Global Institute for Mental Health Innovations, Networking and Development

Mental Health Open ISSN 3122-1181 Vol. 2 (2026). Issue 1.

DOI: https://doi.org/10.64257/9zka7n11

Neglecting Connection: Associations Between Parental Emotional Support and Youth Mental Health in Four Latin American Countries {under peer review}

research article

Clariana Vitória Ramos de Oliveira PhD, School of Nursing, University of Nevada Las Vegas. 4505 S. Maryland Pkwy. Las Vegas, NV 89154, United States; https://orcid.org/0000-0001-9987-9948

Hannah E. Fraley PhD, Blooming Integrative Psychiatry, Inc.: Canyon Lake, California, United States; https://orcid.org/0000-0003-0383-5399

Timothy Grigsby PhD, Public Health School, University of Nevada Las Vegas. 4505 S. Maryland Pkwy. Las Vegas, NV 89154, United States; https://orcid.org/0000-0002-9416-4502

Cauane Blumenberg PhD, Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil. 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Causale consultoria, Pelotas, Brazil. Av. Adolfo Fetter 4331 – B25, Pelotas, RS, Brazil; https://orcid.org/0000-0002-4580-3849

Rafaela Martins PhD, Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil. 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Causale consultoria, Pelotas, Brazil. Av. Adolfo Fetter 4331 – B25, Pelotas, RS, Brazil; https://orcid.org/0000-0003-3538-7228

Stevan Weine, Center for Global Health, University of Illinois in Chicago. 1940 W. Taylor M/ C 584, Chicago, IL 60612, USA; https://orcid.org/0000-0002-4515-3065

Candace W. Burton PhD, York University School of Nursing. 04 Scholars Walk |, North York, ON M3J 1P3, Canada; https://orcid.org/0000-0002-0557-6020

Abstract

Background: Mental health disorders among adolescents in Latin America vary widely, with prevalence ranging from 30.0% in Colombia to 54.8% in Honduras. These disparities occur alongside high rates of alcohol consumption, above the global average. Family support, especially parental involvement, is a critical protective factor, with evidence showing it can buffer against suicide-related behaviors and other adverse outcomes.

Objective: This study examines several dimensions of parental support and their associations with psychological distress, suicidal behavior, and substance use among youth in four Latin American countries.

Methods: Data used in this cross-sectional study came from a nationally representative cross-sectional household survey of 13,174 Latin American youths aged 13 to 24 called the Violence Against Children Survey in Colombia, El Salvador, Haiti, and Honduras. Country inclusion was based on the availability of publicly accessible VACS datasets at the time of analysis (2023). We used outcome-specific regression models to assess associations between parental support and youth mental health distress, suicidal and drug use behavior.

Results: In Colombia, difficulty communicating with parents and reduced closeness were linked to increased psychological distress, with similar patterns in El Salvador and Honduras. In Haiti, less closeness with parents was associated with an increased risk for psychological distress. In Colombia, a strong maternal relationship was negatively associated with self-inflicted harm, whereas communication difficulties increased. In El Salvador, a lack of closeness with mothers was positively associated with drug use. Across all four countries, alcohol abuse by the youths consistently showed associations with communication difficulties and a lack of parental closeness.

Conclusions: These findings highlight the importance of parental support and positive parent-youth relationships in promoting adolescent well-being. Strengthening parental communication and family cohesion may help reduce mental health problems and substance use among adolescents.

Keywords: Adolescent, Psychological distress, Substance use, Suicidal behavior, Latin American

Introduction

The prevalence of mental health disorders varies significantly across Latin American countries, and studies of diverse youth populations show varying rates. For example, in Colombia, the prevalence stands at 30.0% (Gómez-Restrepo et al., 2023), while in El Salvador, it is 45.9% (Ramos de Oliveira & Jeong, 2021). Haiti records a prevalence of 36.7% (Eustache et al., 2017), and Honduras exhibits the highest at 54.8% (Souza et al., 2011). Further, average alcohol per capita consumption (APC) in Latin American countries is above the world average (approximately 8.4 and 6.4 L, respectively), with high rates of heavy drinking, alcohol use disorders, disability, and premature death (Medina-Mora et al., 2021).

Family support, particularly parental involvement, plays a critical role in shaping adolescent mental health outcomes. Evidence suggests that parental support can act as a buffer against suicide-related behaviors, even more so than peer relationships in some contexts (Nunez et al., 2024). Yet, the relationship between parental support and adolescent outcomes is not universally held; rather, it is shaped by cultural norms, gender roles, and parenting practices specific to each country and community (Bornstein, 2012; Bosqui et al., 2024). For instance, collectivist cultures like those found in many Latin American countries may emphasize familial interdependence, whereas the expression and interpretation of parental warmth, control, and support can differ considerably across contexts (Bornstein, 2012; Mogro-Wilson & Cifuentes, 2021).

Most research in the region has focused on maternal roles, likely due to systemic challenges in engaging fathers in caregiving and research (Esteve et al., 2022; Fagan, 2014). Yet, both developmental theory and empirical studies underscore the importance of involving both parents, as relationships with mothers and fathers contribute uniquely to adolescents' socio-emotional development (Choi et al., 2021; Volling et al., 2019). Parental warmth and responsiveness are consistently linked to better emotional regulation, empathy, and prosocial behaviors (Hoffman, 2008; Pastorelli et al., 2021). In contrast, limited parental connection, trust, and support are associated with poorer mental health outcomes among adolescents, including psychological distress, suicide-related behaviors, and early substance use (Dube et al., 2006; Hughes et al., 2017; Meeker et al., 2021; Wang & Yen, 2017).

Despite growing recognition of the importance of family in youth development, prevention programs targeting mental health and substance use often inadequately address the familial context. A gap persists in understanding the specific dimensions of parental support most relevant to youth mental health, particularly regarding the differential impact of support from mothers versus fathers. Positive parent-youth relationships are associated with enhanced self-esteem, emotional regulation, empathy, and prosocial behaviors, all of which contribute to optimal development (Hoffman, 2008).

Conversely, a lack of parental connection, involvement, trust, and protection may lead to numerous negative health consequences, including mental health problems and suicide-related behaviors (Nunez et al., 2024). In particular, adverse childhood experiences are consistently associated with suicide-related behaviors among youth, which may include exposure to family dysfunctions (Dube et al., 2006; Hughes et al., 2017; Meeker et al., 2021; Nunez et al., 2024; Wang & Yen, 2017). However, a higher risk of psychological vulnerabilities such as suicide, poor coping mechanisms, and early alcohol or drug use were associated with negative parental factors, such as divorce, domestic violence, and exposure to sexual abuse (Nunez et al., 2024). It is important to understand the role of parents and families in the healthy development of Latin American youth, given recent findings pointing to parental support as a protective factor against negative health issues in this population (Nunez et al., 2024).

