Prevalence and Correlates of Depression, PTSD, and Suicidality Among Adolescents in Institutional Care in Jordan

Background: Adolescents in residential care have been identified as having increased mental illness rates compared to community populations. One in five children and one in three adolescents are estimated as having a mental health condition. Mental health problems have been found to predict suicide attempt and completion in youth. Among youth in out-of-home placements, mental illness prevalence rates have been found to consistently exceed established rates for youth within the community.  With approximately 2 million children residing in institutional care, it is important to understand the prevalence of mental health conditions and their impact on suicidality within this vulnerable population in order to provide more effective services. Although research has investigated the prevalence of mental health needs and suicidality of institutionalized children in many parts of the world, youth in the Middle East remain an under-investigated population. This study examines the prevalence and correlates of PTSD, depression and suicidality of youth residing in institutional care in Jordan.

Methods: Eighty-six youth, ages 7-18, residing in residential care across Jordan were interviewed for PTSD (UCLA PTSD Index for DSM-IV ‘UPID’), depression (Center for Epidemiologic Studies—Depression Scale ‘CES-D’), and suicidality (endorsement of suicidal ideation or intent to deliberately hurt of kill themself). Data was also collected from staff-caregivers and administrative files. Prevalence rates were examined using descriptive analyses. Logistic regressions were used to model suicidality across depression, PTSD, comorbid depression/PTSD, controlling for demographics, case history, youth self-beliefs, and social support factors.

Results: Institutionalized adolescents endorsed high rates of mental health problems, with this study finding that 45% of the youth experience depression and 24% experiencing PTSD. 17% of the youth reported comorbid depression and PTSD. Suicidality was also endorsed by 27% of youth in the sample. Depression and presence of abuse were significant correlates of suicidality in adjusted logistic regression models.  Specifically, depressed youth were 3.6 times more likely to report suicidality than their non-depressed counterparts and abused youth were four times more likely to report suicidality compared to their non-abused counterparts.

Implications: Results parallel existing prevalence rates of institutionalized youth throughout the world.  Although institutional care supports housing and material needs, there is a clear need for greater attention to mental health and psychosocial wellbeing. Elevated rates of mental illness and suicidality indicate the importance of addressing these needs early in institutions to ensure healthy development over the life course for these vulnerable children. Developing institutional and community-based programs that foster peer relationships is recommended for youth assessed with depression and/or PTSD, specifically within more collective-based societies. Policy and program recommendations to be discussed include: the need for comprehensive assessment and screening, incorporating and implementing mental health services within institution settings in Jordan; and the development of culturally-appropriate alternatives to institutional care in the region.