Abstract
This study aimed to investigate the associations of emotional and behavioral problems with physical activity (PA), as well as the mediated role of sleep quality in these associations. Additionally, we also examined whether sex-based disparity could be observed in the aforementioned associations. A multi-stage random cluster sampling method was adopted to recruit 15,071 adolescents (response rate: 99.8%) from 20 junior and senior high schools across 10 districts in Guangzhou, China. Information on emotional and behavioral problems, sleep quality, and PA were collected. Generalized linear mixed models and mediation analyses were utilized for analysis. Results showed that after adjusting for significant covariates, emotional and behavioral problems were found to be negatively associated with PA scores (β estimate = -0.019, 95% CI: -0.021 to -0.017). Among the various emotional and behavioral problems examined, hyperactivity exhibited a greater impact on PA among girls than boys, while peer problems showed the opposite trend in boys (P < 0.05). Sleep quality partially mediated the association between emotional/behavioral problems and PA scores (indirect effect = -0.006, 95% CI: -0.007 to -0.005), with the most considerable mediating effect observed in the relationship between emotional symptoms and PA scores (38.7%). This mediating effect of sleep quality was similarly observed in both boys and girls. These findings highlight the importance of mitigating emotional and behavioral problems as well as improving sleep quality, which could contribute positively to increased levels of PA among adolescents.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Data can be available upon reasonable request to the corresponding author.
References
Altman, D. G., & Bland, J. M. (2003). Interaction revisited: The difference between two estimates. Bmj, 326(7382), 219. https://doi.org/10.1136/bmj.326.7382.219
Atoui, S., Chevance, G., Romain, A. J., Kingsbury, C., Lachance, J. P., & Bernard, P. (2021). Daily associations between sleep and physical activity: A systematic review and meta-analysis. Sleep Medicine Reviews, 57, 101426. https://doi.org/10.1016/j.smrv.2021.101426
Belair, M. A., Kohen, D. E., Kingsbury, M., & Colman, I. (2018). Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: Evidence from a population-based sample of Canadian adolescents. British Medical Journal Open, 8(10), e021119. https://doi.org/10.1136/bmjopen-2017-021119
Benitez-Porres, J., Alvero-Cruz, J. R., Sardinha, L. B., Lopez-Fernandez, I., & Carnero, E. A. (2016). Cut-off values for classifying active children and adolescentes using the physical activity questionnaire: PAQ-C and PAQ-ACut-off values for classifying active children and adolescents using the physical activity questionnaire: PAQ-C and PAQ-A. Nutricion Hospitalaria, 33(5), 564. https://doi.org/10.20960/nh.564
Booth, F. W., Roberts, C. K., Thyfault, J. P., Ruegsegger, G. N., & Toedebusch, R. G. (2017). Role of inactivity in chronic Diseases: Evolutionary insight and pathophysiological mechanisms. Physiological Reviews, 97(4), 1351–1402. https://doi.org/10.1152/physrev.00019.2016
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., & Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
Chen, C., & Chen, J. (2017). Psychometric properties of strengths and difficulties Questionnaire-Chinese Version: A systematic review. Chinese Journal of School Health, 33(04), 685–688.
Cnaan, A., Laird, N. M., & Slasor, P. (1997). Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Statistics in Medicine, 16(20), 2349–2380. https://doi.org/10.1002/(sici)1097-0258(19971030)16:20>2349::aid-sim667<3.0.co;2-e
Corder, K., Sharp, S. J., Atkin, A. J., Griffin, S. J., Jones, A. P., Ekelund, U., & van Sluijs, E. M. (2015). Change in objectively measured physical activity during the transition to adolescence. British Journal of Sports Medicine, 49(11), 730–736. https://doi.org/10.1136/bjsports-2013-093190
Da Azevedo, M., Singh-Manoux, A., Brunner, E. J., Kaffashian, S., Shipley, M. J., Kivimaki, M., & Nabi, H. (2012). Bidirectional association between physical activity and symptoms of anxiety and depression: The Whitehall II study. European Journal of Epidemiology, 27(7), 537–546. https://doi.org/10.1007/s10654-012-9692-8
