Cross-lagged analysis of the relationship between risk perception, physical activity, and adolescent mental health

Introduction

With the opening of the global epidemic, many places further optimize their epidemic control and tend to open up and rationalize their control layout. However, during the period of gradual liberalization, many places are experiencing brief disease "outbreaks". In this social environment, new coronaviruses are mutating and spreading faster, and from another point of view, the public perception of social disease risk is becoming stronger. As one of the susceptible groups, the risk of social diseases has deterred adolescents from outdoor physical activity, which over time has caused some psychological fear and thus mental health problems. [1]

Trauma theory considers "psychological trauma" as the most basic concept in trauma theory, which refers to the unhealable damage left on the victim's mind by an event or disaster, and the victim can be an individual or a group. [2] Some studies have shown that adolescents may suffer from illnesses during or even before openness, causing psychic damage and fear of participating in outdoor activities. And it is proposed in social risk theory that the risk capacity constructed by the epidemic creates expansive threats when conditions allow; such risks induce the formation of risk consciousness in adolescents, leading to an overall identity in coping with risks and risk perception to tend to avoid them. At the same time, La Caille et al. investigated that during the epidemic, the adolescent population had increased sedentary time and reduced physical activity, contributing to higher levels of anxiety. [3] coupled with the new crown epidemic led schools at all levels to adopt a new model of online teaching. Students invariably increase their screen time during dormitory studies, and excessive screen entertainment time is also a risk indicator for anxiety in adolescents. [4] A study of global adolescent mood problems during the epidemic showed a 31% prevalence of anxiety symptoms and a 34% prevalence of depressive symptoms among adolescents, both significantly higher than before the epidemic. [5] Emotional problems such as anxiety and depression are high-risk factors for triggering suicidal behavior in adolescent populations; however, a study by Yufu Dong during the SARS epidemic showed that physical exercise significantly alleviated the adverse mental health states such as tension and anxiety caused by public emergent crisis events. And appropriate physical exercise was also recommended as a means of regulating individual mental health during the new crown epidemic. [6] However, it is unknown whether physical exercise is still effective for mental health under the risk perception of the disease. Therefore, the present study investigated the correlation between risk perception, physical activity, and adolescent mental health. The mental health status of adolescents in special periods needs to be taken into account by society.

This study used a longitudinal design and cross-lagged analysis to explore the relationship between physical exercise and disease risk perception and mental health, respectively, in adolescent populations to provide a reference for mitigating adolescent mental health problems in the context of openness prevention and control.

Since the worldwide epidemic started, several locations have improved their epidemic control strategies and tended to open up and streamline their control architecture. However, numerous locations are currently dealing with brief illness "outbreaks" during the period of increasing liberalization. The public's impression of the risk of social disease is growing stronger, and novel coronaviruses are evolving and disseminating more quickly in this social milieu. Due to their vulnerability, adolescents have been discouraged from engaging in outdoor physical activity due to the risk of social diseases, which has over time led to some psychological anxiety and consequently difficulties with mental health. [1] According to trauma theory, the most fundamental idea is "psychological trauma," which refers to the irreparable harm an incident or tragedy leaves on the victim's mind. The victim can be an individual or a group. [2] According to certain research, adolescents may experience illnesses during or even before openness, which might harm their minds and make them afraid to engage in outside activities. And it is also suggested in social risk theory that the epidemic's capacity for risk creates expansive threats when the circumstances permit; these risks cause the development of risk consciousness in adolescents, resulting in a general identity in risk management and a tendency to avoid risk perception. The adolescent population had increased inactive time and decreased physical activity throughout the epidemic, resulting in higher levels of anxiety, according to research by La Caille et al. New online teaching models were used by schools of all levels as a result of [3] and the recent crown outbreak. During dorm studies, students always increase their screen use, and for teenagers, excessive screen time is also a risk factor for anxiety. [4] The prevalence of anxiety symptoms among adolescents was found to be 31%, while the prevalence of depressive symptoms was found to be 34%, both significantly greater than they were before the epidemic. [5] Adolescent populations are at high risk for emotional issues like anxiety and depression, which can lead to suicidal behavior. However, a study done by Yufu Dong during the SARS epidemic revealed that physical activity significantly reduced the negative mental health states like tension and anxiety brought on by public emergent crisis events. Additionally, adequate physical activity was advised as a way to control people's mental health amid the recent crown pandemic. [6] It remains unclear, nevertheless, if exercising is still good for mental health when there is a disease-related risk perception. Therefore, the current study looked into the relationship between adolescent mental health, physical exercise, and risk perception. Society must take into account the state of adolescents' mental health during particular times.

