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Objectives and Approach This study utilized an explanatory sequential mixed methods approach to investigate the developmental well-being of children from refugee backgrounds in British Columbia (BC), Canada. Objective 1 (quantitative) leveraged population-level, government administrative data individually linked to a province-wide, routinely collected, teacher-reported measure of children’s development in kindergarten (the Early Development Instrument; EDI) to examine developmental outcomes across five domains for children identified as first-generation refugees (N=770), first-generation immigrants (N=7875), and non-migrants (N=199,186). In Objective 2 (qualitative), the population-level EDI results were brought to focus groups with BC educators and settlement workers (N=7) who work closely with children from refugee backgrounds to further corroborate, expand, and elaborate on the findings. Results A series of multiple linear regression models; adjusted for age, sex, and English Language Learner status showed that first-generation refugee status was significantly predictive of lower EDI scores in the areas of language & cognitive development, communication & generation knowledge, social competence, emotional maturity, and physical health & well-being. Focus group results corroborated the quantitative findings, added critical complexity/context (e.g., impacts of trauma), and identified important policy-oriented levers (e.g., early, accessible assessments and supports). Conclusions The study provided an understanding of the population-level developmental well-being of children from refugee backgrounds in BC, framed by rich, contextualized, and actionable knowledge from focus groups. Implications Showcasing the combined breadth and depth of using a mixed methods approach, how we can best support the developmental challenges and build upon the strengths of children from refugee backgrounds will be discussed.

Objectives: Poverty exposes children to adverse conditions that negatively impact development. However, there is limited understanding on how different types of poverty may affect children of various immigration backgrounds differently in outcomes such as school readiness. This study examined these relationships between household and/or neighbourhood poverty, poverty timing, and immigration background with school readiness outcomes at kindergarten. Methods: This study utilized a retrospective, population-based cohort of administrative records linked with surveys completed by kindergarten teachers for 15 369 children born in British Columbia, Canada. The exposures investigated were neighbourhood poverty (residing in a neighbourhood in the lowest income-quintile) and/or household poverty (receiving a health insurance subsidy due to low household income). Experiencing both neighbourhood and household poverty simultaneously was defined as “combined” household and neighbourhood poverty. The outcome of vulnerability on school readiness domains was assessed at kindergarten (47.8% female; mean age = 6.01 years) using teacher ratings on the Early Development Instrument (EDI). Results: Children exposed to combined poverty between age 0 and 2 had greater odds of being vulnerable in two or more domains of school readiness than children not exposed to any poverty during this period (adjusted odds ratio (aOR) = 2.07, 95% CI: [1.74; 2.47], p

Abstract Background The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. Methods Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. Results Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. Conclusions These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.

The aim of this study was to examine the factors associated with mental health outcomes in school staff during the second year of the COVID-19 pandemic. Adapting the Transactional Model of Stress and Coping, we tested whether school staff who lived with others and adopted healthier behaviours (e.g., diet, physical activity) would be more likely to manage pandemic stressors, altering mental health outcomes. The current study included 2,343 school staff (60% teachers) from the greater Vancouver area in British Columbia, Canada, who completed the online questionnaire between February 3 and June 18, 2021 as part of a longitudinal study of COVID-19 impacts on schools. Results showed that participants’ perceived risk of getting COVID-19 was associated with poorer mental health among both male and female school staff. Furthermore, when perceived risk of COVID-19 was low, living with others reduced the negative impact of pandemic stressors on anxiety symptoms and dispositional optimism among female school staff. We detected no influence of health behaviours on the associations between stressors and mental health. Favorable health behaviours were also associated with lower anxiety and psychological distress among female school staff. These findings underlie the importance of proactive prevention and intervention strategies to address the mental health of school staff.

