Exploring Protective and Risk Factors for Mental Health Among Indigenous Youth in Canada

1. Introduction

Adolescence is a critical developmental period marked by rapid biological, psychological, and social changes, during which patterns of health behavior and emotional wellbeing are established (Jaworksa & MacQueen, 2015; Steinberg, 2014; Simón Márquez et al., 2025). Substance use, including alcohol consumption, often emerges during this period and has been consistently associated with mental health outcomes among youth, including depression, anxiety, and suicidality (Bolanis et al., 2020; Gobbi et al., 2019; Stewart et al., 2024). In Canada, alcohol remains one of the most used substances among youth, with approximately 57% of youth aged 15-19 reporting alcohol use in 2019, and prevalence increasing substantially across older adolescent age groups and high school students (Canadian Centre on Substance Use and Addiction, 2022; Health Canada, 2019). Among school-aged youth, recent national survey data indicates that approximately 22% of students in grades 7-12 reported alcohol use in the past 30 days, with prevalence increasing sharply across adolescence, from 6% in Grade 7 to 67% in Grade 12 (Health Canada, 2025). These increases underscore the developmental significance of adolescence as a period of developmental significance during which substance use patterns and related mental health risks become more established (Health Canada, 2025; Shaska et al. 2025).

Existing research, including systematic reviews and longitudinal studies, indicates that alcohol use is associated with increased risk of depressive symptoms, anxiety, and suicidal ideation, and poorer self-reported mental health among youth (Canadian Centre on Substance Use and Addiction, 2022; McCambridge et al., 2011; Pedersen & von Soest, 2015). For example, Canadian youth who report binge drinking and co-occurring depressive symptoms have been shown to experience significantly elevated risk of suicidality, relative to peers without either condition (Archie et al., 2011). These associations are particularly important during adolescence, as youth are navigating identity development, emotional regulation, and social influences that shape both substance use and mental health trajectories (Geoffroy et al. 2024; Steinberg, 2014).

Despite this growing body of literature, relatively little research has examined these relationships among Indigenous youth. Indigenous youth in Canada experience unique developmental contexts shaped by ongoing structural inequities, including the enduring impacts of colonization, intergenerational trauma, and systemic barriers to health and social resources (Kirmayer et al., 2011; Reading & Wien, 2009). Within this context, substance use among Indigenous youth must be understood as occurring with broader social and historical determinants of health. Recent Canadian longitudinal research with First Nations youth has demonstrated that alcohol use increases progressively across adolescence, and that periods of increased alcohol consumption are prospectively associated with elevated symptoms of depression and anxiety at subsequent assessment points (Reynolds et al., 2024). Complementary research has similarly demonstrated that alcohol use and depressive symptoms frequently co-occur among Indigenous youth, particularly in the context of historical trauma, disrupted cultural continuity, and social marginalization (Bombay et al., 2014; Stewart et al., 2024). Together, these findings suggest that alcohol use may both reflect and contribute to broader mental health challenges among Indigenous youth.

At the same time, Indigenous communities demonstrate considerable resilience, with protective factors such as cultural continuity, community engagement, and connection to land playing a critical role in supporting youth wellbeing (Hatala et al., 2020; Chandler & Lalonde, 1998). Building on this broader evidence, recent work from the Smart Indigenous Youth (SIY) initiative provides important insight into how Indigenous youth in Canada conceptualize mental health and wellbeing within these contexts. In qualitative focus group discussions, youth described mental health as closely connected to relationships, cultural identity, and opportunities for meaningful participation in community life (Kannan et al., 2022; Walker et al., 2023). During the COVID-19 pandemic, the SIY study further demonstrated that disruptions to routine, social connection, and physical activity were associated with increased psychological distress, while engagement in family, community, and cultural practices supported resilience (Kannan et al., 2025). Similarly, in a study conducted among 28 Indigenous youth aged 16-25 in Saskatoon, Saskatchewan, Hatala et al. (2020) found that engagement with land, nature, and culturally grounded community spaces supported resilience and emotional wellbeing among Indigenous youth.

From a developmental perspective, gender is also an important factor shaping both substance use and mental health during adolescence. Research has consistently shown that adolescent girls report higher levels of internalizing symptoms, including anxiety and depression, whereas boys are more likely to report externalizing behaviors, including earlier substance use initiation and higher rates of conduct relate behaviours (Askari et al., 2021; Gobbi et al., 2019; Pedersen & von Soest, 2015; Public Health Agency of Canada, 2022; Statistics Canada, 2024).

