Abstract
Background: Children in care who experience frequent placement changes face a heightened risk for negative mental health outcomes. Understanding the strength and direction of this relationship is crucial for informing policy and practice, yet UK-based evidence remains unconsolidated. We conducted the first systematic review and meta-analysis examining the relationship between placement instability and mental health outcomes in the UK care system, synthesising evidence from studies assessing mental health as both an outcome and predictor of placement instability.
Methods: Following our pre-registered protocol (PROSPERO: BLINDED), we searched five electronic databases (PyscNet, PubMed, International Bibliography of the Social Sciences, Child Development and Adolescent Studies, and Scopus) for peer-reviewed studies conducted in the UK up to 9th February 2024. Eligible studies included a care-experienced sample, measured placement (in)stability, measured at least one mental health outcome, and quantitatively examined the relationship between placement changes and mental health. A random-effects meta-analysis was conducted, and risk of bias was assessed using adapted versions of the Newcastle-Ottawa Scale. Study selection and reporting followed PRISMA guidelines.
Findings: We included 15 studies (6,905 care-experienced individuals), with 12 contributing to the meta-analysis. Children with unstable placements were more than twice as likely to experience poor mental health outcomes compared to those with stable placements (OR = 2·07, 95% CI 1·65-2·59, I2 = 61·8%). However, there was a lack of evidence examining the causal direction of this effect.
Interpretation: For children in the UK care system, placement instability doubles the risk of adverse mental health outcomes, which is of considerable importance given the already elevated rate of mental disorders in this group. Further research is urgently needed to clarify the (bi)directional nature of this relationship and guide targeted intervention. Meanwhile, policymakers must prioritise collaborations between mental health services and local authorities to prevent the cycle of instability and mental health deterioration.
Methods: Following our pre-registered protocol (PROSPERO: BLINDED), we searched five electronic databases (PyscNet, PubMed, International Bibliography of the Social Sciences, Child Development and Adolescent Studies, and Scopus) for peer-reviewed studies conducted in the UK up to 9th February 2024. Eligible studies included a care-experienced sample, measured placement (in)stability, measured at least one mental health outcome, and quantitatively examined the relationship between placement changes and mental health. A random-effects meta-analysis was conducted, and risk of bias was assessed using adapted versions of the Newcastle-Ottawa Scale. Study selection and reporting followed PRISMA guidelines.
Findings: We included 15 studies (6,905 care-experienced individuals), with 12 contributing to the meta-analysis. Children with unstable placements were more than twice as likely to experience poor mental health outcomes compared to those with stable placements (OR = 2·07, 95% CI 1·65-2·59, I2 = 61·8%). However, there was a lack of evidence examining the causal direction of this effect.
Interpretation: For children in the UK care system, placement instability doubles the risk of adverse mental health outcomes, which is of considerable importance given the already elevated rate of mental disorders in this group. Further research is urgently needed to clarify the (bi)directional nature of this relationship and guide targeted intervention. Meanwhile, policymakers must prioritise collaborations between mental health services and local authorities to prevent the cycle of instability and mental health deterioration.
| Original language | English |
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| Publisher | SSRN |
| DOIs | |
| Publication status | Published - 16 Dec 2024 |
Funding
CV is funded through an ESRC South West Doctoral Training Partnership (SWDTP) PhD studentship at BLINDED.
| Funders | Funder number |
|---|---|
| Economic and Social Research Council |
