title: The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments.
abstract: OBJECTIVE
  Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health.
  
  
  METHODS
  A total of 2,393 adolescents aged 15-19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports.
  
  
  RESULTS
  The highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females and males (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender.
  
  
  CONCLUSIONS
  Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.
authors.affiliation: Department of Epidemiology and Social Science Research on Reproductive Health, Shanghai Institute of Planned Parenthood Research, Shanghai, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: School of Public Health, Fudan University, Shanghai, People's Republic of China.
authors.forename: XianChen
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Social Science Research on Reproductive Health, Shanghai Institute of Planned Parenthood Research, Shanghai, People's Republic of China. Electronic address: Chaohual@yahoo.com.
authors.forename: Chaohua
authors.initials: C
authors.lastname: Lou
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Freya L
authors.initials: FL
authors.lastname: Sonenstein
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Kalamar
authors.affiliation: Population Council, New Delhi, India.
authors.forename: Shireen
authors.initials: S
authors.lastname: Jejeebhoy
authors.affiliation: Wits Reproductive Health & HIV Institute, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.affiliation: Institute of Child Health, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria.
authors.forename: Adesola Oluwafunmilola
authors.initials: AO
authors.lastname: Olumide
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State, Nigeria.
authors.forename: Oladosu
authors.initials: O
authors.lastname: Ojengbede
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003863:Depression / Q000191:economics / Q000523:psychology; D005260:Female; D014943:Global Health; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008603:Mental Health / Q000191:economics / Q000706:statistics & numerical data; D009549:Nigeria / Q000453:epidemiology; D011204:Poverty Areas; D000297:Psychology, Adolescent; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012494:Sampling Studies; D012944:Social Support; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000191:economics; D055815:Young Adult
keywords: Adolescent; Mental health; Social support; Suicidal thoughts