Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries

Abstract

Little is known about the role of active school travel (AST) on mental health among adolescents. Thus, this study aimed to explore the AST-depression association among adolescents aged 12-15 years from 26 low-and middleincome countries (LMICs). Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents [mean (SD) age 13.8 (1.0) years; 49.3% boys). Both depressive symptoms and AST were assessed by a single question self-reported measure, respectively. Participants who reported having 5 days or above were considered as AST. Multivariable logistic regression analysis (accounting for sampling weights) was performed while controlling for gender, age, physical activity, sedentary behavior, and food insecurity, and a countrywide meta-analysis was undertaken. The prevalence of depressive symptoms and AST were 30.1% and 37.0%, respectively. Compared with those not having AST, adolescents with AST were less likely to have self-reported depressive symptoms (OR = 0.88, 95%CI: 0.85-0.93) regardless of gender. Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12% lower odds for depressive symptoms (OR = 0.88; 95%CI: 0.82-0.94) but with a moderate between-country heterogeneity (I 2 = 59.0%). Based on large samples of adolescents from LMICs, it would be expected that AST may play a critical role in preventing adolescent depression worldwide. However, it is necessary to consider more country-specific This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Associations of leisure‐time physical activity and active school transport with mental health outcomes: A population‐based study

“…Only few studies have evaluated associations between AST and mental health. Our results are inconsistent with the previous findings from a study conducted in upper‐middle‐ and high‐income countries, 23 but consistent, to some extent, with a study conducted in Ireland 24 . However, both studies lacked essential covariate adjustments, including leisure‐time PA. Other two contradicting observations from middle‐ and low‐income countries might be explained by inadequate control for sociodemographic and cultural factors 23,24 .…”

“…Our results are inconsistent with the previous findings from a study conducted in upper‐middle‐ and high‐income countries, 23 but consistent, to some extent, with a study conducted in Ireland 24 . However, both studies lacked essential covariate adjustments, including leisure‐time PA. Other two contradicting observations from middle‐ and low‐income countries might be explained by inadequate control for sociodemographic and cultural factors 23,24 . For example, these studies did not control for socioeconomic indicators, although a safe active transport infrastructure in lower‐income countries may only be accessible to adolescents with higher social status and wellbeing.…”

“…24 However, both studies lacked essential covariate adjustments, including leisure-time PA. Other two contradicting observations from middle-and low-income countries might be explained by inadequate control for sociodemographic and cultural factors. 23,24 For example, these studies did not control for socioeconomic indicators, although a safe active transport infrastructure in lower-income countries may only be accessible to adolescents with higher social status and wellbeing. Furthermore, these studies did not adjust for health behaviors, such as substance use, which attenuated the association in our study.…”

“…21 In contrast, similar findings of an Irish study attenuated to null after adjusting for sociodemographic confounders. 22 In low-and middle-income countries, AST has been associated with lower odds of depression symptoms 23,24 and fewer suicide attempts. 25 Nevertheless, all previous studies have lacked essential covariate adjustments, such as leisure-time PA or socioeconomic status, the latter being a major determinant of mental health.…”

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

“…The Global School-based Student Health Survey (GSHS) is a publicly available dataset in which researchers can perform data analysis to determine risk and protective factors of major non-infectious illnesses (details can be found from https://extranet.who.int/ncdsmicrodata/index.php/catalog/GSHS and http://www.cdc.gov/gshs). Likewise, procedures of data collection were clearly described in previous studies [32][33][34]. Of note, data were weighted for non-response and probability selection.…”