Measurement Invariance of the Flourishing Scale among a Large Sample of Canadian Adolescents

Sleepless nights, troubled futures: The association between insufficient sleep and child flourishing

OBJECTIVE

To examine associations between sleep and flourishing among children ages 0-5 years in the United States and whether these differ by age, developmental needs, and family resilience.

STUDY DESIGN AND METHODS

Cross-sectional data from the 2020-2021 National Survey of Children's Health (N = 31,095) were used with survey-weighted logistic regression to explore associations between insufficient sleep (defined as not meeting age-recommended daily sleep guidelines: 12-16 h for 4- to 12-month-olds, 11-14 h for 1- to 2-year-olds, and 10-13 h for 3- to 5-year-olds) and flourishing (using four markers combined and categorized into two groups). Tests of effect measure modification (EMM) were performed on the multiplicative and additive scales.

RESULTS

Weak but notable evidence was found that children with insufficient sleep had decreased odds of flourishing (aOR = 0.76; 95 % CI: 0.60, 1.00). No evidence of EMM by child age or family resilience was found. However, the sleep-flourishing association differed significantly by children's developmental needs, suggesting that the combined effect of sleep and developmental needs impact flourishing more than either factor alone.

CONCLUSIONS

Approximately 38 % of children ages 0-5 years in the United States are estimated to have insufficient sleep. This study provides evidence that insufficient sleep is associated with decreased flourishing among children with special health care needs (CSHCN).

FUTURE IMPLICATIONS

Increasing sleep interventions among children under five is warranted among children with special health care needs. The association between sleep and flourishing within specific CSHCN categories, including emotional, behavioral, or developmental (EBD) criteria, should be explored to optimize sleep policies.

Changing eating to manage weight or shape: A cross-sectional and prospective study of the prevalence and correlates in a large Canadian adolescent cohort

OBJECTIVE

The present study examined reports of changing eating to manage weight/shape over one year among adolescents. It also tested how changing eating for weight/shape was associated with physical activity (resistance training, moderate-to-vigorous physical activity; MVPA) and mental health (depressive symptoms, flourishing), and whether weight perceptions moderated these associations.

METHODS

Participants were Canadian adolescents (N = 20,614, Mage ± SD = 14.4 ± 1.3, 52.9% girls) who completed self-report surveys in the 2020-2021 and 2021-2022 waves of the COMPASS study. Separate multilevel models were tested for each outcome.

RESULTS

Approximately 30% of adolescents reported changing their eating to manage weight/shape at least once a week. More days of changing eating were associated with significantly higher depressive symptoms and lower flourishing cross-sectionally (b = 0.51, b = -0.27) and over time (b = 0.35, -0.20); the flourishing association over time was weaker for adolescents who perceived themselves as overweight relative to about right. More days of changing eating were also associated with more MVPA and resistance training cross-sectionally (b = 2.81, b = 0.19) and over time (b = 1.28, b = 10). The relationship between changing eating and MVPA over time was stronger for adolescents who perceived themselves as overweight relative to about right; whereas the cross-sectional relationship between changing eating and resistance training was weaker.

CONCLUSIONS

Reports of changing eating to manage weight/shape were associated with divergent health outcomes; research into how and to what extreme adolescents are changing eating to manage weight/shape, and identity factors that may contribute to these differences, is warranted.

Factors associated with prospective changes in weight control intentions among adolescents

INTRODUCTION

The present study examined predictors of negative changes in weight control intentions from before to during the COVID-19 pandemic among adolescents.

METHODS

Participants were Canadian secondary school students enrolled in the COMPASS study and had completed self-report surveys before (T1; 2018/2019 and/or 2019/2020 school year) and during (T2; 2020/2021 and/or 2021/2022) the COVID-19 pandemic (N = 11,869, Mage ± SD = 13.79 years old ± 1.15, 52.89% girls, 45.30% boys, 1.81% gender diverse). Demographic, interpersonal, behavioral, and psychological predictors of weight control intention change from T1 (stay the same weight, not doing anything about weight) to T2 (lose weight, gain weight) were tested using multilevel logistic regressions.

RESULTS

Over one-third (37.0%) of adolescents who reported wanting to stay the same weight at T1 changed their intention to lose or gain weight at T2, as did 28.5% of adolescents who reported not wanting to do anything about their weight at T1. Changing weight control intention from "not doing anything about weight" at T1 to weight gain/loss at T2 was associated with resistance training, emotion dysregulation, bullying, social media use, and gender. Changing weight control intention from "stay the same weight" at T1 to weight gain/loss at T2 was associated with gender, perceived financial comfort, social media use, and flourishing.

