The survey is based on anonymous self-reports from 11,108 students in grades 7 through 12, recruited from 246 schools across 42 Ontario school boards. Data were collected between December 2024 and June 2025, providing one of the most extensive recent assessments of adolescent mental health, substance use and risk behaviour in the province. Conducted every two years since 1977, the OSDUHS is Canada’s longest-running ongoing school survey of adolescents. Its long historical record allows researchers to distinguish short-term recovery from longer-term changes in youth well-being, substance use and exposure to potentially harmful environments.

The most encouraging findings concern the decline in several acute mental-health indicators since 2023. Forty-six per cent of students reported symptoms consistent with moderate-to-serious psychological distress, while 23 per cent reported serious psychological distress. Both measures have fallen significantly from their pandemic-era levels and have returned approximately to pre-pandemic estimates. Yet the longer view is considerably more troubling: a decade ago, moderate-to-serious distress affected 24 per cent of students and serious distress affected 11 per cent. In other words, the immediate shock associated with the pandemic has diminished, but the underlying burden of emotional suffering among adolescents has grown substantially over time.

Self-rated mental health shows the same pattern. Thirty per cent of students described their mental health as fair or poor, an improvement from 38 per cent in 2023 but twice the 15 per cent recorded a decade earlier. Self-rated mental health is not a clinical diagnosis, but it is a valuable population-level indicator because it reflects how individuals evaluate their own emotional and psychological functioning. Persistent increases in this measure can signal unmet needs that may not yet appear in formal diagnoses or treatment statistics. The survey also found that 29 per cent of students needed professional mental-health support during the previous year but did not seek it, although this proportion has declined significantly since 2023.

The reasons students gave for avoiding care reveal why improved indicators do not necessarily mean that support systems are working adequately. Many believed they should be able to manage their difficulties alone, worried that their parents would discover they were seeking help, or doubted that professional treatment would be effective. These barriers are especially significant during adolescence, when concerns about privacy, stigma and independence can strongly influence health decisions. Delayed care can allow distress to become more severe, interfere with school attendance and relationships, and increase the risk that young people will rely on maladaptive coping strategies. The findings suggest that access must be accompanied by confidential, credible and youth-friendly services that students trust enough to use.

Substance-use trends provide a more positive counterpoint. Alcohol, tobacco and several other substances remain at or near historic lows, continuing a decades-long decline among Ontario students. Compared with 2023, significantly fewer students reported vaping, using cannabis, taking prescription opioids for non-medical reasons, or misusing cough and cold medications. Nearly half of students—48 per cent—reported abstaining completely from alcohol, tobacco or nicotine, and cannabis. The decline may reflect changing social norms, prevention efforts, tighter regulation and reduced exposure to some traditional forms of substance use. However, falling rates for established products do not mean that the overall risk environment is disappearing; instead, it may be shifting toward newer products and behaviours.

Nicotine pouches are one of the clearest examples of that shift. Six per cent of students reported using them during the previous year, nearly twice the proportion who reported smoking tobacco cigarettes, at 3.5 per cent. These small, tobacco-free packets are placed between the lip and gum, where nicotine is absorbed through the oral lining and enters the bloodstream. Because they do not produce smoke, they can be used discreetly and may be perceived as less harmful than cigarettes. Their pharmacological risk, however, remains significant: nicotine activates receptors in the brain’s reward system, reinforces repeated use and can produce dependence. Adolescence is a particularly sensitive period because neural systems involved in impulse control, reward learning and decision-making are still developing. The survey also indicates that quitting vaping may be difficult for many students. Among those who vape, 65 per cent attempted to stop at least once in the past year and 39 per cent tried three or more times, suggesting repeated unsuccessful cessation efforts and possible nicotine dependence.

