'I turn to my closest friends for support': queer youth navigating mental health during COVID-19.

The objectives of this in-depth qualitative study were to identify how COVID-19 impacted the mental health experiences of queer youth in Vancouver, Canada. Between November 2020 and June 2021, fifteen queer youth aged 15 to 25 were enrolled in the study. They participated in semi-weekly, solicited digital diary entries and semi-structured intake and follow-up interviews about COVID-19, social distancing protocols, and mental health. Using thematic analysis, two major themes were identified. First, participants described how COVID-19 impacted social support by highlighting the limitations of their existing social networks and feelings of disconnect from others in the local queer community. Second, participants described how public health guidance and the offloading of responsibility for COVID-19 risk-management onto the individual was a significant source of anxiety and stress, and how they moralised the struggle to balance compliance with the desire to connect with others. These findings highlight the need to understand the negative mental health outcomes arising from moralising approaches to public health that offload risk-management onto the individual, isolate queer youth, and hamper their identity-development processes.

Young Adults' Mental Health and Unmet Service Needs in the Context of the COVID-19 Pandemic Across Canada and France.

While young adults experienced mental health challenges during the COVID-19 pandemic, little is known about how their mental health needs were subsequently met through access to mental health services (MHS). From October to December 2020, we conducted an online survey of young adults (18-29 years) living in Canada and France to investigate factors associated with unmet MHS needs. Of the 3222 participants expressing a need to access MHS (50.7% of the total sample), 58.2% in Canada and 74.8% in France reported unmet MHS needs. In both countries, those who identified as men and those who lost income due to COVID-19, were more likely to report unmet MHS needs. In Canada, participants from Quebec, those living in rural areas, and those who experienced ethno-racial discrimination had higher odds of reporting such unmet needs. Urgent investments are needed to improve access to MHS for young adults during and after the COVID-19 pandemic.

Moderation of the association between COVID-19-related income loss and depression by receipt of financial support: Repeated cross-sectional surveys of young adults in Canada and France (2020-2021).

Background: To mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments and family/friends mobilized financial support interventions (e.g., emergency aid funds) and assistance. However, little is known about how financial assistance alleviated mental health problems. This study aimed to investigate the moderating effect of financial support from the government or from family/friends on the association between income loss and depression among young adults. Methods: Two online cross-sectional surveys among young adults ages 18-29 living in Canada and France were conducted in 2020 (n = 4,511) and 2021 (n = 3,329). Moderate-to-severe depressive symptoms were measured using the Patient Health Questionnaire-9 (cut-off score: ≥10). Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family/friends modeled separately), controlling for demographics. Results: Overall, half reported depressive symptoms (2020/2021: 53.5%/45.6%), and over a third lost income (2020/2021: 10.2%/11.6% all income, 37.7%/21.6% some income). In 2020, 40.6% received government financial support (17.7% in 2021) while family/friends support was received by 12% (in both surveys). In both surveys, among those who received governmental financial support, income loss was associated with depression, whether participants lost all their income (e.g., 2020: Adjusted Odds Ratios (AOR) 1.75, 95% Confidence Interval [1.29-2.44]), or some of their income (e.g., 2020: AOR 1.45 [1.17-1.81]). However, among those who received family/friends financial support, income loss was no longer significantly associated with depression in both cycles, whether participants lost all their income (e.g., 2020: AOR 1.37 [0.78-2.40]), or some of their income (e.g., 2020: AOR 1.31 [0.86-1.99]). Conclusions: Association between income loss and depression was moderated by receipt of family/friends financial support but not by receipt of government financial support. Financial support interventions may help to mitigate the negative effects of income loss on young adults mental health during periods of economic crisis.

Factors Associated with Self-Reported Changes in Alcohol Use among Young Adults during the COVID-19 Pandemic: A Comparative Analysis between Canada and France.

While the COVID-19 pandemic impacted young adults' alcohol use patterns, little is known about how changes in alcohol use may differ across different settings. Our objective was to identify and compare factors associated with changes in alcohol use among young adults in Canada and France during the first year of the COVID-19 pandemic. We conducted an online cross-sectional survey in October-December 2020 with young adults aged 18-29 (n = 5185) in Canada and France. In each country, weighted multinomial logistic regressions were performed to identify factors associated with self-reported decrease and increase in alcohol use separately (reference: no change). Respectively, 33.4% and 21.4% reported an increase in alcohol use in Canada and France, while 22.9% and 33.5% reported a decrease. Being 25-29 was a predictor of decrease in Canada, while living away from family was associated with an increase in France. In both countries, participants were more likely to report an increase if they reported depressive symptoms, smoking tobacco, or cannabis use. Conversely, those who had been tested for COVID-19 and those who were highly compliant with COVID-19 preventive measures were more likely to report a decrease. Efforts are needed to develop alcohol use interventions for young adults, including in ways that prioritize those with mental health challenges.

Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon.

Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty-a context which we summarize here as "street involvement"-are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.

COVID-19 vaccine intention among young adults: Comparative results from a cross-sectional study in Canada and France.

