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

 

Reviewer: Rashella D'Amico

Completed: 09-08-2026 06:08

 

Recommendation: Accept Submission

 

 

	Yes	No	N/A
Is the research question clearly defined?	+
Are the methods appropriate and sufficiently detailed?	+
Is the data analysis robust and replicable?	+
Are the conclusions supported by the results?	+
Is the manuscript well organised and clearly written?	+
Are tables, figures, and supplementary material informative and necessary?	+
Is the abstract an accurate summary of the study?	+
Does the manuscript contribute meaningfully to the field?	+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

This manuscript addresses a genuinely underrepresented gap with comparative, quantitative data on parenting and adolescent wellbeing across four Latin American and Caribbean countries. As it presents a large, multi-country cross-sectional analysis (N = 13,174) examining parental support dimensions and mental health/substance use outcomes among Latin American youth, the scale of the sample and the outcome-specific modelling strategy are commendable. It contributes meaningfully to the field. However, several areas need clarification and tightening.

The introduction invokes ACE literature in a single citation cluster, indicating that “adverse childhood experiences are consistently associated with suicide-related behaviors among youth, “but does not return to this framework in the discussion, despite it being directly relevant to the findings. The research question is clearly defined and the objective is explicit. Associations between dimensions of parental support, psychological distress, suicidal behavior, and substance use are openly explored across the designated countries. Data source, sample sizes, outcome operationalization, and regression analysis (Poisson, logistics, ordered logistics) are all specified. Methods are specific enough to replicate, but there is no correction for multiple comparisons across countries, outcomes, exposures, and some effect sizes are very large without discussion of CI or small stratum sizes that could be responsible for instability in the data or reliability of the findings. The article is well organized and clearly written with conclusions that are supported by the results. The intervention/policy language in the discussion is informative and pertinent. The push toward translational framing is a genuine strength. Statements such as the call for “future intervention programs in Honduras and El Salvador should prioritize enhancing parent-child communication” and the broader “need for effective programs and policies to build or strengthen family support give clear goals for practitioners and policy makers rather than appealing only to epidemiological literature.

Strengths

●   Drawing on VACS data across Colombia, El Salvador, Haiti, and Honduras gives this study a wider reach than single-country studies in this literature.

●   The authors appropriately vary model choice by outcome type (Poisson for the distress score, logistic for dichotomous suicide/drug items, ordered logistic for binge drinking), rather than defaulting to one model across the board.

●   IRB/national ethics approval, age-appropriate consent/assent procedures, and a clear CDC data-access pathway are all documented.

●   The authors proactively flag cross-sectional design, self-report bias, cross-year data collection (2012-2018), and the sparse data from Haiti. This kind of self-critique is appreciated and should be preserved.

Areas for Improvement

1. Adjustment is limited to age, education, ethnicity, and wealth index. Given that VACS is fundamentally a violence-exposure survey, and violence exposure is a well-established confounder of both parenting quality and youth mental health, its absence from the adjustment set is a meaningful gap rather than a minor omission. I recommend either including a violence-exposure covariate where available, or explicitly justifying why it was excluded.

2. The design tests four countries by up to four outcomes by multiple exposure variables, without any correction. One might expect Bonferroni, FDR, or discussion of a pre-specified confirmatory subset. Several of the reported associations are large (e.g., 224-346% higher odds of suicidal behavior for communication difficulty), and readers need some indication of how many comparisons were run in total and how the authors are guarding against chance findings.

3. Odds ratios in the 200-300%+ range, particularly from country-specific strata, warrant a check on underlying cell counts. For example, the reported 346% higher odds of self-inflicted injury for youths who found it very difficult to talk to their father (OR ≈ 4.46) carries a 95% CI of roughly 1.55 to 12.88, an eight-fold spread between the lower and upper bound. A CI that wide indicates the estimate is likely being driven by a small number of events in that stratum, and readers cannot judge its stability without knowing the underlying cell counts. I recommend the authors report Ns per stratified cell (or at minimum comment on precision) so readers can judge whether these estimates are stable or driven by sparse data, especially for Haiti, which is already notated as data-limited.

4. Country inclusion was based on "availability of publicly accessible VACS datasets at the time of analysis," which is a pragmatic comparison. This should be stated plainly as a convenience-based selection in the methods, and the discussion should be more explicit that cross-country comparisons are exploratory rather than a matched design.

5. The exposures studied in the manuscript including: low closeness and difficulty communication with a parent, map closely onto emotional neglect. This is one of the original ACE domains identified by Felitte et al. (1998). The manuscript frames parental support only as a protective factor that buffers other adversities, rather than considering whether the absence of parental support is itself best understood as an ACE-type exposure with its own dose-response literature.  The authors report their own dose-response findings in the psychological distress results, noting that “a dose response relationship was observed” between decreasing closeness/communication and increasing distress. This pattern closely parallels the dose-response gradient that is the signature of the ACE literature (Hughes et al., 2017 cited) where risk for adverse outcomes escalates with the number or severity of adverse exposures. Making this connection explicit would situate the study’s central finding within a well-established, quantitatively robust body of work and strengthen the theoretical framing. I recommend the authors engage the ACE literature more fundamentally in the discussion, including citing the foundational ACE study (Felitti et al., 1998). This would strengthen the case made elsewhere in this review for including violence exposure as a covariate, since ACE frameworks typically treat parental neglect and violence exposure as co-occurring, cumulative risk factors rather than independent ones.

Minor Suggestions

●   Verify sample sizes in the methods; Colombia and El Salvador are both listed as n = 2,433, which seem unlikely.

●   Consider consolidating the eight result tables. Several could move to supplementary material to improve readability of the main text.

●   The abstract omits NSSI as an outcome distinct from suicidal behavior; consider a brief mention for full alignment with the results section.

Overall Assessment

This is a substantive contribution to an underdeveloped area of literature. Family context and the effects on youth mental health has not been well studied outside of ACE driven research and it is distinctly lacking across Latin America and the Caribbean. With clearer handling of confounding, transparency around multiple comparisons and cell sizes, this manuscript has strong potential to make a meaningful and citable contribution to the field.

Recommendation: Accept with Minor Revision