Introduction
Methods
Study population
Indicators of CA
Indicator of childhood adversity | Definition | ICD classification | Data source |
---|---|---|---|
Familial death | Parental or sibling death | N/A | Causes of Death Register |
Parental criminality | Parent sentenced to prison, probation, or forensic psychiatric care | N/A | Register of Court Convictions |
Parental substance abuse | Parental hospitalization for alcohol and/or narcotic-related substance abuse, or parental alcohol or narcotic-related drug conviction | ICD-9: 291–292, 303–3050, 3570, 4255, 5353, 5710, 5711–5713, 6483, 6555, 9650, 9696–9697 | National Patient Register |
ICD-10: E244, F10–F16, F18–F19, G312, G621, G721, I426, K292, K70, K852, K86, O354–355, P044, T40, T436, T51, Z502–503, Z714, Z721–Z722 | Register of Court Convictions | ||
Parental separation and/or single-parent household | Either having parents separated or living in a single-parent household, or both | N/A | Longitudinal Integration Database for Health Insurance and Labor Market Studies |
Parental psychiatric morbidity | Parental hospitalization for mental disorder (excluding substance-abuse related disorders) | ICD-9: 290–319 | National Patient Register |
ICD-10: F00–F99 | |||
Household receiving public assistance | Public assistance during at least one year, where more than 50% of the yearly income constituted public assistance | N/A | Total Enumeration Income Survey |
Residential instability | Two or more changes in place of residence | N/A | Total Population Register |
Personality disorder
Confounders, mediators and moderators
Statistical analysis
Results
Total | Any PD diagnosis | |
---|---|---|
N | 107,287 (100) | 770 (100) |
Child characteristics, n (%)
| ||
School performance | ||
Grade point average (GPA, SD) | 14.1 (2.9) | 13.1 (2.7) |
Missing | 3417 (3) | 42 (5) |
Childhood/adolescent psychopathology [psychiatric disorder before age 18 (excluding PD diagnoses)] | 7289 (7) | 250 (32) |
Psychiatric disorder after age 18 (excluding PD diagnoses) | 8827 (8) | 472 (61) |
Parental characteristics
| ||
Parental educational level | ||
9 years of education | 6322 (6) | 50 (6) |
10–12 years of education | 46,042 (43) | 371 (48) |
>12 years of education | 54,792 (51) | 340 (44) |
Missing | 131 (0) | 9 (1) |
Average annual family income in Swedish Krona (SD) | 438,050 (541,843) | 368,234 (399,342) |
Mother born outside of Sweden | 20,481 (19) | 135 (18) |
Indicators of childhood adversity
| ||
Familial death | 3456 (3) | 34 (4) |
Parental criminality | 4572 (4) | 64 (8) |
Parental substance abuse | 9173 (9) | 118 (15) |
Parental separation and/or single-parent household | 47,467 (44) | 468 (61) |
Parental psychiatric morbidity | 5437 (5) | 78 (10) |
Household receiving public assistance | 20,899 (19) | 259 (34) |
Residential instability | 4551 (4) | 63 (8) |
Total number of childhood adversities
| ||
0 | 52,698 (49) | 246 (32) |
1 | 29,209 (27) | 223 (29) |
2 | 14,935 (14) | 154 (20) |
3+ | 10,445 (10) | 147 (19) |
Rates of PD (No/100,000 person years) | Model Ia
| Model IIb
| Model IIIc
| Model IVd
| |
---|---|---|---|---|---|
Familial death | 198.3 (137.3–277.1) | 1.4 (1.0–1.9) | 1.1 (0.8–1.6) | 1.0 (0.7–1.5) | 0.9 (0.6–1.4) |
Parental criminality | 278.7 (214.7–355.9) | 2.0 (1.5–2.6) | 1.8 (1.3–2.3) | 1.5 (1.2–2.0) | 1.4 (1.1–1.9) |
Parental substance abuse | 262.9 (217.6–314.8) | 1.9 (1.6–2.3) | 1.7 (1.4–2.1) | 1.4 (1.2–1.8) | 1.3 (1.1–1.6) |
