Prevalence and comorbidity of mental disorders among adolescents living in residential youth care

Abstract

Most adolescents are placed in residential youth care (RYC) because of severe psychosocial strains and child maltreatment, which represent risk factors for developing mental disorders. To plan RYC units and ensure that residents receive evidence-based psychiatric interventions, it is necessary to obtain reliable and valid prevalence estimates of mental disorders in this population. However, there is a lacuna of research on diagnoses derived from standardized clinical interviews. The aim of this study was to assess the prevalence and comorbidity of mental disorders applying diagnostic interviews in an entire population of adolescents living in RYC in Norway. All young people in RYC were invited to participate in the study. Eighty-six RYC institutions with 601 eligible adolescents were included and 400 adolescents, 12–20 years old, participated in the study, yielding a response rate of 67 %. Anonymous Child Behaviour Checklist scores for 141 (70 %) of the declining residents were also available, allowing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) for 541 youths to be estimated. Diagnoses were assessed by trained interviewers with the Child and Adolescent Psychiatric Assessment interview (CAPA). Seventy-six point two per cent (71.5–80.8 CI 95 %) of adolescents received at least one 3-month DSM-IV diagnosis. Prevalence rates for internalizing psychiatric disorders were higher than for behavioural disorders. Comorbidity was high between these two groups. Mental disorders were prevalent among children and youth in RYC. Our results create major concerns and challenge the existing organization of the RYC system.

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

“…Estimated prevalence rates of psychiatric diagnoses showed only a small deviance from the observed prevalence rates, which were based on completed psychiatric interviews, thereby confirming the representativeness of the 335 youths who completed the psychiatric interview. For further details, see Greger et al [24] and Jozefiak et al [22].…”

Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

“…The present study is based on data from the project ''Mental health in children and adolescents in child welfare institutions'' [3]. All Norwegian child welfare institutions hosting youths aged 12-23 years were invited to participate.…”

“…However, to enable convergence of the Mplus program in the analysis of the measurement model, the Externalizing problem sum scale (instead of its two subscales Rule-breaking and Aggressive Behavior) had to be entered as one indicator. We also decided to indicate psychopathology as one latent variable because of the high comorbidity between internalizing and externalizing problems observed in an earlier study with this sample [3]. The KINDL-R subscales Physical Well-being, Emotional Wellbeing, and Friends, each consisting of four items, were treated as latent constructs and used as indicators for one latent variable QoL.…”

“…In Norway, foster care is the preferred form of placement and RYC institutions are a last resort [1,2]. Adolescents in RYC therefore represent a high-risk population for serious psychopathology, having a very high prevalence of mental disorders and a poorer quality of life (QoL) in most life domains compared to their peers in the general population [3,4]. Hence, child welfare services should foster wellbeing and QoL and ensure that residents in institutions gain access to evidence-based psychiatric treatment for their psychopathology.…”

“…First, all adolescents living in RYC have been removed from their primary caregivers and a considerable portion has also experienced many out-ofhome placements by child welfare services [26]. Having experienced substantial and significant childhood adversities, their relationships to significant others have likely been affected, resulting in increased attachment problems compared to other populations [3,27,28]. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect the overall level of self-perceptions.…”