Background This pragmatic randomized controlled study examined the effects of a 4-week nature walk (vs. urban walk) intervention on university students’ mental health, a population known to experience high rates of psychological symptoms. Method Using a parallel group design, university students were randomized to complete 2-3 weekly walks over 4 weeks in either an urban greenspace (nature condition) or city streets (urban condition). Assessments were completed online at pre-randomization/baseline, weekly (primary outcomes only), and post-intervention. The primary outcomes were positive and negative affect, with depressive and anxiety symptoms as secondary outcomes. Trial registration: NCT05889078. Mixed model analyses (adjusting for baseline measures) adhered to intent-to-treat principles. Results Ninety-three participants (47 in nature, 46 in urban) received the intervention. Participants were mostly female (87%; Mage=20.61 years; SD=1.94). Mixed model analyses revealed no effect of the nature walks on positive and negative affect, nor on depressive and anxiety symptoms. Post-hoc moderation analyses revealed greater reductions in depressive symptoms for the nature (vs urban) condition, but only in participants with higher baseline depressive symptoms (p for interaction=.04). To illustrate, for students with baseline symptoms in the moderately-severe-to-severe range, the mean difference in depressive symptoms at post-intervention was -3.86 (95% CI: -7.38 to -0.33), with a large effect size (d=0.85). Limitations The small sample size and higher number of female participants limit the generalizability of results. Conclusions Although this study did not provide evidence that nature walks improve mental health for all university students, benefits were observed for reducing depressive symptoms for those with higher baseline symptoms.

BACKGROUND:Non-suicidal self-injury (NSSI) is relatively common in adolescence and associated with mental health symptoms, yet the prevalence of NSSI and mental health correlates in childhood remain poorly understood. OBJECTIVE:Document the lifetime prevalence of NSSI in elementary-school children and concurrent associations with self- and teacher-reported mental health symptoms and peer problems. METHODS:Cross sectional analysis of 859 children (mean age=10.9 years; n = 419 males) from 33 elementary schools in Quebec, Canada who completed a self-report measure of NSSI (5-item Self-Mutilation subscale; Self Harm Inventory) and self- and teacher-report measures of concurrent mental health, including depressive symptoms (Children's Depression Inventory-Short-Form; self-reported only), emotional distress, withdrawal, impulsive/hyperactive/inattentive behaviors, disruptive behaviors, prosocial behaviors, and peer relationship difficulties (victimization) (Social Behavior Questionnaire). Mental health symptoms were transformed into z-scores. RESULTS:Lifetime prevalence of NSSI (any method, at least once) was 28.2 %, with no sex differences between males (26.7 %) and females (29.4 %) (p=.403), with scratching being the most frequently reported method (17.2 %). Children reporting NSSI had significantly poorer mental health across indicators examined in both self- and teacher reports, although associations were generally smaller for teacher-reported symptoms. To illustrate, for 1 standard deviation increase in self-reported symptom scores, odds of NSSI were 2.31 times higher for depressive symptoms (95 % CI 1.82-2.92), and 1.70 times higher for peer victimization (95 % CI 1.46-1.99). Associations were stronger among children endorsing multiple NSSI methods compared to those reporting only one. CONCLUSION:NSSI (especially scratching) is present in late childhood and associated with worse mental health symptoms and peer problems.

Canadian population-based data show that sexually diverse youth face greater mental health challenges than their heterosexual peers. However, nuances within sexual diversity—particularly among mostly heterosexual persons—are overlooked, and psychotic-like experiences remain underexplored. We examined the mental health of sexually diverse young adults from Quebec, spanning indicators from well-being to psychotic-like experiences. Data were drawn from 1324 youth from the Quebec Longitudinal Study of Child Development—a representative cohort born in 1997/98 and followed up until age 23. Participants self-reported their sexual orientation and mental health across nine indicators: suicidality, depression, anxiety, binge drinking, cannabis, other drug use, psychotic-like experiences, well-being, and help-seeking. Standardized mean differences (SMD) assessed group differences, stratified by assigned sex at birth and sexual orientation. A total of 324 (24.47

