Childhood adversity is associated with an increased risk of mental health problems, such as anxiety and depression, and physical illnesses, such as cancer and cardiovascular diseases. It is also associated with socioeconomic disadvantage, including lower educational attainment and unemployment. Childhood adversity, which includes various forms of abuse and neglect, is therefore an important public health problem. This thesis aims to contribute to a better understanding of the risks of childhood adversity, and how these can be mitigated. It does so by, first, describing the complexity in health and socioeconomic disadvantage after childhood adversity over the life course. Second, it approaches the corresponding processes of vulnerability and resilience, i.e., the negative and positive adaptation to adversity, with a particular interest in identifying factors that can break the accumulation of early disadvantage. A third focus is to compare men and women in terms of both outcomes and mechanisms of vulnerability and resilience processes, and to discuss the findings from a gender perspective.

Study I was a scoping review on mediators and moderators of childhood adversity, collating evidence on known resilience factors in relation to different health and socioeconomic indicators of wellbeing. One of the main conclusions was that resilience is predominantly investigated in terms of mental health outcomes and individual-level resilience factors, such as coping styles and attachment patterns, as well as relational factors, such as social support. Accordingly, there is untapped potential in researching structural-level factors, including in relation to the school system. Furthermore, research seldomly takes possible gender differences in resilience processes into account. The three empirical studies that followed the scoping review were all based on the same data material, the Stockholm Birth Cohort Multigenerational study. The cohort comprises 14,608 individuals, with follow-up data available up to the age of 68. All empirical studies used out-of-home care placement for family reasons as a proxy for the experience of adversity in childhood. Study II applied group-based multi-trajectory modelling to describe trajectories of disadvantage across a range of psychiatric and somatic diagnoses as well as socioeconomic indicators in individuals with out-of-home care experience. The study also investigated gender and education as predictors of trajectory group membership. It found evidence of a lower risk of, for example, unemployment-related disadvantage associated with higher educational attainment, and a tendency for men to be overrepresented in the groups characterised by increased risk across multiple dimensions of disadvantage. Study III investigated mediators and moderators of out-of-home care experience in relation to different psychiatric diagnoses. It identified two gendered pathways of accumulation of disadvantage, with delinquent behaviour being a stronger mediator in boys, and early parenthood a stronger mediator in girls. It also confirmed that academic performance is relevant to resilience processes. Study IV used sequence analysis to describe labour market exit routes in the overall sample and the out-of-home care sample. Individuals with experience of out-of-home care had an increased likelihood of exiting the labour market early, which is associated with greater financial vulnerability. Again, education lowered the risk of some forms of early exit, in both samples. Taken together, this thesis confirmed the potential impact of childhood adversity across the life course, and highlighted the complexity of ensuing disadvantage. Furthermore, it showed that education is an important consideration when working towards providing equal opportunities to high-risk populations.