Trends in Well-Being Among Youth in Australia, 2017-2022

Key Points Question Has children’s well-being changed from 2017 to 2022, and do these changes vary by sociodemographic characteristics? Findings This longitudinal analysis of annual cross-sectional data of students (40 392 to 56 897 per year) in South Australian schools revealed a decline in children’s well-being since 2017, which has been particularly pronounced since 2020. The data show persistent declines in well-being from 2020 through 2022, with significant sociodemographic disparities. Meaning The findings underscore the need for effective interventions sensitive to age and sex to support the well-being of all children.


Introduction
Well-being encompasses various dimensions of psychological, physical, and social experiences. 1ong youth, higher well-being is positively associated with lifestyle behaviors such as healthy eating and exercise 2 and negatively associated with smoking, alcohol, and drug use. 3Furthermore, higher well-being is associated with higher internal locus of control, self-esteem, intrinsic motivation, 4 academic achievement, [5][6][7] satisfaction with schooling, 8 and fewer school discipline problems. 9ere is a growing emphasis on monitoring and enhancing student well-being worldwide.The Programme for International Student Assessment 10 now reports internationally comparable wellbeing outcomes for students across 90 countries.In South Australia, an annual Well-being and Engagement Collection (WEC) 11 census began in 2017.A cross-sectional analysis of the 2019 WEC reported that between 13% and 25% of students aged 8 to 18 years (n = 75 966) experienced low well-being (defined in the study as scoring <2 on a scale ranging from 1-5). 12 Almost half of the sample (40.7%) experienced low well-being on at least 1 indicator, with socioeconomic-, age-, and sex-related differences observed.However, to date, WEC well-being analyses have been crosssectional.It remains unknown whether South Australian students' well-being has improved, worsened, or remained stable over time.
The COVID-19 pandemic and its restrictions have caused significant disruptions to school and community well-being programs.School closures, isolation, social distancing, and cancelled extracurricular activities have impacted how young people learn, socialize, and play.Physical activity has decreased while sedentary time has increased. 13Recreational screen time has increased by an estimated 52% (an additional 84 minutes per day). 14,15Rates of obesity, nutritional deficiency, and fast food consumption have increased. 16,17nce the COVID-19 pandemic began, poor mental health has become an increasing concern. 182022 rapid review found 7 longitudinal studies of changes in youth well-being. 19Six of these studies (5 European and 1 Australian) reported worse well-being during the pandemic compared with the prepandemic period.Certain demographic groups may be at increased risk, such as those in rural and remote areas or culturally and linguistically diverse families, who already face the greater risk of poorer health outcomes. 20Although COVID-19 has impacted youth well-being, it remains unclear how much it has affected different sociodemographic groups.Therefore, this study aimed to examine how well-being has changed over the past 6 years (2017-2022) among South Australian students and how these changes differed by sociodemographic factors.

Participants
The WEC survey was mainly conducted online, with some schools using a paper-based format.Data linkage was available only for government (public) schools, not private (independent or Catholic) schools.A parental opt-out consent process was used to maximize participation rates and ensure data representativeness.Students had the option to withdraw from the survey or not answer specific questions.Only students in grades 4 to 9 (approximate ages, 9-14 years) with complete data for at least 1 of the study waves were included in the analytical sample.Students attending non-mainstream schools (eg, special schools for students with a disability) or with missing data were excluded.categorical variable.Raw and standardized β values representing changes in well-being for each year, compared with the reference year of 2017, were reported, and marginal means over time (from 2017 to 2022) were derived for the well-being measures.

Interactions Between Well-Being and Sociodemographic Characteristics
Interactions between calendar year and sociodemographic characteristics of sex, school grade, highest parental education, main language spoken at home, and residential region were included in the mixed-effects linear regression models described above.The models were used to estimate marginal means across the various levels of the sociodemographic characteristics over time.
Estimates were plotted to aid interpretation of differences in well-being between sociodemographic groups and how the well-being measures changed differentially by sociodemographic group over time.All analyses were carried out with R statistical software (R Foundation) 33 using the lme4 34 package.

Participant Characteristics
In 2017, the largest analytical sample included 41 448 participants, with a mean (SD) age of 12.1 (1.7) years (21 393 [51.6%] males).Between 2017 and 2022, the analytical samples included 25% to 35% of all South Australian government school students in grades 4 through 9.Over the 6 years, total analytical samples ranged between 118 187 participants for cognitive engagement and 119 033 for optimism (eFigure 1 in Supplement 1).Characteristics of the largest analytical sample are shown in the Table.Each year, there were approximately equal distributions of students in grades 4-5, 6-7, and 8-9 and most parents had a diploma (45%-50%).Most students were from major cities (69%-72%) and primarily spoke English at home (81%-87%).eTable 1 in Supplement 1 compares sociodemographic characteristics of included participants with excluded participants.

