Effectiveness of substance use disorder treatment as an alternative to imprisonment.

INTRODUCTION: Drug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. However, their effectiveness in reducing important public health outcomes such as recidivism and substance-related health harms remains ambiguous and contested. We used nationwide register data from Sweden to evaluate the effectiveness of contract treatment sanction, the Swedish version of drug court, in reducing substance misuse, adverse somatic and mental health outcomes, and recidivism. METHODS: In this prospective cohort study, two quasi-experimental designs were used: difference-in-differences and the within-individual design. In the latter, we compared the risk of outcomes during time on contract treatment to, 1) parole after imprisonment and, 2) probation. RESULTS: The cohort included 11,893 individuals (13% women) who underwent contract treatment. Contract treatment was associated with a reduction of 7 percentage points (95% CI: -.088, -.055) in substance misuse, 5 percentage points (-.064, -.034) in adverse mental health events, 9 percentage points (-.113, -.076) in adverse somatic health events, and 3 fewer charges (-3.16, -2.85) for crime in difference-in-differences analyses. Within-individual associations suggested that the same individual had longer times-to-event for all outcomes during contract treatment than on parole or on probation. CONCLUSIONS: Contract treatment is an effective intervention from both public health and criminal justice perspective. Our findings suggest that it is a superior alternative to incarceration in its target group. Further, we find that an implementation approach that is less punitive and more inclusive than what is typical in the US can be successful.

Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study.

AIMS: To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents. METHODS: A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender. RESULTS: For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years. CONCLUSIONS: All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.

Using age difference and sex similarity to detect evidence of sibling influence on criminal offending.

BACKGROUND: Sibling resemblance in crime may be due to genetic relatedness, shared environment, and/or the interpersonal influence of siblings on each other. This latter process can be understood as a type of 'peer effect' in that it is based on social learning between individuals occupying the same status in the social system (family). Building on prior research, we hypothesized that sibling pairs that resemble peer relationships the most, i.e., same-sex siblings close in age, exhibit the most sibling resemblance in crime. METHODS: Drawing on administrative microdata covering Finnish children born in 1985-97, we examined 213 911 sibling pairs, observing the recorded criminality of each sibling between ages 11 and 20. We estimated multivariate regression models controlling for individual and family characteristics, and employed fixed-effects models to analyze the temporal co-occurrence of sibling delinquency. RESULTS: Among younger siblings with a criminal older sibling, the adjusted prevalence estimates of criminal offending decreased from 32 to 25% as the age differences increased from less than 13 months to 25-28 months. The prevalence leveled off at 23% when age difference reached 37-40 months or more. These effects were statistically significant only among same-sex sibling pairs (p < 0.001), with clear evidence of contemporaneous offending among siblings with minimal age difference. CONCLUSIONS: Same-sex siblings very close in age stand out as having the highest sibling resemblance in crime. This finding suggests that a meaningful share of sibling similarity in criminal offending is due to a process akin to peer influence, typically flowing from the older to the younger sibling.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults.

BACKGROUND: Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS: The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS: An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care. CONCLUSIONS: The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.

Children's educational attainment, occupation, and income and their parents' mortality.

Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970-2007. Higher levels of children's education are associated with 30-36 per cent lower parental mortality at ages 50-75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11-16 per cent lower all-cause mortality at ages 50-75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39-46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.

Adult criminality among former residential school adolescents.

BACKGROUND: There is evidence from around the world that disruptive behaviour during adolescence is associated with increased risk of later criminality. Outcomes for young people placed in the Finnish residential school because of severe conduct problems are not known. AIMS: Our aims were to investigate criminality after leaving a residential school placement during adolescence, and to compare trends in criminality between four successive graduate cohorts (1991, 1996, 2001 and 2006). METHODS: We used official records to study complete national cohort of all 861 people who had been resident in the Finnish residential school system on the last day of each of the years 1991, 1996, 2001 and 2006. They were compared with 4255 matched general population controls. The follow-up time was up to 20 years. RESULTS: Two-thirds (66%) of all residential school graduates (N = 566: 448/78% men, 118/41% women) had at least one criminal conviction in adulthood, a 13-fold elevation over the general population rate. The most prevalent crime categories were violence (N = 409, 48%: 331/58% men, 78/27% women) and property crimes (N = 405: 47%: 346/60% men, 51/21% women). The risk of violent crime was 18 times that among controls; 13 of residential school males (2.3%) had a homicide conviction. Once adult, the risk of offending decreased with age. There was a significant trend for improvement in offending rates between the earliest and latest residential school cohorts. CONCLUSIONS: The risk of committing crimes after a residential school placement is sufficiently elevated that alternative strategies, perhaps particularly longer-term post-release supervision and aftercare, should be considered. Indications of lower crime rates in later cohorts suggest that some positive changes to the school regime and/or aftercare may have been made already. Copyright © 2017 John Wiley & Sons, Ltd.