Although culturally and historically distinct, Colombia, El Salvador, Haiti, and Honduras share structural challenges that justify their comparative analysis in parenting and mental health. Across Latin America and the Caribbean, substantial treatment gaps and limited investment in mental health services persist, particularly for youth and vulnerable populations (Kohn et al., 2018). In Central America, El Salvador and Honduras are part of the “Northern Triangle,” a region characterized by high levels of violence, poverty, and forced migration, all of which exert significant stress on family systems and parenting practices (Silva et al., 2022). Haiti faces longstanding structural violence, political instability, and extreme poverty, resulting in severely limited access to mental health care and heightened psychosocial risk for children and caregivers (Cénat et al., 2025, Legha & Solages, 2015). In Colombia, decades of internal conflict, forced displacement, and socioeconomic disparity have generated stark mental health inequalities; indeed, displacement itself accounts for about 31% of mental health disparities in conflict-affected zones, while fewer than 10% of those with diagnosed disorders receive care (León-Giraldo et al., 2021). Lastly, youth migration from the Northern Triangle (El Salvador and Honduras) is marked by high trauma exposure and a mismatch between behavioral health services and the cultural vulnerabilities of Latina immigrants (Silva et al., 2022). Analyzing these four countries provides a theoretically grounded basis for comparing how parenting practices intersect with mental health outcomes in contexts of systemic adversity, health system fragmentation, and socio-economic instability.

This study is grounded in Family Systems Theory, which conceptualizes the family as an integrated emotional unit in which individual behavior and well-being are interdependent (Minuchin, 1974). Within this framework, parental support is not merely an individual attribute but a systemic feature that reflects broader family functioning. Disruptions in this system, such as inconsistent parenting, lack of emotional attunement, or family conflict, can undermine adolescents’ emotional regulation and increase vulnerability to psychological distress and risk behaviors (Minuchin, 1974). Given that family structures and parental roles are shaped by cultural values, the impact of maternal and paternal support likely varies across Latin American countries, underscoring the importance of a culturally informed systems perspective.

This study examines several dimensions of parental support and their quantitative associations with psychological distress, suicidal behavior, and substance use among youth in four Latin American countries (Colombia, El Salvador, Haiti, and Honduras). The hypothesis is that parental support is associated with psychological distress, suicidal behavior, and substance use among Latin American youth, with patterns differing by country.

Methods

Study Design

Data used in this cross-sectional study came from the Violence Against Children Survey (VACS) in Colombia, El Salvador, Haiti, and Honduras. VACS is a nationally representative cross-sectional household survey of 13- to 24-year-olds (Chiang et al., 2016). It measured experiences of physical, emotional, and sexual violence during childhood, adolescence, and young adulthood, as well as risk and protective factors for and consequences of violence (Chiang et al., 2016). The VACS have been implemented in 25 countries across Africa, the Asia-Pacific region, Latin America, and the Caribbean (CDC, 2024). The analytic sample comprised 13,174 Latin American and Caribbean youth drawn from four countries: Haiti (n = 2,846; data collected in 2012), Honduras (n = 5,190; 2017), El Salvador (n = 2,433; 2018), and Colombia (n = 2,433; 2018). Country inclusion was based on the availability of publicly accessible VACS datasets at the time of analysis (2023).

Trained interviewers conducted structured interviews in person. The data collection process had two parts: an initial demographic interview with the household head, followed by a comprehensive interview with the adolescent respondent, focusing on parental relationships.

Ethical Statement

The VACS protocols were reviewed and approved by the institutional ethics review bodies in each participating country and by the Centers for Disease Control and Prevention (CDC) Institutional Review Board. Written informed consent was obtained from all participants aged 18 years and older. For participants younger than 18 years, written permission was obtained from a parent or legal guardian, and written assent was obtained from the adolescent prior to participation. Participation was voluntary, confidentiality was maintained throughout the survey, and respondents could decline to answer any question or withdraw from the interview at any time without penalty. Consistent with VACS protocols, trained interviewers followed standardized procedures to protect participant safety and privacy and provided information and referrals to appropriate support services when needed.

Outcomes

Regarding youth mental health, four outcomes of interest were available: psychological distress, suicidal behavior, drug use, and alcohol abuse. Below, we describe how each of these was operationalized. Information about Haiti is presented in supplementary material, as the dataset included closeness with mother and father, and outcomes for psychological distress and alcohol use.

Psychological distress. Psychological distress was operationalized as the sum of six variables that asked how often respondents felt: i) nervous; ii) anxious; iii) restless; iv) sad; v) that everything was an effort; and vi) worthless. Each variable was coded using a Likert scale as follows: i) all the time; ii) most of the time; iii) some of the time; iv) a little of the time; and v) none of the time. Higher scores indicate higher psychological distress (range 6-30).

Suicide. Non-Suicidal Self-injury (NSSI) and Suicidal behavior were measured by three questions that asked if the respondent had ever: Suicidal behavior = i) hurt him/herself; ii) tried to kill him/herself; and/or NISSI = iii) thought about killing him/herself. Each of the three variables had yes or no response options and was analyzed separately.

Substance use. Binge alcohol use was assessed by asking the respondent the number of the last 30 days on which they had four or more drinks in a row. This variable was further categorized into three groups: i) 0 days; ii) 1 day; and iii) 2 or more days. Drug use was measured by a yes or no question that asked if the respondent had used any illicit drugs in the past 30 days.

Exposure Outcomes

Parenting support. Three variables were examined as exposures relevant to parental support, with each being separately assessed based on maternal and paternal aspects. Two yes or no variables indicated if the youth respondent had a relationship with their mother and/or father. Difficulty of conversation with mother or father (How easy or difficult is it to talk to your mother/father individually about things that really bother you? Would you say very easy, easy, difficult, or very difficult?) by two, four-item Likert scale with response options: i) very easy; ii) easy; iii) difficult; and iv) very difficult. Closeness with mother and father (How close do you/did you feel to your biological mother/father?): two three-item Likert scale variables with response options: i) very close; ii) close; and iii) not close.

Confounding factors

Associations between exposures and outcomes were analyzed using regression models (see Statistical Analyses section). Both crude and adjusted models were fitted, and four confounding factors were included in adjusted analyses: youth age, level of education, ethnicity, and wealth index score (via principal component analysis of variables regarding household building materials, source of drinking water, possession of assets, and type of toilet used).