CONCLUSIONS

Results highlight the prevalence of maladaptive weight control intention changes among adolescents, and elucidate related behavioral, interpersonal, demographic, and psychological factors. Findings can inform targeted intervention and prevention strategies to disrupt maladaptive changes in weight control intentions among high-risk subgroups.

Preliminary Effectiveness of a Brief School-Based HERO Intervention: Improving the Wellbeing of Final Year Adolescent Female Students

Young people face multiple challenges, including appearance dissatisfaction, academic stressors, anxiety and depression. These challenges may increase during the final year of high school and may have become further exacerbated by the COVID-19 pandemic. This study examines the preliminary effectiveness of a brief, uncontrolled school-based intervention aimed at enhancing Psychological Capital (PsyCap), consisting of positive resources of hope, self-efficacy, resilience and optimism (HERO), and reducing mental health symptoms among female year 12 students (n = 95, Mage = 16.78, SD = 0.45). Outcomes on measures of HERO and secondary outcomes of flourishing, appearance dissatisfaction, anxiety and depression were measured at pre and post-intervention. In the overall cohort, no significant changes were found on the HERO outcomes or flourishing post-intervention, while symptoms of depression, anxiety and appearance dissatisfaction decreased significantly. For students with higher baseline anxiety, optimism and anxiety symptoms improved significantly at post-intervention. However, students with lower baseline anxiety experienced significant decreases in self-efficacy and optimism, as well as a significant increase in anxiety symptoms post-intervention. Baseline depression levels did not impact intervention outcomes. The findings, although mixed and limited by the lack of control group, suggest that a brief intervention grounded in PsyCap theory may improve student wellbeing under challenging circumstances.

Evolution of Sleep Duration and Screen Time Between 2018 and 2022 Among Canadian Adolescents: Evidence of Drifts Accompanying the COVID-19 Pandemic

PURPOSE

We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic.

METHODS

A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation.

RESULTS

A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time.

DISCUSSION

Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.

Exploring the association between internalized weight bias and mental health among Canadian adolescents

BACKGROUND

Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders.

OBJECTIVES

To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender.

METHODS

Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models.

RESULTS

Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls.

CONCLUSION

IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls.

Income Inequality and the Odds of Online Gambling Among a Large Sample of Adolescents in Canada

Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality.

The Indonesian Version of the Flourishing Scale: Is it Reliable and Valid for Indonesian People?

The Flourishing Scale (FS) was developed to measure individual psychological well-being. The FS was developed based on psychological well-being theories that include meaning and purpose in life, involvement in activities, social relationships, and feelings of competence. The psychometric properties of the FS have been studied in several countries. However, research that provides reports on reliability and validity for the Indonesian version of the FS is limited. The aim of the study was, therefore, to evaluate the psychometric properties of the Indonesian version of FS which include reliability, internal structure, and convergent validity. 1129 respondents completed the FS, Scale of Positive and Negative Experience (SPANE), and Patient Health Questionnaire 9 (PHQ-9). The Cronbach's Alpha coefficients indicate a good internal consistency of the FS. The result of the Confirmatory Factor Analysis confirmed that a single-factor structure of the FS fit to the data. The result of the Multi-Group Confirmatory Factor Analysis showed measurement invariance across two subsamples. The results of the correlation test show a significant correlation between the FS with the SPANE and PHQ-9. Taken together, the Indonesian version of the FS can be considered a reliable and valid instrument to measure psychological well-being for Indonesian people.

The resounding influence of benevolent childhood experiences

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Measurement of flourishing: a scoping review

Introduction

Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a scoping review across PubMed and EMBASE of studies introducing original flourishing scales (defined as a previously unpublished measure of mental health or wellbeing that used "flourishing" in its definition). Studies focusing on adult populations that were published before April 28, 2023 were considered eligible for inclusion.

Results

Out of 781 studies retrieved, we identified seven eligible studies covering seven unique flourishing scales. We find that all seven scales are multidimensional and assess features over monthly or yearly intervals. While most of the scales (six out of seven) include indicators of both hedonic and eudaimonic wellbeing, the operationalization of these dimensions of wellbeing varies considerably between scales. Several of the scales have been translated and validated across multiple geographical contexts, including higher- and lower-income countries.

Discussion

Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may be useful to provide holistic and widely applicable measures of wellbeing. This review contributes to concept validation efforts that can guide strategies to sustain flourishing societies.

School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents

PURPOSE

Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life.

