Death anniversaries may trigger stress responses that negatively affect health in bereaved individuals. Little is known about such reactions after adult sibling loss. This study examined whether mortality risk increases around the anniversary of a sibling's death. Using Swedish national register data (1990-2016), we conducted a time-stratified case-crossover study including 12 789 adults who experienced sibling loss and later died. Conditional logistic regression estimated associations between mortality and death anniversaries (including pre-anniversary and post-anniversary periods), adjusting for time-invariant confounders. Analyses were stratified by the bereaved's sex and age, the sibling's sex, sibling order, and whether ≥1 parent was alive at the bereaved's death. Among women, mortality risk was lower on the anniversary date (OR, 0.44; 95% CI, 0.21-0.93), and in the period from 1 day before and up to the anniversary date for women who lost a younger or same-age sibling (OR, 0.45; 95% CI, 0.20-1.00). In contrast, men bereaved before age 50 years had a heightened risk in the period ranging from 12 days before and up to the anniversary (OR, 1.40; 95 % CI, 1.05-1.86). Overall, sibling-death anniversaries were not associated with elevated mortality, though observed sex- and age-specific patterns merits further investigation.

Background: The associations between both early life and later adversities and prenatal stress physiology, particularly HPA axis function, are still largely unknown. Inconclusive previous studies highlight the necessity for adopting life-course approaches. This study examined the associations between adverse childhood experiences (ACEs), adverse prenatal life events (APEs), and patterns of maternal prenatal HPA function assessed via joint-trajectories of hair glucocorticoid concentrations (HGC). Particularly, ACEs were tested as a potential moderator.

Methods: We analyzed data from 269 women from the French EDEN cohort. Retrospective information on maternal HGC for all pregnancy trimesters was obtained from hair samples collected after delivery. ACEs were treated as a binary exposure, and APEs were measured through a cumulative score. Inverse probability weights from propensity scores were applied to adjust for baseline sociodemographic characteristics, prenatal psychopathology, and health-related confounders.

Results: Three prenatal HPA trajectories were identified: blunted (14.7%), normative (56.3%), and hyperreactive (29.0%). ACEs and APEs interacted to predict higher odds of a hyperreactive trajectory (p < 0.01) when combining blunted and normative HPA patterns as the reference category. After stratification, APEs were associated with a hyperreactive trajectory only among ACE-exposed women (aOR_ipw =2.22 [1.28; 3.84], p < 0.01). A sensitivity analysis excluding the blunted group yielded consistent results.

Conclusions: Lifetime adversities were associated with stress dysregulation. APEs appear to heighten vulnerability to HPA function dysregulation, especially after previous exposure to ACEs. These findings provide insight into how adversities throughout the life course can interact to become embodied through maternal stress physiology.

Background: In Sweden, individuals with severe substance use disorder may be committed to compulsory care under the Care of Abusers Act (LVM). Mortality after discharge from LVM is high, particularly from opioid-related causes. Until February 2016, participation in opioid agonist therapy (LARO) was prohibited during LVM care despite national treatment guidelines. A regulatory change on 15 February 2016 allowed initiation and continuation of LARO during compulsory care. This study aimed to assess the impact of that reform on LARO uptake and post-discharge mortality. Methods: Using linked national registers, we followed all individuals discharged from LVM between 2012 and 2019. Participation in LARO during LVM was identified through prescription data and in-facility medication records. Mortality within 180 days after discharge was analyzed using Cox regression. Analyses included before–after comparisons around the policy change with interaction by LARO eligibility, and direct comparisons between eligible clients who did versus did not participate in LARO during LVM. Results: After the policy change, the proportion of LVM episodes involving LARO increased from approximately 3%–4% in 2015 to over 15% by 2020. Mortality within 180 days after discharge declined after the reform, with a larger reduction among clients eligible for LARO. Among eligible clients admitted after the policy change, participation in LARO during LVM was associated with lower mortality (hazard ratio 0.15, 95% CI 0.04–0.59). Conclusions: Allowing opioid agonist therapy during compulsory care was associated with increased treatment uptake and reduced short-term post-discharge mortality. Integrating evidence-based treatment into compulsory care may reduce avoidable deaths.

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.

BACKGROUND: Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.

OBJECTIVE(S): Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.

STUDY DESIGN: This was a register study based on all women living in Skåne, Sweden on January 1^st, 2104, with at least 1 singleton birth in 2014–2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.

RESULTS: In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15–2.42), infections of the genitourinary tract (2.30, 1.67–3.16), premature rupture of membranes (2.42, 1.24–4.69 for women with mild intellectual disability), and false labor (1.27, 1.05–1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.

CONCLUSION(S): Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.

