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  • 1.
    B. Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Bishop, Lauren
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Intergenerational transmission of alcohol misuse: mediation and interaction by school performance in a Swedish birth cohort2020In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 74, no 7, p. 598-604Article in journal (Refereed)
    Abstract [en]

    Background Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse.

    Methods Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0–19) and participants' own alcohol misuse in adulthood (ages 20–63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19).

    Results Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation.

    Conclusion Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.

  • 2.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Posttraumatisk stress hos flyktingföräldrar och konsekvenser för barnen2019In: Barn, migration och integration i en utmanande tid / [ed] Karin Helander; Pernilla Leviner , Stockholm: Ragulka Press , 2019Chapter in book (Other (popular science, discussion, etc.))
  • 3.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brendler-Lindquist, Monica
    de Montgomery, Edith
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Parental Posttraumatic Stress and School Performance in Refugee Children2022In: Journal of Traumatic Stress, ISSN 0894-9867, E-ISSN 1573-6598, Vol. 35, no 1, p. 138-147Article in journal (Refereed)
    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.

  • 4.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Evicted children and subsequent placement in out-of-home care: A cohort study2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195295Article in journal (Refereed)
    Abstract [en]

    Background

    Evictions may have serious consequences for individuals’ health and wellbeing. Even though an eviction may be experienced as a significant crisis for the family, there is little previous knowledge on consequences for evicted children. This study represents the first attempt to examine to what extent children from evicted households were separated from their parents and placed in out-of-home care (foster family or residential care) using population-based data, net of observed confounding factors related to the socioeconomic and psychosocial circumstances of their parents.

    Methods

    This study takes advantage of information from a Swedish national database, consisting of about 8 000 evicted individuals and a random sample of 770 000 individuals from the national population, linked to individual-level, longitudinal data from Swedish national registers. Our analytical sample consists of information for more than 250 000 children born in 1995–2008, including 2 224 children from evicted households. We used binary logistic regression based on the Karlson/Holm/Breen method to account for observed imbalances at baseline between evicted and non-evicted children.

    Results

    Compared to non-evicted children, the crude odds ratio for placement in out-of-home care in evicted children was 12.10 (95% CI 8.54–17.14). Net of observed confounding factors related to the socioeconomic and psychosocial circumstances of the parents, evicted children had a twofold elevated risk of being placed in out-of-home care (odds ratio 2.26, 95% CI 1.55–3.27). Crude OR for evicted children in comparison with children under threat of eviction (eviction not formally executed) was 1.71 (95% CI 1.17–2.49) and adjusted OR 1.58 (95% CI 1.06–2.35).

    Conclusion

    Children who experience eviction constitute a disadvantaged group and are at significant risk of being separated from their parents and placed in out-of-home care. These results demonstrate the importance of providing support for these children and their parents. Strategies to prevent households with children from being evicted seem to be an important and viable intervention path.

  • 5.
    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.

  • 6.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Charboti, Susanna
    Montgomery, Edith
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental PTSD and school performance in 16-year-olds – a Swedish national cohort study2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 4-5, p. 264-272Article in journal (Refereed)
    Abstract [en]

    Aim: Posttraumatic stress disorder (PTSD) in parents can have severe consequences also for their children. Prevalence of PTSD is high among refugees. Refugee children have been reported to perform poorly in school. The aim of this study was to investigate the impact of PTSD in refugee and native Swedish parents on children’s school performance and to compare the impact of PTSD with that of other major psychiatric disorders.

    Methods: Register study where multiple regression models were used to analyse school performance in 15–16-year-olds in a national cohort (n = 703,813). PTSD and other major psychiatric disorders (bipolar, depression and/or psychotic disorders) were identified from out- and in-patient hospital care.

    Results: Maternal and paternal PTSD were associated with lower grades, with adjusted effects of 0.30–0.37 SD in refugee and 0.46–0.50 SD in native Swedish families. Impact of PTSD was greater than that of other psychiatric disorders and comorbidity to PTSD did not increase this impact. Although the impact of PTSD on grades was greater in children in native Swedish families, consequences with regard to eligibility to secondary education were greater for children in refugee families, where 35% of these children were ineligible.

    Conclusions: Parental PTSD has major consequences for children’s school performance and contributes to the lower school performance in children in refugee families in Sweden. Identification and treatment of PTSD in refugee parents is important for offspring educational achievement. Psychiatric clinics and treatment centres need to have a strategy for support, including educational support, to the offspring of their patients with PTSD.

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  • 7.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    de Montgomery, Edith
    Brendler-Lindquist, Monica
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 12, p. 1953-1962Article in journal (Refereed)
    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.

  • 8.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Juarez, Sol Pia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Health risk behaviours among migrants by duration of residence: protocol for a systematic review and meta-analysis2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e038388Article, review/survey (Refereed)
    Abstract [en]

    Introduction International migrants’ health has often been found to deteriorate in new countries, partly due to changes in health risk behaviours such as alcohol consumption, tobacco use, physical inactivity, and poor dietary habits. However, limited efforts have been made to comprehensively evaluate the extent to which migrants adopt unhealthy risk behaviours with longer duration of residence. This systematic review and meta-analysis will summarise evidence on international migrants’ behavioural patterns by duration of residence in multiple country contexts.

