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Hjern, A., Vinnerljung, B. & Brännström, L. (2024). Cardiovascular Disease and Risk Factors in Individuals With a History of Out-of-home Care. Pediatrics (2), Article ID e2023063174.
Open this publication in new window or tab >>Cardiovascular Disease and Risk Factors in Individuals With a History of Out-of-home Care
2024 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, no 2, article id e2023063174Article in journal (Refereed) Published
Abstract [en]

Background: Exposure to childhood out-of-home care (foster family and residential care) is associated with an increased risk of ill-health and disability in adulthood, but the risk for cardiovascular disease has not previously been studied longitudinally.

Methods: This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 881 731 of whom 26 310 (3.0%) had a history of out-of-home care. The study population, born 1972 to 1981, was followed from age 18 to age 39 to 48 years for hospitalizations and death.

Results: After adjusting for year of birth and maternal education, individuals with a history of childhood out-of-home-care experienced a doubling of the risk for coronary disease (hazard ratio; 95% confidence interval: 2.05; 1.74-2.41) and stroke (hazard ratio 1.85; 1.59-2.15), compared with the general population, with similar estimates for men and women. Women with a history of out-of-home care had a more than doubled risk for cigarette smoking in early pregnancy, with a relative risk of 2.26; (2.18-2.34) and a moderately increased risk for gestational diabetes relative risk 1.49 (1.19-1.86). There was marked attenuation (40% to 90%) in effect estimates for disease and risk factors after further control for cohort members educational achievement at age 15-16 years.

Conclusions: A history of childhood out-of-home care was associated with a doubled risk of early cardiovascular disease events. Cigarette smoking and educational underachievement were the main identified risk factors.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-226202 (URN)10.1542/peds.2023-063174 (DOI)
Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-02Bibliographically approved
Hjern, A., Palacios, J., Despax, J. & Vinnerljung, B. (2023). Couple partnership and divorce in domestic and non-European international adoptees. A Swedish national cohort study with follow up until 36 to 45 years. Children and youth services review, 155, Article ID 107215.
Open this publication in new window or tab >>Couple partnership and divorce in domestic and non-European international adoptees. A Swedish national cohort study with follow up until 36 to 45 years
2023 (English)In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 155, article id 107215Article in journal (Refereed) Published
Abstract [en]

Adoption research shows a growing interest in adopted persons in their adult years. This article examines couple partnerships and divorce among adult adoptees and non-adoptees. Using population-based Swedish register data with follow-up until age 36–45 years, domestic and international adoptees were compared with the general population, as well as with immigrants who settled in Sweden in their early years and share with international adoptees a non-European physical appearance. Given their preadoption adversities and associated increased mental health problems, as well as postadoption experiences of perceived discrimination, adoptees were expected to have more problems in the formation and breakdown of partner relationships, particularly in the case of international adoptees. The study used data from national registers on Swedish national cohorts born 1972–83, including two study groups with a non-European origin who settled in Sweden at age 0–8 years (14,761 international adoptees and 11,085 immigrants) as well as 906 domestic adoptees and 936,988 Swedish born with a Swedish-born mother from the general population. In contrast with international adoptees, who have a 14 % lower adjusted rate of couple compared with the general population, domestic adoptees were more like the Swedish general population in terms of couple partnership formation. However, in terms of divorce, domestic and international adoptees share a significantly higher incidence than the general population and the immigrants study groups. Both in the formation and breakdown of couple relationships, international adopted men present less favorable outcomes than international adopted women. Further research is needed to elucidate the reasons behind these patterns.

Keywords
Adult adoptees, Marriage and cohabitation, Divorce, Early adversity, Perceived discrimination
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-224312 (URN)10.1016/j.childyouth.2023.107215 (DOI)001096582300001 ()2-s2.0-85174831192 (Scopus ID)
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2023-12-06Bibliographically approved
Hjern, A., Palacios, J. & Vinnerljung, B. (2023). Early childhood adversity and non-affective psychosis: a study of refugees and international adoptees in Sweden. Psychological Medicine, 53(5), 1914-1923
Open this publication in new window or tab >>Early childhood adversity and non-affective psychosis: a study of refugees and international adoptees in Sweden
2023 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 53, no 5, p. 1914-1923Article in journal (Refereed) Published
Abstract [en]

Background. Previous Scandinavian studies have shown increased levels of psychiatric morbidity in young refugees and international adoptees with an origin outside Europe. This study investigated their risk of non-affective psychotic disorders (NAPD) and whether this risk is influenced by early childhood adversity, operationalised as age at adoption/residency, and/or gender.

Methods. Register study in Swedish national cohorts born 1972-1990 including 21 615 non-European international adoptees, 42 732 non-European refugees that settled in Sweden at age 0-14 years and 1 610 233 Swedish born. The study population was followed from age 18 to year 2016 for hospitalisations with a discharge diagnosis of NAPD. Hazard ratios (HRs) were calculated in gender stratified Cox regression models, adjusted for household income at age 17.