Immigrant and refugee children and adolescents form a growing socially, culturally, and economically diverse group with the potential for wide-ranging adaptation outcomes. The goal of the study was to examine whether developmental competencies (social-emotional and academic) and sociodemographic disparities (e.g., SES and migration class) identified in kindergarten forecast the academic achievement trajectories of first- and second-generation immigrant and refugee children, from childhood to adolescence. The study used a retrospective, longitudinal, population-based design by making use of linked, individual-level administrative data from four sources (e.g., Immigration, Refugees, and Citizenship Canada and Ministry of Education; IRCC, 2014 and BC MED, 2014) to identify a study cohort of immigrant and refugee children in British Columbia, Canada (N = 9,216). We utilized an analytical approach (group-based trajectory modeling) that allowed us to capture heterogeneity in the Grade 4 to Grade 10 academic (literacy and numeracy) trajectories. The resulting literacy and numeracy achievement trajectories were wide-ranging--some children thriving, some catching up, and some falling behind over time. Children's developmental competencies assessed in kindergarten (literacy, numeracy, and social-emotional) were found to predict later trajectory group membership in significant and, at times, interacting ways. Trajectory group membership also differed by migration class (refugee/immigrant), generation status, socioeconomic status, English language learner status, and sex. The findings highlight the need for early, targeted school and community interventions that will help set all immigrant and refugee children onto long-term paths of positive adaptation.

Abstract Background The COVID-19 pandemic has contributed to increases in negative emotions such as fear, worry, and loneliness, as well as changes in positive emotions, including calmness and hopefulness. Alongside these complex emotional changes has been an inequitable worsening of population mental health, with many people experiencing suicidal ideation and using substances to cope. This study examines how patterns of co-occurring positive and negative emotions relate to structural vulnerability and mental health amid the pandemic. Methods Data are drawn from a cross-sectional monitoring survey (January 22–28, 2021) on the mental health of adults in Canada during the pandemic. Latent class analysis was used to group participants (N = 3009) by emotional response pattern types. Descriptive statistics, bivariate cross-tabulations, and multivariable logistic regression were used to characterize each class while quantifying associations with suicidal ideation and increased use of substances to cope. Results A four-class model was identified as the best fit in this latent class analysis. This included the most at-risk Class 1 (15.6%; high negative emotions, low positive emotions), the mixed-risk Class 2 (7.1%; high negative emotions, high positive emotions), the norm/reference Class 3 (50.5%; moderate negative emotions, low positive emotions), and the most protected Class 4 (26.8% low negative emotions, high positive emotions). The most at-risk class disproportionately included people who were younger, with lower incomes, and with pre-existing mental health conditions. They were most likely to report not coping well (48.5%), deteriorated mental health (84.2%), suicidal ideation (21.5%), and increased use of substances to cope (27.2%). Compared to the norm/reference class, being in the most at-risk class was associated with suicidal ideation (OR = 2.84; 95% CI = 2.12, 3.80) and increased use of substances to cope (OR = 4.64; 95% CI = 3.19, 6.75). Conclusions This study identified that adults experiencing structural vulnerabilities were disproportionately represented in a latent class characterized by high negative emotions and low positive emotions amid the COVID-19 pandemic in Canada. Membership in this class was associated with higher risk for adverse mental health outcomes, including suicidal ideation and increased use of substances to cope. Tailored population-level responses are needed to promote positive coping and redress mental health inequities throughout the pandemic and beyond.

BackgroundExisting screening tools for mental health issues among postsecondary students have several challenges, including a lack of standardization and codevelopment by students. HEARTSMAP-U was adapted to address these issues. ObjectiveThis study aimed to evaluate the suitability of HEARTSMAP-U as a self-screening tool for psychosocial issues among postsecondary students by evaluating its validity evidence and clinical utility. MethodsA prospective cohort study was conducted with University of British Columbia Vancouver students to evaluate HEARTSMAP-U’s predictive validity and convergent validity. Participating students completed baseline and 3-month follow-up assessments via HEARTSMAP-U and a clinician-administered interview. ResultsIn a diverse student sample (n=100), HEARTSMAP-U demonstrated high sensitivity (95%-100%) in identifying any psychiatric concerns that were flagged by a research clinician, with lower specificity (21%-25%). Strong convergent validity (r=0.54-0.68) was demonstrated when relevant domains and sections of HEARTSMAP-U were compared with those of other conceptually similar instruments. ConclusionsThis preliminary evaluation suggests that HEARTSMAP-U may be suitable for screening in the postsecondary educational setting. However, a larger-scale evaluation is necessary to confirm and expand on these findings.

