Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective.

OBJECTIVE: To study educational gradients in births after medically assisted reproduction across 5 countries with different institutional arrangements. DESIGN: We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in 5 countries. SETTINGS: Not applicable. PATIENTS: This study includes survey or register data containing information on births in 5 countries: N = 61,564 for Denmark, N = 37,533 for France, N = 12,889 for Spain, N = 17,097 for the United Kingdom, and N = 3,700,442 for the United States. INTERVENTION (FOR RCT) OR EXPOSURE (FOR OBSERVATIONAL STUDIES): None. MAIN OUTCOME MEASURES: The probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree. RESULTS: University-educated mothers are more likely to give birth after assisted reproduction compared with mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whereas they attenuate but persist in the other countries. The United States seems to show a larger educational gradient. CONCLUSION: The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States - the context with the lowest subsidization - seems to show larger educational gradients than other contexts. In the context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realize their fertility intentions in countries with less generous subsidization of treatments.

From unequal injuries to unequal learning? Socioeconomic gradients in childhood concussions and the impact on children's academic performance.

Previous research identifies stark socioeconomic disparities in child injuries, yet research on the repercussions hereof on other aspects of children's lives remains sparse. This paper tests whether social gradients in minor traumatic brain injuries (mTBIs or concussions) contribute to corresponding inequalities in children's academic performance. Previous research on this topic is mostly based on small samples and confounded by non-random selection into experiencing mTBIs. We improve on prior research by using high quality, large N, administrative registry data. Further, we control for selection into having an mTBI via comparing the test score progression of children having an mTBI with children who experience an mTBI in later years (staggered difference-in-differences). Based on Danish ER/hospital records and national test score data, we find that children from families with lower earnings and less education are more likely to experience an mTBI and that having an mTBI negatively correlates with reading test scores. However, comparing present with future mTBI cases, we show that having an mTBI within a year before a test does not negatively affect children's reading scores. Our findings suggest that negative correlations between mTBIs and academic performance more likely reflect socioeconomic gradients in mTBI incidents rather than a direct causal effect. Further, socioeconomic gradients in mTBI incidents do not significantly contribute to corresponding disparities in academic performance.

Changes in anxiety and depression during the COVID-19 pandemic in the European population: A meta-analysis of changes and associations with restriction policies.

BACKGROUND: Early studies of common mental disorders (CMDs) during the COVID-19 pandemic mainly report increases; however, more recent findings have been mixed. Also, studies assessing the effects of restriction measures on CMDs show varied results. The aim of this meta-analysis was to assess changes in levels of CMDs from pre-/early to during the pandemic and the effects of restriction policies in the European population. METHODS: We searched for studies assessing both pre-pandemic and peri-pandemic self-reported emotional distress and symptoms of depression or anxiety among nationally/regionally representative samples in Europe and collected microdata from those studies. Estimates of corona containment index were related to changes in CMDs using random-effects meta-regression. RESULTS: Our search strategy resulted in findings from 15 datasets drawn from 8 European countries being included in the meta-analysis. There was no evidence of change in the prevalence of emotional distress, anxiety, or depression from before to during the pandemic; but from early pandemic periods to later periods, there were significant decreases in emotional distress and anxiety. Increased school restrictions and social distancing were associated with small increases in self-reported emotional distress. CONCLUSIONS: Despite initial concerns of increased emotional distress and mental illness due to the COVID-19 pandemic, the results from this meta-analysis indicate that there was a decrease in emotional distress and no change in anxiety or depression in the general population in Europe. Overall, our findings support the importance of strong governance when implementing periodic and robust restriction measures to combat the spread of COVID-19.

The association between type of conception through medically assisted reproduction and childhood cognition: a Danish population-wide cohort study.

BACKGROUND: Previous research has indicated that children conceived through medically assisted reproduction (MAR) generally have cognitive outcomes comparable to or better than naturally conceived children. However, previous studies have been limited in their ability to examine this relationship at a population level and consider variations across different types of MAR. METHODS: This study utilizes data from all live births in Denmark between 2006 and 2009 (n = 259 608), including a subset of births resulting from MAR conceptions (n = 13 566). The dependent variable is the standardized test scores obtained in the second and third grades of primary schools. A comparison is made between the test scores of children spontaneously conceived (SC) and those conceived through intrauterine insemination (IUI) and assisted reproductive technologies (ART). Ordinary least squares regressions are employed, with a baseline model adjusted only for birth year, as well as models that additionally account for conception-related confounders and sociodemographic family characteristics. RESULTS: In the baseline analysis, ART- and IUI-conceived children displayed better test scores compared with their SC peers. However, after adjusting for relevant factors, ART-conceived children performed worse than SC peers, while IUI-conceived children performed equally well as SC peers and better than ART-conceived children. CONCLUSIONS: These results likely reflect differences in the selection process of potential parents into the type of MAR, as well as the consequences of variations in fecundability. Nevertheless, the differences observed across conception types were overshadowed by test score disparities in socioeconomic background.

