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Abstract
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Aims: The mental health of children and adolescents in child protection services represents a critical public health challenge, necessitating specialized attention and care. However, comprehensive prevalence data remain limited in the scientific literature.This systematic review evaluates the prevalence of psychiatric disorders among minors and young adults in child protection services. It examines overall and disorder-specific prevalence rates, considering variations by child-protection care type, age, gender, and access to mental health care and psychotropic medication prescription.
Methods: A systematic search conducted in April 2024 through five scientific databases (PubMed, Web of Science, APA PsycArticles, Lens.org, and LiSSa) identified studies reporting the prevalence of psychiatric disorders in children aged 0–21 years in child protection systems in high-income developed countries. The review protocol was developed by a biostatistician from the University Hospital of Rouen in France and was registered on PROSPERO (CRD42024624124).
Results and Conclusions: Among 31 studies meeting the inclusion criteria, the median prevalence of psychiatric disorders was found to be 57%. Studies with control groups confirmed that this population was at least twice as likely to have psychiatric disorders compared to their peers in the general population. The overall prevalence increased with age, peaking between 9 and 11 years. While most specific disorders increased with age, some followed distinct developmental patterns: attachment disorders were most prevalent among children aged between 0 and 8 years, ADHD peaked between 6 and 15 years, oppositional defiant disorder was most frequent during preadolescence and conduct disorders were more commonly observed in late adolescence and early adulthood. Girls were more likely to experience internalizing disorders and suicidal behaviors, while boys had higher rates of externalizing disorders. Prevalence rates were lowest in home-based care, higher in foster care, and peaked in institutional placements, especially when linked to judicial interventions. Access to mental health care remained inconsistent, with psychotropic medications frequently prescribed without adequate psychiatric follow-up. Future research should focus on establishing standardized diagnostic protocols and conducting national-level epidemiological studies to inform policy and improve mental health services for this vulnerable population.
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