Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis.

Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.

Understanding priorities and needs for child and adolescent mental health in Greece from multiple informants: an open resource dataset.

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [ https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard ]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs.

Problem checklists and standardized diagnostic interviews: evidence of psychometric equivalence for classifying psychiatric disorder among children and youth in epidemiological studies.

BACKGROUND: The standard approach for classifying child/youth psychiatric disorder as present or absent in epidemiological studies is lay-administered structured, standardized diagnostic interviews (interviews) based on categorical taxonomies such as the DSM and ICD. Converting problem checklist scale scores (checklists) to binary classifications provides a simple, inexpensive alternative. METHODS: Using assessments obtained from 737 parents, we determine if child/youth behavioral, attentional, and emotional disorder classifications based on checklists are equivalent psychometrically to interview classifications. We test this hypothesis by (1) comparing their test-retest reliabilities based on kappa (κ), (2) estimating their observed agreement at times 1 and 2, and (3) in structural equation models, comparing their strength of association with clinical status and reported use of prescription medication to treat disorder. A confidence interval approach is used to determine if parameter differences lie within the smallest effect size of interest set at ±0.125. RESULTS: The test-retest reliabilities (κ) for interviews compared with checklists met criteria for statistical equivalence: behavioral, .67 and .70; attentional, .64 and .66; and emotional, .61 and .65. Observed agreement between the checklist and interviews on classifications of disorder at times 1 and 2 was, on average, κ = .61. On average, the ß coefficients estimating associations with clinical status were .59 (interviews) and .63 (checklists); and with prescription medication use, .69 (interviews) and .71 (checklists). Behavioral and attentional disorders met criteria for statistical equivalence. Emotional disorder did not, although the coefficients were stronger numerically for the checklist. CONCLUSIONS: Classifications of child/youth psychiatric disorder from parent-reported checklists and interviews are equivalent psychometrically. The practical advantages of checklists over interviews for classifying disorder (lower administration cost and respondent burden) are enhanced by their ability to measure disorder dimensionally. Checklists provide an option to interviews in epidemiological studies of common child/youth psychiatric disorders.

Individual- and family-level associations between child psychopathology and parenting.

Parenting can protect against the development of, or increase risk for, child psychopathology; however, it is unclear if parenting is related to psychopathology symptoms in a specific domain, or to broad liability for psychopathology. Parenting differs between and within families, and both overall family-level parenting and the child-specific parenting a child receives may be important in estimating transdiagnostic associations with psychopathology. Data come from a cross-sectional epidemiological sample (N = 10,605 children ages 4-17, 6434 households). Parents rated child internalizing and externalizing symptoms and their parenting toward each child. General and specific (internalizing, externalizing) psychopathology factors, derived with bifactor modeling, were regressed on parenting using multilevel modeling. Less warmth and more aversive/inconsistent parenting in the family, and toward an individual child relative to family average, were associated with higher general psychopathology and specific externalizing problems. Unexpectedly, more warmth in the family, and toward an individual child relative to family average, was associated with higher specific internalizing problems in 4-11 (not 12-17) year-olds. Less warmth and more aversive/inconsistent parenting are broad correlates of child psychopathology. Aversive/inconsistent parenting, is also related to specific externalizing problems. Parents may behave more warmly when their younger children have specific internalizing problems, net of overall psychopathology.

Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey.

OBJECTIVES: To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences. METHODS: The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics. RESULTS: Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth. CONCLUSION: Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.

Resettlement, mental health, and coping: a mixed methods survey with recently resettled refugee parents in Canada.

