In April 2024, the Department of Public Health Sciences and its Center for So-cial Research on Alcohol and Drugs (SoRAD) at Stockholm University, hosted a Nordic conference for social science researchers in the field of ANDTS (Al-cohol, Drugs, Doping, Tobacco, Gambling). The conference was prompted by the decline in Nordic cooperation and comparative research in this area. It was funded by Forte (the Swedish Research Council for Health, Working Life and Welfare), and brought together about 70 researchers. The conference focused on comparative research on different addictive substances and behaviors, countries, research methods, and themes, e.g., policy, youth and migration. The conference opened with a theoretical presentation on Nordic cooperation, the relationship between Nordic cooperation and the Nordic welfare state, and the Nordic as a political concept. This was followed by an exposition of the visions and advantages as well as the challenges and reality of conducting Nordic regis-ter-based research. Next, the first day offered an overview of some recently finished Nordic comparisons. These looked at adolescents use of novel tobacco and nicotine products, labor market integration of adults with substance use problems, privatization and marketization of substance use treatment, emerging trends in harmful types of gambling according to helpline data, and older peo-ple’s drinking habits. These presentations covered Denmark, Finland, Green-land, Iceland, Norway and Sweden. The day was concluded with reflections on 35 years of experience in conducting Nordic comparative research. The second day was devoted to an in-depth look at topics of great interest and comparison in recent years: Drug policy, harm, reduction, and drug-related crimes; Regis-ter studies, mortality, and migration; and Adolescents/young adults’ substance use and well-being. On the last day, the conference looked ahead towards pos-sible comparisons by focussing on the importance of regulating harmful indus-tries, like alcohol and gambling. Two big research programs were presented: one on deaths of despair among young people, and one on the future of social work with substance use in a changing treatment system. Finally, new ideas on how to return to the study of organized activities of people who use drugs in the Nordic countries were outlined. The conference was well-received by the participants, who called for continued opportunities to gather and discuss re-search. Possibilities for continuing this work will be explored.

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.

Introduction: Sweden, with its history of restrictive alcohol policies and a large and diverse migrant population, constitutes an interesting context for studies on alcohol consumption patterns in migrant groups. This study examines how hazardous drinking among migrants in Sweden varies by origin, duration of residence and age at migration.

Methods: Pooled cross-sectional survey data from the Västra Götaland region of Sweden, collected in 2011 and 2015, were linked to register data containing demo-graphic, socioeconomic and migration-related factors (i.e., country of birth, duration of residence, age at migration), for 7754 migrants and 68,493 Swedish-born individuals aged 18–84 years. Logistic regression analyses were applied to estimate odds ratios (OR) and 95% confidence intervals (CI) for hazardous drinking, identified by the validated Alcohol Use Disorders Identification Test.

Results: Relative to Swedish-born individuals, migrants from other Nordic countries had higher odds of hazardous drinking (OR 1.45, 95% CI 1.18–1.77), while migrants from other European (OR 0.55, 95% CI 0.44–0.69) and non-European (OR 0.25, 95% CI 0.20–0.31) countries showed lower likelihoods. Among non-Nordic migrants in particular, hazardous drinking was more common among those with a longer duration of residence and those who migrated at pre-school ages.

Discussion and Conclusions: Hazardous drinking among non-Nordic migrants increasingly resembled that of the Swedish-born population over time, aligning with findings in less restrictive alcohol policy contexts. Understanding how drinking patterns vary among migrant groups over time and across policy contexts is essential for developing effective public health strategies to reduce hazardous consumption and associated health and social harms.

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.

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.

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.

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.

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.

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.

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.