A qualitative study of traumatic experiences and positive coping strategies: voices from Thai adolescents living in poverty

Introduction

Background

Adolescence, typically between ages 10 and 19 years, is a key stage for forming identity and place in society. Socio-economic factors, like family income and access to education, strongly influence growth and opportunities (1). In 2019, about 670,000 Thai children and youth were out of school due to poverty, and in 2021, 30.1% of Thai adolescents reported high stress levels (2-4). Adolescents living in poverty (ALP) face many challenges that hinder their development. They grow up in environments that harm their mental, physical, emotional, and spiritual well-being, missing out on opportunities and lacking access to education, healthcare, and recreation (5). These difficulties lead to feelings of powerlessness, with many facing family oppression and social exclusion, which contribute to inequality and social rejection (5,6).

Additionally, ALP are more likely to experience traumatic events such as being abused and living in hazardous environments (6). The family faces daily difficulties which cause stress and pressure. The parents must work hard to earn sufficient income for daily expenses (7), often resulting in decreased emotional availability for their adolescent children. The adolescents have to face a lack of love and care. In addition, family conflict emerges, which then leads to domestic violence towards adolescents, including sexual abuse, physical abuse, emotional abuse, and child neglect (7,8). Such maltreatment can cause both physical injuries and psychological trauma (8).

If ALP cannot adapt or deal with the consequences of poverty, mental health problems could occur, such as stress, anxiety, and depression (6). Additionally, adolescents who have encountered traumatic events are likely to be less adaptable to the environment than those who never encountered such situations (7). Typically, stress reactions are temporary and psychological recovery occurs relatively quickly under normal circumstances (7). However, in some cases, having encountered traumatic events leads to traumas that create a domino effect (6,8). Subsequently, individuals may develop three primary symptoms of posttraumatic stress disorder (PTSD) (9), including re-experiencing, hyperarousal, and avoidance (10).

In previous studies, there were both quantitative and qualitative studies on experiences related to poverty of children and ALP (9-12). Also, there were studies on coping strategies of ALP, both those with and without mental health problems such as stress, depression, and anxiety (13,14). These mental health problems were not apparent until they developed into trauma (15-18). According to the literature review, previous studies have not clearly addressed the traumatic experiences and positive coping strategies of ALP in the Asian context, which triggered the research question in this study (19-21): “What are traumatic experiences and positive coping strategies of Thai ALP?”. This aims to fill the knowledge gap and gain a deeper understanding of the poverty context of adolescents with traumatic experiences. This study started by choosing to study ALP with traumatic experiences resulting from the crises frequently found in Thailand, such as being abused by family members (1-4,20,22). The traumatic experiences and positive coping strategies of ALP would be investigated subsequently. This study would provide deep insight into traumatic experiences and positive coping strategies of ALP. Additionally, school staff and agencies involved could apply the study results for the design and development of interventions supporting and promoting mental health for ALP in schools.

Rationale and knowledge gap

ALP face significant challenges, including poor living conditions, social exclusion, and traumatic experiences such as abuse, family conflict, and neglect. These issues often lead to mental health problems like stress, anxiety, depression, and PTSD. While previous research has explored the impacts of poverty and coping strategies, much of it focuses on non-Asian contexts, failing to address the relationship between traumatic experiences and coping mechanisms in specific cultural settings. Furthermore, most studies rely on quantitative data, overlooking personal experiences and cultural factors, and there is a lack of longitudinal studies on the long-term effects of poverty. This qualitative study aims to fill these gaps by investigating the traumatic experiences and positive coping strategies of Thai ALP, with the goal of informing culturally sensitive interventions to support their mental health and resilience.

Objective

The aim of this study is to explore the traumatic experiences of Thai ALP and identify their positive coping strategies. The findings will provide deeper understanding of their challenges and inform the development of culturally appropriate interventions to support their mental health and well-being.

Methods

Positionality and reflexivity of the authors

As researchers with academic backgrounds in psychology, we acknowledge that our perspectives are influenced by our identities as women who were born and raised in middle-class Thai families. However, our professional experiences working with children and adolescents, particularly underprivileged youth, have provided critical insights into the complexities of their lived experiences. We recognize these experiences as both individual/psychological and socially constructed, aligning with the constructivist paradigm adopted for this study. This stance guided our commitment to exploring and understanding the meanings participants ascribed to their experiences within their specific social contexts.

Our study investigates traumatic experiences and positive coping strategies, guided by the framework of Foa et al.’s (10) concept of traumatic symptoms in children—including re-experiencing, hyperarousal, and avoidance as well as Pahuyut et al.’s (22) concept of positive coping, among ALP. Given the sensitive nature of these topics, a qualitative research approach was deemed the most appropriate for capturing the nuanced realities of informants and addressing the research questions. We incorporated perspectives from adolescents, parents, and teachers to ensure a comprehensive understanding. Grounded in the constructivist paradigm, we acknowledge that knowledge is co-constructed between researchers and informants. This perspective recognizes that our pre-existing beliefs and experiences inevitably shape the processes of data collection and interpretation, as meaning is actively constructed through interactions within the research context.

