Childhood behavioral disorders and trauma: Predictors of comorbid mental disorders among adult foster care alumni.

Abstract

This study identifies the prevalence of mental health comorbidity in a large multistate foster care alumni sample as well as early childhood and trauma-related predictors of comorbidity. Secondary analysis of case record and interview data for 1,038 alumni served by Casey Family Programs in 13 states were used to assess pre-foster care, during foster care, and post-foster care predictors of comorbidity, defined as 2 or 3 mental health conditions. Findings indicate that 9.8% of alumni had 2 mental disorders and 10.4% had 3 disorders. Multivariable analyses show that alumni who were female, lived below the poverty line, and who were unmarried were more likely to have comorbid mental disorders. Controlling for these significant factors, alumni who had childhood behavioral disorders or who were maltreated during foster care were more likely to have comorbid mental diagnoses. Alumni who perceived their foster parents as helpful some or a lot compared with a little had less comorbidity. The prevalence of comorbidity in this adult foster care alumni sample is higher than youth still in foster care and adults in the general population. This research highlights the need to prevent trauma-related interpersonal violence within foster families and ensure alumni access to health-care provisions long after they exit foster care. Recommendations focus on the need for comprehensive mental health assessments and quality treatment that addresses multiple conditions. Future research examining the effects of alumni mental health and treatment access on intergenerational outcomes is also recommended.