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  • 1.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    A decade lost: does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?2018In: Article in journal (Refereed)
    Abstract [en]

    Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

    Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

    Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

    Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

  • 2.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bäck, Karin
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental alcohol-related disorders and school performance in 16 year olds - a national cohort study2016In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 10, p. 1795-1803Article in journal (Refereed)
    Abstract [en]

    To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.

    Register study in a national cohort.

    Setting

    Sweden.

    740 618 individuals born in Sweden in 1990-1996.

    Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16, was analysed in relation to sociodemographic confounders and psychosocial covariates, using linear and logistic regressions.

    Both mothers’ and fathers’ alcohol-related hospital admissions were associated with lower z-scores of grades and national mathematic tests scores. After adjustment for parental education and sociodemographic confounders, beta-coefficients of z-scores of grades were -0.42 (95% CI -0.45, -0.39) and -0.42 (95 % CI -0.43,-0.40), and beta-coefficients of mathematic tests scores were -0.36 (95% CI -0.39, -0.33) and -0.31 (95% CI -0.33, -0.29), for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusted ORs for not being eligible for secondary school were 1.99 (95% CI 1.84-2.15) and 2.04 (95% CI 1.95-2.15) for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89 to 1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.

    Conclusions

    In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use, and criminality and receipt of social or child welfare interventions.

  • 3.
    Berlin, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    School performance in primary school and psychosocial problems in young adulthood among care leavers from long term foster care2011In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 33, no 12, p. 2489-2494Article in journal (Refereed)
    Abstract [en]

    We used data from Swedish national registers for ten entire birth year cohorts (1972–1981) to examine psychosocial outcomes in young adulthood for youth that left long term foster care after age 17, comparing them with majority population peers, national adoptees and peers who had received in-home interventions before age 13. The population was followed in the registers from age 16 to 2005. Data were analyzed in Cox regression models.

    Youth who left long term foster care had six-to eleven fold sex and birth year adjusted excess risks for suicide attempts, substance abuse and serious criminality from age 20, and for public welfare dependency at age 25. Overrisks were considerably lower for the in-home intervention group and the national adoptees. Adjusting results for poor school performance in the final year in primary school (ages 15–16) reduced overrisks by 38–52% for care leavers from long term foster care.

    Irrespective of issues of causality, poor school performance seems to be a major risk factor for future psychosocial problems among youth who age out of long term foster care. The results suggest that promoting foster children's school performance should be given high priority by agencies.

  • 4. Björkenstam, C.
    et al.
    Bjorkenstam, E.
    Ljung, R.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Tuvblad, C.
    Suicidal behavior among delinquent former child welfare clients2013In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 6, p. 349-355Article in journal (Refereed)
    Abstract [en]

    Child welfare clients represent a high-risk group for delinquency and adult criminality, but also for future suicidal behavior. We examine associations between delinquency and suicidal behavior in a national child welfare population. This register-based cohort study is based on data for all Swedish former child welfare clients born between 1972 and 1981 that experienced interventions before their adolescent years. We followed 27,228 individuals from age 20 years until 31 December 2006. Juvenile delinquency was defined as being convicted of at least one crime between age 15 and 19. The risk of suicidal behavior was calculated as incidence rate ratios (IRRs). Fifteen percent of the women and 40 % of the men had at least one conviction between the age 15 and 19. The adjusted risk of suicidal behavior among women with five or more convictions was 3.5 (95 % CI 2.0-6.2); corresponding IRR for men was 3.9 (95 % CI 3.1-4.9). Child welfare experience-specifically of out-of-home care-in combination with delinquency is a potent risk factor for suicidal behavior among young adults. However, we cannot exclude that some of this association is an epiphenomenon of uncontrolled confounders, such as impulsivity or severity of psychiatric disease. Despite this caveat, results should be disseminated to practitioners in the health and correction services.

