Adopted children who have grown up in more favourable family environments than their siblings are at lower risk of mental health issues, criminality and social problems – benefits that, in some cases, extend to the next generation. These are the findings of a new study of Swedish siblings published in The BMJ.
Children who grow up in difficult family circumstances are at greater risk of experiencing problems later in life. These may include mental health issues, difficulties at school or criminal behaviour.
To determine the extent to which these factors can be influenced, researchers at Karolinska Institutet studied pairs of siblings in Sweden where one sibling was adopted away from a high-risk family while the other remained with and grew up with their biological parents. This allowed them to compare the long-term effects of different family environments while taking genetic factors into account.
“Our study shows that a more favourable home environment can make a big difference, particularly for children who start life with clear risk factors,” says Erik Pettersson, associate professor at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.
Followed over 12 000 siblings
The study is based on Swedish population registers and covers just over 12 000 full and half-siblings born between 1950 and 1980. All come from families where at least one parent had experienced some form of psychiatric or social issue, such as mental illness, criminality or attempted suicide, and where at least one child had been given up for adoption before the age of ten. Families who took in adopted children often had greater resources and higher socio-economic status.
The results show that the adopted children had a lower risk of mental illness, criminality and dependence on social security benefits as adults, compared to their siblings who grew up with their biological parents. They also performed better at school and, on average, attained a higher level of education. Furthermore, men who had been adopted performed better during military conscription, both on intelligence tests and in interviews measuring stress resilience and social adaptability.
May affect the next generation
The researchers also investigated whether these differences were passed on to the next generation. In total, nearly 22,000 children of the sibling pairs were studied.
On average, the children of adopted siblings displayed higher functioning than their cousins, for example a lower risk of criminality and financial problems. The effects were weaker than in the previous generation, but pointed in the same direction.
“This suggests that improved living conditions benefit not only the individual, but also the next generation,” says Erik Pettersson.
Value of support measures
He emphasises that the results should not be seen as an argument for adoption, which is currently uncommon in Sweden. However, he believes the study highlights the value of interventions for children in vulnerable environments.
“Research into the effects of various support measures aimed at giving children a better upbringing is both limited and fragmented,” he says. “Some studies show significant long-term benefits; others show little or none at all. Our study suggests that the potential is considerable, even though we cannot say which measures are most important.”
Study shows that income remains lower for up to 10 years after diagnosis
Photo by Sydney Sims on Unsplash
A diagnosis of depression in connection with hospital treatment can have long-term consequences for personal finances. This is shown in a new registry-based study from the Department of Public Health, University of Southern Denmark, which follows nearly five million people in Denmark over time.
The study found that income is around 10% lower 10 years after diagnosis compared with people without depression, and the gap does not disappear. At the same time, the income loss for depression is greater than for several physical illnesses such as stroke and breast cancer.
Mental illness has the greatest financial impact
The study compares depression, alcohol use disorder, stroke and breast cancer. Income falls after illness in all four groups, but the decline is greatest for mental disorders.
“We see that mental disorders affect not only health, but also people’s economic life course to a considerable extent,” says Emily K. Johnson, PhD Student at the Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark.
She is first author of the study, which has been published in JAMA Health Forum.
“The income loss grows over time and can still be measured 10 years later. Even though mental disorders are more common in women, losses are generally greater for men,” Emily K. Johnson explains.
Not just a temporary loss
While earlier studies have often focused on short-term sick leave, the new study shows that income loss persists and in many cases grows over time.
– It is not only about being away from work for a period. We see changes in the entire income trajectory, says Emily K. Johnson.
This may, among other things, reflect reduced ability to keep a job, change jobs or progress in a career.
May reinforce social inequality
Income loss is greatest among people in the middle of working life, when earnings would normally be increasing. At the same time, the loss grows over time for younger people.
“If you are affected early in your career, you may lose your footing in the labour market. That can be difficult to recover later,” says Emily K. Johnson.
People outside the labour market are also hit particularly hard. For them, illness may make it even harder to enter employment. The findings therefore suggest that illness can reinforce existing social inequality.
Income falls before the illness is registered
Income already begins to decline in the years before people receive a diagnosis of depression in hospital care. This suggests that the consequences begin before the illness is formally registered and treated.
The study includes people who had contact with a hospital, either as inpatients or outpatients, including psychiatric hospital care. People treated only by their general practitioner or by private psychologists or psychiatrists are not included.