    Methods and analysis PubMed/MEDLINE, Web of Science and ProQuest databases will be searched for quantitative or mixed-method observational studies published in peer-reviewed scientific journals between 1 January 2000 and 31 December 2019. Studies comparing foreign-born individuals by duration of residence will be included. Information on study characteristics, descriptive statistics and measures of effect will be extracted. All included studies will be quality assessed using a modified Newcastle-Ottawa scale. The review will include narrative synthesis and, if sufficient and comparable data are available, random effects meta-analyses. The review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

    Ethics and dissemination Ethical approval is not required since previously published information from peer-reviewed studies will be assessed. The results of this review will be published in peer-reviewed journals and presented at scientific conferences. Other forms of dissemination will include communication to broader audiences using well-established channels, including through university-based press releases. Progress will be regularly updated on the International Prospective Register of Systematic Reviews to ensure full transparency.

  • 9.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn till föräldrar med cancer – hur många berörs och vilka är konsekvenserna i ett livsloppsperspektiv?2016Report (Other academic)
  • 10.
    Berg, Lisa
    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).
    Barn till separerade föräldrar: Hälsa, utbildning och sociala levnadsförhållanden i ett livsloppsperspektiv2016Report (Other academic)
    Abstract [sv]

    En halv miljon barn i Sverige har föräldrar som inte bor tillsammans. Syftet med den här studien, som utförts av CHESS på uppdrag av Socialstyrelsen, är att belysa hälsa och social situation under skolåren och tidig vuxen ålder för dessa barn. Rapporten baseras på information inhämtad från nationella register och surveyundersökningar om betyg och utbildningskarriär, arbete och inkomster, kriminalitet, psykisk ohälsa, missbruk samt kronisk sjukdom och dödlighet.

    Sammanfattningsvis visar resultaten från denna studie att barn till separerade föräldrar har en ökad risk för ohälsa, skolmisslyckande och ekonomisk utsatthet under skolåren, ungdomsåren och i ung vuxen ålder. Bland dessa barn har barn som bor enbart eller mest med en förälder det största behovet av förebyggande insatser från samhället, i synnerhet om separationen sker i tidig ålder.

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  • 11.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Thern, Emelie
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all‐cause mortality: Results from the Stockholm Public Health Cohort2023In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 7, p. 1850-1859Article in journal (Refereed)
    Abstract [en]

    Introduction: The social gradient in consumption behaviours has been suggestedto partly explain health inequalities. The majority of previous studies have onlyincluded baseline measurements and not considered potential changes in behav-iours over time. The study aimed to investigate the contribution of alcohol con-sumption and smoking to the social gradient in mortality and to assess whetherthe use of repeated measurements results in larger attenuations of the main asso-ciation compared to using single baseline assessments.

    Methods: Longitudinal survey data from the population-based Stockholm PublicHealth Cohort from 2006 to 2014 was linked to register data on mortality until2018 for 13,688 individuals and analysed through Cox regression.

    Results: Low socioeconomic position (SEP) was associated with increased mortal-ity compared with high SEP; hazard ratios 1.56 (95% CI 1.30–1.88) for occupa-tional status and 1.77 (95% CI 1.49–2.11) for education, after adjustment fordemographic characteristics. Using repeated measurements, alcohol consumptionand smoking explained 44% of the association between occupational status andall-cause mortality. Comparing repeated and baseline measures, the percentageattenuation due to alcohol consumption increased from 11% to 18%, whereas itremained similar for smoking (25–23%).

    Discussion and Conclusions: Smoking and alcohol consumption explained alarge part of the association between SEP and mortality. Comparing results fromtime-fixed and time-varying models, there was an increase in overall percentageattenuation that was mainly due to the increased proportion explained by alcoholconsumption. Repeated measurements provide a better estimation of the contri-bution of alcohol consumption, but not smoking, for the association between SEPand mortality.

  • 12.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ljunggren, Gunnar
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Underutilisation of psychiatric care among refugee adolescents in Stockholm2021In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, p. 563-570Article in journal (Refereed)
    Abstract [en]

    Aim: Refugee children have been shown to underutilise psychiatric services in Scandinavia. The aim of this study was to investigate determinants of psychiatric care utilisation in adolescents in refugee families.

    Methods: The study used regional data on healthcare use linked to sociodemographic data from national registers in a total population of 93 537 adolescents in the Stockholm County born in 1995‐2000, including 18 831 with a refugee background. Cox regression analyses were fitted to estimate Hazard ratios (HRs) of psychiatric care utilisation in the age‐span 11‐18 years.

    Results: Psychiatric care use was lower in the large majority of adolescents in refugee families that originated in low‐ and middle‐income countries, with adjusted HRs 0.34 (95% CI 0.28‐0.42) and 0.51 (95% CI 0.46‐0.56), respectively, compared with the Swedish majority population. Among the foreign‐born refugee adolescents, psychiatric care use increased with duration of residence in Sweden and was higher in children who obtained residency as asylum seekers compared with those who settled in family reunification.

    Conclusion: Adolescents in newly settled refugee families with a background in low‐ and middle‐income countries should be a priority in mental health assessment of refugee children and referral to psychiatric care facilitated for children in need.