  • 5. Björkenstam, Emma
    et al.
    Björkenstam, Charlotte
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hallqvist, Johan
    Ljung, Rickard
    Juvenile delinquency, social background and suicide-a Swedish national cohort study of 992 881 young adults2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 6, p. 1585-1592Article in journal (Refereed)
    Abstract [en]

    Background As the suicide rates in young adults do not show a clear decline, it is important to elucidate possible risk factors. Juvenile delinquency has been pointed out as a possible risk behaviour. Methods This register-based cohort study comprises the birth cohorts between 1972 and 1981 in Sweden. We followed 992 881 individuals from the age of 20 years until 31 December 2006, generating 10 210 566 person-years and 1482 suicides. Juvenile delinquency was defined as being convicted of a crime between the ages of 15 and 19 years. Estimates of risk of suicide were calculated as incidence rate ratio (IRR) with 95% confidence intervals (CIs) using Poisson regression analysis with adjustment for potential confounding by their own and their parents' mental illness or substance abuse, parental education, single parenthood, social assistance, adoption and foster care. Results Among females, 5.9%, and among males, 17.9%, had at least one conviction between the ages 15 and 19 years. In the fully adjusted model, females with one conviction had a suicide risk of 1.7 times higher (95% CI 1.2-2.4), the corresponding IRR for men was 2.0 (95% CI 1.7-2.4) and 5.7 (95% CI 2.5-13.1) and 6.6 (95% CI 5.2-8.3), for women and men with five or more convictions. The effect of severe delinquency on suicide was independent of parental educational level. Conclusions This study supports the hypothesis that individuals with delinquent behaviour in late adolescence have an increased risk of suicide as young adults. Regardless of causality issues, repeated juvenile offenders should be regarded by professionals in health, social and correctional services who come into contact with this group as a high-risk group for suicide.

  • 6. Björkenstam, Emma
    et al.
    Burström, Bo
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Björkenstam, Charlotte
    Pebley, Anne R.
    Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 142, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% Cl: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.

  • 7. Björkenstam, Emma
    et al.
    Burström, Bo
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kosidou, Kyriaki
    Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes2016In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 77, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Childhood adversity (CA) is associated with increased risks of psychiatric disorder in young adulthood, but details in this association are less known. We aimed to explore the association of a range of CA indicators with psychiatric disorder in young adulthood, and the impact of age at exposure, disorder type and accumulation of indicators. We capitalized on Sweden's extensive and high-quality registers and analyzed a cohort of all Swedes (N = 107,704) born in Stockholm County 1987-1991. Adversities included familial death, parental substance misuse and psychiatric disorder, parental criminality, parental separation, public assistance recipiency and residential instability. Age at exposure was categorized as: 0-6.9 years (infancy and early childhood), 7-11.9 years (middle childhood), and 12-14 years (early adolescence). Psychiatric disorders after age 15 were defined from ICD codes through registers. Risks were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI). Results showed that exposure to at least one CA was associated with an increased risk of psychiatric disorder (HR 1.4, 95% CI: 1.3-1.4). Risks were increased for mood, anxiety, and psychotic disorders and ADHD but not for eating disorders. The risk varied with type of disorder but was similar for all exposure periods. Individuals with multiple (3+) CAs had a two-fold risk of psychiatric disorder (HR 2.0, 95% CI: 1.9-2.1). In conclusion, our findings support the long-term negative impact of CA on mental health, regardless of developmental period of exposure. Given that experience of CA is common, efforts should be put to alleviate the burden of childhood adversities for children, particularly among the most disadvantaged.

  • 8. Björkenstam, Emma
    et al.
    Dalman, Christina
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Ringbäck Weitoft, Gunilla
    Walder, Deborah J.
    Burström, Bo
    Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 5, p. 473-480Article in journal (Refereed)
    Abstract [en]

    Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.

    Methods We used a Swedish cohort of 96 399 individuals born during 1987–1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.

    Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.

    Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.

  • 9. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mittendorfer-Rutz, Ellenor
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hallqvist, Johan
    Ljung, Rickard
    Multi-Exposure and Clustering of Adverse Childhood Experiences, Socioeconomic Differences and Psychotropic Medication in Young Adults2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, article id e53551Article in journal (Refereed)
    Abstract [en]

    Purpose

    Stressful childhood experiences have negative long-term health consequences. The present study examines the association between adverse childhood experiences, socioeconomic position, and risk of psychotropic medication in young adulthood.

    Methods

    This register-based cohort study comprises the birth cohorts between 1985 and 1988 in Sweden. We followed 362 663 individuals for use of psychotropic medication from January 2006 until December 2008. Adverse childhood experiences were severe criminality among parents, parental alcohol or drug abuse, social assistance recipiency, parental separation or single household, child welfare intervention before the age of 12, mentally ill or suicidal parents, familial death, and number of changes in place of residency. Estimates of risk of psychotropic medication were calculated as odds ratio (OR) with 95% confidence intervals (CIs) using logistic regression analysis.

