Mental health

and Mental health

and physical activity
physical activity
among
adolescents
among adolescents

Summary report

Centre for Physical Activity and Nutrition Research

Summary report Jenny Veitch

Clare Hume

Anna Timperio

Kylie Ball

Jo Salmon

David Crawford
 D E A K I N U N I V E R S I T Y

Mental health
and physical activity
among adolescents

Summary report
Centre for Physical Activity and Nutrition Research

Jenny Veitch Clare Hume Anna Timperio

Kylie Ball Jo Salmon David Crawford

Contact details for further information:
Dr Jenny Veitch
Centre for Physical Activity and Nutrition Research
Deakin University
221 Burwood Hwy
Burwood, Vic 3125
Email: [email protected]
www.deakin.edu.au/cpan

iii Summary report

Acknowledgements
C-PAN gratefully acknowledges the funding provided by the National Health and
Medical Research Council to conduct this project. Thanks are also extended to
the Victorian Health Promotion Foundation which provided additional support
for analysis and dissemination of project findings.

Particular thanks goes to all the children, adolescents and families involved in
the project, as well as to the schools, principals and teachers who provided their
support.

The contributions of the following staff are also acknowledged: Dr Nick

Andrianopoulous, Dr Michelle Jackson, Anna Sztendur, Rebecca Roberts, David
Attard, Leah Galvin and Julie Rankine.

Anna Timperio is supported by a Victorian Health Promotion Foundation Public

Health Research Fellowship; Kylie Ball is supported by a National Health and
Medical Research Council Senior Research Fellowship; Jo Salmon is supported
by a Heart Foundation Career Development Award; and David Crawford is
supported by a Victorian Health Promotion Foundation Senior Research
Fellowship.

Mental health and physical activity among adolescents iii

v Summary report
Contents
Executive summary 1
1. Background and study aims 3
1.1 How do we define mental health disorders 3
1.2 How common are mental health disorders among adults? 4
1.3 How common are mental health disorders among youth? 5
1.4 How is depression treated and managed? 5
1.5 Physical activity and depression 6
1.6 Television viewing and depression 7
1.7 Study aims 7
2. Study design and methods 8
2.1 Study design 8
2.2 Study participants 8
2.3 Objectively-measured physical activity 9
2.4 Participants survey 9
3. Study findings 11
3.1 Characteristics of participants 11
3.2 Patterns of physical activity and depressive symptoms 12
3.3 Associations between depression and physical activity,
organised sport and television viewing 15
4. Study conclusions 18
5. References 20

Mental health and physical activity among adolescents v

List of figures
Figure 1 Physical activity and depressive symptoms in boys and girls
in 2004 16
Figure 2 Organised sport and depressive symptoms in boys and girls
in 2004 16
Figure 3 Television viewing and depressive symptoms in boys and
girls in 2004 16

List of tables
Table 1: Mean age of adolescent boys and girls in 2004 and 2006 11
Table 2: Changes in physical activity, organised sport and television 13
viewing time among adolescent boys and girls
Table 3 Presence of depressive symptoms among adolescent 14
boys and girls
Table 4: Associations between depressive symptoms in 2004 and
physical activity, organised sport and television (TV)
viewing in 2006 17

vi
1 Summary
Summaryreport
report
Executive summary
In the World Health Organisation’s report on the Global Burden of Disease,
depression is identified as the leading cause of disability among adults, and
one of the leading causes of overall disease burden.

Young people are an important group to consider when examining mental

health issues as the symptoms of depression are often first evident during
childhood and adolescence.

Physical activity has been shown to have substantial benefits among adults
experiencing symptoms of depression, but there is less evidence for its
effects on depressive symptoms amongst children and adolescents.

In order to inform efforts to promote mental health amongst young people,

this study sought to examine associations between symptoms of depression
and physical activity, organised sport and television viewing. It also sought
to examine whether depression itself influences levels of physical activity.
This study examined a sample of Victorian adolescents in 2004 (aged 14) and
again in 2006 (aged 16). Depression symptoms were measured using the
Centre for Epidemiological Studies Depression Scale for Children (CES-CD)
and physical activity was objectively measured using accelerometers.

