How does family support mitigate the impact of childhood adversity on adolescent mental health?

Abstract Background Childhood adversity is associated with increased risk of developing mental health problems over the life course. We investigated how family emotional support in adolescence may mitigate the impact of childhood adversity on adolescent mental health. Methods We used longitudinal data from the UK Millennium Cohort Study on 9,269 children followed to age 17 years. Individuals were assigned to exposure trajectories characterised using group-based trajectory models that included measures of poverty and family adversities (parental mental ill health, parental alcohol misuse and domestic violence) up to age 14 years. Using counterfactual causal mediation analysis and four-way decomposition modelling approach, we evaluated how perceived family emotional support at age 14 (measured using the three-item Short Social Provisions Scale) influences the association of childhood adversity trajectories on mental health at ages 14 and 17, assessing the relative contributions of mediation and interaction simultaneously. Results Compared with children experiencing low adversity and poverty, those exposed to childhood adversity were almost three times more likely to experience poor mental health (RR 2·99, 95% CI 2 ·41 to 3·57) at age 14 and age 17 (RR 2·58, 95% CI 2·09 to 3·06). Perceived emotional support mitigates up to 18% (95% CI: 9% to 26%) of this effect at age 14, and 13% (95% CI: 5% to 22%) at age 17, mainly due to interactive mechanisms. Conclusions Childhood adversity has a strong effect on mental health, which is partially mitigated by perceived family support in adolescence. Policies that support positive family functioning may be particularly beneficial for children who have experienced adversity. Key messages • Socio-economic – associated mental health problems in adolescence differed based on levels of family support. • Approximately 20% of the social inequality in mental health outcomes in adolescence may be mitigated or reduced by improving levels of family support.