    Results

    Adverse childhood experiences were associated with increased risks of psychotropic medication. The OR for more than three adverse childhood experiences and risk of psychotropic medication was for women 2.4 (95% CI 2.3–2.5) and for men 3.1 (95% CI 2.9–3.2). The risk of psychotropic medication increased with a higher rate of adverse childhood experiences, a relationship similar in all socioeconomic groups.

    Conclusions

    Accumulation of adverse childhood experiences increases the risk of psychotropic medication in young adults. Parental educational level is of less importance when adjusting for adverse childhood experiences. The higher risk for future mental health problems among children from lower socioeconomic groups, compared to peers from more advantaged backgrounds, seems to be linked to a higher rate of exposure to adverse childhood experiences.

  • 10. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 3, p. 472-477Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. Methods: We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. Conclusion: This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.

  • 11. Björkenstam, Emma
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Impact of childhood adversities on depression in early adulthood: A longitudinal cohort study of 478,141 individuals in Sweden2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 223, p. 95-100Article in journal (Refereed)
    Abstract [en]

    Objective: Although the relationship between childhood adversity (CA) and depression is widely accepted, there is little information on what proportion of depression is attributable to CA. Method: We used a Swedish cohort of 478,141 individuals born in 1984-1988 in Sweden. Register-based CA indicators included parental death, parental substance abuse and psychiatric morbidity, parental criminality, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Estimates of risk of depression, measured as retrieval of prescribed antidepressants and/or psychiatric care with a clinical diagnosis of depression, between 2006 and 2012 were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using a Cox regression analysis. Results: All CAs predicted depression in early adulthood. Furthermore, the predictive association between the CA indicators and depression was graded, with highest HRs observed for 4+ CAs (HR: 3.05 (95% CI 2.83-3.29)) for a clinical diagnosis for depression and HR: 1.32 (95% CI 1.25-1.41) for antidepressant medication after adjustments were made for important confounding factors. Of the studied CAs, child welfare intervention entailed highest HR for depression. Conclusion: Regardless of causality issues, children and youth with a history of multiple CA should be regarded as a high-risk group for depression by professionals in social, and health service's that come into contact with this group.

  • 12.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Långsiktiga resultat av kontaktfamilj/person för äldre barn: en personorienterad ansats.2014Report (Other (popular science, discussion, etc.))
  • 13.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Bo, Vinnerljung
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Child welfare clients have higher risks for teenage childbirths: which are the major confounders?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 4, p. 592-597Article in journal (Refereed)
    Abstract [en]

    Background: Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors. Methods: Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973–1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor’s relative contribution to the difference between crude and adjusted odds ratios (ORs). Results: Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls’ school failure was the most potent confounder, accounting for 28–35% of the difference between crude and adjusted ORs. Conclusion: As in majority populations, girls’ school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

  • 14.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care2017In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 67, p. 408-418Article in journal (Refereed)
    Abstract [en]

    Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.

  • 15.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Karlsson, Henrik
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Childhood risk factors for disability pension among adult former Swedish child welfare clients: Same or different as for majority population peers?2018In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 84, p. 94-102Article in journal (Refereed)
    Abstract [en]

    This study contributes to the literature on preventing social exclusion, here indicated by collecting disability pension in adulthood, by asking whether the pattern and strength of childhood related risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on > 500,000 Swedes, including around 18,000 former child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Systematic comparisons of effect sizes suggest that the differences in pattern were marginal, but there were significant differences in strength. Overall, poor educational achievement and low educational attainment were the two most prominent risk factors across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of collecting disability pension was on the scale of 20% if either of the two risk factors could be eliminated. Among child welfare alumni, however, the hypothetical reduction was even larger, nearly 30% on average. Prevention strategies targeting poor school performance and low educational attainment may thus substantially reduce the prevalence of disability pension among adults with a history of child welfare involvement.

  • 16.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kontaktfamilj/person för yngre och äldre barn: Har insatsens varaktighet och ansamlingar av ogynnsamma omständigheter under barnens uppväxt någon betydelse för utfall på lång sikt?2015Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    I denna rapport undersöks om insatsens varaktighet och ansamlingar av ogynnsamma omständigheter under uppväxten har ett samband med hur det går på längre sikt för de barn där insatsen kontaktfamilj eller kontaktperson inleddes under småbarnsåren och/eller förpuberteten. Analyserna omfattar alla de barn födda i Sverige 1973-1990  där insatsen påbörjades när de var 2-5 år (n=6 693) och/eller när de var 10-13 år (n=6 389).