“This suggests that the course of illness starts earlier and that the consequences for working life emerge gradually,” Emily K. Johnson explains. Job loss, income loss and poor mental health can reinforce one another over time,
The study is based on Danish registry data and includes all non-retired residents aged 18 to 65 between 2000 and 2018. People with illness were compared with similar people without a diagnosis, matched on factors including age, sex, education and income, and baseline health.
Income was measured as disposable income, meaning post-tax income including wages, transfers and capital income.
Can inform health policy priorities
According to the researchers, the findings can help improve decision-making in health and social policy.
“Priority setting should not be based only on how many people become ill, but also on how illness affects people’s working lives and finances, especially for those early in their careers,” says Emily K. Johnson.
The study adds new knowledge by comparing mental and physical illnesses using the same method, making it possible to assess their relative consequences.
Limitations
The study includes only people who had contact with a hospital and therefore does not cover everyone with depression. At the same time, it cannot establish cause and effect with certainty, especially in the case of mental disorders which are difficult to measure. In addition, only people who survive the course of illness are included in the analyses of income over time.
North Korean defectors who resettled in South Korea share genetics but markedly contrasting early-life exposures with South Korean residents. Research published in the Journal of Internal Medicine compared overall and site-specific cancer incidence rates between North Korean defectors and native South Koreans.
Breast cancer cells. Image by National Cancer Institute
Using the Korean National Health Insurance database, researchers matched 25 798 North Korean defectors and 1 276 601 South Korean residents. Defectors had higher risks of infection-related cancers (such as liver and cervical cancers) and lower risks of breast, colon, and prostate cancers (which are more prevalent in developed countries). Over time, though, their cancer profile changed, suggesting adaptation to South Korean society.
“The study provides a model for understanding how cancer epidemiology evolves in such transitions, offering lessons that may help guide prevention and health planning for other vulnerable groups in transition worldwide,” said corresponding author Sin Gon Kim, MD, PhD, of the Korea University College of Medicine.
The cost of each recommended diet, defined as the cost of the least expensive food items to meet FBDG at a constant energy total of 2,330 kcal d−1 in 2021 PPP dollars per person per day. Diet cost estimates were derived for 172 countries where available to calculate the cost of meeting FBDG of Argentina (ARG), Benin (BEN), Malta (MLT), Pakistan (PAK), the United States (USA) and Viet Nam (VNM); from 171 countries of the HDB, Bangladesh (BGD), China (CHN), Ghana (GHA), India (IND), Indonesia (IDN), Jamaica (JAM), the Netherlands (NLD) and Zambia (ZMB); from 169 countries of Ethiopia (ETH), Oman (OMN); and 162 countries of the EAT-Lancet reference diet (EAT). Source: Herforth et al., Nature Food 2025.
A decade-long project measuring access to healthy foods worldwide is wrapping up in August, after shedding new light on the scope and specifics of nutrition insecurity, kickstarting solutions, and shifting the conversation around the affordability of healthy diets.
“I’m just stunned by the speed of adoption,” said Will Masters, director of the project and professor of food policy and economics at the Friedman School. “For the first time, governments are measuring whether people have access to the biological requisites of an active and healthy life.”
Based on national dietary guidelines from many countries around the world, the team’s Healthy Diet Basket dietary standard was validated as a way to measure diet costs in the most recent of the team’s 27 scientific journal articles. The new study appeared this month in Nature Food.
“The indicator captures an implicit consensus on what countries around the world agree that people need for healthy diets,” said Anna Herforth, N05, co-director of Food Prices for Nutrition and lead author of the paper. “The importance of meeting dietary needs has been recognized for a long time, but measuring whether people can actually do that has been elusive until now.”
Measuring Affordability
The team has found that the minimum cost of a healthy diet, using the cheapest locally available food options in each country, was generally between $3 and $4 per person in 2021, with a global average of $3.68 per person. That same year, the international extreme poverty line was $2.15.
In other words, “many people in the world who are counted as ‘non-poor’ still can’t afford to meet the basic requirements for a healthy diet,” Herforth said.
A healthy diet is more than just having enough calories. Our bodies need a balance of different foods from different food groups—vegetables, fruits, starchy staples, legumes, animal-source foods such as meat, eggs, or dairy—to acquire all the nutrients for an active, healthy life.
