Association of traditional leisure time activities during adolescence to later psychiatric morbidity in early adulthood – a systematic review
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Aug 10, 2025
About this article
Article Category: Review
Published Online: Aug 10, 2025
Page range: 82 - 102
DOI: https://doi.org/10.2478/sjcapp-2025-0009
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© 2025 Johanna Timonen et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Figure 1.
Search terms combined for each tier
| Tier 1 |
Tier 2 |
Tier 3 |
Tier 4 |
|---|---|---|---|
| “Leisure Activities”[Mesh] OR “leisure activit*”[tw] OR “leisure time”[tw] OR hobby*[tw] OR hobbies[tw] OR sport*[tw] | “Adolescent”[Mesh] OR adolescen*[tw] OR teenage*[tw] OR youth [tw] | “Mental Disorders”[Mesh] OR “mental health disorder*”[tw] OR “mental disorder*”[tw] OR “Psychiatric Disorder*”[tw] OR anxiet*[tw] OR depress*[tw] OR “substance use disorder*”[tw] | “Cohort Studies”[Mesh] OR “Follow-Up Studies”[Mesh] OR “Prospective Studies”[Mesh] OR follow-up*[tw] OR followup[tw] OR “prospective stud*”[tw] OR cohort*[tw] |
Aims and the findings of the reviewed studies regarding the association of leisure time activity in childhood and adolescence to later psychiatric disorders diagnosed by young adulthood_
| Authors, publishing year (country) | Aims of the study addressing leisure time activity in childhood and adolescence and later psychiatric disorders | Detailed results | Overall conclusion based on the results |
|---|---|---|---|
| Desphande et al. (2020) USA | To estimate the effect of playing football during adolescence (at grades 7–12) on diagnosis after age 18 years for depression, anxiety or panic disorders, and PTSD in early adulthood (age 24–32 years). Secondary outcomes for nicotine, cannabis or alcohol abuse were examined. | Study did not find evidence that participation in middle or high school football had a harmful effect on depression or anxiety and substance dependence in early adulthood. | Participating or intending to participate in school football does not appear to be a major risk factor for early adulthood depression, anxiety, or PTSD. |
| Easterlin et al. (2019) USA | To examine among those affected by at least one ACEs, the association of team sports participation during adolescence (at school grades 7–12) to ever having diagnosed for depression or anxiety and to have positive screen results for current clinical depression in adulthood (age 24–32 years). | In total sample, team sports participation in adolescence (compared to non-participants) associated to a decreased likelihood for an adult diagnosis of depression (adj. OR with 95% CI = 0.76, 0.59–0.97) and anxiety (0.70, 0.56–0.89.) | Considering that participation in team sports has been linked to improved adult mental health for individuals with adverse childhood experiences (ACEs), pediatricians may consider recommending team sports involvement for patients with ACEs. Additionally, parents may contemplate enrolling their children with ACEs in team sports. |
| In boys, teams sport participation was associated with a decreased likelihood of having a diagnosis of depression (0.67, 0.46–0.99) or anxiety (0.66, 0.45–0.96), and for showing current depressive symptoms (0.75, 0.56–0.99), while in girls the association was found for diagnosis of anxiety (0.73, 0.54–0.98). | |||
| Okkenhaug et al. (2015) Norway | To investigate the prevalence and pattern of physical activity in adolescence (age 13–19 years) with later diagnosis for schizophrenia (cases) or bipolar disorder (contrasts), and in mentally healthy controls. | The cases with schizophrenia and contrasts with bipolar disorders, compared to healthy controls, reported less physical activity regarding exercise hours being less than one hour per week (53.3%, 61.1%, 29.1%; p < 0.05). | Those who develop schizophrenia might have started to develop a hazardous lifestyle already in their teens. It is important in a preventive perspective to gain more knowledge concerning the relationship between health-related habits and later development of psychiatric morbidity. |
| Participating in team sport was lower in cases with schizophrenia than in controls (53.3%. 79.2%; p=0.048). | |||