The primary researcher responsible for data collection has been trained in qualitative research at both the master’s and doctoral levels and has worked as a counseling psychologist with underprivileged adolescents for approximately 1 year. Additionally, she has conducted in-depth qualitative interviews with children living in poverty in Suksasongkhro schools for 2 months. These experiences have shaped her sensitivity toward the complexities of adolescent trauma, while also making us as a research team aware of the potential biases we bring into the research process. While our backgrounds allow us to approach the topic with empathy, they may also influence how we define and interpret trauma and coping mechanisms.

We also acknowledge the power dynamics inherent in this research, particularly as middle-class and university-educated researchers studying the experiences of economically disadvantaged adolescents. To maintain transparency and minimize power imbalances, the primary researcher prioritized informant agency, creating a safe and respectful space where informants could openly share their experiences. She used open-ended questions to allow informants to lead discussions rather than imposing preconceived frameworks. Through these measures, we strive to uphold ethical integrity and ensure that the voices of informants remain central to this research.

Research design and informants

This qualitative study aimed to examine the traumatic experiences and positive coping strategies in ALP. The primary researcher collected data at one of Suksasongkhro schools in Thailand. The Suksasongkhro school selected for data collection is located in southern Thailand, covering an area of approximately 200 rai (about 79 acres). The school serves a diverse population of underprivileged children, as it is situated in a multicultural region where Thai and Islamic communities coexist. Additionally, the researcher has previous experience in counseling practicum at this school, which helped facilitate access to informants while ensuring ethical considerations and trust-building with students, parents, and teachers.

There were 18 informants, including ALPs, their parents/guardians, and teachers, which was a sufficient number to reach data saturation. The selection of informants, specifically parents/guardians and teachers, was based on their direct caregiving roles and close interactions with the key informant. Only those who were actively involved in the daily lives and well-being of the key informant were included to ensure that the data accurately reflected the ALP’ experiences and support systems. “Key informants” consisted of six ALPs who were studying in lower secondary school, age ranged between 13 to 15 years, and annual household income not higher than 20,000 baht. We performed purposive sampling method applying the following inclusion criteria: (I) had encountered at least one traumatic event assessed by a screening for traumatic experience perception; (II) obtained the score of 30 or over from a screening for traumatic symptoms (the overall mean was at the level of ‘having frequent stress’); and (III) was willing to participate in this study. The exclusion criteria: the parents of ALP were unable to participate in this study. We excluded three ALPs due to being unable to contact their parents for the interviews. In addition, informants consisted of six parents and six teachers of ALP. General information of the informants is presented in Table 1.

Research instruments

Instruments used to select key informants: (I) a screening for traumatic event perception was a screening for traumatic situations frequently found among Thai ALP such as verbally assaulting and over-pressuring (23). The screening included six traumatic events with forced choice questions (‘Yes’ or ‘No’) asking about the situations the ALP had encountered. (II) A screening for traumatic symptoms to identify ALP with trauma after exposure to the traumatic event. This screening form was developed based on the concepts of Foa et al. (10). It was a 4-point rating scale, with each level representing “No symptoms at all”, “Some days”, “Often”, and “Nearly every day”. The scale consisted of 15 questions, with scores ranging from 0 to 45. Therefore, respondents who scored an average of 30 or above were classified as experiencing frequent or higher levels of traumatic symptoms, meeting the eligibility criteria for participation in the study. We used these screenings to select key informants, following the inclusion criteria.

For in-depth interviews, to obtain information on traumatic experiences and positive coping strategies of ALP with traumas after exposure to traumatic events, we applied the following concepts: (I) Foa et al.’s (10) concept about traumatic symptoms in children, including re-experiencing, hyperarousal, and avoidance; (II) types of child abuse (21); and (III) positive coping strategies developed by Pahuyut et al. (22), referring to an individual’s abilities to perceive goal, understand oneself, and generate positive thinking to make a decision and use effective method to solve a problem. Also, the individual was capable to take an action that is appropriate and consistent with one’s own desire. These concepts have been previously validated in the context of Thai adolescents. Concerning the development of the interview guidelines, which was a semi-structure interview protocol, we selected to use open-ended questions to facilitate the informants to freely express opinions and tell their stories. The questions were categorized into two sections: The first section involved the questions about traumatic experiences such as “How is your relationship with people in the family and school?”, “What is the traumatic event occurring when you are in poverty and how does it affect you?”. The second section involved the questions about positive coping strategies such as “When that event happened, how did you cope with it?”, “Is there anything positive you’ve learned from that event and what is it?”. The concepts used to develop the questions were merely a map providing the direction for this study in the development of the interview guidelines. Although these concepts were derived from the theories and studies related to ALP, we would not rely on the theories or let them influence us on our judgement about the phenomena occurring in the fieldwork. However, the questions were used as the guidelines facilitating emergent fact. Also, during and after the interviews, we took field notes on the informants’ expression occurring while they were telling their stories, the informants’ personal information, and challenges found during the interviews.

