不同类型屏幕时间与3~6岁儿童心理行为发育问题的相关性

黄金娇; 叶佩琪; 魏倩; 吕萍萍; 石宇阳; 史慧静

doi:10.16835/j.cnki.1000-9817.2023.12.016

不同类型屏幕时间与3~6岁儿童心理行为发育问题的相关性

doi: 10.16835/j.cnki.1000-9817.2023.12.016

复旦大学公共卫生学院妇幼与儿少卫生教研室，上海 200032

基金项目:

上海市第六轮加强公共卫生体系建设重点学科建设项目 GWVI-11.1-32

详细信息

作者简介:
黄金娇(1998-)，女，江苏镇江人，在读硕士，主要研究方向为学校卫生与青少年健康

通讯作者:
史慧静，E-mail：hjshi@fudan.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: B844.1 G78 F764.6
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出版历程
- 收稿日期: 2023-08-07
- 修回日期: 2023-10-12
- 网络出版日期: 2023-12-26
- 刊出日期: 2023-12-25

Association of screen time with psychological and behavioral development problems in children aged 3-6 years

Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai (200032), China

摘要

摘要: 目的探讨3~6岁儿童各类型电子屏幕使用时间及其与心理行为发育问题的关联，为儿童屏幕使用和心理健康促进提供科学依据。方法以上海亲子队列中完成3~6岁随访的3 875对母子为研究对象，问卷调查儿童每日平板、手机、电视、投影及其他类型屏幕使用时间，使用年龄-发育进程问卷(ASQ-3)和长处与困难问卷(家长版)(SDQ)评价儿童心理行为发育问题。采用χ²检验、Mann-Whitney U和Kruskal-Wallis秩和检验比较不同特征儿童心理行为发育问题检出率和屏幕时间，多因素二元Logistic回归分析屏幕时间与心理行为发育问题的关联。结果 49.91%的儿童每天屏幕时间超过1 h，电视、平板、手机屏幕时间分别为0.39(0.25，0.96)、0.25(0，0.61)、0.18(0，0.25)h/d。男童精细动作、解决问题、个人-社会能区可疑发育迟缓以及存在亲社会行为不足和外化行为的检出率(8.54%，6.77%，5.46%，30.07%，27.39%)均高于女童(4.64%，4.85%，2.48%，22.10%，22.36%)(χ²值分别为23.76，6.49，22.37，31.81，13.06，P值均 < 0.05)。不同父母文化程度儿童沟通、精细动作和解决问题能区可疑发育迟缓以及存在内化行为和外化行为的检出率差异有统计学意义(χ²值分别为14.37，15.18，21.10，11.66，9.27；16.34，26.75，32.89，16.97，6.37，P值均 < 0.05)；母亲孕期是否有焦虑/抑郁症状的儿童解决问题能区可疑发育迟缓以及存在亲社会行为不足、内化行为和外化行为的检出率差异有统计学意义(χ²值分别为5.61，9.05，21.90，7.17；8.75，6.06，12.76，5.55，P值均 < 0.05)。男童总屏幕时间多于女童(1.07，1.00 h/d，Z=-2.08，P=0.04)。父母大学及以上文化程度的儿童总屏幕时间、手机和电视屏幕时间相比父母其他文化程度的儿童更短(父亲：H值分别为42.01，44.49，21.24；母亲：H值分别为42.31，39.21，26.47，P值均 < 0.01)。各类屏幕时间中，手机屏幕时间影响心理行为发育最多；调整模型后，儿童手机屏幕时间增加，能区可疑发育迟缓、情绪行为异常风险增加(P值均 < 0.05)；平板、手机、电视屏幕时间与外化行为均呈正相关(OR值分别为1.36，1.57，1.27，P值均 < 0.05)。结论儿童屏幕时间与心理行为发育问题的发生风险呈正相关，以手机屏幕时间的影响最为显著。家长应当限制儿童的屏幕时间，避免屏幕时间过长影响心理行为发育。
- 注视，眼 /
- 时间 /
- 精神卫生 /
- 回归分析 /
- 儿童，学龄前
Abstract: Objective To investigate the distribution of various types of screen time and examine the association of screen time with psychological and behavioral development problems in children aged 3-6 years, so as to provide scientific basis for children's screen use and mental health promotion. Methods A total of 3 875 mother-child dyads who completed the follow-up in Shanghai Maternal-Child Pairs Cohort were included. The daily usage time of children's tablet, mobile phone, TV, projectors, and other types of screens were obtained in questionnaire survey. Children's psychological and behavioral development problems were evaluated by Age-Stage Questionnaire, Third Edition (ASQ-3) and Strengths and Difficulties Questionnaire (Parent version) (SDQ). The Chi-square test, Mann-Whitney U and Kruskal-Wallis