Statistical analyses

Depending on the outcome analyzed, different regression models were fitted. For psychological distress, a score ranging from 6 to 30, a Poisson regression model with robust variance was fitted. For dichotomous outcomes, such as suicide-related questions and drug use, a logistic regression was fitted. Finally, for the alcohol abuse outcome, an ordered logistic regression was fitted. For all models, both crude and adjusted analyses were performed. Adjusted analyses included mutual adjustment for all confounding factors available in the survey. All analyses were conducted using Stata 18 (StataCorp LLC, College Station, TX, USA), and applied a 5% significance level.

Results

Descriptive statistics for youths’ well-being and parents' emotional and social support characteristics are displayed in Table 1. Respondents reported that suicidal behaviors ranged from 11.2% in Honduras to 11.6% in Colombia. The prevalence of NSSI ranged from 6.2% in El Salvador to 12.0% in Colombia, with the highest prevalence of suicide attempts also seen in Colombia (7.3%) (see Table 1). Most respondents (90.9%) reported not having had four or more drinks at once in the last 30 days. Illicit drug use ranged from 0.9% in El Salvador to 5.6% in Colombia. Finally, the higher psychological distress results were seen in Haiti (Med=13, IQR=10-16).

Regarding exposures (Table 1), over 80% of the sample had relationships with their mother and father. Further, over 40% reported finding it easy to talk with their mothers and fathers about subjects that bothered them. In all countries, youths reported being closer to their mothers compared to their fathers.

Table 1. Descriptive statistics for outcomes of interest across countries.

	Colombia (n=2705)		El Salvador (n=2433)		Haiti (n=2846)		Honduras (n=5190)
	Median	IQR	Median	IQR	Median	IQR	Median	IQR
Psychological distress	10	6;13	10	6; 14	13	10;16	11	8;14
	N	%	N	%	N	%	N	%
Suicide behavior
Though	364	12.0	128	6.2	*	*	492	9.4
Self-inflicted injury	300	11.6	226	11.5	*	*	573	11.2
Attempt	197	7.3	60	3.2	*	*	292	5.5
Alcohol use (Times 4+ drinks)
0	1491	63.4	2285	93.4	2627	91.7	4640	90.9
1	375	17.1	62	3.8	90	3.2	227	4.4
2 or more	469	19.5	65	2.8	129	5.1	252	4.7
Drug use	164	5.6	18	0.9	*	*	111	2.1
Relationship with mother	2524	95.0	2250	95.8	*	*	4772	94.6
Difficulty talking to mother
Very easy	559	21.7	571	25.9	*	*	938	19.1
Easy	1416	56.0	1222	53.2	*	*	2553	53.7
Difficult	405	16.7	350	16.0	*	*	991	21.0
Very difficult	144	5.5	107	4.9			290	6.1
Closeness with mother
Very close	1269	52.9	1360	60.1	1357	50.6	2435	49.5
Close	1124	39.7	807	34.5	1243	42.7	2065	43.2
Not close	195	7.4	135	5.4	196	6.7	347	7.3
Relationship with father	2010	86.7	1753	84.4	*	*	3806	83.0
Difficulty talking to father
Very easy	277	15.2	317	17.6	*	*	619	16.0
Easy	983	44.0	822	43.9	*	*	1695	45.1
Difficult	519	27.6	427	25.2	*	*	1015	26.6
Very difficult	231	13.2	187	13.3	*	*	477	12.4
Closeness with father
Very close	642	28.5	736	38.2	847	34.2	1366	33.8
Close	1077	51.5	846	42.9	1233	47.1	1940	50.2
Not close	424	19.9	299	18.8	470	18.7	674	16.1

Note: *Data not available for this county; IQR = Interquartile Range

Association between parental support and youth psychological distress

Table 2 shows the association between parental support and youth psychological distress. In Colombia, a stronger relationship with the mother was associated with a 20% lower likelihood of psychological distress, even after adjusting for confounding factors. A dose-response relationship was observed: the less close youths were to their parents, and the more difficult they found communication, was associated with higher levels of psychological distress. After adjustment, those who found it very difficult to talk to their mothers had a 44% higher chance of distress (95% CI = 1.15; 1.82), and for fathers, the chance increased by 43% (95% CI = 1.20; 1.69). Similarly, not being close to mothers and fathers was associated with higher distress by 35% (95% CI = 1.13; 1.62) and 22% (95% CI = 1.11; 1.35), respectively, compared to those who reported parental closeness.

The results from El Salvador and Honduras mirrored those from Colombia. In El Salvador, youths who found it very difficult to talk to their mothers and fathers had a 43% (95% CI = 1.28; 1.59) and 17% (95% CI = 1.03; 1.33) higher chance of psychological distress, respectively, compared to those who found it easy. In Honduras, difficulty talking to mothers and fathers increased the chance by 16% (95% CI = 1.07; 1.22) and 15% (95% CI = 1.09; 1.22), respectively, though the associations were slightly lower than in El Salvador.

It is important to note the similarity between the crude and adjusted results in Haiti (Table 8), largely due to the survey's limited data, with only the wealth index available. The sole exposure measured in Haiti was self-reported closeness to parents. After adjusting for wealth, those who considered themselves "close" to their mothers had a 4% higher chance of psychological distress (95% CI = 0.99; 1.08), while those "not close" had a 16% higher chance (95% CI = 1.09; 1.27). Similar patterns were seen for fathers, with a 3% higher chance for those "close" (95% CI = 0.99; 1.08) and an 11% higher chance for those "not close" (95% CI = 1.05; 1.18).

Table 2. Unadjusted and adjusted associations of parental emotional social support with psychological distress.

