher symptoms of anxiety, depression, and stress. This result may be attributed to the low compliance rate (2.5%) and the small sample size of this subgroup (n = 26), leading to limited statistical power. Furthermore, some potential residual confounding factors, such as genetics (family history of mental disorders), socioeconomic conditions (e.g., overcrowded housing, feelings of insecurity, hopelessness, and risk of violence), social context (friendship networks and parental support), and childhood experiences (e.g., trauma, bullying, and negative interactions) could not be fully controlled and may lead to misleading conclusions about these relationships. Thus, it cannot be concluded that full compliance with the guidelines has no positive effect on mental health. The low compliance rate to meet all three parameters of the 24-HMB are in line with previous studies [24, 35, 54, 55]; therefore, given the low adherence among adolescents, public health programs should be developed to help young people achieve the 24-HMB recommendations.
How the time that we spend during our 24 hour of the day is divided in PA, SB, and SLP, the time-use displacements between these behaviours should be considered when designing interventions. In accordance to Sampasa-Kanyinga et al. [35], the benefits of PA may not be the same if the activity is performed to the detriment of SLP (bad trade-off) or ST (good trade-off). Moreover, we need to understand how different domains of these behaviours, such as PA settings (e.g., indoors vs. outdoors), types of ST (e.g., active vs. passive, use of smartphone, social media), and SLP (e.g. total sleep duration or sleep quality) affects the mental health of pediatric population. Furthermore, although adhering to multiple movement behaviour guidelines is important for optimizing the mental health of adolescents, the relationship may not be unidirectional. Reverse causality likely plays a role, as better psychological well-being can encourage the adoption and maintenance of healthier lifestyles.
Our study added worth information to the limited evidence about the associations between the 24-HMB and mental health symptoms in Brazilian adolescents. However, the results of this study should be interpreted in light of its limitations. First, although reliable self-report questionnaires commonly used in epidemiological studies with youth were used, they may be subject to biases such as recall bias and social desirability bias. Second, although the current study had a representative sample, these adolescents are from a specific region of southern Brazil; therefore, generalizing these results to the national adolescent population should be done with caution. Third, only 2.5% (26 adolescents) of the participants met all three 24-HMB recommendations, which may have affected the statistical power in this specific combined analysis. Thus, future systematic, large-scale, and longitudinal studies are needed to the best understanding of 24-HMB on adolescents’ mental health.
In conclusion, the results of the current study reinforce the importance of meet the 24-hour movement behaviour guidelines. Moreover, the combined analyses showed that not meet any recommendation was associated higher depression, anxiety and stress symptoms, especially for ST + SLP combination. Given the low adherence to the 24-HMB recommendations among adolescents, setting achievable goals to meet at least one of these recommendations could be considered in future public health programs. School-based lifestyle programs, involving the school community and parents, should be developed to promote adolescent mental health and raise awareness about the benefits of healthy movement behaviours. These initiatives should encourage students to reduce sedentary time in favour of PA and emphasize the role of good SLP hygiene in supporting well-being.
Supplementary information
Acknowledgements
We would like to thank the Regional Education Center for their involvement in this study. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code001, and Araucaria Foundation. Bruna Costa author would also like to acknowledge support by CAPES (nº 88887.751116/2022-00 - Educational Scholarship – PostDoctoral Research). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Abbreviation
- ACSM
American College of Sports Medicine
- BMI
Body mass index
- DASS-21
Depression, anxiety and stress scale
- MVPA
Moderate to vigorous physical activity
- PA
Physical activity
- PAQ-A
Physical Activity Questionnaire for Adolescents
- SLP
Sleep
- ST
Screen time
- UNICEF
United Nations Children's Fund
- WHO
World Health Organization
- 24-HMB
24-hour movement behaviour
Author’ contributions
Conceptualization, ASN, GP, and BC, methodology, ASN, GCS, and TMS; Data curation and analysis, ASN and BGGC; investigation, ASN, MCJF, and PHGD; writing—original draft preparation, ASN, MCJF, PHGD, BC, and GP; writing—review and editing, ASN, GCS, AMMR, and BGGC; project administration, ASN. All authors read and approved the final manuscript.
Funding
This project was funded in part by Araucaria Foundation; however, the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Data availability
The dataset of the present study is available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The study was approved by the human research ethics committee of the State University of Northern of Parana, Brazil (nº 6.566.645). All procedures applied in the research study were in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants and their literate legal guardian.
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.
Supplementary Materials
Data Availability Statement
The dataset of the present study is available from the corresponding author upon reasonable request.