Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures

Meryem Seçen Yazıcı; Meltem Küçükdağ; Mustafa Karadeniz; Cansu Pınar Yavaş

doi:10.18521/ktd.1911037

Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures

Abstract

Aims: In Türkiye, court-mandated health protection measures ensure mental health assessment and follow-up for children in the child protection system. Evidence on factors associated with institutional care history in this population is limited. This study described the sociodemographic and clinical characteristics of these children and examined documented clinical and psychosocial correlates of institutional care history.

Material and Methods: Children and adolescents followed under a health protection measure in the child and adolescent psychiatry outpatient clinic of a state hospital between June 2023 and January 2024 were retrospectively reviewed (n=113). Psychiatric diagnoses and treatments were obtained from clinical records, and psychosocial risk variables from official social assessment reports. Correlates of institutional care history were evaluated using multivariable logistic regression adjusted for age and sex, with discrimination assessed by the area under the receiver operating characteristic curve.

Results: At least one psychiatric diagnosis was present in 81.4% of cases and psychotropic medication use in 51.3%, while 27.4% had discontinued outpatient follow-up. Institutional care history was independently associated with caregiving inadequacy (aOR=10.58; 95% CI:2.92–38.42), history of sexual abuse (aOR=3.83; 95% CI:1.14–12.91), and family history of crime (aOR=3.11; 95% CI:1.16–8.37); physical abuse was not significant. The model indicated good in-sample separation (AUC=0.825).

Conclusion: Institutional care history was most prominently associated with documented caregiving inadequacy, alongside sexual abuse history and family history of crime. Systematic assessment of caregiving safety, trauma exposure, and family legal adversity may support coordinated, trauma-informed follow-up. Prospective, multicentre studies are needed before these findings inform predictive decision-making.

Keywords

References

T.C. Aile ve Sosyal Hizmetler Bakanlığı. 5395 sayılı Çocuk Koruma Kanunu (Madde 5: koruyucu ve destekleyici tedbirler). Sayı 25876 [Internet]. Ankara: T.C. Resmi Gazete [Official Gazette of the Republic of Türkiye]; 2005 Jul 03 [cited 2026 Mar 01]. Available from: https://www.aile.gov.tr/uploads/chgm/uploads/pages/kanunlar/5395-sayili-cocuk-koruma-kanunu.pdf
Karadağ F, Çavdar Kolbüken Y. Sağlık tedbiri kararı bulunan çocukların koruyucu/önleyici hizmetler kapsamında değerlendirilmesi. Tıbbi Sosyal Hizmet Dergisi. 2022;(19):86-102. doi:10.46218/tshd.1074232.
Nasıroğlu S. Sağlık tedbiri alınan çocuk ve ergenlerin ruhsal açıdan değerlendirilmesi. Cukurova Med J. 2017;42(3):484-9. doi:10.17826/cutf.296421.
Bozduman Çelebi S, Güneş S, İnal Ulutaş G. Sağlık tedbiri nedeniyle bir eğitim araştırma hastanesinde takipli olan çocukların sosyodemografik özelliklerinin değerlendirilmesi: üç yıllık retrospektif inceleme. Harran Üniv Tıp Fak Derg. 2025;22(4):650-6. doi:10.35440/hutfd.1708415.
Strathearn L, Giannotti M, Mills R, Kisely S, Najman J, Abajobir A. Long-term cognitive, psychological, and health outcomes associated with child abuse and neglect. Pediatrics. 2020;146(4):e20200438. doi:10.1542/peds.2020-0438.
Bronsard G, Alessandrini M, Fond G, Loundou A, Auquier P, Tordjman S, et al. The prevalence of mental disorders among children and adolescents in the child welfare system: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(7):e2622. doi:10.1097/MD.0000000000002622.
United Nations General Assembly. Guidelines for the alternative care of children: resolution / adopted by the General Assembly [Internet]. Resolution no: A/RES/64/142. New York: United Nations; 2010 [cited 2026 Mar 06]. Available from: https://digitallibrary.un.org/record/673583
Dozier M, Zeanah CH, Wallin AR, Shauffer C. Institutional care for young children: review of literature and policy implications. Soc Issues Policy Rev. 2012;6(1):1-25. doi:10.1111/j.1751-2409.2011.01033.x.

