Identifying Adolescent Mental Health and Behavioral Risk Profiles: The Role of Childhood Adversities, Family Environment, and Peer Support

BACKGROUND: Adolescents in low- and middle-income countries (LMICs) experience a disproportionately high burden of emotional and behavioral problems (EBPs), shaped by early adversities, limited psychosocial support, and structural disadvantages. In Bangladesh, mental health concerns among adolescents remain under-recognized, with limited data on how mental health symptoms cluster and which subgroups are at elevated risk. Identifying distinct risk profiles is essential for informing targeted interventions. METHODS: Using data from a cross-sectional school-based survey (N = 1040), we applied latent class analysis (LCA) to identify mental health risk profiles based on emotional symptoms, conduct problems, insomnia, suicidal behavior, truancy, physical fights, bullying, and peer/social isolation. Multinomial logistic regression models were used to examine associations between latent class membership and adverse childhood experiences (ACEs), family/peer relational factors, and sociodemographic characteristics. RESULTS: Three distinct mental health and behavioral risk classes were identified: low risk (36.3%), moderate risk (36.1%), and high risk (27.6%). The high-risk class showed elevated internalizing symptoms, externalizing behaviors, and psychosocial adversities, including conduct problems, loneliness, truancy, bullying, and physical fighting. In the fully adjusted model, sexual abuse (aOR = 2.64) and witnessing violence aganist the mother (aOR = 3.56) were the strongest predictors of high-risk membership. Lack of peer support was significantly associated with both moderate-risk (aOR = 2.13) and high-risk (aOR = 2.25) membership, whereas poor parental understanding increased the odds of moderate-risk classification (aOR = 1.70). In the interaction model, females exposed to household mental illness had disproportionately higher odds of belonging to the high-risk class. CONCLUSION: Adolescent mental health in Bangladesh is shaped by a complex interplay of trauma, family functioning, and gender. Trauma-informed, gender-sensitive interventions are urgently needed to address these disparities.