Connections matter: Adolescent social connectedness profiles and mental well-being over time.

INTRODUCTION: This study examined profiles of social connectedness among early adolescents in grade 7 before the COVID-19 pandemic was declared (Winter 2020), and in grade 8 during the second Wave of the pandemic (Winter 2021). METHOD: Linked data from 1753 early adolescents (49% female) from British Columbia, Canada who completed the Middle Years Development Instrument survey in grades 7 and 8 were used. Participants reported on life satisfaction, depressive symptoms, and connectedness with peers and adults at home, school and in the community. We used Latent Profile Analysis to identify connectedness profiles at both time points, and Latent Transition Analysis to examine transitions in connectedness profiles over time. Multiple regression analyses examined the associations between profile membership in grade 7 and mental well-being in grade 8, and the associations between transitions in profile membership (i.e., increase vs. decrease in connectedness over time) and mental well-being. RESULTS: Connectedness in multiple domains in grade 7 was related to significantly higher levels of mental well-being in grade 8, controlling for demographics, well-being in grade 7, and COVID-related mental health worries. Well-being was highest when students felt highly connected in all domains and lowest when they felt lower levels of connection. Increases in connectedness were associated with improvements in mental well-being and decreases with a decline in well-being over time. CONCLUSIONS: Experiencing connectedness with peers and adults is critical for the mental well-being in early adolescence. Providing opportunities to connect is important in the context of major societal challenges such as the COVID-19 pandemic.

Childhood poverty and school readiness: Differences by poverty type and immigration background.

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 < 0.001). The effect of combined poverty was larger than household poverty only (aOR = 1.54, 95% CI: [1.31; 1.82], p < 0.001) or neighbourhood poverty only (aOR = 1.49, 95% CI: [1.30; 1.70], p < 0.001). Combined poverty was associated with negative outcomes regardless of timing. Both non-immigrants (aOR = 2.40, 95% CI: [1.92; 3.00], p < 0.001) and second-generation immigrants (aOR = 1.63, 95% CI: [1.22; 2.17], p < 0.001) experiencing combined poverty scored lower on school readiness. Conclusions: Children who experienced combined poverty had lower levels of school readiness at kindergarten, regardless of timing and immigration background.

Parent psychological distress and parent-child relationships two years into the COVID-19 pandemic: Results from a Canadian cross-sectional study.

BACKGROUND: Mental 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 FINDINGS: Data 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. CONCLUSIONS: This 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.

Teacher mental health and workplace well-being in a global crisis: Learning from the challenges and supports identified by teachers one year into the COVID-19 pandemic in British Columbia, Canada.

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.

Suicidal Ideation Amongst University Students During the COVID-19 Pandemic: Time Trends and Risk Factors.

OBJECTIVE: Examine time trends in suicidal ideation in post-secondary students over the first three waves of the COVID-19 pandemic in Canada and identify subpopulations of students with increased risk. METHOD: We analysed 14 months of data collected through repeated cross-sectional deployment of the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) survey at the University of British Columbia. Estimated log odds weekly trends of 30-day suicidal ideation (yes/no) were plotted against time with adjustments for demographics using binary logistic generalized additive model (GAM). Risk factors for 30-day suicidal ideation frequency (four categories) were examined using the ordered logistic GAM, with a cubic smoothing spline for modelling time trend in obervation weeks and accounting for demographics. RESULTS: Nearly one-fifth (18.9%) of students experienced suicidal ideation in the previous 30 days. While the estimated log odds suggested that binary suicidal ideation was relatively stable across the course of the pandemic, an initial drop followed by an increasing trend was observed. Risk factors for suicidal ideation frequency during the pandemic included identifying as Chinese or as another non-Indigenous ethnic minority; experiencing current symptoms of depression or anxiety; having a history of suicidal planning or attempts; and feeling overwhelmed but unable to get help as a result of COVID-19. Older age was identified as a protective factor. CONCLUSIONS: The general university student population in our study was relatively resilient with respect to suicidal ideation during the first three waves of the pandemic, but trends indicate the possibility of delayed impact. Specific sub-populations were found to be at increased risk and should be considered for targeted support. Further analyses should be undertaken to continue monitoring suicidality trends throughout the remainder of the pandemic and beyond.