METHODS

We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups.

RESULTS

Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes.

CONCLUSION

Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.

I CAN Intervention to Increase Grit and Self-Efficacy: A Pilot Study

In recent years, there has been a growing interest in increasing motivational factors within the domain of psychology. Among these factors, Grit, Mindset, Self-Efficacy, and Well-Being (Flourishing) have been suggested to play an important role in individuals' performance and Well-Being. Thus, cultivating these factors in the general population is important. Previous interventions have displayed substantial effects in certain areas. However, these interventions have primarily been Mindset oriented. This paper presents a novel intervention approach by also emphasizing the importance of brain development; the importance of stimuli for building a network in the brain; the importance of repetition for strengthening the network; and the importance of perseverance and deliberate practice for achievement. The purpose of the current study was to examine the effects of a 35-40 min online intervention to increase the beliefs of 'I CAN' for 38 university students in Norway. The mean age of the 38 participants was 22.55 (SD = 1.59) and they completed a pre-test assessment of the Grit-S Scale, Theories of Intelligence Scale (Mindset), General Self-Efficacy Scale, and Flourishing Scale (Well-Being). This was followed up by the novel intervention and finally a post-test of the scales eight weeks later. The results showed an increase in Grit, Self-Efficacy, and Well-Being. However, only Grit displayed a significant increase. We aimed at creating an intervention where the participants would "turn on the switch", meaning that they develop stronger beliefs. These promising results warrant a further development of the intervention, and studies with a larger group.

Boarding versus day-students: A mixed-methods analysis of sleep and its relationship with psychological distress

BACKGROUND

Boarding students face unique challenges when entering school, including: adapting to a novel environment, where they are separated from family, friends and culture, for up to 40 weeks per year. A particular challenge is sleep. A further challenge is coping with the demands of boarding with its potential impact on psychological well-being.

AIMS

To explore how boarders' sleep differs from that of their day-student peers, and how this relates to psychological well-being.

SAMPLE AND METHODS

309 students (59 boarding students and 250 day-students, at one Adelaide school) completed the School Sleep Habits Survey, Depression-Anxiety-Stress-Scale-21 (DASS-21), and Flourishing Scale. Boarding students additionally completed the Utrecht Homesickness Scale. Thirteen boarding students described experiences of sleeping in boarding through focus groups.

RESULTS

Boarding students, compared to day-students reported 40 minutes more sleep per weeknight (p < .001), with earlier sleep onset (p = .026), and later wake-up (p = .008) times. No significant differences were observed between boarding' and day-students' DASS-21 scores. Hierarchical regression revealed longer total weekday sleep time predicted higher psychological well-being in both boarding and day-students. Additionally, in boarding students, low homesickness-loneliness and homesickness-ruminations further predicted psychological well-being. Thematic analysis of boarding students' focus group responses revealed that night-time routine, and restricting technology use at night facilitated sleep.

CONCLUSIONS

This study supports - in both boarding and day-students - the importance of sleep for adolescent well-being. Sleep hygiene can play an important role in boarding student sleep, especially: regular night-time routine and restricting technology use at night. Finally, these findings suggest that poor sleep and homesickness have an adverse effect on boarding student psychological well-being. This study highlights the importance of strategies which promote sleep hygiene and minimize homesickness, in boarding school students.

The association between adolescents' self-esteem and perceived mental well-being in Sweden in four years of follow-up

BACKGROUND

The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person's approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents' self-reported self-esteem at age 12-13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17.

METHODS

Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12-13, and 17 (n = 654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the "Mental Health Continuum," representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12-13. Other independent explanatory variables were gender, the family's economy, and the mother's educational level.

RESULTS

Self-esteem appeared relatively stable from 12-13 to 17 years (M = 20.7 SD = 5.8 vs. M = 20.5 SD = 1.7). There was a significant but inverted U - shaped association between SE at age 12-13 and perceived MWB at age 17 [F (1, 646) = 19.02, β-0.057; CI -0.08--0.03, Eta = 0.03, p = .000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother's educational level was significantly positively associated with perceived MWB of girls.

CONCLUSIONS

Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.

