title: Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: cohort study.
abstract: OBJECTIVE
  To compare the risks of admission to hospital for any type of psychiatric disorder and for four specific psychiatric disorders among adults who as children were evacuated to Swedish foster families during the second world war and their non-evacuated siblings, and to evaluate whether these risks differ between the sexes.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  National child evacuation scheme in Finland during the second world war.
  
  
  METHODS
  Children born in Finland between 1933 and 1944 who were later included in a 10% sample of the 1950 Finnish census ascertained in 1997 (n = 45,463; women: n = 22,021; men: n = 23,442). Evacuees in the sample were identified from war time government records.
  
  
  METHODS
  Adults admitted to hospital for psychiatric disorders recorded between 1971 and 2011 in the Finnish hospital discharge register.
  
  
  METHODS
  We used Cox proportional hazards models to estimate the association between evacuation to temporary foster care in Sweden during the second world war and admission to hospital for a psychiatric disorder between ages 38 and 78 years. Fixed effects methods were employed to control for all unobserved social and genetic characteristics shared among siblings.
  
  
  RESULTS
  Among men and women combined, the risk of admission to hospital for a psychiatric disorder did not differ between Finnish adults evacuated to Swedish foster families and their non-evacuated siblings (hazard ratio 0.89, 95% confidence interval 0.64 to 1.26). Evidence suggested a lower risk of admission for any mental disorder (0.67, 0.44 to 1.03) among evacuated men, whereas for women there was no association between evacuation and the overall risk of admission for a psychiatric disorder (1.21, 0.80 to 1.83). When admissions for individual psychiatric disorders were analyzed, evacuated girls were significantly more likely than their non-evacuated sisters to be admitted to hospital for a mood disorder as an adult (2.19, 1.10 to 4.33).
  
  
  CONCLUSIONS
  The Finnish evacuation policy was not associated with an increased overall risk of admission to hospital for a psychiatric disorder in adulthood among former evacuees. In fact, evacuation was associated with a marginally reduced risk of admission for any psychiatric disorder among men. Among women who had been evacuated, however, the risk of being admitted to hospital for a mood disorder was increased.
authors.affiliation: Swedish Institute for Social Research, Stockholm University, SE-10691, Stockholm, Sweden torsten.santavirta@sofi.su.se.
authors.forename: Torsten
authors.initials: T
authors.lastname: Santavirta
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland torsten.santavirta@sofi.su.se.
authors.forename: Nina
authors.initials: N
authors.lastname: Santavirta
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.affiliation: Department of Social & Behavioral Sciences and Department of Epidemiology, Harvard School of Public Health, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gilman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D049673:History, 20th Century; D049674:History, 21st Century; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011050:Policy Making; D016016:Proportional Hazards Models; D012036:Refugees / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors; D035781:Siblings / Q000523:psychology*; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D047789:World War II