Social Support Among Minoritized Emerging Adults With Serious Psychological Health Issues

Abstract

This convergent mixed method study examines the role of social support in the lives of minoritized emerging young adults with serious mental illness (YA-SMI), focusing on how they perceive and experience support from family, friends, and other sources. Data were gathered from 114 YA-SMI (ages 18–34) participating in a recovery program. Descriptive analyses revealed that 44% of participants reported family as their only source of support, while others relied on a combination of supports or reported no support. Ordinal logistic regression revealed that growing up in a household with mental illness was associated with lower odds of being in a higher support category, compared to no support. Qualitative interviews (n = 57) identified four themes: types of support, qualities of support by source, pathways to treatment, and loss. Findings suggest that YA-SMI benefit from diverse support, with non-family members providing crucial informational support. Implications for policy, practice and research are discussed.

As youth emerge into young adulthood, they face significant developmental changes (Arnett, 2000). Arnett et al. (2014) report that the instability of emerging adulthood can lead to a lack of adequate social support. This is critical, as social support has been shown to be among the most significant factors related to a successful transition to adulthood (Pettit et al., 2011; Shulman et al., 2009). Healthy social relationships have been found to play an instrumental role in successful adult development and overall wellbeing (Scales et al., 2016). More specifically, a few studies have shown that young adults with serious mental illness (YA-SMI) can experience delays in social development and experience difficulties in maintaining social relationships (Munson et al., 2013; Sabella, 2021; Stein et al., 2013). However, two studies recently revealed that there is a dearth of research examining social support in the context of mental health, and that very little is known about how social support impacts the lives of marginalized youth and young adults with serious mental illness (Sapiro & Ward, 2020; Scardera et al., 2020). Considering that in 2023, young adults aged 18–25 had the highest prevalence of SMI (10.3%) compared to older age groups (SAMSHA, 2024), it is critical to develop a more clear understanding of the social support relationships in the lives of YA-SMI, along with how social support can help address the current youth mental health crisis that is facing our nation (Office of the Surgeon General, 2021).

Resilience Framework: Risk and Protection

Resilience provides a framework for examining both risk and protective factors and has enabled developmental scholars to understand how some youth develop into healthy adults despite having been exposed to risks (Feldman, 2020; Ungar et al., 2013; Zimmerman, 2013). It places emphasis on the presence of protective factors that have the potential to mitigate negative developmental trajectories (Zimmerman, 2013). Social support is a common protective factor, a positive promotive resource to help youth overcome negative effects of risk, including adverse childhood experiences (ACEs) (Curry & Abrams, 2015; Okpych, 2024; Werner & Smith, 1992). Social support can be protective in many ways, for example by enhancing skill building, problem-solving, the ability to self-regulate, self-efficacy, and/or optimism (Masten, 2019), and it has been shown to have a positive impact on health behaviors (Aschbrenner et al., 2013; Umberson & Karas Montez, 2010). Recent scholarly work argues for a more holistic definition of resilience—encompassing the impact of personal, material, political, and institutional factors on the wellbeing of Black, Asian, and minority ethnic families and communities (Sims-Schouten & Gilbert, 2022; Rosenberg et al., 2023). It is evident that understanding if and how risk exposure influences the availability of social support is important for enhancing resilience (Ungar & Theron, 2020). This study examines predictors of family-focused social support, including ACEs and psychiatric symptoms, while also exploring how social support functions in the lives of marginalized YA-SMI, an understudied sub-group of emerging adults.

Previous Literature

Social Support

Social support contributes to and promotes positive mental health (Corrigan & Phelan, 2004; Scardera et al., 2020; Topor et al., 2006; Turner & Brown, 2010; Umberson & Karas Montez, 2010; Van Droogenbroeck et al., 2018). It has been conceptualized in many ways, including types, sources, duration, and the amount of support an individual can access (Thoits, 2011). Social support is multidimensional (Malecki & Demaray, 2003; Morelli et al., 2015), and includes informational, emotional, material/tangible and advocacy support (House et al., 1988). In this study, one of our main aims is to understand natural supports, defined as social support relationships that occur outside of formal systems of care (e.g., mental health system), including family members, friends, neighbors and faith leaders. Natural supports, sometimes referred to as informal supports, have been found to be essential for mental health recovery (Bjørlykhaug et al., 2022; Chronister et al., 2015). Finally, consistency and mutuality have been found to be important relationship qualities among marginalized youth and young adults living with mental health conditions (Munson et al., 2015; Sapiro & Ward, 2020).

A Closer Look at Family Support

Family members are instrumental in the lives of people living with serious mental illness. Some research has shown that family support among children and youth living with a mental health condition is associated with positive outcomes (Hoagwood et al., 2010; McConnell et al., 2016; Moore et al., 2018); however, studies also document that family relationships can contribute to negative impacts on mental health and development (Hovland et al., 2023; Sapiro & Ward, 2020). Indeed, research has suggested that family support can be a “mixed blessing” (Hovland et al., 2023; Moses, 2010; Tracy et al., 2010).

A few studies have focused on family support in the lives of emerging adults with serious mental health conditions (Sapiro & Quiroz, 2022; Sapiro & Ward, 2020). One study among youth receiving outpatient services reported that 40% of natural supports were family members, and that the majority of advice came from family who spoke positively about mental health services (Ben-David et al., 2017). Family support has also been found to be important in providing a sense of acceptance, wellbeing and safety (Hovland et al., 2023). Individuals with SMI have specifically identified family as important to their recovery (Chronister et al., 2021; Hovland et al., 2023), specifically in assisting with health management, day to day living, and community participation (Chronister et al., 2021). Also, engaging family members in the treatment process has been shown to be important in improving young adult’s mental health (Stein et al., 2013). Family has been critical to helping young people access mental health services (Lindsey et al., 2010). Finally, young adults acknowledge spending time with family as an important part of community engagement (Thomas et al., 2017). Very few studies have specifically examined social support among minoritized YA-SMI.

Predictors of Family Support: ACEs and Psychiatric Symptoms

Adverse Childhood Experiences.

ACEs are stressful and potentially traumatic events that occur during childhood (Felitti et al., 2019). ACEs are prevalent in the United States (U.S.); indeed, a sample across five states revealed that over a third of adults reported being exposed to at least two ACEs (Bynum et al., 2010). Research has shown that adults who are exposed to ACEs have increased difficulties in developing positive relationships (Poole et al., 2018). Furthermore, a sample of college students showed that those with high levels of ACEs reported lower levels of social support (Karatekin & Ahluwalia, 2020). Finally, Merrick and Colleagues (2017) found that ACEs related to family, particularly household mental illness, were linked to depression, attempted suicide and substance use in adulthood.

