Excessive screen time (ST) use has been linked to more depressive and anxiety symptoms, whereas moderate use may confer benefits for psychological health in adolescents. However, its role in psychological health following concussion in adolescents remains unclear. This study examined the effects of ST use on depressive and anxiety symptoms in adolescents following concussion. A total of 102 adolescents comprising 62 (mean [standard deviation (SD)] = 15.2 [1.7] years; 45.2% female) within 10 days of a diagnosed concussion, and 40 age- and sex-matched healthy controls (mean age [SD] = 14.99 [1.62] years; 50% female) participated in the study. Psychological symptoms were assessed using the Children's Depression Rating Scale and the Screen for Child Anxiety Related Emotional Disorders in the first 10 days (V1) and 3 months (V2) postinjury. Recreational ST use was self-reported at V1. K-means clustering classified adolescents with concussion into ST subgroups. Robust regression and false discovery rate correction examined group differences at V1 and V2 postinjury. Three clusters of ST use were identified: low (N = 14; mean [SD] = 1.97 [0.89] h/day), moderate (N = 25; mean [SD] = 5.22 [0.86] h/day), and high (N = 23; mean [SD] = 8.96 [1.42] h/day). At V1, all groups reported higher depressive and anxiety symptoms than controls (p < 0.041). At V2, all symptoms in the moderate-use group returned to control levels; however, the high-use group reported elevated depressive symptoms (F = 12.48, p = 0.001, Q = 0.003), and the low-use group reported elevated anxiety (F = 23.15, p < 0.001, Q < 0.001) compared with controls. Moderate recreational ST use was associated with significant recovery, while low and high ST use were associated with persistent symptoms in adolescents following concussion. Adolescents may benefit from recommendations that support a "Goldilocks" approach to ST use following concussion.
Keywords: adolescents; anxiety; concussion; depression; digital media; screen time.