Leisure-time sedentary behavior and loneliness among 148,045 adolescents aged 12–15 years from 52 low- and middle-income countries

Highlights

• Sedentary behavior and loneliness are highly prevalent among school going adolescents in low and middle income countries.

• Being sedentary for ≥8h/day is associated with a twice as high risk for feeling lonely compared to being sedentary for <1h/day.

• Future longitudinal data are required to confirm/refute the findings to inform public health campaigns.

Abstract

Background

Loneliness is widespread in adolescents and associated with a myriad of adverse physical and mental health outcomes. Exploring variables associated with loneliness is important for the development of targeted interventions. The aim of the current study was to explore associations between leisure-time sedentary behavior (LTSB) and loneliness in adolescents from 52 low- and middle-income countries.

Methods

Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month self-perceived loneliness and LTSB were collected. Multivariable logistic regression and meta-analysis were conducted to assess the associations.

Results

Among 148,045 adolescents (mean age 13.7± SD 1.0 years; 48.5% female), the prevalence of loneliness increased from 8.7% among those with 1–2 h/day of LTSB to 17.5% among those spending >8 h/day sedentary. Compared to those who engage in less than 1 h of LTSB per day, the OR (95%CI) of loneliness for 1–2 h/day, 3–4 h/day, 5–8 h/day and >8 h/day were 1.00 (0.91–1.11), 1.29 (1.15–1.45), 1.37 (1.17–1.61), and 1.66 (1.39–1.99), respectively.

Limitations

The study is cross-sectional, therefore the directionality of the relationships cannot be deduced.

Conclusions

Our data suggest that LTSB is associated with increased odds for feeling lonely in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public health campaigns.

Introduction

Loneliness is defined as the discrepancy between a person's desired and actual social relationships (Perlman and Peplau, 1981). It has been associated with a myriad of adverse physical and mental health outcomes in adulthood including premature mortality (odds ratio = 1.26, 95% confidence interval = 1.04–1.53) (Holt-Lunstad et al., 2015). Contrary to common stereotypes, loneliness is not restricted to middle-aged or older people, but can occur at any life stage, even in early adolescence (Luhmann and Hawkley, 2016). Indeed, the prevalence of loneliness in adolescents aged 13 to 15 years has been reported to range from 5.2 to 14.7% (Stickley et al., 2016). Although evidence regarding the adverse health outcomes of loneliness in adolescence is limited compared to older adults (Choi and Matz-Costa, 2017, Neergheen et al., 2019), there is preliminary evidence that loneliness is already in this life stage associated with a variety of negative mental and physical health outcomes. In the only study to date, the Social and Health Assessment (SAHA) survey which included 2205 Czech, 1995 Russian, and 2050 US male and female adolescents aged 13 to 15 years old, adolescents who were lonely had a higher odds for reporting anxiety (with odds ratios ranging from 1.63 in Russian male to 5.49 in US male adolescents) and depressive symptoms (with odds ratios ranging from 10.65 in Czech female to 40.13 in US female adolescents) (Stickley et al., 2016). Loneliness was also associated with somatic symptoms such as headaches and pain in at least half of the adolescents (Stickley et al., 2016). The underlying mechanisms for the higher risk for mental and physical health problems in adolescents who feel lonely remain entirely unclear (Cacioppo and Patrick, 2008). In adults, several psychobiological processes including neuroendocrine dysregulation and exaggerated blood pressure and inflammatory reactivity to acute stress (Brown et al., 2018) have been suggested. It is also possible that poorer health behaviors might be central to the association between loneliness and mental and physical health problems in adolescents (Stickley et al., 2016). For example, a recent study showed that adolescent loneliness is linked to different forms of substance use (Stickley et al., 2014), while previous research has demonstrated an association between adolescent alcohol and drug use and somatic symptoms and mental health problems (Center on Addiction, 2011).

One health behavior which has rarely been studied in relation to loneliness is sedentary behavior (i.e., any behavior during waking hours with energy expenditure less than or equal to 1.5 metabolic equivalents while in a sitting or reclining posture (Cart, 2012)). There is now evidence that adolescent sedentary behavior is, independent from physical activity levels, associated with physical and mental disease risk (de Oliveira and Guedes, 2016, Farren et al., 2018, Raudsepp and Vink, 2019, Schuch et al., 2017, Wu et al., 2017). More in detail, more time spent sedentary is in adolescents associated with a higher risk for developing depressive symptoms (Edwards and Loprinzi, 2016), which on its turn are a risk factor for loneliness (Mullarkey et al., 2018). Thus, if loneliness is associated with increasing time spent sedentary, this information may provide clues on the mechanisms that link loneliness with adverse health outcomes.

The current evidence in adolescents comes from a few studies in Western countries and concluded that there is insufficient evidence for an association between time spent in specific sedentary behaviors and loneliness (Hoare et al., 2016). One study on 261 adolescents between 12 and 16 years from suburban California public schools found no significant associations between loneliness and total daily average time spent talking on the phone, watching TV and using the Internet (Gross, 2004), while another Australian study on 336 young people aged between 15 and 21 years from a secondary school and a university population reported no significant associations with time spent online (categorized by time spent communicating, entertainment purposes, or information-related activities) (Donchi and Moore, 2004). Both studies were however conducted before the social media era. Also, the sample size was small and may not have been sufficiently powered to detect a statistical difference. Another gap in the literature is that evidence from low and middle-income countries (LMICs) is currently entirely lacking. Exploring associations between loneliness and sedentary behavior with a focus on LMICs is important given different sociocultural attitudes towards sedentary behavior (e.g., a sign of wealth), different access to devices (e.g., television, computers) and different environmental factors (e.g., safety, climate) in LMICs compared with high-income countries (Arat and Wong, 2017).

Given the current gaps in the literature, the aim of the current study was to assess the association between loneliness and LTSB in adolescents using data from 52 LMICs from six World Health Organization regions (African Region, Region of the Americas, Eastern Mediterranean Region, European Region, South-East Asia Region, and Western Pacific Region).