  • 13.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Arat, Arzu
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death during childhood and violent crime in late adolescence to early adulthood: a Swedish national cohort study2019In: Palgrave Communications, ISSN 2055-1045, Vol. 5, article id 74Article in journal (Refereed)
    Abstract [en]

    Childhood parental death has been associated with adverse health, social and educational outcomes. Studies on long-term outcomes are in general scarce and there is little evidence on the long-term impact on anti-social behaviour. This study takes advantage of high-quality register data to investigate risk of violent crime in relation to childhood parental death in a large national cohort covering the entire Swedish population born in 1983–1993 (n = 1,103,656). The impact of parental death from external (suicides, accidents, homicides) and natural causes on risk for violent crime from age 15 to 20–30 years, considering multiple aspects of the rearing environment (including parental psychiatric disorders and criminal offending), was estimated through Cox regression. Unadjusted hazard ratios associated with parental death from external causes ranged between 2.20 and 3.49. For maternal and paternal death from external causes, adjusted hazard ratios were 1.26 (95% confidence intervals: 1.04–1.51) and 1.44 (95% confidence intervals: 1.32–1.57) for men, and 1.47 (95% confidence intervals: 1.05–2.06) and 1.51 (95% confidence intervals: 1.27–1.78) for women. With the exception of maternal death among women (hazard ratio 1.26, 95% confidence intervals: 1.03–1.53), parental death from natural causes was not associated with increased risks in adjusted models. The results underscore the importance of preventive interventions to prevent negative life-course trajectories, particularly when death is sudden and clustered with other childhood adversities.

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  • 14.
    Berg, Lisa
    et al.
    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).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death during childhood and depression in young adults – a national cohort study2016In: Journal of Child Psychology and Psychiatry, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 57, no 9, p. 1092-1098Article in journal (Refereed)
    Abstract [en]

    Background

    There are few prospective, population-based studies on childhood parental death and psychiatric disorders in adulthood, and previous findings are inconclusive. This study investigated the association between parental death from natural and external (suicides, accidents or homicides) causes before 18 years and the risk of clinical depression in young adults, in relation to age at loss and gender of both child and parent.

    Methods

    In this register-based study, a national cohort born in Sweden during 1973–1982 (n = 862,554) was followed with regard to hospital admissions and outpatient care for depression during 2006–2013. Multivariate Cox proportional hazards models were used to estimate the impact of parental death, taking sociodemographic and parental psychosocial covariates into account.

    Results

    Maternal death from natural causes was associated with a hazard ratio (HR) of outpatient care for depression of 1.19 [95% confidence interval (CI), 1.02–1.40] in men and 1.15 (1.01–1.31) in women, after adjustment for sociodemographic confounders, with similar effect sizes for paternal natural death. Death from external causes consistently had higher effect size compared with natural deaths, in particular in relation to risk of hospital admissions for depression where they were as high as HR 3.23 (2.38–4.38) for men, and 1.79 (1.30–2.47) for women after a loss of a mother. Losing a parent in preschool age, compared with losing a parent as a teenager, was associated with higher risks of both hospitalization (p = .006) and outpatient care (p = .001) for depression.

    Conclusions

    This study indicates that parental loss to death from natural causes during childhood is associated with a small increased risk of long-term consequences for psychological health. Children who lose their parents to death from external causes, that is suicides, accidents or homicides, and children losing a parent in young ages are, however, at particular risk and should be given priority in preventive interventions after parental loss.

  • 15.
    Berg, Lisa
    et al.
    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).
    Saarela, Jan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental Death During Childhood and Subsequent School Performance2014In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 133, no 4, p. 682-689Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality.

    METHODS: This was a register-based national cohort study of 772117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1-5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as -coefficients and odds ratios (ORs) with 95% confidence intervals (CIs).

    RESULTS: Parental death was associated with lower grades (ORs: -0.21 [95% CI: -0.23 to -0.20] and -0.17 [95% CI: -0.19 to -0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: -0.27 [90% CI: -0.28 to -0.26]), compared with natural deaths (OR: -0.16 [95% CI: -0.17 to -0.15]), was not seen after adjustment for SEP and psychosocial situation of the family.

    CONCLUSIONS: Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.

  • 16. Björkenstam, Emma
    et al.
    Burström, Bo
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cumulative childhood adversity, adolescent psychiatric disorder and violent offending in young adulthood2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 5, p. 855-861Article in journal (Refereed)
    Abstract [en]

    Background

    Childhood adversity (CA) is a risk indicator for psychiatric morbidity. Although CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending.

    Methods

    We used a cohort of 476 103 individuals born in 1984–1988 in Sweden. Register-based CAs included parental death, substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance, child welfare intervention and residential instability. Adolescent psychiatric disorder was defined as being treated with a psychiatric diagnosis prior to age 20. Estimates of risk of violent offending after age 20 were calculated as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Mediation was tested with the bootstrap method.

    Results

    Exposure to CA was positively associated with violent offending, especially when accumulated. Individuals exposed to 4+ CAs who were also treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6–14.0). Corresponding IRR among 4+ CA youth with no psychiatric disorder was 5.1 (95% CI 4.5–5.6). Psychiatric disorder mediated the association between CA and violent offending.

