Introduction

Adolescence is a critical transition that might be more difficult for international adoptees who have to cope with specific additional developmental tasks. Considerable research has compared the adjustment difficulties of adoptees and their non-adopted peers, demonstrating that internationally adopted adolescents are at higher risk for emotional and behavioral problems and report more mental health problems, indicating that the adoptive status may be associated with higher levels of maladjustment1,2. Additionally, previous research has evidenced that internationally adopted adolescents are more likely to develop psychological issues and need psychiatric treatment than domestic adoptees and non-adopted adolescents3,4,5,6. Although international adoptees showed a relevant recovery from early adversities3, relatively few investigations have focused on the adopted adolescents’ perception of their psychological well-being, and comparisons with their non-adoptive peers are even less common. Moreover, the comparison of adoptees living in different countries has been overlooked. To fill this gap, the current study focused on adolescents’ psychological well-being, measured in terms of life satisfaction, comparing internationally adopted and non-adopted adolescents living in four European countries.

Life satisfaction is a pivotal topic that has gained considerable importance within the theoretical frame of positive psychology and is widely considered a valuable measure of subjective well-being7,8, along with other indicators of adaptive functioning9. Subjective well-being consists of affective and cognitive components. While affective well-being refers to the experience of frequent pleasant and infrequent unpleasant feelings, the cognitive component is most commonly assessed through measures of life satisfaction, assuming that a high level of life satisfaction is matched with the feeling that goals, desires, and standards are largely satisfied. Through this framework, the satisfaction with life perspective of Cantril10 makes an overall assessment of life satisfaction. Several studies on non-adopted youth consistently report a sharp decrease in life satisfaction throughout adolescence; other studies demonstrate a lower level of life satisfaction for girls than for boys11,12,13. Except for a recent study in Spain, life satisfaction has rarely been reported in the adoptee population14.

Some cross-cultural studies on the general population have revealed differences in the levels of life satisfaction among adolescents in different countries, highlighting that life satisfaction includes a cultural dimension15,16,17. With this regard, literature has largely overlooked that subjective life satisfaction may depend on the sociocultural factors of the current context in which the child lives. Moreover, several relational and social factors have been shown to contribute to the variability in adoptees’ adjustment, suggesting a key role played by the context in reducing psychological problems and fostering different resilience pathways throughout the adoptees’ lifespan5.

Previous research has identified several factors contributing to improved well-being and life satisfaction. A key factor is family, an essential source of resilience that can support healthy development in children throughout their lives. Numerous studies have indicated that the quality of parent-child relationships, particularly aspects such as open communication18 and family support19,20, is positively associated with life satisfaction among non-adopted adolescents21,22. Additionally, research by Ranieri et al.23 has shown that Italian adolescents who are adopted and engage in more open discussions with their parents about adoption issues tend to report higher levels of life satisfaction. Research on family relationships consistently provides a ‘positive portrait’ of adoptive families. For example, no differences in parent-child communication and family support were found between adopted and non-adopted children in Spain14, and higher parent-child communication openness was found in adoptive families compared to non-adoptive ones in Italy24.

In addition, peer relationships and satisfaction with the school play an important role in the social and psychological development of adolescents25, strongly influencing their life satisfaction17,26,27. The results of the HBSC 2021/22 surveillance align with previous HBSC data and suggest that perceived social support (especially family, followed by school and friend support) is essential for promoting life satisfaction among adolescents28. In this regard, cases of poor social competence and low satisfaction in friendships have been reported for international adoptees14,29. A number of relevant studies have examined the school experience of international adoptees, suggesting that the school environment can be particularly challenging for adoptees, as they are more likely to have lower academic achievement and lower levels of acceptance among their classmates than non-adopted peers30. As a consequence, they can be more vulnerable to the experience of bullying and microaggressions31,32,33,34. In addition, a Spanish study35 on adopted adolescents found a strong association between perceived social support and perceived general health, including life satisfaction, for both adopted and non-adopted adolescents, with family support playing a more prominent role for adopted than non-adopted adolescents. However, within the adoption literature, very few studies have examined family, school, and social relationships together and have focused on more than one receiving country35,36.

