Association Between Physical Activity and Sedentary Behavior With Depressive Symptoms Among US High School Students, 2019

Charles H. Wang; Nicholas Peiper, PhD, MPH

Prev Chronic Dis. 2022;19(11):E76

Abstract and Introduction

Abstract

Introduction: The prevalence of depression among US adolescents has increased during the past decade. Previous studies found relationships among physical activity, sedentary behavior, and depression, but more recent information is needed to inform research and practice. We used national surveillance data to assess the association of physical activity and sedentary behavior with depressive symptoms among US high school students.

Methods: This study included 13,526 high school students from the 2019 Youth Risk Behavior Survey. The dependent variable was the presence of depressive symptoms in the past year that lasted almost every day for at least 2 weeks in a row and interfered with usual activities. The independent variables were physical activity (overall activity, muscle-strengthening exercises, participation on sports teams) and sedentary behavior (watching television, using a computer or digital device). We used weighted multivariable logistic regression to evaluate the association of physical activity and sedentary behavior variables with depressive symptoms, while controlling for demographic characteristics and other health behaviors.

Results: The prevalence of depressive symptoms was 36.7%. Participating in physical activity 5 or more days in the past 7 days (adjusted odds ratio [aOR], 0.81; 95% CI, 0.68–0.97) and participating on 1 or more sports teams in the past year (aOR, 0.66; 95% CI, 0.55–0.78) were associated with reduced odds of depressive symptoms. Using a computer or digital device for 3 or more hours per school night was associated with higher odds of reporting depressive symptoms (aOR, 1.61; 95% CI, 1.41–1.85).

Conclusion: Inadequate physical activity and excessive sedentary behavior are associated with depressive symptoms among US high school students. Interventions targeting physical activity and sedentary behavior may be a public health strategy to reduce depressive symptoms in this population.

Introduction

Depression is a common mental disorder among adolescents that is characterized by various psychological symptoms such as persistent sadness, lack of enjoyment, and deterioration of happiness.^[1] These symptoms start to become pronounced during the transition to high school in middle adolescence and can lead to lack of sleep, disturbance in appetite, a sedentary lifestyle, and even suicide. Depressive symptoms among adolescents in high school have been increasing since approximately 2012, with the most dramatic increases starting in 2015.^[2,3] While increases in depressive symptoms have been noted across many age groups since 2012, the prevalence of past-year major depressive episodes increased most rapidly among adolescents in high school (aged 14–17 y).^[4,5] These recent trends may be indicative of emergent risk factors and mental health problems among adolescents in high school.

Although considerable research has focused on psychological risk factors such as stress and traumatic childhood experiences, the relationships among physical activity, sedentary behaviors, and depression is a growing area of interest.^[6,7] National surveillance data indicate that the percentage of adolescents in high school who were physically active for at least 60 minutes per day on 5 or more days in the past week decreased from 2011 to 2019.^[8] Similarly, sedentary behaviors such as using digital devices for something other than schoolwork, which limits physical activity, also became more common among adolescents in high school during this time.^[9,10] According to the American Academy of Child and Adolescent Psychiatry, children aged 8 to 12 years spend roughly 4 to 6 hours per day observing a screen, and adolescents in high school often spend up to 9 hours.^[11] Excessive screen time can lead to inactivity, which then can lead to weight problems, self-image issues, depressive symptoms, and poor health-related quality of life.^[12,13] More recently, the COVID-19 pandemic led to decreases in opportunities for regular physical activity and increases in depressive symptoms.^[14]

Although many factors contribute to adolescents' mental well-being, dietary behavior has been gaining attention as a key factor in the prevention and management of depression.^[15] In addition, depressive symptoms among adolescents may also be related to factors such as substance use and behaviors that contribute to violence (eg, feeling unsafe at school, fighting, bullying, cyberbullying), although the relationships may be bidirectional.^[16–21] For example, depression is associated with substance use among males during adolescence and young adulthood,^[21] and exposure to acute and chronic stressful events, such as bullying by peers and maltreatment, can be associated with depression among adolescents.^[20]

