Psychiatric Characteristics and Mental Health Service Use Among Hospitalised Youth in Foster Care, Adoption, and Child Welfare Supervision: A Retrospective Comparative Study
- 1Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Abstract
BackgroundYouth involved in child protection systems are at increased risk of psychiatric disorders and are overrepresented in inpatient mental health services. However, few studies have directly compared the clinical characteristics and mental health service use of youth across different child protection pathways.
ObjectiveTo compare clinical characteristics, psychosocial risk factors, clinical complexity, and mental health service use among psychiatrically hospitalised youth in foster care, adoption, and child welfare supervision.
Participants and SettingThis retrospective observational study included 236 children and adolescents across three child protection pathways admitted to a Child and Adolescent Inpatient Psychiatry Unit between 2018 and 2024.
MethodsClinical, psychosocial, and service-use data were extracted from medical records and compared using univariate analyses, multilevel mixed-effects models, logistic regression, and time-to-event analyses.
ResultsAll groups showed high comorbidity and clinical severity, but distinct clinical profiles emerged. Youth in foster care more frequently presented with externalising disorders, trauma exposure, and substance use; adopted youth showed higher rates of neurodevelopmental and prenatal adversity-related conditions; and youth under child welfare supervision more often presented with affective symptoms and suicidal ideation. Post-discharge emergency department re-consultation differed significantly between groups (p = 0.007) and was most frequent among adopted youth, who also had higher odds of psychiatric readmission. Youth in foster care had the shortest median time to emergency re-consultation, although time-to-event differences were not significant (p = 0.476).
ConclusionsDistinct clinical and service-use profiles across child protection pathways support trauma-informed, placement-sensitive mental health care and stronger coordination between child protection and mental health services.
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BibTeX
@misc{solerdelcoll2026psychiatric,
title = {{Psychiatric Characteristics and Mental Health Service Use Among Hospitalised Youth in Foster Care, Adoption, and Child Welfare Supervision: A Retrospective Comparative Study}},
author = {M. Solerdelcoll and G. Sugranyes and I. Baeza},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.13.26362960},
url = {https://www.medrxiv.org/content/10.64898/2026.09.13.26362960v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Psychiatric Characteristics and Mental Health Service Use Among Hospitalised Youth in Foster Care, Adoption, and Child Welfare Supervision: A Retrospective Comparative Study
AU - M. Solerdelcoll
AU - G. Sugranyes
AU - I. Baeza
PY - 2026
DA - 2026/09/13
PB - medRxiv
DO - 10.64898/2026.09.13.26362960
UR - https://www.medrxiv.org/content/10.64898/2026.09.13.26362960v1
AB - BackgroundYouth involved in child protection systems are at increased risk of psychiatric disorders and are overrepresented in inpatient mental health services. However, few studies have directly compared the clinical characteristics and mental health service use of youth across different child protection pathways. ObjectiveTo compare clinical characteristics, psychosocial risk factors, clinical complexity, and mental health service use among psychiatrically hospitalised youth in foster care, adoption, and child welfare supervision. Participants and SettingThis retrospective observational study included 236 children and adolescents across three child protection pathways admitted to a Child and Adolescent Inpatient Psychiatry Unit between 2018 and 2024. MethodsClinical, psychosocial, and service-use data were extracted from medical records and compared using univariate analyses, multilevel mixed-effects models, logistic regression, and time-to-event analyses. ResultsAll groups showed high comorbidity and clinical severity, but distinct clinical profiles emerged. Youth in foster care more frequently presented with externalising disorders, trauma exposure, and substance use; adopted youth showed higher rates of neurodevelopmental and prenatal adversity-related conditions; and youth under child welfare supervision more often presented with affective symptoms and suicidal ideation. Post-discharge emergency department re-consultation differed significantly between groups (p = 0.007) and was most frequent among adopted youth, who also had higher odds of psychiatric readmission. Youth in foster care had the shortest median time to emergency re-consultation, although time-to-event differences were not significant (p = 0.476). ConclusionsDistinct clinical and service-use profiles across child protection pathways support trauma-informed, placement-sensitive mental health care and stronger coordination between child protection and mental health services.
ER -