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Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century

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Abstract

The objectives of the study are (i) to describe and compare the epidemiology of emotional/behavioral problems and associated risk/protective factors among nationally representative samples of institutionally reared and similarly aged community-based adolescents brought up in their natural homes by means of youth self-reports, caregiver/parent, and teacher informants; and (ii) to identify mental health service needs and utilization. A cross-sectional survey was conducted between November 2005 through April 2006 using an equal probability cluster sample of 11–18 year old adolescents in institutional care settings (N = 350; 163 males, 187 females) and results were compared with similarly aged community sample of youth living in their natural homes (N = 2,206). The Sociodemographic Information Form, Youth Self Report (YSR), Child Behavior Checklist (CBCL) by caregivers for institutional sample and parents for the community sample, and Teacher’s Report Form (TRF) were used to obtain standardized data on demographic characteristics, emotional/behavioral problems, and risk/protective factors. The prevalence of problems behaviors by YSR, caregiver/parent CBCL, and TRF were: 47, 15.1, 20.5% for the institutional versus 10.1, 7.5 and, 9.5% for the community samples, respectively (p < 0.05). Youth self-reports were fourfold, and all informant reports were twofold higher for institutional versus community comparisons. Furthermore, institutional sample had consistently higher rates, not only of Externalizing, but Internalizing, Social Problems, Attention Problems, and Thought Problems, as well as discrete DSM-oriented scales, suggesting that labeling of institutional youth as simply aggressive and delinquent contributes to their further marginalization and does not comprehensively address their mental health needs. In terms of protective factors, we found that: perceived social support, high competency scores, supportive caregiving, getting along well with peers and relatives (positive relationships), and problem solving skills were significantly protective of mental health. On the other hand fatalistic beliefs, cigarette and alcohol use were significantly associated with increased risk for problem behaviors (p < 0.05). The primary reason for institutional placement was family disruption (68.9%), poverty (15.7%), abandonment (8.4%), and physical or sexual abuse (5.4%). Only 31.2% of the youth were in fact true orphans (loss of one or both parents). It is therefore remarkable that in terms of service use, despite consistently high prevalence of problem behaviors across all informant sources, only 2.4% of the youth had received any speciality mental health services during institutional care. In conclusion, there is a pressing need to transform the social and health care policy and to provide family and community-based alternatives for youth currently in institutional care in Turkey. Before this goal is achieved, it is necessary to address their mental health needs urgently and comprehensively. The highest rates of problems by youth self-report also support the view that the youths’ own voices ought to be heard and need to inform the reform process regarding their future care.

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Acknowledgments

We would like to express our gratitude to the Social Services and Child Protection General Directorate’ staff, caregivers, teachers, and the youth themselves who gave up time for interviews and completing the forms for the implementation of this study. Our sincere thanks to Tom Achenbach for his invaluable comments and suggestions. This study was supported by an in-country research award by the Fogarty/NIH ICOHRTA grant D43 TWO5807 (K.M.).

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, School of Medicine, Ankara University, Ankara, Turkey

    Nese Erol

  2. Department of Public Health, School of Medicine, Harran University, Sanlıurfa, Turkey

    Zeynep Simsek

  3. Division of Developmental Medicine, Department of Psychiatry, The Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Kerim Münir

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  1. Nese Erol
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  2. Zeynep Simsek
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Correspondence to Nese Erol.

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Erol, N., Simsek, Z. & Münir, K. Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century. Eur Child Adolesc Psychiatry 19, 113–124 (2010). https://doi.org/10.1007/s00787-009-0047-2

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