Table 3.

The relationship between sedentary behaviour and psychosocial health

No. of participants (No. of studies)	Design	Quality assessment					Absolute effect	Quality
		Risk of bias	Inconsistency	Indirectness	Imprecision	Other
The range of mean ages at time of exposure measurement was ~1 to 4.3 years; the oldest mean age at follow-up was ~12 years. Data were collected by randomized trial, cross-sectionally, and up to 9.5 years of follow-up. Psychosocial health measures were: aggression toward a sibling (assessed by the Aggressive Sibling Social Behavior Scale); aggressive behaviours/aggression, delinquent behaviours, total behaviour problems, externalizing problems, internalizing problems, emotional reactivity, anxious or depressed symptoms, and attention problems (assessed by the CBCL or Japanese CBCL); attentional problems (assessed by the hyperactivity subscale of the BPI); attention problems and hyperactivity (assessed by the BASC-2); bullying (assessed by unpublished questionnaire); co-operation, assertion, responsibility, self-control, and total social skills (assessed by the Social Skills Rating System); emotional symptoms/problems, conduct problems, hyperactivity-inattention, peer problems, and prosocial behaviour (assessed using the SDQ); self-esteem, emotional well-being, family functioning, and social networks (assessed using the KINDLR); social-emotional competence (assessed by the MIT-SEA); soothability, sociability, and emotionality (assessed by the CTQ); victimization, anxiety, physical aggression, and prosocial behaviour (assessed by the SBQ); and risk of being a bully, victim, or bully-victim (assessed by unpublished questionnaire).
412 (1)	Randomized triala	Serious risk of biasb	No serious inconsistency	No serious indirectness	No serious imprecision	None	Screen time c was significantly lower in the intervention vs control group at 2, 6, and 9 months post-interventiond. Aggressive and delinquent behaviours were not different between the intervention and control groups at baseline, but were significantly lower in the intervention vs control group at 9-months post-intervention [34].	Moderatee
13,301 (9)	Longitudinalf	Serious risk of biasg	No serious inconsistency	No serious indirectness	No serious imprecision	None	Screen-based sedentary behaviours: Time e-gaming or on a computer (duration): 1/1 studies reported mixed unfavourable and null associations [96] TV time (duration): 2/9 studies reported unfavourable associations [95, 103] 5/9 studies reported mixed unfavourable and null associations [90, 92, 96, 97, 99] 1/9 studies reported null associations [100] 1/9 studies reported mixed null and favourable associations [102]	Very lowh
9429 (7)	Cross-sectionali	Serious risk of biasj	No serious inconsistency	No serious indirectness	No serious imprecision	None	Objectively measured sedentary time: Total sedentary time (accelerometer-derived): 1/1 studies reported null associations [104] Screen-based sedentary behaviours: TV time (duration): 2/6 studies reported unfavourable associations [101, 103] 2/6 studies reported null associations [100, 106] 1/6 studies reported mixed unfavourable and null associations [105] 1/6 studies reported mixed null and favourable associations [98]	Very lowk

BASC-2 Behavior Assessment System for Children, BPI Behavior Problems Index, CBCL Child Behavior Checklist, CTQ Child Temperament Questionnaire, KINDL ^R Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents-Revised Version, MIT-SEA Modified Infant-Toddler Social and Emotional Assessment, SBQ Social Behavior Questionnaire, SDQ Strengths and Difficulties Questionnaire

^aIncludes 1 randomized controlled trial [34]

^bSerious risk of bias. Unclear if allocation was adequately concealed prior to group assignment; group allocation was adequately concealed from control, but not intervention group during the study; knowledge of outcome of interest was not prevented and outcome measurement is likely to have been influenced by lack of blinding; baseline data were not reported, making it impossible to determine if baseline imbalances existed between groups [34]

^cScreen time was significantly lower in the intervention vs control group at 2-, 6-, and 9-month follow-up post-intervention (mean ± SD: 2 month: 39.48 ± 16.36 vs 86.64 ± 21.63 min/day; 6 month: 24.72 ± 4.45 vs 84.95 ± 14.77 min/day; 9 month: 21.15 ± 6.12 vs 93.96 ± 18.84 min/day; all p < 0.001)

^dIntervention: 3 printed materials and interactive CDs and one counselling call, intending to decrease screen time; 8-week duration. Control: Usual care; unaware of counselling interventions

^eThe quality of evidence from the randomized trial was downgraded from “high” to “moderate” because of a serious risk of bias in the single randomized controlled trial that diminished the level of confidence in the observed effects

^fIncludes 9 longitudinal studies [90, 92, 95–97, 99, 100, 102, 103] from 6 unique samples. Verlinden et al. [97, 99] reported data from the Generation R Study; and Pagani et al. [90, 92] and Watt et al. [95] reported data from the Quebec Longitudinal Study of Child Development (QLSCD). Results are presented separately and participants are counted only once

^gSerious risk of bias. Questionable validity and reliability of television duration exposure measure [90, 92, 97, 99, 100, 102, 103]; questionable validity and reliability of television duration exposure measure on weekdays only [96]; poor reliability of outcome measures for responsibility [102] and emotional symptoms, conduct problems, peer problems, and prosocial behaviour [100]; large amount of unexplained missing data and pattern of nonresponse indicates reason for missing data may have been related to the outcome of interest [97]; complete results were not reported for all relationships examined [99]

^hThe quality of evidence from longitudinal studies was downgraded from “low” to “very low” because of a serious risk of bias that diminished the level of confidence in the observed effects

ⁱIncludes 7 cross-sectional studies [98, 100, 101, 103–106] from 7 unique samples

^jSerious risk of bias. Questionable validity and reliability of television duration exposure measure [98, 100, 101, 103, 105, 106]; poor reliability of outcome measures for emotional symptoms, conduct problems, peer problems, and prosocial behaviour [100]; small amount (218/4020) of unexplained missing outcome data at 3-year follow-up [92]

^kThe quality of evidence from cross-sectional studies was downgraded from “low” to “very low” because of a serious risk of bias that diminished the level of confidence in the observed effects