As a guide for reducing adolescent mental health issues in the context of openness prevention and control, this study used a longitudinal design and cross-lagged analysis to explore the relationship between physical activity and disease risk perception and mental health, respectively, in adolescent populations.

Methods

Adolescence is a stage of life when children transition into adult roles. It also describes the human life group between childhood and adulthood. Adolescents are often separated into two stages: 14–17 years old and 18–25 years old. This study concentrated on adolescents between the ages of 14 and 17. Five high schools were chosen at random from three different regions of China [7] for two questionnaire surveys. Survey T2 was conducted in January 2023 to re-survey the first survey respondents. Survey T1 was conducted in December 2022; 200 questionnaires were distributed in high schools; 32 invalid questionnaires were excluded; and 168 valid questionnaires were obtained. Survey T2 200 questionnaires were distributed in high schools; 24 invalid questionnaires were excluded; and 176 valid questionnaires were obtained. The final valid sample consisted of 344 data in total. Informed consent was gained from the study's respondents, 166 female students and 178 male students, who made up 51.75 percent of the total sample.

Measures

The survey for this study was divided into four sections: the New Coronary Pneumonia Epidemic Risk Perception Scale, the Adolescent Physical Activity Rating Survey, the Mental Health Assessment Scale, and the Personal Information Survey.

The scale of Adolescent Physical Activity (Grading Scale). The National Physical Fitness Monitoring Center of China and the Institute of Sports Science of the General Administration of Sports of China prepared the physical activity questionnaire for college students based on the entries about physical activity in the 2020 National Fitness Activity Status Survey and the measurement indexes of exercise behavior proposed by Qiu Fen et al. The Likert scale included five points. Cronbach's alpha for the entire scale was 0.926 (T1) and 0.930. (T2). The dependability of the split-half was 0.902 (T1) and 0.911 (T2). For 200 teenagers who underwent follow-up testing at intervals of 30 days, the stability coefficient was 0.835 (p༜0.01).

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) published by the American Psychiatric Association were used to administer the Mental Health Assessment Form (MHAF), which is based on the Generalized Anxiety Disorder-7 (GAD-7). It has been demonstrated in prior studies to have strong reliability and validity, making it a valid instrument for determining the likelihood of or predisposition to develop a generalized anxiety disorder. The scale has seven entries, with each symptom being scored on a 4-point scale ranging from 0 to 3, for a total of 21. GAD-7 scores were categorized into 4 groups based on the scoring criteria: 0–4 for no noticeable anxiety symptoms, 5–9 for mild anxiety, 10–14 for moderate anxiety, and 15–21 for severe anxiety due. Cronbach's alpha for the entire scale was 0.914 (T1) and 0.925. (T2). The dependability of the split-half was 0.922 (T1) and 0.941. (T2). (p༜ 0.01) The stability coefficient was 0.871.

Cui Xiaoqian et al. developed the Coronavirus Risk Perception Scale (CRPS), which consists of nine questions with three dimensions of severity, susceptibility, and controllability on a 5-point Likert scale. The severity, susceptibility, and controllability of risk perception are rated from "low (1)" to "high (5)" in increasing order.

Statistical Examination

The normal distribution of the recovered data was tested using statistical software, numerical values were employed for descriptive and statistical purposes, and gender was chosen as the moderating variable. To discover the most appropriate model for the multi-cluster analysis, it was required to restrict several parameters, and the measurement error model was ultimately selected as the analysis model. Investigative factor analysis AMOS 21.0 with SPSS was used to analyze the data with KMO values of 0.82 (T1) and 0.88 (T2), Bartlett's test of sphericity, approximate X2 = 409.878, df = 5, p༜0.01 (T1) and approximate X2 = 413.617, df = 5, p༜0.01 (T2).