Not Next to You: Peer Rejection, Sociodemographic Characteristics and the Moderating Effects of Classroom Composition.

While a range of sociodemographic characteristics are associated with a greater risk of peer rejection at school, it is currently unclear how key theoretical frameworks explaining rejection apply to such characteristics. This study examines how migration background, gender, household income, parental education and cognitive ability are linked to peer rejection. Building on person-group dissimilarity and social identity theory, the study assesses the moderating role of classroom composition and the extent to which students reject classmates who differ to themselves (i.e., outgroup derogation). Data is drawn from a nationally representative sample of 4215 Swedish eighth grade students (Mage = 14.7, SDage = 0.39; 67% of Swedish origin; 51% girls) in 201 classes. While rejection based on migration background, gender, household income and cognitive ability was moderated by the school-class composition, only the rejection of immigrant background students, boys and girls was related to outgroup derogation. Furthermore, Swedish origin students' outgroup derogation increased as the share of immigrant background students decreased. Addressing social inequalities in rejection may require different strategies depending on sociodemographic characteristic.

Stress/depression across the COVID-19 pandemic in Denmark.

BACKGROUND: Global estimates suggest strained mental health during the first year of the COVID-19 pandemic, but the lack of nationally representative and longitudinal data with clinically validated measures limits knowledge longer into the pandemic. METHODS: Data from 10 rounds of nationally representative surveys from Denmark tracked trends in risk of stress/depression from just before the first lockdown and through to April 2022. We focused on age groups and men and women in different living arrangements and controlled for seasonality in mental health that could otherwise be spuriously related to pandemic intensity. RESULTS: Prior to first lockdown, we observed a "parent gap", which closed with the first lockdown. Instead, a gender gap materialized, with women experiencing higher risks than men-and higher than levels predating first lockdown. Older respondents (+ 70 years) experienced increasing risks of stress/depression early in the pandemic, while all other groups experienced decreases. But longer into the pandemic, risks increased for all age groups and reached (and sometimes exceeded) levels from before first lockdown. CONCLUSION: Denmark had low infection rates throughout most of the pandemic, low mortality rates across the entire pandemic, and offered financial aid packages to curb financial strains. Despite this circumstance, initial improvements to mental health during the first lockdown in Denmark were short-lived. Two years of pandemic societal restrictions correspond with deteriorating mental health, as well as a change from a parenthood gap in mental health before first lockdown to a gender gap two years into the pandemic.

Not Just Later, but Fewer: Novel Trends in Cohort Fertility in the Nordic Countries.

With historically similar patterns of high and stable cohort fertility and high levels of gender equality, the Nordic countries of Sweden, Finland, Norway, Denmark, and Iceland are seen as forerunners in demographic behavior. Furthermore, Nordic fertility trends have strongly influenced fertility theories. However, the period fertility decline that started around 2010 in many countries with relatively high fertility is particularly pronounced in the Nordic countries, raising the question of whether Nordic cohort fertility will also decline and deviate from its historically stable pattern. Using harmonized data across the Nordic countries, we comprehensively describe this period decline and analyze the extent to which it is attributable to tempo or quantum effects. Two key results stand out. First, the decline is mostly attributable to first births but can be observed across all ages from 15 to the mid-30s. This is a reversal from the previous trend in which fertility rates in the early 30s increased relatively steadily in those countries in the period 1980-2010. Second, tempo explains only part of the decline. Forecasts indicate that the average Nordic cohort fertility will decline from 2 children for the 1970 cohort to around 1.8 children for the late 1980s cohorts. Finland diverges from the other countries in terms of its lower expected cohort fertility (below 1.6), and Denmark and Sweden diverge from Finland, Iceland, and Norway in terms of their slower cohort fertility decline. These findings suggest that the conceptualization of the Nordic model of high and stable fertility may need to be revised.

Risk of stress/depression and functional impairment in Denmark immediately following a COVID-19 shutdown.

