Social Support, Traditional Care Practices, and Mental Health in Rural Ecuadorian Youth.

Anxiety and depression account for a growing share of disability among adolescents and young adults globally, yet mental-health research and interventions focus primarily on clinical services, despite many in rural low- and middle-income settings relying on informal and culturally embedded systems of care. Using data from 488 emerging adults in a floriculture-intensive rural region of Ecuador, we quantified how ancestral medicine use and access to social support relate to anxiety and depression symptoms in a setting where formal mental-health care is limited. Anxiety and depressive symptoms were common (45% and 32%, respectively). Greater access to social support was strongly associated with lower depression scores and reduced odds of depressive symptoms, whereas associations with anxiety were weaker and more variable. In contrast, ancestral medicine use was associated with higher anxiety but showed no clear association with depression, indicating engagement with ancestral medicine as a care-seeking response to elevated psychological distress within a pluralistic care ecology rather than evidence of symptom alleviation. In contrast, access to social support was strongly associated with lower depression and reduced odds of depressive symptoms, with effects concentrated among males and among individuals reporting high relationship satisfaction and low loneliness. Pre-existing health conditions did not materially modify these associations. These patterns indicate that relationship quality governs whether access to social support translates into psychological protection, rather than social support operating as a uniformly protective exposure. These findings reframe youth mental health in rural agricultural settings as shaped less by engagement with specific therapeutic practices than by the structure and quality of social relationships, highlighting social support as a dominant correlate of resilience and ancestral medicine use as a marker of unmet mental-health need.