    Med hjälp av avancerade regressionsanalyser ser vi att sammansättningen av bakgrundsproblem inte verkar ha något tydligt specifikt samband med hur det går i framtiden. Det är antalet problem som verkar betyda något. I den yngre gruppen verkar barnen med flest problemfaktorer i hembakgrunden ha dragit nytta av längre insatstid. Där är det med andra ord möjligt att en långvarig tillgång till en kompenserande vuxenmiljö utanför den egna familjen kan ha påverkat de mest utsatta barnens utveckling på sikt. För barn med färre problemfaktorer fanns det ingen sådant samband, snarare tendenser till det omvända. Det verkar med andra ord som om en långvarig insats för de yngre barnen fungerar bättre för de ’svåraste fallen’.

    För de äldre barnen ser vi svaga tendenser till ett motsatt mönster. De med lägst antal problemfaktorer är de som verkar ha fått svag nytta av lång insatstid. Här är det viktigt att vara medveten om att vi bara har tillgång data som tyder problem i hemmet, inte hos barnet själv (t.ex. förekomsten av beteendeproblem). Det verkar med andra ord som om insatsen var för svag för de mest utsatta barnen. Den äldre gruppen hade generellt mer tecken på problem i barndomen (t.ex. höga förekomster av psykisk ohälsa hos föräldrarna) än den yngre gruppen barn. Den äldre gruppen barn verkar också ha klarat sig betydligt sämre i tonåren och i ung vuxen ålder.

    Eftersom våra sambandsanalyser inte har någon jämförelsegrupp av barn som inte fått någon insats (alla som ingår i analysen har fått mer eller mindre av insatsen) är det viktigt att påpeka att vi med det här sättet att analysera inte kan säga något om insatsen är effektiv eller inte. De mönster vi alltjämt har funnit ska därför tolkas som ’tendenser till dämpad försämring’ över tid. Det finns dock ingenting som tyder på att socialtjänsten bör vara restriktiv med att ge yngre barn från utsatta familjer en kontaktfamiljsinsats under lång tid.  För de äldre barnen finns det dessvärre inga resultat som är tillräckligt handfasta för att tjäna som underlag för rekommendationer.

  • 17.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Children Placed In Out-of-Home Care as Midlife Adults: Are They Still Disadvantaged or Have They Caught Up With Their Peers?2017In: Child Maltreatment, ISSN 1077-5595, E-ISSN 1552-6119, Vol. 22, no 3, p. 205-214Article in journal (Refereed)
    Abstract [en]

    International research has consistently reported that children placed in out-of-home care (OHC) have poor outcomes in young adulthood. Yet, little is known about their outcomes in midlife. Using prospective data from a cohort of more than 14,000 Swedes born in 1953, of which nearly 9% have been placed in OHC, this study examines whether there is developmental continuity or discontinuity of disadvantage reaching into middle age in OHC children, compared to same-aged peers. Outcome profiles, here conceptualized as combinations of adverse outcomes related to education, economic hardship, unemployment, and mental health problems, were assessed in 1992–2008 (ages 39–55). Results indicate that having had experience of OHC was associated with 2-fold elevated odds of ending up in the most disadvantaged outcome profile, controlling for observed confounding factors. These findings suggest that experience of OHC is a strong marker for disadvantaged outcomes also in midlife.

  • 18.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Effectiveness of Sweden's Contact Family/Person Program for older children2015In: Research on social work practice, ISSN 1049-7315, E-ISSN 1552-7581, Vol. 25, no 2, p. 190-200Article in journal (Refereed)
    Abstract [en]

    Objectives: To estimate the impacts of Sweden’s Contact Family/Person Program (CFPP) for older children on participants’ long-term outcomes related to mental health problems, illicit drug use, public welfare receipt, placement in out-of-home care, educational achievement, and offending. Method: We analyzed longitudinal register data on more than 1,000,000 individuals born between 1973 and 1984, including 6,386 individuals who entered CFPP at 10–13 years of age, with a follow-up until 2008. The program impact was estimated by means of propensity score matching. Results: Outcomes for those who had received the intervention were not better than that for matched peers who did not receive the intervention. Conclusions: The results did not find support for CFPP effectiveness in reducing risks of compromised long-term development in older children.