Abstract Background Gender inequity and the subsequent health impacts disproportionately affect communities in the Global South. However, most gender equity measures, such as Pulerwitz’ (2000) Sexual Relationship Power Scale (SRPS), are developed and validated in the Global North and then applied in Global South settings without investigation of context applicability or validity. This study examines the SRPS’ validity evidence, comprehensiveness, and contemporary relevance for young South African women and men. Methods Between 2019 and 2021, 38 cognitive interviews (CIs) were conducted among previous participants of a South African youth cohort study ‘AYAZAZI’ (2015–2017) to explore youth’s perceptions of the SRPS. The SRPS measures women’s perceptions of their partner’s controlling behaviours, and men’s perceptions of their own controlling behaviours. Using CIs, participants responded to a 13-item adaptation of the SRPS for use among South African youth (strongly agree-strongly disagree), and then were asked to think-aloud their reasoning for responses, their understanding and perceived relevance of each item, and made overall suggestions for scale adaptations. An item appraisal coding process was applied, whereby Cognitive Coding assessed the types of cognitive problems youth had with understanding the items, and Question Feature Coding assessed which item features caused problems for participant understandings. Finally, youth recommendations for scale adaptations were summarized. Results Overall, 21 women and 17 men aged 21–30 participated in CIs in Durban and Soweto, South Africa. Cognitive Coding revealed 1. Comprehension issues, and 2. Judgements related to items’ applicability to lived experiences and identities (e.g., being unmarried). Question Feature Coding revealed items’ 1. Lack of clarity or vagueness in wording and 2. Logical problems in assumptions leading to multiple interpretations (e.g., item ‘my partner always need to know where I am’ interpreted as both controlling and caring behaviour). Multiple, overlapping issues revealed how many items failed to “fit” within the present-day living realities of South African youth. Youth recommended several item adaptations and additions, including strength-based items, to existing measures of gender equity and relationship power. Conclusion Given identified issues, several adaptations including revising items to be more inclusive, contemporary, context specific, relational, and strength-based are needed to validly measure gender equity and power dynamics within the relationships of South African youth.

Objective This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress. Methods Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults ( N = 3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use. Results Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons. Conclusions This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources.

Organized activity participation has been linked to children’s emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study’s primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in British Columbia, Canada. We also examined whether this relationship depended on immigration background. Our sample included 14,406 children (47.8% female; mean age = 12.0 years). 9,393 (65.2%) children were of non-immigrant origin (48.9% female; mean age = 12.1 years). 5,013 children (34.8%) were of immigrant origin (45.8% female; mean age = 12.0 years; 40.8% first-generation). Participants completed the Middle Years Development Instrument, a self-report survey measuring children’s wellbeing and assets. We used odds ratios and the χ2 test to compare the organized activity participation of non-immigrant and immigrant-origin children. We used multiple linear regression to measure associations between participation and indicators of emotional wellbeing and assessed whether associations varied based on immigrant background, controlling for demographic factors and peer belonging. Participation in any activity was similar among non-immigrant and immigrant-origin children (OR1st-gen=1.06, p=0.37; OR2nd-gen=0.97, p=0.62). Immigrant generation status modified the relationship between participation and emotional wellbeing (χSWL2=3.69, p=0.03; χDep2=12.31, p

