Preschool children placed out of home following adverse family circumstances are at higher risk for psychiatric disorders and criminal convictions in adulthood, according to study data published in Lancet Child and Adolescent Health.

Researchers conducted a population-wide cohort study using the 1987 Finnish Birth Cohort, which collects data from child welfare, medical, and criminal registers for those born in Finland in 1987. Researchers identified out-of-home placement for children at ages 2 to 6 years and followed up for psychiatric diagnoses, criminal convictions, and psychotropic medication prescriptions at ages 18 to 25 years. Children placed out of home were matched with nonplaced controls based on parental and child characteristics, including family structure and psychiatric diagnoses. Logistic regression analyses were conducted to identify differences in adulthood outcomes between controls and children placed out of home.

Of 54,814 individuals included in analyses, 388 (1%) were placed out of home at ages 2 to 6 years, for whom 386 were assigned matched controls. At ages 18 to 25 years, those who had been placed out of home had a greater risk compared with never-placed controls for substance-related disorders (odds ratio [OR], 2.10; 95% CI, 1.27-3.48), psychotic or bipolar disorders (OR, 3.98; 95% CI, 1.80-8.80), depression and anxiety disorders (OR, 2.15; 95% CI, 1.46-3.18), neurodevelopmental disorders (OR, 3.59; 95% CI, 1.17-11.02), or other mental disorders (OR, 2.06; 95% CI, 1.25-3.39). Additionally, those who had been placed as children were more likely to use psychotropic medication (OR, 1.96, 95% CI, 1.38-2.80) and to have higher rates of criminal convictions for violent (OR, 2.43; 95% CI, 1.61-3.68) and property (OR, 1.86; 95% CI, 1.17-2.97) offenses.

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According to these data, preschool children placed out of home are at high risk for adverse psychiatric outcomes and criminal convictions as adults. These results suggest a significant need for psychiatric resources for children placed in foster care or other out-of-home circumstances. Further research is necessary to identify the precise childhood circumstances associated with adverse outcomes so that child protection services might be optimized.


Côté SM, Orri M, Marttila M, Ristikari T. Out-of-home placement in early childhood and psychiatric diagnoses and criminal convictions in young adulthood: a population-based propensity score-matched study [published online July 26, 2018]. Lancet Child Adolesc Health. doi:10.1016/S2352-4642(18)30207-4