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	IRR	95%CI	P value	IRR	95%CI	P value	IRR	95%CI	P value	IRR	95%CI	P value	IRR	95%CI	P value	IRR	95%CI	P value
Relationship with mother			0.001			0.002			0.025			0.033			0.139			0.225
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.78	0.67; 0.90		0.80	0.69; 0.92		0.89	0.80; 0.98		0.89	0.81; 0.99		0.95	0.89; 1.02		0.96	0.89; 1.03
Difficulty talking to mother			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	1.03	0.95; 1.11		1.03	0.96; 1.12		1.02	0.96; 1.08		1.03	0.97; 1.10		0.98	0.94; 1.02		0.99	0.95; 1.03
Difficult	1.34	1.20; 1.49		1.34	1.21; 1.49		1.21	1.12; 1.31		1.23	1.14; 1.33		1.16	1.11; 1.22		1.17	1.11; 1.22
Very difficult	1.43	1.12; 1.82		1.44	1.15; 1.82		1.41	1.26; 1.57		1.43	1.28; 1.59		1.14	1.07; 1.22		1.15	1.07; 1.22
Closeness with mother			0.001			0.001			< 0.001			< 0.001			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.09	1.00; 1.18		1.08	1.00; 1.17		1.12	1.08; 1.17		1.13	1.09; 1.18		1.06	1.03; 1.09		1.06	1.03; 1.10
Not close	1.36	1.12; 1.65		1.35	1.13; 1.62		1.23	1.12; 1.35		1.23	1.12; 1.35		1.20	1.14; 1.27		1.20	1.14; 1.27
Relationship with father			0.105			0.209			0.056			0.042			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.92	0.82; 1.02		0.93	0.84; 1.04		0.94	0.88; 1.00		0.93	0.87; 1.00		0.93	0.90; 0.97		0.94	0.90; 0.97
Difficulty talking to father			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	1.04	0.93; 1.17		1.03	0.93; 1.15		1.02	0.96; 1.08		1.03	0.97; 1.10		0.97	0.92; 1.02		0.97	0.93; 1.02
Difficult	1.30	1.14; 1.48		1.28	1.12; 1.45		1.23	1.15; 1.33		1.25	1.16; 1.34		1.11	1.05; 1.17		1.11	1.06; 1.17
Very difficult	1.46	1.21; 1.75		1.43	1.20; 1.69		1.15	1.02; 1.31		1.17	1.03; 1.33		1.15	1.09; 1.22		1.16	1.09; 1.22
Closeness with father			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.09	0.99; 1.20		1.09	0.98; 1.20		1.10	1.04; 1.15		1.10	1.05; 1.16		1.06	1.02; 1.10		1.06	1.02; 1.10
Not close	1.23	1.12; 1.36		1.22	1.11; 1.35		1.15	1.04; 1.27		1.16	1.05; 1.27		1.19	1.14; 1.24		1.19	1.15; 1.24
^a Adjusted by age, highest level of education, ethnicity, and wealth index. ^b Adjusted by age, highest level of education, and wealth index. IRR = Incidence Rate Ratio. 95% CI = 95% Confidence Interval.

Association between parental support, Non-Suicidal Self-injury (NSSI) and suicidal behavior

Tables 3, 4, and 5 present the associations between parental support, NSSI, and suicidal behavior, adjusting for youth age, education level, ethnicity, and wealth index score.

In Colombia (see Table 3), having a relationship with the mother significantly decreased the odds of NSSI (95% CI = 0.13; 0.68), with no association found for fathers. Youths who found it very difficult to talk to their mothers or fathers had notably higher odds of NSSI (95% CI = 1.30; 6.99 for mothers, 95% CI = 2.47; 17.89 for fathers). Additionally, those not close to their fathers had 304% higher odds of NSSI (95% CI = 1.71; 9.53) compared to those who were very close, though no significant association was found for closeness to mothers.

Regarding parental social emotional support and self-inflicted injury (Table 4), having a relationship with their mother was associated with less self-inflicted injury (95% CI = 0.15; 0.95), but no association was observed for having a relationship with fathers. Those who found it very difficult to talk to their mothers had 224% higher odds (95% CI = 1.46; 7.23) of self-inflicted injury compared to those who found it very easy. Similar results were found regarding the father, as those who found it very difficult to talk to fathers had 346% higher odds (95% CI = 1.55; 12.88) of self-inflicted injury compared to peers. Comparing parents’ social emotional support and suicidal attempts (Table 5), youths reporting not being close to fathers had a higher risk of suicide attempts compared to those very close to fathers (95% CI = 1.67; 12.17).

Considering NSSI, in El Salvador, those with a relationship with their mother had 76% lower odds of NSSI, while having a relationship with a father yielded 50% lower odds of NSSI. Unlike Colombia, the strongest association here was observed for closeness with mothers – those reporting not being close had 367% higher odds (95% CI = 1.97; 11.05) of suicide attempts compared to those reporting very close.

The results from Honduras were similar to those from Colombia. Regarding NSSI, having a relationship with their mother reduced the odds of suicidal thoughts by 58%, and with their father by 46%, compared to youths without such relationships. Youths who found it very difficult to talk to their mothers or fathers had significantly higher odds of NSSI (95% CI = 1.78; 4.54 for mothers; 95% CI = 2.17; 5.83 for fathers). Similarly, lack of closeness to both parents was associated with higher odds of NSSI (95% CI = 2.98; 6.22 for mothers; 95% CI = 3.15; 6.04 for fathers).

For suicide attempts, having a relationship with both parents had a protective effect. Not being close to either parent raised the risk of suicide attempts (95% CI = 3.46; 7.79 for mothers; 95% CI = 2.95; 7.19 for fathers).

Regarding self-inflicted injury, having a relationship with the mother lowered the odds by 45% (95% CI = 0.38; 0.80), and with the father by 39% (95% CI = 0.46; 0.80). Difficulty communicating and lack of closeness with parents significantly increased the odds of self-inflicted harm. Youths not close to their mothers had 134% higher odds (95% CI = 1.62; 3.36), and those not close to their fathers had 116% higher odds (95% CI = 1.58; 2.96) of self-inflicted harm compared to those very close to their parents.

Table 3. Unadjusted and adjusted associations of parental emotional social support with NSSI (suicidal thought).