Data collection

We obtained a letter of assistance from the Graduate School of Srinakharinwirot University addressed to the director of a Suksasongkhro school in Thailand. That was to request for assistance with the research project and a gate keeper—the head of the academic affair to provide a primary researcher the access to the key informants—ALP. The interview sessions for all informants were conducted at the Suksasongkhro school. At the beginning of the interview process, she introduced herself as a researcher and a counseling psychologist, establishing rapport and trust with the adolescents while ensuring that informants understood their right to refuse to answer certain questions before proceeding with data collection. Afterwards, she purposively selected ALP based on the inclusion criteria. She also contacted their parents and teachers to ask them to participate in the study. She clarified the detail of the study and the protection of research informants. Subsequently, the appointments for interviews were made; she was the only interviewer. On the appointment date, she gave the information sheet to the informants. The information sheet explained possible benefits of the study, reasons for selecting the informants, research procedures, possible risks of taking part, incentives, and research informants’ rights. Positive relationship with the informants was established through warm and friendly gestures to build their trust which would facilitate them to freely inform their experiences. Also, prior to the interviews, she asked for permission to record the conversations throughout the interviews from the informants. If an informant showed distress, the interview was paused or stopped as needed. Informants were then offered comfort, reassurance, and grounding techniques if upset. She collected data via the methods of in-depth interview and field note taking. It was only herself conducting the interviews and each interview lasted 30–90 minutes. There were four reinterviews: three reinterviews with three ALP (one per each adolescent) and one reinterview with one parent. The reinterviews were conducted to clarify missing or incomplete information from certain informants. These were short follow-up sessions, lasting no more than 20 minutes. She spent 5 months in data collection, from September 2020 to January 2021.

Data analysis

To enhance the trustworthiness of our findings, we employed rigorous reflexivity practices throughout the research process. After the interview, the primary researcher transcribed the recorded information verbatim. Subsequently, she stored data in personal files using the software Microsoft Word and then read through to gain understanding about it. Afterwards, she analyzed the data performing thematic analysis (24). The obtained data was coded and categorized; meanwhile, non-related data was discarded. Data was collated into sub-groups and then put into categories based on similar meanings and directions of the relationships. The data was subsequently analyzed by linking related categories to draw conclusions based on emerging patterns. The derived conclusions were then analyzed and interpreted on the basis of the determined themes. Initial themes were identified based on the research questions: (I) traumatic experiences and (II) positive coping strategies, utilizing a blended approach of both inductive and deductive data analysis methods. Afterwards, she validated credibility of the data via member checking technique. The primary researcher conducted member checking with all informants and found that they agreed with the analysis and had no additional suggestions regarding the findings presented for their review. Triangulation was also conducted for the validation: (I) Data triangulation, referring to the interviews with informants, i.e., the parents and teachers of the ALP. Data from different sources would strengthen data richness and accuracy. And (II) analyst triangulation, the research team analyzed the data to obtain results which were then compared and discussed together until consensus was reached.

Ethical considerations

This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Institutional Review Board of Srinakharinwirot University (No. SWUEC/E/G-243/2563) on August 14, 2020 before the implementation of this study and informed consent was taken from all individual participants. There are two forms of informed consent in this study. One is a standard informed consent form and the other is an informed consent form for a person who is under the age of 18 years.

Results

Theme one: the impact of poverty on traumatic experiences

ALP face numerous challenges as they navigate identity development and their social environment. These hardships often expose them to difficult, risky situations, resulting in significant traumatic experiences. According to data analyses, traumatic experiences of ALP with traumas resulted from poverty in Thai educational system were as follows.

Impact of impoverishment

Most adolescents from families with an annual income under 20,000 baht were considered to be living in extreme poverty. They faced shortages of basic needs like food and allowance, leading to feelings of embarrassment and low self-esteem. This often resulted in a reluctance to attend school, frequent absences, and, in some cases, the consideration of dropping out of the education system.

“The time that has nothing to eat, eat rice with salt, lime fish sauce, that’s all… About allowance, mom doesn’t have enough. I have to earn it myself. Don’t want to go to school because I feel that I couldn’t get along with anyone. Talking to others is difficult. Sometimes, I don’t want to study here anymore, want to go back to study at the school close to home.” (Alice: ALP).

“Lately, mom and dad’s income reduce. Mom sent me 200 baht monthly… Staying at school is not quite happy. Staying home, I feel happier. So, take leave to stay home for long.” (Ivy: ALP).

Impact of abuse

Most adolescents experienced emotional abuse, primarily verbal attacks from their parents, including harsh words, threats, and humiliation, often being pressured beyond their abilities. Living at home and in the boarding school, Suksasongkhro, led to feelings of neglect by both family and peers. Physical abuse, mostly from mothers (biological or stepmothers), occurred when adolescents disobeyed. At school, peers also inflicted physical harm, such as beatings and using objects as weapons. Some adolescents faced sexual abuse from peers, often due to bullying rooted in their introverted nature and low socio-economic status. These adolescents were seen as inferior and became victims of sexual violence, leaving them feeling ashamed, stressed, and traumatized, disconnected from their sense of self.

“They cursed me. ‘Meung’ [You, impolite word] is stupid, do not listen to them [crying]. I kept thinking ‘What’s wrong with me”. I tried to focus on studying. I got these grades… I don’t want to be a doctor. I only want to study what I like.” (Chun: ALP).

