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Cited by 103Child Development and Digital TechnologyImpact of Technology on AdolescentsChild and Adolescent Psychosocial and Emotional Development

Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study

Open access
Nagata, Jason M., Al-Shoaibi, Abubakr A.A., Leong, Alicia W., Zamora, Gabriel, Testa, Alexander, Ganson, Kyle T., Baker, Fiona C.·2024·BMC Public Health
DOI 10.1186/s12889-024-20102-xPMC PMC11457456
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Abstract

Background: Despite the ubiquity of adolescent screen use, there are limited longitudinal studies that examine the prospective relationships between screen time and child behavioral problems in a large, diverse nationwide sample of adolescents in the United States, which was the objective of the current study. Methods: We analyzed cohort data of 9,538 adolescents (9–10 years at baseline in 2016–2018) with two years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We used mixed-effects models to analyze associations between baseline self-reported screen time and parent-reported mental health symptoms using the Child Behavior Checklist, with random effects adjusted for age, sex, race/ethnicity, household income, parent education, and study site. We tested for effect modification by sex and race/ethnicity. Results: The sample was 48.8% female and racially/ethnically diverse (47.6% racial/ethnic minority). Higher total screen time was associated with all mental health symptoms in adjusted models, and the association was strongest for depressive (B = 0.10, 95% CI 0.06, 0.13, p < 0.001), conduct (B = 0.07, 95% CI 0.03, 0.10, p < 0.001), somatic (B = 0.06, 95% CI 0.01, 0.11, p = 0.026), and attention-deficit/hyperactivity symptoms (B = 0.06, 95% CI 0.01, 0.10, p = 0.013). The specific screen types with the greatest associations with depressive symptoms included video chat, texting, videos, and video games. The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents. The association between screen time and depressive symptoms was stronger among White compared to Asian adolescents. Conclusions: Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small. Video chat, texting, videos, and video games were the screen types with the greatest associations with depressive symptoms. Future research should examine potential mechanisms linking screen use with child behavior problems.

AI snapshot

Written from the paper’s full text.

TL;DR

In a nationwide ABCD Study cohort of 9,538 early adolescents followed for two years, higher baseline screen time was prospectively associated with higher parent-reported mental health symptoms across all CBCL DSM-oriented scales, especially depressive symptoms. Effect sizes were small, and some associations differed by race/ethnicity but not by sex.

Key findings

  • Higher total screen time was associated with all CBCL DSM-oriented symptom scales in adjusted models; the strongest associations were for depressive symptoms (B = 0.10, 95% CI 0.06, 0.13, p < 0.001), conduct symptoms (B = 0.07, 95% CI 0.03, 0.10, p < 0.001), somatic symptoms (B = 0.06, 95% CI 0.01, 0.11, p = 0.026), and ADHD symptoms (B = 0.06, 95% CI 0.01, 0.10, p = 0.013).
  • The screen types with the greatest associations with depressive symptoms were video chat, texting, videos, and video games.
  • Associations between screen time and depressive, ADHD, and oppositional defiant symptoms were stronger among White compared with Black adolescents; the association with depressive symptoms was also stronger among White compared with Asian adolescents.
  • There was no evidence of effect modification by sex for any outcome (p for screen time × sex interaction > 0.05).

Methods

  • Prospective cohort analysis using ABCD Study data from baseline to Year 2, including 9,538 adolescents ages 9–10 at baseline in 2016–2018; 2,337 of 11,875 participants were excluded for missing total screen time or confounders.
  • Baseline self-reported screen time was measured across six modalities and total screen time was calculated as a weighted weekday/weekend average; outcomes were parent-reported CBCL DSM-oriented t-scores at one- and two-year follow-up.
  • Mixed-effects models were used, with unadjusted and adjusted models controlling for baseline CBCL scores, age, sex, race/ethnicity, household income, parent education, data collection period, and study site; analyses tested effect modification by sex and race/ethnicity and applied propensity weights.

Limitations

  • The paper states that screen time was self-reported and may be subject to response, recall, and social desirability bias; it also does not capture content or context of screen use.
  • The paper states that follow-up was limited to two years starting at ages 9–10, inverse causality or bidirectional associations are possible, unmeasured confounders may remain, and effect sizes were relatively small.
  • Evident from the text: mental health symptoms were parent-reported via the CBCL rather than clinical diagnoses, and the observational design cannot establish causality.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12889-024-20102-x

Cites

132 of 132 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 89 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The association between screen time and depressive symptoms was stronger among White compared to Black adolescents.

    “The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents.”
    • Also stated in: § Results · plain
      “screen time was associated with higher depressive (B = 0.13, 95% CI 0.09, 0.17), attention-deficit/hyperactivity (B = 0.07, 95% CI 0.02, 0.13), and oppositional defiant (B = 0.05, 95% CI 0.01, 0.10) symptom scores in White adolescents but not among Black adolescents.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.
  • Findingown data

    The association between screen time and oppositional defiant symptoms was stronger among White compared to Black adolescents.

