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Ahead of Our Time

Lifestyle choices in adolescence linked to poor mental health

Research by a team at the University of Alberta establishes a clear link between a wide range of lifestyle behaviour choices made by middle adolescents and their mental well-being.

The project was the first to look at 12 lifestyle behaviours in middle adolescence, comparing those results to the frequency of depression and anxiety symptoms reported by the same group of youth a year later. The behaviours included diet – including eating vegetables, fruits and grains – physical activity, screen time, sleep and the use of substances such as tobacco, alcohol, e-cigarettes and cannabis.

Of those surveyed in 2017-18, more than 70 per cent were classified as having very unfavourable or unfavourable lifestyles. A year later, those who had made unfavourable lifestyle choices reported higher rates of depression and anxiety, particularly among girls.

The study, published in 2023, was supervised by Paul Veugelers, a professor in the School of Public Health whose career has focused on children’s lifestyles and how it affects their health. His then-PhD student Julia Dabravolskaj led the analysis.

This study builds on earlier research by Veugelers’s team, which looked at early adolescent lifestyle behaviours and found the same link with behaviour choices and mental health outcomes.

Mental health problems are growing at an alarming rate in Canada, especially since the COVID-19 pandemic. More than one million, or one in four, young Canadians live with mental disorders, and three-quarters of all mental health issues emerge before age 25.

Understanding adolescent behaviours and their link to mental health is crucial, says Veugelers, because it provides evidence that could lead to earlier and more comprehensive intervention programs. “If you intervene in all lifestyle behaviours early on, kids are more likely to retain those healthy lifestyles throughout their lives.”

The research project used data from COMPASS (Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking and Sedentary behaviour), a longitudinal study that collects information annually based on extensive questionnaires filled in anonymously by grade 9-12 students in Alberta, Ontario, British Columbia and Quebec.

The U of A project was based on answers from 24,274 participants, with an average age of 14.5 to 15.5 over the two-year data collection period.

Dabravolskaj said the answers to the behaviour questions were discouraging. On average, participants met 5.6 of 12 recommendations, and almost none met all 12 recommendations. Only 3.9 per cent of participants met recommendations for eating vegetables and fruits, 4.5 per cent for grains and 4.9 per cent for screen time, including streaming TV shows and movies, playing games, surfing the internet, texting, messaging and emailing. “The screen time results weren’t surprising – it’s our new reality – but they were really sad,” she says.

In the past, most school-based intervention programs have focused on just one or two lifestyle behaviours, and as a result, are usually only effective short-term, says Dabravolskaj. She and Veugelers hope this study will provide evidence to encourage policy-makers and education experts to fund complex intervention programs targeting a wide range of adolescent behaviours.

One such initiative is APPLE Schools, a comprehensive school health program founded by Veugelers in 2007, which is now operating in 93 schools in western Canada. It works with the whole school community to improve eating habits, physical activity and mental well-being.

Mental health problems are growing at an alarming rate in Canada, especially since the COVID-19 pandemic. More than one million, or one in four, young Canadians live with mental disorders, and three-quarters of all mental health issues emerge before age 25.

“The approach is out there,” says Veugelers. “We just need the policy-makers to have the courage to step up.”

Veugelers is grateful to WCHRI for its support for his work. “Generally, the first focus is always on patients and sick kids, and I understand that. But it’s really important that an organization like WCHRI has a broad perspective and understands that there’s different ways of addressing health, not only in hospitals or waiting until kids are sick, but doing something on the prevention side.”


Paul Veugelers was supported by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

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