Introduction Sexually diverse adolescents report higher suicidality (ideation and attempts) than their heterosexual peers, but information on the onset and course of suicidality from early adolescence to young adulthood among contemporary sexually diverse individuals remains limited. This study traces suicidality trajectories across this critical developmental period, comparing sexually diverse and heterosexual adolescents both overall and by sex assigned at birth.Methods Data was drawn from the Quebec Longitudinal Study of Child Development, an ongoing population-based prospective birth cohort. This study included 1,505 participants who self-reported their sexual attraction at ages 15-17 (2013-2015) and past-year suicidal ideation and attempts using 3-items at ages 13, 15, 17 and 23 (2011-2021) from which a suicidality severity score was derived.Results 11.5% of the sample (n = 173, 60.5% female) reported sexually diverse attraction. Growth curve modelling tested the random effect of sexually diverse (vs. heterosexual) attraction on suicidality severity intercept, linear and quadratic latent growth factors. Age-specific contrasts in suicidality severity between sexually diverse and heterosexual adolescents were also examined. Compared to heterosexual adolescents, sexually diverse adolescents showed a steeper increase in suicidality severity from ages 13 to 17, and declining yet persisting disparities from ages 17 to 23. Although developmental trajectories differed across sexually diverse males and females, both experienced greater suicidality severity during adolescence compared with heterosexual peers.Discussion Our findings point to a developmental trajectory in which sexually diverse adolescents, particularly females assigned at birth, experience elevated suicidality that persists into young adulthood. Targeted and timely interventions during this critical developmental period are essential for suicide prevention.

Importance:Risk and protective factors for suicide mortality in youths remain poorly synthesized, as prior reviews have focused on all ages or nonfatal outcomes. Objective:To systematically assess factors associated with risk of suicide mortality in youths. Data Sources:MEDLINE, PsycINFO, Embase, and CINAHL from inception to March 7, 2025. Study Selection:Case-control and cohort studies of youths (aged ≤24 years) examining risk and/or protective factors associated with suicide mortality vs living general-population controls were included. Two independent reviewers screened 9497 records. Data Extraction and Synthesis:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 reviewers independently screened reports; 1 extracted data, verified by a second. Evidence was synthesized using vote counting and random-effects meta-analysis in April 2026. Main Outcomes and Measures:The primary outcome was suicide mortality at age 24 years or younger. Results:Ninety reports from 68 studies, mostly from high-income countries, identified distinct risk and/or protective factors; 54 reports contributed to 30 meta-analyses. The factors associated with the highest odds of suicide risk included schizophrenia (odds ratio [OR], 22.23; 95% CI, 12.05-41.03; I2 = 85.4%; 7 reports), mood disorders (OR, 11.32; 95% CI, 6.11-20.97; I2 = 64.6%; 7 reports), and self-harm (OR, 14.06; 95% CI, 5.58-35.39; I2 = 90.1%; 10 reports). Clinical indicators of health care use were also associated with higher risk, including mental health services use in preceding year (OR, 7.39; 95% CI, 6.45-8.47; I2 = 0.0%; 5 reports) and psychiatric admission (OR, 31.96; 95% CI, 13.83-73.86; I2 = 94.8%; 6 reports). At the socioecological level, several indicators were associated with higher risk, including maltreatment (OR, 4.03; 95% CI, 1.41-11.50; I2 = 67.1%; 5 reports), out-of-home placement (OR, 4.47; 95% CI, 2.15-9.28; I2 = 42.1%; 5 reports), youth justice system involvement (OR, 2.70; 95% CI, 1.94-3.75; I2 = 64.2%; 7 reports), and low educational attainment (OR, 2.95; 95% CI, 1.66-5.24; I2 = 76.0%; 5 reports). In contrast, indicators of family stability were associated with lower risk, including living with both parents (OR, 0.55; 95% CI, 0.48-0.62; I2 = 12.1%; 11 reports). Heterogeneity was substantial across analyses, while Newcastle-Ottawa ratings indicated moderate-to-high study quality. Conclusions and Relevance:In this systematic review and meta-analysis, suicide mortality in youths was associated with mental disorders, health care contact, and adversity, supporting both clinical care and population-level prevention, with future research needed in underrepresented populations.