rank sum test were used to compare the detection rate of psychological and behavioral development problems and screen time in children with different characteristics. Multivariate binary Logistic regression was used to analyze the association of screen time with psychological and behavioral development problems. Results There were 49.91% of children having screen time more than 1 h/d. Children's TV, tablet and mobile phone screen time were 0.39(0.25, 0.96), 0.25(0, 0.61) and 0.18(0, 0.25) h/d. The detection rates of suspected developmental delay in fine motor, problem-solving and personal-social domains and pro-social behavior deficiency and externalizing behaviors in boys (8.54%, 6.77%, 5.46%, 30.07%, 27.39%) were higher than that in girls (4.64%, 4.85%, 2.48%, 22.10%, 22.36%) (χ²=23.76, 6.49, 22.37, 31.81, 13.06, P < 0.05). There were statistically significant differences in the detection rates of suspected developmental delay in communication, fine motor and problem-solving, as well as internalizing behavior and externalizing behavior of children with different parents' educational levels (χ²=14.37, 15.18, 21.10, 11.66, 9.27; 16.34, 26.75, 32.89, 16.97, 6.37, P < 0.05). There were significant differences in the detection rates of suspected developmental delay in problem-solving, prosocial behavior deficiency, internalizing behavior and externalizing behavior of children whose mothers had anxiety/depression symptoms during pregnancy (χ²=5.61, 9.05, 21.90, 7.17; 8.75, 6.06, 12.76, 5.55, P < 0.05). The average total screen time of boys was longer than that of girls (1.07, 1.00 h/d, Z=-2.08, P=0.04). Compared with children with other educational levels of their parents, the total screen time, mobile phone and TV screen time of children whose parents had college education or above were short (father: H=42.01, 44.49, 21.24, mother: H=42.31, 39.21, 26.47, P < 0.01). Among all types of screen time, mobile phone screen time had the most impact on psychological and behavioral development. More mobile phone screen time increased the risk of suspected developmental delay and abnormal emotional behavior (P < 0.05). Screen time of tablet, mobile phone and TV were positively correlated with externalizing behavior (OR=1.36, 1.57, 1.27, P < 0.05). Conclusions Screen time is related to children's psychological and behavioral development problems and mobile phones affect the most. Parents should limit their children's screen time to avoid excessive screen time affecting their psychological and behavioral development.
- Fixation, ocular /
- Time /
- Mental health /
- Regression analysis /
- Child, preschool
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表 1 不同特征儿童心理行为发育问题检出率比较

