A Participatory Action Research Qualitative Thematic Analysis of Young Men's Perspectives on Well-being and Flourishing

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They often face severe mental health challenges due to displacement factors. While evidence-based clinical interventions exist, international demand for mental health services frequently outweighs capacity. This qualitative study explores the interrelationship between individual mental health (flourishing) and broader social and systemic determinants of mental health, highlighting alternative supports for young people's mental health. Using arts-based methods within a Participatory Action Research approach, we collaborated with 20 young men (aged 15–18) living in Atlantic Canada who came from conflict-affected backgrounds, including Syria, Sudan, and Somalia, to explore well-being and its contextual supports. Findings reveal an interconnected web of formal and informal supports, synthesized into four themes: 1. the external bedrock of support, 2. arenas for growth, 3. cultivation of personal growth, and 4. well-being. Findings show that a strong foundation of external support is the prerequisite for the internal growth necessary for flourishing. Crucially, youth highlighted how systemic barriers, such as unsafe public transportation and a lack of accessible neighbourhood spaces, often undermine access to these supports. Results demonstrate that supporting mental health requires a dynamic interplay among the external environment, relational factors, internal development, and policy and implementation supports. Collectively, these findings emphasize the importance of accounting for social and structural determinants of mental health across municipal and government sectors. Here, findings offer actionable implications for policy and practice, particularly regarding structural determinants of mental health, such as the provision of safe, accessible community infrastructure to promote flourishing among refugee youth. Refugee youth mental health promotion flourishing participatory action research arts-based research Figures Figure 1 Introduction Children account for 29 per cent of the world’s population, but 40 per cent of all forcibly displaced people [ 1 ]. Furthermore, it is estimated that there are currently about 49 million forcibly displaced children globally [ 1 ]. The political, economic and social factors that force people into displacement are largely characterized by oppression, marginalization, danger and violence [ 1 ]. Children are especially vulnerable to the impact of these factors, often resulting in heightened mental health challenges requiring effective supports and interventions [ 2 ]. While there is growing evidence around clinical interventions to support refugee children and youth [ 3 , 4 ], concomitantly, there is evidence that internationally, demand for mental health services outweighs professional and systemic capacity to respond to this need [ 5 ]. Accordingly, we are compelled to consider alternative ways of supporting the well-being of these young people. As Legerski et al. (2024, p. 213) contend, while evidence-based interventions and targeted therapies are essential, “there is a need for more research to address the complex, dynamic interrelationships between individual mental health and broader systemic factors.” Research focused on the social and structural determinants of mental health shows that contextual and relational supports situated within children’s lived environments can have a profound impact on their well-being outcomes [ 6 , 7 ]. Given their positioning, these factors are likely to have a much broader reach than clinical interventions. Considered through a dual continuum model [ 8 ], we can also surmise that support factors linked to social and structural determinants of mental health will, in some instances, delay the onset of more chronic mental illnesses and, where such illnesses exist, reduce severity and improve prognosis. Ensuring that impactful contextual and relational supports are situated within young people’s environments, however, requires the direct input of the children and youth living in that context. Their experiences are not merely anecdotal; they constitute critical data essential to the development of effective community programs, social policies, and support systems. By centering their perspectives, we move beyond assumptions that reflect knowledge and engage with the complex, nuanced realities that shape their well-being. This article reports on research grounded in the principle that those most affected by community conditions are the foremost experts on their own needs. Using arts-based methods within a Participatory Action Research (PAR) approach, we collaborated with a group of 20 young men (aged 15–18 at the start of the study) living in an urban context in Atlantic Canada to explore what wellbeing entails and the contextual supports that underpin it. Findings highlight an interconnected web of formal and informal supports, embedded within systemic factors that affect accessibility, relevance, and a sense of safety in accessing these supports. In the following sections, we contextualize this work by reviewing existing research and theory, and then detail the methods used to collect and analyze data. Following this, we present the core thematic findings: the external bedrock of support, the cultivation of an inner resilient self, and the tangible arenas where growth occurs. Finally, we will synthesize these themes into a cohesive model of well-being constructed by the participants as co-researchers, concluding with actionable implications for policy and practice. Literature review Supporting youth mental health outside of a clinical context Dual continuum model for understanding of mental health and flourishing The UN [ 9 ] Sustainable Development Goals call for human flourishing, defined as “all human beings can fulfill their potential in dignity, equality, and in a healthy environment.” Similarly, the WHO [ 10 ] defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn and work well, and contribute to their community. It has intrinsic and instrumental value and is a basic human right.” Additionally, they note that “Mental health exists on a complex continuum, which is experienced differently from one person to the next. At any one time, a diverse set of individual, family, community and structural factors may combine to protect or undermine mental health.” Keyes [ 11 ], in his work on flourishing over almost three decades, provides a helpful framework for understanding this so-called “complex continuum.” In summary, the Dual Continuum Model of Mental Health comprises two axes, one reflecting mental well-being and the other mental illness. According to the model, an individual can have good or bad mental well-being (reflected on the vertical axis) while also having or not having a mental illness (reflected on the horizontal axis). Flourishing occurs when a person is situated high on mental well-being with a corresponding absence of mental illness symptoms [ 12 ]. Subsequent research with the model suggests that promoting mental health and well-being plays an important role in the presence or absence of mental illness symptomology. Much as good physical health is associated with a lower likelihood of catching a cold and, when a person does get sick, with faster recovery, good mental health is associated with reduced mental illness symptoms and improved prognosis [ 8 , 12 ]. To this end, drawing attention to health-promoting factors, this model implicates the social and structural determinants of mental health in our efforts to support the mental health of refugee youth. Social and structural determinants of mental health A substantial body of research emphasizes that mental health outcomes are inextricably linked to the conditions in which people live, learn, and develop. These factors, the social and structural determinants of mental health (SDMH), generate and perpetuate intergenerational cycles of advantage and good health or disadvantage and poor health [ 7 ]. SDMH are the contextual conditions – or social determinants -- to which individuals are exposed throughout their life course, from conception onward, which influence mental health outcomes and contribute to population-level mental health disparities. These conditions are significantly influenced by economic policies, social norms, and political systems – structural determinants -- underpinning the contexts in which people live [ 13 , 14 ]. Structural determinants are the overarching, upstream factors often considered the root causes of health inequities [ 15 ]. They encompass the large-scale political, economic, and social policies, practices, and values that operate at national and local levels. Structural determinants shape the distribution of money, power, and resources, which in turn determine individuals’ lived contexts and their opportunities for safe, secure, and healthy lives [ 7 ]. Power structures often manifest along class, race and sexual lines, with historical trajectories. Social determinants, by contrast, represent people’s daily lived experiences resulting from the underpinning structural conditions [ 15 ]. Economic factors linked to social determinants include financial insecurity, employment status, food insecurity, and housing instability or disadvantage [ 7 , 13 , 14 , 16 ]. Education is typically associated with educational inequality, literacy, and parental education levels [ 7 , 13 , 14 ]. Access to support services is often associated with health and healthcare, focused on access to and quality of healthcare, including preventative care and barriers to accessing such care [ 7 , 13 , 14 , 16 ]. Social and Community Context encompasses experiences of discrimination, social isolation, and the presence of social support and community cohesion [ 7 , 13 , 14 , 16 , 17 ]. Finally, the neighbourhood and the built environment include the physical quality of housing, neighbourhood safety, environmental conditions (e.g., air and noise pollution, lack of green space), and residential segregation or marginalization [ 7 , 13 , 14 , 16 ]. The core principle unifying these domains is that differences in SDMH are not randomly distributed, leading to poor mental health outcomes that are disproportionately experienced by individuals living in communities that are socially and economically marginalized [ 7 , 17 ]. The influence of SDMH is particularly critical during adolescence, when complex cognitive and affective neural systems are being refined and are highly sensitive to the physical and social environment in which this occurs [ 6 ]. Being raised in poverty is associated with structural and functional brain changes, often affecting neurocognitive performance [ 6 ]. Negative and prolonged contextual factors, such as socioeconomic disadvantage, can accelerate brain development and reduce plasticity. Exposure to environmental factors common in disadvantaged urban areas, such as air and noise pollution and limited green space, are associated with adverse brain development and low mental health in children and adolescents [ 6 , 7 ]. Additionally, adolescents exposed to adverse SDMH demonstrate significantly higher vulnerability to a range of mental health issues. Poverty is a fundamental risk factor for emotional, mental, and behavioural disorders in youth [ 14 ]. Children growing up in socioeconomic disadvantage are two to three times more likely to experience mental health problems compared to their non-disadvantaged peers [ 7 ]. Contextual stressors are shown to exacerbate their vulnerability to illnesses such as depression and anxiety [ 14 ]. Moreover, poverty exacerbates stress for parents and is consistently linked to child maltreatment and neglect [ 7 ]. Critically, when considering the relationship of SDMH and refugee populations, exposure to neighbourhood disadvantage and crime is associated with elevated PTSD, anxiety, and depressive symptoms in adolescence [ 17 ]. The highest rates of mental health concerns, including suicide attempts, suicidal ideation, and non-suicidal self-injury, have been found in youth groups categorized by high overall or high social SDOH deficits (adversity and discrimination) [ 16 ]. Experiences of discrimination and marginalization translate directly into adverse mental health outcomes. Racial and or ethnic discrimination is related to negative outcomes across multiple developmental domains, with particularly strong effects seen in adolescence [ 6 ]. Structural racism also increases exposure to individual-level stressors, such as family conflict and material hardship, which in turn have a negative impact on the brain [ 7 ]. Ultimately, the goal of understanding SDMH is to recognize that poor mental health outcomes are not randomly distributed but arise from inequitable access to resources, often stemming from systemic discrimination and structural inequalities [ 7 , 13 ]. Addressing youth mental health effectively requires moving beyond individual clinical solutions to implementing broad public health policies that tackle the root causes, such as poverty alleviation and structural racism, particularly during critical early life and adolescent developmental periods [ 7 , 16 ]. Without addressing structural determinants such as poverty and neighbourhood conditions, and establishing the fundamental conditions necessary for healthy development, a