Objective This prospective longitudinal study of a general population sample investigates whether maternal experience of out-of-home care (OHC) constitutes an independent risk factor for the development of externalising and internalising symptoms in offspring, after adjusting for other commonly associated aetiologic risks. Participants 18 810 families in the UK Millennium Cohort Study with complete information provided by the birth mother regarding her OHC experience and ethnicity. Primary outcome measures Offspring externalising and internalising symptoms assessed by the Strengths and Difficulties Questionnaire as reported by the birth mother. Design Latent profile analysis of offspring behavioural adjustment trajectories to identify distinct patterns of co-occurring internalising and externalising problem trajectories from age 3 to 17 years. The role of maternal OHC experience and other risk factors as predictors of adjustment patterns were examined descriptively and using multinomial regression. Results Five groups of symptom trajectories were identified: two normative groups with very low (33%) and low symptom levels (40%) and three problem behaviour groups including high externalising/moderate internalising (10%), high internalising/high externalising (5%) and moderate internalising/high externalising (12%). Compared with the normative group, higher symptoms were predicted by family socioeconomic status (SES), housing conditions, maternal health, parent–child relationship and child characteristics. Maternal OHC experience was a significant risk factor for all three problem groups, with the highest relative risk (RRR 4.82) observed for children showing high internalising/externalising symptoms. However, after controlling for the other risk factors, maternal OHC experience was no longer significantly associated with higher symptoms. Conclusion Maternal OHC experience is associated with an elevated risk of offspring presenting adjustment problems, characterised by co-occurring internalising and externalising symptom trajectories. However, the impact of maternal OHC experience on their children’s adjustment was fully attenuated by other common etiological risks, suggesting that these factors play a critical role in mediating the risk.
Schoon et al. (Thu,) studied this question.