title: [Epidemiology of emotional and behavioral problems in children and adolescents reared in orphanages: a national comparative study].
abstract: OBJECTIVE
  We examined the prevalence of emotional and behavioral problems, and associated factors in children and adolescents aged 6-18 years that were reared in orphanages. We aimed to compare these children and adolescents with a nationally representative age-matched sample that were raised by their own families and to identify mental health service needs in orphanages.
  
  
  METHODS
  This cross-sectional study included 674 children and adolescents aged 6-18 years that were selected from orphanages using stratified and probability cluster sampling. A socio-demographic information form, and the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and Youth Self-Report Form (YSR) were used for data collection.
  
  
  RESULTS
  According to the information provided by caregivers, teachers, and youths, the prevalence of problem behaviors ranged between 18.3% and 47% among those in institutional care versus between 9% and 11% among the national sample. Among those in institutional care, the prevalence of externalizing problems (21.4%-41.9%) was significantly higher than the prevalence of internalizing problems (6.2%-40.1%). At the syndrome level, the prevalence of social problems (5.7%-11.7%), thought disorders (7.2%-18.4%), and attention problems (7.7%-31.4%) among the youths in institutional care was higher than among the national sample (1.6%-5.8%). Age at first admission, receiving institutional care because of neglect and abuse, moves 2 or more times between institutions, recurrent physical illness, receiving poor quality care, lack of regular contact with parents or relatives, lack of regular contact with teachers and the institutional staff, poor problem-solving skills, fatalistic beliefs, tobacco and alcohol use, the feeling of stigmatization, and low-level competency were significantly associated with an increased risk of behavioral and emotional problems. In this representative study, only 2.4% of the children received any mental health care services.
  
  
  CONCLUSIONS
  There is an urgent need to develop alternative care models and routine screening for mental health. The training of professionals and development of mental health services for children in institutional care should be a priority.
authors.affiliation: zsimsek@harran.edu.tr
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Simşek
authors.forename: Neşe
authors.initials: N
authors.lastname: Erol
authors.forename: Didem
authors.initials: D
authors.lastname: Oztop
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ozer Ozcan
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000453:epidemiology* / Q000523:psychology; D001526:Behavioral Symptoms / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000523:psychology; D054540:Child, Orphaned / Q000523:psychology*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D019372:Orphanages; D011594:Psychometrics; D014421:Turkey / Q000453:epidemiology