Results

A common test for bias

To minimize bias between the two surveys towards a single dimension, a procedure strength and Harman's one-way test were used to evaluate the questionnaire format, which was disseminated online using Questionnaire Star and had bolded question stems and titles. There was 1 eigenroot component, and the eigenvalues of the major factors were T1=19.323% and T2=21.542%. According to the principle of the common method bias test, the primary features accounted for less than 40% of the variance, indicating that the common method bias of the survey test is acceptable. [10]

Analysis of the descriptive characteristics and correlations between mental health, physical exercise, and risk perception

Independent samples The t-test was used to assess the gender differences in each variable (see Table 1), and the results revealed stable gender differences in mental health (P＜0.001), risk perception (P＜0.001), and physical activity (P＜0.001) over time for both T1 and T2. In addition to the comparison of means in Table 2, it was discovered that men reported greater mental health scores than women and that women had higher scores on two repeated tests. The risk perception levels of women were higher than those of males. Mental health and risk perception had effect sizes of 0.159 (d=0.262) and 0.179 (d=0.278) for men and 0.255 (d=0.416) and 0.195 (d=0.402) for women, respectively.

Table 1 Gender-independent sample t-test

Variables	HV-test	Levene-test		T-test
		F	P	T	df	P	95%CI
		F	P	T	df	P	LLCI	ULI
T1 mental health	variance chi-squared	2.593	0.109	4.265	344	0.001^2）	0.676	0.886
T2 mental health	variance chi-squared	0.422	0.969	2.512	344	0.004^2）	0.518	0.883
T1 physical activity	variance chi-squared	0.438	0.509	-0.653	344	0.292	-0.348	0.693
T22 physical activity	variance chi-squared	0.231	0.969	-1.056	344	0.515	-0.394	1.130
T1 risk perception	variance chi-squared	0.910	0.341	2.513	344	0.001^1）	0.116	0.885
T2 risk perception	variance chi-squared	0.584	0.445	2.868	344	0.001^1）	0.355	0.916

1) P＜0.001；2）P＜0.01

To exclude interference from demographic variables, a partial correlation analysis was undertaken for the three variables of mental health, physical activity, and risk perception, and gender was added for comparison to obtain more precise results. (See Table 2.) T1 mental health and T2 mental health were strongly positively associated (p＜0.001), as were T1 risk perception and T2 risk perception. The positive correlation between T1 mental health, T1 physical exercise, and T1 risk perception in the first questionnaire survey (p＜0.001) and T2 mental health, T2 physical exercise, and T2 risk perception in the second questionnaire survey (p＜0.001) indicated the consistency of the recovered data and the synchronization of the correlations.

Table 2 Results of descriptive statistics and partial correlation analysis for each variable

Variables	T1 mental health	T2 mental health	T1 physical activity	T2 physical activity	T1 risk perception	T2 risk perception
T1 mental health	1
T2 mental health	0.672^1）	1
T1 physical activity	0.432^1）	0.423^1）	1
T2 physical activity	0.436^1）	0.363^1）	0.589^1）	1
T1 risk perception	0.552^1）	0.332^1）	0.214^1）	0.374^1）	1
T2 risk perception	0.307^1）	0.351^1）	0.178^1）	0.545^1）	0.274^1）	1
General M±SD	2.812±0.189	1.534±0.165	2.375±0.124	3.684±0.21	3.707±0.119	1.810±0.152
Male M±SD	2.815±0.242	1.548±0.199	2.381±0.150	3.703±0.242	3.694±0.151	1.819±0.191
Female M±SD	2.804±0.291	1.547±0.304	2.363±0.223	3.657±0.403	3.733±0.194	1.891±0.249

1) P＜0.001；2）P＜0.01

Analysis of risk perception, physical activity, and adolescent mental health across periods