Lionetti F, Pastore M, Barone L. Attachment in institutionalized children: a review and meta-analysis. Child Abuse Negl. 2015;42:135-45. doi:10.1016/j.chiabu.2015.02.013.
Akdağ B. Sağlık tedbiri kapsamındaki çocukların çocuk psikiyatri perspektifinden değerlendirilmesi: bir ilçe örneklemi. Current Perspectives in Social Sciences. 2023;27(2):152-9. doi:10.5152/JSSI.2022.22372.
Güller B, Yaylacı F. Sağlık tedbiri nedeniyle takip edilen çocuk ve ergenlerin sosyo-demografik ve klinik özellikleri. Turk J Child Adolesc Ment Health. 2022;29(2):67-74. doi:10.4274/tjcamh.galenos.2021.38257.
Karagöz D. Bir çocuk psikiyatrisi kliniğine başvuran çocuk evlerinde kalan çocuk ve ergenlerin klinik özelliklerinin incelenmesi. Turk J Child Adolesc Ment Health. 2023;30(2):154-61. doi:10.4274/tjcamh.galenos.2022.49368.
Yektaş Ç, Tufan AE, Yazıcı M. Düzce ili çocuk evlerinde kalan çocuk ve ergenlerin klinik ve sosyodemografik özellikleri. Konuralp Med J. 2018;10(3):298-304. doi:10.18521/ktd.454244.
Yıldız A, Bilge Y. Çocuk evlerinde ve aileleriyle yaşayan erkek ergenlerde görülen psikolojik bozuklukların bağlanma biçimleri ve duygu düzenleme açısından incelenmesi. Toplum ve Sos Hizmet. 2020;31(4):1459-85. doi:10.33417/tsh.738311.
Yulaf Y, Gümüştaş F. Kurum bakımında yaşayan ve evlat edinilen çocuk ve ergenlerin ruhsal bozukluklar açısından karşılaştırılması. Cukurova Med J. 2019;44(3):904-10. doi:10.17826/cumj.504819.
Drake B, Jonson-Reid M, Ocampo MG, Morrison M, Dvalishvili D. A practical framework for considering the use of predictive risk modeling in child welfare. Annals of the American Academy of Political and Social Science. 2020;692(1):162-81. doi:10.1177/0002716220978200.
Austin A. Is prior parental criminal justice involvement associated with child maltreatment? A systematic review. Child and Youth Services Review. 2016;68:146-53. doi:10.1016/j.childyouth.2016.07.008.
Öztürk AB, Albayrak H, Karataş K, Aslan H. Cinsel istismara karşı Çocuk Koruma Kanunu kapsamında verilen tedbirlere yönelik meslek elemanlarının değerlendirmeleri. Pamukkale Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2024;(62):167-88. doi:10.30794/pausbed.1413021.
Klassen SL, Hickman DL. Reporting child abuse and neglect on K-12 campuses. In: Best practices for trauma-informed school counseling [Internet]. IGI Global Scientific Publishing; 2022 [cited 2026 Mar 05]. p. 204-29. doi:10.4018/978-1-7998-9785-9.ch010.
Humphreys KL, Gleason MM, Drury SS, Miron D, Nelson CA, Fox NA, et al. Effects of institutional rearing and foster care on psychopathology at age 12 years in Romania: follow-up of an open, randomised controlled trial. Lancet Psychiatry. 2015;2(7):625-34. doi:10.1016/S2215-0366(15)00095-4.
Besemer S, Ahmad SI, Hinshaw SP, Farrington DP. A systematic review and meta-analysis of the intergenerational transmission of criminal behavior. Aggression and Violent Behavior. 2017;37:161-78. doi:10.1016/j.avb.2017.10.004.
Ercan ES, Polanczyk G, Akyol Ardıc U, Yuce D, Karacetin G, Tufan AE, et al. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry. 2019;73(2):132-40. doi:10.1080/08039488.2019.1574892.
Engler AD, Sarpong KO, Van Horne BS, Greeley CS, Keefe RJ. A systematic review of mental health disorders of children in foster care. Trauma Violence Abuse. 2022;23(1):255-64. doi:10.1177/1524838020941197.
Paul E, Ortin A. Psychopathological mechanisms of early neglect and abuse on suicidal ideation and self-harm in middle childhood. Eur Child Adolesc Psychiatry. 2019;28(10):1311-9. doi:10.1007/s00787-019-01287-8.
Arnett AB, Antúnez M, Zeanah C, Fox NA, Nelson CA. Physical and neurophysiological maturation associated with ADHD among previously institutionalized children: a randomized controlled trial. J Child Psychol Psychiatry. 2025;66(7):967-79. doi:10.1111/jcpp.14110.
Daley SF, Gonzalez D, Mirabal AB, Afzal M. Child abuse and neglect. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2026 Mar 05]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459146
Lee T, Fouras G, Brown R; AACAP Committee on Quality Issues. Practice parameter for the assessment and management of youth involved with the child welfare system. J Am Acad Child Adolesc Psychiatry. 2015;54(6):502-17. doi:10.1016/j.jaac.2015.03.005.