To tell or not to tell? Psychopathic traits and response integrity in youth delinquency surveys.

BACKGROUND: Individuals with high psychopathy scores are capable of providing valid self-reports on their own personality traits, but there have been no empirical studies of the effect of psychopathic features on responding to sensitive survey questions about specific behaviours. AIMS: The aim of this study is to investigate any relationship between facets of psychopathy and participants' willingness to report antisocial acts in youth delinquency surveys, controlling for demographic variables known to be associated with response integrity. METHODS: In a nationally representative sample of 4,855 Finnish mainstream adolescents aged 15-16, honesty of responding was assessed through direct response integrity questions related to violence, property crime and drug use. Psychopathy was measured with the Antisocial Process Screening Device - Self Report (APSD-SR). RESULTS: Callous-unemotional traits and, to a lesser degree, narcissistic features were associated with a dishonest response style, although the effect size was modest. CONCLUSIONS: Although psychopathy does not seem to influence the capability and willingness to report personality traits accurately, it may be associated with endorsing dishonest responses to questions about specific behaviours that have possible repercussions. Our findings suggest that previously observed associations between adolescents' self-reported delinquent behaviour and psychopathic traits may be underestimations of the strength of the effects.

Childhood family background and mortality differences by income in adulthood: fixed-effects analysis of Finnish siblings.

BACKGROUND: Events and conditions during childhood have been found to affect health and mortality at later stages in life. We studied whether childhood conditions explain the observed all-cause and cause-specific mortality disparity between income groups in adulthood. METHODS: We used a 10% register linked sample of Finnish households in the 1950 census identifying 51 647 children aged 0-14 with at least one sibling of the same sex and followed them for mortality from the age 35 until ages 57-72. Using Cox regression with sibling design, we estimated hazard ratios (HRs) for quintiles of personal income at the age 35. We controlled for observed childhood family sociodemographic characteristics and allowed different baseline hazard functions for each group of siblings in order to control for all shared unobserved characteristics within families. RESULTS: Accounting for the observed childhood characteristics did not attenuate the income disparity in mortality, whereas adjusting for the sociodemographic characteristics in adulthood reduced the difference of the lowest quintiles by ∼70% among men and 30-40% among women. Controlling for the unobserved childhood characteristics in the sibling design did not provide any further explanation to the income differentials in mortality. This applied also for cause-specific mortality among men. HR to the cardiovascular diseases was 38% higher and 73% higher in alcohol, accidental and violent causes in the lowest quintile even after adjusting for all observed and unobserved characteristics. CONCLUSIONS: The excess mortality in the lowest income quintiles persists even after shared childhood family conditions among siblings are accounted for.

Investigating child sexual abuse material availability, searches, and users on the anonymous Tor network for a public health intervention strategy.

Tor is widely used for staying anonymous online and accessing onion websites; unfortunately, Tor is popular for distributing and viewing illicit child sexual abuse material (CSAM). From 2018 to 2023, we analyse 176,683 onion domains and find that one-fifth share CSAM. We find that CSAM is easily available using 21 out of the 26 most-used Tor search engines. We analyse 110,133,715 search sessions from the Ahmia.fi search engine and discover that 11.1% seek CSAM. When searching CSAM by age, 40.5% search for 11-year-olds and younger; 11.0% for 12-year-olds; 8.2% for 13-year-olds; 11.6% for 14-year-olds; 10.9% for 15-year-olds; and 12.7% for 16-year-olds. We demonstrate accurate filtering for search engines, introduce intervention, show a questionnaire for CSAM users, and analyse 11,470 responses. 65.3% of CSAM users first saw the material when they were children themselves, and half of the respondents first saw the material accidentally, demonstrating the availability of CSAM. 48.1% want to stop using CSAM. Some seek help through Tor, and self-help websites are popular. Our survey finds commonalities between CSAM use and addiction. Help-seeking correlates with increasing viewing duration and frequency, depression, anxiety, self-harming thoughts, guilt, and shame. Yet, 73.9% of help seekers have not been able to receive it.

