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Can adoption at an early age protect children at risk from depression in adulthood? A Swedish national cohort study
  1. Anders Hjern1,2,
  2. Jesus Palacios3,
  3. Bo Vinnerljung2,4
  1. 1 Centre for Health Equity Studies (CHESS), Karolinska Institutet, Stockholm University, Stockholm, Sweden
  2. 2 Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Developmental Psychology, University of Seville, Sevilla, Spain
  4. 4 Department of Social Work, Stockholm University, Stockholm, Sweden
  1. Correspondence to Dr Anders Hjern; anders.hjern{at}


Objective Our aim was to investigate whether the risk of depression in adulthood in children raised by substitute parents from an early age differ by care arrangements.

Methods Register study in Swedish national cohorts born 1972–1981, with three study groups of children raised in adoptive or foster homes with care starting before the age of 2 years and a comparison majority population group. Cox regression estimated HRs of prescribed antidepressive medication and specialised psychiatric care with a diagnosis of depression in adulthood during 2006–2012.

Results Compared with the general population, long-term foster care carried the highest age-adjusted and sex-adjusted HR for both antidepressive medication, 2.07 (95% CI 1.87 to 2.28), and psychiatric care for depression, 2.85 (95% CI 2.42 to 3.35), in adulthood. Adults raised by adoptive parents were far more similar to the general population with HR of 1.19 (95% CI 1.00 to 1.43) for domestic and 1.13 (95% CI 1.08 to 1.18) for international adoption for antidepressive medication. Adjusting the analysis for school marks and income attenuated these risks more in the long-term foster care group.

Conclusion The study demonstrates the benefits of early adoption when substitute parents are provided for young children, and underlines the importance of improved educational support for children in foster care.

  • depression
  • adoption
  • foster home care

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  • Patient consent for publication Not required.

  • Contributors AH came up with the idea of this manuscript, made the register linkages, created the data set for the analyses, made all statistical analyses and wrote the first draft of the manuscript. JP and BV both contributed to the theoretical framework of the study, the interpretation of the results and the writing of the manuscript. All three authors have read and approved the final manuscript.

  • Funding This study was supported by a grant from the Bank of Sweden Tercentenary Foundation P10-0514:1.

  • Competing interests None declared.

  • Ethics approval This study was approved by the ethics committee in the Stockholm region (No. 2014/415-31/5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The register data used in this study is protected by Swedish legislation and cannot be shared by researchers not involved in the study.

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