Types of Traumas and Mental Health and School Outcomes Among Adolescents in Orphanages: Evidence from South Korea

Background and Purpose: Globally an estimated 143 million children under the age of 17 are orphaned with the majority in Asia, followed by Sub-Saharan Africa. Despite efforts to promote family-based alternative care many youth live in institutional settings (i.e. orphanages), including in South Korea where there is a disproportionate reliance on institutions to care for children without parental care. Children in institutions are at increase risk of emotional problems and poorer school attainment than youth reared in families. Moreover, adverse early life experiences (abuse, neglect, trauma) are known to increase risk for depression and PTSD. Few studies have explored the types of traumas and subsequent problems experienced by adolescents reared in institutional care. Hence, the following questions were explored: 1) What types of traumas do adolescents in orphanages experience most often? 2) And, is there an association between number of types of trauma and mental health problems (PTSD symptoms, depression), school grades and engagement, controlling for demographic and placement factors?

Method: This cross-sectional study included a convenience sample of 147 adolescents, ages 10 to 18 (M=16.1, SD=1.9), from 10 orphanages located in the Seoul Capital Area and a southern province in South Korea. The sample was primarily boys (67%) and the mean age of entering their current institution was 8.2 (SD=4.1). Structured face-to-face interviews included the following: 1) lifetime types of traumas experienced; 2) PTSD symptoms (Foa, 2001); 3) depression (CDI); 4) school grades and school engagement; and 5) demographic and placement factors (age, gender, number of types of placements, age entered care). Descriptive statistics were first analyzed, followed by simple correlations and multiple regressions with each dependent variable.

Results: Adolescents scored an average score of 11.6 on depression and 2.8 on PTSD symptoms. The mean number of types of traumatic exposure that adolescents experienced was 2.8 (SD=2.3). The most common types of trauma were: serious illness or injury to self (46%) or someone close (46%), death of someone close (30%), separated from parent (30%), serious accident (27%), and physical abuse at home (24%). Adolescents with more types of placements reported more types of trauma exposure (p<.001), but no differences were found in number of traumas by age, gender, or age entered the facility. Bivariate analyses indicated adolescents with more types of traumas self-reported higher PTSD symptom severity (p<.001), but no significant association with depression. This association remained significant in multiple regression models, controlling for age and number of types of placements.

Conclusions: Fortunately, adolescents in South Korean institutions in this study do not report experiencing many types of traumas over their lifetime. They primarily experience personal and relational traumas related to illness, injuries or death to self or someone close to them. Youth who experienced more frequent changes in placements were more likely to experience more types of traumas, and greater exposure to different types of traumas increased their risk of PTSD symptom severity. Greater attention to placement changes and helping adolescents in institutions with personal and relational traumas would assist in ensuring their healthy development.