Sex
There were differences in well-being by sex, with female students almost always reporting the poorest well-being for satisfaction, optimism, happiness, emotional regulation, worry, and sadness.
Between 2017 and 2019, the differences between the sexes for these measures were small (range, 0.00 to 0.17; SMD range, 0.00 to 0.16), but from 2020 on, differences widened.By 2022, females had worse well-being than males on all these measures, with differences of up to 0.43 (SMD, 0.41) for worry and 0.35 (SMD, 0.34) for sadness.In contrast, females had higher well-being scores than males for cognitive engagement and perseverance.In earlier years (2017 to 2019), differences were as high as 0.20 (SMD, 0.25) for cognitive engagement and 0.22 (SMD, 0.24) for perseverance.However, from 2020 onward, these measures worsened for females while they stayed relatively constant for males.By 2022, cognitive engagement and perseverance scores for both sexes converged.

School Grade
For all well-being measures, the poorest well-being was consistently reported by participants in higher school grades.Across the 6 years, well-being measures in grades 8 and 9 were between 0.10 (SMD, 0.10) and 0.38 (SMD, 0.41) units worse than those in grades 4 and 5.There was a widening of the well-being gap between students from grades 8 and 9 and students from grades 4 and 5 from 2019 onward for satisfaction, happiness, and perseverance.The largest widening was observed for satisfaction, with differences between the 2 school grade groups increasing from −0.29 (SMD, 0.32) in 2020 to −0.36 (SMD, 0.40) in 2022.

Parental Education
Students with parents of the highest education level consistently reported better well-being than students with parents of the lowest education level.Except for emotional regulation, for which differences by parental education appeared negligible, differences in well-being measures between

Not English
Primary language spoken at home English All models include random intercepts to account for repeated observations within participants and clustering at the school level.Plots for region of residence can be found in eFigure 2 in Supplement 1.
those of the highest and lowest parental education levels ranged from 0.10 (SMD, 0.13) to 0.28 (SMD, 0.29) across the 6 years.Differences appeared relatively consistent over time.

Not English
Primary language spoken at home English All models include random intercepts to account for repeated observations within participants and clustering at the school level.Plots for region of residence can be found in eFigure 2 in Supplement 1.

Language Spoken at Home
Consistently, students speaking primarily not English at home reported better well-being than those primarily speaking English at home.Differences in worry and sadness were negligible from 2017 to 2019, after which they increased slightly to a maximum of 0.14 (SMD, 0.15) for sadness by 2022.For the remaining well-being measures, differences were larger, ranging between 0.07 (SMD, 0.08) for

Not English
Primary language spoken at home English All models include random intercepts to account for repeated observations within participants and clustering at the school level.Plots for region of residence can be found in eFigure 2 in Supplement 1. satisfaction and 0.26 (SMD, 0.28) for emotional regulation.These differences were relatively consistent over time.

Residential Region
There were small and inconsistent differences in well-being by residential region.Students residing in outer regional/remote settings tended to have higher well-being than those residing in major cities.Across the 6 years, differences ranged from 0.05 to 0.09 (SMD range, 0.05-0.12)for satisfaction, 0.04 to 0.09 (SMD range, 0.05-0.11)for optimism, and 0.04 to 0.11 (SMD range, 0.04-0.12)for emotional regulation.