The digital environment is another defining influence on adolescent health. Nearly all students reported using social media every day, and 25 per cent spent at least five hours per day on these platforms. Seventy-eight per cent spent three or more hours in front of an electronic screen during free time. Although these figures have been relatively stable in the short term, they have climbed sharply over the longer term: in 2013, only 11 per cent reported five or more daily hours on social media, while in 2009, 55 per cent reported at least three hours of recreational screen use. Similar increases have occurred in videogaming. Digital platforms can provide social connection, information and entertainment, but high exposure may also intensify social comparison, cyberbullying, body-image pressure and contact with harmful material. The survey reports an association between greater social-media use and poorer self-reported mental health, although such findings cannot by themselves establish that screen use directly causes psychological distress. Distressed students may also turn to digital platforms more frequently, creating a potentially reinforcing cycle.

The sharpest emerging signal is online gambling. Twelve per cent of students reported gambling online during the previous year, up from 8 per cent in 2023. Online sports betting has expanded particularly rapidly, increasing from 1 per cent in 2019 to 10 per cent in 2025. Nearly one-quarter of students, 23 per cent, said they encountered online-gambling advertisements every day. Digital betting platforms remove many traditional barriers to participation: gambling can be accessed through a smartphone, integrated into sports broadcasts and promoted through personalized advertising. Intermittent rewards, near-misses and rapid feedback can stimulate powerful learning mechanisms in the brain’s reward circuitry, while the constant availability of betting may encourage repeated play. Adolescents may be especially vulnerable because systems governing risk evaluation and long-term planning continue to mature. The findings raise questions about how minors are bypassing age restrictions and how advertising, celebrity endorsements and sports-related promotions may normalize gambling before adulthood.

Taken together, the 2025 OSDUHS results portray a generation moving away from some traditional substances while confronting a more complex mixture of psychological, technological and commercial pressures. The easing of pandemic-related distress is an important sign of recovery, but it should not be mistaken for a return to healthy baseline conditions. Rates of serious distress, poor self-rated mental health and unmet demand for professional care remain elevated compared with the past. At the same time, nicotine pouches, persistent vaping, intensive social-media and videogame use, and rapidly expanding online betting are reshaping the conditions in which young people grow up. CAMH researchers say the results support stronger youth mental-health services, continued substance-use surveillance and tighter restrictions on gambling advertising, including limits on celebrity and athlete endorsements and promotions during sports broadcasts. The survey’s central message is both hopeful and urgent: the acute crisis may be receding, but the long-term health of Ontario’s students will depend on whether institutions respond to the newer risks now moving into everyday adolescent life.

Subject of Research: Mental health, substance use, digital-media use and online gambling among Ontario students.

Article Title: 2025 Ontario Student Survey Shows Pandemic Mental-Health Crisis Easing as Online Gambling and Nicotine Pouch Use Rise

News Publication Date: 24-Aug-2026

Web References: https://www.camh.ca/-/media/research-files/osduhs-mental-health-and-wellbeing-report_2023.pdf; https://www.camh.ca/en/science-and-research/institutes-and-centres/institute-for-mental-health-policy-research; https://www.camh.ca/-/media/driving-change-files/public-policy/camh-gambling-policy-framework-pdf.pdf

References: Centre for Addiction and Mental Health, 2025 Ontario Student Drug Use and Health Survey; Institute for Mental Health Policy Research, OSDUHS mental health and drug-use reports.

Keywords: adolescent mental health, Ontario students, psychological distress, youth substance use, nicotine pouches, vaping, cannabis, social media, videogaming, online gambling, gambling advertising, youth health, CAMH

Depression and anxiety, long recognized as major contributors to mental health burdens worldwide, often occur simultaneously, creating comorbidity that compounds the difficulty of clinical treatment and management. For medical students, who already face intense academic pressure and rigorous schedules, the co-occurrence of these disorders can produce devastating effects on both their personal well-being and educational outcomes. The researchers’ focus on the post-peak period of the COVID-19 pandemic is particularly timely, capturing the ongoing mental health repercussions after the initial crisis phases have subsided.

Network analysis, which maps out the interconnections between symptoms rather than treating depression and anxiety as isolated or simply additive conditions, serves as a powerful tool in this research. By conceptualizing symptoms as nodes and their relationships as edges in a network, the study identifies central symptoms that may serve as key drivers of distress. This methodological innovation allows for a more granular and dynamic understanding of how depression and anxiety coalesce to impair academic engagement, offering new potential intervention targets.