BACKGROUND: Existing estimates of the impact of the COVID-19 burden on mental wellbeing come from countries with high mortality rates. This study therefore aimed to investigate the impact of the first COVID-19 lockdown (March-April 2020) on risk for stress/depression and functional impairment in a representative sample of adult individuals in Denmark, which had lower infection rates, and whether the impact of lockdown was heterogeneous across living situation. METHODS: Using a representative, randomly drawn sample from the complete Danish adult population interviewed in March 2 to April 13, 2020 (n = 2836) and again in July 2020 (n = 1526, 54% retention rate), we study how the imposed lockdown announced March 11 following the onset of the first Danish wave of COVID-19 infections affected mental wellbeing. We use the World Health Organization Five Well-being Index (WHO-5) and the Work and Social Adjustment Scale (WSAS) to capture risk for stress/depression (WHO-5 < 50) and functional impairment (WSAS > 10). Using covariate adjusted ordinary least squares linear probability models and exploiting variation in the timing of responses occurring just before and just after the introduction of lockdown, we compare respondents before lockdown to respondents that answered during lockdown, as well as to answers in re-interviews in July. RESULTS: In our fully controlled models, we find reduced depressive symptoms among adults immediately after the shutdown, concentrated in adults with children living at home (-.089, p < .01 (from pre lockdown baseline .273)). Measures of functional impairment also declined immediately after the March shutdown among adults with children living at home (-.066, p < .05 (from pre lockdown baseline .150)). Impairment intensified for the entire sample between March and July (+.199, p < .001 (from pre lockdown baseline .248)), but depressive symptoms remained at lower rate in July (-.033, p < .05 (from pre lockdown baseline .332). CONCLUSIONS: Findings in Denmark indicate that living with children at home may have, in the short term, buffered the potential mental health sequelae of the COVID-19 shutdown.

Psychiatric hospital admission and later crime, mental health, and labor market outcomes.

Most OECD countries have downsized treatment capacity at psychiatric hospitals substantially. We investigate consequences of these reductions by studying how the decision whether to admit individuals in mental distress to a psychiatric hospital affects their subsequent crime, treatment trajectories, and labor market outcomes. To circumvent nonrandom selection into admission, we use a proxy of occupancy rates prior to a patient's first contact with a psychiatric hospital as an instrument. We find that admissions reduce criminal behavior, likely due to incapacitation, and predominantly for males and those with a criminal record. Furthermore, admission lowers patients' subsequent labor market attachment, likely because a psychiatric hospital admission is an eligibility criterion for welfare benefits.

Effect of concussion on salary and employment: a population-based event time study using a quasi-experimental design.

OBJECTIVE: Concussions are the most frequent traumatic brain injuries. Yet, the socioeconomic impact of concussions remains unclear. Socioeconomic effects of concussions on working-age adults were studied on a population scale. DESIGN: This population-based, event time study uses administrative data as well as hospital and emergency room records for the population of Denmark. SETTING: We study all Danish patients, aged 20-59 years, who were treated at a public hospital or at an emergency room between 2003 and 2017 after suffering a concussion without other intracranial or extracranial injuries (n=55 424 unique individuals). None of the patients had a prior diagnosis of intracranial or extracranial injuries within the past 10 years leading up to the incident. PRIMARY AND SECONDARY OUTCOME MEASURES: As primary endpoint, we investigate the mean effect of concussion on annual salaried income within a 5-year period after trauma. In an exploratory analysis, we study whether the potential impact of concussion on annual salaried income is driven by patient age, education or economic cycle. RESULTS: Concussion was associated with an average change in annual salary income of -€1223 (95% CI: -€1540 to -905, p<0.001) corresponding to a salary change of -4.2% (95% CI: -5.2% to -3.1 %). People between 30 and 39 years and those without high school degrees suffered the largest salary decreases. Affected individuals leaving the workforce drove the main part of the decrease. Absolute annual effect sizes were countercyclical to the unemployment rate. CONCLUSIONS: Concussions have a large and long-lasting impact on salary and employment of working-age adults on a nationwide scale.

Education, Gender, and Cohort Fertility in the Nordic Countries.

Systematic comparisons of fertility developments based on education, gender and country context are rare. Using harmonized register data, we compare cohort total fertility and ultimate childlessness by gender and educational attainment for cohorts born beginning in 1940 in four Nordic countries. Cohort fertility (CTF) initially declined in all four countries, although for cohorts born in the 1950s and later, the CTF remained stable or declined only modestly. Childlessness, which had been increasing, has plateaued in Denmark, Norway and Sweden. Women's negative educational gradient in relation to total fertility has vanished, except in Finland, while men's positive gradient has persisted. The highest level of men's childlessness appears among the least educated. In the oldest female cohorts, childlessness was highest among the highly educated, but these patterns have changed over the cohorts as childlessness has increased among the low educated and remained relatively stable among higher educated women. In Denmark, Norway and Sweden, childlessness is now highest among the least educated women. We witness both a new gender similarity and persistent (among men) and new (among women) educational disparities in childbearing outcomes in the Nordic region. Overall, the number of low educated has decreased remarkably over time. These population segments face increasing social and economic disadvantages that are reflected as well in their patterns of family formation.

Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children's academic performance.