Psychometric properties of the Spanish version of the Flourishing Scale in the Honduran population

Studying Flourishing is important to understand wellbeing. The current study aimed to determine the psychometric properties of the Spanish version of the Flourishing Scale (FS) in the Honduran population. The primary sample consisted of 422 residents of the Central District of Honduras; this included 275 (65.17%) women and 147 men (34.83%). Their average age was 28.18 years (SD = 10.58). Findings from the Exploratory Factor Analysis and Confirmatory Factor Analysis support a unidimensional factor structure. The FS achieved a high internal consistency with McDonald's ω = 0.89, 95% CI [0.86, 0.91]. The average inter-item correlation was 0.48, 95% CI [0.43, 0.53]. Using Student's t-test for paired samples, results indicate that none of the FS items varied significantly between baseline and post-test. Additionally, Spearman's rho was used to correlate test-retest scores; this yielded a statistically significant correlation coefficient of 0.66. The Flourishing Scale had adequate convergent validity with the Subjective Happiness Scale (r = 0.70) and the PANAS-Positive Affect Subscale (r = 0.70) (p < 0.001). In contrast, it correlates inversely with the PANAS-Negative Affect Subscale (r = -0.34) and the PHQ-9 (r = -0.51). Strict measurement invariance for sex was supported. The results indicate that the Flourishing Scale has robust psychometric properties for the Honduran population. Practical implications for public policy are discussed.

Reciprocal associations between positive emotions and resilience predict flourishing among adolescents

INTRODUCTION

The broaden and build theory of positive emotions maintains that positive emotions serve to broaden individuals' thoughts and behaviours, resulting in the accrual of resources (e.g. resilience) that catalyze upward spirals of well-being. However, there is a relative dearth of research examining the upward spiral hypothesis in the context of adolescence.

METHODS

Adolescents (n = 4064) in participating Canadian high schools were surveyed annually for three years as part of the COMPASS study. Reciprocal associations between positive emotions and resilience were examined as predictors of flourishing.

RESULTS

Adolescents who experienced positive emotions more frequently than usual reported higher levels of resilience one year later. Similarly, adolescents who had higher levels of resilience than usual reported more positive emotions the following year. Higher than usual levels of resilience and positive emotions positively predicted flourishing.

CONCLUSION

Positive emotions result in a cascade of beneficial outcomes including increased resilience and enhanced well-being, catalyzing an upward spiral towards flourishing. Opportunities to enhance positive emotions early on in adolescence may help build resources that can set students on the path towards increased well-being.

The Implementation of Narrative Exposure Therapy (NET) for Transgender and Gender Diverse Adolescents and Young Adults

Purpose

There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma.

Methods

Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing.

Results

Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation.

Conclusion

NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.

A systematic review of adolescent flourishing

Traditionally, the study of well-being has been approached from the hedonic and eudaimonic perspectives. However, the last findings suggest that both aspects are complementary, giving place to an integrated conceptualization of well-being called flourishing. In spite of the constant increase of research around this construct, there is still little information regarding flourishing in adolescents. The objective of this study is to review the available literature on flourishing in adolescence in relation to its tie with other constructs, its study in different contexts and the way it has been operationalized. The selection of the studies was conducted in two phases. First, it was verified that the exclusion and selection criteria were met. Then, an evaluation of the quality of the pre-selected studies was carried out. The data were synthesized through the thematic synthesis method. For the results, 28 empirical studies were selected. Four thematic axes were identified: (a) Flourishing in different contexts, (b) Flourishing in regards to other results and positive psychological characteristics and/or their negative counterpart, (c) Flourishing and psychosocial vulnerability, and (d) indicators for the evaluation of flourishing. Suggestions are provided with the goal of consolidating the science of human flourishing.

Stronger together: Coping behaviours and mental health changes of Canadian adolescents in early phases of the COVID-19 pandemic

BACKGROUND

The impact of the COVID-19 pandemic and consequent public health restrictions on the mental health of adolescents is of global concern. The purpose of this study was to examine how Canadian adolescents coped during the early pandemic and whether different coping methods were associated with changes in mental health from before the pandemic to the early lockdown response.

METHODS

Using two-year linked survey data (2018-2020) from a prospective cohort of secondary school students (n = 3,577), linear regression models were used to examine whether changes in mental health (anxiety [Generalized Anxiety Disorder-7 scale], depression [Center for Epidemiologic Studies Depression 10-item scale Revised], emotion regulation [Difficulties in Emotion Regulation Scale], psychosocial well-being [Flourishing scale]) were related to each coping behaviour.

RESULTS

The most common reported coping behaviours included staying connected with friends online (78.8%), playing video games, watching TV/movies, and/or surfing the internet/social media (76.2%), studying or working on schoolwork (71.0%), and getting exercise (65.2%). The use of positive coping mechanisms during the early pandemic period (e.g., keeping a regular schedule, time with family, time with friends online) was associated with less adverse mental health changes from before to during the early lockdown; whereas, negative coping mechanisms (e.g., spending time alone, eating junk food) were consistently associated with more adverse mental health changes.

