The Relationship Between the Mental Health of Slovenian Adolescents and the Support of their Various Personal Social Networks

The Constitution of the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (1). Mental illness accounts for 16 percent of the global burden of disease in the 10-19 age group (2). Mental health problems developing in adolescence account for ten times the long-term healthcare costs of those developing in adulthood (3). According to epidemiological studies, 10-20 percent of children and adolescents under the age of eighteen suffer from mental disorders corresponding to international classifications (4). Data on the prevalence of mental illness become even more important in light of international research findings stating that 50-70 percent of adults with severe mental illness experienced disorders or recognizable traces thereof already in childhood or adolescence, meaning that with a different approach the disorders could have been limited or prevented much earlier (5).

Mental health (as defined by WHO) is influenced by individual factors as well as those at the socioeconomic, environmental and societal levels. The existing categorisations of mental health factors differ (6), but those relating to children and adolescents predominantly include (a) individual, (b) family, (c) school environment and (d) wider environment factors (5).

In adolescence, relationships change both quantitatively and qualitatively. In the context of close interpersonal relationships, adolescent social development is primarily influenced by the relationships with parents, friends and peers (7). Family represents the fundamental social framework for learning and developing values and rules, and family life is gradually perceived as a key mechanism of well-being and health (8). During adolescence, peer relationships become more extensive and intense. The importance of peers increases as they encourage the development of identity, personality traits and social skills (9). A large part of our lives is spent at school, which has been proven to influence health and health behaviour: a stimulating school environment strengthens the development of healthy habits, health and life satisfaction, and vice versa (10). Support from teachers and peers and school satisfaction are often associated with protective factors of mental health (11).

The number of Slovenian children and adolescents with mental disorders has been increasing in the last decade, together with a growing number of visits to primary and secondary healthcare and of prescriptions issued for treating mental disorders (5). The aim of the study was to examine the role and importance of Slovenian adolescents’ social networks for their mental health, in order to meaningfully strengthen social support where necessary and possible, with the desire for changes not only at the individual or local level, but in the direction of the design and implementation of policies and intervention strategies at the national level. With this aim in mind the study objectives were to determine 1) whether adolescent mental health (perceived stress and risk of depression) is related to the support experienced in various personal social networks (family, friends and school environment, i.e. classmates and teachers), 2) whether experiencing support from a larger number of personal social networks has a cumulative effect on adolescent mental health, and 3) whether the importance of support from individual social networks is equivalent.

In our literature review, we did not find any research measuring the same indicators, i.e. the association of social network support with the Cohen Perceived Stress Scale and the WHO-5 Well-Being Index, but we did find research examining the association between different sources of social support and other variables as indicators of mental health. To the best of our knowledge, this topic has not been systematically explored on Slovenian or other data until now.

Our research has found that the perceived support from family, friends, classmates and teachers in adolescents is negatively related to perceived stress and the risk of depression, that adolescents with the support of a larger number of personal social networks have better mental health, and that in explaining adolescent mental health in terms of perceived stress and the risk of depression, family is not the most important source of support. Multiple linear regression results showed that support from classmates and/or teachers is more important than family support in explaining mental health in adolescents. Many other studies also show that parental, teacher, classmate and friend support are significantly associated with adolescent mental health (20–25). In adolescents, good social support is associated with reduced symptoms of stress, anxiety and depression (20, 21), better subjective well-being and positive emotions (22, 23), better selfimage (24) and better academic achievements (25).

Our analyses confirm that the support of a greater number of personal social networks is significantly related to better mental health of adolescents. Other studies discuss the cumulative impact of protective and risk factors as well (20, 26), but their independent and combined impact on mental health should be considered for a complete understanding (20). For example, some studies show that family and peer support are more likely to have additive rather than compensatory effects (27, 28), meaning that if an adolescent does not receive adequate support at home, good peer support cannot fully compensate for this loss.

Our results show that teacher support is more important than family support in explaining good adolescent mental health in terms of perceived stress. In the risk of depression, classmate and teacher support are most important, while family support is equal to friend support. We did not find any research examining the experience of support in personal social networks in relation to the Cohen Perceived Stress Scale and the WHO-5 Well-Being Index, but we did find research that included other variables as indicators of mental health. Some support our findings (22, 29, 30), while others, on the contrary, state that parental or family support is the strongest predictor of mental health during this period (23, 31). The mutual influence of individual social support sources proved to be important here as well. One study found that school staff support was positively associated with good mental health among youth with less family support, suggesting that teacher support is most beneficial for youth with a less supportive family environment. It also showed that peer friendships can act as a protective or risk factor depending on the level of connectedness with school - connectedness with peers was associated with better mental health only for students with a higher level of connectedness with school staff (20). The same applies to how interaction between family and peers affects the occurrence of risky behaviors (32). Lower levels of family support may exacerbate the potentially negative effects of adolescent relationships on their health and well-being. Conversely, peer support can have a positive effect on young people’s well-being if accompanied by family support (33).

Our research had some limitations. Different scales were used to measure perceived family and friend support and perceived teacher and classmate support, but the internal consistency of individual sets was good nevertheless. Also, the research shows the relationship between social support and perceived stress and the risk of depression, but not the causality. Another limitation is that our sample includes numerically fewer adolescents with more frequently expressed stress and the risk of depression. Despite the limitations, the research has some strengths in advancing the theoretical understanding of the complex relationship between social support from multiple sources and adolescent mental health, and may have practical implications.

This research primarily demonstrates the importance of perceived social support for adolescent mental health. The findings provide recommendations for a sensible and effective formulation of much-needed national mental health policies and strategies in contrast to existing fragmented and less effective individual mental health programmes. The school, together with teachers and classmates, proved to be a very important source of support compared to other sources, therefore it is reasonable and necessary to strengthen its role in the area of young people’s mental health. Interventions focused on student-teacher relationships may be particularly important for adolescents with lower family support (20). Interventions based on peer support (e.g. organised school and extracurricular activities, workshops and gatherings) must take into account possible harmful effects for students with less family support and carefully monitor the dynamics and events within groups.

Regarding future research, an agreement on unified variables as indicators of mental health would facilitate the comparison of results. The advantage of the used instruments measuring perceived stress and the risk of depression is their international applicability and thus comparability. Also, while an increasing number of studies, including the present one, demonstrates the importance of individual microsystems, little progress has been made in considering various environmental levels and understanding the interactions between them that also influence adolescent mental health. Therefore, we suggest studies in this direction in the future. Furthermore, much of the existing evidence is based on cross-sectional studies (20, 25, 29–31, 34) that do not include prior mental health problems. There is an association of lower social support and smaller and poorer social networks with youth with a history of mental health problems, which may in turn result in an inflated effect size (21). Therefore, longitudinal studies are needed to establish causal relationships.

Taking into account the results of the research and the factors that prevent adolescents from accessing appropriate professional help (e.g., parental burden, shame from stigma, insufficient or inadequate resources, geographical distance, paid services), the school environment may be the one that can provide the most opportunities for strengthening the social support and mental health of adolescents through effective public health programmes and interventions. Systematic placement of psychosocial and public health content in the Slovenian educational system and everyday educational process can in the long run lead to the normalisation and destigmatisation of the mental health field. However, this requires effective mutual cooperation and connection between the health and education professions.