BACKGROUND: Resettlement experiences of refugee parents are under-researched despite evidence indicating higher risk of poor mental health. The current study integrates family systems and social determinants of refugee mental health frameworks to examine: (1) Refugee parents' experiences of resettlement stressors and mental health; (2) Perceived impacts of resettlement stressors on individual and family indicators of well-being; and (3) Refugee parents' coping strategies and resources. METHODS: The study draws on data from a mixed methods survey conducted with 40 Government-Assisted Refugee parents who had resettled to Hamilton, Canada within the past 4 years. Quantitative and qualitative data were analyzed separately and then integrated at the results stage using a weaving approach. RESULTS: Results indicate significant exposure to economic and social stressors across multiple domains of daily life, as well as high levels of parental psychological distress. Parents drew linkages between resettlement stressors and negative mental health impacts that were compounded by intersecting risk factors of ill health, caregiving burden, single parenthood, and low levels of education and literacy. Most parents rated themselves as coping well or very well and described various coping strategies such as positive reframing, problem solving, planning, and turning to religion. Quantitative and qualitative findings indicate high frequency of positive parent-child interaction and low frequency of family conflict, and highlight the importance of family as a protective resource for coping with adversity. Exploratory regression analyses suggest that longer stay in Canada, poorer self-rated health, higher levels of resettlement stressors, and more conflict between adults in the household may be associated with greater psychological distress. CONCLUSION: Study findings highlight both the resilience of refugee parents and the psychological toll of navigating their families through a new and challenging environment. Policies and programs to provide comprehensive social and economic supports to refugees beyond the first one to two years after arrival are necessary to mitigate the mental health impacts of displacement over time and strengthen individual and family resilience. Such programs should include culturally responsive and family-based models of mental health care that acknowledge collective experiences and impacts of adversity, as well as harness family resources to overcome past and present challenges.

Comparing youth with vs without outpatient mental health services on subsequent acute mental health care visits.

BACKGROUND: Use of acute care for mental health concerns has been increasing among youth in recent years. Improving access to outpatient mental health services may prevent downstream acute care visits. PURPOSE: To examine differences in rates of acute mental health care visits among youth with- versus without prior outpatient mental health services. METHODOLOGY: A total of 2,442 youth ages 14-17 years participated in a provincially representative cross-sectional epidemiological survey, the 2014 Ontario Child Health Study. This sample was individually linked to health administrative databases, with nearly universal coverage of all medically necessary physician and acute care visits. Our exposure was parent and youth reported outpatient mental health service use in the six-month period prior to completing the survey. Exposed youth (n=691) were matched with unexposed youth using a propensity score informed by a range of clinical and socio-demographic factors. Our outcome was acute mental health care visits in the 18-month period following completion of the survey, ascertained though the linked health administrative data. RESULTS: In our propensity score matched sample, we found no difference in rates of subsequent acute mental health care visits (HR= 1.14, 95%CI 0.44, 2.98) between youth with- versus without prior outpatient mental health services. CONCLUSIONS: There is a need to further understand the types of services youth are receiving in outpatient settings to determine if, and for whom, outpatient mental health services reduces the likelihood of future acute mental health care visits.

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.

Reimagining mental health care for newcomer children and families: a qualitative framework analysis of service provider perspectives.

BACKGROUND: Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada. METHODS: Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method. RESULTS: Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake. CONCLUSIONS: The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.

The science of child and adolescent mental health in Greece: a nationwide systematic review.

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Neighbourhood and family correlates of immigrant children's mental health: a population-based cross-sectional study in Canada.

BACKGROUND: Immigrant children exhibit significant variation in their mental health outcomes despite disproportionate exposure to socio-economic adversity compared to their non-immigrant peers. Identifying aspects of neighbourhood and family contexts that are most salient for immigrant children's mental health can help to inform and target interventions to prevent mental disorder and promote mental well-being among this population. METHODS: The study analyzed multi-informant data from 943 first- and second-generation immigrant caregiver and child dyads from the Hamilton Youth Study, a representative sample of immigrant and non-immigrant families in Hamilton, Ontario. Multivariate multilevel regression models examined associations between neighbourhood and family characteristics and processes, and parent and child self reports of internalizing and externalizing problems. RESULTS: Positive and negative parenting behaviours were significantly associated with internalizing and externalizing problems, with negative parenting demonstrating associations with externalizing problems across both parent and child reports (b = 0.26-1.27). Neighbourhood social disorder and parental trauma exposure were associated with greater internalizing and externalizing problems, and neighbourhood immigrant concentration was associated with fewer externalizing problems for parent reports only. Adding parental distress and parenting behaviour to the models reduced the coefficients for parental trauma exposure by 37.2% for internalizing problems and 32.5% for externalizing problems and rendered the association with neighbourhood social disorder non-significant. Besides the parenting variables, there were no other significant correlates of child-reported internalizing and externalizing problems. CONCLUSIONS: Results highlight the importance of parenting behaviour and parental experiences of trauma and distress for immigrant children's mental health. While not unique to immigrants, the primacy of these processes for immigrant children and families warrants particular attention given the heightened risk of exposure to migration-related adverse experiences that threaten parental and family well-being. To prevent or mitigate downstream effects on child mental health, it is imperative to invest in developing and testing trauma-informed and culturally responsive mental health and parenting interventions for immigrant families.

