Extensive evidence suggests that gratitude is linked to greater life satisfaction. However, relatively little is known about how dynamic patterns of gratitude correspond to both fluctuations and stable patterns of life satisfaction, and whether these associations differ as a function of individual factors. Thus, the degree of gratitude variability (fluctuation around one's typical level) and instability (day-to-day shifts) in gratitude were examined in relation to both mean levels and fluctuating patterns of life satisfaction, while considering emotion regulation difficulties and mental health challenges as between-person moderators. Participants (N = 257) were predominantly Chinese young adults aged between 18 and 25 years (Mage = 21.27), who completed a daily diary across 14 days. Multiple regression analyses indicated that greater gratitude variability and instability were associated with lower mean levels of life satisfaction, but these associations were no longer significant after controlling for average gratitude. Further, gratitude variability and instability were positively associated with greater fluctuations in life satisfaction, above and beyond average gratitude. No significant moderation effects were observed. These findings suggest that the degree and consistency of day-to-day gratitude fluctuations have implications for life satisfaction in daily life, and that these processes appear to operate similarly across individuals with varying levels of mental health challenges and emotion regulation difficulties.

Introduction The surge in postsecondary students reporting mental health concerns, coupled with increased utilisation of on-campus and hospital-based mental healthcare, highlights a need to understand effective service navigation. To address this system gap, the University of Toronto and the Centre for Addiction and Mental Health (CAMH) leveraged their unique expertise and resources to develop the University of Toronto Navigation (UTN) service. UTN introduces care navigators to facilitate postsecondary student transitions from acute mental health services to community or campus mental healthcare. There has been limited implementation and evaluation of navigator models specific to the postsecondary context to date, which hinders scalability. This paper describes the study protocol of Navigation to Enhance Post-Secondary Students’ Acute Mental Health Care Transitions, a study that aims to collaborate with students, navigators and clinicians to evaluate the UTN service.Methods and analysis A one-stage, single-arm multimethods study design will be used to evaluate the UTN service. We will recruit 103 students following their UTN intake appointment. Students will complete quantitative measures assessing health outcomes, experiences of care and service utilisation at baseline and at three subsequent time points across a 6-month follow-up period. The quantitative data will be linked to administrative healthcare data. The primary evaluation outcome will be defined as attending an appointment with an appropriate care provider (in person or virtually) within 30 days of discharge from the hospital. We will conduct interviews with students and referring clinicians to gather perspectives regarding their experiences and satisfaction with the UTN service in greater depth.Ethics and dissemination Research ethics board approvals have been obtained from the University of Toronto and CAMH. Results will be disseminated through publications and presentations, and a toolkit will be cocreated to support implementation and adaptation of hospital-based navigator interventions in postsecondary contexts.

Research on the etiology of nonsuicidal self-injury (NSSI) has been largely deficit-focused, with emotion dysregulation frequently underscored as a common predictor of NSSI. Meanwhile, strengths-based models have been less frequently employed. This cross-sectional study explored the direct and indirect (through emotion regulation difficulties) potentially protective effects of strengths-based psychological variables (i.e., mindfulness, self-compassion, optimism, and resilience) on the likelihood of reporting past-year NSSI in a cross-national sample of university students (N = 861) residing in Belgium (n = 320), Canada (n = 136), and Australia (n = 406). The fit of the logistic mediation model did not differ when country was included, suggesting that the model was broadly applicable across all three contexts. Greater mindfulness, self-compassion, optimism, and resilience were all indirectly associated with a lower likelihood of reporting past-year NSSI through better emotion regulation. Notably, greater self-compassion and optimism were also directly associated with a lower likelihood of reporting past-year NSSI. Findings lend preliminary cross-national support for the possible protective roles of strengths-based psychological variables in relation to NSSI and for the mediating role of emotion regulation in these relations. Results also underscore the distinct contributions of self-compassion and optimism in relation to past-year NSSI, independent of those explained by emotion regulation, shedding light on a strengths-based etiological model that extends beyond emotion regulation difficulties.

