Excessive Screen Time Among U.S. High School Students: Mental Health, Suicidal Ideation and Social Image Factors

<b>Background/Objectives:</b> Adolescents' screen time has increased alongside rising rates of depression and suicidal ideation and behavior. This study examined associations between excessive screen time and mental health among U.S. high school students, and explored whether social image factors (overweight perception, sports team participation, and academic performance) mitigate these associations. <b>Methods:</b> We analyzed data from the 2019 Youth Risk Behavior Surveillance System (YRBSS) (N = 13,677). Screen time was categorized as <2, 2-3, ≥4 h per day for television watching and digital device use (excluding school-related use). Multivariate logistic regression analyses estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for associations between screen time and mental health outcomes, adjusting for demographic and social image factors. <b>Results:</b> Overall, 31.7% of students reported using digital devices for ≥4 h per day, compared with 10.2% who watched television for ≥4 h per day. Using digital devices for ≥4 h per day was significantly associated with difficulty concentrating (AOR = 1.68), insufficient sleep (AOR = 1.43), feeling sad or hopeless (AOR = 1.86), and suicidal ideation (AOR = 1.69 for considering suicide; AOR = 1.77 for planning suicide) compared with using digital devices for <2 h per day, after adjusting for demographic and social image factors. Significant associations between television viewing and mental health outcomes appeared to be largely explained by social image factors. Female students and certain racial/ethnic groups were more likely to report mental health difficulties. Students with a positive social image reported lower odds of poor mental health outcomes and excessive screen time. <b>Conclusions:</b> Excessive digital device use is associated with poor mental health and suicidal ideation among high school students, with female students particularly vulnerable. Social image factors were also associated with screen time and mental health outcomes. Interventions that promote school engagement, sports team participation, and a positive social image may help mitigate the adverse effects of excessive screen time.