QuestionWhat factors are associated with risk of suicide mortality among individuals aged 24 years and younger?FindingsIn this systematic review and meta-analysis of 90 reports (68 reports), mental disorders-particularly acute conditions such as schizophrenia and mood disorders-and prior self-harm were associated with suicide mortality. Prior health care contact (eg, psychiatric admission) and a range of social determinants (eg, maltreatment, out-of-home placement, and social disadvantage) were also associated with higher risk, whereas family stability (eg, living with both parents) was associated with lower risk.MeaningSuicide mortality in youths reflects both psychiatric vulnerability and social adversity, supporting the need for integrated prevention strategies combining early intervention with population-level prevention approaches targeting social determinants. This systematic review and meta-analysis examines factors associated with risk of suicide mortality in individuals aged 24 years and younger. ImportanceRisk and protective factors for suicide mortality in youths remain poorly synthesized, as prior reviews have focused on all ages or nonfatal outcomes.ObjectiveTo systematically assess factors associated with risk of suicide mortality in youths.Data SourcesMEDLINE, PsycINFO, Embase, and CINAHL from inception to March 7, 2025.Study SelectionCase-control and cohort studies of youths (aged <= 24 years) examining risk and/or protective factors associated with suicide mortality vs living general-population controls were included. Two independent reviewers screened 9497 records.Data Extraction and SynthesisFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 reviewers independently screened reports; 1 extracted data, verified by a second. Evidence was synthesized using vote counting and random-effects meta-analysis in April 2026.Main Outcomes and MeasuresThe primary outcome was suicide mortality at age 24 years or younger.ResultsNinety reports from 68 studies, mostly from high-income countries, identified distinct risk and/or protective factors; 54 reports contributed to 30 meta-analyses. The factors associated with the highest odds of suicide risk included schizophrenia (odds ratio [OR], 22.23; 95% CI, 12.05-41.03; I2 = 85.4%; 7 reports), mood disorders (OR, 11.32; 95% CI, 6.11-20.97; I2 = 64.6%; 7 reports), and self-harm (OR, 14.06; 95% CI, 5.58-35.39; I2 = 90.1%; 10 reports). Clinical indicators of health care use were also associated with higher risk, including mental health services use in preceding year (OR, 7.39; 95% CI, 6.45-8.47; I2 = 0.0%; 5 reports) and psychiatric admission (OR, 31.96; 95% CI, 13.83-73.86; I2 = 94.8%; 6 reports). At the socioecological level, several indicators were associated with higher risk, including maltreatment (OR, 4.03; 95% CI, 1.41-11.50; I2 = 67.1%; 5 reports), out-of-home placement (OR, 4.47; 95% CI, 2.15-9.28; I2 = 42.1%; 5 reports), youth justice system involvement (OR, 2.70; 95% CI, 1.94-3.75; I2 = 64.2%; 7 reports), and low educational attainment (OR, 2.95; 95% CI, 1.66-5.24; I2 = 76.0%; 5 reports). In contrast, indicators of family stability were associated with lower risk, including living with both parents (OR, 0.55; 95% CI, 0.48-0.62; I2 = 12.1%; 11 reports). Heterogeneity was substantial across analyses, while Newcastle-Ottawa ratings indicated moderate-to-high study quality.Conclusions and RelevanceIn this systematic review and meta-analysis, suicide mortality in youths was associated with mental disorders, health care contact, and adversity, supporting both clinical care and population-level prevention, with future research needed in underrepresented populations.

