Risk and protective factors for depression and substance use in an adolescent child welfare sample

doi:10.1016/j.childyouth.2011.06.019

Children and Youth Services Review

Volume 33, Issue 11, November 2011, Pages 2127-2137

https://doi.org/10.1016/j.childyouth.2011.06.019 Get rights and content

Abstract

Research on the mental health needs of maltreated youth in out-of-home care remains limited. The goal of the current study was to examine two common mental health concerns (i.e., depression, substance use) among 122 12–15 year olds in out-of-home placements. Specifically, we investigated potential risk and protective factors among socio-demographic, maltreatment, youth, family, and community variables. We relied on data collected through the AAR-C2, a Canadian needs assessment and outcome monitoring tool. Approximately 4 in 10 (39.2%) youth endorsed at least one mental health problem, which we defined as the youth scoring at least one standard deviation above the sample mean for the depression items and the youth indicating the presence of alcohol and/or substance use over the past year. Almost 1 in 10 (8.3%) reported struggling with both mental health issues. Results from logistic regressions indicated that adolescent females were at higher risk of experiencing depression than males, and increasing age was associated with increased risk for substance use. Turning to protective factors, results indicated that the greater the perceived quality of the youth–caregiver relationship, the lower the risk for mental health difficulties (i.e., depression, substance use). Moreover, participation in extracurricular activities appeared to protect youth against depression or substance use. Results imply that the youth–caregiver relationship and involvement in extracurricular activities are important areas to consider to promote the well-being of maltreated youth in out-of-home care.

Research highlights

► We examine correlates of depression and substance use in a child welfare sample. ► Higher quality relationships among female caregivers and adolescents are protective. ► Involvement in extracurricular activities also contributes to resilience. ► Adolescent females are at higher risk of experiencing depression than males. ► Increasing age is associated with increased risk for substance use.

Introduction

Youth in out-of-home care because of maltreatment experiences are at risk for impairments in mental health functioning yet many also exhibit resilience in that they are functioning well despite adverse past experiences (Compas et al., 1989, Legault et al., 2006, Reams, 1999). The present study examined the associations of maltreatment-, demographic-, youth-, and family-related variables on mental health functioning. Two mental health indicators, namely depressive symptoms and substance use, were examined in a high-risk sample of 12–15 year old males and females who were in the child welfare system because of family violence experiences which compromised their safety within the home.

Section snippets

Canadian child welfare system

The Canadian child welfare system is based on provincial legislation which requires that legally-mandated agencies responsible for child protection (i.e., Children's Aid Societies) respond accordingly in cases of suspected child abuse and neglect. The most recent statistics from 2009/10 indicate that Ontario received 161,819 reports from concerned community members regarding the welfare of children aged 0–15 years (Ontario Association of Children's Aid Societies, 2011). Responses to a report of

Incidence of child maltreatment

The most comprehensive information about the reasons youth come into contact with child welfare can be found in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS), which currently has three data collection cycles (1998, 2003, 2008; Trocmé et al., 2010). In Ontario, the most recent data can be found in the 2003 Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2003; Fallon et al., 2005), which used CIS data collected in 2003 but also augmented the sample size.

Child maltreatment outcomes in child welfare populations

Numerous studies have examined child maltreatment outcomes and have found that it is linked with many deleterious effects, including anxiety, mood, and disruptive problems (e.g., Hildyard and Wolfe, 2002, Springer et al., 2007, Douglas et al., 2010). Within the child welfare population, research indicates that these youth are at increased risk of psychological maladjustment (Compas et al., 1989, Reams, 1999). For example, the OIS-2003 found that in almost half of all investigations, there was

Risk and protective factors

While youth in care who have experienced maltreatment often are at risk for deleterious outcomes, many effectively manage their difficulties and demonstrate resilience in the face of adversity. Masten (2001) defined resilience as “good outcomes in spite of serious threats to adaptation and development” (p. 228). Resilience has been the focus of child welfare research for decades as researchers have been interested in identifying both risk and protective factors for maltreated youth. Different