Symptoms of depression were present in over 40% of adolescent girls and

over 20% of adolescent boys in 2004. The proportion of boys and girls
reporting significant depressive symptoms did not increase from 2004 to
2006.

Tracking individuals during the study period helped to identify persisting

symptoms of depression as well as patterns of emerging symptoms over
time. It was found that 11% of boys and 28% of girls showed depressive
symptoms in both 2004 and 2006. Further, 14% of boys and 13% of girls
who did not display depressive symptoms in 2004 had developed depressive
symptoms by 2006.

Mental
Mentalhealth
healthand
andphysical
physicalactivity
activityamong
amongadolescents
adolescents vi1
 In 2004, when the participants were 14 years of age, neither participation in
physical activity or organised sport, nor television viewing were associated
with the presence of depressive symptoms. Furthermore, neither physical
activity nor organised sport were predictive of the likelihood of developing
depressive symptoms two years later. However, girls who reported
symptoms of depression at age 14 watched approximately 168 minutes/week
more television at age 16.

It would seem from this study that physical activity has little association with
the presence of depressive symptoms for adolescents between the ages of
14 and 16 in this small sample; however reporting depressive symptoms at
age 14 was associated with increased TV viewing at age 16 among girls. It
may be that girls with depressive symptoms withdraw from social activities
preferring more solitary pursuits such as TV viewing, or that specific
symptoms of depression (e.g. feeling tired or finding it hard to initiate
activities), may also explain higher levels of TV viewing.

It is evident that the findings from adult studies cannot necessarily be

extrapolated to adolescents, and that we need to direct future research
efforts to understanding the complex influences on adolescent health so that
appropriate action can be taken.

This report describes the key findings of the study. It will be of interest to
parents and families of adolescents; teachers and schools; policy makers;
health professionals; and other organisations interested in mental health
among young people.

23 Summary report
Background and study aims

1.1 How do we define mental health disorders?

Mental health is complex and is much more than simply the absence of illness.
It describes the capacity of individuals to interact with each other and their
environment in a way that promotes optimal development and the use of
cognitive, affective and relational abilities, as well as overall wellbeing 1.

Mental health disorders are described as the range of cognitive, emotional

and behavioural disorders that affect lives and productivity 1. According to
the United States Department of Health and Human Services: “Mental illness
is a term that refers collectively to all diagnosable mental disorders. Mental
disorders are health conditions that are characterised by alterations in thinking,
mood or behaviour (or some combination thereof) associated with distress
and/or impaired functioning.” 2

According to the fourth edition of the Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV), there are several major diagnostic classes of mental
disorders, including for example, substance-related disorders, mood disorders,
anxiety disorders, dissociative disorders and personality disorders 2.

Depression is one of the most common mental disorders 1. It is defined as a

mood disorder and is characterised by feelings of sadness, a loss of interest or
pleasure in nearly all activities, feelings of hopelessness and suicidal thoughts
or self-blame 1. Depression or depressive symptoms can occur on a continuum.
Clinical depression must be diagnosed by a health professional, however,
people with depressive symptoms could be considered at risk of developing a
mental health disorder.

Mental health and physical activity among adolescents 23

1.2 How common are mental health disorders
among adults?
The Australian Institute of Health and Welfare report into Australia's health
describes the prevalence of mental health disorders, including trends over
recent years. Data collected via the National Survey of Mental Health and
Wellbeing (published in 1997) suggests that the proportion of adults with
a mental health disorder was approximately 18%, and the prevalence of
a long-term mental or behavioural disorder was 11% 3. In the 2004-2005
National Health survey, the prevalence of mental health problems was
estimated using self-report measures. When considered in combination,
these data suggest there has been a substantial increase in mental health
problems in recent years from 5.9% in 1995, to 9.6% in 2001, and 11.0% in
2004-05 3.

