Background: Adolescent mental health is a global concern, however, time trends and the COVID-19-related restrictions vary across countries. This study examined changes in adolescent mental health and substance use in Russia between 2002, 2015 and during the pandemic in 2021. Methods: Cross-sectional school-based surveys of 12- to 18-year-olds were carried out in a Siberian city in 2002 (N = 713), 2015 (N = 840) and 2021 (N = 721) using the Strengths and Difficulties Questionnaire, data on tobacco, alcohol and drug use and socio-demographic information. We examined the effect of cohort, gender, family composition and parental occupation on mental health and substance use. Results: There were increases in emotional symptoms and internalising problems (B = 0.93, p <.001) and decreases in substance use over 19 years (B = -.73, p <.001). Changes in adolescent mental health and substance use were substantial from 2002 to 2015 and nonsignificant from 2015 to 2021. Increases in mental health problems were evident only among girls; a decrease in alcohol use was larger among boys. Family composition and parental occupation did not account for these changes. Conclusions: These results suggest that the mental health of Russian adolescent girls has worsened in the 21st century; the gender gap in mental health has widened; the gender gap in alcohol use was reversed in 2021. The findings highlight the need for research into gender-specific factors and for effective interventions. The lack of changes in Russian adolescent mental health and substance use from 2015 to during the pandemic in 2021 suggests successful coping; however, more research is needed.
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