continued focus on downstream individual treatment and intervention will fall short of the needs of refugee youth [ 6 , 7 , 15 ]. Children and youth as refugees As previously stated, approximately 49 million children globally are currently forcibly displaced [ 1 ]. Many of these children are resettled in host countries as refugees, with or without their families. For example, in 2024, Canada admitted 76,685 refugees and protected persons as permanent residents, of which approximately 17% were minors [ 18 ]. These numbers continue to rise annually, reflecting the growing international humanitarian crises [ 1 ]. Factors that drive people towards asylum claims are primarily rooted in safety concerns. When people feel structurally unsafe (i.e., their broader social context and government are unable to provide safety) and are confronted with ongoing danger, they are inclined to flee. Key push factors include violence, conflict, and insecurity caused by armed conflict or civil war, ethnic, religious, or political violence, characterized by widespread human rights violations [ 1 ]. Additionally, persecution or the threat of persecution, in which a person fears harm because of who they are or what they believe, is another significant push factor. People may be targeted for political opinion, religion, race or ethnicity, gender or sexual orientation, membership in a particular social group (e.g., journalists, activists), and/or tribal or caste identity [ 1 ]. Other reasons include state repression or state-sponsored harm, gender-based and family-based violence [ 19 ], national economic collapse linked to insecurity (such as extreme poverty caused by war), environmental disasters combined with state failure, and the targeting of children [ 1 , 19 ], amongst others. The implication is that most people arriving in a host nation as refugees will most likely have had extreme adverse experiences. Refugee youth experience many of the same mental health concerns as other young people, but the frequency, intensity, and complexity of their needs are often far greater because of exposure to violence, loss, displacement, and resettlement stress. Refugee youth often experience exposure to war, violence, bombing, militia/gang threats, loss of family members, dangerous migration journeys and or detention or family separation. Consequently, they often require support for anxiety and depression, where chronic fear, uncertainty, and disrupted daily life contribute to generalized anxiety, panic symptoms, sadness and hopelessness, and sleep disturbances and nightmares [ 20 , 21 ]. Mental health challenges are then often augmented by uncertainty stemming from aspects of the resettlement process. These include immigration hearings, family reunification, housing instability, and financial insecurity [ 22 , 23 ]. Strengths that these youth may bring with them, such as creativity, strong insights, cultural, familial and community bonds, and multilingual and adaptive capacities, are often undermined by these negative experiences. In response, youth require stabilization through a sense of safety and predictability. Environments characterized by consistency, predictability, clear routines and provision of basic needs foster and support mental well-being. The absence of these exacerbates mental health challenges [ 23 , 24 ]. Additionally, refugee youth often navigate two worlds at once. Managing this requires culturally responsive counselling, interpretation and language support, space to affirm identity and cultural practices, and community-based, relational supports rather than purely clinical ones [ 23 , 25 ]. For refugee youth, schools are major sites of stress and support. Here they need peer integration support, anti-racism and anti-bullying supports, trauma-informed teachers, academic catch-up assistance and support for interrupted education [ 23 , 26 ]. Refugee youth also require support for acculturation stress. Youth face pressure to adapt quickly, role reversal with parents, identity conflict and discrimination or xenophobia [ 2 , 27 , 28 , 29 ]. To manage this, they often need identity development support, spaces to belong (youth groups, mentorship), and guidance in navigating multiple cultural expectations [ 30 , 31 ]. Finally, and importantly, they need their own strengths recognised and supported [ 24 ]. What these support factors look like locally however, and how they interact with one another, is largely contextually shaped. Understanding these needs in broad terms does not mean we understand the specificities of these supports and their nuanced functioning within specific communities, for specific populations. This study Findings presented in this article are from a study exploring the contextual factors that support youth well-being in an urban area of Atlantic Canada, [Study title blinded for review]. Situated within a social and structural determinants of mental health model, the study responds to the uptrend in the rates of young people struggling with their mental health, unable to experience well-being [ 32 ]. Specifically, we sought to collaborate to identify mid- and upstream mental health supports [ 33 ], centring youth experiences in the results used to inform policies focused on mental health promotion [ 33 ]. The study was conducted in partnership with a local [community youth service provider; blinded for review]. Youth researchers in the study all identified as young men and were predominantly from Syria, Sudan, and Somalia (aged 15–18 at the start of the research). These countries are identified by the UNHCR [ 1 ] as being characterized by violence, conflict, and insecurity caused by armed conflict or civil war, ethnic, religious, or political violence, characterized by widespread human rights violations. Research Methodology [STUDY NAME] used qualitative arts-based methods with 20 youth to unpack what wellbeing looks like to young men from conflict backgrounds, and what factors in their lived environment support and or jeopardize their wellbeing. Youth were informed of the study by staff at the [community partner service]. Where they were interested, youth were invited to a meet-and-greet session in which the study and their research rights were explained to them. Following this, several sessions were held, during which the team of student and youth researchers got to know one another through activities. Sessions were facilitated by the study's lead researcher [blinded]. Following this, youth were asked to photograph, over seven days, the spaces they move through in the city and to reflect on how these spaces support or undermine their well-being. Once images had been made, individual photo-elicitation interviews were conducted with the youth to explore their photos in depth, expanding the young men’s thinking about wellbeing factors in their lives [ 34 ]. We then held a group meeting in which the youth shared their photos and key findings from their interviews, which furthered the discussion. We then worked in three smaller groups to explore emerging factors in more detail. Here, we used facilitation tools, such as body mapping, to explore what wellbeing entails, and then arranged previously identified contextual factors around our young people's maps to examine in greater depth the interaction between youth and their lived environment. These methods were intentionally chosen for their unique capacity to explore the rich context of personal experience. Finally, the youth worked with the lead researcher and students to analyze the data using thematic analysis [ 35 ]. Here, youth worked with code cards, sorting them through a consensus process into groups, which were then further discussed to identify the themes represented by these code groups. By collectively constructing a narrative model of well-being from individual concepts, the youth directly engaged in the analysis process. This approach ensures that the resulting framework accurately reflects their shared understanding and priorities. The following sections present the core themes that emerged from this collaborative analysis, reflecting the building blocks of well-being as defined by the youth themselves. The transcript of the analysis workshop forms the basis of the findings section. As such, little to no excerpts from transcripts are included. Ethical consent was obtained from [BLINDED] University, the host institution for the research. In accordance with this, all youth provided freely given, informed written consent to participate, and where necessary, due to age, from their guardians. Findings: The Building Blocks of Well-being Findings reflect a web of interconnected personal, relational, and contextual supports that interact to promote young people’s well-being. While conceptualized as a web, there is still an anchoring foundation of supports that youth need to experience the personal growth required for well-being. Building on these foundational supports are additional critical components, including education, culture, and other contextual resources, that interact to foster personal growth and ultimately well-being. These findings echo research on the SDMH, extending them to provide a contextualized understanding of how these determinants interact to support wellbeing (see Image 1). The Bedrock of Support: Community Context and Relationships Our analysis revealed that a supportive external environment is the essential foundation for individual well-being. Youth researchers consistently emphasized that before a young person can focus on internal growth and personal achievement, they require a secure and nurturing base. This foundation is built on positive relationships with family, friends, and the broader community, which together foster a sense of safety and belonging. The Role of Family and Community Youth identified the concepts of "Safe Families and communities" and a "sense of belonging" as deeply interconnected. They articulated a two-directional model where community is defined not just as a physical place but as a web of relationships that “helps families be more supported. And the more families are supported, the better the community is.” This reciprocal dynamic creates an environment where individuals feel secure and valued enough to engage meaningfully with their surroundings. However, this foundational bedrock is frequently threatened. Youth contrasted the ideal of safety with the lived reality of environments where they see “needles around the place like the parks,” roads near vital community hubs where shootings have occurred, and public spaces like the library where drug use necessitates a call for greater security. Ultimately, if the physical environment is not safe, a sense of belonging (as bolstered by relationships) is undermined. By contrast, a safe environment creates space for families and community members to express care and have fun. Youth also explained that a safe physical and relational environment Image 1 : Codes and Themes of Youth Wellbeing is characterized by a sense of acceptance, mutual respect, comfort (a subjective sense of acceptance for who you are and being okay), and being “healthy.” The Function of Friendships Friendships were identified as a distinct and vital pillar of support. Youth stressed the importance of “healthy friendships, where we experience acceptance, comfort.” While family support is crucial, friends offer a unique, relatable perspective built on shared experience. As one youth noted, with friends, “you go through the same things and can help each other because you understand.” This suggests a relationship of mutual understanding and peer-based validation that differs from the often-hierarchical support of family, especially where parents have come from such a different social context to the one they are living in now. This peer connection provides a crucial space for acceptance among those navigating similar life stages, but also seems to solidify relationships with family because of shared youth experiences with parents. This external foundation of community and relationships provides the security necessary for young people to turn inward and develop their personal attributes. Arenas for Growth: Key Spaces, Activities, and Tangible Needs The research demonstrated that abstract concepts of well-being become concrete in the tangible settings of daily life. This section explores the specific places, activities, and material needs that Youth identified as crucial arenas for their happiness, health, and personal development. These arenas are where the internal skills of the “Inner Architect” (see next section) are cultivated and tested. The Significance of Structured Community Spaces Specific community hubs were repeatedly cited as vital to youth well-being, though access is not always guaranteed. For the youth in this study [COMMUNITY PARTNER; BLINDED] is valued for providing food and safe, fun activities, and was described as a welcoming place that feels like “family.” Youth noted however, that limited operating hours restrict their access around school hours. Similarly, the mosque serves as a critical space for spiritual and community connection. Youth described it as a place that provides peace, shared purpose, and a sense of belonging, making it a key environment for emotional regulation and self-reflection. Finally, the library was identified as a safe, quiet place for study, personal development, and social connection. Like the mosque, it functions as