Social Psychiatry and Psychiatric Epidemiology

, Volume 41, Issue 2, pp 95–102 | Cite as

Suicidal behaviour in national and international adult adoptees

A Swedish cohort study
  • Annika von Borczyskowski
  • Anders Hjern
  • Frank Lindblad
  • Bo Vinnerljung
Original Paper

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Key words

international adoption national adoption suicide suicide attempt cohort study gender 

References

  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 346–367Google Scholar
  2. 2.
    Bagley C, Young L, Scully A (1993) International and transracial adoptions. A mental health perspective. Avebury, AldershotGoogle Scholar
  3. 3.
    Baldessarini RJ, Hennen J (2004) Genetics of suicide: an overview. Harv Rev Psychiatry 12:1–13PubMedGoogle Scholar
  4. 4.
    Beautrais AL (2000) Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry 34:420–436PubMedGoogle Scholar
  5. 5.
    Bergman ME, Drasgow F (2003) Race as a moderator in a model of sexual harassment: an empirical test. J Occup Health Psychol 8:131–145CrossRefPubMedGoogle Scholar
  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 3–10Google Scholar
  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 11:64–77PubMedCrossRefGoogle Scholar
  8. 8.
    Bohman M (1970) Adopted children and their families—a follow-up study of adopted children, their background, environment and adjustment. Proprius, StockholmGoogle Scholar
  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 8:308–319Google Scholar
  10. 10.
    Brodzinsky DM (1987) Adjustment to adoption: a psychosocial perspective. Clin Psychol Rev 7:25–47Google Scholar
  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 69:87–99Google Scholar
  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 43:1131–1136PubMedGoogle Scholar
  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 52:42–52PubMedGoogle Scholar
  14. 14.
    Canetto SS, Sakinofsky I (1998) The gender paradox in suicide. Suicide Life-Threat Behav 28:1–23PubMedGoogle Scholar
  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 40:1239–1248CrossRefPubMedGoogle Scholar
  16. 16.
    Collishaw S, Maughan B, Pickles A (1998) Infant adoption: psychosocial outcomes in adulthood. Soc Psychiatry Psychiatr Epidemiol 33:57–65CrossRefPubMedGoogle Scholar
  17. 17.
    Feigelman W (2000) Adjustments of transracially and inracially adopted young adults. Child Adolesc Soc Work J 17:165–183CrossRefGoogle Scholar
  18. 18.
    Gunnar MR, Bruce J, Grotevant HD (2000) International adoption of institutionally reared children: research and policy. Dev Psychopathol 12:677–693CrossRefPubMedGoogle Scholar
  19. 19.
    Hjern A, Lindblad F, Vinnerljung B (2002) Suicide, psychiatric illness, and social maladjustment in international adoptees in Sweden: a cohort study. Lancet 360:443–448CrossRefPubMedGoogle Scholar
  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 143–163Google Scholar
  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 182:71–76CrossRefPubMedGoogle Scholar
  22. 22.
    Levy-Shiff R, Zoran N, Schulman S (1997) International and domestic adoption: child, parents, and family adjustment. Int J Behav Dev 20:109–129Google Scholar
  23. 23.
    Lindblad F, Hjern A, Vinnerljung B (2003) International adopted children as young adults—a Swedish cohort study. Am J Orthopsychiatr 73:190–202CrossRefGoogle Scholar
  24. 24.
    Moscicki EK (1994) Gender differences in completed and attempted suicides. Ann Epidemiol 4:152–158PubMedCrossRefGoogle Scholar
  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, StockholmGoogle Scholar
  26. 26.