ACEs related to the family context may be particularly important for ethnoracially minoritized YA-SMI in the U.S. due to factors such as racial discrimination and police violence (Anglin, 2023). The racism-related stressors faced by minoritized families (Williams et al., 2022), along with the risk of heritability associated with mental illness, also indicate that family psychopathology may be a significant risk for minoritized YA-SMI. In the present study we focused on ACEs in the family context to examine if family-based ACEs, some of which have been found to be more concentrated in minoritized families (e.g., family member in jail/prison, See Pettit & Gutierrez, 2018), impact social support among YA-SMI.

Psychiatric Symptoms.

Our study also examined mental health symptoms, as symptoms have long been associated with the ability to form and maintain social relationships (Moran et al., 2024; Sapiro & Ward, 2020). One study revealed that young adults with mental health challenges experienced disruptions in the formation of their relationships including intimate, and marital relationships (Cook et al., 2025). Research also suggests that YA-SMI often experience the loss of key relationships with family members and peers and also experience loneliness and social isolation (Moran et al., 2024; Sapiro & Ward, 2020). The purpose of this study was to address the dearth of research on social support relationships among minoritized YA-SMI, with a particular focus on the context of family support.

Present Study

The present study uses mixed methods to build understanding of the social support relationships in the lives of minoritized YA-SMI, with a focus on family-focused support. The study addresses three aims: (1) describe the natural support relationships among YA-SMI; (2) examine the predictors of reporting family-focused natural support; and (3) explore qualitative themes related to YA-SMI’s reported experiences with social support. The study examined the following research questions to deepen the understanding of social support relationships among YA-SMI: (1) What is the mean number of natural supports reported by study participants?; (2) Who are the natural supports? (3) What factors are associated with reporting family-focused natural support?; and, (4) In what ways do YA-SMI discuss social support in their lives?

Methods

Data Procedures and Recruitment of Sample

Data for the present study come from a sample of racial and ethnic minoritized YA-SMI aged 18–34 who participated in Wave 1 of a NIMH-funded randomized trial of an engagement intervention for YA-SMI receiving personalized recovery-oriented services (PROS) (See Munson et al., 2020; R34 MH111861, PI: Munson). The larger study examined the feasibility, acceptability, and preliminary impact of a brief intervention to help orient young adults to their treatment and improve their engagement in treatment (Munson et al., 2021). The trial occurred in collaboration with two large behavioral health agencies that provide services in low-resourced communities in a large urban area. Intake staff introduced the project to potential participants and if they were interested, they contacted the project staff directly. Recruitment for the study occurred over a two-year period, 2018–2020. Young adults were eligible if they met the following criteria: (1) Between the ages of 18 and 34 years; (2) Living with a SMI; (3) In the intake process or enrolled in the PROS program; and, (4) Formerly involved with or received safety net programs/services (e.g., Medicaid, juvenile justice, foster care, Supplemental Nutrition Assistance Program). All participants completed informed consent procedures that were approved by the University’s Committee on Activities Involving Human Subjects. A sample of minoritized young adults living with SMI were recruited and completed the survey (N = 114), and a sub-sample of the larger study completed the semi-structured interviews (N = 57).

Study Design

This study used a convergent parallel mixed methods design, which allowed the research team to triangulate the quantitative and qualitative data and provide a more complete understanding of the research question(s) – deriving information from both sources of data (Creswell, 2003; Cresswell & Plano Clark, 2017). This design allowed our research team to compare the data types, which were collected concurrently. This pragmatic approach values both empiricism and constructivism and allows studies to build a comprehensive understanding of the research questions (Kemp & Samuels, 2019). Both quantitative and qualitative data in the present study are from the baseline interview. The study team examined the descriptive statistics and discussed three emerging types of natural support categories: (1) no natural support, (2) mixed type natural support category, and (3) family-focused natural support category. To examine what factors predicted type of support “network,” we used an ordinal logistic regression. Then, a team of analysts followed the analytic steps of thematic analysis (Braun & Clarke, 2006) with open coding and constant comparison throughout the process to analyze the qualitative interview data. Finally, we used a joint display to examine the qualitative themes that emerged by whether the young adult grew up in a household with mental illness, which emerged as a significant predictor of family-focused support. Each of these iterative steps is discussed in detail below.

Quantitative Measures

Dependent Variable

Natural Supports.

We examined natural supports in three important ways: (1) the presence or absence of natural supports; (2) the number of natural supports; and, (3) the centrality of family members in the young adult’s support network. These data are based on four items in our survey. The first item identified if each young adult possessed natural support relationships in their lives: “Do you have natural supports in your life, people who help you who are not professionals, with respect to mental health and going to personalized recovery oriented services (PROS)?” For all young adults who responded “yes”, the survey followed with open-ended items querying “Who are the natural supports?”. We then created a variable focused on type of support network: “0” no reported natural support relationships, “1” a mixed type natural support network (e.g., family, friends, neighbor) or “2” a family-focused natural network (e.g., mother, father, brother). In this study we report how many YA-SMI reported the presence of a natural support (NS), examine what predicts having a family-focused natural social support network, and report on a set of themes that emerged in the data, illuminating some of the ways in which social support shows up in the lives of participants.

Independent Variables

Adverse Childhood Experiences.

ACEs were measured using the ACE International Questionnaire (ACE-IQ), which was developed based on the ACEs within the Behavioral Risk Factor Surveillance Survey (World Health Organization, 2018). The full ACE-IQ consists of 13 sub-dimensions, with higher scores (0–13 range) specifying more exposure to adverse experiences in childhood (see World Health Organization, 2018). For the purposes of this study we used 5 items focused on the family/household environment. The questions asked about growing up during the first 17 year of life and included the following questions: (1) “Did you live with a household member who was a problem drinker or alcoholic, or misused street or prescription drugs?”, (2) “Did you live with a household member who was depressed or mentally ill?”, (3) “Did you live with a household member who was ever sent to jail or prison?”, (4) “Were your parents ever separated or divorced?,” and, (5) “Did your mother or father or guardian die?” Responses to the items were coded as (0) “No” (1) “Yes.”

Psychiatric Symptoms.

Psychiatric symptomatology was assessed using the Colorado Symptom Index (CSI), which is a widely used measure of psychiatric symptomatology (Shern et al., 1994). The CSI is a measure that asks individuals to self report how often they experience a range of psychiatric symptoms (i.e., paranoia, suspicion, racing thoughts) during the past month (e.g., How often have your voices, thoughts, or feelings interfered with your doing things?). Response options range from (1) not at all to (5) at least every day. In the present study, total scores range from 10 to 50 with higher scores indicating greater psychiatric symptomatology. The CSI has demonstrated high reliability and validity (Boothroyd & Chen, 2008), and the Cronbach alpha for the present study was 0.86. A sample question reads, How often have your voices, thoughts, or feelings interfered with your doing things?