Reading Between the Lines: A Pursuit of Estimating the Population Prevalence of Mental Illness Using Multiple Data Sources.

Population-based prevalence estimates of mental illness are foundational to health service planning, strategic resource allocation, and the development and evaluation of public mental health policy. Generating valid, reliable, and context-specific population-level estimates is of utmost importance and can be achieved by combining various data sources. This pursuit benefits from the right combination of theory, applied statistics, and the conceptualization of available data sources as a collective rather than in isolation. We believe there is a need to read between the lines as theory, methodology, and context (i.e., strengths and limitations) are what determines the meaningfulness of a combined prevalence estimate. Currently lacking is a gold standard approach to combining estimates from multiple data sources. Here, we compare and contrast various approaches to combining data and introduce an idea that leverages the strengths of pre-existing individually linked population-based survey and health administrative data sources currently available in Canada.

The 25-Item Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B): Test-Retest Reliability and Construct Validity When Used as Categorical Measures.

OBJECTIVE: Child and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P). METHODS: This study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (ß) estimated in structural equation models. RESULTS: The average differences between the MINI-KID-P and OCHS-EBS-B in κ and ß were -0.022 and -0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error. CONCLUSIONS: Although falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error.

Resilience in the Face of Adversity: Family Processes and the Immigrant Paradox in Youth Externalizing Problems.

BACKGROUND: Despite increased exposure to social adversity, immigrant youth have fewer externalizing problems compared to non-immigrants. Explanations for this apparent advantage remain unclear. This study examined the extent to which socio-economic characteristics and family processes account for group differences in externalizing problems between immigrant and non-immigrant youth. METHODS: Data come from a population-based cross-sectional study of 1,449 youth and their primary caregiver in Hamilton, Ontario. Computer-assisted structured interviews were administered separately to primary caregivers and youth, which included assessments of externalizing problems and measures of family obligation, parental monitoring, value of education and socio-economic characteristics. RESULTS: First- and second-generation immigrant youth had lower levels of externalizing problems compared to non-immigrants. The magnitude of group differences was larger for parent (d = 0.37-0.55) versus youth reports of externalizing behaviours (d = 0.15-0.29). Family socio-economic and process characteristics partially accounted for group differences, which remained significant in the parent-reported model but rendered non-significant in the youth-reported model. CONCLUSION: Results suggesting the potential protective effects of positive family processes for immigrant youth could be extended to non-immigrant youth to inform the development of parenting and family skills interventions. Promoting familial sources of resilience is a potential avenue for reversing downward trends in mental health seen across successive generations of immigrant youth, while also reducing risk of behavioural difficulties among non-immigrant youth.

Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study.

BACKGROUND: Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services. METHODS: As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. RESULTS: Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. CONCLUSION: Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.

Adolescent health outcomes: associations with child maltreatment and peer victimization.

