Screen Time and Other Determinants of Mental Health Predicting Emerging Psychotic-like Experiences in 9-10 Year Old Children

IMPORTANCE: Worsening child psychotic-like experiences (PLEs) are risk factors of poor future mental health including full blown psychotic illness. Identifying readily assessable indicators for worsening PLEs are therefore of great interest. OBJECTIVE: To examine relationships between a set of indicators (behaviors and stressors) previously associated with mental health (screen time, school environment, neighborhood safety, family conflict, parental (caregiver) acceptance, and sleep habits) and worsening PLE severity. DESIGN, SETTING, AND PARTICIPANTS: This prospective study included 4296 children (mean age 10 years (standard deviation = 0.7)), 52% boys) from the Adolescent Brain and Cognitive Development study. MAIN OUTCOMES AND MEASURES: The primary outcome was 12-month distress score of the Prodromal-Questionnaire Brief-Child (PQ-BC) Version, modeled after controlling for age, sex, race, ethnicity, parental marital status/education, and baseline PQ-BC severity. RESULTS: Significant baseline indicators of worsening PLE severity by 12-month follow-up included high screen time (46% increase for ≥ 4.6 hours/day (vs. 0 to 1.5 hours/day), 95% CI = 28% to 66%), living in an unsafe neighborhood (30% increase in most unsafe (vs. safest), 95% CI = 6% to 61%), high family conflict (30% increase with 2-3 and 16% increase with ≥ 4 "yes" responses to questions re: conflict (vs. none), 95% CIs = 16% to 46% and 2 to 32%, respectively), lack of parental acceptance (13% decrease in group with highest possible acceptance (vs. low group), 95% CI = -24% to -2%), and sleeping < 9 hours/night (16% increase (vs. sleeping 9-11 hours/night), 95% CI = 7% to 27%). Examining screen time variants, significant associations were observed with time watching videos (33% increase for ≥ 1.2 hours/day (vs. 0 to 0.1 hours/day), 95% CI = 16% to 52%) and time texting (29% decrease when texting 0.1-0.2 hours/day (vs. none), 95% CI = -41% to -15%). An interaction between sex and video chatting was also observed, as video chatting was a negative indicator in girls but not boys. CONCLUSIONS AND RELEVANCE: Screen time, crime, and family environment were identified as future indicators of mental health risk. These results suggest the value of prospective evaluation of behavior and stressors in identifying at risk groups.