The increasing enrollment in post-secondary education has highlighted the need for effective university policies to support students facing mental health challenges. This study explores the impacts of involuntary university leaves of absence on students with mental health issues, focusing on their experiences, the effectiveness of these policies, and recommendations for improvement. Using a qualitative methodology involving framework analysis, 22 emerging adult undergraduate students from across Canada were interviewed to understand their journeys before, during, and after taking an involuntary leave of absence. The study identifies three primary themes: (a) the health and well-being journey in the context of the leave of absence; (b) the interactions between mental health and university structures, supports, and policies; and (c) other influences on mental health and well-being. Academic pressure, interpersonal stressors, and the COVID-19 pandemic significantly contributed to the need for a leave of absence. Student outcomes, however, differ markedly: some students report relief and personal growth, whereas others contend with disrupted identities and difficulties reengaging with university life. The study underscores the importance of tailored support systems and policies that address the unique needs of students with mental health issues, advocating for a balance between institutional requirements and student well-being.

BackgroundPhysical activity (PA) is a promising prevention approach for supporting mental health and enhancing social inclusion among postsecondary students. However, it is unclear whether similar outcomes are realized when PA programming is delivered in-person versus virtually. ObjectiveUsing data from a multiphase research project, the purpose of the study was to examine the influence of on-campus PA programming (virtual and in-person delivery) on mental ill health symptoms (ie, anxiety and depression), social inclusion indices (ie, social connectedness, emotional ties, and social relationship quality), and well-being. Three objectives were addressed: (1) to assess pre-post change in symptoms, social inclusion indices, and well-being for virtual and in-person delivery; (2) to evaluate whether outcome change over time differed by delivery mode; and (3) to examine whether change in symptoms and social inclusion indices predicted change in well-being for both delivery modes. MethodsPhysically inactive postsecondary students experiencing mental ill health participated in a 6-week structured and supervised PA program. Pre-post intervention data were collected across 3 phases, and the analytical samples included: 1. In-person delivery (n=87; 82%, 69/84 young adults; 86%, 74/86 women; 38%, 33/86 White; 20%, 17/86 Chinese; 86%, 75/87 with mental illness; 2. Virtual delivery (n=62; 69%, 42/61 young adults; 95%, 59/62 women; 34%, 21/62 White; 21%, 13/62 South Asian; 55%, 34/62 with mental illness), and 3. Data from students who received in-person or virtual delivery: (n=92; 67%, 61/91 young adults; 90%, 83/92 women; 32%, 29/92 White; 20%, 18/92 South Asian; 59%, 54/92 with mental illness). Data were analyzed using 2-tailed paired samples t tests to address objective 1, a 2 (delivery mode) × 2 (time: pre-post) repeated-measures ANOVA to address objective 2, and hierarchical regression analyses to address objective 3. ResultsBoth virtual and in-person PA delivery were effective for symptom reduction and social inclusion improvements across all outcomes (P<.001), with moderate-to-large effects. There was no significant time × delivery mode (F5,84=0.72, ηp²=0.04, P=.60) interaction effect. Change in social inclusion indices explained unique variance in well-being, beyond covariates (gender, mental illness, and ethno-racial identity), and symptom reduction for virtual (R2adj = 0.75, ΔR2=0.08, P<.001) and in-person (R2adj = 0.72, ΔR2=0.16, P<.001) PA delivery. ConclusionsOnline distance learning is increasing across postsecondary settings worldwide, underscoring the need for accessible, technology-enabled mental health prevention interventions. The results provide support for the effectiveness of virtual and in-person PA programming for reducing symptoms of anxiety and depression, while also enhancing social inclusion indices and overall well-being. Social inclusion indices were also a key contributor to improved well-being, emphasizing the relevance of social factors in both virtual and in-person PA-based mental health prevention strategies for postsecondary students.

