Selon la littérature, l’émergence de troubles mentaux est liée statistiquement à l’adoption chez les adolescents, ainsi que leur surreprésentation en hôpital psychiatrique. Nous formulons l’hypothèse que les difficultés liées à cette situation s’expriment selon une catégorie diagnostique spécifique. Pour la vérifier, nous avons collecté, de manière rétrospective, les diagnostics de 148 adolescents hospitalisés dans une clinique psychiatrique bruxelloise en 2003–2004 et nous les avons comparés selon leur origine familiale (adoptés, immigrés, autochtones non-adoptés). Les diagnostics les plus fréquents étaient les troubles du comportement chez les adoptés, les troubles psychotiques chez les immigrés et les troubles affectifs chez les autochtones. Dans cet échantillon de petite taille, aucune différence diagnostique n’a été observée entre les adoptés internationaux et nationaux. Les résultats globaux indiquent que les diagnostics des adolescents adoptés internationaux sont différents de ceux des immigrés. Les troubles du comportement seraient pour les adolescents adoptés un mode préférentiel d’expression des difficultés liées à l’abandon et l’adoption. Le recours à un traitement hospitalier de ces troubles pourrait être influencé par d’autres facteurs, notamment, la perception des troubles par l’entourage. Une étude plus large permettrait de confirmer cette hypothèse.

Several studies have revealed an increased risk in the appearance of behavioural and psychological problems among adopted teenagers. Others noted their over-representation in psychiatric hospitals and in mental health consultations. Adolescence could be a crucial period on the basis of their subjective identity, and of the sudden appearance of psychological difficulties for the adopted adolescents consecutive to questions regarding their origin and role in the family. Some authors suggested that the influence of racial discrimination among adopted adolescents could play a role in the genesis of mental disorders. No studies concerning adopted adolescents in psychiatric hospital have ever been published in Belgium, and the differences in culture and in legislation do not justify a direct transposition of the conclusions of a study from one country to another.

Our hypothesis is that the psychic disorders of adopted teenagers cannot be summarized by the difficulty of facing racial discrimination but that the difficulties related to the abandonment and adoption are expressed according to a specific diagnostic category, different from that of immigrant adolescents.

This retrospective study concerns in-patients (12 to 20 years old), hospitalized from January 1, 2003 to December 31, 2004 in the service for adolescents and dissociative disorders of the Private Psychiatric Clinic Fond’Roy in Brussels. At first admission the prevalence of psychiatric diagnoses among adopted patients was compared according to age, sex, family origin, as well as to age of adoption. Three family origins were considered: Adopted, immigrant of 1st and the 2nd generations and native adolescents who had not been adopted. Among the adopted patients, we distinguished the internationally and nationally adopted adolescents. The internationally adopted adolescents were defined as originating from another continent and thus likely to be object of racial discrimination. Only three main diagnostic categories were considered: Conduct disorders or problems of externalisation, affective disorders or problems of internalisation, and psychotic disorders. To control the hypothesis of independence of the variables, the chi-square of Pearson was calculated for each comparison.

Eight patients could not be included in any of the diagnostic categories and were excluded from the study.

The 148 selected patients in the study counted 81 boys (54.7%) and 67 girls (45.3%). 23 of them (15.5%) were between 12 to 14 years old, 73 (49.3%) from 15 to 17 years old and 52 (35.1%) from 18 to 20 years old. Seventeen patients were adopted ones (11.5%), 36 were immigrants who had not been adopted (24.3%) and 95 were native adolescents who had not been adopted (64.2%). There were 9 international adopted patients (52.9%) and 8 national ones (47.1%). Our study showed that, according to a rough estimate, among the hospitalized teenagers the percentage of adopted patients was 5 to 10 times superior to that of the Belgian general population. This important request for psychiatric treatment cannot be directly interpreted as a higher prevalence of mental disorders associated with adoption. Hospitalization can also be influenced by social and psychological factors specific to the adoptive families, as suggested by socio-medical authors. The behavioural disorders were more frequent than expected in the adopted patients group (47.1%), the psychotic disorders more frequent among the immigrants (52.8%) and affective disorders more frequent in the native patients who had not been adopted (60.0%), with P<0.0001. These latest disorders were more frequent in girls (64.2%) and the psychotic disorders in boys (45.7%), with P<0.00005. The behavioural disorders were more frequent in the 12–14-year group (52.2%) and slightly more frequent in the 15–17-year group (26.0%), the psychotic disorders were more frequent in the 18–20-year group (61.5%), with P<0.00001. The behavioural disorders thus preferentially touch the adopted teenagers hospitalised in psychiatry, they tended to decrease as age increased and they did not show a relationship with the sex of the patients. These data can be interpreted as a tendency of the adopted patients to develop adolescent problems of externalisation when they encounter psychological difficulties. In Belgium, these disorders are interpreted by the psychosocial workers as a psychiatric reason for hospitalisation. In addition, a Dutch study described an increased incidence of anxio-depressive disorders in young adopted adults that were not hospitalized. This observation could be interpreted as the need for in-patient care in a safe environment for behavioural problems and as an increased possibility of out-patient care for affective disorders. The distribution of the diagnoses did not differ significantly among internationally and nationally adopted adolescents, with P>0.05. These disorders would thus rather be influenced by the common status of the adopted patients and not by racial differences. However, the small number of patients included in the internationally adopted group did not allow a direct statistical comparison with the immigrant group. Broadly speaking one may say that adopted patients and immigrants were not hospitalised for the same psychiatric reasons.

The age of adoption was mentioned in the files of 16 of the 17 adopted ones. Affective disorders were only observed for adoptions before the age of three (50.0%) and psychotic disorders for adoptions above the age of three (50.0%), with P<0.05. However two problems prevented us examining the influence of a late age of adoption on the development of psychotic disorders: The small sample size of adopted children and the age of admission of the adopted patients. The 8 patients adopted after the age of three were all older than 15 years old and had thus a greater risk of presenting psychotic disorders.

The etiology of the behavioural problems responsible for the psychiatric hospitalisation of adopted adolescents must preferentially be attributed to factors related to their abandonment and their adoption, rather than to a difference of physical appearance and racial discrimination. This conclusion raises the question of the choice of treatment in a psychiatric service for these patients. A research conducted in a wider population could contribute to the validity of our conclusion. It should examine the other possible factors influencing the need for hospitalisation, more particularly the motivations of the persons requesting hospital care.