At-a-glance – Prosocial behaviour and happiness among children aged 6 to 11 years in Canada

Introduction

The Public Health Agency of Canada monitors positive mental health (PMH) outcomes and their determinants, guided by the Positive Mental Health Surveillance Indicator Framework (PMHSIF).^{Footnote 1} The importance of taking life course stages into account (i.e. childhood [0 to 11 years], youth [12 to 17 years], adulthood [18+ years]) was identified during the initial PMHSIF development.^{Footnote 2} Adult and youth versions of the PMHSIF have been released and updated multiple times,^{Footnote 1} but a child version remains in development. To begin to fill that gap, a scoping review was conducted to understand how PMH is conceptualized in childhood, with hedonic/emotional well-being, psychological well-being, social well-being and social emotional learning/positive development emerging as key aspects of child PMH.^{Footnote 3}

The next step for surveillance is to identify and examine potential indicators of child PMH. The Canadian Health Measures Survey (CHMS) has frequently measured two PMH outcomes among children: prosocial behaviour and happiness. Prosocial behaviours are voluntary actions meant to benefit others—including helping, sharing and comforting^{Footnote 4}—and can be considered part of social emotional learning/positive development (i.e. social awareness, relationship skills, social competence).^{Footnote 5Footnote 6} Happiness definitions have varied across time and cultures,^{Footnote 7} but it is commonly conceptualized by researchers as a core element of hedonic/emotional well-being (with pleasure, enjoyment or life satisfaction).^{Footnote 8}

Despite these outcomes being included in the earliest CHMS cycles,^{Footnote 9Footnote 10} understanding of their epidemiology among Canadian children is limited. To gain insight into what indicators based on these measures would tell us about child PMH if they were used for surveillance, our objectives were to investigate whether levels of happiness and prosocial behaviour among Canadian children (1) vary over time, (2) differ between sociodemographic groups, and (3) are associated with each other.

Methods

Data

The CHMS is a repeated cross-sectional survey by Statistics Canada that collects representative data on the health of people in Canada through questionnaires and direct health measures. We used shared data from the household questionnaires of the first six cycles,^{Footnote 9Footnote 10Footnote 11Footnote 12Footnote 13Footnote 14} which were administered via personal interview in the respondent’s home from 2007–2019 (cycle dates are reported in Table 1). The target population was 3 to 79 years of age in cycles 2–6, and 6 to 79 years in cycle 1. Full-time Canadian Forces members, and those living in institutions, on reserves or other Indigenous settlements, and in specific remote regions were not part of the target population, nor were those living in the territories from cycle 3 onward. A multistage sampling strategy is used for the CHMS, where collection sites are selected from regions, followed by a random sample of dwellings and then sampling individuals within households. We restricted our analyses to 6- to 11-year-olds (Ns = 1081, 1076, 1024, 1032,
1040 and 1011 for cycles 1–6, respectively).

Measures

Prosocial behaviour was measured in cycles 1–4 (2007–2015) using five items from the prosocial behaviour subscale of the Strengths and Difficulties Questionnaire (SDQ).^{Footnote 15} The SDQ has been validated for Canadian children and youth, with evidence provided for its factorial validity, internal consistency, and measurement invariance across sex, age, and language.^{Footnote 16} Parents/guardians (hereafter referred to as “parents”) were asked whether each statement (e.g. “is helpful if someone is hurt, upset or feeling ill”) was “not true” (scored 0), “somewhat true” (scored 1), or “certainly true” (scored 2) of their child’s behaviour over the last six months. Responses were summed, with total scores ranging from 0–10. Based on Canadian-specific cut-offs,^{Footnote 17} we categorized children with total scores of 8–10 as having normative levels of parent-rated prosocial behaviour (previously labeled “normal”) and those with scores of 0–7 as having nonnormative levels (previously labeled “borderline” [7] and “clinical” [0–6]).

Happiness was measured in cycles 1, 2, 5 and 6 (2007–2011, 2016–2019) using the single-item emotion attribute measure from the Health Utilities Index Mark 3 (HUI3).^{Footnote 18} Parents were asked (with input from their child if needed) whether they would describe their child as being usually “happy and interested in life,” “somewhat happy,” “somewhat unhappy,” “unhappy with little interest in life,” or “so unhappy that life is not worthwhile.” Consistent with the coding used for the youth and adult self-rated version of this measure in the PMHSIF,^{Footnote 1} we categorized “happy and interested in life” as high perceived happiness.