“That day, I went to the toilet alone. That friend followed me, shoved me into a room, touched my boobs, and tried to rape me. I shouted for help from other friends. Luckily, those friends arrived in time… Earlier, that friend had a fistfight with me.” (Allice: ALP).

“His stepmom slapped him until he was bleeding… When he was with his father, he was skin and bone, didn’t have much to eat. Usually, didn’t get allowance to school.” (Khun Jai: Gavin’s mother).

“He said his friend punched him, so he beat his friend with steel rod. He said like this. Because his friend bullied him first, so he beat back and broke his friend’s arm.” (Kru Phum: Gavin’s teacher).

Impact of broken family

Most adolescents discussed that the broken family dynamic resulted from conflicts within their families, leading to separation and changes in family structure. Issues such as “divorce”, “living apart from parents”, and “family disagreements” were commonly mentioned.

“Mom divorced dad for a long time. I live with mom and sister. Dad has a new wife and they live in a separate house. Deeply, I want mom and dad to get back and live together. I want all of us to live together; but I know that it’s impossible.” (May: ALP).

“Split up with their dad for a long time, then live in separate houses. Their stepmom doesn’t want their dad to meet them if I am there. I know that ‘Nong’ [Anyone younger] wants us to be back and live together, but I don’t think so.” (Khun Ploy: May’s mother).

Impact of abuse and exposure to violence

Most adolescents discussed that exposure to domestic violence, stemming from family conflicts, put them at risk. This resulted in lasting emotional and physical scars, as they vividly remembered the violence. The adolescents lived in fear of the perpetrators and no longer wished to stay in the same house with them.

“It’s… A stepfather fought with mom, so he threw the aquarium and I blocked it to protect mom. So, it hit me instead. I have a scar here [point a finger to let me see it]. I hate him so much, don’t want to live under the same roof anymore.” (Alin: ALP).

“I was watching cartoon at that time. Suddenly, one uncle who was an addict walked here and found a metal cutting tool. I ran away and hid under the bed. Then, my crippled uncle tried to ‘wai’ [putting palms together to show respect], apologized, did something wrong… something like that. He hit his head with that steel. And I saw it with my own eyes, bleeding. He then walked away. I then walked on tiptoes to see it. Blood was all over the place, knew that the uncle was no longer alive, I walked, ran for dear life… Many years have passed, it’s still fresh in my memory. I was scared of that uncle. Luckily, he is now in jail.” (Alice: ALP).

Family disparities and its impact

Most adolescents discussed that their parents treated them and their siblings unequally, leading to feelings of worthlessness and a lack of love. As a result, they spent more time with friends than with family.

“Like, sometimes think about it and then break into tears. Feel that they don’t love me, they love ‘Nong’ [anyone younger] more… It makes me not want to stay at home, would rather stay with friends. It is happier.” (Ivy: ALP).

Engaging in risky sexual behaviors

Due to a lack of parental attention and the stress from past traumatic experiences, most adolescents craved love and emotional support. When peers or romantic partners entered their lives, they felt a sense of belonging and became vulnerable to sexual advances. As a result, they engaged in unprotected sex and frequently changed partners, lacking proper education on self-care and protection.

“I was drunk and had sex with my boyfriend, and didn’t use condom [crying]… Didn’t know what to do, didn’t want to upset mom.” (Ivy: ALP).

“We agreed to, both I and he, we then secretly had sex at school… did not use condom because we didn’t have it. Finally, being caught in the act by a teacher.” (Alice: ALP).

Social isolation and exclusion

Due to their families’ limited income, most parents and teachers of these adolescents couldn’t afford school activities, leaving the adolescents feeling excluded from opportunities they were eager to participate in. This caused feelings of sadness and missed chances to develop their skills. Additionally, some ALP didn’t want to attend school because they felt isolated and disconnected.

“Almost got to join the school parade once. Teacher told me to rent a costume. My family didn’t have money so I didn’t get to join the parade. The day the activity was held, I didn’t go to school, didn’t want to see, didn’t want to join the activity.” (Alin: ALP).

This theme highlights how poverty impacts adolescents at risk, leading to basic need shortages, low self-esteem, and school absenteeism. They also face abuse, family breakdowns, and domestic violence, resulting in trauma and isolation. Poverty further limits social participation and contributes to risky behaviors, hindering emotional development and well-being, emphasizing the need for comprehensive support.

Theme two: resilience through positive coping strategies

Despite experiencing trauma from exposure to difficult events, ALP developed unique coping strategies that helped them navigate and overcome the challenges of living in poverty, enabling them to build resilience and survive. This theme was categorized into two sub-themes.

Internal sources of positive coping

When faced with challenges from living in poverty, most adolescents found ways to cope. These included “having hope”, believing their lives would improve, and “putting in effort to overcome adversity”. After traumatic events, they chose to remain positive, using hurtful words from parents or others as motivation to succeed.

“In my head, there are only their words. When studying difficult subjects and feel discouraged, those words will come up to push me… Then, I’ll be more focused, study harder.” (Chun: ALP).

Most adolescents also “looked for ideas on how to live well” from their traumatic experiences. They believed there was good intention behind their parents’ actions and applied these lessons in their daily lives, striving to become better individuals.

