| 1. |
- Almquist, Ylva B., et al.
(författare)
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Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood
- 2020
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 3:6
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Tidskriftsartikel (refereegranskat)abstract
- Importance Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited. Objective To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood. Design, Setting, and Participants This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016. Exposures Childhood experiences of OHC based on information from the Social Register (age 0-19 years). Main Outcomes and Measures Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years). Results In this cohort of 14559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions. Conclusions and Relevance The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span. Question How are childhood experiences of placement in out-of-home care associated with trajectories of hospitalization because of suicide attempts from early into late adulthood? Findings In this cohort study of 14559 individuals, individuals were grouped into 4 trajectories with differential onset of suicide attempts across adulthood. Childhood experiences of placement in out-of-home care were associated with increased risks of following each of these trajectories. Meaning The elevated risk of suicide attempts among former child welfare clients persists into young adulthood, indicating the necessity for clinical attention to childhood experiences of out-of-home care as a risk marker for suicidal behavior across the life span. This cohort study examines the association between childhood experiences of placement in out-of-home care and trajectories of hospitalization because of suicide attempts from early into late adulthood in Sweden.
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| 2. |
- Bergström, Martin, et al.
(författare)
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Interventions in Foster Family Care: A Systematic Review
- 2020
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Ingår i: Research on social work practice. - : SAGE Publications. - 1049-7315 .- 1552-7581. ; 30:1, s. 3-18
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers. Method: A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods. Results: In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes. Discussion: These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
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| 3. |
- Brännström, Lars, 1972-, et al.
(författare)
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Gender-specific trajectories of offending from adolescence until age 40 among individuals with experience of out-of-home care : A national cohort study
- 2023
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Ingår i: Developmental Child Welfare. - : Sage Publications. - 2516-1032 .- 2516-1040.
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Tidskriftsartikel (refereegranskat)abstract
- It is well-known that experiences of out-of-home care (OHC; foster-family care and residential care) are linked to criminal behavior. Less is known how criminal activity in the OHC population develops over the life course and to what extent such development is characterized by desistance or persistence. Using population-based longitudinal register data for more than 740,000 Swedish men and women, of which around 2.5% have experience of OHC, followed until age 40, results from group-based trajectory modelling and multinomial regression suggest that OHC-experienced individuals with various timing and duration of placement, especially men first placed as teenagers, have substantially elevated likelihood for persistent offending compared to peers without OHC experience. However, most OHC-experienced followed pathways characterized by desistance. Our findings have implications for understanding the dynamics of offending in OHC populations and underscores the necessity for interventions that can prevent the onset of criminal careers, as well as disrupt or modify the ongoing paths of offending within this disadvantaged group of individuals.
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| 4. |
- Brännström, Lars, et al.
(författare)
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Inequalities in educational outcomes in individuals with childhood experience of out-of-home care : What are driving the differences?
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrior research has shown that individuals with experience of out-of-home care (foster family care or residential care) in childhood are educationally disadvantaged compared to their peers. In order to be better equipped to design interventions aimed at improving the educational outcomes of children for whom society has assumed responsibility, this study seeks to further our understanding about which factors that contribute to the educational disparities throughout the life course.MethodsUsing longitudinal data from a cohort of more than 13,000 Swedes, of which around 7% have childhood experience of out-of-home care, Peters-Belson decomposition is utilized to quantify the extent to which the gap in educational achievement in school (age 16) and midlife educational attainment (age 50) captures differences in the prevalence of factors influencing educational outcomes, and differences in the impacts between these factors.ResultsWe find that the achievement and the attainment gap was around 13% and 9% respectively. These gaps were to a large extent explained by differences in the distribution of predictors. The major explanatory factor for placed children’s lower achievement was a lower average cognitive ability. Yet there were some evidence that the rewards of cognitive ability in these children differed across the life course. While the lower returns of cognitive ability suggest that they were underperforming in compulsory school, the higher returns of cognitive ability on midlife attainment indicate that–given previous underperformance–their attainment at age 50 reflects their cognitive capacity more accurately than their achievement at age 16 do.ConclusionThe large influence of the unequal distribution of predictors suggests that policy efforts are needed to promote equity in the distribution of factors contributing to educational achievement and attainment. Since cognitive ability was found to be an important contributory factor, such efforts may include promoting cognitive and intellectual development among children in out-of-home care, preferably starting at a young age.
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| 5. |
- Brännström, Lars, 1972-, et al.
