Anders Hjern

Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: a cohort study

BACKGROUND Many intercountry adoptees are reaching adolescence in western Europe and the USA, and the mental health and social adjustment of these individuals as adolescents and young adults has now become an important issue. We aimed to assess mental health disorders and social maladjustment in adolescence and young adulthood in intercountry adoptees in Sweden. METHOD Our data was obtained from the Swedish national registers for the cohort born in 1970-79. We used multivariate Coxs regression models of person-years to compare indicators of suicide death (1986-95), court sentences (1986-93), and discharges for psychiatric illness, suicide attempts, and substance abuse (1987-94) in 11,320 intercountry adoptees with 2343 Swedish-born siblings, 4006 immigrant children, and a general population of 853 419 Swedish-born residents. FINDINGS After adjustment for major sociodemographic confounders, intercountry adoptees were more likely than other Swedish-born children to die from suicide (odds ratio 3.6, 95% CI 2.1-5.9); attempt suicide (3.6, 3.1-4.2); be admitted for a psychiatric disorder (3.2, 2.9-3.6), drug abuse (5.2, 2.9-9.3) or alcohol abuse (2.6, 2.0-3.3); or to commit a crime (1.6, 1.5-1.7). Siblings in adoptive homes had lower odds ratios for most outcomes than did adoptees, whereas adoptees and immigrant children had much the same odds ratios. INTERPRETATION Adoptees in Sweden have a high risk for severe mental health problems and social maladjustment in adolescence and young adulthood. We advise professionals to give appropriate consideration to the high risk of suicide in patients who are intercountry adoptees.

Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non-farming environments. A nationwide study over three decades

Background Asthma and allergies are less common in children who have been raised in farming environments.

School stressors, psychological complaints and psychosomatic pain

Background: The proportion of Scandinavian school children reporting psychosomatic pain and psychological complaints have increased in recent decades. In this study we investigated these symptoms in relation to potential stressors in the school environment.

Suicide in first- and second-generation immigrants in Sweden A comparative study

Background: Studies of suicide in first-generation immigrants have consistently shown higher rates compared to their country of origin. Little is known about the risk of suicide in second-generation immigrants and intercountry adoptees. The aim of this study was to investigate rates of suicide death in second-generation immigrants and intercountry adoptees in comparison with their parental generation and the majority population. Method: The study was based on multivariate analyses of register data on suicide death during 1990–98 in a Swedish national cohort of 2.7 million residents (10–68 years). Results: Second-generation immigrants tended to have higher odds than the first-generation immigrants compared to the majority population in all six minority groups studied. The Finnish minority had the highest and the Middle Easterners the lowest odds for suicide death in both generations of immigrants. The intercountry adoptees had very high odds for suicide death (adjusted OR: 5.0; 95 % CI 3.5–7.0). Conclusions: Second-generation immigrants are at greater risk for suicide death than their parental generation. Intercountry adoptees should be of particular concern in suicide prevention.

Psychiatric Morbidity in Adolescents and Young Adults Born Preterm: A Swedish National Cohort Study

OBJECTIVE. Increasing numbers of infants born preterm survive into adulthood. Previous studies have reported increased levels of neurologic and cognitive disabilities in these children. In this study, we analyzed the effect of having been born preterm on psychiatric morbidity. METHODS. A Swedish national cohort of 545628 individuals born in 1973–1979 was followed up in the national registers during 1987–2002. Multivariate Cox analysis of proportional hazards was used to estimate the hazard ratios of hospital admissions for psychiatric disorders and alcohol/illicit drug abuse. RESULTS. There was a stepwise increase in psychiatric hospital admissions with an increasing degree of preterm birth. A total of 5.2% of children born at 24 to 28 weeks’ gestation and 3.5% born at 29 to 32 weeks’ gestation had been hospitalized because of a psychiatric disorder. The hazard ratios for psychiatric disorders were 1.68 in the group of very preterm children (gestational weeks 24–32), 1.21 in the moderately preterm group (gestational weeks 33–36), and 1.08 in the early term group (gestational weeks 37–38) after adjustment for socioeconomic confounders. Moderately preterm and early term birth accounted for 85% of the risk attributed to preterm/early term birth. The effect of preterm birth was greater in households with low socioeconomic status. CONCLUSION. Preterm birth carries some risk for psychiatric disorders requiring hospitalization in adolescence and young adulthood (ages 8–29 years). Even if this risk increases with degree of preterm birth, most subjects are moderately preterm, a group in need of more attention in research and secondary prevention.