CONCLUSION

This study demonstrates the importance of social support and connections with both friends and family, as well as keeping and maintaining a routine, over the pandemic. Interventions supporting positive relationships and engagement in these coping behaviours may be protective for adolescent mental health during disruptive events.

Mental health and cannabis use among Canadian youth: Integrated findings from cross-sectional and longitudinal analyses

BACKGROUND AND PURPOSE

Using data from two methodologically independent youth research studies in Canada, the Health Behaviour in School-aged Children (HBSC) study and the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study, the objective of this study was to compare associations between youth's mental health and cannabis use across samples. Using similar indicators in both studies, our goal was to affirm the potential for nationally representative cross-sectional analyses (HBSC) to replicate findings found in a longitudinal non-representative data source (COMPASS), enhancing opportunity for causal inferences.

METHODS

Data were collected from grade 9 and 10 Canadian students participating in the 2017/18 HBSC (n=8462) and 2017/18 to 2018/19 waves of COMPASS (n=32,023). Using multivariable Poisson regression models, the strength and statistical significance of the effects of mental health indicators on cannabis use outcomes were estimated within both studies and compared for consistency. Using a 2-year linked sample of students participating in COMPASS, models examining the impact of mental health indicators on cannabis use initiation and maintenance over time were similarly fit using Poisson regression to estimate relative risk.

RESULTS

Similar associations between mental health problems and cannabis use were observed in both data sources. The direction, magnitude, and precision of the estimates for restless sleep, loneliness, poor wellbeing, and cannabis use were highly comparable across both studies. Worse mental health was consistently associated with current and lifetime cannabis use among youth.

DISCUSSION

Cross-sectional and longitudinal findings from two large methodologically diverse studies in Canada demonstrate a replicable association between indicators of mental health and youth cannabis use. Similarities were identified and two generalizations may be concluded: 1) potentially causal etiological relationships inferred from HBSC data were supported in longitudinal findings based on COMPASS, and 2) longitudinal COMPASS data aligns with nationally representative data from HBSC.

The association of physical activity, sleep, and screen time with mental health in Canadian adolescents during the COVID-19 pandemic: A longitudinal isotemporal substitution analysis

BACKGROUND

The impact of COVID-19 on adolescent mental health is a global concern. Increased screen time and reduced physical activity due to the lockdown measures have been linked to detrimental mental health outcomes; however, the literature remains limited by cross-sectional and retrospective designs, and consideration of behaviours in isolation. Prospective evidence is necessary to examine whether moderate-to-vigorous physical activity (MVPA), sleep and screen time influenced changes in mental health.

METHOD

Analyses used data from a prospective cohort study of secondary school students in Canada with baseline data from the 2018-2019 school year and linked follow-up data from online surveys completed during the initial COVID-19 outbreak (May-July 2020). Multilevel linear regression models were used to evaluate the within- and between-person isotemporal substitution effects of sleep, MVPA and screen time behaviours on depression, anxiety, subjective well-being, and trait emotional dysregulation.

RESULTS

Linked longitudinal data from 2645 students attending 44 schools were available. Between-person effects indicated that individuals who engaged in more MVPA and sleep while minimizing screen time had lower depression scores, less severe emotional dysregulation, and better subjective well-being. While controlling for between-person effects, within-person year-on-year change suggests those who increased screen time while decreasing either MVPA or sleep experienced mental health decline on all outcomes.

CONCLUSION

MVPA and sleep were associated with youth mental health during the early COVID-19 lockdown. Increasing MVPA and sleep (or at least mitigating the increase of screen time) compared to the prior year was associated with better mental health during the early pandemic. A limitation to consider is that the screen time measure represents a combination of screen behaviours, and effects of replacing screen time may have varied if distinctions were made.

Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities

We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community-based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017-2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture.

Rates and correlates of well-being among youth experiencing homelessness

Mental health concerns have been well studied among youth experiencing homelessness, yet few studies have explored factors that contribute to well-being in this population. The current cross-sectional study examined rates and correlates of well-being among youth experiencing homelessness. This is a descriptive, secondary analysis of the baseline data from a clinical intervention study. Ninety-nine youth (aged 16-25) who were experiencing homelessness were recruited in Chicago. Approximately 40% of the sample reported average or above average well-being relative to existing benchmarks. Having medical insurance, a mobile phone, and a history of more severe childhood trauma were unique cross-sectional predictors of worse well-being (all ps < 0.034). A significant portion of our sample experienced well-being. Having access to certain resources may be counterintuitive indicators of poorer well-being among youth experiencing homelessness, perhaps because they are indicators of greater need or increased social comparison among these youth.