“They were like, keep after us, teach us. They hit us. But that’s to teach, not to hurt us. Now, don’t feel like taking a trip, but would rather study, work. Formerly, I thought taking a trip was fun, gain more experiences. But I think if I study, I will finish the school. Also, if I study and the school breaks, I’ll get to have a trip. I think I should study harder, it’s better.” (Ivy: ALP).

When most adolescents faced negative feelings from living in poverty at home and school, they turned to “recreational activities” like drawing and listening to music to relax and distract themselves. They also chose to “get some sleep”, which helped them release stress and regain energy for the next day. Additionally, after difficult experiences, many adolescents found comfort in “praying” as part of their Buddhist practice, helping them feel better.

“Praying before sleep at school. That is to help us relax, remove stress, feel better, and sleep well.” (May: ALP).

When the family faced financial struggles, the adolescents tried to “understand the family’s impoverishment”. They empathized with their parents, appreciated what little they had, and made efforts to “earn money” to ease the family’s burden.

“Yep! Earlier, rarely stayed with mom. When having no money at all, will ask for free food at the temple. An uncle was a monk there. He collects alms and keeps food for me. Every morning, go get it, eat it before going to school. At home, eat temple food at noon and in the evening. For every meal, I can eat like this because our family doesn’t have money.” (Alice: ALP).

“She makes egg roll for sale. It can be done only at weekends. She gains some small income from that, don’t have to ask much from her mom.” (Kru Chom: Ivy’s teacher).

In poverty, most adolescents were at risk of danger. To protect themselves, they focused on “avoiding harmful situations” by steering clear of people, places, or scenarios that could lead to conflict or danger, which helped them feel safe, both emotionally and physically.

“Sometimes seniors, sometimes juniors, try to avoid them, stay away from them, don’t make eye contact, don’t talk to them, keep space while walking, don’t attract attention… They are the school bullies; I don’t want to get involved with them.” (Chun: ALP).

“When seeing a stepmother getting mad, I will be somewhere else, and then get back later.” (Gavin: ALP).

External sources of positive coping

When faced with the challenges of living in poverty, most adolescents coped by “asking for help from others”, including parents, trusted adults, teachers, or friends. They sought help for safety, protection from harm, and guidance in overcoming difficulties. Additionally, they turned to trusted individuals for support when lacking basic necessities, receiving assistance such as food, money, and advice, which helped them navigate life at home and school.

“At the time that I had a fight with a stepmother, I went to a step grandmother, asked her to call mom, asked mom to come and get me… Mom came and get me. I moved to live with mom since then.” (Gavin: ALP).

“Nongs [anyone younger] lost their shoes. And they would come to let me know. And then I’ll take them to ask for new shoes. Then, I temporarily fix the problem by keeping the shoes of some of them who cannot take care of their own shoes in my room.” (Kru Phum: Gavin’s teacher).

“At that time, her family was in a lot of troubles. She came to ask me for permission to sell something at school. I then let her sell egg roll so she would have a little bit of extra income.” (Kru Chom: Ivy’s teacher).

In addition to asking for help, when most adolescents experienced negative emotions at home or school, they coped by “doing activities with close ones”, such as family, friends, and teachers. These activities helped them relax, reduce stress, and strengthen relationships, which in turn encouraged them to overcome challenges.

“When feeling bad, I’d like to ask my friend to take a walk with me, stroll along. The school’s area is large… It makes me feel better when getting back to the dorm.” (Ivy: ALP).

“She generally blends in. Walk into teachers’ room, saying ‘Teacher, I’d like to help you with this and that.’ From frown, it was changed to see her smile.” (Kru Amp: May’s teacher).

This theme discusses how ALP develop resilience through positive coping strategies. Internally, they maintain hope, use adversity as motivation, and find comfort in activities such as drawing, music, and prayer. Externally, they seek help from trusted adults and engage in activities with loved ones to reduce stress. These strategies help them cope with trauma and overcome life’s challenges.

Theme three: support requirements

Beyond examining the challenges and coping strategies of ALP, the study highlighted the critical need for support from parents, teachers, and other community resources to help these adolescents navigate their difficulties in the following domains.

Educational and career development

Most adolescents needed support in improving their studies, receiving vocational training, and securing scholarships. The majority of parents and teachers wanted them to continue their education until completing upper secondary school. They all viewed scholarships as essential, believing they would lead to a brighter future. Gaining education and vocational skills would enable the adolescents to advance and eventually support their families.

“Studying matter, give advice on studying.” (May: ALP).

“If, want to help him, it would be about a scholarship because there are another two sisters, he is quite worried.” (Kru Tharn: Chun’s teacher).

Enhancing problem-solving abilities

Due to exposure to traumatic events, most adolescents struggled with emotional regulation, lacked assertiveness when bullied, and were prone to irritability. They wanted to improve their emotional management and become more assertive in facing life’s challenges. Most parents, teachers, and caregivers believed the adolescents needed support in developing their personalities, particularly in managing emotional issues and undesirable behaviors at school.

“Mostly, friends generally calling me by mom and dad’s names. I don’t like it. I often cry. I often sulk, want them to stop mocking, don’t know what to say.” (May: ALP).

“Want to change habits, I have bad habits, hot temper.” (Gavin: ALP).