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Relationship with mother			0.017			0.004			< 0.001			< 0.001			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.29	0.10; 0.80		0.29	0.13; 0.68		0.23	0.12; 0.45		0.24	0.12; 0.49		0.39	0.28; 0.56		0.42	0.28; 0.61
Difficulty talking to mother			0.010			0.006			< 0.001			< 0.001			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.89	0.50; 1.59		0.92	0.54; 1.57		0.52	0.26; 1.05		0.62	0.29; 1.34		0.90	0.63; 1.28		0.94	0.65; 1.35
Difficult	1.90	0.87; 4.15		2.07	1.02; 4.22		1.31	0.60; 2.88		1.63	0.71; 3.71		2.30	1.57; 3.36		2.40	1.64; 3.50
Very difficult	3.28	1.29; 8.33		3.01	1.30; 6.99		3.59	1.72; 7.52		4.05	1.86; 8.84		2.86	1.82; 4.48		2.84	1.78; 4.54
Closeness with mother			0.121			0.119			0.005			0.005			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	0.75	0.44; 1.28		0.77	0.45; 1.31		2.31	1.29; 4.17		2.56	1.34; 4.89		1.18	0.92; 1.51		1.26	0.98; 1.63
Not close	1.79	0.75; 4.24		1.77	0.76; 4.13		3.36	1.33; 8.51		3.41	1.31; 8.87		4.16	2.88; 6.00		4.27	2.98; 6.11
Relationship with father			0.088			0.066			0.013			0.005			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.49	0.22; 1.11		0.52	0.25; 1.05		0.49	0.28; 0.86		0.43	0.24; 0.77		0.50	0.38; 0.66		0.54	0.41; 0.71
Difficulty talking to father			0.002			< 0.001			0.027			0.024			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	1.10	0.46; 2.62		1.21	0.49; 3.02		0.52	0.20; 1.35		0.55	0.22; 1.42		0.95	0.57; 1.58		0.98	0.58; 1.65
Difficult	1.86	0.76; 4.56		2.11	0.85; 5.26		1.33	0.52; 3.42		1.47	0.57; 3.79		3.33	2.06; 5.40		3.35	2.04; 5.50
Very difficult	5.74	1.97; 16.73		6.65	2.47; 17.89		2.25	0.79; 6.41		2.57	0.96; 6.88		3.74	2.32; 6.05		3.55	2.17; 5.83
Closeness with father			0.007			< 0.001			0.017			0.012			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	0.77	0.40; 1.48		0.79	0.42; 1.48		2.19	1.16; 4.12		2.35	1.21; 4.57		1.60	1.14; 2.26		1.67	1.19; 2.34
Not close	3.15	1.28; 7.76		4.04	1.71; 9.53		2.53	1.22; 5.22		2.91	1.35; 6.30		4.33	3.13; 6.00		4.36	3.15; 6.04
^a Adjusted by age, highest level of education, ethnicity, and wealth index. ^b Adjusted by age, highest level of education, and wealth index. OR = Odds Ratio. 95% CI = 95% Confidence Interval.

Table 4. Unadjusted and adjusted associations of parental emotional social support with suicidal behavior (self-inflicted injury).

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Relationship with mother			0.059			0.039			0.003			0.005			< 0.001			0.002
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.37	0.13; 1.04		0.38	0.15; 0.95		0.36	0.19; 0.70		0.37	0.18; 0.74		0.54	0.37; 0.77		0.55	0.38; 0.80
Difficulty talking to mother			0.019			0.004			< 0.001			< 0.001			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.98	0.52; 1.84		1.06	0.55; 2.02		0.53	0.22; 1.27		0.52	0.25; 1.11		1.22	0.88; 1.69		1.26	0.90; 1.77
Difficult	1.85	0.77; 4.47		1.94	0.79; 4.74		1.33	0.55; 3.21		1.24	0.57; 2.73		2.26	1.58; 3.22		2.24	1.56; 3.23
Very difficult	2.87	1.22; 6.76		3.24	1.46; 7.23		1.75	0.65; 4.70		1.93	0.78; 4.75		2.12	1.38; 3.26		2.24	1.44; 3.47
Closeness with mother			0.457			0.339			0.306			0.319			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.04	0.57; 1.89		0.98	0.54; 1.78		1.40	0.84; 2.33		1.32	0.81; 2.18		1.27	1.01; 1.59		1.29	1.02; 1.64
Not close	1.60	0.74; 3.46		1.69	0.79; 3.62		1.65	0.71; 3.85		1.68	0.73; 3.88		2.28	1.56; 3.33		2.34	1.62; 3.36
Relationship with father			0.351			0.455			0.060			0.069			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.74	0.39; 1.40		0.77	0.38; 1.54		0.61	0.36; 1.02		0.61	0.36; 1.04		0.62	0.47; 0.82		0.61	0.46; 0.80
Difficulty talking to father			0.076			0.047			0.006			0.002			0.019			0.006
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	1.50	0.61; 3.73		2.00	0.78; 5.13		1.06	0.52; 2.16		1.09	0.52; 2.25		1.20	0.85; 1.71		1.23	0.85; 1.80
Difficult	1.31	0.59; 2.92		1.59	0.65; 3.90		1.80	0.84; 3.84		1.80	0.83; 3.88		1.59	1.09; 2.31		1.69	1.12; 2.54
Very difficult	3.51	1.32; 9.36		4.46	1.55; 12.88		4.39	1.64; 11.76		4.44	1.75; 11.30		1.68	1.11; 2.55		1.83	1.19; 2.82
Closeness with father			0.352			0.247			0.042			0.033			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.70	0.79; 3.65		1.89	0.87; 4.09		1.31	0.85; 2.02		1.39	0.90; 2.15		1.41	1.06; 1.88		1.37	1.02; 1.85
Not close	1.20	0.49; 2.94		1.33	0.52; 3.42		2.86	1.23; 6.65		2.74	1.26; 5.97		2.05	1.50; 2.79		2.16	1.58; 2.96
^a Adjusted by age, highest level of education, ethnicity, and wealth index. ^b Adjusted by age, highest level of education, and wealth index. OR = Odds Ratio. 95% CI = 95% Confidence Interval.

Table 5. Unadjusted and adjusted associations of parental emotional social support with suicidal behavior (suicidal attempt).

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Relationship with mother			< 0.001			< 0.001			< 0.001			0.001			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.15	0.05; 0.44		0.18	0.07; 0.47		0.19	0.08; 0.45		0.23	0.09; 0.57		0.43	0.28; 0.66		0.46	0.29; 0.72
Difficulty talking to mother			< 0.001			0.002			< 0.001			< 0.001			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.75	0.33; 1.71		0.69	0.33; 1.46		0.42	0.17; 1.01		0.54	0.23; 1.30		1.05	0.65; 1.70		1.10	0.69; 1.76
Difficult	2.64	0.92; 7.57		2.19	0.84; 5.70		1.13	0.38; 3.36		1.51	0.52; 4.35		2.79	1.69; 4.59		2.94	1.80; 4.81
Very difficult	2.46	0.78; 7.72		2.09	0.75; 5.84		3.53	1.48; 8.41		4.38	1.91; 10.05		4.20	2.37; 7.47		4.09	2.28; 7.33
Closeness with mother			0.088			0.088			0.031			0.002			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	0.88	0.34; 2.29		0.84	0.34; 2.08		2.49	0.99; 6.23		1.91	0.99; 3.68		1.44	1.03; 2.02		1.52	1.07; 2.17
Not close	2.26	0.83; 6.16		2.15	0.80; 5.75		3.90	1.33; 11.38		4.67	1.97; 11.05		5.05	3.39; 7.53		5.19	3.46; 7.79
Relationship with father			0.099			0.202			0.011			0.006			< 0.001			< 0.001
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.50	0.22; 1.14		0.56	0.22; 1.37		0.38	0.18; 0.79		0.33	0.15; 0.73		0.54	0.39; 0.75		0.56	0.40; 0.79
Difficulty talking to father			0.009			0.004			0.327			0.372			< 0.001			< 0.001
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	1.09	0.35; 3.44		0.86	0.25; 3.00		0.44	0.13; 1.44		0.47	0.15; 1.50		1.31	0.64; 2.68		1.31	0.63; 2.71
Difficult	2.84	0.86; 9.38		2.21	0.63; 7.69		0.91	0.24; 3.38		0.93	0.26; 3.31		4.08	2.07; 8.04		3.89	1.95; 7.75
Very difficult	5.60	1.67; 18.74		4.65	1.46; 14.84		1.05	0.27; 4.06		1.23	0.34; 4.45		4.67	2.36; 9.21		4.28	2.12; 8.62
Closeness with father			0.016			0.002			0.101			0.081			< 0.001			< 0.001
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	0.93	0.37; 2.30		0.82	0.34; 1.98		2.93	1.08; 7.93		3.42	1.16; 10.07		2.02	1.28; 3.21		2.03	1.27; 3.23
Not close	3.98	1.36; 11.67		4.50	1.67; 12.17		2.53	0.81; 7.92		3.10	0.84; 11.43		4.73	3.03; 7.37		4.61	2.95; 7.19

