The interplay of digital fatigue and sleep deprivation in adolescent mental health: a post-pandemic imperative for school nursing
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20263231Keywords:
Digital fatigue, Sleep deprivation, Adolescent mental health, School nursing, COVID-19Abstract
The risk of high pre-sleep screen use, delayed sleep onset time, and increased insomnia among adolescents has increased significantly following and during the COVID-19 pandemic, which has also significantly increased their digital technology use. Sleep loss also exacerbates mental health concerns including depression, anxiety, emotional dys-regulation and suicidality, disproportionately affecting female adolescents, youth with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorders, and socioeconomically disadvantaged groups. This is a narrative review of peer-reviewed literature (2020-2024) that reviews the relationships among digital fatigue, sleep deprivation and adolescent mental health, and the role of school nurses in multi-tiered systems of support (MTSS) to address the interlinked risks. Peer-reviewed articles, systematic reviews, and meta-analyses were identified through PubMed, Scopus, and Google Scholar using a combination of the following terms: adolescents, digital fatigue, sleep deprivation, screen time, mental health, school nursing, and COVID-19. Studies were included if they included adolescents aged 10–19 years, and addressed digital screen use and sleep or psychological outcomes, and were published in or after 2020. Evidence was integrated within and across domains. Screen time, especially in the hours leading up to sleep, was consistently linked to a reduced sleep onset, poor sleep quality, and an increase in insomnia, through the suppression of melatonin and stimulation of cognitive activity. Disruption of sleep was associated with depression, anxiety, and suicidality, with a bidirectional relationship exacerbated by pandemic-related stress and less physical activity. School nurses became the front-line MTSS moderators in screening, education and policy advocacy. Culturally responsive, longitudinal studies, and more robust implementation of school nursing programs are needed to safeguard adolescent mental health and combat adolescent digital fatigue and sleep loss.
References
Gregersen EM, Astrupgaard SL, Jespersen MH, Gårdhus TP, Albris K. Digital dependence: online fatigue and coping strategies during the COVID-19 lockdown. Media Cult Soc. 2023;45(5):967-84.
Hollis C. Editorial: the role of digital technology in children and young people's mental health -- a triple-edged sword? J Child Psychol Psychiatry. 2020;61(1):1-3.
Khan A, Lee EY, Rosenbaum S, Khan SR, Tremblay MS. Dose-dependent and joint associations between screen time, physical activity, and mental wellbeing in adolescents: an international observational study. Lancet Child Adolescent Health. 2021;5(10):729-38.
Rocha S, Fuligni A. The impact of the COVID-19 pandemic on adolescent sleep behavior. Curr Opin Psychol. 2023;52:101648.
Uccella S, Cordani R, Salfi F, Gorgoni M, Scarpelli S, Gemignani A, et al. Sleep deprivation and insomnia in adolescence: implications for mental health. Brain Sci. 2023;13(4):569.
Stoilova M, Edwards C, Kostyrka-Allchorne K, Livingstone S, Sonuga-Barke E. Adolescents' mental health vulnerabilities and the experience and impact of digital technologies: a multimethod pilot study. London: King's College London and LSE; 2021.
Twigg L, Duncan C, Weich S. Is social media use associated with children's wellbeing? J Adolesc. 2020;80:73-83.
Pjevač A, Safiye T, Biševac E, Mahmutović E, Jovanović M. How the COVID-19 pandemic has affected mental health and internet addiction in adolescents: a comprehensive review. Arh Farm. 2024;74:569-81.
Alho K, Moisala M, Salmela-Aro K. Effects of media multitasking and video gaming on cognitive functions. Eur Psychol. 2022;27(2):131-40.
Dong HY, Wang B, Li HH, Yue XJ, Jia FY. Correlation between screen time and autistic symptoms. Front Psychiatry. 2021;12:619994.
Shafi RM, Nakonezny PA, Miller KA, Desai J, Almorsy AG, Ligezka AN, et al. Altered markers of stress in depressed adolescents after acute social media use. J Psychiatr Res. 2021;136:149-56.
Chau K, Perrin P, Chau N. Associations between excessive screen time and school and out-of-school injuries among adolescents: A population-based study. Psychiatr Res. 2024;331:115679.
Toquero CMD. Smartphone sleep technology: health apps during COVID-19 to mitigate psychosocial stress among children and adolescents. J Sci Educ. 2021;1(2):41-7.
Choi H, Kim B, Kim I, Kang JG, Lee Y, Lee H, et al. Analysis of the status and future direction for digital therapeutics in children and adolescent psychiatry. J Korean Acad Child Adolescent Psychiatr. 2023;34(4):192.
Yilmaz R, Karaoglan Yilmaz FG. Problematic internet use in adults: the role of happiness, psychological resilience, dispositional hope, and self-control and self-management. J Rational-Emotive Cognitive-Behavior Ther. 2023;41(3):727-45.
da Silva Bandeira A, Silva KS, Bastos JL, Silva DA, da Silva Lopes A, Barbosa Filho VC. Psychosocial mediators of screen time reduction after an intervention for students from schools in vulnerable areas: A cluster-randomized controlled trial. J Sci Med Sport. 2020;23(3):264-9.
Kaditis AG, Ohler A, Gileles-Hillel A, Choshen-Hillel S, Gozal D, Bruni O, et al. Effects of the COVID-19 lockdown on sleep duration in children and adolescents: a survey across different continents. Pediatr Pulmonol. 2021;56(8):2265-73.
Athanasio BS, Oliveira ACS, Argelaz RL, Silva ACS, Miranda DM. How the COVID-19 pandemic has affected children and adolescents' sleep habits: a systematic review. Rev Debates Psiquiatr. 2023;13:1-85.