Importance:Suicidal ideation is increasingly common in youth. Trajectories and associated mental health symptoms across development remain poorly understood. Objective:To describe trajectories of suicidal ideation from early adolescence to young adulthood and identify preceding and co-occurring mental health symptoms to inform optimal prevention. Design, Setting, and Participants:This cohort study used data from a contemporary, longitudinal cohort study, the Québec Longitudinal Study of Child Development (QLSCD), including reports from participants, parents, and teachers. The QLSCD is a population-based birth cohort study of 2120 singletons born between 1997 and 1998 in Québec, Canada, and followed up to age 25 years (2023). Data were analyzed from September 2024 to February 2025. Main Outcomes and Measures:Serious suicidal ideation in the past 12 months was assessed by a question to participants at ages 13, 15, 17, 20, 23, and 25 years. Exposures:Mental health symptoms (eg, internalizing, externalizing) as reported by parents, teachers, and self-reports on validated questionnaires and standardized across 5 developmental periods: preschool (3-5 years), childhood (6-12 years), early adolescence (13 years), mid-late adolescence (15-17 years), and young adulthood (20-25 years). Results:A total of 1635 participants (845 female [51.7%]; participant number is weighted to account for selective attrition) provided answers on suicidal ideation, with survey weights applied. A total of 3 trajectories were identified: minimal/no ideation (1433 [87.6%]), onset in early adolescence (117 [7.1%]), and onset in young adulthood (86 [5.2%]). Relative to minimal/no ideation, onset in early adolescence was associated with elevated symptoms across nearly all mental health indicators from childhood through adulthood. This included both internalizing (eg, childhood depressive symptoms: risk ratio [RR], 1.75; 95% CI, 1.45-2.05) and externalizing (eg, childhood disruptive symptoms: RR, 1.60; 95% CI, 1.29-1.91) symptoms and maternal antisocial symptoms (RR, 1.39; 95% CI, 1.11-1.66). In contrast, onset of suicidal ideation in young adulthood was associated with internalizing symptoms (eg, mid-late adolescence depressive symptoms: RR, 1.84; 95% CI, 1.28-2.39) emerging in adolescence and worsening mental distress in young adulthood. Conclusions and Relevance:Results of this cohort study revealed 2 pathways to suicidal ideation: onset in early adolescence, with persistent childhood internalizing/externalizing symptoms, and onset in young adulthood linked to internalizing symptoms emerging in adolescence without prior distress. Findings suggest timely addressing of mental health symptoms and developmental stage-specific prevention.

BACKGROUND:Officially reported and self-reported measures of child maltreatment show poor agreement and may differentially predict psychosocial problems in adulthood. However, research remains primarily based on retrospective self-reports, warranting examination of the validity of prospective assessments of maltreatment. OBJECTIVE:To assess the construct validity of prospective indicators of child maltreatment using a longitudinal cohort of Canadian children. PARTICIPANTS AND SETTING:The population-based cohort comprises 2120 participants born between 1997 and 1998 in Quebec, Canada. METHODS:Maternal and familial risk factors (maternal age, depressive symptoms, and antisocial behaviors, socioeconomic status, and single-parent home) and early adulthood functioning difficulties (depression, anxiety, suicidality, alcohol misuse, and unemployment status) were assessed across various time points (0-23 years). Associations between factors and prospective and retrospective maltreatment indicators were appraised. RESULTS:Most maternal and familial risk factors (80 %) showed associations with indicators of prospective maltreatment (ΔM = +/-0.04 to 0.72; p < 0.05). Several early adulthood functioning difficulties (30 %) showed associations with physical (ΔM = 0.05 to 0.22; p < 0.05) and sexual abuse (ΔM = 0.33 to 0.34; p < 0.05), while emotional, supervisory, and physical neglect were only associated with educational/employment status (ΔM = 0.04 to 0.10; p < 0.05). Cumulatively assessed maltreatment also showed a dose-response relationship with maternal and familial risk factors/functioning difficulties. CONCLUSIONS:The strong construct validity exhibited by our prospective indicators highlights the need to assess child maltreatment multi-modally. Our findings further contribute to the wider discussion surrounding the measurement of child maltreatment.

