Research report - Health and social living conditions of internationally adopted adults

This is a summary of the research report Health and social living conditions of internationally adopted adults , a report from CHESS and Karolinska Institutet in collaboration with the Department of Social Work at Stockholm University on behalf of the Swedish Agency for Family Law and Parental Support (MFoF). The report in its entirety can be downloaded hereLink to another website.. Behind the report are Anders Hjern, Department of Medicine Solna, Karolinska Institutet and CHESS, Stockholm University / Karolinska Institutet, and Bo Vinnerljung, Department of Social Work, Stockholm University.

There are about 60,000 internationally adopted in Sweden today. 20 years ago, register studies from the National Board of Health and Welfare showed that the internationally adopted had a significantly increased risk of psychiatric care and suicide during adolescence and young adulthood. This new report examined whether the high psychiatric morbidity of internationally adopted patients persists into adulthood. The report also focuses on social living conditions in adulthood in the form of family formation, childbirth and work, where the follow-up time in previous studies has been too short to allow any definite conclusions.

Study population and data

The study was based on anonymised data from national registers provided by Statistics Sweden and the National Board of Health and Welfare. The study population consisted of internationally adopted and refugees originating in Asia, Latin America and Africa who arrived in Sweden before the age of eight and native Swedes with a Swedish background. The analyzes of psychiatric morbidity were based on longitudinal data on 1.6 million individuals born 1973-1986 who were followed from the age of 18 until 2017 (31-45 years), of which just over 18,000 were internationally adopted and 22,000 refugees. The analyzes of social living conditions were based on people born in 1972-1983, and this also included a group of more than 900 Swedish adoptees, adoptees who were born in Sweden and had been adopted in early childhood.

Doubled risk for inpatient psychiatric care

Our analyzes showed that a quarter of the women and a fifth of the men among the internationally adopted had had contact with psychiatric care after the age of 18, which was approximately 60% more than for native Swedes. The risks for international adoptees were particularly high for inpatient psychiatry, where they had a doubled risk of ever being admitted to a psychiatric ward in a hospital compared with native Swedes, and this increase in the risk of new onset did not decrease with increasing age. On the other hand, the risk of suicide decreased significantly with increasing age and in later birth cohorts, despite the risk of inpatient hospital care due to depression remaining high. Possibly this can be explained by an increased awareness of the international suicides' increased suicidal tendencies in recent years.

The risk of psychiatric care among internationally adopted people was consistently lowest among those who were adopted during their first year of life and then increased with increasing age when the adoption was completed. This points to the importance of difficult life circumstances before adoption, such as orphanages and neglect, for the increased risk of psychiatric illness.

Increased risk of disease-related long-term unemployment

Two thirds of the internationally adopted had a firm foothold in the labor market aged 34-45 and these had an average salary that well corresponded to their level of education. Internationally adopted people were twice as long outside the labor market due to illness compared with non-adopted Swedes, while the highest risk here was among the Swedish adopted people.

Involuntary loneliness - cause of ill health and suicide?

The internationally adopted had less often established cohabitation / marriage than others in the study, and this applied in particular to the internationally adopted men who had a 20% lower incidence of such relationships than native Swedes. Both the internationally and Swedish-adopted who had experience of marriage had about 50% more often undergone a divorce, and also here the risk was greatest for internationally adopted men. The difficulties in establishing partnerships were also reflected in the fact that internationally adopted women gave birth less often than native Swedes and refugees. These difficulties in establishing and maintaining partner relationships with internationally adopted people were not primarily explained by ill health and were particularly pronounced for adoptees originating in Africa.

The partners of the internationally adopted were to a very large extent native Swedes, which reflects the ethnicity of the upbringing family. Similarly, the majority of the refugees' partners had a foreign origin. One interpretation of these results is to see the difficulties of internationally adopted people in establishing partner relationships as a consequence of a subtle form of discrimination in the social context in which one grows up.

High risk of divorce and difficulties in establishing partner relationships lead to international adoptees living alone as adults much more often than others in Swedish society. It is likely that this contributes to the high risk of depression and suicide among the internationally adopted.

Great need for targeted efforts

The results of the study point to the international adoptees' increased need for psychiatric care continuing into adulthood and that international adoptees have more difficulty than others in establishing and maintaining couple relationships. These results point to the need for state support for concrete initiatives, aimed at both adoptive families and the adopted. But it is also important to systematically examine the demand for support, mainly among the adopted but also their families.

The state inquiry into international adoptions in 2003 presented proposals for the establishment of regional centers for support and counseling for international adoptees and their families, and the establishment of a knowledge center with responsibility for disseminating knowledge and supporting method development and research. The government chose not to proceed with these proposals. The results of this report indicate that these proposals should be taken up for a new unconditional discussion.

.