Details

Primary Language

English

Subjects

Health Services and Systems (Other)

Journal Section

Research Article

Authors

Meryem Seçen Yazıcı ^*
0000-0003-4375-936X
Türkiye

Meltem Küçükdağ
0000-0002-7014-5593
Türkiye

Mustafa Karadeniz
0000-0002-0867-0573
Türkiye

Cansu Pınar Yavaş
0000-0001-7495-4788
Türkiye

Publication Date

October 27, 2026

Submission Date

March 16, 2026

Acceptance Date

August 10, 2026

Published in Issue

Year 2026 Volume: 18 Number: 3

DOI

https://doi.org/10.18521/ktd.1911037

IZ

https://izlik.org/JA26BJ23JW

Cite

RIS / Bibtex

APA

Seçen Yazıcı, M., Küçükdağ, M., Karadeniz, M., & Yavaş, C. P. (2026). Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures. Konuralp Medical Journal, 18(3), 303-310. https://doi.org/10.18521/ktd.1911037

AMA

1.Seçen Yazıcı M, Küçükdağ M, Karadeniz M, Yavaş CP. Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures. Konuralp Medical Journal. 2026;18(3):303-310. doi:10.18521/ktd.1911037

Chicago

Seçen Yazıcı, Meryem, Meltem Küçükdağ, Mustafa Karadeniz, and Cansu Pınar Yavaş. 2026. “Clinical and Psychosocial Factors Associated With Institutional Care History in Children Followed Under Health Protection Measures”. Konuralp Medical Journal 18 (3): 303-10. https://doi.org/10.18521/ktd.1911037.

EndNote

Seçen Yazıcı M, Küçükdağ M, Karadeniz M, Yavaş CP (October 1, 2026) Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures. Konuralp Medical Journal 18 3 303–310.

IEEE

[1]M. Seçen Yazıcı, M. Küçükdağ, M. Karadeniz, and C. P. Yavaş, “Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures”, Konuralp Medical Journal, vol. 18, no. 3, pp. 303–310, Oct. 2026, doi: 10.18521/ktd.1911037.

ISNAD

Seçen Yazıcı, Meryem - Küçükdağ, Meltem - Karadeniz, Mustafa - Yavaş, Cansu Pınar. “Clinical and Psychosocial Factors Associated With Institutional Care History in Children Followed Under Health Protection Measures”. Konuralp Medical Journal 18/3 (October 1, 2026): 303-310. https://doi.org/10.18521/ktd.1911037.

JAMA

1.Seçen Yazıcı M, Küçükdağ M, Karadeniz M, Yavaş CP. Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures. Konuralp Medical Journal. 2026;18:303–310.

MLA

Seçen Yazıcı, Meryem, et al. “Clinical and Psychosocial Factors Associated With Institutional Care History in Children Followed Under Health Protection Measures”. Konuralp Medical Journal, vol. 18, no. 3, Oct. 2026, pp. 303-10, doi:10.18521/ktd.1911037.

Vancouver

1.Meryem Seçen Yazıcı, Meltem Küçükdağ, Mustafa Karadeniz, Cansu Pınar Yavaş. Clinical and Psychosocial Factors Associated with Institutional Care History in Children Followed Under Health Protection Measures. Konuralp Medical Journal. 2026 Oct. 1;18(3):303-10. doi:10.18521/ktd.1911037