Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Twenty-five years ago, Anderson and Simonitch (1981) declared that depression was “a common reaction to emancipation” for youth aging out of the foster care system. In 1990 Barth reported that 100% of a small sample young adults who aged out of foster care 3 years prior scored above the clinical cut-off on the CESD, cementing the impression that there is strong link between leaving foster care and depression.

Similarly, the NACTS study of youth leaving special education and residential treatment services reported an alarming jump in substance use as youth aged out of those systems (Davis & Vander Stoep, 1997). This study uses a longitudinal cohort of older foster youth to ask, “Does self-reported depression and drug use increase soon after older youth leave the foster care system?”

Methods

A cohort of 404 young people from the Missouri foster care system was interviewed every three months (9 times) from their 17th birthdays to their 19th birthdays. The cohort represented 90% of those eligible with an initial 9% refusal rate. Retention at the 19th birthday was at 80% (n=325). Multiple imputation procedures were used to estimate missing data with five implicate data sets using the IVEWare program.

The 11-item Depression Outcome Module (Smith, Burnam, Burns, Cleary, & Rost, 1994) assessed depressive symptoms at each of the nine interviews. Substance use was measured 3 times (ages 17, 18 and 19) with items from the Diagnostic Interview Schedule for DSM-IV. We used two measures of substance use here: a dichotomous measure of past month marijuana use and past month use of another illicit substance. A five category independent variable captured 6 months periods when youth left the foster care system. MPLUS 3.12 was used to estimate a linear growth curve models and growth mixture models for change over time.

Results

Depression remained flat over time across all exit categories. The estimate slope of depression over time was -.06. Approximately 12-13% of the sample met clinical cut-off scores for depression at each wave. Growth mixture modeling identified a large group with low stable depression scores (78%), a moderate decreasing depression group (16%) and a small increasing depression group (6%).

Self-reported marijuana and other drug use increased substantially from age 17 to 19. Increases occurred most markedly soon after youth left custody. For example, for youth who left care between 17 and 18, past month marijuana use increased from 11% to 20% between those ages, but did not rise substantially over the next year (21%). For youth who left between ages 18 and 19, past month marijuana use increased from 9% to 23% between those ages.

Implications

Depression may be less common among youth exiting the foster care system than anticipated by practitioners. Drug use, however, may increase during the transition out of the foster care system. Since youth leaving the foster care system possess fewer protective resources, this rise in drug use may possess more serious consequences than for age-mates not from the foster care system.