Many public health studies have demonstrated associations among physical activity, sedentary behaviors, and depressive symptoms among high school students, although more recent investigations are needed, given recent increases in depressive symptoms among adolescents in high school.^[2–5] A meta-analysis in 2017 showed that evaluations of physical activity and depression among US adolescents were gender-specific, focused on only one aspect of physical activity or sedentary behavior, or employed small sample sizes.^[22] By analyzing data from a large sample of the most recent (2019) Youth Risk Behavior Survey (YRBS), this study provides updated evidence on the associations among multiple aspects of physical activity, sedentary behavior, and depressive symptoms among adolescents. By using YRBS's nationally representative sample, which accurately represents the characteristics of high school students in the US, the results of this study can be generalized to all US students in grades 9 through 12.^[23] Our primary objective was to describe the association between different measures of physical activity and sedentary behavior with depressive symptoms among US high school students. We hypothesized that higher levels of physical activity and lower levels of sedentary behavior would be associated with lower levels of depressive symptoms after controlling for demographic characteristics. Our secondary hypothesis was that the associations would hold after additionally controlling for dietary behaviors, substance use, and behaviors that contribute to violence.

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Abstract and Introduction
Methods
Results
Discussion
References
Sidebar

Table 1. Characteristics of High School Students, 2019 Youth Risk Behavior Survey
Characteristic	Overall, % (SE) (N = 13,526)
Grade
9	26.7 (0.6)
10	25.5 (0.4)
11	24.3 (0.6)
12	23.6 (0.6)
Sex
Female	49.4 (0.7)
Male	50.6 (0.7)
Race and ethnicity
American Indian or Alaska Native	0.7 (0.08)
Asian American and Native Hawaiian/Other Pacific Islander	5.4 (1.4)
Hispanic	26.0 (2.3)
Non-Hispanic Black	12.2 (1.1)
Non-Hispanic White	51.2 (2.4)
Non-Hispanic multiracial	4.5 (0.4)
Physical activity
Active ≥5 days in past 7 days	44.1 (1.1)
≥1 Sports team during past 12 months	57.4 (1.5)
Muscle strengthening ≥3 days in past 7 days	49.5 (0.9)
Sedentary behavior on average school day
≥3 Hours of television	19.7 (0.7)
≥3 Hours on a computer or digital device	46.1 (0.8)
Dietary behaviors in past 7 days
Skipped breakfast all days	16.6 (0.7)
No fruits	11.8 (0.7)
No vegetables^a	7.7 (0.4)
Substance use
Cigarettes in past 30 days	5.9 (0.5)
E-cigarettes in past 30 days	32.7 (1.0)
Cannabis in past 30 days	21.7 (0.1)
Alcohol in past 30 days	29.2 (0.1)
Prescription pain medicine in lifetime	14.2 (0.8)
Illicit drugs in lifetime^b	14.6 (0.9)
Behaviors contributing to violence
School safety concerns in past 30 days	8.7 (0.6)
Physical fight in past 12 months	21.8 (0.8)
Bullied at school in past 12 months	19.5 (0.7)
Cyberbullied in past 12 months	15.7 (0.5)

^aDid not eat green salad, potatoes, carrots, and other vegetables 1 or more times during the past 7 days.
^bLifetime use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens.

Table 2. Weighted Prevalence of Depressive Symptoms Among High School Students, 2019 Youth Risk Behavior Survey
Characteristic	% (SE)
Overall	36.7 (0.8)
Grade
9	33.2 (1.2)
10	37.0 (1.5)
11	37.9 (1.2)
12	39.0 (1.4)
Sex
Female	46.7 (1.1)
Male	26.8 (0.8)
Race and ethnicity
American Indian or Alaska Native	45.5 (6.6)
Asian American and Native Hawaiian/Other Pacific Islander	31.9 (2.1)
Hispanic	40.0 (1.0)
Non-Hispanic Black	31.5 (1.4)
Non-Hispanic White	36.0 (1.0)
Non-Hispanic multiracial	45.3 (3.3)
Physical activity
Active ≥5 days in past 7 days	30.1 (1.0)
≥1 Sports team during past 12 months	32.7 (1.0)
Muscle strengthening ≥3 days in past 7 days	33.4 (1.1)
Sedentary behaviors on average school day
≥3 Hours of television	40.5 (1.3)
≥3 Hours on a computer or digital device	42.7 (1.0)
Dietary behaviors in past 7 days
Skipped breakfast all days	48.8 (1.6)
No fruits	37.5 (1.8)
No vegetables^a	32.6 (2.0)
Substance use
Cigarettes in past 30 days	58.0 (2.7)
E-cigarettes in past 30 days	48.7 (1.0)
Cannabis in past 30 days	50.4 (1.4)
Alcohol in past 30 days	48.7 (1.2)
Prescription pain medicine in lifetime	59.8 (1.4)
Illicit drugs in lifetime^b	59.8 (1.9)
Behaviors contributing to violence
School safety concerns in past 30 days	60.0 (2.4)
Physical fight in past 12 months	47.2 (1.3)
Bullied at school in past 12 months	61.9 (1.5)
Cyberbullied in past 12 months	65.1 (1.5)

