# Long-term follow-up of individuals at risk of or who developed resignation syndrome in childhood, were granted residence permits and cared for within the Stockholm region: a register study

## TL;DR

This study examines the long-term mental health and educational outcomes of individuals who were at risk of or developed resignation syndrome in childhood and were granted residency in Sweden.

## Contribution

The study provides novel insights into the long-term psychiatric and educational outcomes of individuals with resignation syndrome compared to various comparison groups.

## Key findings

- Individuals at risk of or who developed resignation syndrome did not show significantly higher psychiatric care utilization compared to Swedish-born individuals.
- Siblings of the exposed group had a significantly lower risk of outpatient psychiatric care.
- Fully developed resignation syndrome cases had higher psychiatric care utilization compared to Swedish-born children.

## Abstract

To investigate long-term outcomes of individuals at risk of or who developed resignation syndrome (RS) in childhood and who received residence permits in Sweden.

We followed individuals born 1988–2002, living in Stockholm, in healthcare registers until December 2016 (N = 5,226). The exposed group was defined as exhibiting potential symptoms of RS of varying severity in childhood (n = 107), and compared with their siblings, refugees, unaccompanied migrants, individuals who received child and adolescent mental health services (CAMHS) without RS, and Swedish-born individuals with Swedish-born parents. We estimated the cumulative incidence of psychiatric diagnoses until age 18. Outcomes included psychiatric care utilization, prescribed/purchased psychotropic medication in adulthood, and education attainment. We estimated crude and adjusted hazard ratios (aHR) using Cox proportional hazards models and crude and adjusted odds ratios using multivariable logistic regression models, with 95% confidence intervals, and adjusted for socioeconomic factors.

The exposed group not only had the risk of RS or developed RS in childhood but a large share was also diagnosed with anxiety/PTSD, depression, eating disorders and attempted suicide. At follow-up, psychiatric care utilization and psychotropic medication prescription rates did not differ significantly between the exposed group (as the reference) and Swedish-born individuals with Swedish-born parents, nor among refugees or unaccompanied migrants. Individuals who received CAMHS without RS, had a significantly higher risk of having been prescribed medication (aHR 2.41; CI:1.51, 3.83) and using outpatient psychiatric care (aHR 1.78; CI:1.15, 2.75). Siblings of the exposed group had a significantly lower risk of using outpatient psychiatric care (aHR 0.28; CI:0.12, 0.67). The exposed group was similar to all the comparison groups with regards to having finished high school at age 22 except for unaccompanied migrants and the sibling group who had a significantly lower odds of the outcome. In a sensitivity analysis including only individuals with fully developed RS symptoms (n = 53), other comparison groups had lower relative risks of using outpatient psychiatric care compared with individuals with fully developed RS symptoms (the reference group), including the Swedish-born general population group (aHR 0.57; CI:0.35, 0.93), refugees (aHR 0.43; CI: 0.26, 0.72) and unaccompanied migrants (aHR 0.54; CI: 0.33, 0.86) but people who used CAMHS during childhood had no difference in relative risk.

Despite severe baseline morbidity, individuals at risk of or who developed RS did not altogether exhibit an increased risk of psychiatric care during follow-up and attained an educational level on par with individuals who had received CAMHS. However, individuals with fully developed RS symptoms had a higher risk of psychiatric care utilization compared to Swedish-born children with Swedish-born parents. As the findings reflect a heterogeneous group of children assessed to be at varying risks of developing RS rather than only confirmed, fully developed RS cases, further research on long-term outcomes of RS is needed particularly in larger, representative samples of RS cases including those not granted residency permits in Sweden.

Not applicable.

The online version contains supplementary material available at 10.1186/s12888-026-07830-7.