Predictors of Reduction in Symptoms of Depression for Children and Adolescents in Foster Care

Children and adolescents in the foster care system have less favorable mental health outcomes than those in the general population. Within this system, depression is one of the most commonly diagnosed disorders, with prevalence rates up to three times that of same-aged peers, and is associated with long-term negative outcomes such as greater substance use, suicidality, and psychiatric hospitalization. The elevated rate of depression in children and adolescents in foster care and increased risk of adverse outcomes over time highlight the importance of identifying factors that promote reduction of symptoms of depression in this population. Using Optimal Data Analysis, this study examines the moderating effect of ecological systems variables, as measured by the Child and Adolescent Needs and Strengths-Mental Health, on decreases in depressive symptomatology in a sample of 228 foster care youth between the ages of 4 and 20. Results revealed positive change in adjustment to trauma (i.e., symptoms of Post-Traumatic Stress Disorder) as the optimal predictor of reduction of symptoms of depression. Positive change in family functioning, total youth strengths, positive change in sexualized behavior, and positive change in school functioning emerged as additional predictors of reduction of depression. These results indicate that clinically significant decreases over time in symptoms of depression are associated with concurrent improvement in variables across the social ecologies of children and adolescents, including the individual youth, family, and school systems. Implications for service providers working with this population are discussed.