Study On The Association Between 24-hour Movement Behavior And Depression,Anxiety And Depressive-Anxiety Comorbid Symptoms In Adolescents

ObjectiveAdolescence is a critical period for individual growth and development,as well as an important period for significant psychological changes.During this period,adolescents’physical and mental development is not yet sound,and their personality development is unbalanced and contradictory,which can easily lead to depression and anxiety,and have a negative impact on the development of adolescents’physical and mental health.In recent years,the prevalence of depression and anxiety among adolescents has been increasing,and the comorbidity of depression and anxiety among adolescents has become increasingly prominent,which has become an important public health issue related to the future of the country and the nation.Studies have shown that physical activity,sedentary behavior（SB）and sleep（SLP）are important factors influencing depression and anxiety in adolescents.However,most existing studies have independently analyzed the effects of SB,SLP,or physical activity on depression and anxiety in adolescents,ignoring the intrinsic link between activity behaviors,which may lead to pseudo-correlation,inconsistency with reality,or difficulty in interpretation.From the perspective of Time-Use Epidemiology,people’s 24-hour movement behavior includes moderate-to-vigorous physical activity（MVPA）,light-intensity physical activity（LPA）,SB and SLP.The total time of these four behavior activities is fixed,with typical compositional data characteristics.Therefore,it is more scientific to explore the relationship between 24-hour movement behavior and depression,anxiety and depression-anxiety comorbidity in adolescents based on the compositional data analysis（Co DA）method,taking 24-hour movement behavior as a structural whole.Based on the Co DA method,this study explored the association of 24-hour movement behavior with depression,anxiety,and depressive-anxiety comorbid symptoms in adolescents,and analyzed the effect of time redistribution of each behavior activity on the risk of depression,anxiety,and depressive-anxiety comorbid symptoms.Explore the optimal time-use composition to reduce the occurrence of depression,anxiety and depression-anxiety comorbid symptoms in adolescents,and to provide reasonable behavioral time allocation suggestions for promoting adolescents’mental health.MethodsThis study adopts a cross-sectional research design,and the research objects are 749 first-grade students（aged 14-17 years old）from a middle school in Foshan City.The 24-hour movement behavior data of students was collected by combining questionnaires and three-axis accelerometers.The basic information,living habits and family function status of the students were collected through questionnaires.The Patient Health Questionnaire-9（PHQ-9）was used to evaluate students’depressive symptoms,and the Generalized Anxiety Disorder-7（GAD-7）was used to evaluate students’anxiety symptoms.Based on the Co DA framework,this study uses the isometric logratio transformation（ilr）method to analyze the proportional distribution of adolescents’24-hour movement behavior time during the week,school days,and weekends.The chi-square test was used to compare the differences in the detection rate of depression,anxiety and depressive-anxiety comorbid symptoms among different demographic variables and related factors.Compositional Logistic regression was used to investigate the association of adolescents’24-hour movement behavior with depression,anxiety and comorbid symptoms of depression and anxiety.A compositional Logistic isotemporal substitution model was constructed to analyze the effect of the mutual substitution between behavioral activities on depression,anxiety and comorbid symptoms of depression and anxiety.Using the increment chart to analyze the change of OR value of depression,anxiety and depression-anxiety comorbidity caused by the reallocation of 24-hour movement behavior under different allocation times.Finally,a predictive model of the optimal time-use composition was constructed to explore the optimal time-use composition to reduce the occurrence of depression,anxiety,and depressive-anxiety comorbid symptoms in adolescents.A loess curve was fitted to analyze the relationship between each time-use composition and the predicted outcome,and a three-dimensional quaternary plot was used to visualize the optimal time-use composition area.ResultsA total of 698 students were included in this study,including 310 boys（44.41%）,388 girls（55.59%）,and 72.48%of students aged 14-15.1.Depression,anxiety and depression-anxiety comorbid symptoms in adolescents:The detection rate of depressive symptoms in adolescents aged 14-17 was 13.18%,the detection rate of anxiety symptoms was 10.03%,and the detection rate of depression-anxiety comorbid symptoms was 6.88%.Among teens with depressive symptoms,52%also had generalized anxiety symptoms.Adolescents with moderate or severe family dysfunction have higher detection rates of depression,anxiety and comorbid symptoms of depression and anxiety,which are higher than those without family dysfunction.2.Adolescents’24-hour movement behavior:no matter in the week,school day or weekend,students spend longer time in SB and SLP,and shorter in MVPA and LPA.and the composition percentage of 24-hour movement behavior in descending order of SB>SLP>LPA>MVPA;daily MVPA and LPA time on study days were higher than on weekends（MVPA:55.61 minutes vs.35.55 minutes;LPA:239.40 minutes vs.211.75 minutes）,and the daily SB and SLP time were higher on weekends than on study days（SB:717.22 minutes vs.681.47 minutes;SLP:475.49 minutes vs.463.52 minutes）.Whether it was a week,school day,or weekend,adolescents with