2023 Canadian Health Survey on Children and Youth — Changes in the mental health of respondents from the 2019 survey
Released: 2024-09-10
Today, the longitudinal component of the 2023 Canadian Health Survey on Children and Youth (CHSCY) is being released. The survey followed up with individuals who participated in the 2019 survey to see how the physical and mental health of the children and youth have changed over the past four years. These respondents answered some of the same questions to help assess any shifts in their physical and mental health. The findings released today focus on self-reported mental health, and indicate that about a quarter of youth reported a change in their mental health across the four-year follow-up period. Most notably, teenaged girls in 2023 were the most likely to experience declines in their self-reported mental health since 2019.
There are many factors that may have influenced the mental health of children and youth over the four-year period. The life changes that occur during the transition to adolescence and young adulthood can contribute to lowering levels of self-rated mental health for some youth. At the same time, the COVID-19 pandemic had a big impact on the lives of many Canadians, and some effects are still being felt today. For children and youth, school closures and social distancing measures implemented during critical periods of social development may have been particularly impactful. Additionally, previous research has demonstrated that there has been a decline in mental health among teens and young adults over the last decade, with a sharper decline during 2020 and 2021.
In 2019, the CHSCY asked youth aged 12 to 17 years to rate their mental health using five broad categories: "excellent", "very good", "good", "fair", or "poor". At that time, 12% of this age group had rated their mental health as "fair" or "poor". That proportion more than doubled to 26% in 2023, when they were aged 16 to 21 years.
This release assesses the stability of youth self-reported mental health over this time period—that is, how much of this increase in "fair" or "poor" mental health is the result of those whose perceived mental health had worsened from "good" or better in 2019 to "fair" or "poor" in 2023, and how much comes from those whose perceived mental health remained "fair" or "poor" between the two survey years. This release also examines gender and age group differences in self-reported mental health and optimism towards school over this time period.
About one in five youth who felt their mental health was "good" or better in 2019 no longer feel that way in 2023
The CHSCY longitudinal data indicate that most youth (77%) reported their mental health in a similar way in 2023 as they did in 2019.
However, among the 88% of youth who rated their mental health as "good", "very good", or "excellent" in 2019, about one in five (21%) reported a decline to "fair" or "poor" by 2023. This type of decline in perceived mental health was more common among older teens who were making the transition to young adulthood throughout the pandemic. Nearly one-quarter (23%) of youth aged 15 to 17 who reported "good", "very good", or "excellent" mental health in 2019 rated their mental health to be "fair" or "poor" when surveyed again four years later. For adolescents who were aged 12 to 14 in 2019 (16 to 18 in 2023), this proportion was 19% in 2023.
Among the 12% of youth who rated their mental health as "fair" or "poor" in 2019, 38% of them experienced an improvement and rated their mental health as "good", "very good" or "excellent" in 2023. Though encouraging, it also means a majority (62%) of those with "fair" or "poor" mental health in 2019 still had low self-rated mental health four years later.
Girls more likely than boys to report mental health declines
In 2019, 16% of girls aged 12 to 17 rated their mental health as "fair" or "poor", more than twice that of boys (7%). The proportions increased in 2023 to 33% for girls (from 16 to 21 years) and 19% for boys (from 16 to 21 years).
Compared with boys, girls were more likely to not only experience declines in their self-rated mental health but also to maintain low self-rated mental health across the four-year follow-up period. Among boys and girls who reported "good", "very good", or "excellent" mental health in 2019, 26% of girls reported their mental health was "fair" or "poor" in 2023, compared with 17% of boys. A higher percentage of girls (67%) also maintained their "fair" or "poor" mental health rating from 2019 compared with boys (52%).
In both 2019 and 2023, the CHSCY also asked parents of children aged 5 to 17 to rate their child's mental health using the same broad categories: "excellent", "very good", "good", "fair", or "poor".
For boys and girls aged 5 to 17 in 2023 (aged 1 to 13 in 2019), about the same percentage of their parents (53% for boys and 51% for girls) reported mental health improvements in their child to "good", "very good" or "excellent" in 2023. Reports of declines to "fair" or "poor" were slightly more common among girls (7%) than among boys (5%).
Declines in mental health less common among younger children
Of the parents who rated their child's mental health as "good", "very good" or "excellent" in 2019, 6% reported declines to "fair" or "poor" in 2023, meaning that the majority (94%) of parents still held this view in 2023. Reports of this type of decline were more common among parents of youth aged 12 to 17 (8%) than parents of children aged 5 to 11 (4%). This mirrors a trend similar to what was seen among self-reporting older youth. Across both youth and parent reports, declines in mental health were more common in the older age groups.
With parent reports, it is important to note that the 2019 survey revealed a difference between parent and youth perspectives on mental health. Parents often rated their child's mental health more positively than the youth themselves did.
Optimism about school diminishes with age, particularly among those with declining mental health
This September, as many children and youth are returning to school or starting at a new school for the first time, it is important to highlight that attitudes towards school can be an important indicator of a child's overall wellbeing.
In the 2019 and 2023 surveys, parents were asked about their child's optimism toward school while youth were directly asked about how often they looked forward to school. Options included "Never", "Sometimes", "Often" and "Always".