    “The association between screen time and depressive, attention-deficit/hyperactivity, and oppositional defiant symptoms was stronger among White compared to Black adolescents.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.
  • Findingown data

    In White adolescents, screen time was associated with higher depressive symptoms (B = 0.13, 95% CI 0.09, 0.17).

    “screen time was associated with higher depressive (B = 0.13, 95% CI 0.09, 0.17), attention-deficit/hyperactivity (B = 0.07, 95% CI 0.02, 0.13), and oppositional defiant (B = 0.05, 95% CI 0.01, 0.10) symptom scores in White adolescents but not among Black adolescents.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.
  • Findingown data

    In adjusted models, higher total screen time was associated with oppositional defiant symptoms (B = 0.04, 95% CI 0.01, 0.07, p = 0.011).

    “Total screen time | 0.10 (0.06, 0.13) | < 0.001 | 0.05 (0.01, 0.09) | 0.029 | 0.06 (0.01, 0.11) | 0.026 | 0.06 (0.01, 0.10) | 0.013 | 0.04 (0.01, 0.07) | 0.011 | 0.07 (0.03, 0.10) | < 0.001”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.
  • Findingown data

    In adjusted models, higher total screen time was associated with anxiety symptoms (B = 0.05, 95% CI 0.01, 0.09, p = 0.029).

    “Total screen time | 0.10 (0.06, 0.13) | < 0.001 | 0.05 (0.01, 0.09) | 0.029 | 0.06 (0.01, 0.11) | 0.026 | 0.06 (0.01, 0.10) | 0.013 | 0.04 (0.01, 0.07) | 0.011 | 0.07 (0.03, 0.10) | < 0.001”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data

    Supplemental analyses adjusting for sleep and physical activity in addition to Model 2 covariates showed similar results, although some associations were slightly attenuated.

    “Supplemental analyses adjusting for sleep and physical activity in addition to the covariates adjusted for in Model 2 showed similar results although some associations were slightly attenuated (Appendix B).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The effect sizes per hour of screen time in this study are similar in magnitude to previously reported effect sizes for screen time and nutrition as measured by the MIND diet score.

    “These effect sizes per hour of screen time are similar in magnitude to the effect sizes previously reported on screen time and nutrition as measured by the MIND (Mediterranean-DASH [Dietary Approaches to Stop Hypertension] Intervention for Neurodegenerative Delay) diet score [114].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] Nagata JM, Weinstein S, Bashir A, Lee S, Al-Shoaibi AAA, Shao IY et al. Associations of contemporary screen time modalities with early adolescent nutrition. Acad Pediatr. 2024;24:748–54. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    There was not a statistically significant association between social media and depression or any of the mental health outcomes, although the coefficients were all in the positive direction.

    “Of note, there was not a statistically significant association between social media and depression or any of the mental health outcomes, although the coefficients were all in the positive direction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The specific screen types with the greatest associations with depression include video chat, texting, videos (e.g., YouTube), and video games.

    “The specific screen types with the greatest associations with depression include video chat, texting, videos (e.g., YouTube), and video games.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a significant association between total screen time and depressive, ADHD, and ODD symptoms in White adolescents, but not in Black adolescents.

    “demonstrating a significant association between total screen time and depressive, ADHD, and ODD symptoms in White adolescents, but not in Black adolescents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The longitudinal study identified several important prospective associations between screen time and DSM-oriented symptoms in a national sample of adolescents, most notably depression and conduct symptoms.

    “Our longitudinal study identified several important prospective associations between screen time and DSM-oriented symptoms in a national sample of adolescents, most notably depression and conduct symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The same ABCD analysis found that male adolescents reported higher overall screen time than female adolescents, while female adolescents reported higher daily use of social networking, texting, and video chatting.

    “The same analysis found that, while male adolescents reported higher overall screen time than female adolescents, female adolescents reported higher daily use of social networking, texting, and video chatting [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Nagata JM, Ganson KT, Iyer P, Chu J, Baker FC, Pettee Gabriel K, et al. Sociodemographic correlates of contemporary screen time use among 9- and 10-year-old children. J Pediatr. 2022;240:213–e2202. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Data from the ABCD Study showed that, compared to White adolescents, Black adolescents reported greater total screen time use and Asian adolescents reported lower screen time use.

    “For instance, data from the ABCD Study showed that, compared to White adolescents, Black adolescents reported greater total screen time use and Asian adolescents reported lower screen time use [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Nagata JM, Ganson KT, Iyer P, Chu J, Baker FC, Pettee Gabriel K, et al. Sociodemographic correlates of contemporary screen time use among 9- and 10-year-old children. J Pediatr. 2022;240:213–e2202. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More screen time has been associated with depressive symptoms among children and adolescents in several systematic reviews.