  • 19.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Long-term outcomes of Sweden’s Contact Family Program for children2012Report (Other academic)
  • 20.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Long-term outcomes of Sweden's Contact Family Program for children2013In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 37, no 6, p. 404-414Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the long-term impacts of Sweden's Contact Family Program (CFP) for children on participants' future outcome profiles, here conceptualized as combinations of outcomes related to mental health problems, public welfare receipt, illicit drug use, placement in out-of-home care, educational achievement, and offending. Methods: We analyzed longitudinal register data on more than 950,000 children born 1980-90, including 6693 children who entered CFP at 2-5 years of age, with a follow-up until 2008. Children's outcome profiles were identified by latent class analysis. The average program impact was estimated by means of propensity score matching. Results: Long-term outcomes for those who had received the intervention were not better than for matched peers who did not receive the intervention. Simulation-based sensitivity analyses indicate that some of our estimated negative treatment effects may be affected by unobserved factors related to program participation and outcomes. However, both selection and outcome effects must be extremely strong in order to generate notable positive effects of CFP participation. Conclusions: The results did not find support for CFP effectiveness in reducing risks of compromised long-term development in children. Since the intervention reaches a high-risk group of children and is popular among users, volunteer families and professionals, the program should be reinforced with knowledge-based components that target known risk factors for child welfare recipients.

  • 21.
    Brännström, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Risk factors for teenage childbirths among child welfare clients: findings from Sweden2015In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 53, no 6, p. 44-51Article in journal (Refereed)
    Abstract [en]

    This study contributes to the literature on preventing teenage childbirths by asking whether the pattern and strength of risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on more than 700,000 Swedish females, including around 29,000 child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Comparisons of effect sizes suggest that the differences in pattern were marginal, but there were notable differences in strength. The girls' school failure was the most prominent risk factor across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of teenage childbirths is on the scale of 30% if this risk factor could be eliminated. In the child welfare subgroups, however, the hypothetical improvement was even larger, around 40%. Reducing the high rate of school failure could thus yield a profound reduction in teenage childbirths in child welfare subgroups, where the incidence of teenage childbirth is substantially higher compared to other peers.

  • 22. Elgestam, E
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Nordlund, K
    Skole till barna i barnevernet2009In: Omsorgssvikt i offentlig regi, Oslo: Voksne for Barn Forlag , 2009, p. 29-34Chapter in book (Other academic)
  • 23.
    Forsman, Hilma
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data2016In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 57, p. 61-71Article in journal (Refereed)
    Abstract [en]

    Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973–1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances.

  • 24.
    Forsman, Hilma
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Interventions aiming to improve school achievements of children in out-of-home care: a scoping review2012In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 34, no 6, p. 1084-1091Article in journal (Refereed)
    Abstract [en]

    The educational underachievement of children in out-of-home care has been known for decades. In this scoping review, we compiled and analyzed – with a narrative approach – evaluated interventions that aimed to improve foster children's school achievements. Despite a comprehensive searching strategy, only eleven relevant studies were found, indicating that little has been done in intervention research to improve educational outcomes for children in public care. Nine out of the eleven interventions reported some positive results. Literacy was improved in most studies, while evaluated attempts to enhance numeracy skills yielded mixed results. Positive results came from a range of different interventions, e.g. tutoring projects and structured individualized support. We conclude that most focused interventions seem to improve foster children's poor academic achievements, but tutoring projects have so far the best empirical support from evaluations with rigorous designs. Also there's a definite need for more intervention research.

  • 25.
    Forsman, Hilma
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Skolstödjande insatser för socialt utsatta barn2017In: Skolsocialt arbete: skolan som plats för och del i det sociala arbetet / [ed] Åsa Backlund, Sara Högdin, Ylva Spånberger Weitz, Malmö: Gleerups Utbildning AB, 2017, p. 195-205Chapter in book (Other academic)
  • 26.
    Fridell Lif, Evelina
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Childhood Adversities and Later Economic Hardship among Swedish Child Welfare Clients: Cumulative Disadvantage or Disadvantage Saturation?2017In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 47, no 7, p. 2137-2156Article in journal (Refereed)
    Abstract [en]

