Long-term Health and Social Outcomes in Children and Adolescents Placed in Out-of-Home Care

• IMPORTANCE Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification.OBJECTIVE To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors.DESIGN, SETTING, PARTICIPANTS This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021.EXPOSURES Placement in out-of-home care up to age 15 years.MAIN OUTCOMES AND MEASURES Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality.RESULTS A total of 30127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The highest relative risks were observed for those with violent crime arrests (aHR, 4.16; 95% CI, 3.74-4.62; cumulative incidence, 24.6% in individuals who had been placed in out-of-home care vs 5.1% in those who had not), substance misuse (aHR, 4.75; 95% CI, 4.25-5.30; cumulative incidence, 23.2% vs 4.6%), and unintentional poisoning injury (aHR 4.79; 95% CI, 3.56-6.43; cumulative incidence, 3.1% vs 0.6%). Additional adjustments for perinatal factors, childhood behavioral problems, and traumatic injuries, including experiencing violence, did not materially change the findings.CONCLUSIONS AND RELEVANCE Out-of-home care placement was associated with a wide range of adverse outcomes in adulthood, which persisted following adjustments for measured preplacement factors and unmeasured familial factors.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

Nyckelord

prescription drug

adolescent

adulthood

antisocial behavior

anxiety disorder

attention deficit disorder

autism

bipolar disorder

cause of death

child

cohort analysis

communication disorder

conduct disorder

controlled study

crime

cumulative incidence

depression

drug dependence

falling

family income

female

Finland

foster care

home care

human

injury

institutional care

intellectual impairment

International Classification of Diseases

intoxication

learning disorder

long term care

major clinical study

male

mental disease

motor dysfunction

neurologic disease

oppositional defiant disorder

personality disorder

premature mortality

problem behavior

schizophrenia spectrum disorder

sibling

social aspect

social status

suicidal behavior

suicide attempt

traffic accident

unemployment

violence

ambulatory care

devices

pediatrics

preschool child

procedures

time

Child

Preschool

Cohort Studies

Humans

Outcome Assessment

Health Care

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)