Browsing by Subject "FOSTER-CARE"

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  • Santavirta, Torsten; Santavirta, Nina; Gilman, Stephen (2018)
    Importance Although there is evidence that adverse childhood experiences are associated with worse mental health in adulthood, scarce evidence is available regarding an emerging concern that the next generation might also be affected. Objective To compare the risk of psychiatric hospitalization in cousins whose parents were vs were not exposed to the Finnish evacuation policy that involved a mean 2-year stay with a Swedish foster family. Design, Setting, and Participants This multigenerational, population-based cohort study of Finnish individuals and their siblings born between January 1, 1933, and December 31, 1944, analyzed the association of evacuee status as a child during World War II in the first generation with the risk of psychiatric hospitalization among offspring in the second generation. Evacuee status during World War II was determined using the Finnish National Archive’s registry of participants in the Finnish evacuation. Data on evacuee status were linked to the psychiatric diagnoses in the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012, for offspring (n = 93 391) born between January 1, 1950, and December 31, 2010. Sex-specific Cox proportional hazards regression models were used to estimate hazard ratios for risk of psychiatric hospitalization during the follow-up period. Because offspring of evacuees and their nonevacuated siblings are cousins, the Cox proportional hazards regression models included fixed effects to adjust for confounding factors in families. Data analysis was performed from June 15, 2016, to August 26, 2017. Exposures Parental participation in the evacuation during World War II (coded 1 for parents who were evacuated and placed in foster care and 0 for those not evacuated). Main Outcomes and Measures Offspring’s initial admission to the hospital for a psychiatric disorder, obtained from the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012. Results Of the 93 391 study persons, 45 955 (49.2%) were women and 47 436 (50.8) were men; mean (SD) age in 2012 among survivors was 45.4 (6.58) years. Female offspring of mothers evacuated to Sweden during childhood had an elevated risk of psychiatric hospitalization (hazard ratio for any type of psychiatric disorder: 2.04 [95% CI, 1.04-4.01]; hazard ratio for mood disorder: 4.68 [95% CI, 1.92-11.42]). There was no excess risk of being hospitalized for a psychiatric disorder among women whose fathers were exposed to the Finnish evacuation policy during World War II or among men whose mothers or fathers were exposed. Conclusions and Relevance In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder—in particular, a mood disorder—in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.
  • Talaslampi, Heli; Jahnukainen, Markku; Manninen, Marko (2019)
    According to multiple studies, adolescents placed in out-of-home care (OOHC) are less well-educated than their peers in the general population. Reform school (RS) is an institution for youth placed in OOHC due to severe behavioral problems. The educational outcomes of former RS residents are not known. We examined the possible differences in educational level by comparing Finnish national register data for 814 former RS residents in four cohorts (placed in out-of-home care in 1991, 1996, 2001 and 2006) to 4021 of their peers in the general population matched by gender, age, and place of birth. The educational level differences were analyzed by the chi(2) test of association. Logistic regression models were performed to identify the predictors of having a basic education only. Based on the results, individuals with an RS background have a high risk of low education. Among the RS population, being in the youngest cohort, lack of aftercare provided by RSs, and a diagnosis of substance-related disorders predict lower levels of education. These results call for immediate action. Long-term aftercare programs should be provided for former RS residents. Extending compulsory school attendance to upper secondary study is likely to improve the educational level of the RS population. In addition, effective programs for intervening substance abuse problems should be provided both in RS and aftercare. By these actions, it may be possible to reduce current social exclusion and poor long-term prognosis associated with RS placement.