    “More screen time has been associated with depressive symptoms among children and adolescents in several systematic reviews [11, 12, 43–50].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [11] Santos RMS, Mendes CG, Sen Bressani GY, de Alcantara Ventura S, de Almeida Nogueira YJ, de Miranda DM, et al. The associations between screen time and mental health in adolescents: a systematic review. BMC Psychol. 2023;11:127. source

      Not checked in the free run.

    • cites [12] Tang S, Werner-Seidler A, Torok M, Mackinnon AJ, Christensen H. The relationship between screen time and mental health in young people: a systematic review of longitudinal studies. Clin Psychol Rev. 2021;86:102021. source

      Not checked in the free run.

    • cites [43] Cai Z, Mao P, Wang Z, Wang D, He J, Fan X. Associations between problematic internet use and mental health outcomes of students: a meta-analytic review. Adolesc Res Rev. 2023;8:45–62.

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    • cites [44] Costigan SA, Barnett L, Plotnikoff RC, Lubans DR. The health indicators associated with screen-based sedentary behavior among adolescent girls: a systematic review. J Adolesc Health off Publ Soc Adolesc Med. 2013;52:382–92. source

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    • cites [45] Hoare E, Milton K, Foster C, Allender S. The associations between sedentary behaviour and mental health among adolescents: a systematic review. Int J Behav Nutr Phys Act. 2016;13:108. source

      Not checked in the free run.

    • cites [46] Keles B, McCrae N, Grealish A. A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. Int J Adolesc Youth. 2020;25:79–93. source

      Not checked in the free run.

    • cites [47] McCrae N, Gettings S, Purssell E. Social media and depressive symptoms in childhood and adolescence: a systematic review. Adolesc Res Rev. 2017;2:315–30.

      Not checked in the free run.

    • cites [48] Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open. 2019;9. source

      Not checked in the free run.

    • cites [49] Wang X, Li Y, Fan H. The associations between screen time-based sedentary behavior and depression: a systematic review and meta-analysis. BMC Public Health. 2019;19:1524. source

      Not checked in the free run.

    • cites [50] Liu M, Wu L, Yao S. Dose–response association of screen time-based sedentary behaviour in children and adolescents and depression: a meta-analysis of observational studies. Br J Sports Med. 2016;50:1252–8. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The CBCL has high test-retest reliability (ICC = 0.95), strong validity, and acceptable internal consistency (alphas 0.63-0.79).

    “The CBCL has high test-retest reliability (ICC = 0.95), strong validity (ability of all items to discriminate significantly p < 0.01) [98], and acceptable internal consistency with alphas ranging from 0.63 to 0.79 [99].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [98] Achenbach TM, Rescorla LA. Manual for the ASEBA Preschool forms and profiles. Burlington, VT: Research Center for Children, Youth, & Families; 2000.

      Not checked in the free run.

    • cites [99] Taber KS. The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018;48:1273–96. source

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    Study design and conductcitation

    Data analyses applied propensity weights based on the American Community Survey.

    “Data analyses were performed using Stata 18.0 (College Station, TX) and applied propensity weights based on the American Community Survey [104].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Heeringa S, Berglund P. A guide for population-based analysis of the Adolescent Brain and Cognitive Development (ABCD) Study baseline data. bioRxiv. 2020. 2020.02.10.942011. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Tang et al. (2021) found a small but significant correlation between screen time and subsequent depressive symptoms among adolescents aged 10 to 24 years.

    “In a systematic review of longitudinal studies examining the relationship between screen time and internalizing mental health symptoms, Tang et al. (2021) found a small but significant correlation between screen time and subsequent depressive symptoms among adolescents aged 10 to 24 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tang et al. (2021) source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study controlled for data collection period (before or during the COVID-19 pandemic) in analyses of Year 2 data because the pandemic affected both screen time and mental health.

    “Because the two-year follow-up data collection period (2018–2020) coincided with the COVID-19 pandemic, which affected both screen time and mental health, we controlled for the data collection period (before or during the COVID-19 pandemic, using March 13, 2020 as the start date of the COVID-19 pandemic in the US) in the analyses of the Year 2 data.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    In Model 2, outcomes were adjusted for baseline CBCL scores and confounders (age, sex, race/ethnicity, household income, parent education, data collection period, and study site).

    “In Model 2, the outcomes were CBCL DSM-oriented scale t-scores from Year 1 and Year 2, adjusted for baseline CBCL DSM-oriented scale t-scores and the following confounders at baseline: age, sex, race/ethnicity, household income, parent education, data collection period, and study site.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous cross-sectional studies have found potential associations between screen time and symptoms of conduct disorder and ODD among adolescents.

    “Similarly, previous cross-sectional studies have found potential associations between screen time and symptoms of conduct disorder and ODD among adolescents [67–72].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [67] Kronenberger WG, Mathews VP, Dunn DW, Wang Y, Wood EA, Larsen JJ, et al. Media violence exposure in aggressive and control adolescents: differences in self- and parent-reported exposure to violence on television and in video games. Aggress Behav. 2005;31:201–16. source

      Not checked in the free run.

