Drug-Induced Deaths and Non-Fatal Poisonings in Youth-Associations With Household Adversities and Out-Of-Home Care

Drug-induced deaths have increased in many countries, representing one of the most common causes of death among young people, including in Finland. More information is needed to understand the factors leading to these preventable incidents. We examined whether household adversities (parental substance use disorder (SUD), parental psychiatric disorder and long-term financial difficulties) and out-of-home care (OHC) were associated with drug-induced deaths or non-fatal poisonings.

Population-level data from Finnish national health care and social welfare registers was used. Two cohorts born in 1991 (n = 65,103) and 1997 (n = 58,998) were followed up from birth until the end of 2019. The outcome was drug-induced death/non-fatal drug poisoning. Mortality hazards were estimated using a competing events regression model.

Youths experiencing household adversities (HR 1.60 for long-term income support) or OHC (HR 9.91) encountered a drug-induced death/non-fatal drug poisoning more often than others. Household adversities increased the hazard of drug-induced death/non-fatal poisoning, especially among those who had never been placed in OHC (HR 1.70 for parental SUD; 2.45 for long-term income support), whereas no statistically significant association was found among those who had experienced household adversities but had been placed in OHC.

Household and other childhood adversities as well as substance use often form a complex and intertwined set of problems resulting in poor outcomes in young people's lives. Early, accessible and effective interventions are needed for families facing such challenges. Sufficient resources and needs-based services should be guaranteed to secure safe and healthy development for children with adverse childhood experiences.