Table 1. Comparison of detection rates of psychological and behavioral development problems in children with different characteristics

特征	选项	人数	统计值	沟通能区可疑发育迟缓	粗大动作能区可疑发育迟缓	精细动作能区可疑发育迟缓	解决问题能区可疑发育迟缓	个人-社会能区可疑发育迟缓	亲社会行为不足	存在内化行为	存在外化行为
性别	男	1 979		77(3.89)	133(6.72)	169(8.54)	134(6.77)	108(5.46)	595(30.07)	554(27.99)	542(27.39)
	女	1 896		57(3.01)	108(5.70)	88(4.64)	92(4.85)	47(2.48)	419(22.10)	492(25.95)	424(22.36)
			χ²值	2.27	1.74	23.76^*	6.49^*	22.37^*	31.81^*	2.05	13.06^*
双胞胎	是	98		5(5.10)	11(11.22)	7(7.14)	8(8.16)	7(7.14)	25(25.51)	30(30.61)	23(23.47)
	否	3 777		129(3.42)	230(6.09)	250(6.62)	218(5.77)	148(3.92)	989(26.18)	1 016(26.90)	943(24.97)
			χ²值	0.81	4.32^*	0.04	1.00	2.59	0.02	0.67	0.11
分娩方式	顺产	1 717		55(3.20)	112(6.52)	102(5.94)	89(5.18)	68(3.96)	443(25.80)	456(26.56)	425(24.75)
	剖宫产	2 158		79(3.66)	129(5.98)	155(7.18)	137(6.35)	87(4.03)	571(26.46)	590(27.34)	541(25.07)
			χ²值	0.60	0.49	2.38	2.36	0.01	0.22	0.30	0.05
出生胎龄/周	< 37	174		8(4.60)	19(10.90)	16(9.20)	15(8.60)	12(6.90)	49(28.20)	52(29.90)	57(32.80)
	≥37	3 701		126(3.40)	222(6.00)	241(6.50)	211(5.70)	143(3.90)	965(26.10)	994(26.90)	909(24.60)
			χ²值	0.71	6.90^*	1.93	2.58	3.98^*	0.38	0.77	5.97^*
每天夜间睡眠/h	< 8	13		2(15.38)	3(23.08)	2(15.38)	3(23.08)	3(23.08)	3(23.08)	6(46.15)	6(46.15)
	≥8	3 862		132(3.42)	238(6.16)	255(6.60)	223(5.77)	152(3.94)	1 011(26.18)	1 040(26.93)	960(24.86)
			χ²值	5.56^*	6.36^*	1.61	7.06^*	12.36^*	0.06	2.43	3.14
每天身体活动/h	< 1	2 743		108(3.94)	174(6.34)	184(6.71)	175(6.38)	120(4.37)	761(27.74)	796(29.02)	711(25.92)
	1~ < 2	1 085		26(2.40)	65(5.99)	71(6.54)	51(4.70)	34(3.13)	242(22.30)	243(22.40)	244(22.49)
	≥2	47		0	2(4.26)	2(4.26)	0	1(2.13)	11(23.40)	7(14.89)	11(23.40)
			χ²值	a^*	0.48	0.47	a^*	3.55	12.09^*	20.84^*	4.95
家庭人均月收入/元	< 4 500	476		28(5.88)	35(7.35)	36(7.56)	35(7.35)	18(3.78)	144(30.25)	159(33.40)	146(30.67)
	4 500~7 500	1 139		44(3.86)	84(7.37)	84(7.37)	73(6.41)	46(4.04)	291(25.55)	332(29.15)	292(25.64)
	>7 500	2 260		62(2.74)	122(5.40)	137(6.06)	118(5.22)	91(4.03)	579(25.62)	555(24.56)	528(23.36)
			χ²值	12.40	6.27^*	2.87	4.23	0.07	4.69	19.41^*	19.41^*
父亲文化程度	初中及以下	209		14(6.70)	18(8.61)	19(9.09)	21(10.05)	10(4.78)	50(23.92)	66(31.58)	54(25.84)
	高中/中专/大专	1 923		78(4.06)	131(6.81)	152(7.90)	134(6.97)	88(4.58)	511(26.57)	555(28.86)	518(26.94)
