Improve Children’s Mental Health – Turn Off the TV

Obesity is a global epidemic, in adults and children. The increase in childhood obesity has been linked to behavioral and environmental factors: decreased physical activity and increased television viewing. Now it is clear that these activities are detrimental not only to physical health, but also psychological health. A recent study published in the journal Pediatrics suggests that television viewing and physical inactivity are determinants of psychological distress in children.

The investigators of the study conducted a cross-sectional survey of nearly 1500 children aged 4 to 12 years. They evaluated the association between psychological distress, time spent on television viewing and other screen entertainment activities, and levels of physical activity in the study population. Approximately 4% of the children showed an abnormally high level of psychological distress, as assessed by the Strengths and Difficulties Questionnaire. On average, children spent 2.4 hours daily watching television, but one-quarter of the children reported at least 3 hours of television and screen entertainment each day. Both television and screen entertainment and physical inactivity were independently correlated with high levels of psychological distress, after adjustment for other factors including age, gender, single-parent status, medical conditions, and dietary indicators.

In this study, a low level of television and screen entertainment was considered to be less than 1.6 hours daily, and a high level was considered greater than 2.7 hours daily. Similarly, a low level of physical activity was considered less than 6 sessions of physical activity lasting at least 15 minutes weekly; a high level of physical activity was considered to be more than 10 such sessions. Children with high levels of television and screen entertainment were 24% more likely to have high levels of psychological distress. (The children with the highest levels of television viewing also reported the lowest levels of fruit intake and the highest levels of sugar intake; children with high levels of television viewing also reported the lowest levels of physical inactivity.) Children that had high levels of television and screen entertainment, as well as low levels of physical activity, were 46% more likely to experience psychological distress, indicating that these behaviors are additive determinants of psychological distress.

In a similar cross-sectional analysis of American children aged 4 to 11 years, 37.3% of the study population reported less than 6 sessions of active play each week, 65% reported more than 2 hours of screen time, including television, videos, computers, and computer games, each day. More than one-quarter of the children reported both these behaviors. These behaviors are not consistent with the American Academy of Pediatrics recommendations for healthy pediatric development, which includes less than 2 hours daily of screen time and at least 60 minutes of physical activity daily.

But, do these poor lifestyle choices –- television viewing and inactivity -– cause psychological distress or are they a result of it? Possibly, the children with increased levels of distress are showing early signs of depression or other mental health disorders such as fatigue or reduced interest in play or other enjoyable activities. In either case, physical activity enhances the physical, social, emotional, and cognitive development of children; and physical activity levels in children are a predictor of mental health as adults. Encouraging physical activity in children will contribute to healthy psychosocial development, as well as lower the risk for obesity, along with its myriad of related conditions. The simple act of turning off the television can inspire the growth of healthy, well-adjusted children.


Anderson, S., Economos, C., & Must, A. (2008). Active play and screen time in US children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis BMC Public Health, 8 (1) DOI: 10.1186/1471-2458-8-366

Hamer, M., Stamatakis, E., & Mishra, G. (2009). Psychological Distress, Television Viewing, and Physical Activity in Children Aged 4 to 12 Years PEDIATRICS, 123 (5), 1263-1268 DOI: 10.1542/peds.2008-1523

Marshall, S., Biddle, S., Gorely, T., Cameron, N., & Murdey, I. (2004). Relationships between media use, body fatness and physical activity in children and youth: a meta-analysis International Journal of Obesity, 28 (10), 1238-1246 DOI: 10.1038/sj.ijo.0802706

Viner, R., Haines, M., Taylor, S., Head, J., Booy, R., & Stansfeld, S. (2006). Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents International Journal of Obesity, 30 (10), 1514-1521 DOI: 10.1038/sj.ijo.0803352

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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