Abstract
OBJECTIVES: To investigate associations between adventurous play, outdoor play and screen time and mental health (MH) in British preschool-aged children. DESIGN: Cross-sectional. SETTING: A nationally representative sample of caregivers of 2-4 years old (n=1066) in England, Scotland and Wales (Britain), recruited through an online research data and analytics group (YouGov UK). PARTICIPANTS: Caregivers of 1018 children provided valid complete-case data (age 2: n=298 (29%), age 3: n=365 (36%), age 4: n=355 (35%); female n=481 (47%); white: n=878 (81%)). OUTCOME MEASURES: Four outcomes, derived from parent-report questionnaires: internalising and externalising scores (using the Strengths and Difficulties Questionnaire) and positive and negative affect scores (using the Positive and Negative Affect Schedule for Children-P). Linear regression was used to explore associations between the three exposures (time (in hours per week) a child spent: (1) playing adventurously; and engaging in (2) educational screen time and (3) recreational screen time) and the four outcomes; interactions between play and screen time variables were also tested. Models were adjusted for child and parental demographic variables. RESULTS: For each additional hour per week a child engaged in adventurous play, they had lower internalising scores (-0.02 (-0.03 to -0.01)) and higher positive affect scores (0.04 (0.02 to 0.05)). More hours per day (vs <1 hour/day) of educational screen time and recreational screen time were associated with higher internalising and negative affect scores. Greater educational screen time was associated with lower positive affect and higher externalising scores, with adventurous play moderating the association between higher educational screen time, internalising and negative affect. CONCLUSION: In British preschoolers, adventurous play is associated with better MH outcomes, whereas higher educational screen time was associated with poorer MH, indicating that adventurous play may benefit preschoolers' MH or that preschoolers with better mental health are more likely to engage in adventurous play. Adventurous play may also offset possible negative associations with screen time.