Les jeunes accueillis au titre de la protection de l’enfance présentent de nombreuses vulnérabilités dont certaines ont obéré leur développement. On connaît peu leur situation à long terme et leur qualité de vie. Quels facteurs de risque ont entravé leur parcours ? Quels facteurs de protection ont minimisé les événements stressants vécus ?

L’étude, longitudinale dans le passé, a porté sur 123 jeunes ayant vécu avec leur fratrie plus de trois ans en village d’enfants. Des approches complémentaires – enquête postale incluant le profile de Duke, entretiens en face-à-face, données institutionnelles – ont permis d’analyser l’insertion socioprofessionnelle, la vie relationnelle ainsi que la qualité de vie liée à la santé. Des analyses multivariées par régression logistique ont mis en évidence le rôle propre de certains facteurs.

À un âge moyen de 36,5 ans, les anciens placés présentent majoritairement une insertion générale satisfaisante. La qualité de vie liée à la santé varie positivement en fonction de cette insertion et du support de l’entourage, et négativement en fonction des violences subies pendant l’enfance et de la persistance de troubles psychiques au-delà du placement.

Les situations les plus précaires, témoignant de cumul de facteurs de risque, interrogent sur la nécessité d’identifier de façon précoce les besoins complexes des jeunes en protection de l’enfance et de mettre en place les soins en santé mentale les mieux adaptés.

Child welfare literature underlines a higher prevalence of health problems and psychiatric disabilities in fostered young people than in the general population. Questions remain about their social integration and health in the long term: Which risk factors continue to alter their pathway? Which protective factors have minimized a problematic psychosocial adaptation over time?

A follow-up study in the past was conducted on a SOS children’s village on 123 young people who had been reared for more than 3years and left care after the age of 14. A survey was mailed to these adults aged 23–50years old, followed by face-to-face interviews. All relevant institutional files were analysed. Attrition rates were very low in this high-risk population. An overall score of social integration aggregates data regarding: occupational situation, family life, relationships, general psychosocial state. Health-related quality of life (Duke Profile) was analyzed by means of multiple dimensions including mental and social health, self-esteem, depression and disability. Multivariate analyses by logistic regression were used to examine the specific roles of decisive factors on social integration.

At a mean age of 36.5years, two thirds were well integrated socio-economically, only one out of five had psychosocial problems. Three factors increased the risk of poor socioeconomic integration: accumulation of parental risk factors, having been placed with two or more siblings’ groups and persisting mental health problems when leaving care. The quality of life was significantly associated with a better perception of social and mental health and with self-esteem. It varied positively, taken into account with professional integration, relationships and supportive environment, and negatively according to past adversities: parental domestic violence, maltreatment, and persisting mental health problems. Except from disabilities and to a lesser degree sociability, globally, these former fostered population did not seem different from counterparts in terms of health measures, anxiety and depression.

Results highlight the importance of continuity and stability in placement. For the professionals, it is necessary to give more attention to the question of rearing together several groups of siblings. Persisting mental health problems during placement and when leaving care would suggest a vital need for the staff to identify and to implement intensive, appropriate therapeutic care.