an arena for achieving the “calmness” and focus needed for personal growth. In addition to providing welcoming and safe spaces, all three venues offer youth engaging opportunities for learning. Youth explained how the learning that occurs in these spaces is completely different to the form of pedagogy used in school spaces, yet they found this learning so much more impactful and meaningful. Learning in these spaces occurs through both active engagement and observation of others (role models). Additionally, through a process of reflection after doing, by having conversations with older role models, youth can analyze and understand the cause-and-effect component of experiences and their related success or failure. They highlighted the importance of this learning to their own growth and ultimate well-being. Again, these findings highlight the rich interaction between safe physical community spaces, and the impact of supportive relationships within these spaces. Here, youth especially noted how these physical and relational spaces also facilitated their access to and relationship with culture, both their families’ cultures and the new culture in which they are now living. The Role of Sports and Physical Activity Sports and physical activities, particularly soccer and basketball, were consistently framed as essential for well-being. Spaces like the [SOCCER Centre] are more than just fields; they are primary arenas where the internal skill of discipline is cultivated and a sense of accomplishment is earned. Youth explained that beyond physical health, these activities foster teamwork, build social connections, and serve as a healthy escape and a positive outlet for energy. Importantly, they also highlighted that while formal spaces are needed for more formal engagement in these activities, access to informal spaces is equally important. Informal spaces could be more accessible by being situated within their own neighbourhoods and being free for use. To this end, the youth shared how they had previously been able to spontaneously meet up and play soccer in an open lot in their neighbourhood before it had been turned into an apartment complex. Now they have nowhere to do this. Additionally, to get to free spaces in the city, they have to rely on public transportation. They are reluctant to do this for several reasons. First, it removes the spontaneity and ease with which they can gather, requiring more planning. Second, by leaving their communities, they have to go into other city spaces where they may not feel as welcome or safe. And finally, they are hesitant to use public transportation because of feeling unsafe. This is because of the racism expressed by bus drivers, the lack of safety from other passengers and the dirty buses. Relatedly, they noted that these factors often mean it is easier (and safer) to default to their phones. The Importance of Nature and Quiet Spaces Connected to informal outdoor spaces, youth articulated a strong need for “quiet places” and “green spaces.” Youth spoke of the calming and restorative effects of being in nature, linking these spaces directly to the practice of emotional awareness. These environments provide a necessary escape from stressful surroundings and are seen as essential for self-care, relaxation, and achieving the sense of “peace” required for self-reflection. Additionally, however, green spaces provide sites of connection with friends, and a space for families to connect and spend time together. Here youth noted the presence of play parks in their communities, but also discussed how these spaces were too small to accommodate activities like community gatherings or adolescents kicking balls around. By contrast, they argued that spaces where families could connect as part of a broader community served to strengthen social fabric, interpersonal understanding and connection, and ultimately intergenerational relational supports and establish a sense of belonging and safety. Tools for connection and access Interwoven through their identification of core support factors was the pragmatic role of resources that make connections with relationships and physical spaces possible. Most notably, they spoke of cell phones as a means of communicating with friends and family, learning about activities, and accessing transportation services such as Uber and the bus. Along with this, however, they also noted the drawbacks of resources such as public transportation. As previously noted, the youth highlighted that the social and physical conditions of buses make them reluctant to use public transportation. Crucially, access to all these arenas for growth is often obstructed by systemic barriers. Youth highlighted unreliable public transportation—including infrequent service, dirty conditions, and experiences of "racism on busses"—as a significant obstacle preventing them from reaching the very places that support their well-being. Similarly, when they don’t feel a sense of belonging and engagement, including times when they cannot spontaneously connect with friends in their neighbourhood (linking back to safe, accessible green spaces), they are more inclined to scroll on their phones. Youth also explained that when phones and online spaces are used for recreation, they are used at times when “we need to escape or there is nothing to do.” Youth noted that when they feel overwhelmed by life, or are unable to connect face-to-face with friends, that is also when they will go online, especially to participate in games (like FIFA). Cultivating Personal Growth When external foundational supports are available, youth identified a powerful set of internal characteristics and practices that they are able to engage with and that are essential for navigating life’s challenges and achieving personal goals. These internal attributes foster the personal growth required to build personal strengths, a sense of purpose, and achieve emotional stability, as well as ultimately, a sense of well-being. Tangible Expressions of Self-Care Youth discussed the importance of tangible elements like “nice clothes,” a “fresh haircut,” and “good hygiene.” They explained that this is not about materialism but expressions of “self care” and “self pride.” Taking care of one's appearance was directly linked to feeling “mentally happy” and confident. These practices represent a form of self-respect that contributes positively to one's internal state. Emotional Awareness and Regulation The ability to understand and manage one's own emotions was identified as a critical skill for inner well-being. Youth noted skills like “identify your emotions” and “express your emotions” as prerequisites for achieving “calmness” and “confidence.” The logic, as one youth articulated, is that “you won't be able to stay calm because you don't know why you're lashing out.” This underscores the importance of emotional literacy as the basis for self-control and stable, positive emotional states. These internal traits are not developed in a vacuum; they are nurtured and expressed within the tangible spaces and activities that make up a young person's daily life as reflected in the foundational components. Self-awareness is also linked to emotional literacy as well as foundational components. Being able to interact with others, engage in diverse activities, have varied experiences, and understand how these experiences make you feel interacts to support self-awareness, healthy self-expression, and develop a sense of purpose in life. They also interact to build a sense of self and confidence. Collectively, these factors also come together to foster a bi-directional sense of responsibility and independence. Here youth explained that healthy personal growth, fostered by foundational supports, as well as education and connection to culture, can instill a sense of responsibility for self, others and community. These factors also foster personal independence. Critically, the combination of the two ensures that while young people grow to be self-supporting, they are not selfish in their actions. To be self-supporting in healthy ways, requires recognising your co-dependence on others, and the need to be equally responsible for yourself and others. This overall cluster of ideas highlights the belief that self-development is an active, ongoing process that builds identity and direction. Achieving Well-being: A Happy, Healthy Self Discipline was viewed as a cornerstone concept that “ties in with everything else.” Youth described it not as punishment, but as a proactive, positive force necessary for personal growth, achieving goals, and maintaining positive relationships. One youth connected it directly to accomplishment, stating, “if you don't have that discipline, you're not going to have the accomplishments.” This view extended beyond personal achievement to the relational sphere, with another participant noting its practical necessity in maintaining connections: “If you take care of your relationships once a month, you're probably not going to be in relationships.” This theme positioned discipline as the fundamental practice enabling the consistent effort required for a flourishing life. Relatedly youth who are flourishing, have dreams and goals that are intended to realise these dreams. Dreams are varied and connected to school and work, relationships and community, as well as recreation and fun. Youth articulated a clear and dynamic relationship between having a “Sense of Self,” from “Personal Growth,” and having “dreams and goals.” They saw these concepts as feeding into one another in a continuous cycle. As one individual explained, “the more you know, as you're growing the more you know yourself.” This growing self-knowledge, in turn, fuels a sense of purpose and the ability to set and pursue meaningful goals. Additionally, youth who are flourishing have a sense of inspiration; they are inspired to work towards their goals and dreams, drawing on their discipline. Through this, they have a sense of achievement and accomplishment that feeds into a cycle with inspiration, goals and dreams, fostering greater discipline. Youth noted that flourishing doesn’t mean not experiencing failure, not achieving, or getting things wrong. Rather, these seemingly “negative” experiences serve as opportunities to reflect, learn and grow. Such growth, however, is often dependent on relational supports where others can support such reflection and learning. It also requires access to future opportunities to “try again!” In addition to these characteristics, flourishing is seen to encompass being active and finding enjoyment in life. Importantly, these activities are linked to happiness and kindness towards self and others, but also being able to have a sense of peace because of spirituality. Youth explained that having faith means you can make sense of experiences and events in your life, supporting a sense of happiness and peace. However, when faith is paired with religious engagement, you have a community of people around you who can guide you in your faith and meaning-making, especially when experiences are especially difficult. Discussion: A Holistic Model of Youth Well-being The findings from this research present a model of what well-being looks like and how it is supported for a group of young men who have come to a mid-size urban setting in Canada, from war-torn contexts. Their model highlights what young men living with experiences similar to theirs require if their mental health is to be promoted as a buffer for mental challenges and illness [ 12 ]. The model's factors reflect what we know about the social determinants of mental health [ 15 ], the importance of social safety, integration and belonging [ 23 ], and the mediating role of community and peer group support between trauma and depression, especially for young men [ 36 ]. However, the model also demonstrates that supporting mental health does not rely on a static list of factors; rather, it is a dynamic interplay among a young person's external environment, their engagement with the world as mediated by relationships, their internal development, and overall well-being. It tells a story of how flourishing is cultivated. The model, as reflected in Image 1, follows a clear and logical sequence: If we provide young people with supportive relationships, safety, and community, then we provide them with learning opportunities. Collectively, these feed into a process of personal growth that ultimately underpins a happy, healthy young person. This model emphasizes that a strong foundation of external support is the prerequisite for the internal growth that ultimately defines a happy and healthy individual. Echoing what we know about social and structural determinants of mental health, however, social determinants (i.e. contextual and relational supports) are themselves required to be “healthy” if they are going to be positive supports. To be healthy, they require supportive structural determinants (i.e., municipal and government policies and their implementation that account for their impact on mental health) [ 13 , 15 ]. In this way, these findings also hold important implications for the structural determinants of mental health. Key aspects highlighted by the youth was the importance of spaces in which they can engage with social connections, friends especially, in spontaneous and convenient ways. There are key ways in which this data omits and or deviates from a more generic understanding