Study objectives

Research focusing on youth placed in out-of-home care has been growing in the past few years. The goal of this study was to add to the growing research by examining risk and protective factors associated with depression and substance use. While these are common mental health concerns among maltreated youth, they have received limited attention among high-risk populations such as maltreated youth who have been removed from their home. This study focused on the early to middle adolescent period

Sample and procedure

The sample consisted of 122 youth aged 12–15 years who had been in the care of a child welfare agency in the province of Ontario (Canada) for at least one year. Information for participants was drawn from cycles 6 (June 2006–July 2007) and 7 (June 2007–July 2008) of the Ontario Looking After Children (OnLac) project. The OnLAC project, which is supported by the Ontario Ministry of Children and Youth Services (MCYS), aims to better serve the child welfare population by assessing the needs and

Sample description

Table 1 indicates that the sample was evenly divided between sexes, and the average age was approximately 14 years. Most adolescents described themselves as Canadian (38%), followed by French (15%) and English (8%). The average age of the first child welfare placement was about 9 years, and the majority maintained contact with their birth family. Youth had been removed from their home primarily because of neglect (27%), followed by emotional harm (24%), physical harm (17%), other reasons (17%),

Discussion

While previous studies have examined depression and substance use in the general population as well as in child welfare samples, few have examined the association between both outcomes in a child welfare population who have been in out-of-home care for an extended period of time due to adverse life experiences. Our study revealed several variables to be significantly associated with youth positive and negative outcomes.

Although our sample of young adolescents had all experienced maltreatment

Limitations

When considering these results, certain limitations need to be taken into account concerning the methodology. They include non-random sampling and a cross-sectional design, which limits the possibility of making causal inferences on the nature of relationships. Another limitation includes our small sample size of 122 participants. Also, the AAR-C2 was not created to clinically assess depression and substance use; therefore, our assessment of these outcomes is not based on a diagnostic tool.

Conclusions

A higher-quality relationship with female caregivers appears to be related to better outcomes for youth in out-of-home care, at least in the area of depressive symptomatology. A nurturing caregiver provides a safe and predictable environment for youth who are removed from turbulent environments (Drapeau et al., 2007, Griffin et al., 1999, Lynskey and Fergusson, 1997, Masten and Reed, 2002, Wall and Kohl, 2007). Nurturing caregivers are the foundation for positive adaptation for youth in new

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Citation Excerpt :
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Risk and protective factors for depression and substance use in an adolescent child welfare sample

Abstract

Research highlights

Introduction

Section snippets

Canadian child welfare system

Incidence of child maltreatment

Child maltreatment outcomes in child welfare populations

Risk and protective factors

Study objectives

Sample and procedure

Sample description

Discussion

Limitations

Conclusions

Journal of the American Academy of Child and Adolescent Psychiatry

Addictive Behaviors

Journal of Adolescence

Child Abuse & Neglect

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of the American Academy of Child and Adolescent Psychiatry

Children and Youth Services Review

Child Abuse & Neglect

Child Abuse & Neglect

Children and Youth Services Review

Child Abuse & Neglect

Child Abuse & Neglect

Children and Youth Services Review

Journal of Substance Abuse

Child Abuse & Neglect

Child Abuse & Neglect

Substance involvement among youths in child welfare: The role of common and unique risk factors

The American Journal of Orthopsychiatry

Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization

The Journal of Clinical Psychiatry

A dispositional and situational assessment of children's coping: Testing alternative models of coping

Journal of Personality

Risk and resilience in young Londoners

Risk factors for emotional/behavioral problems in young adolescents: A prospective analysis of adolescent and parental stress and symptoms

Journal of Consulting and Clinical Psychology

Does out-of-home placement mediate the relationship between child maltreatment and adult criminality?

Child Maltreatment

Adolescent depression, alcohol and drug use

American Journal of Public Health