The transition from childhood to (young) adulthood marks a time of essential changes. Biological, cognitive, social, and emotional transitions occur in all developmental domains. The neurological plasticity distinctive for youth makes them flexible to adapt to change, but also vulnerable to risky behavior and psychopathology (Rudolph et al., 2017
). Indeed, most mental health problems—depression, substance disorders, anxiety disorders—evolve before the age of 25 (Solmi et al., 2022
). The scientific evidence about the homotypic and heterotypic continuity of youth psychopathology into adulthood highlights the need to understand the mechanisms underlying youth mental health disorders (De Girolamo et al., 2012
; Ranøyen et al., 2018
). Therefore, this study focused on the interrelations between perceived social support and symptom distress among youth with mental disorders, shedding light on the complexities of youth psychopathology.
Several theoretical frameworks, such as the Contemporary Integrative Interpersonal Theory (Hopwood et al., 2023
), form the basis for a wide consensus among researchers that interpersonal interactions shape the psychopathology of humans. Empirical research has shown that interpersonal relationships are crucial to help youth cope with stressful situations and to buffer psychological distress by providing them with social support (Camara et al., 2017
). In the literature, social support is described as the actions undertaken by significant others, including family members, friends, or co-workers, to assist an individual who experiences distress (Thoits, 1986
). However, individual differences might impact one’s perception of these social support functions (Stokes, 1985
). Other research found that not the quality or quantity of received (actual) social support matters, but that perceived support, whether youth feel supported and understood by their close others, is most important (Eagle et al., 2019
). Perceived social support facilitates self-compassion, well-being, and happiness and lowers perceived stress (Wilson et al., 2020
). Overall, studies have indicated the significance of perceived social support for mental health, also among youth (Jakobsen et al., 2022
Perceived social support and symptom distress are highly correlated in youth (e.g., Saikkonen et al., 2018
). Symptom distress is an individual’s reaction to external and internal stressors, characterized by a mixture of psychological symptoms, such as anxiety and sadness (Ritsner et al., 2002
). Two explanatory models hypothesize this relation between social support and symptom distress. Firstly, according to the social causation theory, perceived social support is an antecedent of mental well-being (Cohen & Wills, 1985
). Those youth who perceive higher social support, are likely to have better mental well-being (Chu et al., 2010
). This positive impact of social support on youth well-being can be attributed to the emotional, informational, and instrumental resources that it provides (Pearson, 1986
). Secondly, the social erosion model states that mental health and distress are an antecedent of perceived social support (Kaniasty & Norris, 1993
). That is, the perceived social support of persons with high levels of distress may decrease because of these symptoms. For example, individuals with depressive symptoms might have more complaints, inappropriate disclosure, and social inadequacy, which fosters erosion of their (received and perceived) support (Coyne, 1976
), whereas youth with high levels of aggression might have more parent-child dyadic hostility and conflict-ridden peer relationships which erodes their perceived social support over time (Smokowski et al., 2016
). In conclusion, previous research has indicated that perceived social support and symptom distress are closely linked and there are two main explanations for this association. The social causation theory posits that social support precedes mental well-being, while the social erosion model suggests that mental health disorders lead to a decline in social support.
Prior research into the social causation model explaining the relation between perceived social support and symptom distress in youth has found inconsistent results. The social causation model would predict that disruptions in perceived social support increase symptom distress in youth. Some empirical studies found that less perceived social support resulted in more depression symptoms (Barrera & Garrison-Jones, 1992
; Stice et al., 2004
; van Harmelen et al., 2016
), somatic symptoms (Grigaitytė & Söderberg, 2021
), anxiety symptoms (Calsyn et al., 2005
) and aggressive behavior (Kumar et al., 2014
). Receiving more social support in turn, positively affects mental well-being (Ringdal et al., 2020
). However, this negative relation has not consistently been replicated within the literature. For example, a longitudinal study conducted by Ren et al. (2018
) did not find that perceived social support affected depressive symptoms in adolescents. Thus, while the social causation model predicts that disruptions in perceived social support would increase symptom distress in youth, previous research has yielded inconsistent results.