| Koivukangas et al. (2010) Finland | To explore the association of the level of physical activity after school hours (age 15–16 years) to later onset of first-episode psychosis | Individuals who later developed psychosis were more likely to be physically inactive during adolescence, adj. OR, (95% CI), 3.3 (1.4–7.9) compared to those without psychosis. | Encouraging physical activity is crucial for individuals at risk of developing psychosis to mitigate the negative impact of physical inactivity on overall health. Further research is recommended to explore the effectiveness of physical activity in treating mental health issues in adolescents. |
| Sormunen et al. (2017) Finland | To examine the association of physical activity levels in childhood and adolescence (age ≤ 18 years) to later development of non-affective psychosis and schizophrenia. | Lower physical activity index (relative risk, RR, 95%CI) (1.26, 1.1–1.5), lower level of common activity during leisure time (1.71, 1.2–2.5), and non-participation in sports competitions (2.58, 1.3–5.3) were associated with higher risk for later non-affective psychosis, compared to controls without no psychiatric diagnoses. | Low physical activity level in children and adolescents is an independent predictor for development of non-affective psychosis. Further research is needed to assess the role and possibilities of early exercise and physical activity intervention as a part of psychosis prevention. |
| Correspondingly, lower physical activity index (1.4, 1.2–1.7), lower common activity during leisure time (1.8, 1.0–3.0), lower intensity of physical activity (1.7, 1.1–2.9), lower frequency of participation in organized training (1.40, 1.1–1.8) and non-participation in sports competitions (4.88, 1.4–17.0) were associated with higher risk for later development of schizophrenia. | |||
| Samek et al. (2015) USA | To analyze whether involvement in high school sports and other extracurricular actives (at age 19 years) associated to adult antisocial behavior (AAB) (at mean age 22.4 years) and has impact on the association between conduct disorder (CD) before 15 years and AAB in young adulthood. | Fewer AAB symptoms (mean) were associated to involvement in in clubs (yes vs. no, 0.61 vs. 0.90, p<0.001) and plays/musicals, 0.57 vs. 0.85, p<0.01) compared with those not involved. | It appears that high school sports involvement may decrease risk for persistent antisocial behavior. It is crucial for future research to continue to identify additional environmental factors that mitigate the relationship between conduct disorder and adult antisocial behavior. |
| The association between CD before 15 yrs and AAB in young adulthood was significantly weaker (χ2=4.13, p=0.04) among those involved in high school sports (β=0.28; p <.001) compared with those not involved in sports (β =0.49; p<0.001). | |||
| Timonen et al. (2021) Finland | To analyze the association of different levels of social leisure time activity (SLA) during adolescence (ages 15–16 years) with the incidence of mental disorders up to young adulthood (the ages of 16–33 years). | Low SLA was associated with increased likelihood of any psychiatric disorder (OR 1.61, 95% CI 1.13–2.30), anxiety disorders (OR 2.07, 95% CI 1.37–3.15) and behavioral disorders (OR 4.12, 95% CI 1.90–8.96). Furthermore, high SLA was associated with decreased likelihood of any psychiatric disorders (OR 0.78, 95% CI 0.66–0.93), substance use disorders (OR 0.53, 95% CI 0.36–0.78), affective disorders (OR 0.72, 95% CI 0.57–0.91) as well and anxiety disorders (OR 0.79, 95% CI 0.63–0.99). Social leisure time activity was not associated with psychotic disorders of the study participants. | Socially active leisure time during adolescence is a protective factor against the development of later psychiatric disorders. Social support of the community in the early phase is one way to prevent development of mental health symptoms into manifest psychiatric disorders. In terms of prevention of mental disorders, these study findings encourage families, schools, and other communities to continue to enhance and develop community-based social leisure time activities for children and adolescents. |
