ABSTRACT When depressive illness has its onset during adolescence it can exert a profound negative influence upon the individual and their daily functioning. Early identification of young people at risk of, or already experiencing, depressive symptoms is critical to enabling targeted intervention from clinicians, including occupational therapists. Early identification, however, is hampered by an incomplete understanding of how the disorder manifests in the daily lives of adolescents. The mental health determinants and sequelae of engagement in everyday activities represent core concerns of occupational therapists. As part of therapy with adolescents in Child and Youth Mental Health Services (CYMHS), occupational therapists endeavour to improve health by assessing time use, and engaging in interventions which explicitly target involvement in daily activity. Notwithstanding current practice, evidence for a link between actual time use and depressive symptom severity is scant. Background and Research Aims In this thesis the time use of adolescents is explored and related to depressive symptom severity in a series of three cross sectional studies. In keeping with ecologically- and occupation-focussed theoretical models of health and adolescent development (Bronfenbrenner & Morris, 2006; Poulsen & Ziviani, 2004; World Health Organization, 2002), a novel approach to the study of time use has been taken. The studies quantify the amount of time that adolescents are exposed to the various conditions inherent in activities and their ecological settings. In conceptualising time use as ‘exposure’, attention is drawn specifically to common affordances of activities. In this thesis these are described as ‘underlying dimensions’ of time use. Key underlying dimensions of interest include (a) ‘physical exertion’ in daily time use, (b) time spent with different social partners, and (c) time engaged in structured activities. The studies make use of cumulative estimates of time use by summing each episode of exposure to the underlying dimensions of time use, across the out-of-school hours. This research was conducted with the aims of (a) aiding early identification of adolescents who are vulnerable to depressive illness, (b) examining the evidence for the assessment of time use in CYMHS, (c) identifying aspects of adolescent time use which are appropriate targets for occupational therapists’ intervention, and (d) directing future research into the effectiveness of time use-focussed interventions offered by occupational therapists to adolescents who are vulnerable to depressive illness. Methodology and Study Findings All the studies involve secondary analysis of interview and time diary data collected from a nationally representative sample of approximately 730 adolescents (13-18 years) participating in the Panel Study of Income Dynamics Child Development Supplement II. Data were gathered in 2002/2003 by the Institute of Social Research at the University of Michigan in America. Studies 1 and 2 employ ordinal logistic regression analyses to separately explore two of the underlying dimensions of time use, namely the physical exertion in daily activity, and the time spent engaged in activity alone or with key social partners (including parents, siblings and friends). These studies indicate that time devoted to physical activity of moderate to vigorous intensity does not predict depressive symptom severity, breadth of participation in sporting extracurricular activity may be protective against depressive illness for males. For both genders, factors related to the positive or negative aspects of social relationships (such as adolescents’ ratings of how close they felt to parents, and the extent of risky behaviour among friends) appear to be stronger predictors of depressive symptomatology than the actual amount of time engaged in activity with others. Study 3 is informed conceptually and methodologically by the findings of Studies 1 and 2, and uses structural equation modeling, to examine a complex multivariate model of time use and depressive symptoms. This model incorporates a large range of factors which are theorized to influence the qualitative experience of spending time in a given context (e.g., adolescents’ perceptions of friend acceptance, which may influence the psychological impact of a prolonged encounter with friends). Study 3 reveals that the quantity of time over the course of a weekday or weekend day that adolescents are exposed to different types of activity (e.g., structured extracurricular activity, shared activity with parents) has no direct association with depressive symptom severity. However, an indirect path is identified, whereby the amount of time devoted to joint activity with parents is linked with depressive symptom severity via adolescent perceptions of parent acceptance. Conclusions and Recommendations The studies of this thesis have shown that the conceptualisation and quantification of time use as cumulative exposure to some specific underlying dimensions of engagement, are of little direct assistance in identifying young people who are vulnerable to depressive illness, however, this information may inform a range of clinical practices for occupational therapists working in CYMHS. Information on time use is therefore worth gathering in such services, particularly when it provides insights into social contact. It has been clearly and consistently identified that time use and its links with depression cannot be fully appreciated without considering the nature of adolescents’ relationships with their social partners in time use. Findings indicate that when time spent engaged in joint activity with parents is scant, or when poor relationships with parents are reported, adolescents at risk of depression are likely to benefit from therapy which is directed towards enhancing the quantity and quality of parent-adolescent interactions. The significance of this research lies in the generation of evidence to support further research into time use and its implications for mental health. Greater support for the specialist role of occupational therapists in addressing time use concerns will be gained through future studies which explore the immediate affective experience of spending time in activity, the personal and environmental contextual factors which mediate these experiences, and the implications of such experiences for mental health. Further to the insights gained regarding time use and depressive illness, the thesis presents an approach to research (i.e., a secondary analysis) and research methodologies which may be used by occupational therapists to answer complex questions regarding occupational engagement across the lifespan. Keywords: Adolescence, Depression, Internalizing Disorder, Time Use, Time Diary, Physical Activity, Social Contexts, Structured Extracurricular Activity, Organised Activity, Structural Equation Modeling. Australian and New Zealand Standard Research Classifications (ANZSRC): 111714 Mental Health 100%.