The aim of the current study was twofold. First, to compare internationally adopted and non-adopted adolescents regarding communication with parents, family and friend support, liking school, and life satisfaction. This comparison was conducted in four European countries, allowing for exploring differences and similarities across cultural and social contexts. Second, investigate the association between adoption status and life satisfaction, considering the country of residence and factors such as gender, age, communication with parents, school liking, and support from family and friends, which may influence the relationship as underlying confounders or moderators.

Methods

Participants and procedure

The present study involved internationally adopted and non-adopted adolescents living in four different countries: Italy, France, Norway, and Spain. The Group for European Adoption Research (GEAR) collected data on adopted adolescents as part of cross-national research on internationally adopted adolescents in four different European countries (for more details about the methodology, see Miller et al. 202236). Inclusion criteria for adoptees were identical for all four countries: adolescents between the ages of 10.5 years and less than 18 years at the time of the study, internationally adopted; adolescents from domestic adoptions, and children returned to the care system were excluded. Non-adopted youth were drawn from the Health Behaviour in School-aged Children (HBSC) 2018 survey (for more details, see Inchley et al. 201837) in Italy, France, Norway, and Spain.

HBSC and GEAR research protocols in each country received ethical approval from local authorities. Specifically, the Italian HBSC study protocol and questionnaire were formally approved by the Ethics Committee of the Italian National Institute of Health (PROT-PRE876/17, 20 November 2017); the Norwegian HBSC Protocol was considered and recommended by the Norwegian Centre for Research Data (ID code 56623/4/LH), which is the Norwegian national authority for data protection; the French HBSC study received approval from the French Data Collection Authority (CNIL) and the French Ministry of Education; the Spanish 2017/18 HBSC study was approved by the Coordinating Committee on Biomedical Research Ethics of Andalucía (reference number 0746-N-17). The GEAR research protocol was approved by the Ethical Committee of the Department of Psychology of the Catholic University of Milan for Italy; by the Délégation à la Recherche Clinique et à l’Innovation (#D18-P016), and the Tufts University Institutional Review Board (#1811026) in France; by the Comité de Ética de la Investigación Biomédica de Andalucía in Spain, and a waiver from the Norwegian Center for Research Data because the survey was anonymous. Passive or active consent for participation in the HBSC study was obtained from school administrators, parents, and adolescents before involvement, consistent with the regulations of each participating country. Anonymous self-report questionnaires were completed in the classroom under a teacher’s or trained interviewer’s supervision. For adoptees, parents’ written informed consent was obtained before participation. Adopted adolescents whose families consented were informed about the study’s main objectives and asked to complete an anonymous self-report questionnaire. The present study is based on the secondary use of a subset of anonymized data from the HBSC survey37 and the anonymized data from the GEAR study36, with no further experiments or data collection. Thus, ethical approval is not required. The study was conducted under the international guidelines and regulations and the Declaration of Helsinki.

Each adoptee was matched (with a ratio of 1– 1) by gender, age group, and country of residence with an adolescent from the HBSC community sample. The final study sample comprised 776 adolescents from four countries (Italy, France, Norway, and Spain), 388 adopted adolescents, and 388 non-adopted adolescents. Of the 776 adolescents, 340 (43.8%) were girls; 126 (16.2%) were from 10.5 years to 13 years of age, 330 (42.5%) > 13 to 15.5 years of age, and 320 (41.2%) > 15.5 to < 18 years of age. Table 1 shows descriptive statistics of the sample. The majority of adopted adolescents come from Eastern Europe (49.3%); the rest came from Latin America and the Caribbean (21.5%), Asia (21.8%), and Africa (7.4%). The median age at the time of adoption was 42 months (interquartile range 19.5 to 74 months).

Table 1 Characteristics of the adopted adolescents’ sample.
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The same questionnaires were administered in the four countries to adopted and non-adopted adolescents between 2017 and 2019. Concerning the adoptive group, there were differences in how each country recruited subjects and administered the questionnaire. In France, Italy, and Norway, participants were recruited through the collaboration of international adoption agencies and adoptive parents’ organizations; the enrolled participants were asked to complete an anonymous online self-report questionnaire that was broadcast through an online platform. In Spain, participants were drawn from the “LAIS.US study”, a longitudinal study on child welfare and protection in Spain, and the questionnaire was administered during home visits by trained psychologists. Concerning the methodology of the HBSC 2018 study, all countries and regions participating in HBSC must adhere to a common international standard protocol developed by the HBSC Network (for more details, see Inchley et al., 201837).