Analysis

We conducted analyses using SAS Enterprise Guide Version 7.1. We used sampling and bootstrap weights from Statistics Canada to account for the sampling design. We combined cycles that measured the PMH outcome(s) of interest and combined weight files in line with Statistics Canada recommendations.^{Footnote 19Footnote 20} Also aligned with their recommendations,^{Footnote 20} we specified degrees of freedom in our analyses based on the total number of data collection sites sampled minus the number of regions for each cycle. To examine potential differences over time, we obtained overall and sex-stratified weighted percentages with 95% confidence intervals (CIs) for normative parent-rated prosocial behaviour and high perceived happiness at each relevant cycle. We also conducted unadjusted logistic regression analyses to determine whether there were any significant differences compared to 2007–2009 (i.e. cycle 1). To investigate potential sociodemographic differences (specific variables and breakdowns are reported in Table 2), we obtained weighted percentages with 95% CIs for normative parent-rated prosocial behaviour and high perceived happiness for each group and conducted unadjusted logistic regression analyses.

Similar analyses were conducted to examine how prosocial behaviour and happiness were associated. We used pairwise deletion to deal with missing data (sample sizes are reported in the notes for Tables 1 and 2).

Table 2. Comparing normative parent-rated prosocial behaviour and high perceived happiness across sociodemographic characteristics and to each other, children aged 6 to 11 years, CHMS, 2007–2015/2019, Canada

Sociodemographic characteristic / PMH outcome	Normative parent-rated prosocial behaviour		High perceived happiness
	Weighted % (95% CI)	OR (95% CI)	Weighted % (95% CI)	OR (95% CI)
Sex
Female	93.8 (92.5–95.2)	Reference	92.6 (90.8–94.5)	Reference
Male	83.3 (79.8–86.7)	0.33 (0.23–0.46)Footnote a	90.6 (88.4–92.9)	0.77 (0.54–1.10)
Age (years)
6–7	85.6 (81.5–89.6)	Reference	94.3 (92.2–96.4)	Reference
8–9	89.8 (87.6–92.1)	1.49 (1.05–2.12)Footnote a	92.0 (89.2–94.8)	0.69 (0.39–1.24)
10–11	89.6 (87.3–91.9)	1.45 (0.99–2.14)	88.9 (86.4–91.4)	0.48 (0.30–0.78)Footnote a
Household income tertile
Low	88.4 (84.8–91.9)	Reference	90.8 (87.9–93.6)	Reference
Middle	88.4 (85.2–91.6)	1.01 (0.62–1.64)	92.7 (90.1–95.3)	1.29 (0.80–2.10)
High	88.5 (85.9–91.0)	1.01 (0.67–1.53)	91.8 (87.5–96.2)	1.14 (0.52–2.51)
Household educational attainment
High school or less	89.2 (84.9–93.5)	Reference	89.6 (86.1–93.1)	Reference
Post-secondary	88.0 (86.1–90.0)	0.90 (0.57–1.40)	91.9 (90.1–93.7)	1.31 (0.81–2.14)
Household composition
Lone-parent	85.7 (77.3–94.2)	Reference	86.6 (79.1–94.0)	Reference
Two-parent	88.8 (86.5–91.1)	1.32 (0.60–2.91)	92.1 (90.6–93.6)	1.81 (0.92–3.57)
Prosocial behaviour
Nonnormative	N/A	N/A	73.6 (65.2–82.0)	Reference
Normative	N/A	N/A	94.9 (93.7–96.1)	6.67 (4.20–10.60)Footnote a
Happiness
Not high	58.0 (47.3–68.8)	Reference	N/A	N/A
High	90.2 (87.6–92.8)	6.67 (4.20–10.60)Footnote a	N/A	N/A

Results

The vast majority of children had normative levels of parent-rated prosocial behaviour at each time point, ranging 86.0%–90.2% overall, 93.4%–94.6% for females and 77.9%–87.0% for males. Similarly, high perceived happiness was reported for most children, ranging 91.1%–92.2% overall, 89.4%–94.9% for females and 88.7%–93.0% for males. The prevalence of normative parent-rated prosocial behaviour and high perceived happiness in later years did not significantly differ from those observed in 2007–2009 (Table 1).