Parental separation and/or single-parent household | 203.7 (185.6–223.0) | 2.0 (1.7–2.3) | 1.8 (1.5–2.1) | 1.6 (1.3–1.8) | 1.4 (1.2–1.7) |
Parental psychiatric morbidity | 295.1 (233.3–368.3) | 2.1 (1.7–2.7) | 1.9 (1.5–2.5) | 1.6 (1.2–2.0) | 1.4 (1.1–1.9) |
Household receiving public assistance | 250.0 (220.5–282.4) | 2.1 (1.8–2.4) | 1.9 (1.7–2.3) | 1.6 (1.4–1.9) | 1.4 (1.2–1.7) |
Residential instability | 285.2 (219.1–364.9) | 2.0 (1.5–2.6) | 1.8 (1.4–2.3) | 1.5 (1.1–1.9) | 1.3 (0.9–1.7) |
Total number of CAs
| |||||
0 | 95.2 (83.6–107.8) | 1 (REF) | 1 (REF) | 1 (REF) | 1 (REF) |
1 | 158.5 (138.4–180.7) | 1.6 (1.4–2.0) | 1.6 (1.3–1.9) | 1.5 (1.2–1.8) | 1.4 (1.1–1.7) |
2 | 211.1 (179.1–247.2) | 2.2 (1.8–2.7) | 2.1 (1.7–2.6) | 1.8 (1.4–2.2) | 1.5 (1.2–1.9) |
3+ | 285.3 (241.0–335.3) | 3.0 (2.4–3.7) | 2.7 (2.2–3.4) | 2.1 (1.7–2.6) | 1.7 (1.3–2.2) |
n cases (any PD) | Rates of PD (No/100,000 person years) | Model Ia
| Model IIb
| |
---|---|---|---|---|
CA and childhood/adolescent psychopathology
| ||||
No CA, no childhood/adolescent psychopathology | 187 | 75.6 (65.1–87.2) | 1 (REF) | 1 (REF) |
1 CA, no childhood adolescent psychopathology | 153 | 116.1 (98.4–136.0) | 1.5 (1.2–1.9) | 1.4 (1.1–1.8) |
2+ CAs, no childhood adolescent psychopathology | 180 | 161.1 (138.4–186.5) | 2.1 (1.7–2.6) | 1.7 (1.3–2.1) |
No CA, childhood adolescent psychopathology | 59 | 532.4 (405.3–686.7) | 6.9 (5.1–9.2) | 6.7 (5.0–9.0) |
1 CA, childhood adolescent psychopathology | 70 | 783.8 (611.0–990.3) | 10.1 (7.7–13.3) | 8.2 (6.1–11.1) |
2+ CAs, childhood adolescent psychopathology | 121 | 949.0 (787.4–1133.9) | 12.5 (9.9–15.7) | 9.2 (7.1–12.0) |
n cases (any PD) | Rates of PD (No/100,000 person years) | Model Ia
| Model IIc
| |
---|---|---|---|---|
CA and school performance (n = 103,380)
| ||||
No CA, highest grade group | 33 | 46.6 (32.1–65.5) | 1 (REF) | 1 (REF) |
1 CA, highest grade group | 25 | 93.1 (60.2–137.4) | 1.9 (1.1–3.2) | 1.8 (1.1–3.1) |
2+ CAs, highest grade group | 23 | 184.5 (117.0–276.9) | 3.7 (2.2–6.3) | 3.5 (2.0–5.9) |
No CA, middle grade group | 115 | 95.0 (78.5–114.1) | 2.5 (1.7–3.6) | 2.5 (1.7–3.6) |
1 CA, middle grade group | 81 | 132.2 (105.0–164.3) | 3.3 (2.2–4.9) | 3.2 (2.1–4.8) |
2+ CAs, middle grade group | 72 | 171.3 (134.1–215.8) | 4.1 (2.7–6.1) | 3.8 (2.4–5.7) |
No CA, lowest grade group | 91 | 149.0 (120.0–183.0) | 4.6 (3.1–6.8) | 4.2 (2.8–6.3) |
1 CA, lowest grade group | 111 | 229.4 (188.7–276.2) | 6.7 (4.5–9.8) | 5.5 (3.7–8.3) |
2+ CAs, lowest grade group | 177 | 279.8 (240.1–324.2) | 7.7 (5.3–11.2) | 6.0 (4.0–8.9) |
Latent classes | Total (n, column %) | PD | Model Ia
| Model IIb
| Model IIIc
| Model IVd
|
---|---|---|---|---|---|---|
Class 1: “No adversities” | 58,750 (54.8) | 291 (0.5) | 1 (REF) | 1 (REF) | 1 (REF) | 1 (REF) |
Class 2: “Few with familial death, substance abuse and criminality” | 29,076 (27.1) | 232 (0.8) | 1.6 (1.4–1.9) | 1.5 (1.3–1.8) | 1.4 (1.2–1.7) | 1.3 (1.1–1.6) |
Class 3: “Separation and public assistance” | 11,855 (11.0) | 135 (1.1) | 2.3 (1.9–2.8) | 2.2 (1.7–2.7) | 1.8 (1.4–2.2) | 1.4 (1.1–1.8) |
Class 4: “Substance abuse, separation and public assistance” | 5437 (5.1) | 90 (1.7) | 3.3 (2.6–4.2) | 3.0 (2.3–3.9) | 2.2 (1.7–2.9) | 1.8 (1.4–2.4) |
Class 5: “Substance abuse, and psychiatric morbidity” | 832 (0.8) | 9 (1.1) | 2.2 (1.1–4.3) | 1.9 (1.0–3.8) | 1.6 (0.8–3.2) | 1.6 (0.8–3.2) |
Class 6: “Most adversities” | 1337 (1.2) | 13 (1.0) | 1.9 (1.1–3.3) | 1.8 (1.0–3.2) | 1.6 (0.9–2.8) | 1.4 (0.8–2.5) |