BackgroundMental health impacts of the COVID-19 pandemic have not been felt equally within populations. Parents with children living at home were early on identified as a population at heightened mental health risk, with concerns about the potential long-term impacts of the pandemic on parents' mental health, family functioning, and children's well-being. This study investigates impacts of the pandemic on parents' psychological distress, contextual sources of distress, and associations with family functioning nearly two years into the pandemic.Methods and findingsData were drawn from a national cross-sectional survey of adults living in Canada in November and December 2021 that was representative by age, gender, household income, and region. Parents with children < 18 years old living at home (N = 553) reported their experiences of psychological distress, pandemic-related stressors, coping mechanisms, and family functioning (changes in parent-child interactions, children's anxiety). Chi-square tests, logistic regression, and linear regression analyses examined sociodemographic inequities in parents' levels of psychological distress, sources and mitigating mechanisms of distress, and associations between psychological distress and family functioning. Nearly two years into the pandemic, parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress. Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial stressors. Parents with greater psychological distress reported increases in negative parent-child interactions due to the pandemic and higher anxiety among their children.ConclusionsThis study identifies sustained negative impacts of the pandemic on parents' mental health and family functioning in Canada nearly two years into the pandemic, despite high vaccine uptake and declining infection rates. Disparities in financial stress, social support structures, and pre-existing mental health were identified as underlying sources of psychological distress. These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequities.

The COVID-19 pandemic and related school disruptions have led to increased concerns for the mental health of teachers. This study investigated how the challenges and systemic supports perceived by teachers during the COVID-19 pandemic were associated with their mental health and workplace well-being. This cross-sectional, survey-based study was conducted in February 2021, just prior to the third wave of the pandemic in British Columbia (BC), Canada (N = 1,276). Four multivariable linear regression models examined the associations between teachers’ pandemic-related challenges (pandemic-related personal stressors, teacher workload, difficulty implementing safety measures, meeting students’ needs), systemic supports (education system mental health and well-being support), and four mental health (psychological distress, and quality of life) and workplace well-being outcomes (job-related positive affect, turnover intentions), adjusting for sociodemographic and school characteristics. The Pratt index (d) was used to assess the relative importance of each predictor. A thematic qualitative analysis was conducted on teachers’ open-ended responses. Teachers’ workplace well-being (job-related positive affect and turnover intentions) was predominantly associated with their perceptions of education system support for their mental health and well-being (d = 46%, d = 41%, respectively). The most important predictor of general mental health (psychological distress and quality of life) was the number of COVID-19 related personal stressors teachers reported (d = 64%, d = 43%, respectively). The qualitative analyses corroborated and expanded upon the quantitative findings. Understanding pandemic-related challenges and supports impacting teacher mental health and workplace well-being equips us to make evidence-informed policy decisions to support teachers now and in future school disruptions.

BackgroundEvidence on the association between mental health disorders and cancer risk is inconclusive, despite well-established associations between mental health disorders and lifestyle factors such as smoking. This study examines the relationships between depression, anxiety and cancer risk, and the potential mediating effects of lifestyle factors.MethodsA study of 34,571 participants aged 40-69 years in the CARTaGENE cohort was conducted. Depression was defined by questionnaire (PHQ-9), antidepressant use, and a composite of questionnaire, antidepressant use, or lifetime self-reported physician diagnosis. Anxiety was defined by questionnaire (GAD-7). Co-morbid depression and anxiety was also assessed. Cox regression models were used to investigate associations between mental health and risk of prostate, lung, and all cancers combined. Mediating effects of lifestyle factors were assessed using Baron and Kenny mediation criteria.ResultsThere were positive associations between mental health disorders, all cancers and lung cancer risk, however with the exception of anxiety and lung cancer in women (Hazard Ratio [HR] = 1.67, 95% CI: 1.01-2.76), associations were attenuated with adjustment for sociodemographics, health status and lifestyle factors. In the mediation analysis, smoking accounted for 27%, 18%, and 26%, of the total effect between depression (PHQ-9), anxiety, and co-morbidity and lung cancer, respectively in women. In men, smoking accounted for 17% of the total effect between depression (PHQ-9, antidepressant, or lifetime self-report of physician diagnosis) and all cancers.ConclusionsPositive associations were observed between mental health disorders, all cancer and lung cancer risk, however most relationships were attenuated with adjustment for lifestyle factors. Smoking status mediated a significant proportion of the relationships between mental health disorders and cancer risk.