Sociodemographic comparisons are reported in Table 2. Males had significantly lower odds of having normative parent-rated prosocial behaviour compared to females (83.3% vs. 93.8%, respectively; OR = 0.33, 95% CI: 0.23–0.46). Moreover, 8- to 9-year-olds had significantly higher odds of having normative parent-rated prosocial behaviour compared to 6- to 7-year-olds (89.8% vs. 85.6%, respectively; OR = 1.49, 95% CI: 1.05–2.12). In contrast, 10- to 11-year-olds had significantly lower odds of having high perceived happiness compared to 6- to 7-year-olds (88.9% vs. 94.3%, respectively; OR = 0.48, 95% CI: 0.30–0.78). No other significant sociodemographic differences were found.

Prosocial behaviour and happiness were positively associated (OR = 6.67, 95% CI: 4.20–10.60; Table 2). Children with high perceived happiness had significantly higher odds of having normative parent-rated prosocial behaviour (90.2%) compared to children without high perceived happiness (58.0%), and children with normative parent-rated prosocial behaviour had significantly higher odds of having high perceived happiness (94.9%) compared to children with nonnormative parent-rated prosocial behaviour (73.6%).

Discussion

Most children in Canada had normative parent-rated prosocial behaviour and high perceived happiness, with no notable differences since 2007–2009. The high prevalence is unsurprising for normative prosocial behaviour as its cut-off was selected to include approximately 80% of the highest scores on the SDQ prosocial subscale for children and youth in CHMS cycles 3 and 4 (2012–2015).^{Footnote 17} Whether normative prosocial behaviour and high perceived happiness remain as prevalent among children in more recent years could be explored if/when datasets from subsequent CHMS cycles with relevant data become available.

Examining other Canadian data,^{Footnote 1} the percentages of youth and adults who reported usually being “happy and interested in life” were lower than the estimates obtained for children in this study. However, we are unable to discern whether this is due to age-related changes,^{Footnote 21} generational differences, or methodological differences.^{Footnote 22} For instance, parental perceptions of mental health can be more positive than self-rated perceptions.^{Footnote 23} Longitudinal data are needed to provide clearer explanations. While children were present during the questionnaire administration to provide input if needed, it is unclear how much they actually contributed. The amount of convergence/divergence between parent-rated and child-rated PMH indicators could be explored in future studies. The importance of capturing children’s perspectives in the measurement and reporting of their PMH was a key takeaway from the aforementioned scoping review^{Footnote 3} and was an area flagged for future research by the OECD.^{Footnote 24}

We found sex differences in parent-rated prosocial behaviour, with normative levels being more common among females than males. This replicates previous research on prosocial behaviour, although the size of this difference can depend on the type of prosocial behaviour, the measurement method and the target of the behaviour, and could be partially influenced by gender stereotypes.^{Footnote 25} Also consistent with previous findings,^{Footnote 25} the older age groups of children tended to have higher parent-rated prosocial behaviour than the youngest (although the difference for the oldest age group did not reach statistical significance; p = .06). Conversely, perceived happiness was highest among the youngest (vs. oldest) age group. These discrepant findings reinforce the importance of monitoring multiple PMH outcomes.^{Footnote 2Footnote 3Footnote 24}

In sum, this study furthers our understanding of the epidemiology of prosocial behaviour and happiness among Canadian children. However, there are limitations. The very high prevalence for both indicators may be indicative of ceiling effects, which could have hindered the detection of differences over time and between groups. The presence of the child and interviewer could have also contributed to the high prevalence via socially desirable responding by parents.^{Footnote 26} Moreover, while the positive association between prosocial behaviour and happiness aligns with previous research^{Footnote 27} and provides evidence for their convergent validity, common method biases may also contribute to some of their overlapping variance.^{Footnote 28} The cross-sectional nature of the data limits causal inferences; whether perceived prosocial behaviour leads to perceived happiness (or vice versa) cannot be established. Results may not generalize to those excluded from the CHMS (e.g. those living on First Nations reserves). Ongoing surveillance beyond 2019 and of other (self-reported) PMH indicators are needed for a comprehensive understanding of child PMH in Canada. Nevertheless, this study provides initial insights into the PMH of children in Canada based on two indicators, which could be integrated into surveillance tools like the PMHSIF.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Authors’ contributions and statement

• CAC: Conceptualization, methodology, formal analysis, writing – original draft.
• DL: Writing – review and editing.
• KRA: Writing – review and editing.
• LLO: Writing – review and editing.
• MV: Writing – review and editing, validation.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

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