This study aimed to determine the psychometric properties and factor structure of the Brief Resilience Scale (BRS) among a cohort of first-year Canadian undergraduate students. A total of 2709 undergraduate students completed baseline surveys in fall 2021/2022; of these, 856 students completed follow-up surveys in spring 2022/2023. At baseline, most students identified as female (72.7%), White (60.3%) and Canadian (93.8%). The internal consistency and convergent and predictive validity of the BRS were explored and confirmatory factor analysis of three models was conducted. Multiple regression was used to examine if BRS scores modified the effect of stressors on depression and anxiety. In this cohort, the BRS had good internal consistency (alpha = 0.85) and a 2-factor structure based on positively and negatively worded items had the best fit. While higher BRS scores appeared to modify the negative effect of perceived stress on baseline depression and anxiety, there was insufficient evidence that BRS scores modified the effects of adverse childhood events on baseline anxiety scores. While the BRS is valid in this population, it may not fully capture student understanding of resilience.

Bullying is a harmful relationship problem that has negative impacts on youth mental health. Relative to contexts with high rates of bullying, youth who are victimized in contexts with lower overall rates of bullying experience worse mental health impacts – this effect is known as the healthy context paradox. Research has yet to examine whether the healthy context paradox also exists for identity-based bullying. This form of bullying, also known as stigma-based and bias-based bullying, occurs when youth are targeted because of an aspect of their social identity (e.g., race, religion, sexual orientation, gender identity, disability, or body weight). The current study used a nationally representative sample of Canadian youth in grades 6-10 (n = 23,764 from 217 schools) from the Health Behavior in School-aged Children study to examine whether there is a healthy context paradox for identity-based bullying specifically. Results from multivariable regression analyses indicated that, in general, both individual-level and school-level identity-based bullying were associated with poorer youth mental health. However, there was little to no evidence of a healthy context paradox effect, as the negative effect of bullying was greatest in low-prevalence schools in only 1 of 12 associations between individual-level victimization and mental health examined. It is possible that identity-based bullying may be less sensitive to such contextual effects, or that other levels of youths’ social ecologies (e.g., neighbourhoods) matter more when examining variation in identity-based bullying.

Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically treated injury across 31 mainly European countries over 20 years, then explored whether observed temporal trends varied according to the prevalence of known behavioral risk factors. The data source included six cycles of the Health Behavior in School-aged Children study (2002-22; weighted n = 954 298, participants aged 11-15 years). Outcomes included self-reports of any and multiple medically treated injuries. Measures of behavioral risks included indicators of violence, substance use, and physical activity. Within countries reporting increases in injuries, variations in reported engagement in known behavioral risk factors were examined. Nearly half of adolescents reported at least one medically treated injury (47%-53% of boys; 38%-44% of girls) and nearly one quarter reported multiple injuries (23%-30% of boys; 16%-22% of girls). In the pooled analysis, temporal trends included increases in any medically treated injury for girls (all age groups) and boys (11 years only) and multiple injuries (boys and girls, all age groups). At the country-level, we observed more temporal increases than decreases. Increases in physical activity were observed coincident with observed injury trends. In one of the largest European analyses of its kind, we demonstrated the ongoing burden of adolescent injury. Persistently high rates of adolescent injuries are concerning, and the origins of temporal increases require an initial focus on sport and physical activity.

Background Mental health concerns are common among undergraduates and have been linked to lifestyle factors. This study examined the relationship between recreational screen time at university entry and mental health over the academic year, and the potential moderating role of self-esteem. Methods Data from the longitudinal Queen's U-Flourish Survey (2021/2022) included measures of screen time unrelated to academic work (leisure and social) and validated screening measures for anxiety (GAD-7), depression (PHQ-9), insomnia (SCI-8), disordered eating (SCOFF), and low well-being (SWEMWBS). Multivariable log-binomial regression was used to examine associations between screen time and mental health. Results At entry to university, a higher proportion of males (n = 394) than females (n = 1,135) reported averaging 4 + hours/day of leisure screen time (57.4% vs. 45.3%, P < 0.001), while a greater proportion of females reported 4 + hours of social screen time (32.2% vs. 25.2%, P = 0.01). Higher screen time was associated with increased risk of clinically significant levels of symptoms and reduced well-being at school entry, with greater effects for leisure compared to social screen time. Students reporting 7-9 and 10 + hours/day of leisure screen time were more likely to screen positive for anxiety (by 20% and 39%), depression (39%; 47%), insomnia (22%; 55%), and low well-being (45%; 68%) compared to students averaging <= 3 hours/day. Effects were comparable between males and females, except greater leisure screen time was associated with increased risk of disordered eating among females only. Associations between screen time and screening positive at the end of the academic year were largely attenuated. Leisure screen time >= 3 hours/day was most strongly associated with anxiety and depression among students with higher self-esteem. Conclusions Recreational screen time >= 3 hours/day is common among first-year undergraduates and associated with higher levels of anxiety and depressive symptoms and lower well-being. It should be considered in campus mental health promotion and prevention efforts.