depressive symptoms had more daily SB and less MVPA than those without depressive symptoms.Adolescents with depression,anxiety,or comorbid symptoms of depression and anxiety all had relatively short sleep duration.Variation matrix results of 24-hour movement behavior showed that SLP was strongly correlated with SB and LPA,while MVPA was weakly correlated with LPA,SB and SLP.3.Association of 24-hour movement behavior with depression,anxiety,and depressive-anxiety comorbid symptoms in adolescents:After adjusting for confounding variables,relative to the remaining activity behavior composition,increased daily SLP time in adolescents was associated with a lower risk of depressive symptoms（OR=0.35,95%CI=0.14-0.84,P=0.021）.Compositional Logistic isotemporal substitution results showed that,after adjusting for confounding variables,replacing 20-minutes SLP with LPA during a week of activity was associated with increased odds of developing depressive symptoms in adolescents（OR=1.16,95%CI=1.01-1.33）;replacing 20-minute LPA with SLP was associated with lower odds of developing depressive symptoms in adolescents（OR=0.87,95%CI=0.75-0.99）.On weekends,reallocating 10 and20 minutes from SLP to LPA were significantly associated with higher odds of depressive symptoms（10 minutes:OR=1.07,95%CI=1.01-1.12;20 minutes:OR=1.14,95%CI=1.02-1.26）and anxiety symptoms（10 minutes:OR=1.07,95%CI=1.01-1.13;20 minutes:OR=1.14,95%CI=1.02-1.28）;while a 10-minute and 20-minute reallocation to SLP from LPA was associated with lower odds of depressive symptoms（10 minute:OR=0.94,95%CI=0.89-0.99;20minutes:OR=0.88,95%CI=0.79-0.98）and anxiety symptoms（10 minutes:OR=0.93,95%CI=0.88-0.99;20 minutes:OR=0.87,95%CI=0.77-0.98）.Whether in a week or a weekend,reallocation of 10-minute and 20-minute SB to SLP were associated with lower odds of depressive symptoms in adolescents(one week:OR_10min=0.92,95%CI=0.86-0.98;OR_20min=0.85,95%CI=0.75-0.96;weekends:OR_10min=0.94,95%CI=0.91-0.98;OR_20min=0.88,95%CI=0.82-0.95);conversely,reallocation of 10-minute and 20-minute SLP to SB was associated with increased odds of depressive symptoms in adolescents(one week:OR_10min=1.09,95%CI=1.02-1.16;OR_20min=1.18,95%CI=1.04-1.34;weekend:OR_10min=1.06,95%CI=1.02-1.11;OR_20min=1.13,95%CI=1.05-1.22).Mutual substitution between activities other than SLP had no statistically significant effect on depression,anxiety,or depressive-anxiety comorbid symptoms.Incremental graphs showed that,regardless of the week,school days or weekends,the substitution of SLP for the other three activity behaviors had a trend of reducing the risk of depression,anxiety and depressive-anxiety comorbid symptoms in adolescents.4.The optimal time-use composition for reducing depression,anxiety and depression-anxiety comorbid symptoms in adolescents:During a week of activities,the optimal time-use composition（minutes/day）for reducing depression and anxiety symptoms in adolescents were:SLP=540（510-550）,SB=513（470-660）,LPA=314（110-410）,MVPA=73（10-130）;SLP=534（480-550）,SB=677（470-800）,LPA=142（110-290）,MVPA=87（10-130）.On school days,the optimal time-use composition（min/day）to reduce depression and anxiety symptoms in adolescents were:SLP=544（490-560）,SB=479（440-640）,LPA=324（100-440）,MVPA=93（10-140）;SLP=540（470-560）,SB=647（440-770）,LPA=146（100-320）,MVPA=107（20-140）.During weekends,the optimal time-use composition（minutes/day）to reduce depression and anxiety symptoms in adolescents were:SLP=656（600-670）,SB=584（450-770）,LPA=130（50-330）),MVPA=70（10-120）;SLP=597（440-670）,SB=706（550-870）,LPA=63（50-110）,MVPA=74（10-120）.The loess curve shows that whether in a week,school day or a weekend,after considering the remaining activity behavior,the increase of SLP time was associated with a lower risk of depression and anxiety symptoms,while increased SB time was associated with an increased risk of depression and anxiety symptoms;the loess curve fitted by LPA and anxiety also showed an upward trend.The optimal time-use composition（min/day）for reducing depression-anxiety comorbid symptoms in adolescents during the week,school days,and weekends were:SLP=550（540-550）,SB=572（470-660）,LPA=195（110-290）,MVPA=123（100-130）;SLP=557（540-560）,SB=524（440-640）,LPA=228（100-320）,MVPA=131（100-140）);SLP=647（600-670）,SB=654（550-770）,LPA=66（50-110）,MVPA=73（10-120）.ConclusionThe adolescents in this study have a certain degree of depression and anxiety symptoms,and there are more severe depressive-anxiety comorbid symptoms in adolescents;family dysfunction may be an important factor affecting depression and anxiety in adolescents.There may be time differences in the distribution of adolescents’24-hour movement behavior time;adolescents with depressive symptoms have more SB and less MVPA than adolescents without depressive symptoms;adolescents with depression,or anxiety,or depressive-anxiety comorbid symptoms all had shorter sleep duration.Increased daily SLP time is associated with a reduced risk of depressive symptoms in adolescents.Replacing LPA or SB with SLP during the week and weekends is associated with lower odds of depressive symptoms,and replacing LPA with SLP on weekends is associated with lower odds of anxiety symptoms;the substitution effect of activity behavior may be influenced by time-period factors,and the result of mutual substitution of activity behaviors is asymmetric.The optimal time-use composition prediction model provided the optimal time-use composition for reducing depression,anxiety,or depressive-anxiety comorbid symptoms in adolescents.The results of this study can provide new ideas and theoretical basis for further exploring the relationship between activity behaviors and depression and anxiety,and provide a scientific basis for the formulation of behavioral time allocation guidelines for Chinese adolescents.