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

Purpose: Little is known about the role of active school travel (AST) on mental health among adolescents. Thus, this study aimed to explore the association between AST and depressive symptoms among adolescents aged 12-15 yeas from 26 low- and middle-income countries (LMICs).Methods: 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% girls). Self-reported measures assessed depressive symptoms during the past 12 months, and AST. Participants reporting yes for depressive symptoms and having 5 or more days for walking or cycling to school were regarded as having depressive symptoms and AST. Multivariable logistic regression analysis was performed and a countrywide meta-analysis undertaken. Results: The prevalence of depressive symptoms and AST were 30.0% 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% decreased odds for depressive symptoms (OR = 0.88; 95% CI: 0.82-0.94) but with a moderate between-country heterogeneity (I2 = 59.0%). Conclusion: The current study indicates that AST may be an effective prevention against depressive symptoms among adolescents from LMICs. However, when implementing interventions based on AST to reduce depressive symptoms, more country-specific factors should be taken into consideration. Future studies should adopt improved study design to confirm or negate our research findings, which informs public mental health interventions.