Results. The adjusted risks of NAPD were 2.33 [95% confidence interval (CI) 2.07-2.63] for the international adoptees and 1.92 (1.76-2.09) for the former child refugees, relative to the Swedish-born population. For the international adoptees there was a stepwise gradient for NAPD by age of adoption from adjusted HR 1.66 (1.29-2.03) when adopted during the first year of life to adjusted HR 4.56 (3.22-6.46) when adopted at ages 5-14 years, with a similar risk pattern in women and men. Age at residency did not influence the risk of NAPD in the refugees, but their male to female risk ratio was higher than in Swedish-born and the adoptees.

Conclusion. The risk pattern in the international adoptees gives support to a link between early childhood adversity and NAPD. Male gender increased the risk of NAPD more among the refugees.

Keywords
Adoption, refugees, migration, psychosis, early childhood, adversity
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:su:diva-204465 (URN)10.1017/S003329172100355X (DOI)000785770100001 ()34470690 (PubMedID)
Available from: 2022-05-08 Created: 2022-05-08 Last updated: 2023-04-17Bibliographically approved
Brännström, L., Andershed, A.-K., Vinnerljung, B., Hjern, A. & Almquist, Y. B. (2023). Gender-specific trajectories of offending from adolescence until age 40 among individuals with experience of out-of-home care: A national cohort study. Developmental Child Welfare
Open this publication in new window or tab >>Gender-specific trajectories of offending from adolescence until age 40 among individuals with experience of out-of-home care: A national cohort study
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2023 (English)In: Developmental Child Welfare, ISSN 2516-1032Article in journal (Refereed) Epub ahead of print
Abstract [en]

It is well-known that experiences of out-of-home care (OHC; foster-family care and residential care) are linked to criminal behavior. Less is known how criminal activity in the OHC population develops over the life course and to what extent such development is characterized by desistance or persistence. Using population-based longitudinal register data for more than 740,000 Swedish men and women, of which around 2.5% have experience of OHC, followed until age 40, results from group-based trajectory modelling and multinomial regression suggest that OHC-experienced individuals with various timing and duration of placement, especially men first placed as teenagers, have substantially elevated likelihood for persistent offending compared to peers without OHC experience. However, most OHC-experienced followed pathways characterized by desistance. Our findings have implications for understanding the dynamics of offending in OHC populations and underscores the necessity for interventions that can prevent the onset of criminal careers, as well as disrupt or modify the ongoing paths of offending within this disadvantaged group of individuals.

National Category
Social Work
Identifiers
urn:nbn:se:su:diva-226203 (URN)10.1177/25161032231217265 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00057
Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-02
Dunlavy, A., Gauffin, K., Berg, L., De Montgomery, C. J., Europa, R., Eide, K., . . . Hjern, A. (2023). Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study. Scandinavian Journal of Public Health, 51(3), 330-338
Open this publication in new window or tab >>Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study
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2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 3, p. 330-338Article in journal (Refereed) Published
Abstract [en]

Aims: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. Methods: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Results: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. Conclusions: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

Keywords
Refugee youth, health inequalities, integration policy, mental health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-197077 (URN)10.1177/14034948211031408 (DOI)000677402200001 ()34304618 (PubMedID)2-s2.0-85111083786 (Scopus ID)
Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2023-06-09Bibliographically approved
Europa, R. T., Eide, K., Hjern, A., Manhica, H. & Dunlavy, A. (2023). Narcotic offences and drug use disorders among young refugees in Norway. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Narcotic offences and drug use disorders among young refugees in Norway
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2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: We examined the patterns of healthcare utilisation for drug use disorders (DUDs) and charges related to narcotics among young refugees in Norway considering the role of sex, country of origin and condition of arrival (accompanied versus unaccompanied minors).

Methods: Based on national registers, sex-stratified Cox regression models were used to estimate hazard ratios to assess the risk of being charged with a narcotics offence and the use of healthcare services related to DUDs. The sample consisted of 15,068 young refugees and 573,241 young Norwegians born in Norway to two Norwegian-born parents. All of the young people in the sample were born between 1983 and 1994. The follow-up period was from January 2008 to December 2015.

Results: Compared with their Norwegian peers, both male and female refugees showed either a similar or lower risk of receiving healthcare for DUDs. However, male refugees showed an increased risk of being charged with a narcotic offence, except those from Afghanistan and the former Yugoslavia. Accompanied male refugees were at a higher risk of being charged, while unaccompanied male refugees showed a lower risk.

Conclusions: Young male refugees generally had a higher risk of being charged for narcotic offences while showing a similar risk of receiving healthcare for DUDs compared to Norwegian-born young people. However, young men from Afghanistan and the former Yugoslavia deviated from this pattern. This may be partially explained by the length of time spent in Norway. The results add support to previous qualitative studies suggesting that punitive drug policies may disproportionately affect men from minority groups. Further research controlling for parental household-level factors is warranted.