Economic stability and its impact

Most adolescents, along with the majority of their parents and teachers, needed support with the family’s financial situation. They believed that improving the family’s income would alleviate financial difficulties. Additionally, parents hoped their children could find work during school holidays to help ease the family’s financial burden.

Emotional support in daily life

Most adolescents sought emotional support from those around them, including family and teachers. The majority of parents and teachers recognized the importance of providing encouragement, guidance, and advice. Teachers, in particular, observed the stress adolescents experienced from various challenges. Offering supportive conversations helped build their confidence and motivation, enabling them to overcome obstacles and reach their potential.

“I want emotional support from my surrounding people. It helps me to be focused, not feel discouraged.” (Alin: ALP).

“Want them to have a school counselor to provide advice to Nong [anyone younger] when Nong feel bad. Because it is a boarding school, mom lives far away, talking is not easy.” (Khun Ann: Alice’s mother).

“Must talk about several things to help her feel OK, have confidence, pay much more attention on herself and family. She is smart, knowledgeable, but sometimes that knowledge is hidden.” (Kru Nok: Alin’s teacher).

The aforementioned results can be summarized based on themes and sub-themes as shown in Figure 1.

Figure 1 Research results.

This theme emphasizes the support ALP need in areas like education, emotional well-being, financial stability, and problem-solving. They require help with studies, scholarships, and vocational training. Emotional support from parents and teachers is essential for building confidence, while financial assistance can ease family struggles. ALP also need guidance in managing emotions and facing challenges to build resilience and improve their future.

Discussion

The following discussion summarizes the results, organized around the key issues outlined below.

Traumatic experiences

Considering ALP’s experiences of living life in poverty, which were both an obstacle and life lessons they had to face, the results discovered that ALP were exposed to traumatic events both in the family and at school. Besides living in poverty and a lack of necessities, the adolescents faced the following issues: growing up in broken families, parents divorcing when they were young, having a stepfather/stepmother with a stepbrother/stepsister or having many family members, making ALP feel that they were treated unequally and abandoned; being exposed to emotional and physical abuse, as well as emotional neglect by parents, other family members, peers, and teachers at school; being exposed to sexual abuse by peers at school and oppressed because those peers perceived that they did not have to respect ALP or that ALP were worthless; and witnessing domestic violence that harmed ALP’s mental, physical, emotional, and spiritual conditions (1-5,20).

This study is based on the concept of traumatic symptoms in children, focusing on adolescents who experience hyperarousal and avoidance due to various forms of violence (10,21,22). It also integrates the concept of positive coping strategies (22,25,26), suggesting that children who understand their emotions can adapt and cope better. These concepts help explain the study’s findings, which show that adolescents with traumatic experiences from poverty, and a lack of family support, are more likely to engage in sexual risk-taking, unprotected sex, and having multiple sexual partners (27,28).

That is consistent with the study by Juma et al. discovering that poverty increased the risk of undesirable sexual behaviors among ALP (7,11,12). For school life, ALP generally missed out on social activities because they could not afford them. Moreover, they were frequently bullied by peers. Being ALP was likely to make them bullied more frequently than other adolescents (22,24,25). This is because they had introverted personalities and did not dare to assert themselves to protect their rights. To be bullied and mocked negatively affected the adolescents: they experienced depression, lost confidence, were isolated, and did not want to make friends (26,28). Alternatively, if the adolescents expressed themselves, they would react aggressively and violently because they could not regulate emotions. Also, they copied family members’ aggressive behaviors (25).

The aforementioned traumatic experiences among Thai adolescents are similar to the study on experiences of challenges among ALP with mental disorders in the international context (26,27) and similar to experiences of adults with depression resulting from having been ALP with traumas resulting from having experienced challenges (29,30).

Positive coping strategies

In this study, I adopted the concept of positive coping strategies from Pahuyut et al. (22) as a theoretical framework guiding me to discover positive coping strategies of ALP in the Thai educational system who suffered traumas due to poverty. Results revealed that ALP had both internal and external positive coping strategies. They positively responded to existing challenges in several ways: ALP had hope that life in the future would be better than the present. They tried to overcome offenses given by surrounding people, improve themselves, be optimistic, and look for lessons from obstacles to be applied in living well. They avoided putting themselves into harmful situations to keep themselves safe both emotionally and physically. When their family faced poverty, the adolescents were able to have sympathy with their parents and tried to work for extra money to ease the family burden as much as they could. The adolescents also asked for help from their close ones whom they trusted, such as family members, teachers, and friends, when facing challenges. In addition, the adolescents asked these people to join their activities to relax and promote intimacy. These positive coping strategies were in line with positive coping strategies of adolescents in the Thai context (20,29,31,32). ALP with traumas had coping strategies similar to Thai adolescents: they were able to be positive when challenges were presented in daily life; they tried to look for a solution that would not cause trouble to themselves and others; and they selected the solution based on their needs (33). For example, when the family faced financial problems, the adolescents tried to have sympathy with their parents, tried to earn money from jobs with good faith both at home and school, and selected jobs that fit their abilities to reduce the burden on the parents.

Additionally, when ALP had negative feelings towards the situations they were facing, they tried to do recreational activities within their ability at that moment: get some sleep to relax and pray before sleep to let themselves feel better. Praying contributed to a fresh mind and wisdom to tackle existing problems (30,34).