The transition to university represents a novel social context for nonsuicidal self-injury (NSSI) experiences to be shared among emerging adults. However, longitudinal work on NSSI reveal experiences among young adults is scarce, precluding an understanding of factors that promote reveals and help-seeking. To address these gaps, predictors of NSSI reveals among 592 university students ( M age = 18.11, 72% female) with lifetime histories of NSSI were examined. Participants completed an online survey three times (3 months apart) over their first year of university. It was found that 50% of students reported an NSSI reveal at some point across their first year of university. Binary logistic regression analyses showed that students reporting greater NSSI lifetime severity at baseline were more likely to later report a voluntary disclosure, while students reporting greater depressive symptoms at baseline were more likely to later report an involuntary discovery. Findings inform NSSI response efforts on post-secondary campuses.

Despite growing research on nonsuicidal self-injury (NSSI) in university settings and evidence that the risk of engaging in NSSI increases when they know someone who does, little is known about the relationship between social exposure to NSSI and students' perceptions of public stigma regarding NSSI. Drawing on intergroup contact theory, which posits that increased contact with stigmatized groups reduces prejudice, understanding how knowing someone who self-injures relates to stigma is particularly important. This study addressed these gaps by examining these factors among university students from three countries. Potential commonalities across countries and the moderating role of personal NSSI history were also examined. A total of 1,059 students (77.4% female, M-age = 21, age range = 17-53 years) participated, having been recruited on the basis that they knew someone who engaged in NSSI. Participants (50.8% Australian, 33.4% Belgian, 15.8% Canadian) completed a survey reporting on their own experiences with NSSI, the perceived NSSI experiences of the person they know who self-injures, and perceptions of public attitudes and stigma toward NSSI. Participants most commonly identified friends as the individuals they knew who self-injured. Pearson's correlations revealed positive interrelations among social exposure to NSSI and perceived public NSSI stigma. Hierarchical regression and moderation analysis showed this association was moderated by country, but not by personal NSSI history. Analysis of variance results indicated Canadian students perceived significantly lower levels of public NSSI stigma compared to Australian and Belgian counterparts. These findings underscore the importance of implementing stigma-reduction strategies sensitive to country-specific contextual factors. Future research should further explore the role of knowing someone who self-injures, as well as cultural and national influences on stigma perceptions.

Post-secondary students report high levels of stress and mental health challenges. Identifying the key sources of stress can guide efforts to mitigate the most significant stressors and better support students' mental health. The Post-Secondary Student Stressors Index (PSSI), a 46-item inventory, was designed to comprehensively assess stressors specific to post-secondary students. However, its dimensional structure and its association with mental health indices require further validation. In the present study, a Principal Component Analysis was conducted to examine the structure of the PSSI, and the associations between the resulting stressor components and several mental health indices. Participants included 1,214 first-year students (Mage = 18.14 years, SD = 0.95), who completed the PSSI, as well as measures of perceived stress, depressive symptoms, and anxiety symptoms. Results suggested 12 components that accounted for 42 of the original 46 items, with most components demonstrating moderate to high internal consistency (α = .70 -.90). Correlational analyses revealed positive associations between the PSSI components and measures of perceived stress, depressive symptoms, and anxiety symptoms, although components with lower endorsements were associated with weaker correlations. By identifying valid and reliable components of the PSSI, this study facilitates the use of specific stressor components in future research on student stress and mental health.