Flourishing Scale: Adaptation and Evidence of Validity in a Chilean High School Context

This study aimed to adapt the Flourishing Scale to a Chilean high school context and provide evidence of its validity. Data were collected from 1,348 students (52% girls) from three different Chilean schools. The results of confirmatory factor analysis (CFA) supported a one–factor solution, multiple–group CFA supported gender invariance, and structural equation model indicated that the FS is related to positive and negative academic feelings. Overall, the evidence indicates that the Flourishing Scale adapted to the high school context is an instrument that produces valid and reliable scores in our high school Chilean sample.

Do You Really Want to Be Forever Young? Emotional Health and Psychosocial Well-being by Relative Birth Quarter in Canadian Adolescents

PURPOSE

Those born earlier within cohorts of similarly aged children tend to outperform peers in athletic and academic pursuits. Subsequent evidence suggests relatively younger children may also experience worse emotional and psychosocial health; however, evidence from middle adolescents is limited. This study assessed whether depression, anxiety, and psychosocial well-being differed by the relative birth quarter (RBQ) within a cohort of grades 9-12 in secondary schools across Canada.

METHODS

Data from the 2018-19 student self-report surveys of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behavior study were analyzed. Students having made normative progress were categorized into RBQs by the provincial enrollment cutoff date (n = 49,921). Hierarchical modeling approaches assessed whether self-reported depression, anxiety, psychosocial well-being, and positive controls differed by RBQ after controlling for covariates.

RESULTS

Despite relative age effects for positive control outcomes, no significant difference was detected for anxiety and depression scores or likelihood of meeting thresholds for having clinically relevant symptoms. However, a significant difference emerged between RBQs for psychosocial well-being scores; post hoc tests found that psychosocial well-being scores were lower in the fourth RBQ than those in all prior quarters.

DISCUSSION

Results agree with limited findings that relative age differences in emotional health are not significant in older cohorts. Nonetheless, relatively older individuals reported very small (d = .04-.05) advantages in psychosocial well-being than their youngest peers, which aligns with previous data. Longitudinal approaches to assess relative age effects on mental health during and throughout the transition into middle adolescence are warranted.

Income inequality and depression among Canadian secondary students: Are psychosocial well-being and social cohesion mediating factors?

Background

Nearly one-third of secondary school students report experiencing depressive symptoms in the past year. Existing research suggests that increasing rates of depression are due in part to increasing income inequality. The aim of this study is to identify mechanisms by which income inequality contributes to depression among Canadian secondary school students.

Methods

We used data from a large sample of Canadian secondary school students that participated in the 2017/18 wave of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample included 61,642 students across 43 Census divisions (CDs) in Quebec, Ontario, Alberta, and British Columbia. We used multilevel path analysis to determine if the relationship between CD-level income inequality and depression was mediated by student's psychosocial well-being and/or social cohesion.

Results

Attending schools in CDs with higher income inequality was related to higher depression scores among Canadian secondary students [unstandardized ß (ß) = 5.36; 95% CI = 0.74, 9.99] and lower psychosocial well-being (ß = −14.83, 95% CI = −25.05, −4.60). Income inequality was not significantly associated with social cohesion, although social cohesion was associated with depression scores among students (ß = −0.31; 95% CI = −0.34, −0.28).

Discussion

Findings from this study indicate that income inequality is associated with adolescent depression and that this relationship is mediated by psychosocial well-being. This study is the first of its kind in Canada to assess the mechanisms by which income inequality contributes to adolescent depression. These findings are applicable to school-level programs addressing mental health.

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The current study used a novel technique to explore how income inequality contributes to adolescent depression.

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Psychosocial well-being mediated the relationship between income inequality and adolescent depressive symptoms in our sample.

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Given that the study used an in-class school survey, the results of this work may have implications for school-based programs.

