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Teens referred to child welfare services have increased risk for suicide, other risky behaviors

Adolescents referred to U.S. child welfare services for alleged maltreatment were approximately 50% more likely to attempt suicide compared with adolescents not involved with child welfare services.

“Prior research suggests that teens who have been victims of maltreatment may be at higher risk for a number of health-risk behaviors,” study researcher Amy Heneghan, MD, of Palo Alto Medical Foundation, and colleagues wrote. “Results are mixed, in that several studies show that some health-risk behaviors such as alcohol use, drug use, and suicidality are consistently higher among teens who have experienced maltreatment, whereas other studies suggest that substantiated maltreatment does not have a strong clear link with risk into adulthood for alcohol use or drug use.”

Amy Heneghan

Researchers reviewed data from the National Survey of Child and Adolescent Well-being (NSCAW II), a nationally-representative 3-year longitudinal study of 5,872 children referred to U.S. child welfare agencies. Study participants were aged 0 to 17.5 years.

Overall, 65.6% of study participants reported at least one health-risk behavior. Adolescents aged 15 to 17.5 years were more likely to report health-risk behaviors (P < .001).

Seventy-five percent of adolescents with a prior out-of-home placement and 77% of adolescents with Child Behavior Checklist (CBCL) scores of 64 or higher reported at least one health-risk behavior.

Marijuana use was more common among adolescents with prior out-of-home placement and higher CBCL scores (P ≤ .05, respectively).

Smoking was more common among adolescents who had not been previously referred to child welfare services and those with higher CBCL scores (P ≤ .05, respectively).

Older adolescents, those with prior out-of-home placement and those with higher CBCL scores were more likely to report risky sexual activity.

Fighting was significantly more common among adolescents with prior reports of maltreatment (17.3% vs. 8.6%; P ≤ .05), as was weapon carrying among those with prior out-of-home placement and higher CBCL scores.

Suicidality was more common among females (19% vs. 6.4%; P ≤ .01), those who reported physical (21.5% vs. 10.4%; P ≤ .05) or sexual abuse (21.5% vs. 7.9%; P ≤ .01) and those with higher CBCL scores (29% vs. 7.3%; P ≤ .01).

Compared with youth from the NSCAW I, conducted 10 years prior to NSCAW II, prevalence of smoking and sexual activity was higher in the current cohort (P ≤ .05, respectively).

Health-risk behaviors were less commonly reported among older adolescents in the NSCAW II study vs. those in the 2011 Youth Risk Behavior Surveillance System study, except for suicidality, which was approximately 1.5 times higher (11.3% vs. 7.8%).

“Health-risk behaviors in adolescents are common and challenging for parents, educators and the health care system,” study researcher Ruth E. K. Stein, MD, of the Children’s Hospital at Montefiore in New York, said in a press release. “While it was surprising that teens involved with [child welfare services] and the broader teen population reported the same level of health-risk behaviors, it is believed that children growing up in a stable environment with good parental relationships are at less risk for long-term negative outcomes, making it all the more important that efforts to address such behaviors are an ongoing part of [child welfare services] monitoring.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.