Background:Mindfulness-based programming (MBP) is increasingly being implemented within university settings to support students' mental health, and it typically includes the instruction of formal mindfulness (FM) and informal mindfulness (IM) activities. However, recent evidence suggests that university students with a history of nonsuicidal self-injury (NSSI) may experience challenges in response to FM (eg, physical or psychological discomfort), whereas the flexibility and brevity inherent in IM may be better tolerated. Objective:This randomized controlled trial compared web-based FM and IM programs to each other and to an inactive control condition in terms of (1) effectiveness and (2) acceptability as a function of NSSI history (NSSI or no NSSI) and time (1 week after the program or 1 month after the program). Indices of effectiveness included dispositional mindfulness, well-being, perceived stress, psychological need satisfaction, emotion regulation styles, and academic engagement. Methods:Participants were university students with (n=127) and those without (n=100) past-year NSSI engagement. All procedures were conducted online. Once informed consent was obtained and eligibility was confirmed, participants were randomly assigned to 1 of 3 conditions: FM program, IM program, or inactive control condition. One week before the FM and IM programs commenced, all participants completed a baseline survey assessing all indices of effectiveness. Participants assigned to the FM and IM conditions then attended hour-long mindfulness program group sessions once per week over 4 consecutive weeks, while those assigned to the inactive control condition did not complete any study tasks during this time. Mindfulness program sessions were hosted on the videoconference platform Webex. The same survey completed at baseline was completed again 1 week and 1 month following the intervention period, with added acceptability measures for those who took part in the FM and IM programs. Results:Overall, the results did not differ as a function of NSSI history. A series of 3-way analyses of covariance revealed that both the FM and IM programs were effective at improving dispositional mindfulness (P<.001; ηp2=0.07), nonjudging (P=.03; ηp2=0.04), describing (P=.007; ηp2=0.05), well-being (P=.04; ηp2=0.03), and psychological need satisfaction (P=.005; ηp2=0.05) immediately after the program, with these improvements sustained 1 month later. Neither program resulted in improved awareness, nonreacting, observing, stress, emotion regulation styles, or academic engagement (all P>.05). Moreover, 3-way ANOVAs revealed high acceptability of both the FM and IM programs, with a preference for IM immediately after the program (P=.03; ηp2=0.03). Conclusions:The findings of this study underscore the effectiveness and acceptability of the FM and IM programs to MBP in the university context, as well as the potential value of explicitly teaching and similarly emphasizing both FM and IM, an approach that may be optimally responsive to diverse needs and preferences among students.

The post-secondary years are marked by heightened stressors and nonsuicidal self-injury (NSSI) among emerging adults. However, the effects of university stressors on NSSI in daily life remains poorly understood. In the present study, the associations among several university stressors and NSSI urges and behaviors were examined, and the moderating role of gender was explored. The sample included 130 students (72% cisgender women, Mage = 17.96), who completed a baseline assessment followed by 14 days of daily entries, yielding 1,625 assessments. Hierarchical linear modeling revealed that total stressor occurrence predicted same-day NSSI urges and behaviors, though gender did not moderate these associations. Interpersonal stressors were linked to same-day NSSI urges and behaviors, as well as next-day urges. Balancing responsibilities were associated with same-day NSSI urges, and low grades predicted both same-day urges and behaviors. These findings emphasize the importance of post-secondary institutions tailoring mental health programs to address students' unique needs.

Mindfulness instruction comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. FM involves sustaining attention on thoughts, emotions and bodily sensations through structured practices, while IM involves incorporating mindfulness into daily activities. However, recent evidence suggests that FM may pose challenges for students with recent non-suicidal self-injury (NSSI), whereas the flexibility and brevity inherent in IM may be better tolerated. This randomized controlled trial compared a FM induction, IM induction and control task among university students with ( n  = 103) and without ( n  = 123) past-year NSSI in terms of acceptability and pre-post state mindfulness, stress and well-being. Notably, results did not differ as a function of NSSI history. Two-way ANOVAs revealed that only IM was consistently preferred over the control task. Furthermore, three-way mixed ANOVAs revealed that—when assessed using brief Visual Analogue Scales—state well-being increased in all conditions, state mindfulness increased after both IM and FM, and state stress only decreased after IM. Notably, these differences by condition appeared to be of short duration as they were not found with lengthier measures. Results highlight the potential promise of IM and the importance of measurement selection when assessing the transient effects of mindfulness inductions in research.

Despite experiencing greater rates of mental health challenges, racialized postsecondary students are accessing campus-based supports at lower rates than their White peers. As much of the existing research pertaining to racialized students' support-seeking at postsecondary institutions has focused on the barriers to access, little is known about the experiences of racialized students who overcome these barriers and access support. In the present study, the unique experiences of racialized students accessing wellness and mental health supports on a large university campus in Canada were examined. Thirty-one racialized undergraduate students completed semistructured interviews, which were analyzed using reflexive thematic analysis with intersectionality as a guiding theoretical framework. Five themes were developed under the overarching theme that "Racialized students navigate a mental health system built without them in mind." This study has implications for creating more inclusive mental health supports on postsecondary campuses.

