Date of Award

Summer 8-15-2017

Author's School

Graduate School of Arts and Sciences

Author's Department

Social Work

Additional Affiliations

Brown School of Social Work

Degree Name

Doctor of Philosophy (PhD)

Degree Type



Research conducted over the past 100 years in Western nations support the adverse effects of orphanages on children’s emotional, developmental, and social well-being as well as economic costs to society (Save the Children UK, 2009; Bakermans-Kranenburg, Van IJzendoorn & Juffer, 2008; Williams & Greenberg, 2010). Globally, the number of orphaned and abandoned children is conservatively estimated to be around 143 million, of whom the majority reside in Asia, followed by Sub-Saharan Africa (UNICEF, UNAIDS, & USAID, 2004). South Korea (hereafter “Korea”) is an exemplary nation for study because it has a well-established child welfare system, including family-based alternatives (domestic and international adoption, foster care); however, the nation continues to rely disproportionately on orphanages to protect children and adolescents in need of parental care. Since 2000 there has been a small but growing number of studies published by Korean scholars on the psychosocial problems of children in orphanages. However, few of these studies focused on adolescents and none measured trauma exposure or extent of PTSD symptoms. Furthermore, few explored risk and protective factors within the school environment and none explored factors specific to being in alternative care, such as feelings about the loss of birthparents or discrimination for living in an orphanage.

Therefore, utilizing a risk and resilience framework (Garmezy, 1973, 1985; Werner & Smith, 1977; Rutter, 1979) two research questions were posed in this study. The first research question asked: 1) What is the extent of mental health, behavioral, and academic problems among adolescents in Korean orphanages, and what individual factors (demographics, placement experiences, insecure attachment style, birthparent loss appraisal, birthparent loss coping), interpersonal factors (lifetime types of traumas, discrimination because of being in an orphanage, perceived social support, orphanage caregiver school support, birthparent contact) and school factors (school bullying, supportive learning climate) are significant predictors of mental health, behavioral, and academic problems? The second research question was exploratory and addressed: 2) Are adolescent’s cognitions about birthparent loss significantly associated with mental health, behavior, or academic problems, and if so, does birthparent loss coping style (avoidant or active style), mediate the relationship between birthparent loss appraisal and problems among adolescents in Korean orphanages?

This cross-sectional study involved a quantitative survey involving structured interviews with a convenience sample (N=170) of Korean adolescents. The adolescents were between the ages of 11 to 18 years and resided in 10 orphanages located in the Seoul Capital area and a southern province. Data analysis for the first research question involved descriptive and bivariate analyses. Six multiple regression models were then performed to identify significant risk and protective factors associated with mental health (depression and PTSD symptoms), behavioral (internalizing and externalizing behaviors), and academic (school grades and school engagement) problems. For the exploratory second research question, first bivariate analyses were conducted to determine whether there were significant correlations among the predictor (birthparent loss appraisal), mediators (active coping and avoidant coping), and each outcome (depression, PTSD, internalizing behavior problems, externalizing behavior problems, school grades, and school engagement). Twelve simple mediation models were performed to calculate the path coefficients and significance test of the indirect effect utilizing bootstrap re-sampling methodology.

Results from the first research question found 29% of adolescents had mild to severe depressive symptoms and 20% met clinical thresholds for likely PTSD diagnosis. Additionally, 15% of youth in the current study met borderline to clinically significant thresholds for internalizing behavior problems and 22% for externalizing behavior problems. Adolescents in the study were found to have moderate levels of school engagement; however, many were underperforming academically, with most reporting below average or poorer grades in Math and English. Youth reported experiencing an average of 2.6 traumatic events in their lifetime. Furthermore, 37% reported they experienced discrimination because of being in an orphanage, and 40% reporting they had been victims of school bullying in the past year.

Results from the multiple regression analyses identified eight significant risk and protective factors across individual, interpersonal, and school levels that predicted mental health, behavioral, and academic problems among adolescents in Korean orphanages. Five risk factors were found to be significantly associated with more internalizing problems: female, more negative affect and preoccupation with birthparent loss, more types of traumas, and experiencing discrimination because of being in an orphanage. More negative affect and preoccupation with birthparent loss and a more insecure attachment style were found to be significant predictors of more depressive symptoms. Greater birthparent loss and more types of trauma were also significant predictors of more PTSD symptoms. More number of trauma types was also found to be associated with more externalizing behavior problems, as was being a victim of school bullying. Only one risk factor, a more insecure attachment style, was found to be associated with lower school engagement; no risk factors were found to be associated with lower school grades.

Two protective factors were also identified to be significant. More perceived social support was associated with better school grades, more school engagement, less internalizing behavior problems, and lower depressive symptoms. Having a supportive school environment was found to be protective across all outcomes, except for school grades. Finally, results from the exploratory mediation analyses posed by the second research question found out of the 12 models, three were significant. Only active coping was found to be a significant mediator on the relationship between birthparent loss appraisal and three outcomes: depression symptoms, school engagement, and school grades.

This study contributed to knowledge about adolescents in Korean orphanages and their specific mental health, behavioral, and school needs. It was the first study to measure the extent of PTSD symptoms and trauma exposure and to identify significant predictors of PTSD in this population of youth. Furthermore, this study identified two school-related factors, school bullying (risk factor) and a supportive school learning climate (protective factor), to be significant predictors of mental health, behavioral, and school outcomes among youth in Korean orphanages. Finally, this study was the first to measure the extent of discrimination because of being in an orphanage and experiences of birthparent loss among youth in orphanage care in Korea. Study findings have implications for policies, practices, and research to enhance the mental health, behavioral, and school needs of youth in formal systems of child welfare in Korea and globally.


English (en)

Chair and Committee

Wendy Auslander

Committee Members

Geoff Childs, Tonya Edmond, Patricia Kohl, Shanta Pandey,


Permanent URL: