The mediating role of self-esteem in the association between perceived social support and youth mental health difficulties

Abstract Background This study examined whether self-esteem mediates the association between perceived social support and youth mental health difficulties in a heterogeneous sample of school-recruited youths and clinically referred inpatient and outpatient youths. Methods The study included 312 children and adolescents (mean age = 14.36 years, SD = 2.19, range = 9–19; 37.5% boys, 62.5% girls). The primary analysis was a covariate-adjusted mediation model in the full sample, with perceived social support (MSPSS) as the predictor, self-esteem (RSE) as the mediator, and Strengths and Difficulties Questionnaire (SDQ) Total Difficulties as the outcome. Hierarchical clustering based on SDQ, RSE, and MSPSS item profiles was conducted as a secondary, exploratory analysis. Results Higher perceived social support was associated with higher self-esteem (B = 0.26, 95% CI [0.20, 0.31], bootstrapped p < 0.001), and higher self-esteem was associated with fewer mental health difficulties (B = −0.43, 95% CI [−0.50, −0.35], bootstrapped p < 0.001) in the covariate-adjusted full-sample model. The indirect effect via self-esteem was statistically detectable (B = −0.11, 95% CI [−0.14, −0.08], bootstrapped p < 0.001), indicating partial mediation. Exploratory cluster-specific analyses indicated that the indirect effect was significant in the lower-difficulties/higher-resources cluster (B = −0.05, 95% CI [−0.09, −0.02], bootstrapped p = 0.003), but not in the higher-difficulties/lower-resources cluster (B = −0.01, 95% CI [−0.04, 0.00], bootstrapped p = 0.077). Conclusion Self-esteem appears to represent one pathway linking perceived social support to fewer mental health difficulties in youth. Cluster-specific findings should be interpreted as exploratory and suggest that the strength of this pathway may vary across psychosocial profiles.