Measures

The variables of interest considered for comparing adopted and non-adopted adolescents included the following.

Life satisfaction. Life satisfaction was assessed by Cantril’s Self-Anchoring Ladder Scale10, a reliable self-report instrument for subjective well-being38. Participants were asked to rate their life satisfaction using this visual analog scale (range 0–10): the higher the score, the greater the feeling of life satisfaction. The results were dichotomized as low (score 0–5) and high (score 6–10) life satisfaction39.

Communication with mother and father. Adolescents were asked how easy it is for them to talk to their mother and father about things that really bother them. Response options ranged from 1 = “very easy” to 4 = “very difficult”. Since a fifth option, “I don’t have/don’t see this person”, was included only in the HBSC questionnaire, the 25 subjects who indicated this response were excluded. Findings were dichotomized as very easy/easy or difficult/very difficult37. Then we combined these two dichotomized variables and obtained four categories of adolescents: those who easily talked with both parents, with the father but not with the mother, with the mother and not with the father, and those who did not talk easily with either. Participants who did not answer any one of these items were considered missing.

Family and Friend Support. Participants were asked to respond to the subscales of The Multidimensional Scale of Perceived Social Support40, which assesses perceived social support from family members and friends. Family and friend support subscales include four statements each, separately evaluating family support and friend support on a 7-point Likert scale (from 1 = “very strongly disagree” to 7 = “very strongly agree”). The items are combined into a mean score (only for respondents who have answered all items). Cronbach’s alpha showed a 0.84 and 0.87 internal consistency for family and friend support in the adopted group and 0.93 and 0.94 in the non-adopted group. Using the criteria established by the International HBSC protocol, those who scored equal or more than 5.5 were categorized as high family or friend support, according to the specific subscale39.

Liking school. The study investigated liking school by asking participants, “How do you feel about school at present?” The responses, which ranged from 1 = “I like it a lot” to 4 = “I don’t like it at all,” were dichotomized into “a lot” versus others39.

Data analysis

Descriptive data are shown as absolute numbers and percentages for categorical variables, and medians and interquartile ranges (IQR) for continuous variables. Chi-square and Kruskal-Wallis tests, as appropriate, were used to evaluate significant differences regarding the variables of interest between adopted and non-adopted adolescents, both overall and stratifying by country of residence. Cross-country differences between adopted and non-adopted adolescents were also tested using logistic regression models with each variable of interest as the dependent one, including the interaction between country and adoption status (adopted versus non-adopted).

Multilevel logistic regression models were applied to assess the association between adoption status as the independent variable and life satisfaction as the dependent, dichotomized as low (score 0–5) vs. high (score 6–10). Gender and age were included as covariates, while among the variables of interest mentioned above, only those found to be statistically significant in the multivariable analysis were used. Finally, interactions between adoption status and confounders were considered, retaining those that significantly modified the interest association. The final model (with the best performance criteria) included gender, age, communication with parents (considering mother and/or father as described above), friend support, and the interaction between adoption status and communication with parents. Results were reported as odds ratios (ORs) and 95% confidence intervals (CI). Model goodness of fit was computed with reference to the Brier score (closer to 0 indicates better fit)41 and the Nagelkerke R242. All statistical tests were two-sided, and the level of statistical significance was set at 0.05. All analyses were carried out using R version 4.1.243.