This systematic review and meta-analysis aims to describe Canadian youth mental health during the COVID-19 pandemic, focusing on changes in anxiety and depressive symptoms and suicidality. We searched four databases up to February 2023 for longitudinal or repeated cross-sectional studies reporting on changes in depressive and anxiety symptoms, suicidality, or related services utilization among young people under 25 years old residing in Canada during the COVID-19 pandemic. Random-effects meta-analyses were performed for studies comparing depressive and anxiety symptoms from before to during the first, second, and third COVID-19 waves (up to June 2021), and between COVID-19 waves. Other studies were described narratively. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist. Of the 7916 records screened, 35 articles met inclusion criteria for this review. Included studies were highly heterogeneous in design, population, and type of change investigated, and many had a high risk of bias. The meta-analyses found that depressive symptoms worsened minimally from pre-pandemic to wave 1 but returned to pre-pandemic levels by wave 2. Anxiety symptoms were broadly comparable from pre-pandemic to waves 1 and 2 but worsened from waves 1 to 3 and from pre-pandemic to wave 1 for girls. The narrative review included several studies that provided inconclusive evidence of increases in services utilization. The current evidence is limited and highly heterogeneous, making it insufficient to draw definitive conclusions regarding the short- to medium-term impact of the pandemic on youth mental health in Canada. Obtaining better mental health surveillance among Canadian youth is imperative.

ObjectivesFindings from a birth cohort study indicated that the mental health of young adults had not worsened during the first wave of the COVID-19 pandemic, compared to 2018. This study examined longitudinal changes in mental health between March 2018 and June 2021 in the context of protracted public health mitigation measures about 12 months after the onset of the pandemic.MethodsParticipants from the Quebec Longitudinal Study of Child Development (n = 2120 at inception; n = 1461 during the COVID-19 pandemic), a population-based cohort of individuals born in 1997/1998, reported on their depressive and anxiety symptoms as well as suicidal ideation prior to the pandemic in 2018 (age 20), and during the pandemic in the summer of 2020 (age 22) and spring of 2021 (age 23).ResultsDepressive (Cohen's d = 0.15 [95% CI: 0.09 to 0.20]) and anxiety (Cohen's d = 0.33 [95% CI: 0.27 to 0.39]) symptoms increased between 2018 and 2021 for both males and females, but suicidal ideation did not change. There was also a significant increase in moderate to severe depressive (31.7% to 36.3%) and anxiety (14.7% to 24.8%) symptoms from 2018 to 2021. Youth who were students, those who were experiencing financial stress, food insecurity, and loneliness, and those without pre-existing poor mental health experienced the largest increase in depressive and anxiety symptoms over time.ConclusionThese findings highlight the mental health burden experienced by young adults during the COVID-19 pandemic, highlighting the need for preventive services and continued longitudinal follow-ups of these youths.

This study examines the contribution of parental reactions to their child's identity development and psychological adjustment following their child's coming out as gay, lesbian, or bisexual (GLB). Interviews on parental reactions were administered to 53 parents, and questionnaires on identity and adjustment were administered to their 53 GLB youths. Parental interviews were coded using 10 positive and negative dimensions of parental reactions. There were no gender differences in levels of positive and negative parental reactions and in levels of GLB youths’ outcomes. However, as expected, parents’ support of their child's sexual orientation, parents’ attempts to control their child's sexual orientation, and parents’ struggles with their child's sexual orientation were significantly associated with dimensions of youths’ identity and psychological adjustment. Parents’ gender also moderated the strength of the associations between parental reactions and youths’ outcomes. This study is of clinical relevance for intervention regarding sexually diverse populations.

Objective: To evaluate the mental health care needs perceived as unmet by adults in Quebec who had experienced depressive and (or) anxious symptomatology (DAS) in the previous 2 years and who used primary care services, and to identify the reasons associated with different types of unmet needs for care (UNCs) and the determinants of reporting UNCs. Method: Longitudinal data from the Dialogue Project were used. The sample consisted of 1288 adults who presented a common mental disorder and who consulted a general practitioner. The Hospital Anxiety and Depression Scale was used to measure DAS, and the Perceived Need for Care Questionnaire facilitated the assessment of the different types of UNCs and their motives. Results: About 40% of the participants perceived UNCs. Psychotherapy, help to improve ability to work, as well as general information on mental health and services were the most mentioned UNCs. The main reasons associated with reporting UNCs for psychotherapy and psychosocial interventions are “couldn't afford to pay” and “didn't know how or where to get help,” respectively. The factors associated with mentioning UNCs (compared with met needs) are to present a high DAS or a DAS that increased during the past 12 months, to perceive oneself as poor or to not have private health insurance. Conclusions: To reduce the UNCs and, further, to reduce DAS, it is necessary to improve the availability and affordability of psychotherapy and psychosocial intervention services, and to inform users on the types of services available and how to access them.