Within Indigenous determinants of health (IDOH) research, health and wellbeing are conceptualized as shaped by interconnected social, cultural, environmental, and structural determinants rather than isolated individual behaviours. This framework emphasizes the role of cultural continuity, community relationships, access to resources, and connection to land in supporting youth wellbeing (Reading & Wien, 2009; Greenwood et al., 2018). In parallel, the Two-Eyed Seeing approach (Etuaptmumk) provides a methodological and interpretive lens through which Indigenous and Western ways of knowing can be brought together, supporting a more holistic understanding of mental health, substance use, and resilience among Indigenous youth (Bartlett et al., 2012; Bartlett et al., 2015). This perspective is particularly relevant to the present study, which seeks to interpret substance use and mental health within both behavioural and culturally grounded frameworks.

The present study builds on this body of work by examining the association between alcohol use and self-reported mental health among Indigenous adolescents participating in the SIY initiative. In addition, this study examines the role of gender and engagement in land-based activities in shaping mental health outcomes. By situating substance use within culturally and developmentally informed frameworks, this study contributes to nuanced understanding of adolescent mental health and supports culturally grounded approaches to Indigenous youth wellbeing.

2. Materials and Methods

2.1. Study Design and Context

This study used cross-sectional survey data from the 2018 phase of the SIY initiative, a community-driven digital citizen science program conducted in rural First Nations communities in Saskatchewan, Canada (Katapally, 2020). Although SIY employs a broader mixed-methods and participatory research design, the present analysis was limited to the quantitative baseline survey component. The analytic sample included Indigenous youth aged 13–18 years (N = 64). Consistent with participatory Indigenous health research approaches, youth were engaged as citizen scientists in the broader SIY initiative, contributing to data collection processes and interpretation of findings (Kannan et al., 2022; Walker et al., 2023). Citizen science refers to a participatory research approach where community members are active contributors to the generation, interpretation, and application of knowledge, rather than solely serving as research subjects (Bonney et al., 2016). Digital citizen science includes the use of digital devices (i.e., smartphones) that allowed youth to contribute contextually grounded, real-time data, while informing how findings were translated into community action (Katapally, 2019). This approach aligns with prior SIY research demonstrating that participatory digital citizen science methods can effectively capture youth experiences and support contextually grounded interpretations of mental health and wellbeing (Kannan et al., 2022; Katapally, 2020).

Participation was voluntary, and informed consent was obtained from all participants (Katapally, 2019). The study adhered to OCAP^® principles (FNIGC, 2014). Ethical approval was obtained from a harmonized Research Ethics Board at the University of Regina and University of Saskatchewan (REB #2017-29), with additional approval for secondary analysis from the Toronto Metropolitan University REB (REB #2025-536) on December 15th, 2025. All procedures followed TCPS2 Chapter 9 guidelines and community-informed data governance protocols.

2.2. Variables of Interest

The primary outcome was self-reported mental health, where youth were asked, “in general, how would you say your mental health is?” Raw response options included “poor, fair, good, very good, excellent, and I don’t know”. This variable was coded as binary (0 = poor and fair; 1 = good, very good, and excellent), with “I don’t know” re-coded into ‘N/A’ or non-response and treated as missing. This approach aligns with prior research examining youth mental health as both a risk and protective factor (Keyes, 2007). Alcohol use was measured by asking, “have you ever consumed alcohol in your life?”, with response options of “yes” or “no”., Both raw and cleaned responses were represented in binary form (0 = none; 1 = any), capturing both current and past use.

Gender (male/female) and participation in land-based activities were included as key covariates. Land-based activity was captured by asking: “do you currently participate in any activities out on the land (i.e., hunting, trapping, fishing)?” with response options ‘yes’ or ‘no’. Additional sociodemographic covariates were also explored. Youth were asked “what is your household income”, with response options: ‘under $10,000’, ‘$10,000-$20,000’, ‘$20,000-$30,000’, ‘$30-000-$40,000’ and options continuing in $10,000 increments until $100,000, when the final response option was ‘$100,000 or more’. This was recoded to 0= <$50,000, and 1= >$50,000. Youth were also asked “what is the highest level of education your guardian/caregiver has attained?”, with response options of: ‘elementary school’, ‘some secondary/high school’, ‘completed secondary/high school’, ‘some post-secondary (college or university)’, ‘received university or college degree/diploma’ and ‘don’t know/does not apply’. These were recoded as 0=completed secondary/high school or below, and 1= some post-secondary or above.

