Abstract
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. 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. 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. 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.
Highlights
Childhood adversity, in interaction with stressful life events, has been shown to increase the risk for psychosis independent of pre-existing genetic liability (Sideli et al, 2020)
2% completed their compulsory education within the special education system, while this was the case for 4% of the international adoptees and 6% of the refugees
Risk estimates relative to the Swedish comparison population decreased slightly in all ages among adoptees when children in special education were excluded, among those adopted after age 5 years, but remained considerably higher for those adopted after age 2 years compared with those adopted at an earlier age. In this register study of hospitalisation with a discharge diagnosis of non-affective psychotic disorders (NAPD) in adult Swedish national cohorts, we found a twofold increased risk for two categories of migrants with an origin outside Europe, international adoptees and former child refugees
Summary
In interaction with stressful life events, has been shown to increase the risk for psychosis independent of pre-existing genetic liability (Sideli et al, 2020). A previous Swedish register study revealed that hospital admissions with a psychiatric disorder were about three times as common among international adoptees in youth as in the general population (Hjern, Lindblad, & Vinnerljung, 2002). 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. 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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