Neighbourhood context and diagnosed mental health conditions among immigrant and non-immigrant youth: a population-based cohort study in British Columbia, Canada.

PURPOSE: Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with a higher proportion of foreign-born residents) tend to experience fewer mental health problems-likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood-a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada). METHODS: Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC's largest school districts from age 5 through 19 over the study period (1995-2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification of Diseases (ICD) diagnostic codes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant). RESULTS: Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were-for some disorders-stronger for first-generation than second-generation or non-immigrant youth. CONCLUSIONS: Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health.

Prevalence of Mental Health Disorders Among Immigrant, Refugee, and Nonimmigrant Children and Youth in British Columbia, Canada.

Importance: There remains limited understanding of population-level patterns of mental disorder prevalence for first- and second-generation immigrant and refugee children and youth and how such patterns may vary across mental disorders. Objective: To examine the diagnostic prevalence of conduct, attention-deficit/hyperactivity disorder (ADHD), and mood/anxiety disorders in immigrant, refugee, and nonimmigrant children and youth in British Columbia, Canada. Design, Setting, and Participants: This retrospective, population-level cohort study examined linked health administrative records of children and youth in British Columbia (birth to age 19 years) spanning 2 decades (1996-2016). Physician billings, hospitalizations, and drug dispensations were linked to immigration records to estimate time-in-British Columbia-adjusted prevalence of mental disorder diagnosis among children and youth from immigrant or refugee backgrounds compared with those from nonimmigrant backgrounds. Analyses were conducted from August 2020 to November 2021. Main Outcomes and Measures: The diagnostic prevalence of conduct, ADHD, and mood/anxiety disorders were the main outcomes. Results were stratified by migration category (immigrant, refugee, nonimmigrant), generation status (first- and second-generation), age, and sex. Results: A total of 470 464 children and youth in British Columbia were included in the study (227 217 [48.3%] female). Nonimmigrant children and youth represented 65.5% of the total study population (307 902 individuals). Among those who migrated, 142 011 (87.8%) were first- or second-generation immigrants, and 19 686 (12.2%) were first- or second-generation refugees. Diagnostic prevalence of mental disorders varied by migration category, generation status, age, and sex. Children and youth from immigrant and refugee backgrounds (both first- and second-generation), compared with nonimmigrant youth, generally had a lower prevalence of conduct disorder (eg, age 6-12 years: first-generation immigrant, 2.72% [95% CI, 2.56%-2.90%] vs nonimmigrant, 7.03% [95% CI, 6.93%-7.13%]), ADHD (eg, age 6-12 years: first-generation immigrant, 4.30% [95% CI, 4.10%-4.51%] vs nonimmigrant, 9.20% [95% CI, 9.08%-9.31%]), and mood/anxiety disorders (eg, age 13-19 years: first-generation immigrant, 11.07% [95% CI, 10.80%-11.36%] vs nonimmigrant, 24.54% [95% CI, 24.34%-24.76%]). Among immigrant children and youth, second-generation children and youth generally showed higher prevalence of conduct, ADHD, and mood/anxiety disorders than first-generation children and youth (eg, ADHD among second-generation immigrants aged 6-12 years, 5.94% [95% CI, 5.75%-6.14%]; among first-generation immigrants aged 6-12 years, 4.30% [95% CI, 4.10%-4.51%]). Second-generation refugee children had the highest diagnostic prevalence estimates for mood/anxiety in the 3-to-5-year age range relative to first- and second-generation immigrant and nonimmigrant children (eg, second-generation refugee, 2.58% [95% CI, 2.27%-2.94%] vs second-generation immigrant, 1.78% [95% CI, 1.67%-1.89%]). Mental disorder diagnoses also varied by age and sex within immigrant, refugee, and nonimmigrant groups. Conclusions and Relevance: These findings show differences in diagnostic mental disorder prevalence among first- and second-generation immigrant and refugee children and youth relative to nonimmigrant children and youth. Further investigation is required into how cultural differences and barriers in accessing health services may be contributing to these differences.