BACKGROUND: High rates of COVID-19 vaccination uptake are required to attain community immunity. This study aims to identify factors associated with COVID-19 vaccine uncertainty and refusal among young adults, an underexplored population with regards to vaccine intention generally, in two high-income settings: Canada and France. METHODS: A cross-sectional online survey was conducted from October to December 2020 among young adults ages 18-29 years (n = 6663) living in Canada (51.9%) and France (48.1%). Multinomial logistic regression analyses were performed to identify the sociodemographic and COVID-19-related measures (e.g., prevention behavior and perspectives, health-related concerns) associated with vaccine uncertainty and refusal. We conducted weighted analyses by age, gender and province/region of residence. RESULTS: Intention to accept vaccination was reported by 84.3% and 59.7% of the sample in Canada and France, respectively. Higher levels of vaccine uncertainty and refusal were observed in France compared to Canada (30.1% versus 11%, 10.2% versus 4.7%). In both countries, we found higher levels of vaccine acceptance among young adults who reported COVID-19 prevention actions. Vaccine uncertainty and refusal were associated with living in a rural area, having lower levels of educational attainment, not looking for information about COVID-19, not wearing a face mask, and reporting a lower level of concern for COVID-19's impact on family. Participants who had been tested for COVID-19 were less likely to intend to refuse a vaccine. CONCLUSIONS: COVID-19 vaccine acceptance was high among young adults in Canada and France during a time in which vaccines were approved for use. Targeted interventions to build confidence in demographic groups with greater hesitance (e.g., rural and with less personal experience with COVID-19) may further boost acceptance and improve equity as vaccine efforts continue to unfold.

Widening mental health and substance use inequities among sexual and gender minority populations: Findings from a repeated cross-sectional monitoring survey during the COVID-19 pandemic in Canada.

This paper examines the mental health and substance use impacts of the COVID-19 pandemic among sexual and gender minority (SGM) populations as compared to non-SGM populations, and identifies risk factors for mental health and substance use impacts among SGM groups. Data were drawn from two rounds of a repeated cross-sectional monitoring survey of 6027 Canadian adults, with Round 1 conducted May 14-19, 2020 and Round 2 conducted September 14-21, 2020. Bivariate cross-tabulations with chi-square tests were utilized to identify differences in mental health and substance use outcomes between SGM and non-SGM groups. Separate multivariable logistic regression models were used to identify risk factors for mental health and substance use outcomes for all SGM respondents. Compared to non-SGM respondents, a greater proportion of SGM participants reported mental health and substance use impacts of the COVID-19 pandemic, including deterioration in mental health, poor coping, suicidal thoughts, self-harm, alcohol and cannabis use, and use of substances to cope. Among SGM respondents, various risk factors, including having a pre-existing mental health condition, were identified as associated with mental health and substance use impacts. These widening inequities demonstrate the need for tailored public mental health actions during and beyond the pandemic.

Widening mental health and substance use inequities among sexual and gender minority populations: Findings from a repeated cross-sectional monitoring survey during the COVID-19 pandemic in Canada

This paper examines the mental health and substance use impacts of the COVID-19 pandemic among sexual and gender minority (SGM) populations as compared to non-SGM populations, and identifies risk factors for mental health and substance use impacts among SGM groups. Data were drawn from two rounds of a repeated cross-sectional monitoring survey of 6027 Canadian adults, with Round 1 conducted May 14-19, 2020 and Round 2 conducted September 14-21, 2020. Bivariate cross-tabulations with chi-square tests were utilized to identify differences in mental health and substance use outcomes between SGM and non-SGM groups. Separate multivariable logistic regression models were used to identify risk factors for mental health and substance use outcomes for all SGM respondents. Compared to non-SGM respondents, a greater proportion of SGM participants reported mental health and substance use impacts of the COVID-19 pandemic, including deterioration in mental health, poor coping, suicidal thoughts, self-harm, alcohol and cannabis use, and use of substances to cope. Among SGM respondents, various risk factors, including having a pre-existing mental health condition, were identified as associated with mental health and substance use impacts. These widening inequities demonstrate the need for tailored public mental health actions during and beyond the pandemic.

Increases in Alcohol and Cannabis Use Associated with Deteriorating Mental Health among LGBTQ2+ Adults in the Context of COVID-19: A Repeated Cross-Sectional Study in Canada, 2020-2021.

Lesbian, gay, bisexual, trans, other queer, and Two-Spirit (LGBTQ2+) people are particularly at risk for the psycho-social consequences of the COVID-19 pandemic, though population-tailored research within this context remains limited. This study examines the extent of, and associations between, increased alcohol and cannabis use and deteriorating mental health among LGBTQ2+ adults in Canada during the COVID-19 pandemic. Data are drawn from LGBTQ2+ respondents to a repeated, cross-sectional survey administered to adults living in Canada (May 2020-January 2021). Bivariate cross-tabulations and multivariable logistic regression models were utilized to examine associations between increased alcohol and cannabis use, and self-reported mental health, overall coping, and suicidal thoughts. Five-hundred and two LGBTQ2+ participants were included in this analysis. Of these, 24.5% reported increased alcohol use and 18.5% reported increased cannabis use due to the pandemic. In the adjusted analyses, increased alcohol use was associated with poor overall coping (OR = 2.28; 95% CI = 1.28-4.07) and worse self-reported mental health (OR = 1.98; 95% CI = 1.21-3.25), whereas increased cannabis use was associated with suicidal thoughts (OR = 2.30; 95% CI = 1.16-4.55). These findings underscore the need for population-tailored, integrated substance use and mental health supports to address interrelated increases in alcohol/cannabis use and worsening mental health among LGBTQ2+ adults, in the context of the COVID-19 pandemic and beyond.