    National register data were used in a longitudinal design to test two competing hy-potheses regarding links between cumulative exposure to childhood adversities andlater adverse outcomes, conceptualised as economic hardship in early adulthood,among more than 11,000 Swedish youths who had received the same in-home childwelfare intervention at ages two to five or at ages ten to thirteen. The cumulative-disadvantage perspective argues that the accumulation of childhood adversitiesincrease the likelihood of negative outcomes later in life. In contrast, thedisadvantage-saturation perspective suggests that the accumulation of childhood ad-versities is less consequential for initially disadvantaged individuals. Results from logis-tic regression analyses showed a pronounced positive association between theaccumulation of childhood adversities and economic hardship (measured as extensivemeans-tested social assistance recipiency) in early adulthood. After adjustments forsocio-economic confounders, the analyses showed that youth exposed to four or morechildhood adversities during childhood had two- to four-fold elevated odds of receiv-ing extensive social assistance compared to peers who had received the same inter-vention, but had no indications of exposure to childhood adversities. The results lendsupport to the relevance of accumulated childhood adversities for understandinglong-term outcomes in child welfare populations.

  • 27.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Björkenstam, Emma
    Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0151755Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973-82 (n = 872 912), which was followed from age 18 to 29-40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7-2.5], two CHD indicators 5.6 [4.4-7.1], three or more indicators 9.4 [7.1-12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks-those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9-14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4-1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage.

  • 28.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Fridell, Mats
    Hesse, Morten
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Childhood socio-economic status, school failure and drug abuse: a Swedish national cohort study2013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 8, p. 1441-1449Article in journal (Refereed)
    Abstract [en]

    Aim To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood. Design setting and participantsRegister study in a Swedish national cohort born 1973-88 (n=1405763), followed from age 16 to 20-35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse. Measurements Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than -1standard deviation and/or no grades in core subjects. Findings School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76-5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20-2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19-1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13-4.31). Conclusions School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

  • 29.
    Gauffin, Karl
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    School performance and alcohol-related disorders in early adulthood: a Swedish national cohort study2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 3, p. 919-927Article in journal (Refereed)
    Abstract [en]

    Background Alcohol misuse is an important global health determinant and a major contributor to health inequalities. We aimed to investigate the association between school performance and alcohol-related disorders in early adulthood in a longitudinal register-based national cohort study. Methods We followed a register-based national cohort of Swedish citizens born 1973-1984 (N = 948 440) from compulsory school graduation at age 15-16 to 2009. We divided the population into five groups: high school marks (> mean+1 SD); high average (between mean and mean - 1 SD); low average (between mean and mean - 1 SD); low (< mean - 1SD); and missing. Cox proportional hazard models were used to investigate the relation between school marks at time of graduation and hospital care for alcohol-related disorders in early adulthood. Results There was a steep gradient in the risk of alcohol-related disorders related to school performance. In comparison with peers in the top category of school marks, students with low marks had adjusted hazard ratios of 8.02 [95% confidence interval (CI) 7.20 to 8.91], low average 3.02 (2.72 to 3.35) and high average 1.55 (1.39 to 1.73). The risk associated with low school marks was stronger in the male population and in the group from high socioeconomic background. Conclusions The study demonstrated a strong graded relation between low school performance and alcohol-related disorders in young adulthood. School performance should be taken into account when developing prevention programmes/policies targeting alcohol misuse among teenagers and young adults, especially if the aim is to reach high-risk groups.

  • 30. Hjern, A
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Lindblad, F
    Santé et adaption sociale chez jeunes adultes adoptés á l’international en Suede.2009In: Adoption: un lien pour la vie / [ed] I J Chomilier & M Duyme, Marseille: Solal, Collection Résiliences , 2009, p. 95-108Chapter in book (Other academic)
  • 31.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Klöfvermark, Josefin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Manhica, Hélio
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Children as next of kin in Sweden2017Report (Other academic)
  • 32.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn som anhöriga: hur går det i skolan?2015In: Att se barn som anhöriga: om relationer, interventioner och omsorgsansvar / [ed] Ulrika Järkestig Berggren, Lennart Magnusson, Elizabeth Hanson, Kalmar: NKA och Linnéuniversitetet , 2015, p. 117-132Chapter in book (Other academic)
  • 33.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn som anhöriga: hur går det i skolan?2013Report (Other academic)
  • 34. Kling, Stefan
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Somatic assessments of 120 Swedish children taken into care reveal large unmet health and dental care needs2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 4, p. 416-420Article in journal (Refereed)
    Abstract [en]