	大学及以上	1 743		42(2.41)	92(5.28)	86(4.93)	71(4.07)	57(3.27)	453(25.99)	425(24.38)	394(22.60)
			χ²值	14.37^*	5.86	15.18^*	21.10^*	4.42	0.74	11.66^*	9.27^*
父亲职业	无业/设备操作/军人	752		39(5.19)	69(9.18)	68(9.04)	62(8.24)	42(5.59)	204(27.13)	231(30.72)	199(26.46)
	商业、服务业	1 043		35(3.36)	73(7.00)	68(6.52)	63(6.04)	44(4.22)	290(27.80)	284(27.23)	262(25.12)
	专业技术人员	1 362		41(3.01)	64(4.70)	82(6.02)	65(4.77)	48(3.52)	352(25.84)	360(26.43)	344(25.26)
	机关/企业/事业单位	718		19(2.65)	35(4.87)	39(5.43)	36(5.01)	21(2.92)	168(23.40)	171(23.82)	161(22.42)
			χ²值	9.00^*	19.98^*	9.57^*	11.71^*	8.02^*	4.73	9.22^*	3.45
母亲文化程度	初中及以下	229		17(7.42)	26(11.35)	27(11.79)	24(10.48)	14(6.11)	71(31.00)	75(32.75)	59(25.76)
	高中/中专/大专	1 802		70(3.88)	128(7.10)	144(7.99)	134(7.44)	79(4.38)	484(26.86)	528(29.30)	481(26.69)
	大学及以上	1 844		47(2.55)	87(4.72)	86(4.66)	68(3.69)	62(3.36)	459(24.89)	443(24.02)	426(23.10)
			χ²值	16.34^*	19.89^*	26.75^*	32.89^*	5.31^*	4.77	16.97^*	6.37^*
孕期焦虑	否	3 415		114(3.34)	204(5.97)	219(6.41)	188(5.51)	133(3.89)	867(25.39)	880(25.77)	828(24.25)
	是	460		20(4.35)	37(8.04)	38(8.26)	38(8.26)	22(4.78)	147(31.96)	166(36.09)	138(30.00)
			χ²值	1.24	2.98	2.24	5.61^*	0.83	9.05^*	21.90^*	7.17^*
孕期抑郁	否	3 412		106(3.11)	204(5.98)	210(6.15)	185(5.42)	131(3.84)	871(25.53)	889(26.06)	830(24.33)
	是	463		28(6.05)	37(7.99)	47(10.15)	41(8.86)	24(5.18)	143(30.89)	157(33.91)	136(29.37)
			χ²值	10.56^*	2.83	10.52^*	8.75^*	1.92	6.06^*	12.76^*	5.55^*
孕期烟草暴露	是	2 192		68(3.10)	125(5.70)	134(6.11)	117(5.34)	79(3.60)	570(26.00)	590(26.92)	523(23.86)
	否	1 683		66(3.92)	116(6.89)	123(7.31)	109(6.48)	76(4.52)	444(26.38)	456(27.09)	443(26.32)
			χ²值	1.92	2.31	2.20	2.25	2.06	0.07	0.02	3.09
母亲分娩年龄/岁	< 30	2 267		74(3.26)	142(6.26)	151(6.66)	127(5.60)	87(3.84)	612(27.00)	663(29.25)	627(27.66)
	≥30	1 608		60(3.73)	99(6.16)	106(6.59)	99(6.16)	68(4.23)	402(25.00)	383(23.82)	339(21.08)
			χ²值	0.62	0.02	0.01	0.53	0.38	1.94	14.06^*	21.74^*
母乳喂养时长/月	< 6	846		39(4.61)	63(7.45)	56(6.62)	57(6.74)	35(4.14)	246(29.08)	236(27.90)	217(25.65)
	6~ < 12	1 681		53(3.15)	99(5.89)	113(6.72)	85(5.06)	72(4.28)	460(27.36)	453(26.95)	425(25.28)
	≥12	1 348		42(3.12)	79(5.86)	88(6.53)	84(6.23)	48(3.56)	308(22.85)	357(26.48)	324(24.04)
			χ²值	4.30	2.80	0.05	3.50	1.07	12.64^*	0.53	0.92
注： ()内数字为检出率/%；*P＜0.05；a Fisher精确概率检验。