    Conclusion

    CA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who also develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group.

  • 17. Chen, Jiaying
    et al.
    Mittendorfer-Rutz, Ellenor
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Norredam, Marie
    Sijbrandij, Marit
    Klimek, Peter
    Associations between Multimorbidity Patterns and Subsequent Labor Market Marginalization among Refugees and Swedish-Born Young Adults-A Nationwide Registered-Based Cohort Study2021In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 11, no 12, article id 1305Article in journal (Refereed)
    Abstract [en]

    Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.

  • 18. Chen, Jiaying
    et al.
    Mittendorfer-Rutz, Ellenor
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Nørredam, Marie
    Sijbrandij, Marit
    Klimek, Peter
    Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1054261Article in journal (Refereed)
    Abstract [en]

    Background: Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.

    Objective: We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.

    Methods: This longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.

    Results: In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).

    Conclusion: To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

  • 19. de Montgomery, Christopher Jamil
    et al.
    Norredam, Marie
    Krasnik, Allan
    Holm Petersen, Jørgen
    Björkenstam, Emma
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Sijbrandij, Marit
    Klimek, Peter
    Mittendorfer-Rutz, Ellenor
    Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263450Article in journal (Refereed)
    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.

  • 20.
    Dunlavy, Andrea
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    De Montgomery, Christopher Jamil
    Europa, Ryan
    Eide, Ketil
    Ascher, Henry
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Stockholm, Sweden.
    Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 3, p. 330-338Article in journal (Refereed)
    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.

  • 21.
    Grotta, Alessandra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Hiyoshi, Ayako
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Örebro University, Örebro, Sweden.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Kawachi, Ichiro
    Saarela, Jan
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Suicide Around the Anniversary of a Parent’s Death in Sweden2023In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 4, article id e236951Article in journal (Refereed)
    Abstract [en]

    Importance  Bereavement following parental death experienced in adulthood may be associated with suicide over many years, but this risk has received scant attention.

    Objective  To investigate whether the risk of suicide increases among adult children around the anniversary of a parent’s death.

    Design, Setting, and Participants  This case-crossover study used Swedish register-based longitudinal data from 1990 to 2016, based on the entire national population. Participants included all adults aged 18 to 65 years who experienced parental death and subsequently died by suicide. Conditional logistic regression was used to quantify the association between the anniversary (or preanniversary and postanniversary periods) and suicide, controlling for time-invariant confounding. All analyses were stratified by sex of the offspring. The analyses were also stratified by the sex of the deceased parent, time since parental death, age, and marital status. Data analyses were performed in June 2022.

    Exposures  Anniversary of a parent’s death (or preanniversary and postanniversary periods).

    Main Outcomes and Measures  Suicide.

    Results  Of 7694 individuals who died by suicide (76% intentional self-harm), 2255 (29%) were women, and the median (IQR) age at suicide was 55 (47-62) years. There was evidence of an anniversary reaction among women, with a 67% increase in the odds of suicide when exposed to the period from the anniversary to 2 days after the anniversary, compared with when not being exposed (odds ratio [OR], 1.67; 95% CI, 1.07-2.62). The risk was particularly pronounced among maternally bereaved women (OR, 2.29; 95% CI, 1.20-4.40) and women who were never married (OR, 2.08; 95% CI, 0.99-4.37), although the latter was not statistically significant. An increased risk of suicide from the day before up to the anniversary was observed among women bereaved between the ages of 18 and 34 years (OR, 3.46; 95% CI, 1.14-10.56) and between the ages of 50 and 65 years (OR, 2.53; 95% CI, 1.04-6.15). Men had an attenuated suicide risk for the period from the day before up to the anniversary (OR, 0.57; 95% CI, 0.36-0.92).

  • 22.
    Hiyoshi, Ayako
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Örebro University, Sweden; University College London, United Kingdom; Osaka University Graduate School of Medicine, Japan.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Parental death in childhood and pathways to increased mortality across the life course in Stockholm, Sweden: A cohort study2021In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 18, no 3, article id e1003549Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have shown that the experience of parental death during childhood is associated with increased mortality risk. However, few studies have examined potential pathways that may explain these findings. The aim of this study is to examine whether familial and behavioural factors during adolescence and socioeconomic disadvantages in early adulthood mediate the association between loss of a parent at age 0 to 12 and all-cause mortality by the age of 63.

    Methods and findings

    A cohort study was conducted using data from the Stockholm Birth Cohort Multigenerational Study for 12,615 children born in 1953, with information covering 1953 to 2016. Familial and behavioural factors at age 13 to 19 included psychiatric and alcohol problems in the surviving parent, receipt of social assistance, and delinquent behaviour in the offspring. Socioeconomic disadvantage in early adulthood included educational attainment, occupational social class, and income at age 27 to 37. We used Cox proportional hazard regression models, combined with a multimediator analysis, to separate direct and indirect effects of parental death on all-cause mortality.

