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

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.