of SDMH. First youth did not discuss economic factors. That said, much of what they did discuss implicates parental emotional and time availability (such as engagement in community events). Such availability requires fiscal stability. Similarly, housing stability and health of homes and the surrounding built environment are required to support cognitive development, physical health, and achievement of goals and dreams. Second, while most Western models of SDMH ordinarily associate education with more formal education systems, young people are increasingly explaining how education is so much more than this [ 37 , 38 ]. Here too, youth in this study refer to the complex interplay of relationships, opportunities to try things and get it wrong, and lived environment in their educational outcomes. These insights expand our understanding of what education means to young people, informing not just what healthier formal education systems could look like, but also the diverse actors and contexts that should be included in these systems. Similarly, the youth in this study highlight aspects of town planning and infrastructure (the built environment) that require consideration. Public transportation, for example, not only needs to be available, but also needs to be clean and safe. Such a requirement is probably not only relevant to this group of youth, but many other groups within urban centres, such as people who identify as female, professionals, parents with young children, and the elderly. Importantly, safety doesn’t only concern the behaviour of other passengers but also the behaviour of bus drivers and their interactions with passengers. Finally, having green spaces and recreational facilities within cities is not enough. Thought needs to be given to where these spaces are positioned, and who has access to them. Accessibility in turn is not just about cost, or location, but also size and resourcing. The young men in this study were very concerned about the discomfort or even harm they could cause by just playing with a soccer ball in their local “park” because it was small and filled with play structures for younger children. When the importance of green spaces, face-to-face social connection, and engagement in physical activity to fostering mental health vis-à-vis depression, anxiety and PTSD in adolescent refugee populations [ 15 , 17 ] are considered, the importance of these considerations becomes clear. Importantly, the findings of this study have their limitations. This research has been conducted with a group of 20 youth who identify as male in a mid-size urban setting. The voices of female identifying youth, and the diversity of youth who identify as LGBTQAI + need to be accounted for in future research. Additionally, quantitative survey results may be used to affirm the resonance of these findings with larger populations of youth. Similarly, the insights of younger adolescents are absent from these findings and should also be explored in future research. Conclusion This research has detailed a model of youth well-being that is complex, interconnected, and deeply rooted in the lived experiences of 20 young men who have come to a mid-size urban Canadian context from backgrounds of extreme adversity and violence. The primary finding is that well-being is not supported by a simple checklist of resources, but engages a dynamic ecosystem of relevant and accessible supports. It is built upon a non-negotiable foundation of safe and supportive relationships within families and communities. This secure base—when it can be established against real-world threats—enables young people to cultivate internal strengths, purpose, and self-awareness through meaningful engagement in safe, accessible, and purposeful activities and spaces. These activities cultivate the internal growth that youth need in order to flourish, not just cope, with the complex challenges they have experienced that threaten their mental health and well-being. These relational and contextual supports, however, require policy and related resource allocation from local and national leadership in order to both be present and persistent. Declarations Clinical trial number : not applicable Funding Declaration : The research was made possible with funding from the Canadian Institutes of Health Research (funding reference number: 513352) Availability of Data and Materials : The data that support the findings of this study are available from the lead author, but restrictions apply to the availability of these data, given the ethics approval of the research from the host organization, and so are not publicly available. The data are, however, available upon request, subject to the approval of Dalhousie University's Research Ethics Board. Ethics Statement : The Dalhousie University Health Sciences Research Ethics Board approved this study. The research was carried out in accordance with the Canadian Tri-Council guidelines. Consent to participate : Freely given, informed consent to participate was obtained from all participants, and, where necessary due to age, from their guardians. Consent to publish : Freely given, informed consent to publish findings from the study was obtained from all participants, and, where necessary due to age, from their guardians. Author Contribution LL is the lead researcher on the study. She led the data gathering, analysis and writing of this article. TS is the project manager and assisted with the data gathering, analysis and writing of this article. TJ is the lead of the community partner and assisted with recruiting participants and the final drafting and editing of the article. YR are the youth researchers on the study who participated in the data gathering and analysis. The findings section is written from the transcript of the data analysis workshop. References UNHCR. Global trends: Forced displacement in 2024. United Nations High Commissioner for Refugees; 2025. https://www.unhcr.org/global-trends . Abdi S, Akinsulure-Smith AM, Sarkadi A, Fazel M, Ellis BH, Gillespie S, Juang LP, Betancourt TS. Promoting positive development among refugee adolescents. J Res Adolescence. 2023;33:1064–84. https://doi.org/10.1111/jora.12890 . Legerski JP, Nedegaard R, Isakson BL. (2024). Evidence-based practices for treating child and adolescent refugees. In, A. Maragakis & M. Janikian, M, editors, Evidence-Based Behavioral Health Practices in Pediatric Specialty Settings (pp. 213–233). Springer. https://doi.org/10.1007/978-3-031-71004-9_11 Velu ME, Kuiper RM, Schok M, Sleijpen M, de Roos C, Mooren T. Effectiveness of trauma-focused treatments for refugee children: A systematic review and meta-analyses. Eur J Psychotraumatology. 2025;16(1):2494362. https://doi.org/10.1080/20008066.2025.2494362 . 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J Am Acad Child Adolesc Psychiatry. 2022;61(11):1385–9. https://doi.org/10.1016/j.jaac.2022.04.020 . Robins LB, Rodgers D, Barburoglu Y, Griffith J, Arnold CL. Unlocking Adolescent Mental Health: Exploring Social Determinants and Depression With the Social Ecological Model. J Hum Serv. 2024;43(1):115–36. https:/​/​doi.org/​10.52678/​001c.122132 . Hastings PD, Guyer AE, Parra LA. Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity. Biol psychiatry Cogn Neurosci neuroimaging. 2022;7(12):1215–24. https://doi.org/10.1016/j.bpsc.2022.06.004 . Mitchell KJ, Banyard V, Colburn D. The Contribution of Social and Structural Determinants of Health Deficits to Mental and Behavioral Health Among a Diverse Group of Young People. Int J Environ Res Public Health. 2025;22(7):1013. https://doi.org/10.3390/ijerph22071013 . Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social Determinants of Mental Health: Where We Are and Where We Need to Go. Curr psychiatry Rep. 2018;20(11):95. https://doi.org/10.1007/s11920-018-0969-9 . Immigration R, and Citizenship Canada. (2025). 2025 Annual report to Parliament on immigration . Government of Canada. https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/annual-report-parliament-immigration-2025.html Freedman J. Gendering the International Asylum and Refugee Debate. 2nd ed. Palgrave Macmillan; 2015. Blackmore R, Boyle JA, Fazel M, Ranasinha S, Gray KM, Fitzgerald G, Misso M, Gibson-Helm M. The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Med. 2020;17(9):e1003337. https://doi.org/10.1371/journal.pmed.1003337 . Schumacher L, Echterhoff J, Zindler A, Barthel D. Depression among refugee youth in an outpatient healthcare center: Prevalence and associated factors. Front Psychiatry. 2024;15:1367799. https://doi.org/10.3389/fpsyt.2024.1367799 . Cowling MM, Whelan TA, Anderson JR. school-based predictors of mental health and well-being for refugee and asylum-seeking children: Evidence from Malaysia. School Mental Health. 2025;17:916–34. https://doi.org/10.1007/s12310-025-09780-z . Fazel M, Reed RV, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet (London England). 2012;379(9812):266–82. https://doi.org/10.1016/S0140-6736(11)60051-2 . Betancourt TS, Khan KT. The mental health of children affected by armed conflict: Protective processes and pathways to resilience. Int Rev Psychiatry. 2008;20(3):317–28. https://doi.org/10.1080/09540260802090363 . Ellis BH, Miller AB, Abdi S, Barrett C, Blood EA, Betancourt TS. Multi-tier mental health program for refugee youth. J Consult Clin Psychol. 2013;81(1):129–40. https://doi.org/10.1037/a0029844 . Pastoor L. The mediational role of schools in supporting psychosocial transitions among unaccompanied young refugees upon resettlement in Norway. Int J Educational Dev. 2015;41:245–54. https://doi.org/10.1016/j.ijedudev.2014.10.009 . Berry JW. Theories and models of acculturation. In: Schwartz SJ, Unger J, editors. The Oxford Handbook of Acculturation and Health. Oxford University Press; 2017. pp. 15–28. Güngör D, Perdu N. Resilience and acculturation among refugee adolescents. Int J Intercultural Relations. 2017;56:1–12. https://doi.org/10.1016/j.ijintrel.2016.10.005 . Oppedal B, Idsoe T. Conduct problems and depression among unaccompanied refugees: The association with pre-migration trauma and acculturation. Anales De Psicología Annals Psychol. 2012;28(3):683–94. https://doi.org/10.6018/analesps.28.3.155981 . Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, Keane T, Saxe GN. Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004;43(1):24–36. https://doi.org/10.1097/00004583-200401000-00012 . Martin S, Horgan D, O'Riordan J, Maier R. Refugee and migrant children's views of integration and belonging in school in Ireland - and the role of micro- and meso-level interactions. Int J Incl Educ. 2023;28(13):3214–33. https://doi.org/10.1080/13603116.2023.2222304 . UNICEF Canada. Worlds Apart: Canadian Companion to UNICEF Report Card 16. Toronto: UNICEF Canada; 2020. https://www.unicef.ca/en/unicef-report-card-16 . Barry MM. Community mental health promotion principles and strategies. In: Barry MM, Clarke AM, Petersen I, Jenkins R, editors. Implementing Mental Health Promotion. 2nd ed. Springer; 2019. pp. 163–94. Liebenberg L. The visual image as discussion point: Increasing validity in boundary crossing research. Qualitative Res. 2009;9(4):441–67. https://doi.org/10.1177/1468794109337877 . Liebenberg L, Jamal A, Ikeda J. Extending youth voices in a participatory thematic analysis approach. Int J Qualitative Methods. 2020;19:1–13. https://doi.org/10.1177/1609406920934614 . Moscardino U, Scrimin S, Capello F, Altoè G. Social support, sense of community, collectivistic values, and depressive symptoms in adolescent survivors of the 2004 Beslan terrorist attack. Social Science Medicine. 2010;70(1):27–34. https://doi.org/10.1016/j.socscimed.2009.09.035 . Wood M, Liebenberg L, Ikeda J, Vincent A. & Youth participants of Spaces & Places (2020). The role of educational spaces in supporting Inuit youth resilience. Child Care Pract, 26 (4), 390–415. https://doi.org/10.1080/13575279.2020.1765143 Youth of Spaces &, Places, Eskasoni, Liebenberg L, Reich J, Hutt-MacLeod D, Denny J-F, Gould MR. Two-eyed seeing for youth wellness: Promoting positive outcomes with interwoven resilience resources. Transcult Psychiatry. 2022. https://doi.org/10.1177/13634615221111025 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Apr, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviews received at journal 29 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 19 Jan, 2026 Reviewers invited by journal 23 Dec, 2025 Editor assigned by journal 23 Dec, 2025 Submission checks completed at journal 22 Dec, 2025 First submitted to journal 22 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8380085","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":565004709,"identity":"12c87f8e-e5d9-4e90-9f4e-ea0db5df8309","order_by":0,"name":"Linda 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Furthermore, it is estimated that there are currently about 49\u0026nbsp;million forcibly displaced children globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The political, economic and social factors that force people into displacement are largely characterized by oppression, marginalization, danger and violence [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children are especially vulnerable to the impact of these factors, often resulting in heightened mental health challenges requiring effective supports and interventions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While there is growing evidence around clinical interventions to support refugee children and youth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], concomitantly, there is evidence that internationally, demand for mental health services outweighs professional and systemic capacity to respond to this need [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Accordingly, we are compelled to consider alternative ways of supporting the well-being of these young people. As Legerski et al. (2024, p. 213) contend, while evidence-based interventions and targeted therapies are essential, \u0026ldquo;there is a need for more research to address the complex, dynamic interrelationships between individual mental health and broader systemic factors.