The purpose of the study was to examine on-campus physical recreation engagement as a student-life activity for supporting post-secondary student psychosocial well-being, physical activity (PA) guideline adherence, and academic achievement among post-secondary students. The study aimed to: (1) test a comprehensive model examining associations between engagement in on-campus physical recreation, psychosocial well-being outcomes (campus climate, social support, loneliness, psychological distress), PA guideline adherence, and academic achievement; and (2) explore model differences in the associations among students living with and without a mental health condition. Cross-sectional data from the national spring 2023 Canadian Campus Well-Being Survey were used. The analytical sample included 9575 students (Mage = 23.17 years; 48 % White; 65 % women; 29 % with a mental health condition). Based on findings from structural equation modeling, physical recreation engagement was directly associated with PA guideline adherence, social support, psychological distress, and loneliness. PA guideline adherence, social support, and campus climate were also directly associated with psychological distress, loneliness, and academic achievement. Physical recreation engagement was indirectly associated with more favourable outcomes in academic achievement, psychological distress, and loneliness through higher levels of social support. Physical recreation was indirectly associated with lower levels of psychological distress and loneliness through PA guideline adherence. Exploratory multi-group invariance analyses supported no model differences in the structural associations among students with a mental health condition. Promising targetable processes for supporting student psychosocial well-being through physical recreation engagement are provided. Theoretical and practical implications for informing whole-campus preventive well-being strategies centered on physical recreation among post-secondary students are discussed.

OBJECTIVE:Major depressive disorder (MDD) in youth is an independent risk factor for premature cardiovascular disease (CVD). While previous research has considered individual CVD risk factors in relation to depression, this study examined the association between depression and CVD risk among children and adolescents with MDD using a validated composite measure. METHODS:Youth with MDD were recruited through an outpatient psychiatry program and underwent semistructured psychiatric diagnostic assessment to confirm diagnosis. Healthy control participants were recruited from community settings. All participants completed the Center for Epidemiological Studies Depression Scale for Children to assess depressive symptoms. The continuous metabolic syndrome score, a validated measure for cardiometabolic risk assessment in youth, was computed using aggregated standardized z-scores of CVD risk factors, including fasting blood glucose, body mass index, blood pressure, fasting triglycerides, and high-density lipoprotein cholesterol. Hierarchical multiple regression models tested the association between depression (diagnosis and symptoms) and CVD risk while accounting for covariates. RESULTS:Participants (N=277; 73.6% female) had a mean age of 15.2 (SD=1.8) years. Cardiovascular disease risk was significantly higher among youth with depression (n=196, mean=0.77, SD=2.98) compared with healthy controls (n=81, mean=-0.39, SD=2.77; P=.002). Depression diagnosis and depressive symptoms were associated with increased CVD risk (β=0.40, P=.004; β=0.15, P=.02, respectively), after adjusting for covariates. CONCLUSIONS:Adolescents with MDD demonstrate increased cardiovascular disease risk compared with healthy youth, highlighting early evidence of association between depression and cardiovascular disease. Consequently, childhood and adolescence may serve as crucial periods for preventive intervention targeting cardiovascular health among youth with depression.

Emerging adults (ages 18–29 years) in post-secondary school experience significant disruptions in sleep and increased vulnerability to mental health challenges. One burgeoning mental health concern that may be exacerbated by poor sleep is nonsuicidal self-injury (NSSI). Prior cross-sectional studies have shown that poor sleep is commonly reported among young adults who engage in NSSI. However, daily diary studies examining within-person variability in nightly sleep (and deviations from one’s typical sleep patterns) in relation to NSSI urges and behaviors are scant. It is also unclear which individuals may be most vulnerable to the effects of poor sleep in daily life. The associations among sleep duration, sleep quality, NSSI urges and behaviors, and two potentially relevant moderators (i.e., self-criticism and pain tolerance) were examined in the present study. Participants (N = 160, 83

Emerging adulthood brings concerns about sense of self and belonging to the forefront, a period during which many young adults experience loneliness and mental health challenges. Self-esteem, or one's evaluation of self-worth, may both predict and/or be predicted by loneliness, though longitudinal research is needed to disentangle the nature of these associations. Therefore, the link between loneliness and self-esteem was examined while considering the moderating role of emotion regulation difficulties. Participants (N = 1,217, Mage = 18.14, 71% female-identifying) completed a survey at three timepoints over one year. Random-intercept cross-lagged panel modelling indicated a bidirectional within-person association between increases in loneliness and decreases in self-esteem. Emotion regulation difficulties did not moderate the association, though it was associated with both loneliness and self-esteem. These findings suggest that during emerging adulthood, loneliness may hinder self-esteem which is likely to lead to further loneliness.

