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Review 2: "Child and parent physical activity, sleep and screen time during COVID-19 compared to pre-pandemic nationally representative data and associations with mental health"

This study found higher rates of sleep problems and increased weekend screen time compared to national pre-pandemic data in Australia. While the study was well-formulated, reviewers recommended that authors better isolate the causality of the phenomena observed.

Published onOct 19, 2020
Review 2: "Child and parent physical activity, sleep and screen time during COVID-19 compared to pre-pandemic nationally representative data and associations with mental health"
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Child and parent physical activity, sleep and screen time during COVID-19 compared to pre-pandemic nationally representative data and associations with mental health
Description

Objective: To investigate differences in movement behaviors (physical activity, sleep, screen time) in both parents and children during the early stages of COVID-19 pandemic in Australia, compared to pre-COVID-19 national data; and, estimate associations between these movement behaviors with parent and child mental health. Methods: We used cross-sectional baseline data from the COVID-19 Pandemic Adjustment Study (CPAS; N=2,365). Participants were parents of children aged ≤18 years, residing in Australia. We drew on nationally representative pre-COVID data from the Longitudinal Study of Australian Children (LSAC; N=9,438). In both studies, parents provided the same self-report measures of physical activity, sleep quality, as well as measures of child physical activity and screen time. Parents reported on their own and their child’s mental health. Results: Compared to LSAC, children in CPAS had more sleep problems (17.4% vs 8.9%, p<.001) and more weekend screen time (3.98 hours vs 3.35 hours, p<.001), while more parents had poor sleep quality (56.7% vs 21.0%, p<.001) despite increased weekly physical activity (3.86 days vs 2.85 days, p<.001). Children’s sleep problems were associated with increased depression, anxiety and irritability symptoms, after accounting for physical activity and screen time (all p<.001). Poorer parent sleep quality and lower levels of physical activity were associated with poorer mental health across all indicators (all p≤.001). Conclusion: Government funded mental health programs to implement evidence-based sleep interventions for children and their parents, along with targeted messaging around physical activity should be considered to promote mental health within the family context during lockdown restrictions.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review:

Based on a large representative sample, the current study investigated differences in movement behaviors (physical activity, sleep, screen time) in both parents and children during the early stages of COVID-19 pandemic in Australia, compared them to the pre-COVID-19 national data, and further estimated associations between these movement behaviors with parent and child mental health. They found children in the current study had higher rates of sleep problems and increased weekend screen time compared to national pre-pandemic data in Australia. Parents had higher levels of sleep problems compared with pre-pandemic data, while physical activity also appeared to be higher.

The main conclusions and claims are convincing given the size and representativeness of the sample, flexible analytic methods, and strict logic in the study. Yet, there are a few points that need to be examined. First, the data collection duration lasted for 20 days at the beginning of confinement and the variables (e.g. sleep) might change dramatically. Second, it seems the variables are not so well-organized. For instance, consider whether it is appropriate to include sleep and screen time as movement behaviors, even though they do deserve attention and the results are informative. Third, the Conclusion section in the Abstract reads more as suggestions than a conclusion. Fourth, I suggest referring to Liu’s study on children’s sleep during the COVID-19 in China {Liu, Zhijun & Tang, Hui & Jin, Qiyun & Wang, Guanghai & Yang, Zixin & Chen, Hongyan & Yan, Hongxia & Rao, Wenjie & Owens, Judith. (2020). Sleep of preschoolers during the coronavirus disease 2019 (COVID‐19) outbreak. Journal of Sleep Research. 10.1111/jsr.13142.)}.

For all these reasons, I recommend the strength of evidence as "Reliable" and advise that this preprint go through minor revisions.

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