    Among the 12,582 offspring in the study (men 51%; women 49%), about 3% experienced the death of a parent in childhood. During follow-up from the age of 38 to 63, there were 935 deaths among offspring. Parental death was associated with an elevated risk of mortality after adjusting for demographic and household socioeconomic characteristics at birth (hazard ratio [HR]: 1.52 [95% confidence interval: 1.10 to 2.08, p-value = 0.010]). Delinquent behaviour in adolescence and income during early adulthood were the most influential mediators, and the indirect associations through these variables were HR 1.03 (1.00 to 1.06, 0.029) and HR 1.04 (1.01 to 1.07, 0.029), respectively. After accounting for these indirect paths, the direct path was attenuated to HR 1.35 (0.98 to 1.85, 0.066). The limitations of the study include that the associations may be partly due to genetic, social, and behavioural residual confounding, that statistical power was low in some of the subgroup analyses, and that there might be other relevant paths that were not investigated in the present study.

    Conclusions

    Our findings from this cohort study suggest that childhood parental death is associated with increased mortality and that the association was mediated through a chain of disadvantages over the life course including delinquency in adolescence and lower income during early adulthood. Professionals working with bereaved children should take the higher mortality risk in bereaved offspring into account and consider its lifelong consequences. When planning and providing support to bereaved children, it may be particularly important to be aware of their increased susceptibility to delinquency and socioeconomic vulnerability that eventually lead to higher mortality.

  • 23. Hiyoshi, Ayako
    et al.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Saarela, Jan
    Fall, Katja
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Shebehe, Jacques
    Kawachi, Ichiro
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Montgomery, Scott
    Substance use disorder and suicide-related behaviour around dates of parental death and its anniversaries: a register-based cohort study2022In: The Lancet Public Health, ISSN 2468-2667, Vol. 7, no 8, p. e683-e693Article in journal (Refereed)
    Abstract [en]

    Background Parental death and its anniversaries, including anticipation of these dates, might cause distress andincrease the risk of substance use disorder and suicide-related behaviour in bereaved adolescents and young adults.We examined whether the risk of substance use disorder and suicide-related behaviour increases around the date ofparental death and subsequent anniversaries.

    Methods Using Swedish national registers, we conducted a cohort study of individuals aged 12–24 years. We includedindividuals aged 12–24 years between Jan 1, 2001, and Dec 31, 2014, whose parents were alive at entry (n=1 858 327)and followed up with them until the end of age 24 years. We excluded individuals with a half-sibling, a history ofemigration, a previous record of the outcome events, a parental death before study entry, two parental deaths on thesame day during the follow-up, or missing data for relevant variables. Follow-up ended on the day of an outcomeevent or on Dec 31, 2014; at age 25 years, emigration, or death; or a year before the second parental death. We studiedsubstance use disorder and suicide-related behaviour outcomes separately and included non-fatal and fatal events inboth outcomes. We used Cox regression to estimate hazard ratios (HRs), controlling for baseline psychiatric,demographic, and socioeconomic characteristics. Parental death was modelled as a time-varying exposure over72 monthly periods, starting from 1 year before the parental death to the fifth year and later after the death.Unmeasured confounding was also addressed in within-individual comparisons using a case-crossover design.

    Findings During follow-up (median 7·5 [IQR 4·3–10·6] years), there were 42 854 substance use disorder events, witha crude rate of 3·1 per 1000 person-years. For suicide-related behaviour, there were 19 827 events, with a crude rate of1·4 per 1000 person-years. Most of the events studied were non-fatal. In the month of parental death, the HR forsubstance use disorder risk was 1·89 (95% CI 1·07–3·33) among male participants, and, for suicide-related behaviour,was 3·76 (1·79–7·89) among male participants and 2·90 (1·61–5·24) among female participants. In male participants,there was an increased risk around the first anniversary (substance use disorder: HR 2·64 [95% CI 1·56–4·46] duringthe anniversary month; 2·21 [1·25–3 ·89] for the subsequent month; and for suicide-related behaviour: 3·18[1·32–7·66] for the subsequent month). Among female participants, an increased risk of substance use disorderrecurred around every year consistently in the month before the anniversary of the death and there was an increasedrisk for suicide-related behaviour in the months of the first and second anniversaries.

    Interpretation Although effect sizes were large in this cohort study, the number of individuals who had the outcomeswas small. Nevertheless, adolescents and young adults, especially women and girls, who had the death of a parentshowed increased risk of substance use disorder and suicide-related behaviour around the first few death anniversaries.Adolescents and young adults, especially women and girls, who had the death of a parent could benefit from preventivemeasures to reduce distress around the first few years of death anniversaries

  • 24.
    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)
  • 25.
    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)
  • 26.
    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)
  • 27.
    Juárez, Sol P.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis2022In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 67, article id 1604437Article, review/survey (Refereed)
    Abstract [en]

    Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

    Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

    Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

    Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contex

  • 28.
    Juárez, Sol Pia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Honkaniemi, Helena
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aims: Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants’ health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

    Methods: Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

    Results: The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

    Conclusions: Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

  • 29.
    Li, Baojing
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Brännström Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Liu, Can
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study2023In: SSM - Population Health, ISSN 2352-8273, Vol. 22, article id 101357Article in journal (Refereed)
    Abstract [en]

    There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-gender combination. We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorder partially operated via low income of the fathers. Furthermore, grandparents' psychiatric disorders influenced their children's and grandchildren's income. We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents' mental health problems could cast a long shadow on their children's and grandchildren's socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.

