Associations of 24-Hour Movement Behavior with Depressive Symptoms and Anxiety in Children: Cross-Sectional Findings from a Chinese Sample

This study examined the associations between adherence to 24-hour movement behavior guidelines (24-HMB) and the mental-health-related outcomes of depressive symptoms and anxiety in Chinese children. Data on movement behavior from 5357 children (4th and 5th grades), including physical activity, recreational screen time and sleep, were self-reported using the Health Behavior School-Aged Children Survey. Depressive symptoms and anxiety were self-reported using the Chinese version of the nine-item Patient Health Questionnaire and the Generalized Anxiety Disorder Scale, respectively. Depressive symptoms and anxiety were treated as categorical variables. Only 3.2% of the participants met physical activity, screen time, and sleep 24-HMB guidelines. Ordinal logistic regressions showed that, compared with participants who met the 24-HMB guidelines, participants who met none (odds ratio (OR) = 2.62, 95% CI: 1.76-3.90) or any one of the guidelines (OR = 1.88, 95% CI: 1.27-2.77) had higher odds of depressive symptoms. Similarly, there were higher odds of anxiety in participants who met none (OR = 2.32, 95% CI: 1.45-3.70) or any one of the recommendations (OR = 1.62, 95% CI: 1.03-2.57) compared with participants who met all the 24-HMB guidelines. Meeting the 24-HMB guidelines is associated with better mental-health-related outcomes in Chinese children. Because of the low prevalence of Chinese children meeting the 24-HMB recommendations, the present findings highlight the need to encourage children to regularly engage in physical activity, decrease their time spent sitting, and improve their sleep patterns.