Out-of-home placement, sleep problems, and later mental health and crime: A prospective investigation

Abstract

Previous research suggests that out-of-home placement experiences increase the risk for mental health problems and criminal involvement. However, few studies have examined the mechanisms whereby out-of-home placement increases the risk for these outcomes. The present study examines whether sleep problems in part explain the relationship between childhood placement experiences and depression and anxiety and criminal arrests in adulthood. Data are from a prospective longitudinal study of 531 children with documented cases of childhood maltreatment (14% with no out-of-home placement, 68% placed solely for abuse and/or neglect, and 18% placed for maltreatment and delinquency) who were followed up into adulthood. Cases are from 1967 to 1971 from a metropolitan county in the Midwest. Sleep problems were assessed in young adulthood (M_age = 29 years). Depression and anxiety symptoms and arrest records were assessed in middle adulthood (M_age = 40 years). Structural equation modeling was used to test hypotheses. Both types of out-of-home placement experiences (for maltreatment only and for maltreatment and delinquency) predicted more sleep problems in adulthood across all models. Sleep problems in young adulthood predicted higher levels of anxiety and depression in middle adulthood, but not criminal arrests. Sleep problems mediated the relationship between placement only and internalizing symptoms and results differed for male, female, White, and Black individuals examined separately. Using court-substantiated cases of childhood abuse and neglect, this study demonstrates the long-term negative consequences of out-of-home placement experiences for sleep problems and anxiety and depression in adulthood. More attention is needed to insure adequate sleep for maltreated children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Figure 1.

Schematic diagram of the hypothesized model illustrating the potential role of sleep problems as a mediator of the relationship between out-of-home placement experiences and two subsequent outcomes (criminal arrests and internalizing symptoms in later life). Out-of-home placement refers to placement for abuse or neglect and placement for abuse or neglect plus delinquency, compared to no out-of-home placement. Sleep problems were assessed with responses to questions about trouble falling asleep, waking up too early, and sleeping too long. The latent factor of internalizing symptoms includes scores on standardized assessments of depression and anxiety.