Concerning the abilities to have goals, have self-understanding, and cope with future events, which were included in the definition of positive coping strategies for Thai adolescents (29,35), I did not discover these features in this study. That is because the situation in which ALP suffered oppression from family members and people at school for a long period, together with having traumas resulting from poverty, hindered them from realizing their abilities and strengths. They did not know a direction in life and could not set their life goals because their families were poor. In their opinion, they believed that they would not have further education or the promising future that other normal adolescents would have.

Also, due to the fact that the adolescents had suffered traumas, they still remembered past events and were under stress and pressure caused by exposure to traumatic events. That hindered them from finding solutions to get over these traumas and achieve life balance. Nevertheless, both the internal and external positive coping skills of ALP with traumas discovered in this study were the best coping strategies the adolescents could use at that time. They tried to use the strategies to face the situations and reduce stress and negative emotions. When realizing the existing stress and pressure, ALP tried to be active in finding the solutions to deal with the problems and combat the obstacles resulting from poverty. That was to enable the adolescents to live in poverty (15,31).

Limitations

The findings from this study, while based on data from a single school in Southern Thailand, offer valuable insights into the experiences and needs of ALP. These results can serve as a starting point for further research on ALP in diverse regions of Thailand, allowing for a broader understanding of their challenges and coping strategies. In addition, since the data collection for this study took place during the coronavirus disease 2019 (COVID-19) pandemic, the interview process was not continuous and was occasionally interrupted. For instance, schools were closed for approximately 2–3 months following government directives, and data collection could only resume once the situation had improved. As a result, some informants who had initially agreed to participate were no longer willing or available for interviews, as they had to take on additional work responsibilities to support their families financially. This posed further challenges for the research team, as it required additional time and effort to recruit new informants while ensuring that the study remained consistent with its original research objectives. Future studies should expand the sample size and include multiple schools to obtain a more comprehensive view. Additionally, the findings highlight the need for targeted interventions, such as school policies and community-based support programs, to address the specific needs of ALP in various contexts (30).

Conclusions

Gaining a comprehensive understanding of the experiences of ALP who have encountered trauma and identifying their positive coping strategies is essential for the development of effective interventions that can support and promote their mental health. The theme “Needs for support” highlights the significant needs of ALP, their parents, and teachers, which include assistance in areas such as educational development, vocational skills, and problem-solving. This emphasizes the importance of a multidisciplinary approach, involving teachers, psychologists, social workers, and other school personnel, in providing tailored support. Schools can utilize this information to design policies and initiatives that address ALP’s needs, such as vocational training programs, scholarship opportunities, school lunch support, and programs allowing students to earn while studying. These efforts can help ALP maintain hope, develop themselves, and improve their life prospects despite living in poverty.

Additionally, promoting posttraumatic growth is crucial for helping ALP overcome their past traumas and build resilience. This process supports positive changes, fosters optimism, and improves relationships, ultimately reducing symptoms of depression and enhancing overall well-being. However, posttraumatic growth is most effective when supported by social connections and external resources. Social support—encompassing both emotional and community-based assistance—plays a key role in sustaining these positive changes. Therefore, interventions must address both psychological and social dimensions, providing emotional support while also promoting social justice and equality at the individual, family, and community levels. Training in coping strategies and resource utilization further strengthens ALP’s ability to navigate daily challenges. By integrating various disciplines and focusing on both mental and social well-being, interventions can effectively support the long-term growth and resilience of ALP.

Acknowledgments

We would like to thank to all of the participants of the ALP, for their availability and crucial contribution to the present study.

Footnote

Data Sharing Statement: Available at https://pm.amegroups.com/article/view/10.21037/pm-24-81/dss

Peer Review File: Available at https://pm.amegroups.com/article/view/10.21037/pm-24-81/prf

