Date of Degree

2-2016

Document Type

Dissertation

Degree Name

D.P.H.

Program

Public Health

Advisor

Luisa N. Borrell, DDS, PhD

Advisor

Juan Battle, PhD

Committee Members

Juan Battle, PhD

Luisa N. Borrell, DDS, PhD

Daniel Herman, PhD

Manny J. Gonzalez, PhD

Subject Categories

Epidemiology | Psychiatric and Mental Health | Social Work

Keywords

depression, foster care, foster care placement type, mental health service use, children, adolescents

Abstract

Background: Children and adolescents in foster care with a history of complex trauma such as neglect, emotional, physical, and sexual abuse have a greater odds of being clinically diagnosed with depression in adulthood compared to children and adolescents without such a history. The current study examines the prevalence of depression in a national sample of children and adolescents aged 7 to 17 years. This study asks whether a) foster care is associated with a greater prevalence of depression among children and adolescents in foster care compared to children and adolescents not in foster care; b) there is an association between foster care placement type and depression; and c) there is a greater association with mental health service utilization among children and adolescents in foster care than those not in foster care.

Methods: This study used secondary data from Wave 2 of the National Survey of Child and Adolescent Well-Being II. Descriptive statistics and chi-square statistics were conducted to assess associations of each covariate with a) foster care and depression (n=1,573); b) foster care placement type and depression (n=1,573); and c) foster care and mental health service utilization (n=1,812). Logistic and ordinal logistic regressions were used to estimate the strength of the association between foster care and depression and between foster care placement type and depression. The strength of the association between foster care and mental health service utilization was estimated using logistic regression. Interaction terms were tested to determine whether these associations varied with age, sex, and race/ethnicity. SAS Version 9.3 was used for data management while SUDAAN was used to conduct all the analyses.

Results: Among children and adolescents between 7 and 17 years of age, foster care was not associated with depression after controlling for age, sex, race/ethnicity, maltreatment history, and exposure to violence. Children between 7 and 9 years of age, however, had a higher odds of depression (OR: 1.89, 95% CI: 1.16-3.07, p-value

Conclusion: Child welfare policies should be implemented to address the association between age and depression among children and adolescents who are not in foster care but who receive services from the child welfare system. Collaborative efforts between caregivers and child welfare staff should promote interventions that focus on younger children who have higher prevalence of depression and more severe depression symptoms compared to older adolescents. Finally, programs that ensure higher mental health service utilization among children and adolescents in foster care should be expanded to accommodate all individuals in the child welfare system regardless of foster care status or placement setting.

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