Table 4

Adjusted HRs and 95% CIs examining impact of additional potential confounders of the relationship between care environment and mental health diagnoses

		Factors potentially associated with both exposure and outcome (potential confounders)
	Overall	Social support	Basic material possessions	Importance of religion	Time in nature
	PTSD
Care environment (FBC (ref))	1	1	1	1	1
Institution	0.57 (0.48–0.68)	0.60 (0.51–0.71)	0.66 (0.36–1.21)	0.62 (0.37–1.05)	0.60 (0.36–1.02)
Social support		0.73 (0.72–0.73)
All 3 basic material possessions			0.72 (0.45–1.13)
Importance of religion (Most/Very)				0.72 (0.59–0.88)
Spends time in nature					0.86 (0.42–1.78)
	Depression
Care environment (FBC (ref))	1	1	1	1	1
Institution	0.29 (0.13–0.64)	0.30 (0.15–0.61)	0.33 (0.11–0.94)	0.28 (0.08–0.97)	0.25 (0.08–0.78)
Social support		0.67 (0.48–0.94)
All 3 basic material possessions			0.57 (0.49–0.66)
Importance of religion (Most/Very)				0.47 (0.47–0.48)
Spends time in nature					0.78 (0.26–2.30)
	Anxiety
Care environment (FBC (ref))	1	1	1	1	1
Institution	0.69 (0.68–0.70)	0.69 (0.66–0.71)	0.75 (0.68–0.82)	0.72 (0.70–0.75)	0.70 (0.67–0.73)
Social support		0.83 (0.57–1.23)
All 3 basic material possessions			0.70 (0.40–1.24)
Importance of religion (Most/Very)				0.43 (0.37–0.51)
Spends time in nature					0.89 (0.64–1.25)
	Suicidality
Care environment (FBC (ref))		1	1	1	1
Institution	0.52 (0.39–0.70)	0.57 (0.47–0.68)	0.61 (0.43–0.86)	0.50 (0.35–0.72)	0.49 (0.36–0.66)
Social support		0.73 (0.71–0.74)
All 3 basic material possessions			0.44 (0.36–0.55)
Importance of religion (Most/Very)				0.51 (0.44–0.58)
Spends time in nature					0.88 (0.57–1.36)

Adjusted for age, sex, orphan status, length of time in care environment, PTSD/depression/anxiety/suicidality at baseline, emotional/physical/sexual abuse at baseline and during follow-up, bullied at baseline and during follow-up, clustering by household/institution.
FBC, family-based care; PTSD, post-traumatic stress disorder.