    • cites [68] Liu M, Ming Q, Yi J, Wang X, Yao S. Screen time on school days and risks for psychiatric symptoms and self-harm in mainland Chinese adolescents. Front Psychol. 2016;7(APR):574.

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    • cites [69] Möller-Nehring E, Moach A, Castell R, Weigel A, Meyer M. Conditions facilitating social behavior disorder in children and adolescents in a clinic referred sample. Prax Kinderpsychol Kinderpsychiatr. 1998;47:36–47.

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    • cites [70] Mundy LK, Canterford L, Olds T, Allen NB, Patton GC. The association between electronic media and emotional and behavioral problems in late childhood. Acad Pediatr. 2017;17:620–4. source

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    • cites [71] Paulich KN, Ross JM, Lessem JM, Hewitt JK. Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: utilizing the Adolescent Brain Cognitive Development SM (ABCD) study. PLoS ONE. 2021;16:e0256591. source

      Not checked in the free run.

    • cites [72] Shenoi RP, Linakis JG, Bromberg JR, Casper TC, Richards R, Chun TH, et al. Association of physical activity, sports, and screen time with adolescent behaviors in youth who visit the pediatric emergency department. Clin Pediatr (Phila). 2022;61:335–46. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A more recent review found reciprocal associations between digital media use and ADHD symptoms.

    “A more recent review evaluating the longitudinal associations between digital media use and ADHD symptoms found reciprocal associations between digital media use and ADHD symptoms [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Thorell LB, Burén J, Ström Wiman J, Sandberg D, Nutley SB. Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review. Eur Child Adolesc Psychiatry. 2024;33:2503–26. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small.

    “Screen time is prospectively associated with a range of mental health symptoms, especially depressive symptoms, though effect sizes are small.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.
    • Rests on an assumption: Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A 2015 systematic review concluded there was strong evidence to support a positive association between screen time and hyperactivity/inattention symptoms in children and adolescents.

    “Synthesizing data from eight cross-sectional and three longitudinal studies, a systematic review from 2015 concluded that there was strong evidence to support a positive association between screen time and hyperactivity/inattention symptoms in children and adolescents [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: a systematic review. Prev Med. 2015;76:48–57. source

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    Study design and conductcitation

    Total screen time was calculated based on a previously validated measure.

    “Total screen time was calculated separately for weekdays and weekend days, based on a previously validated measure [93–95].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [93] Bagot KS, Matthews SA, Mason M, Squeglia LM, Fowler J, Gray K, et al. Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci. 2018;32:121–9. source

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    • cites [94] Gray JC, Schvey NA, Tanofsky-Kraff M. Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: findings from the Adolescent Brain Cognitive Development (ABCD) Study. Psychol Med. 2020;50:1539–47. source

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    • cites [95] Paulus MP, Squeglia LM, Bagot K, Jacobus J, Kuplicki R, Breslin FJ, et al. Screen media activity and brain structure in youth: evidence for diverse structural correlation networks from the ABCD study. NeuroImage. 2019;185:140–53. source

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  • May combine two claims.

    Premisecitation

    Prior studies have identified sex differences in the relationship between screen time and mental health outcomes, but this evidence remains inconsistent across studies.

    “Prior studies have identified sex differences in the relationship between screen time and mental health outcomes, but this evidence remains inconsistent across studies [11, 12, 51], calling for additional longitudinal analyses to provide further insight into the moderating effect of sex.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Santos RMS, Mendes CG, Sen Bressani GY, de Alcantara Ventura S, de Almeida Nogueira YJ, de Miranda DM, et al. The associations between screen time and mental health in adolescents: a systematic review. BMC Psychol. 2023;11:127. source

      Not checked in the free run.

    • cites [12] Tang S, Werner-Seidler A, Torok M, Mackinnon AJ, Christensen H. The relationship between screen time and mental health in young people: a systematic review of longitudinal studies. Clin Psychol Rev. 2021;86:102021. source

      Not checked in the free run.

    • cites [51] Zink J, Belcher BR, Imm K, Leventhal AM. The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables. BMC Public Health. 2020;20:472. source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Cultural variability in symptom presentation may not be comprehensively captured by the diagnostic classification system.

    “Other possible explanations include cultural variability in symptom presentation, which may not be comprehensively captured by the diagnostic classification system [126].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [126] Mennies RJ, Birk SL, Norris LA, Olino TM. The main and interactive associations between demographic factors and psychopathology and treatment utilization in youth: a test of intersectionality in the ABCD Study. Res Child Adolesc Psychopathol. 2021;49:5–17. source

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  • May combine two claims.

    Premisecitation

    Higher levels of screen time are associated with reduced sleep duration and more sleep disturbances, which are in turn associated with internalizing, externalizing, and peer problems.