| Iverson et al. (2022) USA | To examine an association of playing high school football (at age 15 years) to depression and anxiety or panic disorder by the age of 37–39 years | Football playing, compared to those who did not play football, was not significantly associated to lifetime history for depression or anxiety/panic disorder. | The results do not find an association between high school football exposure and depression and anxiety later in life. |
| da Silva et al. (2023) Brazil | To evaluate the association of leisure-time and total physical activity (PA) during adolescence (at 11, 15, and 18 years) to major depressive disorder and generalized anxiety disorder in young adulthood (at 22 years). | In crude analyses, all leisure-time and total PA variables assessed in adolescence were negatively associated with major depressive disorder in young adulthood, while corresponding association with generalized anxiety disorder was also present, except in leisure-time PA at 15 years and total PA. In adjusted analyses, active participants to the leisure-time and total PA at 11 years were less likely to have diagnosis for major depressive disorders at 22 years, prevalence ratios (95%CI) being 0.54 (0.11–0.89) and total PA 0.63 (0.41–0.97), while no significant associations was found to generalized anxiety disorder in any of PA variables. | There is a linear trend of leisure-time physical activity throughout adolescence and a lower risk of depression in early adulthood. There was evidence that early adolescence appears to be a sensitive period for the benefits of physical activity on depression in early adulthood. Study reinforces the need for policies to increase leisure-time physical activity levels from early adolescence aiming to decrease the prevalence of depression in youth. |
| The adjusted linear trend analyses showed that the higher level of leisure-time PA throughout adolescence was associated to the lower prevalence of major depressive disorders in young adulthood. | |||
| Mc Kercher et al. (2014) Australia | To examine the association of persistent leisure physical activity (PA) pattern from childhood (age 9–15 years) to adulthood to depression (major depressive or dysthymic disorder) in young adulthood (age 27–36 years). | Males who were increasingly or persistently active, as compared with persistently inactive, had lower risk for depression in adulthood, the relative risk (adj. RR, 95CI%) being 0.31 (0.11–0.92) and 0.35 (0.15–0.81), respectively. | Findings from both prospective and retrospective analyses indicate a beneficial effect of habitual discretionary physical activity since childhood on the risk of depression in young adulthood, given that physical activity is a potentially modifiable risk factor, the public health implications of these findings are substantial. |
| Timonen et al. (2023) Finland | To examine whether adolescence-related social leisure time activity (SLA), per se, is a mediating link in the association between adolescent psychological symptoms and later psychiatric morbidity. | Low SLA was associated with increased likelihood of anxiety disorder (OR 1.92 95% CI 1.25–2.95) behavioral disorder (OR 3.92 95% CI 1.70–9.08). High SLA was associated decreased likelihood of any psychiatric disorder (0.98–2.07) CI 0.68–0.96, affective disorders (OR 0.75 95% CI 0.60–0.95) and anxiety disorder (OR 0.83 95% CI 0.66–1.04). | Socially active leisure time during adolescence is related to better long-term mental health, while socially inactive leisure time associates with the likelihood of later psychiatric morbidity. To prevent psychiatric disorders, it is highly recommended that such leisure time activities are enhanced in society. |
Study characteristics and measures for leisure-time activity in childhood and adolescence and assessment of later psychiatric morbidity up to young adulthood_
| Study-characteristics | Leisure time activity in childhood and adolescence | Later psychiatric morbidity | |||||
|---|---|---|---|---|---|---|---|
| 1. Authors, publishing year, country | 2. The origin of the study material; study design | 3. Number of study participants; study groups, gender | 4. Data collection period, assessment age/school grades for leisure time activity | 5. Instrument for leisure time activity; type of questions | 6. Data collection period, psychiatric diagnoses, and age at assessment | 7. Diagnostic criteria, source or information and treatment setting (if reported) | 8. Confounders |