In the 1997 National Survey of Mental Health and Wellbeing, the Composite
International Diagnostic Interview was used to identify the prevalence of
certain mental disorders among Australian adults. According to the survey,
depression was experienced by 6.8% of females and 3.4% of males, making
it the most common mental disorder among females and the third most
common among males 1. In terms of disease burden, anxiety and depression
were the leading cause of disease burden among females (10% of total
disease burden) and the third leading cause of disease burden among males
(4.8% of total disease burden) 4.

These figures are supported by international data. In the World Health

Organisation’s report into the Global Burden of Disease, depression was
identified as the leading cause of disability among adults, and one of the
leading causes of overall disease burden in low, middle and high income
countries 5.

45 Summary report
1.3 How common are mental health disorders
among youth?
Depression is also seen among children and adolescents, 6 and young people
have been identified as an important group to consider when examining
mental health issues, since symptoms of depression are often first exhibited
during childhood and adolescence 1.

Data from the United States suggests that in 2004, approximately 9% of

adolescents aged 12-17 years experienced a major depressive episode, with
prevalence higher among females (approximately 11%) compared to males
(approximately 6%) 7. Data from Australia suggest that 5% of young people
suffer from a depressive disorder, and approximately 20% of young people
suffer from a mental health problem or disorder within any six month
period 1. Consistent with United States data, Australian adolescent girls are
more likely than boys to exhibit depressive symptoms 1.

These figures are of significant concern in light of evidence that depressive

symptoms persist over time, with approximately 40% of adolescents
reporting maintenance of depressive symptoms after four years 8. This
suggests that effective strategies to treat and manage symptoms of
depression in this population group are needed.

1.4 How is depression treated and managed?

A range of effective treatment options for mental health disorders are
available. These generally fall into two categories, psychosocial and
pharmacological treatments 2.

Psychosocial treatments typically involve psychotherapy and/or

counselling. For example, cognitive psychotherapy has been shown to
have long-term benefits in reducing symptoms of depression 1. Depressed
persons tend to view events in an overly pessimistic way, and have a variety
of distorted patterns of thinking. Cognitive therapy aims to teach them to
develop a realistic, positive and adaptive view of themselves, their future
and the world 1.

Pharmacological treatments target the known changes in patterns of brain

neurotransmitters associated with depression. Anti-depressant medications
are commonly prescribed as treatments for depressive symptoms 1.

There are, however, ongoing issues with maintenance of both

psychological and pharmacological treatments among individuals
experiencing depression 9. Common barriers to effective treatment and
management of depression include: social stigma which may prevent
patients acknowledging that they have depression and need help; a lack
of systematic screening for the general population; patients’ perception
that treating specialists lack the competency and capacity to handle issues
that patients with depression may present with; and poor adherence to
treatment guidelines 9. Alternative models of treatment and management
are therefore urgently required.

Mental health and physical activity among adolescents 45

 1.5 Physical activity and depression?
Physical activity includes any bodily movement produced by the contraction
of skeletal muscle that results in the expenditure of energy 10. Physical activity
includes activities performed predominantly in leisure-time such as organised
sport. It also includes transport-related activity such as walking to work or
school 10.

Physical activity has been shown to have substantial benefits among adults
experiencing symptoms of depression 11. A recent review of the evidence
found 27 observational and 40 intervention studies examining the relationship
between physical activity and depression in adults 12. The review concluded
that even low doses of physical activity can protect against depression, though
moderate and vigorous-intensity physical activity is more effective in reducing
the likelihood of depression than activities of a lighter intensity. Further,
activities performed during leisure-time appear to have greater benefit than
activities performed in other domains such as transport or occupation.

To date, few studies have examined the associations between physical activity
and depression among adolescents, and whether the beneficial effects on
depressive symptoms seen among adults are also evident among younger
people. Findings of the studies are also mixed. Mahoney and colleagues (2002)
found that adolescents who engaged in after-school activities (including sports)
had significantly lower depressed mood scores compared to non-participants 13.
This was supported by Fredericks and Eccles (2006) who found team sports
participation was associated with lower levels of depression 14. In contrast,
several other studies have found no association between participation in
organised extra curricular activities and depression in adolescents 15 - 17.

