Prevalence rate of DSM mental disorders among adolescents living in residential group homes of the French Child Welfare System
Research highlights
► Determine the prevalence of mental disorders among adolescents involved in the Child Welfare. ► These Adolescents presents much more mental disorders than general population at same age. ► First study about this subject in France/ Improvement of screening and curing these population is needed.
Introduction
In France, more than 250,000 children are involved with the Child Welfare System. Half of them are 13 to 17-year-old adolescents. Almost 135,000 are placed in out-of-home care, a half in foster care homes, and the other half in residential group homes (Bailleau & Trespeux, 2008).
Literature focusing on the mental health of children involved with the child welfare system highlights the fact that they are very vulnerable. They generally have significantly dysfunctional families. Family dysfunction is clearly recognized as a factor associated with the development of emotional and behavioral disorders among children and adolescents (Cicchetti and Toth, 1998, Dadds and Barrett, 1996). McMillen, Zima, Scott et al. (2005) assessed the prevalence of mental disorders in the population of youths over 17 years old that was in the foster care system in the state of Missouri (USA): 62% had experienced a mental disorder in their lifetimes and 37% had experience such a disorder in the past year. In California (USA), Garland, Hough, McCabe et al. (2001) estimated the mental disorder prevalence rate at 42% in children involved in the Child Welfare System. McCann, James, Wilson, and Dunn (1996) found that 67% of children in the English child welfare department had a psychiatric disorder diagnosis. In Scotland, Minnis, Everett, and Pilosi (2006) found that 60% of children placed in foster care showed signs of psychiatric problems. In Pennsylvania (USA), Harman, Childs, and Kelleher (2000) reported that children in foster care were 3 to 10 times more likely to receive a psychiatric diagnosis. In a recent study Schmid, Goldbeck, Nuetzel, and Fegert (2008) found prevalence rate around 60% among adolescent living in residential group homes in Germany.
Furthermore, differences in the distribution of mental disorders by gender were emphasized. Within the general population, there were more mood disorders and anxiety disorders in girls, but fewer conduct disorders and attention deficit and hyperactivity disorders than in boys (Fombonne, 2005). McMillen, Zima, Scott, et al. (2005) showed that the increase of mood disorders and anxiety disorders in girls in the child welfare system was more important than in the general population, whereas the rates of conduct disorders and attention deficit hyperactivity disorders did not differ between girls and boys.
Although the few studies available concluded that psychiatric morbidity in children and adolescents involved in child welfare system was very high, they explored a wide range of specific psychiatric problems, not always comparable across studies, and used different screening tools. Furthermore, the organization of the child welfare systems in each country is not strictly comparable. The reasons for and the kinds of placements (i.e., residential group homes, foster care homes, kinship placements, and others) may be different, even in the same country, depending on the culture and according to the custom of local social services. Therefore, the results of previous studies cannot be easily synthesized and generalized to other countries.
To our knowledge, there is no prevalence study of mental disorders in France concerning adolescents in out-of-home care (foster care home or residential group home), nor, more generally, among adolescents involved in the child welfare system. However, such information would be valuable to improve screening of mental disorders and to design appropriate care for this group.
The objective of this study was to provide a first estimate of the prevalence of mental disorders and their distribution by gender in adolescents who are under the care of the French Child Welfare System and who are living in residential group homes.
Section snippets
Participants
Any 13 to 17-year-old adolescent able to speak French who was in one of these residential group homes during the inclusion time period (June 2005 and June 2006), who was present on the day when the interview was planned and who agreed to participate was eligible for the study. After obtaining consent to participate in the study from adolescents and their parents, the adolescents were interviewed by trained researchers. This study was declared and received the approval of the “Comission
Results
The inclusion procedure resulted in a sample of 183 adolescents. In total, 653 individuals in residential group homes were registered in the administrative files during the targeted period of time. The study sample consisted of 106 boys (58%). The mean age was 15.3 years +/−1.4 (Range 13.0–17.5) and did not differ according to gender. No significant differences were found between the included population and the population not included in the study due to major confounding factors registered in
Discussion
In the current study of a sample of adolescents living in residential group homes in France, almost 50% of participants demonstrated at least one psychiatric disorder.
Several limitations of this study should be noted. The size of our sample is one of the limits of this work, even though other studies were conducted in similar environments with samples of comparable size: McMillen, Zima, Scott, et al. (2005) studied a group of 373 fostered adolescents, Minnis, Everett, and Pelosi, (2006)
Conclusion
The prevalence of mental disorders in adolescents living in French residential group homes is 2.5 to 3.5 times higher than in the overall population. Behavioral disorders are not necessarily the reason for this very high rate. Among these adolescents, anxiety disorders and major depression occur the most frequently, as well as suicide attempts. Some mental disorder elements represent a big concern, such as the high rate of co-morbidities, including the “psychotic symptoms” found in almost one
Acknowledgments
This study was supported by the Direction of Research, Evaluation, Studies and Statistics of the French Ministry of Health, Youth and Sports.
The authors are grateful to all the adolescents and the social workers who participated.
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