Puteikis K, Mameniškytė A, Mameniškienė R. Sleep quality, mental health and learning among high school students after reopening schools during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(5):2553.
Mane SV, Taneja N. A study of sleep problems and effect of COVID pandemic on sleep patterns in children and adolescents attending a tertiary care centre in Southern India. Med Sci. 2023;27:e288-3103.
Massar SA, Ong JL, Chee MW. Impact of COVID-19 Mobility Restrictions on Sleep and Well-Being. InCOVID-19 and Sleep: A Global Outlook. Singapore: Springer Nature Singapore. 2023:137-51.
Zhao Y, Paulus MP, Tapert SF, Bagot KS, Constable RT, Yaggi HK, et al. Screen time, sleep, brain structural neurobiology, and sequential associations with child and adolescent psychopathology: Insights from the ABCD study. J Behav Addict. 2024;13(2):542-53.
Madigan S, Eirich R, Pador P, McArthur BA, Neville RD. Assessment of changes in child and adolescent screen time during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Pediatr. 2022;176(11):1188-98.
Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2021;301:113863.
Valenzuela RL, Velasco RI, Jorge MP. Impact of COVID‐19 pandemic on sleep of undergraduate students: A systematic literature review. Stress Health. 2023;39(1):4-34.
Bian WJ, Atrooz F, Patel S, Rababa'h AM. Sleep deprivation, circadian misalignment and addiction vulnerability in adolescents. Front Neurosci. 2022;16:940039.
Sliwa SA, Wheaton AG, Li J, Michael SL. Sleep duration, mental health, and increased difficulty doing schoolwork among high school students during the COVID-19 pandemic. Prev Chronic Dis. 2023;20:E14.
Silva SS, Silveira MAC, Almeida HCR, Nascimento MCPD, Santos MAMD, Heimer MV. Use of digital screens by adolescents and association on sleep quality: a systematic review. Cad Saude Publica. 2022;38(10):e00300721.
de Sá S, Baião A, Marques H, Marques MDC, Reis MJ, Dias S, et al. The influence of smartphones on adolescent sleep: a systematic literature review. Nurs Rep. 2023;13(2):612-21.
Şambel Aykutlu M, Aykutlu HC, Özveren M, Garip R. Digital media use and its effects on digital eye strain and sleep quality in adolescents: a new emerging epidemic? PLoS One. 2024;19(12):e0314390.
Kortesoja L, Vainikainen MP, Hotulainen R, Merikanto I. Late-night digital media use in relation to chronotype, sleep and tiredness in adolescence. J Youth Adolesc. 2023;52:419-33.
Jaffer U, Sharminaz S, Zulkafli NF, Omar M, Che Mohd Nassir CM, Ahmed M, et al. Screen time and sleep quality: a narrative review of digital device usage and its impact on well-being. Int J Educ Psychol Counsell. 2024;9:1068-79.
Atoum M, Alrashed W, Al-Otaibi S, Borini A, Albdour A, Haleem A. The relationship between depression, anxiety, stress, and insomnia with smartphone addiction among adolescents in Jordan. Int J Environ Res Public Health. 2021;18(12):6627.
Burnell K, Garrett SL, Nelson BW, Prinstein MJ, Telzer EH. Daily links between objective smartphone use and sleep among adolescents. J Adolesc. 2024;96:1171-81.
McAllister C, Hisler GC, Blake AB, Twenge JM, Farley E, Hamilton JL. Associations between adolescent depression and self-harm behaviors and screen media use in a nationally representative time-diary study. Res Child Adolesc Psychopathol. 2021;49:1623-34.
Yu DJ, Wing YK, Li TMH, Chan NY. The impact of digital lifestyle on mental health and sleep quality among adolescents: a cross-sectional study. Healthcare (Basel). 2023;11(11):1616.
Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health. 2020;66(6):725-32.
Sohlberg E, Israel AY, Duell N. The complicated relationship between sleep, social media, and mental health in adolescence: a review. J Stud Res. 2023;12(4):1-5.
Rothstein R, Olympia RP. School nurses on the front lines of healthcare: the approach to maintaining student health and wellness during COVID-19 school closures. NASN Sch Nurse. 2020;35(5):269-75.
Binagwaho A, Senga J. Children and adolescent mental health in a time of COVID-19: a forgotten priority. Ann Glob Health. 2021;87(1):1-5.
Kweon YS. Enhancing the school mental health initiative amid COVID-19. J Korean Acad Child Adolesc Psychiatry. 2023;34(1):2-3.
National Association of School Nurses. Elevating the role of school nurses in school-based mental and behavioral health: a consensus document. NASN Sch Nurse. 2024;39(6):301-4.
Hoskote AR, Croce E, Johnson KE. The evolution of the role of U.S. school nurses in adolescent mental health at the individual, community, and systems level: an integrative review. J Sch Nurs. 2023;39(1):51-71.
Hoffman R, Kay SS, Piepenbrink RP, Goldman J, Schuster J, Grimes LR, et al. Engaging school communities during COVID-19: the role of school nurses. Am J Public Health. 2024;114(S5):S402-4.
Bullard JS, McAlister BS, Chilton JM. COVID-19 planning and postpandemic partnerships. NASN Sch Nurse. 2021;36(2):80-4.
Johnson-Staub C. COVID-19 and state child care assistance programs: immediate considerations for state CCDF lead agencies CLASP; 2020.
Taylor-Beirne J, Taylor-Beirne S. The role of the school nurse in supporting school-age children with mental health difficulties: an integrative review. Br J Child Health. 2022;3(3):135-47.