Abstract
BACKGROUND: There is a lack of country-level evidence for the association between social support and adolescent mental health while existing studies vary greatly in how they account for the interplay of multiple sources of social support. METHODS: This study utilised data from the National Adolescent Mental Health Surveys, nationally representative surveys of adolescents aged 10-17 years and their primary caregiver in Kenya, Indonesia, and Vietnam. Patterns of social support among adolescents in each country were assessed using a latent class analysis. The association between the identified social support classes and any mental disorder, suicidal ideation, and self-harm in the past 12 months was assessed using the Bolck-Croon-Hagenaars method, adjusted for demographic characteristics and caregiver mental health. All estimates were weighted to the respective country's population and presented with 95% confidence intervals (CIs). RESULTS: Three latent social support classes were consistently identified in Kenya, Indonesia, and Vietnam: Caregiver-focussed support, Other support, and Limited support. The Caregiver-focussed support class had the highest proportion of adolescents in all three countries (Kenya: 65.3%, 95% CI: 63.0-67.5; Indonesia: 54.0%, 95% CI: 50.4-57.6; Vietnam: 81.6%, 95% CI: 79.0-84.1), although the proportions varied significantly by country. Adolescents in the Caregiver-focussed support class had significantly lower odds of any mental disorder (Kenya: adjusted odds ratio [aOR]: 0.31, 95% CI: 0.25-0.38; Indonesia: aOR: 0.23, 95% CI: 0.17-0.31; Vietnam: aOR: 0.39, 95 CI%: 0.26-0.57), suicidal ideation (Kenya: aOR: 0.14, 95% CI: 0.10-0.19; Indonesia: aOR: 0.17, 95% CI: 0.10-0.29; Vietnam: aOR: 0.42, 95% CI: 0.24-0.76) and self-harm (Kenya aOR: 0.07, 95% CI: 0.04-0.13; Indonesia aOR: 0.23, 95% CI: 0.11-0.47 and Vietnam aOR: 0.16, 95% CI: 0.09-0.27) compared to the Limited support class. Adolescents belonging to the Other support class also demonstrated lower odds of these outcomes than those in the Limited support class. CONCLUSIONS: The association between social support and poor mental health indicates the critical role of primary caregivers, other family members, and peers in adolescent mental health. These findings highlight the need to develop interventions that leverage an adolescent's existing support networks.