Demographic Variables

Demographic variables included age, gender, race/ethnicity, and education. Age was examined as a categorical variable that consisted of 18 to 24 and 25 to 34 years old. Gender was a dichotomous variable that consisted of an indicator of female and male. Education was a dichotomous variable that consisted of “less than high school” and “high school or more”. Race/ethnicity in the study was a categorical variable with response options that consisted of Black, Latine, Multiracial, Asian, and White. Due to the fact that this study centers on the experiences of racial and ethnic minoritized young adults (e.g., Black, Latinx, and Multiracial), White participants were excluded from the analysis. Additionally, Asian participants were dropped from multivariable analyses due to small cell size (n = 2).

Qualitative Data

The qualitative portion of the study included a semi-structured interview. The questions centered on the participants’ mental health narrative, with a particular focus on how they experience their mental health, along with their strategies for mental health management. Questions on the protocol have been used in similar studies and were successful in pilot testing (see Table 1 for the complete list of questions) (Munson et al., 2019). Qualitative interviews occurred with a subset of participants, as investigators began to hear repetition in how participants were talking about their mental health, including their social support relationships, indicating saturation in the data (Saunders et al., 2018).

Table 1.

Qualitative Interview Questions on Mental Health Narratives

	Question
Question 1	To start, can you share with me how you refer to your mental health challenges?
Question 2	How do you think about this part of your life?
Question 3	When you think about your ______what do you think caused these difficulties?
Question 4	How has your life changed as far as dealing with your _______since turning 18? Probes: Can you tell me more about that? Is it more difficult? Less difficult?
Question 5	Can you think for a minute about what has helped you most to deal with _______?
Question 6	How did you initially get mental health services?
Question 7	Do you recall any “key messages” that helped you, or that significantly impacted how you dealt with your mental health?
Question 8	What have been the most challenging parts of living with (their language shared above)?
Question 9	What do you think are the most important types of support a person needs when they are living with ________and trying to make the transition to adulthood?
Question 10	Which part about your emotional or mental health problems is most hard for you to deal with as you are making the transition to adulthood? How about least difficult?
Question 11	How do you manage your mental health?
Question 12	What positive things have you learned about yourself in managing your mental health?

Analytic Strategy and Data Integration

Consistent with the intention of the convergent mixed methods design, the quantitative and qualitative data were analyzed independently and then merged (Fetters et al., 2013) to provide multiple perspectives on social support (Creswell, 2021). The “merging” of the quantitative and qualitative data was used to validate, substantiate, and strengthen the interpretation of findings, allowing for the additional elaboration of concepts. Furthermore, this analytic approach enabled our team to explore whether qualitative and quantitative findings converged or diverged. The study team followed an explicit set of analytic steps (Palinkas et al., 2011), which are discussed below.

First, the research team examined the quantitative data to describe the natural support relationships reported by YA-SMI, and then to identify factors associated with reporting a higher level of natural support. This study is based on a modest quantitative analytic sample (n = 114), and it was not feasible to include all variables of interest in the final model. The quantitative analysis proceeded in three stages. First, zero-order correlations were conducted to evaluate preliminary associations between all variables. Second, independent variables that had significant associations with reporting family-focused support networks were retained. We also retained theoretically relevant variables even if they were not statistically significant. Third, a multivariable ordinal logistic regression model was fitted to estimate associations between study variables. This approach was selected as the outcome consisted of three levels with a meaningful rank order. Model assumptions of independence, proportional odds, and absence of multicollinearity were tested and found to be tenable. For example, we conducted the Brant test to examine the proportional odds assumption and the result was not statistically significant, indicating that the proportional odds assumption holds and that the ordinal logistic regression model is appropriate. Analyses were conducted in Stata 17 and Mplus 8.8 (Muthén et al., 2017), and missing data from either non-response to selected items or attrition were treated using robust estimation with full information maximum likelihood (FIML) for non-biased estimates (Enders, 2001).

Simultaneously, to explore the ways young adults report social support in their lives the research team began open coding the qualitative interviews using constant comparison (Glaser & Strauss, 2017) and following the steps of thematic analysis (Braun & Clarke, 2006). Before this process commenced, members of the coding team met to reflect on their personal experiences with mental health, mental health treatment and social support. The purpose was to engage in reflexivity and increase our awareness of potential biases that could impact our analyses. This process was revisited throughout the study to reduce bias. Four members of the research team independently began open coding with a subset of transcripts (n = 5). The team met numerous times to discuss and compare initial codes, grouped codes, memos, and emergent ideas. Throughout the process, the team engaged in constant comparison of codes and grouped codes on multiple levels, for example within and between interviews and then between analysts. Throughout the process, team members read and discussed coded passages, took memos on emerging ideas and codes, and developed an initial codebook (Padgett, 2016). When disagreements occurred, the team had discussions focused on resolving discrepancies and in each case, a final decision on the most relevant and valid code was made through consensus (Padgett, 2016). Then, team members coded ten more interviews, comparing and contrasting their codes, resolving discrepancies, and refining the project codebook. Two of the project team members (the first and last author) coded the remaining interviews on all content related to social support. They came together multiple times to discuss emerging themes, and areas where they agreed and disagreed, and then presented the final themes to the project team with examples to further build validity and consensus. This led to a final project codebook. ATLAS.ti was used to manage the professionally transcribed data (ATLAS.ti, 2021).

Finally, the first and last author developed a joint display to examine the qualitative themes by the ACE that emerged as significant in the quantitative model, namely whether the participant grew up in a household with mental illness. This integration of both data types allowed the team to examine concordance in the two data sources, while also building further understanding of the experiences of the young adult participants.

Results

Descriptive Statistics

The sample consisted of (n = 114) young adults who were predominantly male (68.8%) and identified as Black (43%), Latinx (37.7%) or Multiracial (19.3%). The mean age of participants was 26.4 years old (SD = 3.7) (range 18–34). Primary diagnoses reported were schizophrenia spectrum disorders (67.5%), bipolar disorder (11.4%), and depressive disorders (21.1%). Eighty-seven percent of the sample reported the presence of a natural support (NS) relationship (N = 99). The mean number of NS reported by participants was 2.1 (SD = 1.2) (range = 0–6). Forty-four percent of the participants reported family-focused support and 43% reported mixed natural support (e.g., combination of family, friends, neighbors, pastors) and 13% reported no social support. Adverse childhood experiences (ACEs) related to family revealed 33.3% of the sample grew up in a household with a family member who was a problem drinker or misused street/prescription drugs, 70.9% grew up in a household where parents were separated or divorced, 33.3% grew up in a household with a family member who was depressed, mentally ill or suicidal, 29.2% reported their mother or father had died, and 33.3% grew up in a household with an incarcerated family member.