Numerous researchers have examined school and student variables that can prevent school failure, dropping out, and the development of delinquent behaviors. Such research suggests that students who establish a strong connection to school early in their academic career have higher academic achievement, better attendance, and more school participation (J. D. Finn, 1989, 1993; Finn & Rock, 1997; Sirin & Rogers-Sirin, 2005). However, there is little research that evaluates mechanisms that could be used to intervene when older students are on course for failure or delinquency. The current study, therefore, attempts to expand on the understanding of precipitating factors for school connection by investigating a possible link between school connection, extracurricular activity participation (EAP), and the relationships with teachers, parents, and peers promoted through activity participation. Latent variable structural equation modeling was used to investigate whether relationships with teachers, parents, and peers mediate the effects of EAP on school connection across time. Data from the base year (8th grade), first follow-up (10th grade), and second follow-up (12th grade) waves of the National Educational Longitudinal Study: 1988-2000 (NELS:88) were used. Three latent variable panel models were created and analyzed; one each for Relationships with Teachers, Relationships with Parents, and Relationships with Peers as the mediating variables. Results supported previous literature in that models reflecting a reciprocal relationship between EAP and school connection were found to have the best fit. Additionally, latent variable structural equation models were constructed to simultaneously compare the influence of EAP on the three types of relationships (i.e., with teachers, parents, and peers) and their subsequent influence on school connection. Finally, a latent variable structural equation model was constructed to explore possible differences in the type of activity in which a student participates on their relationships with others and school connection. / text

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Les activités parascolaires sont de plus en plus reconnues comme un contexte favorisant le développement positif des jeunes, et ce, particulièrement pour les jeunes en milieu défavorisé. Toutefois, l’efficacité de ces interventions varie selon les programmes, leur contexte d’implantation, ainsi que les caractéristiques et l’engagement des jeunes. La présente étude se situe dans l’évaluation du programme La classe enchantée (CE), un programme d’activités parascolaires musicales offert depuis 2017 aux élèves de 4e année d’une école primaire montréalaise pluriethnique en milieu défavorisé. La CE vise spécifiquement à influencer positivement l’épanouissement des jeunes par l’apprentissage collectif de la musique ainsi que par un accès démocratique à ce programme. De façon à mieux comprendre le fonctionnement et les conditions optimales d’implantation de cette initiative novatrice, la présente étude a comme objectif général d’évaluer la mise en œuvre du programme. De façon plus précise, le premier objectif est de décrire le programme et d’identifier les obstacles et facilitateurs en lien avec son implantation. Le deuxième objectif vise ensuite à relever les composantes essentielles de la mise en œuvre favorisant l’engagement des jeunes, et plus largement, leur développement positif. Les données ont été recueillies sur un peu plus de deux ans auprès de quatre groupes d’acteurs, soit les participants, leurs parents, les enseignants de musique ainsi que l’équipe de direction du programme, et ce, principalement à partir d’entrevues. Dans une visée formative, les analyses descriptives et thématiques ont permis de dresser un portrait détaillé de la mise en œuvre de la CE et de ses facteurs d’influence à partir de la structure d’ensemble du modèle psychoéducatif. Parmi ceux-ci, l’instabilité du financement est ressortie comme étant un obstacle constant avec lequel la direction doit composer. Les résultats mettent également en valeur l’importance des enseignants, de la relation qu’ils créent avec les jeunes, mais également de leur expérience avec la clientèle qui est déterminante pour l’instauration d’un climat propice aux apprentissages. Enfin, certaines aptitudes de la direction ainsi que l’ajout d’une coordination à l’interne ressortent comme étant particulièrement importants au sein du programme pour que les acteurs de sa mise en œuvre s’ajustent efficacement aux obstacles rencontrés et répondent aux besoins des jeunes. L’étude dégage également des réflexions quant à l’utilisation de la structure d’ensemble du modèle psychoéducatif comme outil d’évaluation de la mise en œuvre. / Extracurricular activities are increasingly recognized as a context that promotes youth positive development, especially for those living in disadvantaged areas. However, the effectiveness of these interventions varies from one program to another, based on their implementation context, and according to youth characteristics and commitment. This study is part of the evaluation of the La classe enchantée (EC), an