Background

We aimed to first, estimate the association of early childhood out-of-home placement with adult income and reliance on social welfare, and second, to test whether, and to what extent, mental health problems in adolescence/young adulthood and primary school grade point average (GPA) explain these associations.

Method

We used linked registers of all 59,476 births in Finland in 1987. Children who were first placed between the ages 2–6 years were selected as our exposure-group. Outcomes measured in adulthood (26–28 years) were low income (i.e. <11,000US$ annual income during ≥2 of 3 years) and social welfare use (i.e. >3 months of annual social welfare during ≥2 of 3 years). Putative mediators were mental health problems (i.e., psychiatric diagnoses from inpatient/outpatient visits) at ages 18–25 years, and Grade Point Average (GPA). To account for background differences, we matched placed to non-placed children using propensity score matching on parental (e.g., psychiatric diagnoses, education) and child characteristics (e.g., neurodevelopmental problems, prematurity).

Results

Of 54,814 children with complete data, 386 (0.71%) experienced placement (384 were matched). At ages 26–28, placed children had greater odds than never-placed children of low income (OR, 1.74; CI, 1.31–2.32) and social welfare (OR, 2.09; CI, 1.34–3.04). We found significant indirect effects of out-of-home placement on social welfare use via mental health problems (proportion mediated, 22%) and GPA (proportion mediated 11%), and on low income via mental health problems only (proportion mediated, 34%).

Conclusions

Prevention of mental health problems and increased school support for children who experienced out-of-home placement may effectively reduce poor adult socioeconomic outcomes associated with placement.

中文翻译：

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童年的户外安置和成人社会经济成果的途径

背景

我们的目的是首先估计早期儿童外出安置与成人收入和对社会福利的依赖之间的关联，其次，测试青春期/青年期和小学年级的心理健康问题是否以及在多大程度上存在平均分（GPA）解释了这些关联。

方法

我们使用了 1987 年芬兰所有 59,476 名新生儿的关联登记册。首先选择 2-6 岁之间的儿童作为我们的暴露组。在成年期（26-28 岁）衡量的结果是低收入（即 3 年中≥2 年的年收入 <11,000 美元）和社会福利使用（即 3 年中的 2 年≥3 个月的年度社会福利）。假定的中介因素是 18-25 岁的心理健康问题（即，住院/门诊就诊的精神病诊断）和平均成绩 (GPA)。为了考虑背景差异，我们使用父母（例如，精神病学诊断、教育）和儿童特征（例如，神经发育问题、早产）的倾向评分匹配将安置与非安置儿童进行匹配。

结果

在拥有完整数据的 54,814 名儿童中，386 名（0.71%）经历了安置（384 名匹配）。在 26-28 岁的低收入（OR，1.74；CI，1.31-2.32）和社会福利（OR，2.09；CI，1.34-3.04）儿童中，被安置的儿童比从未被安置的儿童有更大的机会。我们发现，外出安置对通过心理健康问题（比例介导，22%）和 GPA（比例介导 11%）以及仅通过心理健康问题（比例介导，34 %）。

结论

预防心理健康问题和增加对经历过户外安置的儿童的学校支持可以有效地减少与安置相关的不良成人社会经济结果。