(författare)
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Intergenerational transmission of placement in out-of-home care : Mediation and interaction by educational attainment
- 2022
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Ingår i: International Journal of Child Abuse & Neglect. - : Elsevier BV. - 0145-2134 .- 1873-7757. ; 123
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with childhood experiences of out-of-home care (OHC) have elevated risks of having their own children taken into societal care. High educational attainment has been linked to favorable long-term outcomes in a host of previous studies on OHC alumni. This could be indicative of resilience, which may also have protective potential against intergenerational continuity of OHC placements.Objective: The present study examined the processes of mediation and interaction by educational attainment, here conceptualized as having completed upper secondary school, regarding the intergenerational transmission of placement in OHC.Participants and setting: Longitudinal data came from a Swedish cohort of parents (and their children) born in 1953 (n = 11,338).Methods: Associations between parental experience of OHC and their children's placement in OHC were analyzed by means of binary logistic regression. Four-way decomposition was used to explore mediation and interaction by parental educational attainment.Results: The odds of having at least one child being placed in OHC was more than six-fold (OR = 6.67, 95% CI = 5.28; 8.06) in the OHC group compared to majority population peers. Mediation and/or interaction by educational attainment accounted for a substantial proportion of the overall association (53%). Interaction effects appeared to be more important for the outcome than mediation.Conclusions: Having completed upper secondary school seems to reflect processes of resilience with the potential to break the intergenerational transmission of placement in OHC. These findings suggest that the impact of enhanced educational attainment of OHC populations may have potential of extending into the fate of the next generation.
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| 6. |
- Brännström, Lars, 1972-, et al.
(författare)
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Outcomes in Adulthood After Long-Term Foster Care : A Sibling Approach
- 2020
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Ingår i: Child Maltreatment. - : SAGE Publications. - 1077-5595 .- 1552-6119. ; 25:4, s. 383-392
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Tidskriftsartikel (refereegranskat)abstract
- When a child is removed from their home and placed in foster care, society takes over the responsibility for that child’s well-being and development. Failure to provide a child with a nurturing upbringing may have negative consequences for the child as well as for society. Using Swedish longitudinal registry data for a national cohort sample of siblings, in which some were placed in foster care and others remained in their birth parents’ care, this study asks whether long-term foster care ensures improved life chances. Results from multilevel regression analyses of a wide range of educational, social, and health-related outcomes in mature adult age (16 outcome constructs) support a row of previous studies indicating that traditional long-term foster care does not seem to improve maltreated children’s life chances.
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| 7. |
- Hjern, Anders, 1957-, et al.
(författare)
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Cardiovascular Disease and Risk Factors in Individuals With a History of Out-of-home Care
- 2024
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Ingår i: Pediatrics. - 0031-4005 .- 1098-4275. ; :2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exposure to childhood out-of-home care (foster family and residential care) is associated with an increased risk of ill-health and disability in adulthood, but the risk for cardiovascular disease has not previously been studied longitudinally.Methods: This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 881 731 of whom 26 310 (3.0%) had a history of out-of-home care. The study population, born 1972 to 1981, was followed from age 18 to age 39 to 48 years for hospitalizations and death.Results: After adjusting for year of birth and maternal education, individuals with a history of childhood out-of-home-care experienced a doubling of the risk for coronary disease (hazard ratio; 95% confidence interval: 2.05; 1.74-2.41) and stroke (hazard ratio 1.85; 1.59-2.15), compared with the general population, with similar estimates for men and women. Women with a history of out-of-home care had a more than doubled risk for cigarette smoking in early pregnancy, with a relative risk of 2.26; (2.18-2.34) and a moderately increased risk for gestational diabetes relative risk 1.49 (1.19-1.86). There was marked attenuation (40% to 90%) in effect estimates for disease and risk factors after further control for cohort members educational achievement at age 15-16 years.Conclusions: A history of childhood out-of-home care was associated with a doubled risk of early cardiovascular disease events. Cigarette smoking and educational underachievement were the main identified risk factors.
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| 8. |
- Hjern, Anders, 1957-, et al.