BackgroundMental health concerns are common among undergraduates and have been linked to lifestyle factors. This study examined the relationship between recreational screen time at university entry and mental health over the academic year, and the potential moderating role of self-esteem.MethodsData from the longitudinal Queen's U-Flourish Survey (2021/2022) included measures of screen time unrelated to academic work (leisure and social) and validated screening measures for anxiety (GAD-7), depression (PHQ-9), insomnia (SCI-8), disordered eating (SCOFF), and low well-being (SWEMWBS). Multivariable log-binomial regression was used to examine associations between screen time and mental health.ResultsAt entry to university, a higher proportion of males (n = 394) than females (n = 1,135) reported averaging 4 +  hours/day of leisure screen time (57.4% vs. 45.3%, P < 0.001), while a greater proportion of females reported 4 +  hours of social screen time (32.2% vs. 25.2%, P = 0.01). Higher screen time was associated with increased risk of clinically significant levels of symptoms and reduced well-being at school entry, with greater effects for leisure compared to social screen time. Students reporting 7-9 and 10 +  hours/day of leisure screen time were more likely to screen positive for anxiety (by 20% and 39%), depression (39%; 47%), insomnia (22%; 55%), and low well-being (45%; 68%) compared to students averaging ≤3 hours/day. Effects were comparable between males and females, except greater leisure screen time was associated with increased risk of disordered eating among females only. Associations between screen time and screening positive at the end of the academic year were largely attenuated. Leisure screen time ≥3 hours/day was most strongly associated with anxiety and depression among students with higher self-esteem.ConclusionsRecreational screen time ≥3 hours/day is common among first-year undergraduates and associated with higher levels of anxiety and depressive symptoms and lower well-being. It should be considered in campus mental health promotion and prevention efforts.

BACKGROUND:Entry to higher education coincides with a period of accelerated psychosocial and brain development. Student need for acceptable and accessible well-being and mental health support is straining university resources. AIMS:To evaluate the acceptability and impact of a digital mental health literacy course tailored for undergraduates and delivered as an accredited interdisciplinary elective. METHOD:Analyses included pre-post course survey data from enrolled students and longitudinal U-Flourish Well-Being Survey data from a comparison sample of non-course takers over the same period (2021-2024). Linear mixed-effects models examined associations between course participation and 12-week changes in mental health literacy, psychosocial risk factors, well-being and common mental health concerns. RESULTS:Pre-post course survey data (N = 2884) supported high acceptability, improvements in resilience (+0.06; 95% CI 0.03-0.08, p < 0.001) and self-compassion (+0.65; 95% CI 0.46-0.84, p < 0.001), and a reduction in brooding (-0.31; 95% CI -0.44 to-0.18, p < 0.001). Taking the course was associated with a reduction in anxiety (β = -0.41; 95% CI -0.55 to -0.27, p < 0.001) and cannabis use (proportional odds ratio 0.82; 95% CI 0.75-0.90, p < 0.001), improvement in sleep quality (β = 0.79; 95% CI 0.61-0.97, p < 0.001) and evidence of a protective effect on well-being (β = 0.24; 95% CI 0.11-0.36, p < 0.001) and depressive symptoms (β = -0.37; 95% CI -0.52 to -0.21, p < 0.001), compared with non-course takers. Effects differed by gender, with women benefitting most, but were comparable across minoritised student subgroups. CONCLUSIONS:Mental health literacy delivered as an accredited undergraduate interdisciplinary course is highly acceptable and associated with improvement in psychological coping and positive effects on student mental health and well-being. Future research should focus on more diverse student samples, underlying mechanisms and sustained effects.

