Self-reported depressive symptoms in school-age children at the time of entry into foster care

Objective. To test the following hypotheses: (1) Children entering foster care report more depressive symptoms and have a higher prevalence of clinically significant depressive symptoms than children not in care. (2) Demographic and historical data can predict which children in foster care are at highest risk for depression. Design. Cross-sectional study, including a comparison group. Setting. Foster Care Health Program in Baltimore, Maryland, and Baltimore City Public Schools. Methods. We administered the Children's Depression Inventory (CDI) to 160 schoolage children entering foster care and to a comparison group of 60 urban, African-American school children. Results. Children entering foster care had higher mean CDI scores than children in published norms (p < 0.03). A similar difference in CDI scores between children in foster care and urban, African-American children did not reach statistical significance. Prevalence of clinically significant depressive symptoms did not differ significantly between the children in foster care, published norms, and comparison group (13.8, 10 and 8.3%, respectively). Depressive symptoms in children entering foster care were associated with age, but not with gender or ethnicity; parental history of affective disorder or substance abuse; history of abuse or neglect; or previous foster care or mental health treatment. Conclusions. Children entering foster care report more depressive symptoms than children in published norms. The prevalence of clinically significant depressive symptoms is similar for children in foster care, published norms, and urban, African-American children. Depressive symptoms in children entering foster care are associated with age, but not with other demographic and historical variables. Implications for practice. Children entering foster care should be a particular priority for mental health screening, with early mental health treatment when indicated.