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表 2 不同组别儿童各类屏幕时间比较/(h·d^-1)

Table 2. Comparison of screen time among children with different groups/(h·d^-1)

组别	选项	人数	总屏幕时间			平板屏幕时间			手机屏幕时间			电视屏幕时间
组别	选项	人数	M(P₂₅，P₇₅)	Z/H值	P值	M(P₂₅，P₇₅)	Z/H值	P值	M(P₂₅，P₇₅)	Z/H值	P值	M(P₂₅，P₇₅)	Z/H值	P值
性别	男	1 979	1.07(0.64, 1.89)	-2.08	0.04	0.25(0, 0.61)	-0.22	0.83	0.07(0, 0.25)	-1.79	0.07	0.39(0.25, 0.96)	-3.55	< 0.01
	女	1 896	1.00(0.61, 1.75)			0.25(0, 0.61)			0.18(0, 0.25)			0.39(0.25, 0.75)
双胞胎	是	98	1.21(0.75, 1.97)	-1.84	0.07	0.25(0, 0.61)	-0.20	0.84	0.25(0, 0.25)	-0.71	0.48	0.61(0.25, 0.96)	-1.17	0.24
	否	3 777	1.00(0.63, 1.79)			0.25(0, 0.61)			0.07(0, 0.25)			0.39(0.25, 0.96)
母亲文化程度	初中及以下	229	1.25(0.75, 2.20)	42.31	< 0.01	0.07(0, 0.39)	11.36	< 0.01	0.25(0, 0.39)	39.21	< 0.01	0.54(0.25, 0.96)	26.47	< 0.01
	高中/中专/大专	1 802	1.14(0.71, 1.89)			0.25(0, 0.61)			0.25(0, 0.25)			0.39(0.25, 0.96)
	大学及以上	1 844	1.00(0.50, 1.71)			0.25(0, 0.61)			0.07(0, 0.25)			0.39(0.25, 0.75)
父亲文化程度	初中及以下	209	1.25(0.71, 2.21)	42.01	< 0.01	0.07(0, 0.61)	6.78	0.03	0.25(0, 0.61)	44.49	< 0.01	0.61(0.25, 0.96)	21.24	< 0.01
	高中/中专/大专	1 923	1.14(0.71, 1.90)			0.25(0, 0.61)			0.21(0, 0.25)			0.39(0.25, 0.96)
	大学及以上	1 743	0.96(0.50, 1.64)			0.25(0, 0.54)			0.07(0, 0.25)			0.39(0.25, 0.75)
父亲职业	无业/设备操作/军人	752	1.21(0.71, 1.95)	15.07	< 0.01	0.25(0, 0.61)	0.33	1.00	0.25(0, 0.39)	23.48	< 0.01	0.39(0.25, 0.96)	10.83	0.01
	商业、服务业	1 043	1.04(0.64, 1.79)			0.25(0, 0.61)			0.07(0, 0.25)			0.39(0.25, 0.96)
	专业技术人员	1 362	1.00(0.61, 1.75)			0.25(0, 0.61)			0.07(0, 0.25)			0.39(0.25, 0.75)
	机关/企业/事业单位	718	1.00(0.50, 1.75)			0.25(0, 0.61)			0.07(0, 0.25)			0.39(0.25, 0.75)
家庭人均月	< 4 500	476	1.12(0.69, 1.89)	10.49	0.01	0.25(0, 0.61)	0.72	0.70	0.25(0, 0.25)	12.51	< 0.01	0.39(0.25, 0.96)	3.50	0.17
收入/元	4 500~7 500	1 139	1.14(0.64, 1.86)			0.25(0, 0.61)			0.21(0, 0.25)			0.39(0.25, 0.96)
	>7 500	2 260	1.00(0.57, 1.75)			0.25(0, 0.39)			0.07(0, 0.25)			0.39(0.25, 0.96)
每天夜间睡眠/h	< 8	13	1.11(0.64, 1.82)	-2.25	0.03	0.25(0, 0.61)	-1.96	0.05	0.18(0, 0.25)	-1.94	0.05	0.39(0.25, 0.96)	-1.47	0.14
	≥8	3 862	1.00(0.61, 1.75)			0.25(0, 0.54)			0.07(0, 0.25)			0.39(0.25, 0.75)
每天身体活动/h	< 1	2 743	1.00(0.64, 1.79)	5.16	0.08	0.25(0, 0.61)	0.35	0.84	0.18(0, 0.25)	4.10	0.13	0.39(0.25, 0.96)	2.67	0.26
	1~ < 2	1 085	1.04(0.61, 1.79)			0.25(0, 0.54)			0.07(0, 0.25)			0.39(0.25, 0.96)
	≥2	47	1.50(0.82, 2.25)			0.25(0, 0.61)			0.25(0, 0.75)			0.61(0.25, 1.25)

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表 3 儿童各类屏幕时间与心理行为发育问题的多因素二元Logistic回归分析[OR值(95%CI)]

Table 3. Multivariate binary Logistic regression analysis of screen time and psychological and behavioral development problems among children[OR(95%CI)]

自变量	能区可疑发育迟缓					SDQ
自变量	沟通	粗大动作	精细动作	解决问题	个人-社会	亲社会行为	内化行为	外化行为
总屏幕时间	1.19(1.04~1.35)^*	1.17(1.06~1.30)^*	1.23(1.11~1.35)^*	1.19(1.07~1.32)^*	1.30(1.16~1.46)^*	1.08(1.02~1.15)^*	1.17(1.10~1.25)^*	1.29(1.22~1.38)^*
平板屏幕时间	1.06(0.79~1.43)	0.98(0.78~1.25)	0.99(0.79~1.24)	0.90(0.70~1.17)	1.20(0.92~1.56)	1.01(0.89~1.16)	1.20(1.06~1.35)^*	1.36(1.20~1.54)^*
手机屏幕时间	1.44(1.03~2.01)^*	1.71(1.35~2.17)^*	1.41(1.10~1.81)^*	1.74(1.36~2.22)^*	1.64(1.22~2.18)^*	1.26(1.07~1.48)^*	1.50(1.28~1.76)^*	1.57(1.34~1.85)^*
电视屏幕时间	1.23(0.97~1.55)	1.11(0.93~1.34)	1.42(1.21~1.68)^*	1.28(1.07~1.53)^*	1.39(1.13~1.71)^*	1.05(0.94~1.17)	1.09(0.98~1.21)	1.27(1.14~1.41)^*
注：自变量屏幕时间为连续变量，因变量心理行为发育问题为二分类变量，以正常发育组为参照；调整母亲孕期焦虑/抑郁、孕期烟草暴露、分娩方式、母亲分娩年龄、母乳喂养时长、父母文化程度、家庭收入、性别、儿童的年龄、夜间睡眠、身体活动；*P < 0.05。

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