The findings reveal that certain symptoms, such as persistent sadness, worry, and concentration difficulties, occupy central positions within the network structure, bridging depression and anxiety and directly correlating with reduced academic engagement. These symptoms seem to form a feedback loop, where heightened emotional distress undermines students’ ability to focus, participate in learning activities, and maintain motivation, thus exacerbating their mental health decline and academic challenges.

Sun and colleagues’ work further uncovers the role of academic engagement as not just an outcome but also a potential mitigating factor within the symptom network. Higher levels of engagement appear to buffer against some of the more debilitating symptoms, suggesting that fostering academic involvement could be a valuable component of mental health interventions. This insight challenges educators and mental health professionals to integrate strategies that promote engagement, even in the context of psychological distress.

The broader implications of this research touch upon the future resilience of the medical workforce. Medical students represent the upcoming cadre of healthcare providers who will be responsible for managing public health crises and delivering care under pressure. Understanding the mental health challenges they face, especially through the lens of co-occurring depression and anxiety, is crucial for developing support systems that ensure their well-being and professional efficacy.

Moreover, the post-peak COVID-19 context provides a unique lens through which to examine shifts in student experiences. The pandemic has accelerated transitions to remote learning, disrupted traditional clinical training, and heightened uncertainties regarding career trajectories. These environmental stressors may have acted as catalysts that intensified or modified the patterns of anxiety and depression observed in this cohort, making the temporal context a critical factor in interpreting findings.

The investigative team employed standardized psychological assessment tools alongside network visualization techniques to construct a comprehensive picture of symptom interrelations. This approach not only quantifies symptom prevalence but also reveals symptom strength and connectivity, which are instrumental in tailoring precise mental health interventions personalized to the complex realities faced by students.

Another compelling aspect of the study is its potential to inform digital mental health platforms, which have gained prominence amid social distancing and remote education. By pinpointing key symptoms and their network positions, digital therapeutic tools can be engineered to target these core nodes, maximizing intervention efficiency and potentially transforming student mental health care delivery.

Experienced clinicians and university administrators stand to benefit from absorbing these findings into their protocols. Early identification of central symptoms could facilitate prompt referral to counseling or psychiatric services, reduce stigma by normalizing the experience of comorbidity, and integrate wellness curricula that emphasize resilience building and psychological flexibility.

From a broader public health perspective, these insights underscore the necessity of embedding mental health considerations into academic environments, particularly in strenuous disciplines like medicine where cognitive demands intersect with emotional vulnerabilities. The pandemic has amplified the urgency of this integration, making this study’s contributions crucial for policy and program development.

The methodological rigor demonstrated by Sun et al. also provides a roadmap for future research, encouraging the adoption of network models to unpack complexity in other student populations or professional groups similarly affected by intertwined mental health disorders. This opens avenues for comparative studies that can identify universal versus context-specific symptom dynamics.

Finally, this research resonates beyond the confines of medical education, offering a compelling example of how data-driven psychological science can inform institutional responses in times of crisis and recovery. As the world emerges from the peak pandemic era, such knowledge is pivotal in crafting environments where students can thrive mentally and academically despite ongoing uncertainties.

In conclusion, the network analysis of comorbid depression and anxiety among medical students in China during the post-peak COVID-19 period reveals intricate symptom dynamics that significantly affect academic engagement. This study not only advances our scientific understanding but provides actionable insights for educators, mental health professionals, and policymakers striving to support the next generation of healthcare providers in an increasingly complex world.

Subject of Research: The study investigates the comorbidity of depression and anxiety and their impact on academic engagement among medical students in China during the post-peak period of the COVID-19 pandemic.

Article Title: Network analysis of comorbid depression and anxiety and their associations with academic engagement among medical students in the Post-Peak COVID-19 period in China.

Article References:
Sun, C., Han, J., Zhu, Z. et al. Network analysis of comorbid depression and anxiety and their associations with academic engagement among medical students in the Post-Peak COVID-19 period in China. BMC Psychol 13, 838 (2025). https://doi.org/10.1186/s40359-025-03181-2

Image Credits: AI Generated