Social context factors and refugee children's emotional health.

BACKGROUND: Refugee children face numerous challenges associated with pre-migration trauma and post-migration adaptation. Much research pertaining to refugee children's well-being focuses on psychiatric symptoms. Relatively few studies have examined how social context factors-such as perceptions of peer belonging, and support from adults at home and at school-contribute to the emotional health of refugee children. Informed by social-ecological theories emphasizing dynamic interactions between the contexts in which children develop, we examined associations between social context factors and emotional health in refugee children. METHODS: Data were drawn from a population-based data linkage in British Columbia, Canada. The analytic sample included 682 grade 4 students (Mage 9.2 years; 46.3% female) with a refugee background who responded to the Middle Years Development Instrument (MDI) during the 2010/2011-2016/2017 school years. The MDI is a self-report survey of children's social and emotional competencies and social context factors completed at school. Regression analyses were used to examine associations of social context factors (school climate, supportive adults at school and at home, and peer belonging) with indicators of emotional health (life satisfaction, self-concept, optimism, and sadness). Refugee generation status (first/second) was considered through stratification and testing of interactions with social context factors. RESULTS: Perceived supportive school climate, support from adults in school and at home, and peer belonging were each independently associated with better emotional health. Results were similar for first- and second-generation children. CONCLUSION: Taken together, results suggest a unique role of the school context to refugee children's emotional health. School-based programming that promotes positive school climate can be considered as an important approach to support newcomer refugee children and their families.

Impacts of the COVID-19 Pandemic on Family Mental Health in Canada: Findings from a Multi-Round Cross-Sectional Study.

Pandemic-related disruptions, including school, child care, and workplace closures, financial stressors, and relationship challenges, present unique risks to families' mental health. We examined the mental health impacts of the coronavirus disease 2019 (COVID-19) pandemic among parents with children <18 years old living at home over three study rounds in May 2020 (n = 618), September 2020 (n = 804), and January 2021 (n = 602). Data were collected using a cross-sectional online survey of adults living in Canada, nationally representative by age, gender, household income, and region. Chi-square tests and logistic regression compared outcomes between parents and the rest of the sample, among parent subgroups, and over time. Parents reported worsened mental health compared with before the pandemic, as well as not coping well, increased alcohol use, increased suicidal thoughts/feelings, worsened mental health among their children, and increases in both negative and positive parent-child interactions. Mental health challenges were more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial/relationship stressors. Increased alcohol use was more frequently reported among younger parents and men. Sustained mental health challenges of parents throughout nearly a year of the pandemic suggest that intervention efforts to support family mental health may not be adequately meeting families' needs. Addressing family stressors through financial benefit programs and virtual mental health supports should be further explored.

The association between diet and mental health and wellbeing in young adults within a biopsychosocial framework.

OBJECTIVE: Predominantly plant-based diets can co-benefit human physical health and the planet. Young adults appear to be on the forefront of the shift to plant-based diets. However, little is known about the relationship between plant-based diets and mental health in this population even though mental health disorders contribute substantially to the global burden of disease, particularly among this age group. DESIGN: In this cross-sectional study we utilize a biopsychosocial framework to assess the association between dietary intake and mental health and wellbeing. Mental health was assessed using self-reported measures of anxiety (GAD-7), depression (PHQ-9) and quality of life (single-item). Dietary intake in the prior month was assessed using a dietary screener (DSQ) and participants were asked to self-identify a diet preference (e.g., vegan). SETTING AND PARTICIPANTS: 339 university undergraduate students. RESULTS: A principal component analysis of dietary intake found three dominant dietary patterns (plant-based, animal-based, and 'junk foods'); 28.1% (n = 95) of participants self-identified as pescatarian, vegetarian, vegan, other. The association between dietary patterns, diet preference and mental health was assessed through regression analysis. After controlling for covariables, we found a significant positive association between the junk food component and depression (z-score ß = .21, p≤.001; adj. R2 = .39) and anxiety (z-score ß = .14; p≤.001; adj. R2 = .32) while no association was found between plant-based, animal-based or self-identified diet preference and the mental health measures. CONCLUSIONS: We did not find a negative association between predominantly plant-based diet patterns and mental health and wellbeing. It is important to consider dietary composition and to conceptualize diet as a health behaviour that is embedded in a biopsychosocial framework.

