Maltreatment, Social Support and Youth Emotional Well-Being

Background/Purpose

Addressing the growing child and adolescent mental health crisis is a global priority, particularly for youth in low- and middle-income countries (LMICs). Although experiencing maltreatment is associated with less emotional well-being, and experiencing social support is associated with more emotional well-being, the relationship between maltreatment, social support and emotional well-being is unknown.

This study aims to better understand relationships between maltreatment, social support, and emotional well-being by using data from the Positive Outcomes for Orphans (POFO) study.

Methods

We used data from the longitudinal POFO study (wave two) of orphaned and separated children and young adults (OSC; ages 11-21) (n=2,535) from five LMICs (Cambodia, Ethiopia, India, Kenya, Tanzania) to examine the relationship between maltreatment (child report), social support (MOS Social Support Survey-16), and emotional well-being (Strengths and Difficulties Questionnaire, total difficulties). Linear models fit with generalized estimating equations (GEEs) were used to examine relationships between 1) maltreatment and emotional well-being, 2) social support and emotional well-being, and 3) maltreatment, social support, and emotional well-being. Associations between subtypes of support and total difficulties were also examined. Social support subtypes included emotional support (someone to confide in, to provide advice and information), tangible support (someone to help with chores, meals or transportation), and positive social support (someone to get together for fun or relaxation). Models controlled for age, gender, physical health, parental vital status (maternal & paternal death), and other trauma experiences (parent/caregiver report and/or child report). Analyses were run in Stata/IC 16.0

Findings

The sample included female (54%) and male (46%) participants. At baseline data collection, participants were ages 11-14 (51%), 15-17 (44%) and 18-21 (5%) and were living in Cambodia (14%), Ethiopia (16%), Hyderabad (18%), Kenya (19%), Nagaland (14%) and Tanzania (18%). Many were paternal orphans (42%), maternal orphans (12%) or double orphans (24%), while others experienced no parental death (22%).

In adjusted associations, for each unit increase in maltreatment there were nearly two times the odds of decreased emotional well-being (Coeff 1.931, 95% CI 1.550 2.311) while social support was associated with decreased total difficulties (Coeff -0.115, 95% CI -0.129 -0.101). Social support reduced difficulties, even in the concurrent presence of maltreatment (Coeff -0.113, 95% CI -0.127 -0.099). Emotional support, tangible support, and positive social support subtypes were also associated with reduced difficulties.

Conclusions/Implications

Measuring both maltreatment and social support may result in a more comprehensive understanding of youth emotional difficulties. Interventions that facilitate social support may promote emotional well-being. In particular, interventions that teach parenting/caretaking skills may benefit from emphasizing the importance of building trust, providing advice, providing information (emotional support), providing help with chores, meals and/or transportation (tangible support), and facilitating enjoyable family/group activities to promote fun or relaxation (positive social support). Interventions promoting peer relationship-building might also benefit from teaching these skills.

While additional research is needed to understand how mental health services impacts associations between maltreatment, social support and emotional difficulties, interventions promoting social support may be particularly useful in communities where trauma-informed mental health services are not readily available or accessible.