  • 30.
    Liu, Can
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Hiyoshi, Ayako
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Örebro University, Sweden; University College London, England.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    School Outcomes Among Children Following Death of a Parent2022In: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, no 4, article id e223842Article in journal (Refereed)
    Abstract [en]

    Importance  To better support children with the experience of parental death, it is crucial to understand whether parental death increases the risk of adverse school outcomes.

    Objectives  To examine whether parental death is associated with poorer school outcomes independent of factors unique to the family, and whether children of certain ages are particularly vulnerable to parental death.

    Design, Setting, and Participants  This population-based sibling cohort study used Swedish national register-based longitudinal data with linkage between family members. Register data were collected from January 1, 1990, to December 31, 2016. Data analyses were performed on July 14, 2021. The participants were all children born between 1991 and 2000 who lived in Sweden before turning age 17 years (N = 908 064).

    Exposure  Parental death before finishing compulsory school.

    Main Outcomes and Measures  Mean school grades (year-specific z scores) and ineligibility for upper secondary education on finishing compulsory school at age 15 to 16 years. Population-based cohort analyses were conducted to examine the association between parental death and school outcomes using conventional linear and Poisson regression models, after adjustment for demographic and parental socioeconomic and health indicators measured before childbirth. Second, using fixed-effect linear and Poisson regression models, children who experienced parental death before finishing compulsory school were compared with their siblings who experienced the death after. Third, the study explored the age-specific associations between parental death and school outcomes.

    Results  In the conventional population-based analyses, bereaved children (N = 22 634; 11 553 boys [51.0%]; 11 081 girls [49.0%]; mean [SD] age, 21.0 [2.8] years) had lower mean school grade z scores (adjusted β coefficient, −0.19; 95% CI, −0.21 to −0.18; P < .001) and a higher risk of ineligibility for upper secondary education than the nonbereaved children (adjusted risk ratio, 1.36; 95% CI, 1.32-1.41; P < .001). Within-sibling comparisons using fixed-effects models showed that experiencing parental death before finishing compulsory school was associated with lower mean school grade z scores (−0.06; 95% CI, −0.10 to −0.01; P = .02) but not with ineligibility for upper secondary education (adjusted risk ratio, 1.07; 95% CI, 0.93-1.23; P = .34). Independent of birth order, losing a parent at a younger age was associated with lower grades within a family.

    Conclusions and Relevance  In this cohort study, childhood parental death was associated with lower school grades after adjustment for familial confounders shared between siblings. Children who lost a parent may benefit from additional educational support that could reduce the risk of adverse socioeconomic trajectories later in life.

  • 31.
    Liu, Can
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hiyoshi, Ayako
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wall-Wieler, Elizabeth
    Martikainen, Pekka
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Parental death and initiation of antidepressant treatment in surviving children and youth: a national register-based matched cohort study2023In: eClinicalMedicine, ISSN 2589-5370, Vol. 60, article id 102032Article in journal (Refereed)
    Abstract [en]

    Background Population-based longitudinal studies on bereaved children and youth’s mental health care use are scarce and few have assessed the role of surviving parents’ mental health status.

    Methods Using register data of individuals born in Sweden in 1992–1999, we performed a matched cohort study(n = 117,518) on the association between parental death and subsequent initiation of antidepressant treatment among individuals bereaved at ages 7–24 years. We used flexible parametric survival models to estimate the hazard ratios (HRs) over time after bereavement, adjusting for individual and parental factors. We further examined if the association varied by age at loss, sex, parental sociodemographic factors, cause of death, and the surviving parents’psychiatric care.

    Findings The bereaved were more likely to initiate antidepressants treatment than the nonbereaved matched individuals during follow-up (incidence rate per 1000 person years 27.5 [26.5–28.5] vs. 18.2 [17.9–18.6]). The HRs peaked in the first year after bereavement and remained higher than the nonbereaved individuals until the end of the follow-up. The average HR over the 12 years of follow-up was 1.48 (95% confidence interval [1.39–1.58]) for father’s death and 1.33 [1.22–1.46] for mother’s death. The HRs were particularly high when the surviving parents received psychiatric care before bereavement (2.11 [1.89–2.56] for father’s death; 2.14 [1.79–2.56] for mother’s death) or treated for anxiety or depression after bereavement (1.80 [1.67–1.94]; 1.82 [1.59–2.07]).

    Interpretation The risk of initiating antidepressant treatment was the highest in the first year after parental death and remained elevated over the next decade. The risk was particularly high among individuals with surviving parentsaffected by psychiatric morbidity.