Background: The classification accuracy of the General Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) in post-secondary students remains uncertain. Methods: Undergraduate students completed a survey (n = 159) and QuickSCID-5 (n = 130). Sensitivity, specificity, and receiver operating characteristics were calculated, and alternative scoring strategies were explored. Results: Most students identified as first-year, Canadian, and female. Among survey respondents, 42% (GAD-7) and 35% (PHQ-9) scored >10. Most students with high stress and GAD-7 scores did not meet the criteria for GAD. At a screening cut-off of >10, sensitivity and specificity were: 80.6/72.3% (GAD-7) and 92.9/72.4% (PHQ-9), respectively. Preliminary evidence supported moderate classification accuracy of GAD-7 (AUC = 0.78) for detecting GAD, but poor accuracy for detecting other disorders. PHQ-9 showed high classification accuracy (AUC = 0.92) for depression; preliminary evidence supported improved accuracy with alternative scoring. Conclusions: While PHQ-9 appears to be a useful screening measure, findings suggest the GAD-7 may capture stress rather than clinical anxiety.

OBJECTIVES:Stepped care models (SCM) for mental health support use standardized measures to assess post-secondary students' mental health and assign care. Understanding students' perceptions of these measures and data use is essential for effective outcomes. This study explored students' views regarding utility of standardized measures and their recommendations for data use by providers. PARTICIPANTS:Eighteen Canadian undergraduates who completed a survey with standardized measures and a diagnostic interview. METHODS:Semi-structured Zoom interviews. Codebook thematic analysis identified key themes. RESULTS:Most participants self-identified as female and South/East Asian or Canadian. Three themes emerged: Enhanced Engagement and Empowerment, Greater Responsiveness to Diversity and Context, and Data-Driven Improvement. Students reported that completing measures increased self-awareness and engagement. Students wanted their data to inform improvements to campus-based services. CONCLUSIONS:Standardized measures can enhance student self-awareness and empowerment. The ability to contextualize experiences and using student data to inform care may inform more effective support.

Relative deprivation (RD) is an important theoretical construct for understanding how health and wellbeing are affected by income inequality. This longitudinal study investigates the association of income-based RD with human flourishing using data from an international sample of youth and adults. The Global Flourishing Study surveyed 207,919 youth (18-24 years), adults (25-64 years) and older adults (65+ years) in 22 countries and followed up with 62% of the sample one year later. The survey measured six domains of flourishing: happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, close social relationships, and financial and material stability. We estimated RD (Yitzhaki index) using household income and demographically matched reference groups. Multilevel linear regressions were then used to examine associations between RD and the flourishing domains, and whether they were moderated by gender and age. The results showed that RD was negatively associated with all six flourishing domains, both cross-sectionally and longitudinally. These associations were generally stronger in youth and adults compared to older adults and, to a lesser extent, in females compared to males. RD undermines human flourishing and contributes to a decline in flourishing over time. Policy actions that reduce income inequality and RD could yield intangible social benefits that cannot be achieved through economic growth or increased wealth. Individual differences in flourishing are associated with relative socioeconomic differences among the groups to which individuals compare themselves.

ObjectivesUnacceptable experiences (UEs) during undergraduate studies and the associated emotional and academic impact have not been rigorously evaluated in the Canadian context. This study aimed to estimate the prevalence of UEs and examine their associations with mental health and academic outcomes in a diverse sample of Canadian undergraduate students.MethodsUndergraduates attending Queen's University completed the U-Flourish Student Well-Being Survey at the beginning and end of each academic year from 2021/2022 to 2023/2024. Validated self-report measures included the GAD-7 (anxiety), PHQ-9 (depression), C-SSRS (suicidal thoughts and behaviours) and WEMWBS-7 (well-being). UEs reported over the academic year included: discrimination, sexual violence/harassment, bullying, hate crimes and physical assault. Multivariable regression analyses examined associations between UEs and student mental health outcomes and cumulative grade-point average (GPA) abstracted from the university database.ResultsNearly one-third (28.9%; range = 27.0-30.1% across years) of students (n = 2,948) reported experiencing at least one UE over the academic year. Discrimination (14.6%) and sexual violence/harassment (14.4%) was reported most frequently, followed by bullying/harassment (10.6%), hate crimes (5.0%) and physical assault (3.2%). UEs were highest in students who identified as non-binary gender (51.6%), 2SLGBTQIA + (39.9%) and as having a lifetime mental illness (41.2%). Each UE increased the risk of screening positive for anxiety and depression over the academic year by 10-19% and 14-40%, respectively. Students reporting UEs were also more likely (13-72%) to report having suicidal thoughts and/or behaviours over the academic year, particularly those reporting sexual violence (RR:1.72; 95% CI:1.45-2.05). Sexual violence, bullying, and hate crimes were associated with lower average cumulative GPA in first year.ConclusionUEs were commonly reported by undergraduate students, especially in minoritised subgroups, and associated with mental health concerns and academic difficulties. These findings highlight the need for further research to inform universal and targeted prevention and early intervention initiatives.