    “Studies have also shown that higher levels of screen time were associated with reduced sleep duration and more sleep disturbances, which were in turn associated with internalizing, externalizing, and peer problems [62, 121].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [62] Guerrero MD, Barnes JD, Chaput J-P, Tremblay MS. Screen time and problem behaviors in children: exploring the mediating role of sleep duration. Int J Behav Nutr Phys Act. 2019;16:105. source

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    • cites [121] Parent J, Sanders W, Forehand R. Youth screen time and behavioral health problems: the role of sleep duration and disturbances. J Dev Behav Pediatr. 2016;37:277–84. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The CBCL's DSM-oriented scales for depression, anxiety disorders, ADHD, somatic symptoms, ODD, and conduct disorders can be used in clinical settings for screening for psychopathology based on the DSM classification system and enhancing diagnostic assessment.

    “Although the scores in the clinical range for specific DSM-oriented scales of the CBCL are not directly equivalent to the corresponding specific diagnosis [41, 42], the CBCL’s DSM-oriented scales for depression, anxiety disorders, ADHD, somatic symptoms, ODD, and conduct disorders can be used in clinical settings for screening for psychopathology based on the DSM classification system and”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Skarphedinsson G, Jarbin H, Andersson M, Ivarsson T. Diagnostic efficiency and validity of the DSM-oriented Child Behavior Checklist and Youth Self-Report scales in a clinical sample of Swedish youth. PLoS ONE. 2021;16:e0254953. source

      Not checked in the free run.

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    Premisecitation

    All three of those studies featured a cross-sectional study design and did not investigate the longitudinal relationship between screen time and internalizing and externalizing behaviors in adolescents.

    “Further, all three studies featured a cross-sectional study design and did not investigate the longitudinal relationship between screen time and internalizing and externalizing behaviors in adolescents.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Eirich R, McArthur BA, Anhorn C, McGuinness C, Christakis DA, Madigan S. Association of screen time with internalizing and externalizing behavior problems in children 12 years or younger: a systematic review and meta-analysis. JAMA Psychiatry. 2022;79:393–405. source

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    Interpretationcitation

    The effects of screen time on mental health could be magnified because average screen time rose during COVID-19.

    “given that average screen time for adolescents rose to nearly eight hours per day during the COVID-19 pandemic, these effects could be magnified [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Nagata JM, Cortez CA, Cattle CJ, Ganson KT, Iyer P, Bibbins-Domingo K, et al. Screen time use among U.S. adolescents during the COVID-19 pandemic: findings from the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatr. 2022;176:94–6. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Studies have demonstrated an acceptable correspondence between the CBCL DSM-oriented scales and DSM diagnoses.

    “Studies have demonstrated an acceptable correspondence between the DSM-oriented scales and DSM diagnoses [33–40].”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [33] Bellina M, Brambilla P, Garzitto M, Negri GAL, Molteni M, Nobile M. The ability of CBCL DSM-oriented scales to predict DSM-IV diagnoses in a referred sample of children and adolescents. Eur Child Adolesc Psychiatry. 2013;22:235–46. source

      Not checked in the free run.

    • cites [34] Cianchetti C, Faedda N, Pasculli M, Ledda MG, Diaz G, Peschechera A, et al. Predictive validity for the clinical diagnosis of a new parent questionnaire, the CABI, compared with CBCL. Clin Child Psychol Psychiatry. 2020;25:507–19. source

      Not checked in the free run.

    • cites [35] Dingle K, Alati R, Williams GM, Najman JM, Bor W, Clavarino A. The ability of YSR DSM-oriented depression scales to predict DSM-IV depression in young adults: a longitudinal study. J Affect Disord. 2010;121:45–51. source

      Not checked in the free run.

    • cites [36] Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The youth self report: applicability and validity across younger and older youths. J Clin Child Adolesc Psychol off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div. 2011;53:40:338–46.

      Not checked in the free run.

    • cites [37] Ferdinand RF. Validity of the CBCL/YSR DSM-IV scales anxiety problems and affective problems. J Anxiety Disord. 2008;22:126–34. source

      Not checked in the free run.

    • cites [38] Krol NPCM, De Bruyn EEJ, Coolen JC, van Aarle EJM. From CBCL to DSM: a comparison of two methods to screen for DSM-IV diagnoses using CBCL data. J Clin Child Adolesc Psychol off J Soc Clin Child Adolesc Psychol Am Psychol Assoc Div. 2006;53:35:127–35.

      Not checked in the free run.

    • cites [39] Lacalle M, Ezpeleta L, Doménech JM. DSM-oriented scales of the Child Behavior Checklist and Youth Self-Report in clinically referred Spanish children. Span J Psychol. 2012;15:377–87. source

      Not checked in the free run.

    • cites [40] Skarphedinsson G, Jarbin H, Andersson M, Ivarsson T. Diagnostic efficiency and validity of the DSM-oriented Child Behavior Checklist and Youth Self-Report scales in a clinical sample of Swedish youth. PLoS ONE. 2021;16:e0254953. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Longitudinal studies provide more robust data and enable the examination of correlations over time.