Only a handful of studies investigated the social erosion model, which would predict that having symptom distress erodes perceived social support over time. In two longitudinal studies, having depressive symptoms significantly decreased adolescents’ (self-reported) peer support (Ren et al., 2018
; Stice et al., 2004
), whilst in another longitudinal study depressive symptoms in girls predicted decreases in family but not friend, social support (Slavin & Rainer, 1990
). In addition, it was found that youth with higher levels of psychological distress reported lower levels of social support from family and friends (Banks & Weems, 2014
) and that aggressive youth perceived less social support from their family (Wolff et al., 2014
). However, two other studies showed no prospective relation between depressive symptoms and perceived social support (Joiner & Metalsky, 1995
; Sheeber et al., 1997
). In sum, empirical research into both the social causation and social erosion model explaining the relation between symptom distress and perceived social support in youth has shown conflicting results. In addition, researchers have urged for more longitudinal studies in outpatient samples that encompass a wider range of psychopathological measures beyond depression (Jakobsen et al., 2022
; Rueger et al., 2016
Furthermore, according to prior research, there should be increased attention on distinguishing between sources that provide social support (Gariepy et al., 2016
; Pössel et al., 2018
). The social network of youth is susceptible to change since there are many transitions during this phase: they build new friendships, acquire a larger network of peers, become more independent of their caretakers and form romantic relationships (Giordano et al., 2006
). Therefore, it is important to consider differences between sources of support, since social support given by caregivers or (non-parental) significant others, such as friends, peers, or teachers, may have a differential impact on symptom distress. Some empirical research has indicated that non-parental others become increasingly important and influential providers of social support across development in young people (Buhrmester, 1996
). A recent longitudinal study found that perceived social support from friends, but not parents, positively impacted adolescents’ well-being and negatively impacted depression and anxiety symptoms (Ringdal et al., 2020
). However, other results demonstrated that adolescents with a lot of stress benefit the most from their family’s support (Pössel et al., 2018
) and that a lack of parental support but not peer support led to a higher risk for developing major depression (Stice et al., 2004
). Results on the second causal relationship, between perceived social support and symptom distress, have been more aligned and predict that depression promotes support erosion but only for peer support (Stice et al., 2004
). This is consistent with theories suggesting that young people rely on caregivers to fulfill their fundamental needs and that caregivers are more likely to be enduring providers of social support for children and teenagers (Gariepy et al., 2016
). In all, the reciprocal effects between perceived social support and symptom distress may differ based on the source of social support.
Interpersonal relationships are crucial to understand youth development and psychopathology (Camara et al., 2017
). According to the social causation theory and the social erosion theory, perceived social support and symptom distress are highly associated (Cohen & Wills, 1985
; Kaniasty & Norris, 1993
). Empirical studies focusing on the social causation and social erosion theories (e.g., Ren et al., 2018
; Ringdal et al., 2020
), found mixed support for these theories. The results of the present study shed new light on the relations between perceived social support and symptom distress over time in a sample of 257 vulnerable youth, whilst controlling for gender and age.
This study represents a novel approach to the literature by investigating the reciprocal relations between perceived social support and symptom distress in youth. Prior investigations predominantly utilized cross-sectional designs, limiting the ability to draw conclusions about the direction of effects (Gariepy et al., 2016
; Rueger et al., 2016
). By using a RI-CLPM approach, this study examined the social causation and social erosion theories while disentangling within-person from between-person effects. The findings indicated that there was no evidence supporting the concurrent associations, cross-lagged paths, or between-person associations. The absence of concurrent associations and between-person associations is further accentuated by the weak correlations between both variables in the present study. There were some medium correlations between perceived social support of a caregiver and symptom distress, but all other correlations were weak. Moreover, no cross-lagged relations between perceived social support (of a caregiver and a significant other) and symptom distress were found. These findings contrast with several prior studies that did find support for the social causation and social erosion theories (e.g., Ringdal et al., 2020
) and align with some other studies that also did not find significant relations (e.g., Ren et al., 2018
). The exploratory analyses demonstrated that the results remained consistent for emerging adults aged 18–23, and additionally, no consistent cross-lagged effects over time were observed between perceived social support and any of the subscales. In all, this study uniquely investigated the temporal and directional effects between perceived social support and symptom distress in youth, utilizing a RI-CLPM approach to disentangle within- and between-person effects, revealing a lack of evidence for concurrent associations, cross-lagged paths, and between-person associations.
The absence of significant findings may be due to both methodological and theoretical factors. First of all, from a methodological point of view, it is notable that even though the standardized estimates in the main model were quite large (e.g., cross-lagged effects of −0.36 and 0.22; Fig. 2
), the effects remained non-significant. The samples used to estimate the RI-CLP models varied in size, ranging from N
= 254 for perceived social support at T1 to N
= 104 for symptom distress at T3 (Table 3
). Due to the lower sample size, particularly in wave three, it is possible that the statistical power was insufficient to detect significant results in the RI-CLPM. To evaluate these possible power insufficiencies, further exploratory analyses were conducted using simplified models, including a cross-lagged panel model without random intercepts and a cross-lagged panel model with two waves. Although these simplified models likely presented higher statistical power, they also did not demonstrate any significant cross-lagged effects. Future research should, however, replicate these findings with larger samples and more follow-up measures whilst utilizing a statistical method that can shed light on the direction of effects.