Having a sense of meaning in life supports adolescent health but is affected by experiences of wealth or poverty. We examined its associations with relative advantage (RA) and relative deprivation (RD) in a sample of Canadian adolescents (n = 17,634) using survey data from the Health Behaviour in School-aged Children study. We calculated RA and RD using all other schoolmates as reference groups in 238 schools. Descriptively, RA was associated with greater meaning and purpose and RD was associated with less. Regression-based estimates of prevalence ratios (PR) revealed more nuanced patterns. RD was associated with less of a sense of meaning and purpose in females and gender-diverse youth only. RA was associated with a reduced risk of low meaning and purpose in females (PR 0.77; 95 % CI: 0.61 to 0.98), with similar trends in males and gender diverse students that did not achieve significance. Although the association was not pronounced at the ecological (school) level, the negative associations with RD were stronger in more unequal schools. To illustrate, in schools of high wealth inequality, RD was most strongly associated with having low meaning and purpose in females (PR 1.59; 95 % CI: 1.20 to 2.11) and gender diverse adolescents (PR 1.97, 95 % CI: 0.90 to 4.33), with no statistically significant effect in males. These patterns reveal the salience of proximal socioeconomic reference cues for adolescents and offer new insights into why inequalities in health and wellbeing are so challenging to address in youth populations. They also underscore the importance of both socioeconomic position and wealth distribution within school settings, providing impetus for thought and change.

BACKGROUND:Mental health challenges are prevalent among Canadian higher education students, with significant rates of depression and anxiety often going untreated due to reduced early detection, stigmatizing beliefs, and practical barriers. The U-Flourish longitudinal electronic survey study launched in 2018 engages new cohorts of incoming undergraduate students and repeatedly collects data about mental health and well-being and access to support. OBJECTIVE:U-Flourish survey data provide a unique opportunity to train evidence-based prediction risk models and a personalized recommendation engine to signpost students to indicated mental health support based on their own data. METHODS:Two approaches were integrated in developing the risk prediction models and recommendation engine: (1) clinically defined rules by experts in the field to detect current and predict the risk of future anxiety and depression and to signpost students to appropriate care using a stepped care approach and based on clinical factors (ie, self-harm and suicidal thoughts, symptom levels, and lifetime history); and (2) machine learning models, trained with additional data including family history, early adversity, and stress indicators, to predict future risks of clinically significant depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder questionnaire). Models were created using the XGBoost algorithm and a 70:30 ratio for training and testing with 10-fold cross-validation. RESULTS:In total, 27.5% of students at entry to university from 2018 to 2023 were identified as having potentially clinically significant levels of anxiety and depression and signposted to university mental health services based on the clinically defined rules. Optimizing thresholds to reduce false negatives, the machine learning models predicted anxiety and depression over the year in students screening negative at baseline with accuracy comparable with reported clinical screening as evidenced by sensitivity ≥90% for all models trained. Models had high negative predictive value (≥89%), balanced against low specificity. Individuals identified at risk for anxiety or depression were signposted primarily to self-guided resources supporting proactive prevention. Model findings also demonstrated that abbreviated screens (2-item Patient Health Questionnaire [PHQ-2] and 2-item Generalized Anxiety Disorder Questionnaire [GAD-2]), with potential to reduce respondent burden and improve adherence, can be used without compromising sensitivity. Indeed, PHQ-2 displayed a 90% sensitivity and GAD-2 displayed a 92% sensitivity. Shapley additive explanations analyses revealed other predictive factors including childhood trauma, family history of mental illness, and functional impairment associated with reported depression and anxiety symptoms. CONCLUSIONS:The risk prediction models and recommendation engine's dual approach rationalize support allocation and promote targeted early intervention and prevention, potentially improving capacity to address the increasing burden on university mental health services. Future directions include further refinement based on a larger harmonized and enriched dataset, independent validation, and implementation studies to estimate the complex factors that influence uptake, reach to services, and acceptability across more diverse student users.