Buying a healthy diet of the cheapest, most basic foods is “completely out of reach” for more than 80 percent of people in African countries, and a total of 2.8 billion people worldwide, Masters said. “For many people, even if they put all their resources into buying food, they wouldn’t have enough to meet dietary standards for lifelong health,” he said.
The project’s purpose is to provide a diagnostic metric that distinguishes between prices, incomes, and other factors as potential causes behind malnutrition, and helps identify what the best solutions might be. Their research shows how some people still face unavailability or high prices for even the least expensive option in each food group needed for a healthy diet. In that situation, governments can make a healthy diet more accessible and affordable by investing in innovation to lower the cost of production and distribution of those products.
What the new cost and affordability data has revealed, says Masters, is the extent to which malnutrition is caused by low incomes available for food, after accounting for nonfood expenses. People whose available income is below the total cost of even the least expensive locally available options for a healthy diet need wage increases or social safety nets to help them afford a healthy life. And if low-cost options for a healthy diet could be purchased but people are choosing less nutritious foods, it is likely the result of other factors such as time use and the cost of meal preparation, or aspirations shaped by culture and marketing. These factors need to be identified and addressed directly to improve diet quality.
The project’s core finding, according to Masters, is that “farmers and food traders can deliver the products needed for a healthy diet at roughly similar cost in most of the world. Malnutrition happens because the poorest third of the world can’t afford to buy enough of the vegetables, fruits, dairy, and fish or other animal source foods needed for health, and the rest of us all too often consume other foods instead.”
What’s Next
Impacts of the new data are already being felt in Nigeria, which became the world’s first country to publish official monthly bulletins on healthy diet costs in January 2024. Labour unions used their findings to negotiate a raise in the national minimum wage that July, and others are using the data to push for changes in farm and trade policy. National bulletins have also been published in Ethiopia, Malawi, Pakistan, and in other countries where the new data can help guide change.
In a larger sense, Yan Bai, AG09, F16, N20, co-corresponding author on Food Prices for Nutrition’s most recent paper, said the work is “contributing to a global shift from focusing on calories alone to embracing a much more rigorous understanding of food and nutrition security—one that prioritises economic access, human health, and sustainability.”
Bai, who started working with the Food Prices for Nutrition project while earning his doctorate at Tufts, is now helping to implement the work at a global scale as an economist with the Development Data Group of the World Bank.
“By providing internationally consistent metrics, we aim to inform evidence-based policymaking and hope to help catalyse broader multisectoral actions to make healthy diets more affordable and accessible to all,” Bai said.
Next, the researchers will collaborate with food providers in Africa to provide data and create new metrics to help build the supply chains for healthy, low-cost foods. They are also planning to continue supporting national governments and international organizations in calculating and using the cost and affordability metrics for healthy diets.
“People have talked about affordability for decades. Now we have a practical way to measure it,” Masters said. “The next step is using those data to guide actions, and bring healthy diets within reach for everyone.”
In a study published in the journal PNAS, a research team led by the University of Minnesota Medical School have shown that the socioeconomic status (SES) of cell donors affects the health outcomes of blood cancer patients who underwent haematopoietic cell transplantation (HCT).
The study examined the health outcomes of 2005 blood cancer patients treated with HCT in the United States. The research team found cancer patients who were transplanted with cells from donors of greatest socioeconomic disadvantage experienced a 9.7% reduction in overall survival and 6.6% increase in transplant-related mortality at three years compared to those transplanted from donors of high socioeconomic status – regardless of the cancer patient’s socioeconomic status.
“Our findings are quite remarkable. We have shown that social disadvantage penetrates so deeply that it is actually transplantable into a new host, and its effects persist over time,” said Lucie Turcotte, MD, MPH, MS, an associate professor at the University of Minnesota Medical School.
The results show the striking biological impact of social disadvantage and how it can alter health outcomes, specifically in the setting of cancer and hematopoietic cell transplantation.
The research team plans to conduct further research to investigate the underlying biological and physiologic drivers of these findings in order to develop interventions to mitigate the adverse health outcomes introduced by socioeconomic disadvantage.
“The importance of these findings reach far beyond cancer and bone marrow transplant care – they demonstrate the profound health effects of social inequality and highlight the critical need for public health interventions,” said Dr Turcotte.
The more gender equal a society is, the more similar men and women will be, adopting more similar interests, personality traits and behavioural patterns. Or so many people seem to believe.
Statements like this might sound like truisms, but science shows reality may be more complicated.