    “Longitudinal studies provide more robust data and enable the examination of correlations over time [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Tang S, Werner-Seidler A, Torok M, Mackinnon AJ, Christensen H. The relationship between screen time and mental health in young people: a systematic review of longitudinal studies. Clin Psychol Rev. 2021;86:102021. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The displacement hypothesis posits that screen time may replace time adolescents spend engaging in physical activity, sleep, in-person interactions, and other beneficial pursuits demonstrated to help reduce depression and anxiety symptoms.

    “The displacement hypothesis posits that screen time may replace time adolescents spend engaging in physical activity, sleep, in-person interactions, and other beneficial pursuits demonstrated to help reduce depression and anxiety symptoms [118–120].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [118] Philippot A, Dubois V, Lambrechts K, Grogna D, Robert A, Jonckheer U, et al. Impact of physical exercise on depression and anxiety in adolescent inpatients: a randomized controlled trial. J Affect Disord. 2022;301:145–53. source

      Not checked in the free run.

    • cites [119] Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, Muñoz NE, Mora-Gonzalez J, Migueles JH et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports Med 2019 499. 2019;49:1383–410. source

      Not checked in the free run.

    • cites [120] Wang X, Cai Z, Jiang W, Fang Y, Sun W, Wang X. Systematic review and meta-analysis of the effects of exercise on depression in adolescents. Child Adolesc Psychiatry Ment Health. 2022;16:16. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationcitation

    It is possible that adolescents from racial/ethnic minority backgrounds who experience isolation, bullying, or discrimination in person may use screens to connect with others with similar backgrounds, which could buffer from depression, anxiety, and other symptoms of poor mental health.

    “However, it is possible that adolescents from racial/ethnic minority backgrounds who might experience isolation, bullying, or discrimination in person may use screens to connect with others with similar backgrounds, which could buffer from depression, anxiety, and other symptoms of poor mental health [125].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [125] Kowalski RM, Dillon E, Macbeth J, Franchi M, Bush M. Racial differences in cyberbullying from the perspective of victims and perpetrators. Am J Orthopsychiatry. 2020;90:644–52. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Internalized stigma about mental health may dissuade individuals from reporting symptoms or seeking help and services.

    “Internalized stigma about mental health may dissuade individuals from reporting symptoms or seeking help and services [126].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [126] Mennies RJ, Birk SL, Norris LA, Olino TM. The main and interactive associations between demographic factors and psychopathology and treatment utilization in youth: a test of intersectionality in the ABCD Study. Res Child Adolesc Psychopathol. 2021;49:5–17. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Parents completing rating scales in the CBCL may make implicit comparisons to a culturally-based standard for how children should behave or to their child's local peers.

    “Furthermore, as parents complete rating scales in the CBCL, they may make implicit comparisons to a culturally-based standard for how children should behave or to their child’s local peers [127].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] Lansford JE, Godwin J, Bornstein MH, Chang L, Deater-Deckard K, Di Giunta L, et al. Parenting, culture, and the development of externalizing behaviors from age 7 to 14 in nine countries. Dev Psychopathol. 2018;30:1937–58. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    It remains unclear whether specific modalities of screen time are differentially associated with adolescent mental health outcomes.

    “Furthermore, it remains unclear whether specific modalities of screen time (e.g., device type, digital media type, and specific websites and applications) are differentially associated with adolescent mental health outcomes, prompting a call for researchers to conduct more nuanced measurements and analyses of screen use that focus on the contents, contexts, and environments in which digital media”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [11] Santos RMS, Mendes CG, Sen Bressani GY, de Alcantara Ventura S, de Almeida Nogueira YJ, de Miranda DM, et al. The associations between screen time and mental health in adolescents: a systematic review. BMC Psychol. 2023;11:127. source

      Not checked in the free run.

    • cites [51] Zink J, Belcher BR, Imm K, Leventhal AM. The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables. BMC Public Health. 2020;20:472. source

      Not checked in the free run.

    • cites [87] Perlmutter E, Dwyer B, Torous J. Social media and youth mental health: assessing the impact through current and novel digital phenotyping methods. Curr Treat Options Psychiatry. 2024;11:34–51. source

      Not checked in the free run.

    • cites [88] Sanders T, Parker PD, del Pozo-Cruz B, Noetel M, Lonsdale C. Type of screen time moderates effects on outcomes in 4013 children: evidence from the longitudinal study of Australian children. Int J Behav Nutr Phys Act. 2019;16:117. source

      Not checked in the free run.

    • cites [89] Sanders T, Noetel M, Parker P, Del Pozo Cruz B, Biddle S, Ronto R, et al. An umbrella review of the benefits and risks associated with youths’ interactions with electronic screens. Nat Hum Behav. 2024;8:82–99. source

      Not checked in the free run.