Emotion profiles among adolescent female athletes: Associations with flourishing

Many girls who participate in sport struggle to negotiate the complex relationship between their desired appearance and maintaining a physique that facilitates performance. As a result, these athletes experience a range of emotions about their bodies that impact their psychological well-being. We examined appearance- and fitness-related emotions using latent profile analysis among 507 adolescent girls involved in organized sport and examined differences in flourishing across the resulting profiles. Four emotion profiles were identified: (i) Frequent Pride, (ii) Occasional Fitness Pride, (iii) Occasional Pride, Rare Guilt/Shame, and (iv) Occasional Emotions. Participants in the Occasional Emotions profile reported the lowest flourishing scores compared to every other profile while those in the Frequent Pride profile reported the highest levels of flourishing. There were no differences in flourishing between those in the Occasional Fitness Pride profile and those in the Occasional Pride, Rare Guilt/Shame profile. Our results demonstrate how subsets of athletes may characteristically experience distinct combinations of emotions that are differentially associated with flourishing. Increasing experiences of body-related pride while mitigating experiences of guilt and shame appear to be important contributors to flourishing. However, experiences of pride may do little to buffer against reductions in flourishing when guilt and shame are experienced.

An Impact Analysis of the Early Months of the COVID-19 Pandemic on Mental Health in a Prospective Cohort of Canadian Adolescents

PURPOSE

The impact of the COVID-19 pandemic on adolescent mental health is a global concern; however, most research is cross-sectional or started after the pandemic response began and thus unable to evaluate within-individual change. The purpose of this prospective study was to evaluate the effect of the initial COVID-19 response on adolescent mental health and ill-health as a natural experiment.

METHODS

We used 3-year linked data from the COMPASS study, including 7,653 Canadian (Quebec, Ontario) adolescents from which 2,099 completed surveys in all three waves (pre-COVID-19 [2018 and 2019] and online [May-July 2020], 2-3 months into the pandemic). A structural equation modeling approach to fixed effects and a difference-in-differences design were used to estimate pre-COVID-19-to-early lockdown change in mental health (psychosocial well-being [flourishing-reverse scored]) and ill-health (depression and anxiety symptoms), compared with 2018-to-2019 change. Models were adjusted for self-selection, age of entry into the cohort, and sociodemographics.

RESULTS

Depression, anxiety, and reverse-flourishing scores increased across all waves; however, the mental health changes from the pre-COVID-19 wave (2019) to 2020 were not greater relative to the changes seen across the 2018-to-2019 waves.

CONCLUSIONS

Our results do not support a detrimental effect of the initial stages of the COVID-19 lockdown measures on adolescent mental health. The deterioration in mental health in the early COVID-19 response was less than the decline found over a prepandemic period. Further prospective research is needed to explore the impact of the prolonged pandemic and related measures on adolescents and inequitable effects in population subgroups.

Substance-related coping behaviours among youth during the early months of the COVID-19 pandemic

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12% of youth in our sample used substances to cope with COVID-19-related changes.

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Substance-related coping was more common among females than males in our sample.

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Greater depression was associated with using substances to cope with COVID-19.

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For females, psychosocial wellbeing may be protective of substance-related coping.

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Secondary impacts of COVID-19 pandemic on youth substance use and mental health.

Objective

As impacts of the COVID-19 pandemic continue to unfold, research is needed to understand how school-aged youth are coping with COVID-19-related changes and disruptions to daily life. Among a sample of Canadian youth, our objective was to examine the mental health factors associated with using substances to cope with COVID-19-related changes, taking account of expected sex differences.

Methods

We used online data collected from 7150 students in the COMPASS study, during the early months of the COVID-19 pandemic (May–July 2020) in British Columbia, Ontario, and Quebec, Canada. We specified a sex-stratified, generalized linear mixed model to estimate the likelihood of engagement in substance-related coping behaviours, while testing for the effects of students’ mental health, individual characteristics, and school neighborhood characteristics.

Results

Twelve percent of students (13.4% of females, 9.9% of males) in our sample reported using cannabis, alcohol, cigarettes, and/or vaping to help cope with COVID-19-related changes. Regardless of sex, students with greater depressive symptoms were more likely to engage in substance-related coping (aOR_Female = 1.04, 95 %CI[1.01–1.07]; aOR_Male = 1.06, 95 %CI[1.013–1.11]). Among females, better psychosocial wellbeing was protective against engagement in substance related-coping (aOR = 0.96, 95 %CI[0.94–0.98]), controlling for current substance use.

Conclusions

Canadian school-aged youth with generally poor mental health may be more likely to have engaged in substance use to help cope with COVID-19-related changes during the first wave of the pandemic, and female youth may be at disproportionate risk of engaging in the behaviour. Ongoing evaluation of the impacts of COVID-19 on youth health is required.

Investigating individual-level correlates of e-cigarette initiation among a large sample of Canadian high school students

INTRODUCTION

Having a better understanding of individual factors associated with e-cigarette initiation can help improve prevention efforts. Therefore, this study aimed to (1) identify baseline characteristics associated with e-cigarette initiation, and (2) determine whether changes in these baseline characteristics were associated with e-cigarette initiation.

