title: Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: a cohort study.
abstract: BACKGROUND
  Many intercountry adoptees are reaching adolescence in western Europe and the USA, and the mental health and social adjustment of these individuals as adolescents and young adults has now become an important issue. We aimed to assess mental health disorders and social maladjustment in adolescence and young adulthood in intercountry adoptees in Sweden.
  
  
  METHODS
  Our data was obtained from the Swedish national registers for the cohort born in 1970-79. We used multivariate Cox's regression models of person-years to compare indicators of suicide death (1986-95), court sentences (1986-93), and discharges for psychiatric illness, suicide attempts, and substance abuse (1987-94) in 11,320 intercountry adoptees with 2343 Swedish-born siblings, 4006 immigrant children, and a general population of 853 419 Swedish-born residents.
  
  
  RESULTS
  After adjustment for major sociodemographic confounders, intercountry adoptees were more likely than other Swedish-born children to die from suicide (odds ratio 3.6, 95% CI 2.1-5.9); attempt suicide (3.6, 3.1-4.2); be admitted for a psychiatric disorder (3.2, 2.9-3.6), drug abuse (5.2, 2.9-9.3) or alcohol abuse (2.6, 2.0-3.3); or to commit a crime (1.6, 1.5-1.7). Siblings in adoptive homes had lower odds ratios for most outcomes than did adoptees, whereas adoptees and immigrant children had much the same odds ratios.
  
  
  CONCLUSIONS
  Adoptees in Sweden have a high risk for severe mental health problems and social maladjustment in adolescence and young adulthood. We advise professionals to give appropriate consideration to the high risk of suicide in patients who are intercountry adoptees.
authors.affiliation: Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden. anders.hjern@sos.se
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
authors.forename: Frank
authors.initials: F
authors.lastname: Lindblad
authors.forename: Bo
authors.initials: B
authors.lastname: Vinnerljung
mesh_terms: D000293:Adolescent; D000300:Adoption; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D015331:Cohort Studies; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D012044:Regression Analysis; D012917:Social Adjustment; D012918:Social Alienation; D019966:Substance-Related Disorders / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology