Mental Health Disorders Among Children in Foster Care

This week we will be discussing a review article published in July 2020 in the Sage Journal of Trauma, Violence, and Abuse. In this article, titled “A Systematic Review of Mental Health Disorders of Children in Foster Care”, authors Engler, Kwabena, Sarpong, Van Horne, Greeley, and Keefe summarize the rate of mental health disorders among children in foster care, the specific types of disorders faced by children in foster care, and how various factors can affect mental health outcomes.

Why did they do it?

According to the Child Healthcare Information Gateway’s 2019 report, there are more than 425,000 children currently in foster care. There are various types of foster care settings (e.g., family homes, group homes, etc.), and across them all, previous research has demonstrated that children in foster care exhibit significantly higher rates of mental health symptoms and disorders compared to the general population. Existing literature suggests that children in foster care are up to 4 times as likely to have at least one mental health disorder compared to children who are not in foster care, regardless of socioeconomic status. 

Given this particularly elevated risk, the authors of this review sought to examine published data that has examined mental health problems faced by children in foster care. Their aim was to provide insight regarding important factors that can affect mental health outcomes. 

How did they do it?

Through a comprehensive literature search, the authors screened 5,042 manuscripts for inclusion based on title and abstract. This eventually yielded 25 articles to be included in the review. The inclusion criteria included the following: articles published in or after 2000, written in English text, and evaluating a sample of children in foster care in the Western countries (i.e., United States, Norway, Australia, and Canada). Of the 25 included articles, seventeen of the articles presented original research, and eight of the articles were literature reviews. 

What did they find?

Overall, the authors were able to identify three primary themes regarding the mental health of children in foster care. First, children in foster care have higher overall rates of mental health disorders compared to children who are not in foster care. The most common diagnoses for children in foster care appear to be oppositional defiant disorder/conduct disorder, major depressive disorder, post-traumatic stress disorder (PTSD), and reactive attachment disorder. Studies reported that as few as 32% and as many as 80% of children in foster care were diagnosed with a mental illness.  It was also concluded that the foster care population has a high rate of comorbidity, with 30.4% of children in foster care being diagnosed with two or three mental disorders (e.g., depression, anxiety, ADHD, and/or a different behavioral disorder).

Second, children in foster care have higher rates of suicidality. One specific finding described the likelihood of suicidal ideation as increasing by 68% each time a child experienced a placement in out-of-home care, conveying the importance of screening for and accurately diagnosing psychiatric disorders such as depression in this vulnerable population.

Finally, the rate and types of mental health disorders among children in foster care can vary based on numerous factors such as the type of maltreatment experienced, placement variables, and other factors unique to children in foster care. Neglect, physical abuse, and sexual abuse were the most common types of maltreatment experienced by children in foster care, and these experiences were found to be the largest overall predictor of mental illness in children in foster care. Relative to the effects of placement variables, the results were slightly mixed, with some studies reporting that a higher number of placements within the foster care system was correlated with increased risk of poor mental health outcomes. However, two studies included in the review found that there was no effect of the number of placements on mental health disorders, suggesting that this relationship should be further examined. Type of placement, however, was found to affect mental health outcomes across studies, with children placed in a group home having clinically significant depressive symptoms at 4.6 times the rate of children who were living with a relative in kinship care. Additionally, the children in a group home experienced suicidal ideation at 7.25 times the rate of those in kinship care. 

For other informative facts, we encourage you to go take a look at this article yourself!

What does it all mean (our take)?

We want to start by thanking the authors for completing this work. While the conclusions in this review are non-directional (i.e., they don’t indicate that foster care causes mental illness in children), they provide a staggering indication of the impact of trauma on mental illness in children. And even more, while trauma in many cases may initiate maladaptive response, it is critical to better manage what happens after a trauma occurs to potentially help mitigate any potential challenges experienced by these children. 

Thorough evaluation of foster caregivers is crucial; helping to educate and train these individuals on childhood trauma, its residual impact, and how to manage downstream effects of trauma will likely provide a way to turn the foster care setting into a more therapeutic and problem-reducing environment.