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Previous research indicates that the disproportionate distribution of income within society is associated with aggression and violence. Although research has been conducted identifying the relationship between income inequality and bullying victimization and perpetration, little is known about possible mediators. We investigated the association between income inequality and bullying perpetration and victimization among adolescents participating in the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. We identified whether school connectedness and psychosocial well-being mediated the relationship between income inequality and bullying behavior. This study used pooled cross-sectional data from 147,748 adolescents aged 13 to 18 from three waves (2015-2016, 2016-2017, 2017-2018) of the COMPASS study from 157 secondary schools in British Columbia, Alberta, Ontario, and Quebec (Canada). The Gini coefficient was calculated based on the school Census Divisions (CD) using the Canada 2016 Census and linked with student data. We used multilevel modeling to investigate the relationship between income inequality and self-reported bullying victimization and perpetration, while controlling for individual-, school-, and CD-level characteristics. A standard deviation increase in Gini coefficient was associated with increased odds for bullying victimization and perpetration. Findings were observed among girls; however, inequality was only associated with perpetration among boys. We identified social cohesion and psychosocial well-being as potential mediators. To counter the adverse effects of income inequality, school-based interventions designed to increase school connectedness and student psychosocial well-being should be implemented to protect against bullying.

Background Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic. Methods We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic. Results The sample included 23 894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B = −0.01, 95% CI = −0.04, 0.02), but was protective against anxiety symptoms (B = −0.03, −0.06, 0.001) during the COVID-19 pandemic. Discussion The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery. [ABSTRACT FROM AUTHOR]

Background: Differential vulnerability to alcohol contributes to socioeconomic inequities in alcohol-attributable harm. This study aimed to estimate the sex-/gender-specific joint effects of socioeconomic position (SEP) and heavy episodic drinking or volume of alcohol use on 100% alcohol-attributable emergency department (ED) visits., Methods: We conducted a cohort study among 36 900 men and 39 700 women current and former alcohol consumers aged 15-64 from population-representative Canadian Community Health Surveys (2003-2008) linked to administrative ED visit data through 2017 in Ontario and Alberta. We estimated sex-/gender-specific associations between SEP (both education and income) and heavy episodic drinking (≥5 standard drinks on one occasion, at least monthly) or volume of alcohol use (standard drinks per week) on incident alcohol-attributable ED visits and assessed additive interactions using the Synergy Index (S)., Results: Lower levels of education (eg, less than high school vs Bachelor's degree or above: men: adjusted HR (aHR)=3.71, 95% CI 2.47 to 5.58; women: aHR=1.75, 95% CI 1.15 to 2.68) and income (eg, quintile (Q)1 vs Q5, men: aHR=2.07, 95% CI 1.35 to 3.17; women: aHR=1.84, 95% CI 0.91 to 3.71) were associated with increased rates of alcohol-attributable ED visits. Among men and women, superadditive joint effects (ie, greater than the sum of both exposures experienced independently) were observed between low SEP (education and income) and heavy episodic drinking and higher volume of alcohol use on alcohol-attributable ED visits., Interpretation: Our results indicate that individuals with lower SEP experience increased vulnerability to alcohol use and related harms. These findings highlight the urgent need for population-level interventions that reduce both the high burden and socioeconomic inequities in alcohol-attributable harm., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time., Methods: Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007-2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables., Results: The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant., Conclusion: Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: In the United States, Hispanics are more likely to experience financial barriers to mental health care than non-Hispanics. We used a unique survey to study the effect of these financial barriers on the severity of depressive symptoms among Hispanics who had previously been diagnosed as having depression. Methods: This cross-sectional study used data from the 2015 Washington Heights Community Survey, administered to 2,489 households in Manhattan, New York City. Multiple regression models and propensity score matching were used to estimate the association between financial barriers to mental health care and depressive symptoms and the likelihood of being clinically depressed. Results: Among those diagnosed with depression, those with financial barriers to mental health services or counseling had significantly higher (β = 0.36, 95% CI = 0.03, 0.70) depressive symptoms. When propensity score matching was utilized, those with financial barriers to mental health services had significantly greater depressive symptoms (β = 0.63, 95% CI = 0.37, 0.89) and were significantly more likely to be currently depressed (OR = 2.38, 95% CI = 1.46, 3.89), in comparison to those who had access. Conclusions: Making mental health care more affordable and therefore more accessible to Hispanics is one step toward mitigating the burden on mental illness and decreasing health disparities.