Several studies have found that some psychological sex differences, such as those in personality, are larger in more gender-equal countries. The same goes for countries that are more educated, prosperous and otherwise have better living conditions. This has become known as the gender-equality paradox.
Until recently, it was unclear how widespread this pattern might be. My team, which included research assistant Kare Hedebrant, tried to address that in a recently published study, where we investigated which psychological sex differences are associated with living conditions and, if so, how.
The study covered a range of themes, from personality and cognitive functions to sexting and circadian rhythm. Our study focused on mostly western countries but used some data from other countries such as India and Kenya.
We reviewed 54 articles that analyse the relationship between magnitudes of psychological sex differences and country-level indicators of living conditions. We also used data from 27 meta-analyses (reviews of previous research) of psychological sex differences and conducted new analyses to determine associations between sex differences and national economy, education, health, gender equality and more.
Sex differences
Each study used data from at least five countries, usually spanning several decades.
We grouped the many psychological dimensions covered by these studies into six categories: personal characteristics, cognition, interpersonal relations, emotion, academic preferences (such as a pull towards science, technology, engineering and maths) and morals and values.
Our findings paint a complex picture, showing that variation in psychological sex difference did not follow a uniform pattern. In countries with better living conditions, males and females are more alike in some regards and more different in others.
For example, differences in personality characteristics were frequently found to be larger in countries with better living conditions. This includes traits such as extroversion, agreeableness and altruism, which research seems to show are more strongly associated with women. The same was true for sex differences in some dimensions of emotion, specifically negative emotions in which females tend to score higher, such as shame.
There were also exceptions to the gender-equality paradox. Sex differences in sexual behaviour, like engaging in casual sex, were consistently found to be smaller in countries with better living conditions. This is probably because women in these countries, where there are more permissive norms, have better access to contraceptives.
A complicated phenomenon
For cognitive functions, sex differences were sometimes larger, sometimes smaller in countries with better living conditions. Interestingly, the sex differences were larger in cognitive domains where women have strengths.
For instance, episodic memory (memory for experienced events) and verbal ability, where females typically do better than males, saw larger sex differences as living conditions improved. Females got better at episodic memory when they had better living conditions. By contrast, sex differences in semantic memory (memory for facts) and mathematical ability, where males tend to do better, decreased when living conditions improved.
This suggests that, when it comes to cognitive abilities, females benefit more than males from improvements in living conditions. The performance gap increases in domains where females have an advantage and closes in domains where males are ahead.
Not all psychological sex differences were associated with living conditions in the same way. So, can we say that there is a gender-equality paradox? Yes, to some extent, since more sex differences grew, rather than decreased, in countries with better living conditions.
In most cases, however, psychological sex difference magnitudes were not significantly associated with living conditions. This suggests that, in general, psychological sex differences are not greatly affected by living conditions but seem instead quite stable. For instance, research often finds females get higher grades at school across different subjects. It’s also common for researcher to find males have greater interest in maths. But neither seems to be affected by living conditions.
Even in cases where the magnitude of sex differences did vary in relation to living conditions, the pattern of male and female advantages usually remained the same. So, for example, though the female advantage over males in episodic memory ability is greater in some countries than others, females outperform males in almost all countries.
In summary, we found little support for the idea that psychological sex differences will vanish as societies develop. Policymakers probably cannot rely on that if they hope to achieve equal distributions of men and women in different professions. Instead, it appears that the dominant feature of psychological sex differences is their robustness in the face of social change.
The “Thrive 5” are five conditions to ensure an infant in the first year of life has what they need for healthy development. Those conditions include environmental stimulation, nutrition, neighbourhood safety, positive caregiving and regular circadian rhythms and sleep. Simple, and yet, it has not yet been prioritised for many reasons including the fact that researchers had not provided empirical data to support making the Thrive 5 a public health priority.
Researchers at Washington University in St. Louis think it’s time to change that. In new research published in JAMA Pediatrics, Deanna Barch and Joan Luby make the case that “Thrive Factor” is a key element of healthy human brain, behavioural and cognitive development.
“When they have access to these basic supports, even in the face of adverse environments, it enhances their brain development, cognition (measures of IQ) and social-emotional development,” said Luby, MD, the university’s Samuel and Mae S. Ludwig Professor of Child Psychiatry at the School of Medicine.
There have been plenty of studies touting the benefits of individual thrive factors, such as encouraging breast-feeding to facilitate growth in general, but this new study looks at several key factors known to influence brain development and shows their relationship to outcomes at age 3.