Draper, C. E., Cook, C. J., Redinger, S., Rochat, T., Prioreschi, A., Rae, D. E., & Norris, S. A. (2022). Cross-sectional associations between mental health indicators and social vulnerability, with physical activity, sedentary behaviour and sleep in urban African young women. Int J Behav Nutr Phys Act, 19(1), 82. https://doi.org/10.1186/s12966-022-01325-w
Duncan, M. J., Riazi, N. A., Faulkner, G., Gilchrist, J. D., Leatherdale, S. T., & Patte, K. A. (2022). The association of physical activity, sleep, and screen time with mental health in Canadian adolescents during the COVID-19 pandemic: A longitudinal isotemporal substitution analysis. Mental Health and Physical Activity, 23, 100473. https://doi.org/10.1016/j.mhpa.2022.100473
Fan, X., & Cao, Z. B. (2017). Physical activity among Chinese school-aged children: National prevalence estimates from the 2016 physical activity and fitness in China-The Youth Study. J Sport Health Sci, 6(4), 388–394. https://doi.org/10.1016/j.jshs.2017.09.006
Feng, N., Xie, Z., Li, Y., Yang, C., & Cui, L. (2023). The relationship between stressful childhood environments and depression for Chinese adolescents: A serial mediation model through perceived discrimination and belief in a just world. Current Psychology. https://doi.org/10.1007/s12144-023-04814-8
Garcia-Hermoso, A., Hormazabal-Aguayo, I., Oriol-Granado, X., Fernandez-Vergara, O., & Cruz, D. P., B (2020). Bullying victimization, Physical Inactivity and sedentary behavior among children and adolescents: A meta-analysis. Int J Behav Nutr Phys Act, 17(1), 114. https://doi.org/10.1186/s12966-020-01016-4
Ghrouz, A. K., Noohu, M. M., Dilshad Manzar, M., Warren Spence, D., BaHammam, A. S., & Pandi-Perumal, S. R. (2019). Physical activity and sleep quality in relation to mental health among college students. Sleep & Breathing = Schlaf & Atmung, 23(2), 627–634. https://doi.org/10.1007/s11325-019-01780-z
Goodman, R., Meltzer, H., & Bailey, V. (2003). The strengths and difficulties Questionnaire: A pilot study on the validity of the self-report version. Int Rev Psychiatry, 15(1–2), 173–177. https://doi.org/10.1080/0954026021000046137
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2020). Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health, 4(1), 23–35. https://doi.org/10.1016/S2352-4642(19)30323-2
He, J. P., Paksarian, D., & Merikangas, K. R. (2018). Physical activity and Mental Disorder among adolescents in the United States. Journal of Adolescent Health, 63(5), 628–635. https://doi.org/10.1016/j.jadohealth.2018.05.030
Holfeld, B., & Ruthig, J. C. (2014). A longitudinal examination of sleep quality and physical activity in older adults. J Appl Gerontol, 33(7), 791–807. https://doi.org/10.1177/0733464812455097
Jamnik, M. R., & DiLalla, L. F. (2019). Health outcomes Associated with internalizing problems in early childhood and adolescence. Frontiers in Psychology, 10, 60. https://doi.org/10.3389/fpsyg.2019.00060
Katzmarzyk, P. T., Friedenreich, C., Shiroma, E. J., & Lee, I. M. (2022). Physical Inactivity and non-communicable Disease burden in low-income, middle-income and high-income countries. British Journal of Sports Medicine, 56(2), 101–106. https://doi.org/10.1136/bjsports-2020-103640
Kelishadi, R., Qorbani, M., Djalalinia, S., Sheidaei, A., Rezaei, F., Arefirad, T., & Motlagh, M. E. (2017). Physical Inactivity and associated factors in Iranian children and adolescents: The Weight disorders Survey of the CASPIAN-IV study. J Cardiovasc Thorac Res, 9(1), 41–48. https://doi.org/10.15171/jcvtr.2017.06
Khalife, N., Kantomaa, M., Glover, V., Tammelin, T., Laitinen, J., Ebeling, H., & Rodriguez, A. (2014). Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and Physical Inactivity in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 53(4), 425–436. https://doi.org/10.1016/j.jaac.2014.01.009
Kortesoja, L., Vainikainen, M. P., Hotulainen, R., Rimpela, A., Dobewall, H., Lindfors, P., & Merikanto, I. (2020). Bidirectional relationship of sleep with emotional and behavioral difficulties: A five-year follow-up of Finnish adolescents. Journal of Youth and Adolescence, 49(6), 1277–1291. https://doi.org/10.1007/s10964-020-01203-3
Kowalski, K. C., Crocker, P. R. E., & Donen, R. M. (2004). The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. 1–38.