\u0026rdquo;\u003c/p\u003e \u003cp\u003eResearch focused on the social and structural determinants of mental health shows that contextual and relational supports situated within children\u0026rsquo;s lived environments can have a profound impact on their well-being outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Given their positioning, these factors are likely to have a much broader reach than clinical interventions. Considered through a dual continuum model [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], we can also surmise that support factors linked to social and structural determinants of mental health will, in some instances, delay the onset of more chronic mental illnesses and, where such illnesses exist, reduce severity and improve prognosis.\u003c/p\u003e \u003cp\u003eEnsuring that impactful contextual and relational supports are situated within young people\u0026rsquo;s environments, however, requires the direct input of the children and youth living in that context. Their experiences are not merely anecdotal; they constitute critical data essential to the development of effective community programs, social policies, and support systems. By centering their perspectives, we move beyond assumptions that reflect knowledge and engage with the complex, nuanced realities that shape their well-being.\u003c/p\u003e \u003cp\u003eThis article reports on research grounded in the principle that those most affected by community conditions are the foremost experts on their own needs. Using arts-based methods within a Participatory Action Research (PAR) approach, we collaborated with a group of 20 young men (aged 15\u0026ndash;18 at the start of the study) living in an urban context in Atlantic Canada to explore what wellbeing entails and the contextual supports that underpin it. Findings highlight an interconnected web of formal and informal supports, embedded within systemic factors that affect accessibility, relevance, and a sense of safety in accessing these supports.\u003c/p\u003e \u003cp\u003eIn the following sections, we contextualize this work by reviewing existing research and theory, and then detail the methods used to collect and analyze data. Following this, we present the core thematic findings: the external bedrock of support, the cultivation of an inner resilient self, and the tangible arenas where growth occurs. Finally, we will synthesize these themes into a cohesive model of well-being constructed by the participants as co-researchers, concluding with actionable implications for policy and practice.\u003c/p\u003e"},{"header":"Literature review","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSupporting youth mental health outside of a clinical context\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eDual continuum model for understanding of mental health and flourishing\u003c/h2\u003e \u003cp\u003eThe UN [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Sustainable Development Goals call for human flourishing, defined as \u0026ldquo;all human beings can fulfill their potential in dignity, equality, and in a healthy environment.\u0026rdquo; Similarly, the WHO [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] defines mental health as \u0026ldquo;a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn and work well, and contribute to their community. It has intrinsic and instrumental value and is a basic human right.\u0026rdquo; Additionally, they note that \u0026ldquo;Mental health exists on a complex continuum, which is experienced differently from one person to the next. At any one time, a diverse set of individual, family, community and structural factors may combine to protect or undermine mental health.\u0026rdquo;\u003c/p\u003e \u003cp\u003eKeyes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], in his work on flourishing over almost three decades, provides a helpful framework for understanding this so-called \u0026ldquo;complex continuum.\u0026rdquo; In summary, the Dual Continuum Model of Mental Health comprises two axes, one reflecting mental well-being and the other mental illness. According to the model, an individual can have good or bad mental well-being (reflected on the vertical axis) while also having or not having a mental illness (reflected on the horizontal axis). Flourishing occurs when a person is situated high on mental well-being with a corresponding absence of mental illness symptoms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Subsequent research with the model suggests that promoting mental health and well-being plays an important role in the presence or absence of mental illness symptomology. Much as good physical health is associated with a lower likelihood of catching a cold and, when a person does get sick, with faster recovery, good mental health is associated with reduced mental illness symptoms and improved prognosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. To this end, drawing attention to health-promoting factors, this model implicates the social and structural determinants of mental health in our efforts to support the mental health of refugee youth.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eSocial and structural determinants of mental health\u003c/h3\u003e\n\u003cp\u003eA substantial body of research emphasizes that mental health outcomes are inextricably linked to the conditions in which people live, learn, and develop. These factors, the social and structural determinants of mental health (SDMH), generate and perpetuate intergenerational cycles of advantage and good health or disadvantage and poor health [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. SDMH are the contextual conditions \u0026ndash; or social determinants -- to which individuals are exposed throughout their life course, from conception onward, which influence mental health outcomes and contribute to population-level mental health disparities. These conditions are significantly influenced by economic policies, social norms, and political systems \u0026ndash; structural determinants -- underpinning the contexts in which people live [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStructural determinants are the overarching, upstream factors often considered the root causes of health inequities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. They encompass the large-scale political, economic, and social policies, practices, and values that operate at national and local levels. Structural determinants shape the distribution of money, power, and resources, which in turn determine individuals\u0026rsquo; lived contexts and their opportunities for safe, secure, and healthy lives [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Power structures often manifest along class, race and sexual lines, with historical trajectories.\u003c/p\u003e \u003cp\u003eSocial determinants, by contrast, represent people\u0026rsquo;s daily lived experiences resulting from the underpinning structural conditions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Economic factors linked to social determinants include financial insecurity, employment status, food insecurity, and housing instability or disadvantage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Education is typically associated with educational inequality, literacy, and parental education levels [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Access to support services is often associated with health and healthcare, focused on access to and quality of healthcare, including preventative care and barriers to accessing such care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Social and Community Context encompasses experiences of discrimination, social isolation, and the presence of social support and community cohesion [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Finally, the neighbourhood and the built environment include the physical quality of housing, neighbourhood safety, environmental conditions (e.g., air and noise pollution, lack of green space), and residential segregation or marginalization [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The core principle unifying these domains is that differences in SDMH are not randomly distributed, leading to poor mental health outcomes that are disproportionately experienced by individuals living in communities that are socially and economically marginalized [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe influence of SDMH is particularly critical during adolescence, when complex cognitive and affective neural systems are being refined and are highly sensitive to the physical and social environment in which this occurs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Being raised in poverty is associated with structural and functional brain changes, often affecting neurocognitive performance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Negative and prolonged contextual factors, such as socioeconomic disadvantage, can accelerate brain development and reduce plasticity. Exposure to environmental factors common in disadvantaged urban areas, such as air and noise pollution and limited green space, are associated with adverse brain development and low mental health in children and adolescents [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, adolescents exposed to adverse SDMH demonstrate significantly higher vulnerability to a range of mental health issues. Poverty is a fundamental risk factor for emotional, mental, and behavioural disorders in youth [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Children growing up in socioeconomic disadvantage are two to three times more likely to experience mental health problems compared to their non-disadvantaged peers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Contextual stressors are shown to exacerbate their vulnerability to illnesses such as depression and anxiety [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, poverty exacerbates stress for parents and is consistently linked to child maltreatment and neglect [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCritically, when considering the relationship of SDMH and refugee populations, exposure to neighbourhood disadvantage and crime is associated with elevated PTSD, anxiety, and depressive symptoms in adolescence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The highest rates of mental health concerns, including suicide attempts, suicidal ideation, and non-suicidal self-injury, have been found in youth groups categorized by high overall or high social SDOH deficits (adversity and discrimination) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Experiences of discrimination and marginalization translate directly into adverse mental health outcomes. Racial and or ethnic discrimination is related to negative outcomes across multiple developmental domains, with particularly strong effects seen in adolescence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Structural racism also increases exposure to individual-level stressors, such as family conflict and material hardship, which in turn have a negative impact on the brain [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUltimately, the goal of understanding SDMH is to recognize that poor mental health outcomes are not randomly distributed but arise from inequitable access to resources, often stemming from systemic discrimination and structural inequalities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Addressing youth mental health effectively requires moving beyond individual clinical solutions to implementing broad public health policies that tackle the root causes, such as poverty alleviation and structural racism, particularly during critical early life and adolescent developmental periods [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Without addressing structural determinants such as poverty and neighbourhood conditions, and establishing the fundamental conditions necessary for healthy development, a continued focus on downstream individual treatment and intervention will fall short of the needs of refugee youth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eChildren and youth as refugees\u003c/h3\u003e\n\u003cp\u003eAs previously stated, approximately 49\u0026nbsp;million children globally are currently forcibly displaced [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Many of these children are resettled in host countries as refugees, with or without their families. For example, in 2024, Canada admitted 76,685 refugees and protected persons as permanent residents, of which approximately 17% were minors [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These numbers continue to rise annually, reflecting the growing international humanitarian crises [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFactors that drive people towards asylum claims are primarily rooted in safety concerns. When people feel structurally unsafe (i.e., their broader social context and government are unable to provide safety) and are confronted with ongoing danger, they are inclined to flee. Key push factors include violence, conflict, and insecurity caused by armed conflict or civil war, ethnic, religious, or political violence, characterized by widespread human rights violations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, persecution or the threat of persecution, in which a person fears harm because of who they are or what they believe, is another significant push factor. People may be targeted for political opinion, religion, race or ethnicity, gender or sexual orientation, membership in a particular social group (e.g., journalists, activists), and/or tribal or caste identity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Other reasons include state repression or state-sponsored harm, gender-based and family-based violence [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], national economic collapse linked to insecurity (such as extreme poverty caused by war), environmental disasters combined with state failure, and the targeting of children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], amongst others. The implication is that most people arriving in a host nation as refugees will most likely have had extreme adverse experiences.