Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: five decades of follow-up of members of the 1958 birth cohort study

Abstract

BackgroundChildren who have been exposed to public (out-of-home) care experience a range of negative outcomes by late adolescence and early adulthood. The longer-term impact of childhood care is, however, uncertain.AimTo examine if there is a prospective association between childhood public care and adverse life outcomes in middle-age.MethodsWe used data from the UK 1958 birth cohort study of 18 558 individuals. Parents reported offspring care status at age 7, 11 and 16. An array of social, criminal, cognitive, and health outcomes was self-reported by cohort members at age 42 (71% response proportion in eligible sample) and a cognitive test battery was administered at age 50 (62% response).ResultsA total of 420 (3.8%) of 11 160 people in the analytical sample experienced childhood public care by age 16. Net of confounding factors, experience of public care (vs none) was linked to 11 of the 28 non-mutually exclusive endpoints captured in middle-age, with the most consistent effects apparent for psychosocial characteristics: 4/7 sociodemographic (eg, odds ratio; 95% confidence interval for homelessness: 2.1; 1.4 to 3.1); 2/2 antisocial (eg, use of illicit drug: 2.0; 1.2 to 3.5); 2/3 psychological (eg, mental distress: 1.6; 1.2 to 2.1); 1/3 health behaviours (eg, current cigarette smoker: 1.7; 1.3 to 2.2); 2/8 somatic health (physical disability: 2.7; 1.9 to 3.8); and 0/5 cognitive function (eg, beta coefficient; 95% confidence interval for immediate word recall: −0.1; −0.3 to 0.1) endpoints.ConclusionsThe present study suggests that selected associations apparent between childhood care and outcomes in adolescence and early adulthood are also evident in middle-age.

Does the trauma associated with out-of-home care transmit across generations? Evidence from the 1970 British Cohort Study during a major health pandemic

“…This study suggests that the direct experience of OHC is associated with long-term negative outcomes across a range of domains, including mental and general health, and feelings of having no control over one’s life. The findings confirm previous evidence showing that inequalities associated with OHC are also present in midlife, 10 18 and spill over across multiple domains. The findings underline the case of extending the support to care leavers into the adult years, enabling them to integrate into society through employment and by establishing committed social and emotional relationships.…”

“…Other outcomes, such as feelings of loneliness and not having someone to listen to one’s problems, however, were fully explained by the indicators of childhood or current socio-economic circumstances included in our models. Confirming previous findings,4–6 8–11 we show that the experience of OHC is associated with disadvantaged family background, low qualification levels, unemployment and living alone in adult life, as well as poor mental and general health. However, we find little evidence to support the assumption of intergenerational transmission of trauma, except regarding poor adult mental health before the pandemic among children of care leaver mothers (OHC2).…”

“…This includes unstable relationships,1–3 poorer mental and physical health 4 5. These outcomes often occur in conjunction with low-level qualifications,6–10 unemployment and a more disadvantaged socioeconomic position 11 12. While there is increasing evidence on outcomes of care leavers in young adulthood up to age 30,8 9 13–16 only few studies extend their focus to mid adulthood 10 17 18.…”

“…These outcomes often occur in conjunction with low-level qualifications,6–10 unemployment and a more disadvantaged socioeconomic position 11 12. While there is increasing evidence on outcomes of care leavers in young adulthood up to age 30,8 9 13–16 only few studies extend their focus to mid adulthood 10 17 18. Less is known about whether disadvantage continues into the second generation, or about the experiences of care leavers during the COVID-19 pandemic 19 20…”

State care in childhood and adult mortality: a systematic review and meta-analysis of prospective cohort studies

“…In the short term, children in substitute care tend to perform less well academically, 11,12 are more prone to permanent school exclusion, 13 are more likely to engage in illicit drug taking, 14 and have a higher prevalence of a range of psychiatric disorders, than their unexposed peers. 15 As looked-after children transition to independent living in early adulthood, there is a suggestion that mental health problems continue, 13,16,17 in addition to there being an increased likelihood of socioeconomic disadvantage, 17,18 homelessness, 19 and engagement in harmful health behaviours. 17,20 The burden of risk ascribed to these unfavourable characteristics raises the possibility that exposure to state care in childhood might be associated with an elevated occurrence of physical health problems later in the life course, most obviously in terms of total mortality, cardiovascular disease, and selected cancers.…”