^a Adjusted by age, highest level of education, ethnicity, and wealth index.
^b Adjusted by age, highest level of education, and wealth index.

OR = Odds Ratio.

95% CI = 95% Confidence Interval.

Associations between parental support and youth drug and alcohol use

Tables 6 and 7 highlight the associations between parental relationships and substance use. In Colombia, youths with a relationship with their father had 67% lower odds of drug use (95% CI = 0.14; 0.79) compared to those without. Difficulty talking to their father (95% CI = 1.06; 11.66) and lack of closeness (95% CI = 1.49; 13.60) were linked to higher odds of drug use, after controlling for confounders. For alcohol abuse, some associations, such as closeness with the mother, emerged only after adjusting for confounding factors, though no dose-response relationship was observed.

In El Salvador, the only significant exposure related to drug use was lack of closeness with mothers, where youths not close to their mothers had 423% higher odds of drug use (95% CI = 1.50; 18.21) versus those very close. For alcohol abuse, results were more consistent across countries. A direct dose-response relationship was found between difficulty talking to mothers and alcohol abuse, with those finding it very difficult having 173% higher odds (95% CI = 1.17; 6.36) compared to those who found communication easy. An indirect dose-response relationship was observed for closeness with fathers, where those not close had increased odds of alcohol abuse compared to those very close.

In Honduras, difficulty talking with your mother was the only variable associated with alcohol abuse, where those reporting greater difficulty also had higher odds of drug use. A dose-response relationship was observed again here, reaching 449% increased odds (95% CI = 2.16; 13.94) of drug use in those reporting it was very difficult to talk to their mothers.

In Haiti (Table 8), there were no associations with alcohol abuse, and the dataset did not include the drug use variable.

Table 6. Unadjusted and adjusted associations of parental emotional social support with drug use.

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Relationship with mother			0.288			0.107			0.649			0.518			0.086			0.159
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.49	0.13; 1.82		0.35	0.10; 1.25		0.62	0.08; 4.96		0.59	0.12; 2.90		0.54	0.27; 1.09		0.57	0.26; 1.25
Difficulty talking to mother			0.008			0.111			0.379			0.337			0.001			0.002
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.57	0.24; 1.36		0.63	0.29; 1.38		0.83	0.20; 3.47		1.32	0.23; 7.61		2.20	1.00; 4.84		2.14	0.95; 4.80
Difficult	0.23	0.07; 0.69		0.26	0.07; 0.99		1.92	0.45; 8.18		2.53	0.51; 12.47		2.96	1.26; 6.95		2.96	1.26; 6.98
Very difficult	0.63	0.14; 2.86		0.72	0.15; 3.47		3.42	0.51; 22.78		4.83	0.60; 39.20		6.27	2.52; 15.59		5.49	2.16; 13.94
Closeness with mother			0.390			0.674			0.016			0.025			0.151			0.091
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	0.77	0.36; 1.65		0.96	0.53; 1.73		0.98	0.25; 3.82		1.14	0.29; 4.50		1.16	0.72; 1.87		1.29	0.79; 2.12
Not close	1.80	0.47; 6.91		1.85	0.44; 7.80		6.08	1.64; 22.51		5.23	1.50; 18.21		2.03	0.99; 4.12		2.20	1.08; 4.48
Relationship with father			0.041			0.012			0.150			0.131			0.049			0.079
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.38	0.15; 0.96		0.33	0.14; 0.79		0.43	0.14; 1.36		0.43	0.14; 1.29		0.56	0.32; 1.00		0.59	0.33; 1.06
Difficulty talking to father			0.149			0.032			0.818			0.856			0.625			0.668
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.63	0.21; 1.88		0.84	0.26; 2.68		0.84	0.14; 5.22		0.92	0.17; 5.03		1.04	0.46; 2.35		1.08	0.48; 2.45
Difficult	2.23	0.57; 8.71		3.52	1.06; 11.66		1.09	0.14; 8.39		1.31	0.20; 8.59		1.11	0.45; 2.73		1.17	0.48; 2.87
Very difficult	1.21	0.27; 5.50		1.95	0.39; 9.77		1.97	0.26; 15.03		1.99	0.29; 13.68		1.66	0.67; 4.12		1.66	0.68; 4.07
Closeness with father			0.226			0.025			0.879			0.819			0.394			0.534
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	2.05	0.68; 6.20		2.57	0.95; 6.97		1.51	0.30; 7.72		1.64	0.33; 8.15		0.76	0.42; 1.36		0.83	0.46; 1.51
Not close	2.73	0.81; 9.17		4.50	1.49; 13.60		1.24	0.17; 9.01		1.20	0.18; 7.86		1.20	0.55; 2.59		1.25	0.58; 2.70
^a Adjusted by age, highest level of education, ethnicity, and wealth index. ^b Adjusted by age, highest level of education, and wealth index. OR = Odds Ratio. 95% CI = 95% Confidence Interval.

Table 7. Unadjusted and adjusted associations of parental emotional social support with alcohol use.

