Can adoption at an early age protect children at risk from depression in adulthood? A Swedish national cohort study.

Anders Hjern,Jesus Palacios,Bo Vinnerljung

doi:10.1136/bmjpo-2018-000353

Abstract

ObjectiveOur aim was to investigate whether the risk of depression in adulthood in children raised by substitute parents from an early age differ by care arrangements.MethodsRegister study in Swedish national cohorts born 1972–1981, with three study groups of children raised in adoptive or foster homes with care starting before the age of 2 years and a comparison majority population group. Cox regression estimated HRs of prescribed antidepressive medication and specialised psychiatric care with a diagnosis of depression in adulthood during 2006–2012.ResultsCompared with the general population, long-term foster care carried the highest age-adjusted and sex-adjusted HR for both antidepressive medication, 2.07 (95% CI 1.87 to 2.28), and psychiatric care for depression, 2.85 (95% CI 2.42 to 3.35), in adulthood. Adults raised by adoptive parents were far more similar to the general population with HR of 1.19 (95% CI 1.00 to 1.43) for domestic and 1.13 (95% CI 1.08 to 1.18) for international adoption for antidepressive medication. Adjusting the analysis for school marks and income attenuated these risks more in the long-term foster care group.ConclusionThe study demonstrates the benefits of early adoption when substitute parents are provided for young children, and underlines the importance of improved educational support for children in foster care.

Highlights

Adverse experiences, child abuse and neglect, have been linked to a number of negative outcomes, with longitudinal evidence showing the impact on physical[1] as well as on mental health.[2]
In a previous study,[11] we have shown that the educational achievement and income of young adult men raised in foster care in Sweden is considerably lower than that of men in the general population with the same test scores on IQ tests, suggesting that educational achievement and income are important components in trajectories from foster care to adulthood
Compared with the general population, individuals in the foster care group had the highest HRs for both outcomes, 2.07 for antidepressive medication, and 2.85 for hospital psychiatric care with a diagnosis of depression

Summary

Introduction

Child abuse and neglect, have been linked to a number of negative outcomes, with longitudinal evidence showing the impact on physical[1] as well as on mental health.[2] Research on stress neurobiology is helping to gain a better understanding of the connections between early adversity (in the form of abuse and neglect, traumatic experiences and chronic exposure to toxic stress), its ‘deep-seated’ neurobiological alterations[3] and later mental health disturbances

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Discussion

Conclusion