The social ecology of adolescent mental health in humanitarian settings: A qualitative study

The social-ecological context of adolescent mental health, particularly adolescents living through humanitarian crises, is understudied. There is a pressing need for such research to inform the development of contextualised systemic interventions for this population. This study investigated the social ecological stressors and risk- and protective-factors experienced by adolescents and their families in crisis-hit Lebanon to inform a contextually grounded systemic psychosocial support intervention. A whole-family systems approach grounded in the Social-Ecological Model was used with a qualitative design to capture the lived experiences of adolescents. Interviews were conducted with 46 Lebanese and Syrian adolescents (48% female, mean age = 13.8 years, SD = 1.65), their families (N = 42 caregivers, 60% mothers), and experienced providers (N = 5) in Lebanon. Transcripts were analysed using Reflexive Thematic Analysis which highlighted six interconnected themes (25 sub-themes) that characterised the life experience of adolescents at each identified systems level. Themes ranged from adolescent mental health and interpersonal relationships to living conditions and access to basic human rights and services. Gender and nationality exerted cross-cutting influences across themes. Findings are discussed drawing on social ecology, systems theory, and liberation psychology. Results highlight a clear need for interventions to involve families and caregivers, and consider adolescents in their social ecological contexts. This approach could better address the needs of adolescents, by supporting adolescent development, enhancing mental health and well-being, reducing community and social isolation, and, more broadly, advocating for social equity, justice, and human rights.