Whilst these studies have looked at how physical activity may affect depression,
a further question remains; does depression affect physical activity? In other
words, does depression actually lead to a lower likelihood of being physically
active, for example, through reducing motivation? It is also possible that the
association between activity participation and depression is bi-directional 17.
Bohnert and Garber (2007) examined this in a prospective study of adolescents’
participation in organised physical activity and symptoms of depression,
however, no evidence of an association was found in either direction.

Significantly, few studies among adolescents have measured overall physical

activity levels and as such, an accurate measure of the intensity or domain

67 Summary report
 of activity being performed has not been captured. This is an important
limitation, as specific domains (leisure-time) and intensities of activity
(moderate and vigorous) have shown the strongest associations with reduced
depression among adults 12. One study by Desha and colleagues (2007), which
used a self-report measure of physical activity among adolescents, found no
association between self-reported moderate-to vigorous-intensity physical
activity (MVPA) and symptoms of depression. Adolescents also self-reported
their involvement in sporting clubs, and higher involvement was associated
with reduced severity of depressive symptoms among males but not among
females 18. However, the validity and reliability of the measure of physical
activity (self-reported time use diaries) was not reported and the authors
suggest using objective measures to comprehensively capture physical activity
participation.

1.6 Television viewing and depression

Few studies have examined the association between time spent in sedentary
pastimes such as television viewing and mental health, particularly among
young people. Existing evidence, including one study among young Spanish
adults 19, is primarily cross-sectional rather than longitudinal, therefore it is
not known whether high levels of television viewing increase the risk of mental
health disorders such as depression.

High levels of television viewing have been associated with several negative
physical and psychosocial health outcomes among youth. There is evidence of
increased risk of overweight and obesity in children and adolescents who spend
large amounts of time watching television 20. There is also evidence that high
amounts of screen time during adolescence can predict obesity later in life 21.

In addition to the physical health outcomes, Ozmert and colleagues (2002)

examined Turkish children aged approximately eight years and found high
levels of television viewing was significantly correlated with social problems,
and with both aggressive and delinquent behaviour 22. However, whether
television viewing is associated with other psychosocial health outcomes
among youth, such as symptoms of depression, is currently unknown.

1.7 Study aims

In light of the gaps in evidence described above, the aims of this study were:

1. To describe the prevalence and incidence of depression between 2004 and

2006 among a sample of Victorian adolescents;

2. To explore associations between physical activity, organised sport,

television viewing and symptoms of depression at age 14;

3. To examine whether physical activity, organised sport or television

viewing at age 14 predict depressive symptoms at age 16; and

4. To examine whether depressive symptoms at age 14 predict physical

activity, organised sport or television viewing at age 16.

Mental health and physical activity among adolescents 67

 Study design and methods

2.1 Study design

The ‘Children Living in Active Neighbourhoods’ study or ‘CLAN’ involved
follow-up of children participating in the Children’s Leisure Activities Study
(CLASS), which was conducted in 2001. This report contains information
collected from adolescents participating in the CLAN study in 2004 and 2006.

The study involved:

• assessment of depression symptoms of adolescents at 14 years and 16

years of age;

• objective assessment of physical activity at the two timeframes; and

• self-report of organised sport participation and television viewing at

the two timeframes.

Approval to conduct this study was received from the Deakin University
Human Research Ethics Committee, from the Victorian Department of
Education and from the Catholic Education Office. Consent for participation
in the study was provided by the child.

2.2 Study participants

Children were recruited to the CLASS study in 2001 from government primary
schools located in high and low socioeconomic status (SES) suburbs of
metropolitan Melbourne. Ten primary schools in eastern suburbs (high SES)
and nine primary schools in western suburbs (low SES) participated in the
study. Participating children and their families were asked if they wished to be
contacted again for a follow-up study.

Data for the present study was only collected from the older cohort of children
who were adolescents in 2004 and 2006.

89 Summary report
 In 2004, participants were:

• secondary schoolchildren (adolescents) in years 7-10.

In 2006, participants were:

• secondary schoolchildren (adolescents) in years 9-12.

