The Mental Health of Care-Experienced Young People: An Exploration of Transdiagnostic Mechanisms and Psychological Support

: (Alternative Format Thesis)

Abstract

Young people who have spent time in the UK care system have often experienced maltreatment, and other adversities such as parental drug use and mental ill-health. Once in care, adversity and disruption can continue, with many separated from siblings and moving between placements. Such experiences can have a devastating impact on mental health. Care-experienced young people (CEYP) are five times more likely to meet criteria for a psychiatric disorder compared to their peers. Yet, services continue to struggle to effectively address the mental health needs of this group. Their unaddressed mental health needs have been identified as a primary driver of lifelong challenges. However, some CEYP thrive despite challenging experiences. There remains a lack of evidence to understand how cognitive mechanisms might drive the different mental health outcomes of this group. In my thesis, two projects aimed to address this. Study 1 used secondary longitudinal data to explore the associations between maltreatment, memory, and mental health. We found no evidence that autobiographical memory serves as a transdiagnostic mechanism linking maltreatment to post-traumatic stress or depressive symptoms in CEYP. Study 2 used a quasi-experimental approach to explore the role of affective cognitive control in CEYP versus their peers. Here, we found that CEYP had a cognitive control deficit, however when isolating the affective component of cognitive control, CEYP were no different from their peers and this was largely unrelated to their mental health and well-being outcomes. As a second part of my thesis, I also sought to explore mental health service provision for CEYP, and how this might differ from those not in care. Study 3 drew on the British child and adolescent mental health survey data to explore the links between trauma exposure, mental health diagnoses, and contact with mental health services for CEYP versus their peers. We found that carers of CEYP more frequently contacted services, and CEYP’s trauma history, not mental health, was associated with this contact. Conversely, parents of non-care-experienced peers were more likely to contact services if the young person had increased comorbidities or a hyperkinetic disorder. Study 4 used an experimental approach to explore whether mental health professionals’ diagnosis and treatment decision-making differed if a young person was identified as in care. Here, I used the framework of post-traumatic stress disorder (PTSD), a mental health diagnosis that is 12 times more common in CEYP than their peers. However, we found that professionals were twice as likely to suggest a diagnosis of PTSD if they thought the young person was not in care, and selecting this diagnosis made clinicians three times more likely to select an evidence-based PTSD treatment. Taken together, this research adds to limited quantitative evidence exploring potentially malleable mechanisms that might drive mental health difficulties in CEYP, as well as providing insight into some challenges they may experience in accessing effective psychological support.

Date of Award	22 Jun 2022
Original language	English
Awarding Institution	University of Bath
Supervisor	Sarah Halligan (Supervisor) & Rachel Hiller (Supervisor)