BACKGROUND: Child maltreatment (CM) and peer victimization (PV) are serious issues affecting children and adolescents. Despite the interrelatedness of these exposures, few studies have investigated their co-occurrence and combined impact on health outcomes. The study objectives were to determine the overall and sex-specific prevalence of lifetime exposure to CM and past-month exposure to PV in adolescents, and the impact of CM and PV co-occurrence on non-suicidal self-injury, suicidality, mental health disorders, and physical health conditions. METHODS: Adolescents aged 14-17 years (n = 2,910) from the 2014 Ontario Child Health Study were included. CM included physical, sexual, and emotional abuse, physical neglect, and exposure to intimate partner violence. PV included school-based, cyber, and discriminatory victimization. Logistic regression was used to compare prevalence by sex, examine independent associations and interaction effects in sex-stratified models and in the entire sample, and cumulative effects in the entire sample. RESULTS: About 10% of the sample reported exposure to both CM and PV. Sex differences were as follows: females had increased odds of CM, self-injury, suicidality, and internalizing disorders, and males had greater odds of PV, externalizing disorders, and physical health conditions. Significant cumulative and interaction effects were found in the entire sample and interaction effects were found in sex-stratified models, indicating that the presence of both CM and PV magnifies the effect on self-injury and all suicide outcomes for females, and on suicidal ideation, suicide attempts, and mental health disorders for males. CONCLUSIONS: Experiencing both CM and PV substantially increases the odds of poor health outcomes among adolescents, and moderating relationships affect females and males differently. Continued research is needed to develop effective prevention strategies and to examine protective factors that may mitigate these adverse health outcomes, including potential sex 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.

Temporal Changes in the Cross-Sectional Associations between Cannabis Use, Suicidal Ideation, and Depression in a Nationally Representative Sample of Canadian Adults in 2012 Compared to 2002.

BACKGROUND: With the recent legalization of nonmedical cannabis in Canada, it is important to document previous associations between cannabis use and major depressive episode and suicidal ideation, as well as the extent to which these associations have changed over time. METHODS: This study uses pooled data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, which are repeated cross-sectional surveys of nationally representative samples of Canadians 15 to 60 years of age (n = 43,466). Binary logistic regression was performed, applying weighting and bootstrapping, to examine the association between at least monthly use of cannabis and past 12-month suicidal ideation and major depressive episode (MDE). RESULTS: At least monthly nonmedical cannabis use was associated with an increased odds of MDE and suicidal ideation, and both associations strengthened in 2012 compared to 2002. Canadians using cannabis at least once a month in 2012 had 1.59 (95% confidence interval [CI], 1.11 to 2.27) times the odds of experiencing suicidal ideation and 1.55 (95% CI, 1.12 to 2.13) times the odds of experiencing MDE compared to those who used cannabis at least once a month in 2002. This temporal change remained after controlling for other substance use. CONCLUSIONS: Monthly cannabis use was consistently related to both suicidal ideation and MDE, and these associations were stronger in 2012 compared to 2002. The findings of this study provide a baseline for the association between cannabis use and suicide and depression in the Canadian population that should be reevaluated now that nonmedical cannabis has been legalized.

Prevalence and Correlates of Sexting Behaviors in a Provincially Representative Sample of Adolescents.

OBJECTIVES: To examine the prevalence and correlates of sending and receiving sexts (i.e., sexually explicit images) in a provincially representative sample of adolescents in Canada. METHODS: Data from the 2014 Ontario Child Health Study, a provincial survey of households with children in Ontario, which includes a sample of 2,537 adolescents aged 14 to 17 years (mean age = 15.42, male = 51.6%) were used to address the research objectives. RESULTS: The past 12 months prevalence of sending and receiving sexts was 14.4% and 27.0%, respectively. In unadjusted logistic regression analyses, non-White adolescents and those living in low-income households were less likely to send or receive sexts compared to White and non-low-income adolescents. Adolescents who disclosed their sexual and/or gender minority identities were 3 to 4 times more likely to send and receive sexts than youth who had not disclosed these identities. Higher levels of mental health problems generally observed among adolescents who sent or received sexts. In fully adjusted models, low income and ethnic minority status were associated with reduced odds of sending and receiving sexts, while sexual and/or gender minority disclosure status was associated with increased odds. Social anxiety was associated with reduced odds of sending and receiving sexts, while conduct disorder was associated with elevated odds. CONCLUSION: The prevalence of sexting behavior was higher among adolescents who disclosed their sexual or gender minority identities. Sexting behaviors were associated with higher levels of mental health problems. Identifying vulnerable populations and the potential mental health ramifications associated with sexting behavior is vital to mitigating negative sequelae.

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.

OBJECTIVES: To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders. METHODS: Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17 years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents. RESULT: Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2 h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance. CONCLUSIONS: Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.