From Screen to Green: Nature as an Upstream Determinant of Psychological Well-being for Young People in a High-Tech Era

Abstract

Background Mental health problems are the leading cause of reduced quality of life among young people globally, and prevalence is increasing. From a public health perspective, it is important to prevent mental illness and promote mental well-being in young people, given this is a developmental period which can determine an individuals’ mental health trajectory across the lifespan. Identifying and addressing risk and protective factors for youth mental health is central in achieving this. While a plethora of determinants of youth mental health exist, two trends which characterise contemporary youth as markedly different from previous generations have been postulated to partially explain observed increases in mental illness among young people. These two trends are: (1) significant increases in the time young people spend engaged with screen-based technologies (increased “screen time”), and (2) significant decreases in young people’s contact with nature (decreased “green time”). Screen time and green time have been identified as relevant and important activities by young people themselves, as well as parents, educators, and health professionals. Aims 1. To critically review the existing literature looking at the relationships between screen time, green time, and psychological outcomes (including mental health, cognitive functioning, and academic achievement) in children and adolescents 2. To explore potential risk and protective factors for the mental health of young Australians (including screen time and green time) in the context of the COVID-19 pandemic 3. To explore mechanisms and pathways underpinning associations between screen time and psychological well-being in young people, paying attention to neurological, cognitive, and social developments experienced in adolescence 4. To investigate the acute psychological impacts of screen time for adolescents, and to explore the restorative (or “buffering”) potential of nature immersion. Methods A public health psychology research approach, capitalising on the strengths afforded by epidemiology and psychology, was employed to address the research aims. Four studies were conducted, using the following methods: 1. A systematic scoping review was conducted to collate and critically review the existing literature looking at the relationships between screen time, green time, and psychological outcomes in children and adolescents 2. An online national cross-sectional study was used to explore potential risk and protective factors relevant to young Australians in the context of the COVID-19 pandemic, drawing on the Complete State Model of Mental Health which considers indicators of mental wellbeing in addition to symptoms of mental illness 3. A theoretical paper, including a conceptual model, was developed to present an integrated synthesis of literature on the theme of contemporary digital technology use and mental health in the context of adolescent development, with a specific focus on the role of selfregulation 4. A randomised pre-post pilot study was undertaken to investigate the short-term impacts of screen time on psychological outcomes in adolescents, and to explore the restorative potential of nature immersion. Results In the systematic scoping review, 186 eligible studies were identified. The majority of included studies were cross-sectional (62%). In general, high levels of screen time were associated with unfavourable psychological outcomes while green time was associated with favourable psychological outcomes. Underlying mechanisms and pathways were poorly articulated in the literature and additional high-quality studies with a longitudinal or experimental component are needed. Evidence suggested that young people from disadvantaged backgrounds may be disproportionately affected by high screen time and low green time, meaning future research should prioritise youth from low socioeconomic backgrounds. This review also highlighted the importance of considering the way in which specific screen-based technologies and green time exposures affect children and adolescents of diverse ages, depending on social and biological factors unique to their developmental stage of life. Few studies considered screen time and green time together and possible reciprocal psychological effects. There was preliminary evidence that green time could “buffer” consequences of high screen time, but more robust evidence is needed to support this premise. Just over 1,000 young Australians living in metropolitan areas participated in the online cross-sectional study. Using the Complete State Model of Mental Health, participants were cross-classified into four mental health states according to their relative proportion of mental well-being and mental illness symptoms. The best mental health state was “Flourishing”, which was characterised by high levels of mental well-being alongside no-to-mild mental illness symptoms. Contrastingly, the worst mental health state was “Floundering”, characterised by low levels of mental well-being alongside moderate-to-severe mental illness symptoms. The two intermediary mental health states were “Languishing” (low levels of mental well-being alongside no-to-mild mental illness symptoms) and “Struggling” (high levels of mental well-being alongside moderate-to-severe mental illness symptoms). Important sociodemographic factors such as age, gender, area-level socioeconomic status, and employment status were adjusted for in analyses. According to the results, using screen time to connect with family and friends during COVID-19 lockdowns was associated with Flourishing mental health, while those who experienced screen fatigue and withdrew from tech-communications were more likely to be Floundering or Struggling, emphasising the important