Child mental health after institutional care in Azerbaijan: prevalence and correlates.

purposeTo examine mental health symptoms and their associations with institutional and sociodemographic characteristics among school-aged children reunified with their families following deinstitutionalization in a country in the South Caucasus.

methodsThis study reports cross-sectional findings from baseline data collected for a randomized clinical trial (ClinicalTrial.gov #NCT05396625). The sample included 434 children (ages 7–12) with histories of institutional placement and 305 caregivers (parents or kin-relatives) recruited in Azerbaijan following family reunification. Individual- and family-level socio-demographic characteristics were examined to assess their associations with mental health outcomes, as reported by children (self-esteem, symptoms of depression, post-traumatic stress disorder/PTSD) and by caregivers (Attention-Deficit/Hyperactivity Disorder/ADHD symptoms, and internalizing and externalizing behavioral problems). Mixed effects regression models were employed to account for clustering of children within families.

resultsOver half (52%) of children with a history of institutional placement scored above the clinical cutoff for depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D), 37% for PTSD symptoms on the Child Revised Impact of Events Scale-8 (CRIES-8), and 36% for ADHD symptoms on the ADHD Rating Scale-IV. Caregiver reports on the Strengths and Difficulties Questionnaire (SDQ) indicated that 45% of children were at high or very high risk for emotional and behavioral problems, with internalizing (54.05%) more than twice as common as externalizing (24.54%). Middle school-aged children exhibited higher symptomatology across multiple mental health outcomes compared to those in elementary school, and children with special needs displayed elevated symptoms across all parent-reported outcomes. According to parent reports, girls showed fewer ADHD (-3.60, 95% CI: -5.80, -1.39) and externalizing (impulsivity, aggression, disruptive behaviors, -1.74, 95% CI: -2.60, -0.89]) but more internalizing symptoms (withdrawn, anxious, persistent sadness, low self-worth) than boys, while child-reported depression did not differ by gender. Lower socio-economic status (e.g., receipt of public assistance, perceived low SES, larger household size, residence outside the capital, and lower caregiver education) and maternal (vs. paternal or non-parental) reports were associated with higher parent-reported internalizing problems among children. Children who had stayed in boarding school-type institutions with weekend home returns showed fewer problems (-2.70, 95% CI: -5.10, -0.31), especially internalizing, than those from orphanages.

conclusionA substantial proportion of children reunified with families following deinstitutionalization exhibit clinically significant mental health symptoms. Mental health symptomatology varied by age, gender, and socioeconomic disadvantage, with the latter exerting a stronger influence on parents’ perceptions than on children’s self-reports. These findings underscore the importance of integrating targeted preventive mental health programs with supportive family-based interventions that also address socio-economic factors, in order to better support this vulnerable population during and after the reintegration process.