    • cites [90] Twenge JM, Farley E. Not all screen time is created equal: associations with mental health vary by activity and gender. Soc Psychiatry Psychiatr Epidemiol. 2021;56:207–17. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Average screen time for adolescents rose to nearly eight hours per day during the COVID-19 pandemic.

    “given that average screen time for adolescents rose to nearly eight hours per day during the COVID-19 pandemic, these effects could be magnified [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Nagata JM, Cortez CA, Cattle CJ, Ganson KT, Iyer P, Bibbins-Domingo K, et al. Screen time use among U.S. adolescents during the COVID-19 pandemic: findings from the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatr. 2022;176:94–6. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The extant literature on the impact of screen exposure on the psychosocial outcomes of racial and ethnic minority adolescents in the United States is sparse.

    “The extant literature on the impact of screen exposure on the psychosocial outcomes of racial and ethnic minority adolescents in the United States is sparse [122–124].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [122] Barr-Anderson DJ, Fulkerson JA, Smyth M, Himes JH, Hannan PJ, Holy Rock B, et al. Associations of American Indian children’s screen-time behavior with parental television behavior, parental perceptions of children’s screen time, and media-related resources in the home. Prev Chronic Dis. 2011;8:A105.

      Not checked in the free run.

    • cites [123] Foulds HJA, Rodgers CD, Duncan V, Ferguson LJ. A systematic review and meta-analysis of screen time behaviour among North American indigenous populations. Obes Rev off J Int Assoc Study Obes. 2016;17:455–66. source

      Not checked in the free run.

    • cites [124] Grant VM, Tomayko EJ, Kingfisher RD. Sleep and physical activity patterns in urban American Indian children. Am J Health Behav. 2020;44:67–75. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Although the study controlled for age, sex, race/ethnicity, household income, parent education, and study site, there is the possibility of unmeasured confounders.

    “Although we controlled for age, sex, race/ethnicity, household income, parent education, and study site, there is the possibility of unmeasured confounders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Academy of Pediatrics advocates for a Family Media Use plan for children 5 to 18 years old.

    “The American Academy of Pediatrics advocates for a Family Media Use plan for children 5 to 18 years old [133]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [133] Hill D, Ameenuddin N, Chassiakos YR, Cross C, Radesky J, Hutchinson J et al. Media use in school-aged children and adolescents. Pediatrics. 2016;138. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Although the study examined the prospective association of screen time leading to mental health outcomes, there is the possibility of inverse causality.

    “Although we examined the prospective association of screen time leading to mental health outcomes, there is the possibility of inverse causality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study had strengths including longitudinal data spanning two years of follow-up in a large, nationwide, diverse sample of US adolescents, allowing examination of moderation by sex and race/ethnicity.

    “Strengths of this study include the longitudinal data spanning two years of follow-up in a large, nationwide sample of adolescents in the US that was diverse, allowing the examination of moderation of effects by sex and race/ethnicity between screen time and mental health symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Screen time does not capture the content or context of screen use.

    “Screen time does not capture the content or context of screen use, which could be examined in future research [20, 128].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] Odgers CL, Schueller SM, Ito M. Screen time, social media use, and adolescent development. Annu Rev Dev Psychol. 2020;2:485–502. source

      Not checked in the free run.

    • cites [128] Kaye LK, Orben A, Ellis DA, Hunter SC, Houghton S. The conceptual and methodological mayhem of screen time. Int J Environ Res Public Health. 2020;17:3661. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Bidirectional associations between screen time and mental health could be supported by the self-perpetuating feedback loop model, whereby screen use leads to worsening mental health and poor mental health leads to increasing reliance on screens to cope.

    “Bidirectional associations between screen time and mental health could be supported by the self-perpetuating feedback loop model [131], whereby screen use leads to worsening mental health and poor mental health leads to increasing reliance on screens to cope [132].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [131] Flannery JS, Maza MT, Kilic Z, Telzer EH. Cascading bidirectional influences of digital media use and mental health in adolescence. Adv Child Dev Behav. 2023;64:255–87. source

      Not checked in the free run.

    • cites [132] Hartanto A, Quek FYX, Tng GYQ, Yong JC. Does social media use increase depressive symptoms? A reverse causation perspective. Front Psychiatry. 2021;12. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Digital technology use among children increases with age, particularly during adolescence.

    “given that digital technology use among children increases with age, particularly during adolescence [129, 130]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [129] Houghton S, Hunter SC, Rosenberg M, Wood L, Zadow C, Martin K, et al. Virtually impossible: limiting Australian children and adolescents daily screen based media use. BMC Public Health. 2015;15:5. source

      Not checked in the free run.

    • cites [130] Atkin AJ, Corder K, van Sluijs EMF. Bedroom media, sedentary time and screen-time in children: a longitudinal analysis. Int J Behav Nutr Phys Act. 2013;10:137. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The current analysis could only follow adolescents for two years, starting from age 9 to 10, due to availability of data from the ongoing ABCD Study.