Discussion
This study found that well-being among South Australian school students in grades 4 through 9 tended to decline over the 2017-2022 period, particularly so after 2019, coinciding with the 2020 COVID-19 pandemic.Sociodemographic groups with lower well-being were most notably students of female sex and those in higher school grades (ie, grades 8-9), with well-being differences of up to approximately 0.4 SDs between groups.In addition, students with parents of lowest vs highest education levels and students speaking mainly English vs speaking mainly not English at home had well-being up to approximately 0.3 SDs lower.Well-being differences by residential region were small (up to approximately 0.1 SDs).Sociodemographic disparities were generally consistent over time, but from 2020 onward, well-being gaps widened slightly by sex and school grade.
Well-being was associated with numerous sociodemographic characteristics, aligning with previous literature indicating that females, older children, children of low socioeconomic status, and children from urban settings had worse well-being. 35,36However, children from households speaking languages other than English reported higher well-being, which contrasts with previous research on racial and ethnic inequalities in children's health and well-being.A systematic review of 121 studies revealed mixed and complex associations between race and well-being, with some studies suggesting that racial discrimination may actually be associated with higher self-esteem and resilience. 37These associations between well-being and race and ethnicity are likely influenced by a range of complex factors, including worldviews, spirituality, social support, family values, and household structure.
A key finding of this study is that children's well-being declined at a greater rate from 2020 on, which coincides with the declaration of the COVID-19 pandemic. 38Although the reductions in wellbeing appear relatively modest (up to approximately 0.2 SDs), even small effect sizes can have an impact at the population level. 39These findings are consistent with earlier research indicating that the pandemic has had negative impacts on mental health in the US, 40 Germany, 41 and Canada, 42 with factors such as social isolation 41 ; cancellation of important events such as graduations, sporting games, and school trips 42 ; increases in recreational screen time; less physical activity; and sleep disturbances 43 contributing to these trends.
Of concern is that the results of this study show that many of the well-being metrics are worsening over time in children of the same age.This is distinct from the well-documented "worsening with age" decline in children's well-being. 35,44This trend was apparent prior to the onset of COVID-19.A previous systematic review of temporal trends in children's well-being had mixed findings, with 10 studies indicating worsening well-being and 13 studies indicating stable or improving well-being over time. 45The authors concluded that there may have been a minor decline in well-being between 1980 and the 2000s, but that well-being was stable since 2010. 45In contrast, the current findings suggest continuing deterioration.This is consistent with wider trends, such as increasing use of social media and technology, 46 increasing rates of obesity, 47 and declining physical activity, 48 which have all been linked with decreased well-being. 35,49,50sults show that declines in children's well-being since the COVID- that despite the end of lockdowns, they continued to experience psychological distress, without returning to their pre-COVID-19 pandemic levels of well-being. 51There is suggestion that children's heightened use of social media and screen time 15 and reduced physical activity 52 have not returned to their pre-COVID-19 pandemic levels, 53 which may be contributing to these trends.
For most well-being markers, the sociodemographic differential appeared to hold constant over time, or slightly widen.The well-being gaps between sexes in both worry and sadness widened considerably over time, as did the gap between older (grade 8-9) and younger (grade 4-5) children.
These findings identify groups that may be at heightened focus for well-being promotion programs and provide clues about protective factors that may be incorporated into interventions.
A major strength of this study is the very large sample that has been followed up for several years.A large battery of well-being measures of existing tools with established psychometric properties was used.

Limitations
This study has several limitations.First, limitations include unavailability of sociodemographic data from students at private schools, thus only students attending government schools (who have relatively lower SES) were represented.There were also no data from children in home schooling.
Yet, most schools in South Australia (approximately 70%) are government schools and approximately 60% of students in grades 4-9 attend government schools.Second, when deciding what sociodemographic factors to explore, there were limitations on what was available from data linkage with school enrollment data.Third, there were inconsistencies in how sex data were collected across the years, meaning that the subgroup with responses of indeterminate and other in 2019 could not be analyzed longitudinally.Fourth, those speaking a language other than English were underrepresented in the included sample, and increasingly so over time.If included students had better English-language skills or parental engagement with their child's school than excluded students, this could have biased the findings toward increasingly better well-being over time for those speaking a language other than English at home.

Conclusions
This study found that the general decline in student well-being has worsened since the onset of COVID-19.Poorer well-being was found among students of female sex, those in later school grades (ie, grades 8-9), those with parents of lower education levels, and those speaking mainly English at home.For sex and school grade, well-being disparities appeared to increase from 2020 onwards.
Interventions targeting the ongoing mental health effects of the COVID-19 pandemic are needed, particularly for sociodemographic groups with the poorest well-being.

Figure 2 ,
Figure 2, Figure 3, and Figure 4 show marginal means of the well-being measures from 2017 to 2022for each of the socioeconomic characteristics (plots for region of residence are included in eFigure 2 in Supplement 1).From the figures, socioeconomic differences in well-being can be observed (the vertical spacings between colored lines are up to 0.44 units [SMD, 0.43 units] apart).Although

Figure 1 .
Figure 1.Changes in Well-Being Over Time

Figure 2 .
Figure 2. Model-Estimated Marginal Means of Satisfaction, Optimism, and Happiness Over Time by Sociodemographic Characteristics

Figure 3 .
Figure 3. Model-Estimated Marginal Means of Cognitive Engagement, Emotional Regulation, and Perseverance Over Time by Sociodemographic Characteristics