METHODS

This study used data from Year 6 (2017/18, baseline) and Year 7 (2018/19, follow-up) of the COMPASS study. The final sample included 12 315 students in Grades 9 to 11 who reported never having tried e-cigarettes at baseline. Students reported demographic information, other substance use, school behaviours, physical activity, sedentary behaviour, sleep, symptoms of anxiety and depression, and emotional regulation and flourishing scores. Hierarchical GEE models, stratified by gender, examined the association between (1) baseline characteristics and e-cigarette initiation at follow-up and (2) changes in baseline characteristics and e-cigarette initiation at follow-up.

RESULTS

In total, 29% of students who had not yet initiated e-cigarette use reported initiating e-cigarette use at follow-up. Students in Grades 10 and 11 were less likely to initiate e-cigarette use. Other substance use, skipping school and meeting the physical activity guidelines at baseline and one-year changes to these behaviours were associated with e-cigarette initiation among both male and female students. Additionally, some differences were noted between females and males.

CONCLUSION

Given that other health behaviours were associated with e-cigarette initiation, prevention approaches should target multiple health-risk behaviours to help prevent youth e-cigarette use. Additionally, school-based approaches may benefit by being implemented at the beginning of high school or in junior high school.

A cultural experience to support mental health in people aged 16-24 during the COVID-19 pandemic compared to a typical museum website: study protocol of an online randomised controlled trial

Background

Despite the high prevalence of common mental disorders in adolescents and young adults, and their association with poor health and socio-economic outcomes throughout the lifespan, many young people do not seek or receive help for such disorders. There is growing interest in the community sector in supporting mental health in young people; however, there is little by way of experimental research in this area. During the COVID-19 pandemic and lockdown, we designed an online cultural experience to reduce anxiety and depression and support mental health in people aged 16–24.

Methods/design

The O-ACE POP (Online Active Community Engagement Proof of Principle) study is a UK-based online randomised controlled trial of an online cultural experience named Ways of Being, involving human centred narratives and viewpoints, compared with a typical museum website (the Ashmolean Museum). We aim to compare efficacy on  affect,  symptoms of epression and anxiety, flourishing and loneliness as well as investigating potential mechanisms of action.

Discussion

The COVID-19 pandemic has provided a unique opportunity to design an innovative approach to supporting mental health in young adults. Findings derived from this study will allow us to evaluate the efficacy of this intervention and will inform the design of studies to further refine the resource and test it further.

Trial registration

ClinicalTrials.gov NCT04663594. Registered on 11 December 2020 (submitted in same form 27 November 2020). Protocol v1.0: 27 November 2020. Date recruitment began: 4 December 2020. Recruitment complete (estimate): February 2021

Do weight perception and bullying victimization account for links between weight status and mental health among adolescents?

Background

The purpose of this study was to explore whether the way youth perceive their weight and their experiences of bullying victimization account for the increased risk of depression and anxiety symptoms, and poor psychosocial well-being, associated with overweight/obesity in a large sample of Canadian secondary school students. We also explored if associations differed by gender.

Methods

We used cross-sectional survey data from year 7 (2018–19) of the COMPASS study. The sample included 57,059 students in grades 9–12 (Secondary III-V in Quebec) at 134 Canadian secondary schools (Alberta, British Columbia, Ontario, Quebec). First, multiple regression models tested associations between body mass index (BMI) classification and mental health outcomes (anxiety [GAD-7] and depression [CESD-10] symptoms, and psychosocial well-being [Diener’s Flourishing Scale]). Second, weight perception and bullying victimization were added to the models. Models were stratified by gender and controlled for sociodemographic covariates and school clustering.

Results

When weight perception and bullying victimization were added to the models, obesity BMI status no longer predicted internalizing symptoms and flourishing scores relative to normal-weight BMIs. Students with ‘overweight’ or ‘underweight’ perceptions, and experiences of bullying victimization in the past month, reported higher anxiety and depressive symptomatology, and lower flourishing levels, in comparison to students with ‘about right’ weight perceptions and without experiences of bullying victimization, respectively, controlling for BMI status. Results were largely consistent across boys and girls.

Conclusions

Results suggest perceptions of weight and experiences of bullying independently contribute to differences in mental health outcomes by weight status among youth. Continued efforts targeting weight-based bullying and weight bias, and the promotion of body size acceptance and positive body image, may help reduce the risk of mental illness and poor mental health among adolescents.