Frank Lindblad

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.

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.

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.

Disclosure, Reactions, and Social Support: Findings from a Sample of Adult Victims of Child Sexual Abuse

Information about abuse characteristics, disclosure, and current social support was collected through semistructured interviews and questionnaires from 122 adult women reporting exposure to child sexual abuse by someone close. Women who used an active disclosure strategy in childhood reported more physical and violent abuse. Moreover, women who reported more severe abuse had more often received negative reactions from the social network. Furthermore, a relation was found between current social support and positive—but not negative—reactions.

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.

Social adversity predicts ADHD-medication in school children--a national cohort study.

Aims:  To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children.

Long-term follow-up of prenatally treated children at risk for congenital adrenal hyperplasia : Does dexamethasone cause behavioural problems?

OBJECTIVES To investigate the long-term effects of prenatal treatment of congenital adrenal hyperplasia (CAH) with emphasis on behavioural problems and temperament. DESIGN A population-based long-term follow-up study of Swedish children at risk for virilising CAH, who had received treatment prenatally with dexamethasone (DEX). The questionnaire-based follow-up was performed when the children had reached school age. METHODS Standardised parent-completed questionnaires were used to evaluate adaptive functioning, behavioural/emotional problems and psychopathology, social anxiety and temperament in DEX-exposed school-aged children (n=26) and matched controls (n=35). In addition, the association between parental questionnaires and childrens self-ratings was investigated. RESULTS There were no statistically significant differences between DEX-exposed children and controls in measures of psychopathology, behavioural problems and adaptive functioning. In a questionnaire on temperamental traits, DEX-exposed children were described by their parents as being more sociable than controls (P=0.042). The correlation analysis showed only modest parent-child agreement on social anxiety, i.e. the increased social anxiety in childrens self-ratings was not confirmed by their parents. CONCLUSIONS DEX-treated children showed good overall adjustment. The parent-child agreement with respect to social anxiety was modest, highlighting the importance of multiple information sources and assessment methods. The clinical significance of the observed difference in sociability cannot be determined within the frameworks of this study. Additional studies of larger cohorts are essential to make more decisive conclusions on the safety of the treatment. Until then, it is important that parents are thoroughly informed about the benefits and potential risks and uncertainties of this controversial treatment.

Parental traumatic stress during and after paediatric cancer treatment

The objective was to cross-sectionally compare parents of children during (n = 175) and after (n = 238) cancer treatment regarding traumatic stress (intrusion, avoidance, arousal). In both groups, time since childs diagnosis ranged from one month to six years. Intrusion and arousal were more frequent in parents during ongoing treatment, although also reported by many parents after treatment. Stress was evaluated in relation to situational and demographic factors: Parents who had experienced a relapse did not differ from parents of non-relapsed children. Time since diagnosis was only weakly associated with stress. In the stage of completed treatment the risk for severe stress was elevated in parents with lower education and immigrant parents. Mothers reported somewhat higher levels of stress than fathers, although the findings were ambiguous. To conclude, many parents experience high levels of disease-related stress, even after successful treatment. The pattern of stress symptoms may vary according to educational level, ethnicity, and gender.

Long-term outcomes of childhood cancer survivors in Sweden : a population-based study of education, employment, and income

Studies of different national populations were indispensable for estimating the impact of illness‐related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied.

Preterm Birth, Social Disadvantage, and Cognitive Competence in Swedish 18- to 19-Year-Old Men

OBJECTIVE: The aim was to study the impact of a range of gestational ages (GAs) on cognitive competence in late adolescence and how this effect is modified by contextual social adversity in childhood. METHODS: This was a register study based on a national cohort of 119664 men born in Sweden from 1973 to 1976. Data on GA and other perinatal factors were obtained from the Medical Birth Register, and information on cognitive test scores was extracted from military conscription at the ages of 18 to 19 years. Test scores were analyzed as z scores on a 9-point stanine scale, whereby each unit is equivalent to 0.5 SD. Socioeconomic indicators of the childhood household were obtained from the Population and Housing Census of 1990. The data were analyzed by multivariate linear regression. RESULTS: The mean cognitive test scores decreased in a stepwise manner with GA. In unadjusted analysis, the test scores were 0.63 stanine unit lower in men who were born after 24 to 32 gestational weeks than in those who were born at term. The difference in global scores between the lowest and highest category of socioeconomic status was 1.57. Adjusting the analysis for the childhood socioeconomic indicators decreased the effect of GA on cognitive test scores by 26% to 33%. There was also a multiplicative interaction effect of social adversity and moderately preterm birth on cognitive test scores. CONCLUSIONS: This study confirms previous claims of an incremental association of cognitive competence with GA. Socioeconomic indicators in childhood modified this effect at all levels of preterm birth.