Bivariate Analyses

In conducting bivariate analyses among study variables there was a significant relationship between the categories of reported natural supports (i.e., no supports, mixed supports, family supports) and growing up in a household with mental illness (χ²(2) = 11.76, p < .01). Results suggest that a higher proportion of the young adults growing up with mental illness reported no support, as opposed to those in the other support categories. Results also showed that there was a marginally significant relationship between the natural support category and psychiatric symptoms (f = 2.5, p < .09), suggesting that psychiatric symptoms were lower for those who reported family-focused natural support (mean = 21.1, SD = 9.3) when compared to those who reported mixed natural support (mean = 25.0, SD = 7.8) and no natural support (mean = 24.4, SD = 10.4).

Multivariable Regression Analysis

Table 2 presents the results from the ordinal logistic regression. Young adults who reported growing up in a household with mental illness had lower odds (AOR = 0.28, 95% [CI] 0.10 – 0.78, p < .05) of being in a higher social support category (“mixed support network” or “family-focused support network”), compared to those who did not report exposure to this specific adversity. Other variables did not emerge as statistically significant.

Table 2.

Ordinal Logistic Regression Predicting Level of Social Support (N = 114)

Predictor	OR (95% CI)
Age	0.87 (0.36–2.10)
Education	0.72 (0.30–1.72)
Gender	1.27 (0.57–2.83)
ACE 6	0.76 (0.30–1.96)
ACE 7	0.28 (0.10–0.78)*
ACE 8	1.48 (0.60–3.64)
ACE 9	0.59 (0.24–1.48)
ACE 10	1.67 (0.70–3.93)
Psychiatric symptom score	0.98 (0.93–1.03)

^*p < .05.

Asian N = 2 and White N = 5 was removed from the analysis due to low N. Hence N omitted the analysis = 114.

ACE KEY: ACE 6: live with anyone who used alcohol or drugs; ACE 7: live with anyone with mental illness or suicidality; ACE 8: parent or guardian who served time in jail or prison; ACE 9: parent/guardian divorced/separated; ACE 10: parent or guardian death.

Qualitative Results

The main qualitative question of interest for the present study was “In what ways do YA-SMI discuss social support in their lives?” Four main themes (with sub-themes) emerged in the data: (1) Types of social support; (2) Differing qualities of support by “source of support”; (3) Pathways to treatment; and, (4) Loss. Importantly, some young adults reported experiencing an absence of support altogether.

Theme 1: Types of Social Support

The YA-SMI in the study discussed emotional, material and informational support, or advice/guidance related to both their mental health and their lives, more broadly.

Emotional Support

Emotional support emerged in three main areas: (1) consistency, (2) presence - “being with and talking to”, and, (3) love, understanding and patience.

Consistency.

Young adults discussed the importance of consistent relationships. One young adult described the consistency of the greeting and structure at the rehabilitation and recovery program they were attending:

I like coming in here and hearing people say good morning or good afternoon, and this is both clients and staff alike. You know, they say good morning. I say it back. I like coming to the groups here. I like the positive atmosphere that’s in this particular program. It’s like every time—most of the time—I’m sorry. Most of the time I come in here, it’s easy for me. I’m able to relax. I’m able to not worry so much.

Participants also highlighted the importance of staying with supports and having supports that will be there ‘their whole life’ and supports ‘who know you the best’, for example one participant stated, “Stay with your family if they’re cool, they can help you with so many things. They know you the best.”

Young adults discussed consistency in different areas of life, for example, “constant treatment, constant good advice. Always having somebody there to have their perspective of your life, especially good advice and medication, medication also will help keep you stabilized and focused on what you have to do”. Another young adult spoke about ‘reminders’. After probing, “Reminders of what?” the young adult stated, “Medication, showering, basic stuff.” Whether providing regular reminders for activities of daily living (ADLs), consistent welcomes and greetings, constancy in treatment, or consistent support from family who will always be there, consistency echoed throughout the data.

Presence: “Talk About the Things that are Bothering You”.

Young adults discussed presence, having someone there to talk with and be with, including talking on the internet. One young adult reported, “They need someone to talk to, like somebody—you know? Somebody to help them, especially when they’re going through rough times, like someone to give them good advice.” Another participant shared, “Just to let people know that they have their back and someone to talk to”, suggesting the value of someone to talk to as helpful. They also reported that engaging in activities and healthy coping with natural supports when they were together was helpful, “I have friends…it gives me an excuse to go out get some fresh air, get some light, get some sun”. Finally, one young adult shared that he often talked about his mental health with friends at church and that it was helpful and relieving:

I used to go to church. I used to hang out with my friends. I used to go to and talk about my problem with my friends—not directly saying, oh, I have a disorder, but just saying, like—talking about, oh, I feel stressed. Oh, I feel this way. And sometimes, it kind of relieves it.

Love: “Understanding, Patience and Love - Those are the Most Important”.

Young adults reported the importance of love, understanding, and patience, and they reported that sometimes these qualities can be hard to find. One young adult plainly stated: “They [young adults] need a lot of love. They need a lot of compassion. Thoughtfulness, gentleness, togetherness”. Another young adult shared the love they felt from family, friends and ‘the recovery program’ and how the social support impacted them:

Lots of love and support that I get from people, like my family, my friends, and the program …This program in particular—you know, I can’t really say anything bad about this program because they really do care about what their client needs. If it wasn’t for them, I would not be in the job training that I am today.

There was also a sense that ‘being understood’ was critical, for example, one young adult stated, “I think you just need people to understand versus trying to, you know, judge you … Or try to understand because you can’t understand something you don’t know.” Another young adult shared the most important type of support was, “Love and understanding, patience, family, and real friends.” Some young adults talked about the value of being accepted, “I would say the most important thing would be…family and friends support and accepting [you] for who you are. Succinctly, when asked to reflect on the most important types of support a person needs one young adult stated, “They need love. They need caring. They need a good support, a very good support team”.