2.3 Objectively-measured physical activity

Adolescents’ physical activity was objectively measured using an accelerometer.
Accelerometers allow researchers to estimate the amount of activity, as well as
the intensity of that activity throughout the day. Adolescents participating in
the CLAN study were requested to wear an MTI Actigraph accelerometer for
eight consecutive days in order to measure their habitual physical activity 23.
These devices were worn on the right hip and measured intensity and duration
of movement in real-time. A formula was then applied to calculate average
minutes per day in moderate-to vigorous-intensity physical activity (MVPA)24.

2.4 Participants survey

Organised sport
Adolescents’ participation in organised sport was examined using a
modified version of the valid and reliable Adolescent Physical Activity Recall
Questionnaire (APARQ) 25, which was incorporated into a survey administered
at school. This questionnaire asks adolescents to list the ‘organised’ sports
or games they usually participated in during summer and winter school
terms. For each activity, adolescents reported the number of times per week
(frequency) with which they participated in this activity and the usual amount
of time they spent performing this activity each time they did it (duration). The
frequency was multiplied by the duration to obtain the total time spent in each
activity per week. This was then summed to indicate the total time (minutes)
spent in organised sport per week.

Television viewing
The survey also included questions about television viewing. Adolescents were
asked to estimate the total time they usually spent watching television and
videos/DVD’s during a typical week.

Symptoms of depression
The survey also contained 20 items from the Center for Epidemiological
Studies Depression Scale for Children (CES-DC) 26, 27. The CES-DC is a valid and
reliable tool for examining symptoms of depression among children and young
people. Adolescents were asked to indicate their agreement with the items that
listed ways they may have felt or acted in the past week, with response options
on a four point scale (‘Not at all’, ‘A little’, ‘Some’ and ‘A lot’).

Mental health and physical activity among adolescents 89

 Some examples of items included in the questionnaire are as follows:

During the past week…

- I was bothered by things that don’t usually bother me

- I felt down and unhappy

- I felt like things I did just didn’t work out right

- I felt lonely, like I didn’t have any friends

- I felt sad

- I didn’t sleep as well as I usually sleep

- It was hard to get started doing things

- I felt like crying

The responses to each of the 20 items were summed to create a scale, with a
score greater than 15 indicating the presence of depressive symptoms 26.

10
11 Summary report
Study findings

3.1 Characteristics of participants

A total of 264 adolescents participated in this component of the CLAN study
in 2004, however, the results presented here are based on a sample of 155
adolescents for whom there was complete information for 2004 and 2006.

As shown in Table 1, in 2004 participants were aged approximately 14 years and

in 2006 approximately 16 years.

Table 1 Mean age of adolescent boys and girls in 2004 and 2006

Boys Girls
n 62 93
Average age (years)
2004 14.5 14,4
2006 16.4 16.2

Mental health and physical activity among adolescents 10

11
3.2 Patterns of physical activity and depressive
symptoms

Key findings:
• Adolescent boys were significantly more active than girls at both
time points in the study.
• Participation in MVPA, including organised sport, declined
significantly over the two years among adolescent boys and girls.
• Time spent viewing television was similar amongst girls and boys
and declined over the two year period of the study.
• At both time points in the study, symptoms of depression were present
in almost 40% of adolescent girls and almost 20% of adolescent boys.
• Eleven percent of boys and 28% of girls showed depressive symptoms
in both 2004 and in 2006.
• Fourteen percent of boys and 13% of girls who did not display
depressive symptoms in 2004 had developed depressive symptoms by
2006.

Physical activity, organised sport and television viewing

Table 2 shows the amount of time spent in moderate-to vigorous-intensity
physical activity (MVPA, minutes/day), in organised sport (minutes/week) and
in television viewing (minutes/week) among adolescent boys and girls in 2004
and 2006.

In both 2004 and 2006, boys spent significantly more time in MVPA compared
to girls. On average, at age 14, boys spent over 100 minutes/day and girls spent
approximately 70 minutes/day. At age 16, boys spent 56 minutes/day and girls
39 minutes/day. These figures show significant declines in MVPA as adolescents
got older, with MVPA almost halving among both boys and girls over the two-
year period.

