Hard-to-treat or hard-to-catch? Clinical features and therapeutic outcomes of help-seeking foster care youths with mood disorders

Front Psychiatry. 2023 Oct 13:14:1211516. doi: 10.3389/fpsyt.2023.1211516. eCollection 2023.


Introduction: The high level of emotional problems in youths placed in foster care contrasts with the limited use of evidence-based treatments. This study aims to better characterize the clinical features and therapeutic outcomes of foster care youths with mood disorders.

Methods: A secondary analysis of data collected in the context of a French-Canadian clinical research network on pediatric mood disorders in four sites was conducted to compare three groups of patients with depressive or bipolar disorder: those without exposure to child welfare intervention (WCWI, n = 181), those who received non-placement psychosocial intervention (NPI, n = 62), and those in placement interventions (PI, n = 41).

Results: We observed a very high rate of academic problems in patients in the groups NPI/PI compared to those in the WCWI group. Patients in the PI group had more disruptive behavioral disorders (OR = 6.87, 95% CI [3.25-14.52]), trauma-related disorders (OR = 3.78, 95% CI [1.6-8.94]), and any neurodevelopmental disorders (OR = 2.73, 95% CI [1.36-5.49]) compared to the other groups (NPI/WCWI). Among inpatients, the Clinical Global Impression-Improvement scale and the change in the Children Global Assessment Scale during the hospital stay did not differ across the three groups. We observed a higher prescription rate of antipsychotics in the PI group compared to the NPI/WCWI groups, but no significant difference for antidepressants and mood stabilizers.

Discussion: These findings support the view that, when provided with dedicated support, fostered inpatient youths can improve in a range comparable to other inpatients. Undetected neurodevelopmental disorders and academic problems are likely important contributors of the burden of mood disorders in these youths.

Keywords: adverse chilhood experiences; child adversity; complex psychotrauma; depressive disorder; developmental psychotrauma; disruptive mood dysregulation disorder; early-onset bipolar disorder.

Grants and funding

French researchers received funding by la Mission interministérielle de lutte contre les drogues et les conduites addictives (MILDECA), and l’Observatoire national des Jeux (ODJ) (“IReSP-15-Prevention-11” IRESP/GC/SB/108). Canadian researchers received funding by the Quebec Network on Suicide, Mood Disorders and Related Disorders RQSHA (Grant: ASClin #2).