Mental health-related hospitalisations among adolescents with previous child protection contact from birth to age 11

Objectives To examine the burden of mental health-related hospitalisations among adolescents by levels of previous child protection contact. Design, setting and participants Whole-of-population study of children born in South Australia, 1991-1999 (n=175,115), using de-identified linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform. Main outcome measures Adolescents: proportion of adolescents aged 12-17 years with mental health hospitalisations; Hospitalisations: proportion of all adolescent mental health hospitalisations according to the level of child protection contact from 0-11 years. Results Overall, 15.5% (27,203/175,115 children) of adolescents had a history of child protection contact between ages 0-11 years, and 3.2% (5,646/175,115; 95% CI, 3.1 – 3.3) had a mental health-related hospitalisation between ages 12-17 years. Of the 10,633 mental health-related hospitalisations, 44.9% (95% CI, 44.0 – 45.9) were among adolescents with previous child protection contact even though they comprised only 15.5% of the study population. Of 5,646 adolescents with at least one mental health-related hospitalisation, 40.4% (95% CI, 39.1 – 41.7) had previous child protection contact. Among the population who experienced out-of-home care, 17.5% (209/1,191; 95% CI, 15.5 – 19.8) had experienced a mental health-related hospitalisation during adolescence, compared to 2.3% (3,366/147,912; 95% CI, 2.2 – 2.4) of adolescents with no prior child protection contact. Conclusion Almost 45% of mental health hospitalisations for 12-17-year-olds occurred among children who had child protection contact, despite that group comprising only 15.5% of the study population. Potential trauma sequelae associated with child protection history is important to consider in the response to adolescents hospitalised due to mental health challenges. The known Adolescent mental health is an important public health issue and those in child protection are at higher risk of experiencing mental health challenges. The new We have quantified the burden of adolescent mental health hospitalisations attributable to the population with prior child protection system contact. For adolescents aged 12-17 years, those with a child protection history accounted for 44.9% of all adolescent mental health hospitalisations. The implications Potential trauma sequelae associated with child protection history are important to consider in the response to adolescents hospitalised due to mental health challenges. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Prof Lynch was awarded a National Health and Medical Research Council (NHMRC) Australia Fellowship (award No. 570120); and NHMRC Centre of Research Excellence (award No. 1099422). Prof Lynch and Assoc Prof Chittleborough were awarded an NHMRC Partnership Project Grant (grant No. 1056888). Dr Pilkington and Ms Montgomerie were supported by funds from the NHMRC Centre for Research Excellence. Dr Malvaso is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200100679). Ms Procter was supported by funds from the Westpac Scholars Trust. Ms Judd was supported by funds from Healthy Development Adelaide. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was granted by the South Australian Department of Health Human Research Ethics Committee (2022/HRE00137), the University of Adelaide Human Research Ethics Committee (H-185-2011), and the Aboriginal Health Research Ethics Committee (REC2411/9/14). Approval to use these data was also provided by the custodians of each data source. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data analysed in the present study are not available.