Naturalistic development of trait mindfulness: A longitudinal examination of victimization and supportive relationships in early adolescence.

Scholars have only just begun to examine elements of young adolescents' social ecologies that explain naturalistic variation in trait mindfulness and its development over time. We argue that trait mindfulness develops as a function of chronically encountered ecologies that are likely to foster or thwart the repeated enactment of mindful states over time. Using data from 4,593 fourth and seventh grade students (50% female; MageG4 = 9.02; 71% English first language) from 32 public school districts in British Columbia (BC), Canada, we examined links from peer belonging, connectedness with adults at home, and peer victimization to mindfulness over time. Variable-centered analyses indicated that young adolescents with lower victimization in fourth grade reported higher mindfulness in seventh grade, and that cross-sectionally within seventh grade victimization, peer belonging, and connectedness with adults at home were each associated with mindfulness. Contrary to our hypothesis, connectedness with adults at home moderated the longitudinal association between victimization and mindfulness such that the negative association was stronger among young adolescents with high (vs. low) levels of connectedness with adults at home. Person-centered analysis of the fourth graders' data confirmed our variable-centered findings, yielding four latent classes of social ecology whose mindfulness levels in seventh grade largely tracked with their victimization levels (from highest to lowest mindfulness): (1) flourishing relationships, (2) unvictimized but weak relationships with adults, (3) moderately victimized but strong relationships, and (4) victimized but strong relationships. Overall, our findings contribute to a growing body of evidence indicating that trait mindfulness may develop as a function of ecologically normative experiences in young adolescents' everyday lives.

Associations between periods of COVID-19 quarantine and mental health in Canada.

Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience.

Screen time and extracurricular activities as risk and protective factors for mental health in adolescence: A population-level study.

This study examines adolescents' (N = 28,712; 49% female; Mage = 12.25, SDage = 0.51) recreational screen time and participation in extracurricular activities during after-school hours in association to indicators of positive (optimism, satisfaction with life) and negative (anxiety, depressive symptoms) mental health and wellbeing. Data were drawn from a population-level study with the Middle Years Development Instrument (MDI) with grade 7 students in British Columbia (BC), Canada. The research was implemented in public school districts between 2014 and 2018. We found that adolescents who participated in extracurricular activities (e.g., sports, arts programs, community programs) were significantly less likely to engage in recreational screen-based activities (e.g., watching programs, browsing the internet, playing computer games) for 2 or more hours after school. Findings from Multilevel Structural Equation Modeling analyses showed that extracurricular participation was associated with higher levels of satisfaction with life and optimism, and lower levels of anxiety and depressive symptoms. In contrast, longer screen time (≥2 h/day) was associated with lower levels of satisfaction with life and optimism, and higher levels of anxiety and depressive symptoms; shorter screen time (<2 h/day) was associated with favorable mental health and wellbeing. For screen time, the effect was moderated by gender; the association between longer screen time and poorer mental health and wellbeing was significantly more pronounced for girls than boys. For both boys and girls, mental health and wellbeing were most favorable if they participated in extracurricular activities and reported less than 2 h of recreational screen time per day.

The Association of Residential Instability and Hospitalizations among Homeless and Vulnerably Housed Individuals: Results from a Prospective Cohort Study.