Material Support

Interestingly, while present, material support was discussed less than emotional and informational support. Some participants discussed foundational basic material needs when asked what types of support are most important. For example, one participant reported a social service program provided material support, such as a place to stay “off the streets”:

They took care of me and certain places I went to they fed me, let me stay there, and then after I did the time I had to do, I left, and whenever I felt like I needed to go back, I just went back and got more help and then I got lucky and I got into a program that got me off of the streets and I was thankful for all the stuff that helped.

Another young adult reported, “I would definitely say health care, um, financial stability, and, um, eating right”. Another young adult reported the importance of both emotional and material support (e.g., money):

They need a lot of love. They need a lot of compassion. Thoughtfulness, gentleness, togetherness adulthood they would have to learn. They’d have to learn to depend on themselves and to conquer, you know, and to overcome. And also they’re going to need a lot of money.

Informational Support: Guidance and Advice

Support relationships provided impactful guidance and advice to the young adult participants in the following areas: (1) goal-oriented messages, (2) mental health messages, and (3) messages about identity/self-concept. Interestingly, approximately 24% (n = 14) of the young adults reported that they did not recall receiving any messages from supports, and a few young adults (n = 4) noted that the most helpful messages came from within themselves (e.g., “I love myself. I am so proud of myself…it came from me”; “I don’t think people have told me. I think I learned from myself”).

Goal-Oriented Messages

Some messages were related to not giving up on their education, for example, one young adult reported, “Like they tell me like don’t stop studying, like don’t give up on nothing.” Another young adult reported that their parents told them to stay focused on their goals: “Yeah, you know, always stay focused if there’s a goal you have. Always stay focused on the goal you have that you set for yourself, and don’t let anybody change that for you.” Finally, professionals also gave the participants messages about focusing on their goals, for example, “Being positive. Stay focused to what goals I want to accomplish. They speak to me about my health, taking my health seriously.”

Mental Health Messages

Young adults reported receiving advice and guidance related to mental health. Young adults reported that parents, friends, and other natural supports provided important messages about pacing their mental health journey. One participant reported that after a challenging panic attack, their parents shared, “Don’t worry. Things will get better. If you believe in yourself, if you learn how to cope, it’s not going to be always the same, that hard.” Others reported receiving messages to go at their own pace, take their time and be patient, for example, “…Just one day at a time, and I just take my time and do things” and “Patience… Yeah, to be patient. I was kind of impatient in the beginning.” One participant heard a similar message from a friend: “He told me one day just take one day at a time, you know, don’t stress yourself out for little things, you know, life comes with challenges but comes with its good moments too. You know? One day at a time…That’s the one I hold onto”. Finally, one participant reported that they received an important message related to recovery, “Yeah. I think – I don’t think you’re ever going to be, like – recovery is not about, like, overcoming it, but it’s about, like, dealing with it. Like, there’s no cure right now. So you just have to deal with it.”

Numerous participants discussed receiving advice to stay busy, distracted, and/or engaged in activities. Interestingly, one participant reported that staying busy is like medication, “stay busy, because if you’re being in the house—staying busy is the best medication.” Another young adult reported hearing that staying busy can help you deal with hearing voices:

Basically, people have told me, just keep yourself busy when you’re dealing with voices, when you’re dealing with—mentally ill. Take your medication and always keep your mind busy. Write. Journal. Watch TV. Take walks. Do exercise. Just keep yourself busy.

Others discussed receiving messages to “stay positive”. For example, one young adult reported their family told them, “Give yourself a pat on the back once a day, whether it be physically or a poem you write, a quote you put yourself in…instead of pushing myself down, becoming more depressed or more – you know, more painful.” Another participant, similarly, reported their family advised them, “Stay positive, just sometimes talk – not like self-talk, and also just try to tell yourself it’s not going to be always that – the symptom is going to decrease and go away. It might come back, but just stay positive.”

Not surprisingly, numerous participants were advised and encouraged to engage in mental health treatment: “Take your medication.” “Go to appointments.” One participant was advised, “That if I keep taking my medications my life will get better. As prescribed. If I keep taking my meds my life will get better.” Another participant reported, more broadly, “Like well my people tell me like just -- just take your medication.” Another young adult reported that the peer staff advised them, “People around me that care about me. They see what I’m going through so they see the meds are very, like, a gateway towards my recovery that could push me faster, faster, faster towards what I am going through.”

Similarly, messages and guidance were given related to non-pharmacological treatments. For example, one young adult reported that they were advised, “Even if I don’t feel like going, when – when I do do it, I know I feel better.” Another participant shared they listen to themselves regarding going to the PROS program:

Come to program every day, don’t worry about other people saying…’You don’t belong here.’ I think people that have mental illnesses belong here and this is the best place for your recovery because I missed so many days coming to [the] program just because my friends say, ‘Oh don’t come here, you don’t belong here’...

Finally, another young adult shared they received detailed messaging about how (and why) to stay out of the hospital:

Don’t be in the hospital again. That’s the one thing I learned, and I’m trying not to –I try and keep my promise with the friends I made in the hospital. Like, don’t be in the hospital. It is the worst place you could ever be in, because there’s nothing to do in that frickin’ hospital at all. All you do is just sit around playing cards or watch TV or mostly sit in your room working out. That’s it. There’s really nothing else to do…You don’t have no phone, no -- it’s supposed to be a family environment, but it’s not a family environment at all in the hospital.

Messages About Identity/Self-concept: “This Illness Does Not Define Me”

A handful of young adults shared that an important piece of advice was not to focus on what other people think of them. For example, one participant said their friends tell them: “Don’t worry about what people are saying to you…Just keep doing what you’re supposed to, and that’s what I’m doing.” Another young adult reported that a professional told them they are not defined by their illness: “Got some good advice. It was, your mental illness—your mental diagnosis does not define who you are as a person. I thought that was, like, a good way of thinking about mental health issues”. Another participant shared that they received advice to let go and focus on themselves, “Well, letting go the things that are…make me sad. And focusing on me and my wellbeing and doing activities such as going on vacation…and interacting with my family.” Finally, multiple young adults shared they received the important message that they are not alone, “You are not the only one.”

Theme 2: Differing Qualities of Support by “Source”

Analysts noted that there were varying aspects of support that differed by who was providing the support. In these sections, we highlight the common qualities reported by the source of the support.

Family Support: Instrumental and Complicated Relationships

Approximately half of the young adults mentioned family provided them support. Family members were instrumental in showing consistency, encouraging treatment, and providing love. Interestingly, in some cases family members’ behaviors were also highlighted as factors that participants’ perceived caused their mental health problems (e.g., abuse, neglect, addiction). A significant dimension of family support mentioned by participants can be summarized by the words, “they’d be there for you no matter what”. Participants discussed family relationships as distinct for their longevity and understanding:

Being around family instead of friends, because if I was around friends, they’d start complaining after a while or getting angry or weird, trying to change up on me. But because I have a family, they’re understanding my sickness. They’ve dealt with me for years and they realize that, you know, we’re not just going to throw him over the bridge. We’re going to find out what he’s here for, what is his message as a worker, as a guy, as his own man standing on his own two feet.