The cross-lag analysis of risk perception, physical exercise, and mental health of adolescents was conducted by pre-correlation analysis with bias scores according to the packing and dimensionality reduction technique, and the data model was constructed using AMOS25.0 statistical software (Figure 1). In the cluster analysis, it was necessary to restrict various parameters to find the most appropriate model, by comparing the pre-defined model, the path coefficient equation, and the model with the fewest number of parameters. Comparing the fitness of six models—the preset model, the path coefficient equality model, the covariance equality model, and the variance equality model—led to the selection of the measurement error model as the analytical model. The data were good for model fit results, X²/df=1.713 (p<0.01); absolute fit index RMSEA=0.082; relative fit index CFI=0.911, GFI=0.931, NF1=0.935, IF1=0.959, TLI=0.956, and risk perception T1, physical exercise T2, and mental health T2,3 The variables were created as distinct models of mediating effects, and the Bootstrap method was used to examine the mediating effect of physical exercise T2 between risk perception T1 and mental health T2. The foundation of the Bootstrap approach was to investigate the correlation of a*b. On the one hand, the Sobel test is conducted, which has high data needs, a big sample size, and a normal distribution, resulting in low testing efficiency. The sampling test procedure for the initial sample is contrasted with this. The Bootstrap sampling approach is a more prevalent test due to its efficiency, and there are no limits on the distribution pattern of the sampling for the mediating effect. The bootstrap sampling method is based on repeated sampling of the initial sample, and the significance of the coefficient of the mediating effect is evaluated using a 95% confidence range (CI). [11] Hayes (2009) suggested that the initial sample is sampled up to a thousand times for the Bootstrap mediation effect test. If the results of the Bootstrap mediated effects test reveal that the Bootstrap test CI does not contain the value 0, the indirect impact will begin to take effect (Chen, R. et al., 2013). In this study, the technique of calculating the mediating effect Bootstrap 95% CI was based on sampling the sample 1000 times for the mediating effect test, and the findings are presented in Table 3. The point estimate of the direct effect of risk perception T1 → physical exercise T2 → mental health T2 was 1.010, the mediating effect was 0.012, the Z value was 0.112, and the indirect effect Bootstrap 95% CI from this path did not have a 0 value, indicating a significant mediating effect of physical exercise between risk perception and mental health.

Table 3 Intermediation effect result test

item	Total effect（C）	a	b	Intermediary value effect（a*b）	Boot SE	Z-value	P-value	95% BootCI	Direct effect	Test conclusion
risk perception T1→physical exercise T2→mental health T2	1.022**	0.048	0.245	0.012	0.105	0.112	0.911	0.197~0.229	1.010**	Significant intermediation

The results demonstrated that the influence of mental health T1 on physical exercise T2 (β=0.08) was statistically significant, as was the effect of physical exercise T1 on mental health T2 (β=0.33) and the effect of risk perception T1 on mental health T2 (β=0.28) and physical exercise T2 (β=0.19). There was no statistically significant relationship between mental health T1 (β=-0.01) and physical activity T1 (β=-0.27) and risk perception T2 (p>0.05).

Discussion

According to the results of the data analysis, there is a longitudinal causal association between perceived disease risk, physical activity, and teenagers' mental health. It suggests that physical activity can still affect mental health despite risk perception. And female adolescents had a larger risk perception than male adolescents, which is consistent with the findings of other researchers. [12] There are several reasons why female adolescents may have a higher risk perception than male adolescents. Females tend to have greater empathy, which may make them more aware of potential dangers and risks in their surroundings. [13] Furthermore, societal and cultural variables may have a role, as females are typically socialized to be more careful and aware of potential threats. Girls are typically exposed to more risk information and receive more safety-related messages than boys, according to studies. Males were less concerned about viral infections than females, females perceived the end of the epidemic to be closer than males, and female adolescents had high-risk perceptions of viral susceptibility due in part to their dissatisfaction with the government's real-time release of information, the speed of emergency plans, and the implementation of comprehensive prevention and control. [14] According to physiological theories, females have higher estrogen levels, which have been linked to heightened anxiety and stress responses. It has been discovered that estrogen increases the activity of the hypothalamic-pituitary-adrenal (HPA) axis, a major component of the body's stress response. This increased activity might result in elevated amounts of the stress hormone cortisol, which can induce feelings of worry. Another possible explanation is that women have more receptors for the neurotransmitter serotonin, which is related to mood regulation and anxiety, in their brains. Lower serotonin levels are linked to increased anxiety and depression, as demonstrated in [15], therefore the higher receptor density in female teenagers may render them more susceptible to these sensations during the transmission of social disorders. Thus, gender and the social information teenagers are exposed to are intimately associated with psychological issues emerging from adolescents' risk perception. In addition, the study indicated that male adolescents engaged in more physical activity than female adolescents, a finding that is consistent with earlier research. [16] Males are socialized to value physical activity and strength, whereas girls are socialized to value attractiveness and thinness. This may result in varied physical activity attitudes and motives. Male adolescents have stronger self-esteem and self-efficacy, which can drive them to participate in physical exercise, but female adolescents have different preferences and lower self-efficacy, which may make them less inclined to participate in physical activity. In addition, school closures and other interruptions to everyday life during social disease epidemics may make it harder for adolescents to maintain a regular physical activity routine. Boys may be more likely to find opportunities to engage in physical activity, such as playing sports, visiting bodybuilding rooms, or using internet training videos, whereas girls may encounter greater obstacles to physical activity.