Results

Statistically significant differences were found when comparing the median age at adoption and areas of origin of the adopted adolescents residing in the four countries, in line with differences in the adoption systems and procedures in the four countries (www.commissioneadozioni.it) (Table 1). Survey results, overall and stratified by countries and adoption status, are reported in Table 2. In general, a higher proportion of low life satisfaction was found in the adopted group than in the non-adopted group (25.0% versus 13.2%, p < 0.001); after stratification by country, this difference was significant only in Italy (27.9% versus 14.1%, p < 0.01) and Norway (63.3% versus 16.7%, p < 0.001). A lower proportion of adopted adolescents reported talking easily/very easily to their mother compared to their non-adopted peers (62.9% versus 76.5%, p < 0.01), while liking school “a lot” was more frequent in the adopted group (26.6% versus 15.6%, p < 0.001). These results were consistent across all countries. No significant difference emerged for the other considered variables.

Table 2 Survey results stratified by country and adoption status.
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The final multivariable logistic regression model evaluating the association between adoption status and life satisfaction found that adopted adolescents had a higher risk of low life satisfaction than non-adopted peers (OR = 5.73, 95% CI 2.70–12.16) (Table 3). On the other hand, high levels of friend support were found to be protective against low life satisfaction (OR = 0.34, 95% CI 0.22–0.52), regardless of adoption status. Furthermore, a significant interaction effect between adoption status and ease of communication with parents was observed. In particular, lack of easy communication with both parents emerged as a risk factor for lower life satisfaction, but to a lesser extent for the adoptees than for the non-adopted peers (respectively, OR = 1.67, 95% CI 1.25–11.43 versus OR = 7.56, 95% CI 3.15–18.15, p = 0.003). Among adolescents who did not communicate easily with both parents, the overall risk of low life satisfaction remained higher for adoptees than non-adopted peers (OR = 9.57, 95% CI 4.38–21.43 versus OR = 7.56, 95% CI 3.15–18.15). However, this difference is not statistically significant. Moreover, an Intraclass Correlation Coefficient (ICC) of 10% indicated that approximately 10% of the total variance was attributable to the differences between the four countries. The variables entered into the model explained 18.6% of the variance of low life satisfaction (Nagelkerke R2 = 0.186). Brier score equals 0.13, indicating an overall good accuracy of the model.

Table 3 Adoption status and life satisfaction: multilevel logistic regression model’s odds ratios (ORs), 95% confidence interval (95%CI), and p-values (p).
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Discussion

The present research investigated life satisfaction in a carefully matched cohort of internationally adopted and non-adopted peers, considering ease of communication with mother and father, family and friend support, liking school, and country of residence.

Overall, our findings suggest that adolescence is a more challenging developmental period for international adoptees than for non-adopted adolescents, consistent with several studies1,2 that showed significantly lower levels of perceived psychosocial adjustment among adoptees than among non-adopted peers. While these previous studies focused on the negative outcomes, the present one shifts the focus to the adolescents’ perceptions of their well-being and explores variations across different cross-cultural and social contexts in four European countries.

Internationally adopted adolescents were more likely to report low life satisfaction than non-adopted peers, with similar patterns across the four countries. However, part of the variability in low life satisfaction, which emerged in our multivariable analysis, can be attributed to differences between countries. Although the four countries share similar socio-demographic and economic characteristics44, they also have important cultural differences. Gender equality, for example, which is usually higher in Scandinavian countries, has been positively associated with life satisfaction among adults and reflexively also among adolescents through supportive social relationships in family, peer, and school contexts17. Our findings revealed that life satisfaction was notably low among adopted adolescents in Norway, aligning with studies that emphasize adoption-related issues of identity and belonging, loneliness, and mental health struggles faced by Norwegian international adoptees45,46.

This study also provides a deeper understanding of the family and social relationships that account for differences in adolescents’ well-being. Both internationally adopted and non-adopted adolescents reported similar levels of high family support. This finding is consistent with other studies and confirms the existence of positive resources within the adoptive family context14,31. Across the four countries, father-child communication was similar between adopted and non-adopted adolescents, in contrast to other studies which found better father-child communication for adoptees than for non-adoptees24. The results also showed that fewer adopted adolescents talk easily with their mothers compared to non-adopted peers, suggesting that the mother-child relationship may be a critical issue for adoptees. Nevertheless, the present research showed that communication within the family can be seen as a key pivotal factor that significantly influences adolescents’ life satisfaction. Regardless of the adoption status, adolescents who reported more difficulty in communicating with both mother and father were at higher risk of low life satisfaction. However, among adopted adolescents, ease of communication with only the mother or neither parent was associated with an increased risk of low life satisfaction, although this risk was even higher among non-adopted peers. We can suppose that poor family communication leads to an increased risk among adoptees, although not an excessive one, as they are already at a higher risk of experiencing low life satisfaction. We might infer the existence of a kind of ceiling effect.