Another young adult echoed this sentiment, “Family support plays a big role because they’re pretty much – they know you your whole life.” For many, family members were also discussed as instrumental in providing linkages to mental health services, for example, hospital admissions, “It was hot. It was the heat. It was the heat. Then my mother called an ambulance and – called an ambulance. And then she said – well, they took me over to ____ hospital.”

Peers: Emotional Support From Someone Like Me

Participants discussed the importance of support from peers, both friends (and associates) and those working as peer specialists. For example, friends provided messages around not giving up: “I remember one of my friends just saying to keep pushing forward, don’t give up” and “Okay, there’s this friend of mine who told me not to give up, not to back down, not to feel depressed, and he told me stay strong and never give up.” Another young adult shared, “I was always told no matter how bad things get, never give up.” Finally, one participant reported their friends have been accepting of their mental health condition, highlighted in this exchange:

And actually like – and I had – and I tell all my friends that I know, like I’m not scared to say I tell them I have like schizophrenia. And I tell them… And they don’t – and they accept me for what I am. And they were like ‘That’s all right [name] … we know you for years, like we accept you.’ I was like ‘Thank you…’

Peer specialists were discussed as being accepting and providing an opportunity for mutual support:

I don’t think people are below me or over me, you know? I don’t feel I know more than them or they know less than me. I think everything is – everybody’s trying to help each other. Even the peers in here, the – they’re helping each other. There’s groups. They share. It’s way stronger than AA meetings and stuff like that in this place.

Professionals: Emotional Work

Support from professionals illuminated how young adults perceive treatment and some of the ways in which professionals facilitate recovery. For example, one young adult reported:

Those groups are special. They’re very nice. I just – probably my first experience about it that I liked it so much, you know? I was very – that memory over there of my first group is very astonished. I was astonished. Very shy to share. I shared. They wanted me to open up more. And it did. This opened me up more to a lot of things with these programs and stuff, the community, other stuff like that…

[Interviewer: What did it open you up to? What does “open up” mean, when you say it opened you up?]

Like, breaking out of my shell towards myself and my recovery. You know, it’s not that person. You think of it as hiding away your feelings and your recovery because I had trauma in my life and that’s what escalated what happened to me in my life.

Another participant stated, “Therapy helped…Because they spoke to me about things. They asked how I felt; I explained some things. I talked about some things and answered some questions. And, they showed me things and talked about things”. Finally, another young adult mentioned therapy when asked what do you think are the most helpful types of support: “I would say it would be good to see a therapist. Talk about the things that are bothering you.”

Theme 3: Pathways to Treatment

Analysts examined the data around how young adults reported they first accessed mental health services. These data were informative and included four common pathways to initial access to treatment: (1) the instrumental role of mothers; (2) systems (e.g., police, judges, churches, schools); (3) self referrals; and, (4) mental health professionals.

The Instrumental Role of Mothers

The most common pathway to initial access to treatment was parental support, with most examples highlighting the instrumental role of mothers providing “connections” to accessing care. For example, one participant reported, “my mother took me to the hospital”, another reported their mother had “connections”, and yet another stated, “Well when I first got mental health services, my mom forced me because I had hyperactivity disorder so I just went there against my will”. Whether voluntary or not, mothers were featured heavily in the narratives around accessing care. While participants mentioned significant others and siblings, mothers were far-and-away the most involved in assisting young adults with accessing treatment.

Systems (e.g., Police, Judges, Churches, Schools)

Young adults also reported that they initially accessed services through public systems, for example, more than one young adult reported that they accessed treatment via the courts or the judge: “I got mental health through the judge”; “Well, I was introduced by the court system -- because I’ve been in and out of jail. They prescribed me to go to [mental health program]”. Others stated it was the police who led them to treatment, “One day, they [cops] just came to my house and took me to the hospital…” Similarly, another participant stated, “I was arrested and the cops drove me to the hospital”. Schools and churches were also discussed as pathways to initially accessing care.

Self-Referrals

While fewer in number, it was noteworthy that young adults reported finding and accessing mental health care by themselves: “I googled mental health services … I googled it and then a number came up and I called the number and the woman who I spoke to she asked for my cellphone number and she literally sent me a list of different mental health services within my zip code”; “I used the internet to find the service”; and, “I searched up online”. Another young adult shared how he took himself to the hospital: “When I was doing drugs. When I was smoking weed. Then one day I just decided to stop because it wasn’t – weed is not for me – One day I was crying and decided I had to go to the hospital I was depressed.”

Medical and Mental Health Professionals

These emerging adults also discussed some support from professionals in accessing treatment. Medical doctors, therapists, and psychiatrists were mentioned as assisting with finding various mental health services. Young adults reported, “My medical doctor referred me”; “She [therapist] referred me to [mental health program] because I was going through a lot with my mom, and work, and school, and how I balanced it at the same time, and the balance and the arguments with my mom and my siblings.”

Theme 4: Loss and Lack of Support: Losing Friends…

Noteworthy, a number of participants reported they do not have support and that nobody provided them with key messages or advice. In one case, a young adult discussed, in depth, the loss of support that can accompany the diagnosis of a mental health condition:

It’s that -- it’s like losing friends, you know, and how -- how quickly like you -- you could switch from being this person to that person, you know. Like I -- I would say some certain things when I was manic that it -- I don’t agree with at all, you know…But just -- but, you know, like you would lose friends and then they read it on Facebook and you was…

Another participant echoed the loss they experienced after being diagnosed with a mental health condition and dealing with the side effects of medication:

Let me see. It changed a lot, like dealing with these side effects. Side effects of the medication make me feel anxious, so I couldn’t hardly hang out with my friends and all because of feeling anxious and people looking at me like I’m strange. It’s been a struggle—arguments with parents, leaving home.

Finally, a participant reported they have become more isolated: “I’m more to myself. I have – I don’t have a lot of friends like how I used to. I have two friends now and I think it’s better for me like that to be honest”. Loss was present in these narratives, and young people feel these losses as they are emerging into adulthood.

In conclusion, some young adults shared statements that clearly suggest that it is the support, more broadly, that is important – not who provides it. Some responses suggest that participants perceived young adults need support from multiple sources:

They need family. They need friends. Support from their family. If they go to a program they need their peers at their program. Their worker. Any worker they have that’s assigned to them, they need support from the worker. So as long as you get support from the worker and psychiatrist – I get support from my psychiatrist – everything should be good.