Variables	Colombia						El Salvador						Honduras
	Crude			Adjusted ^a			Crude			Adjusted ^b			Crude			Adjusted ^a
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Relationship with mother			0.856			0.356			0.864			0.998			0.342			0.305
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.92	0.39; 2.20		0.66	0.27; 1.60		0.91	0.33; 2.56		0.89	0.32; 2.54		0.80	0.50; 1.27		0.76	0.45; 1.28
Difficulty talking to mother			0.783			0.496			0.079			0.041			0.011			0.003
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.91	0.57; 1.44		0.87	0.53; 1.43		1.62	0.61; 4.31		1.87	0.71; 4.89		1.14	0.84; 1.54		1.22	0.90; 1.67
Difficult	1.21	0.62; 2.36		1.35	0.71; 2.55		1.55	0.72; 3.33		1.93	0.91; 4.06		1.23	0.87; 1.75		1.48	1.02; 2.13
Very difficult	0.84	0.37; 1.92		0.89	0.36; 2.25		2.64	1.14; 6.11		2.73	1.17; 6.36		2.17	1.35; 3.48		2.38	1.47; 3.84
Closeness with mother			0.264			0.043			0.906			0.204			0.104			0.021
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.39	0.93; 2.08		1.65	1.12; 2.45		0.88	0.40; 1.90		0.98	0.43; 2.25		1.07	0.84; 1.36		1.27	0.99; 1.64
Not close	1.21	0.57; 2.55		1.40	0.62; 3.15		1.06	0.38; 2.92		1.06	0.37; 3.02		1.56	1.03; 2.36		1.77	1.16; 2.69
Relationship with father			0.650			0.844			0.667			0.551			0.005			0.010
No	1.00			1.00			1.00			1.00			1.00			1.00
Yes	0.87	0.46; 1.62		0.93	0.46; 1.87		0.84	0.37; 1.88		0.81	0.35; 1.90		0.66	0.49; 0.88		0.66	0.48; 0.91
Difficulty talking to father			0.107			0.190			0.025			0.275			0.292			0.324
Very easy	1.00			1.00			1.00			1.00			1.00			1.00
Easy	0.99	0.53; 1.85		1.11	0.58; 2.14		0.43	0.21; 0.90		0.47	0.22; 1.02		0.87	0.61; 1.23		0.90	0.62; 1.29
Difficult	0.61	0.29; 1.28		0.67	0.32; 1.43		0.90	0.46; 1.74		0.97	0.49; 1.93		0.99	0.67; 1.46		1.11	0.74; 1.67
Very difficult	0.58	0.26; 1.29		0.79	0.34; 1.85		2.11	0.51; 8.73		2.45	0.53; 11.44		1.28	0.82; 1.99		1.29	0.81; 2.04
Closeness with father			0.548			0.308			0.112			0.042			0.008			0.028
Very close	1.00			1.00			1.00			1.00			1.00			1.00
Close	1.21	0.79; 1.85		1.45	0.89; 2.35		0.99	0.54; 1.80		1.02	0.55; 1.89		0.92	0.68; 1.24		1.05	0.77; 1.42
Not close	1.40	0.72; 2.71		1.50	0.72; 3.13		3.01	1.01; 9.02		3.37	1.09; 10.43		1.53	1.06; 2.20		1.60	1.09; 2.35
^a Adjusted by age, highest level of education, ethnicity, and wealth index. ^b Adjusted by age, highest level of education, and wealth index. OR = Odds Ratio. 95% CI = 95% Confidence Interval.

Table 8. Unadjusted and adjusted associations of parental emotional social support with Psychological Distress and alcohol use in Haiti

Variables	Psychological Distress				Alcohol use
Variables	Crude		Adjusted ^c		Crude		Adjusted ^c
Closeness with mother
Very close	1.00				1.00
Close	1.03	0.99; 1.08	1.04	0.99;1.09	1.02	0.67; 1.54	1.05	0.68;1.63
Not close	1.17	1.09; 1.27***	1.16	1.08; 1.25	1.30	0.63; 2.69	1.25	0.60; 2.60
Closeness with father
Very close	1.00				1.00
Close	1.03	0.99; 1.08	1.03	0.99; 1.08	0.99	0.62; 1.59	1.02	0.64; 1.65
Not close	1.11	1.05; 1.18**	1.11	1.05;1.17	1.13	0.66; 1.95	1.09	0.62; 1.91
^c Adjusted by age and wealth index. * p-value <0.05, p-value <0.01, * p-value <0.001.

Discussion

Findings from this large, cross-national study of 13,174 Latin American youths aged 13 to 24 highlight the significant role of parental support in shaping adolescent mental health and behavior. The study offers important insights into culturally nuanced expressions of support across Colombia, El Salvador, Haiti, and Honduras, reinforcing the relevance of family-based studies in diverse low- and middle-income settings. Grounded in Family Systems Theory (Minuchin, 1974), the results illustrate how the emotional and communicative dynamics within families, particularly the relational ties between youth and parents, are deeply embedded in broader cultural norms and directly associated with key youth outcomes. These findings reflect the influence of familism, a core Latino cultural value emphasizing family loyalty and interdependence. Higher familism correlates with reduced internalizing symptoms among youth, consistent across Latino samples (Ayon et al., 2010).

Relationship and closeness with parents

In Colombia and El Salvador, the relationship between youth and their mother is a protective factor against psychological distress. Conversely, in Honduras, the relationship with parents is the only variable that exhibited a distinct pattern, with the connection with their father being strongly associated as a protective factor for psychological distress. Similarly, in a recent study examining rural Honduran adolescent pregnancy in 176 villages, girls who reported their father as part of their social network had a lower risk of adolescent pregnancy (Shakya et al., 2020). In Haiti, the absence of closeness between youth and parents may pose a risk for heightened psychological distress compared to youths who maintain a close relationship with their parents. The role of parental relationships, particularly with mothers in Colombia and El Salvador, and fathers in Honduras, implies the need for socio-culturally sensitive approaches when addressing youth psychological well-being across Latin America, indicating a need for interventions that foster closer family ties.

Colombian youths showed a lower risk of drug use when reporting a close relationship with their father, while those not close had increased chance. Similarly, the odds of binge drinking were higher among Colombian youth lacking closeness with their mother. In El Salvador, drug use risk factors were significant only for those not close to their mother. These findings were based on cross-sectional quantitative data. Future longitudinal studies are necessary to explore the developmental and long-term impact of parental relationships on substance use, while qualitative research could elucidate mechanisms behind family influences on substance use among Latin youth. Integrating parental support initiatives into mental health promotion could also significantly reduce youth psychological distress. Additionally, family-based interventions that foster supportive parental behaviors may be effective in preventing adolescent substance abuse (Sparks et al., 2013).

For NSSI and suicidal behavior, Colombian youths who maintained a relationship with their mother had 62% lower odds of engaging in suicidal behavior compared to those without such a relationship. Similarly, in El Salvador and Honduras, parental relationships were protective against NSSI, with a lack of closeness significantly increasing the risk. In contexts marked by economic instability and migration (e.g., Honduras, El Salvador), close family relationships serve as vital emotional anchors. Research indicates that familism and cohesive family relationships guard against internalizing behaviors and self-harm (Kuhlberg et al., 2010). In systemic terms, self-harm may reflect breakdowns in familial support structures, where the emotional system fails to provide adaptive coping resources (Lai & Chen, 2023).

