Background  Childhood adversity places individuals in a vulnerable position, resulting in potentially enduring disadvantage across life domains like health and work. Studying the manifestation of this disadvantage is crucial for understanding which resources society can provide to mitigate or prevent it, which makes this subject a fundamental public health concern. This study investigated whether disadvantage patterns after childhood adversity differ by gender and educational level, using out-of-home care as proxy for early adversity.

Methods  We used register data from a 1953 Swedish birth cohort. Distinct profiles of socioeconomic and health disadvantage in individuals with out-of-home care experience were identified using group-based multi-trajectory modelling. Multinomial logistic regression was then used to determine whether gender and education, individually or in interaction with each other, predict group membership.

Results  In the population without history of out-of-home care, adulthood disadvantage was highly gendered, with women being more likely to experience disadvantage related to unemployment and poor health, while criminality and substance misuse was more common among men. History of out-of-home care was associated with a general increase in adulthood disadvantage, but the gender differences were largely absent. Women in this group were however less likely than men to experience disadvantage across multiple life domains (complex disadvantage OR = 0.56, p = 0.046; unemployment-related disadvantage OR = 0.51, p = 0.005). Higher level of education was associated with reduced likelihood of membership in the group marked by disabling health disadvantage (OR = 0.55, p = 0.002) and complex disadvantage (OR = 0.37, p = 0.001). An interaction term between gender and education was not significant.

Conclusions  Adulthood disadvantage was more common in the group with history of out-of-home care. The gender differences in disadvantage present in the full cohort were largely attenuated among individuals with out-of-home care history. We showed that using administrative data on outcomes across multiple life domains can provide rich descriptions of adult experiences after childhood adversity. Future research could examine gender differences in mechanisms translating into resilient or vulnerable trajectories, including the protective potential of education in relation to specific disadvantage patterns.

The aim of this study is to explore the association between grandparental socioeconomic disadvantages and grandchild psychiatric disorders, the role of parental socioeconomic and psychosocial factors in this association, as well as potential gender differences. We utilized a cohort study design using data from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Grandparental and parental socioeconomic disadvantages, respectively, included low income, non-employment, and overcrowding. Parental psychosocial disadvantages included single parenthood, psychiatric disorders, and criminality. Psychiatric disorders in the grandchildren were reflected by hospitalizations due to mental and behavioral disorders from age 18 to 30 (1986–2019). Analyses were performed within the Structural Equation Modeling framework. We found an association between grandparental socioeconomic disadvantages and grandchild psychiatric disorders (standardized total effect 0.155, 95% confidence interval [CI] 0.099–0.211), which was mediated through parental psychosocial disadvantages (standardized mediating effect 0.101, 95% CI 0.073–0.130). The mediation was more pronounced via psychosocial disadvantages among mothers than fathers. These findings indicate that psychosocial disadvantages among parents, especially mothers, reflect an important mediating mechanism, and addressing such disadvantages may help mitigate social inequalities in mental health across generations.

Experiences of out-of-home care (placement in foster-family care or residential care) and parental death in childhood are known risk factors for premature all-cause mortality. However, it remains unclear whether parental death during placement moderates the association between out-of-home care and mortality, particularly when considering the timing and duration of placement. Longitudinal register data from 10 Swedish birth cohorts (n = 948,483) were analyzed. Around 2.5% (n = 23,628) had out-of-home care experience during ages 0–19. Sex-specific Cox proportional hazard regression models assessed associations between experience of out-of-home care (categorized by timing and duration), parental death, and premature all-cause mortality (ages 20–47). Both men and women with out-of-home care experience displayed increased risk of premature all-cause mortality, as did those who experienced parental death before age 20. However, statistical interaction analyses revealed no moderating effect of parental death on the association between placement and premature all-cause mortality. Compared to non-placed individuals, parental death during placement in out-of-home care did not further increase the risk of premature mortality across placement groups. Possible reasons include strong attachments within the out-of-home care setting or reduced stress towards biological parents. Further research is needed to explore the complex dynamics of parental loss within out-of-home care populations.