^aDid not eat green salad, potatoes, carrots, and other vegetables one or more times during the past 7 days.
^bLifetime use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens.

Table 3. Multivariate Associations Between Physical Activity and Sedentary Behaviors With Depressive Symptoms Among High School Students, 2019 Youth Risk Behavior Survey
Characteristic	Adjusted odds ratio (95% CI)
Characteristic	Model 1^a	Model 2^a
Grade
9	1 [Reference]	1 [Reference]
10	1.18 (0.97–1.43)	1.20 (0.99–1.45)
11	1.21 (1.03–1.43)	1.25 (1.08–1.44)
12	1.16 (0.94–1.44)	1.11 (0.90–1.37)
Sex
Female	1 [Reference]	1 [Reference]
Male	0.44 (0.39–0.49)	0.48 (0.41–0.56)
Race and ethnicity
American Indian or Alaska Native	1.82 (0.88–3.78)	1.53 (0.68–3.45)
Asian American and Native Hawaiian/Other Pacific Islander	0.76 (0.58–0.99)	1.15 (0.86–1.56)
Hispanic	1.12 (0.97–1.30)	1.33 (1.14–1.54)
Non-Hispanic Black	0.79 (0.61–1.01)	0.90 (0.66–1.21)
Non-Hispanic White	1 [Reference]	1 [Reference]
Non-Hispanic multiracial	1.51 (1.12–2.02)	1.49 (1.08–2.04)
Physical activity
Active ≥5 days in past 7 days	0.81 (0.69–0.93)	0.81 (0.68–0.97)
≥1 Sports team during past 12 months	0.71 (0.62–0.82)	0.66 (0.55–0.78)
Muscle strengthening ≥3 days in past 7 days	1.04 (0.92–1.19)	0.99 (0.86–1.13)
Sedentary behaviors on average school day
≥3 Hours of television	1.08 (0.92–1.26)	1.06 (0.87–1.30)
≥3 Hours on a computer or digital device	1.66 (1.44–1.91)	1.61 (1.41–1.85)
Dietary behaviors in past 7 days
Skipped breakfast all days	—	1.45 (1.23–1.71)
No fruits	—	1.00 (0.77–1.31)
No vegetables^b	—	0.80 (0.65–1.00)
Substance use
Cigarettes in past 30 days	—	1.25 (0.90–1.73)
E-cigarettes in past 30 days	—	1.29 (1.07–1.57)
Cannabis in past 30 days	—	1.15 (0.87–1.51)
Alcohol in past 30 days	—	1.23 (1.02–1.49)
Prescription pain medicine in lifetime	—	1.99 (1.65–2.41)
Illicit drugs in lifetime^c	—	1.67 (1.36–2.04)
Behaviors contributing to violence
School safety concerns in past 30 days	—	1.93 (1.50–2.49)
Physical fight in past 12 months	—	1.40 (1.18–1.66)
Bullied at school in past 12 months	—	2.13 (1.77–2.57)
Cyberbullied in past 12 months	—	2.14 (1.72–2.66)

Abbreviation: —, does not apply.
^aRespondent's demographics were controlled for in Model 1; Model 2 included demographics, dietary behaviors, substance use, and behaviors contributing to violence.
^bDid not eat green salad, potatoes, carrots, and other vegetables one or more times during the past 7 days.
^cLifetime use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens.