Life meaning and purpose as an unrecognized determinant of mental health equity in Canadian adolescents

The etiological pathways through which structural determinants result in health inequities remain unclear. In adolescent populations, a sense of meaning and purpose in life has been hypothesized and considered cross-sectionally to represent an intermediary determinant in the pathway that connects wealth with mental health outcomes. The purpose of this study was to prospectively explore how life meaning and purpose contributes to disparities in mental health observed by affluence in an adolescent cohort.

We used two-year linked survey data collected from a cohort of 17,745 students at Canadian secondary schools in 2020/2021 and 2021/2022. Structural equation models were used to examine the prospective associations between students' perceived relative family affluence and anxiety and depression symptoms, mediated by their sense of meaning and purpose in their lives. Models were stratified by gender identity.

The prevalence of clinically-relevant depression and anxiety symptoms was lowest among cisgender boys and highest among transgender and gender diverse adolescents. Conversely, life meaning and purpose was reported most often by cisgender boys, followed by cisgender girls. Meaning and purpose in life partially mediated associations between relative affluence and depression and anxiety symptoms.

Consistent with determinants of health models and past cross-national analyses of adolescent health survey data in Canada, results provide prospective evidence in support of life meaning and purpose as an intermediary determinant of mental health in adolescents. Experiences that foster a sense of meaning and purpose in life require recognition as determinants of health, and suggest an intangible resource that can be applied to clinical and public health initiatives that address adolescent mental health.