The present study examined the association of residential instability with hospitalizations among homeless and vulnerably housed individuals over a 4-year time period. Survey data were linked to administrative records on hospitalizations. Specifically, we used data from the Health and Housing in Transition study, a prospective cohort study that tracked the health and housing status of homeless and vulnerably housed individuals in Canada. Responses from Vancouver-based participants (n = 378) from baseline and 3 follow-ups were linked to their administrative health records on hospitalizations (Discharge Abstract Database - Hospital Separation Files; 2008-2012). A generalized estimating equations model was used to examine associations between the number of residential moves and any hospitalizations during each year (none versus ≥ 1 hospitalizations). Analyses included demographic and health variables. Survey data were collected via structured interviews. Hospitalizations were derived from provincial administrative health records. A higher number of residential moves were associated with hospitalization over the study period (adjusted odds ratio: 1.14; 95% confidence interval: 1.01, 1.28). Transgender, female gender, perceived social support, better self-reported mental health, and having ≥ 3 chronic health conditions also predicted having been hospitalized over the study period, whereas high school/higher education was negatively associated with hospitalizations. Our results indicate that residential instability is associated with increased risk of hospitalization, illustrating the importance of addressing housing as a social determinant of health.

Associations of Birth Factors and Socio-Economic Status with Indicators of Early Emotional Development and Mental Health in Childhood: A Population-Based Linkage Study.

Using a linked population-based database established on healthcare, socio-economic, and survey datasets in British Columbia, Canada, we examined how biological, socio-demographic, and socio-economic status (SES) factors at birth related to children's emotional development and mental health. One analysis examined teacher-rated anxiety, hyperactivity, and aggression for kindergarten children (Mage = 5.7; n = 134,094). Another analysis examined administrative healthcare records comprising of physician-assigned diagnostic codes for mental health conditions (conduct disorder, attention deficit hyperactivity disorder, anxiety disorder and depression) from ages 5 through 15 (n = 89,404). Various factors at birth, including gestational age, birthweight, and maternal demographics, were related to emotional development and mental health in childhood. Across outcomes, low SES indicated detrimental associations with various aspects of children's emotional development and mental health (e.g., adjusted odds of mental health conditions were 25-39% higher for children of low income families versus others). Findings reinforce evidence that poverty (reduction) is a primary public health issue.

More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire - Expanded.

BACKGROUND: Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) - Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL - Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. METHODS: Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. RESULTS: Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). CONCLUSIONS: MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).

Benefits of Extracurricular Participation in Early Adolescence: Associations with Peer Belonging and Mental Health.

Extracurricular participation plays an important role in positive youth development. Yet, little is known about the stability and change in extracurricular participation from middle childhood to early adolescence. Also, there is a gap in knowledge about the underlying processes that drive developmental outcomes associated with extracurricular participation. The present study examined transitions in extracurricular participation from grade 4 to 7, and investigated whether shifting from non-participation to participation in activities was associated with better mental health, considering peer belonging as a mediator. Latent Class Analyses of early adolescents' (50% female) self-reports on the Middle Years Development Instrument in grades 4 and 7 (N = 10,149) revealed four clusters of extracurricular involvement at both grade levels (i.e., "no activities", "all activities", "sports only", "individual activities"). Latent Transition Analysis showed that young people were most likely to stay in the same activities cluster from grade 4 to 7. About 10% were non-participants in grade 4 and had moved to activities by grade 7. In this subgroup, moving from non-participation to both sports and to all activities was associated with better mental health over time; this pathway was fully mediated by higher levels of peer belonging. The results suggest that supporting non-participants to join extracurricular activities can have implications for their mental health. Practical implications for communities, such as removing potential barriers to involvement before the onset of adolescence, are discussed.

Extracurricular activity profiles and wellbeing in middle childhood: A population-level study.

This study examined profiles of participation in extracurricular activities (ECAs) in 4th grade children (N = 27,121; Mean age = 9.20 years; SD = .54; 51% male) in British Columbia, Canada. Latent class analyses were used to establish activity profiles and determine class membership; ANCOVA was used to investigate differences in mental wellbeing (optimism, life satisfaction, self-concept) and perceived overall health between groups. Data came from a cross-sectional, population-level child self-report survey (i.e., the Middle Years Development Instrument) implemented with 4th grade children in public schools. We found four distinct ECA profiles: participation in "All Activities", "No activities", "Sports" (i.e., individual and team sports), and "Individual activities" (i.e., educational programs, arts/music, individual sports). Wellbeing and health scores were highest for children in the "All Activities" and the "Sports" clusters, and lowest for those in "No Activities" and the cluster reflecting individual activities (i.e., "Individual activities"). Results are discussed in the context of previous research, and with respect to practical relevance.

