Lirong Zhang,1 Shaocong Zhao,1 Shuangyin Zhao,1 Hua Zheng,2 Yizhen Ke,1 Weichen Yang,1 Mingxing Lei3,4 

1Department of Physical Education, Xiamen University of Technology, Xiamen, Fujian, 361024, People’s Republic of China; 2College of Physical Education and Health Science, Chongqing Normal University, Chongqing, 401331, People’s Republic of China; 3Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, People’s Republic of China; 4Nursing Department, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

Correspondence: Lirong Zhang, Department of Physical Education, Xiamen University of Technology, No. 600, Ligong Road, Jimei District, Xiamen, 361024, Fujian, People’s Republic of China, Tel +86 13806063882, Email 22674481@qq.com Mingxing Lei, Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China, Tel +86 18811772189, Email leimingxing2@sina.com

Background: Sedentary lifestyles among adolescents have been associated with various health concerns, particularly regarding psychological well-being and sleep quality. However, the associative relationship between sedentary behavior and these health outcomes remains unclear. This study aims to clarify the association between sedentary lifestyle and psychological and sleep health among adolescents through propensity scores matching analysis.
Methods: A total of 2,846 adolescents from three universities participated in the study. Data on demographics, exercise habits, eating patterns, sedentary behavior, psychological health, sleep health, self-esteem, and social support were collected. A sedentary lifestyle was defined as sitting for more than six hours daily. Psychological health was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety and the Patient Health Questionnaire-9 (PHQ-9) for depression, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Self-esteem was evaluated with the Self-Esteem Scale (SES), and social support was measured using the Social Support Rating Scale (SSRS). Propensity scores matching analysis was employed to investigate the associative relationship between sedentary lifestyles and the measured outcomes.
Results: Prior to propensity scores matching, significant differences were observed in baseline characteristics between participants with and without sedentary lifestyles, including gender (P=0.01), dietary habits (P< 0.001), mobile device usage (P< 0.001), stress events (P=0.001), physical activity (P< 0.001), and chronic diseases (P=0.024). Participants with sedentary lifestyles exhibited higher scores on the GAD-7 (P< 0.001), PHQ-9 (P< 0.001), and PSQI (P< 0.001), along with lower self-esteem (SES, P=0.041) and social support (SSRS, P< 0.001) compared to their more active counterparts. Following propensity scores matching, no significant differences in baseline characteristics were found between the two groups (All P> 0.282), indicating a successful matching process. Post-matching analysis revealed that individuals with sedentary lifestyles had significantly higher GAD-7 (P=0.002), PHQ-9 (P=0.013), and PSQI scores (P=0.001) than those without sedentary lifestyles, while no significant differences were found in SES (P=0.755) and SSRS (P=0.676).
Conclusion: Our findings indicate that a sedentary lifestyle is associated with poorer psychological health and sleep quality among adolescents, even after controlling for various demographic and lifestyle factors. These results underscore the importance of promoting physical activity and reducing sedentary behavior in this population to enhance their overall well-being.

Keywords: sedentary lifestyle, psychological health, anxiety, depression, sleep health, propensity scores matching analysis