Integrated Results: Examining Adverse Childhood Experiences and Family Support

Analysts used a joint display to triangulate and expand on data related to adverse childhood experiences and family support (Caracelli & Greene, 1997; Guetterman et al., 2015; Miles, 1994). The team developed a matrix segmenting the cases on whether or not they grew up in a household with mental illness, as this ACE emerged as significant in the quantitative results. Results from the joint display confirmed that growing up in a household with mental illness was associated with a lower likelihood of receiving family support (See Table 3). More specifically, in the joint display, results showed that over half of the participants who completed a qualitative interview and grew up in a household with the presence of mental illness did not discuss family as the most important type of support in the interview, compared to only 36% of the cases who did not grow up with this family adversity. This convergence in the data strengthen the finding that it may be particularly difficult to find family support when you grow up in a household where someone is struggling with a mental health condition.

Table 3.

Joint Display of Themes by Growing up With Mental Illness in the Household (N = 57)

Variable (ACEs)		Most important type of support -Family		Initial access to mental health services - family		Key messages -Family
Grew up w/ mental illness in the household (N = 15)	47% (n = 7)	Spending time with my family, like supporting my mom like - like talking to my mom - like before me and my mother weren’t getting along at all, but now we’re - ever since my grandma’s death like we’ve gotten so close.	27% (n = 4)	“My father was in and out the streets, and then he owed people money and these people know him from me. And they like watched me ... And they were like, “I think your son is smokin’ this or that.” ... And that’s when all the problems with me came in and then they [family] was worrying, “We’re gonna make you see a doctor.”	27% (n = 4)	“Stay busy. That’s one of them. Yeah, I mean, besides don’t be too comfortable—I mean don’t be too comfortable meaning that, you know, don’t not do nothing all your life, and when you’re old, you get up in age, you know—don’t be like the people here” (Mother)
Did not grow up w/mental illness in the household (N = 42)	64% (n = 27)	Being around family instead of friends, because if I was around friends, they’d start complaining after a while or getting angry or weird, trying to change up on me. But because I have a family, they’re understanding my sickness. They’ve dealt with me for years and they realize that, you know, we’re not just going to throw him over the bridge I would say the most important thing would be family and friends support and accepting for who you are	31% (n = 13)	“My mother got some connect—my cousin and my mother got some connections.” “Well, I had, like, anxiety, panic attack. And I, at that time, was living with my mother and my dad. And I went—she took me to a private psychiatrist, and they were prescribing me medications.”	26% (n = 11)	“Don’t worry. Things will get better. If you believe in yourself, if you learn how to cope, it’s not going to be always the same, that hard.” (Mother, father) Don’t worry about what people are saying to you. Don’t worry about what they talk about. Just keep doing what you’re supposed to, and that’s what I’m doing. (Brother, friends)
		Most important type of support - Non-family- focused		Initial access to mental health services - Nonfamily-focused		Key messages -Non-family- focused
Grew up w/ mental illness in the household (N = 15)	53% (n = 8)	Lots of love and support that I get from people, like my family, my friends, and the program like this. This program in particular— you know, I can’t really say anything bad about this program because they really do care about what their client needs. If it wasn’t for them, I would not be in the job training that I am today. (Program)	73% (n = 11)	“Well, I was introduced 7 by the court system ... because I’ve been in and out of jail. They prescribed me to go to [program].” (Courts) “I had like a crisis when I was in high school and then I -- and I was like admitted in St. Luke’s Hospital.” (school)	73% (n = 11)	“He told me just take one day at a time, don’t stress yourself out for little things, you know, life comes with challenges but comes with its good moments too ... One day at a time.” (Friend) “Being positive. Stay focused to what goals I want to accomplish. They speak to me about my health, taking my health seriously” (Caseworker, psychiatrist)
Did not grow up with mental illness in the household (N = 42)	36% (n = 15)	“I would say it would be good to see a therapist. Talk about the things that are bothering you.” (Therapist)	69% (n = 29)		74% (n = 31)

Discussion

This study details the types of support minoritized YA-SMI perceive in their lives, many of which map onto the classic types of support reported in the literature (House et al., 1988). Importantly, this study reveals that some minoritized YA-SMI perceive they do not have support, and others report significant loss of support, due in part to their mental health condition. Family support emerged as complex, and findings suggest that among minoritized young adults who grew up in a household with mental illness, there may have been more of a need for support from sources other than family. We discuss these findings, in turn, below.

The present study provided valuable insights into the particular types of emotional, material and informational support young adults perceive is important in their lives. For example, consistency, mental health messages about medication and therapeutic services, and both formal and informal strategies for coping emerged as critical sources of support. More specifically, the process of having someone to be with and talk to was discussed as “relieving”, which is reminiscent of the important process of catharsis, or being able to share suffering and negative emotions with another, an important emotion regulation process (Chang et al., 2023). Related to informational support, many participants reported receiving similar messages about keeping busy and/or staying distracted as a way of coping with symptoms, including positive symptoms – which has long been reported in the adult literature (Alverson et al., 1995). Interestingly, the qualitative data on advice and guidance on treatment was mixed; indeed, quite a few supports advised participants to take their medication and engage in treatment, including the perspective that mental health treatment can be “the gateway to recovery”.

Further, qualitative findings revealed that YA-SMI need support from multiple sources, for example family, peers, and professionals, and this could be the case because it was suggested that each source of support may have distinct value, providing young adults with unique types of support. Finally, similar to a recent systematic review, our study found that diverse social contacts assisted participants on their initial ‘pathways to treatment’, such as family, the police, and school officials, among others (MacDonald et al., 2018).

Data revealed the central role of family in the lives of YA-SMIs. Family members provided all types of support that were important to the mental health journeys of young adults. Our quantitative data showed that young adults who grew up with mental illness in their household were less likely to report family-focused natural supports. One explanation for this could be that young adults who grow up in households where others are experiencing mental illness may need to find respite outside of the family, for example, from friends, neighbors, community members, and faith leaders (Källquist & Salzmann-Erikson, 2019; Van Parys et al., 2015). It is possible that family members may be less available if they need to provide significant caregiving to a family member struggling with their mental health. It is also possible that for ethnic minoritized youth and families, there are increased institutional barriers to services for the family themselves, a lack of equity, and/or a lack of trust that may prevent them from seeking services and assisting their family members due to legacies of medical mistrust (Washington et al., 2008).