Social adversity contributes to high morbidity in psychoses in immigrants – a national cohort study in two generations of Swedish residents

BACKGROUND Recent reports have indicated that immigrants have an elevated risk of schizophrenia as well as an increasing tendency for social exclusion. The aim of this study was to compare rates of schizophrenia and other psychoses in immigrants and their children of different ethnic groups with the majority population in Sweden in relation to social adversity. METHOD The study population consists of a national cohort of 1.47 million adults (born 1929-1965) and 1.16 million children and youth (born 1968-1979) in family households from the national census of 1985. Multivariate Cox regression analyses was used to study hospital discharge data during 1991-2000 in relation to socio-economic household indicators from 1985 and 1990 (single adult household, adults having received social welfare, parental unemployment, urban residency, housing and socio-economic status). RESULTS First as well as second generation immigrants had higher age and sex adjusted risk ratios for schizophrenia as well as for other psychoses (RRs 1.4-3.1 and 1.0-2.0 respectively) compared with the Swedish majority population. These risk ratios decreased considerably after adjusting for socio-economic indicators, for all groups, but particularly for the non-European immigrants. However, an elevated risk still remained in the Finnish and Eastern and Southern European study groups. CONCLUSIONS A higher risk of schizophrenia and psychoses was found in two generations of immigrants of diverse ethnicity. The results indicate that social adversity contributes to the higher risk.

Intercountry Adopted Children as Young Adults— A Swedish Cohort Study

In a national cohort study, the family and labor market situation, health problems, and education of 5,942 Swedish intercountry adoptees born between 1968 and 1975 were examined and compared with those of the general population, immigrants, and a siblings group--all age matched--in national registers from 1997 to 1999. Adoptees more often had psychiatric problems and were longtime recipients of social welfare. Level of education was on par with that of the general population but lower when adjusted for socioeconomic status.

Social class in asthma and allergic rhinitis: a national cohort study over three decades

The aim of this study was to assess whether the association with social class differed between allergic rhinitis and asthma and whether these associations have changed over time. The Swedish Military Service Conscription Register was linked to two other national registers for 1,247,038 male conscripts in successive cohorts born between 1952 and 1977. The percentage of asthma cases associated with allergic rhinitis was 15% in the oldest cohort and 44% in the youngest cohort. Low socio-economic status (SES) was associated with an increased risk (assessed as odds ratio) of asthma without allergic rhinitis (1.14, 95% confidence interval (CI) 1.11–1.17) but a slightly reduced risk of asthma with allergic rhinitis (0.96, 95% CI 0.93–1.00). The risk of allergic rhinitis was 0.84, 95% CI 0.82–0.85. A positive interaction between SES and year of birth occurred in all three conditions. Low SES was related to a reduced risk of asthma with allergic rhinitis in the earliest cohort (0.72, 95% CI 0.53–0.82) but a slightly increased risk in the most recent cohort (1.07, 95% CI 1.01–1.14). In conclusion, the role of social class has changed over time. The steepest increase in asthma and allergic rhinitis occurred in conscripts with a low socio-economic status.

Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents

Background Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization.

ADHD after fetal exposure to maternal smoking

INTRODUCTION Smoking during pregnancy has been reported to be associated with a twofold to fourfold increased risk of attention-deficit hyperactivity disorder (ADHD) in the offspring. Genetic and socioeconomic confounders may contribute to this association. The aim of this study was to investigate the association between fetal exposure to maternal smoking during pregnancy and ADHD, taking such potential confounders into consideration. METHODS A register study in a population of 982,856 children, 6-19 years of age, born at term, and residents in Sweden in 2006 was conducted. Logistic regression was used to calculate odds ratios (ORs) of maternal smoking habits during pregnancy on ADHD medication in the 927,007 study subjects where maternal smoking habits were available from the Medical Birth Register in the presence of socioeconomic and parental psychiatric morbidity confounders. To adjust the analysis also for genetic confounding, we used a within-mother between-pregnancy approach in offspring of 26,292 mothers with inconsistent smoking habits (smoking/non-smoking) between pregnancies. RESULTS The OR for ADHD medication in offspring of mothers who smoked >or=10 cigarettes/day was 2.86 (2.66-3.07) in the entire study population after adjustment for sex and age, while this same exposure yielded an OR of only 1.26 (0.95-1.58) when two pregnancies of the same mother were analyzed in a within-subjects design. DISCUSSION Smoking during pregnancy has a strong association with ADHD in the offspring in the general Swedish population, but this risk is primarily explained by genetic and socioeconomic confounding.