Adolescents performed between 359 and 394 minutes/week of organised

sport in 2004, and there was no significant difference between boys and girls.
Participation in organised sport declined as adolescents got older, with boys’
participation declining by 130 minutes/week and girls’ declining by 79 minutes/
week over the two-year period.

There was no significant difference in time spent watching television between

boys and girls, however, television viewing time declined significantly over the
two years by approximately three hours/week among girls and approximately
two hours/week among boys.

12
13 Summary report
Table 2. Changes in physical activity, organised sport and television viewing time
among adolescent boys and girls

Boys Girls
n 62 93
MVPA
(Mean, SD mins/day)
2004 ‡ 105.3 (±45.53) 71.1 (±27.99)
2006 § 55.9 (±21.80) 39.2 (±19.04)
Change from 2004 and 2006 -49.4 (±43.79)† -31.9 (±27.68)†
Organised sport
(Mean, SD mins/week)
2004 394.2 (±294.08) 358.5 (±259.40)
2006 263.8 (±198.99) 279.5 (±231.46)
Change from 2004 and 2006 -130.4 (±290.07)a -79.0 (±272.70)a
Television viewing
(Mean, SD mins/week)
2004 836.1 (±424.51) 800.4 (±500.38)
2006 692.7 (±464.09) 611.3 (±383.04)
Change from 2004 and 2006 -143.5 (±482.26)b -189.1 (±425.80)†

‡p≤0.0001 – significant difference in between boys and girls in 2004

§ p≤0.0001 – significant difference between boys and girls in 2006
†p≤0.0001 – significant decline between 2004 and 2006
a p≤.0.001 – significant decline between 2004 and 2006
b p≤.0.05 – significant decline between 2004 and 2006

Symptoms of depression
Table 3 shows the presence of depressive symptoms among CLAN participants.
A score on the CES-DC of 15 or greater indicates the presence of depressive
symptoms 26.

Significantly more girls than boys scored 15 or greater on the scale at both time
points, with almost 40% of girls showing the presence of depressive symptoms in
2004 and again in 2006; compared with approximately 19% and 26% respectively
for boys. The mean score on the CES-DC was approximately 11 (out of a possible
60) among boys and approximately 14 among girls.

Mental health and physical activity among adolescents 12

13
Table 3. Presence of depressive symptoms among adolescent boys and girls

Boys Girls
n 62 93
Depressive symptoms
(% CES-DC score ≥15)
2004* 19.4 37.6
2006 c 25.8 40.9
Depressive symptoms
(mean, SD range 0-42)
2004 11.0 (±6.86) 13.7 (±9.66)
2006 11.8 (±9.18) 14.1 (±8.45)
Change from 2004 and 2006 +0.8 (±8.05) +0.4 (±8.67)

*p≤0.05– significant difference between boys and girls in 2004

cp≤0.1 – non-significant trend for difference between boys and girls in 2006

When individuals’ symptoms of depression were analysed over-time, it was

found that among boys:

• 66% did not show depressive symptoms in 2004 or 2006;

• 8% who showed depressive symptoms in 2004 resolved these

symptoms by 2006;

• 14% who did not show depressive symptoms in 2004 had

developed symptoms by 2006; and

• 11% who showed depressive symptoms in 2004 had maintained

these in 2006.

Among girls:

• 49% did not show depressive symptoms in 2004 or 2006;

• 9% who showed depressive symptoms in 2004 had resolved these

symptoms by 2006;

• 13% who did not show depressive symptoms in 2004 had

developed symptoms by 2006; and

• 28% who showed depressive symptoms in 2004 had maintained

these in 2006.

14
15 Summary report
3.3 Associations between depression and physical
activity, organised sport and television viewing

Key findings:
• No association was found between participation in MVPA,
organised sport and television viewing and the presence of
depressive symptoms.
• Participation in MVPA, organised sport or time spent watching
television at baseline did not predict likelihood of depressive
symptoms at follow-up in 2006.
• Adolescents who reported depressive symptoms in 2004 did
not participate in significantly more or less physical activity or
organised sport at follow-up.
• Girls who reported depressive symptoms in 2004 watched
approximately 168 more minutes of television per week at follow-up
compared with girls who did not report depressive symptoms in 2004.
• Between the ages of 14 and 16 years, physical activity seems to have
little association with the presence of depressive symptoms.

The study examined:

• whether physical activity, organised sport and television viewing

are associated with the presence of depressive symptoms among
adolescents;

• whether physical activity, organised sport and television viewing

predict the presence of depressive symptoms later in adolescence;
and

• whether depressive symptoms predict lower participation in physical

activity and organised sport, and higher levels of television viewing
later in adolescence.

The analyses showed no significant associations between MVPA, organised

sport and television viewing and the presence of depressive symptoms among
boys and girls in 2004 (Figures 1,2,3).

There were also no significant associations between participation in physical

activity, organised sport and television viewing in 2004, and the presence of
depressive symptoms in adolescent boys and girls at follow-up in 2006.

Mental health and physical activity among adolescents 14

15
Figure 1. Physical activity and depressive symptoms in boys and girls in 2004

Not depressed Depressed

Boys

Girls

0 20 40 60 80 100 120
MVPA (mins/day)

Figure 2. Organised sport and depressive symptoms in boys and girls in 2004

Not depressed Depressed

Boys

Girls

0 100 200 300 400 500 600

organised sport (mins/week)

Figure 3. Television viewing and depressive symptoms in boys and girls in 2004

Not depressed Depressed

Boys

Girls

0 100 200 300 400 500 600 700 800 900

TV viewing (mins/week)

16
17 Summary report
 Table 4 shows that girls who reported depressive symptoms at baseline watched
approximately 168 more minutes/week of television at follow-up than girls who
did not report depressive symptoms at baseline. No significant associations
were shown for television viewing among boys or for MVPA or organised sport
among boys or girls.

Table 4. Associations between depressive symptoms in 2004 and physical activity,

organised sport and television (TV) viewing in 2006

Depression
Boys Girls
Beta coefficient 95%CI Beta coefficient 95%CI
MVPA‡
(mins/day) 0.06 -0.23 – 0.36 -0.09 -0.34 – 0.16
Organised
sport†
(mins/week) 0.54 -4.36 – 5.43 0.29 -2.39 – 3.96
TV viewing§
(mins/week) -4.28 -12.30 – 3.75 3.53* 1.27 – 5.79
(~168.5 mins/week)

‡ Analyses were adjusted for MVPA in 2004 and clustering by school

† Analyses were adjusted for organised sport in 2004 and clustering by school
§ Analyses were adjusted for TV viewing in 2004 and clustering by school
*p≤0.01

Mental health and physical activity among adolescents 16

17
 Study conclusions
The CLAN study has been one of the first studies internationally to examine the
prevalence of depressive symptoms longitudinally among a sample of Victorian
adolescents, and to explore associations between physical activity, organised
sport and television viewing and depression.

The study found the prevalence of depression to be particularly high among this
sample of adolescent girls, with over 40% displaying symptoms of depression
(compared with 20% of adolescent boys).

Previous studies have shown that adolescent girls exhibit twice the prevalence
rate of depressive symptoms compared to males in the same age group 28.
Prepubertal boys and girls are equally likely to show depressive symptoms,
however, the high number of females with depressive symptoms arises after the
age of 13 years 29. In the current study, tracking of individuals over the two year
period found that 28% of girls showed depressive symptoms in both 2004 and
in 2006, and 13% of girls who did not display depressive symptoms in 2004 had
developed depressive symptoms by 2006. Another study of 1,176 adolescents
found that nearly 40% of adolescents reported continued depressive symptoms
over a four year period, with much higher proportions of girls than boys
reporting depressive symptoms 8.

The study found no significant associations between the physical activity

variables and the presence of depressive symptoms in adolescents. However,
girls with depressive symptoms in 2004 reported significantly higher TV viewing
in 2006. One possible explanation for this finding is that adolescent girls
with depressive symptoms may withdraw from social activities 30, preferring
more solitary pursuits such as TV viewing. Additionally, specific symptoms
of depression (e.g. feeling tired; finding it hard to initiate activities) may also
explain higher levels of TV viewing in these girls 27.