Consistent with earlier findings, regression analysis revealed that adolescents' perceptions of risk affect their mental health. Individuals with higher risk perceptions are likely to suffer more anxiety, despair, and stress, as demonstrated by Study 17. Due to disruptions in their everyday life and social networks, as well as the uncertainty and dread induced by illness, adolescents may be more susceptible to the effect of the social risk of disease on their mental health. Increased risk perception among teenagers can result in elevated levels of anxiety, worry, and fear, which can have a severe effect on their mental health. In addition, teenagers with a high perception of danger may be more inclined to adopt maladaptive coping techniques, such as avoidance, which may exacerbate their mental health issues. Conversely, teenagers with reduced risk perceptions may be more likely to adopt healthy coping methods, such as physical activity and social support, which can positively impact their mental health, with physical activity being recognized as the "top choice" for molding mental health. Cross-lagged studies have also identified physical exercise as a mediator of risk perception management in teenagers' mental health. Physical activity" is frequently used to self-regulate, assisting schoolchildren in stabilizing their moods and enhancing their physical condition. Mental health is the subjective reaction of the brain to external reality, and awareness represents the pinnacle of mental development. Mental health consists of cognitive reappraisal, emotional control, and volitional molding [18] processes. The analysis of cognitive reappraisal through distraction theory reveals that attention is the direction and concentration of mental activity on a particular object with two characteristics: directionality and concentration, and when a person directs and concentrates his or her consciousness on a particular activity, his or her awareness of everything else around him or her decreases proportionally. According to the notion of distraction, exercise can divert and distract an individual's attention from unfavorable stimuli, allowing them to ignore unpleasant stimuli and focus on positive stimuli, so improving their mood. [19] Individuals have limited cognitive resources for attention, and when these resources are exhausted, new stimuli cannot be absorbed. When individuals dedicate cognitive resources to vital activities, such as exercise, negative emotions are eliminated from awareness and only the positive feelings associated with exercise are experienced. Then, there will be a reconsideration of the new cognition, which will shift the focus away from the negative event and significantly improve students' anxiety and despair. [20] Second, social interaction theory for emotion regulation discovered that the intrinsic social ties prominent in physical activity and the mutual support amongst individuals engaging in exercise have a significant influence on the effect of exercise on psychological well-being. There are favorable impacts of social support on mental health [21], including emotional support, information, and companionship, which all moderate the development of depression and anxiety symptoms [22]. It can be demonstrated that physical activity has some effect. [23] According to the prominent researcher Skaalvik, who argued that self-efficacy is the belief in one's abilities, including the ability to plan, organize, and produce relevant activities essential to achieve goals, self-efficacy was evaluated in terms of will shaping. [24] Students in high school complete the workout program due to their self-confidence and gain satisfaction from the sense of completion. Some studies have demonstrated that the more peer support students receive during exercise, the more maintained their exercise practice, and some researchers have hypothesized that social support mediates the effect of exercise on the mental health of college students. [25] Compared to male college students, female college students received greater social support from their peer group and more encouragement from their peers to engage in physical activity, adopt healthy eating habits, and improve their body image. [26]

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Cross-lagged analysis of the relationship between risk perception, physical activity, and adolescent mental health

Abstract

Introduction

Methods

Measures

Statistical Examination

Results

Discussion

Declarations

Competing interests

Funding

Authors' contributions

Acknowledgments

References