Nous connaissons mal les réalités des parents qui apprennent que leur jeune est gai, lesbienne ou bisexuel. Cet article présente l’analyse de contenu d’entrevues menées auprès de 12 parents d’un jeune GLB. L’entrevue porte sur le contexte familial pré- coming out , les changements des dynamiques conjugale, parentale, familiale et sociale à la suite du coming out , et l’impact des réactions parentales sur le bien-être identitaire et psychosocial du jeune. Les analyses révèlent 10 dimensions de réactions parentales regroupées dans les catégories suivantes : préoccupations parentales avec l’orientation sexuelle du jeune et soutien social. Ces dimensions peuvent être utiles aux intervenants qui oeuvrent auprès des familles avec un jeune GLB.

Background: The aims of this study were to: (1) evaluate the psychometric properties of a French Canadian version of the Hospital Anxiety and Depression Scale (HADS-FC) in a large population of primary care patients in Quebec, Canada; (2) conduct a transcultural validation of the original HADS in a subsample of English-speaking patients; (3) explore HADS properties in subgroups with or without multimorbidity.Methods: A sample of 14,833 adults recruited in 64 primary care clinics completed the HADS, including 3,382 patients at elevated risk of mental disorders that also completed the Composite International Diagnostic Interview-Simplified (CIDIS). The HADS' internal consistency and discriminant validity were assessed, its factor structure was evaluated, and receiver operating characteristic (ROC) analyses were undertaken to evaluate its case finding abilities.Results: The HADS-FC had good reliability (Cronbach's alphas ranging from 0.79 to 0.89 depending on language version and subscales) and discriminant validity, and a two-factor structure reflecting anxiety and depression factors. Results were similar in patient subgroups with or without multimorbidity. Optimal cut-off values were calculated: HADS: >= 16 (sensitivity 62%, specificity 77%), HADS-A: >= 10 (sensitivity 66%, specificity 73%) and HADS-D: >= 7 (sensitivity 65%, specificity 75%).Limitations: Our cohort selection process and use of the CIDIS as a gold standard may have contributed to the limited case-finding performance of the HADS-FC.Conclusions: The HADS-FC and English HADS presented good psychometric properties in primary care patients, including patients with and without multimorbidity. However, its performance as a screening instrument in these settings with patients of varying clinical profiles requires more scrutiny. (C) 2012 Elsevier B.V. All rights reserved.

Turgeon, L., & Chartrand, E. (2003). Psychometric properties of the French Canadian version of the State-Trait Anxiety Inventory for Children. Educational and Psychological Measurement 63(1), 174-185. (DOI: 10.1177/0013164402239324).

Thirty-one couples and their daughters participated in a study of the contribution of family and friendship relationships in adolescence, and of daughter/friend communication in adulthood to the adult daughters' perception of friendship support in adulthood. Questionnaires and direct observation of communication skills were used to evaluate marital quality, parental quality, and friendship quality at Time 1 (T1). At Time 2 (T2), 7 years later, daughters and their best friends completed questionnaires and videotaped social support interactions. A hierarchical regression model was used to predict daughters' perception of friendship support in adulthood. The findings indicated that higher levels of T1 mother/father marital satisfaction, higher levels of T1 mother/daughter positive communication, lower levels of T1 mother/daughter negative communication, and higher levels of T2 daughters' validation during communication with best friend uniquely predicted higher levels of T2 daughters' perception of friendship support. The findings suggest that family relationship quality in adolescence contributes to children's ability to develop and maintain adaptive resources for coping with stress in adulthood.