In order to further explore this result, our team integrated our data sources using a joint display (Guetterman et al., 2015), and this analysis provided a deeper understanding of this relationship. More specifically, the joint display revealed convergence, as the percentage of narrative interviews that included empirical data related to family support was higher among those who did not grow up with mental illness, as compared to those who did. More young adults who did not grow up with mental illness reported that family were the most important type of support and that family were involved in helping them initially access treatment. This adds to the previous literature in the area of first episode psychosis, which has found similar results related to family (MacDonald et al., 2018). Interestingly, growing up with mental illness in the household did not make a difference in who provided guidance and advice, as both groups (those who grew up with and without the presence of mental illness in the household) reported advice coming from non-family supports. In both cases more advice and guidance came from professionals and friends (See Table 3). More research is needed to further understand where and whom young adults are receiving advice and education from specifically about mental health.

It is clear from this study that family is an important resource for minoritized YA-SMI. Family members, whilst there was conflict and complexities in these relationships, were consistent supports, those that “know you” and “will not leave you” because of your mental health condition. Mothers emerged as essential, related to all kinds of support and importantly in helping their children access professional services. Building on these results professionals working with this population may want to focus resources on psychosocial interventions that involve family members, such as family psychoeducation (Lukens et al., 1999), multiple family group interventions (McKay et al., 2002), and family navigator interventions (Oluwoye et al., 2023). Based on our results, these interventions may benefit from modules on the impact of ACEs in ways that are culturally relevant for families. In future efforts to improve services for YA-SMI and their families, it is also critical to acknowledge structures of inequities and barriers to care for caregivers and families who may need support themselves.

Finally, many sources were identified as pathways to treatment, including police who may in fact exacerbate mental health conditions, and even be traumatic (Jones et al., 2022), as police violence and incarceration have been shown to have negative outcomes and implications for young adult mental health outcomes and overall wellbeing (DeVylder et al., 2018).

Limitations

All research has limitations and this study is no exception. First, the quantitative analysis has a relatively small sample size and the study is cross-sectional. A larger sample may have provided more power to detect effects of other predictor variables. Second, the study team included trained interviewers, and yet there was not always consistency in the questions asked in each interview. Third, the larger trial occurred in collaboration with two large behavioral health agencies providing treatment services. Thus, marginalized YA-SMI who are not connected to treatment (at these agencies) may have provided different perspectives. Our team paid attention to these limitations in the data analytic stage, while also attending to researcher and team reflexivity related to their own experiences. Regardless of these limitations, results from this study can inform future research, practice and policy efforts to address youth and young adult mental health.

Implications

This mixed methods study has implications for practice and research, particularly for those working to improve the lives of minoritized YA-SMI who are more susceptible to ACEs, social isolation, and structural racism and inequities. First, it is important to ensure interventions for YA-SMI include a focus on strengthening existing natural supports, while also creating opportunities and channels for the development of new relationships. Second, services for YA-SMI can incorporate recovery supports that expand beyond treatment such as young adult socialization groups and activity programming, mentorship from peer support specialists, and opportunities for joining community organizations focused on, for example, shared neighborhoods, faith, culture, or hobbies. Interventions and policies aimed at strengthening family support may benefit from the data that reveal that young adults find consistency, along with patience and understanding, as critical qualities in needed support. Third, these qualities can be prioritized in the expansion of family psychoeducation and family navigator programs. Indeed, these data suggest that family members may be important facilitators in addressing the common challenges and roadblocks that exist when trying to keep minoritized young adults engaged in mental health care, such as mistrust. Fourth, at the community level, organizations and institutions can be conduits of critical destigmatization campaigns and opportunities for emerging adults to be more accepted by their families, peers and service providers. Mental health advocacy opportunities (Smith et al., 2014) and trainings (e.g., Mental Health First Aid) offered to family, peers, and community members can reduce stigmatizing attitudes and behaviors in the social environments of YA-SMI (Morgan et al., 2018). Finally, during intake it may be beneficial to have clinical assessment processes that focus more deeply on natural support relationships, including family, in order to be more sensitive to the complex family dynamics and the socio ecological context that may be impacting a minoritized emerging adult client. Social relationships can make a difference in the lives of emerging adults who have many more years to live, and further research is needed to understand how they can make the greatest impact. The young adults in this study revealed great strength, resilience, and resistance while sharing their stories and experiences with social support. Future research can build on these data.

Supplementary Material

Supplemental Material

Supplemental material for this article is available online.

Biographies

Moiyattu Banya is a PhD candidate at the NYU Silver School of Social Work. Her research focuses on adolescent and youth mental health, with a focus on girls and young women in vulnerable contexts. Moiyattu directed the project, led the quantitative and qualitative analysis and wrote the initial draft of the manuscript.

Dr. Melissa L. Villodas is an Assistant Professor at George Mason University Department of Social Work. Her research centers on understanding how social determinants impact the mental health of vulnerable young people, while considering how to address these challenges through treatment and initiatives at the micro, mezzo, and macro levels. Dr. Villodas contributed to the writing of the introduction section with a particular focus on the theoretical frameworks.

Aaron H. Rodwin is a PhD candidate at the NYU Silver School of Social Work. His research focuses on young adult mental health and music-based interventions to improve young adult mental health. Mr. Rodwin contributed to the quantitative and qualitative analysis of the paper.

Dr. Rei Shimizu is an Assistant Professor at the University of Alaska Anchorage School of Social Work. Her research is focused on health behavior change and health-related decision-making. Dr. Shimizu contributed to the quantitative and qualitative analysis of the paper.

Dr. Kiara L. Moore is an Assistant Professor at the NYU Silver School of Social Work. Dr. Moore’s areas of specialization are mental health services and marginalized youth during the transition to adulthood. Dr. Moore contributed to the manuscript by providing further expertise around minoritized emerging adults.

Dr. Ifrah M. Magan is an Assistant Professor at the NYU Silver School of Social Work. Dr. Magan takes a critical intersectional approach to research exploring how institutional and structural racism and oppression impact the lived experiences of Black, Muslim, and forcibly displaced populations. Dr. Magans contributions focused on providing further expertise around minoritized emerging adults.

Dr. Beth Sapiro is an Assistant professor at Montclair State University with a focus on trauma, violence and poverty in qualitative research. Dr. Shapiro contributed to the manuscript by providing further expertise around social support.

Dr. Michelle R. Munson is a Professor at the NYU Silver School of Social Work. Her research seeks to understand how society’s structural conditions and social relationships, through both verbal and non-verbal communication, shape young adults’ decisions to seek (or not seek) professional mental health services. Dr. Munson is the senior author for the publication and contributed to all aspects of the manuscript particularly the qualitative and mixed methods analysis.