School performance in primary school and psychosocial problems in young adulthood among care leavers from long term foster care

We used data from Swedish national registers for ten entire birth year cohorts (1972–1981) to examine psychosocial outcomes in young adulthood for youth that left long term foster care after age 17, comparing them with majority population peers, national adoptees and peers who had received in-home interventions before age 13. The population was followed in the registers from age 16 to 2005. Data were analyzed in Cox regression models.Youth who left long term foster care had six-to eleven fold sex and birth year adjusted excess risks for suicide attempts, substance abuse and serious criminality from age 20, and for public welfare dependency at age 25. Overrisks were considerably lower for the in-home intervention group and the national adoptees. Adjusting results for poor school performance in the final year in primary school (ages 15–16) reduced overrisks by 38–52% for care leavers from long term foster care.Irrespective of issues of causality, poor school performance seems to be a major risk factor for future psychosocial problems among youth who age out of long term foster care. The results suggest that promoting foster children's school performance should be given high priority by agencies.

► All Swedish residents born 1972-1981 were followed in a host of national registers from age 16 to 2005.
► Care leavers from long term foster care had substantially poorer school performance than majority population peers.
► They had lower chances of getting a secondary education than majority population peers with similar school performance.
► They had high excess risks for future suicide attempts, substance abuse, serious criminality and welfare dependency.
► Up to 55% of these excess risks could be statistically “explained” by poor school performance.