Moderating role of sociodemographic factors in parental psychiatric treatment before and after offspring severe self-harm.

BACKGROUND: Parental psychiatric disorders are known risk factors for adolescent self-harm. Although this association is likely to have a bidirectional element, evidence on changes in parental psychiatric treatment following offspring self-harm is scarce. METHODS: Finnish children born in 1987-1996 with a hospital-treated episode of self-harm between the ages 13 and 19 years (N = 3636) were identified using administrative register data, and their biological mothers (N = 3432) and fathers (N = 3167) were followed two years before and after the episode. Data on purchases of psychotropic medication, specialized psychiatric treatment and psychiatric sickness allowances were used to examine psychiatric treatment among parents. Differences by parental education, employment and living arrangements were assessed, and offspring self-harm was compared with offspring accidental poisonings and traffic accidents. RESULTS: Psychiatric treatment peaked among mothers during the three-month period after offspring self-harm, after which the treatment prevalence decreased but remained slightly elevated relative to the time preceding offspring self-harm. Higher levels of education and being employed increased the likelihood of treatment right after the episode. Among fathers, changes in treatment were negligible. Treatment trajectories around the comparison events of accidents were similar in shape but more muted than among the parents whose children had self-harmed. LIMITATIONS: General practitioner visits or other data from primary health care were not available. CONCLUSION: Mothers receive increased psychiatric treatment after stressful offspring events. Our results indicate that prevention of self-harm and accidents would be beneficial not only for those directly concerned but also for their family members.

Partner violence surrounding divorce: A record-linkage study of wives and their husbands.

Objective: This study analyzes the victimization trajectories of partner violence against women surrounding divorce, depending on whether the couple has children together. Background: Prior studies have found that partner violence is associated with an increased risk of divorce. No study has assessed the victimization trajectories surrounding divorce for women with and without children, although women with children may remain at higher risk of violence following divorce. Method: Using Finnish record-linkage data of 22,468 divorced and 333,542 continuously married women and their husbands, we used repeated-measures logistic regression analyses to assess changes in victimization for partner violence before and after divorce. The outcomes considered were police-reported crimes committed by husbands against their wives and hospital-treated assault injuries recorded for wives. Results: The risk of crime victimization for partner assault was already elevated from 2 to 3 years before divorce, peaked in the year prior to divorce, and then mainly leveled off 1-2 years after divorce. Hospital data show that the time of the greatest risk was from 6 to 12 months before divorce, when divorce is usually filed for. Women with younger children experienced elevated risks of physical violence shortly before divorce and remained at higher risk of menace than women without children for a year after divorce. Conclusion: Divorcing women committed assaults against their husbands, but these were mostly accompanied by victimization, suggesting that resistant violence was common for women as perpetrators. Women with a history of victimization need support, especially at the starts of their divorce processes.

Does early drug use-related police contact predict premature mortality and morbidity: A population register-based study.

INTRODUCTION: The aim was to analyse whether age at first drug offense predicts premature mortality and morbidity due to substance use and violence among adolescents and young adults. METHODS: A prospective longitudinal register-linkage study based on a total population sample from Finland including individuals born between 1987 and 1992 and aged 15-25 years during follow-up in 2002-2017 (n = 386 435). Age-specific rates of deaths and health-care admissions (morbidity) during a 5-year follow-up were calculated from the first drug offense. Cox regression models were used to estimate differences in mortality and morbidity at ages 21-25. RESULTS: Of all 15- to 20-year-olds, 1.4% (n = 5540) have had a police contact. The 5-year mortality rates (per 1000 person-years) among those with first drug offense at ages 15-16 was 2.92 [95% confidence interval (CI) 1.56-6.18], and 5.26 (CI 4.00-7.07) and 5.05 (CI 4.06-6.38) at ages 17-18, and 19-20, respectively. The rates of morbidity varied between 61.20 (CI 52.43-71.76) and 87.51 (CI 82.11-93.33). Both mortality and morbidity rates were over 10 times higher than among the general population. In models adjusted for family background, first police contact at an early age (15-16) did not increase the risk of mortality at ages 21-25 compared with first police contact at ages 17-18 (hazard ratio 1.55, CI 0.77-3.09) or 19-20 (hazard ratio 1.52, CI 0.78-2.98). The results were similar for morbidity. DISCUSSION AND CONCLUSIONS: Adolescents with drug-related police contacts have high risk of mortality and morbidity due to substance use and violence regardless of age of first contact.