OBJECTIVE:Many students who need mental health support do not receive it. We examined associations between perceived barriers and university mental health service access. Participants: First-year Oxford University undergraduates (n = 443) with unmet mental health needs. METHODS:Logistic regression tested which perceived practical, attitudinal, and stigma-related barriers predicted service use. Subgroup analyses targeted screen-positives for anxiety (GAD-7) and/or depression (PHQ-9). RESULTS:Reduced service use was linked to attitudinal barriers, minimizing problems (OR = 0.64; CI = 0.42-0.98) and difficulty discussing problems (OR = 0.59; CI = 0.38-0.91), especially among screen positives for the latter (OR = 0.49; CI = 0.27-0.89); practical barriers, uncertainty about how to get help (OR = 0.64; CI = 0.42-0.97) and time limitations (OR = 0.66; CI = 0.44-0.98), especially in screen-positives for both (OR = 0.46; CI = 0.26-0.79; OR = 0.47; CI = 0.27-0.79); and stigma-related barriers, feeling ashamed (OR = 0.63; CI = 0.40-0.98), appearing weak (OR = 0.65; CI = 0.42-0.98), and friends' reactions (OR = 0.58; CI = 0.38-0.88). CONCLUSIONS:Multiple perceived barriers were associated with a reduced likelihood of accessing university mental health services. Developing mental health literacy and streamlined pathways may improve timely support access for students with unmet needs.

ObjectivesTo describe age and gender specific time trends in adolescent violence across 19 countries over 28 years.MethodsThe paper presents analysis of eight cycles of the Health Behaviour in School-aged Children (HBSC) Study from 1994–2022, involving 789,531 children aged 11, 13, and 15. Indicators of violence included physical fighting, school bullying and cyberbullying (from 2018). Log-binomial regression models were used to test for linear temporal trends, with Generalized Estimating Equations used to account for clustering by country.ResultsSchool bullying perpetration and victimization declined over time in each age/gender group in most countries. Similar declines were reported for frequent physical fighting among boys (all ages) and girls (age 15 only). The prevalence of violent behaviour was almost universally higher in boys in the early cycles than in girls, but this gender difference attenuated over time. For cyberbullying, significant increases were observed since 2018 in all groups except age 15 girls in most countries.ConclusionThis analysis of a large cross-national dataset suggests a decline in traditional forms of adolescent violence. However, the increases in cyberbullying warrant further monitoring.

The etiological pathways through which structural determinants result in health inequities remain unclear. In adolescent populations, a sense of meaning and purpose in life has been hypothesized and considered cross-sectionally to represent an intermediary determinant in the pathway that connects wealth with mental health outcomes. The purpose of this study was to prospectively explore how life meaning and purpose contributes to disparities in mental health observed by affluence in an adolescent cohort. We used two-year linked survey data collected from a cohort of 17,745 students at Canadian secondary schools in 2020/2021 and 2021/2022. Structural equation models were used to examine the prospective associations between students’ perceived relative family affluence and anxiety and depression symptoms, mediated by their sense of meaning and purpose in their lives. Models were stratified by gender identity. The prevalence of clinically-relevant depression and anxiety symptoms was lowest among cisgender boys and highest among transgender and gender diverse adolescents. Conversely, life meaning and purpose was reported most often by cisgender boys, followed by cisgender girls. Meaning and purpose in life partially mediated associations between relative affluence and depression and anxiety symptoms. Consistent with determinants of health models and past cross-national analyses of adolescent health survey data in Canada, results provide prospective evidence in support of life meaning and purpose as an intermediary determinant of mental health in adolescents. Experiences that foster a sense of meaning and purpose in life require recognition as determinants of health, and suggest an intangible resource that can be applied to clinical and public health initiatives that address adolescent mental health.

The World Health Organization (WHO) Commission on the Social Determinants of Health (CSDH) conceptual framework identifies socio-economic position as a structural determinant of health. Recognized intermediary determinants include biological, behavioural, and psychosocial factors. We examined whether connections afforded by a healthy spirituality potentially act as unrecognized intermediary determinants in adolescent populations, contributing to inequities in mental health. Reports from 42,843 children (21,007 boys, 21,836 girls) from eight countries who participated in the 2017-2018 Health Behaviour in School-aged Children (HBSC) study were used to describe correlations between family affluence and positive levels of mental health, using a cross-sectional design. Based on the CSDH conceptual framework and multivariable regression analyses, we then examined whether these associations were mediated by spiritual health. Connections afforded by a high level of spiritual health were universally correlated with positive mental health status. In three Western European nations (England, Scotland, and Wales) and Canada affluence was correlated with better mental health and this was partially mediated by spiritual health. Among the four Eastern European countries (Latvia, Lithuania, Moldova, Poland), our findings did not support aspects of the CSDH framework that focus on affluence as a direct determinant of health. Spiritual health potentially is an intermediary determinant of children's health in some Western countries, but not in Eastern countries. The universality of social determinants of health models and the measures used in their evaluation require careful assessment across cultures, political contexts, and health outcomes.

