Table 5_Physical activity contexts and adolescent mental health: a systematic review of structured and unstructured approaches, 2015–2025.docx

BackgroundAdolescent mental health problems represent a growing public health concern worldwide. Physical activity (PA) is a modifiable protective factor that supports emotional and social wellbeing, yet most research has emphasized the amount or intensity of activity rather than the context in which it occurs. Comparing structured settings (for example, PE, team sport, classroom programs, supervised dance/arts) and unstructured settings (for example, self-directed leisure, community, or nature-based opportunities) may help identify which forms of engagement best promote mental health and guide scalable interventions.
ObjectiveTo synthesize recent evidence on associations between physical activity contexts and mental health outcomes among adolescents, and to compare structured vs. unstructured approaches.
MethodsA systematic review with narrative synthesis (without meta-analysis) was conducted following PRISMA 2020. Eligible designs included cross-sectional, cohort, quasi-experimental, and qualitative studies. Risk of bias was appraised using JBI (cross-sectional/cohort), ROBINS-I (non-randomized), and CASP-Qualitative. Narrative synthesis followed SWiM guidance for both quantitative and qualitative evidence, and certainty of evidence was summarized using GRADE and CERQual.
ResultsAcross contexts, associations were predominantly favorable for wellbeing/affect, self-concept/competence, and prosocial/connectedness, with more mixed patterns for depression/anxiety and resilience. Effects were moderated by environmental quality, supervision, and autonomy support. Certainty ranged from very low to moderate due to the predominance of observational designs and reliance on self-report measures.
ConclusionsThe available evidence suggests that policy and practice may benefit from combining competence-building, structured opportunities with safe, autonomy-supportive, unstructured, and nature-based options in schools and communities. These implications should be interpreted with caution, given the predominance of observational study designs and the very low to moderate certainty of the evidence. Reporting environmental fidelity and motivation-related constructs may enhance interpretability and support translation into routine mental health promotion services.

背景
青少年心理健康问题已成为全球日益严峻的公共卫生关切。身体活动（Physical Activity，PA）是可干预的保护性因素，有助于促进个体的情绪与社会福祉，但既往多数研究多聚焦于活动的总量与强度，却鲜少探讨活动开展的情境背景。对比结构化活动场景（例如体育与健康课（Physical Education，PE）、团体运动、课堂项目、受督导的舞蹈/艺术活动）与非结构化活动场景（例如自主休闲活动、社区活动或自然参与机会），有助于明确何种形式的活动参与最能促进心理健康，并为可推广的干预措施提供指导。

研究目的
本研究旨在整合青少年身体活动情境与心理健康结局间关联的最新研究证据，并对比结构化与非结构化活动模式的效果差异。

研究方法
本研究遵循系统综述与元分析首选报告条目2020（Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020，PRISMA 2020）声明，开展了一项采用叙事合成（不包含元分析）的系统综述。纳入的研究设计包括横断面研究、队列研究、类实验研究与质性研究。偏倚风险评估分别采用JBI量表（适用于横断面/队列研究）、ROBINS-I工具（适用于非随机研究）以及CASP-Qualitative评价框架。叙事合成严格遵循无元分析叙事合成指南（Synthesis Without Meta-analysis，SWiM）对定量与质性研究证据进行整合，证据确定性等级总结则分别采用推荐分级、评估、制定与评价系统（Grading of Recommendations Assessment, Development and Evaluation，GRADE）与质性研究证据等级评价框架（Confidence in the Evidence from Reviews of Qualitative research，CERQual）。

研究结果
整体而言，各类活动场景与心理健康结局的关联多呈正向趋势，尤其体现在幸福感与情绪状态、自我概念与能力感知以及亲社会行为与社会联结维度；而在抑郁与焦虑症状及心理韧性维度，关联模式则更为混杂。活动效果受环境质量、活动督导以及自主性支持的调节。由于纳入研究多为观察性设计且均依赖自我报告测量手段，证据确定性等级从极低至中等不等。

研究结论
现有证据表明，在学校与社区场景中，将能力培养导向的结构化活动机会，与安全、支持自主性的非结构化活动及自然场景活动相结合，可为政策制定与实践应用提供参考。鉴于纳入研究多为观察性设计且证据确定性仅为极低至中等水平，对本研究结论的解读需保持谨慎。未来研究应报告活动场景的忠实度以及与动机相关的研究构念，以提升结果的可解释性，助力研究成果转化为常规心理健康促进服务实践。