extracurricular music program offered since 2017 to 4th graders attending a multi-ethnic Montreal school located in a disadvantaged area. The EC specifically aims to positively influence youth development through collective music learning as well as through a democratic access to the program. In order to better understand the functioning and optimal conditions for implementing this innovative initiative, the present study aimed as a general objective to evaluate the implementation of the program. More specifically, our objectives were to describe the program and identify the obstacles and facilitators related to its implementation, as to identify the essential implementation components promoting youth engagement and positive development. Data were collected over two years among four groups of actors, namely the participants, their parents, the music teachers, and the program management team. Data were mainly collected from interviews. We relied on the psychoeducational model to draw a detailed portrait of the implementation of EC using descriptive and thematic analysis. Among the main factors associated with the program implementation, funding instability has emerged as a constant barrier for the management team. Our results also highlight the importance of the teachers and the relationship they create with their students, but also their experience with the clientele, which was decisive for the creation of an efficient learning climate. Finally, the management team skills as well as the addition of internal coordination stand out as being particularly important to allow program promoter to effectively adjust to obstacles and better meet student needs. The study also highlights important insight regarding the relevance of the psychoeducation model as an implementation tool as well as broader recommendations on the implementation of extracurricular activity programs.

Le présent projet avait comme objectif d’évaluer, chez des adolescents participant à une équipe sportive, si l’accompagnement d’un entraîneur humaniste formé par l’organisme Pour 3 Points (P3P) était associé à des niveaux d’anxiété sociale et généralisée inférieurs comparativement à l’accompagnement par un entraîneur n’ayant pas été formé par cet organisme. À partir des études faites au Québec sur l’organisme de P3P, il était attendu que les adolescents encadrés par un entraîneur humaniste auraient moins de symptômes d’anxiété sociale et/ou d’anxiété généralisée que les adolescents encadrés par un entraîneur « régulier ». Cette hypothèse a été testée auprès d’un échantillon (n = 144) constitué d’adolescents entre 12 et 17 ans (m = 14,404, ÉT = 1,611) issus de 15 équipes sportives provenant de milieux scolaires et communautaires de la grande région de Montréal. Ces adolescents étaient répartis en deux groupes, soit les adolescents encadrés par un entraîneur formé par P3P (n = 44) et les adolescents encadrés par un entraîneur régulier (n = 100). Des variables de contrôle, telles que le sexe, l’âge et l’indice de milieu socioéconomique ont été ajoutés aux analyses ANCOVA. Les résultats obtenus ne démontrent aucune différence significative entre le groupe P3P et le groupe non-P3P. Bien que l’hypothèse de recherche n’ait pas été confirmée, il demeure pertinent d’étudier le rôle des entraîneurs sportifs relativement aux symptômes anxieux des adolescents athlètes qu’ils accompagnent. Aucune étude ne s’était penchée sur l’impact potentiel associé au fait d’être encadré par un entraîneur humaniste sur les comportements intériorisés des adolescents. Ainsi, cette étude permet d’ouvrir le sujet pour de futures recherches. / The objective of this project was to evaluate, in adolescents participating in a sports team, whether the accompaniment of a humanist trainer trained by the organization Pour 3 Points (P3P) was associated with lower levels of social and generalized anxiety in adolescents participating in a sports team compared to coaching by a coach whom P3P has not trained. Based on studies done in Quebec on the P3P organization on the subject, we expected that adolescents supervised by a humanist coach would have fewer symptoms of social anxiety and/or generalized anxiety than adolescents accompanied by a "regular" trainer. This hypothesis was tested with a sample (n = 144) of adolescents between 12 and 17 years old (M = 14.404, SD = 1.611) from 15 sports teams from school and community settings in greater Montreal. These adolescents were divided into two groups, adolescents supervised by a coach trained by P3P (n = 44) and adolescents supervised by a regular coach (n = 100). We conducted ANCOVA analyses that accounted for control variables, such as gender, age, and socioeconomic status. The results showed no significant difference between the intervention and comparison groups. Although the research hypothesis has not been confirmed, it remains relevant to study the role of sports coaches concerning athlete-adolescents' anxiety symptoms. No study had looked at the potential impact of being accompanied by a humanistic coach on the internalized behaviors of youth. Thus, this study opens up the subject for future research.