(författare)
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Couple partnership and divorce in domestic and non-European international adoptees. A Swedish national cohort study with follow up until 36 to 45 years
- 2023
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Ingår i: Children and youth services review. - 0190-7409 .- 1873-7765. ; 155
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Tidskriftsartikel (refereegranskat)abstract
- Adoption research shows a growing interest in adopted persons in their adult years. This article examines couple partnerships and divorce among adult adoptees and non-adoptees. Using population-based Swedish register data with follow-up until age 36–45 years, domestic and international adoptees were compared with the general population, as well as with immigrants who settled in Sweden in their early years and share with international adoptees a non-European physical appearance. Given their preadoption adversities and associated increased mental health problems, as well as postadoption experiences of perceived discrimination, adoptees were expected to have more problems in the formation and breakdown of partner relationships, particularly in the case of international adoptees. The study used data from national registers on Swedish national cohorts born 1972–83, including two study groups with a non-European origin who settled in Sweden at age 0–8 years (14,761 international adoptees and 11,085 immigrants) as well as 906 domestic adoptees and 936,988 Swedish born with a Swedish-born mother from the general population. In contrast with international adoptees, who have a 14 % lower adjusted rate of couple compared with the general population, domestic adoptees were more like the Swedish general population in terms of couple partnership formation. However, in terms of divorce, domestic and international adoptees share a significantly higher incidence than the general population and the immigrants study groups. Both in the formation and breakdown of couple relationships, international adopted men present less favorable outcomes than international adopted women. Further research is needed to elucidate the reasons behind these patterns.
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| 9. |
- Hjern, Anders, 1957-, et al.
(författare)
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Early childhood adversity and non-affective psychosis : a study of refugees and international adoptees in Sweden
- 2023
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Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 53:5, s. 1914-1923
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Tidskriftsartikel (refereegranskat)abstract
- Background. Previous Scandinavian studies have shown increased levels of psychiatric morbidity in young refugees and international adoptees with an origin outside Europe. This study investigated their risk of non-affective psychotic disorders (NAPD) and whether this risk is influenced by early childhood adversity, operationalised as age at adoption/residency, and/or gender.Methods. Register study in Swedish national cohorts born 1972-1990 including 21 615 non-European international adoptees, 42 732 non-European refugees that settled in Sweden at age 0-14 years and 1 610 233 Swedish born. The study population was followed from age 18 to year 2016 for hospitalisations with a discharge diagnosis of NAPD. Hazard ratios (HRs) were calculated in gender stratified Cox regression models, adjusted for household income at age 17.Results. The adjusted risks of NAPD were 2.33 [95% confidence interval (CI) 2.07-2.63] for the international adoptees and 1.92 (1.76-2.09) for the former child refugees, relative to the Swedish-born population. For the international adoptees there was a stepwise gradient for NAPD by age of adoption from adjusted HR 1.66 (1.29-2.03) when adopted during the first year of life to adjusted HR 4.56 (3.22-6.46) when adopted at ages 5-14 years, with a similar risk pattern in women and men. Age at residency did not influence the risk of NAPD in the refugees, but their male to female risk ratio was higher than in Swedish-born and the adoptees.Conclusion. The risk pattern in the international adoptees gives support to a link between early childhood adversity and NAPD. Male gender increased the risk of NAPD more among the refugees.
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| 10. |
- Hjern, Anders, et al.
(författare)
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Increased risk of suicidal behaviour in non-European international adoptees decreases with age - A Swedish national cohort study
- 2020
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Ingår i: eClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 29-30
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Tidskriftsartikel (refereegranskat)abstract
- Background: Non-European international adoptees in Sweden were shown to have a three-to fourfold higher risk of suicidal behaviour in youth during 1986-1995 compared with the general population. The aim of this study was to investigate whether this high risk persists beyond youth and in later cohorts.Methods: A register study of Swedish national cohorts born 1972-86 including 20 625 non-European international adoptees, and comparison populations of 10 915 non-European immigrants and 1 435 167 Swedish born was performed. The study population was followed from age 18 between 1991 and 2016, with suicide and hospital admissions due to suicide attempt as outcomes. Poisson regression models of person time in the study, adjusted for gender and household income at age 17, were fitted to calculate relative risks (RR).Findings: Adjusted RR for suicide in non-European international adoptees was high at age 18-22, 2.74 (95% C. I. 1.95-3.86), but decreased gradually to age 33-43 when the risk was similar to Swedish-born. Adjusted RR for suicide attempts in international adoptees was 2.33 (2.15-2.52) at age 18-22, decreased slightly with older age, but remained higher than Swedish born in all age-classes. Risks for both outcomes were greatest, around three times higher compared with the Swedish-born in the oldest birth cohorts of non-European international adoptees, born 1972-76. Risks for both suicidal outcomes increased with higher age at adoption.Interpretation: The risk of suicidal behaviour in non-European international adoptees in Sweden decreases with age and is lower in later birth cohorts and in infant adoptions.
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