2.3. Analytic and Sample Considerations

Initial bivariate analyses were conducted to examine associations between alcohol use and self-reported mental health. Additional logistic regression modelling assessed the adjusted association between alcohol use and mental health, controlling for retained covariates. To account for the modest sample size and potential sparsity in contingency tables, Fisher’s exact tests were also conducted to examine bivariate associations between alcohol use and self-reported mental health (Soetewey, 2020). In addition, stratified descriptive statistics and stratified Fisher’s exact tests were conducted by gender (male/female) and age group (13-15 vs. 16-18 years) to explore potential effect heterogeneity.

As this study involved secondary analysis of an existing cross-sectional dataset, a formal a priori sample size calculation was not conducted. Instead, sample size considerations were addressed retrospectively through an a priori power sensitivity analysis, which indicated that the available analytic sample (N= 64) was sufficient to detect moderate to large effects, while smaller associations may not have been detectable. Given the relatively small sample size and the number of covariates included in multivariable models, findings were interpreted cautiously, with particular attention to the width of confidence intervals and estimated precision.

3. Results

3.1. Sample Characteristics

The sample consisted of 64 Indigenous adolescents aged 13–18 years. Mental health and substance use varied across participants. Following multiple imputation, 50.0% of youth reported positive self-reported mental health, and 57.8% reported having consumed alcohol. The sample was evenly distributed by gender (53.1% female; 46.9% male). Most participants were aged 13–15 years (79.7%), with a smaller proportion aged 16–18 years (20.3%). Full sample characteristics are presented in Table 1.

3.2. Bivariate Associations

Bivariate analyses were conducted using Fisher’s exact tests to examine associations between alcohol use and self-reported mental health. Alcohol use was significantly associated with lower odds of reporting positive mental health (OR = 0.31, 95% CI [0.09-0.96], p = 0.042). In contrast, other behavioural and contextual variables showed weaker or non-significant associations with mental health in bivariate analyses. Results presented in Table 2.

3.3. Stratified Analyses by Gender and Age

Stratified analyses were conducted to explore whether the association between alcohol use and mental health differed by gender and age group. Among female youth, alcohol use was associated with lower odds of positive mental health (OR = 0.44, p = 0.434). A similar pattern was observed among male youth (OR = 0.32, p = 0.236), depicted in Table 3, although neither association reached statistical significance.

Descriptive differences between genders were notable, visualized further in Table 4. Male youth were substantially more likely to report positive mental health compared to female youth (70.0% vs. 32.4%). Conversely, female youth reported higher rates of alcohol use (67.6% vs. 46.7%).

Age-stratified analyses, presented in Table 5, suggested a similar pattern. Among youth aged 13–15 years, alcohol use was associated with lower odds of positive mental health (OR = 0.31, p = 0.051), approaching statistical significance.

Age-stratified Fisher’s Exact Tests, presented in Table 6, were conducted to examine associations between alcohol use, mental health, and suicidal ideation separately among younger (13-15 years) and older (16-18 years) participants. Among youth aged 13-15 years, alcohol use was associated with lower odds of positive self-reported mental health (OR = 0.31, 95% CI [0.08–1.09], p = 0.051), approaching statistical significance. In contrast, no statistically significant association was observed among youth aged 16-18 years (OR = 0.00, 95% CI [0.00–3.76], p = 0.231), although interpretation was limited by the small subgroup sample size.

3.4. Multivariable Analyses

Multivariable logistic regression analyses were conducted to assess whether alcohol use remained associated with mental health after adjustment for gender. In adjusted models, alcohol use was no longer significantly associated with self-reported mental health (OR = 0.64, 95% CI [0.10–3.93], p = 0.631). However, gender emerged as a significant predictor. Male youth had substantially higher odds of reporting positive mental health compared to female youth (OR = 4.99, 95% CI [1.65–15.10], p = 0.004). These findings are presented in Table 7. Other sociodemographic variables were explored; however, were not retained in final models due to poor model fit and limited contribution to explanatory power.

