Parental substance use disorder and offspring not in education, employment or training: a national cohort study of young adults in Sweden

Aims To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. Design, setting and participants A register-based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. Measurements The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. Findings We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09-1.16) for males, and HR = 1.15 (95% CI 1.12-1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17-19 years, HR = 1.37 (95% CI 1.25-1.50) for males, and HR = 1.31 (95% CI 1.18-1.44) for females. Conclusions In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17-19 years for both males and females, decreasing with greater age.