| Desphande et al. (2020) USA | The National Longitudinal Study of Adolescent to Adult Health (Add Health) study; nationally representative sample of American adolescents | total n=2197, all men
* n=521 adolescents, who participated or intended to participate school football * n=1676 controls, who did not play or intended to play school football, including 610 sport controls (non-collision sport) and 1066 non-sport controls (played no school sport) |
1994–1995, at school grades 7–12 | Questionnaire for leisure activities; participation in base-/softball, basketball, football, swimming, tennis, track, or volleyball) | 2008, depression, anxiety, post-traumatic disorder at age 24–32 years. In addition, single diagnosis of nicotine, cannabis, alcohol dependence/abuse | Self-reported, the Center for Epidemiological Studies Depression scale (CES-D) | subjects' health, behavior, educational experience, family background, and family health history |
| Easterlin et al. (2019) USA | The National Longitudinal Study of Adolescent to Adult Health (Add Health study) | total n=4888 having exposure to ACEs (physical and sexual abuse, emotional neglect, parental alcohol misuse and incarceration, living with a single parent) | 1994–1995, at school grades 7–12 | Questionnaire for leisure activities; one question for participation or intention to participate in any of the following team sports (base-/softball, basketball, cheerleading/dance team, field hockey, football, ice hockey, soccer, swimming, tennis, trac, volleyball, wrestling and other sport. | 2008, depression, anxiety, at age 24–32 years | Self-reported, Positive response to question “having ever received a diagnosis of depression or anxiety) and having positive screen result for current depression assessed with the 10-item subscale of the CES-D-scale. | subjects' health, behavior, educational experience, family background, and family health history |
| Oggenhaug et al. (2015) Norway | Longitudinal population-based case-cohort study in the North-Troendelag region of Norway (the Young-HUNT1 study) |
* 15 adolescents with later diagnosis of schizophrenia (cases) * 18 adolescents with later diagnosis of bipolar disorder (contrast) *120 healthy adolescents matched on age and gender for cases |
1995–1997 (baseline), at age of 13–19 years (mean 16 years) | Young-HUNT1 questionnaire; several questions inquiring active involvement in sports; exercise hours/days per week); participations to team sports (soccer, hand-, basket- and volleyball) and to individual sports (sports other than team sports) | After baseline (exact years not reported), Schizophrenia, bipolar disorder, onset ages not reported | ICD-10, psychiatric diagnoses were identified through the patient administrative system | not mentioned, but discussed in discussion part |
| Koivukangas et al. (2010) Finland | Northern Finland Birth Cohort 1986 study | n=6987 (3367 boys, 3629 girls) | 2001–2002, at the age 15–16 years | Postal questionnaire including one question about how many hours a week, outside of school hours, spent on brisk physical activity (i.e. causing some sweating and shortness of breath). Responses were analyzed in categorized into three groups: inactive (not at all or about half an hour a week), somewhat active (about 1 h to 2–3 h a week), active (at least about 3–6 h or more a week). | 2002–2005, nonorganic psychosis (excluding persons who had developed psychosis before 2002) | ICD-10, psychiatric diagnosis from the Finnish Hospital Discharge Register and antipsychotic reimbursements marked on the Finnish Social Insurance Institute's (FSII) register. Inpatient, outpatient | family's socio-economic status and parent ′s physical activity |
| Sormunen et al. (2017) Finland | Follow up study for Cardiovascular Risk of Young Finns; population-based cohort study | n = 3596; of whom n=3325 controls with no psychiatric diagnoses during follow-up | 1980,1983, 1986, at age 9–18 years | Questionnaire for physical activity assessing engagement in leisure-time physical activities using several questions. ZZ | During follow-up period of 1980–2012, non-affective psychosis, including a subgroup for schizophrenia |
(ICD-8/9/10 psychiatric diagnoses from the Finnish Hospital Discharge Register converted to DSM-IV diagnoses. Inpatient, outpatient |
parents' mental disorders and parent′s physical activity |