3.5. Gender Differences in Contextual Factors

Additional analyses, presented in Table 8, were conducted to examine gender differences in behavioural and contextual variables. Male youth had significantly higher odds of participating in land-based activities compared to female youth (OR = 3.1, 95% CI [1.01–9.99], p = 0.044). Although not statistically significant, male youth also demonstrated lower odds of alcohol use relative to female youth (OR = 0.42, p = 0.129).

These findings suggest that gender differences in engagement with culturally and behaviorally relevant factors may contribute to observed differences in self-reported mental health outcomes.

4. Discussion

This study examined the relationship between alcohol use, gender, and self-reported mental health among Indigenous youth. While alcohol use was associated with poorer mental health at the bivariate level, this relationship was not statistically significant in adjusted models. These findings align with a growing body of adolescent literature suggesting that the relationship between substance use and mental health is complex, dynamic, and influenced by multiple developmental and contextual factors (Reynolds et al., 2024; Gobbi et al., 2019; Pedersen & von Soest, 2015). This attenuation following adjustment is consistent with broader youth mental health literature indicating that gender and social support structures can meaningfully shape observed associations (Geoffroy et al., 2024; Bolanis et al., 2020). Within Indigenous youth contexts, this relationship must also be interpreted within broader relational and structural determinants of health, including community connectedness, cultural continuity, and access to supportive resources (Hatala et al., 2020; Reading & Wien, 2009).

Importantly, qualitative findings from the SIY initiative provide critical insight into how these relationships may be understood within Indigenous contexts. Kannan et al. (2022) found that Indigenous youth described mental health as relational and holistic, emphasizing connection to family, peers, culture, and community. Similarly, Kannan et al. (2025) demonstrated that disruptions to these connections during COVID-19 school closures were associated with increased psychological distress, including feelings of isolation and reduced wellbeing. While these qualitative studies did not directly examine alcohol use, they offer important contextual evidence regarding the relational and emotional environments that shape youth wellbeing. Broader adolescent literature has consistently shown that alcohol use is associated with emotional distress, perceived social disconnection, and poorer mental health outcomes (Gobbi et al., 2019; Bolanis et al., 2020; Geoffroy et al., 2024). Taken together, these findings support interpreting alcohol use as embedded within a broader network of relational and emotional experiences rather than as an isolated behavioural risk factor.

From this perspective, the non-significant association observed in adjusted models may reflect the influence of broader relational and contextual factors that shape youth mental health. For example, engagement in culturally grounded activities, strong family support, and opportunities for meaningful participation in community life may buffer the potential negative effects of substance use (Hatala et al., 2020; Walker et al., 2023; Kannan et al., 2025). Recent evidence further suggests that culturally centred and community-led supports, including land-based learning, peer support, and access to traditional teachings, are associated with enhanced wellbeing, stronger identity development, and greater resilience among Indigenous youth (Thorburn et al., 2025; Li & Glecia, 2025). Together, these findings suggest that mental health outcomes are shaped by the interplay between behavioural risk factors and protective relational, cultural, and community resources, consistent with qualitative SIY findings that emphasize the protective role of cultural engagement and community connection in fostering youth resilience. (Kannan et al., 2025; Walker et al., 2023).

Gender emerged as a significant predictor of mental health, with male youth more likely to report positive self-reported mental health than female youth in the adjusted model. This finding is consistent with broader adolescent literature indicating that girls more frequently report internalizing symptoms, including anxiety, depressive symptoms, and emotional distress during adolescence (Geoffroy et al., 2024; Gobbi et al., 2019). However, within the present study, this pattern may also reflect differences in how wellbeing is experienced, expressed, and supported across gender. For instance, girls may be more likely to recognize and disclose emotional distress, whereas boys may experience distress through behavioural or externalizing pathways that are less directly captured by global self-report mental health measures (Pedersen & von Soest, 2015; Rice et al., 2021). These findings suggest that gender may shape distinct pathways to both risk and resilience in adolescent mental health.

Stratified analyses further supported these findings, demonstrating consistent directional associations between alcohol use and poorer mental health across both gender and age groups, although these results did not reach statistical significance within subgroups. This likely reflects limited statistical power rather than the absence of an underlying relationship. Descriptively, female youth reported higher rates of alcohol use and lower levels of positive mental health, whereas male youth demonstrated higher engagement in land-based activities and more favourable mental health outcomes. Age-stratified findings suggested that the association between alcohol use and mental health may be more pronounced among younger adolescents, although estimates among older youth were unstable due to small subgroup sizes. Together, these patterns highlight the importance of considering heterogeneity in youth experiences when interpreting associations between substance use and mental health.