Regarding the social context, the adopted group showed similar perceptions of friend support to their non-adopted peers but a higher proportion of “liking school a lot”. While previous studies of adoptees’ school experiences have focused on the behavioral and emotional outcomes and academic achievement of school-age children, showing an educational disadvantage and gaps in educational attainment between adopted and non-adopted children47, this study is the first to report on adoptees’ perceptions of school satisfaction. This finding, which highlights adoption as a potential source of growth and resilience rather than a risk, is consistent with previous evidence. Although some studies have suggested that adoptees face some challenges in everyday life in the school context31,33, other studies have reported some areas (e.g., being less withdrawn, less overtly aggressive toward peers, less likely to be classified as bullies than comparison youth, and exhibiting more prosocial behavior) where adoptees appeared to have better levels of adjustment than non-adopted youth33,34,48,49. Unfortunately, we did not investigate which factors are associated with satisfaction with school placement; therefore, our arguments are speculative.

Our results also suggested that friend support was a crucial protective factor in reducing the risk of low life satisfaction for adoptees and non-adoptees across the four countries. This finding, in line with previous research35, underlined the relevance of peer relationships for internationally adopted adolescents and pointed out the crucial role of friend support for adoptees’ overall health.

Finally, in agreement with the literature, the results of our analysis reported an increased risk of low life satisfaction in girls and as age increases, although not reaching statistical significance. We can hypothesize that factors such as adoptive status, social support, and communication play a more prominent role in life satisfaction, potentially outweighing the effect of gender and age.

There are some limitations to this study. The first significant limitation relates to the data collection (recruitment procedure and survey administration) used in the adopted and non-adopted groups. Non-adopted adolescents completed their questionnaires at school, whereas adoptees mostly answered online. A second limitation of this study is that many of the adoptive families were self-selected, so the resulting sample could not fully represent the population of international adoptees. Moreover, socioeconomic status (SES), which could be a confounder in the association evaluated in our study, could not be considered in the analyses because SES-related items were not included in the GEAR survey. Given these limitations, similarities or differences between countries should be interpreted cautiously. In addition, the current findings may depend on the type of adoption considered, and future research should replicate this study to better investigate the potential differences between adopted and non-adopted groups, considering different types of adoption, such as domestic and international, early and late adoption. Finally, the use of longitudinal study designs could provide additional valuable information. Analyzing how it evolves would contribute to a more accurate picture of adolescents’ psychological well-being.

Conclusion

The findings of this study extend the current understanding of the impact of the adoption status on adolescent perceived life satisfaction, accounting for the potential mechanisms of relationships that involve the perceived support in family, peer, and school contexts whilst controlling for gender and age. The results showed that internationally adopted adolescents were more likely to report low life satisfaction than non-adopted peers, with similar patterns across France, Italy, Norway, and Spain. However, some cross-national differences emerged, which aligns with existing literature that recognizes the influence of social and cultural context on adolescents’ life satisfaction, especially adoptees. Our findings confirm that key resources in the family and social environment are crucial in deeply and positively affecting adolescent life satisfaction regardless of the adoptive status.

Implications

Prevention and intervention programs that aim to improve adolescents’ well-being can be enhanced by including strategies to help them achieve and maintain high-quality interpersonal relationships and supportive environments in all contexts (family, peers, and school).

Moreover, parent enrichment interventions should be implemented and widely disseminated to support adoptive families in fully utilizing their numerous resources. Since difficulties in parent-child communication negatively influence adolescents’ well-being, it would be desirable for adoptive parent interventions to focus on competencies related to their adoption history, such as openness in communication about adoption-specific issues, disclosure of emotions linked to multiple adoption-related losses, and trauma-based competencies. Finally, developing and promoting a culture of inclusion and understanding around adoption remains critical for maximizing the resilience of adoptees.