    “The current analysis was limited by the availability of data from the ongoing ABCD Study and could only follow adolescents for two years, starting from age 9 to 10.”
    Quote in the paperNot a substantial claim
42 of 42

  • The paper relies on this without support.

    The observed prospective associations between screen time and mental health symptoms are not due to unmeasured confounding.

    “higher total screen time was prospectively associated with higher scores on all DSM-oriented scales of the CBCL at both one- and two-year follow-up, even after adjusting for confounders.”

  • The paper relies on this without support.

    Missing data for total screen time and confounders were missing at random, so excluding participants with missing data did not bias the associations.

    “Among 11,875 participants, 2,337 had missing data for total screen time and confounders, especially in Year 2, leaving 9,538 participants for the current analysis.”

  • The paper relies on this without support.

    Longitudinal analyses of the association between screen time and somatic symptoms had not been published before this study.

    “To our knowledge, analyses of the longitudinal associations between screen time and somatic symptoms have not been published.”

  • The paper relies on this without support.

    The minimum age requirement to have a social media account is 13 years old.

    “younger than the minimum age requirement to have a social media account (13 years old).”

  • The paper relies on this without support.

    Depression and other mental health conditions increase in mid- to late-adolescence.

    “given that depression and other mental health conditions increase in mid- to late-adolescence”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Traditional sedentary games have been associated with negative health outcomes due to prolonged inactivity.

    “Unlike traditional sedentary games, which have been associated with negative health outcomes due to prolonged inactivity [64–67], AVGs incorporate bodily movement as a core component of gameplay [68]; exergaming is a specific type of AVG designed primarily for exercise rather than entertainment [68].”

    From Health Benefits of Video Games in Adolescents and Young Adults (2026) · cites this paper as [67]

    The Discussion (page not available) reports an association between video-game screen time and depressive symptoms in early adolescents. It proposes that screen time may displace physical activity, but does not establish that the association is due to prolonged inactivity or extend the finding to negative health outcomes generally. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Screen-time components exceed reported total

    Minor

    The six reported mean screen-time components sum to 4.4 hours per day, not the reported total of 4.0. The 0.4-hour gap is larger than rounding to one decimal place can explain.

    Reported 4 · recomputed 4.4

  • Somatic-symptom confidence interval has reversed bounds

    Minor

    For the Native American subsample, the printed 95% confidence interval runs from 0.32 to −0.01: its lower bound exceeds its upper bound. The reported coefficient of −0.17 also falls outside those printed bounds.

  • Printed formula does not calculate a weighted daily average

    Minor

    As parenthesized, division by seven applies only to the weekend term; the weekday term remains multiplied by five. That conflicts with the stated calculation of a weighted average of weekday and weekend screen time.

3 of 3

Cites

Flagged first, then by citations

4 of the 136 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. McCrae N, Gettings S, Purssell E. Social media and depressive symptoms in childhood and adolescence: a systematic review. Adolesc Res Rev. 2017;2:315–30.
  2. D’Souza RS, Hooten WM. In: StatPearls, editor. Somatic syndrome disorders. Treasure Island (FL): StatPearls Publishing; 2023.
  3. U.S. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd Edition. Department of Health and Human Services; 2018.
  4. Dickson K, Richardson M, Kwan I, MacDowall W, Burchett H, Stansfield C, et al. Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London; 2018.
  5. Viner RM, Davie M, Firth A. The health impacts of screen time: a guide for clinicians and parents. Edinburgh, Scotland: Royal College of Paediatrics and Child Health; 2019.

Cited by

Sorted by citations

Related

Authors
Nagata, J. M., Al-Shoaibi, A. A. A., Leong, A. W., Zamora, G., Testa, A., Ganson, K. T., & Baker, F. C.
Affiliations
  • University of California, San Francisco (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • The University of Texas Health Science Center at Houston (US)
  • University of Toronto (CA)
  • SRI International (US)
Corresponding author
Nagata, Jason M.
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2024-10-07
Volume
24
Issue
1
Pages
2686-2686
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-024-20102-x
PMC
PMC11457456
OpenAlex
W4403162922
Semantic Scholar
39cef393b2da94867e9b5e2323e2e4159054cd21
Cited by
103
References
136
Citations by year
2026: 63 · 2025: 40
FWCI
129.13
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institutes of Health (K08HL159350, R01MH135492)
  • Doris Duke Charitable Foundation (2022056)
Topics
  • Social Sciences › Education › Child Development and Digital Technology
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
screen time, adolescent mental health, depressive symptoms, conduct problems, somatic symptoms, video games, video chat, text messaging, adolescents, racial and ethnic disparities, sex differences
MeSH terms
Screen Time, Adolescent, Adolescent Behavior, Child, Female, Humans, Longitudinal Studies, Male, Mental Health, Prospective Studies, United States, Adolescent Development

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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