\u003c/p\u003e \u003cp\u003eRefugee youth experience many of the same mental health concerns as other young people, but the frequency, intensity, and complexity of their needs are often far greater because of exposure to violence, loss, displacement, and resettlement stress. Refugee youth often experience exposure to war, violence, bombing, militia/gang threats, loss of family members, dangerous migration journeys and or detention or family separation. Consequently, they often require support for anxiety and depression, where chronic fear, uncertainty, and disrupted daily life contribute to generalized anxiety, panic symptoms, sadness and hopelessness, and sleep disturbances and nightmares [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Mental health challenges are then often augmented by uncertainty stemming from aspects of the resettlement process. These include immigration hearings, family reunification, housing instability, and financial insecurity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Strengths that these youth may bring with them, such as creativity, strong insights, cultural, familial and community bonds, and multilingual and adaptive capacities, are often undermined by these negative experiences.\u003c/p\u003e \u003cp\u003eIn response, youth require stabilization through a sense of safety and predictability. Environments characterized by consistency, predictability, clear routines and provision of basic needs foster and support mental well-being. The absence of these exacerbates mental health challenges [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, refugee youth often navigate two worlds at once. Managing this requires culturally responsive counselling, interpretation and language support, space to affirm identity and cultural practices, and community-based, relational supports rather than purely clinical ones [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. For refugee youth, schools are major sites of stress and support. Here they need peer integration support, anti-racism and anti-bullying supports, trauma-informed teachers, academic catch-up assistance and support for interrupted education [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Refugee youth also require support for acculturation stress. Youth face pressure to adapt quickly, role reversal with parents, identity conflict and discrimination or xenophobia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. To manage this, they often need identity development support, spaces to belong (youth groups, mentorship), and guidance in navigating multiple cultural expectations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Finally, and importantly, they need their own strengths recognised and supported [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. What these support factors look like locally however, and how they interact with one another, is largely contextually shaped. Understanding these needs in broad terms does not mean we understand the specificities of these supports and their nuanced functioning within specific communities, for specific populations.\u003c/p\u003e\n\u003ch3\u003eThis study\u003c/h3\u003e\n\u003cp\u003eFindings presented in this article are from a study exploring the contextual factors that support youth well-being in an urban area of Atlantic Canada, [Study title blinded for review]. Situated within a social and structural determinants of mental health model, the study responds to the uptrend in the rates of young people struggling with their mental health, unable to experience well-being [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Specifically, we sought to collaborate to identify mid- and upstream mental health supports [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], centring youth experiences in the results used to inform policies focused on mental health promotion [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The study was conducted in partnership with a local [community youth service provider; blinded for review]. Youth researchers in the study all identified as young men and were predominantly from Syria, Sudan, and Somalia (aged 15\u0026ndash;18 at the start of the research). These countries are identified by the UNHCR [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] as being characterized by violence, conflict, and insecurity caused by armed conflict or civil war, ethnic, religious, or political violence, characterized by widespread human rights violations.\u003c/p\u003e "},{"header":"Research Methodology","content":" \u003cp\u003e[STUDY NAME] used qualitative arts-based methods with 20 youth to unpack what wellbeing looks like to young men from conflict backgrounds, and what factors in their lived environment support and or jeopardize their wellbeing. Youth were informed of the study by staff at the [community partner service]. Where they were interested, youth were invited to a meet-and-greet session in which the study and their research rights were explained to them. Following this, several sessions were held, during which the team of student and youth researchers got to know one another through activities. Sessions were facilitated by the study's lead researcher [blinded]. Following this, youth were asked to photograph, over seven days, the spaces they move through in the city and to reflect on how these spaces support or undermine their well-being. Once images had been made, individual photo-elicitation interviews were conducted with the youth to explore their photos in depth, expanding the young men\u0026rsquo;s thinking about wellbeing factors in their lives [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. We then held a group meeting in which the youth shared their photos and key findings from their interviews, which furthered the discussion. We then worked in three smaller groups to explore emerging factors in more detail. Here, we used facilitation tools, such as body mapping, to explore what wellbeing entails, and then arranged previously identified contextual factors around our young people's maps to examine in greater depth the interaction between youth and their lived environment. These methods were intentionally chosen for their unique capacity to explore the rich context of personal experience.\u003c/p\u003e \u003cp\u003eFinally, the youth worked with the lead researcher and students to analyze the data using thematic analysis [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Here, youth worked with code cards, sorting them through a consensus process into groups, which were then further discussed to identify the themes represented by these code groups. By collectively constructing a narrative model of well-being from individual concepts, the youth directly engaged in the analysis process. This approach ensures that the resulting framework accurately reflects their shared understanding and priorities. The following sections present the core themes that emerged from this collaborative analysis, reflecting the building blocks of well-being as defined by the youth themselves. The transcript of the analysis workshop forms the basis of the findings section. As such, little to no excerpts from transcripts are included.\u003c/p\u003e \u003cp\u003eEthical consent was obtained from [BLINDED] University, the host institution for the research. In accordance with this, all youth provided freely given, informed written consent to participate, and where necessary, due to age, from their guardians.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings: The Building Blocks of Well-being","content":"\u003cp\u003eFindings reflect a web of interconnected personal, relational, and contextual supports that interact to promote young people\u0026rsquo;s well-being. While conceptualized as a web, there is still an anchoring foundation of supports that youth need to experience the personal growth required for well-being. Building on these foundational supports are additional critical components, including education, culture, and other contextual resources, that interact to foster personal growth and ultimately well-being. These findings echo research on the SDMH, extending them to provide a contextualized understanding of how these determinants interact to support wellbeing (see Image 1).\u003c/p\u003e\n\u003ch3\u003eThe Bedrock of Support: Community Context and Relationships\u003c/h3\u003e\n\u003cp\u003eOur analysis revealed that a supportive external environment is the essential foundation for individual well-being. Youth researchers consistently emphasized that before a young person can focus on internal growth and personal achievement, they require a secure and nurturing base. This foundation is built on positive relationships with family, friends, and the broader community, which together foster a sense of safety and belonging.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe Role of Family and Community\u003c/h2\u003e \u003cp\u003eYouth identified the concepts of \"Safe Families and communities\" and a \"sense of belonging\" as deeply interconnected. They articulated a two-directional model where community is defined not just as a physical place but as a web of relationships that \u0026ldquo;helps families be more supported. And the more families are supported, the better the community is.\u0026rdquo; This reciprocal dynamic creates an environment where individuals feel secure and valued enough to engage meaningfully with their surroundings. However, this foundational bedrock is frequently threatened. Youth contrasted the ideal of safety with the lived reality of environments where they see \u0026ldquo;needles around the place like the parks,\u0026rdquo; roads near vital community hubs where shootings have occurred, and public spaces like the library where drug use necessitates a call for greater security. Ultimately, if the physical environment is not safe, a sense of belonging (as bolstered by relationships) is undermined. By contrast, a safe environment creates space for families and community members to express care and have fun. Youth also explained that a safe physical and relational environment\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u003cem\u003eImage 1\u003c/em\u003e:\u003c/h2\u003e \u003cp\u003eCodes and Themes of Youth Wellbeing\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eis characterized by a sense of acceptance, mutual respect, comfort (a subjective sense of acceptance for who you are and being okay), and being \u0026ldquo;healthy.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe Function of Friendships\u003c/h2\u003e \u003cp\u003eFriendships were identified as a distinct and vital pillar of support. Youth stressed the importance of \u0026ldquo;healthy friendships, where we experience acceptance, comfort.\u0026rdquo; While family support is crucial, friends offer a unique, relatable perspective built on shared experience. As one youth noted, with friends, \u0026ldquo;you go through the same things and can help each other because you understand.\u0026rdquo; This suggests a relationship of mutual understanding and peer-based validation that differs from the often-hierarchical support of family, especially where parents have come from such a different social context to the one they are living in now. This peer connection provides a crucial space for acceptance among those navigating similar life stages, but also seems to solidify relationships with family because of shared youth experiences with parents. This external foundation of community and relationships provides the security necessary for young people to turn inward and develop their personal attributes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eArenas for Growth: Key Spaces, Activities, and Tangible Needs\u003c/h2\u003e \u003cp\u003eThe research demonstrated that abstract concepts of well-being become concrete in the tangible settings of daily life. This section explores the specific places, activities, and material needs that Youth identified as crucial arenas for their happiness, health, and personal development. These arenas are where the internal skills of the \u0026ldquo;Inner Architect\u0026rdquo; (see next section) are cultivated and tested.