Nonsuicidal self-injury (NSSI) is a highly prevalent mental health concern among adolescents and young adults. Understanding not only who is most at risk, but when in daily life, is necessary to prevent NSSI. To explore the role of several theoretically relevant "barriers" to NSSI (i.e., lack of exposure to NSSI, sensitivity to blood, self-worth, and perceived stigma) in NSSI urges and behaviors, daily diary sampling was used in the present study. Participants included 236 young adults (130 with recent NSSI, 106 without recent NSSI) who completed daily assessments for 14 days. Across the daily diary period, participants who engaged in NSSI reported greater exposure to NSSI, insensitivity to blood, perceived stigma toward NSSI, and lower self-worth compared to individuals without a history of NSSI. Hierarchical linear modeling revealed that within individuals, greater than typical insensitivity to blood and lower self-worth predicted same day NSSI urges and behaviors, and lower self-worth also predicted next day NSSI urges and behaviors. Greater exposure to NSSI also predicted same day NSSI urges, and next day NSSI behavior. Findings underscore that increasing self-worth and aversion to NSSI, and decreasing exposure to NSSI, may serve as important targets for NSSI prevention and intervention.

OBJECTIVES:Emerging evidence suggests that alexithymia, a psychological construct defined by the inability to describe emotion, differentiate feelings, and think in an internally oriented way, may be relevant in understanding engagement in nonsuicidal self-injury (NSSI). However, there is a paucity of longitudinal work on alexithymia and NSSI, which is necessary to discern whether alexithymia may heighten risk for NSSI over time. METHODS:In the present study, the association between alexithymia and NSSI was examined among 1125 emerging adults (Mage = 17.96, 72% female), who completed a survey at two time points 4 months apart. RESULTS:Participants with a history of NSSI reported higher levels of alexithymia than those with no NSSI engagement. A zero-inflated negative binomial regression model revealed that higher alexithymia at Time 1 predicted greater diversity in NSSI methods (i.e., NSSI versatility), but not NSSI frequency, at Time 2, for those already engaging in NSSI (p < 0.01, controlling for NSSI history at Time 1, emotion regulation difficulties, age, and gender). Significant differences were found in NSSI functions based on alexithymia among individuals with a lifetime history of NSSI at both time points. Among participants with a history of NSSI, alexithymia was most strongly correlated with anti-dissociation, sensation seeking, self-punishment, toughness, and interpersonal boundaries NSSI functions. CONCLUSION:Findings underscore that alexithymia may be relevant to understanding NSSI severity.

Recent theory and research suggest that elevated pain tolerance may be an important predictor of nonsuicidal self-injury (NSSI) engagement, particularly among individuals high in emotional dysregulation. However, researchers have yet to examine the role of state pain tolerance in NSSI behaviours in daily life, or the moderating effects of emotional dysregulation. In the present study, the link between pain tolerance and NSSI, as well as the moderating effects of emotional dysregulation, were examined using a daily diary approach. Participants included 130 emerging adults (Mage = 17.96, 72 % female) with recent NSSI engagement who completed a baseline survey and 14 days of daily diary assessments. Participants reported on their daily pain tolerance and NSSI (i.e., urges, engagement, frequency, and NSSI versatility). Using hierarchical linear modelling, it was found that state pain tolerance predicted same day NSSI engagement, NSSI frequency, and NSSI versatility, particularly for those with high trait emotion dysregulation. For individuals high in emotional dysregulation, pain tolerance also predicted next-day NSSI versatility. Pain tolerance may be relevant in NSSI risk assessment and prevention.