    AimFor decades, non-Nordic countries have consistently reported high rates of somatic health problems among children placed in care by the authorities. This study examined the unmet health and dental care needs of Swedish children in foster and residential care. MethodsThe health of 120 consecutive children aged 0-17 years, who had recently been placed in foster or residential care in one Swedish region, was assessed by an experienced paediatrician using patient records, their medical history and a physical examination. ResultsFollowing the assessments, 51% of the subjects received at least one referral to a specialist or to primary care, either for a previously undetected medical condition or for a follow-up of a previously detected condition noted in their patient records. The study showed that 40% of the girls and 33% of boys were overweight and completed vaccination rates were only 86% for children up to the age of six and 68% for 7- to 17-year-olds. Half of the 7- to 17-year-olds had untreated dental decay. ConclusionOur study revealed a large unmet need for health and dental care interventions among children placed in foster care and residential care and a systematic strategy is required to address those needs.

  • 35. Mattsson, Titti
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn i familjehem: förslag på åtgärder som skulle göra skillnad för samhällets mest utsatta2016Report (Other academic)
  • 36. Rangmar, Jenny
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Strömland, Kerstin
    Aronson, Marita
    Fahlke, Claudia
    Psychosocial Outcomes of Fetal Alcohol Syndrome in Adulthood2015In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, no 1, p. E52-E58Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS. METHODS: We carried out a national register-based study of 79 adults with an FAS diagnosis, at a mean age of 32. Education, social adjustment, and mental health outcomes were analyzed and compared with 3160 comparison individuals matched on age, gender, and place of birth. RESULTS: The FAS group was much more likely to have received special education (25% vs 2%), be unemployed (51% vs 15%), and receive a disability pension (31% vs 3%) than the comparisons, but the levels of criminal offenses were similar. The FAS group had higher hospital admission rates for alcohol abuse (9% vs 2%) and psychiatric disorders (33% vs 5%) and was more likely to be prescribed psychotropic drugs (57% vs 27%). CONCLUSIONS: Swedish children with FAS have quite diverse psychosocial outcomes in adulthood, considerably worse than for majority population peers. Potential risk and protective factors within the FAS group deserve study to enable development of effective interventions.

  • 37.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death in childhood and self-inflicted injuries in young adults - a national cohort study from Sweden2016In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 25, no 10, p. 1103-1111Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that parental death influences health and mortality in bereaved offspring. To date, few studies have examined whether exposure to parental bereavement in childhood is associated with suicidality later in life. The aim of the present research was to investigate whether parental death during childhood influences self-inflicted injuries/poisoning in young adulthood. A national cohort born during 1973–1982 (N = 871,402) was followed prospectively in the National Patient Discharge Register from age 18 to 31–40 years. Cox regression analyses of proportional hazards, with adjustment for socio-demographic confounders and parental psychosocial covariates, were used to test hypotheses regarding parental loss and hospital admission due to self-inflicted injuries/poisoning. Parental deaths were divided into deaths caused by (1) external causes/substance abuse and (2) natural causes. Persons who had lost a parent to an external cause/substance abuse-related death had the highest risk of being admitted to a hospital for a self-inflicted injury/poisoning; HRs 2.03 (1.67–2.46) for maternal death and 2.03 (1.84–2.25) for paternal death, after adjustment for socio-demographic confounders and risk factors among surviving parents. Risks were also increased for parental death due to natural causes, but at a lower level: 1.19 (1.01–1.39) and 1.28 (1.15–1.43), respectively. Losing a father before school age was associated with a higher risk of hospital admission for a self-inflicted injury/poisoning than was loss at an older age for both genders. Maternal loss before school age was associated with a higher risk only for men, particularly maternal death by natural causes (p < 0.01).

  • 38.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sibling death in childhood and self-inflicted injuries in young adults: A national cohort study from Sweden2016Conference paper (Refereed)
  • 39.
    Sallnäs, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Instabilitet i familjehemsvården – en regional studie om sammanbrott bland yngre barn och bland barn i långvarig familjehemsvård: Oplanerade avbrott i familjehemsplaceringar av yngre barn och långvarigt placerade barn2012Report (Other academic)
  • 40.
    Sallnäs, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Samhällsvårdade tonåringar som vuxna: en uppföljande registerstudie2009In: Socionomens forskningssupplement, ISSN 0283-1929, no 3, p. 30-43Article in journal (Refereed)
  • 41.
    Sallnäs, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kyhle Westermark, Pia
    Breakdown of teenage placements in Swedish foster and residential care.2009In: Children in State Care / [ed] Courtney, M & Thoburn, J, Farnham, England: Ashgate, 2009Chapter in book (Other (popular science, discussion, etc.))
  • 42. Tideman, E
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hintze, K
    A Isaksson, A
    Improving foster children’s school achievements: Promising results from a Swedish intensive small scale study2011In: Adoption & Fostering: The Quarterly Journal of British Agencies for Adoption & Fostering, ISSN 0308-5759, E-ISSN 1740-469X, Vol. 35, no 1, p. 44-56Article in journal (Refereed)
    Abstract [en]