Studies of adults suggest physical activity may protect against depression 27;
but the current study does not support this among adolescents. There are a
number of possible explanations for this. Firstly, the number of participants

18
19 Summary report
in the study with complete data was small, with the final sample reduced
to 155 adolescents. This may have influenced the power of the analyses
to detect associations between depressive symptoms and MVPA, and
organised sport. Secondly, during adolescence, MVPA is likely to be
strongly influenced by a number of factors external to the adolescent,
for example mandatory physical education, which may be less likely
to influence individuals’ mental health than voluntary participation in
physical activity. Another factor that future research may need to consider
is the social element of physical activity (such as spending time with
friends), which may be particularly important for adolescents. It is also
important to acknowledge that there are multidimensional causes of
depression in children/adolescents such as emotional and/or social issues 31
which may interact with physical activity to influence the onset/presence of
depression.

A possible limitation of the study lies in the use of the CES-DC scale. The
cut point of 15 on the CES-DC used to indicate the presence of depressive
symptoms is somewhat arbitrary and scores one or two above or below this
point may not necessarily indicate the presence or absence of depressive
symptoms 26.

A further limitation was that accelerometers were worn for just one week on
two occasions, two years apart, and this may not represent habitual physical
activity for the participants involved. In addition, the accelerometer data
does not enable the authors to distinguish, leisure time physical activity
from other forms of physical activity. This may be significant given that
the adult literature specifically identifies leisure-time physical activity as
important for protecting against depressive symptoms.

Physical activity appears to have little association with depressive

symptoms among adolescents in this sample, but girls with depressive
symptoms in early adolescence had increased TV viewing two years later.
This suggests that a range of different factors may be more important
in adolescents, including social and emotional factors which were not
examined in this study.

It is evident that the findings from adult studies cannot necessarily be

extrapolated to adolescents, and that future research efforts should be
directed to understanding the complex influences on adolescent health so
that appropriate action can be taken.

Mental health and physical activity among adolescents 18

19
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21
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Further references
Carver A, Salmon J, Campbell K, Baur L, Garnett S, Crawford D. How do
perceptions of local neighborhood relate to adolescents' walking and cycling?
American Journal of Health Promotion. 2005;20(2):139-47.
Davison KK, Lawson CT. Do attributes in the physical environment influence
children's physical activity? A review of the literature. International Journal of
Behavioral Nutrition and Physical Activity. 2006;319.
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and correlates of walking and bicycling to school. Archives of Pediatric and
Adolescent Medicine. 2003;157(9):887-92.
Hume C, Salmon J, Ball K. Associations of children's perceived neighborhood
environments with walking and physical activity. American Journal of Health
Promotion. 2007;21(3):201-7.
Saelens B, Sallis J, Frank L. Environmental correlates of walking and cycling:
Findings from the transportation, urban design, and planning literature.
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Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity
of children and adolescents. Medicine and Science in Sports and Exercise.
2000;32(5):963-75.
Salmon J, Salmon L, Crawford D, Hume C, Timperio A. Associations among
individual, social and environmental barriers and children's walking or cycling
to school. American Journal of Health Promotion. 2007;22(2):107-13.
Salmon J, Telford A, Crawford D. The Children's Leisure Activities Study (CLASS).
Summary Report. Melbourne: Centre for Physical Activity and Nutrition
Research, Deakin University; 2004.
Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, Baur
LA, Crawford D. Personal, family, social, and environmental correlates of
active commuting to school. American Journal of Preventive Medicine.
2006;30(1):45-51.
Timperio A, Crawford D, Telford A, Salmon J. Perceptions about the local
neighborhood and walking and cycling among children. Preventive Medicine.
2004;38(1):39-47.

22 Summary report
 Mental health
and Mental health
and physical activity
physical activity
among
adolescents
among adolescents

Summary report

Centre for Physical Activity and Nutrition Research

Summary report Jenny Veitch

Clare Hume

Anna Timperio

Kylie Ball

Jo Salmon

David Crawford