Social Determinants in Adolescent Mental Health: A Call for Effective Screening Strategies

ABCD cohort analyses identify family conflict and peer reputational harm among the strongest social predictors of adolescent mental-health risk.

Machine-learning models incorporating social predictors accounted for roughly 40% of the variance in adolescent mental-health outcomes.

Clinically relevant family factors to probe include ongoing verbal conflict, caregiver instability, and household chaos. Here, ongoing verbal conflict denotes repeated, unresolved heated exchanges; caregiver instability encompasses changes in the primary caregiver or inconsistent caregiving; and household chaos reflects irregular routines and environmental disorganization that can disrupt sleep and supervision.

Peer networks pose comparable risk when adolescents occupy marginalized positions or experience reputational harm—being the target of exclusion, rumor, or public shaming correlates with higher symptom burden.

By contrast, membership in cohesive, reciprocal friendship groups associates with lower risk, and mapping school social structure can help prioritize outreach to isolated or reputationally harmed students.

Practical implementation steps include embedding short family and social-network modules in intake forms, training staff to ask sensitively about reputational harm, and monitoring outcomes to refine referral thresholds and intervention targets.

Key Takeaways:

• Integrate items on family conflict and caregiver instability into routine adolescent mental-health intake workflows.
• Add brief social-network or school-structure questions to identify reputational harm and isolated students.
• When these risks are present, prioritize brief family-level interventions and school-based group supports to address relational drivers of distress.