    Peters BR, Atkins MS, McKay MM (1999) Adopted children's behavior problems: a review of five explanatory models. Clin Psychol Rev 19:297–328PubMedGoogle Scholar
  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 177:546–550CrossRefPubMedGoogle Scholar
  28. 28.
    Rooth DO (2002) Adopted children in the labor market—discrimination or unobserved characteristics. Int Migr Q Rev 40:71–98Google Scholar
  29. 29.
    Selman P (2002) International adoption in the new millennium: the quiet migration revisited. Popul Res Policy Rev 21:205–225CrossRefGoogle Scholar
  30. 30.
    Simon RJ, Altstein H (1996) The case for transracial adoption. Child Youth Serv Rev 18:5–22Google Scholar
  31. 31.
    Slap G, Goodman E, Huang B (2001) Adoption as a risk factor for attempted suicide during adolescence. Pediatrics 108(E30):1–8Google Scholar
  32. 32.
    Smyer MA, Gatz M, Simi NL, Pedersen NL (1998) Childhood adoption: long-term effects in adulthood. Psychiatry 61:191–205PubMedGoogle Scholar
  33. 33.
    SPSS Inc. (2004) Advanced statistics 12.0. SPSS Inc., ChicagoGoogle Scholar
  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 28:839–855CrossRefPubMedGoogle Scholar
  35. 35.
    Statistics Sweden (1982) Socio-economic classification (SEI). Statistics Sweden, StockholmGoogle Scholar
  36. 36.
    Statistics Sweden (2004) Statistical yearbook of Sweden 2004. Statistics Sweden, Stockholm, pp 267–306Google Scholar
  37. 37.
    Sullivan PF, Wells JE, Bushnell JA (1995) Adoption as a risk factor for mental disorders. Acta Psychiatr Scand 92:119–124PubMedGoogle Scholar
  38. 38.
    Tizard B (1991) International adoption: a review of the evidence. J Child Psychol Psychiatry 32:743–756PubMedGoogle Scholar
  39. 39.
    Turecki G (2001) Suicidal behavior: is there a genetic predisposition? Bipolar Disord 3:335–349CrossRefPubMedGoogle Scholar
  40. 40.
    Verhulst FC, Versluis-den Bieman HJ (1995) Developmental course of problem behaviors in adolescent adoptees. J Am Acad Child Adolesc Psych 34:151–159Google Scholar
  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 29:104–111Google Scholar
  42. 42.
    Verhulst FC, Althaus M, Versluis-den Bieman HJ (1992) Damaging backgrounds: later adjustment of international adoptees. J Am Acad Child Adolesc Psych 31:518–524Google Scholar
  43. 43.
    Versluis-den Bieman HJ, Verhulst FC (1995) Self-reported and parent reported problems in adolescent international adoptees. J Child Psychol Psychiatry 36:1411–1428PubMedGoogle Scholar
  44. 44.
    Vinnerljung B (1992) 235 Syskon med olika uppväxtöden (235 Siblings with contrasting childhood fates). Lunds Universitet, Meddelanden från socialhögskolan 1992:5 LundGoogle Scholar
  45. 45.
    Wannan G, Fombonne E (1998) Gender differences in rates and correlates of suicidal behaviour amongst child psychiatric outpatients. J Adolesc 21:371–381CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Annika von Borczyskowski
    • 1
    • 2
    • 3
  • Anders Hjern
    • 4
    • 5
  • Frank Lindblad
    • 1
    • 3
  • Bo Vinnerljung
    • 4
    • 6
    • 7
  1. 1.Dept. of Public Health Sciences, Division of Psychosocial Factors and HealthKarolinska InstitutetStockholmSweden
  2. 2.Hamburg University of Applied SciencesHamburgGermany
  3. 3.National Institute for Psychosocial MedicineStockholmSweden
  4. 4.Centre for EpidemiologyNational Board of Health and WelfareStockholmSweden
  5. 5.Dept. of Clinical Sciences, Huddinge University HospitalKarolinska InstitutetStockholmSweden
  6. 6.Institute for Evidence-Based Social Work PracticeNational Board of Health and WelfareStockholmSweden
  7. 7.Dept. of Social WorkUniversity of StockholmStockholmSweden

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