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    • Hone et al Hone Jarden Schofield Duncan contend

    2018-11-05

    Hone et al. (Hone, Jarden, Schofield, & Duncan, 2014) contend that policy-makers are increasingly interested in assessments of health that include measures of positive mental health and well-being, with an emphasis on strengths-based approaches as opposed to an illness-focus. Positive mental health typically includes “hedonic” components, such as enjoying life, but also commonly measures components such as level of engagement in society and positive functioning, which benefit productivity and XL184 health outcomes (Hone et al., 2014). In this way, well-being and ill-being are no longer regarded as opposite ends of the same spectrum; population level data on positive mental health are valued in their ability to provide distinct information from rates of mental illness. The addition of a positive mental health measure in the Canadian Community Health Survey (CCHS) in 2011 reflects this shift in perspective and presents unique opportunities to investigate underlying determinants of positive mental health at a national level. The current study aimed to address an important knowledge gap by investigating the association between household educational attainment and adolescent self-reported positive mental health in a representative national sample.
    Methods
    Results The study sample included 10,091 adolescents aged 12 to 19 years. As shown in Table 2, males and females were equally represented (49.3% female), and 26.6% of participants identified as an ethnic minority (i.e., did not identify as white/Caucasian). Most adolescents were represented in the younger age categories, 12 to 14 years (38.5%) and 15 to 17 years (40.3%), than the age category 18 to 19 years (21.2%). The majority of adolescents reported experiencing flourishing mental health (83.2%). Within XL184 participating households, post-secondary graduation was the most frequently reported highest level of educational attainment (82.8%), followed by secondary school graduation (10.0%), incomplete post-secondary (4.7%), and incomplete secondary school education (2.5%). Overall, a higher proportion of adolescents reported flourishing in the 12 to 14 age group compared to the 15 to 17, or 18 to19 age groups. Flourishing was more prevalent among males compared to females. In bivariate analyses, a greater proportion of adolescents reported to be flourishing in households where completed post-secondary or completed secondary education was the highest education level attained (83.7% and 83.5%, respectively). The lowest proportion of flourishing (74.4%) was reported among adolescents living in households where incomplete post-secondary was the highest education level (all results shown in Table 2). Table 3 shows the results of the logistic regression analyses. After adjusting for household income, single parent status, and household size, adolescents had 36% lower odds of flourishing in homes where the highest education level was incomplete post-secondary compared to completed post-secondary (OR = 0.64, 95% CI = 0.44, 0.95). No other education categories were associated with statistically significant differences in adolescent positive mental health when compared to completed post-secondary. Higher household income was associated with significantly higher odds of flourishing (income > $80,000 compared to < $20,000) before and after adjusting for covariates. In unadjusted analyses, two-parent status was associated with higher odds of flourishing, but desert biome association was not significant after adjusting for education, income, and household size. Households containing 3 or more persons were also associated with higher odds of flourishing, but not at statistically significant levels. When stratified by age group and gender, the association between household educational attainment and adolescents’ self-reported positive mental health was strongest for younger adolescents and females (Table 4). When stratified by age, after adjusting for covariates, non-completion of post-secondary school was associated with significantly lower odds of positive mental health among adolescents aged 12 to 14 (OR: 0.43; 95% CI = 0.21, 0.84). Although incomplete post-secondary remained the most vulnerable education category at all ages, odds ratios were not statistically significant for adolescents aged 15 to 17 (OR = 0.91, 95% CI = 0.47, 1.75) or 18 to 19 (OR = 0.68, 95% CI = 0.37, 1.27). When stratified by gender, incomplete post-secondary was associated with lower positive mental health among both males and females, but was only statistically significant among females (ORfemales = 0.50, 95% CI = 0.29, 0.88 compared to ORmales = 0.84, 95% CI = 0.49, 1.43). Age by gender interactions were not observed.