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe Significance of Structured Community Spaces\u003c/h2\u003e \u003cp\u003eSpecific community hubs were repeatedly cited as vital to youth well-being, though access is not always guaranteed. For the youth in this study [COMMUNITY PARTNER; BLINDED] is valued for providing food and safe, fun activities, and was described as a welcoming place that feels like \u0026ldquo;family.\u0026rdquo; Youth noted however, that limited operating hours restrict their access around school hours. Similarly, the mosque serves as a critical space for spiritual and community connection. Youth described it as a place that provides peace, shared purpose, and a sense of belonging, making it a key environment for emotional regulation and self-reflection. Finally, the library was identified as a safe, quiet place for study, personal development, and social connection. Like the mosque, it functions as an arena for achieving the \u0026ldquo;calmness\u0026rdquo; and focus needed for personal growth.\u003c/p\u003e \u003cp\u003eIn addition to providing welcoming and safe spaces, all three venues offer youth engaging opportunities for learning. Youth explained how the learning that occurs in these spaces is completely different to the form of pedagogy used in school spaces, yet they found this learning so much more impactful and meaningful. Learning in these spaces occurs through both active engagement and observation of others (role models). Additionally, through a process of reflection after doing, by having conversations with older role models, youth can analyze and understand the cause-and-effect component of experiences and their related success or failure. They highlighted the importance of this learning to their own growth and ultimate well-being.\u003c/p\u003e \u003cp\u003eAgain, these findings highlight the rich interaction between safe physical community spaces, and the impact of supportive relationships within these spaces. Here, youth especially noted how these physical and relational spaces also facilitated their access to and relationship with culture, both their families\u0026rsquo; cultures and the new culture in which they are now living.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe Role of Sports and Physical Activity\u003c/h2\u003e \u003cp\u003eSports and physical activities, particularly soccer and basketball, were consistently framed as essential for well-being. Spaces like the [SOCCER Centre] are more than just fields; they are primary arenas where the internal skill of discipline is cultivated and a sense of accomplishment is earned. Youth explained that beyond physical health, these activities foster teamwork, build social connections, and serve as a healthy escape and a positive outlet for energy.\u003c/p\u003e \u003cp\u003eImportantly, they also highlighted that while formal spaces are needed for more formal engagement in these activities, access to informal spaces is equally important. Informal spaces could be more accessible by being situated within their own neighbourhoods and being free for use. To this end, the youth shared how they had previously been able to spontaneously meet up and play soccer in an open lot in their neighbourhood before it had been turned into an apartment complex. Now they have nowhere to do this. Additionally, to get to free spaces in the city, they have to rely on public transportation. They are reluctant to do this for several reasons. First, it removes the spontaneity and ease with which they can gather, requiring more planning. Second, by leaving their communities, they have to go into other city spaces where they may not feel as welcome or safe. And finally, they are hesitant to use public transportation because of feeling unsafe. This is because of the racism expressed by bus drivers, the lack of safety from other passengers and the dirty buses. Relatedly, they noted that these factors often mean it is easier (and safer) to default to their phones.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe Importance of Nature and Quiet Spaces\u003c/h2\u003e \u003cp\u003eConnected to informal outdoor spaces, youth articulated a strong need for \u0026ldquo;quiet places\u0026rdquo; and \u0026ldquo;green spaces.\u0026rdquo; Youth spoke of the calming and restorative effects of being in nature, linking these spaces directly to the practice of emotional awareness. These environments provide a necessary escape from stressful surroundings and are seen as essential for self-care, relaxation, and achieving the sense of \u0026ldquo;peace\u0026rdquo; required for self-reflection.\u003c/p\u003e \u003cp\u003eAdditionally, however, green spaces provide sites of connection with friends, and a space for families to connect and spend time together. Here youth noted the presence of play parks in their communities, but also discussed how these spaces were too small to accommodate activities like community gatherings or adolescents kicking balls around. By contrast, they argued that spaces where families could connect as part of a broader community served to strengthen social fabric, interpersonal understanding and connection, and ultimately intergenerational relational supports and establish a sense of belonging and safety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTools for connection and access\u003c/h2\u003e \u003cp\u003eInterwoven through their identification of core support factors was the pragmatic role of resources that make connections with relationships and physical spaces possible. Most notably, they spoke of cell phones as a means of communicating with friends and family, learning about activities, and accessing transportation services such as Uber and the bus. Along with this, however, they also noted the drawbacks of resources such as public transportation. As previously noted, the youth highlighted that the social and physical conditions of buses make them reluctant to use public transportation.\u003c/p\u003e \u003cp\u003eCrucially, access to all these arenas for growth is often obstructed by systemic barriers. Youth highlighted unreliable public transportation\u0026mdash;including infrequent service, dirty conditions, and experiences of \"racism on busses\"\u0026mdash;as a significant obstacle preventing them from reaching the very places that support their well-being.\u003c/p\u003e \u003cp\u003eSimilarly, when they don\u0026rsquo;t feel a sense of belonging and engagement, including times when they cannot spontaneously connect with friends in their neighbourhood (linking back to safe, accessible green spaces), they are more inclined to scroll on their phones. Youth also explained that when phones and online spaces are used for recreation, they are used at times when \u0026ldquo;we need to escape or there is nothing to do.\u0026rdquo; Youth noted that when they feel overwhelmed by life, or are unable to connect face-to-face with friends, that is also when they will go online, especially to participate in games (like FIFA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCultivating Personal Growth\u003c/h2\u003e \u003cp\u003eWhen external foundational supports are available, youth identified a powerful set of internal characteristics and practices that they are able to engage with and that are essential for navigating life\u0026rsquo;s challenges and achieving personal goals. These internal attributes foster the personal growth required to build personal strengths, a sense of purpose, and achieve emotional stability, as well as ultimately, a sense of well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTangible Expressions of Self-Care\u003c/h2\u003e \u003cp\u003eYouth discussed the importance of tangible elements like \u0026ldquo;nice clothes,\u0026rdquo; a \u0026ldquo;fresh haircut,\u0026rdquo; and \u0026ldquo;good hygiene.\u0026rdquo; They explained that this is not about materialism but expressions of \u0026ldquo;self care\u0026rdquo; and \u0026ldquo;self pride.\u0026rdquo; Taking care of one's appearance was directly linked to feeling \u0026ldquo;mentally happy\u0026rdquo; and confident. These practices represent a form of self-respect that contributes positively to one's internal state.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eEmotional Awareness and Regulation\u003c/h2\u003e \u003cp\u003eThe ability to understand and manage one's own emotions was identified as a critical skill for inner well-being. Youth noted skills like \u0026ldquo;identify your emotions\u0026rdquo; and \u0026ldquo;express your emotions\u0026rdquo; as prerequisites for achieving \u0026ldquo;calmness\u0026rdquo; and \u0026ldquo;confidence.\u0026rdquo; The logic, as one youth articulated, is that \u0026ldquo;you won't be able to stay calm because you don't know why you're lashing out.\u0026rdquo; This underscores the importance of emotional literacy as the basis for self-control and stable, positive emotional states. These internal traits are not developed in a vacuum; they are nurtured and expressed within the tangible spaces and activities that make up a young person's daily life as reflected in the foundational components.\u003c/p\u003e \u003cp\u003eSelf-awareness is also linked to emotional literacy as well as foundational components. Being able to interact with others, engage in diverse activities, have varied experiences, and understand how these experiences make you feel interacts to support self-awareness, healthy self-expression, and develop a sense of purpose in life. They also interact to build a sense of self and confidence.\u003c/p\u003e \u003cp\u003eCollectively, these factors also come together to foster a bi-directional sense of responsibility and independence. Here youth explained that healthy personal growth, fostered by foundational supports, as well as education and connection to culture, can instill a sense of responsibility for self, others and community. These factors also foster personal independence. Critically, the combination of the two ensures that while young people grow to be self-supporting, they are not selfish in their actions. To be self-supporting in healthy ways, requires recognising your co-dependence on others, and the need to be equally responsible for yourself and others. This overall cluster of ideas highlights the belief that self-development is an active, ongoing process that builds identity and direction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eAchieving Well-being: A Happy, Healthy Self\u003c/h2\u003e \u003cp\u003eDiscipline was viewed as a cornerstone concept that \u0026ldquo;ties in with everything else.\u0026rdquo; Youth described it not as punishment, but as a proactive, positive force necessary for personal growth, achieving goals, and maintaining positive relationships. One youth connected it directly to accomplishment, stating, \u0026ldquo;if you don't have that discipline, you're not going to have the accomplishments.\u0026rdquo; This view extended beyond personal achievement to the relational sphere, with another participant noting its practical necessity in maintaining connections: \u0026ldquo;If you take care of your relationships once a month, you're probably not going to be in relationships.\u0026rdquo; This theme positioned discipline as the fundamental practice enabling the consistent effort required for a flourishing life.\u003c/p\u003e \u003cp\u003eRelatedly youth who are flourishing, have dreams and goals that are intended to realise these dreams. Dreams are varied and connected to school and work, relationships and community, as well as recreation and fun. Youth articulated a clear and dynamic relationship between having a \u0026ldquo;Sense of Self,\u0026rdquo; from \u0026ldquo;Personal Growth,\u0026rdquo; and having \u0026ldquo;dreams and goals.\u0026rdquo; They saw these concepts as feeding into one another in a continuous cycle. As one individual explained, \u0026ldquo;the more you know, as you're growing the more you know yourself.\u0026rdquo; This growing self-knowledge, in turn, fuels a sense of purpose and the ability to set and pursue meaningful goals. Additionally, youth who are flourishing have a sense of inspiration; they are inspired to work towards their goals and dreams, drawing on their discipline. Through this, they have a sense of achievement and accomplishment that feeds into a cycle with inspiration, goals and dreams, fostering greater discipline. Youth noted that flourishing doesn\u0026rsquo;t mean not experiencing failure, not achieving, or getting things wrong. Rather, these seemingly \u0026ldquo;negative\u0026rdquo; experiences serve as opportunities to reflect, learn and grow. Such growth, however, is often dependent on relational supports where others can support such reflection and learning. It also requires access to future opportunities to \u0026ldquo;try again!\u0026rdquo;\u003c/p\u003e \u003cp\u003eIn addition to these characteristics, flourishing is seen to encompass being active and finding enjoyment in life. Importantly, these activities are linked to happiness and kindness towards self and others, but also being able to have a sense of peace because of spirituality. Youth explained that having faith means you can make sense of experiences and events in your life, supporting a sense of happiness and peace. However, when faith is paired with religious engagement, you have a community of people around you who can guide you in your faith and meaning-making, especially when experiences are especially difficult.