Liang, L., Yang, J., & Yao, S. (2019). Measurement equivalence of the SDQ in Chinese adolescents: A horizontal and longitudinal perspective. Journal of Affective Disorders, 257, 439–444. https://doi.org/10.1016/j.jad.2019.06.049
Liu, M., Zhang, J., Hu, E., Yang, H., Cheng, C., & Yao, S. (2019). Combined patterns of physical activity and screen-related sedentary behavior among Chinese adolescents and their correlations with Depression, anxiety and self-injurious behaviors. Psychol Res Behav Manag, 12, 1041–1050. https://doi.org/10.2147/PRBM.S220075
Liu, Y., Tang, Y., Cao, Z. B., Chen, P. J., Zhang, J. L., Zhu, Z., & Hu, Y. Y. (2016). Results from Shanghai’s (China) 2016 Report Card on Physical Activity for Children and Youth. Journal of Physical Activity & Health, 13(11 Suppl 2), S124–S128. https://doi.org/10.1123/jpah.2016-0362
Ma, L., Evans, B., Kleppang, A. L., & Hagquist, C. (2021). The association between screen time and reported depressive symptoms among adolescents in Sweden. Family Practice, 38(6), 773–779. https://doi.org/10.1093/fampra/cmab029
Mannikko, N., Ruotsalainen, H., Miettunen, J., Marttila-Tornio, K., & Kaariainen, M. (2020). Parental socioeconomic status, adolescents’ screen time and sports participation through externalizing and internalizing characteristics. Heliyon, 6(2), e03415. https://doi.org/10.1016/j.heliyon.2020.e03415
Morales, A., Rodriguez-Menchon, M., Tomczyk, S., Fernandez-Martinez, I., Orgiles, M., & Espada, J. P. (2021). Internalizing and externalizing symptoms in Spanish children aged 6–8: Results of a latent profile analysis. Journal of Affective Disorders, 279, 617–623. https://doi.org/10.1016/j.jad.2020.10.066
Nigg, C. R., Wunsch, K., Nigg, C., Niessner, C., Jekauc, D., Schmidt, S. C. E., & Woll, A. (2021). Are physical activity, Screen Time, and Mental Health Related during Childhood, Preadolescence, and adolescence? 11-Year results from the German Motorik-Modul Longitudinal Study. American Journal of Epidemiology, 190(2), 220–229. https://doi.org/10.1093/aje/kwaa192
Olive, L. S., Telford, R. M., Byrne, D. G., Abhayaratna, W. P., & Telford, R. D. (2016). Psychological distress leads to reduced physical activity and fitness in children: The Australian longitudinal LOOK study. Journal of Behavioral Medicine, 39(4), 587–598. https://doi.org/10.1007/s10865-016-9723-0
Philipp, J., Zeiler, M., Waldherr, K., Truttmann, S., Dur, W., Karwautz, A. F. K., & Wagner, G. (2018). Prevalence of emotional and behavioral problems and subthreshold psychiatric disorders in Austrian adolescents and the need for prevention. Social Psychiatry and Psychiatric Epidemiology, 53(12), 1325–1337. https://doi.org/10.1007/s00127-018-1586-y
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., & Olson, R. D. (2018). The physical activity guidelines for americans. Journal of the American Medical Association, 320(19), 2020–2028. https://doi.org/10.1001/jama.2018.14854
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput, 36(4), 717–731. https://doi.org/10.3758/bf03206553
Quach, J. L., Nguyen, C. D., Williams, K. E., & Sciberras, E. (2018). Bidirectional associations between child sleep problems and internalizing and externalizing difficulties from preschool to early adolescence. JAMA Pediatr, 172(2), e174363. https://doi.org/10.1001/jamapediatrics.2017.4363
Qurban, H., Wang, J., Siddique, H., Morris, T., & Qiao, Z. (2019). The mediating role of parental support: The relation between sports participation, self-esteem, and motivation for sports among Chinese students. Current Psychology, 38(2), 308–319. https://doi.org/10.1007/s12144-018-0016-3
Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132(1), 98–131. https://doi.org/10.1037/0033-2909.132.1.98
Rottenberg, J., Yaroslavsky, I., Carney, R. M., Freedland, K. E., George, C. J., Baji, I., & Kovacs, M. (2014). The association between major depressive disorder in childhood and risk factors for Cardiovascular Disease in adolescence. Psychosomatic Medicine, 76(2), 122–127. https://doi.org/10.1097/PSY.0000000000000028
Sanz-Martin, D., Ubago-Jimenez, J. L., Ruiz-Tendero, G., Zurita-Ortega, F., Melguizo-Ibanez, E., & Puertas-Molero, P. (2022). The Relationships between Physical Activity, Screen Time and Sleep Time According to the Adolescents’ Sex and the Day of the Week. Healthcare (Basel), 10(10), https://doi.org/10.3390/healthcare10101955
Sashegyi, A. I., Brown, K. S., & Farrell, P. J. (2000). Application of a generalized random effects regression model for cluster-correlated longitudinal data to a school-based Smoking prevention trial. American Journal of Epidemiology, 152(12), 1192–1200. https://doi.org/10.1093/aje/152.12.1192
