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There is a large and growing amount of evidence on how the experience of foster care has a direct impact on the health and welfare of transition age youth. The most prominent findings indicate that simply being in foster care is associated with later post-traumatic stress disorder (PTSD) and depression rates that are nearly twice that of youth in the general population.

There are some variations in these findings based on types of foster care provided. For instance, placement with relatives is least associated with negative outcomes.

Placement stability is very often connected to various mental health factors of foster youth; the more placements/disruptions the more psychiatric problems.

Okpych and Courtney (2017) extended this research to include suicidal ideation and behaviors. They studied 706 foster youth ages 16 and 17 in California. They conducted lengthy interviews and extensive case record reviews and analyses.

Prominent findings:

  • Almost half of the foster youth “screened positive for either a mental health or substance abuse disorder” (p. 5).
  • One quarter of the youth indicated that they had already attempted suicide.
  • Depression was the frequent psychiatric disorder with nearly a quarter of the youth reporting depression during the previous year.
  • Placement instability was directly associated with more depression, PTSD, substance abuse and alcohol disorders.
  • The odds of attempting suicide for foster youth living in group homes was 2.6 times higher than for youth living in therapeutic foster homes and 3.5 times higher than for youth living in relative foster care.
  • Of the 9% of youth living in nonrelative foster care, 42% reported attempting suicide.
  • Early emotional abuse was a prominent predictor of foster youth suicide attempts.
  • LGBTQ youth were the most likely type of foster youth in the sample to experience all of the forms of psychiatric disorders studied and attempt suicide.


  • Placement in non-relative foster care and group homes should be limited to youth who are more psychologically resilient and balanced prior to placement.
  • Youth with emotional abuse histories should be placed with emotionally healthy relatives.
  • Once a good placement is identified, every effort should be made to prevent placement disruption expect for a permanency placement.
  • LGBTQ youth seem at greatest risk for depression, PTSD, and suicide attempts. All child welfare systems should have strong service components for these youth and case workers should have a solid working knowledge of the existence and operation of Gay-Straight Alliance (https://gsanetwork.org/) groups in local schools for LGBTQ youth.
  • Mental wellness supports should be in place for foster youth in care, especially who encountered emotional abuse prior to entering care.

Original article citation:  Okpych, N. J., & Courtney, M. E. (2017). Characteristics of foster care history as risk factors for psychiatric disorders among youth in care. American Journal of Orthopsychiatry. Online publication: http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/ort0000259

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Dr. Chris Downs has devoted much of his professional career to improving services and outcomes for older, at-risk youth. Chris is President of The Downs Group LLC, based in Seattle and has the pleasure of working with many talented professionals in child welfare and allied areas including his company Associates.