A comparative study of mental health and wellbeing in adopted children, children in foster and kinship care, and the general population

BACKGROUND: Children with care experience are at elevated risk of poor mental health and wellbeing, yet large-scale comparative studies of placement type, particularly including adoption following a period in care, remain limited. This study examined mental health and wellbeing outcomes across different care arrangements using population-level data from children attending secondary school (age 11 to 16) in Wales, UK. METHODS: Data were drawn from the School Health Research Network 2023 Student Health and Wellbeing Survey, completed by 129,761 children across 202 mainstream schools in Wales, UK. Analyses included 103,316 children in the general population and 2384 care-experienced children, comprising those in kinship care (n = 1,460), non-relative foster care (n = 589), and adoptive families (n = 335). Groups were compared on youth self-reported measures including the Strengths and Difficulties Questionnaire (SDQ), Short Mood and Feelings Questionnaire (SMFQ), and the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). RESULTS: Children in the general population had better mental health and wellbeing outcomes than care-experienced peers. Adopted children reported the poorest mental health outcomes across all domains, exhibiting significantly higher total SDQ difficulties, internalising and externalising difficulties, depressive symptoms, and the lowest wellbeing scores. Children in foster care had better mental health and wellbeing relative to the other care experienced groups, followed by children in kinship care. CONCLUSIONS: Findings highlight substantial disparities in mental health and wellbeing among care-experienced youth, with adopted children showing the most elevated difficulties. These results underscore the need for policies to include targeted mental health support for care-experienced children across all settings, including post-adoption contexts.