  • 32.
    Manhica, Hélio
    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).
    Almquist, Ylva B.
    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).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Labour market participation among young refugees in Sweden and the potential of education: a national cohort study2019In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, Vol. 22, no 4, p. 533-550Article in journal (Refereed)
    Abstract [en]

    This register-based study examined the importance of education on labour market participation among young refugees in Sweden. The study population consisted of unaccompanied (n = 1606) and accompanied refuges (n = 4142), aged 23–26 years in 2006–2010, after 7 years of residence in Sweden. Native Swedish, aged 24 years (n = 347,255) constituted the comparison population, with intercountry adoptees (n = 6689) as an alternative reference group. Gender-stratified multinomial regression models indicated that unaccompanied and accompanied male and female young refugees had higher risks of being in insecure work force and NEET compared to native Swedes with comparable levels of education. However, young refugees and intercountry adoptees with primary education had similar risks of poor labour market outcomes. The educational differences within each group concerning the risk of being in insecure work force were comparable. With the exception of unaccompanied females, secondary education seemed to be less protective against being in NEET among young refugees compared to native Swedes and intercountry adoptees. We conclude that while young refugees face employment disadvantages, education has the potential of mitigating poor labour market outcomes in this group.

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  • 33.
    Manhica, Hélio
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Rodríguez García de Cortázar, Ainhoa
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Hospital admissions due to alcohol related disorders among young adult refugees who arrived in Sweden as teenagers: A national cohort study2017In: BMC Public Health, E-ISSN 1471-2458, Vol. 17, article id 644Article in journal (Refereed)
    Abstract [en]

    Background: Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers.Methods: The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005–2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population.Results: Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00–2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71–3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for.Conclusion: Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

  • 34.
    Manhica, Hélio
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gauffin, Karl
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva
    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).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ainhoa, Rodríguez García de Cortázar
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Alcohol related disorders among young adult refugees who arrived in Sweden asteenagers - a national cohort studyManuscript (preprint) (Other academic)
  • 35.
    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).

  • 36.
    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 (Other academic)
  • 37.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, J.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sibling death in childhood predicts mortality in young adults – a Swedish national cohort study2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no Suppl. 3, p. 53-53Article in journal (Refereed)
    Abstract [en]

    Background

    Previous studies have found that the loss of a family member increases mortality among bereaved family members. Although, some previous evidence have found associations between loss of a sibling in adulthood and subsequent mortality few studies have studied whether sibling deaths in childhood is associated with all-cause and cause-specific mortality in young adulthood.

    Methods

    A national cohort born during 1973–1982 (N= 871 402) was followed prospectively in the Swedish Cause of Death Register from age 18 to 30–35. Multivariate Cox analyses of proportional hazards with adjustment for socio-demographic confounders were used to test the association between sibling loss and all-cause and cause-specific mortality in young adulthood. Sibling deaths were divided into deaths caused by external causes and natural causes and we studied mortality from CVD, cancer, other diseases, suicides and accidents among bereaved siblings.

    Results

    In men, the mortality risk for bereaved persons versus non bereaved persons during childhood/adolescence was 1.48 (95% CI: 1.17, 1.86), and in women it was 1.45 (95% CI: 1.01, 2.09) after adjustment for socio-demographic confounders. Losing anon-infant sibling (>1 years) was most detrimental for both men (HR: 1.65, 95% CI: 1.23, 2.23) and women (HR: 1.54,95% CI: 0.95, 2.50) while bereaved men (HR: 1.86, 95% CI:1.28, 2.72) and women (HR: 1.75, 95% CI: 0.97, 3.18) were most vulnerable when exposed to loss of a sibling inadolescence (12-18 years). Further, preliminary analyses showed that external causes of death were most detrimental for mortality among bereaved siblings.

    Conclusions

    Sibling death during childhood predicts mortality in young adulthood, particularly when persons are exposed in adolescence. Men and women are about equally vulnerable to sibling deaths at different stages of childhood.

  • 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).
    Saarela, Jan
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Experience of sibling death in childhood and risk of psychiatric care in adulthood2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Sibling loss has received scant attention in the bereavement literature. A previous study suggested an overall increased risk of mortality in siblings bereaved during childhood. However, the underlying disease pattern behind increased mortality is unclear. We studied the influence of sibling loss during childhood on in and outpatient care with an underlying psychiatric diagnosis in adulthood.

    Methods

    A national cohort born in Sweden in 1973-1982 (N = 717,723) was followed prospectively in the Cause of Death Register until 2013, i.e. from ages 18 years to 31-40 years of age. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric in- and outpatient care during follow-up.

    Results

    After adjustment for socio-demographic confounders and parental psychosocial covariates, HR for psychiatric inpatient-and outpatient care in bereaved siblings versus non- bereaved siblings was fairly small and non-significant in women. Bereaved men had increased HR for both psychiatric inpatient- (HR 1.17, 95% CI 1.00-1.36) and outpatient care (HR 1.21, 95% CI 1.10-1.33). Risks were however more pronounced when exposed to loss of a sibling in adolescence (i.e. in the ages 12-18 years) in both men and women.

    Conclusions

    The death of a sibling in childhood was associated with slightly increased risk of psychiatric in and out-patient care in surviving siblings in adulthood in men but not in women. Individuals experiencing the loss of a sibling in childhood may need particular attention from health care services.