These findings align with studies showing the protective impact of maternal closeness on NSSI across both clinical and non-clinical youth samples (DiFilippo & Overholser, 2000). A study from Cape Town, South Africa, also showed that maternal closeness reduced NSSI and risky behaviors, particularly in males (Gilreath et al., 2009). Collectively, these results highlight the importance of fostering close familial relationships as a strategy for reducing self-harm and suicidal tendencies in vulnerable youth.

Parent-youth communication

Communication also emerged as a pivotal factor for youth well-being. For instance, Colombian youths who reported very difficult communication with their mothers had 224% higher odds of suicidal behavior, while those with difficult communication with their fathers had 346% higher odds than peers with easier communication. Latino cultures often adhere to patriarchal norms that restrict emotional openness with fathers, a phenomenon sometimes referred to as “emotional silencing” (Bornstein, 2013). In a family-systems context, communication breakdowns signal broader relational dysfunction, undermining the protective buffer provided by parental guidance (Minuchin, 1974). A systematic review found a negative correlation between the quality of parent-child communication and various poor mental health outcomes, particularly in adolescents experiencing depression, PTSD, and psychosis (Zapf et al.). Studies also show that youth tend to engage more with mothers, likely due to the warmth, responsiveness, and intimacy typical of mother-child interactions (Aunola & Nurmi, 2005).

Parental influence on psychosocial factors related to substance abuse has been widely documented. Moreover, studies have shown that positive family communication, especially regarding substance use prevention, is associated with reduced lifetime alcohol use among youth, as observed in Nicaragua (Trucco, 2020). This aligns with studies showing that Latino youth with weaker parental engagement are more prone to substance misuse (German et al., 2009; Valdivieso-Mora et al., 2016). Given these findings, future intervention programs in Honduras and El Salvador should prioritize enhancing parent-child communication around substance use to mitigate risky behaviors.

Several studies with diverse Latino populations, primarily Mexican-American, have demonstrated that increased parental communication and engagement significantly decrease the risk of substance use (Kam & Cleveland, 2011; Marsiglia et al., 2016; Pokhrel et al., 2008). Similar findings were observed in a cohort study in Ethiopia, where positive parent-adolescent relationships not only reduced adolescent substance use but also improved self-esteem, decreased depressive symptoms, and mitigated school-related issues (Bireda & Pillay, 2018). Together with our study, these works emphasize the importance of parental involvement in reducing substance use risk, accentuating the value of strong parent-youth relationships

In conclusion, the primary strength of our study lies in its documentation of diverse associations between various forms of parental support and multiple dimensions of the mental health and well-being of youth across four Latin American countries. The relationship between parental support and improved youth mental health, alongside reduced risk behaviors, highlights the crucial role of the family environment for Latinx youth. In today's Latin America, where violence, migration, poverty, and inequality impact youth, these findings underscore the importance of supportive family structures (Sánchez-Castro et al., 2024) and the need for effective programs and policies to build or strengthen family support.

Limitations

This study has several limitations. First, due to its cross-sectional design, causal inferences cannot be established. Future longitudinal studies are needed to assess how parental support influences youth outcomes over time. Second, data relied entirely on self-reported measures, which may be affected by recall bias or social desirability bias, particularly in reporting sensitive behaviors like suicidal ideation or substance use. Third, the cultural meaning of "parental support" may vary across settings and languages, which may influence how youth interpret and respond to survey questions. Fourth, although the study includes four countries, data for Haiti were limited, restricting the depth of analysis and comparison. Fifth, paternal involvement remains underexplored, as cultural and methodological barriers often limit accurate reporting of father engagement. Sixth, VACS data were collected across different years (2012–2018), which may limit comparability across countries. Cultural, social, and policy contexts related to parenting and youth mental health may have changed over time, particularly following the COVID-19 pandemic, and therefore the findings may not fully reflect current conditions. Finally, the study did not account for contextual factors such as family income, education, or violence exposure, which may moderate the associations observed. These factors are particularly relevant in Latin America, where structural inequalities can shape parenting capacity and adolescent mental health.

Conclusions

This study of 13,174 Latin American youths aged 13 to 24 reveals that parental support significantly contributes to youth mental health well-being. With a robust sample from four low-income countries, findings highlight the critical roles of both mothers and fathers in youth mental health. Future research should explore the familial and developmental mechanisms behind these associations and how social and cultural factors impact parent-child dynamics. Additionally, examining other support sources, such as friends or teachers, could offer insights for interventions. Improving parental communication and family cohesion may be effective strategies for reducing substance use in youth across societies.

Ethical Statement - The survey protocol underwent independent review and approval by both the National Ethics Committee on Research in Health of Colombia, El Salvador, Haiti, and Honduras, and the U.S. Centers for Disease Control and Prevention (CDC) Institutional Review Board.

Data Availability Statement - The data analyzed in this study were obtained from the Violence Against Children and Youth Surveys (VACS), coordinated by the U.S. Centers for Disease Control and Prevention (CDC). These datasets contain highly sensitive information related to violence exposure and mental health among children and adolescents. To ensure participant privacy and comply with ethical and legal protections, the data are not publicly available. Researchers who wish to access VACS data may submit a formal request to the CDC at VACSDataRequest@cdc.gov. Access may be granted upon approval of the request and completion of a data use agreement outlining confidentiality and data security requirements.

Funding - No funding.

Competing Interests - The authors declare that there are no conflicts of interest related to the research, authorship, or publication of this article.

Authors' Contribution –

All authors have made substantial contributions to the manuscript and meet the criteria for authorship.

● CVRO: Conceptualization, Methodology, Writing – Original Draft, Writing – Review & Editing, Supervision, Project Administration.

● HEF: Writing – Original Draft, Writing – Review & Editing.

● TG: Writing – Review & Editing.

● CB: Formal Analysis, Data Curation.

● RM: Formal Analysis, Data Curation.

● SW: Writing – Review & Editing.

● CWB: Writing – Review & Editing.

All authors reviewed and approved the final manuscript.

Use of AI technologies – No artificial intelligence (AI) technologies was used in the manuscript.

Acknowledgments – The authors would like to thank all participants who contributed to this study. We are especially grateful to the adolescents and families who shared their experiences and made this research possible. We also acknowledge the support of the collaborating institutions, research assistants, and community partners involved in data collection and project coordination. Their contributions were essential to the completion of this work.

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