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

Shuan Liu1, Sitong Chen2, Xiaohong Zhu3, Brendon Stubbs4, Qian Yu5, Mark D. Griffiths6, Can Jiao7, Aiguo Chen8, Md Mahbub Hossain9, Zsolt Demetrovics10,11, Albert S. Yeung12, Jinming Li5, Xingyu Zhang5, Liye Zou5,*

1 Faculty of Educational Science, South China Normal University, Guangzhou, 510631, China
2 Institute for Health and Sport, Victoria University, Melbourne, 8001, Australia
3 College of Sports Science, Jishou University, Jishou, 212013, China
4 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, WC2R 2LS, UK
5 Exercise and Mental Health Laboratory, Institute of KEEP Collaborative Innovation, Shenzhen University, Shenzhen, 518060, China
6 Psychology Department, Nottingham Trent University, Nottingham, NG1 4FQ, UK
7 School of Psychology, Shenzhen University, Shenzhen, 518060, China
8 College of Physical Education, Yangzhou University, Yangzhou, 225127, China
9 Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX77843, USA
10 Institute of Psychology, ELTE Eötvös Loránd University, Budapest, 1064, Hungary
11 Centre of Excellence in Responsible Gaming, University of Gibraltar, Europa Point, GX11 1AA, Gibraltar
12 Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA

* Corresponding Author: Liye Zou. Email:

International Journal of Mental Health Promotion 2021, 23(2), 141-153.


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 (I2 = 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 factors when implementing AST-related mental health interventions. Future studies should adopt the solid study design to confirm or negate our research findings.


Cite This Article

Liu, S., Chen, S., Zhu, X., Stubbs, B., Yu, Q. et al. (2021). Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries. International Journal of Mental Health Promotion, 23(2), 141–153.

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.
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