Springer Nature is making SARS-CoV-2 and COVID-19 research free View research | View latest news | Sign up for updates

Suicidal behaviour in national and international adult adoptees

A Swedish cohort study



Previous studies have shown an elevated risk for suicidal behaviour in adolescent and young adult international adoptees. Comparisons between national and international adoptees in this respect have been inconclusive.


A total of 6,065 international adoptees were compared to 7,340 national adoptees and 1,274,312 non-adopted study subjects, all born between 1963 and 1973 and followed up until 2002 using the National Swedish Registers. Cox regression of person years was used in multivariate analyses to compare risks for suicide death and suicide attempt.


International adoptees had clearly increased risks for suicide attempt (risk ratio 4.5 [95% confidence interval 3.7–5.5]) and suicide death (3.6 [2.6–5.2]) after adjustments for sex, age and socio-economic factors. National adoptees had lower risks than international adoptees, but had increased risks compared to non-adoptees (suicide attempt, 2.8 [2.2–3.5]; suicide death, 2.5 [1.8–3.3]). Biological parents' morbidity explained approximately one third of the increased risk for national adoptees. Female international adoptees' risk for suicide attempt was elevated to an even greater extent than in male international adoptees, when compared to the general population.


Clinicians should be aware that an increased risk for suicide and suicide attempts in international adoptees is a topic that is equally relevant to child and adult psychiatry.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Andersson G (2000) International adoption in Sweden. The perspective of the Adoption Centre in its 30th year. In: Selman P (ed) International adoption: development, trends and perspectives. British Association for Adoption and Fostering (BAAF), London, pp 346–367

  2. 2.

    Bagley C, Young L, Scully A (1993) International and transracial adoptions. A mental health perspective. Avebury, Aldershot

  3. 3.

    Baldessarini RJ, Hennen J (2004) Genetics of suicide: an overview. Harv Rev Psychiatry 12:1–13

  4. 4.

    Beautrais AL (2000) Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry 34:420–436

  5. 5.

    Bergman ME, Drasgow F (2003) Race as a moderator in a model of sexual harassment: an empirical test. J Occup Health Psychol 8:131–145

  6. 6.

    Bertolote JM (2001) Suicide in the world: an epidemiological overview 1959–2000. In: Wasserman D (ed) Suicide—an unnecessary death. Martin Dunitz, London, pp 3–10

  7. 7.

    Bimmel N, Juffer F, van Ijzendoorn MH, Bakermans-Kranenburg MJ (2003) Problem behaviour of internationally adopted adolescents: a review and meta-analysis. Harv Rev Psychiatry 11:64–77

  8. 8.

    Bohman M (1970) Adopted children and their families—a follow-up study of adopted children, their background, environment and adjustment. Proprius, Stockholm

  9. 9.

    Bohman M (1995) De svenska adoptivbarnen: det sociala arvet i ett historiskt perspektiv (Adopted children in Sweden: the theory of social inheritage in a historical perspective). Socialmed Tidskr 8:308–319

  10. 10.

    Brodzinsky DM (1987) Adjustment to adoption: a psychosocial perspective. Clin Psychol Rev 7:25–47

  11. 11.

    Brooks D, Barth RP (1999) Adult transracial and inracial adoptees: effects of race, gender, adoptive family structure, and placement history on adjustment outcomes. Am J Orthopsychiatr 69:87–99

  12. 12.

    Cadoret RJ, Troughton E, O'Gorman TW, Heywood E (1986) An adoption study of genetic and environmental factors in drug abuse. Arch Gen Psychiatry 43:1131–1136

  13. 13.

    Cadoret RJ, Yates WR, Troughton E, Woodworth G, Stewart MA (1995) Adoption study demonstrating two genetic pathways to drug abuse. Arch Gen Psychiatry 52:42–52

  14. 14.

    Canetto SS, Sakinofsky I (1998) The gender paradox in suicide. Suicide Life-Threat Behav 28:1–23

  15. 15.

    Cederblad M, Hook B, Irhammar M, Mercke AM (1999) Mental health in international adoptees as teenagers and young adults. An epidemiological study. J Child Psychol Psychiatry 40:1239–1248

  16. 16.

    Collishaw S, Maughan B, Pickles A (1998) Infant adoption: psychosocial outcomes in adulthood. Soc Psychiatry Psychiatr Epidemiol 33:57–65

  17. 17.

    Feigelman W (2000) Adjustments of transracially and inracially adopted young adults. Child Adolesc Soc Work J 17:165–183

  18. 18.

    Gunnar MR, Bruce J, Grotevant HD (2000) International adoption of institutionally reared children: research and policy. Dev Psychopathol 12:677–693

  19. 19.

    Hjern A, Lindblad F, Vinnerljung B (2002) Suicide, psychiatric illness, and social maladjustment in international adoptees in Sweden: a cohort study. Lancet 360:443–448

  20. 20.