Keywords
Young refugees, immigrant health, ethnic minorities, prejudicial policing
National Category
Substance Abuse Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-223452 (URN)10.1177/14034948231201895 (DOI)001078541400001 ()37795672 (PubMedID)2-s2.0-85173735424 (Scopus ID)
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2023-10-30
Granlund, A., Soares, F. C., Hjern, A., Dahllöf, G. & Julihn, A. (2022). Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study. BMC Oral Health, 22, Article ID 111.
Open this publication in new window or tab >>Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study
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2022 (English)In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 22, article id 111Article in journal (Refereed) Published
Abstract [en]

Background: To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin.

Method: This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.

Results: Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years.

Conclusions: Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

Keywords
Acculturation, Child, Dental caries, Ethnicity, Human development index, Length of stay, Migration, Socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-204361 (URN)10.1186/s12903-022-02130-4 (DOI)000779357600001 ()35392882 (PubMedID)2-s2.0-85128098290 (Scopus ID)
Available from: 2022-05-05 Created: 2022-05-05 Last updated: 2022-05-05Bibliographically approved
de Montgomery, C. J., Norredam, M., Krasnik, A., Holm Petersen, J., Björkenstam, E., Berg, L., . . . Mittendorfer-Rutz, E. (2022). Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion. PLOS ONE, 17(2), Article ID e0263450.
Open this publication in new window or tab >>Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263450Article in journal (Refereed) Published
Abstract [en]

Background

Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions.

Methods

Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012-2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics.

Results

The risk of marginalisation was 2.1-2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77-85% of associations eliminated).

Conclusions

The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

National Category
Sociology
Identifiers
urn:nbn:se:su:diva-205245 (URN)10.1371/journal.pone.0263450 (DOI)000795889700024 ()35171929 (PubMedID)2-s2.0-85124774579 (Scopus ID)
Available from: 2022-06-01 Created: 2022-06-01 Last updated: 2022-06-01Bibliographically approved
Berg, L., de Montgomery, E., Brendler-Lindquist, M., Mittendorfer-Rutz, E. & Hjern, A. (2022). Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents. European Child and Adolescent Psychiatry, 31(12), 1953-1962
Open this publication in new window or tab >>Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents
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2022 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 12, p. 1953-1962Article in journal (Refereed) Published
Abstract [en]

Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child's own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995-2000 and followed between 2011 and 2017 (11-18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90-3.14) among foreign-born refugee children and HR 1.77 (1.33-2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29-7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11-3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

Keywords
Refugees, Parental post-traumatic stress, Intergenerational trauma, Psychiatric care, Adolescents
National Category
Psychology Psychiatry
Identifiers
urn:nbn:se:su:diva-195820 (URN)10.1007/s00787-021-01827-1 (DOI)000663516400001 ()34146175 (PubMedID)2-s2.0-85108420766 (Scopus ID)
Available from: 2021-08-31 Created: 2021-08-31 Last updated: 2022-11-18Bibliographically approved
Berg, L., Brendler-Lindquist, M., de Montgomery, E., Mittendorfer-Rutz, E. & Hjern, A. (2022). Parental Posttraumatic Stress and School Performance in Refugee Children. Journal of Traumatic Stress, 35(1), 138-147
Open this publication in new window or tab >>Parental Posttraumatic Stress and School Performance in Refugee Children
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2022 (English)In: Journal of Traumatic Stress, ISSN 0894-9867, E-ISSN 1573-6598, Vol. 35, no 1, p. 138-147Article in journal (Refereed) Published
Abstract [en]

Refugee children in the Nordic countries have been reported to perform poorly in school and carry a high burden of familial posttraumatic stress. The present study aimed to investigate the impact of maternal and paternal posttraumatic stress on the school performance of refugee children. We used national register data on school grades at age 15-16 along with demographic and migration indicators during 2011-2017 in a population of 18,831 children in refugee families in Stockholm County, Sweden. Parental posttraumatic stress was identified in regional data from three levels of care, including a tertiary treatment center for victims of torture and war. Multivariable linear and logistic regression models were fitted to analyze (a) mean grade point averages as Z scores and (b) eligibility for upper secondary school. In fully adjusted models, children exposed to paternal posttraumatic stress had a lower mean grade point average, SD = -0.14, 95% CI [-0.22, -0.07], and higher odds of not being eligible for upper secondary education, OR = 1.37, 95% CI [1.14, 1.65]. Maternal posttraumatic stress had a similar crude effect on school performance, SD = -0.15, 95% CI [-0.22, -0.07], OR = 1.25, 95% CI [1.00, 1.55], which was attenuated after adjusting for single-parent households and the use of child psychiatric services. The effects were similar for boys and girls as well as for different levels of care. Parental posttraumatic stress had a small negative effect on school performance in refugee children, adding to the intergenerational consequences of psychological trauma.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:su:diva-196727 (URN)10.1002/jts.22708 (DOI)000673843500001 ()34275166 (PubMedID)2-s2.0-85110275121 (Scopus ID)
Available from: 2021-09-14 Created: 2021-09-14 Last updated: 2022-05-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1645-2058

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