Association of Childhood Social-Emotional Functioning Profiles at School Entry With Early-Onset Mental Health Conditions.

Importance: More than 50% of lifetime mental health disorders develop by early adolescence, and yet it is not well understood how early childhood social-emotional functioning varies in populations or how differences in functioning may be associated with emerging mental health conditions. Objectives: To identify profiles of social-emotional functioning at kindergarten school entry (age 5 years) and to examine to what extent profiles are related to early-onset mental health conditions (ages 6-14 years). Design, Setting, and Participants: This prospective cohort study followed up a population cohort of 34 552 children in British Columbia, Canada, from birth (born 1996-1998) to age 14 years (last follow-up, December 31, 2011). Data were analyzed from the Developmental Trajectories cohort that links British Columbia child development data from the Early Development Instrument (EDI) to British Columbia Ministry of Health and Ministry of Education records. Data were analyzed between May and September 2017. Exposures: Early childhood social-emotional functioning (defined as social competence, internalizing, and externalizing symptoms) rated by the children's kindergarten teachers. Main Outcomes and Measures: Occurrences of physician-assessed mental health conditions throughout childhood and early adolescence, including depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder (ADHD), calculated from billing codes from the International Classification of Diseases, Ninth Revision recorded in provincial health insurance data. Results: Data from 34 323 children (mean [SD] age, 5.7 [0.3] years; 17 538 [51.1%] were boys) were analyzed at kindergarten and followed up to age 14 years (15 204 completed follow-up). Latent profile analysis identified 6 unique social-emotional functioning profiles at school entry, with 41.6% of children (n = 14 262) exhibiting comparative vulnerabilities in internalizing or externalizing behaviors. Prevalence of mental health conditions from ages 6 to 14 years was 4.0% for depression, 7.0% for anxiety, 5.5% for conduct disorder, 7.1% for ADHD, and 5.4% for multiple conditions. Zero-inflated Poisson analyses showed an association between social-emotional functioning profiles at kindergarten school entry and physician-assessed mental health conditions by age 14 years (range of adjusted odds ratios: depression, 1.10 [95% CI, 0.76-1.60] to 2.93 [95% CI, 1.93-4.44]; anxiety, 1.00 [95% CI, 0.74-1.36] to 1.73 [95% CI, 1.11-2.70]; conduct disorder, 2.17 [95% CI, 1.41-3.34] to 6.91 [95% CI, 4.90-9.74]; ADHD, 1.46 [95% CI, 1.11-1.93] to 8.72 [95% CI, 6.46-11.78]; and multiple conditions, 1.20 [95% CI, 0.88-1.63] to 6.81 [95% CI, 4.91-9.44]). Children with higher teacher ratings of aggression and hyperactivity had more frequent consultations for conduct disorder, ADHD, and multiple conditions. Conclusions and Relevance: This study's findings suggest that more than 40% of children enter the school system with relative vulnerabilities in social-emotional functioning that are associated with early-onset mental health conditions. The results raise important questions for using population-level early childhood development monitoring in the context of universal and proactive mental health strategies.

"I Haven't Given Up and I'm Not Gonna": A Phenomenographic Exploration of Resilience Among Individuals Experiencing Homelessness.

Resilience is a factor related to positive health outcomes. Exploring this concept among adults experiencing homelessness can inform interventions while subsequently considering individuals' strengths. A phenomenographic approach was applied to examine this concept among a sample of 22 individuals involved in qualitative interviews. The phenomenographic inquiry identified eight conceptions and found resilience is captured in both positive and negative ways. Conceptions are summarized by two categories, situated in an outcome space which describes the overall resilience experience and the different ways these conceptions are understood and experienced. Categories summarize conceptions as Staying Strong and Sustaining Positive Beliefs, which highlight the construct as being captured by a persistent positive aspect; however, the findings also uniquely describe the influence of negative conceptions toward the overall phenomenon. The findings suggest resilience is recognizable during adversity, and it is a phenomenon that has the potential to be strengthened.