    Eva Tideman , Bo Vinnerljung , Kristin Hintze and Anna Aldenius Isaksson report on the results of a Swedish project aimed at improving foster children's school achievements. Standardised psychological and pedagogical instruments were used for assessing each individual foster child's potential, her or his educational service needs, and for tailoring the individualised educational and psychological support that was provided for two years. After this period, the 25 children included in the project were re-tested with the same instruments. Post-intervention test results were compared to preintervention scores for assessing outcomes. Results showed significant gains in IQ (as measured by WISC-III), reading and spelling skills, but weaker, non-significant improvements in maths skills.

  • 43. Tideman, Eva
    et al.
    Sallnäs, Marie
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Forsman, Hilma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Paired reading: ett försök i sju kommuner med lästräning för famljehemsplacerade barn2013Report (Other academic)
  • 44. Tordön, R
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Axelsson, U
    Improving foster children’s school performance: a replication of the Helsingborg study2014In: Adoption & Fostering: The Quarterly Journal of British Agencies for Adoption & Fostering, ISSN 0308-5759, E-ISSN 1740-469X, Vol. 38, no 1, p. 37-48Article in journal (Refereed)
  • 45.
    Vinnerljung, B
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Berlin, M
    Hjern, A
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Skolbetyg, utbildning och risker för ogynnsam utveckling hos barn2010In: Social Rapport 2010, Stockholm: Socialstyrelsen , 2010, p. 227-266Chapter in book (Other academic)
  • 46.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Commentary on Katz LY, Au W, Singal D, Brownell M, Roos N, Martens PJ, Chateau D, Enns MW, Kozyrskyj AL, Sareen J. Suicide and suicide attempts in children and adolescents in the child welfare system2012In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 15, no 2, p. 38-Article in journal (Refereed)
  • 47.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjälp fosterbarn att klara sig bättre i skolan2011In: Ett annat hemma. : Om samhällets ansvar för placerade barn / [ed] A Fredriksson och A Kakuli, Stockholm: Gothia förlag , 2011, 1.1, p. 51-68Chapter in book (Other academic)
  • 48.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Registerforskning och socialt arbete2012In: Metoder og perspektiver i barne- og ungdomsforskning / [ed] E Backe-Hansen & I Frönes, Oslo: Gyldendal Akademisk, 2012, p. 242-262Chapter in book (Other academic)
  • 49.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Uppväxtbakgrund, skolmisslyckande och narkotikamissbruk - en registerstudie av 1.4 miljoner svenskar2013In: Med narkotikan som följeslagare: femton texter till Bengt Svensson / [ed] Björn Johnson och Philip Lalander, Malmö: Hälsa och samhälle, Malmö högskola , 2013, p. 139-146Chapter in book (Other academic)
  • 50.
    Vinnerljung, Bo
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Disability pension among adult former child welfare clients: a Swedish national cohort study2015In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 56, p. 169-176Article in journal (Refereed)
    Abstract [en]

    Using longitudinal register data on all persons born in Sweden 1973–1978, we report on prevalence of disability pension among young adults who were child welfare clients during their formative years, and explore risk factors for this long-term outcome. For most child welfare subgroups, prevalence approached or exceeded ten percent. Multivariate logistic regression analyses found high crude odds ratios of disability pension among child welfare alumni. These were substantially reduced – but not obliterated – after adjustments for a host of background factors. Decomposition analyses revealed that child welfare alumni’s poor school performance and low educational attainment accounted for most of the confounding effects. We also found that child welfare clients with a disability pension had far higher rates of psychosocial problems in their adult lives than other peers with a disability pension. Child welfare alumni should be regarded as a high risk group for future disability pension and for permanent exclusion from the labor market. Rates of suicidal behavior in adult age were extreme among some subgroups of child welfare alumni with a disability pension, which should be communicated to agencies who are likely to meet these groups (eg. primary health care).

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