The Development of Mental Health Problems Among Out-of-Home Placed Children and Adolescents Into Adulthood: A Longitudinal Prospective Study

Theoretical background: Children and adolescents who live or have lived in residential out-of-home care represent a psychologically highly burdened sample. Although previous studies showed that mental health problems may evolve during residential out-of-home care, findings regarding the trajectory of such mental health problems in young adulthood remain inconclusive. Objective: The present study has two objectives: (a) to examine the prevalence and course of mental health problems among children and adolescents in residential out-of-home care from childhood/adolescence to young adulthood; (b) to identify possible predictors during childhood/adolescence associated with mental health problems in adulthood. Method: We longitudinally assessed a total of 164 children and adolescents in residential out-of-home at baseline (mean age = 15.4 years; 32.1% female) and at a 10-year follow-up (mean age = 25.60 years) after leaving residential out-of-home care. Mental health problems were assessed with self-report questionnaires using the Achenbach System of Empirically Based Assessment (ASEBA) scales (i. e., Youth Self-Report [YSR] and the Young Adult Self-Report [YASR]). Statistical methods included descriptive data and linear regression analyses. Results: First, white 46.2% of participants had scores above the cut-off on the internalizing problems scale in childhood/adolescence, only 36.4% of the participants did so in young adulthood. Second. 58.7% of participants showed scores above the cut-off on the externalizing problems scale in childhood/adolescence, while only 26.6% had scores above the cut-off in young adulthood. Third, 62.2 % of children and adolescents had scores above the cut-off on the total problems scale, whereas only 35.7% of participants also showed scores above the cut-off in young adulthood. The results reveal a significant reduction in mental health problems from childhood/adolescence to young adulthood (moderate effect sizes). Moreover, 29.4% of children and adolescents showed persistence of mental health problems into young adulthood, whereas 31.5% of participants did not report any noteworthy mental health problems during childhood/adolescence and young adulthood. The latter group (persistent low) showed significantly less psychopathic traits than the former group (persistent high). The strongest predictors of mental health problems in adulthood were similar mental health problems in childhood/adolescence on the respective scales. Finally, girls had a higher risk of higher internalizing problems in young adulthood than boys. Discussion and conclusion: The findings of the present study showed a reduction in mental health problems among children and adolescents in residential out-of-home care from childhood/adolescence to young adulthood. However, almost one-third of these youths showed a persistent trajectory of mental health problems. More research is needed to implement evidence-based interventions and out-of-home care to further support a successful transition to an independent adult life.

Automated summary

The present study aimed to examine the prevalence and trajectory of mental health problems among children and adolescents in residential out-of-home care from childhood/adolescence to young adulthood. The results showed a significant reduction in mental health problems over time, but approximately one-third of the participants still experienced persistent mental health issues. Childhood/adolescent mental health problems were strong predictors of mental health problems in adulthood. Girls had a higher risk of internalizing problems in young adulthood compared to boys.