    Irhammar M, Cederblad M (2000) Outcome of international adoption in Sweden. In: Selman P (ed) International adoption: development, trends and perspectives. British Association for Adoption and Fostering (BAAF), London, pp 143–163

  21. 21.

    Janssen I, Hanssen M, Bak M, Bijl RV, de Graaf R, Vollebergh W, McKenzie K, van Os J (2003) Discrimination and delusional ideation. Br J Psychiatry 182:71–76

  22. 22.

    Levy-Shiff R, Zoran N, Schulman S (1997) International and domestic adoption: child, parents, and family adjustment. Int J Behav Dev 20:109–129

  23. 23.

    Lindblad F, Hjern A, Vinnerljung B (2003) International adopted children as young adults—a Swedish cohort study. Am J Orthopsychiatr 73:190–202

  24. 24.

    Moscicki EK (1994) Gender differences in completed and attempted suicides. Ann Epidemiol 4:152–158

  25. 25.

    Nordlöf B (2001) Svenska adoptioner i Stockholm 1918–1973 (Swedish adoptions in Stockholm 1918–1973). FoU-rapport 2001: 8. Socialtjänstförvaltningen. Forsknings- och utvecklingsenheten, Stockholm

  26. 26.

    Peters BR, Atkins MS, McKay MM (1999) Adopted children's behavior problems: a review of five explanatory models. Clin Psychol Rev 19:297–328

  27. 27.

    Qin P, Agerbo E, Westergard-Nielsen N, Eriksson T, Mortensen PB (2000) Gender differences in risk factors for suicide in Denmark. Br J Psychiatry 177:546–550

  28. 28.

    Rooth DO (2002) Adopted children in the labor market—discrimination or unobserved characteristics. Int Migr Q Rev 40:71–98

  29. 29.

    Selman P (2002) International adoption in the new millennium: the quiet migration revisited. Popul Res Policy Rev 21:205–225

  30. 30.

    Simon RJ, Altstein H (1996) The case for transracial adoption. Child Youth Serv Rev 18:5–22

  31. 31.

    Slap G, Goodman E, Huang B (2001) Adoption as a risk factor for attempted suicide during adolescence. Pediatrics 108(E30):1–8

  32. 32.

    Smyer MA, Gatz M, Simi NL, Pedersen NL (1998) Childhood adoption: long-term effects in adulthood. Psychiatry 61:191–205

  33. 33.

    SPSS Inc. (2004) Advanced statistics 12.0. SPSS Inc., Chicago

  34. 34.

    Statham DJ, Heath AC, Madden PA, Bucholz KK, Bierut L, Dinwiddie SH, Slutske WS, Dunne MP, Martin NG (1998) Suicidal behaviour: an epidemiological and genetic study. Psychol Med 28:839–855

  35. 35.

    Statistics Sweden (1982) Socio-economic classification (SEI). Statistics Sweden, Stockholm

  36. 36.

    Statistics Sweden (2004) Statistical yearbook of Sweden 2004. Statistics Sweden, Stockholm, pp 267–306

  37. 37.

    Sullivan PF, Wells JE, Bushnell JA (1995) Adoption as a risk factor for mental disorders. Acta Psychiatr Scand 92:119–124

  38. 38.

    Tizard B (1991) International adoption: a review of the evidence. J Child Psychol Psychiatry 32:743–756

  39. 39.

    Turecki G (2001) Suicidal behavior: is there a genetic predisposition? Bipolar Disord 3:335–349

  40. 40.

    Verhulst FC, Versluis-den Bieman HJ (1995) Developmental course of problem behaviors in adolescent adoptees. J Am Acad Child Adolesc Psych 34:151–159

  41. 41.

    Verhulst FC, Althaus M, Versluis-den Bieman HJ (1990) Problem behavior in international adoptees: II. Age at placement. J Am Acad Child Adolesc Psych 29:104–111

  42. 42.

    Verhulst FC, Althaus M, Versluis-den Bieman HJ (1992) Damaging backgrounds: later adjustment of international adoptees. J Am Acad Child Adolesc Psych 31:518–524

  43. 43.

    Versluis-den Bieman HJ, Verhulst FC (1995) Self-reported and parent reported problems in adolescent international adoptees. J Child Psychol Psychiatry 36:1411–1428

  44. 44.

    Vinnerljung B (1992) 235 Syskon med olika uppväxtöden (235 Siblings with contrasting childhood fates). Lunds Universitet, Meddelanden från socialhögskolan 1992:5 Lund

  45. 45.

    Wannan G, Fombonne E (1998) Gender differences in rates and correlates of suicidal behaviour amongst child psychiatric outpatients. J Adolesc 21:371–381

Download references

Author information

Correspondence to Annika von Borczyskowski.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

von Borczyskowski, A., Hjern, A., Lindblad, F. et al. Suicidal behaviour in national and international adult adoptees. Soc Psychiat Epidemiol 41, 95–102 (2006). https://doi.org/10.1007/s00127-005-0974-2

Download citation

Key words

  • international adoption
  • national adoption
  • suicide
  • suicide attempt
  • cohort study
  • gender