Selinus, E. N., Durbeej, N., Zhan, Y., Lichtenstein, P., Lundstrom, S., & Ekblom, M. (2021). Inattention and hyperactivity symptoms in childhood predict physical activity in adolescence. Bmc Psychiatry, 21(1), 629. https://doi.org/10.1186/s12888-021-03603-6
Stefan, L., Sporis, G., Kristicevic, T., & Knjaz, D. (2018). Associations between sleep quality and its domains and insufficient physical activity in a large sample of Croatian young adults: A cross-sectional study. British Medical Journal Open, 8(7), e021902. https://doi.org/10.1136/bmjopen-2018-021902
Tapia-Serrano, M. A., Garcia-Hermoso, A., Sevil-Serrano, J., Sanchez-Oliva, D., & Sanchez-Miguel, P. A. (2022). Is adherence to 24-Hour Movement guidelines associated with a higher academic achievement among adolescent males and females? Journal of Science and Medicine in Sport / Sports Medicine Australia, 25(2), 155–161. https://doi.org/10.1016/j.jsams.2021.09.005
Tonnaer, F., Siep, N., van Zutphen, L., Arntz, A., & Cima, M. (2017). Anger provocation in violent offenders leads to emotion dysregulation. Scientific Reports, 7(1), 3583. https://doi.org/10.1038/s41598-017-03870-y
Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., & Fang, S. C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943–1952. https://doi.org/10.1007/s11136-005-4346-x
Ueno, T., Ito, K., Murai, T., & Fujiwara, H. (2020). Mental Health Problems and their Association with Internet Use in Medical residents. Front Public Health, 8, 587390. https://doi.org/10.3389/fpubh.2020.587390
Vitale, K. C., Owens, R., Hopkins, S. R., & Malhotra, A. (2019). Sleep Hygiene for optimizing recovery in athletes: Review and recommendations. International Journal of Sports Medicine, 40(8), 535–543. https://doi.org/10.1055/a-0905-3103
Wang, W., Du, X., Guo, Y., Li, W., Teopiz, K. M., Shi, J., & McIntyre, R. S. (2021). The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study. Sleep Medicine, 82, 71–77. https://doi.org/10.1016/j.sleep.2021.03.009
Wang, W., Du, X., Guo, Y., Li, W., Zhang, S., Zhang, W., & Lu, C. (2021). Associations among screen time, Sleep Duration and depressive symptoms among Chinese adolescents. Journal of Affective Disorders, 284, 69–74. https://doi.org/10.1016/j.jad.2021.01.082
Wassenaar, T. M., Wheatley, C. M., Beale, N., Nichols, T., Salvan, P., Meaney, A., & Johansen-Berg, H. (2021). The effect of a one-year vigorous physical activity intervention on fitness, cognitive performance and mental health in young adolescents: The fit to study cluster randomised controlled trial. Int J Behav Nutr Phys Act, 18(1), 47. https://doi.org/10.1186/s12966-021-01113-y
Xin, L., Yan, W., XiaoTong, L., DongFeng, L., Chun, S., MinHao, X., & ZhengZhen, W. (2015). The revision and reliability validity of Chinese version of youth physical activity questionnaire (PAQ-A). Journal of Beijing Sport University, 38(05), 63–67. https://doi.org/10.19582/j.cnki.11-3785/g8.2015.05.012
Acknowledgements
We wish to give particular thanks to all participating schools and students who have made the study possible.
Funding
This work was supported by the Guangzhou Education Science Planning Major project (grant No. 2020zd006), the National Natural Science Foundation of China (grant No. 81903339), the Natural Science Foundation of Guangdong Province (grant No. 2022A1515012333), and the Science and Technology Planning Project of Guangzhou (grant No. 202102020136).
Author information
Authors and Affiliations
Contributions
All authors listed have made a substantial, direct and intellectual contribution to the work. CH, YY, GS, CL, and LG conceptualized, and designed this study; CH, YY, YH, WL, XZ, and LG analyzed the data, interpreted the data, and drafted the manuscript; CL and LG provided intellectual guidance in improving the manuscript; CH, YY, CL, and LG assisted in revising the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors.
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration or comparable ethical standards.
Conflict of interest
All authors declare that they have no conflicts of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Huang, C., Yang, Y., Shi, G. et al. Associations between emotional/behavioral problems and physical activity among Chinese adolescents: the mediating role of sleep quality. Curr Psychol 43, 12709–12720 (2024). https://doi.org/10.1007/s12144-023-05397-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-023-05397-0