ARTICLES
Prevalence of Psychiatric Disorders Among Older Youths in the Foster Care System

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ABSTRACT

Objective:

To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates.

Method:

Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003.

Results:

Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families.

Conclusions:

Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.

Section snippets

Participants

From December 2001 to May 2003, the Missouri Division of Family Services (MDFS) provided to the research team the names and caseworkers of youths from eight Missouri counties who would be turning age 17 in the following month and were in the custody and care of the Division. The eight counties included the six in and around St. Louis and two in southwest Missouri added to make the sample more ethnically representative of youths in the state's foster care system. These counties represent 7 of

RESULTS

Table 1 provides descriptive information on the study's 373 participants. The mean (±SD) age of the sample was 16.99 (±0.09) years. Youths entered the foster care system for the first time at the mean age of 10.61 (±4.50) years. It was more common for youths to report two or more types of maltreatment than one type alone. Seventy-five percent of youths who had been physically neglected, and 77% of those who had been sexually or physically abused also reported another maltreatment type.

DISCUSSION

Findings from this study suggest that older youths in the foster care system have a disproportionately high rate of psychiatric disorders, and for many, the onset of at least one disorder begins before entry into the foster care system. Compared with a sample of working-class 18-year-old youths in the community (Reinherz et al., 1993), the youths in this study had prevalence rates of major depression three times greater and rates of PTSD two times greater. Rates of disruptive behavioral

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    This study was funded by a grant from the NIMH (R01 MH 61404).

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    Copyright © 2005 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.