Investigators of a cohort study in this week's issue of THE LANCET have found that children adopted from foreign countries to homes in Sweden have a higher risk of severe mental health problems and social maladjustment in adolescence and young adulthood than do children born in Sweden to Swedish parents.
In Sweden, the late 1960s saw a decrease in the number of Swedish children available for adoption, and thus adoption of children born abroad became much more common. Now, many of these intercountry adoptees are reaching adolescence and young adulthood, and the social adjustment and mental health of these individuals is becoming important. Generally, children adapt well during their preschool and early school years, but less is known about their adjustment at adolescence.
Anders Hjern and colleagues used Swedish National Registers to identify adoptees and three comparison groups from children who were born in 1970-79 who were still alive and residents of Sweden in 1985. The investigators compared mental health problems, suicide, and drug or alcohol abuse between the intercountry adoptees; children born in Sweden to two Swedish-born parents (general population); Swedish-born siblings of adoptees (sibling group); and children born in Latin America or Asia who had arrived in Sweden before their seventh birthday, but who had a mother who was born in their continent of origin (immigrant group).
After adjustment for socioeconomic factors and parental risk factors, intercountry adoptees were about three to five times more likely to commit suicide, attempt suicide, be admitted for a psychiatric disorder, and abuse alcohol or drugs than were children in the general population group.
Anders Hjern comments: "The magnitude of the problems of help-seeking intercountry adoptees is often underestimated because of a socially established adoptive home. Professionals are advised to take seriously the concerns of adoptees and their parents and intervene with appropriate consideration of the high risk of suicidal behaviour."
In an accompanying Commentary (p 423), Wun Jung Kim from the Medical College of Ohio, USA, concludes: "It cannot be overemphasised that most intercountry adoptees differ little from the general population in terms of mental health and delinquent or criminal behaviours. The Hjern study does not indicate maladjustment in the 84% of the male and the 92% of the female intercountry adoptees in Sweden. It is possible that over 80% of intercountry adoptees in Sweden fared well, which is similar to other studies in Sweden, Europe, and the USA. Adoption is a sound social policy that meets the multiple needs of any community regardless of time and place. It brings unwanted and needy children to caring parents. It also fulfills the need of childless couples to accomplish the important stage of parenthood in their life. And adoption relieves the burden of communities to care for abandoned children. Nourished with attention and buffered against racism, children flourish in most circumstances, including transcultural or transracial adoptive homes."
Contact: Dr Anders Hjern, Centre for Epidemiology, Swedish National Board of Health and Welfare, 10630 Stockholm, Sweden: T) +46 8 5555 3129; F) +46 8 5555 3327;E) anders.hjern@sos.se
Professor Wun Jung Kim, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Kobacker Center, Medical College of Ohio, Toledo, OH 43614, USA; T) +1 419 383 3815; F) +1 419 383 3098; E) wjkim@mco.edu
Journal
The Lancet