“The novelty here is putting them all together and thinking of them as a constellation of things that are necessary and important for a child to be able to thrive,” said Barch, PhD, vice dean of research, a professor of psychological & brain sciences in Arts & Sciences and the Gregory B. Couch Professor of Psychiatry at the School of Medicine.
The study is part of a change in thinking in the child development field as scientists have learned that much of our health is not just genetically predetermined but is powerfully influenced by the psychosocial environment. The human brain is still undergoing rapid development at birth, and researchers are trying to understand the environmental factors that shape this development.
The study of 232 infants and their mothers looked at positive factors in the environment in the foetal period and first year of life that enhance brain development, minimise negative behaviours and increase cognitive outcomes. Participants were evaluated on social disadvantage indexes beginning in utero and early life T-Factor scores were also calculated. As infants approached age 3, they were re-evaluated for social, emotional and cognitive development along with using MRIs to scan brain structure.
The results were clear that T-Factor is powerful: Even infants coming from adverse conditions and under-resourced backgrounds can have healthy development if they get their Thrive 5.
The researchers note that policymakers and paediatric primary care providers should be informed about the importance of focusing on elements of the T-Factor and how they can lead to many downstream advantages for both the child and society.
It may seem obvious to anyone that a baby needs care, sleep, food, stimulation and safety but “nobody has particularly focused on or prioritised the importance of this during foetal development and in the first year of life to enhance critical developmental outcomes,” Luby said.
“The Thrive Factor provides a solid foundation for healthy development. It has been underappreciated in primary care just how malleable the brain is to experience,” Luby added.
Barch said the next step will be setting up interventions to test in randomised controlled trials. Another advantage to T-Factor is it is highly feasible to share and promote in broad populations.
Interventions would likely take the form of multiple Zoom sessions with parents to educate and coach them on how to best provide each thrive factor. But that would just be the start, since parents need resources to help them provide thrive factors.
Though T-Factor can help kids overcome adverse conditions, Barch emphasised the need for understanding just how tough those adverse conditions can be on a new parent.
“If you’ve never suffered from financial adversity, you don’t understand how hard that makes life,” she said.
Parents can struggle to provide conditions to thrive because they may have to support many people in their household, may not have adequate number of rooms to ensure easier child sleep training, must work multiple jobs and can’t get away to breast feed, and live in unsafe neighbourhoods that keep them in a constant state of vigilance.
Though education can help caregivers, it will take public policy interventions to ensure parents can access all the Thrive Factors, especially when it comes to access to safe housing and adequate income to support even these basic needs of developing infants.
“We need to make it so families can have the resources necessary to provide these core things to kids because it’s going to have such a big impact on kids’ development across the course of their lifespan,” she said.
People with low income or education levels may benefit from screening for alcohol-related conditions
Photo from Pixabay CC0
Men and women with lower income or education levels are more likely to develop medical conditions related to alcohol abuse compared to similar individuals with a higher socioeconomic status. Alexis Edwards of Virginia Commonwealth University, US, and colleagues report these findings in a new study published March 19th in the open access journal PLOS Medicine.
The World Health Organization estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and injury worldwide, and results in three million deaths each year. Excessive alcohol consumption can also take an economic toll. Previous studies have identified links between a person’s socioeconomic status and alcohol use, but currently it is unclear how an individual’s social class impacts their future risk of acquiring alcohol-related medical conditions, like alcoholic liver disease.
In the new study, researchers used a model that follows people over time to estimate their risk of developing medical conditions from alcohol abuse using two indicators for socioeconomic status: income and education level. The researchers analysed data from more than 2.3 million individuals in a Swedish database to show that both men and women with a lower income or education level were more likely to develop these conditions. The associations held true, even when researchers controlled for other relevant factors, such as marital status, history of psychiatric illness and having a genetic predisposition to abuse alcohol.
The new findings are important for understanding which populations are most likely to suffer from medical conditions resulting from alcohol abuse, and contribute to a growing body of literature on health disparities that stem from socioeconomic factors. The researchers recommend that individuals with lower income or education levels might warrant additional screening by clinicians to evaluate their alcohol consumption and identify related conditions.
The authors add, “Among individuals with an alcohol use disorder, those with lower levels of education or lower incomes are at higher risk for developing an alcohol-related medical condition, such as cirrhosis or alcoholic cardiomyopathy. Additional screening and prevention efforts may be warranted to reduce health disparities.”