Notably, male youth were also more likely to report participation in land-based activities. This finding is particularly important when considered alongside qualitative SIY findings, which has identified land-based programming as a key mechanism for promoting youth wellbeing through cultural connection, identity development, and community engagement (Kannan et al., 2022; Walker et al., 2023). These patterns suggest that gender differences in mental health may, in part, reflect differences in access to or engagement with culturally protective resources.

From an Indigenous Determinants of Health Perspective, these findings reinforce the importance of situating substance use within broader social, cultural, and historical contexts (Reading & Wien, 2009). Alcohol use among Indigenous youth cannot be understood solely as an individual behaviour, but rather as a response shaped by intersecting structural conditions, including colonization, intergenerational trauma, and inequitable access to resources (Kirmayer et al., 2011; Bombay et al., 2014). For instance, Bombay et al. (2014) found that the intergenerational impacts of the Residential School system continue to influence mental health through pathways of family disruption, unresolved trauma, and chronic psychosocial stress. This suggests that substance use among Indigenous youth may, in part, be understood within broader histories of colonial disruption and trauma-informed coping processes rather than solely as an individual-level risk behaviour.

Applying a Two-Eyed Seeing framework (Bartlett et al., 2012), these findings highlight the importance of integrating Western behavioural models with Indigenous relational perspectives. While Western approaches emphasize measurable associations between substance use and mental health outcomes, Indigenous frameworks conceptualize wellbeing as holistic and relational, emphasizing the interconnected nature of physical, emotional, mental, and spiritual domains, as well as relationships with community, culture, and the land (Bartlett et al., 2012; Indigenous Services Canada, 2015; Reading & Wien, 2009). Together, these perspectives suggest that interventions should move beyond individual behaviour change and instead prioritize culturally grounded, community-led approaches that strengthen relational and environmental supports for youth.

Future research should prioritize culturally grounded, community-led approaches to adolescent mental health, particularly within Indigenous youth contexts. This includes research that is co-developed with youth, elders, and community partners, and that centres strength-based protective factors while creating meaningful opportunities for participation. There is also a need for longitudinal and mixed-methods studies to examine how substance use, mental health, and culturally protective resources interact across developmental stages of adolescence. In addition, future intervention research should evaluate the effectiveness of community-led and culturally responsive mental health supports in promoting resilience, strengthening identity, and reducing substance-related harms among Indigenous youth.

5. Strengths and Limitations

The study’s strengths include its community-driven design, participatory approach, and the integration of culturally and contextually relevant variables, including land-based activity and sense of belonging, which are highly pertinent to Indigenous youth wellbeing. The use of data from the Smart Indigenous Youth (SIY) initiative further strengthens the study by situating the analysis within a broader framework of youth engagement, citizen science, and community-informed knowledge generation. In addition, the inclusion of culturally grounded indicators alongside behavioural and demographic variables supports a more holistic understanding of youth mental health.

However, several limitations should be acknowledged. First, the relatively small sample size limited statistical precision, likely contributing to the wide confidence intervals observed for several estimates, and restricting the stability and fit of more complex multivariable models. Consequently, sociodemographic covariates could not be retained in the adjusted analyses, representing an important limitation, as these factors may have confounded the observed associations. Second, the cross-sectional design precludes causal inference and limits the ability to determine temporal ordering between predictors and mental health outcomes. Third, reliance on self-report measures may introduce reporting bias, such as recall bias and social desirability bias, particularly for sensitive variables such as alcohol use and mental health. Given the relatively small sample size, a power sensitivity analysis was conducted to assess the minimum detectable effect size. Findings indicated that the study was adequately powered to detect moderate to large effects but may have been underpowered to detect smaller associations. Accordingly, both statistical significance and effect size estimates were considered in interpretation, and findings should be understood as exploratory and interpreted with appropriate caution.

6. Conclusions

This study highlights the complex relationship between alcohol use and mental health among Indigenous adolescents. Findings underscore the importance of gender and cultural engagement in shaping youth wellbeing. Collectively, these results suggest that mental health and substance use support should move beyond individual behaviour change models and instead prioritize culturally grounded and community-led approaches that strengthen relationships, cultural continuity, and land-based engagement. These findings further emphasize the need to consider gendered pathways to both distress and resilience in intervention design and future research.