role of technology during the pandemic. Reporting increased contact with nature during lockdowns, living in a green/natural neighbourhood, having access to a private outdoor space, and living within walking distance of a green or bluespace (e.g., lake) were protective of mental health during the pandemic, highlighting the benefits of urban green infrastructure for mental health “in place”. The sample used for this study was not a random representative sample, meaning reliable prevalence estimates could not be provided; however, quota sampling was used to recruit a sample which was diverse and well distributed across the spectrum of socioeconomic status. While a substantial body of literature has demonstrated associations between extensive screen time and poor mental health for adolescents, debates are ongoing and cannot be settled unequivocally with available evidence. Following the precautionary principle, in the theoretical paper it was argued that the pursuit for scientific certainty about the psychological impacts of screen time should not postpone preventive measures to protect adolescent wellbeing. Rather, specifying plausible mechanisms and possible pathways was considered an important step forward. In line with this, the theoretical paper integrated important segments of the literature relating to both cognition and emotion, and offered a developmental perspective on how contemporary digital technologies could undermine adolescent mental health by impeding several critical neurological, cognitive, and social developments in adolescence, which are associated with self-regulation capabilities. These capabilities enable cognitive control of emotions to protect against internalizing problems seen in depression and anxiety, through reappraisal of threats and reducing rumination. It was argued that a large amount of daily time devoted to digital technologies could displace opportunities for experience-dependent maturation of self-regulation capabilities, and also exploit immature neuroanatomy. Presented in the paper is an in-depth discussion on how the development of these capabilities required for self-regulation may be specifically affected by (1) the addictive properties of digital technologies, (2) media multi-tasking, and (3) pervasive exposure to social and emotional content online. These factors were considered within the broader contexts of contemporary adolescent socialisation and evolutionary neurobiology. A conceptual model was developed to integrate findings and highlight relevant synergies. Eighty-seven adolescents (52% female, mean age = 15.5 years) were recruited to participate in the randomised pre-post pilot study. In brief, participants completed validated, computer-based measures of mood, sustained attention capacity (Sustained Attention to Response Task), and inhibitory control (Stop-Signal Task) at three time-points: (1) at baseline, (2) after a period of screen time, and (3) after a period of rest. Participants were randomised to either an indoor setting or an outdoor environment (nature immersion in the Botanic Gardens) for the rest period. It was hypothesised that (a) following the period of screen time, adolescents would experience acute decreases in mood, inhibition, and attention abilities, and (b) following the period of screen time, adolescents who participated in nature immersion would experience superior mood, inhibition, and attention restoration when compared to adolescents who rested in the indoor setting. The results did not support the first hypothesis, which meant that the second hypothesis could not be adequately tested. The 30- minute screen time period did not provide the anticipated reduction in mood, inhibition, or attention abilities. Pre-determining a screen time period which may lead to this detectable deficit was a challenge due to the lack of experimental evidence available in the screen time literature. A number of important conceptual and methodological lessons were learned through this study, particularly around potentially useful screen time activities for experimental studies, required sample sizes and statistical power, and meaningful outcome measures which are more applicable in real-world scenarios. These lessons will provide valuable guidance for future research in this field. General conclusion Screen time and green time appear to influence psychological well-being in contrasting ways, with high levels of screen time typically associated with unfavourable psychological outcomes and green time associated with favourable psychological outcomes. As such, the combination of high screen time and low green time may present a dual-burden on youth psychological well-being in the 21st century. The existing evidence mostly comes from crosssectional studies; however, the preponderance of studies with broadly similar findings, across a myriad of settings and heterogeneous exposure measures, suggests that the associations are not chance findings and are possibly causal. The study conducted during the COVID-19 pandemic added some complexity and demonstrated that context matters, with screen time presenting as an important support for young Australians during lockdowns. The study also highlighted the importance of investing in urban green infrastructure to support youth mental health in the immediate pandemic context and for years to come. There remains a need for more (appropriately powered) experimental studies which explore how green time may be used as a public health resource in a high-tech era. Overall, societies need to shift away from solely relying on clinical responses to youth mental health problems, to public mental health solutions that prevent mental illness, promote mental well-being, and ensure lifelong psychological well-being for whole populations. Screen time and green time are an important part of this response and illustrate where this change is invited.