Results showed that 16% of parents who reported their child as often or always looking forward to school in 2019, reported the opposite four years later when their child was aged 7 to 11. A higher percentage of boys (21%) in this age group had their parents reporting this decline, relative to girls (11%). Although there were declines observed, a majority of children (84%) in this age group have remained optimistic about school since 2019, according to their parents.
Among youth who responded to this question on their own behalf in both years (i.e., youth aged 16 to 21 years in 2023), nearly half (49%) of those who felt like they often or always looked forward to school in 2019, no longer felt this way in 2023. This decline in optimism was more pronounced among girls (52%) than boys (45%).
When examining the mental health changes of those who reported a decline in optimism toward school in 2023, 13% of parents of children aged 7 to 11 who rated their child's mental health as "good", "very good" or "excellent" in 2019 had reported declines to "fair" or "poor" in 2023. Comparatively, among children who remained optimistic about school according to their parents, 2% of parents had reported a decline of their child's mental health status from "good", "very good" or "excellent" in 2019 to "fair" or "poor" in 2023.
For youth aged 16 to 21 who reported declines in optimism toward school in 2023, of those who rated their mental health as "good", "very good" or "excellent" in 2019, 11% reported declines to "fair" or "poor" in 2023. Only 5% of those who remained optimistic about school had reported a decline of their mental health status from "good", "very good" or "excellent" in 2019 to "fair" or "poor" in 2023.
Looking ahead
Trends identified during the pandemic have highlighted a need for high quality data on the mental and physical health of children and youth. The longitudinal component of the 2023 CHSCY is particularly valuable in assessing these changes over time, as it contains data collected from the same children and youth in both 2019 and 2023 on topics such as physical activity, the use of electronic devices, time spent in school and extracurricular activities, mental health, and substance use, among others.
In line with Statistics Canada's Disaggregated Data Action Plan, these data also contain sociodemographic characteristics such as racialized populations, Indigenous identity, sex, gender and sexual orientation and immigration status, among others.
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Note to readers
The longitudinal component for the 2023 Canadian Health Survey on Children and Youth (CHSCY) was developed by Statistics Canada, the Public Health Agency of Canada, and a national research team led by the Offord Centre for Child Studies at McMaster University. The Offord Centre for Child Studies received funding from the Canadian Institutes of Health Research to directly support the longitudinal data collection and lead the initial longitudinal analyses. The data were collected from March to June 2023.
In total, data for all 41,934 children and youth surveyed from the 2019 CHSCY were selected for the longitudinal portion of the 2023 iteration. The response rate was 54.2% in 2023, which resulted in 22,739 complete cases. Survey sample weights were applied so that the analyses would be representative of the 2019 Canadian population for children and youth.
The final sample for the CHSCY 2023 survey was aged between 5 and 21 years. For those between 5 and 11, data were collected from the person most knowledgeable (PMK) about the preselected child or youth. The PMK was usually the birth, step or adoptive parent (98%) of the selected child or youth. For simplicity, the term "parent" is used in this release. For those aged 12 to 17 years, data were collected from both the parent and the youth. For those aged 18 to 21 years, data were collected only from the youth.
Results in this release are based on age groups for whom the parent answers the question of interest in both years or the youth answers the question in both years. Cases where the parent answers in one year but the youth answer in another year are excluded from the analysis.
For those aged 12 to 15 in 2023, there is a change in who responds to the question on optimism toward school between the two years. In 2019, when aged 8 to 11, their parents responded on their behalf. However, in 2023, they respond to this question for themselves. For this reason, changes in optimism toward school for this age group are not reported on.
It should be noted that for weighting purposes, children or youth who died or moved out of Canada between the 2019 and 2023 collections were considered respondents and assigned a longitudinal weight (51 cases were identified as such). Although no survey data were collected in 2023 for them (all 2023 responses are set to "not stated"), these cases are present on the microdata file as they allow for the estimation of the total number of children and youth in the population who have been lost for these reasons. They are excluded from the present analyses, however.
In this release, when two estimates are said to be significantly different, this indicates that the difference was statistically significant at a 95% confidence level (p-value less than 5%).
Given that the non-binary population is small, data aggregation to a two-category gender variable is sometimes necessary to protect the confidentiality of responses. In these cases, individuals in the category "non-binary persons" are distributed into the other two gender categories. Unless otherwise indicated in the text, the category "boys" includes boys and men, as well as some non-binary children and youth, while the category "girls" includes girls and women, as well as some non-binary children and youth. For more information on the concept of gender, see Gender of Person Reference Guide.
Methodological adjustments have been made to account for age, gender and provincial differences.
Please note that gender is based on the gender reported back in 2019.
Please note that Self-rated mental health (SRMH) was measured with the question "In general, how is your mental health?" in the 2019 and 2023 CHSCY. Response options were "Excellent", "Very good", "Good", "Fair", and "Poor". Those who responded to the question with "Fair" or "Poor" were considered as having low SRMH.
Optimism toward school was measured with the question "How often do you look forward to going to school?" in the 2019 and 2023 CHSCY. Response options were "Never", "Sometimes", "Often", and "Always". This question was asked only to or about those who were enrolled in school, which included nearly all respondents.
This article does not distinguish between developmental and pandemic-related effects on youth mental health.
Contact information
For more information, or to enquire about the concepts, methods or data quality of this release, contact us (toll-free 1-800-263-1136; 514-283-8300; infostats@statcan.gc.ca) or Media Relations (statcan.mediahotline-ligneinfomedias.statcan@statcan.gc.ca).
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