  • 39.
    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).
    Saarela, Jan
    Kawachi, Ichiro
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Experience of Sibling Death in Childhood and Risk of Death in Adulthood: A National Cohort Study From Sweden2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 185, no 12, p. 1247-1254Article in journal (Refereed)
    Abstract [en]

    Although there is some evidence of an association between loss of a sibling in adulthood and subsequentmortality, there have been no previous studies in which investigators have examined whether the death of a sibling in childhood is associated with adult mortality using total population data. Data on a national cohort born in Sweden in 1973-1982 (n = 717,723) were prospectively collected from the Cause of Death Register until 2013 (i.e., from the ages of 18 years to 31-40 years). Cox proportional hazards models were used to analyze the association between sibling loss during childhood and death in young adulthood. After adjustment for sociodemographic confounders and parental psychosocial covariates, the hazard ratio for all-cause mortality in bereaved siblings versus nonbereaved siblings was 1.39 (95% confidence interval: 1.14, 1.69). Risks were more pronounced for those who lost a noninfant sibling (i.e., > 1 year of age) (hazard ratio = 1.53, 95% confidence interval: 1.18, 1.95) and those who lost a sibling in adolescence (i.e., between the ages of 12 and 18 years) (hazard ratio = 1.71, 95% confidence interval: 1.24, 2.35). Excess mortality risk was found for concordant causes of death (i. e., siblings dying from the same causes) but not for discordant causes.

  • 40.
    Rostila, Mikael
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Saarela, Jan
    Kawachi, Ichiro
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Harvard T.H. Chan School of Public Health, USA; Karolinska Institutet, Sweden.
    Experience of sibling death in childhood and risk of psychiatric care in adulthood: a national cohort study from Sweden2019In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 12, p. 1581-1588Article in journal (Refereed)
    Abstract [en]

    Studies have found that sibling loss is associated with an increased risk of death from external causes (i.e. suicides, accidents and homicides). Increased psychiatric health problems following bereavement could underlie such an association. We studied the influence of sibling loss during childhood on psychiatric care in young adulthood, adjusting for psychosocial covariates shared by siblings in childhood. A national cohort born in Sweden in 1973–1982 (N = 701,270) was followed prospectively until 2013. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric inpatient and outpatient care identified by the Hospital Discharge Register. After adjustment for confounders, the HRs of psychiatric care in men who experienced sibling loss were 1.17 (95% CI 1.07–1.27) while the associations turned non-significant in women after adjustment for family-related psychosocial covariates, HR 1.07 (95% CI 0.99–1.16). An increased risk was found in men bereaved in early childhood (1.22 95% CI 1.07–1.38) and adolescence (1.27 95% CI 1.08–1.48). Among women, loss of a sibling during adolescence was significantly associated with psychiatric care (1.19 95% CI 1.03–1.36). Increased psychiatric health problems following bereavement could underlie the previously found association between sibling loss and mortality from external causes. Family-related psychosocial conditions shared by siblings in childhood may account for the association between sibling death and psychiatric care in adulthood.

  • 41. Taipale, Heidi
    et al.
    Niederkrotenthaler, Thomas
    Helgesson, Magnus
    Sijbrandij, Marit
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Tanskanen, Antti
    Mittendorfer-Rutz, Ellenor
    Initiation of antidepressant use among refugee and Swedish-born youth after diagnosis of a common mental disorder: findings from the REMAIN study2021In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, p. 463-474Article in journal (Refereed)
    Abstract [en]

    Purpose The objective of this study was to compare the initiation and type of antidepressant use between refugees and matched Swedish-born youth after a diagnosis of a common mental disorder (CMD) and assess sociodemographic and clinical factors associated with the initiation.

    Methods The study cohort included youth aged 16-25 years, with an incident diagnosis of CMD based on specialized health care registers in Sweden 2006-2016, without prior antidepressant use during 1 year. One Swedish-born person was matched for each identified refugee youth (N = 3936 in both groups). Initiation of antidepressant use and factors associated with the initiation, were investigated with logistic regression yielding Odds ratios, OR, and 95% Confidence Intervals, CI.

    Results Refugees were less likely to initiate antidepressant use compared with Swedish-born (40.5% vs. 59.6%, adjusted OR 0.43, 95% CI 0.39-0.48). Selective serotonin reuptake inhibitors (SSRIs) were less frequently initiated for refugees than Swedish-born (71.2% vs. 81.3% of initiations,p < 0.0001). Sertraline was the most commonly initiated antidepressant both for refugees (34.3%) and Swedish-born individuals (40.3%). Among refugees, factors associated with increased odds of antidepressant initiation were previous use of anxiolytics or hypnotics, previous sickness absence of < 90 days, cancer and older age (OR range 1.07-2.72), and less than 5 years duration of residency in Sweden was associated with decreased odds (OR 0.76, 95% CI 0.63-0.92).

    Conclusion Young refugees with a CMD seem to initiate antidepressants in general and those most effective considerably less often than their Swedish-born counterparts.

  • 42. Taipale, Heidi
    et al.
    Niederkrotenthaler, Thomas
    Tanskanen, Antti
    Cullen, Alexis E.
    Helgesson, Magnus
    Berg, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sijbrandij, Marit
    Klimek, Peter
    Mittendorfer-Rutz, Ellenor
    Persistence of antidepressant use among refugee youth with common mental disorder2021In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 294, p. 831-837Article in journal (Refereed)
    Abstract [en]

    Background: The objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation.

    Methods: Youth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use.

    Results: Among youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk.

    Limitations: Only persons treated in specialized healthcare could be included.

    Conclusion: The relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.

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