Mental Disorders Among Out-of-Home Placed Children and Adolescents Into Adulthood: A Multimodal Approach

Out-of-home placed children and adolescents have experienced high rates of psychosocial burden and mental disorders. These disadvantages can persist after leaving care. To date, the development of mental disorders from childhood and adolescence into adulthood in this high-risk population remains unclear. At the intersection of epidemiology, developmental psychopathology, and child welfare, the aim of the present cumulative dissertation was to enrich existing research on the development of mental disorders from adolescence into adulthood among out-of-home placed individuals.
In Study I, the data relied on the Swiss MAZ. study. The aim was to examine the relationship between childhood adversities, impulsive behavior, and substance-use disorders among child welfare and juvenile justice placed adolescents in residential care with a cross-sectional approach. The results showed that impulsive behavior was the strongest factor associated with substance-use disorders in the multivariate regression analyses for both samples. In Study II, the objective was to use a meta-analytic approach to provide an overview of prevalence rates of mental disorders among adults formerly in child welfare and juvenile justice out-of-home care. The pooled prevalence rates demonstrated that one third of adults formerly in child welfare out-of-home care and almost half of adults with a juvenile justice placement history showed any mental disorder, which was higher than in the general population. In Study III, the data was obtained from the longitudinal Swiss MAZ.-JAEL study. The goal was to investigate the development into adulthood of mental disorders among child welfare and juvenile justice placed adolescents in residential care. The structural equation modeling revealed a stable relationship between adolescent and adult general psychopathology in both samples.
Treating impulsive behavior and incorporating trauma-informed care may reduce substance-use disorders among adolescents in residential care. Given the stability of general psychopathology from adolescence into adulthood, transitional psychiatry and child welfare face the challenge of refining ongoing mental health services for mentally distressed adolescents both in out-of-home care and after leaving it. More longitudinal research on larger samples of child welfare and juvenile justice placed youths in the transition to an independent adult life is needed to estimate rates of mental disorders with standardized assessments and quality characteristics of care, and thus to reach conclusive findings about the trajectories of specific disorders.