Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

Abstract

While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3–17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6–66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33–2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study

“…Our results are consistent with the findings of previous meta-analyses of mental disorders among adolescents in the juvenile justice system [13] and adolescents placed by the child welfare system [11], and these rates are far higher compared to a pooled prevalence rate (13%) for any mental disorder among children and adolescents in the general population [12]. In the present study, the prevalence rate of 86% for any mental disorder among the total sample in adulthood (child welfare: 83%; juvenile justice: 94%) is higher than in a recent meta-analysis of mental disorders in adults formerly placed in out-of-home care by child welfare or juvenile justice authorities [35], and also far higher than a pooled prevalence rate of 18% for any mental disorder in the general adult population [68]. The high prevalence rates found in the present study may be due to the inclusion of both child welfare and juvenile justice youths.…”

“…Previous studies have revealed that older youths in foster care show disproportionally high rates of lifetime and past-year psychiatric disorders [e.g., 34], and adults with a history of child welfare out-of-home care showed a prevalence rate of 30% for any mental disorder [35].…”

“…It is acknowledged that out-of-home placed youths often face various challenges related to mental disorders in their transition from in-care to out-of-care, often when they turn 18 and have to leave out-of-home care in the transition to young adulthood (e.g., homelessness, adult mental health issues, or unemployment; [6,[31][32][33]). Previous studies have revealed that older youths in foster care show disproportionally high rates of lifetime and pastyear psychiatric disorders (e.g., [34]), and adults with a history of child welfare out-of-home care showed a prevalence rate of 30% for any mental disorder [35]. Similarly, prospective and retrospective studies have emphasized that adolescents who were placed within the juvenile justice system suffer from multiple mental health problems in young adulthood [36,37]; adults with a juvenile justice placement history showed an even higher rate of 45% for any mental disorder in adulthood [35].…”

Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample

“…Another strength of the current study is the long follow-up interval of 10 years. This is noteworthy given that young-adult care leavers (i.e., juveniles who left residential care or juvenile-justice institutions) are often difficult to locate, since many live in rather unstable and changing circumstances ( 65 ) or suffer from severe mental-health disorders ( 66 ).…”

Sources and Types of Social Supports and Their Association with Mental Health Symptoms and Life Satisfaction among Young Adults with a History of Out-of-Home Care

“…The impact of the care experience, especially the type of care placement, in mitigating or increasing mental health problems is not yet fully understood [8]. Development of mental health problems in childhood and adolescence can continue into later life [9], although there is also evidence of stabilization in positive behavioral adjustment [10]. Mental health problems are also associated with a range of other adverse outcomes, notably lower levels of educational attainment and engagement [11,12].…”