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

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

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

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

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

Responses to increased alcohol availability may vary across the population as a function of differential vulnerability. This study therefore aimed to examine the effects of the implementation of Saturday opening at the Swedish alcohol retail monopoly in 2000 on risks of hospitalization due to external causes (HEC) among different population subgroups. Leveraging the experimental design of the reform, longitudinal difference-in-differences analyses were applied to a register-based cohort of individuals aged 20-40 at the time of implementation. The population was stratified into groups of Swedish, Finnish, and Middle Eastern origin, known to represent different levels of alcohol consumption and rates of alcohol-related morbidity. Results showed a 17.7% increase (P <. 029) in the risk of HEC among individuals of Finnish origin, as jointly caused by both increased prevalence in the experiment area and decreased prevalence in the control area. The increase was primarily driven by younger men with lower levels of education. Those of Swedish origin exhibited largely similar patterns (9.7% increase; P <. 001), while no measurable impact was observed among individuals of Middle Eastern origin (-21.4% decrease; P <. 076). The findings confirm that increasing alcohol availability contributes to the disease burden related to alcohol among population subgroups already susceptible to its effects.

Individuals with childhood experience of out-of-home care (OHC) face elevated risks of criminal behavior and poor mental health compared with the majority population. Evidence on how trajectories of offending and psychiatric disorders covary among individuals with experience of OHC is needed. This study is based on a cohort of 14,608 individuals (n = 1,319 with OHC experience) born in the Stockholm metropolitan area in 1953 (49% women) from birth to age 63 (2016). Group-based multi-trajectory modeling among those with at least one offense or psychiatric disorder (40.5% of the men, 16.6% of the women) identified four co-occurring trajectories for both sexes. Multinomial regression analyses showed that adolescent OHC placement, particularly in institutions and for behavioral reasons, was linked to higher odds of early-adulthood-limited or decreasing offending and psychiatric trajectories. Most individuals recover from offending and psychiatric disorders by retirement, but placed individuals in particular remain at high risk for offending, alongside psychiatric disorders, throughout early adulthood. Early assessment and tailored attention to needs and risk levels is important when designing long-term care services to mitigate this. Research on underlying mechanisms, and on collaboration between the welfare, justice, and psychiatric care systems, can help to design effective intervention strategies and policies.

Previous research has begun to unravel the mechanisms by which multiple factors in the parental generation link grandparental socioeconomic disadvantages to grandchild psychiatric disorders. This study aims to further disentangle such multigenerational mechanisms by exploring the role of parental childhood factors. We utilized a three-generational cohort study design with data from the Stockholm Birth Cohort Multigenerational Study. The sample included 2,708 individuals born in 1953 (parental generation, G1), their 5,416 parents (grandparental generation, G0), and 5,967 children (grandchild generation, G2). Using structural equation modeling (SEM), we analyzed the mediating role of G1 protective factors during childhood (i.e., high family relationship quality, positive parenting styles, high educational performance, positive peer relationships) and G1 adult psychosocial disadvantages (i.e., single parenthood, psychiatric disorders, and criminality) in the association between G0 socioeconomic disadvantages (i.e., low income, non-employment, and overcrowding) and G2 psychiatric disorders (i.e., measured as hospitalizations due to mental and behavioral disorders between ages 18 and 30). The association between G0 socioeconomic disadvantages and G2 psychiatric disorders was mediated through the paths from G1 childhood family relationship quality, peer relationships, and educational performance to G1 adult psychosocial disadvantages. Peer relationships and educational performance in childhood mattered more among G1 fathers, whereas family relationship quality in childhood played a more important role among G1 mothers. The findings indicate that parental childhood factors – specifically family relationship quality, peer relationships, and educational performance – serve as important resilience resources in disrupting the multigenerational transmission of disadvantages, with implications for mental health of future generations.

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

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

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

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

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

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

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

Background and aims: Alcohol-related disorders (ARDs) are associated with severe attributable harms that evolve throughout the life course, comprising distinct trajectories. Yet, how mortality affects the identification, shape and number of trajectory groups remains poorly understood. This study aimed to: (1) derive trajectories of hospital-presenting ARDs between early and late adulthood; (2) compare trajectories that include mortality information versus trajectories excluding individuals who died during follow-up; and (3) predict trajectory membership based on exposure to familial risk factors between ages 0–19.

Design: Prospective cohort study using group-based trajectory modeling to identify hospital-presenting ARD trajectories.

Setting: Stockholm, Sweden.

Participants: 1953 birth cohort (n = 14 608), with 43 years of follow-up data (ages 20–63), comprising two study samples: total sample (alive at age 20, n = 14 559) and surviving sample (alive at age 63, n = 13 276).

Measurements: Hospital-presenting ARDs were measured using national inpatient care data (1973–2016). Familial risk factors were assessed using national and local records on parental alcohol-related offenses, mental health problems, criminality and investigations by child welfare services.

Findings: Five distinct hospital-presenting ARD trajectories were identified in the total sample; four were identified in the surviving sample. Mortality disproportionately affected individuals assigned to the two trajectories characterized by medium-to-high peaks of hospital-presenting ARDs (64.9% and 80.6% attrition due to death, respectively). The most severe trajectory was not identified in the surviving sample. Familial risk factors were significant predictors of trajectory membership for both samples, with odds ratios ranging between 1.67 and 8.10, though with largely overlapping 95% confidence intervals between the two risk groups and across trajectories.

Conclusions: Mortality may disproportionately affect individuals assigned to trajectories of hospital-presenting alcohol-related disorders (ARDs) characterized by severe alcohol-attributable harms. Longitudinal studies of ARDs that exclude deceased participants may therefore underrepresent the most vulnerable groups: those with chronic or escalating ARDs.