Internalizing, Externalizing Problems and Psychiatric Hospitalizations: Examination of Maltreatment Chronicity and Coping Style in Adolescents in Foster Care

Child maltreatment is associated with internalizing and externalizing problems in adolescents, as well as psychiatric hospitalizations, which represent severe mental health difficulties and substantial burden on individuals and the health care system. These negative outcomes are especially prevalent in youth in foster care. Not all youth exposed to maltreatment, however, demonstrate poor mental health outcomes. Additional factors, such as maltreatment chronicity and coping style, may help explain why some (but not all) youth develop major psychiatric problems. The purpose of the present study was to examine how maltreatment chronicity and coping style were associated with internalizing, externalizing, and psychiatric hospitalizations, and whether coping style moderated the relation between maltreatment chronicity and mental health in a sample of foster adolescents. Participants were 283 adolescents ages 12-19 residing in foster care. Youth reported on maltreatment, coping, and mental health; caregivers reported on mental health. Psychiatric hospitalizations were obtained from medical records. Youth who experienced more maltreatment had higher caregiver- and self-reported internalizing, and more psychiatric hospitalizations. Youth who approached problems directly had lower caregiver-reported internalizing and externalizing, while youth who dealt with stressors alone had higher self-reported internalizing and externalizing, and more psychiatric hospitalizations. Youth who avoided facing their problems had less psychiatric hospitalizations. Further, a significant interaction revealed that youth with more maltreatment who avoided problems had less psychiatric hospitalizations, suggesting that avoiding problems may be more protective for youth with the most chronic abuse and neglect. Findings highlight the importance of examining both maltreatment and coping.