Besides, it might be possible that perceived social support and symptom distress (as well as other factors like aggression, agoraphobia, anxiety, cognitive problems, mood, somatic complaints, and social phobia) do not exhibit reciprocal influences on each other among youth in treatment. Firstly, in the present study, it was observed that the means of symptom distress remained relatively constant over time. The absence of a stable decline in symptom distress, which is further accentuated by the lack of significant stability paths of symptom distress and its subscales, could explain the null findings since perceived social support can not account for (at least a portion of) any change in symptom distress. Secondly, the absence of associations, correlations, and reciprocal relations might be explained by the study’s sample. The current sample involved youth seeking and/or starting mental health therapy due to (severe) mental health disorders. Based on the social erosion theory, it could be that these youth’s perceived social support had already been eroded before they started treatment as they might have endured prolonged periods of high distress prior to starting treatment. Starting treatment might enhance perceived social support over time because positive experiences in therapy (e.g., building a therapeutic relationship, developing trust, disclosing thoughts and feelings) can serve as a model for youth to generalize to their relationships outside of therapy (Follette et al., 1996
; Thompson & Goodvin, 2016
). Prior research has, however, shown that the (newly built-up) effects of perceived support require some time to manifest (i.e., a sleeper effect of support; Torsheim et al., 2003
). Following youth who are in treatment for 1 year in total might, therefore, be too short to capture all reciprocal effects, especially because there are often waiting times between intake and the start of treatment. In summary, the non-significant findings may be explained by two theoretical factors: the heterogeneous nature of symptom distress as an outcome and the sleeper effect of support.
This study’s results on the autoregressive effects indicated that perceived social support from a caregiver was stable over time in all models (for the whole of symptom distress and its subscales), whereas support from a significant other was not. Young individuals who perceived high levels of support from their caregiver at one time point were likely to perceive similar levels of support at a later point, which supports the theory that caregivers are a dependable and stable source of social support for children and adolescents despite changing relationships (Gariepy et al., 2016
). Conversely, the youth’s perceived support of a significant other was fluctuating. According to prior research, this instability could be due to changes in peer networks or the possibility of oscillating between feelings of acceptance and rejection (Paus et al., 2008
; Rudolph et al., 2017
; Stice et al., 2004
). In addition, some youth who are in treatment no longer participate in social and community life (such as school) and, as a result, have (temporarily) fewer social contacts. These differences in stability between sources of support can also be observed through percentages obtained from the questionnaire responses. In particular, out of 64 youth who completed all questionnaires in all three waves of the study, 72% consistently reported the perceived support of the same caregiver for each of the three waves, whereas 60% of the youth consistently reported about the same significant other. It is recommended that future research investigates potential variations in perceived social support, such as examining whether the quality or stability of a relationship has a more significant impact on perceived social support than the source of support.
The autoregressive effects of symptom distress were inconsistent. In the main model and some subscales, there were significant autoregressive paths, mostly from T2 to T3 in Model B. Thus, in general, symptom distress fluctuated between T1 and T2, and remained more stable between T2 and T3 (with p = 0.08 in the Model A of the main analysis and p < 0.01 in the Model B). One possible explanation that could account for these findings is the waiting time between intake and the start of treatment. The initial measurement took place at intake, which is often followed by a waiting period before the actual start of treatment. Therefore, at T2, some youth were just beginning their treatment, and this could clarify why treatment benefits, such as stable reductions in symptom distress, were only noticeable between T2 and T3.
The finding that caregivers were a relatively stable form of support for youth who are in treatment, whilst perceived support from significant others such are peers and siblings was more fluctuating, holds practical implications. Previous research has pointed out the lack of support for parent/family involvement in therapy for young individuals (Rueger et al., 2016
), despite attachment theorists and researchers demonstrating the importance of family support for children of all ages (Bowlby, 1969
). Hence, caregivers could be educated about their role as a significant source of support and could be provided with resources to support their children in developmentally appropriate ways. Such interventions should aim to reduce negative behaviors like hostility and rejection and provide encouragement and support from caregivers to their children (McLeod et al., 2007
; Rueger et al., 2016
). Possible avenues for future research include examining the interrelations between conflict, perceived social support and mental health-related outcomes, distinguishing between perceived social support from a father or mother and investigating whether distinct groups of youth are characterized by consistently low or high levels of perceived social support. Furthermore, the timing of assessments has an important role in longitudinal designs, and future studies need to identify the optimal time points to capture changes in perceived social support and symptom distress among youth undergoing treatment.
Limitations of this study should be considered. A first possible limitation is the measure of perceived social support, which relied on only two items. The questionnaire showed acceptable reliability estimates but could have been improved by including more items for more reliable results. Secondly, the present study used two follow-up assessments at 6-month intervals, which may have limited the ability to capture acute dynamic changes occurring within shorter timeframes. Therefore, future research should consider utilizing more frequent assessments, such as weekly or monthly intervals. Thirdly, in the context of the current study, which includes youth aged between 12 and 24 years, the within-person dynamics of perceived social support may have changed as a function of age. However, the RI-CLPMs did control for age and a sensitivity analysis with emerging adults showed no distinctions from the outcomes observed in the total sample. Future research endeavors should consider clustering participants into distinct age groups to elucidate the within-person fluctuations that may arise within these groups.
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