Funding: This study was funded by a Behavioral Science Research Institute (BSRI), Srinakharinwirot University.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://pm.amegroups.com/article/view/10.21037/pm-24-81/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Institutional Review Board of Srinakharinwirot University (No. SWUEC/E/G-243/2563) on August 14, 2020 before the implementation of this study and informed consent was taken from all individual participants. There are two forms of informed consent in this study. One is a standard informed consent form and the other is an informed consent form for a person who is under the age of 18 years.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. National Economic and Social Development Council. The situation, problems, and statistics of Thai children and adolescents. 2019. Available online: https://www.nesdc.go.th [Accessed 1 Mar 2025].
2. Department of Mental Health. The number of Thai children and adolescents. 2021. Available online: https://www.kidforkids.org [Accessed 1 Mar 2025].
3. Special Education Administration Bureau, Thailand. Suksasongkhro Schools [brochure]. Bangkok: Special Education Administration Bureau, Office of the Basic Education Commission, Ministry of Education. Available online: https://rajk.org/news-all/news/item/931-10.html
4. National Statistical Office. The 2023 household socio-economic survey whole kingdom, Bangkok, Thailand: National Statistical Office. 2024. Available online: https://www.nso.go.th/nsoweb/storage/survey_detail/2024/20240702120458_45133.pdf [Accessed 5 Mar 2025].
5. Minujin A, Delamonica E, Davidziuk A, et al. The definition of child poverty: a discussion of concepts and measurements. Environ Urban 2006;18:45-60. [Crossref]
6. Moser C, Norton A. Poverty reduction strategies and the role of local and national government. World Dev 2001;29:1-17.
7. Juma M, Ngugi H, Okumu M. Poverty and its impact on children and adolescents in Kenya. J Child Poverty 2013;19:342-58.
8. Klasen S. Poverty, inequality, and youth outcomes in developing countries. J Youth Adolesc 2010;39:1-9.
9. Thompson E, Platt R, Larkin J. Adolescent stress and coping: a systematic review of the literature. J Adolesc Health 2016;58:14-27.
10. Foa EB, Johnson KM, Feeny NC, et al. The child PTSD Symptom Scale: a preliminary examination of its psychometric properties. J Clin Child Psychol 2001;30:376-84. [Crossref] [PubMed]
11. Turner L, Dennis M, Kinnison T. Impact of childhood trauma on adult mental health: Post-traumatic stress disorder in adolescents. Psychiatric Clinics of North America. 2018;41:359-70.
12. Juma M, Ngugi H, Okumu M. Poverty and sexual risk-taking behaviors among adolescents. Health Educ Res 2013;28:819-28.
13. Finkelhor D, Ormrod R, Turner H. Polyvictimization: A neglected component in child victimization. Child Abuse Negl 2007;31:7-26. [Crossref] [PubMed]
14. Kaplan H, Dalgaard K, Butts M. Poverty and its effects on adolescent mental health. Am J Public Health 2014;104:924-32.
15. Roy B, McLeod H. Coping strategies among adolescents in economically disadvantaged situations. J Adolesc Mental Health 2015;32:22-35.
16. Lee S, Morris M, Patten A. Adolescents in poverty: Stress, anxiety, and coping strategies. J Soc Work Pract 2016;28:50-60.
17. McEwen B, McEwen C. Social stress and the biology of coping. Ann NY Acad Sci 2012;1486:122-43.
18. McClure R, Couper M, Alvarado M. Adolescent mental health and coping strategies: A study of mental health services in schools. J Child Adolesc Psychiatr Nurs 2017;30:8-16.
19. Moore R, Graham H. Depression and the role of coping strategies in adolescents. Eur Child Adolesc Psychiatry 2017;26:1-10.
20. Lau Y. Traumatic experiences of Thai adolescents: A qualitative study. Int J Child Adolesc Mental Health 2019;12:171-82.
21. Maras M, Delamater A. Bullying and its effects on adolescents from disadvantaged backgrounds. Adolescence 2014;49:81-93.
22. Pahuyut S, Sangsiriwut R, Manochai P. Positive coping strategies of Thai adolescents in educational settings. J Thai Educ 2015;45:112-28.
23. Roth DH. Adult reflections on childhood verbal abuse [dissertation]. Saskatoon: University of Saskatchewan; 2004. Available online: https://harvest.usask.ca/items/aa19a508-ec35-4a97-836b-128418dc8e9d
24. Liamputtong P. Qualitative data analysis: conceptual and practical considerations. Health Promot J Austr 2009;20:133-9. [Crossref] [PubMed]
25. Parker D, Atkins C. Peer violence and its psychological effects on adolescents. J Youth Adolescence 2015;44:671-83.
26. Anderson J, Reilly J. Aggression and coping mechanisms among children exposed to violence. Am J Orthopsychiatry 2014;84:34-45.
27. Shaw S, Phillips C. Challenges faced by adolescents with mental health disorders in low-income settings. Psychiatr Rehabil J 2016;39:92-100.
28. Nichols W, Purcell L. Coping mechanisms in adolescents living in poverty. Psychol Res Child Care 2017;4:15-26.
29. Montgomery S, McLeod C. Depression and childhood trauma in adults: A longitudinal study. Clin Psychol Rev 2014;34:347-54.
30. Tan J, Yip Y. The role of spirituality in adolescent coping: A focus on Thai adolescents. J Spirituality Ment Health 2017;19:160-71.
31. Connolly R, O’Neill H. Stress reduction strategies and their impacts on adolescent mental health. Adolescence 2016;51:91-102.
32. Juma M, Alaii J, Bartholomew LK, et al. Understanding orphan and non-orphan adolescents’ sexual risks in the context of poverty: a qualitative study in Nyanza Province, Kenya. BMC Int Health Hum Rights 2013;13:32. [Crossref] [PubMed]
33. Mahantamak R, Sakunpong N, Suwathanpornkul I. Development of post-traumatic growth scale among economically disadvantaged children. J Nurs Health Sci Res 2023;15:e262293.
34. Mahantamak R, Sakunpong N, Suwathanpornkul I. Development of an intervention to foster post-traumatic growth and perceived social support among economically disadvantaged students in Thailand: A design-based research study. J Health Res 2024;38: [Crossref]
35. Sakunpong N, Choorat P, Mahantamak R, et al. Exploring congruence and counseling competencies: a qualitative study of counseling students trained in the Satir Model. Humanit Arts Soc Sci Stud 2024;24:404-13. [Crossref]