| Samek et al. (2015) USA | Sibling Interaction and Behavior Study (SIBS); Longitudinal study | n=1226, (555 men, 671 women) | 1994–1995, after completion of high school usually at age 19 years | The Social Adjustment Interview asking about involvement in extracurricular actives (yes, no) in high school: team sport (varsity, intramural), student government, debate/forensics, clubs, plays/musicals, newspaper. | Exact years not reported, conduct disorder before age of 15 years, adult antisocial personality disorder symptoms (yes, no) in the 12 months preceding the assessment at median age 22.4 years | Structured Clinical Interview for DSM-III-R for Personality Disorders, modified for DSM-IV | parent′s education and marital status |
| Timonen et al. (2021) Finland | The Northern Finland birth cohort 1986 | n=6838 (3298 males, 3540 females) | 2001–2002, at age 15–16 years | Postal questionnaire designed for a cohort study: several questions about the intensity and level of participation in leisure-time activities. Based on these variables, three social activity levels (high, middle, moderate) were formed and analyzed. XX | Up to end of 2018, any major groups of psychiatric disorders (excluding those who had been diagnosed before age 16 years) | ICD-10 psychiatric diagnoses from the Care Register for Health Care (CRHC) Inpatient, outpatient | parents living together, parental educational level, parents' mental health disorders |
| Iverson et al. (2022) USA | The National Longitudinal Study of Adolescent to Adult Health (Add Health) |
n=1762, all men * n=369, play or intend to play high school football * n=952, not played or indented to play football * (n=441 missing information on football playing) |
1994–1995 (Wave I), in school grades 7–12, at median age 15 years | Questionnaire about leisure activities; questions about participating in clubs, organizations, and teams, specifically, in playing football. | 2016–2018 (Wave V follow-up), Depression or anxiety/panic disorder on average at 38 years of age | Self-reported; a question about whether a doctor, nurse of other health care provider ever had told the participant to have or have had depression or anxiety/panic disorder. | subjects' health, behavior, educational experience, family background, and family health history |
| Timonen et al. (2023) Finland | the Northern Finland birth cohort 1986 | n=6709 (3227 males, 3482 females) | 2001–2002, at age 15–16 years | Postal questionnaire; designed for a cohort study: several questions about the intensity and level of participation in leisure-time activities. Based on these variables, three social activity levels (high, middle, moderate) were formed and analyzed. | Up to end of 2018, any and major groups of psychiatric disorders up to age 16–33 years (excluding those who had been diagnosed before the age of 16) |
ICD-10 psychiatric diagnoses from the Care Register for Health Care (CRHC) Inpatient, outpatient |
parents living together, parental educational level, parents' mental health disorders |
| da Silva et al. (2023) Brazil | The 1993 Pelotas Birth Cohort, Brazil | n=3247 (1514 men, 1733 women) | Exact years not reported, at age of 11, 15, and 18 years | The International Physical Activity Questionnaire assessing duration and weekly frequency of recreational moderate- and vigorous-intensity activities. VV | Major depressive disorder, generalized anxiety disorder, at age of 22 yrs | Mini International Neuropsychiatric Interview (MINI) based on DSM-IV and ICD-10 diagnostic criteria, and applied to follow the DSM-V criteria | sex (male and female), skin color (white, black, brown indigenous), family income at birth (in minimum maternal schooling at birth (in complete years). |
| McKercher et al. (2014) Australia | The Childhood Determinants of Adult Health Study, National Longitudinal Study | n=1630 (759 males, 871 females) from 109 schools | 1985, 2004–2006, at age 9–15 years | Questionnaire from the Australian Schools Health and Fitness Survey inquiring about past-week frequency and duration of school and extracurricular sport and exercise. YY | 2004–2006, depression (major depressive and dysthymic disorder) at age 27–36 years | Depression module of the Composite International Diagnostic Interview (CIDI-Auto), | status, education level, main source of income, current occupation, smoking status, and number of live births |