Long-term Health and Social Outcomes in Children and Adolescents Placed in Out-of-Home Care.

Importance: Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification. Objective: To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors. Design, Setting, and Participants: This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855 622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021. Exposures: Placement in out-of-home care up to age 15 years. Main Outcomes and Measures: Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality. Results: A total of 30 127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The highest relative risks were observed for those with violent crime arrests (aHR, 4.16; 95% CI, 3.74-4.62; cumulative incidence, 24.6% in individuals who had been placed in out-of-home care vs 5.1% in those who had not), substance misuse (aHR, 4.75; 95% CI, 4.25-5.30; cumulative incidence, 23.2% vs 4.6%), and unintentional poisoning injury (aHR 4.79; 95% CI, 3.56-6.43; cumulative incidence, 3.1% vs 0.6%). Additional adjustments for perinatal factors, childhood behavioral problems, and traumatic injuries, including experiencing violence, did not materially change the findings. Conclusions and Relevance: Out-of-home care placement was associated with a wide range of adverse outcomes in adulthood, which persisted following adjustments for measured preplacement factors and unmeasured familial factors.

The effect of low childhood income on self-harm in young adulthood: Mediation by adolescent mental health, behavioural factors and school performance.

Low childhood income is an established risk factor of self-harm in adolescence and young adulthood, and childhood income is additionally associated with various correlates of self-harm. How these correlates, such as psychiatric disorders, substance abuse, violent behaviour and school problems, mediate the effect of childhood income on self-harm, is less understood. The purpose of the current paper is to examine this mediation. The study is based on administrative register data on all Finnish children born in 1990-1995. An analytical sample of 384,121 children is followed from age 8 to 22. We apply the parametric g-formula to study the effect of childhood income on the risk of self-harm in young adulthood. Adolescent psychiatric disorders, substance abuse, prior self-harm, violent criminality and victimization, out-of-home placements, not being in education, employment or training and school performance are considered as potential mediators. We control for confounding factors related to childhood family characteristics. As a hypothetical intervention, we moved those in the lowest childhood income quintile to the second-lowest quintile, which resulted in a 7% reduction in hospital-presenting self-harm in young adulthood among those targeted by the intervention (2% reduction in the total population). 67% of the effect was mediated through the chosen mediators. The results indicate that increases in childhood material resources could protect from self-harm in young adulthood. Moreover, the large proportion of mediation suggests that targeted interventions for high-risk adolescents may be beneficial. To our knowledge, this is the first paper to use the parametric g-formula to study youth self-harm. Future applications are encouraged as the method offers several further opportunities for analysing the complex life course pathways to self-harm.

No causal associations between childhood family income and subsequent psychiatric disorders, substance misuse and violent crime arrests: a nationwide Finnish study of >650 000 individuals and their siblings.

BACKGROUND: Childhood family income has been shown to be associated with later psychiatric disorders, substance misuse and violent crime, but the consistency, strength and causal nature of these associations remain unclear. METHODS: We conducted a nationwide cohort and co-sibling study of 650 680 individuals (426 886 siblings) born in Finland between 1986 and 1996 to re-examine these associations by accounting for unmeasured confounders shared between siblings. The participants were followed up from their 15th birthday until they either migrated, died, met criteria for the outcome of interest or reached the end of the study period (31 December 2017 or 31 December 2018 for substance misuse). The associations were adjusted for sex, birth year and birth order, and expressed as adjusted hazard ratios (aHRs). The outcomes included a diagnosis of a severe mental illness (schizophrenia-spectrum disorders or bipolar disorder), depression and anxiety. Substance misuse (e.g. medication prescription, hospitalization or death due to a substance use disorder or arrest for drug-related crime) and violent crime arrests were also examined. Stratified Cox regression models accounted for unmeasured confounders shared between differentially exposed siblings. RESULTS: For each $15 000 increase in family income at age 15 years, the risks of the outcomes were reduced by between 9% in severe mental illness (aHR = 0.91; 95% confidence interval: 0.90-0.92) and 23% in violent crime arrests (aHR = 0.77; 0.76-0.78). These associations were fully attenuated in the sibling-comparison models (aHR range: 0.99-1.00). Sensitivity analyses confirmed the latter findings. CONCLUSIONS: Associations between childhood family income and subsequent risks for psychiatric disorders, substance misuse and violent crime arrest were not consistent with a causal interpretation.