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.

Childhood emotional and behavioral difficulties have a profound impact on later life outcomes, making it crucial to identify early-life risk factors that predict emotional and behavioral difficulties. However, much of the existing research has concentrated on diagnosing, rather than predicting, emotional and behavioral difficulties, and has often focused on adolescents rather than younger children. This study employs machine learning (ML) techniques to construct an interpretable predictive model using data from the UK Household Longitudinal Study, aiming to identify key risk factors that influence children's emotional and behavioral difficulties during childhood. We examined maternal habits during pregnancy and parent-reported data on birth, breastfeeding and regulatory problems during the newborn stage. Our findings highlighted lack of breastfeeding, low birthweight and maternal smoking during pregnancy as the three most significant predictors of emotional behavioral difficulties. Other important factors were related to infant regulatory problems. Heterogeneity analysis revealed gender differences in predictive power, with maternal smoking during pregnancy being a stronger predictor for boys, and the amount of fussing in infancy having a greater impact on girls. This study highlights the importance of comprehensive prenatal and postnatal care, advocates for early screening of emotional and behavioral difficulties, and calls for gender-specific approaches in assessing and addressing emotional and behavioral difficulties in children.

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.

Introduction: Postpartum hemorrhage (PPH) is a key concern in maternal health, with early identification important for preventing severe complications. In a crowded delivery ward, where the number of births exceeds the normal range, labor management, and PPH prevention may be compromised. Although previous research has mainly focused on crowding over the entire day, it remains unclear whether crowding in the hours surrounding birth influences PPH risk. Therefore, our study aimed to assess the association between delivery ward crowding, adjacent to birth, and PPH and to explore whether births during periods of potentially lower staffing, such as summer months or weekends, could amplify this risk. Material and methods: This case-control study included 1 027 620 births in Sweden (2004–2019) from the Medical Birth Register. PPH, defined as estimated blood loss >1000 mL, cases were identified using a diagnostic code for PPH and were matched (1:10) with controls by the standardization criteria: delivery ward, year, and time of birth (night/day). The secondary outcome was PPH with blood transfusion. After standardization, crowding was defined as the number of births in a ±2-h interval around the index birth exceeding the 75th percentile. Unadjusted conditional logistic regression was used to study the association between crowding and PPH, PPH with blood transfusion, and to examine whether giving birth during a weekend or summer vacation month (June–August) modified these associations. Results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Labor induction and emergency cesarean delivery were less common in births that occurred during crowded compared to noncrowded time intervals. Crowding was not associated with an increased risk of PPH (OR: 0.97; 95% CI: 0.95–0.99) or PPH with blood transfusion (OR: 0.99; 95% CI: 0.92–1.07). Giving birth during a summer month or a weekend did not change the estimates for the association between crowding and PPH. Conclusions: Focusing on a narrow time frame around birth, crowding in the delivery ward was not associated with an increased, but instead a modest reduction, in risk of PPH. Future studies should investigate how staffing in relation to crowding influences the risk of PPH and other adverse birth outcomes.

Background While well-established associations exist between socioeconomic conditions and smoking during pregnancy (SDP), less is known about social disparities in the risk of continuous SDP. Intersectional analyses that consider multiple social factors simultaneously can offer valuable insight for planning smoking cessation interventions.

Methods We include all 146,222 pregnancies in Sweden between 2006 and 2016 where the mother smoked at three months before pregnancy. The outcome was continuous SDP defined as self-reported smoking in the third trimester. Exposures were age, education, migration status and civil status. We examined all exposures in a mutually adjusted unidimensional analysis and in an intersectional model including 36 possible combinations. We present ORs with 95% Confidence Intervals, and the Area Under the Curve (AUC) as a measure of discriminatory accuracy (DA).

Results In our study, education status was the factor most strongly associated to continuous SDP among women who smoked at three months before pregnancy. In the unidimensional analysis women with low and middle education had ORs for continuous SDP of 6.92 (95%CI 6.63–7.22) and 3.06 (95%CI 2.94–3.18) respectively compared to women with high education. In the intersectional analysis, odds of continuous SDP were 17.50 (95%CI 14.56–21.03) for married women born in Sweden aged ≥ 35 years with low education, compared to the reference group of married women born in Sweden aged 25–34 with high education. AUC-values were 0.658 and 0.660 for the unidimensional and intersectional models, respectively.

Conclusion The unidimensional and intersectional analyses showed that low education status increases odds of continuous SDP but that in isolation education status is insufficient to identify the women at highest odds of continuous SDP. Interventions targeted to social groups should be preceded by intersectional analyses but further research is needed before recommending intensified smoking cessation to specific social groups.