\u003c/p\u003e"},{"header":"Discussion: A Holistic Model of Youth Well-being","content":" \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003cp\u003eThe findings from this research present a model of what well-being looks like and how it is supported for a group of young men who have come to a mid-size urban setting in Canada, from war-torn contexts. Their model highlights what young men living with experiences similar to theirs require if their mental health is to be promoted as a buffer for mental challenges and illness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The model's factors reflect what we know about the social determinants of mental health [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], the importance of social safety, integration and belonging [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and the mediating role of community and peer group support between trauma and depression, especially for young men [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, the model also demonstrates that supporting mental health does not rely on a static list of factors; rather, it is a dynamic interplay among a young person's external environment, their engagement with the world as mediated by relationships, their internal development, and overall well-being. It tells a story of how flourishing is cultivated. The model, as reflected in Image 1, follows a clear and logical sequence: If we provide young people with supportive relationships, safety, and community, then we provide them with learning opportunities. Collectively, these feed into a process of personal growth that ultimately underpins a happy, healthy young person. This model emphasizes that a strong foundation of external support is the prerequisite for the internal growth that ultimately defines a happy and healthy individual. Echoing what we know about social and structural determinants of mental health, however, social determinants (i.e. contextual and relational supports) are themselves required to be \u0026ldquo;healthy\u0026rdquo; if they are going to be positive supports. To be healthy, they require supportive structural determinants (i.e., municipal and government policies and their implementation that account for their impact on mental health) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this way, these findings also hold important implications for the structural determinants of mental health.\u003c/p\u003e \u003cp\u003eKey aspects highlighted by the youth was the importance of spaces in which they can engage with social connections, friends especially, in spontaneous and convenient ways. There are key ways in which this data omits and or deviates from a more generic understanding of SDMH. First youth did not discuss economic factors. That said, much of what they did discuss implicates parental emotional and time availability (such as engagement in community events). Such availability requires fiscal stability. Similarly, housing stability and health of homes and the surrounding built environment are required to support cognitive development, physical health, and achievement of goals and dreams. Second, while most Western models of SDMH ordinarily associate education with more formal education systems, young people are increasingly explaining how education is so much more than this [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Here too, youth in this study refer to the complex interplay of relationships, opportunities to try things and get it wrong, and lived environment in their educational outcomes. These insights expand our understanding of what education means to young people, informing not just what healthier formal education systems could look like, but also the diverse actors and contexts that should be included in these systems. Similarly, the youth in this study highlight aspects of town planning and infrastructure (the built environment) that require consideration. Public transportation, for example, not only needs to be available, but also needs to be clean and safe. Such a requirement is probably not only relevant to this group of youth, but many other groups within urban centres, such as people who identify as female, professionals, parents with young children, and the elderly. Importantly, safety doesn\u0026rsquo;t only concern the behaviour of other passengers but also the behaviour of bus drivers and their interactions with passengers. Finally, having green spaces and recreational facilities within cities is not enough. Thought needs to be given to where these spaces are positioned, and who has access to them. Accessibility in turn is not just about cost, or location, but also size and resourcing. The young men in this study were very concerned about the discomfort or even harm they could cause by just playing with a soccer ball in their local \u0026ldquo;park\u0026rdquo; because it was small and filled with play structures for younger children. When the importance of green spaces, face-to-face social connection, and engagement in physical activity to fostering mental health vis-\u0026agrave;-vis depression, anxiety and PTSD in adolescent refugee populations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] are considered, the importance of these considerations becomes clear.\u003c/p\u003e \u003cp\u003eImportantly, the findings of this study have their limitations. This research has been conducted with a group of 20 youth who identify as male in a mid-size urban setting. The voices of female identifying youth, and the diversity of youth who identify as LGBTQAI\u0026thinsp;+\u0026thinsp;need to be accounted for in future research. Additionally, quantitative survey results may be used to affirm the resonance of these findings with larger populations of youth. Similarly, the insights of younger adolescents are absent from these findings and should also be explored in future research.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research has detailed a model of youth well-being that is complex, interconnected, and deeply rooted in the lived experiences of 20 young men who have come to a mid-size urban Canadian context from backgrounds of extreme adversity and violence. The primary finding is that well-being is not supported by a simple checklist of resources, but engages a dynamic ecosystem of relevant and accessible supports. It is built upon a non-negotiable foundation of safe and supportive relationships within families and communities. This secure base\u0026mdash;when it can be established against real-world threats\u0026mdash;enables young people to cultivate internal strengths, purpose, and self-awareness through meaningful engagement in safe, accessible, and purposeful activities and spaces. These activities cultivate the internal growth that youth need in order to flourish, not just cope, with the complex challenges they have experienced that threaten their mental health and well-being. These relational and contextual supports, however, require policy and related resource allocation from local and national leadership in order to both be present and persistent.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e: \u0026nbsp;The research was made possible with funding from the Canadian Institutes of Health Research (funding reference number: 513352)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e: The data that support the findings of this study are available from the lead author, but restrictions apply to the availability of these data, given the ethics approval of the research from the host organization, and so are not publicly available. The data are, however, available upon request, subject to the approval of Dalhousie University's Research Ethics Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e: The Dalhousie University Health Sciences Research Ethics Board approved this study. The research was carried out in accordance with the Canadian Tri-Council guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: Freely given, informed consent to participate was obtained from all participants, and, where necessary due to age, from their guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e: Freely given, informed consent to publish findings from the study was obtained from all participants, and, where necessary due to age, from their guardians.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLL is the lead researcher on the study. She led the data gathering, analysis and writing of this article. TS is the project manager and assisted with the data gathering, analysis and writing of this article. TJ is the lead of the community partner and assisted with recruiting participants and the final drafting and editing of the article. YR are the youth researchers on the study who participated in the data gathering and analysis. The findings section is written from the transcript of the data analysis workshop.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNHCR. Global trends: Forced displacement in 2024. 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Transcult Psychiatry. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/13634615221111025\u003c/span\u003e\u003cspan address=\"10.1177/13634615221111025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Refugee youth, mental health promotion, flourishing, participatory action research, arts-based research","lastPublishedDoi":"10.21203/rs.3.rs-8380085/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8380085/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChildren constitute 40% of all forcibly displaced people globally. They often face severe mental health challenges due to displacement factors. While evidence-based clinical interventions exist, international demand for mental health services frequently outweighs capacity. This qualitative study explores the interrelationship between individual mental health (flourishing) and broader social and systemic determinants of mental health, highlighting alternative supports for young people's mental health. Using arts-based methods within a Participatory Action Research approach, we collaborated with 20 young men (aged 15\u0026ndash;18) living in Atlantic Canada who came from conflict-affected backgrounds, including Syria, Sudan, and Somalia, to explore well-being and its contextual supports. Findings reveal an interconnected web of formal and informal supports, synthesized into four themes: 1. the external bedrock of support, 2. arenas for growth, 3. cultivation of personal growth, and 4. well-being. Findings show that a strong foundation of external support is the prerequisite for the internal growth necessary for flourishing. Crucially, youth highlighted how systemic barriers, such as unsafe public transportation and a lack of accessible neighbourhood spaces, often undermine access to these supports. Results demonstrate that supporting mental health requires a dynamic interplay among the external environment, relational factors, internal development, and policy and implementation supports. Collectively, these findings emphasize the importance of accounting for social and structural determinants of mental health across municipal and government sectors. Here, findings offer actionable implications for policy and practice, particularly regarding structural determinants of mental health, such as the provision of safe, accessible community infrastructure to promote flourishing among refugee youth.\u003c/p\u003e","manuscriptTitle":"A Participatory Action Research Qualitative Thematic Analysis of Young Men's Perspectives on Well-being and Flourishing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:58:49","doi":"10.21203/rs.3.rs-8380085/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T15:43:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T16:40:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-30T00:05:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158671719252282570722644163456166538365","date":"2026-01-22T13:54:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317817395212283941281112429492369983789","date":"2026-01-21T15:25:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218262217640726410911175930562917555909","date":"2026-01-19T19:11:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T04:48:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T09:41:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-22T18:49:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-22T18:42:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e49d60a-6858-47fb-bcfd-bf6c83aa68cb","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:01:31+00:00","versionOfRecord":{"articleIdentity":"rs-8380085","link":"https://doi.org/10.1186/s12982-026-01739-y","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-04-17 15:58:29","publishedOnDateReadable":"April 17th, 2026"},"versionCreatedAt":"2025-12-30 09:58:49","video":"","vorDoi":"10.1186/s12982-026-01739-y","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01739-y","workflowStages":[]},"version":"v1","identity":"rs-8380085","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8380085","identity":"rs-8380085","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}