OBJECTIVE:To examine a potential synergistic effect of history of childhood adversity and COVID-19 pandemic exposure on the association with mental health concerns in undergraduate students. Participants: We used U-Flourish Survey data from 2019 (pre-pandemic) and 2020 (during-pandemic) first-year cohorts (n = 3,149) identified at entry to a major Canadian University. METHODS:Interactions between childhood adversity (physical and sexual abuse, and peer bullying) and COVID-19 pandemic exposure regarding mental health concern (depressive and anxiety symptoms, suicidality, and non-suicidal self-harm) were examined on an additive scale. RESULTS:We found a positive additive interaction between physical abuse and pandemic exposure in relation to suicidality (combined effect was greater than additive effect (risk difference 0.54 vs. 0.36)). Conversely, less than additive interactions between peer bullying and pandemic regarding depression and anxiety were observed. CONCLUSIONS:Childhood adversities have diverse reactions to adult stressor depending on the nature of the childhood adversity and the mental health outcomes.

OBJECTIVE:To describe student access to university mental health services and barriers and gaps in support. METHODS:This multiple cohort study used self-report data from 4,138 undergraduate students who completed the U-Flourish Well-Being Survey at the start and completion of first year from 2018 to 2023. The survey incorporated validated measures of mental health symptoms, barriers to care, and open-text questions about the mental health care experience and perceived gaps. Quantitative analyses summarized utilization patterns and barriers. An interpretive qualitative analysis identified common themes about support services and opportunities for improvement from the student perspective. RESULTS:At university entry, 43% of students screened positive for anxiety and/or depression, 30% reported a lifetime mental disorder and 23% a lifetime history of self-harm. Over first year, 15% of students surveyed accessed university mental health services. Access was more likely in students identifying as older, gender diverse, female, having a prior mental disorder and those who screened positive for anxiety or depression. Common attitudinal and practical barriers reported included thinking problems would resolve (74%), being uncomfortable sharing (73%), and not knowing how to get help (50%). Common stigma barriers included concerns about what family or friends might think. Students expressed that both campus-based well-being and mental health care offered during flexible hours and accessible through online booking were important. CONCLUSIONS:Student-tailored mental health literacy may be a sustainable approach to address the attitudinal and practical barriers identified. If such barriers are reduced, an increased service demand would be expected and improved efficiencies needed. A clear Statement of Services, an online singular point of access with embedded triage to signpost students to indicated levels of care, and clearly worked-out care pathways including to community-based services would better align with a stepped care model, improve efficiency and access, and foster realistic expectations around university mental health support.

INTRODUCTIONThe study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families.METHODSThis cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school.RESULTSThis sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17-1.40), 32% more likely to report persistent feelings of hopelessness (1.22-1.43), 22% more likely to report emotional problems (1.13-1.32), 42% more likely to report low life satisfaction (1.27-1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21-1.55).CONCLUSIONYouth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences.

AIM:To assess the acceptability and explore the utility of a novel digital platform designed as a student-facing well-being and mental health support. METHODS:An adapted version of i-spero® was piloted as a student-facing well-being support and as part of routine university-based mental health care. In both pathways, student participants completed baseline demographics and brief validated measures of well-being and mental health. Weekly measures of anxiety (GAD-7) and depression (PHQ-9) and a Week 8 Experience Survey were also scheduled. Integrated mixed methods analysis was used to assess acceptability and explore the utility of these platforms. RESULTS:Students in the well-being (n = 120) and care pathways (n = 121) were mostly female and between 19 and 22 years of age. Baseline screen positive rates for anxiety and depression were high in both the well-being (68%) and care pathways (80%). There was a substantial drop in adherence over Week 1 (50% well-being; 40% care) followed by minor attrition up to Week 8. Anxiety and depressive symptom levels improved from baseline in students who dropped out after Week 1 (p ≤ .06). The student experience was that i-spero® improved their emotional self-awareness, understanding of progress in care, and knowledge about when to seek help. Most students agreed (>75%) that i-spero® should form part of regular university student wellness support. CONCLUSIONS:Digital well-being and mental health support seems acceptable to university students; however, engagement and persistence are areas for further development. Such digital tools could make a positive contribution to an evidence-based stepped approach to student well-being and mental health support.