What is the prevalence and temporal trends of high perceived social support among children and adolescents across 45 countries? Findings from the Health Behaviour in School-aged Children study

Perceived social support is a key determinant of pediatric health and well-being, yet little is known about how its sources vary and evolve across populations. This study evaluated the prevalence, time trends, and correlates of perceived social support from family, friends, classmates, and teachers in a large, multinational sample. Data were drawn from 455,031 participants (mean age = 13.5 years; 51% female) in 45 countries participating in the Health Behaviour in School-aged Children study (2013–2018). Perceived social support was assessed separately for family, friends, classmates, and teachers. Linear and generalized logistic mixed models with country-level random intercepts were applied to account for clustering of participants within countries and to predict social support scores and high social support status for each domain adjusted by age, sex, socioeconomic status (SES), body mass index, and survey wave. Temporal comparisons between survey waves reflect population-level differences across repeated cross-sectional samples rather than within-individual developmental change. Family was the strongest source of support, with 71% of participants reporting high family support, followed by friends (60%), while support from teachers (5.7%) and classmates (4.0%) was less common. Older adolescents had lower odds of high family support (odds ratio [OR]= 0.65; 95% confidence interval [CI] 0.63 to 0.66 for ages 12.5 to 14.5; OR = 0.49; 95% CI 0.48 to 0.50 for ages 14.5 to 17; both p < 0.001), reflecting age-related differences at the population level, and friends’ support (OR = 0.95; 95% CI 0.94 to 0.97; p < 0.001), indicating a small but statistically significant difference. Girls reported higher odds of support from friends (OR = 1.63; 95% CI 1.60 to 1.65; p < 0.001) and classmates (OR = 1.33; 95% CI 1.29 to 1.38; p < 0.001) but slightly lower odds of support from family (OR = 0.89; 95% CI 0.88 to 0.91; p < 0.001). Higher SES was positively associated with high family (OR = 1.48; 95% CI 1.44 to 1.52; p < 0.001) and friends’ support (OR = 1.44; 95% CI 1.41 to 1.47; p < 0.001) but inversely associated with classmates’ support (OR = 0.83; 95% CI 0.78 to 0.88; p < 0.001) with effects reflecting average population-level differences. Perceived social support among youth varies by source and individual characteristics. Family and friends remain the main providers, although their role gradually decreases with age, whereas classmates and teachers offer limited but modestly increasing support. These temporal differences represent aggregate changes across survey cycles rather than longitudinal change within individuals. Our findings underscore the potential value of targeted efforts such as strengthening family communication during adolescence, fostering inclusive peer climates, and enhancing teacher–student relationships through school-based social and emotional learning and inclusion-focused interventions, particularly for vulnerable groups.