Purpose There is a lack of multigenerational research on the extent to which mental health is informed by transmission of multiple disadvantages across previous generations. This study aims to investigate how family socioeconomic and psychosocial disadvantages cluster and transition over grandparental and parental generations, and how this might be associated with grandchild psychiatric disorders.

Methods We utilized a cohort study with data following three generations from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Family disadvantages as exposures were measured across two periods– grandparental adulthood (parental childhood) and parental adulthood (grandchild childhood), and included socioeconomic (i.e., low income, non-employment, overcrowding, and single parenthood) and psychosocial aspects (i.e., single parenthood, teenage motherhood, psychiatric disorders, and criminality of father). Psychiatric disorders in the adult grandchildren as outcome were defined by hospitalizations with a main or contributing diagnosis reflecting mental and behavioral disorders from age 18 until 2019.

Results Multiple disadvantages within the grandparental and parental generations, respectively, predicted higher probabilities of grandchild psychiatric disorders. Multigenerational transmission is evident in that grandchildren with combinations of grandparental socioeconomic disadvantages and parental psychosocial disadvantages had comparably high probabilities of psychiatric disorders. Importantly, improved socioeconomic and psychosocial circumstances across previous generations predicted comparably low probabilities of grandchild psychiatric disorders.

Conclusion Mental health of future generations is informed by the transmission of multiple disadvantages across previous generations, and the transition from grandparental socioeconomic disadvantages into parental psychosocial disadvantages is particularly important.

Families who have contact with child welfare services (CWS) often face a number of socioeconomic and psychosocial challenges, which may have led to the parents being unable to adequately care for their children. To date, understandings regarding the parents’ socioeconomic and psychosocial conditions after the placement of a child are limited. A database search of PubMed, Sociological abstract, CINAHL, PsycINFO, Scopus, and Web of Science was performed to identify studies that investigate the socioeconomic and psychosocial conditions of parents with children in OHC published between January 1, 1980 and November 20, 2021. Of 19,750 screened articles, 51 qualitative articles met the inclusion criteria. Emerging themes relating to parents’ subjective experiences were synthesized into three overarching themes: (1) experiencing a loss, (2) living a fragile reality, and (3) opportunity for change. The results demonstrate that more support is needed for parents as the placement of their child is a challenging time that places stress on their psychosocial and socioeconomic conditions, no matter the reason for placement. With the right support, positive adaptations could be possible.

Background Psychiatric disorders are a substantial public health concern, and childhood adversity a well-known risk factor for it. Investigating gender differences in vulnerability and resilience processes following out-of-home care (OHC) as proxy for childhood adversity can help map opportunities for the prevention of psychiatric disorders. Methods We followed a large birth cohort for psychiatric disorders (anxiety, depression, and self-harm, and substance misuse) between age 25–62 years, comparing individuals with and without OHC experience. We investigated different extra-familial risk and resources factors following OHC via gender-stratified mediation and moderation analyses to approximate risk accumulation (vulnerability processes) and buffers of risk (resilience processes). Results OHC is prospectively associated with psychiatric disorders in adulthood. Lower school grades, delinquency, and early parenthood are mediators of the association, with the exception of education in girls in relation to anxiety, depression, and self-harm, and early parenthood in boys in relation to substance misuse. Number of best friends moderates OHC experience in boys, and there is a trend for higher educational achievement to also act as buffer, even though this trend was not statistically significant. Leisure time activities did not act as buffer. Conclusion Vulnerability and resilience processes after childhood adversity are gendered: Risk accumulation runs via delinquency and poorer educational outcomes in boys more than in girls, while early parenthood is a more dominant risk factor in girls. Having more best friends and higher grades may act as buffer, especially in boys.

Background: While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies. Methods: We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality. Findings: Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]). Interpretation: Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood. Funding: Medical Research Council; National Institute on Aging; Wellcome Trust.

Background Childhood adversity is associated with a host of negative health and socioeconomic outcomes far into adulthood. The process of avoiding such outcomes is often referred to as resilience. Mapping resilience comprehensively and across contexts is highly relevant to public health, as it is a step towards understanding environments and interventions that contribute to preventing or reversing negative outcomes after early adverse experiences. Objectives This review scoped out the literature on resilience factors in relation to adulthood outcomes as diverse as mental health and educational attainment. Our aim was to understand where there is untapped research potential, by examining the current evidence base on resilience factors in terms of (a) resources that can buffer the impact of childhood adversity and (b) the pathways linking adversity to long-term outcomes. Furthermore, we aimed to identify gender patterns in these resources and pathways, which has not been a primary interest of reviews on resilience to date, and which can add to our understanding of the different ways in which resilience may unfold. Eligibility criteria Studies had to include an adversity experienced in childhood, an outcome considered indicative of resilience in adulthood, and at least one putative resilience factor, which had to be approached via mediation or moderation analysis. We considered cohort, case-control and cross-sectional studies. Sources of evidence We searched PubMed, Scopus and PsycINFO and included original, peer-reviewed articles published before 20 July 2023 in English, German, French, Spanish, Dutch and Swedish. Charting methods All three authors collaborated on the extraction of information relevant to answering the research questions. The results were visually and narratively summarised. Results We included 102 studies. Traditionally anchored in the field of psychology, the resilience literature focuses heavily on individual-level resilience factors. Gender was considered in approximately 22% of included studies and was always limited to comparisons between men and women. There is no evidence that childhood adversity impacts men and women differently in the long term, but there is some evidence for gender differences in resilience factors. Conclusions There is untapped potential in resilience research. By considering structural-level factors simultaneously with individual-level factors, and including gender as one of the elements that shape resilience, we can map resilience as a heterogeneous, multilevel process from a public health perspective. This would complement the extensive existing literature on individual-level factors and help reframe resilience as a concept that can be intervened on at a structural level, and that is subject to societal norms and forces, such as gender. There is a lack of quantitative studies including transgender and gender-non-conforming persons.

Aim: The current study explores heterogeneity in the aggregate age-crime curve. This is achieved by analyzing to what extent there is empirical support for the existence of pivotal typologies in developmental and life-course criminology, as well as whether there is any heterogeneity in trajectories among adult-onset offenders (first recorded for crime at age 25 or later).

Methods: Data were drawn from a population-representative birth cohort of 14,608 males and females, followed prospectively in registers from age nine to 64. Trajectories of antisocial and criminal behavior were identified by means of group-based trajectory modelling.

Results: A small group with a high prevalence of crime across the life course, among both males and females, was found. Furthermore, a large proportion of offenders were adult-onset offenders, and there was meaningful heterogeneity in their criminal trajectories. However, the data did not lend much support to the hypothesized phenomenon of late-blooming.

Conclusion: There is meaningful heterogeneity in the aggregate age-crime curve, including trajectories that resonate fairly well with predictions derived from Moffitt's taxonomy. Nevertheless, there are firm reasons for theorizing proximate causes for the onset and continuation of crime beyond emerging adulthood.

Families involved with child welfare services (CWS) often diverge systematically from the general population. They are more likely to live in challenging circumstances characterised by adverse socioeconomic conditions (e.g. poverty) and psychosocial adversities (e.g. mental health problems and substance misuse). Past research has primarily focused on the development and lifelong health and social outcomes of children who have experienced out-of-home care (OHC). However, the separation could also trigger negative emotions and other changes in parents, but much less attention has been paid to the associations between children’s placement and parents’ lives.

This scoping review synthesises results from quantitative studies investigating the socioeconomic and psychosocial outcomes of parents who have experienced the removal of a child into OHC. Six databases were comprehensively searched, with 15 studies selected for inclusion in the review. Studies were conducted among countries of the Organization for Economic Cooperation and Development (OECD) with substantial heterogeneity in the methods and designs, as grouped into three categories: “cross-sectional assessments” (4 studies), “longitudinal assessments” (7 studies) and “pre-post assessment” (4 studies).

To a large extent, studies focus on psychosocial outcomes among mothers. The majority indicate that having a child placed in OHC is associated with the deterioration of psychosocial or socioeconomic outcomes among parents. We may conclude that parents who have experienced the removal of a child are a group that deserves tailored support and counselling. However, further quantitative research into aspects of parents’ lives after children’s OHC placement is needed, particularly with longitudinal designs and more rigorous methods to enable a better understanding of the causes and effects of these associations. This might support the development of targeted and effective interventions for these families.