A closer look at labour market status and crime among a general population sample of young men and women.

Those in the most criminally active age groups are facing particular difficulties in entering the labour market and accumulating stable work experiences. This study uses a large representative sample of Finnish adolescents to examine how different labour market statuses are associated with crime. Both for men and women, within-individual variation in employment is inversely linked to all crime measures considered, albeit to a different extent. In addition, qualitatively different categories of non-employment (e.g., non-participation without legitimate reason, studying, being on parental leave) are distinctly associated with crime. The findings underscore the importance of a detailed conceptualization of labour market status in research that aligns with the changed nature of employment and approximates the actual labour market experiences of young adults.

Trauma and violent offending among adolescents: a birth cohort study.

BACKGROUND: Earlier studies, based on data collected among juvenile court clients or prisoners, suggest that there is an association between trauma and adolescent-onset offending. However, there is a lack of large-scale data on juvenile violence and clinical mental health observations with unselected participants, and a risk-factor-oriented research combining multiple variables affecting violent behaviour. METHODS: We analyse the effect of trauma on violent offending using longitudinal register-linkage population data. The study is based on administrative data on all Finnish children born between 1986 and 2000, linked with their biological and adoptive parents (N=913 675). The data include annually updated demographic and socioeconomic information from Statistics Finland, hospital discharge and specialised outpatient service records as well as the data from all suspected criminal offences known to the police (1996-2017). We measured trauma diagnosis at age 12-14 and followed participants for subsequent violent criminality from age 15 to 17. RESULTS: The population average estimates, taking into account observed substance abuse and other mental health diagnoses, shows that trauma-related disorders (adjustment problems, post-traumatic stress disorder and acute stress disorder) were associated with violent offending. The same was true in sibling fixed effect models, which take into account genetic and environmental confounding shared by siblings. DISCUSSION: These results suggest that severe stress related to traumatic or strong negative life changes in adolescence is a risk factor for violent behaviour.

Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood.

INTRODUCTION: Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities. METHODS: The study uses administrative register data on a 20% random sample of Finnish households with children aged 0-14 years in 2000. We follow children born in 1986-1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models. RESULTS: The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities. CONCLUSIONS: Our findings suggest that both parents' adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.

Substance abuse in parents and subsequent risk of offspring psychiatric morbidity in late adolescence and early adulthood: A longitudinal analysis of siblings and their parents.

The effects of substance abuse on other family members are not fully established. We estimate the contribution of parental substance abuse on offspring psychiatric morbidity in late adolescence and early adulthood, with emphasis on the timing and persistency of exposure. We used a nationally representative 20% sample of Finnish families with children born in 1986-1996 (n = 136,604) followed up in 1986-2011. We identified parental substance abuse and offspring psychiatric morbidity from hospital discharge records, death records and medication registers. The effects of parental substance abuse at ages 0-4, 5-9 and 10-14 on psychiatric morbidity after age 15 were estimated using population averaged and sibling fixed effects models; the latter controlling for unobserved factors shared by siblings. Parental substance abuse at ages 0-14 was associated with almost 2-fold increase in offspring psychiatric morbidity (HR = 1.86, 95% CI 1.78-1.95). Adjustment for childhood parental education, income, social class and family type reduced these effects by about 50%, with some further attenuation after adjustment for time-varying offspring characteristics. In the sibling fixed effects models those exposed at 0-4 or 5-9 years had 20% (HR = 1.20, 95% CI 0.90-1.60) and 33% (HR = 1.33, 95% CI 1.01-1.74) excess morbidity respectively. Also in sibling models those with early exposure at ages 0-4 combined with repeated exposure in later childhood had about 80-90% higher psychiatric morbidity as compared to never exposed siblings (e.g. for those exposed throughout childhood HR = 1.81, 95% CI 1.01-3.25). Childhood exposure to parental substance abuse is strongly associated with subsequent psychiatric morbidity. Although these effects are to a large extent due to other characteristics shared within the parental home, repeated exposure to parental substance abuse is independently associated with later psychiatric morbidity.