Attention Deficit/Hyperactivity Disorder (ADHD) is negatively associated with a range of academic achievement measures. We use Danish administrative register data to study the impact of medical treatment of ADHD on children's academic performance assessed by student grade point average (GPA). Using administrative register data on children, who begin medical treatment, we conduct a natural experiment and exploit plausible exogenous variation in medical nonresponse to estimate the effect of medical treatment on school-leaving GPA. We find significant effects of treatment on both exam and teacher evaluated GPAs: Compared to consistent treatment, part or full discontinuation of treatment has large significant negative effects reducing teacher evaluation and exam GPA with .18 and .22 standard deviations, respectively. The results demonstrate that medical treatment may mitigate the negative social consequences of ADHD. Placebo regressions indicate that a causal interpretation of our findings is plausible.

Explaining the Consequences of Imprisonment for Union Formation and Dissolution in Denmark.

Crime and subsequent imprisonment reduces men's chances on the marriage market and increases their divorce risk, but existing research, with a few notable exceptions, is silent about the underlying mechanisms driving these effects. This article studies the effect of home confinement under electronic monitoring as a noncustodial alternative to imprisonment on the risk of relationship dissolution and being single, thereby distinguishing between effects of incarceration and of committing crime. We study a policy that expanded the use of electronic monitoring to address nonrandom selection into electronic monitoring instead of in prison. Results from a sample of 4,522 men show that home confinement under electronic monitoring significantly and persistently lowers the risk both of being single and of becoming single during the first five years following conviction. The results show that one of the tools that could promote decarceration trends also secures better relationship outcomes of convicted men.

Temporary Life Changes and the Timing of Divorce.

Marriage is a risky undertaking that people enter with incomplete information about their partner and their future life circumstances. A large literature has shown how new information gained from unforeseen but long-lasting or permanent changes in life circumstances may trigger a divorce. We extend this literature by considering how information gained from a temporary change in life circumstances-in our case, a couple having a child with infantile colic-may affect divorce behavior. Although persistent life changes are known to induce divorce, we argue that a temporary stressful situation allows couples more quickly to discern the quality of their relationship, in some cases leading them to divorce sooner than they otherwise would have. We formalize this argument in a model of Bayesian updating and test it using data from Denmark. We find that the incidence of infantile colic shortens the time to divorce or disruption among couples who would have split up anyway.

The Effect of Medical Treatment of Attention Deficit Hyperactivity Disorder (ADHD) on Foster Care Caseloads: Evidence from Danish Registry Data.

Since the early 2000s, foster care caseloads have decreased in many wealthy democracies, yet the causes of these declines remain, for the most part, a mystery. This article uses administrative data on all Danish municipalities (N = 277) and a 10% randomly drawn sample of all Danish children (N = 157,938) in the period from 1998 to 2010 to show that increasing medical treatment of attention deficit hyperactivity disorder (ADHD) accounts for a substantial share of the decrease in foster care caseloads. According to our estimates, the decline in foster care caseloads during this period would have been 45% smaller absent increases in medical treatment of ADHD. These findings are especially provocative in light of recent research showing ambiguous effects of medical treatment of ADHD. Future research should be attentive to how medical treatment aimed at addressing children's acute behavioral problems could also have a powerful effect on foster care caseloads.

Family matters? The effect of kinship care on foster care disruption rates.

Compared with other types of out-of-home care, kinship care is cheap, and offers the child a more familiar environment. However, little is known about the causal effect of kinship care on important outcomes. This study is the first to estimate causal effects of kinship care on placement stability, using full-sample administrative data (N=13,157) and instrumental variables methods. Results show that, in a sample of children of age 0-17 years, kinship care is as stable as other types of care, and only when the kin caregiver is particularly empathic and dutiful does this type of care prove more stable. Thus, in terms of stability, most children do not benefit additionally from being placed with kin.

Cumulative risks of foster care placement for Danish children.

Although recent research suggests that the cumulative risk of foster care placement is far higher for American children than originally suspected, little is known about the cumulative risk of foster care placement in other countries, which makes it difficult to gauge the degree to which factor foster care placement is salient in other contexts. In this article, we provide companion estimates to those provided in recent work on the US by using Danish registry data and synthetic cohort life tables to show how high and unequally distributed the cumulative risk of foster care placement is for Danish children. Results suggest that at the beginning of the study period (in 1998) the cumulative risk of foster care placement for Danish children was roughly in line with the risk for American children. Yet, by the end of the study period (2010), the risk had declined to half the risk for American children. Our results also show some variations by parental ethnicity and sex, but these differences are small. Indeed, they appear quite muted relative to racial/ethnic differences in these risks in the United States. Last, though cumulative risks are similar between Danish and American children (especially at the beginning of the study period), the age-specific risk profiles are markedly different, with higher risks for older Danish children than for older American children.