The role of adolescents’ relationships with their parents and peers in the association between economic circumstances and internalising symptoms: analysis of longitudinal data from Ethiopia, India, Peru and Vietnam

Background: Adolescents’ social relationships might partly explain the increased risk of mental health problems in adolescents living in poorer economic circumstances. There are few studies in low-and middle-income countries where most of the worlds’ adolescents live. We investigated whether adolescents’ relationships with their parents and peers mediated the association between their economic circumstances and internalising symptoms in Ethiopia, India, Peru and Vietnam. Methods: We analysed longitudinal data of 3,529 adolescents from the Young Lives study (1,741 female [49.3%]). Household consumption expenditure and adolescents’ subjective assessment of household wealth were measured at age 15. The mediators – adolescents’ positive relations with their parents and peers – were measured at age 19. The outcome – internalising symptoms, characterised by low mood and anxiety – was measured at age 22. Mediation was assessed through counterfactual g-computation formula, adjusting for baseline and intermediate confounders. Findings: We found no evidence that adolescents’ positive relations with their parents and peers mediated the association between economic circumstances and internalising symptoms in any country. Living in poorer economic circumstances was typically associated with greater future internalising symptoms.Interpretation: The role of adolescents’ parent and peer relationships in mediating the effects of poorer economic circumstances on internalising mental health is potentially less important in these countries compared to a more important role in high-income countries as highlighted by previous studies. Further research is needed to explore other potential mechanisms, including different aspects of social relationships, that might influence mental health outcomes for adolescents living in poverty across different settings.